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[Purpose] The purpose of this study was to clarify the preliminary reference values for the lumbar spine range of motion associated with lateral bending exercises by gender and age group. [Methods] Subjects were 82 volunteers without low back pain, including five males and five females in each age group from 16-19 to 80-89 years. All subjects underwent radiographs of the lumbar spine with lateral flexion; the range of lateral flexion of the vertebrae from T12 to the sacrum (ROLB) was measured twice by three observers. [Results] The ROLB of the entire T12-S1 of all subjects showed a significant negative correlation with age in both sexes (p < 0.01). The ROLB of the lumbar spine tended to be greater in females, with a statistically significant difference between those aged 16-19 and 70-79 (p < 0.05). Lateral flexion angles for each intervertebral segment were largest at L3-L4 and smallest at L5-S1 (0.7°). [Conclusion] Lumbar ROLB reference values were examined by gender and age group; ROLB was greatest in L3-L4, and ROLB tended to be lower in older age groups.

A 24-year-old man with severe atopic dermatitis underwent anterior cruciate ligament (ACL) reconstruction of the right knee seven years earlier but developed a surgical site infection. The infection did not heal after removal of the metal implants, and a fistula eventually developed. This condition was left untreated for six years before he was referred to our hospital. Magnetic resonance imaging showed fluid in the tibial bone tunnel and extensive bone marrow edema surrounding the bone tunnel. Based on these findings, abscess formation within the tibial bone tunnel and osteomyelitis spreading to the proximal tibia were suspected. During the surgery, a portion of artificial ligament and non-absorbable suture were observed in the bone tunnel, and the infection healed immediately after removal of this complex. When surgical site infection occurs after ACL reconstruction, it is important to completely remove all artificial materials as early as possible.

Background: The treatment of septic non-union of the tibia is a challenging area.　The objective of this clinical study was to improve the treatment outcomes in patients with a highly active infection by the three strategies consisting of a two-staged operation, a flow-through technique for vascular anastomosis of a free vascularized fibular graft (FVFG), and continuous local intra-arterial infusion of heparin., Patients & Method: Five patients with septic non-union of the tibia who were treated with an FVFG (mean age: 52.8 years) were enrolled.　The mean postoperative follow-up period was 47.2 months, and the mean length of the bone defect was 111 mm.　A two-staged operation, in which polymethylmethacrylate (PMMA) beads containing antibiotics were inserted into a bone defect followed by bone reconstruction performed with an FVFG later.　Vascular anastomosis was performed with the flow-through technique in all patients.　Immediately after FVFG, heparin was continuously infused through a femoral arterial catheter for 1 week., Result: Bone union was confirmed an average of 18.8 weeks after-surgery in all patients without reoperation for thrombus., Conclusion: Our attempt to apply the strategies appears to be a viable treatment option for septic non-union of the tibia., Competing Interests: Conflicts of Interest: None declared

Purpose: This study investigated the shape of bone grafts and associations with upper limb function over the long term after free vascularized fibular head graft (FVFHG) for reconstruction of the proximal humerus after wide resection for bone sarcoma., Methods: Patients comprised 3 women who had undergone FVFHG at least 5 years previously. Age at surgery was 12 years in 2 cases and 76 years in one. The mean follow-up periods were 10 years 4 months. Evaluated parameters comprised: 1) graft hypertrophy, and 2) shape of the fibular head as changes in shape of the bone graft; and 3) ISOLS score, and 4) DASH score as indicators of upper limb function., Results: Rates of graft hypertrophy of the fibular shaft were -14%, -17%, and -20%, respectively, with transverse diameter decreasing in all cases. In terms of changes in shape of the grafted fibular head, transverse diameter had diminished in 2 patients (-5 mm and -2 mm), and the head had been completely resorbed in the remaining patient. Both patients in whom the fibular head remained were young, and both had good ISOLS scores >80% and good DASH scores of 5.0 and 8.3. The patient in whom the fibular head had been resorbed was elderly, with ISOLS and DASH scores of 73.3% and 34.2, respectively; comparatively poor compared with the other two. A comparison of ISOLS and DASH scores before and after fibular head resorption, however, showed no deterioration in either score., Conclusions: Long-term follow-up of humerus reconstruction by FVFHG showed no deterioration in upper limb function despite the risk of fibular head resorption. FVFHG of the proximal humerus is a reconstruction technique that can provide good long-term upper limb function.

Rat liver lipoamide dehydrogenase (LipDH) was separated into three types on DE-32 column chromatography, but no difference was observed among them in either immunological reactivity or enzymatic properties. A reconstitution experiment of branched-chain alpha-keto acid dehydrogenase complex (BCKADH) revealed that the most anionic type of LipDH was the most effective for the enzyme complex while the three types of LipDH were the same in the affinity for BCKADH subcomplex. All three types of LipDH were equally effective in reconstituting pyruvate dehydrogenase complex, alpha-ketoglutarate dehydrogenase complex and the glycine cleavage system. However, either pyruvate dehydrogenase or alpha-keto-glutarate dehydrogenase complex appeared to involve a certain LipDH in vivo which was firmly integrated into and hardly dissociable from the complex. A broad specificity of LipDH was observed for the glycine cleavage system. When BCKADH reconstitution experiments were carried out with both LipDHs from various sources and purified rat liver BCKADH subcomplex, the effectiveness of animal LipDHs was proportional to the extent of their immunological reactivity to the anti-rat LipDH antibody. However, BCKADH activity was also restored by a certain bacterial LipDH which had no cross-reactivity with the antibody, and LipDHs from some bacterial species, which reacted well with the antibody, showed no effect for the reconstitution of BCKADH. Thus, the determinant(s) of LipDH for the integration into alpha-keto acid dehydrogenase complexes including BCKADH can be its tertiary and/or quarternary structure rather than its primary and secondary structures.