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Avellan S, Mabrouk A, Taillebot V, Pithioux M, Ollivier M. Using a patient-specific cutting guide enables identical knee osteotomies: An evaluation of accuracy on sawbones. Orthop Traumatol Surg Res 2024:103813. [PMID: 38218221 DOI: 10.1016/j.otsr.2024.103813] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
PURPOSE It was hypothesized that using a Patient-Specific Cutting Guide (PSCG) would allow the creation of sawbones model osteotomies, identical in the 3 planes and the hinge parameters, that can be used for biomechanical studies. The aim of the study was to evaluate the accuracy of the PSCG system and to introduce and assess the new hinge parameter; the hinge area. METHODS Six identical sawbones tibia models were identically set up for identical osteotomy cuts by the same surgeon in the same session and with identical instruments. A medical scanner was used to evaluate the 3D configuration of all the specimens. The analyzed parameters included the cutting angles in both the coronal and sagittal planes (degrees) and the hinge and the slicing areas (cm2), and the hinge thickness (mm). The values were statistically evaluated for average, standard deviation, 95% confidence index, and delta to the expected values were calculated. RESULTS The mean values for the coronal and sagittal angles were 110.5̊±1̊ and 89.8̊±0.8̊, respectively. The 95% confidence index level ranged between 0.1̊, and 0.8̊ in both the coronal & the sagittal planes. The mean values for the hinge thickness, the hinge area, and the slicing area were 12.7±1.5mm, 4.2±0.9 cm2, and 18.3±1.2 cm2, respectively. CONCLUSION In the presented study, it can be demonstrated that mechanically identical osteotomy specimens, with regard to the cutting planes and hinge parameters, can be reliably created using the PSCG. The identical specimens can be used for biomechanical research purposes to further expand our knowledge of the factors affecting osteotomy outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sébastien Avellan
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France; BIOBank®, Tissue Bank, Lieusaint, France
| | - Ahmed Mabrouk
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France; Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Virginie Taillebot
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France.
| | - Martine Pithioux
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
| | - Matthieu Ollivier
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
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Taheri FH, Hassani M, Sharifzadeh Z, Behdani M, Abdoli S, Sayadi M, Bagherzadeh K, Arashkia A, Abolhassani M. Tuning spacer length improves the functionality of the nanobody-based VEGFR2 CAR T cell. BMC Biotechnol 2024; 24:1. [PMID: 38178096 PMCID: PMC10768260 DOI: 10.1186/s12896-023-00827-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The chimeric antigen receptor-expressing T (CAR-T) cells for cancer immunotherapy have obtained considerable clinical importance. CAR T cells need an optimized intracellular signaling domain to get appropriately activated and also for the proper antigen recognition, the length and composition of the extracellular spacer are critical factors. RESULTS We constructed two third-generation nanobody-based VEGFR2-CARs containing either IgG1 hinge-CH2-CH3 region or hinge-only as long or short extracellular spacers, respectively. Both CARs also contained intracellular activating domains of CD28, OX40, and CD3ζ. The T cells from healthy individuals were transduced efficiently with the two CARs, and showed increased secretion of IL-2 and IFN-γ cytokines, and also CD69 and CD25 activation markers along with cytolytic activity after encountering VEGFR2+ cells. The VEGFR2-CAR T cells harboring the long spacer showed higher cytokine release and CD69 and CD25 expression in addition to a more efficient cytolytic effect on VEGFR2+ target cells. CONCLUSIONS The results demonstrated that the third-generation anti-VEGFR2 nanobody-based CAR T cell with a long spacer had a superior function and potentially could be a better candidate for solid tumor treatment.
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Affiliation(s)
- Fatemeh Hajari Taheri
- Hybridoma Lab, Department of Immunology, Pasteur Institute of Iran, Tehran, Iran
- Food and Drug Laboratory Research Center (FDLRC), Iran Food and Drug Administration (IFDA), MOH & ME, Tehran, Iran
| | - Mahmoud Hassani
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Sharifzadeh
- Hybridoma Lab, Department of Immunology, Pasteur Institute of Iran, Tehran, Iran
| | - Mahdi Behdani
- Department of Medical Biotechnology, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Shahryar Abdoli
- Department of Medical Biotechnology, Golestan University of Medical Science, Gorgān, Iran
| | - Mahtab Sayadi
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Kowsar Bagherzadeh
- Eye Research Center, Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Arashkia
- Department of Molecular Virology, Pasteur Institute of Iran, Tehran, Iran.
| | - Mohsen Abolhassani
- Hybridoma Lab, Department of Immunology, Pasteur Institute of Iran, Tehran, Iran.
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Doi K, Mizuno J, Ohara Y, Tani S. Comparison of the Degree of Expanded Spinal Canal Area between the Hinge-Side Area and the Open-Side Area in Cervical Open-Door Laminoplasty. Neurol India 2023; 71:689-692. [PMID: 37635499 DOI: 10.4103/0028-3886.383874] [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] [Indexed: 08/29/2023]
Abstract
Background There have been reports on the significant canal cross-sectional area (CSA) expansion difference between pre- and post-operation, but no comparison of CSA expansion between the hinge-side area (Area H) and the open-side area (Area O) has been reported. This study aimed to measure the spinal CSA expansion between Area H and Area O retrospectively after open-door laminoplasty using new titanium spacers and evaluated this common decompression procedure's effectiveness. Materials and Methods This study included 27 patients diagnosed with cervical spondylotic radiculopathy or myelopathy, ossification of the posterior longitudinal ligament, and developmental canal stenosis from February 2021 to October 2022. The CSA difference between pre- and post-cervical laminoplasty (C4-C6 levels) was measured with cervical transverse computed tomography scan images. The CSA difference in Area H and Area O between pre- and post-laminoplasty was similarly calculated. Results The spinal canal areas of each segment after open-door laminoplasty were significantly enlarged (P < 0.05). Area O was also significantly enlarged compared to that of Area H (P < 0.05). Conclusion Area O was more enlarged than Area H, and both sides were statistically enlarged after open-door laminoplasty.
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Affiliation(s)
- Kazuma Doi
- Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Junichi Mizuno
- Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Yukoh Ohara
- Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa; Department of Neurosurgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Tani
- Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
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Bhambid M, Dey V, Walunj S, Patankar S. Toxoplasma Gondii Importin α Shows Weak Auto-Inhibition. Protein J 2023:10.1007/s10930-023-10128-2. [PMID: 37284905 DOI: 10.1007/s10930-023-10128-2] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/08/2023]
Abstract
Importin α is a nuclear transporter that binds to nuclear localization signals (NLSs), consisting of 7-20 positively charged amino acids found within cargo proteins. In addition to cargo binding, intramolecular interactions also occur within the importin α protein due to binding between the importin β-binding (IBB) domain and the NLS-binding sites, a phenomenon called auto-inhibition. The interactions causing auto-inhibition are driven by a stretch of basic residues, similar to an NLS, in the IBB domain. Consistent with this, importin α proteins that do not have some of these basic residues lack auto-inhibition; a naturally occurring example of such a protein is found in the apicomplexan parasite Plasmodium falciparum. In this report, we show that importin α from another apicomplexan parasite, Toxoplasma gondii, harbors basic residues (KKR) in the IBB domain and exhibits auto-inhibition. This protein has a long, unstructured hinge motif (between the IBB domain and the NLS-binding sites) that does not contribute to auto-inhibition. However, the IBB domain may have a higher propensity to form an α-helical structure, positioning the wild-type KKR motif in an orientation that results in weaker interactions with the NLS-binding site than a KRR mutant. We conclude that the importin α protein from T. gondii shows auto-inhibition, exhibiting a different phenotype from that of P. falciparum importin α. However, our data indicate that T. gondii importin α may have a low strength of auto-inhibition. We hypothesize that low levels of auto-inhibition may confer an advantage to these important human pathogens.
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Affiliation(s)
- Manasi Bhambid
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Vishakha Dey
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
- Indiana University School of Medicine, Indianapolis, USA
| | - Sujata Walunj
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Australia
- IITB-Monash Research Academy, IIT Bombay, Mumbai, India
| | - Swati Patankar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India.
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Clement ND, Avery P, Mason J, Baker PN, Deehan DJ. First-time revision knee arthroplasty using a hinged prosthesis : temporal trends, indications, and risk factors associated with re-revision using data from the National Joint Registry for 3,855 patients. Bone Joint J 2023; 105-B:47-55. [PMID: 36587261 DOI: 10.1302/0301-620x.105b1.bjj-2022-0522.r1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The aim of this study was to identify variables associated with time to revision, demographic details associated with revision indication, and type of prosthesis employed, and to describe the survival of hinge knee arthroplasty (HKA) when used for first-time knee revision surgery and factors that were associated with re-revision. METHODS Patient demographic details, BMI, American Society of Anesthesiologists (ASA) grade, indication for revision, surgical approach, surgeon grade, implant type (fixed and rotating), time of revision from primary implantation, and re-revision if undertaken were obtained from the National Joint Registry data for England, Wales, Northern Ireland, and the Isle of Man over an 18-year period (2003 to 2021). RESULTS There were 3,855 patient episodes analyzed with a median age of 73 years (interquartile range (IQR) 66 to 80), and the majority were female (n = 2,480, 64.3%). The median time to revision from primary knee arthroplasty was 1,219 days (IQR 579 to 2,422). Younger age (p < 0.001), decreasing ASA grade (p < 0.001), and indications for revision of sepsis (p < 0.001), unexplained pain (p < 0.001), non-polyethylene wear (p < 0.001), and malalignment (p < 0.001) were all associated with an earlier time to revision from primary implantation. The median follow-up was 4.56 years (range 0.00 to 17.52), during which there were 410 re-revisions. The overall unadjusted probability of re-revision for all revision HKAs at one, five, and ten years after surgery were 2.7% (95% confidence interval (CI) 2.2 to 3.3), 10.7% (95% CI 9.6 to 11.9), and 16.2% (95% CI 14.5 to 17.9), respectively. Male sex (p < 0.001), younger age (p < 0.001), revision for septic indications (p < 0.001) or implant fracture (p = 0.010), a fixed hinge (p < 0.001), or surgery performed by a non-consultant grade (p = 0.023) were independently associated with an increased risk of re-revision. CONCLUSION There were several factors associated with time to first revision. The re-revision rate was 16.2% at ten years; however, the risk factors associated with an increased risk of re-revision could be used to counsel patients regarding their outcome.Cite this article: Bone Joint J 2023;105-B(1):47-55.
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Affiliation(s)
- Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Peter Avery
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, UK
| | | | - Paul N Baker
- Department of Orthopaedic Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - David J Deehan
- Department of Orthopaedic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
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Teo SJ, Koh DTS, Soong JW, Yeo W, Wilson A, Lee KH. Distalization of hinge site with use of hinge wire reduces hinge fracture rates in closing wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2022. [PMID: 36562809 DOI: 10.1007/s00167-022-07286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Closing wedge distal femoral osteotomies (CWDFO) are attractive treatment options for unicompartmental knee osteoarthritis with coronal plane deformity. However, it has been traditionally associated with high rates of hinge fracture that can adversely impact recovery and patient outcomes. Appropriate siting of hinge point can be an effective method of reducing the incidence of hinge fractures. This study aims to illustrate a case series of CWDFO with low rates of hinge fracture utilising our preferred hinge point site. METHODS A retrospective study of a cohort of 39 CWDFO was performed between May 2019 and May 2022. Both medial and lateral CWDFO were included. The hinge point in all cases was placed at the level of the inferior margin of the metaphyseal flare, and inferior to the gastrocnemius origin, with a hinge thickness of 10 mm. Post-operative radiographs were obtained at 2, 4 and 8 weeks after surgery to assess for hinge fracture and union. RESULTS Thirty-nine cases of CWDFO were performed, consisting of eighteen cases of valgus malalignment that underwent medial CWDFO and twenty-one cases of varus malalignment that underwent lateral CWDFO. At surgery, the mean age was 47.6 (± 13.9) years and mean BMI was 29.4 (± 4.9). There were 23 men and 16 women. Three cases of hinge fractures occurred intraoperatively, translating into a hinge fracture rate of 7.69%. However, union was achieved in all three cases and all patients in this case series were able to progress to weight bear as tolerated at 2 months post-osteotomy. CONCLUSION Distal placement of the hinge at the level of the inferior metaphyseal flare margin with the use of a hinge wire can greatly reduce the rates of hinge fracture in CWDFO. LEVEL OF EVIDENCE Level III.
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Sharma V, Gupta M. Designing of kinase hinge binders: A medicinal chemistry perspective. Chem Biol Drug Des 2022; 100:968-980. [PMID: 35112799 DOI: 10.1111/cbdd.14024] [Citation(s) in RCA: 3] [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] [Received: 07/06/2021] [Revised: 01/16/2022] [Accepted: 01/29/2022] [Indexed: 01/25/2023]
Abstract
Protein kinases are key regulators of cellular signaling and play a critical role in oncogenesis. Inhibitors of protein kinases are pursued by both industry and academia as a promising target for cancer therapy. Within the protein kinases, the ATP site has produced more than 40 FDA-approved drugs. The ATP site is broadly composed of a hinge region, gatekeeper residues, DFG-loop, ribose pocket, and other hydrophobic regions. The hinge region in the ATP site can be used for designing potent inhibitors. In this review, we discuss some representative studies that will highlight the interactions of heterocyclic compounds with hinge regions of different kinases like BRAF kinase, EGRF kinase, MAP kinase, and Mps1 kinase.
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Affiliation(s)
- Vikas Sharma
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Mohit Gupta
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon, USA.,GreenLight Biosciences, Woburn, MA, United States
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Deehan DJ, Clement ND, Avery P, Mason J, Baker PN. Temporal trends of primary hinge knee arthroplasty and risk factors associated with revision: National Joint Registry data from 2003 to 2018 for 4921 patients. Knee 2022; 34:279-287. [PMID: 35101741 DOI: 10.1016/j.knee.2022.01.004] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/15/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim was to describe temporal changes and associated changes in patient demographics and surgical variables, revision rate and factors associated with revision of primary hinge knee arthroplasty (HKA) in the UK. METHODS National Joint Registry data for England, Wales, Northern Ireland and Isle of Mann was used to examine the temporal trends in patient demographics, surgical factors and indications for primary HKA usage over a 16-year (2003 to 2018) period and associated risk factors for revision. RESULTS There were 4921 patient episodes with a median follow up of 5.5 (range 0 to 16.3) years. The median age was 75years and the majority were female (72.9%). There was a tenfold increase in the use of HKA (p < 0.001), with an increased relative usage in female patients (p = 0.010), but no significant changes in age (p = 0.484) or BMI (p = 0.781). There were 227 revisions performed at a median of 695days. The overall unadjusted probabilities of revision at 1, 5 and 10 years were 1.5% (95% confidence intervals (CI) 1.1to1.8), 4.4% (95%CI 3.7 to 5.0) and 6.4% (95%CI 5.5 to 7.3), respectively. Cox proportional hazard analysis demonstrated younger age (p < 0.01), male sex (hazard ratio (HR) 1.43, p < 0.01), morbid obesity (HR 2.31, p = 0.022) or previous trauma as the indication (HR 1.48, p = 0.025) were associated with an increased risk of revision. CONCLUSION There was an increase in the use of HKA with increased uptake among female patients. The revision rate was a 6.4% at 10 years, however, younger age, male sex, morbid obesity or previous trauma were associated with an increased risk of revision. LEVEL OF EVIDENCE III Retrospective study.
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Affiliation(s)
- David J Deehan
- Department of Orthopaedic Surgery, Level 7, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN, UK.
| | - Nick D Clement
- Edinburgh Orthopaedics Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - Peter Avery
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - James Mason
- Warwick Clinical Trials Unit Medical School Building, Coventry CV4 7HL, UK
| | - Paul N Baker
- Department of Orthopaedic Surgery, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
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Azoti W, Aghazade M, Ollivier M, Bahlouli N, Favreau H, Ehlinger M. Orientation and end zone of the osteotomy cut for high tibial osteotomy: Influence on the risk of lateral hinge fracture. A finite element analysis. Orthop Traumatol Surg Res 2021; 107:103031. [PMID: 34343697 DOI: 10.1016/j.otsr.2021.103031] [Citation(s) in RCA: 5] [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: 11/08/2020] [Revised: 02/22/2021] [Accepted: 03/09/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION the hinge plays a fundamental role in the support and consolidation of a high tibial osteotomy. The objective of this work was to analyse the influence of the end zone of the osteotomy cut and its orientation in relation to the articular joint line (JL) on the risk of hinge fracture. HYPOTHESIS a specific orientation and end zone of the osteotomy cut can be utilised to decrease the risk of hinge fracture. MATERIAL AND METHOD a finite element (FE) model was used to reproduce the proximal portion of the tibia and the proximal tibiofibular joint with transverse isotropic elastic bone properties. A 1.27mm thick, complete, anteroposterior saw cut was made with a U-shaped saw blade. Five proximal and lateral tibial zones were used according to Nakamura et al corresponding to the end zones of the osteotomy cut. Three angulations of the cut relative to the JL were defined: 10°, 15°, 20°. The tests consisted of simulating 15 possible situations (3 angulations for each of the 5 end zones) on this model. These simulations made it possible to identify the existence of a local stress concentration (von Mises, in MPa) at the level of the hinge, corresponding to the main judgment criterion. RESULTS If we consider only the end zones of the osteotomy cut, regardless of its angulation with respect to the JL, the zone which presents, on average, the lowest local stress concentration is the AM zone (40.3MPa). If we consider only the angulation of the osteotomy cut, with respect to the JL, regardless of the end zone of the cut, the angulation that locally concentrates, on average, the least stress is an angulation at 10° (147.7MPa). Finally, it is important to define the best end zone of the osteotomy cut for each angulation value in relation to the JL: for an angulation of 10°, the end zone must be in AM (38MPa), but also for an angulation of 15° (45MPa), and for an angulation of 20° (38MPa). DISCUSSION-CONCLUSION With the inherent caveats of the experimental conditions, the hypothesis is confirmed. An end zone of the osteotomy cut exists (AM) and an orientation (10°) that induces the lowest local stress concentration and therefore the least likely to induce lateral hinge fracture. However, the orientation of the osteotomy cut is also a matter of surgical habit, especially regarding complementary osteotomy of the tibial tuberosity that some may want to avoid. Thus, it is equally important to know the best end zone associated with a given angulation of the cut in relation to the JL, which according to these results is the AM zone for each angulation. This information helps guide the operator in their surgical practices according to their habits. LEVEL OF EVIDENCE V, expert opinion.
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Affiliation(s)
- Wiyao Azoti
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | | | - Matthieu Ollivier
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital Universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | | | - Henri Favreau
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Matthieu Ehlinger
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France; Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Ollivier M, Fabre-Aubrespy M, Micicoi G, Ehlinger M, Hanak L, Kley K. Lateral femoral closing wedge osteotomy in genu varum. Orthop Traumatol Surg Res 2021; 107:102989. [PMID: 34144255 DOI: 10.1016/j.otsr.2021.102989] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/21/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 02/03/2023]
Abstract
The distal femoral valgisation osteotomy has a variety of indications due to enhanced understanding of segmental deformities of the lower limb. Historically, an overall varus deformity was corrected at the tibia, and a valgus deformity at the femur. This approach of performing an "all in the tibia" correction for an overall varus can nevertheless lead to abnormal postoperative morphology because it is non-anatomical; creating joint line obliquity, and potentially shear stress on the cartilage. An original lateral femoral closing wedge osteotomy technique is described, allowing the correction of a genu varum of femoral or mixed origin, in the event of an associated tibial valgisation osteotomy. The detailed technique minimizes the risk of a hinge fracture while improving post-operative outcomes.
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Affiliation(s)
- Matthieu Ollivier
- Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Institute of Movement and Locomotion, 270, Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
| | - Maxime Fabre-Aubrespy
- Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille Univ, APHM, CNRS, ISM, Institute of Movement and Locomotion, 270, Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - Grégoire Micicoi
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, UR2CA, University Côte d'Azur, Nice, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie du Membre Inférieur, Hôpital de Hautepierre II, Hôpitaux Universitaires de Strasbourg, 67098 Strasbourg, France
| | | | - Kristian Kley
- Orthoprofis Hannover Luisenstraße 10/11, 30539 Hannover, Germany
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Nakayama H, Kanto R, Onishi S, Kambara S, Amai K, Yoshiya S, Schröter S, Tachibana T, Iseki T. Hinge fracture in lateral closed-wedge distal femoral osteotomy in knees undergoing double-level osteotomy: assessment of postoperative change in rotational alignment using CT evaluation. Knee Surg Sports Traumatol Arthrosc 2021; 29:3337-3345. [PMID: 32748235 DOI: 10.1007/s00167-020-06197-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/29/2020] [Accepted: 07/27/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to examine the radiological features of hinge fracture occurring at the distal medial femoral cortex in knees undergoing biplanar lateral closed-wedge distal femoral osteotomy (LCW-DFO) in double-level osteotomy (DLO) based on pre- and postoperative CT image analyses. It was hypothesised that medial hinge fractures in LCW-DFO would occur with a similar incidence to that in high tibial osteotomy, and its occurrence would affect the clinical/radiological outcomes and induce unintended change in alignment depending on the fracture type (direction of the fracture). METHODS A consecutive series of 36 knees (31 patients) with primary varus osteoarthritis undergoing DLO comprised the study population. The mean age at surgery was 62.0 ± 5.9 years. Presence of hinge fracture was assessed on radiographs and CT images at 1 week. The fracture type was classified depending on the direction of the fracture line: crack propagation in line with the osteotomy (type 1) and fractures extending proximally (type 2) or distally (type 3) from the tip of the wedge. Computer-assisted assessments of bony limb alignment and bony geometry were conducted on a full-length weight-bearing radiograph and CT images using image analysis software. In addition, subjective clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Radiological and clinical follow-up results at 1 and 2 years were compared to the preoperative data, while comparative analysis was made between the subjects with and without a hinge fracture. RESULTS Postoperative image examinations revealed type 1 and 2 medial femoral hinge fractures in 4 and 7 knees, while no type 3 fracture was identified in the study population. Consequently, the overall incidence of the hinge fracture was 30.6% (11 of the 36 knees). Four of those 11 fractures (36.4%) could not be detected on plain radiographs. CT image analysis for three-dimensional bony geometry showed greater increase in internal rotation of the distal bony segment (increased femoral antetorsion by 9.5° on average) after surgery compared to the knees without a hinge fracture (P = 0.01). Clinical evaluation using the KOOS at 2 years showed no significant difference between the groups with and without hinge fractures. CONCLUSION In LCW-DFO, medial femoral hinge fractures occurred in 30.6% of the cases. Knees with type 1 hinge fracture exhibited significantly greater increase in femoral antetorsion as compared to those without hinge fracture. In this case series, postoperative weight-bearing protocol was delayed for knees with hinge fracture. Consequently, surgical results were not affected by the occurrence of hinge fracture for up to 2 years. LEVEL OF EVIDENCE IV (case series).
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Affiliation(s)
- Hiroshi Nakayama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan.
| | - Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Shintaro Onishi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Shunichiro Kambara
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, 1-4 Ohama-cho, Nishinomiya, Hyogo, Japan
| | - Kenta Amai
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Nishinomiya Kaisei Hospital, 1-4 Ohama-cho, Nishinomiya, Hyogo, Japan
| | - Steffen Schröter
- Diakonie Klinikum Jung-Stilling, Wichernstraße 40, 57074, Siegen, Germany
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
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Naresh P, Pottabatula SS, Selvaraj J. Dengue virus entry/fusion inhibition by small bioactive molecules; A critical review. Mini Rev Med Chem 2021; 22:484-497. [PMID: 34353253 DOI: 10.2174/1389557521666210805105146] [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] [Received: 10/02/2020] [Revised: 02/14/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
Many flaviviruses are remarkable human pathogens that can be transmitted by mosquitoes and ticks. Despite the availability of vaccines for viral infections such as yellow fever, Japanese encephalitis, and tick-borne encephalitis, flavivirus-like dengue is still a significant life-threatening illness worldwide. To date, there is no antiviral treatment for dengue therapy. Industry and the research community have been taking ongoing steps to improve anti-flavivirus treatment to meet this clinical need. The successful activity has been involved in the inhibition of the virus entry fusion process in the last two decades. In this study, the latest understanding of the use of small molecules used as fusion inhibitors has been comprehensively presented. We summarized the structure, the process of fusion of dengue virus E protein (DENV E), and the amino acids involved in the fusion process. Special attention has been given to small molecules that allow conformational changes to DENV E protein viz. blocking the pocket of βOG, which is important for fusion.
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Affiliation(s)
- Podila Naresh
- Department of Pharmaceutical Chemistry JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamilnadu. India
| | - Shyam Sunder Pottabatula
- Department of Pharmaceutical Chemistry JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamilnadu. India
| | - Jubie Selvaraj
- Department of Pharmaceutical Chemistry JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamilnadu. India
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Jimba T, Ikutomi M, Tsukamoto A, Matsushita M, Yamasaki M. Effect of Hinge Motion on Stent Edge-Related Restenosis After Right Coronary Artery Treatment in the Current Drug-Eluting Stent Era. Circ J 2021; 85:1959-1968. [PMID: 34234051 DOI: 10.1253/circj.cj-21-0196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stent edge-related restenosis (SER) remains a potential limitation of drug-eluting stent (DES). Hinge motion at the stent edge could lead to mechanical stress and contribute to incidents of SER. We investigated the effect of hinge motion on SER after implantation of current-generation DES in the right coronary artery (RCA), where excessive vessel movement is commonly observed.Methods and Results:Of 647 consecutive lesions in the RCA treated with second-generation or later DESs, 426 with follow-up angiography were included in this study. Intravascular imaging analysis was performed for 584 stent edges and reference segments. Binary restenosis occurred in 42 lesions (9.9%), and 55% were SERs. The hinge angle was significantly larger in the SER group than in the other restenosis or the no-restenosis group (17.9° vs. 11.6° and 10.6°, respectively; P<0.001). Lesions with an excessive hinge angle (>11.5°) had an increased rate of target lesion revascularization (19.1% vs. 7.2%; P<0.001) during the median follow-up period of 1,578 days. In per-edge analysis, hinge angle and residual plaque burden were independent predictors of SER. The coexistence of excessive hinge motion and residual plaque burden had a synergistic effect on stenotic progression in quantitative angiographic analysis (Pinteraction<0.001) at follow-up angiography. CONCLUSIONS Substantial stress determined by angulation at a stent edge and its interaction with residual plaque can be considered as one plausible mechanism for SER.
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Affiliation(s)
- Takahiro Jimba
- Department of Cardiovascular Medicine, NTT Medical Center Tokyo
| | | | | | | | - Masao Yamasaki
- Department of Cardiovascular Medicine, NTT Medical Center Tokyo
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Justo A, Vilette H, Ehlinger M, Pasquier G, Laumonerie P, Cavaignac É. A retrospective comparison of central and posterior hinge joints in 53 total knee arthroplasties. Orthop Traumatol Surg Res 2021; 107:102868. [PMID: 33636414 DOI: 10.1016/j.otsr.2021.102868] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The number of hinged total knee arthroplasty (HTKA) procedures is constantly increasing. There are two hinge types: central (CHTKA) and posterior (PHTKA). The primary purpose of the study was to compare implant survival in patients with CHTKA versus PHTKA. The secondary purpose was to analyse the radiological and clinical results of the implants. HYPOTHESIS There is no difference between the two groups. MATERIALS AND METHODS This study involved 53 patients who received a HTKA for either primary, trauma or revision surgery, of these 32 were in the CHTKA group and 21 in the PHTKA group, with a mean age of 69 years (38-89). The exclusion criteria were: etiology of sepsis, incomplete records and refusal to use data. The revision rate, with the replacement of prosthetic components, was the primary endpoint. The secondary outcomes were: mobility, complications, VAS, IKS, Devane, Charnley and Oxford knee scores, and radiological progression. RESULTS The mean follow-up was 51 months (1-139). At 60 months, overall survival rate of the HTKA was 81%, with a confidence interval (CI) of 95% (71-93.2), and there was no difference between CHTKA and PHTKA, 77.7% (95% CI, 63.3-95.4) versus 85.7% (95% CI, 72-100), p=0.625, respectively. Flexion was 101°±15 (80-140) for CHTKA versus 98°±12 (30-130) for PHTKA, p=0.006. VAS was 0.5±16 (0-6) for CHTKA versus 1.6±14 (0-4) for PHTKA, p=0.000008. The IKS was 103±39 (15-180) for CHTKA versus 81±51 (9-200) for PHTKA, p=0.03. There were no differences in either radiological progression, complications or other functional scores. DISCUSSION No significant difference was observed between the survival of CHTKA and PHTKA. CHTKA had better flexion, reduced VAS and increased IKS. Surgeons should be aware of these findings and apply careful consideration to their choice of hinge. LEVEL OF EVIDENCE IV; retrospective single-centre study.
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Affiliation(s)
- Arthur Justo
- Service de chirurgie orthopédique et traumatologique, Hôpital Pierre-Paul-Riquet, 1, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France.
| | - Hugo Vilette
- Service de chirurgie orthopédique et traumatologique, Hôpital Pierre-Paul-Riquet, 1, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Matthieu Ehlinger
- Service de chirurgie du membre inférieur et de traumatologie, Hautepierre II, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Gilles Pasquier
- Service de chirurgie orthopédique et traumatologique, Hôpital Roger-Salengro, CHU de Lille, avenue Émile-Laine, 59037 Lille cedex, France
| | - Pierre Laumonerie
- Service de chirurgie orthopédique et traumatologique, Hôpital Pierre-Paul-Riquet, 1, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Étienne Cavaignac
- Service de chirurgie orthopédique et traumatologique, Hôpital Pierre-Paul-Riquet, 1, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
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Park YS, Kogeichi Y, Haku T, Kim TK, Yokota H, Nakagawa I, Motoyama Y, Nakase H. Hinge and floating decompressive craniotomy for infantile acute subdural hematoma: technical note. Childs Nerv Syst 2021; 37:295-298. [PMID: 33108518 DOI: 10.1007/s00381-020-04942-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/19/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Abstract
Cranioplasty complications after decompressive craniectomy (DC) in infants are not fully recognized. We aimed to devise and assess the efficacy of a hinge and floating DC (HFDC) technique for treating infantile acute subdural hematoma. Five infants, aged 2-20 months, were included. Intracranial pressure was controlled below 20 mmHg, no additional surgery was required, and there was no incidence of surgical site infection or bone graft resorption.
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Affiliation(s)
- Young-Soo Park
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan.
- Division of Neurosurgery, Children's Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, Japan.
| | - Yohei Kogeichi
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Takahide Haku
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Tae Kyun Kim
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Hiroshi Yokota
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
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Kendoff D, Haasper C, Gehrke T, Klauser W, Sandiford N. Management of Gonarthrosis with a Rotating Hinge Prosthesis: Minimum 10-Year Follow-up. Clin Orthop Surg 2020; 12:464-469. [PMID: 33274023 PMCID: PMC7683197 DOI: 10.4055/cios19153] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/31/2020] [Indexed: 11/08/2022] Open
Abstract
Background The use of hinged designs is usually reserved for severe deformities or instability in contemporary total knee arthroplasty (TKA). Results have been mixed with some authors reporting relatively high incidences of complications. The aim of this study is to present the results of primary TKA performed with a hinged prosthesis with a minimum 10-year follow-up. We also examined the factors that influence survivorship of this prosthesis. Methods A total of 238 primary TKA procedures were performed using hinged prostheses. Indications included osteoarthritis, rheumatoid arthritis, posttraumatic deformity, and arthritis. Clinical outcomes were assessed using the Hospital for Special Surgery score. Radiologic assessment was performed at each follow-up. Survivorship was calculated based on the Kaplan-Meier method. All complications were documented. Results Mean follow-up was 13.5 years (standard deviation [SD], 3.4). Mean flexion at final review was 118° (SD, 20°). Fifty-four percent and 20% reported excellent and good functional scores, respectively. Survivorship was 94% at 13.5 years in patients over 60 years of age and 77% in patients less than 60 years of age. Survivorship in patients with preoperative varus deformity was 96% and that in valgus knees was 79%. Conclusions The results of this study suggest that when rotating hinges are used for primary TKA, the best results are achieved in patients over 60 years old. The indications for this design in the setting of primary TKA include significant deformities, severe bone loss, and ligamentous laxity.
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Affiliation(s)
| | - Carl Haasper
- Orthopaedic Department, ENDO-Klinik, Hamburg, Germany
| | | | | | - Nemandra Sandiford
- Joint Reconstruction Unit, Southland Hospital, Invercargill, New Zealand
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Guinn JMV, Mayer R, Chou D. Open Door Laminoplasty - Hinge Creation and Fracture Avoidance: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E419. [PMID: 32243543 DOI: 10.1093/ons/opaa060] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/02/2020] [Indexed: 11/14/2022] Open
Abstract
This surgical video demonstrates a technique for an open-door laminoplasty with its associated risks.1-3 The key to maintaining a strong hinge that can be opened without fracture lies in gradual, slow drilling of the hinge followed by sequential, progressively wider opening of the laminoplasty. This is in contradistinction to a single opening maneuver, which "cracks" the hinge and can result in fracture and disconnection of the lamina from the spine. We present our technique of C4-6 right-sided open-door laminoplasty. A C3 laminectomy is performed instead of a laminoplasty in order to prevent any muscular dissection of C2. This not only maintains the strong muscular attachment to C2, but it also helps alleviate postoperative pain since the muscles are maintained.4-6 The top of C7 is drilled to decompress the C6-7 level, and the C7 spinous process, along with its strong attachment to T1, is maintained to prevent kyphosis. The video highlights methods for maintaining key muscular and ligamentous attachments (C2 muscles and C7-T1 ligament) to decrease kyphosis risk, progressive hinge opening to help mitigate the risk of hinge fracture, and methods to help decrease postoperative pain (avoiding laminoplasty of C3, maintaining muscular and ligamentous attachments as stated above, and contouring the spinous processes in a manner that avoids protrusion into the paraspinal muscles). We have received informed consent of this patient to submit this video.
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Affiliation(s)
- Jeremy M V Guinn
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Rory Mayer
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Dean Chou
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
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Dessyn E, Sharma A, Donnez M, Chabrand P, Ehlinger M, Argenson JN, Parratte S, Ollivier M. Adding a protective K-wire during opening high tibial osteotomy increases lateral hinge resistance to fracture. Knee Surg Sports Traumatol Arthrosc 2020; 28:751-8. [PMID: 30783689 DOI: 10.1007/s00167-019-05404-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE It was hypothesized in this in-vitro study that positioning a K-wire intersecting the cutting plane at the theoretical lateral hinge location would limit the cut depth and help preserve the lateral hinge during the opening of the osteotomy. Objectives were (1) to compare the mechanical resistance of the hinge and the protective effect of leaving the K-wire during the opening procedure (2) to check if the K-wire would limit the depth of the osteotomy. METHODS An ex-vivo mechanical study, testing 5 pairs of fresh-frozen tibias, was designed. CT-scan based Patient-specific cutting guides were obtained to define the cutting plane and the location of the K-wire at the hinge, using standardized 3D planning protocol. In each pair, OWHTO was performed either with or without the K-wire. To evaluate the hinge's resistance to fracture, the specimens were rigidly fixed at the proximal tibia and a direct load was applied on the free tibial diaphysis to open the osteotomy. The maximum load at breakage, maximum permissible displacement and maximal angulation of the osteotomy before hinge failure was measured. To assess the preservation of an unscathed hinge (protected by the K-wire), the distance from the end of the osteotomy cut to the lateral tibial cortical was measured in mm. RESULTS The maximum load to hinge breakage in the K-wires PsCG knees compared to the control group (48.3 N vs 5.5 N, p = 0.004), the maximum permissible displacement (19.8 mm vs 7.5 mm, p = 0.005) and the maximal angulation of the osteotomy before hinge breakage (9.9° vs 2.9°, p = 0.002) were all statistically superior in the K-wires PsCG knees compared to the control group. A mean distance of 10 ± 1 mm between cut-bone (saw-print) and lateral hinge cortical bone was found post-performing the osteotomy and the hinge failing. CONCLUSION The maximum load to breakage and the maximum permissible displacement were, respectively, 880% and 260% higher during the opening of the OWHTO in using K-wires compared to the non-K-wire control group. This confirms the mechanical advantage of using a K-wire for both stabilization and protecting the Hinge during OWHTO. This comparative cadaveric study shows an improvement of the lateral hinges resistance to failing during the opening of the osteotomy. This can be achieved by the placement of a K-wire intersecting the cutting plane at the theoretical location of the lateral hinge.
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Ehlinger M, Ollivier M, Course S, Guerin A, Lantz É, Zahraa D, Bonnomet F, Bahlouli N. Effect of saw blade geometry on crack initiation and propagation on the lateral cortical hinge for HTO: Finite element analysis. Orthop Traumatol Surg Res 2019; 105:1079-1083. [PMID: 31447398 DOI: 10.1016/j.otsr.2019.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/12/2018] [Revised: 01/23/2019] [Accepted: 04/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The hinge plays a primary role in the hold and healing of a high tibial osteotomy (HTO). Weakening of the hinge is a risk factor for failure. The aim of our study was to determine whether the geometry of the saw blade's cutting edge impacts crack initiation or propagation on the hinge. HYPOTHESIS A certain cutting edge geometry exists that will reduce this risk. MATERIALS AND METHODS A finite element model with transverse isotropic elastic bone properties was created. A 1.27-mm thick saw cut (full thickness in anteroposterior direction) was made leaving a 1cm lateral cortical hinge. Three different cutting edge geometries were compared: rectangular, U-shaped, V-shaped. Opening of the osteotomy was done over 1mm for 1 s by a load applied distally with the proximal portion fixed. In the first simulation, no crack was initiated at the hinge, while in the second simulation, the beginnings of a 2mm crack angled upward at 15° was added. These two simulations were used to identify whether a local stress riser was present at the hinge. This information was used to calculate the energy release rate to the hinge, which corresponds to the energy needed to initiate and propagate a crack on the hinge. RESULTS In the first simulation (no crack initiation), a rectangular saw blade geometry resulted in the lowest local stress concentration. In the second simulation (with crack initiation), the U-shaped geometry resulted in the lowest local stress concentration. The U-shaped geometry had the lowest energy release rate, meaning that it was the least likely to initiate and propagate a crack on the lateral cortical hinge. DISCUSSION/CONCLUSION Keeping the inherent limitations related to computer modelling in mind, our findings show that a U-shaped cutting edge is least likely to initiate or propagate a crack since it has the lowest energy release rate. This confirms our hypothesis. LEVEL OF EVIDENCE V, expert opinion.
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Affiliation(s)
- Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France; Laboratoire ICube, équipe MMB, 67400 Illkirch, France.
| | - Matthieu Ollivier
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | | | - Arnaud Guerin
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | - Éric Lantz
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | - Dany Zahraa
- Laboratoire ICube, équipe MMB, 67400 Illkirch, France
| | - François Bonnomet
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
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Dorofeev A, Tylla A, Drescher WR, Stangl R. Opposite cortical fractures in closed-wedge HTO: New classification and treatment algorithm. Knee 2019; 26:1058-1066. [PMID: 31427241 DOI: 10.1016/j.knee.2019.07.014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/07/2019] [Accepted: 07/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND An intact opposite cortex (OC) is essential for HTO stability. For an appropriate prognosis of the role of opposite cortical fracture (OCF) in the development of mechanical complications, it is important to identify the type of OCF. This study seeks to establish an OCF classification in CWHTO with a treatment algorithm. METHODS The clinical radiological results of 187 angle-stable navigated CWHTOs were retrospectively analyzed. Two OCF types (according the direction of fracture line) with three subtypes (A-nondisplaced, B-primarily, and C-secondarily displaced) were identified. RESULTS A total of 67.6% of type 1 and 44.7% of type 2 OCFs were non-displaced (p = 0.041). Secondary displacement developed in 36.2% of type 2 OCFs and in none of the type 1 OCFs. The tibial pseudoarthrosis rate was significantly higher with displaced type 2B and 2C OCFs than with non-displaced 2A fractures (30.8% vs. 4.8%, p = 0.03). The regression analysis showed a relevant correlation between OCF types 1B, 2B, and 2C and the incidence of mechanical complications; the significance of type 2C fractures (OR 43.8) for the incidence of tibial pseudoarthrosis was more than twice as high than for type 1B fractures. CONCLUSION Type 1 OCFs are considered to be stable and type 2 OCFs unstable with a tendency to become displaced. Only 57.4% of type 2 OCFs were recognizable intraoperatively; thus, increased attention must be focused on this event in postoperative repeat radiographs. The classification provides practice-relevant therapeutic approaches.
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Affiliation(s)
- Anton Dorofeev
- Sana Klinikum Rummelsberg, Department of Orthopaedic Surgery, Rummelsberg 71, 90592 Schwarzenbruck, Germany.
| | - Alfred Tylla
- Sana Klinikum Rummelsberg, Department of Orthopaedic Surgery, Rummelsberg 71, 90592 Schwarzenbruck, Germany.
| | - Wolf Robert Drescher
- Sana Klinikum Rummelsberg, Department of Orthopaedic Surgery, Rummelsberg 71, 90592 Schwarzenbruck, Germany; Department of Orthopaedics, RWTH University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Richard Stangl
- Sana Klinikum Rummelsberg, Department of Orthopaedic Surgery, Rummelsberg 71, 90592 Schwarzenbruck, Germany.
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Abstract
The skull is a vertebrate novelty. Morphological adaptations of the skull are associated with major evolutionary transitions, including the shift to a predatory lifestyle and the ability to masticate while breathing. These adaptations include the chondrocranium, dermatocranium, articulated jaws, primary and secondary palates, internal choanae, the middle ear, and temporomandibular joint. The incredible adaptive diversity of the vertebrate skull indicates an underlying bauplan that promotes evolvability. Comparative studies in craniofacial development suggest that the craniofacial bauplan includes three secondary organizers, two that are bilaterally placed at the Hinge of the developing jaw, and one situated in the midline of the developing face (the FEZ). These organizers regulate tissue interactions between the cranial neural crest, the neuroepithelium, and facial and pharyngeal epithelia that regulate the development and evolvability of the craniofacial skeleton.
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Affiliation(s)
- Jennifer L Fish
- University of Massachusetts Lowell, Department of Biological Sciences, 198 Riverside St., Olsen Hall 619, Lowell, MA 01854, U.S.A..
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Chalakkal P, N Ferreira A, C Da Costa G, A Aras M. Functional Lingual Arch with Hinge-type Lockable Dentulous Component. Int J Clin Pediatr Dent 2017; 10:302-308. [PMID: 29104394 PMCID: PMC5661048 DOI: 10.5005/jp-journals-10005-1455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/17/2017] [Accepted: 02/28/2017] [Indexed: 12/02/2022] Open
Abstract
The conventional lingual arch is a nonfunctional fixed space maintainer used in the mandibular arch to maintain arch length by the prevention of mesial movement of the permanent first molars. This study highlights a functional lingual arch with a hinge-type lockable dentulous component that incorporates molar tubes, with various advantages over the conventional lingual arch.
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Affiliation(s)
- Paul Chalakkal
- Assistant Professor, Department of Pedodontics and Preventive Dentistry, Goa Dental College & Hospital, Bambolim, Goa, India
| | - Amanda N Ferreira
- Postgraduate Student, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India
| | - Godwin C Da Costa
- Lecturer, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India
| | - Meena A Aras
- Professor and Head, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India
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23
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Hur JW, Park YK, Kim BJ, Moon HJ, Kim JH. Risk Factors for Delayed Hinge Fracture after Plate-Augmented Cervical Open-Door Laminoplasty. J Korean Neurosurg Soc 2016; 59:368-73. [PMID: 27446518 PMCID: PMC4954885 DOI: 10.3340/jkns.2016.59.4.368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 01/05/2015] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 11/27/2022] Open
Abstract
Objective Delayed hinge fracture (HF) that develops after cervical open door laminoplasty can be a source of postoperative complications such as axial pain. However, risk factors related to this complication remain unclear. We performed a retrospective clinical series to determine risk factors for delayed HF following plate-only open-door cervical laminoplasty. Methods Patients who underwent plate-only open-door laminoplasty and had available postoperative computed tomography (CT) scans (80 patients with 270 laminae) were enrolled. Hinge status, hinge gutter location, open location, hinge width, number of screws used, operation level, and open angle were observed in the CT to determine radiographic outcome. Demographic data were collected as well. Radiographic and clinical parameters were analyzed using univariate and multivariate logistic regression analysis to determine the risk factors for HF. Results Univariate logistic regression analysis results indicated poor initial hinge status, medially placed hinge gutter, double screw fixation on the elevated lamina, upper surgical level, and wide open angle as predictors for HF (p<0.05). Initial hinge status seemed to be the most powerful risk factor for HF (p=0.000) and thus was collinear with other variables. Therefore, multivariate logistic regression analysis was performed excluding initial hinge status, and the results indicated that medially placed hinge gutter, double screw fixation on the elevated lamina, and upper surgical level were risk factors for HF after adjustment for other confounding factors. Conclusion To prevent HF and to draw a successful postoperative outcome after cervical laminoplasty, surgical and clinical precautions should be considered.
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Affiliation(s)
- Junseok W Hur
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea.; Department of Neurosurgery, Korea University Anam Hospital, Seoul, Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Bum-Joon Kim
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea.; Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea
| | - Hong-Joo Moon
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Joo-Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
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Pham TT, Bonnevialle N, Rongières M, Bonnevialle P, Mansat P. Mechanical failure of the Coonrad-Morrey linked total elbow arthroplasty: A case report. Orthop Traumatol Surg Res 2014; 100:831-4. [PMID: 25262098 DOI: 10.1016/j.otsr.2014.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 02/10/2014] [Revised: 05/16/2014] [Accepted: 07/25/2014] [Indexed: 02/02/2023]
Abstract
Semiconstrained (linked design) total elbow arthroplasty is indicated in a wide variety of cases. Long-term survival is better than with non-linked prostheses. However, mechanical failure of the hinge mechanism is a complication that may occur during follow-up. We report a case of failure of the axle assembly of a Coonrad-Morrey elbow prosthesis 8 years after implantation for nonunion of a supracondylar distal humerus fracture. Initial revision surgery included changing the axle and the polyethylene bushings. Revision surgery was necessary 1 year later when the axle failed again. A custom-designed locking axle had to be used to stabilize the hinge mechanism. After 3 years follow-up, the hinge was intact, there was no loosening of the components and function of the elbow was good.
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Affiliation(s)
- T T Pham
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France
| | - N Bonnevialle
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France
| | - M Rongières
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France
| | - P Bonnevialle
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France
| | - P Mansat
- Institut de l'appareil locomoteur du CHU de Toulouse, Département d'Orthopédie et traumatologie, Hôpital Pierre-Paul-Riquet, place du Docteur-Baylac, 31059 Toulouse Cedex, France.
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25
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Richer BC, Seeger K. The hinge region of type VII collagen is intrinsically disordered. Matrix Biol 2014; 36:77-83. [PMID: 24810542 DOI: 10.1016/j.matbio.2014.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 11/24/2022]
Abstract
Type VII collagen (Col7) is important for skin integrity. As a major component of the anchoring fibrils, Col7 is essential for linking different skin layers together. The central collagenous domain of Col7 contains several interruptions of the collagen triple helix. The longest interruption is 39 amino acids long and referred to as the hinge region. The hinge region is highly conserved between species. This region was predicted to adopt a coiled coil structure and to serve as the trimerization domain of Col7. To gain insight into the potential function of the hinge region we investigated a heterologous expressed peptide by CD and NMR spectroscopy. CD spectroscopy implies that the hinge region is intrinsically disordered. Resonance assignment was performed and allowed secondary structure analysis based on the chemical shift values. Seven amino acids in the N-terminal moiety show residual α-helical conformation. Subsequent investigation of temperature dependency of amide chemical shifts indicated participation in hydrogen bonding of amino acid residues in the C-terminal moiety of the hinge region. Therefore, the hinge region does not form a coiled coil structure under the employed experimental conditions. The intrinsic disorder of the hinge region might be desired for flexibility to serve as a "hinge" or the hinge region is an important interaction site as typically observed for intrinsically disordered proteins.
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26
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Bailey FP, Andreev VI, Eyers PA. The resistance tetrad: amino acid hotspots for kinome-wide exploitation of drug-resistant protein kinase alleles. Methods Enzymol 2014; 548:117-46. [PMID: 25399644 DOI: 10.1016/B978-0-12-397918-6.00005-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Acquired resistance to targeted kinase inhibitors is a well-documented clinical problem that is potentially fatal for patients to whom a suitable back-up is not available. However, protein kinase alleles that promote resistance to inhibitors can be exploited experimentally as gold-standards for "on"- and "off"-target validation strategies and constitute a powerful resource for assessing the ability of new or combined therapies to override resistance. Clinical resistance to kinase inhibitors is an evident in all tyrosine kinase-driven malignancies, where high rates of mutation drive tumor evolution toward the insidious drug-resistant (DR) state through a variety of mechanisms. Unfortunately, this problem is likely to intensify in the future as the number of target kinases, approved inhibitors, and clinical indications increase. To empower the analysis of resistance in kinases, we have validated a bioinformatic, structural, and cellular workflow for designing and evaluating resistance at key mutational hotspots among kinome members. In this chapter, we discuss how mutation of amino acids in the gatekeeper and hinge-loop regions (collectively termed the "resistance tetrad") and the DFG motif represent an effective approach for generating panels of DR kinase alleles for chemical genetics and biological target validation.
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Ayala-Camargo A, Anderson AM, Amoyel M, Rodrigues AB, Flaherty MS, Bach EA. JAK/STAT signaling is required for hinge growth and patterning in the Drosophila wing disc. Dev Biol 2013; 382:413-26. [PMID: 23978534 DOI: 10.1016/j.ydbio.2013.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 07/31/2013] [Accepted: 08/18/2013] [Indexed: 01/15/2023]
Abstract
JAK/STAT signaling is localized to the wing hinge, but its function there is not known. Here we show that the Drosophila STAT Stat92E is downstream of Homothorax and is required for hinge development by cell-autonomously regulating hinge-specific factors. Within the hinge, Stat92E activity becomes restricted to gap domain cells that lack Nubbin and Teashirt. While gap domain cells lacking Stat92E have significantly reduced proliferation, increased JAK/STAT signaling there does not expand this domain. Thus, this pathway is necessary but not sufficient for gap domain growth. We show that reduced Wingless (Wg) signaling dominantly inhibits Stat92E activity in the hinge. However, ectopic JAK/STAT signaling does not perturb Wg expression in the hinge. We report negative interactions between Stat92E and the notum factor Araucan, resulting in restriction of JAK/STAT signaling from the notum. In addition, we find that the distal factor Nub represses the ligand unpaired as well as Stat92E activity. These data suggest that distal expansion of JAK/STAT signaling is deleterious to wing blade development. Indeed, mis-expression of Unpaired within the presumptive wing blade causes small, stunted adult wings. We conclude that JAK/STAT signaling is critical for hinge fate specification and growth of the gap domain and that its restriction to the hinge is required for proper wing development.
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Affiliation(s)
- Aidee Ayala-Camargo
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, New York 10016-6402, USA
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Abstract
In the United States, prostate cancer (PCa) is the most commonly diagnosed non-cutaneous cancer in males and the second leading cause of cancer-related death for men. The prostate is an androgen-dependent organ and PCa is an androgen-dependent disease. Androgen action is mediated by the androgen receptor (AR), a hormone activated transcription factor. The primary treatment for metastatic PCa is androgen deprivation therapy (ADT). For the most part, tumors respond to ADT, but most become resistant to therapy within two years. There is persuasive evidence that castration resistant (also termed castration recurrent) PCa (CRPC) remains AR dependent. Recent studies have shown that there are numerous factors that contribute to AR reactivation despite castrate serum levels of androgens. These include changes in AR expression and structure through gene amplification, mutation, and alternative splicing. Changes in steroid metabolism, cell signaling, and coregulator proteins are also important contributors to AR reactivation in CRPC. Most AR targeted therapies have been directed at the hormone binding domain. The finding that constitutively active AR splice variants that lack the hormone binding domain are frequently expressed in CRPC highlights the need to develop therapies that target other portions of AR. In this review, the role of AR in normal prostate, in PCa, and particularly the mechanisms for its reactivation subsequent to ADT are summarized. In addition, recent clinical trials and novel approaches to target AR are discussed.
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Affiliation(s)
- Ayesha A Shafi
- Department of Molecular and Cellular Biology, Baylor College of Medicine, M515, One Baylor Plaza, Houston, TX 77030, USA
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