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Vydává

Společnost pro pojivové tkáně ČLS J. E. Purkyně z.s.

Odborná společnost ortopedicko-protetická ČLS J. E. Purkyně z.s.

Ambulantní centrum pro vady pohybového aparátu, s.r.o.

ročník 27 / 2020, Suppl. 2

Pokroky ve výzkumu, diagnostice a terapii

Conference

Adaptation –

interdisciplinary aspects

(instead of cancelled

The 22nd Prague-Lublin-Sydney-St Petersburg Symposium)

September 12, 2020

Medical House | Sokolská 31

120 26 Prague 2 | Czech Republic

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1E95 Challenger

Nové řešení pohybu pro míčové,

raketové a běžecké sporty.

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PROTEOR CZ s. r. o. – nestátní zdravotnické zařízení

Ostrava | U Parku 2/2720 | 702 00 Ostrava | tel.: 596 139 259, 596 139 295

Provozovna Olomouc | Mošnerová 7/1184 | 779 00 Olomouc | tel.: 585 414 776, 585 414 823 Provozovna Brno | Milady Horákové 50 | 602 00 Brno | tel. 733 184 083

E | ostrava@proteorcz.cz | olomouc@proteorcz.cz | brno@proteorcz.cz | www.proteorcz.cz

lékařská péče v  oborech ortopedie a  ortopedická protetika  zdravotní péče v  ortotice a protetice   konsilia pro zdravotnická zařízení  výjezdová pracoviště v kraji   zakázková činnost pro zdravotnická zařízení  skoliotická poradna pro léčbu skolióz páteře mladistvých

aplikace a výroba individuálních ortopedických vložek pro sportvýroba individuálních

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POHYBOVÉ ÚSTROJÍ

ročník 27, 2020, Suppl. 2 | datum vydání: 15. 12. 2020

REDAKČNÍ RADA

VEDOUCÍ REDAKTOR: prof. MUDr. Ivo Mařík, CSc.

ZÁSTUPCI VEDOUCÍHO REDAKTORA: prof. Ing. Miroslav Petrtýl, DrSc.

RNDr. Martin Braun, Ph.D.

VĚDECKÝ SEKRETÁŘ: doc. MUDr. Štěpán Kutílek, CSc.

ODPOVĚDNÝ REDAKTOR: ing. Pavel Lorenc, MBA

prof. Ing. Jan Čulík, DrSc. doc. MUDr. Vladimír Kříž doc. RNDr. Petr Sedlak, Ph.D.

MUDr. Jiří Funda prof. Ing. František Maršík, DrSc. prof. MUDr. Václav Smrčka, CSc.

Ing. Hana Hulejová doc. RNDr. Ivan Mazura, CSc. prof. PhDr. Jiří Straus, DrSc.

prof. MUDr. Josef Hyánek, DrSc. MUDr. Pavel Novosad doc. MUDr. Ivan Vařeka, CSc.

doc. MUDr. Petr Korbelář, CSc. PhDr. Iveta Pallová, Ph.D. MUDr. Jan Všetička MUDr. Petr Krawczyk prof. MUDr. Ctibor Povýšil, DrSc. RNDr. Daniela Zemková, CSc.

MEZINÁRODNÍ REDAKČNÍ RADA

Professor Dr. Ing. Romuald Bedzinski, Wroclaw, Poland Assist. Professor Jacek Karski, M.D., PhD. Lublin, Poland Assoc. Professor Michael Bellemore, F.R.A.C.S.,

Sydney, Australia Professor Tomasz Karski, MD, PhD, Lublin, Poland Professor Milan Kokavec, MD. PhD., Bratislava, Slovakia Assist. Professor Jacques Cheneau, MD,

Saint Orens, France Doc. Dr. Med. Kazimierz S. Kozlowski, M.R.A.C.R., Sydney, Australia

Professor Mikhail Dudin, MD, PhD, DSc.,

St. Petersburg, Russia Piet von Loon, MD

Netherlands

Radwan Hilmi, M.D., Lyon, France Assist. Professor Aleksey Arsenev, MD, PhD, St. Petersburg, Russia

Pohybové ústrojí. Pokroky ve výzkumu, diagnostice a terapii.

ISSN 2336-4777 (od roku 2013 pouze on-line verze) Vydává Společnost pro pojivové tkáně ČLS J. E. Purkyně z.s.

& Ortopedicko-protetická společnost ČLS J. E. Purkyně z.s.

& Ambulantní centrum pro vady pohybového aparátu, s. r. o.

Excerpováno v Excerpta Medica a Bibliographia medica Čechoslovaca.

Návrh a grafická úprava obálky Pavel Lorenc.

Časopis je na Seznamu recenzovaných neimpaktovaných periodik vydávaných v České republice. Dvě čísla časopisu vycházejí v elektronické verzi jako ročník s průběžným vydáváním příspěvků po recenzi.

Při příležitosti sympozií je dvakrát ročně vydáváno supplementum.

Pro současné odběratele časopisu PÚ a další zájemce doporučujeme přihlásit se na http://www.pojivo.cz/en/newsletter/, zadat jméno a e-mailovou adresu, na kterou bude časopis posílán.

Na webové doméně SPT ČLS JEP http://www.pojivo.cz/cz/pohybove-ustroji/ naleznete ve formátu PDF všechna jednotlivá čísla a dvojčísla časopisu (včetně Supplement) vydaná od roku 1997.

Rukopisy zasílejte na adresu profesor MUDr. Ivo Mařík, CSc., Olšanská 7, 130 00 Praha 3,

(ambul_centrum@volny.cz) ve formátu doc. Vydavatel upozorňuje, že za obsah inzerce odpovídá výhradně

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LOCOMOTOR SYSTEM

Advances in Research, Diagnostics and Therapy

Published by The Society for Connective Tissues, Czech Medical Association of J. E. Purkyně, Prague, Society for Prosthetics and Orthotics, Czech Medical Association of J. E. Purkyně, Prague, Czech Republic and Ambulant Centre for Defects of Locomotor Apparatus Prague, Czech Republic

Call for papers

Support this journal by sending in your best and most interesting papers. The issue of the journal is published during whole year after proof acceptation of the reviewers. In occasion of the symposia (twice a year) is published the supplement.

Chief Editor: Ivo Mařík

Associate Editors: Miroslav Petrtýl, Martin Braun Scientific Secretary: Štěpán Kutílek

Responsible Editor: Pavel Lorenc

Editorial board

Aleksey Arsenev Jiří Funda Milan Kokavec František Maršík Václav Smrčka

Romuald Bedzinski Radwan Hilmi Petr Korbelář Ivan Mazura Jiří Straus

Michael Bellemore Hana Hulejová Petr Krawczyk Pavel Novosad Ivan Vařeka

Jacques Cheneau Josef Hyánek Vladimír Kříž Iveta Pallová Jan Všetička

Jan Čulík Jacek Karski Kazimierz Kozlowski Ctibor Povýšil Daniela Zemková

Mikhail Dudin Tomasz Karski Piet von Loon Petr Sedlak

Submitted papers: Locomotor System will review for publication manuscripts engaged in diag nos- tics and interdisciplinary treatment of genetic and metabolic skeletal disorders, limb anomalies, secondary osteoporosis, osteo/spondyloarthritis and another disorders that negatively influence development and quality of locomotor apparatus during human life. Both papers on progress in research of connective tissue diagnostics, medical and surgical therapy of multiple congenital abnormalities of skeleton mainly in the fields of paediatric orthopaedic surgery and plastic surgery, orthotics and prosthetics treatment, and papers dealing with biomechanics, clinical anthropology and paleopathology are appreciated.

The journal has an interdisciplinary character which gives possibilities for complex approach to the problems of locomotor system. The journal belongs to clinical, preclinical and theoretical medical branches which connect various up-to-date results and disco veries concerned with locomotor system.

You can find the volumes of Locomotor System journal at http://www.pojivo.cz/cz/pohybove-ustroji/

since 1997 (free of charge). Since 2013 only electronic edition of the journal is available. That is why we recommend to all subscribers and those interested apply at http://www.pojivo.cz/en/newsletter, enter personal data, titles and e-mail address where the journal will be mailed.

Abstracts of presented papers are excerpted in EMBASE/Excerpta Medica (from the year 1994) and in the Bibliographia medica Čechoslovaca (from the year 2010). We prefer the manuscripts to be prepared according to Uniform Requirements for Manuscripts Submitted to Biomedical Journals (Vancouver Declaration, Brit med J 1988; 296, p. 401–405).

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Society For Connective Tissues CMA J.E. Purkynje & Society for Prosthetics and Orthotics CMA J.E. Purkynje & Czech Medical Association J.E. Purkynje

invite you for

CONFERENCE

ADAPTATION – INTERDISCIPLINARY ASPECTS

(INSTEAD OF CANCELLED

THE 22ND PRAGUE-LUBLIN-SYDNEY-ST PETERSBURG SYMPOSIUM)

The Conference will be held under the auspices

the honorary president of the Society for Connective Tissues CMA J.E. Purkynje

Professor Josef Hyánek, MD, DSc.

The Conference will be held in the

Medical House, Sokolská 31, 120 26 Prague 2, Czech Republic, in September 12, 2020

This event belongs to education actions integrated into the life training system of physicians according to professional statute No. 16 of the General Medical Council.

CZECH SOCIETY FOR PROSTHETICS

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PROGRAMME – SATURDAY, SEPTEMBER 12, 2020

8.30–9.00 REGISTRATION OF PARTICIPANTS 9.00

OPENING OF THE CONFERENCE

Professor Ivo Marik, MD, PhD (President of the Society for Connective Tissues CMA J.E. Purkynje)

& Professor Miroslav Petrtýl, Eng, PhD, DSc. (Vice-President of the Society for Connective Tissues CMA J.E.

Purkynje)

& Petr Krawczyk, MD (President of the Society for Prosthetics and Orthotics CMA J.E. Purkynje)

9.00–13.00

MORNING SESSIONS

SESSION I:

ADAPTATION IN MANKIND EVOLUTION Chairmen: Pařízková Jana, Kutílek Štěpán, Piet van Loon

What have we inherited, what do we share with our ancestors: the development of calciotropic hormones (PTH, calcitonin, vitamin D, phosphatonin)

in the course of phylogenesis.

Co jsme podědili, co máme společného s předky: vývoj kalciotropních hormonů (parathormon, kalcitonin, vitamin D, fosfatonin) v průběhu fylogeneze

(15 + 5 min.)

Kutílek Štěpán (Klatovy, Czech Republic) Dept. of Paediatrics; Hospital Klatovy; Klatovy

Hudáková Olga: Introduction of Dr. Piet van Loon

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Negative adaptive strategies of the human locomotor apparatus in children on their intensive sedentary lifestyle

Negativní strategie adaptace pohybového aparátu u dětí na jejich sedavý způsob života (35 + 5 min.)

Van Loon Piet JM1, Grotenhuis Andre H2 Deventer, The Netherlands

1 Orthopedic surgeon, Care to Move, Centre for Orthopedics, Deventer, The Netherlands

2 Professor of neurosurgery, RadboudMC, University of Nijmegen, The Netherlands

The impact of early adaptation for reduced physical activity on body composition and motor development in children and motoric ability in growth period

Vliv rané adaptace k omezenému pohybu na rozvoj tělesného složení a motoriku v období růstu (25 + 5 min.)

Pařízková Jana, Sedlak Petr (Prague, Czech Republic)

Dept. of Anthropology and Human Genetics, Prague, Czech Republic

ROUND TABLE DISCUSSION AFTER EACH LECTURE COFFEE BREAK

SESSION II:

BIOMECHANICS – ADAPTATION OF SKELETON Chairmen: Krawczyk Petr, Petrtyl Miroslav, Marik Ivo

Elucidation of Pathogenesis of Skeleton Deformities at Genetic Skeletal Disorders through Functional Adaptation of Bones

Objasnění patogeneze deformit kostry u Genetických kostních chorob (GKCH) prostřednictvím funkční adaptace kostí (25 + 5 min.)

Mařík Ivo1,2,4, Zemková Daniela1,3, Myslivec Radek4,1, Maříkova Alena1, Černý Pavel5,2, Krawczyk Petr6 (Prague, Czech Republic)

1 Centre for Defects of Locomotor Apparatus l.l.c.; Prague

2 Faculty of Health Care Studies, West Bohemia University; Pilsen

3 Dept. of Paediatrics; University Hospital Motol; Prague

4 Orthopaedic and Traumatology Department, Hospital Pribram; Pribram

5 Ortotika l.l.c.; Prague

6 PROTEOR CZ l.l.c.; Ostrava

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Biomechanical and bioelectrical effects regulate the adaptation processes in cortical bone

Biomechanické a bioelektrické účinky regulují adaptační procesy v kortikalis

(15 + 5 min.)

Petrtýl Miroslav (Prague, Czech Republic

Laboratory of Biomechanics and Biomaterial Engineering, Department of Mechanics, Faculty of Civil Engineering, CTU; Prague

Biomechanic gait model with and without stick

Biomechanický model chůze s holí a bez hole (15 + 5 min.)

Čulík Jan (Prague, Czech Republic)

ROUND TABLE DISCUSSION AFTER EACH LECTURE

COFFEE BREAK SESSION III:

BIOMECHANICS – ADAPTATION OF SKELETON Chairmen: Marik Ivo, Krawczyk Petr

So-called idiopathic scoliosis – biomechanical etiology. Historical dates of discoveries. Classification. Therapy and prophylaxis. Opinions about new knowledge

Tzv. idiopatická skolióza – biomechanická etiologie. Historie objevů. Klasifikace.

Terapie a profylaxe. Názory o nových znalostech(20 + 5 min.)

Karski Tomasz (Lublin, Poland) Vincent Pol University in Lublin, Poland Presenter: Marik Antonín

Faculty of Physics, Education and Sport, Charles University, Prague, Czech Republic

How to Treat Acute Compartemnt Syndrome of Foot and Ankle in Childhood and Adolescence

Jak léčit akutní kompartment syndrom nohy a hlezna u dětí a dospívajících

(20 + 5 min.)

Zwipp Hans (Dresden, Germany)

Orthopedic and Traumatology Department of the University in Dresden, Germany

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Dega pelvic osteotomy in treatment of DDH, 50

th

Anniversary

Degova osteotomie pánve v léčení vývojové dysplazie kyčlí, 50. výročí

(15 + 5 min.)

Karski Jacek1, Okoński Marek1, Ostrowski Jerzy1, Matuszewski Łukasz1, Kandzierski Grzegorz1, Karski Tomasz2 (Lublin, Poland)

1 Paediatric Orthopaedic and Rehabilitation Department of Medical University in Lublin, Poland

2 Vincent Pol University in Lublin, Poland Presenter: Marik Ivo

Centre for Defects of Locomotor Apparatus l.l.c.; Prague; Czech Republic Faculty of Health Care Studies, West Bohemia University; Pilsen

ROUND TABLE DISCUSSION AFTER EACH LECTURE 12.30

CLOSING OF THE CONFERENCE AND PLANNING

THE 23RD PRAGUE-LUBLIN-SYDNEY-ST. PETERSBURG SYMPOSIUM Ivo Marik & Petr Krawczyk & Miroslav Petrtýl & Piet van Loon

LUNCH

SOCIAL PROGRAMME

14.00

NATIONAL MUSEUM

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Organizers of the Conference:

Professor Ivo Marik, MD, PhD & Petr Krawczyk, MD Faculty of Health Care Studies, West Bohemia University, Pilsen &

Ambulant Centre for Defects of Locomotor Apparatus l.l.c., Prague, Czech Republic, E-mail: ambul_centrum@volny.cz &

PROTEOR CZ l.l.c., Ostrava, Czech Republic E-mail: krawczyk@proteorcz.cz

Participants will receive the Programme and Certificate of Attendance.

Abstracts of lectures will be published in Supplement 2 of the journal Locomotor System, vol. 27, 2020 (electronic version, ISSN 2336-4777,

http://www.pojivo.cz/cz/pohybove-ustroji/)

More recent information about the Conference and text-slides of the presentations will be accessible (without charge) on websites www.pojivo.cz and www.ortoprotetika.cz.

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Welcoming speech of Professor Ivo Mařík MD, PhD to participants of

Conference

Adaptation – interdisciplinary aspects

Dear Ladies and Gentlemen, my dear colleagues!

I cordially welcome you at the CONFERENCE: ADAPTATION – INTERDISCIPLINARY ASPECTS that has been organized at last minute by Society for Connective Tissues and Orthotic and Prosthetic Society CMA J.E. Purkynje because of special situation – Coronavirus pandemy.

I would like to thank all our traditional international organizers for their endeavour to support us at distance and all present speakers.

Professor Mikhail Dudin, MD, DSc has written: Unfortunately, due to the ill-fated COVID and the government’s quarantine measures, I could not fly to Golden Prague to meet with my friends. There- fore, in correspondence form I wish all the participants of the conference

good health, warm meetings, brilliant presentations and fruitful discussions!

I remain mentally with you Mikhail

Professor Tomasz Karski, MD, PhD and Assist. Professor Jacek Karski, MD, PhD has sent their outstanding lectures for presentation.

Tomasz has written: “In the time of my presentation on Saturday – 12th September – time 12.00 – 13.00 – I will be by my computer – and if will be some question – I will answer every e-mail. Or is also possible to send a short SMS to no +48 604 933 234 and I will answer.

Best greetings to you and Alena, Petr and all Professors, Organizers and Participants of the Conference Tomasz & Jacek & Families

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Professor Hans Zwipp has written:

Dear Ivo,

when you told me that the meeting was cancelled due to Corona I decided to go to another place at that time, focusing to publish the title I sent you for the journal Locomotor System. So sorry, that I can’t follow you to Prague.

Have a good time with greetings to all, especially to your wife and Tomas Karski Hans

Today, my pleasure is to welcome among us distinguished Czech celebrities Professor Jana Pařízková, MD, DSc.,

well known endocrinologist and anthropologist specialized on child obesity, Professor Miroslav Petrtýl, Eng, DSc.,

well-known biomechanics – specialist in functional adaptation of skeleton, Associate Professor Štěpán Kutílek, PhD,

paediatric osteologist and the head of Paediatric department in Klatovy Hospital, and last but not least

Dr. Piet Van Loon from Deventer,

orthopaedic surgeon fighting for “care to move” in the Netherlands based on aspects of Osteovertebral and Osteoneural growth relations by Milan Roth.

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Now, as usually, let me a short reminiscence of a few moments that we spent with most of you in the 6th Congress of Dr. Aleš Hrdlička in Humpolec in September 3–5, 2019.

Professor Tomasz Karski, MD, PhD was awarded by a Diploma of Honorary Membership in the Czech Medical Association J. E. Purkyně for his lifelong scientific work and care for paediatric orthopaedic patients. The award was handed by the president of the Czech Medical Association J. E. Purkyně Professor Štěpán Svačina, MD, DSc.

(Humpolec, September 3, 2019).

Note: The same honour – a Diploma of Honorary Membership in the Czech Medical Association J. E. Purkyně for professional work, longtime international cooperation and support of The 15th to 21st Prague-Lublin-Sydney-St.

Petersburg Symposium – was awarded to Professor Mihail Dudin, MD, DSc.

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Well known anthropologists were honored by Hrdlička´s Memorable Medal Award: from left in 1st row:

Professor Ivo Marik, MD, PhD, Associate Professor Dr. Petr Sedlak, PhD, Professor Dr. Jane E. Buikstra, PhD, Professor Maria Kaczmarek, MSc, DSc, Professor Elizaveta Valentinovna Veselovskaya and Dr. Alena Němečková (Humpolec, September 3, 2019).

Piet van Loon, MD and

Professor Miroslav Petrtýl, Eng, DSc. (from left)

Professor Tomasz Karski, MD, PhD and Professor Josef Hyánek, MD, DSc (from left)

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The Czech group of participants of the 6th Anthropological Congress of Dr. Aleš Hrdlička – 150 anniversary of birth (September 3–5, 2019, Humpolec, Czech Republic)

Professor Václav Smrčka, MD, PhD and Professor Ctibor Povýšil, MD, DSc (from left)

Helena Doktorová, Eng., Alena Maříková, MD, Professor Ivo Mařík, MD, PhD, and

Dr. Daniela Zemková, PhD (from left)

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Our dear Professor Jana Pařízková, MD, DSc. and Professor Josef Hyánek, MD, DSc.

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ABSTRACTS OF PERSPECTIVE REVIEW ARTICLES

Note: text-slides of the presentations (Kutílek, Piet van Loon, Pařízková, Mařík, Petrtýl, Karski T. and Karski J.) are accessible (without charge) at websites http://www.pojivo.cz and www.ortoprotetika.cz.

WHAT HAVE WE INHERITED, WHAT DO WE SHARE WITH OUR ANCESTORS: THE DEVELOPMENT OF CALCIOTROPIC HORMONES IN THE COURSE OF PHYLOGENESIS

Kutílek Štěpán

Assoc. Professor of Paediatrics; Dept. of Paediatrics; Klatovy Hospital; Klatovy; Czech Republic E-mail: stepan.kutilek@klatovy.nemocnicepk.cz

During evolution, life moved from the sea to the land. This had a significant impact on the deve- lopment of mineral metabolism and its regulation. This review deals with the evolution of most important calciotropic hormones (vitamin D, fibroblast growth factor 23, calcitonin, parathyroid hormone).

Key words: evolution; skeleton; vitamin D, fibroblast growth factor 23; calcitonin; parathyroid hormone

INTRODUCTION

In the course of evolution, life moved from the sea to the land. This had a profound impact on the development of mineral metabolism and its regulation. The evolution of essential calciotropic hormones (vitamin D, fibroblast growth factor 23, calcitonin, parathyroid hormone) and skeleton is a fascinating story.

Vitamin D

Vitamin D is photosynthesized in all organisms starting from the phytoplankton up to mammals.

Microalgae contain both vitamin D3 and provitamin D3, 7-dehydrocholesterol. Vitamin D2 is pro- duced in fungi and yeasts after ultraviolet radiation (UVR) . Vitamin D3 and its provitamin is present in leaves Solanaceae family of trees, shrubs, and herbs. Functions of vitamin D in either phytoplank- ton or zooplankton remain unknown. Several theories have dealt with this issue. The most likely explanations seem to be that provitamin D evolved to protect UVR-sensitive macromolecules from solar UV damage and that vitamin D is also regulating membrane permeability to cations, such as calcium (1,2).

Fish are known to have the utmost natural content of vitamin D as they consume plankton which is rich in vitamin D and is the principal basis for the entire marine food web (1,2). Furthermore, terrestrial animals possess a calcified skeleton and lay eggs with a calcified shell; therefore they need provitamin D for calcium and bone metabolism. Concerning the vitamin D and humans, it is important to realize that in tropical regions with abundant sunshine of vitamin D is synthetized in

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the skin in large amounts. Furthermore, high amount of dark melanin in the skin slows cutaneous synthesis of vitamin D3. Therefore, dark-skinned individuals require a six-time longer exposure to sunlight than fair-skin individuals to achieve the same vitamin D serum levels. From the evolution- ary point of view, when hominines left the forest for the sun-exposed savannah, they lost their fur, acquired a sweating mechanism, and their skin became pigmented to protect them from the higher levels of UVR.

Later, when Homo sapiens migrated out of Africa, they received significantly less UVR, and their skin depigmented to a degree that permitted UVR-induced synthesis of provitamin D3. A selective sweep of the promoter of the vitamin D receptor (VDR) occurred once Homo sapiens migrated out of Africa; it co-adapted with skin colour genes to provide adaptation to latitudes and the levels of exposure to UVB radiation along the route out of Africa (1,2).

Fibroblast Growth Factors

Fibroblast Growth Factors (FGFs) are small proteins (17–34 kDa) secreted in a variety of tissues and acting through binding to transmembrane tyrosine kinase receptors (FGFRs). The activation of FGFRs triggers several cytoplasmic cascades leading to the modification of cell behavior. FGFs play pivotal roles in a variety of developmental and physiological processes (5, 7). Out of FGFs, FGF 23 is the most frequently studied one. FGF23 plays a key role in phosphate and bone metabolism, as it downregulates Npt2a and Npt2c sodium-phosphate cotransporters, thus leading to renal phos- phate wasting. In addition, FGF23 decreases the enzymatic conversion of 25(OH)D to 1,25(OH)2D.

The FGF23 gene is located on human chromosome 12p13 (5, 7). FGFs were initially discovered in mammals (6 subfamilies), and since then have been found in many metazoans and some arthropod viruses, totaling up to 8 subfamilies. FGF gene studies revealed that ancestral FGF gene (named FGF3/4/5/6) was duplicated in tandem before chordate diversification (5). FGF23 was first expressed in fish and onwards in reptiles, birds and mammals (5).

Calcitonin

Calcitonin is a single chain polypeptide hormone which has a protective role against hypercalcemia by restricting osteoclastic bone resorption. Calcitonin is synthesized by:

y the parafollicular cells (C-cells) associated with the ultimobranchial gland in lower vertebrates (fish i.e.salmon)

y the parafollicular cells (C-cells) of the thyroid gland in mammals

y C-cells are derived from the neural crest and migrate forward to localize in the ultimo-branchial body in lower vertebrates and as parafollicular cells in man and related species (6).

Calcitonin is present in ocean fish which live in a high calcium environment with the need to expel calcium. Therefore, calcitonin is older than parathyroid hormone (PTH) which was first recognized in early land-dwelling animals when conservation rather than expulsion of calcium became important (6). An immunoreactive-human calcitonin (i-CT)-like molecule has been demonstrated in the nerv- ous system of protochordates and cyclostome myxine (hagfish), in neural ganglia of Ciona intesti-

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nalis, an immediate ancestor of the vertebrate, but lacking a skeleton and in the ultimobranchial body of the amphibian Rana (6).

Parathyroid hormone

Parathyroid hormone (PTH) is a single chain 84 aminoacid full-length polypeptide secreted by para- thyroid glands. PTH stimulates bone resorption thus releasing calcium from the skeleton reservoir, reduces calciuria and increases renal phosphate excretion. In addition, PTH indirectly increases intestinal calcium absorption by stimulating the renal production of 1,25(OH)2 vitamin D (3).

Parathyroid glands and PTH evolved with the emergence of the tetrapods, reflecting a need for new controls on calcium homeostasis in terrestrial, rather than aquatic, environments (4). The para- thyroid gland developed from the pharyngeal pouch endoderm regulated by Gcm-2 gene forming parathyroid gland. Gcm-2 is present not only in tetrapods but also in teleosts and chondrichthyans, and that in these species, Gcm-2 is expressed within the pharyngeal pouches and internal gill buds that derive from them in zebrafish (Danio rerio), a teleost, and dogfish (Scyliorhinus canicula), a chon- drichthyan (4). Furthermore, Gcm-2 is required for the formation of the internal gill buds in zebrafish.

PTH -encoding genes exist in fish (zebrafish, dogfish) and show that these genes are expressed by the gills. Tetrapod parathyroid gland and the gills of fish are evolutionarily related structures (4).

The gills also express the calcium-sensing receptor (CaSR), which is used in tetrapods to monitor serum calcium levels and modulate PTH secretion as a response to extracellular ionized calcium concentration (4).

CONCLUSION

It was a long path of evolution to achieve a complex skeleton and a complex interplay to permit mineral homeostasis.

REFERENCES

1. HOCHBERG Z , HOCHBERG I. Evolutionary Perspective in Rickets and Vitamin D. Front. Endocrinol. 2019; 10:306.

2. HOLICK MF. Vitamin D: a millenium perspective. J. Cell. Biochem. 2003; 88:296–307.

3. NISSENSON RA, JUPPNER H. Parathyroid Hormone. In: Rosen CJ, ed. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition. John Wiley &Sons 2013: 208-214.

4. OKABE M, GRAHAM A. The origin of PTH gland. Proc Natl Acad Sci U S A 2004;101: 17716-17719.

5. OULION S. BERTRAND S, ESCRIVA H. Evolution of the FGF Gene Family. Int J Evolution Biol 2012;2012 :298147.

6. WIMALAWANSA SJ. Calcitonin: History, Physiology, Pathophysiology and Therapeutic Applications. In: Orwoll E.S., Bilezikian J.P. and Vanderschueren D. ed. Osteoporosis in Men, Elsevier Science. 2010: 653-666.

7. WHITE KE, ECONS MJ. Fibroblast Growth Factor 23 (FGF23). In: Rosen CJ, ed. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition. John Wiley &Sons 2013:188-194.

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NEGATIVE ADAPTIVE STRATEGIES OF THE HUMAN LOCOMOTOR APPARATUS IN CHILDREN ON THEIR INTENSIVE SEDENTARY LIFESTYLE

On the threat on Healthcare systems by sitting and the importance of Milan Roth’s work to understand it.

van Loon Piet JM1, Grotenhuis Andre H2 , Soeterbroek Andre M3

1 Orthopedic surgeon, Posture Network Netherlands, Proktovar Hengelo, The Netherlands pvanloon@planet.nl

2 Em. Professor neurosurgery, Radbou University Nijmegen, The Netherlands

3 Soeterbroek Andre M, analyst, chairman Posture Network Netherlands, The Netherlands

Key words: adaptive strategies; sedentary lifestyle; locomotor apparatus; spine; children; growth;

osteoneural growth relations

We learn lessons from COVID-19: the most serious complications occur in case of chronic lifestyle diseases and the only answer the world has is hygienic measurements. But another pandemic was already present as a great socio-economic burden: the ever-increasing incidence of “Musculoskeletal Conditions”, with arthrosis and degenerative spinal problems on the top.

For this pandemic prevention and hygienic measurements are lacking in most industrialised coun- tries, the most in the USA. Because in aetiology of arthrosis, degenerative spinal problems and spinal deformations the morphogenesis of our skeleton towards a healthy alignment or posture is dependent on the adaptive “skills” of our body to all the loading patterns offered by lifestyle and locomotion patterns during the whole period of growth, prevention should be focussed on the child. It is the origin of Orthopaedics (Andry, 1741): Orthopaedie or “optimal growth”, is the “Art to prevent and correct all bodily deformations by all those means, the fathers and the mothers and all those involved in raising a child can use”. But in modern times the preventive measurements that can be taken, are forgotten or abended.

Scientific question: Is all adaptive capability of a child’s body still used in a proper way in this era with their sedentary lifestyle and sitting while using new technology with screens? It is not. And that is a pity in the light of Darwin’s Evolution theory. Survival and a chance to gain a durable health are questionable at present times.

Adaptation in form during growth is all about the game of our locomotion apparatus with all physi- cal forces and the play with gravity. Form still follows Function!

In classic Orthopaedics the deformative forces by sitting on chairs on the child’s spine was known from Andry on and many ergonomic school furniture on active sitting was designed by Swiss and German docters. The body cannot adapt to all these hours of slumped positions.

But it was Prof. Alf Nachemson in Sweden that performed his famous intradiscal pressure measure- ments in different positions and activities, were passive sitting gave more compression forces in lower discs than heavy lifting! The comparison, what will happen with a young deformable disc and spine is obvious

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Besides increasing sitting hours for children, the introduction of new technology with screens, almost doubled hours of sitting (mostly slumped).

According to Milan Roth in the concepts of Osteoneural Growth Relations the morphogenesis of the skeleton is based on compressive and tensile forces (as in Wolff’s Law). If the nervous tissue is hindered in its growth by stretch and stays “short” it will protect itself against too much tension and will order muscles to keep the skeleton short too.

There is lack of research on the form and optimal function of the thoracolumbar joint. Its plays a crucial role in human locomotion, because it acts as the pivot-joint between the pendulum of the legs and the reversed pendulum of the arms and provides torque and counter torque in two different directions. The conus therefore is situated there to act as the optimal centre of gravity and 0-point of tension in all directions. It is obvious that all Roth’s findings on pneumomyelografy can be found on MRI, but no studies on the mismatch between bone and CNS are published in the case of healthy adolescents.

The discs at the TL-joint are at great risk in sitting children or young spines in longstanding flexed positions. Wullstein proofed this with animal experiments already in 1904.

In an own study amongst 248 adolescents of one school in all the Finger Floor test was assessed and showed 80% not reaching the floor. There was a statistical match between the FFT and tight hamstrings. Boys that play football have the least flexibility, girls that dance or do gymnastics the most. But the bending test photographed from lateral showed hyperkyphosis in about 60% most arcuate, but many angular deformed.

The burden of disease caused by sedentary lifestyle must be reversed by hygienic knowledge by parents, schoolteachers and guided by Public Health. Detoriation of spinal alignment and loss of flexibility should be screened in all and be treated by postural exercises, stretching exercises and in more fixed deformity with corrective bracing.

But the need for focussed research on all aspects of discongruent Osteoneural growth relations and the direct and indirect negative effects on health by sitting is mandatory.

THE IMPACT OF EARLY ADAPTATION TO REDUCED PHYSICAL ACTIVITY ON BODY COMPOSITION AND MOTOR DEVELOPMENT IN CHILDREN

Pařízková Jana1, Sedlak Petr2

1 parizkova.jan@gmail.com

2 Dept. of Anthropology and Human Genetics, Prague, Czech Republic

Key words: adaptation – hypokinesia – growth period – musculoskeletal system

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Reduced level of physical activity has been considered as a significant negative factor of the devel- opment of metabolic and health problem including obesity, diabetes and also musculoskeletal deterioration. This impact depends not only on its character, importance, duration and frequency, but especially on the age and stage of development when the impact and adaptation are intro- duced; this applies especially during early age, when the spontaneous activity is usually on its highest level. In such case the consequences are more easily stabilized and remain more easily as a permanent characteristic of the way of life later on. Adaptive consequences can be proved - modi- fied characteristics of metabolic, functional, morphological status of the growing organism until adulthood. This was revealed both in experimental models using laboratory animals, and also found by observations in some human population groups. Experimental studies concerning the impact of an increased physical activity have been incomparably more numerous as compared to the impact of markedly reduced physical activity, provided comparable conditions of other important condi- tions (e,g. nutrition, genetic factors etc). The impact of the adaptation to various activity – especially in the opposite situation – increased exercise was found even when following later adult offspring of experimental animals – mothers adapted during pregnancy for exercise during pregnancy con- cerning e.g. the microstructure and resistance of the heart muscle. But empirical observations of human subjects concerned also significant changes of functional, metabolic, health consequences of early adaptation to reduced activity (increased and modified deposition of body fat, weakness of musculoskeletal development, deteriorated body posture and joint development, etc); back and joint pain can appear already during early growth, in addition to more frequent accidents etc.

Adequate arrangements of physical activity regime, starting with the possibility for desired high level of spontaneous physical activity at early age has become increasingly more difficult along with modified life style along with developing technique, digitalization etc. during last time, especially in children since earliest periods of their life. This contributed also to the health problems of younger children which have manifested on a larger and modified scale more previously – obesity, diabetes, deterioration of body posture, and other musculoskeletal problems. Therefore, preventive measures of child care have to be implemented much earlier in life than considered before.

EXPLANATION OF PATHOGENESIS OF SKELETON DEFORMITIES AT GENETIC SKELETAL DISORDERS THROUGH FUNCTIONAL ADAPTATION OF BONES

Marik Ivo1,2,4, Zemkova Daniela1,3, Myslivec Radek4,1, Marikova Alena1, Cerny Pavel5,2, Krawczyk Petr6

1 Centre for Defects of Locomotor Apparatus l.l.c.; Prague; Czech Republic

2 Faculty of Health Care Studies, West Bohemia University; Pilsen; Czech Republic

3 Dept. of Paediatrics; University Hospital Motol; Prague; Czech Republic

4 Orthopaedic and Traumatology Department, Hospital Pribram; Pribram; Czech Republic

5 Ortotika l.l.c.; Prague; Czech Republic

6 PROTEOR CZ l.l.c.; Ostrava; Czech Republic ambul_centrum@volny.cz

Key words: deformities of skeleton, functional adaptation of bones, bone modelling and remodel- ling, lateral drift, remodelling at skeletal genetic disorders

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The authors have many years ongoing experience with treatment of skeleton deformities at Genetic Skeletal Disorders (GSD). Deformities of spine and lower extremities (knee and shank deformities) that can be corrected by braces and orthoses (both acting on the three point principle) and/or by low invasive surgical method – so-called guided growth. Both orthotic and surgical methods of treatment use Hüter-Volkmann law (the 3rd mechanism of functional adaptation of bones) which involves growth of long bones.

Functional adaptation of bones is a process where influence of function leads to optimal develop- ment of bone shapes and structure of skeleton. Genetically anchored programmes for development of expedient shapes and structures during ontogenesis assert primary oneself in embryonal period without influence of special mechanic forces, muscle activity and impact of gravity of Earth. Genetic mechanism accruing during evolution creates only basic shapes.

Mechanisms of functional adaptation, i.e. a way haw tissues respond to external epigenetic impacts, are also hereditary anchored. Both genetic and epigenetic processes head towards the same goal.

The muscle movement has morphogenetic function as early as foetal period.

Muscles take the specific forming function only postnatally. It means that genetic influence asserts oneself even in postnatal period when typical symptomatology of bone dysplasias (osteochondro- dysplasias) develops.

In 1892 Wolf described this process: “by consequence of changes of functional requirements comes up in bone by mathematic laws to conversion of internal architecture and only just so to secondary changes of external shape of bone”. “Trajectory” theory is valid only for isotropic and homogenous material.

For this material is valid that both main directions of stress (tension) are perpendicular each to other.

But the skeleton is assumed to be un-isotropic material!

Wolffˇs transformation law and remodelling has been verified in the experimental way and defined with more precision up to 70th years 20th century when 3 fundamental mechanisms (laws) of func- tional adaptation of connective tissues were explained – mainly growth of long bones, apposition and resorption.

1st mechanism of functional adaptation of bones depends on intensity of changing – cycling strain- ing (internal stress in bone), velocity of alteration of deformation, number of cycles, etc. – strictly speaking on activity of osteoblasts (osteocytes) and osteoclasts that are influenced – activated by supraliminal deformation. In range of remodelling equilibrium (1500–2500 microstrains) the bone does not respond to stress. Supraliminal values of changing – cycling straining cause apposition, subliminal bone resorption.

2nd mechanism of bone adaptation is caused by periosteum. The push of periosteum (and also endosteum) against the bone surface causes the resorption of bone tissue, whereas its take up is a cause of apposition. The convex surface of the long bone (diaphysis) inclines to resorption and the concave one to apposition.

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3rd mechanism is a regulation of long bone growth by epiphyseal plate (so-called physis) and is pos- sible only in growing period. According to Hüter and Volkmann law physis creates a new bone tis- sue into axial pressure direction (central line). Increase of stress causes restriction of growth, on the other hand unloading of physis accelerates growth. In situation of oblique loading, the epiphyseal plate regulates the growth of long bone into the direction of the pressure resultant (central line).

Big merits on understanding of bone physiology belong to Harold Frost, Lanyon et al., Jiri Heřt, Milan Roth and a lot of no named anatomists, histologists, morphologists, orthopaedic surgeons, biomechanics, etc.

According to H. Frost, the modelling is a planar apposition and/or resorption process which changes the shape of bone. On the other hand, the remodelling of skeleton runs variously intensively for whole life in Hoffship´s lacunae (so-called basic multicellular units) on surface of bone trabeculae, subperiostally, on cortico-endostal surface and Haversian system of osteons.

In 1995 Sobotka and Mařík (Pohybové ústrojí 2, 1995, č. 1, s. 15–24) described clinical and X-ray investigation of long bones of some bone dysplasias and their macroscopical observation at surgi- cal treatment of bone deformities by means of the fundamental laws of remodelling. The complex loading of bones involves compression, tension, bending, shear and torsion. They explained the phenomena of narrowing, vanishing and displacement of medullary canal of the long bones of children with different types of osteogenesis imperfecta, as well as the causes of disturbed func- tional adaptation of bones at some other bone dysplasias where the decrease in the resistance to deformation is often compensated by apposition of bone tissue on the external bone surface (e.g.

in children with different forms of rickets). This increases the resistance of long bones to torsion and bending (Sobotka, Mařík 1994). Every divergence from the physiological composition of bone tissue is manifested by a disturbance of the resistance against mechanical effects. An excessive amount of the mineral components involves considerably hardness but also fragility of bones of children with sclerosing bone dysplasias (e.g. osteopetrosis) and some people at advanced age. Such bones can carry considerable static loads but they frequently fail by impact. On the other hand, the lack of mineral components in the bone tissue leads to osteomalacia and typical subsequent deformities since it causes the escalated softness and insufficient strength of the skeleton even at rest (Sobotka 1994). The observed biomechanical impulses for bone remodelling can be explained on the basis of the deformation changes of bones. The investigation of these phenomena in cases of genetic skeletal disorders (investigation of X-rays, per-operative observation, results of orthotic and surgical treatment) has led the authors (Sobotka and Mařík 1995) to the formulation of the deformational- rheological theory of bone remodelling. There exist instantaneous elastic deformation changes arising immediately with changes of loading and furthermore the time-dependent viscoelastic deformation changes occurring at constant load or after unloading. According to this theory, the remodelling of bone tissue depends on its time-varying straining represented by extensions and shortenings. Because of the viscoelastic properties of bones (bone tissue contains collagen fibres, proteoglycans and fluids in skeleton), the strains vary not only at varying loading but the strain changes continue and fade as elastic after-effects at constant loads and after unloading – in rest, in sleep. The intensity of remodelling then depends on the amount, changes and duration of straining.

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By this theory we can explain and understand efficiency of orthotic treatment in the night regime or effectiveness of physiotherapy on remodelling of locomotion system.

Material and Methods

During 25 years a group of more than 600 children suffering with genetic skeletal disorders (GSD, bone dysplasias) has been investigated from the point of the fundamental laws of bone remodelling described above. We use X-ray documentation of children, per-operative observation and evaluate the results of orthotic and surgical treatment. Last years we also evaluate bone density at some bone dysplasias by densitometric examination (DEXA).

Results

The most frequent deformities of long bones are demonstrated on photos and X-rays of children with GSD – these are:

1. incomplete correction of long bone curvature by so-called lateral drift (e.g. rickets, genetic rickets, hypophosphatasia, hyperfosphatasia, osteogenesis imperfecta, fibrous dysplasia, enchondromatosis etc.).

2. abnormal (pathologic) changes of cross-sectional areas of long bones by apposition of new bone tissue at the external circumference (subperiosteal apposition) and resorption at the internal circumference causing tubular shape of long bones (e.g. rickets, genetic rickets espe- cially hypophosphatemic rickets, severe types of osteogenesis imperfecta).

3. narrowing, displacement and vanishing of medullary canal of patients with osteogenesis imperfecta that enable compensation – lateral drift – of lower quality to resist loading and deformation. This phenomenon and so-called shepherd´s crook and sabre-like deformities were observed in severe types of osteogenesis imperfecta.

4. abnormal modelling of metaphysis and diaphysis (sclerosing bone dysplasias, multiple exos- toses, enchondromatosis, pachydermoperiostosis, etc.)

5. genetically predetermined oblique growth of epiphyseal plate (e.g. epi-metaphyseal dysplasia) 6. growth retardation localized on medial and/or lateral part of epiphyseal plate (e.g. morbus

Blount)

7. varosity of shanks due to overgrowth of fibula (achondroplasia, hypochondroplasia, pseudoa- chondroplasia, epi-metaphyseal dysplasia, etc.)

8. anteromedial angulation of tibia at fibular hemimelia, type 2 due to fibular fibrocartilage (anlage).

Conclusion

The described fundamental laws of bone remodelling secure healthy organism an ability to adapt shape and solidness of skeleton to varying living condition.

Abnormal shape and above described deformities of skeleton in individuals with bone dysplasias are results of modelling and remodelling of genetic predetermined pathologic bone tissue (that contains abnormal collagen chains, proteoglycans, etc.) with abnormal material properties.

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At various genetic skeletal disorders (bone dysplasias), the functional adaptation of bones is affect- ed in different levels, from the normal course to the pathological one. The remodelling is genetically predetermined. In these cases we observe various deformities of the skeleton.

References

1. FROST HM. The Laws of Bone Structure. 4th ed. Springfield: C.C. Thomas, 1964, 167 s.

2. FROST HM. Perspectives: A proposed general model for the mechanostat (suggestions from a new skeletal-bio- logic paradigm). Ana Rec, 244, 1996, s. 139–47.

3. HEŘT J. Wolfův transformační zákon po 100 letech. Acta Chir orthop et Traum čech, 57, 1990, č. 6, s. 465–76.

4. JEE WSS. Principles in bone physiology. Musculoskel Neuron Interact, 1, 2000, č. 1, s. 11–13.

5. LANYON LE, GOODSHIP AE, PYE CJ, MC FIE JH. Mechanically adaptive bone remodeling. J Biomech, 15, 1982, č. 3, s. 141–54.

6. LANYON LE. Functional strain in bone tissue as an objective and controlling stimulus for adaptive bone remo- deling. J Biomech, 20, , 1987, č. 11/12, s. 1083–1093.

7. MAROTTI G. The structure of bone tissues and the cellular control of their deposition. Ital J. Anat. Embryol, 101, 1996, č. 4, s. 25–79.

8. MAŘÍK I, SOBOTKA Z. Complications of Intramedullary Nailing and Regeneration of Long Bones at some Bone Dysplasias, Pohybové ústrojí, 4, 1997, č. 2, s. 50 - 60.

9. MARÍK I, CULÍK J, CERNY P, ZEMKOVÁ D, ZUBINA P, HYÁNKOVÁ E. New Limb Orthoses with High Bending Pre- Stressing. Orthopädie-Technik Quarterly, English edition III/2003, p. 7–12.

10. MARIK I, MARIKOVA A, HUDAKOVA O, ZEMKOVA D, PETRASOVA S, SORMOVA L, MYSLIVEC R, KUKLIK M, KOZLOWSKI K. Nosology and classification of genetic skeletal disorders: 2010 revision. Application on a cohort of patients. Locomotor System, 19, 2012, No. 3+4 Supl., p. 315-321. ISSN 1212-4575.

11. MAŘÍK I, MAŘÍKOVÁ A, POVÝŠIL C. Kostní genetické choroby. In: Ctibor Povýšil et al. Patomorfologie chorob kostí a kloubů, Galén, 2017: s. 25 – 101.

12. MARIK IVO, ZEMKOVA DANIELA,MYSLIVEC RADEK,MARIKOVA ALENA, CERNY PAVEL, KRAWCZYK PETR.

Functional adaptation of bones. Explanation of skeletal deformities in skeletal genetic disorders. Pohybové ústrojí, 24, 2017, Suplementum 2, p. 64 – 70.

13. MAŘÍK IVO, MAŘÍKOVÁ ALENA, HUDÁKOVÁ OLGA, ZEMKOVÁ DANIELA, † KOLÁŘ JAROMÍR. Vrozená onemoc- nění, nádory kostí a pojivových tkání. In: REVMATOLOGIE, druhé aktualizované a rozšířené vydání, eds. Pavelka, Vencovský, Horák, Šenolt, Mann, Štěpán a kol. (pozn. celkem 49 autorů), Maxdorf 2018, s. 791 – 805.

14. MORTIER GR, COHN DH, CORMIER-DAIRE V. Nosology and classification of genetic skeletal disorders: 2019 revision. Am J Med Genet A. 2019, 179A: 2393–2419.

15. NORDIN M, FRANKEL VH. Biomechanics of bone. In: M. Nordin and V.H. Frankel. Basic biomechanics of the musculoskeletal system, 2nd ed, Philadelphia, London: Lea and Febiger, 1989, s. 3 – 30.

16. PARFITT AM Bone remodeling and bone loss: Understanding the pathophysiology of osteoporosis. Clin Obstetr and Gynecol, 30, 1987, č. 4, s. 789 - 813.

17. PETRTÝL M, HEŘT J, FIALA P. Spatial organization of the Haversian Bone. Journal of Biomechanics, 29, 1996, č. 2, s. 161 – 69.

18. PETRTÝL M, DANEŠOVÁ J. Obecná teorie remodelace kostní tkáně. Pohybové ústrojí, 6, 1999, č. 3+4, s. 244 – 263.

19. PETRTÝL M, DANEŠOVÁ J. Limitní cykly vzniku, funkční stability a zániku kostní tkáně v jejím objemovém ele- mentu. Osteologický bulletin, 5, 2000, č. 4, s. 123 – 130.

20. ROTH, M. Idiopathic scoliosis caused by a short spinal cord. Acta Radiologica Diagnosis, 1968, č. 7, s. 257-271.

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21. ROTH, M. Role of neural growth in the pathomechanism of skeletal dysplasias: an experimental study. Locomotor system, 1995, roč. 2, č. 3, s. 85-111.

22. SOBOTKA Z, MAŘÍK I. Remodelation and regeneration of bone tissue at some bone dysplasias. Pohybové ústrojí, 2, 1995, č. 1, s. 15 - 24.

23. SOKOLOV BP, SHER BM, HAUSMANN J, MAŘÍK I, DEYL Z, KALININ VN. Altered ratio collagen chains in bone of a patient with nonlethal osteogenesis imperfecta. Biochim biophys Acta, 1138, 1992, s. 93-96.

BIOMECHANICAL AND BIOELECTRICAL EFFECTS REGULATE THE ADAPTATION PROCESSES IN CORTICAL BONE

Professor Eng. Petrtýl Miroslav, DSc

Department of Mechanics, Faculty of Civil Engineering, Laboratory of Biomechanics and Biomaterial Engineering, CTU in Prague;

Czech Republic petrtylmir@seznam.cz

Cortical bone adaptation is a summary of physiologically permissible processes that are aimed to maintain and preserve the genetically predetermined (defined) homeostasis. Bone tissue adapta- tion processes are primarily influenced by external and internal biomechanical effects (at all eight structural levels) that initiate the both biochemical and bioelectrical processes at the nano level.

Adaptation processes in bone tissue can be classified from a time point of view as short-lived processes (lasting several months) and long-lived processes – evolutionary (ongoing in a chain of several generations, i.e. decades / centuries). Short-term adaptation processes are tissue model- ling and remodelling, while preserving genetically predetermined anatomical shapes and functions.

Long-term adaptation processes are considered processes of evolution.

Biomechanoelectric effects can be briefly described by the following axioms:

1. External mechanical stimuli (i.e. forces, bending moments, torsional moments) initiate in dif- ferential element (dxidyidzi, i = 1,2,3…8) of each i-th bone level (Fig. 1) the stress/strain states (generally). These states can be defined by tensors exactly.

2. Structural domains on the 8th structural level (i.e. the macro-level) create the anisotropic right- handed and left-handed helical structures, Fig. 2).

3. In the left wall of the right femoral diaphysis, the longitudinal osteon axes are tangents to the left-handed helix and, in the right wall, to the right-handed helix, Fig. 2.

4. Longitudinal axes of osteons in the Haversian bone are oriented in the directions of domi- nant 1st principal stresses and ca in the directions of dominant 1st principal deformations also (Fig. 3). Note: The meaning of the word “dominant” means “long-acting” principal (main) stresses / strains.

5. The 1st principal stresses in the ideal state of the bone remodeling equilibrium are approxi- mately identical with the first principal axis of anisotrophy, with the longitudinal axis of osteon and with the directions of dominant 1st principal strains at the point (i.e. in the differential element/

subelements (dxidyidzi, i = 1,2,3…8) of each i-th bone level (Fig. 3, Fig. 1).

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6. Mechanoelectric synergies activate the intensity and quality of dynamic remodeling and mo deling processes in the bone tissue at all structural levels.

7. Mechanoelectric couplings regulate adaptation processes in bone tissue.

8. Hydroxyapatite nanocrystals (HAPs) in the natural form and tropocollagen molecules (TCMs) are domains of main nano structural bone components. Basic nano structural module consists of a pair of domains: HAP + TCM. Haverty et al. (in 2005) proposed for HAP two polar symme- tries: a monoclinic P21 and hexagonal P63 which do not possess any centre symmetry.

9. When on the HAP is applied a principal strain-load, having the principal direction parallel/identi- cal with the electrical axis, the electrical charges are initiated and located on the surfaces of hydroxyapatite crystal.

10. Mineralisation by the HAP plateaus is considered in the gap zones and on the surfaces of some TCMs mainly.

11. Compressed crystals of HAP initiate the piezoelectric effects in the bone nanostructure.

12. Tensile stresses in tropocollagen molecules initiate transports of streaming potentials (ions).

13. The second fundamental nano structural domain – TCM is considered as a dielectric bioelectric material exhibits the polar uniaxial orientation of molecular dipoles in its nano structure.

14. TCMs are bound to HAP plateaus via bonds and tensile forces in TCMs are transmitted to HAP by shear forces (i.e. by the shear nano stresses, resp. by the shear nano strains). Covalent ties in 1st and 2nd structural level ensure the biomechanical stability of bone tissue.

Fig. 1: Structural levels in cortical femoral bone. Each structural level is defined by one (typical) structural domain, which is always shown below each figure. Populations of the same domains at a lower structural level create a new domain at a next higher structural level.

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15. Mechanochemical covalent ties among adjacent TCMs provide the transversal stability of TCMs and their complexity.

16. The stability in the lateral direction is provided by the electrical strengthening as the conse- quence of electric currents. The electric currents create around TCMs the electromagnetic nano force lines, which attract neighbour TCMs.

Fig. 2: The scheme of orientations of principal (main) longitudinal axes of osteons in the walls of the femur.

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Fig. 3: The scheme of bone remodelling equilibrium in the point A and the state of bone remodelling unbalance in the point B. The first axes of the principal stress as1 and the principal deformation ae1 (in the point/element A) are approximately identical (in 3D) with the principal axis of the material domain (i.e. in our case with the longitudinal axis as of the osteon), resp. with the first axis of anisotropy. The first axes of the principal stress as1 and the principal deformation ae1 (in the point/element B) are NOT identical in 3D with the principal axis of the material domain (i.e. in our case with the longitudinal axis as of the osteon), resp. with the first axis of anisotropy.

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17. The electric current in the TCMs initiates not only the strong contraction of helical nanostruc- ture of tropocollagen molecules (see: the electrical strengthening) but also contributes to the reduction of extreme tensile strains in helical tropocollagen fibres.

18. The extreme compressive strength, tensile strength and flexural strength of all the structural domains (within the all structural levels of the cortical bone) contribute to the high load-bear- ing capacity, as well as to the processes of hydraulic strengthening and electrical strengthening of the bone tissue.

19. The hydraulic strengthening in bone depends on fully hydrated nanostructure (by bound water) and on the presence of extracellular fluid containing non-collagenous proteins, proteoglycans, glycosaminoglycans and other components.

20. The principle of synergy (integrating biomechanical, bioelectrical and biochemical processes) in bone tissue is the proof of the law on conservation energies and their changes during the bone adaptation in all structural levels.

References:

1. HERT J, FIALA P, PETRTYL M. Structure of compact bone and stress of which long bones in man are exposed. Acta Chirurg Orthop et Traumat Cechosl 1990;80:199-208 (in Czech).

2. HERT J, FIALA P, PETRTYL M. Osteon orientation of the diaphysis of the long bones in man. In: Bone 1994;15(3):269- 77. 53.

3. PETRTYL M. Spiral Flow of Elastic Properties in the Compact Femoral Bone, In: Proceedings of the 25th Congr of Eur Soc Artif Organs. Prague. 1988;141-45.

4. PETRTYL M. Curvilinear anisotropic properties of compact femoral bone. Proc 2nd Conf on Biomech of Man Liblice 1988, 123–26 (in Czech).

5. PETRTYL M. Reactivities of the Compact Femoral Bone to the External Load. In: Proceedings of the 24th Congress of Biomech. Paris. 1993; 1028-29. 57.

6. PETRTÝL M, HEŘT J, FIALA P. Spatial organization of the Haversian Bone. Journal of Biomechanics, 29, 1996, č. 2, s. 161 – 69.

7. PETRTÝL M, DANEŠOVÁ J. Obecná teorie remodelace kostní tkáně. Pohybové ústrojí, 6, 1999, No. 3+4, p. 244 – 263 (in Czech).

8. PETRTÝL M, DANEŠOVÁ J. Limitní cykly vzniku, funkční stability a zániku kostní tkáně v jejím objemovém ele- mentu. Osteologický bulletin, 5, 2000, No. 4, p. 123 – 130 (in Czech).

9. PETRTÝL M, BALÍK K, POVÝŠIL C, ŽALOUDKOVÁ M. Submikrostrukturální domény v kortikální kosti lidského femuru. Pohybové ústrojí, 22, 2015, No. 3+4, p. 33-59 (in Czech).

10. PETRTYL M, POVYSIL C, ZALOUDKOVA M. Submicrostructural domains in human secondary osteons, Journal of Frailty, Sarcopenia and Falls, 2016; 1(3):38-52.

11. WANG M. Bioactive materials and processing. In: Shi D (Ed.) Biomaterials and tissue engineering. Berlin- Heidelberg-New York: Springer, 2004. p. 1-246.

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BIOMECHANIC GAIT MODEL WITH AND WITHOUT STICK

Čulík Jan

Prague, Czech Republic culik.j@email.cz

Key words: support stick, French support stick, crutches, walk simulation, simulation, different leg length, effect of health aids, upstairs going simulation, osteoarthritis.

Author examines in the article the movement of the lower limbs while walking with a support stick, a French support stick and crutches. The walking is characteristic by one leg touching the ground and the other is in a swing. The patient’s model of walking was done on a computer. The purpose of the model is to observe the impact of a support stick, a French support stick, or crutches on the vari- ous slopes of the staircase. The computer model can count forces and moments for different speeds and by specifying different lengths of the lower limbs to respect the impact of pathological changes.

The article studies the patterns of movement of the lower limbs when moving along a plane, slope and stairs. The calculation procedures for the position of the joints are deduced during the transfer of weight from the posterior lower limb to the front and during the swing of the lower limb to the new position. According to the proposed very precise mathematical model was the simulation model set up on the computer in CDCSIS [7]. The movement in the one step has three phases – car- rying the balance to the front lower limb, moving the lower limb by swinging to the new position and pushing it. The simulation program determines the position of the joints at each time point.

Inertial forces and inertial moments are determined, and the forces and moments in the joints are determined from the balance conditions of the lower limbs and the upper limbs supported on the stick. The calculation is made for different stair heights, resp. subsoil slope. For zero height of the stairway is modeled walking along the plane. The result of simulation experiments is the determi- nation of moments in the knee joint of the supported lower limb. Moment is transmitted by a pair of forces – joint pressure and muscle tension. These forces are considerable, causing knee pain in patients suffering from arthritis. The problem is solved as spatial in the projection to the media and frontal plane. The mathematical formulas of the computational algorithms are supplemented by numerical results tables. The calculated values are used to animate patient movement on stairs with varying degrees of inclination. The results will be used to investigate the effect of health aids of lower leg and spine disorders.

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SO-CALLED IDIOPATHIC SCOLIOSIS – BIOMECHANICAL ETIOLOGY. HISTORICAL DATES OF DISCOVERIES. CLASSIFICATION. THERAPY AND PROPHYLAXIS. OPINIONS ABOUT NEW KNOWLEDGE

Professor Karski Tomasz, MD, PhD

Actually Professor Lecturer in Vincent Pol University in Lublin, Poland

In the years 1995 – 2009 Head of the Pediatric Orthopedic and Rehabilitation Department at the Medical University in Lublin, Poland

tmkarski@gmail.com Presenter: Bc. Marik Antonín

Faculty of Physics, Education and Sport, Charles University, Prague, Czech Republic

Key words: so-called idiopathic scoliosis, etiology, classification, therapy, prophylaxis, opinions.

Adolescent Idiopathic Scoliosis (AIS) is strictly biomechanical and is connected with asymmetry of the hips movements and next with the function of the hips and the spine. Scoliosis develops because of “permanent standing ‘at ease’ on the right leg” and in some types is connected with

“gait”. Additional influences are going from Central Nerve System – in children with the symptoms of Minimal Brain Dysfunction.

Introduction

In many scoliosis children examined in Lublin, in Pediatric Orthopedic Department and in the Out Patients Clinic – we found the asymmetry movement of the hips - limited adduction of the right hip in “tree various models”, next were found the biomechanical influences connected with – “perma- nent standing ‘at ease’ on the right leg” and with “gait”.

Why standing – in Syndrome of Contractures and Deformities (SofCD) according Professor Hans Mau and Lublin observation – there is “limited adduction of the right hip” in straight position of joint and this phenomenon enable easy standing on the right leg. Why gait – the “maximally blocked movement of the right hip” during gait produces a compensatory movement in the pelvis and in the spine – and it is the cause of the rotation deformity of the spine and gibbous in some types of scoliosis.

Thus, since 1995, we use the term “the so-called idiopathic scoliosis” instead of “idiopathic scoliosis”

(Literature 8–29, 43).

Material

In the years 1984 – 2018, more than 2,500 patients with scoliosis have been observed and treated.

80% of patients were aged 4 to 25. Older patients, in the age of 50 – 70 years, were coming for con- sultation because of spine pain and this group constituted 20 %.

Historical dates of discoveries

The dates in research of scoliosis (Karski T. 1995 – 2007/2020) are the following:

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1. 1995 – the first lecture about biomechanical etiology of the so-called idiopathic scoliosis dur- ing the Orthopedic Congress in Szeged, Hungary.

2. 1996 – the first publication about biomechanical etiology of scoliosis in Orthopädische Praxis in Germany (Literature 21): T. Karski [1996] Kontrakturen und Wachstumstörungen im Hüft- und Beckenbereich in der Ätiologie der sogenannten „idiopatischen Skoliosen” – biomechanische Überlegungen, Orthopädische Praxis 32, 3 (1996) 155-160

3. 2001 and 2004 – was giving the new classification: three (3) etiopathological groups (epg) and four (4) types of scoliosis:

a/ “S” scoliosis in 1st epg, b/ “C” and “S” scoliosis in 2nd epg., c/ “I” scoliosis in 3rd epg.

This last type – “I” scoliosis – before 2004 had not been classified as a scoliosis because in this deformity we observe only “stiffness

Obrázek

Fig. 1: Structural levels in cortical femoral bone. Each structural level is defined by one (typical) structural domain,  which is always shown below each figure
Fig. 2: The scheme of orientations of principal (main) longitudinal axes of osteons in the walls of the femur.
Fig. 3: The scheme of bone remodelling equilibrium in the point A and the state of bone remodelling unbalance in  the point B

Odkazy

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