Muscle Fiber Viability, a Novel Method for the Fast Detection of Ischemic Muscle Injury in Rats

Acute lower extremity ischemia is a limb- and life-threatening clinical problem. Rapid detection of the degree of injury is crucial, however at present there are no exact diagnostic tests available to achieve this purpose. Our goal was to examine a novel technique - which has the potential to accurately assess the degree of ischemic muscle injury within a short period of time - in a clinically relevant rodent model. Male Wistar rats were exposed to 4, 6, 8 and 9 hours of bilateral lower limb ischemia induced by the occlusion of the infrarenal aorta. Additional animals underwent 8 and 9 hours of ischemia followed by 2 hours of reperfusion to examine the effects of revascularization. Muscle samples were collected from the left anterior tibial muscle for viability assessment. The degree of muscle damage (muscle fiber viability) was assessed by morphometric evaluation of NADH-tetrazolium reductase reaction on frozen sections. Right hind limbs were perfusion-fixed with paraformaldehyde and glutaraldehyde for light and electron microscopic examinations. Muscle fiber viability decreased progressively over the time of ischemia, with significant differences found between the consecutive times. High correlation was detected between the length of ischemia and the values of muscle fiber viability. After reperfusion, viability showed significant reduction in the 8-hour-ischemia and 2-hour-reperfusion group compared to the 8-hour-ischemia-only group, and decreased further after 9 hours of ischemia and 2 hours of reperfusion. Light- and electron microscopic findings correlated strongly with the values of muscle fiber viability: lesser viability values represented higher degree of ultrastructural injury while similar viability results corresponded to similar morphological injury. Muscle fiber viability was capable of accurately determining the degree of muscle injury in our rat model. Our method might therefore be useful in clinical settings in the diagnostics of acute ischemic muscle injury

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Can GnRH-agonist treatment cause slipped capital femoral epiphysis?

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Prospective Clinical and Radiologic Evaluation of Patellofemoral Matrix-Induced Autologous Chondrocyte Implantation

Background: While matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in the treatment of knee chondral defects, there remains little available research specifically investigating its use in the patellofemoral joint. Purpose: To prospectively evaluate the clinical and radiologic outcome of MACI in the patellofemoral joint. Study Design: Case series; Level of evidence, 4. Methods: In 47 consecutive patients undergoing patellofemoral MACI, clinical (Knee injury and Osteoarthritis Outcome Score, 36-Item Short Form Health Survey, visual analog scale for pain, 6-minute walk test, knee range of motion, and strength assessment) and magnetic resonance imaging (MRI) assessments were undertaken before and 3, 12, and 24 months after surgery. The MRI was performed to assess graft infill and determine an overall MRI composite score. Results were analyzed according to (1) the patient sample overall and (2) after stratification into 4 subgroups per implant location (patella or trochlea) as well as whether or not adjunct tibial tubercle transfer for patellofemoral malalignment was required. Results: The overall patient sample, as well as each of the 4 procedural subgroups, demonstrated clinically and statistically significant (P < .05) improvements over time for all clinical scores. Graft infill and the MRI composite score also demonstrated statistically significant (P < .05) improvements over time, with no evidence of a main effect for procedure group or interaction between procedure group and time. At 24 months after surgery, 40.4% (n = 19) of patients exhibited complete graft infill comparable with the adjacent native cartilage, with a further 6.4% (n = 3) demonstrating a hypertrophic graft. A further 31.9% (n = 15) of patients exhibited 50% to 100% tissue infill, and 17% (n = 8) demonstrated <50% tissue infill. Two patients (4.3%) demonstrated graft failure. At 24 months after surgery, 85% (n = 40) of patients were satisfied with the results of their MACI surgery. Conclusion: These results demonstrate that MACI provides improved clinical and radiologic outcomes to 24 months in patients undergoing treatment specifically for articular cartilage defects on the patella or trochlea, with and without concurrent realignment of the extensor mechanism if required

The long-term results of meniscus transplantation for articular cartilage defects in the knee joint

Purpose: The purpose of this study was to examine the long-term clinical results of meniscus transplantation for articular cartilage defects in the knee joint. Type of study: Case series. Method: From October 1990 to June 1995, 8 cases underwent allogenic or autogenic meniscus transplantations for articular cartilage defects, and 7 cases were available for follow-up evaluations. The age at surgery ranged from 14 to 42 years old (average 22.5). In one case, a transplantation of tissue-engineered cartilage was performed due to pain 5 years after surgery. The other 6 cases were followed up for 8 to 13 years (average 10.1). The size of the cartilage defect ranged from 1.0 cm2 to 6.3 cm2 (average 2.8cm2). Patients were evaluated with the Lysholm score and MR images. We also performed arthroscopic examinations in 3 cases at the final evaluation. Results: The Lysholm scores ranged from 76 points to 100 points. In MR images, the congruities between the grafted lesions and normal cartilage were evaluated as smooth surfaces in 4, slightly irregular surface in 1, irregular surface in 1, and one had disappeared. In arthroscopic findings at 11 years after surgery, the grafted meniscus could not be found in one knee that had severe osteoarthritis changes, and in the other knee the lesion of the transplanted meniscus resembled a flap tear. In another case, the grafted meniscus and the surrounding cartilage displayed irregular surfaces during transplantation of tissue-engineered cartilage. In histological findings, at 11 years after surgery a small lesion in the grafted area was not hyaline cartilage but fibrocartilage. Conclusions: This study leads us to the conclusion that meniscus transplantation for articular cartilage damage is not compared to ACI although two cases showed good clinical results for a short term but the tissue was remained fibrocartilage tissues for long term.. Level of Evidence: Level 4, case series