Growth Plates Closure Direction For The Distal Fibula And Tibia Or Ankle Region, Tillaux Fracture

I was watching this youtube video (source link) and something the MD talked about I think is really important was the mention on how at least certain growth plates close. There seems to be a direction on how the growth plates close.

He was talking about a very specific type of growth plate injury that happens a lot to young kids who get injured playing sports. It is a special type of the Type III Salter Harris Fractures known as the Tillaux Fracture. The thing is that this type of fracture doesn’t really happen in adults only kids. What I learned is from the section 7:15-8:15 section of the video so if you want to skip to that part, that’s fine too. The thing is this…

Ankle growth plates don’t close uniformly but close from a medial to lateral direction.

We know that the fibula distal end is connected to the tibia with a ligament. This means that the medial side of the growth plate closes before the lateral side. Any type of torsional load (twisting) can cause the medial section which is attached to the fibula end can snap/ break off because of the fact that one side of the growth plate is ossified and has become bone while the other side might still have some cartilage left.

Types Of Cells The Mesenchymal Stem Cell Can Differentiate Into

I thought I could help out the regular and future readers (as well as myself) in understanding the possible ways the mesenchymal stem cells can differentiate into with a picture I found from a PubMed study. The study and article is entitled “Adult mesenchymal stem cells and cell-based tissue engineering.” (source link).

Note: For the complete article file in PDF form, click HERE.

Arthritis Res Ther. 2003;5(1):32-45. Epub 2002 Dec 11.

Adult mesenchymal stem cells and cell-based tissue engineering.

Tuan RS, Boland G, Tuli R.

Source

National Institute of Arthritis, and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA. Tuanr@mail.nih.gov

Abstract

The identification of multipotential mesenchymal stem cells (MSCs) derived from adult human tissues, including bone marrow stroma and a number of connective tissues, has provided exciting prospects for cell-based tissue engineering and regeneration. This review focuses on the biology of MSCs, including their differentiation potentials in vitro and in vivo, and the application of MSCs in tissue engineering. Our current understanding of MSCs lags behind that of other stem cell types, such as hematopoietic stem cells. Future research should aim to define the cellular and molecular fingerprints of MSCs and elucidate their endogenous role(s) in normal and abnormal tissue functions.

From the bottom of the source link page….

Lineage potential of adult human MSCs. MSCs are characterized by their multilineage differentiation potentials, including bone, cartilage, adipose tissue, muscle, tendon, and stroma. This figure depicts some of the in vitro culture conditions (boxed) that promote the respective differentation process into a specific lineage. Signaling pathways and/or components or events shown to be involved in lineage-specific differentiation are in italics. See text for details.

Dotted arrowheads denote potential ‘reverse’ differentiation events. bFGF, basic fibroblast growth factor; bHLH, basic helix–loop–helix; BMP, bone morphogenetic protein; Cbfa1, core binding factor alpha 1; ECM, extracellular matrix; FGF, fibroblast growth factor; GDF, growth/differentiation factor; IBMX, 3-isobutyl-1-methylxanthine; LRP, low-density lipoprotein receptor-related peptide; MAPK, mitogen-activated protein kinase; PDGF, platelet-derived growth factor; SMAD, vertebrate homologue of DrosophilaMothers Against Decapentaplegic (MAD); TGF-β, transforming growth factor beta; WISP, Wnt-1-inducible protein.

Analysis:

We can see that the mesenchymal stem cells are a type of multi-potent progenitor stem cell which seems to be able to differentiate into many different types of cell types. In the article we learn that the mesenchymal stem cell is one of the main ideas people have for using the stem cells in tissue engineering.

If we focus just on the bones and cartilage, we can see that the picture is very clear in listing 1. the pathway, and 2. the types of growth factors or modulating factors which will help lead the mesenchymal stem cell to its desired outcome.

1. Bone

  • Pathway and cause: LRP-5/Wnt Signaling, Telomerase & Cbfa-1
  • Needed growth factors: Dexamethasone, BMPs, Ascorbate, Beta-Glycerophosphate, 1-25- DihydroVitamin D3,

2. Cartilage

  • Pathway and cause: Cell Adhesion, SMADs, WISP-3/Wnt Signaling, MAPK, ECM Interactions, and Sox9
  • Needed growth factors: High-density pellet culture, Serum-free media, Dexamethason, Ascorbate, TGF-Betas (1 & 2), BMPs
What is clear is that there is a LOT more pathways, steps, and component for the MSCs to turn into chondrocytes as well as more different ways in elements for the progenitor stem cell to turn into the cartilage than bone.

 

The Divergence Of Multiple Tribes Throughout History Applying Selective Breeding And Eugenics Proves That Giants Existed In Ancient History

A random thought I recently had was that the way so many different types of tribes and groups of ethnicities had come and gone and the many variations, combinations, and permutations of human body types should result with an extremely high probability that at some point in the history and evolution of the hominid species from the great apes to humans, there had to have been at least 1 tribe or group of human like creatures who grew to at least 8 feet tall.

My thinking process is that if we reverse the time scale back to our primitive ancestors, their lives were far more simple than ours. They didn’t have to worry about jobs, insurance, businesses, investing, school, etc. which we have to deal with in our modern life. What they had to worry about was what most social creatures had to worry about.

Food, water, access to mating partners, having healthy offspring, staying away from danger, staying alert, etc. These are the things they worried about. At this basic level, most hominid which started to walk upright probably developed the realization that being taller was better than being shorter. There is a clear advantage in reaching food in tall trees if one was taller. In addition, due to how body mass and volume increase at a cubic geometric rate in relation to height/ vertical increases, that meant that taller creatures would be literally bigger in size, due to correct proportions.

For many mammals, but especially primates, the male of the species is the larger of the two sexes as well as being stronger in terms of brute force. From what we learn in evolutionary psychology and evolutionary biology, we can say that certain males were alpha and others were beta. I would propose that on average not only did alpha male humans have more testosterone, they were also bigger, specially taller. This meant that they had far more access to mating partners than beta partners. In this brutal sense, the genetically weak and who did not gain the genetic lottery had their genes weeded out of existence. If the practice continued over the subsequent generations, they offpsring in each new generation would get progressively slightly larger.

I am almost positive that in many ancient human societies and tribes, height was as prized and desired as today, if not more. It helped in the human to huma interactions as well as in fighting and sexual competition. I would say that in a synergically way eventually the females also started to choose the taller, bigger male. If this is the case, then we can probably say that in some smaller groups and tribes, where there was few viable options, many tribes people would choose to only mate with the biggest. This is what is known as intentional or selective breeding. Another term is eugenics.

If the ancient societies and tribes purposely pracices eugenics to have taller and more intimidating offspring, it would be over just a few centuries lead to some tribes being very tall in stature. However the thing that would probably cost these tribes is high levels of inbreeding cause from the desire to mate only with people of large sizes, which might mean there was only a few families who did carry such traits forcing them to mate within their own family to keep the genetic advantage, not realizing that they are actually hurting their genetic advantage.

We have many stories by naive americans and most societies in the world about groups of people who were true giants. There have been many skeleton unearthed in different regions of the world which show them being 8-10 feet tall. I suspect the stories about giants are true since it is extremely conceivable that there have been at least a few tribes which focused solely on gaining dominance by using selective breeding to gain the size they wanted.

One of the best examples is the story of the famous Irish giant from the 19th century. He had a pituitary problem causing him to be big but it turned out the pituitary condition had a genetic cause and it would turn out tow of his male cousins also developed overactive pituitaries causing them to swell up in size. If this was ancient times, certain females would choose only to mate with them, causing more pituitary giants and shifting the anthropomorphic measurements in a small town or tribe to completely shift. Another good example was that two of the 3 cases of giants who resulted from the lack of estrogen alpha and/ or beta receptors in their growth plates were the result of a consanguine union (cousin marrigage). The both would turn out to be sterile having extremely low levels of sperm count with almost everything else funcioning fine. If they had been also been non-sterile, their mating chances would increase by a lot in ancient times due to their size, and they would be selectively chosen to have more children than other men, even if they are resulted from consanguinity which should have hurt them genetically but didn’t, due to random chance.

So, just a food for thought.

 

Natural Height Growth Podcast, Episode 4 – Manifesto On Why Height Increase Is High Value And Worth Researching

The podcast series is coming along and this episode was to get out the message to people who might not have found out the website from searching or Google but through podcasts. It has a message which shows why I believe the venture and project to find a way to increase our height is a worthy goal.

Episode #4: Manifesto On Why Height Increase Is High Value And Worth Researching

I wanted to show that in terms of the businesses, ventures, projects, and ideas that are in the world today, few have the type of impact and can reach the type of basic and most universal level as trying to achieve the goal of becoming taller and bigger than who we are.

People always talk about growth in terms of the mental, emotional, spiritual, and financial but what about speaking about growth in the most basic level, the physical? Is not the desire to get slightly closer to the stars and heavens a part of man’s basic desires?

Normally I just wing it and speak from the mind but today I wanted to try something else and read out the entire episode from a transcript. I noticed that overall the speaking style was very rigid and non-fluid. Yikes! I’ve learned my mistakes and will avoid that awkwardness for future episodes.

Click Here to Subscribe via iTunes and/or leave a review for the podcast!

Note: For a transcript of the episode in PDF format, click HERE.

Length of time: 19 min

Listen Here – (to download, right click and ‘save’)

Increase Height And Grow Taller Using Minimal Invasive Piezoelectric Surgery, Part I

In my searching for the right type of piezoelectric material to be added to the LSJL device, something else I found from the Wikipedia article on piezoelectric material was that piezoelectric materials have been used in surgery.

From the Wikipedia article…

Surgery

A recent application of piezoelectric ultrasound sources is piezoelectric surgery, also known as piezosurgery.[34] Piezosurgery is a minimally invasive technique that aims to cut a target tissue with little damage to neighboring tissues. For example, Hoigne et al.[35] reported its use in hand surgery for the cutting of bone, using frequencies in the range 25–29 kHz, causing microvibrations of 60–210 μm. It has the ability to cut mineralized tissue without cutting neurovascular tissue and other soft tissue, thereby maintaining a blood-free operating area, better visibility and greater precision.[36]

Me: What this seems to suggest is that piezosurgery has been shown to be able to make very precise, small distractions in bones without effecting the muscles or blood vessels around it. At this point the idea is only a thought. However let’s see what other things we can find from google and PubMed…

From the Wikipedia article on Piezosurgery…

Piezoelectric surgery, or piezosurgery in short – is a process that utilizes piezoelectric vibrations in the application of cutting bone tissue. The process was developed by Tomaso Vercellotti [1] and has been patented.[1] It is indicated for use in oral, maxillofacial, cranial and spinal procedures.

By adjusting the ultrasonic frequency of the device, it is possible to cut hard tissue while leaving soft tissue untouched by the process. The ultrasonic frequency is modulated from 10, 30, and 60 cycles/s (Hz) to 29 kHz. The low frequency enables cutting of mineralized structures, not soft tissue. Power can be adjusted from 2.8 to 16 W, with preset power settings for various types of bone density. The tip vibrates within a range of 60–200 µm, which allows clean cutting with precise incisions. A recent article on the topic of piezoelectricity has named Piezoelectric surgery as one of the most important applications of this concept, in addition to the trivial medical ultrasound imaging. [2]

Me: What we are seeing is what I speculated was possible after I did the research on the extracorporeal shock wave therapy. We saw that LIPUS (low intensity pulsed ultrasound) could lead to fracture healing, and that the ESWT has a potential to be better since the frequency was higher. This was what made me wonder what would happen to bone if we just increased further either the intensity (magnitude) or frequency in say sound waves or any type of device that can release vibrations at a high level. It seems that Piezosurgery is exactly what happens. The extremely high frequency of the surgery application causes bone material to easily break apart upon contact. The cuts made are very precise.

From one of the cited articles (source)….

Abstract

Background

In hand and spinal surgery nerve lesions are feared complications with the use of standard oscillating saws. Oral surgeons have started using a newly developed ultrasound bone scalpel when performing precise osteotomies. By using a frequency of 25–29 kHz only mineralized tissue is cut, sparing the soft tissue. This reduces the risk of nerve lesions. As there is a lack of experience with this technique in the field of orthopaedic bone surgery, we performed the first ultrasound osteotomy in hand surgery.

Method

While performing a correctional osteotomy of the 5th metacarpal bone we used the Piezosurgery®Device from Mectron [Italy] instead of the usual oscillating saw. We will report on our experience with one case, with a follow up time of one year.

Results

The cut was highly precise and there were no vibrations of the bone. The time needed for the operation was slightly longer than the time needed while using the usual saw. Bone healing was good and at no point were there any neurovascular disturbances.

Conclusion

The Piezosurgery® Device is useful for small long bone osteotomies. Using the fine tip enables curved cutting and provides an opportunity for new osteotomy techniques. As the device selectively cuts bone we feel that this device has great potential in the field of hand- and spinal surgery.

Results and discussion

The Piezosurgery® Device is ideally sized for hand surgery. The cutting was very precise. The edges of the osteotomy were all sharp to the edge, there was no need to split the bone with a chisel, nor was there the danger of a break out. During the osteotomy there were no disturbing vibrations in the area of operation. This absence of vibration is very practical for operations using a magnifier. Vercellotti mentions that to overcome any problems during surgery, instead of increasing pressure on the hand piece, as in traditional techniques, it is necessary to find the correct pressure to achieve the desired result. With piezoelectric surgery, increasing the working pressure above a certain limit impedes the vibrations of the insert [4]. We have also experienced this in our study. The instrument can be moved in all directions comparable to a pen. The tip of the instrument is exchangeable. Using the fine tip enables multiplanar as well as curved cutting. Because of the automatic water cooling during the whole procedure, there is always a clear view onto the object. This is something oral surgeons found especially useful [6]. The authors mention that the downside of the device is the relative slow sawing process. We needed about 30 seconds for one cut of the relatively small bone. This is about 20 seconds longer than the time needed for cutting with the usual saw. Although the power can be regulated with the power box and the use of different scalpels, we agree with other authors that the optimal use of this device is in surgeries of small bones where precise and soft tissue friendly cutting is required [7]. As other literature has shown, the device selectively cuts bone while sparing nerves and other soft tissue [2,3]. This allows for minimal invasive surgeries with limited retraction of soft tissue and minimal stripping of the periosteum, saves time and might have a positive effect on the healing process. Our aim of the first time use of the Piezosurgery® Device in hand surgery was to check its usability in osteotomies of tubular bones. The preparation of the bone was done in the usual manner as is done when cutting with an oscillating saw. The reason for this was to fully visualize the cutting process using this new device, although in the future, it should be possible to minimize the bony exposure. In our patient the postoperative healing of the wound and the bone consolidation (Figure 4) were smooth. The duration of postoperative sick leave was four weeks which is more rapid than the usual recovery period. The patient regained full use of his finger according to the state before the fracture. At no point was there any loss of sensitivity. The patient as well as the surgeons were fully satisfied with the result.

Me: From this PubMed study HERE, the surgeon states ..”The principle of piezosurgery is ultrasonic transduction, obtained by piezoelectric ceramic contraction and expansion. The vibrations thus obtained are amplified and transferred onto the insert of a drill which, when rapidly applied, with slight pressure, upon the bony tissue, results, in the presence of irrigation with physiological solution, in the cavitation phenomenon, with a mechanical cutting effect, exclusively on mineralized tissues.”

I always stated that I would look for a solution to height increase that was NOT just only non-invasive but invasive as well. However the idea was always to look for a minimal invasive procedure or method. One of the biggest points I always emphasized was that the hard bones either had to be distracted or demineralized so that the overall structure can be stretched out easily. The piezosurgery seems to allow surgeons to make very precise cuts in the bone. I remember that to do the distraction osteogenesis the surgeon takes a hammer and chisel and just swings to crack the outer layer of bone in the lengthening bone. If we saw an X-ray of the bones, we’d see that the induced fracture is not clean or orderly. This method for surgery would allow for specified distraction forms and shapes. This means that we can theoreticaly use it to first open up bones at the right amount of distraction shape and thickness and then get our full sized plate shaped grown growth plates (which I proved in a previous post) and implant them into the properly created distractions thus completing the growth plate transplant process.

Note: This idea is definitely a field I wanted to do more research on so I decided to state that this post is just the first part of many.

The Lesson I Learned From The Lean Startup To Pivot, Make Mistakes, Correct And Iterate The Cycle As Fast As Possible

One of the most useful books I’ve ever had the pleasure of reading was the “The Lean Startup “, by Eric Reiss. In the book, the main idea that Reiss expresses is that success of most startups depend on how well and how fast they can “pivot” in their evolution. Reiss’s book has been one of those business books that has come out in the last decade which has really changed the way many businesses and owners think about how the startup should work.

From the Wikipedia article on “The Lean Startup“…

  • The Lean Startup relies on validated learning, scientific experimentation, and iterative product releases to shorten product development cycles, measure progress, and gain valuable customer feedback.[1][2][4] In this way, companies, especially startups, can design their products or services to meet the demands of their customer base without requiring large amounts of initial funding or expensive product launches
  • The lean startup philosophy is based on lean manufacturing, the streamlined production philosophy developed in the 1980s by Japanese auto manufacturers.[13] The lean manufacturing system considers as waste the expenditure of resources for any goal other than the creation of value for the end customer, and thus a target for elimination
  • Ries’ lean startup philosophy seeks to eliminate wasteful practices and increase value producing practices during the product development phase so that startups can have better chances of success without requiring large amounts of outside funding, elaborate business plans, or the perfect product.
  • Continuous deployment is a process “whereby all code that is written for an application is immediately deployed into production,” which results in a reduction of cycle times
  • A pivot is a “structured course correction designed to test a new fundamental hypothesis about the product, strategy, and engine of growth.

These are the basic ideas behind the philosophy. When I read the book, the main thing I took away from the work was this.

  1. Focus on getting the product (article or post) out to the readers public as fast as possible and reduce the amount of time in trying to make them perfect. 
  1. Get feedback from the readers on how they like the material I produce and adapt the material from their behavior and feedback. 
  1. Move as quickly as possible, by changing the business operations, making the neccesary mistakes, correct them quickly, and then moving forward through continuous changes which allow the business or project to morph/ evolve as time moves forward. (ie “PIVOT”)
From this FORBES article by Martin Zwilling, we see that there are multiple types of “Pivots”. he says there are ten types for business.

Pivots come in many different flavors, each designed to test the viability of a different hypothesis about the product, business model, and engine of growth. I agree with Eric’s summary of the top ten types of pivots to consider:

  1. Zoom-in pivot. In this case, what previously was considered a single feature in a product becomes the whole product. This highlights the value of “focus” and “minimum viable product” (MVP), delivered quickly and efficiently.
  1. Zoom-out pivot. In the reverse situation, sometimes a single feature is insufficient to support a customer set. In this type of pivot, what was considered the whole product becomes a single feature of a much larger product.
  1. Customer segment pivot. Your product may attract real customers, but not the ones in the original vision. In other words, it solves a real problem, but needs to be positioned for a more appreciative segment, and optimized for that segment.
  1. Customer need pivot. Early customer feedback indicates that the problem solved is not very important, or money isn’t available to buy. This requires repositioning, or a completely new product, to find a problem worth solving.
  1. Platform pivot. This refers to a change from an application to a platform, or vice versa. Many founders envision their solution as a platform for future products, but don’t have a single killer application just yet. Most customers buy solutions, not platforms.
  1. Business architecture pivot. Geoffrey Moore, many years ago, observed that there are two major business architectures: high margin, low volume (complex systems model), or low margin, high volume (volume operations model). You can’t do both at the same time.
  1. Value capture pivot. This refers to the monetization or revenue model. Changes to the way a startup captures value can have far-reaching consequences for business, product, and marketing strategies. The “free” model doesn’t capture much value.
  1. Engine of growth pivot. Most startups these days use one of three primary growth engines: the viral, sticky, and paid growth models. Picking the right model can dramatically affect the speed and profitability of growth.
  1. Channel pivot. In sales terminology, the mechanism by which a company delivers it product to customers is called the sales channel or distribution channel. Channel pivots usually require unique pricing, feature, and competitive positioning adjustments.
  1. Technology pivot. Sometimes a startup discovers a way to achieve the same solution by using a completely different technology. This is most relevant if the new technology can provide superior price and/or performance to improve competitive posture.
From a first glance by a person who is not running their own startup, this list of ideas will seem very distant from what they are doing and they will have trouble understanding what even the terms mean.
However, the main point is that I am trying to treat this website as a business in some ways and will pivot, iterate, make mistakes, and correct in the cycle of production of content to morph this website into something amazing. There is changes going on with this website EVERYDAY, and a lot of it is in the backend where you as the reader never see about 60% of the work being done.
I may be one person but I move fast and change fast. Behaviors, appearances, and habits are adapted for effectiveness and I try the hardes to implement as many of the 10 pivots for my projects and business as possible. For the readers, this post is to re-iterate my dedication that this website will be changing and improving on a daily rate which new, and more exciting things going on each day. Waste will be kept to a minimum, content production will be maximized, speed will be increased, and operations will be streamlined.