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Sökning: WFRF:(Ohlin Acke)

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  • Andersson, Martin K., et al. (författare)
  • Effects on osteoclast and osteoblast activities in cultured mouse calvarial bones by synovial fluids from patients with a loose joint prosthesis and from osteoarthritis patients.
  • 2007
  • Ingår i: Arthritis research & therapy. - 1478-6362. ; 9:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Aseptic loosening of a joint prosthesis is associated with remodelling of bone tissue in the vicinity of the prosthesis. In the present study, we investigated the effects of synovial fluid ( SF) from patients with a loose prosthetic component and periprosthetic osteolysis on osteoclast and osteoblast activities in vitro and made comparisons with the effects of SF from patients with osteoarthritis (OA). Bone resorption was assessed by the release of calcium 45 (Ca-45) from cultured calvariae. The mRNA expression in calvarial bones of molecules known to be involved in osteoclast and osteoblast differentiation was assessed using semi-quantitative reverse transcriptionpolymerase chain reaction (PCR) and real-time PCR. SFs from patients with a loose joint prosthesis and patients with OA, but not SFs from healthy subjects, significantly enhanced Ca-45 release, effects associated with increased mRNA expression of calcitonin receptor and tartrate-resistant acid phosphatase. The mRNA expression of receptor activator of nuclear factor-kappaB ligand (rankl) and osteoprotegerin (opg) was enhanced by SFs from both patient categories. The mRNA expressions of nfat2 ( nuclear factor of activated T cells 2) and oscar (osteoclast-associated receptor) were enhanced only by SFs from patients with OA, whereas the mRNA expressions of dap12 (DNAX-activating protein 12) and fcr. (Fc receptor common gamma subunit) were not affected by either of the two SF types. Bone resorption induced by SFs was inhibited by addition of OPG. Antibodies neutralising interleukin (IL)-1 alpha, IL-1 beta, soluble IL-6 receptor, IL-17, or tumour necrosis factor-alpha, when added to individual SFs, only occasionally decreased the bone-resorbing activity. The mRNA expression of alkaline phosphatase and osteocalcin was increased by SFs from patients with OA, whereas only osteocalcin mRNA was increased by SFs from patients with a loose prosthesis. Our findings demonstrate the presence of a factor ( or factors) stimulating both osteoclast and osteoblast activities in SFs from patients with a loose joint prosthesis and periprosthetic osteolysis as well as in SFs from patients with OA. SF-induced bone resorption was dependent on activation of the RANKL/ RANK/OPG pathway. The bone-resorbing activity could not be attributed solely to any of the known pro-inflammatory cytokines, well known to stimulate bone resorption, or to RANKL or prostaglandin E-2 in SFs. The data indicate that SFs from patients with a loose prosthesis or with OA stimulate bone resorption and that SFs from patients with OA are more prone to enhance bone formation.
  • Fritzell, Peter, et al. (författare)
  • Cost-Effectiveness of Balloon Kyphoplasty Versus Standard Medical Treatment in Patients With Osteoporotic Vertebral Compression Fracture
  • 2011
  • Ingår i: Spine. - Lippincott Williams & Wilkins. - 0362-2436. ; 36:26, s. 2243-2251
  • Tidskriftsartikel (refereegranskat)abstract
    • Study Design. A multicenter, randomized, controlled, cost-effectiveness analysis. Objective. To assess the cost-effectiveness of balloon kyphoplasty (BKP) compared with standard medical treatment (control) in patients with acute/subacute (<3 months) vertebral compression fracture (VCF) due to osteoporosis. Summary of Background Data. Patients with a VCF due to osteoporosis are common and will increase in number in an aging population, putting a substantial strain on health care. Selected patients may benefit from stabilizing the fracture with cement through BKP, a minimally invasive procedure. BKP has been reported to give good short-time clinical results, and economic modeling has suggested that the procedure could be cost-effective after 2 years compared with standard treatment. Methods. Hospitalized patients with back pain due to VCF were randomized to BKP or to control using a computer-generated random list. All costs associated with VCF and cost-effectiveness were reported primarily from the perspective of society. We used EQ-5D to assess quality of life (QoL). The accumulated quality-adjusted life years (QALYs) gained and costs/QALY gained were assessed using intention to treat. Results. Between February 2003 and December 2005, a total of 63 out of 67 Swedish patients were analyzed: BKP (n = 32) and control (n = 31). Societal cost per patient for BKP was SEK 160,017 (SD = 151,083) = (sic)16,668 (SD = 15,735), and for control SEK 84,816 (SD = - 40,954) = (sic) 8835 (SD = 4266), a significant difference of 75,198 (95% confidence intervals [CI] = 16,037-120,104) = (sic)7833 (95% CI = 1671-12,511). The accumulated difference in QALYs was 0.085 (95% CI = -0.132 to 0.306) in favor of BKP. Cost/QALY gained using BKP was SEK 884,682 = (sic)92,154 and US (sic)134,043. Conclusion. In this randomized controlled trial, it was not possible to demonstrate that BKP was cost-effective compared with standard medical treatment in patients treated for an acute/subacute vertebral fracture due to osteoporosis. However, sensitivity analysis indicated a certain degree of uncertainty, which needs to be considered.
  • Gerdhem, P., et al. (författare)
  • Serum level of cartilage oligomeric matrix protein is lower in children with idiopathic scoliosis than in non-scoliotic controls
  • 2015
  • Ingår i: European Spine Journal. - Springer. - 0940-6719. ; 24:2, s. 256-261
  • Tidskriftsartikel (refereegranskat)abstract
    • The etiology of idiopathic scoliosis remains unknown, but growth is a risk factor for progression. Growth pattern differs in children with and without scoliosis. Cartilage oligomeric matrix protein (COMP) may be associated with scoliosis and growth. We, therefore, studied COMP in children with and without idiopathic scoliosis. We included 105 children, with mean age 14.4 years (range 10-16), under observation or treatment for idiopathic scoliosis, and 103 children from an age-matched population-based cohort. COMP was measured in serum at the time of inclusion. Growth velocity was estimated from repeated height measurements. T tests, analysis of covariance or linear regression were used for statistical comparisons. COMP was mean (SD) 11 (5) units/liter (U/L) in children with scoliosis and 13 (5) U/L in the control cohort (p = 0.005, adjusted for sex and sampling time of the day). When patients and controls were analyzed together, high COMP was correlated with high growth velocity (beta = 0.19, p = 0.003). When patients and controls were analyzed separately, COMP was correlated with growth velocity in children with scoliosis (beta = 0.27, p = 0.007), but not in children without scoliosis (beta = 0.02, p = 0.83) (all analyses adjusted for age, sex and sampling time). Low COMP was significantly correlated with large curve size in children with scoliosis (beta = -0.29, p = 0.003), but not after adjustment for age, sex and sampling time (beta = -0.16; p = 0.14). COMP was lower in children with idiopathic scoliosis than in a control cohort. In children with scoliosis, high COMP was modestly correlated with high growth velocity, but not with curve severity.
  • Grauers, Anna, et al. (författare)
  • Candidate gene analysis and exome sequencing confirm LBX1 as a susceptibility gene for Idiopathic Scoliosis.
  • 2015
  • Ingår i: The Spine Journal. - Elsevier. - 1878-1632. ; 15:10, s. 2239-2246
  • Tidskriftsartikel (refereegranskat)abstract
    • Idiopathic Scoliosis is a spinal deformity affecting approximately 3% of otherwise healthy children or adolescents. The etiology is still largely unknown but has an important genetic component. Genome-wide association studies (GWAS) have identified a number of common genetic variants that are significantly associated with idiopathic scoliosis in Asian and Caucasian populations, rs11190870 close to the LBX1 gene being the most replicated finding. PurposeThe aim of the present study was to investigate the genetics of idiopathic scoliosis in a Scandinavian cohort by performing a candidate gene study of four variants previously shown to be associated with idiopathic scoliosis and exome sequencing of idiopathic scoliosis patients with a severe phenotype to identify possible novel scoliosis risk variants.Study designThis was a case control study.Patient sampleA total of 1,739 patients with idiopathic scoliosis and 1,812 controls were included.Outcome measureThe outcome measure was idiopathic scoliosis.MethodsThe variants rs10510181, rs11190870, rs12946942, and rs6570507 were genotyped in 1,739 patients with idiopathic scoliosis and 1,812 controls. Exome sequencing was performed on pooled samples from 100 surgically treated idiopathic scoliosis patients. Novel or rare missense, nonsense, or splice site variants were selected for individual genotyping in the 1,739 cases and 1,812 controls. In addition, the 5′UTR, noncoding exon and promoter regions of LBX1, not covered by exome sequencing, were Sanger sequenced in the 100 pooled samples.ResultsOf the four candidate genes, an intergenic variant, rs11190870, downstream of the LBX1 gene, showed a highly significant association to idiopathic scoliosis in 1,739 cases and 1,812 controls (p=7.0×10−18). We identified 20 novel variants by exome sequencing after filtration and an initial genotyping validation. However, we could not verify any association to idiopathic scoliosis in the large cohort of 1,739 cases and 1,812 controls. We did not find any variants in the 5′UTR, noncoding exon and promoter regions of LBX1.ConclusionsHere, we confirm LBX1 as a susceptibility gene for idiopathic scoliosis in a Scandinavian population and report that we are unable to find evidence of other genes of similar or stronger effect.
  • Grauers, Anna, et al. (författare)
  • Family history and its association to curve size and treatment in 1,463 patients with idiopathic scoliosis
  • 2013
  • Ingår i: European Spine Journal. - Springer. - 0940-6719. ; 22:11, s. 2421-2426
  • Tidskriftsartikel (refereegranskat)abstract
    • To study family history in relation to curve severity, gender, age at diagnosis and treatment in idiopathic scoliosis. A self-assessment questionnaire on family history of scoliosis was administered to 1,463 untreated, brace or surgically treated idiopathic scoliosis patients. Out of the 1,463 patients, 51 % had one or more relatives with scoliosis. There was no significant difference between females and males, nor between juvenile and adolescent study participants in this respect (p = 0.939 and 0.110, respectively). There was a significant difference in maximum curve size between patients with one or more relatives with scoliosis (median 35A degrees, interquartile range 25) and patients without any relative with scoliosis (median 32A degrees, interquartile range 23) (p = 0.022). When stratifying patients according to treatment (observation, brace treatment or surgery), we found that it was more common to have a relative with scoliosis among the treated patients (p = 0.011). The OR for being treated was 1.32 (95 % CI 1.06-1.64) when the patient had a relative with scoliosis, compared to not having. Larger curve sizes were found in patients with a family history of scoliosis than in the ones without. No relation between family history and gender or between family history and age at onset of idiopathic scoliosis was found. Although the presence of a family history of scoliosis may not be a strong prognostic risk factor, it indicates that these patients are at higher risk of developing a more severe curve.
  • Abul-Kasim, Kasim, et al. (författare)
  • Curve length, curve form, and location of lower-end vertebra as a means of identifying the type of scoliosis.
  • 2010
  • Ingår i: Journal of Orthopaedic Surgery. - SAGE Publications. - 2309-4990. ; 18:1, s. 1-5
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To determine if the curve length, curve form, and location of the lower-end vertebra can identify the type of scoliosis. METHODS: Standing posteroanterior and lateral radiographs of 78 women and 27 men with scoliosis aged 8 to 32 years were retrospectively analysed. Parameters measured were (1) the curve length (the number of vertebrae in the main curve), (2) the curve form (C-form, inverted C-form, or S-form), (3) the curve apex (the vertebral body at the apex of each curve), (4) the site of the scoliosis (thoracic, thoracolumbar, or lumbar), and (5) the location of the lower-end vertebra. RESULTS: Only 3 (4%) of 77 patients with idiopathic scoliosis had a curve length of >8 vertebrae, compared with 19 (90%) of 21 patients with neuromuscular/neuropathic scoliosis (p<0.001, Fisher's exact test). 14 (18%) of the patients with idiopathic scoliosis had an S-form curve, compared with none in those with neuromuscular/neuropathic or congenital/osteogenic scoliosis (p=0.035, Fisher's exact test). No patient with idiopathic scoliosis had the lower- end vertebra located at L5, compared with 8 (38%) patients with neuromuscular scoliosis (p<0.001, Fisher's exact test). The criteria for neuromuscular/neuropathic scoliosis (a curve length of >8 vertebrae, a C-form or inverted C-form curve, and a lower-end vertebra located at L4 or L5) had 81% specificity, 76% sensitivity, 100% positive and 93% negative predictive values. CONCLUSION: These criteria may help identify patients with neuromuscular/neuropathic scoliosis for further investigation by magnetic resonance imaging or computed tomography before they undergo corrective surgery.
  • Abul-Kasim, Kasim, et al. (författare)
  • Dural ectasia in adolescent idiopathic scoliosis: quantitative assessment on magnetic resonance imaging.
  • 2010
  • Ingår i: European Spine Journal. - Springer. - 0940-6719. ; Apr 7, s. 754-759
  • Tidskriftsartikel (refereegranskat)abstract
    • To our knowledge, the assessment of dural sac diameters in patients with adolescent idiopathic scoliosis (AIS) is not reported in the literature. The aim of this study was to find out if, dural ectasia occurs more frequently among patients with AIS, to define cut-off values for dural sac ratio and test the validity of such values. A total of 126 spine MRIs (79 patients with AIS and 47 control subjects) were included in this retrospective analysis (age range 7-25 years, 62% were females). Dural sac diameter (DSD) and vertebral body diameter (VBD) were estimated and dural sac ratio (DSR = DSD/VBD) was calculated at T5 and L3. DSR at T5 and L3 were 0.69 +/- 0.12, and 0.52 +/- 0.10, respectively, in patients with AIS compared with 0.62 +/- 0.11, and 0.44 +/- 0.07, respectively, in controls (P = 0.001 at T5 and <0.001 at L3). Our estimated cut-off values for DSR were 0.84 and 0.58 at T5 and L3, respectively. This resulted in 100% sensitivity compared with 74% when using the cut-off values proposed by Oosterhof et al. No statistically significant association was found between the occurrence of dural sac enlargement in patients with AIS and the severity of scoliotic deformity, the apical vertebral rotation, epidural fat thickness, occurrence of pain, neurological deficit, atypical scoliosis or rapid curve progression. Females were affected more frequently than males. As dural sac enlargement means thinning of the pedicles, we believe that the findings of this study have important clinical implications on the preoperative workup of AIS.
  • Abul-Kasim, Kasim, et al. (författare)
  • Increased rod stiffness improves the degree of deformity correction by segmental pedicle screw fixation in adolescent idiopathic scoliosis.
  • 2011
  • Ingår i: Scoliosis. - BioMed Central (BMC). - 1748-7161. ; 6
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: There are limited reports in literature studying the impact of rod diameter and stiffness on the degree of deformity correction in patients with AIS. AIMS: The aims of this study were to evaluate the 3-dimentional deformity correction achieved by segmental pedicle screw fixation in patients with adolescent idiopathic scoliosis, and to find out if learning or the change to stiffer rods had any positive impact on deformity correction. STUDY DESIGN: Retrospective study. METHODS: Plain radiographs and low-dose spine CTs of 116 consecutive patients (aged 15.9 ± 2.8 years) operated during the period 2005-2009 (group 1: patients operated autumn 2005-2006; group 2: 2007; group 3: 2008; group 4: 2009) were retrospectively evaluated. RESULTS: There was no statistically significant difference between the correction of the Cobb angle (P = 0.425) or lower end vertebra tilt (P = 0.298) in patients operated during the first versus the remaining periods of the study. No restoration of the sagittal kyphosis was reported in the first period compared with 5.9° in the last study period (P < 0.001). The correction of vertebral rotation was also improved from 4.2° to 7.8° (P < 0.001) for the same periods. For the whole study population, there was statistically significant correlation between the order of the operation (patient number) and the restoration of sagittal kyphosis (r = -0.344, P = 0.001), and the correction of vertebral rotation (r = 0.370, P < 0.001), but not for the Cobb angle or LEVT. However, there was no significant difference in restoration of sagittal kyphosis and the vertebral rotation in the first 17 patients compared with the last 17 patients operated with rods of 5.5 mm diameter (P = 0.621, and 0.941, respectively), indicating that rod stiffness had more impact on the deformity correction than did learning. CONCLUSIONS: This study showed that rod stiffness had more impact on the deformity correction than did learning.
  • Abul-Kasim, Kasim, et al. (författare)
  • Low-dose helical computed tomography (CT) in the perioperative workup of adolescent idiopathic scoliosis.
  • 2009
  • Ingår i: European Radiology. - Springer. - 0938-7994. ; 19, s. 610-618
  • Tidskriftsartikel (refereegranskat)abstract
    • The study aims were to estimate the radiation dose in patients examined with low dose spine CT and to compare it with that received by patients undergoing standard CT for trauma of the same region, as well as to evaluate the impact of dose reduction on image quality. Radiation doses in 113 consecutive low dose spine CTs were compared with those in 127 CTs for trauma. The inter- and intraobserver agreement in measurements of pedicular width, and vertebral rotation, measurements of signal-to-noise ratio and assessment of hardware status were the indicators in the evaluation of image quality. The effective dose of the low dose spine CT (0.37 mSv) was 20 times lower than that of a standard CT for trauma (13.09 mSv). This dose reduction conveyed no impact on image quality. This low dose spine CT protocol allows detailed evaluation that is necessary for preoperative planning and postoperative evaluation.
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