The effectiveness of cast wedging for the treatment of pediatric fractures.

We present the results of cast wedging for correction of alignment during the closed treatment of tibial and radial shaft fractures in children. We retrospectively reviewed the radiographic and clinical outcome of 249 cast wedges performed after reangulation of a previously manipulated tibial or radial shaft fracture. A mean improvement of close to 5 in coronal alignment was observed.

IL-32 is a molecular marker of a host defense network in human tuberculosis.

Tuberculosis is a leading cause of infectious disease-related death worldwide; however, only 10% of people infected with Mycobacterium tuberculosis develop disease. Factors that contribute to protection could prove to be promising targets for M. tuberculosis therapies.

Vitamin D supplementation and antibacterial immune responses in adolescents and young adults with HIV/AIDS.

Human monocytes activated by toll-like receptor 2/1 ligand (TLR2/1L) show enhanced expression of the vitamin D receptor (VDR) and the vitamin D-activating enzyme 1α-hydroxylase (CYP27B1). The resulting intracrine conversion of precursor 25-hydroxyvitamin D3 (25OHD) to active 1,25-dihydroxyvitamin D (1,25(OH)2D) can stimulate expression of antibacterial cathelicidin (CAMP). To determine whether this response is functional in HIV-infected subjects (HIV+ ), serum from HIV+ subjects pre- and post-vitamin D supplementation was utilized in monocyte cultures with or without TLR2/1L.

Elbow dislocation with an associated lateral condyle fracture of the humerus: a rare occurrence in the pediatric population.

Background: In the pediatric population, reports of a concomitant lateral condyle fracture (LCF) of the humerus and an elbow dislocation are rare.

Methods: From 2007 to 2013, we identified a group of 12 children who presented to our institution with a concomitant LCF and an elbow dislocation. This subset of fractures (group 1), all of which were managed surgically, is the subject of the present report.

GATA4 is essential for bone mineralization via ERα and TGFβ/BMP pathways.

Osteoporosis is a disease characterized by low bone mass, leading to an increased risk of fragility fractures. GATA4 is a zinc-finger transcription factor that is important in several tissues, such as the heart and intestines, and has recently been shown to be a pioneer factor for estrogen receptor alpha (ERα) in osteoblast-like cells. Herein, we demonstrate that GATA4 is necessary for estrogen-mediated transcription and estrogen-independent mineralization in vitro.

Combination prophylactic therapy with rifampin increases efficacy against an experimental Staphylococcus epidermidis subcutaneous implant-related infection.

The incidence of infections related to cardiac devices (such as permanent pacemakers) has been increasing out of proportion to implantation rates. As management of device infections typically requires explantation of the device, optimal prophylactic strategies are needed. Cefazolin and vancomycin are widely used as single agents for surgical prophylaxis against cardiac device-related infections.

Suppression of iron-regulatory hepcidin by vitamin D.

The antibacterial protein hepcidin regulates the absorption, tissue distribution, and extracellular concentration of iron by suppressing ferroportin-mediated export of cellular iron. In CKD, elevated hepcidin and vitamin D deficiency are associated with anemia. Therefore, we explored a possible role for vitamin D in iron homeostasis.

Is medial pin use safe for treating pediatric supracondylar humerus fractures?

Objectives: We present a group of pediatric supracondylar humerus fractures in whom a medial pin was inserted, in addition to lateral-entry pins, and compared it with a group that was treated with lateral-only entry pins. We evaluated differences in the rate of complications related to the insertion of the medial pin.

Design: Prospective nonrandomized.

Report of the CCFA pediatric bone, growth and muscle health workshop, New York City, November 11-12, 2011, with updates.

Growth retardation, delayed puberty, decreased bone mass, altered bone architecture, hypovitaminosis D and skeletal muscle mass deficits are common in children with inflammatory bowel diseases. The Crohn's and Colitis Foundation of America sponsored a multidisciplinary workshop on the subject of Bone and Skeletal Growth in Pediatric IBD, held in New York City in November 2011. The topic of the workshop was a key recommendation of the Foundation's Pediatric Challenges meeting in 2005.

Identification of perivascular mesenchymal stromal/stem cells by flow cytometry.

Mesenchymal stem/stromal cells (MSCs) are adult multipotent progenitors of great promise for cell therapy. MSCs can mediate tissue regeneration, immunomodulation, and hematopoiesis support. Despite the unique properties of MSCs and their broad range of potential clinical applications, the very nature of these cells has been uncertain.

Ankle fusion in patients with haemophilia.

Ankle fusion in patients with haemophilia is a well-accepted treatment for end-stage arthropathy. However, current published outcome data are based on small sample sizes and generally short-term follow-up. The aim of this study was to evaluate the long-term results of ankle fusion in a large group of haemophilic patients treated at a single institution.

Structural and functional studies of γ-carboxyglutamic acid domains of factor VIIa and activated Protein C: role of magnesium at physiological calcium.

Crystal structures of factor (F) VIIa/soluble tissue factor (TF), obtained under high Mg(2+) (50mM Mg(2+)/5mM Ca(2+)), have three of seven Ca(2+) sites in the γ-carboxyglutamic acid (Gla) domain replaced by Mg(2+) at positions 1, 4, and 7. We now report structures under low Mg(2+) (2.5mM Mg(2+)/5mM Ca(2+)) as well as under high Ca(2+) (5mM Mg(2+)/45 mM Ca(2+)).

Redefining Human Vitamin D Sufficiency: Back to the Basics.

The role of the endocrine vitamin D pathway in regulating the serum calcium concentration in man is well described. In the presence of a low serum calcium level, the vitamin D metabolic pathway is called upon to produce more of the active vitamin D hormone, 1, 25-dihydroxyvitamin D (1, 25-D), via up-regulation of the CYP27b1-hydroxylase activity in the kidney. The consequence is mobilization of skeletal calcium stores to return the circulating calcium level back to the normal range.

Treatment of idiopathic clubfoot: experience with the Mitchell-Ponseti brace.

Objective: The Mitchell-Ponseti (MP) foot abduction orthosis was introduced to provide a more user-friendly alternative to the traditional Denis-Browne (DB) brace in the treatment of idiopathic clubfoot. We describe our experience with the effectiveness of the MP brace to maintain correction of clubfeet corrected using the Ponseti method.

Methods: We evaluated 57 consecutive infants with 84 idiopathic clubfeet who were treated using the Ponseti method.

Type II supracondylar humerus fractures: can some be treated nonoperatively?

Background: The range of injury severity that can be seen within the category of type II supracondylar humerus fractures (SCHFs) raises the question whether some could be treated nonoperatively. However, the clinical difficulty in using this approach lies in determining which type II SCHFs can be managed successfully without a surgical intervention.

Methods: We reviewed clinical and radiographic information on 259 pediatric type II SCHFs that were enrolled in a prospective registry of elbow fractures.

Fibroblast growth factor 23 inhibits extrarenal synthesis of 1,25-dihydroxyvitamin D in human monocytes.

Vitamin D is a potent stimulator of monocyte innate immunity, and this effect is mediated via intracrine conversion of 25-hydroxyvitamin D (25OHD) to 1,25-dihydroxyvitamin D (1,25(OH)(2) D). In the kidney, synthesis of 1,25(OH)(2) D is suppressed by fibroblast growth factor 23 (FGF23), via transcriptional suppression of the vitamin D-activating enzyme 1α-hydroxylase (CYP27B1). We hypothesized that FGF23 also suppresses CYP27B1 in monocytes, with concomitant effects on intracrine responses to 1,25(OH)(2) D.

Factors associated with kyphosis progression in older women: 15 years' experience in the study of osteoporotic fractures.

Age-related hyperkyphosis is thought to be a result of underlying vertebral fractures, but studies suggest that among the most hyperkyphotic women, only one in three have underlying radiographic vertebral fractures. Although commonly observed, there is no widely accepted definition of hyperkyphosis in older persons, and other than vertebral fracture, no major causes have been identified. To identify important correlates of kyphosis and risk factors for its progression over time, we conducted a 15-year retrospective cohort study of 1196 women, aged 65 years and older at baseline (1986 to 1988), from four communities across the United States: Baltimore County, MD; Minneapolis, MN; Portland, OR; and the Monongahela Valley, PA.

Opinions on radiosynovectomy for chronic haemophilic synovitis: point/counterpoint.

Joint bleeding is the hallmark of severe haemophilia and the major cause of disability in patients with this coagulopathy. Repeated bleeding into the same joint can lead to chronic synovitis and progressive arthropathy. Radiosynovectomy is one option for the treatment of chronic haemophilic synovitis, but concerns about the risks of exposure to ionizing radiation have divided clinicians as to the safety and appropriate use of the procedure.

The current management of idiopathic clubfoot revisited: results of a survey of the POSNA membership.

Background: In 2001, the members of the Pediatric Orthopaedic Society of North America (POSNA) were surveyed regarding their approach to treating idiopathic clubfoot deformity. Since that time, several studies have advocated a change in the approach to treating this deformity, moving away from surgical release and toward less invasive methods. The purpose of this study was to assess the recent approach to treating clubfoot among the POSNA membership.

Lateral spurring (overgrowth) after pediatric lateral condyle fractures.

Background: Bony overgrowth over the lateral condyle, or "lateral spurring," is commonly identified after lateral condyle fractures of the humerus in children. Despite its frequent recognition, no prior study has defined the phenomenon, established an incidence rate, explored a correlation with any fracture or treatment characteristics, nor assessed whether it is of functional significance.

Methods: We retrospectively analyzed information on 212 consecutive lateral condyle fractures in children.

Structural biology of factor VIIa/tissue factor initiated coagulation.

Factor VII (FVII) consists of an N-terminal gamma-carboxyglutamic acid domain followed by two epidermal growth factor-like (EGF1 and EGF2) domains and the C-terminal protease domain. Activation of FVII results in a two-chain FVIIa molecule consisting of a light chain (Gla-EGF1-EGF2 domains) and a heavy chain (protease domain) held together by a single disulfide bond. During coagulation, the complex of tissue factor (TF, a transmembrane glycoprotein) and FVIIa activates factor IX (FIX) and factor X (FX).

New perspectives on the vitamin D binding protein.

The serum vitamin D binding protein (DBP), also known as GC-globulin, is a multifunctional protein known for its role in the transport of vitamin D metabolites. DBP also binds fatty acids and actin monomers, preventing their polymerization that could be detrimental in the circulatory system. DBP may have immune functions independent of its role as a transporter of vitamin D.

Extrarenal expression of the 25-hydroxyvitamin D-1-hydroxylase.

Like the vitamin D receptor (VDR), the CYP27B1-hydroxylase is expressed widely in human tissues. This expression profile establishes the potential for interaction of the VDR with the product of the CYP27B1, 1,25-dihydroxyvitamin D (1,25-(OH)(2)D), in either an intracrine or paracrine mode. This expansive expression profile also suggests that the local production and action of 1,25-(OH)(2)D to regulate VDR-directed gene expression may be similarly wide-ranging and distinct from what occurs in the kidney; the proximal renal tubular epithelial cell is the richest source of the CYP27B1 and the site for production of 1,25-(OH)(2)D destined to function as a hormone.

The osteon: the micromechanical unit of compact bone.

The research techniques available for investigation of secondary osteons in human bone enable establishment of their biological composition and quantification of their mechanical properties. Further, the data generated through current research techniques facilitate studies on the significance of osteons in normal and pathological conditions, including via multi-scale modeling conducted with a view of building realistic models of virtual bone, suitable for applications from orthopaedic challenges to endocrine disorders. The understanding of the biomechanical function of the osteon requires clarification of the molecular-cellular processes that form, maintain and remodel the osteon and affect the mechanical function.

Parathyroid hormone treatment improves the cortical bone microstructure by improving the distribution of type I collagen in postmenopausal women with osteoporosis.

Although an important index, the level of bone mineral density (BMD) does not completely describe fracture risk. Another bone structural parameter, the orientation of type I collagen, is known to add to risk determination, independently of BMD, ex vivo. We investigated the Haversian system of transiliac crest biopsies from postmenopausal women before and after treatment with parathyroid hormone (PTH).