Roberto Valentini

Optokinetic analysis of gait cycle during walking with 1 cm- and 2 cm-high heel lifts

The use of orthotic heel lifts is proposed in many cases of Achilles tendon disorders as a first-line or conservative treatment. The use of heeled shoes induces a plantar flexion of the ankle joint with a consequent decrease in the tension forces acting onto the triceps surae. The question to address is how high must the heel be? Gait cycle using 1 cm- and 2 cm-high heel lifts was examined. Each measurement included kinetic and kinematic data on angular variation and moments and power at the hip, knee and foot. The study included 14 healthy subjects (5 males, 9 females) between 20 and 35 years of age. The data provided by the analysis of the force plate curve showed a statistically significant change in some parameters (plate forces, knee moments) which were deemed useful in the analysis of load transfer modalities. A very significant decrease (p=0.0001) was found in the amplitude of the curve expressing the force produced by the whole limb in response to ground reaction forces. This is expressed by a decrease in minimum values, suggesting a lower degree of energy absorption at heel strike, as well as maximum values reflecting the amount of energy generated at push off. This might suggest that by reducing energy absorption by the whole limb a 2-cm heel lift would have a protective effect for those muscles that are most significantly involved in this function, such as the tibiotarsal complex (triceps surae) and the knee complex (rectus femoris).

Percutaneous repair of Achilles tendon ruptures with Tenolig: Quantitative analysis of postural control and gait pattern

BACKGROUND Surgical approach in Achilles tendons rupture involved during the last years has becoming safer and less invasive as possible. Lots of study investigate the outcomes of the mini-invasive technique with Tenolig proving its good results, but never in the long-term. OBJECTIVES Our study want to emphasize the effectiveness of this treatment exploring the postural and gait patterns in a 24-month follow up. METHOD Patients did self-training exercises without specific supervision, instead of a particular postoperative rehabilitation protocol. We compared 21 patients to a control group of 19 health subjects using a clinical examination, a podobarometric and an optokinetic analysis. RESULTS Data shows no differences in time-distance parameters, despite a reduction of propulsion phase data, confirmed also by kinetic analysis. Podobarometric results show only a decrease in the anterior pressure of the injured limb (p=0.09). In standing an increase of anterior-posterior oscillation of the COP (center of pressure) (p=0.03). CONCLUSIONS The results underline the long-term outcome effectiveness of the technique but some functional alterations remain. This could be the reason of the weakness, which always affected the patients. Reduction of the triceps elongation and restoration of strength during the propulsion phase should be the key points in postoperative physiotherapy.

Effect of tanshinone II on cell growth of breast cancer cell line type MCF-7 and MD-MB-231.

Breast cancer is the most common form of cancer in women and the leading cause of cancer death in American women, with over 207,090 new cases of invasive breast cancer in women and about 39,840 deaths from breast cancer in 2010. Current therapies for breast cancer usually have variable effectiveness with high toxicity to normal tissues, and breast tumours often develop metastasis and drug resistance. Therefore, searching for effective regimens with minimal side effects remains the top priority in breast cancer research. The objectives of this study were to evaluate the effects of tanshinone II from a Chinese herb, Salvia miltiorrhiza, on the growth of breast cancer cells type MCF-7 and MDA-MB-231.

Osteoimmunology represents a link between skeletal and immune system

There is a complex interplay between the cells of the immune system and bone. These inter- actions are not only mediated by the release of cytokines and chemokines but also by direct cell-cell contact. Studies of intracellular signaling mechanisms in osteoclasts have revealed that numerous immunomodulatory molecules are involved in the regulation of bone metabolism. Recently, it was proposed that immunoreceptors found in the immune cells are also an essen- tial signal for osteoclasts activation, along with receptor activator of NF-icB (RANK) ligand (RANKL). Collectively, these and similar observations regarding cross-regulation between the immune and skeletal systems constitute the field of osteoimmunology. Here we briefly high- light core areas of interest and selected recent advances in this field.

Postural control deficit during sit-to-walk in patients with Parkinson’s disease and freezing of gait

INTRODUCTION The intricate linkage between Freezing of Gait (FoG) and postural control in Parkinsons disease (PD) is unclear. We analyzed the impact of FoG on dynamic postural control. METHODS 24 PD patients, 12 with (PD + FoG), 12 without FoG (PD-FoG), and 12 healthy controls, were assessed in ON state. Mobility and postural control were measured with clinical scales (UPDRS III, BBS, MPAS) and with kinematic and kinetic analysis during three tasks, characterized by levels of increasing difficulty to plan sequential movement of postural control: walk (W), gait initiation (GI) and sit-to-walk (STW). RESULTS The groups were balanced by age, disease duration, disease severity, mobility and balance. During STW, the spatial distribution of COP trajectories in PD + FoG patients are spread over medial-lateral space more than in the PD-FoG (p < .001). Moreover, the distribution of COP positions. in the transition between sit-to-stand and gait initiation, is not properly shifted toward the leading leg, as in PD-FoG and healthy controls, but it is more centrally dispersed (p < .01) with a delayed weight forward progression (p < .05). In GI task and walk task, COM and COP differences are less evident and even absent between PD patients. CONCLUSION PD + FoG show postural control differences in STW, compared with PD-FoG and healthy. Different spatial distribution of COP trajectories, between two PD groups are probably due to a deficit to plan postural control during a more demanding motor pattern, such as STW.

Atypical Bilateral Femur Fractures in a Long-Term Bisphosphonate Therapy: A Case Report

Atypical Femur Fractures (AFF) are associated with Bisphosphonate Osteoporosis Therapy. Bisphosphonate therapy is widely used as the Gold-Standard Therapy for Osteoporosis: it increases bone density and reduce the risk of vertebral, non-vertebral and hip fractures. However, long-term alendronic acid administration can causes severely suppressed bone turnover and finally non-traumatic stress fractures. Here we present a case of Non-Traumatic stress fractures of bilateral femoral shafts in a Long-Term Alendronic Acid Therapy.

Targeting RANKL in the management of bone loss in patient with breast cancer

The receptor activator of nuclear factor-kappaB ligand (RANKL), its signaling receptor RANK, and its natural decoy receptor OPG are members of the tumour necrosis factor (TNF) and TNF receptor superfamily and are best known for their essential role in controlling osteoclastogenesis. RANKL in bone has also been shown to serve as a chemoattractant for cancer cells, thu explaining the tropism of certain cancers such as breast and prostate cancer to preferentially metastasize to bone. Here, we will discuss the important role of RANKL and its possible role in the management of bone loss in patients with breast cancer.

Unstable pertrochanteric fractures: lights and shadows

Introduction Cartilage lesions are the most common cause of chronic knee pain. The current treatment options consist in conservative strategies, such as visco-supplementation and platelet-rich plasma injections, and surgical management including debridement of the chondral lesion, bone marrow stimulation with microfractures and osteochondral transplant. In this study we combined arthroscopic microfracturing with platelet concentrates, platelet-rich plasma (PRP) and Vivostat platelet-rich fibrin (PRF). Materials and methods Since September 2011 we conducted a prospective trial on 51 patients divided into 3 groups with clinical and radiological evidence of cartilage lesions. All patients underwent a knee arthroscopy with microfracture. The platelet concentrate was administered intra-operatively to the PRF group and post-operatively to the PRP group, as a cycle of 3 intra-articular injection. Finally, the microfractures group underwent only microfractures (control group). Clinical scores (IKDC, KOOS, VAS) have been administered at 6 and 12 months post-operative and was performed a radiological examination with MRI evaluating lesions of patients according to the Mocart criteria (2006). Results All patients achieved a statistically significant clinical improvement from pre-operative to post-operative time. In particular, patients who were treated with platelet concentrates achieved better clinical results compared to patients treated with microfracture only (p \ 0.0001). Comparing PRF group and PRP group patients, the first group showed a significant increase compared to the second of the IKDC scores (p = 0.0349), KOOS (p = 0.0003), VAS (p = 0.0023) at 6 months, with loss of significance at 12 months. From a radiological point of view the PRF group obtained better results earlier than the other two groups. Discussion The application of intra-operative platelet concentrate associated with microfractures has led to significant improvement 6 months postoperatively both clinically and radiologically. The rationale is that a greater concentration of platelets and growth factors leads to a greater stimulation of the bone marrow and a earlier formation of repair tissue. Conclusions Comparing Vivostat PRF application with PRP injections a more rapid and less painful recovery is evident. However, the repair tissue does not have the same characteristics of the articular cartilage. Studies of histology and microscopic anatomy are required to assess the quality of this tissue to define its characteristics.

The “Helix Wire”: our experience in the treatment of humeral neck fractures

The management of proximal humeral fractures is still controversial and no single treatment has been unanimously accepted. This paper focuses on displaced two-part fractures to describe the minimally invasive fixation device known as Helix Wire and to propose precise indications for its use, partly on the basis of our previous study of its mechanical properties. Thirty patients with nondisplaced and displaced humeral neck fractures were treated with implantation of a Helix Wire between January 2005 and September 2005. Clinical and radiographic follow-up was carried out at 1, 2, 6 and 12 months. Clinical and functional assessment was performed using the Constant-Murley score. The results at 1 year after surgery were excellent in 7 cases (23.3%), good in 14 cases (46.6%), fair in 8 cases (26.6%) and poor in 1 case (3.3%). On the basis of our precise indications, elderly patients with nondisplaced or displaced two-part fractures of the proximal humerus may achieve good results with minimally invasive implantation of the Helix Wire.