TB infekce pohybového aparátu

Cílem příspěvku bylo podat základní informace o diagnostice a léčbě osteoartikulární tuberkulózy, doplněnou několika zajímavými kazuistikami.Cílem příspěvku bylo podat základní informace o diagnostice a léčbě osteoartikulární tuberkulózy, doplněnou několika zajímavými kazuistikami

Inflammation time-axis in aseptic loosening of total knee arthroplasty: A preliminary study

Objective Aseptic loosening (AL) is the most frequent long-term reason for revision of total knee arthroplasty (TKA) affecting about 15–20% patients within 20 years after the surgery. Although there is a solid body of evidence about the crucial role of inflammation in the AL pathogenesis, scared information on inflammation signature and its time-axis in tissues around TKA exists. Design The inflammation protein signatures in pseudosynovial tissues collected at revision surgery from patients with AL (AL, n = 12) and those with no clinical/radiographic signs of AL (non-AL, n = 9) were investigated by Proximity Extension Assay (PEA)-Immunoassay and immunohistochemistry. Results AL tissues had elevated levels of TNF-family members sTNFR2, TNFSF14, sFasL, sBAFF, cytokines/chemokines IL8, CCL2, IL1RA/IL36, sIL6R, and growth factors sAREG, CSF1, comparing to non-AL. High interindividual variability in protein levels was evident particularly in non-AL. Levels of sTNFR2, sBAFF, IL8, sIL6R, and MPO discriminated between AL and non-AL and were associated with the time from index surgery, suggesting the cumulative character of inflammatory osteolytic response to prosthetic byproducts. The source of elevated inflammatory molecules was macrophages and multinucleated osteoclast-like cells in AL and histiocytes and osteoclast-like cells in non-AL tissues, respectively. All proteins were present in higher levels in osteoclast-like cells than in macrophages. Conclusions Our study revealed a differential inflammation signature between AL and non-AL stages of TKA. It also highlighted the unique patient’s response to TKA in non-AL stages. Further confirmation of our preliminary results on a larger cohort is needed. Analysis of the time-axis of processes ongoing around TKA implantation may help to understand the mechanisms driving periprosthetic bone resorption needed for diagnostic/preventative strategies.Web of Science148art. no. E022105

Odds-ratio network for postoperative factors revealing differences in the 2-year longitudinal pattern of satisfaction between women and men after total knee arthroplasty

Timely and accurate assessments of the factors influencing satisfaction, a key indicator of success in primary total knee arthroplasty (TKA), may help improve TKA outcomes. Here we performed the longitudinal trend analysis of relation between satisfaction and 12 postoperative factors, which positively or negatively influence the patient satisfaction 2 years after TKA. In a real-world registry cohort (women/men: 1121/650), we showed similarities and differences between women and men in the contribution of postoperative factors to satisfaction 2 years after TKA as assessed by odds-ratio-similarity network. In men, the strongest negative factors were pain and complications, followed by mechanical problems. In women, the strongest negative factors were the pain and knee instability, followed by other mechanical problems, complications and low levels of sports activity. In both sexes, physical activity and the Knee Society Score (general and functional) influenced positively satisfaction; long-distance walking was associated with satisfaction only in women. A trend analysis revealed a reduction in the strength of satisfaction-related factors over 2 years of check-ups, particularly in women. Our study demonstrates that the key check-up for assessing the evolution of satisfaction in the 2 years after TKA was at 3 months in both sexes.Web of Science121art. no. 1747

Spinal shape analysis in 1,020 healthy young adults aged from 19 to 30 years

Background: A number of studies on diseased spine have been published; however, there is a relative paucity of studies investigating spine shape characteristics in healthy populations. Such characteristics are needed for diagnostics of spine disorders and assessment of changes in the spinal shape that may have been caused by influence of the modern life style or intensive sport activity. Objective: The aim of the study was to determine characteristics of the spine shape in a large sample of healthy young adults. Methods: Population cross-sectional study. A non-radiographic surface method (system DTP-3) was used for the assessment of spine shape in the sagittal and frontal planes. A total of 1,020 participants (440 men, 580 women) took part in the study, their mean (± SD) age was 21.8 ± 1.9 years (range 19.1-29.7) for men and 21.9 ± 1.8 years (range 19.3-29.7) for women. All data were checked for normality and are presented as means, standard deviations, ranges, skewness, and kurtosis. Differences between the sexes were assessed with the two-sample t-test. Results: The average sagittal spinal shape was C3 - 12.9° - C7 - 43.0° - T10 - 27.1° - L5 for men and C3 - 12.1° - C6 - 44.5° - T11 - 34.1° - L5 for women. Men showed a significantly smaller thoracic kyphosis and lumbar lordosis curvatures than women. The average curvature due to the lateral deviation in the frontal plane was 6.1° for both sexes, the curvature was larger than 10° in 9.1% of men and 8.8% of women. We found left lateral deviation in 72.5% of men and in 63.6% of women. Conclusions: The study provides characteristics of the spine shape in a large sample of healthy young adults. Such characteristics should be part and parcel of determining the cut-off level for physiological spinal shape. Based on the results of the study, we suggest a lateral deviation of 10° as the maximum for a curvature to be still considered non-pathological

Kouření, předoperační aktivita a čekání na operaci by mohlo predikovat četnost časných reoperací u pacientů s TEP kolena

PURPOSE OF THE STUDY Information that would help physicians make decisions and improve the likelihood of achieving the desired results of medical interventions is sought as part of the concept of the individualized approach to patients. The primary purpose of our study was to identify which features determine the higher/lower likelihood of the need for early reoperation after a TKA (total knee arthroplasty). The successful preoperative identification of high risk patients could lead to the adjustment of the surgical procedure and thus lower the percentage of revision surgeries. MATERIAL AND METHODS In total, 826 patients (296 men and 530 women) were included in our prospective study; these patients underwent TKA implantation at our department between September 2010 and March 2015. The average age of the patients at the time of primary TKA implantation was 68.9 years. Over 60 preoperative and perioperative parameters were tracked and continuously recorded in our arthroplasty register. First, conventional analysis of individual parameters was carried out and odd ratios for their relationship with revision surgeries were set. Subsequently, the data were transformed into a graph and methods of complex network analysis were applied to identify such combinations of features (parameters) that would significantly separate the operated patients into homogeneous subgroups. The observed patient subgroups were then reanalyzed for parameters related to reoperations. RESULTS Thirty-three patients (4% of those studied) required early TKA revision (within 3 years of primary implantation). The most frequent reason for revision surgery was an early postoperative infection. The analysis of observed characteristics proved that the likelihood of revision surgery was by 80% lower in women in comparison with men. Other parameters associated with a higher frequency of reoperations were the level of preoperative activity, smoking and the waiting time for the first operation. Patients waiting for primary TKA implantation for more than 3 months showed a 2.7 times greater likelihood of revision surgery when compared to those who were operated within 3 months after the indication to surgery. Patients declaring medium or high activity levels (assessed by means of the UCLA scale) had a 2.1 times higher likelihood of revision surgery in comparison to patients with low physical activity levels. Smoking meant up to 3.2 times greater likelihood of revision in comparison with nonsmokers. Conversely, no correlation between a greater risk of reoperation and age, BMI (body mass index) or the level of comorbidities evaluated by means of the Charlson scale was confirmed. No correlation between the risk of revision and primary diagnosis was found either. DISCUSSION The frequency of early TKA revision surgeries (within 3 years after the primary surgery) in the evaluated sample is relatively high (4%). On the contrary, the reasons for early revisions correspond with recent publications. The risks of TKA infection overlap with the predictors of wound healing disorders to a great extent. Smoking, obesity and comorbidities decreasing the efficiency of the immune system are mentioned most frequently. Patients waiting for TKA implantation longer were more inclined to require early revision surgery too. Awareness of this fact is reflected in the tendency to shorten the waiting time for TKA surgery. A number of studies have pointed out the negative influence of longer waiting times on postoperative results. In our study, it was men who required revision most frequently, specifically the group of those having smoking and higher physical activity in their case histories. The influence of smoking on early postoperative morbidity is also well known. A significant finding is that stopping smoking can decrease the probability of early reoperation. However, we failed to explain the influence of higher physical activity. The influence of patients' age, BMI, level of comorbidities or primary diagnosis on the frequency of revision surgeries were not demonstrated. CONCLUSIONS We proved that women definitely show a lower risk of early TKA revision surgeries in comparison with men. A higher frequency of reoperations was related to modifiable factors such as smoking, longer waiting times for the primary operation, and a higher preoperative level of physical activity. A significant finding is that stopping smoking could decrease the probability of early TKA revision. Nonetheless, we do not recommend decreasing preoperative physical activity at this point; it will require further studies and verification of this finding. Also, the potential mechanism of the influence of greater preoperative load on the particular reason for revision is yet to be explained.Web of Science85641741

Deadwood position matters: Diversity and biomass of saproxylic beetles in a temperate beech forest

Deadwood plays a key role for biodiversity in forests. A significant number of beetles from this group are currently listed as endangered in the Red List. In addition to other management recommendations, there have been recent efforts to enrich stands with dead wood to promote biodiversity. An important parameter for forestry enterprises is the optimization of these interventions. The study investigated the abundance, species richness, gamma diversity, conservation value and biomass of saproxylic beetles in natural forests using window traps. A total of 89 traps were used for saproxylic beetle monitoring, of which 29 were placed on lying logs, 30 on snags and 30 as controls in forest stand space. A total of 35,011 beetles were recorded in 564 species (61 families). Notably, 20,515 of these belong to saproxylic beetles (59%) in 311 species (55%), with 62 classified as Red-List species (20%). In the group of ‘all saproxylic beetles’, the results indicate that α diversity and γ diversity (q ​= ​0) remain consistent across various deadwood types, while β diversity showed significant differences. Significant differences were found in the Red-List species group, where α diversity and γ diversity differed, with higher values observed in snags. Rarefaction based total species richness of site was estimated to be 391 species, including 74 Red-Listed species. Comparing the sample coverage of the studied stand categories showed that all saproxylic species exhibit a pronounced preference for inhabiting areas featuring lying logs. Conversely, Red-List species mainly inhabit snags, with β diversity being more similar to snags and forest stand space. Notably, both the conservation value (weighted average by conservation status) and beetle biomass are significantly highest in snags, whereas stand space shows the lowest values across all measured saproxylic beetle indices. Furthermore, the use of traps set on the poles in forest stand space resulted in an underestimation of the actual stand richness by 20%–25%. Our results support the conclusion that snags are indispensable features in beech forests, playing a key role in promoting high species diversity, especially among Red-List species, and supporting the biomass of saproxylic beetles. Consequently, it becomes crucial to incorporate a higher percentage of standing deadwood in managed forests or actively create equivalent environments by introducing high stumps