published_or_final_version / Orthopaedic Surgery / Master / Master of Philosophy

Στην παρούσα διδακτορική διατριβή περιλαμβάνεται το αποτέλεσμα εκτεταμένης συγκριτικής μελέτης των μεθόδων που χρησιμοποιούνται στη διάγνωση της εισαγωγής και της εξέλιξης της οστεοπόρωσης. Η οστεοπόρωση, όπως και όλες οι μεταβολικές νόσοι των οστών, αποτελούν ένα σημαντικό πρόβλημα της παγκόσμιας υγείας. Πολλές τεχνικές έχουν προταθεί και εφαρμόζονται για τη διάγνωση της οστεοπόρωσης αλλά και για την παρακολούθηση της εξέλιξής της, με ταυτόχρονη αξιολόγηση της επίδρασης των θεραπευτικών αγωγών. Η μέθοδος της μέτρησης του Μορφικού Συντελεστή Απόσβεσης αποτελεί μια τεχνική γνωστή στην παγκόσμια βιβλιογραφία για την εκτίμηση της ποιότητας των κατασκευών με μη καταστροφικό τρόπο. Η διερεύνηση της δυνατότητας εφαρμογής της μεθόδου στην αξιολόγηση της δομικής ακεραιότητας των οστών με παράλληλη ανάπτυξη θεωρητικού μοντέλου το οποίο υποστηρίζει την ορθότητα των πειραματικών αποτελεσμάτων αποτέλεσε το βασικό στόχο της έρευνας. Ειδικότερα, περιλαμβάνεται αναλυτική έρευνα βιβλιογραφίας στην περιοχή του μη καταστροφικού ελέγχου συμβατικών κατασκευών και υλικών, και ανάπτυξη των κυριότερων τεχνικών που εφαρμόζονται στην καθημερινή κλινική πρακτική για τον διαγνωστικό έλεγχο της οστεοπόρωσης και γενικότερα των παθήσεων του μυοσκελετικού συστήματος [τεχνικές πυκνομετρίας (pQCT, DEXA, QUS, κ.λ.π) αλλά και τεχνικές που ανιχνεύουν μεταβολές των οστών σε επίπεδο αρχιτεκτονικής (ιστομορφομετρία) και σε μοριακό επίπεδο (βιοχημικοί δείκτες), καθώς και φασματοσκοπία Raman] με τα πλεονεκτήματα και μειονεκτήματα κάθε μεθόδου. Λόγω της πολυπλοκότητας του υλικού του οστού, παρατίθενται αναλυτικά οι μηχανικές του ιδιότητες. Στη συνέχεια αναπτύσσεται το θεωρητικό μοντέλο υπολογισμού του Μορφικού Συντελεστή Απόσβεσης και παρουσιάζεται το εκτεταμένο πειραματικό μοντέλο που εφαρμόστηκε σε επίμυες και γυναίκες. Από τη σύγκριση των πειραματικών αποτελεσμάτων της μεθόδου του Συντελεστή Απόσβεσης και των συμβατικών τεχνικών που χρησιμοποιούνται για τη διάγνωση της οστεοπόρωσης με τις αναλυτικές τιμές υπολογισμού του Συντελεστή Απόσβεσης αναδεικνύεται η υψηλή ευαισθησία της προτεινόμενης μεθόδου και τεκμηριώνεται η ωριμότητά της για αποτελεσματική, επαναλήψιμη, έγκυρη και αξιόπιστη αξιολόγηση της δομικής ακεραιότητας των οστών. / Extended comparative study of the methods used in the diagnosis of osteoporosis is included in this thesis. Osteoporosis, as well as all metabolic diseases of bones, consist an important health problem. Many techniques have been proposed and are applied for monitoring of osteoporosis with simultaneous assessment of the effect of therapeutical treatment. Measurement of Modal Damping Factor is a worldwide known technique for the non destructive assessment of structural integrity. The potential of application of this method on the assessment of structural integrity of bones, in combination with development of theoretical model supporting the experimental results has been the main target of this research. Specifically, in the frame of the research, a thorough state of the art has been elaborated in the domain of non destructive testing of conventional structures and materials, as well as on the main techniques applied on everyday clinical practice for diagnosis of osteoporosis and of metabolic diseases of bones [bone density techniques (pQCT, DEXA, QUS), techniques detecting architectural changes (histomorphometry), molecular changes (biochemical markers) and Raman Spectroscopy], accompanied by the advantages and disadvantages of each approach. Due to the complexity of bone structure, its mechanical properties are presented, accompanied by the theoretical model, from which the Modal Damping Factor is calculated, and the experimental model that was applied on osteoporotic rats and women. The comparison between experimental results of Modal Damping Factor and of data from conventional methods used for diagnosis of osteoporosis with the analytical values of Modal Damping Factor permits for elevating the high sensitivity of the proposed method and documenting its maturity for effective, repetitive, and accurate assessment of bone structural integrity.

The objective of the thesis: to evaluate patients’ who are ill with metastasic tumor of long bones (os longum) and have an X-ray – confirmed diagnose of pathological bone break comfort of living. Tasks for the research: 1. To examine patients’ who are ill with metastasic tumor of long bones and have an X-ray – confirmed diagnose of pathological bone break comfort of living, singularities of nursing and their change during the term of research. 2. To compare comfort of living and singularities of nursing of patients’ who are ill with metastasic tumor of long bones and have an X-ray – confirmed diagnose of pathological bone break with those of the control group. 3. To determine factors having impact on comfort of living and nursing of patients’ who are ill with metastasic tumor of long bones and have an X-ray – confirmed diagnose of pathological bone break. 4. To supply with the recommendations for development of nursing of the patients ill with metastasic tumor of long bones. Exploratory group – patients of Orthopedics and Trauma Clinics at the Kaunas University of Medicine Clinics ill with metastasic tumor of long bones and have an X-ray – confirmed diagnose of pathological bone break. Control group (control) - patients of Orthopedics and Trauma Clinics at the Kaunas University of Medicine Clinics suffering from analogous break of long bone but in absence of metastasic tumor of long bones. Results: After summing the collected data up and analyzing it a conclusion was drawn... [to full text]

The CYP27B1 enzyme that synthesizes 1alpha,25-(OH) 2D, is expressed in chondrocytes, suggesting that local production of 1alpha,25-(OH)2D could play an autocrine or paracrine role in the differentiation of these cells. To test this hypothesis, we have engineered mutant mice that do not express the Cyp27b1 gene in chondrocytes. This led to increased width of the hypertrophic zone of the growth plate at E15.5, increased bone mass in neonatal long bones, and increased expression of the chondrocytic differentiation markers Indian Hedgehog and PTH/PTHrP receptor. VEGF mRNA levels were decreased, accompanied by decreased PECAM-1 immunostaining, suggesting a delay in vascularization. We have also engineered mice overexpressing a Cyp27b1 transgene in chondrocytes. The transgenic mice showed a partial mirror image phenotype compared to the tissue-specific inactivation model. These results support an autocrine/paracrine role of 1alpha,25-(OH) 2D in endochondral ossification and chondrocyte development in vivo. / The CYP24A1 enzyme is involved in the catabolic breakdown of 1alpha,25-(OH)2D but also synthesizes the 24R,25-(OH) 2D metabolite. Studies in chicken suggest a role for 24R,25-(OH) 2D in fracture repair. We induced stabilized transverse mid-diaphysial fractures of the tibia in four-month-old wild-type and Cyp24a1-deficient mice. Examination of the callus sections showed delayed hard callus formation in the homozygous mutant animals compared to wild-type littermates. RT-qPCR showed perturbed levels of type X collagen transcripts in mutant mice at 14 and 21 days post-fracture, reflecting the delayed healing. Rescue of the impaired healing by subcutaneous injection of 24R,25-(OH)2D3 normalized the histological appearance of the callus, static histomorphometric index and type X collagen mRNA expression, while 1alpha,25-(OH)2D 3 did not. These results show that Cyp24a1 deficiency delays fracture repair and strongly suggest that vitamin D metabolites hydroxylated at position 24, such as 24R,25-(OH)2D, play an important role in the mechanisms leading to normal fracture healing.

With continually growing availability of high performance computing resources, the finite element methods (FEM) are becoming increasingly more efficient and practical research tools. In the domain of computational biomechanics, FEMs have been successfully applied in investigation of biomedical problems that include impact and fracture mechanics of bone, load transmission through the joints, feasibility of joint replacements, and many others. The present research study was concerned with the development of a detailed, anatomically accurate, finite element model of the human hand and wrist. As a first step in this direction, we used a publically available database of wrist bone anatomy and carpal kinematics to construct a multi-body statistical shape model (SSM) of the wrist. The resulting model provides an efficient parameterization of anatomical variations of the entire training set and can thus overcome the major shortcoming of conventional biomechanical models associated with limited generalization ability. The main contributions of this work are: 1) A robust method for constructing multi-body SSM of the wrist from surface meshes. 2) A novel technique for resampling closed genus-0 meshes to produce high quality triangulations suitable for finite element simulations. Additionally, all techniques developed in the course of this study could be directly applied to create an equivalent model of the tarsus.

The effects of feeding soy protein (SP) or SP plus isoflavones (IF) (150 and 400 mg IF/kg diet) on bone metabolism were assessed in female weanling and retired breeder (RB) rats fed low calcium (Ca) for five weeks. Young rats fed SP-based diets had significantly smaller reductions in bone mineral density (BMD) and bone mineral content (BMC) as a result of the low Ca diet compared to those fed casein-based diets. Added IFs had no further benefits. Soy protein also affected bone metabolism in both the young and RB rats as indicated by markers of bone resorption. Neither the SP nor the added IFs had any effects on BMD or BMC in the RB rats. Feeding SP to young rats resulted in beneficial changes in BMD, BMC, and biochemical markers of bone metabolism. This study indicates that SP positively affects bone metabolism and minimizes the negative effects associated with low Ca intakes in young rats.

No description available.

Intrauterine growth restriction (IUGR) reduces bone mass by 10-30% and impairs arachidonic (AA) and docosahexaenoic (DHA) acid status in infants. Because AA and DHA enhance neonatal bone mass, the aim of this study was to determine the effects of dietary 0.5% AA and 0.2% DHA (w/w) prior to weaning on bone and growth. 40 guinea pigs were randomized to either a control (C) or low-protein diet (LP) during pregnancy and the C diet or the C diet with AA+DHA during lactation. Measurements included bone mass, metabolism, and strength, and erythrocyte lipid of sows and offspring from birth to 16 wk post-partum. The LP diet induced IUGR, while the AA+DHA increased bone mass by 5-20% in sows and offspring and corrected growth and bone mass in IUGR pups. Thus, AA+DHA provided in lactation rescues the growth trajectory in an IUGR state and is beneficial to maternal and neonatal bone mass.

No description available.

Vitamin D is a precursor to a steroid hormone, 1,25 dihydroxyvitamin D (1,25(OH)2D). After its discovery and the characterization of its receptor, the vitamin D receptor (VDR), it was initially thought only to be involved in calcium homeostasis, but further research revealed an important role for vitamin D in the regulation of cell growth and differentiation of such cells as osteoblasts and bone marrow adipocytes. 1,25(OH)2D has also been shown to be a strong inhibitor and pro-differentiator of keratinocytes. The anti-proliferative and pro-differentiative properties of this hormone have led to studies where 1,25(OH)2D anticancer properties were assessed and initial findings that showed a requirement of other factors beyond VDR to induce 1,25(OH)2D signaling led to the identification of the retinoid X receptor, a common heterodimeric partner for several hormone receptors. The focus of thesis was to further elucidate the structure-function relationship of both the vitamin D receptor and the retinoid X receptor. Additionally, contributions to work directed towards further identifying the effects of vitamin D on osteoblast differentiation and survival. Interactions of 1,25(OH) 2D3 with its cognate receptor, identifying a key amino acid (Tryptophan 286) required for ligand contact and transcriptional activation, are described in Chapter 2. Mechanisms of vitamin D action on mesenchymal stem cell differentiation, promotion of osteoblast induction and maturation, and inhibition of adipocyte differentiation, are eluicidated in Chapter 3. Chapter 4 illustrates the effects of RAS/RAF/Mitogen-activated protein kinase mediated RXRalpha phosphorylation on the three-dimensional structure of the RXR/nuclear receptor partner heterodimers. Furthermore, this chapter reveals the inhibitory effect of the phosphorylation of a critical amino acid (serine 260) on the interaction of the AF-2 domain of the RXR with several coactivators, resulting in a decrease in the signaling potential of multiple steroid hormone receptors. The findings of this thesis further the knowledge of several areas of vitamin D biology, including both the canonical areas of bone formation, and the non-canonical area of vitamin D and cancer.