Neonatal enthesis healing involves non-inflammatory formation of acellular scar through ECM secretion by resident cells

Wound healing is a well-orchestrated process that typically recruits the immune and vascular systems to restore the structure and function of the injured tissue. Injuries to the enthesis, a hypocellular and avascular tissue, often result in fibrotic scar formation and loss of mechanical properties, thereby severely affecting musculoskeletal function and life quality. This raises questions about the healing capabilities of the enthesis. Here, we established an injury model to the Achilles entheses of neonatal mice to study the possibility that at an early age, the enthesis can heal more effectively. Histology and immunohistochemistry analyses revealed an atypical process that did not involve inflammation or angiogenesis. Instead, neonatal enthesis healing was mediated by secretion of collagen types I and II by resident cells, which formed a permanent hypocellular and avascular scar. Transmission electron microscopy showed that the cellular response to injury, including ER stress, autophagy and cell death, varied between the tendon and cartilage ends of the enthesis. Single-molecule in situ hybridization, immunostaining, and TUNEL assays verified these differences. Finally, gait analysis showed that these processes effectively restored function of the injured leg. Collectively, these findings reveal a novel healing mechanism in neonatal entheses, whereby local ECM secretion by resident cells forms an acellular ECM deposit in the absence of inflammation markers, allowing gait restoration. These insights into the healing mechanism of a complex transitional tissue may lead to new therapeutic strategies for adult enthesis injuries.

Treatment of Unstable Injury of Pelvic Bones in Pregnant (Case Report)

Summary. There is no doubt in the relevance of the problem of treatment of patients with unstable fractures of pelvic bones, since these injuries involve a threat to the patient's life in the early period and often lead to disability in the future. This article presents a rare case of treatment of a patient with an unstable pelvis injury, while being 16 weeks pregnant. Patient A., born 1993, was admitted after a road accident injury. The examinations included: X-ray, CT, ultrasound, and gynecologist consultation. The patient was diagnosed with closed bilateral fracture of the pubic and ischial bones with displacement; rupture of the left sacroiliac joint with the boundary fracture of the sacrum (61-С1.3 by the Tile-AO-ASIF classification). The patient was 16 weeks pregnant. The surgery – open reduction and extramedullary metalosteosynthesis – was performed at the 9th day after the injury. The patient was discharged to outpatient treatment at the 12th day after the surgery. She started walking on crutches 3 weeks after the surgery; no additional support was needed since 1.5 months after the surgery. The patient gave birth at 39 weeks by surgical intervention (caesarean section). The baby's condition was assessed as 8 according to the Apgar scale. At the control examination 10 months after the surgery, musculoskeletal function of the patient was fully restored.

A nem denaturált 2-es típusú kollagén hatása az arthrosisra

Összefoglaló. Az arthrosis az ízületeket alkotó porc, csont és a környező lágy részek leépülésével járó betegség. A betegség jelentős fájdalommal jár, progresszív, az ízület strukturális átalakulását és ennek következtében jelentős funkcióvesztést és életminőség-romlást okoz. Kialakulásában immunológiai gyulladásos folyamatok is szerepet játszanak, amelyek befolyásolása lehetőséget ad nemcsak tüneti kezelésre, hanem betegségmódosító terápia kialakítására is. A nem denaturált 2-es típusú kollagén oralis alkalmazása szisztémás toleranciát hoz létre, ami a proinflammatoricus folyamatok gátlása és az antiinflammatoricus hatások erősítése révén új lehetőség az immunmodulációra. A klinikai vizsgálatok a betegeknél a fájdalom jelentős csökkenéséről, a mozgásszervek funkciójának javulásáról számolnak be, és a kezelés egészséges ízületben is nyújthat védelmet a mechanikus stressz okozta ízületi károsodással szemben. Orv Hetil. 2021; 162(37): 1481–1484. Summary. Osteoarthritis is a disease of the cartilage, bone and surrounding soft tissues that make up the joints. The disease is associated with significant pain, it is progressive, causing structural transformation of the joint and, as a result, significant loss of function and deterioration in the quality of life. Immunological inflammatory processes also play a role in its development, the influence of which allows not only symptomatic treatment, but also the development of disease-modifying therapy. Oral administration of undenatured type II collagen creates systemic tolerance, which is a new opportunity for immunomodulation by inhibiting proinflammatory processes and enhancing anti-inflammatory effects. Clinical trials have reported significant reduction in pain, improved musculoskeletal function in patients, and the therapy may provide protection against joint damage caused by mechanical stress in healthy joints. Orv Hetil. 2021; 162(37): 1481–1484.

Effects of Exergames and Protein Supplementation on Body Composition and Musculoskeletal Function of Prefrail Community-Dwelling Older Women: A Randomized, Controlled Clinical Trial

This study aimed to investigate the effects of exergames and protein supplementation on the body composition and musculoskeletal function of pre-frail older women. Methods: A randomized controlled clinical trial was conducted with 90 pre-frail older women (71.2 ± 4.5 years old) divided into five groups: control (CG); exergames training (ETG); protein supplementation (PSG); exergames combined with protein supplementation (ETPSG); exergames combined with isoenergetic supplementation (ETISG). The primary outcomes were pre-frailty status, body composition (appendicular muscle mass (ASM); appendicular muscle mass index (ASMI)) assessed by dual energy X-ray absorptiometry and gastrocnemius muscle architecture via ultrasound. Secondary outcomes were protein intake, plasma levels of interleukin (IL)-6, plantar and dorsiflexion isokinetic peak torque, and handgrip strength (HS). Data were analyzed using an ANOVA mixed model test and Bonferroni post hoc test (p < 0.05). The ETG showed a reduction of ASM (16.7 ± 3.4 vs. 16.1 ± 3.3 kg; Δ = −0.5; p = 0.02; d = 0.26) and ASMI (6.8 ± 0.9 vs. 6.5 ± 0.9 kg; Δ = −0.2; p = 0.03; d = 0.35), without changing ASM in other groups. The average protein intake in the supplemented groups (PSG and ETPSG) was 1.1 ± 0.2 g/kg/day. The dorsiflexion peak torque increased 11.4% in ETPSG (16.3 ± 2.5 vs. 18.4 ± 4.2 Nm; p = 0.021; d = −0.58). The HS increased by 13.7% in ETG (20.1 ± 7.2 vs. 23.3 ± 6.2 kg, Δ = 3.2 ± 4.9, p = 0.004, d = −0.48). The fatigue/exhaustion reduced by 100% in ETG, 75% in PSG, and 100% in ETPSG. Physical training with exergames associated with protein supplementation reversed pre-frailty status, improved the ankle dorsiflexors torque, and ameliorated fatigue/exhaustion in pre-frail older women.

Impact of Weight Carriage on Joint Kinematics in Asian Elephants Used for Riding

Background: Elephants in Thailand have changed their roles from working in the logging industry to tourism over the past two decades. In 2020, there were approximately 2700 captive elephants participating in activities such as riding and trekking. During work hours, riding elephants carry one or two people in a saddle on the back with a mahout on the neck several hours a day and over varying terrain. A concern is that this form of riding can cause serious injuries to the musculoskeletal system, although to date there have been no empirical studies to determine the influence of weight carriage on kinematics in elephants. Methods: Eight Asian elephants from a camp in Chiang Mai Province, Thailand, aged between 21 and 41 years with a mean body mass of 3265 ± 140.2 kg, were evaluated under two conditions: walking at a normal speed without a saddle and with a 15% body mass load (saddle and two persons plus additional weights). Gait kinematics, including the maximal angles of fore- and hindlimb joints, were determined using a novel three-dimensional inertial measurement system with wireless sensors. Results: There were no statistical differences between movement angles and a range of motion of the fore- and hindlimbs, when an additional 15% of body mass was added. Conclusion: There is no evidence that carrying a 15% body mass load causes significant changes in elephant gait patterns. Thus, carrying two people in a saddle may have minimal effects on musculoskeletal function. More studies are needed to further test longer durations of riding on different types of terrain to develop appropriate working guidelines for captive elephants. Nevertheless, elephants appear capable of carrying significant amounts of weight on the back without showing signs of physical distress.

Musculoskeletal Adaptation of Young and Older Adults in Response to Environmental, Physical, and Cognitive Conditions

Accidental falls present a large functional and financial burden among people aged 65 years and older. Falls, injuries associated with falls, and the fear of falling decrease quality of life, physical function, and independence for older adults. To prevent falls, improve stability, and protect joints from damage or injury, the typical response to "challenging" conditions include cautious gait, increase muscle co-contraction, and decreased range of motion. These compensatory strategies are more pronounced in the older adult population with apprehensive "cautious" gait at slower speeds, decreased knee flexion, and increased muscle activation around the knee and ankle. The underlying mechanisms and driving forces behind accidental falls are not well investigated. Additionally, the effects of aging on the ability of the musculoskeletal system to adapt to changing and challenging conditions is poorly understood. There exists a gap in knowledge regarding the relationship between accidental fall risk factors, knee joint stability, adaptation mechanisms, and whole-body function. Establishing these relationships between stability and musculoskeletal adaptation may have far reaching implications on improving whole-body function through targeted joint- and muscle-level interventions. The purpose of this study was to compare neuromechanics (whole-body function) of young and older adults walking across various external challenging conditions, quantifying adaptation strategies for both cohorts. This was accomplished through two objectives. In the first objective, joint kinematics, ground reaction force loading and impulse, and lower-limb muscle activation strategies for ten young and ten older adults walking on normal, slick, and uneven surfaces were compared to assess how musculoskeletal adaptation strategies change with age. For the second objective, a pipeline to create subject-specific lower-limb finite element models was developed to investigate joint-level behavior across cohorts. Proof-of-concept for the model development and analysis process was demonstrated for an older and a young adult to implement a novel metric for functional stability and dynamic laxity of the knee joint during the stance phase of gait. Kinematic, force, and muscle activation analysis showed that an uneven surface reduced sagittal joint kinematics during the first 25% of stance, indicating a surface-specific compensatory strategy. Additionally, older adults tended to prepare for and step onto the uneven surfaces in a more conservative manner with joints more flexed or bent. This anticipatory or cautious musculoskeletal adaptation of older adults was also seen in reduced magnitude of initial vertical loading during the loading response of stance (0-25% stance). Results of this research study provide insight into the differences that exist in joint stiffening and other musculoskeletal adaption strategies for young and older adults during external challenging conditions. Specifically, understanding the relationships between joint-level stability and whole-body musculoskeletal function has the potential to inform targeted muscle training programs and joint-level interventions to improve whole-body musculoskeletal function and reduce risk of injuries.

Fascia Mobility, Proprioception, and Myofascial Pain

The network of fasciae is an important part of the musculoskeletal system that is often overlooked. Fascia mobility, especially along shear planes separating muscles, is critical for musculoskeletal function and may play an important, but little studied, role in proprioception. Fasciae, especially the deep epimysium and aponeuroses, have recently been recognized as highly innervated with small diameter fibers that can transmit nociceptive signals, especially in the presence of inflammation. Patients with connective tissue hyper- and hypo-mobility disorders suffer in large number from musculoskeletal pain, and many have abnormal proprioception. The relationships among fascia mobility, proprioception, and myofascial pain are largely unstudied, but a better understanding of these areas could result in improved care for many patients with musculoskeletal pain.

Effects of Quercetin and Coenzyme Q10 on Biochemical, Molecular, and Morphological Parameters of Skeletal Muscle in Trained Diabetic Rats

Background: Diabetes mellitus (DM) affects the musculoskeletal system through its metabolic perturbations. Exercise modulates blood sugar levels and increases the body’s sensitivity to insulin in patients with DM. Objective: This study aimed to investigate the potential effects of combined quercetin and coenzyme Q10 (CoQ10) supplements with or without exercise on the histological, biochemical and molecular structures of diabetic rat’s skeletal muscle. Method: A total of 64 adult male albino rats were divided into six groups: control, trained nondiabetic, non-trained diabetic, diabetic rats treated with combined CoQ10 and quercetin, diabetic rats with treadmill training, and diabetic rats treated with treadmill training and CoQ10 and quercetin. Blood and skeletal muscle samples were obtained from all groups for routine histological examination and biochemical determination of cytokine levels and protein activities. Quantitative real-time polymerase chain reaction (qRT-PCR) and morphometric analysis of PAS and Bax expressions were also performed. Results: Biochemical analysis revealed improvement in all studied parameters with combined CoQ10 and quercetin than exercise training alone. Combined treatment and exercise showed significant improvement in all parameters especially interleukin 6 and malondialdehyde. Fibronectin type III domain-containing protein 5 (FNDC5) expression and irisin levels increased in all trained groups but combined treatment with exercise significantly increased their levels than exercise alone. Histological analysis revealed improvement after exercise or combined treatment; however, when exercise was combined with CoQ10 and quercetin, marked improvement was observed. Conclusion: the combination of CoQ10 and quercetin could be promising in preserving musculoskeletal function in patients with DM concomitantly with physical exercise.