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Background: Clinical studies have reported satisfactory results after osteochondral autograft transplantation (OAT) for central lesions of unstable osteochondritis dissecans (OCD) of the elbow. However, the outcomes after OAT for lateral lesions remain unclear., Hypothesis: The clinical outcomes of OAT would be better for central lesions than for lateral lesions., Study Design: Cohort study; Level of evidence, 3., Methods: The authors retrospectively evaluated 103 juvenile athletes (mean age, 13.2 years; range, 11-16 years) who underwent OAT for symptomatic OCD of the humeral capitellum from 2003 to 2014. Sixteen patients were excluded because they did not fit the inclusion criteria. The final cohort of 87 patients was divided by lesion type into central lesion (n = 43) and lateral lesion (n = 44) groups. When possible, a single large plug was created for grafting and trimmed to reconstruct the rounded joint surface. The clinical, radiographic, and magnetic resonance imaging outcomes were evaluated for each group at a mean follow-up of 43 months (range, 24-100 months)., Results: There were no significant differences in the age, sex, height, weight, duration of symptoms, follow-up time, preoperative range of motion, or Timmerman and Andrews score between the 2 groups. The preoperative osteoarthritic changes (0 of 43 for central vs 5 of 44 cases for lateral; P = .023), mean lesion size (12.2 ± 2.9 vs 18.2 ± 7.0 mm; P < .001), and graft number (1.6 vs 2.8; P < .001) were significantly greater in the lateral group versus the central group. The mean range of extension (2.3° ± 5.4° vs -3.2° ± 8.7°; P < .001) and Timmerman and Andrews score (194 vs 185; P = .006) at the final follow-up were significantly better for patients in the central group. More patients in the lateral group had postoperative radial head subluxation (0 of 43 vs 6 of 44; P = .012) and osteoarthritic changes (1 of 43 vs 9 of 44; P = .008). The mean MOCART score showed no significant differences between the groups (78.0 ± 15.7 vs 72.6 ± 20.9; P = .181). The rate of return to sports at the previous level was 100% in the central group and 86% in the lateral group ( P = .012)., Conclusion: The clinical and radiographic outcomes after OAT associated with unstable OCD of the humeral capitellum were better for central lesions than for lateral lesions. However, satisfactory outcomes and a high rate of return to sports were obtained for unstable lateral lesions after OAT.

We previously reported that circulating peripheral blood-borne cells (PBCs) contribute to early-phase meniscal reparative change. Because macrophages and myofibroblasts are important contributors of tissue regeneration, we examined their origin and distribution in the reparative meniscus. Reparative menisci were evaluated at 1, 2, and 4 weeks post-meniscectomy by immunohistochemistry to locate monocytes and macrophages (stained positive for CD68 and CD163), and myofibroblasts (stained positive for αSMA). Of the total number of cells, 13% were CD68 + at 1 week post-meniscectomy, which decreased to 1% by 4 weeks post-meniscectomy; of these, almost half of CD68 + cells (49.4%: 98.8% as PBCs) were green fluorescent protein (GFP)-positive post-meniscectomy (1, 2, and 4 weeks), indicating that the majority of CD68 + cells were derived from PBCs. Of the total cells, 6% were CD163 + at 1 week post-meniscectomy, which decreased to 1% by week 4. Of the CD163 + cells, the majority were GFP-positive (42.5%: 85.0% as PBCs) after 1 week; however, this decreased significantly over time, which indicates that the majority of CD163 + cells are derived from PBCs during the early phase of meniscal reparative change, but are derived from resident cells at later time points. Of the total cells, 38% were αSMA + at 1 week post-meniscectomy, which decreased to 3% by 4 weeks. The proportion of GFP-positive αSMA + cells was 2.8% after 1 week, with no significant change over time, which indicates that the majority of αSMA + cells originated from resident cells. Here, we describe the origin and distribution of macrophages and myofibroblasts during meniscal reparative change.

In oncology clinical trials, overall survival (OS) is considered the gold standard outcome measure. In phase III trials for neuroendocrine neoplasms (NENs), however, progression-free survival (PFS) is more frequently used, as NENs are relatively rare and indolent neoplasms. But this surrogacy of PFS for OS has never been systematically validated. We, therefore, performed a literature-based analysis of phase II and III trials for NENs to evaluate the correlation between PFS and OS in NENs treated with medical treatment. We identified phase II and III clinical trials of medical treatment for advanced NENs based on a systematic electronic search using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. A total of 20 trials were identified, and 2530 patients and 30 treatment arms were included in the analysis. There was a statistically significant relationship between PFS and OS ( r s , 0.587; 95% confidence interval, 0.249-0.925). Conversely, the objective response rate was not significantly correlated with OS. The results of subgroup analyses indicated that the correlation between PFS and OS was higher for study arms that prohibited concomitant therapy with somatostatin analogues than for those that permitted it. The results of the present analysis indicate that PFS is significantly correlated with OS, and suggest that PFS is an acceptable surrogate for OS in clinical trials for NENs., (© 2017 Society for Endocrinology.)

To know the properties of a particle or a wave, one should measure how its energy changes with its momentum. The relation between them is called the dispersion relation, which encodes essential information of the kinetics. In a magnet, the wave motion of atomic spins serves as an elementary excitation, called a spin wave, and behaves like a fictitious particle. Although the dispersion relation of spin waves governs many of the magnetic properties, observation of their entire dispersion is one of the challenges today. Spin waves whose dispersion is dominated by magnetostatic interaction are called pure-magnetostatic waves, which are still missing despite of their practical importance. Here, we report observation of the band dispersion relation of pure-magnetostatic waves by developing a table-top all-optical spectroscopy named spin-wave tomography. The result unmasks characteristics of pure-magnetostatic waves. We also demonstrate time-resolved measurements, which reveal coherent energy transfer between spin waves and lattice vibrations.

Interleukin-22 (IL-22) acts protectively and harmfully on intestinal tissue depending on the situation; therefore, IL-22 signaling needs to be tightly regulated. IL-22 binding protein (IL-22BP) binds IL-22 to inhibit IL-22 signaling. It is expressed in intestinal and lymphoid tissues, although its precise distribution and roles have remained unclear. In this study, we show that IL-22BP is highly expressed by CD11b + CD8α - dendritic cells in the subepithelial dome region of Peyer's patches (PPs). We found that IL-22BP blocks IL-22 signaling in the follicle-associated epithelium (FAE) covering PPs, indicating that IL-22BP plays a role in regulating the characteristics of the FAE. As expected, FAE of IL-22BP-deficient ( Il22ra2 - /- ) mice exhibited altered properties such as the enhanced expression of mucus and antimicrobial proteins as well as prominent fucosylation, which are normally suppressed in FAE. Additionally, Il22ra2 - /- mice exhibited the decreased uptake of bacterial antigens into PPs without affecting M cell function. Our present study thus demonstrates that IL-22BP promotes bacterial uptake into PPs by influencing FAE gene expression and function., (© 2017 Jinnohara et al.)

Background: Although arthroscopic meniscal reshaping for discoid lateral meniscus (DLM) has better outcomes than total or subtotal meniscectomy, degenerative changes on radiographs are still seen in some patients with meniscal reshaping., Purpose: To assess the risk factors associated with knee joint degeneration after reshaping surgery for juvenile DLM., Study Design: Case-control study; Level of evidence, 3., Methods: Forty patients (45 knees) with a mean age of 12.0 years who underwent arthroscopic meniscal reshaping for DLM were enrolled at a mean of 39.6 months after surgery. For all patients, meniscal saucerization was performed first. Then, if the residual meniscus was unstable, stabilization was provided with suture fixation. At final follow-up, we obtained radiographs to assess degenerative changes to the knee joint using the classification by Tapper and Hoover. Residual meniscal width and meniscal extrusion (defined as a relative percentage of extrusion [RPE]) were measured with magnetic resonance imaging (MRI). Then, the correlation between radiographic evidence of degenerative changes (Tapper and Hoover grade), residual meniscal width, and RPE were assessed with Pearson and Spearman correlation analyses. Logistic regression analysis was used to examine whether preoperative characteristics correlated with degeneration and residual meniscal width., Results: The mean residual meniscal width was 4.6 mm (range, 3.8-6.0 mm), and the mean ± SD RPE was 25.5% ± 21.8% at the final follow-up. There were 28 knees with Tapper and Hoover grade 0, 10 knees with grade 1, and 7 knees with grade 2. The residual meniscal width and RPE were significantly correlated with Tapper and Hoover grade (ρ = -0.489, P = .0007; ρ = 0.414, P = .005, respectively). The residual meniscal width was also significantly correlated with RPE ( r = -0.416, P = .004). The receiver operating characteristic curve showed that a 5.0-mm residual meniscal width was the cutoff value leading to evidence of degeneration. Multiple logistic regression analysis showed that an anterocentral shift on preoperative MRI was a risk factor for degeneration (odds ratio, 27.2; 95% CI, 1.1-360.5; P = .012) and residual meniscal width less than 5.0 mm (odds ratio, 20.9; 95% CI, 1.5-281; P = .022)., Conclusion: Smaller meniscal width and greater severity of meniscal extrusion correlated with knee joint degeneration. An anterocentral shift on preoperative MRI was a risk factor for degenerative changes and smaller residual meniscal width.

Venous thromboembolism, which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is a serious complication after operations involving the lower extremities, and it can be fatal. However, few reports have described the incidence of PE and its associated risk factors after arthroscopic knee surgery. We present a case of bilateral massive PE of the main pulmonary arteries and DVT detected on multi-detector row computed tomography after arthroscopic multiple knee ligament reconstruction. Our patient was asymptomatic despite having several risk factors for thromboembolic events (43 years of age, a long operation time, obesity, and diabetes mellitus) and receiving no pharmacologic thromboembolic prophylaxis. Although fatality due to PE is relatively uncommon, when a patient has several risk factors for PE, perioperative thromboprophylaxis should be considered. Level of evidence IV.

β-Stereoselective mannosylation using donors bearing the 2,6-lactone moiety is described. In general, glycosylation is a nucleophilic substitution reaction between an alcoholic nucleophile and a sugar moiety containing a leaving group at the anomeric position. Owing to stereoelectronic effects, the reaction tends to proceed via an S N 1 mechanism to afford α-glycosides. We found that the introduction of a 2,6-lactone bridge can circumvent the competing S N 1 reaction, affording β-glycosides with stereoinversion via S N 2(-like) mechanisms. Glycosyl trichloroacetimidates are particularly efficient when activated by a combined catalyst of AuCl 3 and 3,5-bis(trifluoromethyl)phenyl thiourea. In addition, the product stereoselectivity was highly dependent on the concentration of the reaction. Moreover, even when the reaction proceeds via an S N 1 mechanism, the corresponding glycosyl cation appears to present sterically a β-directing nature. Overall, 2,6-lactones were promising structures for achieving β-mannosylations.

Purpose: This study was performed to evaluate one-stage anterior cruciate ligament (ACL) reconstruction using a semitendinosus tendon graft injected with bone morphogenetic protein 2 (BMP-2) in a rabbit model., Methods: We injected recombinant human BMP-2 (rhBMP-2) in the experimental group and phosphate-buffered saline in the control group at two sites of the semitendinosus tendon (15 μg in each site) to replace tendon with bone in the bone tunnel. Twenty minutes later, the injected tendon graft was transplanted for ACL reconstruction by passing the graft through the bone tunnel. The animals were harvested at four, eight, or 12 weeks postoperatively and examined by histological and biomechanical methods., Results: Histological analysis revealed that the tendon graft was replaced with new bone in the tunnel of the experimental group. Characteristic features identical to the regenerated direct insertion morphology at the bone-tendon junction were acquired at eight or 12 weeks in the experimental group. Biomechanical pull-out testing revealed greater stiffness in the experimental than control group at 12 weeks, although the maximum load to failure showed no significant difference between the two groups at four, eight, or 12 weeks., Conclusion: These results indicate the potential for ACL reconstruction with regenerated direct insertion morphology.

Purpose: To establish a reference index for the simple identification of the optimum resection point for cam-type impingement on arthroscopy., Methods: Twelve cadaveric left hips with a 20° to 40° center-edge angle, without osteoarthritis, were examined (mean age, 85 ± 10.1 years). The pelvis was fixed such that the anterior pelvic plane and femur were parallel to the table. The resection line for impingement was first defined on the femoral head surface 5 mm distal to the acetabular labrum, from the 9-o'clock (anterior) to 12-o'clock (superior) position. Next, we measured the hip flexion angle necessary for the head-neck junction to reach the resection line. After positioning the wire on the femoral head surface along the resection line from the 9- to 12-o'clock area of the femoral head, we measured the target alpha angle on radiographs at 0°, 15°, 30°, 45°, and 60° of hip flexion using the frog-leg 45/45/30 view (45° of flexion, 45° of abduction, and 30° of external rotation) and Dunn 45 view (45° of flexion, 20° of abduction, and neutral rotation)., Results: The mean hip flexion angle at which the head-neck junction reached the resection line was 31° ± 4.6°. For 0°, 15°, 30°, 45°, and 60° of hip flexion, the mean target alpha angle was 75.5° ± 5.5°, 65.3° ± 5.6°, 56.3° ± 5.8°, 49.0° ± 6.6°, and 42.6° ± 5.8°, respectively, using the frog-leg 45/45/30 view and 75.0° ± 6.0°, 65.8° ± 6.2°, 57.2° ± 7.3°, 50.7° ± 6.9°, and 44.2° ± 5.8°, respectively, using the Dunn 45 view. There were no significant differences between the 2 radiographic techniques (P = .82, P = .84, P = .76, P = .57, and P = .52, respectively)., Conclusions: A description of the degree of hip flexion during cam resection can affect the final alpha angle when using the labrum as a reference for resection., Clinical Relevance: The described index allows systematic navigation of cam lesions during arthroscopy for femoroacetabular impingement patients using the hip flexion angle., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Introduction: In anterior cruciate ligament (ACL) reconstruction, sharp angulation of the graft at tunnel aperture increases local strain to the graft. The purpose of this study is to investigate the relationship between femoral tunnel location and femoral graft bending angle after ACL double bundle reconstruction (ACL-DBR) with two different drilling techniques., Materials and Methods: In ACL-DBR, femoral tunnel was created by two techniques; outside-in technique (26 patients, group A) and transportal technique (25 patients, group B). CT scan was taken at 1 week postoperatively. The position of femoral tunnel exit on the lateral femoral cortex, and intra-articular femoral and tibial tunnel aperture of the anteromedial bundle (AMB) and postero-lateral bundle (PLB) was measured using a rectangular frame on three-dimensional CT images. Femoral graft bending angle was measured using two-dimensional CT images., Results: Femoral tunnel exits of AMB and PLB in group A were significantly anterior and proximal than those in group B (p < 0.05), while there was no significant difference in intra-articular femoral and tibial tunnel apertures between group A and B. A mean femoral graft bending angle of AMB was 80.3° in group A and 69.2 degrees in group B, respectively (p < 0.05). A mean femoral graft bending angle of PLB was 66.3° in group A and 64.6° in group B, respectively. In both groups, a significant (p < 0.05) correlation (r < -0.4) was observed between the position of the femoral tunnel exit (anterior-posterior ratio from femoral anterior border line) and the femoral graft bending angle in AMB., Conclusions: Since the femoral tunnel exit in outside-in technique was located more anterior and proximal, femoral graft bending angle of AMB in outside-in technique was greater than that in transportal technique. Anterior position of the femoral tunnel exit in AMB increased femoral graft bending angle in outside-in and transportal techniques.

Long intercalated defects in canine ribs can be repaired successfully using porous beta-tricalcium phosphate (beta-TCP) cylinders, infused with a biodegradable polymer (poly D,L-lactic acid-polyethylene block copolymer) containing recombinant human bone morphogenetic protein-2 (rhBMP-2). We previously reported the successful regeneration of bony rib and periosteum defects using beta-TCP cylinders containing 400 microg of rhBMP-2. To reduce the amount of rhBMP-2 and decrease the time required for defect repair, we utilized a biodegradable polymer carrier, in combination with rhBMP-2 and the porous beta-TCP cylinders. An 8 cm long section of rib bone was removed and replaced with an implant comprised of the porous beta-TCP cylinders and the polymer containing 80 microg of rhBMP-2. Six weeks after surgical placement of the beta-TCP cylinder/polymer/BMP-2 implants, new rib bone with an anatomical configuration and mechanical strength similar to the original bone was regenerated at the defect site. The stiffness of the regenerated ribs at 3, 6, and 12 weeks after implantation of the composite implant was significantly higher than that of ribs regenerated by implantation of rhBMP-2/beta-TCP implants. Thus, addition of the synthetic polymer to the drug delivery system for BMP potentiated the bone-regenerating ability of the implant and enabled the formation of mechanically competent rib bone. This new method appears to be applicable to the repair of intercalated long bone defects often encountered in clinical practice.

Oligomeric peptide ribonucleic acids (PRNA's), tethering 5'-amino-5'-deoxyribonucleosides as a recognition site for nucleic acids, has been designed and synthesized by solid phase method. PRNA 12-mer found to form stable duplex with complementary DNA.PRNA.DNA duplex composed of PRNA with mismatched DNA has 10-degree lower melting temperature than fullmatched PRNA.DNA duplex. These results demonstrate that binding of PRNA with DNA is sequence specific. It should be emphasized that the on-off switching of PRNA.DNA duplex formation has been realized by the borate added as an external factor.