USES OF FELT IN INDUSTRIAL PRACTICE

Orthopedic felt often can be used quite simply and with great effectiveness to relieve pain referable to positional, traumatic or inflammatory abnormalities of bone, tendon or muscle.Trial of protective and supportive padding with this material is particularly recommended in noninflammatory olecranon bursitis; in beginning ganglion formation; in stenosing tendovaginitis, particularly of the flexor tendons of fingers; in painful heel (subcalcaneal bursitis); and in the correction of postural deformities or imbalances.     

Shock wave treatment in medicine

Extracorporeal shock wave therapy in orthopedics and traumatology is still a young therapy method. Since the last few years the development of shock wave therapy has progressed rapidly. Shock waves have changed the treatment of urolithiasis substantially. Today shock waves are the first choice to treat kidney and urethral stones. Urology has long been the only medical field for shock waves in medicine. Meanwhile shock waves have been used in orthopedics and traumatology to treat insertion tendinitis, avascular necrosis of the head of femur and other necrotic bone alterations. Another field of shock wave application is the treatment of tendons, ligaments and bones on horses in veterinary medicine. In the present paper we discuss the basic theory and application of shock waves and its history in medicine. The idea behind using shock wave therapy for orthopedic diseases is the stimulation of healing in tendons, surrounding tissue and bones. This is a completely different approach compared to urology where shock waves are used for disintegration     

Potentialities of temporal bone computed tomography in the identification of causes of hypoacusis of postinflammatory genesis

Temporal bone computed tomography (CT) was used to examine 64 patients with impaired hearing due to inflammatory diseases of the middle year. In 21 patients, the pathological process was bilateral. A total of 85 series of temporal bone CT scans were analyzed. The patients' age ranged from 2 to 66 years. CT verified adhesive otitis media in 62 cases, otosclerosis in 7, local malformation of the auditory ossicles and/or the labyrinthine fenestrae in 11. No CT changes were revealed in 5 cases. The CT symptoms of adhesive otitis media were identified. These included soft tissue bands and/or soft tissue-density portions that fix the auditory ossicles or block the niches of the labyrinthine fenestrae (31 temporal bones); sclerosis or ossification of the ligaments and tendons of the middle ear (7 temporal bones); calcification foci in the tympanic cavity (9 cases); osteosclerotic changes in the epitympanus (2 cases); cicatricial changes in the tympanic membrane (24 cases); destructive changes in the auditory ossicles (19 temporal bones). There has been evidence that CT may be used for the differential diagnosis of adhesive otitis media from otosclerosis and congenital malformations of the structures of the middle ear.     

Age-related changes of elements and relationships among elements in human tendons and ligaments

To elucidate compositional changes of the tendons and ligaments with aging, the authors investigated age-related changes of element contents in the insertion tendons of the biceps brachii muscle, central tendons of the diaphragma, Achilles’ tendons, posterior longitudinal ligaments (PLLs) of the cervical spine, ligamenta capitum femorum, and anterior cruciate ligaments. After ordinary dissections by medical students, the three tendons and three ligaments were resected and element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that the elements, such as Ca, P, S, Mg, Na, Zn, and Fe, did not change significantly in the three tendons and two ligaments with aging, except for the PLLs where Ca and Mg increased significantly with aging and Fe decreased significantly with aging. With regard to the relationships among elements, the common finding that there were significant correlations between Ca and P contents and between Ca and Mg contents was obtained in the three ligaments. Likewise, the common finding that there was a significant correlation between Ca and Mg contents was obtained in the three tendons. Regarding the relationship between Ca and P contents, the three tendons were different from the three ligaments.     

Extensor tendon: anatomy, injury, and reconstruction

Although seemingly simple in its anatomy and function, the extensor mechanism of the hand is actually a complex set of interlinked muscles, tendons, and ligaments. A thorough understanding of the extensor anatomy is required to understand the consequences of injury at various levels. Reconstructive options must restore normal function. Whereas primary repair of anatomic structures is frequently possible in acute injury, it is rarely possible in chronic situations. Technically exacting procedures may be necessary to restore function.     

Tendon Ruptures Associated With Corticosteroid Therapy

In five patients, tendon ruptures occurred in association with corticosteroid therapy, either systemic or local infiltration. The chronic nature of the pain in all of these patients suggests that what we often call tendinitis may in fact be early or partial ruptures of tendons. Patients who receive local infiltration of corticosteroids should perhaps be advised of the risk of a ruptured tendon. In addition, particularly when the Achilles tendon is involved, immobilization should be utilized initially for a presumed tendinitis or early rupture, to protect the tendon from further injury.     

A proposal to evaluate the fibers’ break probability in ligaments and tendons

Understanding the yield and failure mechanisms of ligaments and tendons is important to have a deeper knowledge of their structure and function. Evaluating what are the limits of the human body is also important to prevent injuries in workers, in athletes and the elderly. The tissue yield mechanism was analyzed by modifying and extending a probabilistic model of collagen bundles. Since not usable experimental data are available in the literature, the model and the method were tested using Monte Carlo simulations. The simulations showed many crucial aspects of the model and gave some indications about possible future real validation experiments. The analysis of the correlation between the simulated data, the model ($R^2$) and the Signal-to-Noise-Ratio (SNR) highlighted the most important parameters that affect effectiveness of the described method: number of fibers, elongation step, noise. This analysis also showed that the numerical differentiation algorithms of the data have a key role on the accuracy of the yield assessment. However, the results also showed that the method is able to correctly estimate the elongation break distribution of the fibers of ligaments and tendons.     

Age-dependent decreases of phosphorus and magnesium in human achilles’ tendons

To elucidate changes of human tendons with aging, the authors studied age-related changes of elements in human Achilles’ tendons by inductively coupled plasma-atomic emission spectrometry. The subjects consisted of seven men and seven women, ranging in age from 61 to 97 yr. It was found that the content of calcium increased progressively with aging in the Achilles’ tendons, whereas the contents of phosphorus and magnesium decreased gradually with aging. The previous investigations demonstrated that the content of calcium and phosphorus increased progressively with aging in most, but not all, human tissues, except for the bones. In ligaments, such as the anterior cruciate ligament and the ligament of the head of the femur, which are histologically similar to the Achilles’ tendon, it was previously found that both the contents of calcium and phosphorus increased with aging in the ligaments. It should be noted that the content of phosphorus in the Achilles’ tendons decreased during the aging process. In addition, it was found that there was a very high direct correlation between phosphorus and magnesium contents in the tendons, but not between calcium and phosphorus contents.     

Diagnosis of dystrophic lesions of the muscular and ligamentous tendons

The authors presented the results of investigations of the humoral, ulnar, hip, knee joints and calcanei in 4140 patients. Histology has shown that calcifications and ossifications at the sites of tendon fixation are localized in tendons. The substitution of tendinous tissue for a bone results from calcareous dystrophy. Three stages can be singled out: (I) the substitution of a tendon portion for a fibrillar cartilage; (II) the calcification of a cartilage; (III) the substitution of a calcified cartilage for a newly developed spongy bone. According to the preliminary data, similar changes can bep6 observed in ligaments, too. The clinical and x-ray examination have shown the frequency of tendinous and ligamentous lesions (tendinosis and ligamentosis) of different sites. They were shown to be pathology that may not be accompanied by pains. The appearance of the pain syndrome means the development of disease.     

A fiber matrix model for interstitial fluid flow and permeability in ligaments and tendons

Collagen fibrils in ligaments and tendons are highly organized into parallel arrays which influence interstitial fluid transport. Finite element (FE) models were developed analogous to the fibrillar arrays in ligaments and tendons to investigate interstitial fluid flow and tissue permeability as a function of interfibrillar spacing and fluid properties. Collagen fibrils were assumed to be a periodic square array of impermeable cylinders. A two-dimensional FE model was used to study transverse fluid flow and a three-dimensional model was used to study flow parallel to the collagen fibrils. Parametric FE analysis provided data to formulate empirical expressions for permeability (kappa) as a function of porosity (phi). Results show that longitudinal permeability (kappa = 1.1.10(-15)phi 2.5[1 - phi]-0.333) can be up to 50 times higher than transverse permeability (kappa = 1.2.10(-15)phi 0.5[phi - phi min]2.5) in a compact array. Maximum fluid shear stresses occur at the narrowest zones of adjacent fibrils (1.21 Pa or 12.1 dyn/cm2 at 10 microns/s of average transverse influx). If interstitial fluid is highly non-Newtonian, the permeability should be considered as flow (shear)-dependent. The computational results suggest that tissue permeability in ligaments and tendons is highly anisotropic, porosity-dependent, and can be estimated by analytic expressions.     

Culture and characterization of juvenile rabbit tenocytes

The culture of rabbit tenocytes could be a useful model in the study of the physiopathology and pharmacotoxicology of tendons. This work was undertaken to examine the in vitro behavior of tenocytes from juvenile rabbit Achilles tendons. We report observations of the morphological and biological characteristics of primary culture and subsequent passages of rabbit tendon cells cultured in monolayer. Data obtained by electron microscopy and growth curves were complementary. After 36 passages, the generation time of tenocytes did not change and no sign of senescene could be seen. Primary culture and the first passages retained the expression of tenocyte differentiated functions, synthesis of type I collagen and decorin. Cell growth behavior was not modified upon passaging. However, when subcultured, tenocytes displayed a modulated phenotype.     

Mechanically overloading collagen fibrils uncoils collagen molecules,placing them in a stable,denatured state

Due to the high occurrence rate of overextension injuries to tendons and ligaments, it is important to understand the fundamental mechanisms of damage to these tissues' primary load-bearing elements: collagen fibrils and their constituent molecules. Based on our recent observations of a new subrupture, overload-induced mode of fibril disruption that we call discrete plasticity, we have sought in the current study to re-explore whether the tensile overload of collagen fibrils can alter the helical conformation of collagen molecules. In order to accomplish this, we have analyzed the conformation of collagen molecules within repeatedly overloaded tendons in relation to their undamaged matched-pair controls using both differential scanning calorimetry and variable temperature trypsin digestion susceptibility. We find that tensile overload reduces the specific enthalpy of denaturation of tendons, and increases their susceptibility to trypsin digestion, even when the digestion is carried out at temperatures as low as 4 °C. Our results indicate that the tensile overload of collagen fibrils can uncoil the helix of collagen molecules, placing them in a stable, denatured state.     

Tensile properties of calcified and uncalcified avian tendons

The mechanical properties of turkey and heron leg tendons have been investigated in dynamic tensile tests. Heron tendons have properties similar to those found for various mammalian tendons. The Young's modulus and the density of turkey tendons increase with increasing calcification. Ultimate tensile stresses are similar to those found for uncalcified tendon, but Young's modulus may reach about 16 GPa, a value normally associated with bone. Calcification lowers the amount of strain energy that can be stored temporarily in the tendons of the legs. The contribution made by elastic strain energy storage to lowering the cost of running is reduced.     

Osteogenic regulation of vascular calcification: an early perspective

Cardiovascular calcification is a common consequence of aging, diabetes, hypercholesterolemia, mechanically abnormal valve function, and chronic renal insufficiency. Although vascular calcification may appear to be a uniform response to vascular insult, it is a heterogenous disorder, with overlapping yet distinct mechanisms of initiation and progression. A minimum of four histoanatomic variants-atherosclerotic (fibrotic) calcification, cardiac valve calcification, medial artery calcification, and vascular calciphylaxis-arise in response to metabolic, mechanical, infectious, and inflammatory injuries. Common to the first three variants is a variable degree of vascular infiltration by T cells and macrophages. Once thought benign, the deleterious clinical consequences of calcific vasculopathy are now becoming clear; stroke, amputation, ischemic heart disease, and increased mortality are portended by the anatomy and extent of calcific vasculopathy. Along with dystrophic calcium deposition in dying cells and lipoprotein deposits, active endochondral and intramembranous (nonendochondral) ossification processes contribute to vascular calcium load. Thus vascular calcification is subject to regulation by osteotropic hormones and skeletal morphogens in addition to key inhibitors of passive tissue mineralization. In response to oxidized lipids, inflammation, and mechanical injury, the microvascular smooth muscle cell becomes activated. Orthotopically, proliferating stromal myofibroblasts provide osteoprogenitors for skeletal growth and fracture repair; however, in valves and arteries, vascular myofibroblasts contribute to cardiovascular ossification. Current data suggest that paracrine signals are provided by bone morphogenetic protein-2, Wnts, parathyroid hormone-related polypeptide, osteopontin, osteoprotegerin, and matrix Gla protein, all entrained to endocrine, metabolic, inflammatory, and mechanical cues. In end-stage renal disease, a "perfect storm" of vascular calcification often occurs, with hyperglycemia, hyperphosphatemia, hypercholesterolemia, hypertension, parathyroid hormone resistance, and iatrogenic calcitriol excess contributing to severe calcific vasculopathy. This brief review recounts emerging themes in the pathobiology of vascular calcification and highlights some fundamental deficiencies in our understanding of vascular endocrinology and metabolism that are immediately relevant to human health and health care.     

Evaluating the viscoelastic properties of biological tissues in a new way

In this paper, a new method for evaluating the viscoelastic properties of biological tissues such as tendons and ligaments is presented. This method obtains the complex modulus of these tissues to characterize their viscoelastic properties. With this method, the stresses and strains measured in time are first transformed (using FFT), and the complex modulus is then obtained. The complex modulus contains sufficient information about the viscoelastic characteristics of the biological tissues. With this method, the mechanical properties of biological tissues can be measured without making apriori assumptions regarding their structures, and the measurements can be made in real time.     

A stereophotogrammetric method for measurements of ligament structure

A stereophotogrammetric method is presented to reconstruct the course of a curve in the three-dimensional space. This method is exclusively suitable as a non-destructive tool to determine the surface fiberstructure of ligaments, tendons and other organised collagenous structures. In addition, it is a convenient tool to measure the geometry of articular surfaces and other complicated surface shapes.     

Cell orientation determines the alignment of cell-produced collagenous matrix

In healing ligaments and tendons, the cells are not aligned and collagen matrix is not organized as in normal tissues. In addition, the mechanical properties of the tissues are abnormal. We hypothesized that the lack of alignment of the collagen matrix results from random orientation of the cells seen in the healing area. To test this hypothesis, a novel in vitro model was used in which the orientation of cells could be controlled via microgrooves, and alignment of the collagen matrix formed by these cells could be easily observed. It is known that cells align uniformly along the direction of microgrooves; therefore MC3T3-E1 cells, which produce large amounts of collagen, were grown on silicone membranes with parallel microgrooves (10 microm wide x 3 microm deep) in the surface. As a control, the same cells were also grown on smooth silicone membranes. Cells on both the microgrooved and smooth silicone surfaces produced a layer of readily visible collagen matrix. Immunohistochemical staining showed that the matrix consisted of abundant type I collagen. Polarized light microscopy of the collagen matrix revealed the collagen fibers to be parallel to the direction of the microgrooves, whereas the collagen matrix produced by the randomly oriented cells on the smooth membranes was disorganized. Thus, the results of this study suggest that the orientation of cells affects the organization of the collagenous matrix produced by the cells. The results also suggest that orienting cells along the longitudinal direction of healing ligaments and tendons may lead to the production of aligned collagenous matrix that more closely represents the uninjured state. This may enhance the mechanical properties of healing ligaments and tendons.     

Quantitative Susceptibility Mapping Differentiates between Blood Depositions and Calcifications in Patients with Glioblastoma

Objectives

The application of susceptibility weighted imaging (SWI) in brain tumor imaging is mainly used to assess tumor-related “susceptibility based signals” (SBS). The origin of SBS in glioblastoma is still unknown, potentially representing calcifications or blood depositions. Reliable differentiation between both entities may be important to evaluate treatment response and to identify glioblastoma with oligodendroglial components that are supposed to present calcifications. Since calcifications and blood deposits are difficult to differentiate using conventional MRI, we investigated whether a new post-processing approach, quantitative susceptibility mapping (QSM), is able to distinguish between both entities reliably.

Materials and Methods

SWI, FLAIR, and T1-w images were acquired from 46 patients with glioblastoma (14 newly diagnosed, 24 treated with radiochemotherapy, 8 treated with radiochemotherapy and additional anti-angiogenic medication). Susceptibility maps were calculated from SWI data. All glioblastoma were evaluated for the appearance of hypointense or hyperintense correlates of SBS on the susceptibility maps.

Results

43 of 46 glioblastoma presented only hyperintense intratumoral SBS on susceptibility maps, indicating blood deposits. Additional hypointense correlates of tumor-related SBS on susceptibility maps, indicating calcification, were identified in 2 patients being treated with radiochemotherapy and in one patient being treated with additional anti-angiogenic medication. Histopathologic reports revealed an oligodendroglial component in one patient that presented calcifications on susceptibility maps.

Conclusions

QSM provides a quantitative, local MRI contrast, which reliably differentiates between blood deposits and calcifications. Thus, quantitative susceptibility mapping appears promising to identify rare variants of glioblastoma with oligodendroglial components non-invasively and may allow monitoring the role of calcification in the context of different therapy regimes.     

The foot as a shock absorber

A mathematical analysis of the deformation of the foot is developed to determine the role that stretch of ligaments and tendons plays in absorbing shock following impact. Our analysis is based on an anatomical biomechanical model that includes each of the bones of the foot. We calculate the time course of the deflection of the joints and the elongation of the ligaments and tendons and determine the ground reaction force acting on the heel. Quasi-linear viscoelastic theory is used for soft tissue constitutive relationships. With biomechanical data selected from the literature, we obtain a vertical force impact peak of 8000 N, occurring at 16 ms following heel strike. This is of higher magnitude and shorter duration than is found experimentally, as is to be expected, since we did not include the heel pad in our model and we assumed that the impact surface was ideally rigid.     

Macroscopic and microscopic anatomy of the shoulder joint and the limbus glenoidalis

Macroscopical and histological examinations were carried out in order to investigate the anatomy of the limbus glenoidalis, with respect to its surrounding structures such as tendons and ligaments. Basically the crosscut limbus glenoidalis has a triangular shape, however, especially in its anterior part, it has a meniscoid or labiate form. Histologically the limbus glenoidalis consists exclusively of connective tissue, rich in cells and fibers. It originates from the fibrocartilaginous rim of the glenoid surface, which merges into the hyalin cartilage. The bundles of fibers have a circular arrangement with radially and reticularly interwoven structures near the tendons of the biceps and triceps muscle.