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Purpose: The Japanese Musculoskeletal Oncology Group have developed an original prosthesis called the Kyocera Modular Limb Salvage system (KMLS system). This prosthesis has a semi-rotating hinge joint and is particularly designed for people with an Asian body type. The metallic parts of the prosthesis are made entirely of titanium alloy. The purpose of this study is to evaluate the clinical outcomes of treatment using this system following tumour resection of primary bone sarcoma of the distal femur. Methods: Between 2002 and 2010, 82 patients with primary bone sarcomas of the distal femur were treated. Seventeen patients underwent stem cementation, while 65 patients were treated with cementless prostheses. The mean follow-up period after surgery was 61 months. Results: Complications were observed in 28 of the 82 patients. Forty-one complications occurred in these 28 patients. Thirteen prostheses (16 %) required revision surgery due to complications, including five cases of stem breakage, three deep infections, three cases of aseptic loosening, one case of displacement of the shaft cap and one case of breakage of the tibial tray. The five-year overall prosthetic survival rate was 80.0 %. Four of the 82 patients underwent subsequent amputation due to local recurrence. The five-year limb salvage rate was 94.5 %. The mean function score according to the scoring system of the Musculoskeletal Tumour Society was 21.8 points (72.5 %). Conclusions: Although further follow-up is required to determine the performance, this prosthesis is considered to be satisfactory for reconstruction of the distal femur after resection of bone sarcoma. [ABSTRACT FROM AUTHOR]

Mobile-bearing total knee arthroplasty (TKA) has several theoretical advantages over fixed-bearing TKA. We conducted a prospective randomized trial to compare the results of mobile-bearing and fixed-bearing posterior-stabilized TKA in the same patients using the same femoral component design of a mobile-bearing prosthesis in one knee and a fixed-bearing prosthesis in the other knee in 25 patients with osteoarthritis. The mean follow-up was 40 months. No significant differences were found in the mobile-bearing and fixed-bearing knees in terms of clinical and radiographic results. No osteolysis, loosening, or revision occurred. One knee with a mobile-bearing prosthesis had a dislocation of the rotating bearing; however, spontaneous reduction occurred and the dislocation did not recur. Satisfactory early results can be achieved in both mobile-bearing and fixed-bearing knees. We could not demonstrate an advantage of a mobile-bearing TKA. [ABSTRACT FROM AUTHOR]

There has been only one report on the physical characteristics of patients with developmental cervical spinal canal stenosis. The objective of this consecutive clinical study was to identify the physical characteristics of patients with developmental cervical spinal canal stenosis. The subjects were 243 patients with cervical spine disease who received treatment in our department between April 2001 and March 2002. These patients were divided into two groups (the groups of patients with and without spinal canal stenosis) on the basis of their lateral cervical spine radiographs. The six items examined were height, weight, sitting height, inter inner canthal distance, upper arm length, and head circumference in each patient, and then their values were compared between the two groups. The mean inter inner canthal distance was 2.7 cm in the group of patients with spinal canal stenosis and 3.5 cm in the group of patients without spinal canal stenosis; a significant difference ( P < 0.01) was observed. Regarding height, weight, sitting height, upper arm length, and head circumference, no significant difference was found while comparing the two groups. In conclusion, developmental cervical spinal canal stenosis seems to be highly likely in patients with smaller inter inner canthal distance. [ABSTRACT FROM AUTHOR]

Introduction Bone remodeling relies on a delicate balance between formation and resorption of bone tissues, processes in which bone-forming osteoblasts and bone-resorbing osteoclasts play central roles. Recently, we reported that anticoagulant activated protein C (APC) promotes osteoblast proliferation, but the role of the blood coagulation system in bone remodeling remains unclear. In this study, to further elucidate the relationship between bone remodeling and blood coagulation, we investigated the effect of APC on osteoclast differentiation. Materials and methods Normal human osteoclast precursor cells were cultured in their growth medium including soluble RANKL, M-CSF, and FBS, and on days 4 and 7, the culture medium was replaced with the same medium containing various concentrations of APC, protein C (PC), sphingosine 1-phosphate (S1P) receptor agonist, FTY720, or APC + various substances without FBS. On day 8, TRAP-positive multinucleated cells (≥ 3 nuclei) were counted manually using a light microscope. The effects of APC on NF-κB and NFATc1 activation were evaluated using specific ELISA. Results APC suppressed RANKL-induced osteoclast differentiation, and this APC-induced suppression of osteoclast differentiation was inhibited by zymogen protein C and aprotinin, a serine protease inhibitor. Immunohistochemistry and RT-PCR analyses suggested that endothelial protein C receptor (EPCR) and protease-activated receptor-1 (PAR-1) were expressed in osteoclast precursor cells and osteoclasts. Both anti-PAR-1 antibody and anti-EPCR antibody (RCR-252), which blocks APC binding to EPCR, inhibited the APC-induced suppression of osteoclast differentiation. FTY720 had no effect on osteoclast differentiation. However, FTY 720 and S1P receptor antagonist, VP 23019, inhibited the APC-induced suppression of osteoclast differentiation. On the other hand, recombinant soluble human ApoER2 and anti-human ApoER2 inhibited the APC-induced suppression of osteoclast differentiation. Further, APC had no effect on NF-κB and NFATc1 activation. Conclusions APC suppresses human osteoclast differentiation mainly by inhibiting the formation of multinucleated cells via EPCR, PAR-1, S1P receptor, and ApoER2 in a manner that depends on APC protease activity. [ABSTRACT FROM AUTHOR]

The article presents a case report of a 59-year-old woman with bilateral congenital hip dislocation who underwent a cementless total hip arthroplasty. The patient has good clinical results but after more than a year, a crepitus deep in the right hip during motion is noticed. It reveals that the concentration of stress at the rim of the thin ceramic liner has caused ceramic liner fracture in which the cobalt-chromium head wear have loss its superior part because of severe wear.

Purpose: The purpose of the study is to assess the orientation and distance of the popliteal artery (PA) from both the anteromedial and anterolateral portals. Methods: The records of 97 patients (100 knees) who underwent knee arthroscopy were reviewed. The shortest distance from the posterior tibial cortex to the PA on the lines from both the medial and lateral borders of the patellar tendon to the PA was evaluated by magnetic resonance imaging at full knee extension. The figure-of-four position was compared between patients with intact and deficient anterior cruciate ligaments (ACLs). The shortest distances from the posterior cruciate ligament (PCL) to the lines running from the medial and lateral borders of the patellar tendon to the PA were also measured. Results: The shortest distances from the posterior tibial cortex to the PA were significantly longer in the figure-of-four position than at full knee extension and during extension in the ACL-deficient than intact group. Distances did not significantly differ in the figure-of-four position. The PA was hidden from the anteromedial portal by the PCL, but remained vulnerable from the anterolateral portal. Conclusions: All-inside meniscus suturing of the posterior horn of the lateral meniscus inserted through the anteromedial portal is safer when the knee is in the figure-of-four position than fully extended. Meniscus repairs should be completed before ACL reconstruction due to vascular positions and the ease of approach. Level of evidence: Prospective correlation study, Level IV. [ABSTRACT FROM AUTHOR]

Objectives. The present study aims to determine the relationship between osteoporosis (OP), vertebral fracture (VF) and mortality. Methods. We followed up 1024 residents of Miyagawa village every 2 years for a mean of 8.4 years between 1997 and 2009. The residents were assessed every 2 years. We defined OP as T scores for bone mineral density that were < 2.5 standard deviations below peak bone mass. VF was assessed by lateral radiography of the thoracic and lumbar spine. The participants were allocated as follows depending on the presence or absence of OP and VF: with OP and without VF (OP group), with VF and without OP (VF group), with OP and VF (OP + VF group) and without OP and VF (Control group). We determined survival/mortality rates until 2011 by reviewing medical histories and death certificates. Results. By 2011, 304 participants had died. The respective 5-year survival rates for the OP + VF, OP, VF and Control groups were 80.6%, 93.7%, 87.8% and 94.2%. Mortality rates were significantly worse for the OP + VF group than the Control group (OP + VF Hazard Ratio: 1.89; 95% CI, 1.27-2.77). Conclusion. Prevention of osteoporotic VF in elderly persons is very important from the viewpoint of increasing life expectancy. [ABSTRACT FROM AUTHOR]

Background: To investigate the prevalence and severity of radiographically detected hallux valgus (HV) as well as associated risk factors among Japanese residents of Miyagawa, a mountain village located in the center of Mie Prefecture. Methods: The height, weight and body mass index (BMI) of 403 participants (male n = 135, female n = 268) recruited from among the residents of Miyagawa Village, Japan aged ≥65 years were measured, and baseline data, including age, sex and medical history were obtained from interviews and questionnaires. Knee osteoarthritis (KOA) was determined from radiographs of the feet and knees, and osteoporosis was determined by measuring bone mineral density. Hallux valgus, defined as angulation of the big toe at the first metatarsophalangeal joint of >20°, was classified as: mild (20°-30°), moderate (30°-40°) or severe (>40°). Risk factors for HV were calculated using multivariate logistic regression analysis that included age, sex, obesity (BMI ≥25), KOA, osteoporosis, Heberden's nodes and low back pain as variables. Results: The overall prevalence of definite radiographic HV was 22.8 % (184/806), and mild, moderate and severe HV was found in 66.3, 27.2 and 6.5 % of the participants, respectively. Hallux valgus was found in at least one foot in 120 (29.8 %) of the participants and the prevalence significantly differed between females with and without HV and KOA (odds ratios: 2.54 and 1.71, respectively). Conclusions: The prevalence of definite radiographic HV was 29.8 %. Female sex and KOA were significantly associated with increased risk for radiographic HV. [ABSTRACT FROM AUTHOR]

Objective: We aimed to confirm the effect of combined treatment with celecoxib and rebamipide would be more effective than celecoxib alone for prevention of upper gastrointestinal (GI) events. Methods: Patients with rheumatoid arthritis, osteoarthritis, and low back pain were enrolled in this study. Patients were randomized to two groups: a monotherapy group (100 mg celecoxib twice daily) and a combination therapy group (add on100 mg of rebamipide three times a day). The GI mucosal injury was evaluated by endoscopic examination before treatment and at 3 months. The primary endpoint was to evaluate the preventive effect of the combination therapy group for GI events, endoscopic upper GI ulcers and intolerable GI symptoms, compared with the monotherapy group. Results: Seventy-five patients were enrolled. Sixty-five patients were analyzed (16 males, 49 females; mean age: 67 ± 13 years). The prevalence of upper GI events, five of endoscopic GI ulcers and one of intolerable GI symptoms, were 6/34 (17.6 %) in the monotherapy group and 0/31 in the combination therapy group, p = 0.0252. Conclusions: The combination therapy group was more effective than the monotherapy group for prevention of upper GI events in this study. Rebamipide might be a candidate for an option to prevent COX-2 selective inhibitor-induced upper GI events. [ABSTRACT FROM AUTHOR]

Abstract: Background: The relationships among the hemostatic markers, the development of deep vein thrombosis (DVT) and the withdrawal of fondaparinux due to a reduction in the hemoglobin levels were examined. Methods: Two-hundred twenty-one Japanese patients who underwent major orthopedic surgery and were treated with 1.5mg of fondaparinux instead of 2.5mg of fondaparinux were studied. Forty-seven of 221 patients discontinued fondaparinux treatment (withdrawal group) and 37 patients developed DVT. Results: The age, frequency of total knee arthroplasty (TKA), withdrawal of fondaparinux, reduction of hemoglobin and the plasma levels of soluble fibrin (SF), D-dimer and fibrinogen and fibrin degradation product (FDP) on day 1 after the operation were significantly higher in the patients with DVT. Elevated SF, D-dimer or FDP levels were associated with the risk for DVT. The age, frequency of TKA or DVT, anti-Xa activity and the creatinine, FDP and D-dimer levels were significantly higher in the withdrawal group. An anti-Xa level >0.33mg/l and an elevated D-dimer or FDP level were associated with the risk of withdrawal. Conclusion: The age and SF levels, TKA and withdrawal of fondaparinux were related to the risk of DVT, and the anti-Xa activity, creatinine level and DVT were related to the risk of withdrawal of fondaparinux due to a reduction in hemoglobin. [Copyright &y& Elsevier]

Background: The incidence of sarcoma diagnosed in the elderly population may be rising due to the increasing life expectancy. The purpose of our study was to evaluate the efficacy of lung metastasectomy and radiofrequency (RF) ablation in elderly sarcoma patients (65 years or older) with lung metastases, compared with adult sarcoma patients younger than 65 years (20-64 years). Materials and Methods: We retrospectively evaluated the clinical efficacy of metastasectomy and lung RF ablation in sarcoma patients with lung metastases. Results: Between 2001 and 2010, lung metastases were detected in 66 adult patients with musculoskeletal sarcomas. Twenty-five patients with lung metastasis were elderly. Twelve of the 25 patients were treated with lung metastasectomy and/or RF ablation. In contrast, 41 patients were adult patients younger than 65 years. Twenty of these 41 patients were treated with lung metastasectomy and/or RF ablation. The 1 and 3-year survival rates after initial treatment for lung metastases were 81.8% and 38.4% in 12 elderly patients, respectively. Compared with the control group, the survival rate in the elderly patients was not significantly different. Conclusion: We conclude that elderly sarcoma patients with lung metastases should always be considered for either metastasectomy or RF ablation. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that ischemia-reperfusion (I/R) produces free radicals leading to lipid peroxidation and damage to skeletal muscle. The purposes of this study were 1) to assess the histological findings of gastrocnemius muscle (GC) and tibialis anterior muscle (TA) in I/R injury model mice, 2) to histologically analyze whether a single pretreatment of edaravone inhibits I/R injury to skeletal muscle in murine models and 3) to evaluate the effect of oxidative stress on these muscles. Methods: C57BL6 mice were divided in two groups, with one group receiving 3 mg/kg intraperitoneal injections of edaravone (I/R + Ed group) and the other group receiving an identical amount of saline (I/R group) 30 minutes before ischemia. Edaravone (3-methy-1-pheny1-2-pyrazolin-5-one) is a potent and novel synthetic scavenger of free radicals. This drug inhibits both nonenzymatic lipid peroxidation and the lipoxygenase pathway, in addition to having potent antioxidant effects against ischemia reperfusion. The duration of the ischemia was 1.5 hours, with reperfusion at either 24 or 72 hours (3 days). Specimens of gastrocnemius (GC) and anterior tibialis (TA) were removed for histological evaluation and biochemical analysis. Results: This model of I/R injury was highly reproducible in histologic muscle damage. In the histologic damage score, the mean muscle fibers and inflammatory cell infiltration in the I/R + Ed group were significantly less than the corresponding values of observed in the I/R group. Thus, pretreatment with edaravone was observed to have a protective effect on muscle damage after a period of I/R in mice. In addition, the mean muscle injury score in the I/R + Ed group was also significantly less than the I/R group. In the I/R + Ed group, the mean malondialdehyde (MDA) level was lower than in the I/R group and western-blotting revealed that edaravone pretreatment decreased the level of inducible nitric oxide synthase (iNOS) expression. Conclusions: Edaravone was found to have a protective effect against I/R injury by directly inhibiting lipid peroxidation of the myocyte by free radicals in skeletal muscles and may also reduce the secondary edema and inflammatory infiltration incidence of oxidative stress on tissue. [ABSTRACT FROM AUTHOR]

We measured the thickness of the transverse structures associated with the bovine coccygeal transverse processes (bone specimen) by using ultrasonic waves and examined the reliability of this measurement for use in spinal surgery. We first measured the velocity of ultrasonic waves propagating in the spinous process. We then made a hole in the transverse process with an air drill and placed an ultrasonic transducer with a center frequency of 10 MHz in the hole. The time of reflection of the ultrasonic wave from the underside of the transverse process was detected to estimate the remaining bone thickness. The thickness estimated by using ultrasound was compared with the thickness measured by microscopic examination. We could detect reflection waves from the underside of the transverse process in 91.7% of cases (i.e., 22 of 24 measurements using 6 bones from 3 cows). The thickness of the transverse processes in which we detected the waves varied from 0.24 to 6.8 mm. The 95% limit of agreement between ultrasonic and histological measurement was 0.71 mm. Pearson?s correlation coefficient showed a strong and positive relationship between the two measurements (r = 0.97, n = 22, P < 0.0001). [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the prevalence and characteristics of unilateral knee osteoarthritis (KOA), to investigate what percent of contralateral healthy knees in patients with unilateral KOA progress to KOA, and to investigate whether knee fractures influence unilateral KOA. Methods: Studies were performed every two years from 1997 to 2009 in Miyagawa village, for a total of seven studies. A total of 1239 village inhabitants aged ≥65 years participated in these studies at least once. KOA was defined as a Kellgren-Lawrence (K/L) grade ≥2. Based on the knee X-ray at the first examination, participants were divided into three groups: no KOA (N group), unilateral KOA (U group), and bilateral KOA (B group). The U group was divided into two subgroups: K/L grade II-I combination (II-I group), and the U group without the II-I combination (G>2 group). To investigate whether knee fractures influence unilateral KOA, the fracture history was considered. Results: The percentages of participants classified into the N, B, and U groups (II-I and G>2 group) were 68.4, 21.6, and 10.0 % (7.8 and 2.1 %), respectively. Most of the U group had the II-I combination (78.7 %). The percentages of knee fractures in the N, B, II-I, and G>2 groups were 3.3, 5.3, 6.3, and 38.5 %, respectively. Overall, 49.2 % of the U group proceeded to bilateral KOA over an average of 5.3 years. Conclusions: The prevalences of definite radiographic bilateral and unilateral KOA were 21.6 and 10.0 %, respectively. Overall, 49.2 % of the participants with unilateral KOA developed KOA in the contralateral knee over an average of 5.3 years. If bilateral KOA advanced simultaneously, the II-I group was considered to represent the midpoint of progression to bilateral KOA. Bilateral KOA advanced simultaneously except in cases with a history of knee trauma, such as fractures. [ABSTRACT FROM AUTHOR]

This longitudinal study aimed to identify risk factors for the incidence and progression of radiographic knee osteoarthritis (OA). We examined the inhabitants of Miyagawa village aged ≥65 years every two years between 1997 and 2007. Anteroposterior radiographs of both knees were graded for OA using the Kellgren-Lawrence (K/L) grading system. Knee OA was defined as grade ≥2. We recorded the incidence of knee OA among participants in whom both knees changed from K/L grades 0 or 1 to ≥2 over a four-year follow-up period. We also recorded the progression of knee OA using this threshold among patients in whom one or both knees changed from K/L grades 2 or 3 to any higher grade over the follow-up period. Baseline data obtained from standard questionnaires, physical findings and X-rays included age, gender, body mass index (BMI), osteoporosis, Heberden's nodes, knee range of motion (ROM), knee pain and cigarette smoking. The rates of incidence and progression of knee OA among 360 participants (241 women, 119 men) who fulfilled the study criteria were 4.0 and 6.0% per year, respectively. Female gender (odds ratio [OR] 2.849, 95% confidence interval [CI] 1.170-6.944) and high BMI (OR 1.243, 95% CI 1.095-1.411) were significantly associated with the incidence of knee OA, and restricted knee ROM (OR 0.941, 95% CI 0.892-0.992) was significantly associated with knee OA progression. Patients with a low knee ROM relative to grade of radiographic knee OA require more careful follow-up than those with a higher ROM. [ABSTRACT FROM AUTHOR]

Abstract: In the evolution of cancer, tumor necrosis factor-alpha (TNF-α) plays a paradoxical role. High doses induce significant anticancer effects, but conversely, physiologic and pathologic levels of TNF-α may be involved in cancer promotion, tumor growth, and metastasis. Infliximab is a chimeric murine monoclonal antibody that binds with high affinity to soluble and membrane TNF-α and inhibits binding of TNF-α to its receptors. In the present study, we investigated the effect of infliximab, a TNF-α antagonist, on breast cancer aggressiveness and bone metastases. Infliximab greatly reduced cell motility and bone metastases in a metastatic breast cancer cell line, MDA-MB-231. The mechanism of bone metastasis inhibition involved decreased expression of CXC chemokine receptor 4 (CXCR4) and increased expression of decorin, which is the prototype of an expanding family of small leucine-rich proteoglycans. These results suggest a novel role for TNF-α inhibition in the reduction or prevention of bone metastases in this breast cancer model. Our study suggests that inhibition of TNF-α using infliximab may become a preventive therapeutic option for breast cancer. [Copyright &y& Elsevier]

Patients with bone metastases in the extremities sometimes require surgical intervention to prevent deterioration of quality of life due to a pathological fracture. The use of localized radiotherapy combined with surgical reinforcement has been a gold standard for the treatment of bone metastases. However, radiotherapy sometimes induces soft tissue damage, including muscle induration and joint contracture. Moreover, cancer cells are not always radiosensitive. Hyperthermia has been studied since the 1940s using an experimental animal model to treat various types of advanced cancer, and studies have now reached the stage of clinical application, especially in conjunction with radiotherapy or chemotherapy. Nevertheless, bone metastases have several special properties which discourage oncologists from developing hyperthermic therapeutic strategies. First, the bone is located deep in the body, and has low thermal conductivity due to the thickness of cortical bone and the highly vascularized medulla. To address these issues, we developed new hyperthermic strategies which generate heat using magnetic materials under an alternating electromagnetic field, and started clinical application of this treatment modality. The purpose of this review is to summarize the latest studies on hyperthermic treatment in the field of musculoskeletal tumors, and to introduce the treatment strategy employing our novel hyperthermia approach. [ABSTRACT FROM AUTHOR]

Abstract: The aggregation of chondroprogenitor mesenchymal cells into precartilage condensation represents one of the earliest events in chondrogenesis. N-cadherin is a key cell adhesion molecule implicated in chondrogenic differentiation. Recently, ADAM10-mediated cleavage of N-cadherin has been reported to play an important role in cell adhesion, migration, development and signaling. However, the significance of N-cadherin cleavage in chondrocyte differentiation has not been determined. In the present study, we found that the protein turnover of N-cadherin is accelerated during the early phase of chondrogenic differentiation in ATDC5 cells. Therefore, we generated the subclones of ATDC5 cells overexpressing wild-type N-cadherin, and two types of subclones overexpressing a cleavage-defective N-cadherin mutant, and examined the response of these cells to insulin stimulation. The ATDC5 cells overexpressing cleavage-defective mutants severely prevented the formation of cartilage aggregates, proteoglycan production and the induction of chondrocyte marker gene expression, such as type II collagen, aggrecan and type X collagen. These results suggested that the cleavage of N-cadherin is essential for chondrocyte differentiation. [ABSTRACT FROM AUTHOR]

Background: Tenascin-C (TN-C) is expressed in the cartilage of osteoarthritis (OA). We examined whether TN-C was involved in cartilage repair of the diseased joints. Human articular cartilage samples were obtained from patients with OA and those with normal joints. Methods: Immunohistochemistry testing of TN-C, chondroitin sulfate (CS), and proliferating cell nuclear antigen (PCNA) was performed. Chondrocytes were isolated from human cartilage and cultured. After treatment with TN-C, chondrocyte proliferation s was analyzed by bromodeoxyuridine (BrdU) incorporation assay using an enzyme-linked immunosorbent assay kit. Glycosaminoglycan content was determined by dimethylmethylene blue (DMMB) assay. The mRNA expression of aggrecan was also analyzed, by quantitative real-time polymerase chain reaction (PCR). Results: In osteoarthritic cartilage, increased TN-C staining was observed with the degeneration of articular cartilage in comparison with normal cartilage. TN-C staining was shown in the cartilage surface overlying CS-positive areas. In addition, the expression of PCNA in the positive areas for TN-C was significantly higher than that in the negative areas. Treatment of human articular chondrocytes with 10 μg/ml TN-C accelerated chondrocyte proliferation, increased the proteoglycan amount in culture, and increased the expression of aggrecan mRNA. Conclusions: Our findings indicate that the distribution of TN-C is related to CS production and chondrocyte proliferation in osteoarthritic cartilage and that TN-C has effects on DNA synthesis, proteoglycan content, and aggrecan mRNA expression in vitro. TN-C may be responsible for repair in human osteoarthritic cartilage. [ABSTRACT FROM AUTHOR]

The objective of this study is to compare the long-term outcomes of infliximab therapy with lower-dose methotrexate (MTX; ≤4 mg per week) and with standard-dose MTX (≥6 mg per week) in Japanese rheumatoid arthritis (RA) patients. One hundred thirty-eight patients with refractory RA were treated with intravenous infliximab; 106 patients underwent lower-dose MTX therapy, and 32 patients underwent standard-dose MTX therapy. Treatment responses at 54 weeks or last observation carried forward (LOCF) assessed using the European League Against Rheumatism (EULAR) response criteria were compared between the two groups. Eighty-eight patients (81.1%) in the lower-dose MTX group and 27 patients (84.3%) in the standard-dose MTX therapy completed 54 weeks of infliximab treatment. A EULAR response criteria good and moderate response was seen in 70.9% in the lower-dose group and 74.1% in the standard-dose group. Good and moderate treatment responses at 54 weeks or LOCF were seen in 66.0% in the lower-dose group and 68.7% in the standard-dose group. The outcome in the lower-dose MTX group was not significantly different from that in the standard-dose group. Therapy with MTX and infliximab was effective in Japanese RA patients, regardless of MTX dosage. [ABSTRACT FROM AUTHOR]

Soluble fibrin (SF) and D-dimer are useful for making the diagnosis of deep vein thrombosis (DVT). However, the evidence for using such markers and optimal timing to diagnose postoperative DVT are unclear. We evaluate the usefulness of SF and D-dimer testing for the diagnosis of postoperative DVT. A total of 207 patients who had total hip arthroplasty or knee arthroplasty were evaluated. SF and D-dimer were tested on postoperative days 1 and 7. DVT was confirmed with ultrasonography. SF level on postoperative day 1 was the most useful, although D-dimer evaluation on postoperative days 1 and 7 was also useful. Using a SF cut-off of more than 4.00 μg ml−1, the sensitivity was 90%, the specificity was 33%. Although the SF and D-dimer tests cannot be used as stand-alone tests, SF and D-dimer are valuable screening tools. We recommend two-stage screening including first with the SF or D-dimer test, followed by ultrasonography or venography. [ABSTRACT FROM AUTHOR]

The article describes the case of a 47-year-old woman who presented a ganglion cyst arising from the posterolateral capsule of the knee. She did not have a history of trauma or participation in active sports. An intra-articular ganglion cyst of the knee has the same symptoms with meniscus tears such as pain, swelling and mechanical blocking. According to the article, magnetic resonance imaging has been proven to be effective in evaluating cystic lesions of the knee.

Osteoarthritis (OA) is a common disease that has a definite genetic component. Only a few OA susceptibility genes that have definite functional evidence and replication of association have been reported, however. Through a genome-wide association study and a replication using a total of ~4,800 Japanese subjects, we identified two single nucleotide polymorphisms (SNPs) (rs7775228 and rs10947262) associated with susceptibility to knee OA. The two SNPs were in a region containing HLA class II/III genes and their association reached genome-wide significance (combined P = 2.43 × 10-8 for rs7775228 and 6.73 × 10-8 for rs10947262). Our results suggest that immunologic mechanism is implicated in the etiology of OA. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Bone is continually remodeled by the action of osteoblasts, osteocytes, and osteoclasts. Resting osteoblasts are able to proliferate and differentiate into mature osteoblasts when physiologically required, as after tissue injury. Activated protein C (APC) is a serine protease that functions in anticoagulation, anti-inflammation, anti-apoptosis, cell proliferation, and wound repair. In this study, we examined the effect of APC on osteoblast proliferation and differentiation. Materials and Methods: We examined the presence of protein C in human fracture hematoma by immunohistochemical staining. We then evaluated the effect of APC, diisopropyl fluorophosphate-inactivated APC (DIP-APC) or protein C zymogen on normal human osteoblast (NHOst) proliferation using tetrazolium salt assay in the presence or absence of aprotinin, hirudin, protein C, antibody against protein C, endothelial protein C receptor (EPCR) or protease-activated receptor (PAR)-1. Finally, activation of p44/42 MAP kinase was evaluated by Western blot analysis. Results: Both APC and DIP-APC increased osteoblast proliferation in a dose-dependent manner, while protein C did not. The APC-induced increased proliferation of osteoblast was not affected by aprotinin, hirudin, and anti-protein C antibody which inhibits the protease activity of APC. Treatment with protein C or anti-EPCR antibody which inhibits APC binding to EPCR inhibited APC-mediated osteoblast proliferation, while treatment with anti-PAR-1 antibody did not. APC promoted the phosphorylation of p44/42 MAP kinase within osteoblasts; this effect was inhibited by the anti-EPCR antibody. Conclusions: APC stimulates osteoblast proliferation by activating p44/42 MAP kinase through a mechanism that requires EPCR but not PAR-1 or the proteolytic activity of APC. APC generated at fracture sites may contribute to fracture healing by promoting osteoblast proliferation. [Copyright &y& Elsevier]

Several reports indicate that multinucleated giant cells that derived from human peripheral blood CD14-positive monocytes have osteoclastic properties, and although the mechanism is not completely understood, the authors have previously demonstrated that spontaneous osteoclastogenesis from monocytes can occur. Here, the authors investigated the effect of detachment and long-term cultures in this process. When monocytes were incubated for 2 weeks, spontaneous formation of polykaryocytes was rarely observed. In addition, when monocytes precultured for 2 weeks were detached by a cell scraper and further subcultured, almost all cells died. Surprisingly, when monocytes were incubated for 8 weeks without any pro-osteoclastogenic factors and without detachment, the authors observed the spontaneous formation of tartrate-resistant acid phosphatase (TRAP)-positive polykaryocytes that were able of lacunae resorption. These findings indicate that cell adhesion is a prerequisite for differentiation and survival of CD14-positive monocytes, and that a long incubation period spontaneously induces multinucleation and bone-resorbing activity of monocytes, even in the absence of osteoclastogenesis-stimulating factors. [ABSTRACT FROM AUTHOR]

Abstract: Fibulin-3 is a member of the fibulin family that has been newly recognized as extracellular matrix proteins. We assessed the effects of fibulin-3 overexpression on chondrocyte differentiation using the clonal murine cell line ATDC5. The ATDC5-FBLN3 stably expressing fibulin-3 protein was spindle-shaped cell compared to the ATDC5-mock with plump cell. The cell growth in the ATDC5-FBLN3 was accelerated in comparison to that in the ATDC5-mock. The ATDC5-FBLN3 was not stained by Alcian blue, nor was there any cartilage aggregate formed after the induction of chondrogenic differentiation. The expression of type II collagen, aggrecan, and type X collagen was completely suppressed in ATDC5-FBLN3 even after the induction of differentiation. The overexpression of fibulin-3 reduced the expression of Sox5 and Sox6, while it maintained the expression of Sox9. These findings suggest that fibulin-3 may play an important role as a negative regulator of chondrocyte differentiation. [Copyright &y& Elsevier]

Standard surgical exposure reduces blood flow to the patella during total knee arthroplasty (TKA). Reduction of patellar blood flow has resulted in patellofemoral complications including osteonecrosis and patellar fracture, necessitating revision surgery. In TKA, avoiding patellar eversion is one type of minimally invasive surgery (MIS) technique. This study is the first to measure patellar blood flow during MIS TKA with the knee in both extension and 90° of flexion followed by lateral retraction and then eversion of the patella. Patellar blood flow was measured using laser Doppler flowmetry in 40 patients during MIS TKA. A significant reduction in flow was noted when the leg was flexed from full extension to 90°. Eversion of the patella reduced patellar blood flow. MIS TKA without patellar eversion may be useful for preventing a reduction in patellar blood flow. [ABSTRACT FROM AUTHOR]

Bone morphogenic proteins (BMPs) may have neurotrophic functions but there is limited evidence of these functions in the peripheral nervous system. We therefore investigated the expression of BMPs and BMP receptors (BMPRs) in normal and injured peripheral nerves. In 10 of 15 Sprague-Dawley rats, a 3-mm segment of sciatic nerve was resected at the trifurcation in the thigh. One day (n = 5) and 7 days (n = 5) after transection, proximal and distal stumps were removed and immunohistochemically analyzed for BMP-2, -7, BMPR-1A, -1B, and -2. The other five animals served as normal controls. In normal nerves, BMP-2 expression was localized at Ranvier's node, and BMP-7 and BMPR-1B were expressed in several axon-Schwann cell units, whereas other receptors were not expressed. After nerve transection, BMP-7 expression was upregulated at both proximal and distal stumps along with Schwann cell columns during Wallerian degeneration. BMPRs were also upregulated compared with the normal nerve. The upregulation in BMP expression after nerve transection suggests that BMPs may play a role in the healing response of the peripheral nerve. [ABSTRACT FROM AUTHOR]

Standard surgical exposure reduces blood flow to the patella during total knee arthroplasty (TKA). Reduction of patellar blood flow has resulted in patellofemoral complications including osteonecrosis and patellar fracture, necessitating revision surgery. In TKA, avoiding patellar eversion is one type of minimally invasive surgery (MIS) technique. This study is the first to measure patellar blood flow during MIS TKA with the knee in both extension and 90 degrees of flexion followed by lateral retraction and then eversion of the patella. Patellar blood flow was measured using laser Doppler flowmetry in 40 patients during MIS TKA. A significant reduction in flow was noted when the leg was flexed from full extension to 90 degrees . Eversion of the patella reduced patellar blood flow. MIS TKA without patellar eversion may be useful for preventing a reduction in patellar blood flow. [ABSTRACT FROM AUTHOR]

The article reports on the study that evaluates the impact of lung radiofrequency (RF) ablation on survival in patients with lung metastases from musculoskeletal sarcomas. It indicates that ablation of all lung tumors was significantly better prognostic factors in both the univariate analysis and the multivariate analyses. It reveals that lung RF ablation is a safe and useful therapeutic option for selected patients.

Decorin, the prototype of an expanding family of small leucine-rich proteoglycans, is involved in a number of cellular processes including matrix assembly, fibrillogenesis and the control of cell proliferation. In this study, we investigated the role of decorin in suppressing tumor aggressiveness and bone metastases. We used a metastatic breast cancer cell line, MDA-MB-231, to show that decorin causes marked growth suppression bothin vitro and in vivo. A cytomegaloviral vector containing the decorin transgene caused greatly reduced cell growth, motility and observed metastases. Bone metastases were decreased by >90% upon decorin transfection. These results demonstrate a novel role for decorin in the reduction or prevention of tumor metastases in this breast cancer model and could eventually lead to improved therapies for metastatic breast cancer. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The anatomic femoral component and Harris-Galante porous II (HGPII) cup were developed to provide more reliable bone ingrowth. We performed 20 cementless total hip arthroplasties (THAs) with anatomic stem/HGPII cup with 22-mm head in 14 consecutive patients, and evaluated the clinical and radiological results for a mean follow-up of 12.8 years. The all-anatomically designed stem provided excellent clinical and radiographic results. Four acetabular components underwent revision: three for fracture of the locking mechanism and wear of the polyethylene liner and one for the locking mechanism failure with dislocation of the HGPII cup. The abduction angles of the four revised acetabular components were apparently higher. The survivorship 13 years after surgery was 78%. Our findings show good long-term results using the anatomic femoral component, while the HGPII cup combined with 22-mm head seems to have poor durability due to locking mechanism failure. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the expression of the proteinase-activated receptor-2 (PAR-2) in human and rat intervertebral disc (IVD). The study used immunohistochemistry and western blot to analyze PAR-2 expression in rat, the effect of the PAR-2-activating peptide (PAR-2AP) on the catabolic cascade, and PAR-2 expression in the degeneration stage in human IVD tissues. Results show that PAR-2 expression is possible with the regulation of the interleukin-1β.

Background: Leptomeningeal carcinomatosis occurs in patients with cancer at the rate of approximately 5%; it develops particularly in patients with breast cancer, lung cancer, melanoma, leukemia, or malignant lymphoma. We describe a rare case of leptomeningeal carcinomatosis in which spinal intradural squamous cell carcinoma with no lesions in the cerebral meninges and leptomeninx, was the primary lesion. Methods: A 64-year-old man complained of sacral pain. Although the patient was treated with analgesics, epidural block and nerve root block, sacral pain persisted. Since acute urinary retention occurred, he was operated on. The patient was diagnosed as having an intradural squamous cell carcinoma of unknown origin. Results: Since the patient presented with a slightly decreased level of consciousness 2 months after surgery, he was subjected to MRI scanning of the brain and spinal cord, which revealed disseminated lesions in the medulla oblongata. The patient died of pneumonia and sepsis caused by methicillin-resistant Staphylococcus aureus 5 months after surgery. Conclusion: We report the first case of a patient with intradural squamous cell carcinoma with unknown origin that developed independently in the sacrum. [ABSTRACT FROM AUTHOR]

The usefulness of limb salvage surgery for distal lower leg sarcoma remains controversial. We analyzed the long-term prognosis, limb function, and complications after limb salvage treatment of patients with distal lower leg sarcoma. Ten patients treated with limb salvage surgery for primary distal lower leg sarcoma were retrospectively reviewed. The median follow-up period after the first operation was 9.0 years. We performed three types of reconstructive techniques for the skeletal defect after a wide resection, including (1) arthrodesis with a combination of autograft and intraoperative autoclaved tumor bone graft in two patients, or allograft in one patient, (2) ankle joint preserving surgery using intraoperative extracorporeal irradiated tumor bone graft in five patients, and (3) prosthesis in two patients. The overall survival rate was 80%. The 5-year disease-free survival was 80%. The rate of limb preservation at the final follow-up was 90%. The mean functional score according to the scoring system of the Musculoskeletal Tumor Society was 88% at the final follow-up. Postoperative complications occurred in seven patients. Skin trouble occurred in three patients, infectious non-union in one patient, fracture in three patients, and loosening of prosthesis in one patient. Despite the high rate of complications, patients treated with limb salvage surgery for the distal lower leg sarcoma revealed excellent final functional results without impairing the oncologic results. Limb salvage surgery is therefore considered to be an effective treatment option for distal lower leg sarcoma when adequate informed consent can be obtained from the patient. [ABSTRACT FROM AUTHOR]

Susceptibility to osteoarthritis, the most common human arthritis, is known to be influenced by genetic factors. Through a genome-wide association study using ∼100,000 SNPs, we have identified a previously unknown gene on chromosome 3p24.3, DVWA, which is associated with susceptibility to knee osteoarthritis. Expressed specifically in cartilage, DVWA encodes a 276-amino-acid protein with two regions corresponding to the von Willebrand factor type A domain (VWA domain). Several DVWA SNPs are significantly associated with knee osteoarthritis in two independent Japanese case-control cohorts. This association was replicated in a Japanese population cohort and a Han Chinese case-control cohort (combined P = 7.3 × 10−11). DVWA protein binds to β-tubulin, and the binding is influenced by two highly associated missense SNPs (rs11718863 and rs7639618) located in the VWA domain. The Tyr169-Cys260 isoform of DVWA, which is overrepresented in knee osteoarthritis, showed weaker interaction. Our findings reveal a new paradigm for study of osteoarthritis etiology and pathogenesis. [ABSTRACT FROM AUTHOR]

Freiberg’s infraction is a rare disorder that arises mostly in adolescent athletes. We describe a 77-year-old woman with the collapse of second metatarsal head with similar clinical appearance to Freiberg’s infraction. Radiological findings at initial visit of our hospital were normal. Her condition was obscure and magnetic resonance imaging showed the subchondral insufficiency fracture with bone marrow edema to the second metatarsal head. Despite the conservative treatment, the second metatarsal head collapsed. She was surgically treated with an osteochondral autograft without complications relating surgery. Furthermore, the histological findings showed that the site of collapse was considered to be secondary lesions resulting from the subchondral insufficiency fracture. [ABSTRACT FROM AUTHOR]

Freiberg's infraction is a rare disorder that arises mostly in adolescent athletes. We describe a 77-year-old woman with the collapse of second metatarsal head with similar clinical appearance to Freiberg's infraction. Radiological findings at initial visit of our hospital were normal. Her condition was obscure and magnetic resonance imaging showed the subchondral insufficiency fracture with bone marrow edema to the second metatarsal head. Despite the conservative treatment, the second metatarsal head collapsed. She was surgically treated with an osteochondral autograft without complications relating surgery. Furthermore, the histological findings showed that the site of collapse was considered to be secondary lesions resulting from the subchondral insufficiency fracture. [ABSTRACT FROM AUTHOR]

Tendon rupture is a common sports injury in adults. However, the mechanical properties of repair tissue are inferior to those of normal tissue. To accelerate tendon healing, an in vivo approach using growth factors has been applied and has shown evidence for the efficacy of biological stimulation of the repair process. Recombinant human osteogenic protein-1 (rhOP-1) has been shown to be effective in stimulating matrix production by various connective tissues. To test the effect of rhOP-1 on the matrix metabolism of tendon cells in vitro, bovine tendon cells were cultured in monolayer with various doses of rhOP-1 for 7 days. The addition of rhOP-1 to cell culture media resulted in significant increases in cell proliferation, DNA content, and the synthesis of proteoglycans (PGs) and collagen, compared to control cultures. The relative percentage of large PGs in the OP-1 culture was higher than that in the control culture. In conclusion, we show for the first time that rhOP-1 stimulates the proliferation of tendon cells and their ability to synthesize and accumulate PGs and collagen in their extracellular matrix. These biological properties may be used in the tissue-engineering of tendon tissues. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:42-48, 2008 [ABSTRACT FROM AUTHOR]

Background: There have been reports of serious complications associated with pedicle screw fixation, including nerve root injuries caused by accidental screw insertion. We have developed a new system of lumbar spinal instrumentation that we call Tadpole system®. The purposes of this report were to show the results of a biomechanical study and the short-term outcome of a clinical study, as well as to determine the usefulness of this system. Methods: The Tadpole system® lumbar spinal fusion is a hook-and-rod system according to which the spine is stabilized using 2 sets of 2 spinous processes each that are held in place by 4 hooks tandemly connected to a rod. The biomechanical study was done using 5 human lumbar cadaveric spines, and the range of motion (ROM) was examined in a non-treatment model, an injured model, a pedicle screw fixation model and a Tadpole system® model. For the short-term clinical study the Tadpole system® was used in 31 patients, and the factors analyzed were operation time, time required for spinal instrumentation, amount of intraoperative bleeding, postoperative improvement rate of the Japanese Orthopaedic Association (JOA) score for lumbar spinal disorders, instrumentation failure, spinous process fracture, spinal fluid leakage, nerve root injury, postoperative infection, and bone fusion 2 years after the operation. Results: The ROM in the Tadpole system® model was slightly bigger than that in the pedicle screw fixation model, but smaller than that in the normal control model. These biomechanical data indicated that the Tadpole system® provided fairly good stability. The mean operation time was 79 min, the mean time required for spinal instrumentation was 8 min, and the mean amount of intraoperative bleeding was 340 mL. The mean postoperative improvement rate of JOA score was 70.9 ± 24.8%. Instrumentation failure (dislocation of a hook) occurred in one patient, and none of the patients developed spinous process fracture, spinal fluid leakage, nerve root injury, or postoperative infection. Two years after the operation, bone union was confirmed in 29 of the 31 patients (93.5%). Conclusion: We conclude that this system is a useful, easy-to-use and safe spinal instrumentation technique for lumbar fusion surgery. [ABSTRACT FROM AUTHOR]

There is a great deal of controversy about the effect of tourniquets on development of deep vein thrombosis (DVT) after total knee arthroplasty (TKA). We investigated the incidence of postoperative DVT after TKA with or without the use of a tourniquet. The patients were 48 consecutive patients undergoing primary ipsilateral cemented TKA for osteoarthritis. Group A (21 patients) underwent the operation without a tourniquet, and Group B (27 patients) underwent the operation with a tourniquet. Ultrasonography to assess DVT was performed before and after the operation. Group B had less intraoperative and total blood loss than Group A. Postoperative DVT was detected in 81.3% of all cases, and symptomatic pulmonary embolism occurred in 1.7%. Most of DVT was found in the calf vein. There was no significant difference in the incidence of postoperative DVT between the two groups. We conclude that the use of a tourniquet is beneficial, because it decreases perioperative blood loss and does not increase the risk of DVT. The incidence of DVT after TKA is considerably high with or without use of a tourniquet. Therefore, prevention and early detection of DVT are important for prevention of fatal pulmonary thromboembolism. [ABSTRACT FROM AUTHOR]

Abstract: The two osteoclastogenesis pathways, receptor activator nuclear factor (NF)-κB ligand (RANKL)-mediated and fusion regulatory protein-1 (FRP-1)-mediated osteoclastogenesis, have recently been reported. There were significant differences in differentiation and activation mechanisms between the two pathways. When monocytes were cultured with FRP-1 without adding M-CSF, essential for the RANKL system, TRAP-positive polykaryocyte formation occurred. FRP-1-mediated osteoclasts formed larger pits on mineralized calcium phosphate plates than RANKL+M-CSF-mediated osteoclasts did. Lacunae on dentin surfaces induced by FRP-1-mediated osteoclasts were inclined to be single and isolated. However, osteoclasts induced by RANKL+M-CSF made many connected pits on dentin surfaces as if they crawled on there. Interestingly, FRP-1 osteoclastogenesis was enhanced by M-CSF/IL-1α, while chemotactic behavior to the dentin slices was not effected. There were differences in pH and concentration of at culture endpoint and in adherent feature to dentin surfaces. Our findings indicate there are two types of osteoclasts with distinct properties. [Copyright &y& Elsevier]

Tenascin-C (TN-C) is a hexameric glycoprotein component of extracellular matrix, and alternative RNA splicing creates two major TN-C size variants (the small and large variants). The large TN-C variants play key roles in many pathologic conditions in adults, including tumorigenesis, regeneration, and inflammation. This cross-sectional study compared levels of large TN-C variants in synovial fluid of patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Synovial fluid samples were obtained from knees of 26 patients with advanced RA and 79 with advanced OA. Expression of TN-C splice variants was examined using Western blotting. The levels of large TN-C variants in synovial fluid were determined by an enzyme-linked immunosorbent assay. Synovium were analyzed for TN-C by immunohistochemistry. Immunoblotting showed the presence of large TN-C variants in synovial fluid from patients with RA and OA. However, levels of large TN-C variants were fourfold higher in RA samples compared with OA samples ( p < 0.01). Synovial fluid levels of TN-C in RA did not correlate with C-reactive protein levels. Immunohistochemistry of the synovium showed stronger reactivity in RA samples than in OA samples. These results indicate that local synthesis of TN-C is increased during rheumatic disease. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:563-568, 2007 [ABSTRACT FROM AUTHOR]

Osteoarthritis (MIM 165720), characterized by degeneration of articular cartilage, is the most common form of human arthritis and a major concern for aging societies worldwide. Epidemiological and genetic studies have shown that osteoarthritis is a polygenic disease. Here, we report that the gene encoding growth differentiation factor 5 (GDF5) is associated with osteoarthritis in Asian populations. A SNP in the 5′ UTR of GDF5 (+104T/C; rs143383) showed significant association (P = 1.8 × 10−13) with hip osteoarthritis in two independent Japanese populations. This association was replicated for knee osteoarthritis in Japanese (P = 0.0021) and Han Chinese (P = 0.00028) populations. This SNP, located in the GDF5 core promoter, exerts allelic differences on transcriptional activity in chondrogenic cells, with the susceptibility allele showing reduced activity. Our findings implicate GDF5 as a susceptibility gene for osteoarthritis and suggest that decreased GDF5 expression is involved in the pathogenesis of osteoarthritis. [ABSTRACT FROM AUTHOR]

A symptomatic cyst is an uncommon complication after total knee arthroplasty (TKA). We present a case of a 77-year-old woman with a large cyst in the right knee caused by metal wear debris from the failure of a Miller-Galante I TKA performed 13 years earlier. The patient was treated with a two-stage operation including revision of the TKA followed by excision of the cyst, because there was a direct communication between the joint cavity and the cyst, and because the patient reported pain corresponding to the cystic area after revision. The patient was pain-free and had a satisfactory result 17 months after the second operation, without recurrence of cyst formation. We recommend two-stage surgery in which the first-stage is correction of the intra-articular pathology with revision TKA and the second-stage is excision of the cyst. [ABSTRACT FROM AUTHOR]

Background and Purpose. Although many studies have described clinical examination measures for the diagnosis of lumbar spinal instability, few of them have investigated the sensitivity and specificity of the measures that were used. The authors devised a passive lumbar extension (PLE) test for assessing lumbar spinal instability. The purpose of this study was to investigate the sensitivity, specificity, and positive likelihood ratio of this test. Subjects and Methods. The PLE test as well as the instability catch sign, painful catch sign, and apprehension sign tests were done for 122 subjects with lumbar degenerative diseases. The subjects were divided into 2 groups--instability positive and instability negative--on the basis of findings on flexion-extension films of the lumbar spine. The sensitivity, specificity, predictive values, and positive likelihood ratio of each test were investigated. Results. The sensitivity and specificity of the PLE test were 84.2% and 90.4%, respectively. These values were higher than those of other signs. The positive likelihood ratio of the PLE test was 8.84 (95% confidence interval = 4.51-17.33). Discussion and Conclusion. The PLE test is an effective method for examining patients for lumbar spinal instability and can be performed easily in an outpatient clinic. [ABSTRACT FROM AUTHOR]

Abstract: Spin-out of mobile-bearing knees is a significant early complication of mobile-bearing total knee arthroplasty. Dislocation of the cam-post mechanism of fixed-bearing posterior-stabilized knees occurs more rarely. We have observed an unusual case of dislocation of posterior-stabilized rotating-platform total knee arthroplasty, which has both a cam-post mechanism and rotating platform. A 65-year-old man with knee osteoarthritis and cervical spondylotic myelopathy underwent total knee arthroplasty using a mobile-bearing prosthesis. The dislocation, which occurred 4 days postoperatively, could not be reduced by closed manipulation. However, spontaneous reduction occurred 6 days after the dislocation, which did not recur. A gap mismatch or trapezoidal-shaped gaps may lead to dislocation or spin-out of the bearing insert. This case illustrates that dislocation of a posterior-stabilized mobile-bearing total knee arthroplasty can occur, and both quadriceps deficiency and ligament laxity may contribute to the risk of dislocation. [Copyright &y& Elsevier]

The purpose of the present study was to clarify changes in the psychological state of mothers of patients with idiopathic scoliosis, and to clarify relationships between the psychological states of the mothers and patients. The Maudsley personality inventory (MPI) was administered to 30 patients with idiopathic scoliosis who underwent surgery and their mothers preoperatively and at about 1 year postoperatively. We investigated the relationships between preoperative MPI scores and postoperative scores in patients and their mothers, respectively, and the relationships between MPI scores for patients and mothers. The results of the present study revealed that patients became more extroverted following surgery, while mothers displayed reduced neurotic tendencies. In conclusion, the mothers of patients who undergo corrective treatment for scoliosis may have experienced a substantial psychological burden before surgery, and doctors who treat patients with scoliosis should bear this point in mind. [ABSTRACT FROM AUTHOR]

Various imaging methods have been employed for the extracorporeal detection of malignant tumors in the human body, such as scintigraphy and PET; however, none is sufficiently accurate and all are also very expensive. To resolve these issues, we attempted to develop a new imaging technique of photodynamic diagnosis (PDD) with acridine orange (AO). AO has the ability to rapidly and specifically accumulate in malignant tumors and emit brilliant green fluorescence after blue light excitation. In this study, we investigated the feasibility of PDD utilizing the fluorovisualization effect of AO, for the extracorporeal detection of mouse osteosarcoma inoculated into the soft tissues. At 2 h after intravenous administration of 0.1, 0.2, 0.5, 1.0, 2.0 and 5.0 mg/kg AO, the tumor and the surrounding normal tissues were illuminated by blue light. The visual fluorescence contrast and ratio (X) of the difference in fluorescence intensity between the tumor and the surrounding normal tissues were evaluated using a high-resolution digital camera equipped with an absorption filter. In addition, the fluorescence contrast was also detected sequentially at 0.5, 1, 2, 3, 6 and 12 h after intravenous administration of AO at 1.0 mg/kg. The results revealed that the optimal condition for clear detection of the tumor was evaluation 2 h after intravenous injection of AO at 0.1 mg/kg, because it provided the best visual contrast on the digital images, and the fluorescence intensity as well as the value of X were higher as compared to the values under other conditions of dose and timing. Based on the results of an acute toxicity study of AO, the estimated LD50 of this substance following intravenous administration was 27.30 mg/kg. In conclusion, we believe that PDD using AO administered intravenously may be feasible for the detection of human musculoskeletal sarcomas in the soft tissues at extremities, and this technique might be a less invasive, less expensive, quicker and more accurate imaging modality than other previously reported imaging methods for this purpose. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: When human blood monocytes were cocultured with stromal cells derived from human giant cell tumor of bone (GCTSC) and a Millipore filter (0.4μm) was interposed between monocytes and GCTSC, multinucleated giant cell formation of monocytes was induced. The multinucleated giant cells have characters as osteoclast-like cells, indicating that a soluble osteoclast-inducing factor(s) is secreted from GCTSC expressing RANK, RANKL/ODF/OPGL and TACE mRNA. Furthermore, OCIF/OPG inhibited GCTSC-induced osteoclastogenesis, showing that the RANK–RANKL system is involved in GCTSC-induced osteoclastogenesis and that soluble form of ODF/RANKL induces osteoclasts from monocytes. GCTSC expressed the cytokine mRNAs such as M-CSF, GM-CSF, IL-3, IL-4, IL-6, and IFN-γ mRNAs. None of IL-1rα, IL-1α, IL-1β, IL-2, IL-4, IL-10, IL-18, TNF-α, G-CSF and IFN-γ could be detected in all culture media. A significant amount of IL-6 could be detected in the culture media of all GCTSC. IL-8 was found in the culture media of two GCTSC and two osteosarcoma-derived cells. M-CSF was detected in all culture media. GCTSC express CaSR, and stimulation of GCTSC with either extracellular Ca2+ or neomycin, agonist of CaSR, augumented the expression of RANKL. Some lines of GCTSC expressed alkaline phosphatase, osteocalcin and Cbfa1, suggesting that GCTSC are intimately related to osteoblastic lineage. [Copyright &y& Elsevier]