Athens Orthopedic Clinic

Abstract Disclosure: R.D. Paparodis: None. D. Bantouna: None. N.G. Angelopoulos: None. S. Livadas: None. J.C. Jaume: None. D.T. Papadimitriou: None. INTRODUCTION Vitamin D deficiency (VDD) (25(OH)D < 30ng/ml) is an extremely common endocrine condition, affecting bone health and predisposing to illness. Its correction (maintain D: 40-60 ng/ml) can follow several formats, often unsuccessful [Paparodis et al. Nutrients 2023. Dec 28;16(1):111]. Several studies suggest a lower dose daily dosing (LDDD) as the preferred strategy, as compared to high dose intermittent dosing (HDID), but safety and compliance - related efficacy outcomes are missing. We designed the present study to address this issue. Methods We performed a retrospective review of all the patients attending our Endocrine Clinics over 10 years, in regard to serum vitamin D concentrations, treatments used and duration and patient adherence, including adverse events, such as nephrolithiasis, hypercalcemia or high vitamin D (>100 ng/ml). The effects of the historically used LDDD were compared to HDID. Our clinics’ dosing regimen depended on baseline D as follows: D < 10 ng/ml: initial loading with 25.000 IU 3/week for 2 months, followed by 25.000 IU 1/week ever after. D 10-19.9 ng/ml: initial loading with 25.000 IU 2/week for 2 months, followed by 25.000 IU 1/week for 2 months and then 25.000 IU every 2 weeks thereafter. D 20-29.9 ng/ml: initial loading with 25.000 IU 1/week for 2 months, followed by 25.000 IU 1/2 weeks for 2 months and then 25.000 IU every month thereafter. Corrections compelled doubling the dose for 2 months when insufficient (D<30ng/ml) or halving the dose when overly sufficient (D>60ng/ml). Results Overall, we evaluated 12,188 patients and 2248 adhered to their treatment strategy >80%. Historical controls (CON) included 673 patients with current use of LDDD for 8-120 months, and 1575 patients on HDID intervention arm (INT) followed for 3.7±2.1 years. Adequacy was found in 319/673 CON (47.4%) after a mean 17.5±24.1 months of treatment with 1772±1994IU daily vs. 1482/1575 (94.1%) on INT arm after 2 months, 765/849 (89.0%) at 1 year, 554/621 (89.1%) at 2 years, 392/436 (89.9%) at 3 years, 254/287 (92.0%) at 4 years and 181/200 (90.5%) at 5 years (Overall adequacy n=3628/2968, 91.4%). Increased D was found in n=0 CON and n=3 INT subjects (129.2, 174.1, 100.9ng/ml), without clinical consequences. Hypercalcemia (>10.4mg/dl) was noted in n=3 CON and n=8 INT (p>0.05), (n=1 not related to hyperparathyroidism). Nephrolithiasis ensued in n=4 CON and n=5 INT (3/4 and 4/5 respectively with history of micro-or nephrolithiasis), p>0.05. Conclusions: HDID appears safe and more effective in treating VDD than LDDD regimens, probably due to better compliance. The proposed regimen attained a remarkably high and sustained success rate, without increased risk of complications, and should be evaluated further in prospective, randomized controlled trials. Presentation: Monday, July 14, 2025

Abstract The objective of this report is to present a case of canine cutaneous reactive histiocytosis with a high number of dendritic cells. A 7‐year‐old male pit bull terrier was presented with a 5‐month history of skin nodules and plaques on the trunk of varying diameter, along with corneal oedema and anterior uveitis. No other clinical signs were observed. Histopathological findings showed that the main cell type of the dermal subcutaneous infiltrate was histiocytoid cells, with a high number of dendritic cells. Treatment with systemic use of cyclosporine A for 6 weeks was effective.

ABSTRACTBackgroundFood allergies are a major health concern with rising prevalence. Dietary habits are changing, and information about cashew‐induced anaphylaxis is limited.MethodsCases of tree nut‐induced anaphylaxis (TIA) registered from 2007 until April 2024 were extracted from the European Anaphylaxis Registry and analyzed.Results1389 cases of TIA out of 5945 registered food‐induced reactions (23%) were identified. 1,083 cases with confirmed elicitor status, including 845 children (median age 4 years, 61% male) and 238 adults (38 years, 40% male), were selected for further analysis. The most frequent elicitors among children were cashew (n = 334), hazelnut (n = 211) and walnut (n = 146). The proportion of cashew‐induced anaphylaxis increased from 2007 to 2024, and reactions were frequently caused by small amounts (< 1 teaspoon). Adults reacted frequently to hazelnut (n = 105), walnut (n = 47) but also almond (n = 35) and to higher amounts. Potential cofactors were present in 50% of the adult patients and 17% of children. The reaction severity was age‐independent, and only a minority of patients was previously aware of their allergy (children 23%, adults 21%). The use of adrenaline was low in lay treatment (children 13%, adults 3%) and reached approximately 40% upon professional treatment.ConclusionCashew is an increasing, relevant allergen leading to anaphylaxis and is now the most frequent cause of TIA among children. These findings highlight the need for effective prevention and treatment measures. Almond was a frequent elicitor among adults and should be further monitored. The acute management requires improvement to comply with current guidelines.

Soft-tissue balancing is an important factor in primary total knee arthroplasty (TKA), with 30 to 50% of TKA revisions attributed to technical operative factors including soft-tissue balancing. Robotic-assisted TKA (RATKA) offers opportunities for improved soft-tissue balancing methods. This study aimed to evaluate the repeatability and reproducibility of ligamentous laxity assessments during RATKA using a digital tensioner.Three experienced RATKA surgeons assessed preresection and trialing phases of 12 human cadaveric knees with varying degrees of arthritis. Ligamentous laxity was assessed with manual varus and valgus stresses in extension and flexion, with a digital tensioner providing feedback on the change of laxity displacement. Intraclass correlation coefficient (ICC) analyses were used to determine the repeatability within a single surgeon and reproducibility between the three surgeons.The results showed excellent repeatability and reproducibility in ligamentous laxity assessment during RATKA. Surgeons had excellent repeatability for preresection and trialing assessments, with median ICC values representing excellent reproducibility between surgeons. Surgeons were repeatable within 1 or 1.5 mm for preresection and trialing assessments. On average, the variation within a surgeon was 0.33 ± 0.26 mm during preresection and 0.29 ± 0.28 mm during trialing. When comparing surgeons to each other, they were reproducible within an average of 0.69 ± 0.33 mm for preresection and 0.65 ± 0.31 mm for trialing.This study demonstrated the reliability of robotic-assisted soft-tissue balancing techniques, providing control over ligamentous laxity assessments, and potentially leading to better patient outcomes. The digital tensioner used in this study provided excellent repeatability and reproducibility in ligamentous laxity assessment during RATKA, highlighting the potential benefits of incorporating robotics in TKA procedures.

Calcified chondroid mesenchymal neoplasm is a recently recognized bone and soft tissue entity primarily found in the extremities and the temporomandibular joint. This neoplasm is typically driven by the fusion of the FN1 gene with a kinase. In this case report, we provide a detailed account of a rare superficial calcified chondroid mesenchymal neoplasm located on the left big toe, characterized by an FN1::FGFR2 fusion. The tumor exhibited a peripheral collarette and consisted of large intradermal histiocytoid to epithelioid cells with no mitotic activity. These cells displayed fine chromatin and abundant pale eosinophilic cytoplasm, forming a swirling syncytium. They were interspersed with localized areas of glassy chondromyxoid matrix containing randomly mineralized calcific material and isolated osteoclast-like giant cells. RNA sequencing confirmed the presence of an FN1 (exon 29)::FGFR2 (exon 7) gene fusion. Our report emphasizes the importance for dermatopathologists to consider this entity when evaluating superficial lesions displaying mesenchymal, chondroid, and calcified attributes.

Introduction.The endometrium is a highly dynamic tissue that undergoes cyclic renewal in preparation for embryo implantation. Cyclic regeneration of the endometrium depends on the functional activity of the cell types that comprise it. The ability of the endometrium to quickly and repeatedly regenerate without scarring is unique, and a disrupted tissue renewal process can lead to infertility due to scarring or thin endometrium. The effectiveness of existing approaches to the treatment of thin endometrium is contradictory and requires the search for new optimal treatment directions. Scientific interest is the use of endogenous cell technologies to stimulate endometrial regeneration, such as platelet-rich plasma, peripheral blood mononuclear cells (PBMCs) and stem cells. The main therapeutic effects of these technologies by cells secreted paracrine factors (secretome). The isolated secretome from the cellular component retains functional activity and can be used as a finished medicinal product. Currently, the most accessible in production and use is the allogeneic and xenogenic secretome of PBMC (SPBMC). Objective. To define the SPBMC as a potential therapy for patients with «thin» hypoplastic endometrium and infertility. Material and methods. The sources of information were publications from the PubMed, Google Scholar, eLibrary.ru databases and in Russian specialized journals related to obstetrics and gynecology. Basic.The use of cellular technologies in the treatment of thin endometrium implies that the injected concentrated endogenous cells secrete bioactive factors (cytokines, chemokines, growth factors, proteins and extracellular vesicles, etc.) that participate in tissue regeneration. These factors modulate biological processes that are crucial for tissue regeneration, such as angiogenesis, cell migration, and immunomodulation. Russian scientists were the first to use autogenic and xenogenic SPBMC as a medicinal product for therapeutic purposes. More than 30 years of research confirm the regenerative effect of SPBMC, and the world’s only drug based on SPBMC shows worthy therapeutic results. Using generalized literature data, the hypothesis about the benefits of SPBMC in the treatment of patients with thin endometrium and infertility is described. Conclusion: PBMC secretome as a finished drug may potentially increase endometrial thickness, pregnancy rate, and live birth in patients with thin endometrium and infertility. SPBMC may be as effective as other biological methods such as platelet-rich plasma, stem cells, or PBMC in terms of clinical efficacy, and may be a more affordable and safer alternative therapy.

Aim: The aim of this literature review is to evaluate the efficacy of microneedling treatment with injectable platelet-rich fibrin (i-PRF) for facial skin rejuvenation applications, using an objective skin analysis system and validated patient-reported outcome measures.