Serafín Costilla

Repair of bone deficiencies in the craniofacial skeleton remains a difficult clinical problem. The aim of this study was to evaluate a novel albumin scaffold seeded with human alveolar osteoblasts and implanted into experimental mandibular defects. An experimental solid protein scaffold was prepared with human plasmatic albumin crossed with a glutaraldehyde-type agent. Microstructure of scaffold and mechanical properties were examined using scanning electron microscopy and a stress-controlled rheometer. Bilateral critical mandibular defects were created in eight immunodeficient rats. Defects of the right side of the mandibles received the cell–scaffold construct in all animals. All left mandibular defects were left untreated as blank controls. Sections of the defects were collected at 5, 8, and 11 weeks postsurgery and processed for histological and immunohistochemical observation, computed tomography examination, and computed tomography digital analysis. Histologically, bone formation was observed in both groups at 5 weeks postsurgery, and the engineered bone became more mature after 8 and 11 weeks, which was similar to normal bone. The origin of bone-forming cells within the defects and the localization of implanted human osteoblasts were confirmed by human vimentin expression. No bone formation could be observed at any control defect. Bone density after 8 weeks was significantly higher than that of the 5-week group (p = 0.02), and significant differences were also observed between 8 and 11 weeks (p < 0.01). The results indicate the clinical feasibility of albumin scaffold loaded with human alveolar cells and that it can be used as a good alternative for bone regeneration.

Osteogenesis imperfecta (OI), is a heterogeneous group of inherited disorders of connective tissue characterized by bone fragility. Patients with this disease frequently suffer fractures, over 80% of the extremities due to the more intensive mechanical load. Fractures of the facial bones occur very infrequently. Several studies have proved that bisphosphonate therapy may be effective in reducing fracture risk in OI patients. We report here an unusual case of pathological mandibular fracture following simple molar extraction in an adult patient with OI type I and oral alendronic acid treatment. Extraction was atraumatical and without bone removal. Fracture was treated by internal fixation by plate osteosynthesis and additional mandibulomaxillary fixation (MMF). Bone healing after fracture treatment was completely normal and no clinical signs of osteoneocrosis were observed. To the best of our knowledge, this is an unusual complication even in this type of patients. Particular care is necessary is these patients during oral surgery, even when they have been treated and controlled.

This study examined the effects of an eight-week progressive resistance training on different strength manifestations, muscle mass and functionality in multiple sclerosis patients. Thirteen volunteered patients (average age 43 years; range 35–51) with a confirmed diagnosis by a neurologist and mild to moderate disability participated twice a week in an eight-week progressive resistance training program after an eight-week control period without training. Intensity ranged from 40–70% of their maximal voluntary contraction. Outcome assessments included magnetic resonance image of the right and left thighs, strength manifestations (maximal voluntary contraction, muscular endurance and power), and functionality by the Up and Go test. All outcome assessments remained unaltered during the eight-week control period. After the eight-week strength training period, isometric strength (+16%, p<0.01), muscular endurance (+84%; p<0.001), maximal power (+51%, p<0.001), muscular hypertrophy from slice 6/27 to slice 11/27 of both thighs (p<0.05), and functionality (p<0.001) improved significantly. Moderate resistance training programs can improve muscle function without injuries and can be a promising therapy to delay the functional deterioration in multiple sclerosis patients.