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Parosteal lipoma is a rare type of lipoma, the incidence being approximately 0.3% of all lipomas. Moreover, parosteal lipoma coexisting with osteochondroma is extremely rare. A few cases with coexistence of osteochondroma and parosteal lipoma have been reported and they were thought to be reactive changes of adjacent bone by parosteal lipoma. However, temporal relationship of these tumors could not be explained. Here, we report a case of parosteal lipoma associated with osteochondroma of the right ilium developed over 6 years, with follow-up radiographs.

To identify the morphological characteristics of the acromion and subacromial bursal space after arthroscopic acromioplasty using magnetic resonance imaging (MRI). One hundred patients who received arthroscopic rotator cuff repair and acromioplasty each received at least three MRI examinations (preoperative, first immediate postoperative, and second follow-up imaging between 8 months and 1 year postoperatively). Changes over time in the thickness and morphology of the postoperative acromion as well as the subacromial bursal space were assessed. Clinical and radiological parameters were also analyzed to identify any association with changes in acromial morphology. Despite minimal acromial thinning observed at the first immediate postoperative state, the acromions showed significant thinning at the second postoperative MRI, with a mean reduction of 32%. Along with acromial thinning, an exaggerated concave contour of the acromial undersurface was observed in some patients. In the subacromial space, a loculated fluid collection developed in 91% of the patients at the second postoperative follow-up. No statistically significant association was noted between postoperative acromial thickness change and clinical or radiological factors (P value > 0.05). A significant delayed reduction in acromial thickness within approximately 1 year of arthroscopic acromioplasty is thought to be a normal postoperative feature. The simultaneous collection of a loculated, cyst-like fluid in the subacromial bursal space may be an important associated factor of postoperative acromial thinning.

Background and Aim Functional dyspepsia (FD) is characterized by chronic and unexplained indigestion at upper abdomen. Because of unsatisfactory effect of conventional treatments, demand is growing for complementary and alternative medicine. Rikkunshito (RKT) is a herbal medicine, which has been widely used for FD in Asia; however, the evidence is lacking. We carried out systematic review and meta‐analysis to evaluate the effect and safety of RKT in the treatment of FD. Methods Electronic databases were searched in April 2019, including PUBMED, EMBASE, and Cochrane Library. All eligible studies should be randomized controlled trials (RCTs) comparing RKT or combination therapy (RKT and western medicine) group to western medicine group. The primary outcome measure was the total clinical efficacy rate (TCE). The secondary outcomes were total dyspepsia symptom scale, gastric emptying rate, gastrin, motilin, recurrence 6 months after treatment, and Hamilton depression rating scale. Results Fifty‐two RCTs with 5475 patients were involved in this systematic review and meta‐analysis. Compared with western medicine, RKT showed significant better result, with higher TCE (relative risk = 1.21, 95% confidence interval 1.17 to 1.25, P

Background The purposes of the present study were (1) to create a magnetic resonance imaging (MRI)-based classification system for septic shoulder arthritis and to show the results of arthroscopic debridement based on the classification in eradicating the infection, and (2) to determine the distribution of the Gachter stages, which are determined on the basis of arthroscopic findings only, in each grade of the novel classification system. Methods The present study included 31 patients who underwent arthroscopic debridement for the treatment of acute septic arthritis of the shoulder between January 2001 and December 2015. The mean duration of follow-up was 2.3 years. The included patients were assessed with use of a novel classification system based on preoperative radiographic and MRI findings. MRI findings were classified as Grade I (only synovitis or joint effusion), Grade II (marrow edema in the bare area of the humeral head), Grade III (cartilaginous erosion), Grade IV (osseous erosion), and Grade V (osseous erosion on MRI also observed on radiographs). No changes on radiographs were observed in Grades I to IV. The intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliability were calculated. Results The overall reinfection rate was 54.8% (17 of 31). Among patients with Grade-I, II, III, IV, and V involvement, the reinfection rates were 0 of 4, 1 of 6, 2 of 4, 9 of 12, and 5 of 5, respectively. A diverse distribution of Gachter stages were found in each grade of the novel classification system, with the exception of Grade V. The ICCs for interobserver and intraobserver reliability were 0.81 and 0.80 for the novel classification system. The ICCs for interobserver and intraobserver reliability were 0.75 and 0.78 for Gachter stages. Conclusions This novel classification system for the grading of acute shoulder infections on the basis of radiographs and MRI allows preoperative grading of septic arthritis to be performed objectively. Patients who were classified as Grade III or higher in the novel classification system had higher reinfection rates than those who were classified as Grade I or II and required more aggressive treatment to eradicate the infection.

To perform a systematic review and meta-analysis to identify magnetic resonance imaging (MRI) features that will aid in the diagnosis of adhesive capsulitis of the shoulder (ACS) and provide a summary of the diagnostic accuracy of the identified features The MEDLINE and EMBASE databases were searched for studies assessing the diagnostic accuracy of MRI features of ACS. Overlapping descriptors used to denote the same imaging finding in different studies were subsumed under a single feature. The pooled accuracy including the diagnostic odd ratios (DORs) with 95% confidence intervals (CIs) of the identified features was calculated using a bivariate random-effects model. In total, 15 studies were included, and 74 overlapping descriptors were subsumed under six features. All six features were found to be informative for ACS diagnosis [coracohumeral ligament thickening: DOR, 13; 95% CI, 6-29; fat obliteration of the rotator interval (RI): DOR, 8; 95% CI, 3-24; RI enhancement: DOR, 44; 95% CI, 14-141; axillary joint capsule enhancement: DOR, 52; 95% CI, 27-98; inferior glenohumeral ligament (IGHL) hyperintensity: DOR, 31; 95% CI, 8-115; IGHL thickening: DOR, 28; 95% CI, 11-70]. The sensitivity and specificity of enhancement of the RI and axillary joint capsule and IGHL hyperintensity were > 80%. Six informative MRI features for ACS diagnosis were identified in this study with RI and axillary joint capsule enhancement and IGHL hyperintensity showing the highest diagnostic accuracy. Informative features observed on non-arthrogram MRI can be as helpful as features observed on direct magnetic resonance arthrography for ACS diagnosis. • Six informative MRI features for ACS diagnosis were identified (diagnostic odds ratio > 1). • RI and axillary joint capsule enhancement and IGHL hyperintensity showed high sensitivities/specificities (> 80%). • The use of non-arthrogram MRI is recommended for ACS diagnosis.

Background Few studies have investigated the characteristic findings of preoperative magnetic resonance imaging (MRI) and the clinical and radiologic outcomes of interstitial tear of the rotator cuff treated with arthroscopic repair after tear completion. Methods Forty-one patients (14 men and 27 women; mean age, 56.5 years) with arthroscopically confirmed interstitial tears underwent single-row repair after tear completion. The minimum follow-up period was 2 years. Results Twenty-eight patients (68.3%) were properly evaluated with MRI before surgery. Seven cases (17.1%) were misdiagnosed as bursal-sided tears and 5 cases (12.2%) were misdiagnosed as articular-sided tears on the basis of presurgical MRI findings. Arthroscopy revealed fibrillation and dimpling of the tendon surface in all cases and congestion within the defect in 36 cases (87.8%). At the final follow-up, the visual analog scale score for pain during motion decreased to 0.8 from a preoperative mean of 6.1 ( P .001). Moreover, at the final follow-up, the mean University of California–Los Angeles score and Constant score improved from 15.7 and 51.8 to 32.1 and 83.8, respectively ( P .001 for all). At 9 months after surgery, MRI revealed no cases of retear. Conclusion Interstitial tears are difficult to diagnose before surgery because MRI findings may lead to the misdiagnosis of interstitial tears as articular- or bursal-sided tears. If MRI-based diagnosis is indicative of articular- or bursal-sided tears but arthroscopy reveals fibrillation and dimpling of the tendon surface, interstitial tears should be suspected. The defective sites in interstitial tears are usually accompanied by congestion.

In patients with stroke and neurodegenerative diseases, overactivation of poly(ADP-ribose) polymerase-1 (PARP-1) causes harmful effects by inducing apoptosis, necrosis, neuroinflammation, and immune dysregulation. The current study investigated the neuroprotective effect of a novel PARP-1 inhibitor, JPI-289, in an animal model of ischemic stroke. A transient middle cerebral artery occlusion (tMCAO, 2 h) model was used to determine the therapeutic effect and the most effective dose and time window of administration of JPI-289. We also investigated the long-term outcomes of treatment with JPI-289 by diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) MRI and by measuring neurological function at 24 h, 7 days, and 28 days after MCAO. The most effective dose and time window of administration of JPI-289 was 10 mg/kg administered 2 h after MCAO with reperfusion. Twenty-four hours after MCAO, infarct volume was reduced by 53% and the number of apoptotic cells was reduced by 56% compared with control. JPI-289 also reduced infarct volume by 16% in the permanent MCAO model. In an MRI-based study, initial infarct volume, as measured using DWI, was similar in the control and JPI-289-treated groups. However, infarct volume and brain swelling were significantly reduced in the group treated with JPI-289 (2 h) at 24 h and 7 days after MCAO. Neurological functions also improved in the group treated with JPI-289 (2 h) until 28 days after MCAO. Inhibition of PARP-1 has neuroprotective effects (reduction of infarct volume and brain swelling) in both tMCAO and pMCAO models of ischemic stroke.

This study aimed to find independent prognostic factors related to retear of the rotator cuff tendon in patients with repaired full-thickness supraspinatus tendon tear by evaluation of pre- and postoperative MR images.Shoulder MR images were retrospectively analyzed for 83 patients who had undergone arthroscopic or open rotator cuff repair with acromioplasty for full-thickness supraspinatus tendon tear from April 2014 to March 2015. On preoperative MR images, the type of rotator cuff tear, extent of retraction of torn tendon, anteroposterior (AP) dimension of torn tendon, signal intensity of tear edge, degree of fat infiltration in supraspinatus and infraspinatus muscles, and acromiohumeral interval (AHI) were assessed. Postoperative cuff integrity seen on MR images was classified into five categories according to the Sugaya classification system, and patients were categorized into retear or intact groups. Factors assessed on preoperative MR images were compared between the two groups.The overall retear rate was 57.8%. Significant differences were observed between the retear and intact groups in terms of the mean values of the extent of tendon retraction (20.4 vs 11.7 mm), AP dimension of the tear (16.1 vs 11.4 mm), AHI (6.8 vs 8.7 mm), and degree of fat infiltration of the supraspinatus and infraspinatus muscles (for the supraspinatus muscle, 3, 30, and 15 patients in the retear group vs 5, 27, and three patients in the intact group had Goutallier grade 1, grade 2, and grades 3 and 4 infiltration, respectively; for the infraspinatus muscle, 27, 12, and 9 patients in the retear group vs 29, 5, and one patient in the intact group had Goutallier grade 1, grade 2, and grades 3 and 4 infiltration, respectively). Multivariable analysis revealed that AHI and degree of tendon retraction were independent predictive factors affecting retear of rotator cuff after repair.The retear rate of repaired rotator cuff tendon was about 57.8%. Independent prognostic factors of retear were degree of tendon retraction and AHI on preoperative MR images.

To investigate the efficacy of double inversion recovery (DIR) sequence for evaluating the synovium of the femoro-patellar joint without contrast enhancement (CE). Two radiologists independently evaluated the axial DIR and CE T1-weighted fat-saturated (CET1FS) images of 33 knees for agreement; the visualisation and distribution of the synovium were evaluated using a four-point visual scaling system at each of the five levels of the femoro-patellar joint and the location of the thickest synovium. The maximal synovial thickness at each sequence was measured by consensus. The interobserver agreement was good (κ = 0.736) for the four-point scale, and was excellent for the location of the thickest synovium on DIR and CET1FS (κ = 0.955 and 0.954). The intersequential agreement for the area with the thickest synovium was also excellent (κ = 0.845 and κ = 0.828). The synovial thickness on each sequence showed excellent correlation (r = 0.872). The DIR showed as good a correlation as CET1FS for the evaluation of the synovium at the femoro-patellar joint. DIR may be a useful MR technique for evaluating the synovium without CE. • DIR can be useful for evaluating the synovium of the femoro-patellar joint. • Interobserver and intersequential agreements between DIR and CET1FS were good. • Mean thickness of the synovium was significantly different between two sequences.

The purpose of this study is to retrospectively investigate the frequency of a focal defect at the lateral patellar retinaculum on knee MRI and to determine the variables that are significantly associated with the defect.Two radiologists independently reviewed 99 knee MR images for the presence of a focal defect at the lateral patellar retinaculum and categorized patients with concordant results into two groups: a group with the defect (≥ 3 mm; group 1) and a group without the defect (3 mm; group 2). Clinical and radiologic variables, including the Kellgren-Lawrence radiographic grade, subcutaneous fat thickness, infrapatellar fat pad area, and the amount of joint effusion, were evaluated. The size and location of the defect were measured in group 1. To correlate MRI and histologic findings, MRI was performed for 11 cadavers, and three histologic specimens were obtained.Of the 99 knee MR images, concordant results between two reviewers were obtained for a total of 96 knees (97%): 25 knees (26%) in group 1 and 71 knees (74%) in group 2. A statistically significant difference between groups (p = 0.033) was noted for the infrapatellar fat pad area only. In all three cadaveric specimens, the lateral patellar retinaculum was more loose and sparse than the medial patellar retinaculum, and this site corresponded to the location of the defect on MRI.A focal defect of the lateral patellar retinaculum was not found to be a rare finding on knee MRI (frequency, 26%), and it may be a normal variant rather than a pathologic change. In addition, we suspect that a focal defect can be a route of infrapatellar fat herniation and a route of superficial extension of the infrapatellar fat pad lesion without a lateral patellar retinaculum tear or invasion.

Background:Numerous studies have shown preoperative fatty infiltration of rotator cuff muscles to be strongly negatively correlated with the successful repair of massive rotator cuff tears (RCTs).Purpose:To assess the association between factors identified on preoperative magnetic resonance imaging (MRI), especially infraspinatus fatty infiltration, and the reparability of massive RCTs.Study Design:Case-control study; Level of evidence, 3.Methods:We analyzed a total of 105 patients with massive RCTs for whom MRI was performed ≤6 months before arthroscopic procedures. The mean age of the patients was 62.7 years (range, 46-83 years), and 46 were men. Among them, complete repair was possible in 50 patients (48%) and not possible in 55 patients (52%). The tangent sign, fatty infiltration of the rotator cuff, and Patte classification were evaluated as predictors of reparability. Using the receiver operating characteristic curve and the area under the curve (AUC), the prediction accuracy of each variable and combinations of variables were measured.Results:Reparability was associated with fatty infiltration of the supraspinatus ( P = .0045) and infraspinatus ( P < .001) muscles, the tangent sign ( P = .0033), and the Patte classification ( P < .001) but not with fatty infiltration of the subscapularis and teres minor ( P = .425 and .132, respectively). The cut-off values for supraspinatus and infraspinatus fatty infiltration were grade >3 and grade >2, respectively. The examination of single variables revealed that infraspinatus fatty infiltration showed the highest AUC value (0.812; sensitivity: 0.86; specificity: 0.76), while the tangent sign showed the lowest AUC value (0.626; sensitivity: 0.38; specificity: 0.87). Among 2-variable combinations, the combination of infraspinatus fatty infiltration and the Patte classification showed the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96). The combination of 4 variables, that is, infraspinatus and supraspinatus fatty infiltration, the tangent sign, and the Patte classification, had an AUC of 0.866 (sensitivity: 0.28; specificity: 0.98), which was lower than the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96) among the 2-variable combinations.Conclusion:The tangent sign or Patte classification alone was not a predictive indicator of the reparability of massive RCTs. Among single variables, infraspinatus fatty infiltration was the most effective in predicting reparability, while the combination of Goutallier classification

The purpose of this study was to investigate whether Baker cyst (BC) was related to the specific arrangement of the medial head of gastrocnemius tendon (MHGT) and the semimembranosus tendon (SMT). Patients who underwent knee MRI with “Baker cyst” in PACS from August 2017 to February 2018 were included in this study. Patients who did not have BC in a knee MRI performed during the same period were included in the control group. A total 210 patients were selected for inclusion in this study. For the imaging analysis, the arrangement pattern between MHGT and SMT was classified into three types: type 1, concave; type 2, flat; and type 3, convex. When imaging analysis was performed, the amount of effusion, the presence of osteoarthritis, and major ligament and meniscal tears were also described. Univariate and multivariate logistic regression analyses were performed. Statistical significance was considered at p < 0.05. The frequency of types 1, 2, and 3 was statistically significant depending on the presence or absence of BC (p < 0.001). The frequency of type 3 was the highest in the presence of BC, while that of type 1 was the highest in the absence of BC. BC was more common in type 2 (OR = 2.54; 95% CI = 1.27–5.07) and type 3 (OR = 4.09; 95% CI = 1.88–8.89). BC is more likely to occur in patients with SMT having a convex shape for MHGT. • Based on axial image of MRI only, one can predict which patients are morphologically more prone to develop a Baker cyst. • On axial images of MRI, Baker cyst is more likely to occur in patients with semimembranosus tendon having a convex shape for medial head of gastrocnemius tendon. • Baker cyst is not associated with the amount of effusion, OA, or internal derangement.

We describe the case of a 30-year-old man who developed chronic bilateral shoulder pain that relapsed and remitted over the course of 1 year. The patient was diagnosed with congenital shoulder fusion anomalies. The right shoulder showed anomalous accessory articulation between the distal third of the clavicle and the acromion along with normal articulation of the shoulder on CT. At the left shoulder, bony fusions were present between the distal portion of the clavicle, the acromion, and the coracoid process, and between the coracoid process, upper portion of the glenoid, and upper body of the scapula, which formed a bony canal and was responsible for hypoplasia of the supraspinatus muscle on CT and MRI. To our knowledge, this is the first description of such congenital shoulder anomalies with extreme bony fusion and is an illustrative example of how imaging may be used to differentiate fusion from other congenital abnormalities of the shoulder to aid diagnosis.

Amyloidosis is a disease characterized by the deposition of non-soluble fibrous protein in multiple tissues with a number of possible causes. This protein deposition can occur in any tissue, yet is most commonly seen in kidneys, heart, and gastrointestinal tracts. However, invasion to bone tissues is not often reported. The deposition of amyloid proteins in bone tissues may result in joint pain and pathological fractures; it is important to elucidate the causes and detect early to determine prognosis and treat optimally. In the present case report, with relevant literature review, the authors report a case of total hip arthroplasty in an amyloidosis patient.

The objective of our study was to retrospectively determine the prevalence and image findings of extraarticular talocalcaneal coalition with os sustentaculum, a type of talocalcaneal coalition that does not appear in current classification systems, in patients with an imaging diagnosis of foot coalition.This study was performed using a database query of radiology reports of ankle and foot CT or MRI examinations performed from August 2001 to November 2013. Eighty-one patients were identified through a keyword search of the database for "talocalcaneal coalition," "tarsal coalition," "coalition," or "os sustentaculum." Imaging features of CT or MRI findings were evaluated. Chart review was used to identify demographic information.Extraarticular talocalcaneal coalition with os sustentaculum was diagnosed in 13 patients (nine men, four women), which represents a prevalence of 16.0% (13/81) in all foot coalitions and 24.1% (13/54) in all talocalcaneal coalitions. Four of 13 patients underwent surgical resection, and histology was obtained in three patients. Nine patients who had no history of trauma were symptomatic and all patients with bone marrow edema at the coalition sites on MRI (n = 5) were also symptomatic. Coexisting extraarticular talocalcaneal coalition with os sustentaculum and intraarticular talocalcaneal coalition were observed in 11 of 13 patients.The os sustentaculum is a component of extraarticular talocalcaneal coalitions and as such is usually related to the presence of symptoms. If a patient with an os sustentaculum has symptoms in the medial talocalcaneal joint area, an extraarticular talocalcaneal coalition related to the os sustentaculum should be considered.

We set out to investigate the cause of persistently increased signal intensity (SI) in the posterior portion of the proximal patellar tendon (pPT) on T1-weighted images (T1WI). MR imaging was performed in eight cadavers, followed by gross histological examination. In addition, 84 patients without trauma history or anterior knee pain were included to compare the SI of the PTs. The patients were divided according to their age, sex, and Kellgren-Lawrence (KL) grades. The length and thickness of the increased SI portion in the pPT and whole PT (wPT) on T1WI were recorded. Histological specimens demonstrated that the adipose tissue, vessels, and perivascular connective tissue invaginated into the posterior portion of the pPT. This histological anatomy corresponded to the pPT signal change on MR imaging. There was linear and interdigitating increased SI of the pPT in all of the 84 patients (100 %). There were no differences in the lengths and thicknesses of the increased SI portion of pPTs and wPTs according to age, sex, and KL grade (all p > 0.05). The increased SI of the pPT on T1WI and fluid-sensitive MR images results from invaginating fat, vessels, and perivascular connective tissue. It is not pathological, but a normal and common finding. • Increased linear/interdigitated SIs of the pPT is a normal and common finding. • Invaginated adipose tissue, vessels, and connective tissue could contribute to increased SI. • The fibrocartilage has a minimal role in increased SI of the pPT. • Age, sex, and KL grade do not significantly influence the increased SI. • Knowledge of this increased SI should help clinicians to avoid unnecessary treatment.

Objectives Polyethylene liner dissociation from an acetabular component is a complication of total-hip arthroplasty (THA) caused by slippage of the liner, which causes pain and requires a revision. The aim of this study was to evaluate sonographic features of liner dissociation and detect useful sonographic findings compared to conventional radiography and computed tomography (CT). Methods Among a total of 226 patients who underwent revision THA at our institution between September 2008 and June 2012, 10 patients (6 male and 4 female; mean age, 56.2 years) who showed severe narrowing of the superior joint space on the THA side and underwent sonography were retrospectively reviewed by evaluating radiographic, CT, and sonographic findings. In evaluation of the images, we put more emphasis on the "radiographic crescent sign," "CT crescent sign," and "sonographic tram track sign." Results At surgery, 7 patients showed liner dissociation, and 3 showed severe liner wear. On radiography, 8 of 10 patients (80%) had a correct diagnosis of the presence or absence of liner dissociation; on sonography, all 10 patients (100%) had a correct diagnosis. The sensitivity, specificity, and accuracy for diagnosis of liner dissociation by pelvic radiography and sonography were 100% (7 of 7), 33% (1 of 3), and 80% (8 of 10) and 100% (7 of 7), 100% (3 of 3), and 100% (10 of 10), respectively. Conclusions Liner dissociation can be easily and well visualized by sonography, especially compared to pelvic radiography and CT. The sonographic tram track sign should be a very useful feature in the early diagnosis of liner dissociation.

Summary Objective To evaluate the clinical characteristics and outcomes of patients with hematogenous vertebral osteomyelitis (HVO) caused by gram-negative bacteria (GNB). Methods We conducted a retrospective chart review of adult patients with HVO from three tertiary-care hospitals over a 7-year period. Results Of the 313 microbiologically diagnosed HVO cases, GNB was responsible for 65 (20.8%) cases. Compared with patients with MSSA HVO, patients with GNB HVO were more likely to be female ( P = 0.03) and have diabetes ( P = 0.03), but less likely to have epidural abscess ( P = 0.02) and paravertebral abscess ( P = 0.003). Clinical outcomes were similar between the GNB and MSSA groups, including in-hospital mortality (4.6% vs. 7.8%; P = 0.53), recurrence (9.7% vs. 4.3%; P = 0.20), and sequelae (31.7% vs. 32.2%; P = 0.95). Among GNB-infected patients, recurrence rates differed according to the total duration of antibiotic treatment: 40.0% (4–6 weeks), 33.3% (6–8 weeks), and 2.1% (≥8 weeks) ( P = 0.002). Conclusions GNB HVO was responsible for 20.8% of adult cases of HVO. Despite some differences in clinical and radiological presentation, clinical outcomes were similar between GNB and MSSA HVO. Antibiotic therapy for ≥8 weeks may benefit patients with GNB HVO.

Selective inhibitors of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) have considerable potential as treatment for osteoporosis as well as metabolic syndrome including type 2 diabetes mellitus. Here, we investigated the anti-diabetic, anti-adipogenic, and anti-osteoporotic activity of KR-67500, as a novel selective 11β-HSD1 inhibitor. Cellular 11β-HSD1 activity was tested based on a homogeneous time-resolved fluorescence method. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) levels were measured in diet-induced obese (DIO)-C57BL/6 mice administered KR-67500 (50 mg/kg per day, p.o.) for 28 days and, additionally, its anti-diabetic effect was evaluated by OGTT and ITT. Thein vitroanti-adipogenic effect of KR-67500 was determined by Oil Red O Staining. Thein vitroanti-osteoporotic activity of KR-67500 was evaluated using bone morphogenetic protein 2 (BMP2)-induced osteoblast differentiation and receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclast differentiation model systems. KR-67500 improved thein vivoglucose tolerance and insulin sensitivity in DIO-C57BL/6 mice. KR-67500 suppressed cortisone-induced differentiation of 3T3-L1 cells into adipocytes. KR-67500 enhanced BMP2-induced osteoblastogenesis in C2C12 cells and inhibited RANKL-induced osteoclastogenesis in mouse bone marrow-derived macrophages. KR-67500, a new selective 11β-HSD1 inhibitor, may provide a new therapeutic window in the prevention and/or treatment of type 2 diabetes, obesity, and/or osteoporosis.

It has been reported that the selective inhibitors of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) have considerable potential for treating type 2 diabetes mellitus, metabolic syndrome and inflammation. In the present study, we investigated the anti-diabetic and anti-inflammatory effects of N-(5-carbamoyladamantan-2-yl)-3-((2-fluorophenyl) sulfonyl)thiazolidine-2-carboxamide (KR-67105), a novel 11β-HSD1 inhibitor, in diabetic mice model and preadipocyte model. KR-67105 concentration dependently inhibited 11β-HSD1 activity in human and mouse 11β-HSD1 overexpressing cells and mouse 3T3-L1 adipocytes. Furthermore, KR-67105 concentration-dependently inhibited 11β-HSD1 activity in the ex vivo assay of C57BL/6 mice. In the study with diet-induced obese (DIO) mice, the administration of KR-67105 (100mg/kg/day, orally for 28 days) improved the glucose tolerance and insulin sensitivity as determined by the oral glucose tolerance test and the insulin tolerance test. Anti-diabetic effect by KR-67105 was associated with the suppression of diabetic related genes expression in liver and fat. Furthermore, KR-67105 suppressed 11β-HSD1 activity in liver and fat of diabetic mice, but showed no effect on adrenal grand weight/body weight ratio and plasma corticosterone concentration in diabetic mice. In 3T3-L1 preadipocytes, cortisone induced the mRNA of inflammatory cytokines and 11β-HSD1 and reactive oxygen species formation. This effect was abolished by co-incubation with KR-67105 in a concentration-dependent manner. Moreover, KR-67105 attenuated cortisone induced iNOS expression and phosphorylation of NF-κB p65, p38 MAPK, and ERK1/2 in preadipocytes. Taken together, it is concluded that a selective 11β-HSD1 inhibitor, KR-67105, may provide a new therapeutic window in the prevention and treatment of type 2 diabetes with chronic inflammation without toxicity.

Intravenous lobular capillary hemangiomas are extremely uncommon and mostly occur in the veins of the neck and upper extremities. Here, we report the clinical and sonographic features of an intravenous lobular capillary hemangioma localized in the right cephalic vein, and we discuss its pathologic findings and differential diagnoses.

Background Magnetic resonance (MR) arthrography is the ideal imaging modality for the acetabular labrum. Three-dimensional (3D) fast spin-echo (FSE) sequences have similar diagnostic performance as two-dimensional (2D) conventional MR imaging for ligaments, menisci, or bone marrow edema in the knee. Purpose To compare the diagnostic accuracy and inter-observer reliability of 3D intermediate-weighted FSE sequence and 2D FSE sequences for the diagnosis of acetabular labral tears. Material and Methods Institutional review board approval was obtained and informed consent was waived for 45 patients (47 hips) who underwent 3D and 2D MR arthrography and subsequent arthroscopic surgery. The 3D sequences were performed using volumetric intermediate-weighted fast spin-echo imaging with fat suppression (voxel size, 0.6 × 0.6 × 1.2 mm; imaging time, 6 min 38 s). Labral tear was retrospectively and independently evaluated by two radiologists in four areas of the labrum (anterosuperior, posterosuperior, anteroinferior, and posteroinferior) on 3D and 2D FSE sequences. Statistical differences between the sensitivity and specificity of the methods were analyzed with the McNemar test, using arthroscopic findings as the reference standard. Inter-observer agreement was calculated using kappa statistics. Results Arthroscopic findings confirmed labral tears at 40 anterosuperior, 23 posterosuperior, 0 anteroinferior, and 2 posteroinferior quadrants. Sensitivity and specificity were 74% and 89% for 2D FSE sequences, and 78% and 92% for 3D FSE sequences, respectively. Sensitivities and specificities for the methods were not different statistically (P > 0.05). Inter-observer agreement for labral tear was substantial for 2D FSE sequences (k = 0.774) and almost perfect for 3D FSE sequences (k = 0.842). Conclusion 3D intermediate-weighted FSE MR arthrography is excellent for diagnosing acetabular labral tears. Sensitivity, specificity, and inter-observer reliability were similar to conventional 2D MR arthrography. For evaluation of the labrum, 3D FSE MR arthrography is more time-efficient than 2D FSE MR arthrography.

BACKGROUND During an epidemic of a novel infectious disease, many healthcare workers suffer from mental health problems. OBJECTIVES The aims of this study were to test the following hypotheses: stigma and hardiness exert both direct effects on mental health and also indirect (mediated) effects on mental health through stress in nurses working at a government-designated hospital during a Middle East Respiratory Syndrome coronavirus (MERS-CoV) epidemic. METHODS A total of 187 participants were recruited using a convenience sampling method. The direct and indirect effects related to the study hypotheses were computed using a series of ordinary least-squares regressions and 95% bootstrap confidence intervals with 10,000 bootstrap resamples from the data. DISCUSSIONS The influences of stigma and hardiness on mental health were partially mediated through stress in nurses working at a hospital during a MERS-CoV epidemic. Their mental health was influenced more by direct effects than by indirect effects., HIGHLIGHTS • During an epidemic of a novel infectious disease, nurses can suffer from mental health problems. • Stigma and hardiness exert both direct effects on mental health in nurses. • Stigma and hardiness exert both indirect effects on mental health via stress in nurses. • The mental health of nurses was affected more by direct effects than by indirect effects.

Epiphyseal involvement of a simple bone cyst (SBC) is rare. Furthermore, its pathological variant is even more uncommon. Herein, we report a case of a 22-year-old woman with an SBC containing unusual mesenchymal tissue proliferation with epiphyseal involvement in the proximal fibula. Magnetic resonance imaging showed a cystic lesion that involved the entire epiphysis as well as some soft tissue components. Hence, our initial differential diagnosis did not include SBC. However, pathology confirmed a SBC. Thus, SBC should be considered in the diagnosis of cystic lesions despite the atypical imaging findings.

Synovial sarcoma of primary bone origin is very rare and has not been previously reported in the cervical vertebra. We report the first case of a synovial sarcoma of the cervical vertebra, presenting as an expansile osteolytic lesion in the posterior osseous elements of the C3 vertebra characteristically with prominent intratumoral vessels.

Carbenoxolone is the 3-hemisuccinate of glycyrrhetinic acid, the active principal of licorice (Glycyrrhiza glabra). It was reported that carbenoxolone improved glucose tolerance with increased insulin sensitivity in mice with high fat diet-induced obesity. In the present study, we elucidated the protective effect of carbenoxolone in fatty liver animal models of C57BL/6-Lep(ob/ob) mice through inhibition of hepatic lipogenesis and apoptosis. In addition, the potential mechanisms by which carbenoxolone could exert such protection were elucidated. Carbenoxolone was daily administrated by gavage for 28 days in C57BL/6 and C57BL/6-Lep(ob/ob) mice. Carbenoxolone prevented the plasma triglyceride and free fatty acid accumulation associated with the reduction of the expression of sterol regulatory element binding protein-1c, liver X receptor, fatty acid synthase and acethyl-CoA carboxylase in the livers of C57BL/6-Lep(ob/ob) mice. Carbenoxolone also prevented hepatic injury through anti-apoptotic action in the livers of C57BL/6-Lep(ob/ob) mice, accompanied by increased Bcl-2 expression and suppressed Bax and cytochrome c expression. As a mechanism, increased inflammatory cytokine expressions were inhibited by carbenoxolone in the fatty livers of C57BL/6-Lep(ob/ob) mice. Furthermore, carbenoxolone inhibited free fatty acid (oleate/palmitate) induced reactive oxygen species formation and reversed free fatty acid induced mitochondrial membrane depolarization in HepG2 cells. Carbenoxolone prevents the development of fatty liver by inhibiting sterol regulatory element binding protein-1c expression and activity with an anti-apoptotic mechanism via the inhibition of inflammatory cytokine and reactive oxygen species formation in the livers of C57BL/6-Lep(ob/ob) mice. It is suggested that carbenoxolone prevents the development and progression of fatty liver disease in patients with insulin resistance.

Glucocorticoid excess (Cushing's syndrome) causes metabolic syndrome such as visceral obesity, insulin resistance, diabetes mellitus, dyslipidaemia and hypertension. The selective inhibitors of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) have considerable potential for treating type 2 diabetes mellitus and metabolic syndrome. In the present study, we investigated the anti-diabetic and anti-adipogenic effects of 4-(2-(1,1-dioxido-6-(2,4,6-trichlorophenyl)-1,2,6-thiadiazinan-2-yl)acetamido)adamantane-1-carboxamide (KR-67183), a novel selective 11β-HSD1 inhibitor; we also investigated the underlying molecular mechanisms in the cortisone-induced 3T3-L1 adipogenesis model system and diet-induced obese (DIO) mice. KR-67183 concentration-dependently inhibited 11β-HSD1 activity in human and mouse 11β-HSD1 over-expressed cells and in the ex vivo assay of C57BL/6 mice. In the study with DIO mice, the administration of KR-67183 (20 and 50 mg/kg/day, orally for 28 days) improved the glucose tolerance and insulin sensitivity with suppressed 11β-HSD1 activity in the liver and fat. However, KR-67183 showed no change in the adrenal gland weight/body weight ratio and plasma corticosterone concentration in DIO mice. Further, KR-67183 suppressed adipocyte differentiation on cortisone-induced adipogenesis in 3T3-L1 cells is associated with the suppression of the cortisone-induced mRNA levels of FABP4, PPARγ2 and GLUT4, and 11β-HSD1 activity. Taken together, it is suggested that a selective 11β-HSD1 inhibitor, KR-67183, may provide a new therapeutic window in the prevention and treatment without toxicity in type 2 diabetes with obesity.

The purpose of this study was to evaluate the sequential MRI findings of intramuscular gossypiboma and to correlate them with the pathologic findings in rabbits.Sterile gauze was packed in the hamstring muscles of 12 rabbits, and sequential MR images were obtained 1, 2, and 4 weeks and 2, 6, and 12 months after gauze insertion. Two rabbits were sacrificed at each time point. Their pathologic findings were compared with the MRI findings on each date.At the acute stage, the gossypibomas appeared as areas of heterogeneous low signal intensity on T2-weighted MR images with inflammatory change around the gossypiboma. In the subacute stage, the gossypibomas appeared as areas of peripheral low and central high signal intensity with wavy stripes of low signal intensity on T2-weighted images. On contrast-enhanced fat-suppressed T1-weighted images, the peripheral enhancement of the masses advanced toward the center of the mass as the fibrocollagenization between the gauze bundles progressed centrally. In the chronic stage, on contrast-enhanced fat-suppressed T1-weighted images, central advancement of the peripheral enhancement occurred according to the maturation of the fibrocollagenization. Calcifications around individual gauze fibers were observed 6-12 months after gauze insertion.On sequential contrast-enhanced fat-suppressed T1-weighted images of rabbits, intramuscular gossypiboma exhibited a chronologic centripetal enhancement pattern for 1 year mainly owing to concentric progression of fibrocollagenization between gauze bundles toward the center of the mass.

The 6-hydroxydopamine (6-OHDA) lesions of the nigrostriatal dopamine system in rat can develop neuropathological and neurochemcial changes similar to those seen in patients with Parkinson’s disease (PD). The purpose of this study was to test the hypothesis that the N-acetylaspartate level (NAA), regarded as neuronal marker would be decreased after 6-OHDA lesions in rat brain and to determine whether metabolic alteration are correlated with behavioral deficit. The animals were undergone adjusting stepping test and proton magnetic resonance spectroscopy (1H-MRS). In vivo 1H-NMR spectra (TR/TE = 2500/144 ms) were acquired from both left (contralateral region) and right striatum (ipsillateral region). There was a highly significant impairment in left forepaw performance and significant reductions in NAA/total creatine (tCr) ratios were observed in the ipsillateral striatum of rat (P < 0.05). Furthermore, there was a significant correlation between left forepaw performance and NAA/tCr level on the whole sample (Spearman correlation test, ρ = 0.634, P = 0.011). Our results suggest that the NAA/tCr ratio may be a valuable criterion for evaluation of functional impairment of the striatum in 6-OHDA rat model of PD.

To evaluate the incidence and pattern of spinous process fractures (SPFs) in patients with osteoporotic compression fractures (OCFs) of the thoracolumbar spine.Spinal MRI or CT of 398 female patients (age range 50-89 years, mean age 70 years) who had OCFs in the thoracolumbar spine were retrospectively reviewed. The incidence, location and imaging results for the SPFs were evaluated.Of the 398 patients who had thoracolumbar OCFs, 14 (3.5%) had SPF. In six patients with single compression fractures, the SPF occurred at the level just above the vertebral compression fracture. In six out of seven patients with multiple continuous compression fractures, the SPF occurred just one level above the uppermost level of the compression fracture. The remaining one patient who had thoracolumbar spinal fixation at T12-L2 with continuous compression fractures in T12-L5 had a SPF in L2. In one patient who had multiple compression fractures in discontinuous levels (fractures at T10 and L1, respectively), the SPF occurred at T12. The directions of the fractures were vertical or oblique vertical (perpendicular to the long axis of the spinous process) in all cases.In the presence of an OCF in the thoracolumbar spine, a SPF was found in 3.5% of cases, and most of the fractures were located just one level above the compression fracture. Therefore, in patients who have OCF, the possibility of a SPF in the level just above the compression fracture should be considered.

This study was investigated to find out the change of reproductive and histological biomarkers of Ruditapes philippinarum exposed to nonylphenol (NP). Experimental period was 16 weeks. Experimental groups were composed of one control condition and three NP exposure conditions (0.05, 0.1, 0.2 mg NP L -1 ). Gonad index was higher in exposure group than control in female and higher in control than exposure group in male. Intersexuality in the NP exposure group was 14.56% with male exhibiting higher ratio than female. Histological analysis of organ system illustrated expansion of hemolymph sinus, loss of striated border of inner epidermis and degeneration of mucous cell in the mantle. In the gill partially disappearance of frontal and lateral cilia, degeneration of mucous cell were observed. Also, hyperplasia of epithelium and disappearance of striated border were observed in the foot. As the concentration of NP increased, the accumulation of lipofuscin increased in the digestive gland. The results of this study suggest that NP induces reduction of survival rate, histopathology and intersex of R. philippinarum. Furthermore, it is indentified that NP functions as an estrogenic effector on the reproduction of R. philippinarum.

A suprapubic cartilaginous cyst from the symphysis pubis is a rare lesion, which may be asymptomatic or cause symptoms such as urinary retention and pelvic pain. It is thought to be secondary to degenerative changes in the symphysis pubis and usually occurs in multiparous women. We report the case of a suprapubic cartilaginous cyst in a 76-year-old asymptomatic woman, which mimicked a bladder mass on ultrasonography.

The purpose was to assess the significance of herniation pits in the femoral neck for radiographic diagnosis of femoroacetabular impingement (FAI). Eighty hips in 62 patients (bilateral in 18) with neutral pelvic orientation were enrolled. Herniation pits were diagnosed when they were located at the anterosuperior femoral neck, close to the physis, and with a diameter of >3 mm. The five radiographic signs of FAI were used: lateral center edge angle (LCE) >39°, acetabular index (AI) ≤0, extrusion index (EI)

An ossifying fibromyxoid tumor (OFMT) is a rare soft tissue neoplasm that presents as a solitary painless well-circumscribed mass usually located in the subcutaneous layer of the trunk or extremities. 1,2 The lesion mainly affects adults and is slightly predominant in men. 2 Almost all of the cases reported in the past were based on the clinical and histologic findings of OFMTs, with only a few reports about radiologic findings. To our knowledge, there have been no previous reports that described the sonographic features of this uncommon tumor. Here we describe the clinical, sonographic, and histologic findings in a case of an OFMT of the buttock.

An eccrine spiradenoma is a rare benign dermal tumor of the sweat gland. It is frequently solitary and presents as a small lesion (usually

Intramuscular hemangiomas are benign soft tissue tumors and predominantly involve the large muscles of the thigh. 1 Only about 1% of hemangiomas originate in the skeletal muscle. 2 In addition to their vascular components, hemangiomas can contain a thrombus, calcifications, hemosiderin, fat, smooth muscle, and fibrous tissue, with fat being the most common component. 1 Calcifications in hemangiomas are commonly noted on radiographic and histologic examinations. These calcifications are more often seen in a cavernous type of hemangioma and are the result of dystrophic calcification within organizing thrombi. 3 However, ossification in hemangiomas is a rare radiologic and histologic phenomenon. 4 Hemangiomas with massive mature bone formation in the skeletal muscle of the extremities have been rarely reported. 4-8 We report a case of an ossified hemangioma in the skeletal muscle of the thigh, with emphasis on the sonographic findings.

Background In the emergency department, patients with abdominopelvic trauma inadvertently undergo both abdominal computed tomography (CT) (for intra-abdominal and intra-pelvic organs) and pelvic CT (CT with multiplanar reformation in three orthogonal planes of the bony pelvis). However, the systemic use of CT is concerning given the cumulative radiation dose. Purpose To evaluate the diagnostic value of abdominal CT in comparison to pelvic CT in patients with suspected pelvic fractures. Material and Methods Seventy-two patients who underwent abdominal CT and pelvic CT within a 2-week period to evaluate pelvic fractures were included. Two reviewers retrospectively analyzed eight anatomical regions of the pelvic bones on both abdominal CT and pelvic CT over a 1-week interval. The interpretation of pelvic CT scans by two senior musculoskeletal radiologists was considered as the reference standard. Diagnostic performance and inter-observer agreement of both CT scans were evaluated. Results For reviewers 1 and 2, abdominal CT showed high accuracy (98% and 98%, respectively) as did pelvic CT. For both abdominal CT and pelvic CT, fracture detection in all anatomical regions of the pelvic bones was not significantly different for the two reviewers ( P ≥ 0.25). Inter-observer agreement for all anatomical regions of the pelvic bones was excellent or good (k = 0.785–1.0). Conclusion Not only pelvic CT but also abdominal CT is acceptable for detection of pelvic fractures, in spite of its thicker sections and different reconstruction algorithm. Therefore, if abdominal CT has already been performed, additional pelvic CT might no longer be necessary in order to exclude a pelvic fracture.

Background The optimal duration of antibiotic treatment for hematogenous vertebral osteomyelitis (HVO) should be based on the patient's risk of recurrence, but it is not well established. Methods A retrospective review was conducted to evaluate the optimal duration of antibiotic treatment in patients with HVO at low and high risk of recurrence. Patients with at least 1 independent baseline risk factor for recurrence, determined by multivariable analysis, were considered as high risk and those with no risk factor as low risk. Results A total of 314 patients with microbiologically diagnosed HVO were evaluable for recurrence. In multivariable analysis, methicillin-resistant Staphylococcus aureus infection (adjusted odds ratio [aOR], 2.61; 95% confidence interval [CI], 1.16-5.87), undrained paravertebral/psoas abscesses (aOR, 4.09; 95% CI, 1.82-9.19), and end-stage renal disease (aOR, 6.58; 95% CI, 1.63-26.54) were independent baseline risk factors for recurrence. Therefore, 191 (60.8%) patients were classified as low risk and 123 (39.2%) as high risk. Among high-risk patients, there was a significant decreasing trend for recurrence according to total duration of antibiotic therapy: 34.8% (4-6 weeks [28-41 days]), 29.6% (6-8 weeks [42-55 days]), and 9.6% (≥8 weeks [≥56 days]) (P = .002). For low-risk patients, this association was still significant but the recurrence rates were much lower: 12.0% (4-6 weeks), 6.3% (6-8 weeks), and 2.2% (≥8 weeks) (P = .02). Conclusions Antibiotic therapy of prolonged duration (≥8 weeks) should be given to patients with HVO at high risk of recurrence. For low-risk patients, a shorter duration (6-8 weeks) of pathogen-directed antibiotic therapy may be sufficient.

Objective To evaluate whether an early bone marrow edema pattern predicts vertebral deformity types and prognosis in osteoporotic vertebral compression fracture (OVCF). Methods This retrospective study enrolled 64 patients with 75 acute OVCFs who underwent early MRI and followed up MRI. On early MRI, the low SI pattern of OVCF on T1WI were assessed and classified into 3 types (diffuse, globular or patchy, band-like). On followed up MRI, the vertebral deformity types (anterior wedge, biconcave, crush), degree of vertebral body height loss, incidence of vertebral osteonecrosis and spinal stenosis were assessed for each vertebral fracture types. Results According to the early bone marrow edema pattern on T1WI, 26 vertebrae were type 1, 14 vertebrae were type 2 and 35 vertebrae were type 3. On followed up MRI, the crush-type vertebral deformity was most frequent among the type 1 OVCFs, the biconcave-type vertebral deformity was most frequent among the type 2 OVCFs and the anterior wedge-type vertebral deformity was most frequent among the type 3 OVCFs (p

To describe the CT findings of focal osteolysis following total hip replacement (THR). CT imaging features of 30 THRs with focal osteolysis visualized on follow-up radiographs and undertaken revision surgery were reviewed. On CT scans, the shape and anatomic location of osteolytic lesions was recorded, as well as their size and number. The presence of cortical disruption or expansion, liner wear, metallosis, and heterotopic ossification was also noted. In each case, surgical and histologic findings were correlated with imaging features. Focal osteolysis was common in the superior part of acetabular and femoral components. CT features of focal osteolysis were multiple, expansile, oval, or round radiolucencies, which were conglomerated into multilobular shape. The cortex adjacent to the osteolytic lesions revealed irregular thinning and discontinuity (29/30, 97%) accompanied by a few tiny fragments. Liner wear was common (27/30, 90%), and metallosis was frequent (8/30, 26.7%). Pathologic results were foreign body reaction in 20 patients, chronic inflammation in eight, and fibrosis in two. CT appearances of focal osteolysis following THR are multilobulated lucent areas with expansile periosteal reaction and cortical abnormalities, mimicking infection or tumor. We consider that CT is useful for the prediction and assessment of the nature and extent of focal osteolysis.

The purpose of this study was to assess the usefulness of magnetic resonance (MR) arthrography of the glenohumeral joint in the diagnosis of adhesive capsulitis.MR arthrography of the glenohumeral joint was performed in 16 patients with arthroscopically proven adhesive capsulitis and 11 controls. Thickness of the joint capsule and synovium, filling ratio of the fluid-distended axillary recess to the posterior joint cavity, and a width of the rotator cuff interval were measured by 2 musculoskeletal radiologists. The measurements of those parameters for the patients with adhesive capsulitis and the controls were compared. Interobserver variability for the measurements of each parameter was calculated.The mean thickness of the joint capsule and synovium was 2.97 mm in patients with adhesive capsulitis and 1.86 mm in controls (P0.001). The mean filling ratio of the fluid-distended axillary to the posterior joint cavity was 0.51 in patients with adhesive capsulitis and 0.82 in controls (P = 0.004). The mean width of the rotator cuff interval was 7.45 mm in patients with adhesive capsulitis and 8.48 mm in controls (P0.05). Intraclass correlation coefficient for interobserver variability showed good agreement (95% CI; 0.72-0.95).On MR arthrography, thickening of the joint capsule and synovium and diminished filling ratio of the axillary recess to posterior joint cavity appeared to be useful diagnostic criteria for the diagnosis of adhesive capsulitis of the shoulder.

Musculoskeletal (MSK) infections, such as osteomyelitis, infectious arthritis and spondylitis have variable radiographic findings depending on their underlying cause and clinical infection stage. Other disease entities, ranging from simple degenerative lesions to tumorous bone conditions, in which there is no evidence of infectious origin, can share similar radiographic findings. It is important to be aware, when interpreting radiographic features that are typically associated with MSK infections, that a non-infectious MSK disease may be mimicking the radiographic findings of infectious diseases.

To describe the characteristic MRI appearance of squatting-induced rhabdomyolysis involving the thigh muscles.This study consisted of 10 cases obtained at 3 institutions from 2005 to 2015. A retrospective review was performed to obtain clinical information and MR scans for rhabdomyolysis of the thigh muscles. MRI was analyzed according to the distribution and degree of muscle involvement; the degree was assessed and graded as normal, mild or prominent.The mean patient age was 20.2 years (range, 15-24 years), and 7 of the 10 patients were male. All patients had history of excessive squatting action, suffered clinically from bilateral thigh pain and were confirmed to have rhabdomyolysis through analysis of serum creatine kinase (CK) levels. All of the patients (10/10) exhibited diffuse mild to prominent degree involvement of the anterior thigh muscles according to fluid-sensitive MR sequences. Among the anterior thigh muscles, the rectus femoris was spared in 8 patients (8/10) and mild degree involved in 2 patients (2/10). Thus, no cases exhibited prominent degree involvement of the rectus femoris muscle.Preservation of the rectus femoris muscle on MRI in squatting-induced rhabdomyolysis may be useful for differentiating rhabdomyolysis from other aetiologies. Advances in knowledge: Preservation of rectus femoris on MRI is distinguishable finding in squatting-induced rhabdomyolysis and reflects the functional anatomy of anterior thigh muscles.

Background Patients with hematogenous vertebral osteomyelitis (HVO) occasionally require instrumentation for spinal stabilization. However, placing instrumentation in the setting of spinal infection raises concerns about recurrent infection due to bacteria adhering to the foreign material. In this study, we evaluated the therapeutic outcomes of patients with HVO who underwent instrumented surgery. Methods We conducted a retrospective chart review of adult patients with microbiologically diagnosed HVO who underwent surgical intervention in 5 tertiary care hospitals over an 8-year period. Results A total of 153 patients with HVO underwent surgical management for their infections. Of these 153 patients, 94 (61.4%) underwent surgical debridement alone (noninstrumented surgery) and 59 (38.6%) underwent surgical debridement and instrumentation (instrumented surgery). The median durations of antibiotic therapy were 66 and 80 days for the noninstrumentation and instrumentation groups, respectively (P = .22). Clinical outcomes were similar between the groups, including rates of infection-related death (2.1% vs 0%; P = .52), primary failure (1.1% vs 5.1%; P = .30), and recurrence (4.8% vs 6.8%; P = .72). Among the instrumentation group, there was a significant decreasing trend for recurrence according to total duration of antibiotic therapy: 22.2% (4-6 weeks), 9.1% (6-8 weeks), and 2.6% (≥ 8 weeks; P = .04). Duration of pre-instrumentation antibiotic therapy and single-stage operation (vs 2-stage operation) were not risk factors for recurrence. Conclusions Spinal instrumentation in patients with HVO may be safe with pathogen-directed prolonged antibiotic therapy and should not be abandoned or delayed solely because of the risk of recurrence.

Parosteal osteoma arising from long tubular bone is an extremely rare bone tumor and should be distinguished from parosteal osteosarcoma, whereas osteochondroma is a common benign bone tumor showing an outgrowth of medullary and cortical bone with a cartilaginous cap. This report describes simultaneously detected parosteal osteoma and osteochondroma arising from the distal femur in a single patient.

The selective inhibitors of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) have considerable potential for treating type 2 diabetes mellitus and metabolic syndrome. In the present study, we investigated the anti-diabetic and anti-adipogenic effects of 2-(3-benzoyl)-4-hydroxy-1,1-dioxo-2H-1,2-benzothiazine-2-yl-1-phenylethanone (KR-66344), as a 11β-HSD1 inhibitor; we also investigated the underlying molecular mechanisms in the cortisone-induced 3T3-L1 adipogenesis model system and C57BL/6-Lep(ob/ob) mice. KR-66344 concentration-dependently inhibited 11β-HSD1 activity in human liver microsome, mouse C2C12 myotube and human SW982 cells. In the C57BL/6-Lep(ob/ob) mice study, the administration of KR-66344 (200mg/kg/d, orally for 5 days) improved the glucose intolerance as determined by the oral glucose tolerance test, in which the area under the curve (AUC) of the plasma glucose concentration was significantly reduced by 27% compared with the vehicle treated group. Further, KR-66344 suppressed adipocyte differentiation on cortisone-induced adipogenesis in 3T3-L1 cells is associated with the suppression of the cortisone-induced mRNA levels of FABP4, G3PD, PPARγ2 and Glut4, and 11β-HSD1 expression and activity. Our results additionally demonstrate evidence showing that KR-66344 improved glycemic control and inhibited adipogenesis via 11β-HSD1 enzyme activity. Taken together, these results may provide evidence of the therapeutic potential of KR-66344, as a 11β-HSD1 inhibitor, in obesity and type 2 diabetes patients with metabolic syndrome.