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Histochemical examination of osteoblastic activity in op/op mice with or without injection of recombinant M-CSF.

Osteopetrotic (op/op) mice do not exhibit bone remodeling because of defective osteoclast formation caused by the depletion of macrophage colony-stimulating factor (M-CSF). In the present study, we investigated tibial bones of op/op mice with or without prior injections of M-CSF to determine whether osteoclast formation and subsequent bone resorption could activate osteoblasts, which is known as a "coupling" phenomenon. In op/op mice, no osteoclasts were present, but the metaphyseal osteoblasts adjacent to the growth plate cartilage seemed to be active, revealing an intense alkaline phosphatase (ALPase) immunoreactivity. Consequently, primary trabecular bones were extended continuously to the diaphysis, indicating that bone modeling is well achieved in op/op mice. In contrast with the metaphysis, most of the diaphyseal osteoblasts were flattened and showed weak ALPase activity, and, as a result, they seemed to be less active. Osteopontin (OPN) was localized slightly at the interface between bone and cartilage matrices of the primary trabeculae. In contrast, in op/op mice injected with M-CSF, tartrate-resistant acid phosphatase-positive osteoclasts appeared, resorbing trabecular bones of the diaphyseal region. The diaphyseal osteoblasts in the vicinity of the active osteoclasts were cuboidal and exhibited strong ALPase immunoreactivity. OPN was observed not only at the bone-cartilage interface, but also significantly on the resorption lacunae beneath the bone-resorbing osteoclasts. These observations indicate that the activation of diaphyseal osteoblasts appears to be coupled with osteoclast formation and subsequent osteoclastic bone resorption. Alternatively, the metaphyseal osteoblasts at the chondro-osseous junction seemed to be less affected by osteoclastic activity.

Acid Phosphatase↗

Thrust plate prosthesis for osteonecrosis of the femoral head: short-term results of 15 patients followed 2-6 years.

BACKGROUND: The thrust plate prosthesis is an implant with a metaphyseal fixation at the proximal femur that transmits the load forces of the hip onto the femoral neck. METHODS: In this prospective study, 15 patients (8 women, 7 men) with 19 cementless thrust plate prostheses because of femoral head necrosis were examined. A clinical and radiologic evaluation was performed preoperatively, at 3, 6, 12, 18, and 24 months postoperatively, and every year thereafter. The mean follow-up period was 44 (range, 24-72) months. The average age at the time of surgery was 49 (27-70) years. The pathogenesis of femoral head necrosis included alcoholism (6 joints of 3 cases), Gaucher disease (1 joint of 1 case), Sheehan syndrome (2 joints of 1 case), and idiopathic (10 joints of 10 cases). RESULTS: The Harris hip score increased from 53 (range, 15-71) to 97 (92-100) points on the final evaluation. Although mean preoperative hip flexion and abduction were 78 degrees (45 degrees -110 degrees ) and 24 degrees (10 degrees -45 degrees ), respectively, these increased to 114 degrees (75 degrees -125 degrees ) and 47 degrees (45 degrees -50 degrees ) 12 months after surgery and remained stable up to the latest follow-up. None of the patients displayed mechanical problems, and revision was not necessary in any case. CONCLUSIONS: The thrust plate prosthesis shows midterm results comparable to those of the cementless stemmed prosthesis and supplies advantages, especially for younger patients with femoral head necrosis, because of its metaphyseal bone-preserving fixation.

Adult↗

A pact with the embryo: Viktor Hamburger, holistic and mechanistic philosophy in the development of neuroembryology, 1927-1955.

Viktor Hamburger was a developmental biologist interested in the ontogenesis of hte vertebrate nervous system. A student of Hans Spemann at Freiburg in the 1920s, Hamburger picked up a holistic view of the embryo that precluded him from treating it in a reductionist way; at the same time, he was committed to a materialist and analytical approach that eschewed any form of vitalism or metaphysics. This paper explores how Hamburger walked this thin line between mechanistic reductionism and metaphysical vitalism in light of his work on the factors influencing growth of neurons into limb buds, and the discovery of nerve growth factor, work carried out with Rita Levi-Montalcini and Stanley Cohen.

Developmental Biology↗

Evaluation of the 3M staplizer: a new internal fixation system.

Clinical evaluation of a new method for internal fixation with power-driven staples is presented. We have used the 3M staplizer for 2 years in 100 cases and the result of the fixation obtained with the titanium staples in metaphyseal bone has been very good. Ninety-six cases healed without any problems, and in 4 there was displacement. The only case with infection was successfully treated with antibiotics. We conclude that the 3M staplizer is a reliable method for internal fixation of metaphyseal bone. The staples are easily driven into the bone, reasonable stability is obtained and the method is fast and safe.

Adolescent↗

Intramedullary pressure, strain on the diaphysis and increase in cortical temperature when reaming the femoral medullary cavity--a comparison of blunt and sharp reamers.

Clinical application has shown intramedullary nailing to be a safe therapeutic procedure, although damage to the vascular system and fat embolism have been demonstrated in animal experiments. The main negative factors were presumed to be the increase in intramedullary pressure and the increase in cortical temperature. In this study, the effect of the blunting of the reamers on the increase in intramedullary pressure, the tangential strain on the diaphysis and the increase in cortical temperature was to be clarified. The measurements were carried out on pairs of human femora reamed with sharp and blunt AO reamers. The pressure was measured in the middle of the diaphysis and in the metaphysis, the strain in the middle of the femur and the temperature on four aspects of the femur. The femora were reamed with identical compression and traction forces in a water bath at 37 degrees C. In comparison with the sharp reamer, the blunt reamer develops 2.1 times the positive diaphyseal pressure, 1.7 times the positive metaphyseal pressure, 1.6 times the negative diaphyseal pressure, 1.5 times the positive tangential strain, 55 times the negative tangential strain and 2.8 times the increase in cortical temperature. There is no difference in the negative metaphyseal pressure. Since blunt reamers produce greater intramedullary pressure values, greater tangential strain on the diaphysis and a greater increase in cortical temperature, the attention of surgeons and operating staff must be drawn to the fact that they should treat the reamers gently and replace them whenever necessary.

Equipment Failure↗

Influence of the compression force on the intramedullary pressure development in reaming of the femoral medullary cavity.

The reaming process is considered the main damage factor in intramedullary nailing, as there are repeated increases in intramedullary pressure and cortical temperature, which can lead to aseptic cortex necroses and fat embolisms. In this study, the influence of the compression force on the increase in pressure is to be examined. The intramedullary pressure was measured in the middle of the diaphysis and in the metaphysis of human femora reamed under various compression forces. The compression force exerted by the surgeon was measured on polyurethane femora. It was observed that an increase in the compression force of 1.8 times led to an increase in the diaphyseal pressure of 4.7 times and of the metaphyseal pressure of 3.1 times. As surgeons exert high compression forces, peak pressures of 970 mmHg diaphyseally and 1150 mmHg metaphyseally must be expected in the hospital. If reaming is carried out with less compression force, the intramedullary pressure can easily be reduced by 79% in the area of the diaphysis and by 68% in the metaphysis.

Femoral Fractures↗

Histopathology of growth plate changes in induced abnormal bone growth in lambs.

Unilateral hip excision arthroplasty in lambs resulted in osteochondrosis developing in distal tibiae and metatarsi of the contralateral pelvic limb. The physeal cartilage of distal tibiae and metatarsi developed clefts which probably represent shear failure. The histopathology of the meataphyseal defects differed between the medial and lateral growth plate sectors. Medially, the lesions were typical of physeal osteochondrosis in other mammals, with disorganized chondrocyte columns, cell death and matrix necrosis. Laterally, metaphyseal defects were predominantly fibrous, and islands of bone formed in physeal cartilage from re-established endochondral ossification. Both medial and lateral metaphyseal defects were associated with disturbed primary spongiosa formation. It is suggested that, in some instances at least, traumatic physeal clefts, resulting from shear failure in previously normal growth cartilage, may interfere with endochondral ossification and produce osteochondrosis.

Animals↗

Osteotoxicity after chronic dietary administration of 13-cis-retinoic acid, retinyl palmitate or selenium in mice exposed to tumor initiation and promotion.

In view of the clinical trials of retinoids as therapeutic agents for premalignant skin lesions, a radiographic study was undertaken to measure skeletal toxicities after chronic dietary administration of retinoids in mice exposed to tumor initiation and promotion. CD-1 mice were initiated with 0.15 moles of 7,12-dimethylbenz[a]anthracene and promoted twice daily with 8 nmoles of 12-0-tetradecanoylphorbol-13-acetate for 23 weeks. Diets were supplemented with 60 IU, 200 IU, or 700 IU of retinyl palmitate (RP) per g diet. After 5 weeks, the 700 IU of RP /g diet was lowered to 350 IU/g diet. Administration of these diets to mice during the 23 weeks of tumor promotion resulted in a 0-fold, 2-fold, or 10-fold increase in bone fractures, respectively. Osteoporotic bone lesions identified on radiographs rose 0-fold, 0-fold, and 10-fold at the respective doses, whereas metaphyseal flares increased 0-fold, 1.4-fold, and 3.6-fold. Bone deformities were augmented 0-fold, 1.8-fold and 2.9-fold at the respective doses. Addition of selenium (2 ppm in the drinking water) did not alter the bone toxicity of RP. 13-cis-retinoic acid (CRA) was less toxic at 700 IU/g diet than was RP at that dose, as evidenced by the death of 12 of 70 mice by the 6th week of dietary RP and no deaths in the 35 mice fed 700 IU CRA/g diet for 23 weeks. CRA at 700 IU/g diet resulted in 3/4 as many osteoporotic bones, 1/3 as many bone fractures, 4/5 as many metaphyseal flares, and a similar number of bone deformities as mice fed 700/350 IU/g diet. At the dose of 200 IU/g food, osteotoxicities were similar in the mice fed diets supplemented with RP and CRA. Thus, the light dose of CRA (700 IU/g diet) was less toxic than the high dose of, RP but at a lower dose (200 IU/g), CRA was as osteotoxic as was RP. Bone fractures in mice exposed to prolonged dietary administration of retinoids was a more sensitive index of retinoid toxicity than was body weight. We have detected osteotoxicity in mice at a total dose of CRA which was about twice the total dose used clinically.

Administration, Oral↗

Possible involvement of vitamin D3-deficiency and relatively enhanced bone resorption in the development of bone loss in streptozotocin-induced diabetic rats.

To explore the pathogenesis of diabetes associated osteopenia, we characterized the osteopenia in streptozotocin (STZ)-diabetic rats pharmacologically and biochemically. The femur metaphyseal bone mineral density measured by single photon absorptiometry decreased time-dependently in the STZ rats compared with that in control, and the difference reached statistical significance from 2 weeks after treatment with STZ. Closely similar bone loss was obtained in ovariectomized (Ovx) and vitamin D deficient(D(-)) rats. Daily oral treatment with a bone resorption inhibitor, FR78844 (a bisphosphonate compound, 100 mg/kg), for 4 weeks significantly attenuated the osteopenia in the STZ and Ovx rats, but not in the D(-) rats, while 1 alpha-hydroxyvitamin D3 (1 alpha-(OH)D3) significantly attenuated the osteopenia in the STZ and D(-) rats in a dose of 0.1 microgram/kg/day, and that in the Ovx rats in 1 microgram/kg/day. The latter dose of 1 alpha-(OH)D3 significantly increased the metaphyseal bone mineral density of the femur in normal rats. Serum levels of 1 alpha, 25-dihydroxyvitamin D (1 alpha, 25-(OH)2D), the most active metabolite of vitamin D, hardly changed in the Ovx rats compared with that in control, but decreased to 24 and 76% that of control in the STZ and D(-) rats, respectively. Serum PTH levels in the STZ, Ovx and D(-) rats were comparable with those in controls, but serum calcitonin levels were reduced to 60 and 66% of control in the STZ and Ovx rats, respectively. Serum osteocalcin levels also decreased in the STZ rats compared to control. It is thus speculated that the predominance of bone resorption over bone formation and the reduction of 1 alpha, 25-(OH)2D are involved in the pathogenesis of diabetes associated osteopenia.

Animals↗

Microvascular hemodynamics in experimental arthritis: disparity between the distribution of microspheres and plasma flow in bone.

The microcirculation in normal and arthritic juxtaarticular bone was studied in 16 young dogs with carragheenan-induced arthritis of one knee. The regional blood flow was determined by the tissue uptake of intracardially injected 15-microns 141Ce-labeled microspheres, and the microvascular plasma volume was determined by the distribution space of circulating 125I-fibrinogen. Disparities between the distribution of plasma flow and microspheres, introduced by plasma skimming or nonentrapment of spheres in the intraosseous circulation, were estimated by 59Fe-transferrin, a third intravascular tracer, injected as a bolus intracardially and trapped peripherally after 15 sec by prompt circulatory arrest. The tissue uptake of the plasma flow tracer was compared to that of microspheres by the ratio between observed and expected activity of 59Fe-transferrin, the expected activity being calculated from the microsphere distribution. The transferrin and microsphere uptake agreed well in patella, marginal epiphyseal bone, and cortical bone, whereas observed activity of transferrin was twice the expected in central epiphyseal bone, three times higher in marrow, and up to eightfold higher in metaphyses adjacent to growth plates. This discrepancy was significantly greater in arthritic bone when the metaphyses were examined in toto. The microsphere method thus appears to underestimate blood flow to cancellous bone and marrow due to uneven distribution of plasma and formed elements from profound plasma skimming and perhaps also by AV shunting.

Animals↗

Skeletal changes in childhood acute lymphoblastic leukemia: correlation with the presence of the cALL antigen.

We studied the occurrence of the radiolucent metaphyseal bands in pretreatment skeletal X-rays and the phenotype of leukemic cell in 66 children with non-T, non-B ALL. A striking correlation was found between the expression of the CALLA on the leukemic cell and the occurrence of the early metaphyseal bands. We speculate that the bands might reflect an ongoing anti-leukemic reaction which may have been in progress before the disease became clinically manifest and which is associated with relatively favorable prognosis after even a modest chemotherapy.

Adolescent↗

Prostaglandin E2 prevents ovariectomy-induced cancellous bone loss in rats.

The object of this study was to determine whether prostaglandin E2 (PGE2) can prevent ovariectomy-induced cancellous bone loss. Thirty-five 3-month-old female Sprague-Dawley rats were divided into two groups. The rats in the first group were ovariectomized (OVX) while the others received sham operation (sham-OVX). The OVX group was further divided into three treatment groups. The daily doses for the three groups were 0, 1 and 6 mg PGE2/kg for 90 days. Bone histomorphometric analyses were performed on double-fluorescent-labeled undecalcified proximal tibial metaphysis (PTM). We confirmed that OVX induces massive cancellous bone loss (-80%) and a higher bone turnover (+143%). The new findings from the present study demonstrate that bone loss due to ovarian hormone deficiency can be prevented by a low-dose (1 mg) daily administration of PGE2. Furthermore, a higher-dose (6 mg) daily administration of PGE2 not only prevents bone loss but also adds extra bone to the proximal tibial metaphyses. PGE2 at the 1-mg dose level significantly increased trabecular bone area, trabecular width, trabecular node density, density of node to node, ratio of node to free end, and thus significantly decreased trabecular separation from OVX controls. At this dose level, these same parameters did not differ significantly from sham-OVX controls. However, at the 6-mg dose level PGE2, there were significant increases in trabecular bone area, trabecular width, trabecular node density, density of node to node, and ratio of node to free end, while there was significant decrease in trabecular separation from both OVX and sham-operated controls. The changes in indices of trabecular bone microanatomical structure indicated that PGE2 prevented bone loss as well as the disconnection of existing trabeculae. In summary, PGE2 administration to OVX rats decreased bone turnover and increased bone formation parameters resulting in a positive bone balance that prevented bone loss (in both lower and higher doses) and added extra bone to metaphyses of OVX rats (in higher dose). These findings support the strategy of the use of bone stimulation agents in the prevention of estrogen depletion bone loss (postmenopausal osteoporosis).

Aging↗

Psychosocial wellness among spiritual healing participants.

The findings reported are based on an exploratory, comparison group study of participants in spiritual healing practices carried out over a 2-year period (1981-1983) in Baltimore, Md. In this study, participation in such forms of healing, which generally occurs in small groups, is related to various measures of psychosocial wellness defined as the emic construct of 'subjective health'. Interview data from regular participants in two types of healing group, charismatic (n = 83) and metaphysical (n = 93), were compared with regular utilizers of primary care (n = 137), using the same data collection procedures. Members of the two types of healing group differ on some social attribute data. Members of charismatic healing groups tend to be of slightly lower SES overall than members of metaphysical healing groups. Members of both types of healing groups, however, had significantly more positive scores on wellness measures than primary care patients, even when sex, age, marital status, illness severity and religiosity were controlled statistically. Findings suggest that such groups play a social support function among regular participants, and that participation in specific healing systems can be seen as a contextual variable which has an effect on subjective self-reports of health or, as defined here, wellness.

Adaptation, Psychological↗

Time of fusion of epiphyses at the elbow and wrist joints in girls of northwest India.

A radiological examination of both elbows and wrists of 149 Northwest Indian schoolgirls between the ages of 11 and 19 years, of middle socio-economic status, was undertaken to determine the time of fusion of the epiphyses with the metaphyses of the medial epicondyle of the humerus, the proximal end of the radius and the distal ends of both radius and ulna. The data were subjected to discriminant function tests as well as sensitivity and specificity tests. If the epiphysis of the medial epicondyle of the humerus or that of the head of the radius has not fused with metaphysis completely, the age of the girl would be < 16 years. However, the age of the girl should be > 16 years if the distal epiphyses of the radius and the ulna show complete fusion with their respective metaphyses. Discriminant function tests show that 91.95% of girls can be correctly classified as being above or below the age of 16 years.

Adolescent↗

The ultimate strength of suture anchors.

Suture anchors of various designs are gaining acceptance for open and arthroscopic procedures. The rapid proliferation of these devices challenges those using them to apply objective criteria for device selection. Comparative data on implant security in different settings, modes of failure, and ultimate failure strengths is lacking. This study was undertaken to independently develop such data for an objective comparison of the suture anchors currently available. Using a fresh never-frozen porcine femur model, 10 samples of each of the 14 different anchors tested were inserted into each of the three different test areas; diaphyseal cortex (usually 3- to 4-mm thick), metaphyseal cortex (usually 1- to 2-mm thick), and a cancellous bone "trough". The suture anchors were threaded with 0.018-inch stainless steel wire or, for anchors requiring a more flexible suture, 0.018-inch stainless steel 1 x 7 wire braid. Tensile stress parallel to the axis of insertion was applied at a rate of 12.5 mm/second by an Instron 1321 (Instron Corp, City, State) until failure. Average failure strength was calculated for each anchor at each test area. The anchors tested were the Mitek G2, Mitek G3, Mitek G4 (Mitek Surgical Products, Norwood, MA), Linvatec Revo screw (Linvatec, Largo, FL), Acufex TAG Wedge, Acufex TAG Rod 2 (Acufex Microsurgical, Mansfield, MA), Statak models 1.5, 2.5, 3.5, 5.0, and 5.2 (Zimmer, Warsaw, IN), Arthrex ESP (Arthrex Inc., Naples, FL), Arthrotek Harpoon, and Arthrotek LactoSorb (Arthrotek, Warsaw, IN). The average failure strength of each of these anchors in the diaphyseal cortex, metaphyseal cortex, and cancellous bone is reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Morphology-mechanical property relations in trabecular bone of the osteoarthritic proximal tibia.

Alteration of morphologic and mechanical properties of trabecular bone in the osteoarthritic proximal tibia may be a contributing factor in tibial component loosening. To explore this issue, the authors performed tissue property measurements, morphologic analysis, and mechanical testing of subchondral, epiphyseal, and metaphyseal trabecular bone specimens retrieved from six human proximal tibias exhibiting a range of medial unicondylar osteoarthritic degeneration. Apparent density in the proximal tibia was altered according to varus misalignment and medial subluxation associated with medial osteoarthritis of the knee. In subchondral bone, a decrease in tissue mineralization contributed to a significant reduction in axial mechanical properties with degenerative disease (P < .0005). In epiphyseal and metaphyseal bone, trabecular thickness and the number of trabeculae increased linearly with volume fraction, providing a power law relationship between axial elastic modulus and apparent density (R2 = .84). Average elastic properties of the tibial epiphysis and metaphysis were not reduced by degenerative disease (P < .05). The results suggest that absolute minimization of tibial resection might not be an optimal strategy for tibial component fixation and that mechanical properties of the tibial resection surface are more homogeneous in planes parallel to the joint surface than in a plane normal to the longitudinal axis of the tibia.

Aged↗

Effects of a fluorinated bisphosphonate on bone remodeling in vivo.

A new fluorinated bisphosphonate, difluoromethylene bisphosphonate (F2MBP), was studied for its effects on physiologic bone remodeling in the actively growing rat tibia. Young male Sprague-Dawley rats were given daily subcutaneous injections of either saline (control) or 30 mg/kg per day of F2MBP, dichloromethylene bisphosphonate (Cl2MBP), or 1-hydroxyethylidene-1, 1-bisphosphonate (HEBP) for 30 days. Microradiographs of the epiphysealmetaphyseal region of tibiae from animals treated with either F2MBP or Cl2MBP demonstrated increased radiodensity but, unlike those treated with HEBP, without an increase in the width of the epiphyseal growth plate. Quantitative analyses of these microradiographs showed that there was an increase of calcified tissue in the metaphyseal region in all diphosphonate groups when compared with controls. However, the HEBP-treated animals exhibited significantly less increase than either F2MBP-treated or Cl2MBP-treated rats. In addition, the total area of calcified tissue in the diaphyseal transverse sections was greater in the F2MBP-treated animals than in controls. Elemental calcium, phosphorus, and fluorine, as detected by the electron probe, also increased in the metaphyseal region of the F2MBP-treated animals, but no significant differences in the calcium: phosphorous ratio were found among the control, F2MBP, and Cl2MBP treatment groups, indicating no alterations in the chemical composition of bone. The greater amount of fluorine in the tibiae of F2MBP-treated animals reflected the presence of the F2MBP molecule. Thus, this study has demonstrated that this new fluorinated bisphosphonate, like Cl2MBP, inhibits physiologic bone remodeling without disturbing mineralization. Furthermore, the presence of fluorine in F2MBP allows the precise localization of the incorporation of the bisphosphonate within the bone.

Animals↗

Intermittent radiographic changes of rickets without defective trabecular bone mineralization in a case of spondylometaphyseal dysplasia.

Although a variety of metaphyseal and spondylometaphyseal dysplasias have been identified, the natural course of the skeletal defects in these disorders has not been well characterized. We describe an 8-year-old girl with spondylometaphyseal dysplasia, most closely resembling the Kozlowski type, in whom rachitic metaphyseal involvement underwent dramatic radiographic healing when she wore leg braces; discontinuation of the braces was followed by recurrence of the growth plate abnormalities. A generalized disturbance in mineral metabolism or skeletal remodeling to explain these radiographic changes was excluded by extensive biochemical studies and histologic examination of an undecalcified iliac crest specimen. Our observations suggest that the defect in endochondral bone formation in the spondylometaphyseal dysplasias may be responsive to mechanical factors and that interventions that alter stress and strain on the skeleton, such as immobilization or use of orthopedic braces, may considerably modify the radiographic appearance of the growth plate disturbance.

Aging↗