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  1 / 2421 MEDLINE  
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PMID:29377928
Author:Büren C; Lögters T; Oezel L; Rommelfanger G; Scholz AO; Windolf J; Windolf CD
Address:Department for Trauma- and Hand Surgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf Moorenstraße 5, Düsseldorf, Germany.
Title:Effect of hyperbaric oxygen therapy (HBO) on implant-associated osteitis in a femur fracture model in mice.
Source:PLoS One; 13(1):e0191594, 2018.
ISSN:1932-6203
Country of publication:United States
Language:eng
Abstract:Hyperbaric oxygen therapy (HBO) is applied very successfully in treatment of various diseases such as chronic wounds. It has been already suggested as adjunctive treatment option for osteitis by immune- and fracture modulating effects. This study evaluates the importance of HBO in an early implant-associated localized osteitis caused by Staphylococcus aureus (SA) compared to the standard therapy. In a standardized murine model the left femur of 120 BALB/c mice were osteotomized and fixed by a titanium locking plate. Osteitis has been induced with a defined amount of SA into the fracture gap. Debridément and lavages were progressed on day 7, 14, 28 and 56 to determine the local bacterial growth and the immune reaction. Hyperbaric oxygen (2 ATA, 90%) was applied for 90 minutes on day 7 to 21 for those mice allocated to HBO therapy. To evaluate the effect of HBO therapy the following groups were analyzed: Two sham-groups (12 mice / group) with and without HBO therapy, two osteotomy groups (24 mice / group) with plate osteosynthesis of the femur with and without HBO therapy, and two osteotomy SA infection groups (24 mice / group) with and without HBO therapy. Fracture healing was also quantified on day 7, 14, 28 and 56 by a.p. x-ray and bone healing markers from blood samples. Progression of infection was assessed by estimation of colony-forming units (CFU) and immune response was analyzed by determination of polymorphonuclear neutrophils (PMN), Interleukin (IL) - 6, and the circulating free DNA (cfDNA) in lavage samples. Osteitis induced significantly higher IL-6, cfDNA- and PMN-levels in the lavage samples (on day 7 and 14, each p < 0.05). HBO-therapy did not have a significant influence on the CFU and immune response compared to the standard therapy (each p > 0.05). At the same time HBO-therapy was associated with a delayed bone healing assessed by x-ray radiography and a higher rate of non-union until day 28. In conclusion, osteitis led to significantly higher bacterial count and infection parameters. HBO-therapy neither had a beneficial influence on local infection nor on immune response or fracture healing compared to the standard therapy in an osteitis mouse model.
Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T


  2 / 2421 MEDLINE  
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PMID:29342179
Author:Ohyama Y; Ito J; Kitano VJ; Shimada J; Hakeda Y
Address:Division of Oral Anatomy, Meikai University School of Dentistry, Sakado, Saitama, Japan.
Title:The polymethoxy flavonoid sudachitin suppresses inflammatory bone destruction by directly inhibiting osteoclastogenesis due to reduced ROS production and MAPK activation in osteoclast precursors.
Source:PLoS One; 13(1):e0191192, 2018.
ISSN:1932-6203
Country of publication:United States
Language:eng
Abstract:Inflammatory bone diseases, including rheumatoid arthritis, periodontitis and peri-implantitis, are associated not only with the production of inflammatory cytokines but also with local oxidative status, which is defined by intracellular reactive oxygen species (ROS). Osteoclast differentiation has been reported to be related to increased intracellular ROS levels in osteoclast lineage cells. Sudachitin, which is a polymethoxyflavone derived from Citrus sudachi, possesses antioxidant properties and regulates various functions in mammalian cells. However, the effects of sudachitin on inflammatory bone destruction and osteoclastogenesis remain unknown. In calvaria inflamed by a local lipopolysaccharide (LPS) injection, inflammation-induced bone destruction and the accompanying elevated expression of osteoclastogenesis-related genes were reduced by the co-administration of sudachitin and LPS. Moreover, sudachitin inhibited osteoclast formation in cultures of isolated osteoblasts and osteoclast precursors. However, sudachitin rather increased the expression of receptor activator of NF-κB ligand (RANKL), which is an important molecule triggering osteoclast differentiation, and the mRNA ratio of RANKL/osteoprotegerin that is a decoy receptor for RANKL, in the isolated osteoblasts, suggesting the presence of additional target cells. When osteoclast formation was induced from osteoclast precursors derived from bone marrow cells in the presence of soluble RANKL and macrophage colony-stimulating factor, sudachitin inhibited osteoclastogenesis without influencing cell viability. Consistently, the expression of osteoclast differentiation-related molecules including c-fos, NFATc1, cathepsin K and osteoclast fusion proteins such as DC-STAMP and Atp6v0d2 was reduced by sudachitin. In addition, sudachitin decreased activation of MAPKs such as Erk and JNK and the ROS production evoked by RANKL in osteoclast lineage cells. Our findings suggest that sudachitin is a useful agent for the treatment of anti-inflammatory bone destruction.
Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
Name of substance:0 (Bone Density Conservation Agents); 0 (Flavonoids); 0 (Glycosides); 0 (Lipopolysaccharides); 0 (Reactive Oxygen Species); 0 (sudachitin)


  3 / 2421 MEDLINE  
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PMID:28664712
Author:Zawadzki PJ; Perkowski K; Kotlarski M; Pietruczuk-Padzik A; Chomicz L
Address:Clinic of Cranio-Maxillo-Facial and Oral Surgery and Implantology, Medical University of Warsaw, Warsaw, Poland. pawel.j.zawadzki@gmail.com.
Title:Comparative study on usefulness of gentamycin-containing collagen implants in the treatment of patients with osteitis and osteomyelitis of the craniofacial skeleton.
Source:Ann Agric Environ Med; 24(2):299-302, 2017 May 11.
ISSN:1898-2263
Country of publication:Poland
Language:eng
Abstract:Introduction and objective. A reduction in incidences of peri-surgical complications due to infections is achieved by antibiotic prophylaxis The objective of the study was to assess the usefulness of gentamycin-containing collagen implants (GCCI) in the treatment of patients with osteitis and osteomyelitis of the craniofacial skeleton. Materials and method. The retrospective study included 103 patients with osteitis and osteomyelitis. 54 patients were treated intra-operatively with GCCI (Garamycin, EusaPharma, Europe). 49 patients were treated according to standard procedures. Light microscopy and in vitro culture techniques were applied for bacteria specific identification, and to investigate the resistance of detected microbiota to antibiotics. Patients received one dose of antibiotic pre-operatively. Post-operative antibiotic treatment was administered individually, according to clinical course and microbiological tests. The patients were followed-up on days 3, 7 and 14 after discharge for local complications; radiographic follow-up was performed 3, 6 and 12 months after surgery. Results. The course of post-operative antibiotic therapy was shorter in GCCI patients than in the control group (median 1 vs. 7 days); they also required shorter hospitalization (median 3 vs. 4 days). Implantation of GCCI significantly reduced the incidence of local complications (OR 0.30, 95%CI 0.11-0.83, p<0.0001), independently of the use of postoperative antibiotic therapy. On follow-up after 3-12 months, all patients presented with good soft tissue and bone healing. Conclusions. The results of this comparative study advocate the use of GCCI in osteomyelitis of various origin in oral and maxillofacial surgery, as they seemed to reduce the incidence of local complications, shorten antibiotic administration time and hospital stay.
Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE
Name of substance:0 (Anti-Bacterial Agents); 0 (Gentamicins); 9007-34-5 (Collagen)


  4 / 2421 MEDLINE  
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PMID:28611080
Author:Glinatsi D; Baker JF; Hetland ML; Hørslev-Petersen K; Ejbjerg BJ; Stengaard-Pedersen K; Junker P; Ellingsen T; Lindegaard HM; Hansen I; Lottenburger T; Møller JM; Ørnbjerg L; Vestergaard A; Jurik AG; Thomsen HS; Torfing T; Møller-Bisgaard S; Axelsen MB; Østergaard M
Address:Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Glostrup, Denmark.
Title:Magnetic resonance imaging assessed inflammation in the wrist is associated with patient-reported physical impairment, global assessment of disease activity and pain in early rheumatoid arthritis: longitudinal results from two randomised controlled trials.
Source:Ann Rheum Dis; 76(10):1707-1715, 2017 Oct.
ISSN:1468-2060
Country of publication:England
Language:eng
Abstract:OBJECTIVES: To examine whether MRI assessed inflammation and damage in the wrist of patients with early rheumatoid arthritis (RA) are associated with patient-reported outcomes (PROs). METHODS: Wrist and hand MRIs of 210 patients with early RA from two investigator-initiated, randomised controlled studies (CIMESTRA/OPERA) were assessed according to the Outcome Measures in Rheumatology RA MRI score (RAMRIS) for synovitis, tenosynovitis, osteitis, bone erosions and joint space narrowing (JSN) at baseline, 1 and 5 years follow-up. These features, and changes therein, were assessed for associations with health assessment questionnaires (HAQ), patient global visual analogue scales (VAS-PtGlobal) and VAS-pain using Spearman's correlations, generalised estimating equations and univariate/multivariable linear regression analyses. MRI features were further tested for trends against specific hand-related HAQ items using Jonckheere trend tests. RESULTS: MRI inflammation, but not damage, showed statistically significant associations with HAQ, VAS-PtGlobal and VAS-pain for status and change scores, independently of C reactive protein and swollen joint count. MRI-assessed synovitis was most consistently associated with PROs, particularly VAS-PtGlobal and VAS-pain. MRI-assessed synovitis and tenosynovitis mean scores were positively associated with patient-reported difficulty to cut meat and open a milk carton (p<0.01), and similar patterns were seen for other hand-related HAQ items. Incorporating metacarpophalangeal joints in the analyses did not strengthen the associations between MRI pathology and PROs. CONCLUSIONS: MRI-assessed inflammation, but not damage, in early RA wrists is associated with patient-reported physical impairment, global assessment of disease activity and pain and influences the physical function in the hand. TRIAL REGISTRATION NUMBER: NCT00660647.
Publication type:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
Name of substance:9007-41-4 (C-Reactive Protein)


  5 / 2421 MEDLINE  
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PMID:28606966
Author:George MD; Østergaard M; Conaghan PG; Emery P; Baker DG; Baker JF
Address:School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Title:Obesity and rates of clinical remission and low MRI inflammation in rheumatoid arthritis.
Source:Ann Rheum Dis; 76(10):1743-1746, 2017 Oct.
ISSN:1468-2060
Country of publication:England
Language:eng
Abstract:OBJECTIVES: Obesity has been proposed as a risk factor for refractory rheumatoid arthritis (RA). We evaluated the impact of obesity on achieving clinical and imaging definitions of low disease activity. METHODS: This study evaluated 470 patients with RA from GO-BEFORE and GO-FORWARD randomised clinical trials. Included patients had blinded clinical disease activity measures and MRI at baseline, 24 and 52 weeks. Synovitis, osteitis and total inflammation scores were determined using the RA MRI scoring system. Multivariable logistic regression analyses compared odds of achieving Disease Activity Score using 28 joints and C-reactive protein (DAS28-CRP) remission, low component measures, or low MRI inflammation measures at 24 weeks in patients with obesity versus no obesity. RESULTS: At 24 weeks, patients with obesity were significantly less likely to achieve DAS28(CRP) remission (OR 0.47; 95% CI 0.24 to 0.92, p=0.03). In contrast, patients with obesity had similar odds of achieving low synovitis (OR 0.94; 95% CI 0.51 to 1.72, p=0.84) and inflammation scores (OR 1.16; 95% CI 0.61 to 2.22, p=0.64) and greater odds of achieving low osteitis scores (OR 2.06; 95% CI 1.10 to 3.84, p=0.02) versus normal weight patients. CONCLUSIONS: Patients with RA and obesity have lower rates of DAS28 remission but similar rates of low MRI activity compared with patients without obesity, suggesting that obesity and its associated comorbidities can bias clinical disease activity measures. TRIAL REGISTRATION NUMBER: NCT00361335 and NCT00264550; Post-results.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Antibodies, Monoclonal); 0 (Antirheumatic Agents); 9007-41-4 (C-Reactive Protein); 91X1KLU43E (golimumab)


  6 / 2421 MEDLINE  
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PMID:28434961
Author:Mustroph CM; Malcolm JG; Rindler RS; Chu JK; Grossberg JA; Pradilla G; Ahmad FU
Address:Department of Neurological Surgery, Emory University, Atlanta, Georgia, USA.
Title:Cranioplasty Infection and Resorption Are Associated with the Presence of a Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis.
Source:World Neurosurg; 103:686-693, 2017 Jul.
ISSN:1878-8769
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Following decompressive craniectomy, hydrocephalus is a common complication often necessitating placement of a ventriculoperitoneal shunt (VPS). Complications in the presence of a VPS have been reported, but a clear association has not been established. METHODS: PRISMA guidelines were used to perform a literature search using PubMed to identify articles that published the complication rates associated with staged or simultaneous cranioplasty and VPS placement. From these event rates, odds ratios (ORs) with 95% confidence intervals (CIs) of complications were calculated. Data were pooled using the Mantel-Haenszel method. The Oxford Center for Evidence-Based Medicine guidelines were used to assess the quality of individual articles and studies. The Newcastle-Ottawa Scale was used to assess the risk of bias in studies. RESULTS: Of the 30 papers reviewed for complications in the presence and absence of a VPS, 7 studies, with a total of 1635 patients, were eligible for meta-analysis. Overall rates of complications (n = 1635; OR, 9.75; 95% CI, 4.8-20.1), infection (OR, 4.9; 95% CI, 2.2-10.7), and bone resorption (OR, 10.6; 95% CI, 4.9-23.0) were increased when a VPS was placed at the time of cranioplasty. Simultaneous procedures were associated with increased complication rates (n = 283; OR, 4.3; 95% CI, 2.3-8.2) compared with staged procedures. CONCLUSIONS: Cranioplasty in the presence of a VPS is associated with a higher rate of overall complications, including infection and bone resorption. Performing cranioplasty and VPS placement in the same operation is associated with an increased rate of complications compared with staged procedures. Surgeons should consider staging these procedures when possible and counsel patients about these risks.
Publication type:JOURNAL ARTICLE; META-ANALYSIS; REVIEW


  7 / 2421 MEDLINE  
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PMID:28403046
Author:Grote V; Silier CC; Voit AM; Jansson AF
Address:From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
Title:Bacterial Osteomyelitis or Nonbacterial Osteitis in Children: A Study Involving the German Surveillance Unit for Rare Diseases in Childhood.
Source:Pediatr Infect Dis J; 36(5):451-456, 2017 May.
ISSN:1532-0987
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Although bacterial osteomyelitis (BO) is a commonly recognized diagnosis in pediatrics, it is often difficult to distinguish from nonbacterial osteitis (NBO). The goal of our study was to distinguish between the 2 disease entities and better define NBO. METHODS: Using the German Surveillance Unit for Rare Diseases in Childhood (Erhebungseinheit für Seltene Paediatrische Erkrankungen in Deutschland), this prospective study during a 5-year period captured 657 patients at first diagnosis of either BO (n = 378) or NBO (n = 279) while analyzing epidemiologic, clinical and radiologic data. RESULTS: BO was reported in 1.2 per 100,000 children with a higher prevalence in younger male patients (58%), and NBO was reported in 0.45 per 100,000 children. BO patients tended to present with fevers (68%), elevated inflammation markers (82%) and local swelling (62%) but a shorter course of symptoms than NBO patients. NBO patients presented in good general health (86%) and were more likely to have multifocal lesions (66%). Staphylococcus aureus was the most prominent pathogen (83%), with only one methicillin-resistant S. aureus reported. Complications ranged from arthritis adjacent to the lesion to hyperostosis and vertebral fractures. CONCLUSIONS: BO and NBO can be distinguished based on symptoms, associated diseases and inflammation markers. NBO should always be considered in pediatric patients presenting with bone lesions and pain, especially in young female patients presenting with good general health, minimal inflammation markers and multifocal lesions in the vertebrae, clavicle and sternum.
Publication type:JOURNAL ARTICLE; MULTICENTER STUDY


  8 / 2421 MEDLINE  
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PMID:28363833
Author:Dinevski N; Sarnthein J; Vasella F; Fierstra J; Pangalu A; Holzmann D; Regli L; Bozinov O
Address:Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Title:Postoperative Neurosurgical Infection Rates After Shared-Resource Intraoperative Magnetic Resonance Imaging: A Single-Center Experience with 195 Cases.
Source:World Neurosurg; 103:275-282, 2017 Jul.
ISSN:1878-8769
Country of publication:United States
Language:eng
Abstract:OBJECTIVES: To determine the rate of surgical-site infections (SSI) in neurosurgical procedures involving a shared-resource intraoperative magnetic resonance imaging (ioMRI) scanner at a single institution derived from a prospective clinical quality management database. METHODS: All consecutive neurosurgical procedures that were performed with a high-field, 2-room ioMRI between April 2013 and June 2016 were included (N = 195; 109 craniotomies and 86 endoscopic transsphenoidal procedures). The incidence of SSIs within 3 months after surgery was assessed for both operative groups (craniotomies vs. transsphenoidal approach). RESULTS: Of the 109 craniotomies, 6 patients developed an SSI (5.5%, 95% confidence interval [CI] 1.2-9.8%), including 1 superficial SSI, 2 cases of bone flap osteitis, 1 intracranial abscess, and 2 cases of meningitis/ventriculitis. Wound revision surgery due to infection was necessary in 4 patients (4%). Of the 86 transsphenoidal skull base surgeries, 6 patients (7.0%, 95% CI 1.5-12.4%) developed an infection, including 2 non-central nervous system intranasal SSIs (3%) and 4 cases of meningitis (5%). Logistic regression analysis revealed that the likelihood of infection significantly decreased with the number of operations in the new operational setting (odds ratio 0.982, 95% CI 0.969-0.995, P = 0.008). CONCLUSIONS: The use of a shared-resource ioMRI in neurosurgery did not demonstrate increased rates of infection compared with the current available literature. The likelihood of infection decreased with the accumulating number of operations, underlining the importance of surgical staff training after the introduction of a shared-resource ioMRI.
Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE


  9 / 2421 MEDLINE  
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PMID:28134079
Author:Baker JF; Østergaard M; Emery P; Baker DG; Conaghan PG
Address:Philadelphia Veterans Affairs Medical Center; University of Pennsylvania, School of Medicine; and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA. bakerjo@uphs.upenn.edu.
Title:Development and validation of rheumatoid arthritis magnetic resonance imaging inflammation thresholds associated with lack of damage progression.
Source:Clin Exp Rheumatol; 35(4):607-613, 2017 Jul-Aug.
ISSN:0392-856X
Country of publication:Italy
Language:eng
Abstract:OBJECTIVES: To determine thresholds for rheumatoid arthritis (RA) magnetic resonance imaging scores (RAMRIS) associated with a low risk of structural damage progression. METHODS: MRI of the dominant hand was performed and RAMRIS scores determined at weeks 0, 24, and 52. X-rays were performed and van der Heijde-Sharp scores (vdHS) determined. In a development cohort (n=297) the changes in MRI erosion score and vdHS score were determined over the 24-week to 52-week interval and progression was defined as change >0.5. We identified 24-week thresholds for synovitis and osteitis that provided >90% sensitivity for imaging progression over the 24 to 52-week interval. The performance of these cut-offs was tested in a validation cohort (n=217). RESULTS: In the development cohort, synovitis or osteitis scores ≤3 by 24 weeks were associated with a low probability of progression on MRI and x-ray. The coefficient for osteitis was stronger than that of synovitis in models predicting x-ray and MRI progression. Therefore, a total inflammation score was weighted on osteitis (x2). An inflammation score ≤9 was more frequently attained than DAS28 remission (64 vs. 38) and was associated with low probability of progression regardless of attainment of clinical remission. In the validation cohort, there was a low odds of MRI progression among those with low synovitis [OR 0.27 (0.086,0.82) p=0.02], osteitis [OR 0.20 (0.085, 0.49) p<0.001] and inflammation scores [OR 0.12 (0.033, 0.41) p=0.001]. CONCLUSIONS: Attainment of low MRI single-hand synovitis and osteitis is not uncommon and predicts a lack of structural progression in RA, independent of clinical remission.
Publication type:JOURNAL ARTICLE; VALIDATION STUDIES


  10 / 2421 MEDLINE  
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PMID:28105482
Author:Militz M; Popp W; Hoffmann R; Ascherl R; Tiemann A
Address:Abteilung für Septische und Rekonstruktive Chirurgie, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland. Matthias.Militz@bgu-murnau.de.
Title:Septische Chirurgie in OuU ­ ein Schlaglicht : Aktuelle Umfrage der DGOU-Sektion Knochen- und Weichteilinfektionen. [Surgery of sepsis in orthopedics and trauma - A highlight : Current survey by the section for bone and soft tissue infections of the German Society for Orthopedics and Trauma].
Source:Unfallchirurg; 120(3):262-268, 2017 Mar.
ISSN:1433-044X
Country of publication:Germany
Language:ger
Abstract:Surgery of sepsis in trauma surgery and orthopedics is attracting increasingly more attention due to the rising presence of multidrug-resistant pathogens and the increasing number of operative interventions. Despite extensive experience over decades neither the symptoms nor the treatment strategies have been evaluated and it has become obvious that a scientific investigation of this complex topic is necessary for optimization of patient care under economically sound conditions. The aim of this article is to give a snapshot from German healthcare institutions for trauma surgery and orthopedics to answer some questions on this topic from the section for bone and soft tissue infections (SeKuWi) of the German Society for Orthopedics and Trauma (DGOU) in cooperation with the German Society for Hospital Hygiene (DGKH).
Publication type:JOURNAL ARTICLE



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