This study investigates the skeletal muscle repair and regeneration process following blunt trauma injury in murine models. Skeletal muscle injury is recorded most often in sports injuries and include strains and sprains, contusions, and bruising, however, there is growing consensus about the role skeletal muscle plays in the reparative process of bone fractures. Skeletal muscle stem cells or satellite cells are mesenchymal stem cell derived cells that exist between the basal lamina and cell membrane of muscle fibers usually in close proximity to capillary beds. After a traumatic injury, satellite cells respond to the influx of signaling from immune cells, oxygen tension, and myogenic proteins which influence differentiation into myoblasts for repair of tissue damage. Research continues to elucidate the relationship between bone and skeletal muscle following trauma injuries. Skeletal muscle stem cells play a vital role in fracture healing, and in certain conditions, are even induced into the osteogenic pathway. The goals of this study are to characterize the temporal progression of myogenesis during muscle repair that will be used with future studies of muscle and bone injury. And to identify potential crosstalk mechanisms between muscle and bone repair during trauma. In our experiment model trauma was introduced to mice with a modified muscle contusion device where a weight was dropped onto the femoral quadriceps muscles and the quadriceps and biceps muscle tissues were harvested at post-operative days (POD) 2, 4, 12, 16, and 24. Reverse-Transcriptase Quantitative Polymerase Chain Reaction was used to analyze gene expression profiles for satellite/stem cells (Pax7 and Prx1), muscle regeneration (MyoD, Myf5, Myl2, and Myh1), angiogenesis (VegfA, VegfR2), myokine (Myostatin and IL6), and BMP signaling (ID1). Our findings indicate that both Pax7 and Prx1 expression slightly decreased after injury but showed a significant (p<0.05) increase and peak of expression at POD 16 in the femoral quadriceps muscles. The early myogenic genes, MyoD and Myf5 peaked early at POD 4 while the adult myofiber markers, Myl2 and Myh2, peaked later at POD 16 in the femoral quadriceps muscles. Only slight changes were observed in the femoral biceps muscles. The angiogenic genes peaked at POD16 in the femoral quadriceps muscles and POD 12 in the femoral biceps muscles. The expression of Myostatin, an inhibitor of muscle mass, decreased early (POD 4 and 12) however showed a non-significant increase at POD 16 in the femoral quadriceps muscles. Lastly, the expression of ID1, which is downstream target of BMP signaling peaked early at POD 4 in the femoral quadriceps muscles. These data indicates that stem/satellite cells decrease in response to muscle injury but by POD 4, myogenic commitment and programming occurs. While early myogensis occurs, BMP signaling peaks and Myostatin expression decreases suggesting a coordinated event. Adult myofiber regeneration occurs in parallel to angiogenesis. The myogenic events were primarily isolated to the injured femoral quadriceps muscles. This model of muscle injury can be used to study muscle regeneration within context to bone injury.

Qi, Lin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

The aim of Graduation thesis is utilisation of classifying systems NANDA International, NIC and NOC by solving of nursing issue Acute pain at children after orthopaedical major surgeries. Part of successful and well adjusted treating of pain is its careful recording into medical documentation. For the goal of creating of the documentation there could be used international classification systems NANDA Intermational, NIC and NOC, with their aid it is possible to complete comprehensive aid, which describes each step of the treatment praxis. The first goal of the thesis was to map awareness of the nursing staff of systems mentioned. The second goal was creating of an aid using separate parts of system NANDA International, NIC and NOC aimed to diagnostics, solving and evaluation of the Problem of Acute pain at children after major surgeries. The last goal was verifying of beneficial effect of the new created documentation in praxis. The first research specimen was build by 58 nurses from four hospitals in Czech Republic working in children's departments. It was approached 8 hospitals altogether, nursing staff of four of them participated in the survey. The second research specimen was build by nurses from Children department in Hospital Pribram. The third part of research was built by 5 children admitted to hospital. The criterion for their attendance was their major surgery operation and their diagnosis Acute Pain. We used the half structured questionnaire for collecting of figures, models method and ideas of content analysis of documents and quasi experiment. Particular steps of research were realised as following: In the period of time February 2013 till March 2013, 60 questionnaires were distributed. Return was 100%. Cooperation with nurses from hospital Pribram lasted from 1. 3. 2013 until 29. 3. 2013. The medical documentation was created during this period of time, the method was tested and evaluated from nurses point of view. We found out, the nurses are familiar with system NANDA International but not aware of other two systems mentioned above. It was researched on statistical basis dependency between awareness of the specific classifications and the highest education grade and age of the nurses was considered, as well. During our stay in Hospital in Pribram, the practical aid was created aimed to evaluation and solving of the issue Acute Pain after orthopedical surgeries. This aid was tested in the same department then. A record was taken into amended forms by children after major surgeries. Concerning forms aimed for nursing praxis there were recorded not only intensity, characters and localisation of the pain, there were recorded which significant marks and connected factors from NANDA International Taxonomie II were possible to observe by particular children. There were recorder information which activities were used for children into forms containing interventions and activities drawn from from classification NIC. Last but not least, the pain was considered on the daily basis using classification NOC. As we found out from discussions with nurses cooperating during the research, more than a half of them perceive the use of the above mentioned aid very contributive. One idea appeared, the aid is needed in the Czech nursing practice. From this point of view, it would be beneficial to pay attention to this issue in the future.

Fourteen adult mongrel dogs were used to evaluate the honey preserved cortical allografts in the repair of diaphyseal femoral defect. The allografts were inserted into a 5cm segmental defect created in the mid-diaphysis of the right femur in each dog. The bones were stabilized with a 3.5mm dynamic compression plate and eight 3.5mm bone screws. Each dog was examined daily to evaluate complications and weight-bearing of the operated limb. Radiographs of the right femur were taken postsurgically and once every 15 days for the next three months. Following this, radiographs were taken once per month until the end of the research. Each two animals were euthanized after 30, 60, 90, 120, 180, 270, and 360 days. The right femur was harvested and prepared for histological evaluation. Nineteen (79.17%) of the twenty-four host-graft interfaces were radiographically healing (union). The mean time to allograft incorporation was 67.10 days (range, 45-90 days). There was no statistical difference in the allograft incorporation time between proximal and distal host-graft interfaces. It was observed Bacillus contamination in three honey samples, however, in allografts it was not verified. Good incorporation of donor graft by bone was observed histologically. Initially, there were osteoclastic activity increases in graft surfaces, and after bone formation. Complications observed were nonunion, allograft fracture, and allograft resorption. We conclude that despite the complications, honey preserved cortical allografts are a viable options to bone reconstruction. / O objetivo do presente estudo foi avaliar a utilização de implante ósseo cortical alógeno conservado em mel na reconstrução de falha óssea segmentar em fêmur de cães. Foi realizada uma falha óssea de 5cm na região diafisária do fêmur direito de 14 cães adultos, sendo utilizado um implante ósseo cortical alógeno conservado em mel para a sua reconstrução. O implante foi estabilizado no leito receptor por meio de uma placa de compressão dinâmica e oito parafusos corticais de 3,5mm. Os animais foram avaliados clinicamente, verificando-se o seu estado geral, o aspecto da ferida cirúrgica e o grau de deambulação. Radiografias do fêmur direito foram realizadas no pós-operatório imediato e quinzenalmente, até o 90 dia de pós-operatório. A partir desse período, as avaliações foram mensais até os 360 dias de pós-operatório. Dois animais foram submetidos à eutanásia aos 30, 60, 90, 120, 180, 270 e 360 dias de pós-operatório, sendo o fêmur direito retirado e encaminhado para exame histológico. A porcentagem de incorporação das interfaces foi de 79,17%, e o tempo médio necessário para a incorporação foi de 67,10 dias, variando entre 45 e 90 dias. Não foi verificada diferença significativa entre o tempo de incorporação das interfaces proximal e distal. Na análise bacteriológica, foi verificado Bacillus spp. em três amostras de mel, porém, não houve crescimento bacteriano nas amostras obtidas dos implantes ósseos. Histologicamente foi verificada adequada união entre as interfaces, com atividade osteoclástica na periferia do implante seguida por osteoblástica e formação de matriz óssea. As principais complicações verificadas foram não-união, fratura e reabsorção intensa do implante. Apesar das complicações, é possível concluir que o implante ósseo cortical alógeno conservado em mel é uma opção viável para a reconstrução óssea.

La radiologie est actuellement la modalité d'imagerie la plus utilisée en chirurgie orthopédique, que ce soit en planification opératoire, en contrôle per-opératoire ou pour le suivi du patient. Un de ses inconvénients est de ne pas permettre un référencement géométrique des objets représentés. Il est donc impossible tout au long du processus chirurgical orthopédique, de mesurer précisément les modifications de géométrie des structures osseuses. En salle d'opération les instruments chirurgicaux sont référencés spatialement et permettent par palpations de points de référence une identification géométrique des structures osseuses. Ceci est limité au contexte chirurgical car ces palpations requièrent des incisions. Dans cette thèse, nous proposons d'introduire en chirurgie orthopédique une nouvelle approche fondée sur l'utilisation d'un capteur d'images ultrasonores dont le positionnement spatial est connu. Nous présentons une méthode d'analyse d'images ultrasonores qui aboutit à la détection des points de référence dans un contexte non chirurgical. Cet apport est fondamental car il introduit une continuité dans le contrôle précis de la géométrie des structures osseuses tout au long du processus chirurgical orthopédique de la planification opératoire jusqu'au suivi du patient. Pour déterminer la position des points de référence sur les images ultrasonores osseuses nous sommes passés par une étape intermédiaire consistant en la détection de l'interface osseuse par des approches fondées sur des modèles de contours. Devant la difficulté du problème lié à la très faible qualité des images ultrasonores osseuses, nous nous sommes orientés vers une approche coopérative innovante. Dès que la sonde est positionnée sur le patient, le système affiche en temps réel le contour détecté et le clinicien peut, par un mouvement continu de la sonde, faire converger le système vers une solution optimale au regard de son expertise et des propriétés images. La validation de nos algorithmes s'est tout d'abord effectuée en mode non coopératif sur une base de données contenant 651 images ultrasonores. Le meilleur algorithme fondé sur la recherche d'un chemin optimal parmi un ensemble de points de contours candidats a été validé en mode coopératif sur un prototype appelé PhysioPilot dédié à la mesure de paramètres physiologiques dans un contexte non chirurgical / X-rays remain the preferred imaging modality for orthopedic surgery for surgical planning, intra-operative control or patient follow-up. Nevertheless, it does not allow anatomical bone structures referencing. It is then impossible to control geometrical modifications of bone structures during the surgical process. However, surgical tools are referenced in the operating-room space and allow the surgeon to define anatomical structures geometrically by defining landmark positions. This process is only allowed during surgical procedures because it requires to do cuts on the patient. In this work, we propose a new approach using an ultrasound probe that is referenced in the operating-room space. We present an image processing algorithm to extract anatomical landmark position in a surgical context. It is a crucial improvement because it allows a complete patient follow-up from pre-operative planning to post-operative consults. To determine anatomical landmark positions on ultrasound images we added an intermediate step to extract the bone/soft tissues interface via several segmentation methods as active contours. Due to the low quality of ultrasound images we decided to design a innovative cooperative process. As the surgeon positions the ultrasound probe on the patient, the bone interface appears on the system screen in real time. Then the clinician can help the segmentation result to converge to the final solution by a soft movement of the probe. The validation of our work was performed on a database of 651 ultrasound images, in a non-cooperative way. The best algorithm that extracts the bone interface by defining the optimal path in a graph of potential candidates was validated with a cooperative protocol on a prototype called PhysioPilot, in order to perform physiological measurements in a non-surgical context

Purpose The purpose of this study was to quantify the number of surgical programs currently training osteopathic residents and to solicit advice for current osteopathic medical students who are interested in pursuing a surgical residency. Methods A questionnaire was sent to all listed Electronic Residency Application Service® (ERAS®) email contacts for the following specialties: General Surgery, Neurological Surgery, Orthopedic Surgery, Otolaryngology, Urology, Integrated Vascular Surgery, Integrated Plastic Surgery, and Integrated Thoracic Surgery. The questionnaire was sent a total of three times. Results Two hundred sixty-four of the 1,040 surgical residency programs responded to the questionnaire. Of these responses, 19% were formerly American Osteopathic Association (AOA) accredited programs. About 47.3% of responding programs indicated they are not currently training an osteopathic physician. One hundred thirteen programs provided additional comments on how osteopathic medical students may improve the competitiveness of their residency applications. These comments included increasing volumes of research activities, performing well on the United States Medical Licensing Exam (USMLE), and completing a sub-internship in the desired field or at a specific institution. Conclusion Osteopathic students still face many barriers to matching into surgical residencies. This study provides concrete steps students may take to increase the competitiveness of their application.

BACKGROUND:Anticoagulation with vitamin K antagonists such as warfarin has historically been used for the long term management of patients with thromboembolic disease. However, these agents have a slow onset of action which requires bridging therapy with heparin and its analogues, which are available only in parenteral route. To overcome these limitations, new oral anticoagulants such as factor Xa inhibitors and direct thrombin inhibitors have been developed. The aim of this article is to systematically review the phase 3 clinical trials of new oral anticoagulants in common medical conditions.METHODS:We searched PubMed (Medline) from January 2007 to February 2013 using "Oral anticoagulants", "New oral anticoagulants", "Randomized controlled trial", "Novel anticoagulants", "Apixaban", "Rivaroxaban", "Edoxaban", "Dabigatran etexilate", "Dabigatran" and a combination of the above terms. The available evidence from the phase 3 RCTs was summarized on the basis of individual drug and the medical conditions categorized into "atrial fibrillation", "acute coronary syndrome", "orthopedic surgery", "venous thromboembolism" and "medically ill patients".RESULTS:Apixaban, rivaroxaban and dabigatran have been found to be either non-inferior or superior to enoxaparin in prophylaxis of venous thromboembolism in knee and hip replacement with similar bleeding risk, superior to warfarin for stroke prevention in atrial fibrillation with significant reduction in the risk of major bleeding, non-inferior to aspirin for reducing cardiovascular death and stroke in acute coronary syndrome with significant increase in the risk of major bleed. Rivaroxaban and dabigatran are also superior to the conventional agents in the management of symptomatic venous thromboembolism. However, compared to enoxaparin, apixaban and rivaroxaban use lead to significantly increased bleeding risk in medically ill patients. Additional studies evaluating the specific reversal agents of these new drugs for the management of life-threatening bleeding or other adverse effects are necessary.CONCLUSION:Considering their pharmacological properties, their efficacy and bleeding complications, the new oral agents offer a net favourable clinical profile in orthopedic surgery, atrial fibrillation, acute coronary syndrome and increase the risk of bleeding in critically ill patients. Further studies are necessary to determine the long term safety and to identify the specific reversal agents of these new drugs.

Title: Rehabilitation of Child with Cerebral Palsy in the Preoperative and Postoperative Period Author: Renata Šmídová Objective: During my practice I have met with a number of pediatric patients affected by cerebral palsy who underwent corrective orthopedic surgery, which in some cases were unfortunately unsuccessful. Based on the initial acquisition of information on this issue, I found a number of studies and articles on the success of orthopedic surgery in cerebral palsy. In many studies point out that the proper choice of physiotherapy has great benefit for orthopedic intervention, so I decide to map a connections orthopedic and physiotherapy approaches on the case and describe the elements of rehabilitation used in the treatment of selected patient. In the first part of the thesis I process in detail neurological disorder cerebral palsy (CP) and surgical treatment of deformities resulting from the operation of this disease. The second part includes a case study that describes the rehabilitation work of the physiotherapist with a child patient who undergoes corrective surgery on the lower limb. The third section contains qualitative research, conducted on the parents. Using the survey was to determine the effect of parents' opinion and the whole course of therapy. The aim: Demonstrate the...

O insucesso nos procedimentos cirúrgicos ortopédicos em razão de infecção pode levar a consequências desastrosas como a osteomielite e a perda de próteses implantadas. A infecção hospitalar é um desfecho de causa multifatorial, na qual a esterilização segura do instrumental cirúrgico ocupa uma posição de extrema importância. Não se sabe até o momento quais os reais desafios microbiológicos que a Central de Material e Esterilização (CME) vem enfrentando ao reprocessar a diversidade dos materiais utilizados nos procedimentos cirúrgicos. Micro-organismos com capacidade para esporular estão presentes em quantidade e frequência significativa? Sabe-se que estes se constituem como desafio mensurável na prática da esterilização, fazendo parte de indicadores biológicos. O objetivo desta pesquisa foi determinar e analisar a carga microbiana recuperada do instrumental cirúrgico, após uso em cirurgias ortopédicas, quantificando e identificando o gênero e a espécie do crescimento de bactérias e fungos. A investigação caracterizou-se como uma pesquisa exploratória, de campo e transversal com abordagem quantitativa. As amostras foram coletadas no Instituto de Ortopedia e Traumatologia (IOT) do Hospital das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), com técnica asséptica, depositando-as individualmente em um saco plástico previamente esterilizado, adicionando 500 mL de água de injeção. Para obtenção da carga microbiana, o instrumental foi sonicado em lavadora ultrassônica (US) por três sessões de 5 segundos cada e, consecutivamente, agitado por 5 minutos para complementar a extração da carga microbiana potencialmente presente na superfície dos materiais (externa e internamente). Em seguida, os lavados foram divididos em três partes iguais e submetidos à filtração em filtro Millipore® de 0,45 µm. Cada membrana foi cultivada em meio apropriado para o crescimento aeróbio, anaeróbio e fungos/leveduras. Para a identificação dos micro-organismos, foram utilizados kits e testes de identificação utilizados na rotina laboratorial de microbiologia clínica. Os resultados demonstraram que os três diferentes potenciais de contaminação apresentaram crescimento microbiano. Nas cirurgias limpas, 47% do instrumental estavam contaminados e o micro-organismo mais prevalente foi o Staphylococcus coagulase negativa (28%), seguido do Bacillus subtilis (11%). Nas cirurgias contaminadas e infectadas, houve um crescimento, de aproximadamente, 70% e 80%, respectivamente nos instrumentos, sendo maior o crescimento do Staphylococcus coagulase negativa (respectivamente, 32% e 29%) e Staphylococcus aureus (respectivamente, 28% e 43%). Considerando que os gêneros Bacillus e o Clostridium são capazes de esporularem, concluiu-se que a CME enfrenta um desafio ao precisar eliminar micro-organismos capazes de esporular, em uma densidade 102 UFC, menor que a dos indicadores biológicos e, aproximadamente, 78% dos micro-organismos recuperados foram bactérias vegetativas com sua curva de morte em torno de 80 ºC / The failure in orthopedic surgical procedures due to infection can lead to devastating consequences such as the loss of implanted prostheses. Hospital infection is an outcome with a multifactorial cause, in which the safe sterilization of the surgical instruments has an extremely important role. To date, it is not known what microbiological challenges the Material and Sterilization Center (MSC) has been facing when reprocessing the variety of materials used during these surgical procedures. Are microorganisms with the capacity to sporulate present in significant quantity and frequency? It is known that these microorganisms constitute a measurable challenge in sterilization practice and that they are part of the biological indicators. This study aimed at measuring the microbial load recovered from surgical instruments after their use in orthopedic surgeries, quantifying and identifying the genus and species of the bacterial and fungal growth. The study was characterized as an exploratory research, field research and cross-sectional with quantitative approach. The samples were collected at the Institute of Orthopedics and Traumatology (IOT) of Hospital das Clínicas (HC) of the School of Medicine of the University of São Paulo (FMUSP), using an aseptic technique, the samples were then placed in a plastic bag that had been previously sterilized with 500 mL of injection solution. To obtain the microbial load, the instruments were sonicated in an ultrasonic (US) washer for three 5-second sessions each and consecutively agitated for 5 minutes to complement the extraction of the microbial load potentially present on the surface of the materials (external and internally). Subsequently, the washed samples were fragmented in three equal parts and these were submitted to filtration in a 0.45 µm Millipore® filter. Each membrane was cultured in medium adequate for the growth of aerobic and anaerobic organisms, as well as fungi and yeasts. The identification of the microorganisms was carried out with identification kits and tests used in clinical microbiology laboratory routine. The results demonstrated that the three different contamination potentials presented microbial growth. In clean surgeries, 47% of the instruments were contaminated and the most prevalent microorganism was coagulase-negative Staphylococcus (28%) followed by Bacillus subtilis (11%). In contaminated and infected surgeries, a growth of approximately 70% and 80%, respectively, was identified in the instruments, with the higher growth being that of coagulase-negative Staphylococcus (respectively, 32% and 29%) and Staphylococcus aureus (respectively, 28% and 43%). Considering that the Bacillus and the Clostridium genera are capable of sporulating, we concluded that the MSC faces a challenge in having to eliminate microorganisms capable of sporulating, although in a lower density than that of biological indicators (102 UFC) and, approximately, 78% of the recovered microorganisms were vegetative bacteria that presented their curve of death at around 80ºC

In the present work, a study of the preparation of new formulations of acrylic bone cements (ABC) has been carried, to obtain materials with capacity for controlled drug delivery of medicaments useful in the therapeutic treatment of osteoporosis. The main research line has been focused on the partial modification of the solid phase of the conventional formulation of ABC, by substituting part of the PMMA beads with different microparticles of synthetic as well as natural biodegradable polymers. The incorporation of these polymers to the conventional formulation, with a structure based on PMMA, has been focused on two well defined points of view: as a structural component, and as a model component to study its delivery from the material to the external medium, to determine the capacity of the formulation for drug delivery. The work was finished with the evaluation of the capacity of controlled release of proteins and the determination of biocompatibility. / En este trabajo se ha llevado a cabo el estudio de nuevas formulaciones de cementos óseos acrílicos (COA) para su posterior evaluación como sistema de liberación controlada de medicamentos útiles en el tratamiento terapéutico de la osteoporosis. El trabajo se ha fundamentado en la modificación parcial de la fase sólida de los COA, mediante la substitución parcial de las microesferas de PMMA, por diferentes micropartículas de polímeros biodegradables, tanto de naturaleza sintética como natural. La incorporación de estos polímeros a la formulación del COA convencional, cuya estructura polimérica básica es el PMMA, ha sido enfocada desde dos puntos de vista bien diferenciados: como un componente estructural, que aporta resistencia mecánica al material, o como un componente que nos permita determinar la capacidad de liberación de un fármaco como el Ibandronato o de una proteína modelo como el colágeno hidrolizado. Finalmente se ha evaluado la biocompatibilidad de los COA modificados.