Academic literature on the topic 'Tendine'

Scenes from mushroom technosciences illuminate forms, practices, and temporalities of atmospheric attunement. This article reanimates moments from scientific literature where chemists and mycologists chase elusive smells and spores, explicating how scientists’ experimental apparatuses of attunement arrange conditions for matsutake to be reduced and concentrated toward the goal of sensibility. Reduction and concentration do more than translate atmospheric elusiveness into specification; achieved through grinding, evaporating, and remixing, they condition a ‘tending to suspension’. Tending to suspension amplifies qualities and throws subjects and sensorial attention into the middle of volumes and durations. ‘Tending’ implies care as well as a ‘tending toward’—the sense that something may develop a tendency. Experimental apparatuses of atmospheric attunement, tending to such tendings, model a method for anthropological study of diffuse objects.

Introduzione L’attività fisica moderata seguita da improvvisa interruzione può influenzare le caratteristiche biologiche del tendine. Lo scopo del lavoro è stato quello di valutare l’attività cellulare, le caratteristiche istologiche, istomorfometriche e microstrutturali del tendine patellare e della sua entesi in condizioni di non allenamento (sedentarietà), allenamento ed improvviso arresto dell’attività fisica. E’ stato ipotizzato che un’iniezione peri-tendinea di acido ialuronico nelle settimane successive all’improvviso arresto dell’attività fisica potesse mantenere l’integrità strutturale e biologica del tendine patellare. Materiali e Metodi 24 ratti Sprague Dawley maschi di 8 settimane sono stati suddivisi in tre gruppi, allenati per 10 settimane, fino a 60-80% VO2max. I ratti sono stati suddivisi in tre gruppi: Non Allenati (6), Allenati (6), Disallenati (12). A 6 dei 12 ratti del gruppo Detrained, è stata praticata un’infiltrazione peri-tendinea a nel tendine patellare destro di 300 μl di acido ialuronico, mentre nei rimanenti 6, è stata praticata l’infiltrazione con soluzione fisiologica. I tendini rotulei espiantati sono stati valutati con coltura cellulare, valutazione biologica molecolare, valutazioni morfologiche microstrutturali, proliferazione, conta ed attività cellulare. Risultati I risultati in vitro hanno evidenziato vitalità e conta cellulare simili fra i Gruppi Trained e Detrained-HA con un incremento significativo del metabolismo cellulare rispetto agli altri Gruppi. La cellularità ha mostrato valori maggiori nei Gruppi Non Allenati e Detrained-NaCl ove si è osservata una biosintesi del collagene III superiore ai Gruppi Trained e Detrained-HA. Contrariamente, la produzione di collagene I e II presentava valori maggiori nei Gruppi Trained e Detrained-HA suggerendo una superiore efficienza tessutale e metabolica di questi ultimi. Conclusioni Questi risultati confermano che l’allenamento ed il suo improvviso arresto hanno effetti sulla struttura tendinea patellare di ratto e che l’iniezione peritendinea di acido ialuronico nel periodo di inattività ha effetti significativi su metabolismo cellulare e sul tendine rispetto al trattamento con soluzione fisiologica.
Introduction Different conditions may alter tendon characteristics. Clinical evidence suggests that tendon injuries are more frequent in athletes that change type, intensity and duration of training. Aim of the study was the assessment of training and especially detraining on the patellar tendon (PT) and its enthesis. We also hypotized that peri-tendineous injection with Ialuronic acid in detrained rats could prevent structural tendon integrity. Materials and Methods: 24 male adult Sprague-Dawley rats were divided into 3 groups: 18 rats were trained on a treadmill for 10 weeks. Of these, 6 rats were euthanized immediately after training (trained group), 12 were caged without exercise for 4 weeks before being injected in peri patellar tendon tissue, 1 group with Ialuronic acid (de-trained HA group) and the other with Saline solution and then euthanized (de-trained Saline group). The remaining 6 rats used as controls (untrained rats). Patellar tendons were evaluated with cellular coltures, molecular biological evaluation, microstructural morphologic evaluation, cellular proliferation, cellular number and activity. Results In vitro results showed cells vitality and number similar between Trained and Detrained-HA groups with an increased significance cellular methabolism vs the others groups. Cellularity showed better values in Non Trained and Detrained-NaCl Groups where we saw superior collagen III biosinthesis vs Trained and Detrained-HA Groups. On the other side Collagen I and II showed better values in Trained and Detrained-HA suggesting a better tissue activity of Detrained-HA Group. Conclusion Sudden interruption of physical activity has a negative effect on tendons and peri-tendineous patellar injection with Ialuronic Acid can represent a protective tendon therapy after a sudden detraining period.

Introduzione L’attività fisica moderata seguita da improvvisa interruzione può influenzare le caratteristiche biologiche del tendine. Lo scopo del lavoro è stato quello di valutare l’attività cellulare, le caratteristiche istologiche, istomorfometriche e microstrutturali del tendine patellare e della sua entesi in condizioni di non allenamento (sedentarietà), allenamento ed improvviso arresto dell’attività fisica. E’ stato ipotizzato che un’iniezione peri-tendinea di acido ialuronico nelle settimane successive all’improvviso arresto dell’attività fisica potesse mantenere l’integrità strutturale e biologica del tendine patellare. Materiali e Metodi 24 ratti Sprague Dawley maschi di 8 settimane sono stati suddivisi in tre gruppi, allenati per 10 settimane, fino a 60-80% VO2max. I ratti sono stati suddivisi in tre gruppi: Non Allenati (6), Allenati (6), Disallenati (12). A 6 dei 12 ratti del gruppo Detrained, è stata praticata un’infiltrazione peri-tendinea a nel tendine patellare destro di 300 μl di acido ialuronico, mentre nei rimanenti 6, è stata praticata l’infiltrazione con soluzione fisiologica. I tendini rotulei espiantati sono stati valutati con coltura cellulare, valutazione biologica molecolare, valutazioni morfologiche microstrutturali, proliferazione, conta ed attività cellulare. Risultati I risultati in vitro hanno evidenziato vitalità e conta cellulare simili fra i Gruppi Trained e Detrained-HA con un incremento significativo del metabolismo cellulare rispetto agli altri Gruppi. La cellularità ha mostrato valori maggiori nei Gruppi Non Allenati e Detrained-NaCl ove si è osservata una biosintesi del collagene III superiore ai Gruppi Trained e Detrained-HA. Contrariamente, la produzione di collagene I e II presentava valori maggiori nei Gruppi Trained e Detrained-HA suggerendo una superiore efficienza tessutale e metabolica di questi ultimi. Conclusioni Questi risultati confermano che l’allenamento ed il suo improvviso arresto hanno effetti sulla struttura tendinea patellare di ratto e che l’iniezione peritendinea di acido ialuronico nel periodo di inattività ha effetti significativi su metabolismo cellulare e sul tendine rispetto al trattamento con soluzione fisiologica.
Introduction Different conditions may alter tendon characteristics. Clinical evidence suggests that tendon injuries are more frequent in athletes that change type, intensity and duration of training. Aim of the study was the assessment of training and especially detraining on the patellar tendon (PT) and its enthesis. We also hypotized that peri-tendineous injection with Ialuronic acid in detrained rats could prevent structural tendon integrity. Materials and Methods: 24 male adult Sprague-Dawley rats were divided into 3 groups: 18 rats were trained on a treadmill for 10 weeks. Of these, 6 rats were euthanized immediately after training (trained group), 12 were caged without exercise for 4 weeks before being injected in peri patellar tendon tissue, 1 group with Ialuronic acid (de-trained HA group) and the other with Saline solution and then euthanized (de-trained Saline group). The remaining 6 rats used as controls (untrained rats). Patellar tendons were evaluated with cellular coltures, molecular biological evaluation, microstructural morphologic evaluation, cellular proliferation, cellular number and activity. Results In vitro results showed cells vitality and number similar between Trained and Detrained-HA groups with an increased significance cellular methabolism vs the others groups. Cellularity showed better values in Non Trained and Detrained-NaCl Groups where we saw superior collagen III biosinthesis vs Trained and Detrained-HA Groups. On the other side Collagen I and II showed better values in Trained and Detrained-HA suggesting a better tissue activity of Detrained-HA Group. Conclusion Sudden interruption of physical activity has a negative effect on tendons and peri-tendineous patellar injection with Ialuronic Acid can represent a protective tendon therapy after a sudden detraining period.

The following thesis is a summa of several research projects and insights around the tendon tissue: first the pathophysiology has been discussed, then the nutraceuticals as prevention strategy. Follows a deep discussion about the role of growth factors in tendon physiology and pathology, finding in the PRP (platelet rich plasma) and PRFM (platelet rich fibrin matrix) a novel and interesting therapy. It has been investigated through a preclinical study comparing and ex vivo model and a quantitative and qualitative assay to identify how the different growth factors may be involved in the tissue repair. At last, a clinical part (diagnostics) has been investigated presenting the results of a study on Achilles tendon evaluated with a novel ultrasound device, the real time elahstosonography: normal achilles tendon of health volunteers has been compared with ruptured ones undergone surgery to assess structural and biomechanics differences.

Con la presente tesi si intende descrivere il progetto di ricostruzione della struttura multiscala del tendine di Achille, esplicando le varie fasi che conducono alla realizzazione di uno scaffold artificiale. Alla struttura tendinea, infatti, è affidata un’importante funzione meccanica: essa permette la trasmissione delle forze dal muscolo all’osso per garantire il movimento del corpo. Eventuali lesioni tendinee comportano gravi problematiche motorie, accentuate dal fatto che tale tessuto non ha la capacità di rigenerazione spontanea; per questo l’ingegneria tissutale ha ricercato alternative alla sua ricostruzione.

L'ingegneria tissutale è progredita notevolmente negli ultimi anni, ma la ricostruzione del tessuto tendineo resta ancora oggi una sfida, per la sua complessa struttura multiscala e le proprietà meccaniche che possiede in virtù del suo ruolo di raccordo tra ossa e muscoli. Nel presente lavoro di tesi si descrive la realizzazione, reticolazione e caratterizzazione di supporti porosi tridimensionali elettrofilati, pensati per la rigenerazione del tessuto tendineo.

Ogni anno nel mondo vengono segnalati più di 33 milioni di infortuni muscoloscheletrici, con significative ripercussioni socio-economiche in termini di ore di lavoro perse e spese economiche conseguenti. Essi costituiscono una delle più frequenti diagnosi in campo ortopedico, rappresentando oltre il 30% di tutte le diagnosi nelle visite muscoloscheletriche effettuate ogni anno. Al giorno d’oggi si conoscono numerose strategie per il trattamento dei tendini danneggiati. Tra queste, gli interventi chirurgici prevedono l’innesto di materiali biologici o sintetici all’interno del sito danneggiato, costituendo una strategia semplice e rapida se paragonati al processo di guarigione naturale; tuttavia, essi hanno dei limiti che possono portare a un insuccesso del trattamento. L’ingegneria tissutale costituisce un promettente approccio da applicare quando la guarigione naturale o la sostituzione chirurgica falliscono. Attualmente, differenti tipologie di cellule e di biomateriali vengono utilizzati per disegnare sostituti tissutali ingegnerizzati. In particolare, gli scaffold possono essere realizzati con biomateriali di origine sintetica o biologica e attraverso diverse tecniche di fabbricazione. Tra queste il cell-electrospinning ha raggiunto un elevato livello di interesse nel campo della medicina rigenerativa. Esso è basato sulla normale tecnica di elettrofilatura, ma aggiunge il vantaggio di poter incapsulare le cellule nelle micro/nanofibre. Grazie a questa tecnica è quindi possibile ricreare in maniera più fedele l’ambiente della matrice extracellulare, preservando e promuovendo la normale attività cellulare. Nonostante ciò, esistono ancora diversi limiti da superare prima che i costrutti tissutali tendinei possano essere utilizzati in ambito clinico. Studi futuri che integrano diversi materiali e tecniche di produzione potranno quindi essere di supporto per il trattamento delle patologie tendinee.

In veterinary as well as human medicine the tenodesmic lesions play a great interest because of their high incidence, the difficult wound healing and therefore an incomplete full functional recover with long periods of inactivity. The therapeutical protocols recently used in the treatment of these lesions are not able to reach a real “restitutio ad integrum”. In sport horses, tendon and ligament injuries are a frequent cause of lameness and entail long periods of rest. Often the healing process does not achieve a complete recovery of the functional and morphologic characteristics of these structures, especially if the entity of the lesion is severe. In equine medicine, there is a continuous research of therapies that enhance a correct regeneration of the injured tissue, stimulating the physiological response on a molecular and cellular level, with the aim of improving the quality of the healing response. The ultimate aim of current research is to obtain a total recovery of the animal’s athletic performance, meanwhile reducing the risk of relapses. During recent years great attention has been focused on verifying the possibility of using Platelet Rich Plasma (PRP) as a treatment for musculoskeletal lesions in the horse: platelet rich plasma contains a high concentration of platelets, which, once activated, are able to secrete a great quantity of growth factors. For years it has been proven that growth factors enhance the healing response of tissues. In this thesis it will be described two clinical studies and one experimental research approach carried out in the Department of Clinical Science in collaboration with the Laboratory of Anatomy of the Department of Experimental Veterinary Sciences of the University of Padova, the Istituto Zooprofilattico della Lombardia e dell’Emilia Romagna of Brescia, the Clinica dell’Ippodromo of Merano and veterinary doctor. Aim of the first clinical study has been to evacuate the clinical effectiveness of intralesional ultrasonographic injections of autologous platelet rich plasma for the treatment of tendon and ligament injuries was evaluated in 9 horses. In all the horses treated (100%) no side effects, local or systemic, were recorded following the injection of platelet rich plasma. In all cases, successive ultrasonographic evaluations, performed at regular intervals, confirmed the favourable progression of the tissue’s healing process with a correct re-alignment of the new fibres. In all cases, the formation of scar tissue or of adherences between the damaged tendon or ligament and the adjacent tissues was not reported. At the end of the rehabilitation period (9-12 months) 7 of the 9 horses treated (77.7%) returned to competition, displaying athletic performances that are comparable to the ones reached before the occurrence of injury. The second clinical study had the aim to evaluate if a combined use of platelet rich plasma and autologous mesenchimal stem cells could determine a better effect on tissutal regenerative response. The use of mesenchimal stem cells is very promising in the veterinary field since their potency has been documented in the tissue engineering research. Recently, several studies proposed the use of platelet rich plasma as a matrix for the application of mesenchmal stem cells knowing that platelets might induce multipotent cells thanks to the great amount of growth factors delivered by these cells. Indeed platelet growth factors showed the ability to differentiate stem cells towards the proper fate and to induce angiogenesis. The combination of platelet rich plasma and stem cells should improve the quality of the regenerative response of the tissue. Our study has been conducted on a group of 17 horses affected by tenodesmic lesions. The combined association of platelet rich plasma and mesenchimal stem cells did not cause collateral side effects; the follow up, evidenced by clinical and ecographic observations, showed an amelioration of the subjects injuries. At the end of the reabilitation period 13 of 17 horses returned to the sport activity and no sign of scar or adherences were observed at the level of new formed tissue. The results obtained from these two clinical studies substain the use of platelet rich plasma as a therapeutic useful tool since is preparation is easy and allow a better tissutal regeneration without the formation of a scar. Moreover, the combined use of platelet rich plasma and mesenchimal stem cells resulted to be very promising for ameliorate tenodesmic lesions. Overall it has been shown that platelet rich plasma could be very effective both alone or in combination with mesenchimal stem cells at the tissue level although did not shorten the rehabiitation period. In the experimental approach used in our study we observed the effect the use of platelet rich plasma and platelet rich plasma in association with mesenchimal stem cells in sheep. The tendon of sheep was experimentally injured and after the treatment animals were sacrificed in order to evalute also histologically the treated tissues. The positive results of this research allowed to obatin new information about the early regenerative response in lesions treated with platelet rich plasma and platelet rich plasma associated with mesenchimal stem cells. The latter study will shed light on the real efficacy of novel treatments on injured tendons that recently are becoming very popular also in the vetetinary medicine.
In medicina umana e veterinaria le patologie teno-desmiche rivestono grande interesse per l’elevata incidenza con cui si verificano, per la difficoltà di ottenere una guarigione completa con un pieno recupero funzionale delle strutture coinvolte e perché comportano lunghi periodi di inattività. I protocolli terapeutici attualmente utilizzati nel trattamento di queste patologie sono lontani dalla potenzialità di una reale “restitutio ad integrum”. Nel cavallo utilizzato per fini sportivi le lesioni dei tendini e dei legamenti rappresentano la principale causa di zoppia e comportano lunghi periodi di riposo; spesso il processo di guarigione non porta ad un completo recupero delle caratteristiche funzionali e morfologiche di queste strutture, soprattutto se l'entità della lesione è grave. Per tale ragione vi è una continua ricerca di terapie in grado di migliorare la rigenerazione corretta del tessuto danneggiato, stimolando la risposta fisiologica a livello molecolare e cellulare con l'obiettivo di ottimizzare la qualità della risposta riparativa. Il fine delle attuali ricerche è quello di ottenere un recupero totale delle prestazioni atletiche degli animali riducendo al minimo il rischio di recidive. Negli ultimi anni grande attenzione è stata posta nel valutare la possibilità di utilizzare il concentrato piastrinico (PRP) come trattamento per le lesioni muscolo-scheletriche del cavallo: il PRP infatti contiene un'alta concentrazione di piastrine, che, nella loro forma attiva, sono in grado di secernere una grande quantità di fattori di crescita. Già da alcuni decenni infatti è stato dimostrato che i fattori di crescita sono in grado di migliorare la risposta di guarigione dei tessuti. In questa tesi verranno illustrati due studi clinici ed uno sperimentale realizzati presso il Dipartimento di Scienze Cliniche dell’Università di Padova in collaborazione con il laboratorio di Anatomia del Dipartimento di Scienze Sperimentali Veterinarie, l’Istituto Zooprofilattico della Lombardia e dell’Emilia Romagna di Brescia, la Clinica dell’Ippodromo di Merano e veterinari liberi professionisti. Scopo del primo studio è stato di valutare l'efficacia clinica dell’iniezione intralesionale ecoguidata di PRP autologo per il trattamento di lesioni tenodesmiche in 9 cavalli. In tutti i cavalli trattati non sono stati registrati effetti collaterali, né locali né sistemici dopo l'iniezione di PRP. Nei diversi soggetti le valutazioni cliniche ed ecografiche eseguite ad intervalli regolari hanno confermato la progressione favorevole del processo di guarigione del tessuto con un corretto ri-allineamento delle fibre neoformate. In nessun caso è stata rilevata la formazione di tessuto cicatriziale o di aderenze tra il tendine danneggiato ed i tessuti adiacenti. Al termine del periodo di riabilitazione (9-12 mesi) 7 dei 9 cavalli trattati (77.7%) sono tornati alle competizioni, con prestazioni atletiche paragonabili a quelle raggiunte prima del verificarsi del danno tissutale. Il secondo studio clinico si è posto invece l’obiettivo di valutare se un utilizzo combinato di PRP e di cellule staminali mesenchimali autologhe potesse determinare un miglior effetto sinergico sul meccanismo dei guarigione tissutale. L’utilizzo delle cellule staminali come strumento per la riparazione tissutale costituisce un’importante prospettiva di ricerca in clinica veterinaria. Sempre con maggior interesse ci si avvicina alle prospettive terapeutiche basate sulla capacità rigenerativa e riparativa di organi e tessuti che le cellule staminali offrono, come la capacità di auto-replicazione e di proliferazione illimitata. La capacità differenziativa di tali cellule ha reso soprattutto nell’ultimo decennio le MSCs una componente potenzialmente promettente nel campo dell’ingegneria tissutale. Recentemente diversi studi hanno proposto l’utilizzo di concentrato piastrinico, sia nella sua forma liquida che in quella gelatinosa, come matrice per l’applicazione di cellule staminali, con l’obiettivo che le piastrine debitamente attivate potessero liberare i diversi fattori di crescita necessari per la differenziazione delle cellule multipotenti. I fattori di crescita liberati dalle piastrine infatti hanno dimostrato di possedere la capacità di favorire la differenziazione delle cellule staminali verso il destino cellulare e di promuovere l’angiogenesi. L’associazione delle cellule mesenchimali con i fattori di crescita piastrinici permette di accelerare l’impianto e la crescita in vivo delle cellule impiantate. Il nostro studio è stato effettuato in un gruppo di 17 cavalli purosangue inglesi affetti da lesioni teno-desmiche. Anche in questo secondo gruppo di cavalli, il protocollo terapeutico scelto non ha evidenziato effetti collaterali locali né sistemici. Il follow up rilevato, in termini di valutazione clinica ed ecografica, ha evidenziato un soddisfacente miglioramento dei soggetti. Non sono state osservati fenomeni cicatriziali né aderenze a livello del tessuto neoformato ed al termine della fase di riabilitazione 13 dei 17 cavalli trattati (76.5%) sono tornati all’attività sportiva con buoni risultati e senza manifestare recidive. I risultati ottenuti durante questi due studi clinici vanno a sostenere l’utilizzo a scopo terapeutico del PRP nel trattamento di lesioni tenodesmiche: infatti PRP non ha causato effetti collaterali locali o sistemici o la comparsa di segni di rigetto, inoltre può essere ottenuto in breve tempo e quindi utilizzato sul paziente in anestesia locale. Inoltre, il PRP ha dimostrato di essere una terapia promettente, in quanto migliora la rigenerazione dei tessuti, favorendo la formazione di tessuto sano e funzionale, invece di tessuto cicatriziale. L’utilizzo combinato di PRP e MSC, sulla base delle valutazioni cliniche, ecografiche e dei risultati ottenuti a breve e a lungo termine risulta essere molto promettente nel trattamento delle lesioni tenodesmiche del purosangue inglese. Comparando i risultati ottenuti nei due studi clinici, possiamo osservare un effettivo apporto benefico del PRP sia da solo che in associazione alle MSCs sia in termini di miglioramento clinico dei soggetti sia in termini di riduzione dei casi di recidiva rispetto ai trattamenti convenzionali. Rimane di fondamentale importanza il protocollo riabilitativo dei cavalli, che deve tener conto dei lunghi tempi di recupero associati alla guarigione del tessuto: i trattamenti studiati nel nostro lavoro, sembrano apportare effettivamente un’ottimale stimolo per la guarigione tissutale per quanto riguarda le caratteristiche del tessuto neoformato ma non consente di accorciare i tempi di recupero dei soggetti trattati. Un importante aspetto di questo progetto è stato infine quello di verificare, in vivo ed in animali sperimentali, l’efficacia da un punto di vista clinico, ecografico ed istologico, dell’applicazione di PRP da solo o in associazione a MSCs autologhe. Questo protocollo è stato utilizzato nel trattamento di lesioni tendinee sperimentalmente indotte nella pecora: uno degli obiettivi che ci siamo posti è di cercare di comprendere maggiormente la reale efficacia di questi trattamenti attraverso approfondimenti istologici ed immunoistochimici dei tessuti trattati. L'esito positivo di tale ricerca, confermato dai rilievi clinici, ecografici ed istologici ha permesso di ottenere maggiori informazioni sull’andamento del processo di guarigione di lesioni trattate con PRP e con PRP e MSCs nel breve periodo. Tale studio potrà quindi gettare le basi per aumentare la casistica e la numerosità sperimentale nell'applicazione di nuove terapie, volte a migliorare sia il tipo che le caratteristiche della guarigione, che sembrano riscuotere, secondo quando riportato in letteratura, risultati sempre più promettenti.

This research project focused on study of adult stromal cells derived from equine and canine mesenchymal tissue and the application of these cell sources in musculoskeletal injuries, particularly in tendon repair. Adult MSCs gained general attention in both human and veterinary medicine, however despite the advances in this field, much studies are needed in order to better understand MSCs behavior. With this goal the following research project focused on: - A comprehensive characterization and study in vitro of mesenchymal stromal cells derived from peripheral blood of horses (ePB-MSCs) and from adipose tissue of dog (cA-MSCs). Moreover the possibility to cryopreserve these cells in the long-term period and the delivery methods of both ePB-MSCs and cA-MSCs in the short-term period was verified. - The use of MSCs from peripheral blood and from adipose tissue in the tendon regeneration process was investigated in two different work: the use of adipose tissue derived MSCs in the re-cellularization of a human biocompatible scaffold, and the use of MSCs derived from ovine peripheral blood injected in experimental tendon lesions of the deep digital flexor tendon (DDFT) in a ovine model. The full characterization of both ePB-MSCs and cA-MSCs was achieved using FACS sorting in order to identify the Cluster of Differentiation (CD) expression on the surface of these cells, by the study of population doubling time (PDT), the analysis of telomerase enzyme presence by Real Time PCR, and the alkaline phosphatase positivity. The differentiative potential of both ePB-MSCs and cA-MSCs was assessed by the in vitro induction of these cells into osteo, muscular and adipogenic lineages and verified by expression of tissue specific gene, like PPAR-y, Desmin, and Osteopontin (SPP-1). The same characterization and differentiative potential were then verified on ePB-MSCs and cA-MSCs after 1 year. Results obtained from this study furnished novel information on adult MSCs and confirmed the possibility to cryopreserve these cells in the long-term period for their potential applications in clinical field. The study on delivery of both ePB-MSCs and cA-MSCs in the short-term period, performed by exposing cells to different media, time and temperature, lead to the conclusion that cells could be delivered in PBS at room temperature no longer than 9-12 hrs; cells were also monitored for CD expression, for apoptotic resistance and ß-galactosidase activity during different time intervals. The second challenge of this research project was on study of regeneration capability of adult MSCs derived from peripheral blood and from adipose tissue in tendon pathologies. A first work was performed using MSCs derived from human lipoaspirate in order to recellularize a human tendon scaffold to be used as insert in full-thickness lesions of flexor hand tendons. A previous re-cellularization was successfully obtained using Tris solution and enzymatic digestion, and the absence of native genonic DNA were assessed by standard PCR. Moreover a good protocol for re-cellularization was obtained, using a collagen matrix gel, which helped a good penetration of stromal cells inside the biocompatible scaffold. Secondly a comparation study among the effect of PB-MSCs, platelet rich plasma (PRP) or combination of both on tendon healing was performed using ovine model. Experimental lesions were made using collagenase 1A injection in the left deep digital flexor tendon (DDFT) of 18 Bergamasca sheep, using the right DDFT as internal control (lesioned, not treated). Sheep were further divided in two groups, the first euthanized after 1 month and the second after 4 months, and tendon were then analyzed by histological and immunohistochemical assays. Results obtained after 4 months showed a significant difference between the treated tendon of all group respect to the relative internal control (lesioned, not treated); notably after 4 months the group that received the treatment with MSCs alone or in combination with PRP, showed significant improvement of the healing process respect to PRP treated group, becoming similar to the normal healthy tendons.
Il seguente progetto di ricerca ha avuto l’obiettivo di studiare in modo approfondito le cellule stromali adulte derivate da sangue periferico di cavallo e da tessuto adiposo di cane e successivamente verificare le loro potenzialità applicative nelle patologie muscolo-scheletriche, in modo particolare nella rigenerazione tendinea. Negli ultimi anni le cellule stromali adulte di derivazione mesenchimale hanno sollevato l’attenzione della comunità scientifica sia in medicina umana che veterinaria, per la potenzialità che possono rivestire nel trattamento di patologie che a tutt’oggi non trovano completa risoluzione clinica. Tuttavia nonostante i notevoli progressi fatti in questo campo di ricerca, ulteriori approfondimenti sono necessari per comprendere del tutto i diversi meccanismi delle cellule stromali adulte sia in vivo che in vitro. Questo studio ha avuto la finalità di: - Effettuare una completa ed esaustiva caratterizzazione delle cellule staminali adulte isolate a partire da sangue periferico di cavallo (ePB-MSCs) e da tessuto adiposo di cane (cA-MSCs). È stata poi indagata la possibilità di criopreservare entrambi i tipi di cellule per un anno, ed infine è stato studiato l’effetto di parametri ritenuti importanti nell’influenzare la vitalità cellulare durante la spedizione delle cellule nel breve periodo evitando il congelamento. - Indagare l’uso di cellule stromali isolate da sangue periferico e da tessuto adiposo nella rigenerazione tendinea in due diversi studi: il primo con l’obiettivo di ottenere la ricellularizzazione di uno scaffold tendineo precedentemente decellularizzato, il secondo con l’obiettivo di verificare il contributo alla rigenerazione tendinea in vivo di cellule stromali isolate da sangue periferico di pecora, immesse in lesioni sperimentali indotte con collagenasi 1A. Per l’ottenimento di una completa caratterizzazione di entrambe le ePB-MSCs e le cA-MSC è stato utilizzato il FACS sorting per analizzare l’espressione dei cluster di differenziamento (CD) presenti sulla membrana cellulare di queste cellule, inoltre è stato effettuato lo studio del tempo di duplicazione cellulare (PDT) e la positività alla fosfatasi alcalina. La potenzialità differenziativa delle ePB-MSCs e delle cA-MSCs è stata verificata mediante l’induzione al differenziamento in vitro di queste cellule verso tessuto osseo, muscolare e adiposo, e successiva verifica dell’espressione di specifici geni, quali la PPAR-y la Desmina e l’ostopontina (SPP-1) mediante PCR. Gli stessi esperimenti effettuati per definire la caratterizzazione di entrambe le ePB-MSCs e le cA-MSCs sono stati effettuati dopo un anno di criopreservazione delle stesse, concludendo che le caratteristiche di staminalità non cambiano nelle cellule stromali adulte di entrambe le specie dopo congelamento. É stata effettuata un’indagine sull’effetto che diversi mezzi di coltura, tempo e temperatura hanno sulla sopravvivenza di entrambe le ePB-MSCs e le cA-MSCs durante la spedizione nel breve periodo. Le cellule stromali di entrambe le specie sono state analizzate per l’espressione dei cluster di differenziamento, per la presenza di resistenza all’attività apoptotica e per la positività alla beta- galattosidasi. I risultati ottenuti hanno portato alla conclusione che le cellule stromali adulte possono essere spedite in soluzione salina (PBS) a temperatura ambiente per non più di 9-12 ore. Il secondo obiettivo di questo progetto di ricerca è stato finalizzato all’applicazione delle cellule stromali isolate da sangue periferico e da tessuto adiposo nella rigenerazione tendinea. Il primo lavoro effettuato ha previsto l’utilizzo di MSCs derivate da lipoaspirato umano per la ricellularizzazione di uno scaffold tendineo umano con la finalità di utilizzarlo nelle lesioni totali dei tendini flessori della mano. Lo scaffold biocompatibile è stato in precedenza decellularizzato grazie all’utilizzo di soluzioni detergenti ed enzimatiche. L’assenza di residuale materiale genomico è stata verificata tramite PCR. Questo studio ha permesso di mettere appunto una tecnica di ricellularizzazione efficiente che, avvalendosi dell’ausilio di una matrice gelificante di collagene, ha garantito una buona penetrazione cellulare all’interno della matrice dello scaffold. Il secondo lavoro effettuato sulla rigenerazione tendinea, ha avuto la finalità di paragonare l’effetto di tre diversi trattamenti (cellule stromali derivate da sangue periferico di pecora (sPB-MSCs), sPB-MSCs + platelet rich plasma (PRP), e PRP) sulla rigenerazione tendinea a 1 mese e a 4 mesi dopo lesione sperimentalmente indotta sul tendine flessore profondo delle falangi di pecora (DDFT). Dopo eutanasia delle pecore a 1 e 4 mesi i tendini sono stati analizzati tramite analisi istologica e immunoistochimica; i risultati ottenuti dopo 4 mesi hanno evidenziato una differenza significativa nel grado di riparazione tissutale tra tutti i gruppi di pecore trattate e i loro rispettivi controlli interni (lesionati, non trattati). Inoltre le pecore che hanno ricevuto il trattamento con sPB-MSCs hanno dimostrato avere il migliore processo riparativo tendineo rispetto al gruppo di pecore trattato solo con PRP per tutti i parametri istologici valutati, risultando molto più simili al tendine sano usato come controllo positivo.

AbstractThe wrist and hand have complex anatomy with small bones and supporting soft tissue structures, which limits the diagnostic yield for radiologic assessment. Knowledge of anatomy and different clinical entities is key to the radiologic diagnosis. Some of the essential anatomic and clinical topics in radiologic interpretation include knowledge of the topographic tendon anatomy of wrist and hand, the intrinsic and extrinsic carpal ligaments, the thumb ligaments, thumb carpometacarpal ligaments, the triangular fibrocartilage complex, the extensor mechanism, and the flexor tendons and pulleys. In this chapter, common traumatic injuries affecting the wrist and hand are reviewed.

Chapter 109 discusses MRI of the ankle and foot internal derangements, namely tendon and ligament tears, osteochondral defects, and miscellaneous. Tenosynovitis may be detected anywhere in the ankle and foot, except along the Achilles tendon where a tendon sheath is absent and there is a paratenon. Tendinosis and tendon tears occur most commonly in the Achilles, posterior tibial, and peroneal tendons. Peroneal tendons may subluxate or dislocate anteriorly with superior peroneal retinacular disruption or may become transposed with intrasheath dislocations. The anterior talofibular ligament is the most commonly torn ankle ligament caused by inversion injuries. Calcaneofibular ligament tears may occur in conjunction with an anterior talofibular ligament tear. MRI is helpful in differentiating stable from unstable talar dome osteochondral defects, because of high spatial resolution of the articular cartilage and underlying bone.

Soft tissues are an important interface between the tendons and bones of the hand. This interface provides both physical and biological functions by facilitating smooth tendon excursion, tendon healing, and tendon and joint stability. Disease of these soft tissues results in pain, swelling, and loss of function, and can be due to systemic conditions or local factors. These conditions include disease of the tendon sheath, disease of the tendon synovium, and diseases of tendon attachments. Inflammation was considered a universal hallmark in these conditions but recent evidence suggests that this is not true for all such conditions, whose treatment has consequently been modified. This knowledge has also caused reflection on the nomenclature used to describe these conditions and has brought clarity to the traditionally used terminology such as tenosynovitis.

The authors proposed an anatomy-based methodology for human modeling to enhance the visual realism of human modeling by using the boundary element method (BEM) and axial deformation approach. To model muscle deformation, a BEM with linear boundary elements was used. The significance of tendons in determining skin layer deformation is also discussed. The axial deformation technique is used to allow for quick deformation. To control tendon deformation, the curve of the axial curve is changed. Each vertex of the skin layer is linked to the muscles, tendons, and skeletons beneath it. The skin layer deforms in response to changes in the underlying muscle, tendon, and skeleton layers. This chapter made use of human foot modeling as the case study. Results have illustrated that the visual realism of human models can be enhanced by considering the changes of tendons in the deformation of the skin layer. The lower computational complexity and enhanced visual realism of the proposed approaches can be applied in human modelling for virtual reality (VR) applications.

Because of their location on the dorsum of the hand, the extensor tendons are particularly vulnerable to injury. This is even more likely over the joints since the dorsal skin is particularly thin there. Injuries can occur from both sharp and blunt trauma. Untreated extensor tendon injuries can result in significant functional impairment and potential long-term permanent deformities of the hand. There are significant differences in treatment for extensor tendon injuries involving the finger zones versus the hand. This chapter will describe the most common treatment modalities for extensor tendon injuries to the hand and forearm.

The disruption and subsequent repair of flexor tendons presents a formidable challenge to the hand surgeon. In an effort to regain excursion of the involved tendons, the definitive outcome depends on a number of variables, including the level of injury, the mechanism of injury, and associated trauma to the skin, pulleys, neurovascular bundles, and bone. The ultimate result, however, is directly proportional to scarring, fibrosis, adhesions, and gap formation that limit the return of normal tendon excursion and the final composite motion of the digit.

Chapter 124 discusses US scanning of the knee, which is commonly performed for assessment of superficial knee structures, such as the extensor mechanism tendons and collateral ligaments, as well as identification of Baker cysts or prepatellar bursae. Dynamic US evaluation, such as flexion/extension of the knee or varus/valgus stress maneuvers, may improve diagnostic performance and further characterize severity of tendon or ligamentous injury and ligament incompetence. US examination may be comprehensive or focused, with constant modification of patient and probe positioning to allow for optimal visualization of the knee structures. Common US artifacts, such as anisotropy of the extensor tendons or heterogeneous appearance of the distal joined attachment of the lateral collateral ligament proper and the distal biceps femoris tendon, should not be mistaken for pathology. Although parameniscal cysts can be readily identified by US, there is ongoing controversy regarding the role of US in evaluation of meniscal tears.

Chapter 121 discusses US of the elbow, which is an important imaging modality for the evaluation of elbow pain, providing soft tissue resolution superior to MRI. Soft tissue injury of the elbow is usually caused by repetitive motion and chronic overuse. The most common indications for elbow US examination are joint effusion, tendon and ligament pathology, olecranon bursitis, and ulnar nerve entrapment. The distal biceps tendon, triceps tendon, and common extensor and common flexor tendons are easily evaluated with US. Dynamic evaluation can determine between partial- and full-thickness radial and ulnar collateral ligament tears. US easily identifies joint effusions and olecranon bursitis. Furthermore, US can be used to guide interventions about the elbow.

Chapter 120 discusses US of the shoulder, which is most commonly performed to evaluate the tendons of the rotator cuff. In this examination, the long head of the biceps tendon, subacromial-subdeltoid bursa, and acromioclavicular joint are also examined. US demonstrates equal diagnostic accuracy to MRI in the assessment of partial- and full-thickness rotator cuff tears. Dynamic US of the shoulder is useful to evaluate subacromial and subcoracoid impingement as well as long head of the biceps tendon subluxation or dislocation. US is excellent in evaluating the postoperative rotator cuff, as the metallic susceptibility artifact encountered in MRI is not a problem in US.

Tendons are dense, fibrous tissues connecting muscle to bone, and their primary function is to transmit muscle forces to the appropriate skeletal elements, thereby enabling movement. In the limb, flexion and extension of the hand (autopod) and wrist are controlled by long tendons that insert into muscles in the arm (zeugopod) [1]. Although tendons are critically important in mediating joint movement, the cellular and molecular events underlying tendon formation remain largely unknown. Using the transcription factor Scleraxis (Scx), which labels all tendon progenitors, we previously showed that in the mouse limb bud, Scx-expressing tendon progenitors are first induced in the mesenchyme underneath the ectoderm at E10.5; at E12.5, progenitors are loosely organized between the cartilage condensations and developing muscles, condensing to form distinct tendons by E13.5 [2]. By E14.5, limb tendon patterning is largely complete, with continued elongation and deposition of matrix from this stage onward.

Muscular dystrophies are degenerative diseases that affect primarily skeletal muscles. Most studies of muscular dystrophy focus on muscles, but tendons are an important part of the musculotendon complex that transmits forces from muscles to bones. As the disease progresses, tendon shortening occurs, and some patients require tendon release or cord lengthening surgery to increase tendon length [1]. Despite the prevalence of these surgeries, very little is known about the mechanical properties of tendons in muscular dystrophy patients, or how they change as the tendon remodels or compensate in response to muscle degeneration.

The Achilles tendon is the largest tendon in the human body. It connects the gastrosoleus complex to the calcaneus bone in the foot. It thus allows for transfer of force and heel elevation during forward propulsion of the foot in gait. It is also one the most commonly injured tendons. (1). Acute repair or acute intervention for non-operatively treated tendons do well to restore function. However, chronic Achilles tendon ruptures often require tendon transfer rather than attempt at primary repair. The treatment considered the gold standard is the transfer of the flexor hallucis longus (FHL) tendon to the Achilles insertion of the calcaneus (2).

Tendon injuries, including acute tendon injuries and tendinopathy, are common in both occupational and athletic settings. However, current treatments for tendon injury are largely ineffective, as they cannot restore normal structure and function to injured tendons. This challenge mainly stems from our incomplete understanding of tendon cell properties and responses to biomechanical and biochemical environments surrounding the cells. In recent years, however, significant progress has been made on two fronts. First, tendon stem cells (TSCs) have been recently identified. The tendon-specific stem cells can self-renew and posses multi-differentiation potential and as such, may be used to repair injured tendons more effectively. Second, platelet-rich plasma (PRP) has now been widely used in orthopaedics and sports medicine to treat injured tendons. In this presentation, I will present data on TSCs, in terms of their differential properties with respect to tenocytes and their differential mechano-responses when subjected to small and large mechanical loading conditions. I will also discuss the basic scientific studies on PRP regarding its effects on TSCs, particularly on their differentiation, which is a critical issue related to the safety and efficacy of PRP treatment in clinics (Fig. 1).

Tendon injuries and chronic pain, known as tendinopathy, are extremely common in supraspinatus and Achilles tendons. Despite their prevalence, the pathogenesis of these conditions is poorly understood. One of most common cited factors for injuries to the rotator cuff tendons is “impingement”, namely, mechanical compression of the supraspinatus tendon by the overlying coracoacromial arch [1]. To date, few studies have investigated the molecular processes underlying this condition.

The primary goal of ACL reconstruction is to limit post-operative anterior knee laxity without over-constraining the knee. For both hamstring tendon and patella tendon grafts used for ACL reconstruction, initial graft tension is applied to limit post-operative knee laxity. Both types of graft stress relax following implantation, decreasing the graft tension. Previous studies have shown that preconditioning reduces the tension decrease due to stress relaxation for both hamstring tendons [1] and patella tendons [2]. While hamstring tendon grafts are typically preconditioned in tension on a graft board prior to implantation to limit stress relaxation, patella tendon grafts are typically implanted without preconditioning. The current study focused on characterizing the influence of preconditioning on stress relaxation for both types of graft. The authors hypothesized that the tension loss due to stress relaxation would be larger for preconditioned hamstring tendon grafts than for preconditioned patella tendon grafts.

In February, 2016, one of the external tendons in pre‐stressed concrete (PSC) box girder bridge in Seoul was failed due to corrosion after 17 years of service. The failure was found during the thawing season regular inspection. Since it was the first tendon failure occurred in South Korea, in‐depth investigation was performed and found that multiple tendons were corroded at many different locations. Seoul City had been preparing for the maintenance of PSC box girder bridges, but the draft maintenance guideline considered overall condition of the bridge and little attention was paid to the condition of tendons. The bridge was evaluated as per the draft guideline and rated as ‘Medium Risk’ although one external tendon was failed. The indices for the evaluation should be properly weighted to prevent failure of tendons.

This paper presents an experimental and numerical method for investigating the biomechanics of soft tissue sutured tendons. The aim is to achieve a better understanding of the mechanics of a sutured tendon applicable to tendon injury.

SET (Samsung Enhanced hull for Tendon) TLP (Tension Leg Platform) has been designed as an innovative TLP hull form with optimized number of tendons compared to conventional TLP design. SHI (Samsung Heavy Industries) designed the SET TLP to have the minimized hull weight with narrow and thin pontoon which results in the less number of tendons without any outboard extension of column or pontoon. The SET TLP has 8 tendons which are evenly attached along with the octagonal shaped-ring pontoon. The unique shape of octagonal ring pontoon distributes the wave load and concentrated tendon loads in larger areas, which can minimize the structural reinforcement. To verify the feasibility of the proposed hull concept with regard to the hydrostatic/hydrodynamic characteristics and tendon design, the numerical analyses for the hydrostatic stability and global performance are carried out. Hydrostatic stability is investigated for all the possible loading cases such as float-off, wet transit, tendon installation and operational conditions, and the proper tank compartments are achieved for all the scenarios without using any temporary stability module. The global performance is validated for all the possible combinations of wave, swell, wind, current and/or squall for a site in Western Africa. Through the frequency-domain analysis and nonlinear time-domain analysis as well, the essential items such as the maximum offset/set-down/top tendon tension, minimum bottom tendon tension are examined and confirms that the certain design criteria of TLP operation are satisfied.

There has been interest in improving arthroscopic subscapularis repairs due to their popularity and efficacy when compared to open subscapularis repairs. However, previous biomechanical analyses of rotator cuff repairs have typically focused on the supraspinatus tendon [1–5]. Testing repair techniques in the subscapularis tendon requires the modification of previously established biomechanical testing methods. Most rotator cuff tendon tests have utilized axial loading on supraspinatus and infraspinatus tendons [1–4]. Most subscapularis tendons are torn with forced external rotation of the shoulder. Axial loading of the subscapularis tendon would not be representative of the injury mechanism. Additionally, past rotator cuff studies have employed a variety of techniques for clamping tendons, including freezing clamps and soft tissue grips. Such methods offer insufficient fixation for tendons that have high muscle content, such as the subscapularis. Several studies have focused on the repair’s ability to restore the appropriate healing environment at insertion footprint. These investigations have used either digitizers or pressure-sensitive film to measure contact area [5–7]. However, there are questions concerning the repeatability and accuracy of the results provided by these techniques. The objective of this study was to compare the biomechanical performance of open, transosseous fixation with that of the arthroscopic, suture anchor technique for subscapularis repair, while making three specific improvements to current testing methods. It sought to: 1) apply physiologically accurate loads to the subscapularis using cyclic, external rotation, 2) identify an effective method of clamping tendons with high muscle content, such as the subscapularis, and 3) introduce a novel, tactile pressure measurement system that measures contact pressure and area in real-time.

Esta guía de práctica del curso en Semiología del Paciente Sano comprende los aspectos básicos de la semiotecnia y la interpretación de los hallazgos semiológicos del examen del sistema osteomuscular, siguiendo este orden: 1) evaluación de los movimientos activos y pasivos; 2) evaluación de la fuerza muscular, 3) evaluación de los signos de lesión a nivel articular, de tendones y ligamentos, y 4) evaluación de la marcha.

In the Common Eider Somateria mollissima, only females incubate the clutch over a period of 25–28 days. Determining their schedule of nest absence, how long they are away, how often, and where they go can be problematic. They must also avoid nest predation while tending to their own needs. We used geolocators to investigate the behavior of incubating females on forested islands in Dolgaya Guba Bay (65°03′N, 035°47′E), White Sea, Russia. Data were obtained for 12 females: three in 2015 and 2016, four in 2017, and two in 2018. During the entire incubation period, females left their nests for the sea 12–28 times. The average duration at sea was 331.0 ± 53.8 min, including 261.1 ± 47.9 min during the darkest hours in otherwise 24-hour daylight. The patterns are similar to those of eiders nesting in lower, nonpolar latitudes, where nights are dark.