Pathogenesis of Age-Related Osteoporosis: Impaired Mechano-Responsiveness of Bone Is Not the Culprit

BACKGROUND: According to prevailing understanding, skeletal mechano-responsiveness declines with age and this apparent failure of the mechano-sensory feedback system has been attributed to the gradual bone loss with aging (age-related osteoporosis). The objective of this study was to evaluate whether the capacity of senescent skeleton to respond to increased loading is indeed reduced as compared to young mature skeleton. METHODS AND FINDINGS: 108 male and 101 female rats were randomly assigned into Exercise and Control groups. Exercise groups were subjected to treadmill training either at peak bone mass between 47-61 weeks of age (Mature) or at senescence between 75-102 weeks of age (Senescent). After the training intervention, femoral necks and diaphysis were evaluated with peripheral quantitative computed tomography (pQCT) and mechanical testing; the proximal tibia was assessed with microcomputed tomography (microCT). The microCT analysis revealed that the senescent bone tissue was structurally deteriorated compared to the mature bone tissue, confirming the existence of age-related osteoporosis. As regards the mechano-responsiveness, the used loading resulted in only marginal increases in the bones of the mature animals, while significant exercise-induced increases were observed virtually in all bone traits among the senescent rats. CONCLUSION: The bones of senescent rats displayed a clear ability to respond to an exercise regimen that failed to initiate an adaptive response in mature animals. Thus, our observations suggest that the pathogenesis of age-related osteoporosis is not attributable to impaired mechano-responsiveness of aging skeleton. It also seems that strengthening of even senescent bones is possible--naturally provided that safe and efficient training methods can be developed for the oldest old

Responsiveness of different pain measures and recall periods in people undergoing surgery after a period of splinting for basal thumb joint osteoarthritis

Background Basal thumb joint osteoarthritis (OA) is a common painful condition of the hand often treated surgically if non-operative care does not provide sufficient pain relief. Many instruments are available to measure pain for this condition including single item and multidimensional measures. To inform our choice of instrument for the purpose of evaluating the value of surgery for people with thumb OA, the aim of this study was to compare the longitudinal validity and signal to noise ratio of a single item numeric rating scale (NRS) for pain and the Patient-rated Wrist and Hand Evaluation (PRWHE) pain subscale, and to assess if recall period affects longitudinal validity of the NRS pain and reported pain levels. Methods We invited 52 patients referred for surgical treatment of basal thumb joint OA to participate in this study. All wore a splint for six weeks followed by surgery. Pain during the past day, week, and month and the PRWHE were collected at baseline, operation day, and 3, 6, 9 and 12 months after surgery. Responsiveness was assessed with two methods: 1) using participant-reported global improvement and PRWHE function subscale as external anchors (longitudinal validity) and 2) comparing Standardized Response Means (SRM). Results The Spearman's rho between PRWHE pain and participant-reported global improvement was better (0.71) compared with NRS past day (0.55), past week (0.62), or past month (0.59). Similar findings were found with PRWHE function as anchor (Pearson's r for PRWHE pain 0.78; NRS past day 0.68; past week 0.73; past month 0.69). The SRM of PRWHE pain subscale (2.8) and NRS past week (2.9) outperformed pain past day (2.3) and month (2.4). Mean pain was 0.3 points (on a 0 to 10 scale) worse during past week when compared with past day and 0.3 worse during past month than during past week. Conclusions All studied pain measures captured the change in pain over time. For clinical trials, we recommend PRWHE pain subscale or NRS past week due to their better signal noise ratio.Peer reviewe

Olkahermopunoksen syntymävaurio

Olkahermopunoksen syntymävaurio johtuu synnytyksessä hermojuuriin kohdistuvasta liian kovasta venytyksestä. Suurin osa vaurioista paranee muutamassa kuukaudessa itsestään, mutta pahimmillaan yläraaja voi jäädä täysin toimimattomaksi. Lähete yliopistosairaalaan tehdään, mikäli vastasyntyneen yläraaja on täysin veltto tai lapsen yläraajan toiminta ei ole toipunut täysin normaaliksi kuukaudessa. Päivittäinen liikeharjoittelu aloitetaan kaikissa tapauksissa jo synnytyslaitoksella. Noin puolet pysyvän vaurion saaneista lapsista hyötyy botuliinitoksiiniruiskeista tai leikkaushoidosta.publishedVersio

Satisfactory thumb metacarpophalangeal joint stability after ligament reconstruction with flexor digitorum superficialis in children with radial longitudinal deficiency

We investigated thumb joint stability and patient-reported and functional outcomes a minimum of 1 year after flexor digitorum superficialis opponensplasty and ligament reconstruction in 23 thumbs of 20 consecutive children with radial longitudinal deficiency. In total, 15 thumbs had preoperative multidirectional instability in the metacarpophalangeal joint. We reconstructed 22 ulnar and 16 radial collateral ligaments. At follow-up, all the metacarpophalangeal joints were stable ulnarly. Seven metacarpophalangeal joints were unstable radially despite ligament reconstruction but had no related complaints. We recommend the flexor digitorum superficialis opponensplasty as a safe and reliable procedure in hypoplastic thumbs to create stability and augment thumb strength.Peer reviewe

Hoitosuositukset, systemaattiset vinoumat ja luottamus lääkäreihin

Luotettavasti laaditut hoitosuositukset ovat työväline, jolla tarjotun hoidon laatua voidaan tutkitusti parantaa. Hoitosuositusten laatiminen on kuitenkin moniulotteinen prosessi, johon ei ole yhtä yksiselitteisesti oikeaa menetelmää ja joka sisältää näytön tulkinnan lisäksi myös monenlaisia arvovalintoja. Siksi hoitosuositusten laatimisprosessi on altis myös päätöksenteon systemaattisille vinoumille. Koska ne eivät johdu yksilöiden tietoisista valinnoista, niiden tehokkaat ehkäisykeinot ovat rakenteellisia. Käsittelemme tässä katsausartikkelissa mekanismeja, joilla päätöksenteko saattaa vinoutua, ja esitämme rakenteellisia ratkaisuja niiden ehkäisemiseksi. Kaksi erityisen merkittävää tekijää, jotka altistavat hoitosuositukset systemaattisille vinoumille, ovat taloudelliset sidonnaisuudet ja ammattikuntaedut. Vinoumien ehkäisykeinoiksi esitämme puolueettomien asiantuntijoiden käyttöä, metodologisen osaamisen vahvistamista ja moniammatillisia työryhmiä.publishedVersionPeer reviewe

Randomised controlled trials in hand surgery : a scoping review

OBJECTIVES: To identify the evidence gaps that exist regarding the efficacy or effectiveness of hand surgery. SETTING: A scoping review. We systematically searched MEDLINE, Embase and CENTRAL databases to identify all hand surgical randomised controlled trials from inception to 7 November 2020. RESULTS: Of the 220 identified randomised controlled trials, none were fundamental efficacy trials, that is, compared surgery with placebo surgery. 172 (78%) trials compared the outcomes of different surgical techniques, and 143 (65%) trials were trauma related. We identified only 47 (21%) trials comparing surgery with non-operative care or injection. CONCLUSION: The evidence supporting use of surgery especially for chronic hand conditions is scarce. To determine optimal care for people with hand conditions, more resources should be aimed at placebo-controlled trials and pragmatic effectiveness trials comparing hand surgery with non-operative care. PROSPERO REGISTRATION NUMBER: CRD42019122710.publishedVersionPeer reviewe

Indications, anaesthesia and postoperative protocol for replantation and revascularization in the hand in Nordic countries

In this survey, we compared the current postoperative practices in the largest replantation units of four Nordic countries. The topics included were indication for surgery, anaesthesia, postoperative monitoring, use of antibiotics, anticoagulation and postoperative intravenous fluids, change of dressings, duration of bed rest and hospital stay, hand therapy and follow-up after discharge. Although there were many similarities between the units in the postoperative protocols, we found a large variety of practices. There is no robust evidence to assess or support or reject most of the strategies in postoperative care. The differences in practice warrant prospective studies in order to establish an evidence-based postoperative protocol for replantation surgery.publishedVersionPeer reviewe

Effects of oxonic acid-induced hyperuricemia on mesenteric artery tone and cardiac load in experimental renal insufficiency

Peer reviewe

Minimal important difference and patient acceptable symptom state for pain, Constant-Murley score and Simple Shoulder Test in patients with subacromial pain syndrome

Abstract Background The results of clinical trials should be assessed for both statistical significance and importance of observed effects to patients. Minimal important difference (MID) is a threshold denoting a difference that is important to patients. Patient acceptable symptom state (PASS) is a threshold above which patients feel well. Objective To determine MID and PASS for common outcome instruments in patients with subacromial pain syndrome (SAPS). Methods We used data from the FIMPACT trial, a randomised controlled trial of treatment for SAPS that included 193 patients. The outcomes were shoulder pain at rest and on arm activity, both measured with the 0–100 mm visual analogue scale (VAS), the Constant-Murley score (CS), and the Simple Shoulder Test (SST). The transition question was a five-point global rating of change. We used three anchor-based methods to determine the MID for improvement: the receiver operating characteristic (ROC) curve, the mean difference of change and the mean change methods. For the PASS, we used the ROC and 75th percentile methods and calculated estimates using two different anchor question thresholds. Results Different MID methods yielded different estimates. The ROC method yielded the smallest estimates for MID: 20 mm for shoulder pain on arm activity, 10 points for CS and 1.5 points for SST, with good to excellent discrimination (areas under curve (AUCs) from 0.86 to 0.94). We could not establish a reliable MID for pain at rest. The PASS estimates were consistent between methods. The ROC method PASS thresholds using a conservative anchor question threshold were 2 mm for pain at rest, 9 mm for pain on activity, 80 points for CS and 11 points for SST, with AUCs from 0.74 to 0.83. Conclusion We recommend the smallest estimate from different methods as the MID, because it is very unlikely that changes smaller than the smallest MID estimate are important to patients: 20 mm for pain VAS on arm activity, 10 points for CS and 1.5 points for SST. We recommend PASS estimates of 9 mm for pain on arm activity, 80 points for CS, and 11 points for SST. Trial registration ClinicalTrials.gov NCT00428870 (first registered January 29, 2007)