Journal of orthopaedic research : official publication of the Orthopaedic Research Society
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Comparative Study
Interpretation of surface EMGs in children with cerebral palsy: An initial study using a fuzzy expert system.
Surface EMG detected simultaneously at different muscles has become an important tool for analysing the gait of children with cerebral palsy (CP), as it offers essential information about muscular coordination. However, the interpretation of surface EMG is a difficult task that assumes extensive knowledge and experience. As such, this noninvasive procedure is not frequently used in the general clinical routine. ⋯ In 23 cases (20%) the predictions of the expert system differed from the clinical findings with 12 cases revealing worse and 11 cases revealing better results in comparison to the clinical findings. As this study is a first attempt to verify the feasibility and correctness of this expert system, the results are promising. Further study is required to assess the correlation with the kinematic data and to include the whole leg.
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Randomized Controlled Trial Multicenter Study
Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study.
Despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition. The objective of this study was to determine whether extracorporeal shock wave therapy can safely and effectively relieve the pain associated with chronic plantar fasciitis compared to placebo treatment, as demonstrated by pain with walking in the morning. This was set in a multicenter, randomized, placebo-controlled, double-blind, confirmatory clinical study undertaken in four outpatient orthopedic clinics. ⋯ This study demonstrated a statistically significant difference between treatment groups in the change from baseline to 3 months in the primary efficacy outcome of pain during the first few minutes of walking measured by a visual analog scale. There was also a statistically significant difference between treatments in the number of participants whose changes in Visual Analog Scale scores met the study definition of success at both 6 weeks and 3 months posttreatment; and between treatment groups in the change from baseline to 3 months posttreatment in the Roles and Maudsley Score. The results of this study confirm that ESWT administered with the Dornier Epos Ultra is a safe and effective treatment for recalcitrant plantar fasciitis.
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The formation of new blood vessels is a prerequisite for bone healing. CYR61 (CCN1), an extracellular matrix-associated signaling protein, is a potent stimulator of angiogenesis and mesenchymal stem cell expansion and differentiation. A recent study showed that CYR61 is expressed during fracture healing and suggested that CYR61 plays a significant role in cartilage and bone formation. ⋯ However, the semirigid fixator group showed a significantly lower CYR61 immunoreactivity in cartilage than the rigid fixator group at this time point. The fraction of cartilage in the semirigid fixator group was not replaced by bone as quickly as in the rigid fixator group leading to an inferior histological and mechanical callus quality at 6 weeks and therefore to a slower healing. The results supply further evidence that CYR61 may serve as an important regulator of bone healing.
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Staphylococcus aureus is responsible for 80% of human osteomyelitis. It can invade and persist within osteoblasts. Antibiotic resistant strains of S. aureus make successful treatment of osteomyelitis difficult. ⋯ antibiotic sensitivities of S. aureus do not change after exposure to the osteoblast intracellular environment. Human and mouse osteoblast cultures were infected and S. aureus cells were allowed to invade. Following times 0, 12, 24, and 48 h ( +/- the addition of erythromycin, clindamycin, and rifampin at times 0 or 12 h), the osteoblasts were lysed and intracellular bacteria enumerated. Transmission electron microscopy was performed on extracellular and intracellular S. aureus cells. In mouse osteoblasts, administration of bacteriostatic antibiotics at time 0 prevented the increase in intracellular S. aureus. If the antibiotics were delayed 12 h, this did not occur. When rifampin (bactericidal) was introduced at time 0 to human and mouse osteoblasts, there was a significant decrease in number of intracellular S. aureus within osteoblasts compared to control. If rifampin was delayed 12 h, this did not occur. Significant time-dependent S. aureus structural changes were observed after exposure to the osteoblast intracellular environment. These studies demonstrate that once S. aureus is established intracellularly for 12 h, the bacteria are less sensitive to antibiotics capable of eukaryotic cell penetration (statistically significant). These antibiotic sensitivity changes could be due in part to the observed structural changes. This leads to the rejection of our null hypotheses that the antibiotic sensitivities of S. aureus are unaltered by their location.
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Delayed repair of tendon to bone injuries leads to decreased biomechanical properties and bone loss.
Repair of the torn rotator cuff tendon is a common procedure performed in the shoulder. In the clinical setting, a significant delay between rotator cuff tear and subsequent repair often exists. The purpose of this study was to investigate the biomechanical properties and bone density of the tendon to bone repair site after acute and delayed repair. ⋯ Inferior rotator cuff healing was demonstrated when there was a delay between injury and repair. Viscoelastic properties of the acute repairs were increased compared to the delayed group at 10 days, indicating tendon stiffening during the 3-week delay before repair. Viscoelastic properties of the acute repairs were decreased compared to the delayed group at 56 days indicating deterioration of properties over time in the delayed group. The deterioration in properties in the delayed group coincide with bone density decreases in the greater tuberosity. These results indicate that bone loss may a significant factor in poor healing.