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Saturday, November 5, 2011

Resveratrol inhibits interleukin 1β-mediated inducible nitric oxide synthase expression in articular chondrocytes by activating SIRT1 and thereby suppressing nuclear factor-κB activity.

In chondrocytes, resveratrol, a natural SIRT1 activator, exerts an anti-inflammatory response via inhibition of nuclear factor kappaB (NF-κB). Given that SIRT1 inhibits the transactivation potential of NF-κB by deacetylating acetylated lysines in p65, the NF-κB subunit, we investigated the effects of resveratrol-activated SIRT1 on articular chondrocytes. We found that when chondrocytes were stimulated with interleukin 1β (IL-1β), the time- and dose-dependent expression of inducible nitric oxide synthase (iNOS) expression and nitric oxide (NO) production was suppressed by resveratrol. Resveratrol-activated SIRT1 mediated this suppression. SIRT1 suppressed not only the nuclear translocation of NF-κB but also the acetylation of p65. Furthermore, acetylated Lys310 in p65, which must be present for transactivation activity, was the immediate downstream target of SIRT1. Therefore, SIRT1 protects against the inflammatory response induced by IL-1β in articular chondrocytes. Resveratrol, as an activator of SIRT1, merits consideration as a therapeutic agent in the treatment and prevention of osteoarthritis. Lei M, Wang JG, Xiao DM, Fan M, Wang DP, Xiong JY, Chen Y, Ding Y, Liu SL. Eur J Pharmacol. 2011 Oct 25. [Epub ahead of print] PMID: 22044919

Safety and efficacy of radiation therapy as secondary prophylaxis for heterotopic ossification of non-hip joints.

Prophylactic radiation therapy (RT) is an established adjuvant therapy for heterotopic ossification (HO) of the hip when delivered in the immediate pre- or postoperative setting. Its role in prevention of recurrence after excision of HO is supported by randomised trials for HO of the hip, but there is scant evidence to demonstrate the safety and efficacy of a similar approach in non-hip joints. In the current study, we evaluate radiological and functional outcomes after prophylactic RT for prevention of HO of the knee and upper extremity. Mishra MV, Austin L, Parvizi J, Ramsey M, Showalter TN. J Med Imaging Radiat Oncol. 2011 Jun;55(3):333-6. PMID: 21696569

Friday, November 4, 2011

Smart materials that get bone to heal

Bone tissue is very good at self-healing, but in many situations the natural healing process is not sufficient. In a dissertation at Uppsala University, Sonya Piskounova shows how functional materials that she and her colleagues have developed can form bone tissue in places in the body where there originally was no bone. MedicalXpress

A New Definition for Periprosthetic Joint Infection

A rise in periprosthetic joint infection (PJI) rates has the orthopedic community moving to develop it’s first-ever agreed upon definition and diagnostic criteria to help better treat patients.

The proposed criteria, published in the November issue of Clinical Orthopaedics and Related Research (PDF) was developed by a Musculoskeletal Infection Society working group led by Javad Parvizi, M.D., director of Research at the Rothman Institute at Jefferson. The group analyzed available research, much of which was conducted at Jefferson, to develop the new definition and criteria. Clinical Orthopaedics and Related Research

Any Ortho Uses? Autodesk bringing 3D modeling to the masses.

On Monday, the design software giant will unveil 123D Catch and 123D Make, new tools that are intended to give almost any user the ability to create digital 3D models and schematics. c/net

Lumbar paraspinal compartment syndrome.

The purpose of this study was to systematically review the available evidence on lumbar paraspinal compartment syndrome with specific reference to patient demographics, aetiology, types, diagnosis, clinical features, and treatment. This was an Institutional Review Board-exempt study performed at a Level 1 trauma center. A PubMed search was conducted with the title query: lumbar paraspinal compartment syndrome. Nathan ST, Roberts CS, Deliberato D. Int Orthop. 2011 Oct 26. [Epub ahead of print] PMID: 22038444

Thursday, November 3, 2011

Monster Anatomy Upper Limb iPad app is a decent radiographic introduction to the upper limb

Monster Anatomy was prominently featured in older Apple commercials for the original iPad with their Lower Limb Anatomy app. iMedicalApps did a full text and video review of the app last year.

This impressive app was well received by us, although one of its major limitations was the fact that it only covered the lower limb. This has now changed with Monster Anatomy releasing a similar app covering the Upper Limb. iMedicalApps

New on Audio Digest

Volume 34, Issue 22
November 21, 2011
The natural history and treatment of patellar dislocation – Robert E. Hunter, MD
Biologic resurfacing of the patella: current options – Brian J. Cole, MD, MBA

Low vitamin D common in spine surgery patients

A new study indicates that many patients undergoing spine surgery have low levels of vitamin D, which may delay their recovery.

In a study of 313 patients undergoing spinal fusion surgery, orthopaedic surgeons at Washington University School of Medicine in St. Louis found that more than half had inadequate levels of vitamin D, including one-fourth who were more severely deficient.

The researchers report their findings today at the 26th Annual Meeting of the North American Spine Society. The study was chosen as one of the meeting's best papers. Eurekalert!

Wednesday, November 2, 2011

Reimplantation of an Extruded Osteoarticular Segment of the Distal Tibia in a 14-Year-Old Girl. Case Report and Review of the Literature

This case report describes the reimplantation of a 15-cm osteoarticular segment of the distal tibia in a 14-year-old girl who was hit by a truck. The bone fragment was debrided and reimplanted on the day of injury. A free flap was performed within 1 week. Bony union was achieved without complication. At 5-year follow-up, the patient is able to ambulate for several hours at a time without an assistive device, although arthritis of the ankle joint is present. She scores 43.8 on the physical component of the 36-Item Short Form Health Survey and 49.0 on the mental component. The patient states that she is very pleased with her outcome. This seems to be the first description of an osteoarticular segment reimplantation of a long bone in the orthopaedic literature. Farrelly, Erin MD; Ferrari, Louis BA; Roland, Donald MD; DiFelice, Gregory S MD. Journal of Orthopaedic Trauma: POST AUTHOR CORRECTIONS, 22 October 2011.

Use for Ortho? Exenatide (Byetta) has rapid, powerful anti-inflammatory effect, UB study shows

Exenatide, a drug commonly prescribed to help patients with type 2 diabetes improve blood sugar control, also has a powerful and rapid anti-inflammatory effect, a University at Buffalo study has shown. The study of the drug, marketed under the trade name Byetta, was published recently in the Journal of Clinical Endocrinology and Metabolism

Apart from corticosteroids, which are known anti-inflammatory drugs, and insulin, no other drug demonstrates such a powerful and rapid anti-inflammatory effect," adds Dandona. Eurekalert!

New Ortho Related Descriptors (MeSH) - 2012

Hyperlinked MeSH Descriptors

Tuesday, November 1, 2011

Investigation of factors affecting loosening of Ilizarov ring-wire external fixator systems at the bone-wire interface

The potential for peri-implant bone yielding and subsequent loosening of Ilizarov ring-wire external fixation systems was investigated using non-linear finite element (FE) analyses. A strain-based plasticity model was employed to simulate bone yielding. FE models also incorporated contact behavior at the wire-bone interface, orthotropic elasticity, and periosteal-endosteal variation of bone properties. These simulations were used to determine the extent and location of yielding with change in age-related bone structure and properties for the bone-Ilizarov construct at the tibial midshaft. Finn E. Donaldson, Pankaj Pankaj, A. Hamish R.W. Simpson. Journal of Orthopaedic Research; Article first published online: 31 OCT 2011 PDF

Clinical features of partial anterior bursal-sided supraspinatus tendon (PABST) lesions.

We characterized PABST lesions that may be overlooked because of their peculiar location in the far anterolateral insertional section of the supraspinatus tendon at the bursal side. PABST lesions usually occur in younger patients, and trauma is frequently associated with acute symptom onset. Surgical treatment was effective for pain reduction and functional improvement. Oh JH, Oh CH, Kim SH, Kim JH, Yoon JP, Jung JH. J Shoulder Elbow Surg. 2011 Oct 29. [Epub ahead of print] PMID: 22036541 PDF

The diagnostic accuracy of magnetic resonance imaging and ultrasonography in gluteal tendon tears - a systematic review.

Gluteal tendon tears are one of the many pathologies causing pain around the greater trochanter that are often labelled as trochanteric bursitis. We systematically reviewed the peer-reviewed literature to establish the accuracy of magnetic resonance imaging and ultrasonography in the diagnosis of gluteal tendon tears in patients with persistent lateral hip pain or Greater Trochanteric Pain Syndrome (GTPS). Westacott DJ, Minns JI, Foguet P. Hip Int. 2011 Oct 28: [Epub ahead of print] PMID: 22038311

Effect of Combined Nicotine and Shrapnel Exposure on Pain Measures and Gait After Nerve Injury

A significant fraction of military soldiers sustain nerve injury and use tobacco or nicotine containing products. Healing of nerve injuries is influenced by many factors, such as degree of original injury, healing potential of the nerve, and general health of patient. However, recently, it has been demonstrated that the presence of retained insoluble metal fragments decreases healing. The effects of systemic nicotine administration, with or without metal fragments at the site of nerve injury, were evaluated. Both the nicotine-administered groups (nicotine, nicotine + shrapnel) showed significant increase in the peroneal function compared with untreated controls, as assessed by paw area (p < 0.05). Furthermore, to test possible role of altered sensory function, we used the hot plate assay. Latency to withdraw paw from a hot plate was significantly shorter in nicotine groups (p < 0.05). These data indicate that nicotine improves sensory and motor aspects of nerve function, in the presence or absence of shrapnel. Rittenhouse, Bradley; Hill-Pryor, Crystal D.; McConathy, Adam; Parker, Peter; Franco, Nelson; Toussaint, Esra; Barker, Darrell; Prasad, Balakrishna; Pizarro, Jose M. Military Medicine, Volume 176, Number 11, November 2011 , pp. 1335-1340(6) PDF

FDA Green Lights Non-Opioid Post-Op Pain Drug

The FDA has approved the non-opioid analgesic bupivacaine liposome injectable suspension (Exparel) for use in postsurgical pain relief.  The 1.3% solution delivers extended pain relief through a liposomal platform, called DepoFoam, that allows the drug to be administered into the surgical site, producing postsurgical analgesia for up to 72 hours, according to Pacira Pharmaceuticals. MedPage Today

3 New Eurekalert! Alerts

MIT: New algorithm could substantially speed up MRI scans. MIT researchers have developed a new algorithm that could substantially speed up MRI scans from 45 to 15 minutes.

Drugs used to tackle hospital-acquired infections can increase post-op complications. The introduction of new antibiotic regimes to tackle hospital-acquired infections, such as C. difficile, must take into account the possibility of increased infections following specific surgical procedures.

Physicians who play Mozart while performing colonoscopy may improve adenoma detection rate. Physicians who listen to Mozart while performing colonoscopy may increase their detection rates of precancerous polyps, according to the results of a new study unveiled today.

Yoga Bests Usual Care for Back Function (CME/CE)

In the second study in as many weeks, yoga has again proven superior to routine care for improving function in patients with chronic low back pain, researchers found.

The stretching-and-mindfulness-based therapy improved back function in adult patients in the U.K. with the condition, more than usual care, Helen Tilbrook, MSc, of the University of York, and colleagues reported in the Annals of Internal Medicine. MedPage Today

Radiologists, primary users of non-cardiac ultrasound

Although non-radiologist physicians have contributed to the widespread use of point-of-care (POC) ultrasound, radiologists remain the primary users, according to a study in the November issue of the Journal of the American College of Radiology. POC ultrasound is defined as an ultrasound performed (and interpreted) by the clinician at the bedside.

A recent paper in the New England Journal of Medicine (PDF and video) by Moore and Copel indicated that miniaturization and a drop in costs have facilitated the growth of non-cardiac POC ultrasound by clinicians and that the concept of an "ultrasound stethoscope" is rapidly moving from the theoretical to a reality. Eurekalert!

Monday, October 31, 2011

Stem Cell Cocktail for Us Old Folks

'Rejuvenated' stem cells coaxed from centenarian. Scientists said Tuesday they had transformed age-worn cells in people over 90 -- including a centenarian -- into rejuvenated stemcells that were "indistinguishable" from those found in embryos.

The technical feat, reported in the peer-reviewed journal Genes & Development, opens a new path toward regenerative medicine, especially for the elderly, the researchers said.

Lemaitre and colleagues decided to alter the standard genetic starter kit used to generate adult stemcells by adding two new ingredients -- known as transcription factors -- called NANOG and LIN28. MedicalXpress

New Ortho Related Books in the Health Sciences Library

Click here for spreadsheet.

Those without call numbers have not yet been cataloged.

Fighting fire with fire: 'Vampire' bacteria has potential as living antibiotic

A vampire-like bacteria that leeches onto specific other bacteria – including certain human pathogens – has the potential to serve as a living antibiotic for a range of infectious diseases, a new study indicates.
The bacterium, Micavibrio aeruginosavorus, was discovered to inhabit wastewater nearly 30 years ago, but has not been extensively studied because it is difficult to culture and investigate using traditional microbiology techniques. However, biologists in the University of Virginia's College of Arts & Sciences, Martin Wu and graduate student Zhang Wang, have decoded its genome and are learning "how it makes its living," Wu said.
The bacterium "makes its living" by seeking out prey – certain other bacteria – and then attaching itself to its victim's cell wall and essentially sucking out nutrients.

Unlike most other bacteria, which draw nutrients from their surroundings, M. aeruginosavorus can survive and propagate only by drawing its nutrition from specific prey bacteria. This kills the prey – making it a potentially powerful agent for destroying pathogens. One bacterium it targets is Pseudomonas aeruginosavorus, which is a chief cause of serious lung infections in cystic fibrosis patients.

His study, detailing the DNA sequence of M. aeruginosavorus, is published online in the journal BMC Genomics [link: (PDF)].It provides new insights to the predatory lifestyle of the bacterium and a better understanding of the evolution of bacterial predation in general. Eurekalert!

See also: Postop wound Infections

See also the BBC documentary: Phage - The Virus that Cures

Sunday, October 30, 2011

Struggling to Be Self-Directed: Residents' Paradoxical Beliefs About Learning.

Self-directed learning (SDL) skills serve as the basis for physician lifelong learning; however, residency training does not typically emphasize SDL skills. To understand residents' needs regarding SDL curricula, the authors used qualitative methods to examine the residency learning culture and residents' views of SDL. Nothnagle M, Anandarajah G, Goldman RE, Reis S. Acad Med. 2011 Oct 25. [Epub ahead of print] PMID: 22030764

Long-term Results of Surgical Decompression of Chronic Exertional Compartment Syndrome of the Forearm in Motocross Racers.

Chronic exertional compartment syndrome (CECS) is occasionally observed in the forearm flexor muscles of motocross racers. Long-term results of fasciectomy and fasciotomy for this syndrome are scarce. Winkes MB, Luiten EJ, van Zoest WJ, Sala HA, Hoogeveen AR, Scheltinga MR. Am J Sports Med. 2011 Oct 26. [Epub ahead of print] PMID: 22031858 PDF

Hook retraction for scapulothoracic arthroscopy.

Scapulothoracic arthroscopy is an established method for evaluating the articulation between the thoracic cage and the scapula. The "chicken-wing" position is often used to enhance visualization of the scapulothoracic space. There are situations in which the chicken-wing position is not feasible or practical, such as in simultaneous arthroscopy of both joints. In this article, we describe a new technique that aids in arthroscopy of the scapulothoracic joint, particularly when the chicken-wing position is unavailable. William Beaumont Army Medical Center, El Paso, Texas, USAThomas DM, Hansen U, Owens BD. Am J Orthop (Belle Mead NJ). 2011 Jul;40(7):372-3. PMID: 22013575

Dual delivery of an antibiotic and a growth factor addresses both the microbiological and biological challenges of contaminated bone fractures.

Introduction: Open fractures are plagued by high complication rates, among which infection and nonunion are the most common, leading to higher morbidity and poor patient outcomes. Despite meticulous surgical care and employment of adjunctive therapies, infection rates remain at 20%, due to the limitations of conventional therapies. Areas covered: Persistent bacteria often survive initial debridement and treatment with antibiotics. Thus, the bone graft subsequently implanted to promote healing can be the nidus for infection. The principles of biofilm theory and the "race to the surface" have been applied to develop dual-purpose bone grafts that are protected by a sustained release of an antibiotic, thereby preventing bacterial colonization. A simultaneous sustained release of a recombinant human growth factor allows the defect to become vascularized and heal. Expert opinion: Current therapies fail to meet the challenges of open fractures. Tissue engineering and drug delivery approaches can address the challenges of healing large bone defects while protecting the implant from infection. When combined as an adjunctive therapy with existing clinical practices for management of open fractures, dual-purpose bone grafts that release both an antibiotic and a growth factor at biologically relevant time scales can potentially reduce infection rates and improve patient outcomes.  United States Army Institute of Surgical Research , Extremity Trauma & Regenerative Medicine Task AreaWenke JC, Guelcher SA. Expert Opin Drug Deliv. 2011 Oct 22. [Epub ahead of print] PMID: 22017669

Accuracy of blind versus ultrasound-guided suprapatellar bursal injection.

RESULTS.: US-guided HA injection exhibited a significantly greater accuracy (48 of 50 knees, 96.0%) than blind injection (41 of 49 knees, 83.7%). Bum Park Y, Ah Choi W, Kim YK, Chul Lee S, Hae Lee J. J Clin Ultrasound. 2011 Oct 28. [Epub ahead of print] PMID: 22033897