计量经济分析 = Econometric analysis

Impatti, adattamento e vulnerabilita Le cause e le responsabilita dei cambiamenti climatici sono state trattate sul numero di ottobre della rivista Cda. Approfondiamo l’argomento presentando il documento: “Cambiamenti climatici 2007: impatti, adattamento e vulnerabilita” votato ad aprile 2007 dal secondo gruppo di lavoro del Comitato Intergovernativo sui Cambiamenti Climatici (Intergovernmental Panel on Climate Change). Si tratta del secondo di tre documenti che compongono il quarto rapporto sui cambiamenti climatici.

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Climate Change 2007: Impacts, Adaptation and Vulnerability.

Hemophilia is a rare disorder that is complex to diagnose and to manage. These evidence-based guidelines offer practical recommendations on the diagnosis and general management of hemophilia, as well as the management of complications including musculoskeletal issues, inhibitors, and transfusion-transmitted infections. By compiling these guidelines, the World Federation of Hemophilia aims to assist healthcare providers seeking to initiate and/or maintain hemophilia care programs, encourage practice harmonization around the world and, where recommendations lack adequate evidence, stimulate appropriate studies.

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Guidelines for the management of hemophilia.

OBJECTIVE: To describe the functional anatomy of the ankle complex as it relates to lateral ankle instability and to describe the pathomechanics and pathophysiology of acute lateral ankle sprains and chronic ankle instability. DATA SOURCES: I searched MEDLINE (1985-2001) and CINAHL (1982-2001) using the key words ankle sprain and ankle instability. DATA SYNTHESIS: Lateral ankle sprains are among the most common injuries incurred during sports participation. The ankle functions as a complex with contributions from the talocrural, subtalar, and inferior tibiofibular joints. Each of these joints must be considered in the pathomechanics and pathophysiology of lateral ankle sprains and chronic ankle instability. Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. Recurrent ankle sprain is extremely common; in fact, the most common predisposition to suffering a sprain is the history of having suffered a previous ankle sprain. Chronic ankle instability may be due to mechanical instability, functional instability, or most likely, a combination of these 2 phenomena. Mechanical instability may be due to specific insufficiencies such as pathologic laxity, arthrokinematic changes, synovial irritation, or degenerative changes. Functional instability is caused by insufficiencies in proprioception and neuromuscular control. CONCLUSIONS/RECOMMENDATIONS: Lateral ankle sprains are often inadequately treated, resulting in frequent recurrence of ankle sprains. Appreciation of the complex anatomy and mechanics of the ankle joint and the pathomechanics and pathophysiology related to acute and chronic ankle instability is integral to the process of effectively evaluating and treating ankle injuries.

Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability.

International Momentum Strategies

The purpose of this study was to evaluate the distribution rate of etiologies leading to ankle arthritis and to quantify and compare the important clinical and radiologic variables among these etiologic groups. We evaluated data from 390 patients (406 ankles) who consulted our center because of painful end-stage ankle osteoarthritis (OA) by using medical history, physical examination, and radiography. Posttraumatic ankle OA was seen in 78% of the cases (n = 318), secondary arthritis in 13% (n = 52), and primary OA in 9% (n = 36). The average American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 38 points (range, 0–74 points), range of motion was 22° (range, 0°−65°), and visual analog scale for pain was 6.8 (range, 2–10). Patients with posttraumatic end-stage ankle OA were younger than patients with primary OA. The average tibiotalar alignment was 88° (range, 51°–116°) and did not differ between the etiologic groups. Our study showed trauma is the main cause of ankle OA and primary OA is rare. In the majority of patients with ankle OA the average tibiotalar alignment is varus regardless of the underlying etiology.

Level of Evidence: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Etiology of Ankle Osteoarthritis

BackgroundAnkle sprains are the most common injuries in sports and recreational activities.HypothesisAnkle osteoarthritis can be caused by ankle ligament lesions. Latency time between injury and osteoarthritis is influenced by the type and side of the injured ligaments. The side of the ligamentous lesion correlates with the hindfoot alignment.Study DesignCase series; Level of evidence, 4.MethodsOf a cohort of 247 patients with ankle arthritis, we reviewed data from 30 patients (33 ankles; mean age, 58.6 years) with ligamentous end-stage ankle osteoarthritis. The patients were evaluated etiologically, clinically, and radiologically.ResultsEtiologic analysis: 55% had a ligamentous lesion from sports injuries (soccer, 33%); 85% injured the lateral ankle ligaments, and 15% injured the medial and medial-lateral ligaments. The mean latency time between injury and osteoarthritis was 34.3 years. The survivorship rate for single severe ankle sprains was worse than that for chronic recurrent ligamentous lesions (me...

Ligamentous Posttraumatic Ankle Osteoarthritis

BackgroundThere are little objective data on structural changes of the chronically unstable ankle. Such knowledge could help with preoperative planning.HypothesisPreoperative ankle arthroscopy provides important insights into the causes and mechanisms of ankle instability and the resulting disability.Study DesignCase series.MethodsFrom 1993 to 1999, arthroscopic examination was performed in the ankles of 148 patients with symptomatic chronic ankle instability that had lasted 6 months or more. All structural changes were recorded and compared with the clinical diagnosis.ResultsA rupture or elongation of the anterior talofibular ligament was noted in 86% of ankles, of the calcaneofibular ligament in 64%, and of the deltoid ligament in 40%. Cartilage damage was noted in 66% of ankles with lateral ligament injuries, whereas 98% of the ankles with deltoid ligament injuries had cartilage damage. Although lateral instability could be verified arthroscopically in 127 patients, medial instability was presumed clin...

Arthroscopic Findings in Patients with Chronic Ankle Instability

Adult human articular chondrocytes were expanded in a medium with 10% serum (CTR) or further supplemented with different mitogens (i.e., EGF, PDGFbb, FGF-2, TGF beta 1, or FGF-2/TGF beta 1). Cells were then induced to redifferentiate in 3D pellets using serum-supplemented medium (SSM), serum-free medium (SFM), or SFM supplemented with factors inducing differentiation of chondroprogenitor cells (i.e., TGF beta 1 and/or dexamethasone). All factors tested during expansion enhanced chondrocyte proliferation and dedifferentiation, as assessed by the mRNA ratios of collagen type II to type I (CII/CI) and aggrecan to versican (Agg/Ver), using real-time PCR. FGF-2/TGF beta 1-expanded chondrocytes displayed the lowest doubling times, CII/CI and Agg/Ver ratios, averaging, respectively, 50, 0.2 and 15% of CTR-expanded cells. Redifferentiation in pellets was more efficient in SFM than SSM only for EGF-, PDGFbb- or FGF-2-expanded chondrocytes. Upon supplementation of SFM with TGF beta and dexamethasone (SFM TD), CII/CI ratios decreased 4.4-fold for EGF- and PDGFbb-expanded chondrocytes, but increased 96-fold for FGF-2/TGF beta 1-expanded cells. Chondrocytes expanded with FGF-2/TGF beta 1 and redifferentiated in SFM TD expressed the largest mRNA amounts of CII and aggrecan and generated cartilaginous tissues with the highest accumulation of glycosaminoglycans and collagen type II. Our results provide evidence that growth factors during chondrocyte expansion not only influence cell proliferation and differentiation, but also the cell potential to redifferentiate and respond to regulatory molecules upon transfer into a 3D environment.

Specific growth factors during the expansion and redifferentiation of adult human articular chondrocytes enhance chondrogenesis and cartilaginous tissue formation in vitro

Beat Hintermann

Papers

Etiology of Ankle Osteoarthritis

Ligamentous Posttraumatic Ankle Osteoarthritis

Arthroscopic Findings in Patients with Chronic Ankle Instability

Specific growth factors during the expansion and redifferentiation of adult human articular chondrocytes enhance chondrogenesis and cartilaginous tissue formation in vitro

Allowance price drivers in the first phase of the EU ETS