Skeletal development of Kinosternon scorpioides limbs (Chelonia: Kinosternidae)

The morphological study of limbs is important for the understanding of tetrapod biology, where it can be applied to taxonomy and phylogeny, as well ecology and behavior. In this study area, osteogenesis is a subject in Kinosternidae, which has been little researched. The main aim of this study was to characterize the skeletogenesis of Kinosternon scorpioides limbs. Samples were histologically processed, and the embryos were cleared with potassium hydroxide and stained with alcian blue and alizarin red. It was observed that the limbs arose in embryonic Stage 10 as mesenchymal condensate cells. The first stylopodium chondrification centers were noted at Stage 14. Zeugopodium chondrification centers appeared at Stage 15; carpal, metacarpal, tarsal, and metatarsal regions were observed at Stage 16, and the cartilage molds of all bones limbs were present at Stage 18. Ossification began in the humerus and femur at Stage 20, and continued into the radius, ulna, tibia, and fibula bones. By Stage 23, it was already effectively directed toward the bone epiphyses in both limbs. At Stage 26 and hatching, only articular cartilages remained, and in the majority of samples the carpal region showed no affinity for alcian blue or alizarin red staining. This study acts as an indicative parameter of the taxon's normal development and can contribute to the phylogenetic understanding of this group.     

超声检测胎儿骨骺次级骨化中心和胎盘分级的临床意义

目的:探讨超声测量胎儿骨骺次级骨化中心和胎盘分级对评估孕龄和胎肺成熟度的临床意义。方法:前瞻性研究从359例孕龄准确的单胎孕妇中获得的518人次超声检查结果,分析胎儿股骨远端次级骨化中心(DFSOC)、胫骨近端次级骨化中心(PTSOC)和胎盘分级与孕龄的关系。选取其中在分娩前1周内接受超声检查且资料完整的184例孕妇,根据新生儿是否发生呼吸窘迫综合征(RDS)分为RDS组(15例)和non-RDS组(169例)。比较两组的DFSOC和PTSOC显示率及胎盘分级情况,并采用Logistic回归分析校正孕周影响,了解DFSOC、PTSOC和胎盘分级与出生后发生RDS的相关性。结果:(1)DFSOC、PTSOC和胎盘分级与超声检查孕周之间均呈正相关,Spearman相关系数分别为0.831、0.716和0.859(P均0.001)。(2)DFSOC、PTSOC和胎盘Ⅰ级以上分别预示胎儿至少已32周、37周和35周的准确度高达88.03%、89.58%和91.51%。(3)RDS组和non-RDS组的DFSOC、PTSOC显示率及胎盘分级比较,差异均有统计学意义(P均0.001);但校正分娩孕周的影响后,三者与出生后的RDS的发生均无显著相关性(P0.05)。结论:胎儿DFSOC、PTSOC和胎盘分级有助于临床上评估某些关键的孕龄,但并不是评估胎肺成熟度的可靠指标。     

Multiple pulmonary leiomyomatous hamartoma with secondary ossification

A 31-year-old woman presented with multiple pulmonary leiomyomatous hamartoma (MPLH) with secondary ossification. She had a past history of parosteal osteosarcoma. The pulmonary lesions were composed of spindle-shaped cells arranged in interlacing fascicles, among which glands or duct-like spaces were scattered. As some lesions contained bony tissues, it was unclear whether or not the pulmonary lesions were metastases of parosteal osteosarcoma. However, the majority of spindle-shaped cells were positive for alpha-smooth muscle actin, including cells proliferating around the bony tissues. Clonality analysis using a target of human androgen receptor (HUMARA) gene disclosed that the pulmonary nodules were polyclonal. These findings do not indicate that the lesions were metastatic. We would like to emphasize that MPLH can show osseous metaplasia.     

Bone tissue content of TGF-β2 changes with time in human heterotopic ossification after total hip arthroplasty

Transforming growth factor beta isoforms (TGF-β₁, TGF-β₂, and TGF-β₃) most likely play a role in bone physiology, but little is known about their relative importance in normal as well as in heterotopic bone. This study focused on possible differences in the localization and relative content of different TGF beta isoforms in heterotopic ossifications (HO) by comparing HOs, which have developed less than 17 months (immature HOs) with those developed 3–9 years (mature HOs). The HOs were harvested after total hip arthroplasty (THA) during revision surgery. The HO samples were decalcified, embedded in paraffin and sectioned. Azan staining was used to evaluate histological structure of the ossifications and immunohistochemical analysis was performed to estimate the localization of three TGF beta isoforms in the HOs. Comparison of different TGF beta isoforms in the immature and the mature ossifications showed that the content of TGF-β₂ was decreased by almost three times in the mature HO as compared to the immature HO (p = 0.0064). The proportions of other isoforms in HOs did not differ significantly. This study shows that the relative importance of TGF betas change with HO development.     

Linkage exclusion and mutational analysis of the noggin gene in patients with fibrodysplasia ossificans progressiva (FOP)

Fibrodysplasia ossificans progressiva (FOP) is an extremely rare and disabling genetic disorder characterized by congenital malformation of the great toes and by progressive heterotopic endochondral ossification in predictable anatomical patterns. Although elevated levels of bone morphogenetic protein 4 (BMP4) occur in lymphoblastoid cells and in lesional cells of patients with FOP, mutations have not been identified in the BMP4 gene, suggesting that the mutation in FOP may reside in a BMP4-interacting factor or in another component of the BMP4 pathway. A powerful antagonist of BMP4 is the secreted polypeptide noggin. A recent case report described a heterozygous 42-bp deletion in the protein-coding region of the noggin gene in a patient with FOP. In order to determine if noggin mutations are a widespread finding in FOP, we examined 31 families with 1 or more FOP patients. Linkage analysis with an array of highly polymorphic microsatellite markers closely linked to the noggin gene was performed in four classically-affected multigenerational FOP families and excluded linkage of the noggin locus to FOP (the multipoint lod score was -2 or less throughout the entire range of markers). We sequenced the noggin gene in affected members of all four families, as well as in 18 patients with sporadic FOP, and failed to detect any mutations. Single-strand conformation polymorphism (SSCP) analysis of 4 of these patients plus an additional 9 patients also failed to reveal any mutations. Among the samples analyzed by SSCP and DNA sequencing was an independently obtained DNA sample from the identical FOP patient previously described with the 42-bp noggin deletion; no mutation was detected. Examination of the DNA sequences of 20 cloned noggin PCR products, undertaken to evaluate the possibility of a somatic mutation in the noggin gene which could be carried by a small subset of white blood cells, also failed to detect the presence of the reported 42-bp deletion. We conclude that mutations in the coding region of noggin are not associated with FOP.     

Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty

BackgroundThe incidence of heterotopic ossification (HO) after total knee arthroplasty (TKA) varies and is of unclear clinical significance. This study aimed to identify the incidence of HO in patients undergoing revision TKA for either stiffness or aseptic loosening/instability and determine if the presence of HO is associated with inferior absolute range of motion (ROM) and ROM gains.MethodsEighty-seven patients were prospectively enrolled and separated into 2 cohorts to evaluate ROM after revision TKA (2017-2019). Group 1 (N = 40) patients were revised for stiffness, while group 2 (N = 47) patients were revised for either aseptic loosening or instability. Goniometer-measured ROM values were obtained preoperatively and at 6 weeks, 6 months, and 1 year postoperatively. Statistical analysis included a Fisher’s exact test to assess for an association between preoperative HO and final ROM at 1 year after revision TKA.ResultsHO was identified on preoperative radiographs in 17 patients (20%). There was a significantly higher rate of preoperative HO in patients revised for stiffness compared to patients revised for instability or loosening (30% vs 11%; P = .03). Five cases of HO qualitatively identified as most clinically severe were associated with lower ROM at each time point compared to the remainder of HO cases in this study cohort (P < .02).ConclusionThe presence of HO is greater in patients undergoing revision TKA for stiffness. Additionally, HO severity appears to have a major effect on preoperative and postoperative ROM trajectory. This information should help guide patient expectations and highlight the need for a comprehensive, standardized classification system for HO.     

Total hip arthroplasty for posttraumatic osteoarthritis following acetabularfracture: A systematic review of characteristics, outcomes, and complications

Purpose: Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture. Methods: Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords “acetabular”, “fracture”, “arthroplasty”, and “post traumatic arthritis” published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies. Results: With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%-63%), implant loosening (1%-24%), and infection (0%-16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%. Conclusion: Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.     

不同下颌前伸力对髁突Runx2和X型胶原表达的影响

目的:探讨不同作用方式的下颌前伸力对髁突软骨内成骨的影响.方法:将28只5周龄雄性wistar大鼠随机分配到周期性、静止性、功能性下颌前伸组及阴性对照组(n=7).各组按照设定的相关参数接受下颌前伸力刺激.实验结束时取标本,免疫组织化学染色,对Runx2、X型胶原的表达进行半定量分析.结果:Runx2和X型胶原表达动态组最高(与对照组比P＜0.01),静态组和功能组较低(与对照组比P＜0.01).静态组X型胶原表达高于功能组(P＜0.01),Runx2表达静态组与功能组差异无显著性(P＞0.05).结论:不同作用方式及作用时间的下颌前伸力差异性调节髁突软骨细胞Runx2及X型胶原的表达水平.     

Pituitary prolactin producing adenoma with ossification: A rare histological variant and review of literature

Pituitary adenoma with ossification is a rare histological variant. Previously there have been four cases reported in the literature. Here a case of pituitary prolactin‐producing adenoma with bone formation in a 21‐year‐old woman is described. The patient had irregular menstruation for three years. MRI revealed an unusual 1.5 cm³ ovoid nodule with partial shell‐like structure showing heterogeneous signals. The pre‐operative prolactin serum level was 258.78 ng/mL. The patient was operated through the trans‐sphenoidal pathway under general anesthesia. Histologically, the tumor was parenchymal and mostly replaced by the well‐differentiated lamellar bony tissue. Sheets of tumor cells interweaved with the mature lamellar bone trabeculae showing no cellular atypia. The cytoplasm of the adenoma cells was slightly eosinophilic and the myelo‐adipose metaplastic foci were also found within the parenchyma. Immunohistochemical staining of tumor cells showed positive expressions of prolactin, synaptophysin and chromogranin A in the cytoplasm of the tumor cells. Meanwhile, negative expressions of S‐100, epithelial membrane antigen, GFAP and other pituitary hormones were also demonstrated. As a rare histological variant of pituitary adenoma, the current case of pituitary prolactin producing adenoma with ossification is reported. It is speculated that the ossification may be derived from the osteo‐metaplasia of mesenchymal fibroblasts resulting from the effects of both secondary ischemia by the outgrowth of the tumor and/or the autocrine effect of prolactin in this case. The bony shell structure may limit the growth of pituitary adenoma.     

Ameloblastoma with Prominent Stromal Ossification

A large ameloblastoma with prominent stromal ossification is reported. The patient was a 39 year old Japanese male with diffuse swelling of the mandible from the left molar to the right premolar region. Radiographic examination showed a radiopaque lesion suggestive of a fibro osseous lesion. However, histologic examination revealed the lesion to be a variant of follicular ameloblastoma. Most of the tumor cells appeared to be squamous metaplasia. The stroma was abundant, with prominent formation of bone trabeculae rimmed by osteoblasts. Differentiation of mesenchymal cells into active osteoblasts with formation of new bone trabeculae was frequently found in the stroma. The prominent stromal bone formation appeared to be reactive in nature, although it remains uncertain whether this type of ameloblastoma can be regarded as a discrete clinicopathologic entity. Acta Pathol Jpn 40: 780 784, 1990.