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The purpose of this study was to investigate radiologic correlation between the ischiofemoral space and morphologic findings in the hip in patients with symptomatic developmental dysplasia of the hip (DDH), borderline DDH, and femoroacetabular impingement (FAI).In 84 patients undergoing hip arthroscopic surgery, 108 hips were divided into three groups according to lateral center-edge angle (LCEA): DDH group (LCEA20°; 18 hips), borderline DDH group (20° ≤ LCEA25°; 26 hips), and FAI group (LCEA ≥ 25°; 64 hips). Ischiofemoral distance was evaluated by radiography and ischiofemoral space and quadratus femoris space by MRI. Software was used to measure the radiographic parameters LCEA, femoral neck-shaft angle, and femoral neck anteversion on preoperative CT scans.Ischiofemoral distance, ischiofemoral space, and quadratus femoris space were significantly smaller in the DDH and borderline DDH groups than in the FAI group. The prevalence of hips with ischiofemoral space17 mm was significantly higher in the DDH (10 of 18 patients [56%]) and borderline DDH (8 of 26 patients [31%]) groups than in the FAI group (4 of 64 patients [6%]). In addition, the prevalence of hips with a quadratus femoris space8 mm was significantly higher in the DDH (2 of 18 patients [11%]) and borderline DDH (3 of 26 patients [12%]) groups than in the FAI (0 of 64 patients [0%]) group. Femoral neck-shaft angle and femoral neck anteversion were significantly greater in the DDH group than in the FAI group.Ischiofemoral impingement syndromes can be considered more likely in patients with DDH than in those with FAI.

In the original publication of the article, the Figures 2 and 3 were published incorrectly. The corrected figures are given below.

Aldehyde dehydrogenase 2 (ALDH2) is the enzyme that degrades and detoxifies the acetaldehyde produced by alcohol metabolism. In our previous study, we found that compared with wild-type mice (WT), climbing exercises did not increase trabecular bone mass in Aldh2 knockout mice (KO). The purpose of this study was to clarify the effect of the Aldh2 gene on cortical bone structure and on the dynamics of skeletal unloading. Eight-week-old male KO and WT were divided into ground control (GC) or tail suspension (TS) groups for one week (i.e., the KOGC, KOTS, WTGC and WTTS groups). We measured the bone mineral density (BMD) of the femur using dual-energy X-ray absorptiometry. We assessed the femoral morphometry using peripheral quantitative computed tomography (pQCT) and evaluated the femoral cortex histomorphometry, and cortical mRNA using quantitative RT-PCR and cortical bone immunohistostaining. No significant differences were found between the femoral BMD of WTGC and that of WTTS, but the BMD in KOTS was significantly lower than that of KOGC. The pQCT results revealed that the cortical BMD of the femoral diaphysis in KOTS was significantly lower than that of KOGC. Furthermore, the cortical bone area and cortical thickness were significantly lower in KOTS than in the other three groups. Cortical histomorphometric analysis revealed that the endosteal and periosteal bone formation parameters were significantly lower in KOTS than in KOGC. Bone formation signals such as parathyroid hormone receptor (PTHR) were significantly decreased in KOTS compared with the levels in KOGC. Cortical bone immunohistostaining revealed a significantly decreased expression of PTHR in the osteocytes of KOTS compared with the expression level in KOGC. Thus, we concluded that when the Aldh2 gene is disrupted, skeletal unloading suppresses bone formation to decrease cortical bone mass, which may be mediated by a decreased expression of PTH receptors in osteocytes.

Members of the transient receptor potential (TRP) family of ion channels play important roles in inflammation and pain. Here, we showed that both TRPV1 and TRPV4 might contribute to biphasic nocifensive behavior and neuroendocrine response following a formalin test. We subcutaneously injected saline, formalin, or the TRPV4 agonist, 4α-phorbol 12,13-didecanoate (4α-PDD) into one hindpaw of wild-type (WT), TRPV1-deficient (Trpv1(-/-)), and TRPV4-deficient (Trpv4(-/-)) mice to investigate nocifensive behaviors (phase I [0-10 min] and phase II [10-60 min]) and Fos expression in the dorsal horn of the spinal cord and other brain regions related to pain, in the paraventricular nucleus (PVN), paraventricular nucleus of the thalamus, the medial habenular nucleus, the medial nucleus of the amygdala and capsular part of the central amygdala. Subcutaneous (s.c.) injection of formalin caused less nocifensive behavior in Trpv1(-/-) and Trpv4(-/-) mice than in WT mice during phase I. In phase II, however, formalin induced less nocifensive behavior only in the Trpv1(-/-) mice, but not in the Trpv4(-/-) mice, relative to WT mice. The number of Fos-like immunoreactive (LI) neurons in laminae I-II of the dorsal horn increased in all types of mice 90 min after s.c. injection of formalin; however, there was no difference in the other regions between saline- and formalin-treated mice. Furthermore, s.c. injection of 4α-PDD did not induce nociceptive behavior nor influence the number of Fos-LI neurons in the all above mentioned regions in any of the mice. These results suggest that TRPV4-mediated nociceptive information from the peripheral tissue excluding the spinal pathway might be involved the formalin behavioral response during phase I. Only TRPV1 might regulate the formalin behavioral response in peripheral neuron.

This study aimed to clarify the association between abnormal Wnt signaling and the cause of idiopathic carpal tunnel syndrome (ICTS) and whether an association exists between Wnt signaling and cell proliferation in the flexor tenosynovium. The subjects included nine patients with ICTS; the controls were nine patients with distal radius fractures without any symptoms of carpal tunnel syndrome. We extracted mRNA from the flexor tenosynovium and compared the expression levels of genes encoding 17 types of Wnt in both subjects and controls via quantitative real-time polymerase chain reaction (PCR). Expression levels of factors involved in cell proliferation, such as estrogen-responsive finger protein, epidermal growth factor receptor, heparin binding-epidermal growth factor-like growth factor, insulin-like growth factor-1, and vascular endothelial growth factor (VEGF) were also measured using quantitative real-time PCR. In addition, we compared the Wnt and MIB-1 protein expression levels to clarify the effect of Wnt on cell proliferation. Quantitative real-time PCR revealed significantly greater expression of the gene encoding Wnt9a in subjects with ICTS than in controls and also revealed a positive correlation between the expression of genes encoding Wnt9a and VEGF in subjects with ICTS. Quantitative evaluation using immunohistochemical staining also indicated more marked Wnt9a expression in subjects than in controls. However, there was no relationship between the expression of Wnt9a and the cell proliferation index MIB-1. These results indicate that Wnt9a expression is enhanced in ICTS and that Wnt9a may be involved in VEGF expression in ICTS.

It is unclear whether osteoclasts are present and activated in cholesteatomas. We explored the expression of messenger RNA (mRNA) for osteoclast biomarkers and regulating factors in middle ear cholesteatomas to elucidate the level of osteoclast activity in this disease. Bone powder was collected from 14 patients with cholesteatomatous and noncholesteatomatous chronic otitis media during tympanomastoidectomy, separately from cortical bone of the mastoid (clean bone powder), from bone neighboring cholesteatoma (cholesteatomatous bone powder), and from bone of the air cells and antrum of noncholesteatomatous chronic otitis media patients (noncholesteatomatous bone powder). The samples collected were soaked in TRIzol reagent, and total RNA was extracted and purified by the acid guanidinium thiocyanate-phenol-chloroform method, followed by the use of magnetic bead technology. The sample was then subjected to quantitative reverse transcription polymerase chain reaction for receptor activator of nuclear factor κB (RANK), tartrate-resistant acid phosphatase (TRAP), cathepsin K (CTSK), osteoclast-associated receptor (OSCAR), calcitonin receptor (CALCR), matrix metalloproteinase 9 (MMP9), receptor activator of nuclear factor κB ligand (RANKL), and osteoprotegerin (OPG). There was no significant difference in the expression of TRAP, CTSK, OSCAR, CALCR, MMP9, or OPG among the clean, cholesteatomatous, and noncholesteatomatous bone powder. On the other hand, the expression of RANK and RANKL was significantly lower in the cholesteatomatous bone powder than in the noncholesteatomatous bone powder (P = 0.003 and P = 0.028, respectively). The RANKL mRNA/OPG mRNA ratio did not differ among the three samples. These results indicate that osteoclasts are unlikely to be activated in cholesteatomas. Bone resorption mechanisms not mediated by osteoclasts may need to be reappraised in cholesteatoma research in future studies.

The efficacy of negative pressure wound therapy (NPWT) in the treatment of skin defect wounds has been established, but it is difficult to apply to hand surgery because of the easy occurrence of air leaks. We report two cases of performing NPWT with surgical gloves. Case1: A 37-year-old male was injured on his right dorsal hand from a punch. He presented to our hospital three days after the injury because of swelling and pain. The wound was infected and contused, so wound lavage and debridement (W&D) were performed under local anesthesia. The infected condition didn't improve after antimicrobial infusion, so W&D were performed again 8 days after the first visit. Then W&D were performed every day, and the infection subsided 15 days after the first visit. NPWT was initiated for the purpose of managing exudate and the wound condition, and healthy granulation tissue formed gradually. Finally, transpositional flap and full-thickness skin graft were performed on day 29. Case2: A 43-year-old male accidentally sustained a high pressure injection of oil into his dorsal hand. He presented to our hospital the next day, and W&D were performed. W&D were performed again two days after the first visit, and artificial dermis was applied over a part of the wound that was impossible to close. A decision was made to apply NPWT and a surgical glove for the purpose of reducing swelling and managing wound exudate. The swelling decreased and granulation tissue formed gradually, then nine days after the first visit a sural nerve graft was applied to bridge the defective area, and a full thickness skin graft was applied. We achieved good wound closure and hand function recovery after using NPWT and a surgical glove.

The purpose of this study was to assess the effect of timing (Early (E) group vs Delayed (D) group) of internal fixation for distal radius fractures on forearm and wrist function in patients who underwent the surgery. The subjects were one hundred six patients who had extra-articular fractures of the dorsally displaced distal radius and were treated with a volar locking plate. The subjects were divided into two groups: E group (Operation on the day of injury or the next day, n = 76 ; and the D group (Operation at 7 days after injury or later, n = 30). Follow-up examinations conducted at 4, 12, and 48 weeks after surgery included measurements of wrist and forearm ranges of motion (ROM), measurement of grip strength (GS), Disability of the Arm, Shoulder and Hand score (DASH), and complications, retrospectively. The patients in both groups improved significantly with respect to ROM, GS, and DASH. At 4 weeks, the patients in the E group had better forearm motion, At 4 and 12 weeks, those who had undergone early surgery had significantly better wrist motion, GS and DASH. At 48 weeks, there were no differences between the groups in ROM, GS, or DASH. Patients with dorsally displaced extra-articular fractures of the distal radius can expect to have better short-term outcomes with early treatment, open reduction and internal fixation using a volar locking plates.

Summary Combined treatment with alendronate and eldecalcitol was found to be more effective in reducing the bone turnover markers and increasing bone mineral density than alendronate treatment with vitamin D3 and calcium supplementation in the osteoporotic patients. Introduction We compared the clinical efficacy and safety of combined treatment with alendronate plus eldecalcitol (ALN + ELD) with those of treatment with ALN plus vitamin D and calcium (ALN + VitD). Methods Osteoporotic 219 patients were randomly assigned to the ALN + ELD, or the ALN + VitD group. Primary endpoint was the inter-group differences in lumbar spine BMD (L-BMD) at patient’s last visit. Secondary endpoints included the differences in BMD at other sites and the bone turnover marker (BTM) levels. Results L-BMD, total hip BMD and femoral neck (FN-BMD) increased from baseline by 7.30, 2.41, and 2.70 % in the ALN + ELD group, and by 6.52, 2.27, and 1.18 % in the ALN + VitD group, respectively. Inter-group differences of the L-BMD and total hip BMD values were not significant. The increase of the FN-BMD was larger in the ALN + ELD group than the ALN + VitD group. Reductions of the BTMs were greater in the ALN + ELD group than the ALN + VitD group. Interaction of the percent increase of the L-BMD with the baseline values of the BTMs was observed in the ALN + VitD group only. The increases of the FN-BMD in patients with lower baseline values of type-I-collagen C-telopeptide (sCTX) and serum 25(OH) D levels

Mechanical stress is essential for us to maintain bone volume and structure. Immobilization and unloading, such as motor paralysis, long-term bedrest and casting of fractured area, cause rapidly remarkable bone loss. The bone remodeling disorder following immobilization demonstrates the acceleration of bone resorption and the suppression of bone formation, and molecular mechanism of the bone remodeling disorder has been gradually revealed recently. It is very difficult for us to improve the bone loss due to disuse completely. Thus, prevention of disuse osteoporosis is important. We should choose suitable treatment after considering the pathophysiology of disuse osteoporosis, and attempt early intervention as soon as possible.

Background: Borderline developmental dysplasia of the hip (BDDH) is frequently diagnosed concurrently with cam impingement. While hip arthroscopy has advanced the treatment of hip joint pathology, including femoroacetabular impingement (FAI), arthroscopic treatment for FAI in the setting of BDDH remains a challenge amid a subset of patients. The risk factors of poor clinical results after hip arthroscopic labral preservation and FAI corrections in the setting of BDDH patients have not been well established. Hypothesis: Pre- and intraoperative findings can predict the poor clinical outcomes after hip arthroscopic surgery for FAI in the setting of BDDH. Study Design: Case control study; Level of evidence, 3. Methods: Of patients with BDDH (defined as lateral center edge [LCE] angle between 20° and 25°) who underwent arthroscopic procedures for FAI between 2009 and 2014, 45 met inclusion criteria (45 hips: 15 males and 30 females). Their mean age was 31.4 years (range, 12-65 years), and the mean LCE angle was 23.2°. Clinical and radiographic follow-up evaluations up to a minimum of 2 years after surgery were performed for all patients. Failure of the procedure was defined as conversion to subsequent surgery or having a Tönnis osteoarthritis grade of 2, and success was defined as patients who did not need subsequent surgery. Univariate analysis and Cox hazard proportional analysis were performed for both cohorts. Results: Of 45 patients, 11 (24%) had revision surgery (endoscopic shelf acetabuloplasty for 5 patients, total hip arthroplasty for 2, and revision hip arthroscopy for 2) or advanced to Tönnis grade ≥2 osteoarthritis and thus constituted the failure group. In the success group, modified Harris Hip Score (median, pre- vs postoperative: 72.1 vs 100, P< .001, Wilcoxon signed-rank test) and nonarthritic hip score (58.8 vs 98.8, P< .001) were significantly improved at the minimum 2-year follow-up. The median age of the failure group was significantly higher than that of the success group (47.0 vs 20.0, P< .001, Mann-Whitney Utest). Risk factors of poor clinical outcomes were identified as follows: age ≥42 years (hazard ratio [HR], 11.6; 95% CI, 2.5-53.9; P= .002, Cox hazard model), broken Shenton line (HR, 6.4; 95% CI, 1.9-22.3; P= .003), Tönnis angle ≥15° (HR, 3.9; 95% CI, 1.2-12.9; P= .03), vertical center anterior (VCA) angle ≤17° (HR, 5.0; 95% CI, 1.5-17.1; P= .01), Tönnis grade 1 at preoperative radiograph (HR, 3.6; 95% CI, 1.1-11.7; P= .04), severe cartilage delamination at acetabulum (HR, 11.8; 95% CI, 3.0-46.1; P< .001), and mild cartilage damage at femoral head (HR, 8.1; 95% CI, 2.1-30.8; P= .002). Conclusion: Preoperative predictors of poorer outcomes from hip arthroscopic labral preservation, capsular plication, and cam osteoplasty in the setting of BDDH are age ≥42 years old, broken Shenton line, osteoarthritis, Tönnis angle ≥15°, and VCA angle ≤17° on preoperative radiographs. Intraoperative predictors of poorer outcomes are severe acetabular chondral damage and even mild femoral chondral damage. Although the patients in the setting of BDDH may have good outcomes from isolated hip arthroscopy, caution is suggested for those with the aforementioned risk factors.

Shoulder arthroscopy is a promising tool for assessing and treating patients with a rotator cuff tear. Arthroscopic rotator cuff repair with suture anchor fixation such as the single-row, double-row, and suture bridge technique are popular procedures that can provide excellent clinical outcomes. On the other hand, longitudinal midsubstance, U-shape, or L-shape tears may benefit more from a side-to-side/margin convergence technique. Despite following the standard side-to-side/margin convergence technique, we continue to see disruption at the site of side-to-side suture margin even with strong sutures. Here, we show our preferred arthroscopic shoelace rotator cuff repair technique using the more durable body tape for a longitudinal U-shape rotator cuff tear.

There is a paucity of literature regarding the results of arthroscopic saucerization, with or without stabilization, for lateral discoid meniscus (LDM) in children, and differences in clinical outcomes between adults and children. The purpose of this study was to compare the clinical outcomes following arthroscopic treatment of symptomatic LDM in children versus adults. Secondly, outcomes of different surgical procedures (saucerization only and saucerization with repair or centralization) were also compared.Fifty-two consecutive patients with LDM were evaluated and divided into two groups. Group 1 had 16 patients (18 knees; nine males, seven females) aged13 years; Group 2 had 36 patients (38 knees; 19 males, 17 females) aged ≥13 years. All patients were arthroscopically treated with saucerization only, or saucerization with repair or centralization for LDM. They had a mean follow-up of 30 months (range 24-72). Clinical outcomes were compared preoperatively and at final follow-up (minimum two years) after surgery using patient-reported outcome scores, International Knee Documentation Committee (IKDC) scores, and Lysholm scores. Radiographic evaluation was also performed for degenerative changes using Kellgren-Lawrence classification.The IKDC scores at final follow-up in Group 1 demonstrated better clinical outcomes when compared with those in Group 2 (91.1 ± 9.49 vs. 73.7 ± 16.4, P = 0.001). No significant intergroup difference was noted at the follow-up for radiographic osteoarthritic grade according to Kellgren-Lawrence classification. Similarly, no differences were found at final follow-up between saucerization only and saucerization with repair or centralization. There were no significant differences in IKDC score of repair and centralization at final follow-up.Clinical outcomes in children aged13 years was significantly better than those aged ≥13 years. Arthroscopic saucerization only or saucerization with repair or centralization for discoid meniscus was effective in improving knee function and preventing early degenerative changes during short-term follow-up periods.

Background We hypothesized that ceramic bipolar shows less impingement between stem neck and outer head compared to metal bipolar, because of its low coefficient of friction with the acetabulum cartilage. In this paper, a three dimensional (3D) postoperative motion analysis has been used to assess the different motion characteristics of metal and ceramic bipolar hip hemiarthroplasty systems. Methods This study was conducted on 40 patients divided in two matched cohorts: 20 patients with metal bipolar and 20 patients with the ceramic bipolar. We obtained motion pictures from standing position to maximum abduction in flexion by fluoroscopy then analyzed by 2D-3D image matching method. The motion range of the "Outer head angle", "Stem neck angle" and the "Stem neck and outer head angle" was compared between the metal bipolar group and the ceramic bipolar group. Results The metal bipolar group's inner head's range of movement was greater than the ceramic bipolar group. Impingement between stem neck and outer head occurred in 30% of metal group patients. There were no impingement cases for the ceramic bipolar group. Conclusions The ceramic bipolar shows less impingement between stem neck and outer head compared to the metal bipolar. Ceramic bipolar may reduce the typical bipolar related complication and exert less effect on the acetabular cartilage due to less surface coefficient of friction.

OBJECTIVE To compare the clinical outcome of arthroscopic surgery for femoroacetabular impingement (FAI) between athlete and nonathlete patients. DESIGN Retrospective case-control study. Level of Evidence III. PATIENTS AND METHODS Seventy-four patients who underwent arthroscopic FAI correction from March 2009 to April 2012 were enrolled in this study. The patients were divided into 2 groups, according to their sports participation (47 in the athlete group and 27 in the nonathlete group). MAIN OUTCOME MEASURES We reviewed clinical and radiographic data for all patients, up to a minimum of 2 years after surgery. We used analysis of covariance to compare the mean patient reported outcome scores including modified Harris hip score (MHHS) and the nonarthritis hip score (NAHS) preoperatively, at 6, 12, and 24 months after surgery. RESULTS The mean age at the time of surgery in the athlete group was significantly lower than that in the nonathlete group. Although there was no significant difference in preoperative MHHS and NAHS, the mean NAHS at 6, 12, and 24 months postoperatively and the mean MHHS at 24 months postoperatively in athletes were significantly higher than that in nonathletes (P < 0.05). CONCLUSIONS Although arthroscopic FAI correction and labral preservation surgery is generally beneficial, it appears to provide a better clinical outcome in athletes than in nonathletes.

For the purpose of understanding the current conditions of the duties of industrial physicians and the consciousness of graduates of the University of Occupational and Environmental Health, Japan (UOEH) engaged in industry, we performed a questionnaire survey in July, 2001 and July, 2008 and reported the results (J UOEH 2009 31: 281-91). A similar survey was carried out in July, 2015. We dispatched the questionnaire to industrial physicians and physicians in occupational health organizations who had graduated from UOEH and got the replies. The investigation asked about their career, their activities, and how they thought about their duties. We compared the three years and got the following results: 1) The ratio of respondents who were satisfied with the salary or official post was 38.3, 48.1, 65.4% in each investigation, respectively. 2) The ratio of the respondents whose official post and rank would not be promoted in the future was 25.3, 28.4, 32.3%, respectively. 3) The ratio of respondents satisfied with the relationship with the superior and the industrial health staff was 70.8, 80.3, 86.1%, respectively. The investigation performed every seven years since July, 2001 showed that the ratio of the graduates of UOEH whose official post and rank would not be promoted in the future had gradually increased, while the ratio of graduates who were satisfied with the relationship with the superior and the industrial health staff had also gradually increased.

Treatment of osteoporosis with once-yearly zoledronic acid was approved in September 2016 in Japan. Like other bisphosphonates, zoledronic acid causes acute-phase responses (APRs), which are more severe in Asian populations than in multinational populations. The aim of this multicenter, randomized, open label, parallel group study is to investigate the incidence of APRs in Japanese patients with primary osteoporosis in real clinical settings, and to test the hypotheses that APRs are suppressed by administering one of the most commonly used nonsteroidal anti-inflammatory drugs in Japan, loxoprofen, immediately after the treatment with zoledronic acid, and the incidence of APRs in patients with prior history of treatment with bisphosphonate is lower than that in naive patients. A total of 400 patients aged 60 or older were randomly allocated to a zoledronic acid plus loxoprofen group or zoledronic acid group on a 1:1 basis. After the treatment, patients were observed for 7 days, during which patients will record APRs for the first 3 days, and body temperature and drugs taken for 7 days. Primary endpoints are incidence of APRs and increase in body temperature, and secondary endpoints are relationship between prior treatment for osteoporosis in the past 3 years versus incidence of APRs, and that versus a change in body temperature. Results supporting the hypotheses will indicate that APRs are manageable with loxoprofen, which patients likely already have, and the APRs will develop less frequently and be less severe in the following years, despite the high risk of APRs in Japanese patients.

Osteochondritis dissecans (OCD) of the femoral head is an unusual cause of hip pain. It can be associated with other intra-articular pathologies including: acetabular labral tears or bone deformities such as Legg-Calve-Perthes Disease (LCPD). In this article, we propose a modern surgical technique using an arthroscopic antegrade and retrograde osteochondral autologous transplantation (OAT) procedure for assessing and treating OCD lesions of the femoral head.

Background Compartment syndrome (CS) of the lower leg in need of a fasciotomy for quick decompression and closure of the wound remains an issue. We report positive outcomes from combining two methods, the shoelace technique and negative pressure wound therapy (NPWT) together, to address this problem. Patients and methods Five patients were diagnosed with the lower leg CS and underwent surgery. The wounds were treated by combining the shoelace technique and V.A.C. ® Therapy, and the wounds’ shoelaces were gradually tightened. Results Eight emergency fasciotomies were performed in five patients with CS. The mean time to wound closure by suturing was 16.2 days and additional skin grafting was performed in only one case. Conclusion The use of this combination of treatments may prevent the need to use a skin graft, which has problems providing pleasing aesthetic results.

Intra-articular distal radial fractures with partial bone loss at the wrist were reconstructed using osteochondral grafts in 2 patients who were followed up for at least 18 months. Both patients experienced posttraumatic arthrosis of the wrist joint. The materials of the intra-articular fixation were bioabsorbable plates and screws. Reconstruction of a partially destroyed articular surface using a costal osteochondral graft is reliable and allows filling and resurfacing an articular cartilage void.

Enhancement of bone resorption and suppression of bone formation in response to reduced mechanical stress cause rapid bone loss. pharmacotherapy for immobilization osteoporosis in motor paralysis and long-term bedrest is effective therapy. Early intervention for rapid bone loss is important for immobilization osteoporosis.

Oxytocin (OXT), which is a well-known neurohypophysial hormone that is synthesized in the paraventricular (PVN) and supraoptic nuclei (SON) of the hypothalamus, is secreted from the posterior pituitary (PP) into the systemic circulation, where it plays an essential role in reproduction, especially during and after childbirth. Many recent studies have shown that OXT contributes to the modulation of several functions, such as social recognition, trust building, anti-nociception, anti-inflammation, stress relief and suppression of feeding. However, little is known about the neuronal networks responsible for OXT effects. Endogenious OXT has two regulations: the 1st regulation is humoral regulation, in which OXT is delivered to target organs from PP via the bloodstream; the 2nd regulation is nerve regulations, in which OXT from parvocellular neurosecretory neurons in the PVN directly project to the central nerve system (CNS). OXT binding sites, as well as OXT receptor expression, are located in various regions of the CNS, including the dorsal horn of spinal cord in rats, where it plays an important role in nociception. We examined the response to acute and chronic nociception/-inflammation in rat models using OXT-monomeric red fluorescent protein 1 (mRFP1) transgenic rats. We used formalin test as acute nociceptive/-inflammatory rat models and adjuvant arthritis as chronic nociceptive/-inflammatory rat models. We studied the effects of acute and chronic nociception/-inflammation on OXT-mRFP1 expression in the hypothalamus, posterior pituitary and spinal cord, and examined the role that OXT plays in acute and chronic nociceptive responses in rats. This review focuses on pain modulation and anti-inflammation by OXT according to previous clinical and animal research.

A number of studies on total hip arthroplasty have compared highly cross-linked polyethylene (HXLPE) with conventional polyethylene (CPE) liners beyond 10 years. However, the impact of HXLPE on the wear-related reoperation rate is unclear. The purpose of this study was to evaluate the clinical advantage of using a single manufacturer's HXLPE in terms of reducing the reoperation rate.The study was a follow-up retrospective cohort study over a mean of 12 years that examined patients aged 45-70 years with cementless total hip arthroplasty using a 26-mm-diameter cobalt-chromium head. Sixty-seven patients (79 hips; HXLPE group = 41 hips, CPE group = 38 hips) were evaluated for a minimum 10-year follow-up. Kaplan-Meier survival analysis was performed, with wear-related reoperations and radiographic osteolysis serving as the end points. The polyethylene wear rate was also assessed.The mean 12-year follow-up rates of survivorship that were evaluated using wear-related reoperations as the end point were 100% and 91.4% in the HXLPE and CPE groups, respectively (P = .007), and the mean 12-year follow-up rates of survivorship with osteolysis as the end point were 100% and 36.2%, respectively (P.001). Compared with the CPE group, the HXLPE group presented a significantly reduced wear rate (HXLPE group, 0.035 mm/y; CPE group, 0.118 mm/y).A unique strength of this study is that we assessed a single manufacturer's HXLPE while keeping most other implant parameters uniform. This study reveals the clinical advantage of using a single manufacturer's HXLPE in terms of a reduced wear-related reoperation rate at a mean 12-year follow-up.

The original version of this article, published on 03 September 2018, unfortunately contained a mistake.

To correlate median nerve T2 signal and shape at the carpal tunnel with steroid injection (SI) response in carpal tunnel syndrome (CTS) patients. One hundred and sixty-three CTS wrists of 92 consecutive patients who were scheduled to undergo SI were prospectively evaluated with 3-T magnetic resonance imaging (MRI) and a nerve conduction study. All patients underwent axial high-resolution T2-weighted MRI (in-plane resolution of 0.25 × 0.25 mm). The CTS wrists were classified into three groups according to the nerve T2 signal and the flattening ratio at the hook of hamate level: group 1, high and oval; group 2, high and flat; group 3, low and flat. Clinical response to SI was evaluated at 6 months after injection. One hundred and thirteen of the 163 wrists (69.3 %) responded well to SI. The percentage of improvement was 81.7 % (49/60) in group 1, 69.9 % (51/73) in group 2, and 43.3 % (13/30) in group 3 (P

Introduction Aldehyde dehydrogenase 2 (ALDH2) degrades acetaldehyde produced by the metabolism of alcohol. The inactive ALDH2 phenotype is prevalent in East Asians, and an association between this ALDH2 polymorphism and osteoporosis has been reported. In our previous study, we found that alcohol consumption results in decreased trabecular bone volume in aldh2 knockout (aldh2−/−) mice compared with the volume in wild-type (aldh2+/+) mice. However, the effect of aldh2 gene on the skeletal phenotype in the absence of alcohol consumption remains unknown. The aim of this study was to clarify the effect of aldh2 disruption on femoral bone structure and dynamics in aldh2-disrupted mice in the absence of alcohol consumption. Materials and methods We examined aldh2−/− and aldh2+/+ mice at the ages of 4, 8 and 12 weeks. The femoral bone length and bone mineral density (BMD) were measured using peripheral quantitative computed tomography. The mechanical strength was assessed by the three-point bending test at 12 weeks, and cortical bone histomorphometry at the femur diaphysis was performed at all three time points. Osteogenic activities in aldh2−/− and aldh2+/+ mice were assessed by osteoblast culture from calvariae of the neonatal mice. Bilateral femoral and tibial bones containing no bone marrow cells of 8-week-old mice were used for analysis of mRNA expression. In addition, mRNA expression in aldh2−/− and aldh2+/+ mice after tail suspension or climbing exercise for 7 days from 8 weeks was analyzed to clarify the response to mechanical loading. Results At 12 weeks, there were no significant differences in femoral bone length, trabecular BMD in the distal metaphyses of the femurs, or mechanical strength between aldh2−/− and aldh2+/ + mice, whereas cortical BMD and cortical thickness were significantly increased and cross-sectional area and bone marrow area were significantly decreased in the femoral diaphysis of aldh2−/− mice relative to the corresponding values in aldh2+/+ mice. At 8 weeks, bone formation rate and mineral apposition rate on the periosteal and endocortical surfaces were significantly increased in aldh2−/− mice relative to the rates in aldh+/+ mice. Calvarial osteoblast culture study revealed that the percentage of alkaline phosphatase stained cells was significantly higher in aldh2−/− mice compared to that in aldh+/+ mice. Quantitative real-time RT-PCR revealed a significant increase in the expressions of bmp2, osterix, runx2, and col1a1 mRNA in aldh2−/− mice, along with an increase in the expression of wnt5a mRNA and the lrp5/sost mRNA ratio. The mRNA expressions of bmp2, osterix, runx2 and pthr in aldh2−/− mice were significantly decreased after climbing exercise compared to those in the control, although the mRNA expressions of bmp2, osterix, runx2 were not significantly decreased and pthr mRNA expression was increased in aldh+/+ mice after climbing exercise. Conclusion Our results show that disruption of aldh2 gene resulted in altered cortical bone structure and dynamics in mice. Cross-sectional area was decreased. Cortical BMD was increased owing to the promotion of cortical bone formation on the periosteal and endocortical surfaces of the femoral diaphysis. The possible mechanisms underlying altered cortical bone structure in aldh2−/− mice were gene-related higher osteogenic activity of osteoblasts and weakened osteogenice response to mechanical loading in growth period.

Background: Recent studies report a relatively high failure rate for tendon-bone healing after rotator cuff repair. Several studies have investigated biologically augmented rotator cuff repair; however, none has shown the application of synovial mesenchymal stem cells for such repair. Purpose: To demonstrate whether cells derived from shoulder tissues have mesenchymal stem cell properties and to identify which tissue is the best source of the mesenchymal stem cells. Study Design: Controlled laboratory study. Methods: Forty-two patients with a diagnosed rotator cuff tear preoperatively were enrolled in this study. Human mesenchymal tissues were obtained during arthroscopic surgery for rotator cuff tears from 19 donors who met the inclusion criteria and had investigable amounts of tissue. Colony-forming units, yield obtained, expandability, differentiation potential, epitope profile, and gene expression were compared among the cells from 4 shoulder tissues: synovium of the glenohumeral joint, subacromial bursa, margin of the ruptured supraspinatus tendon, and residual tendon stump on the greater tuberosity (enthesis). Results: The number of live passage 0 cells from whole tissue was significantly higher in cells derived from the subacromial bursa ( P < .05). Subacromial bursa–derived cells retained their expandability even at passage 10. In adipogenesis experiments, the frequency of Oil Red O–positive colonies was significantly higher for synovium- and subacromial bursa–derived cells than for tendon- and enthesis-derived cells ( P < .0001). In studies of osteogenesis, the rate of von Kossa– and alkaline phosphatase–positive colonies was highest in subacromial bursa–derived cells ( P < .0001). The chondrogenic potential was highest in cells derived from the enthesis. For epitope profiling, 11 surface antigens were measured, and most had similar epitope profiles, irrespective of cell source. Conclusion: The findings indicate that the subacromial bursa is a good candidate for the source of mesenchymal stem cells in rotator cuff tears. Clinical Relevance: Synovial cells from the subacromial bursa in patients with rotator cuff tears are a superior cell source in vitro, suggesting that mesenchymal stem cells from this tissue could be good candidates for biological augmentation of rotator cuff repair.

Currently, volar locking plates are commonly used to treat distal radius fractures (DRF) because of their stable biomechanical construct and because they cause less soft tissue disturbance and allow early mobilisation of the wrist. Complications such as rupture of tendons have been reported to occur with use of volar locking plates. We describe six cases of rupture of extensor pollicis longus (EPL) tendons after the use of volar locking plates. EPL tendon injuries occurred in 2.1% (6/286) of cases after DRF surgery. The causes of EPL rupture after DRF surgery were protrusion of the head tip and insufficient reduction of the dorsal roof fragment of the distal radius. These were considered iatrogenic problems. The cause of EPL rupture was unknown in three cases. We should be extremely careful when determining optimum screw length and reducing displaced dorsal roof fragments to prevent damaging the EPL tendons.

An increase in the arthritis index as a marker of chronic inflammation and suppression of food intake are observed in adjuvant arthritic (AA) rats. Our previous study demonstrated that central oxytocin (OXT)-ergic pathways were activated potently in AA rats. In the present study, OXT-saporin (SAP) cytotoxin, which chemically disrupts OXT signaling was administered centrally to determine whether central OXT may be involved in the developments of chronic inflammation and alteration of feeding/drinking behavior in AA rats. The arthritis index was significantly enhanced in AA rats pretreated with OXT-SAP administered intrathecally (i.t.) but not intracerebroventricularly (i.c.v.). Suppression of food intake was significantly attenuated transiently in AA rats pretreated with OXT-SAP administered i.c.v. but not i.t. Suppression of drinking behavior was not affected by i.t. or i.c.v. administration of OXT-SAP in AA rats. In addition, intraperitoneal administration of an OXT receptor antagonist did not change the arthritis index or feeding/drinking behavior in AA rats. These results suggest that central OXT-ergic pathways may be involved in anti-inflammation at the spinal level and suppression of feeding behavior at the forebrain-brainstem level in AA rats.

Background Cross-linked polyethylene (XLPE) acetabular liners used in cementless total hip arthroplasty (THA) have demonstrated better wear resistance at 10 years compared with conventional polyethylene (CPE) liners. No clinical studies have compared XPLE to CPE liners beyond 10 years. Methods We performed a 15-year retrospective cohort study on cementless THA performed in patients with developmental hip dysplasia to measure the differences in polyethylene wear rates and the presence of osteolysis. Twenty-four THAs with XLPE and 17 THAs with CPE were evaluated. The mean age of patients was 55.9 years (41-68) in the XLPE group and 54.4 years (40-67) in the CPE group. The mean follow-up period was 15.1 years (13.9-16.1) in the XLPE group and 15.2 years (14.5-16.0) in the CPE group. Results The XLPE group had a significantly lower wear rate at 5 and 10 years compared with the CPE group; however, no significant difference was found at 15 years (XLPE group, 0.040 mm/y; CPE group, 0.034 mm/y). In addition, the incidence of osteolysis did not differ significantly between the groups. However, the incidence of excessive wear between 10 and 15 years after surgery in the XLPE group was significantly higher than that in the CPE group. Conclusion XLPE demonstrated no advantage in the wear rate or the incidence of osteolysis at 15 years, despite having superior wear resistance up to 10 years. It is concerning that the incidence of excessive wear was higher in the XLPE group between 10 and 15 years, and this finding should alert the arthroplasty community to this possible problem with the more highly cross-linked polyethylene.

Background: The use of bioabsorbable implants to negate the need for subsequent removal could offer major clinical advantages for the fixation of fractures. The aims of this study were to compare the mechanical properties of novel bioabsorbable plates with those of titanium plates in a fracture model and to demonstrate the clinical results of the use of these new plates for metacarpal fractures. Methods: The first set of experiments compared the mechanical properties of bioabsorbable and titanium plates. Two types of bioabsorbable plates (one-third tubular and semi-tubular in cross-section) made of hydroxyapatite/poly-L-lactide and two types of titanium plates (for 1.5 and 2.0-mm screws) were tested. Each plate was fixed on a polyether ether ketone (PEEK) rod, which was transversely cut at its midsection. The second part of the study compared the clinical results associated with the bioabsorbable and titanium plates that were used in sixteen nonrandomized consecutive patients with metacarpal fractures. Results: The bending strength and stiffness of one-third tubular bioabsorbable plate constructs were comparable with those of titanium plates for 1.5-mm screws, and those of one-half tubular bioabsorbable plates were comparable with those of titanium plates for 2.0-mm screws. The mean torsional strength (and standard deviation) of the semi-tubular bioabsorbable plates (79.0 ± 7.9 N·cm) was significantly greater than that of titanium plates for 2.0 mm screws (56.7 ± 4.0 N·cm) (p < 0.05). There were no significant differences in six-month postoperative clinical results between patients who received bioabsorbable plates and those who received titanium plates (total range of active motion, 267.0° ± 6.0° compared with 250.0° ± 28.3°; grip strength, 92.7% ± 19.7% compared with 86.4% ± 28.6% of that on the contralateral side). Conclusions: The bending strength, stiffness, and torsional strength of novel one-third or semi-tubular bioabsorbable plates, when fixed on a PEEK rod, were comparable with those for titanium plates for 1.5 or 2.0-mm screws. There were no significant differences in clinical results between these two types of plates in a small group of patients after short-term follow-up.

The purpose of this study was to evaluate the treatment results, with and without internal fixation of ulnar styloid base fractures associated with acute distal radius fractures. A total of 48 patients were enrolled, including 20 patients treated by internal fixation (fixation group) and 28 treated without internal fixation (non-fixation group). The evaluated parameters were postoperative range of motion, grip strength, DASH score, and the presence or absence of ulnar wrist pain over time. The outcome was assessed as "excellent" in 15 patients of the fixation group and 21 patients of the non-fixation group, and "good" in five patients of the fixation group and seven patients of the non-fixation group. There were no significant differences in the clinical outcomes or any of the parameters at the final evaluation between the two groups. However, the grip strength was significantly better in the non-fixation group than in the fixation group until 12 weeks postoperatively. The overall clinical outcome was good in both groups, with no significant difference between the groups.

We gathered seven specialists from various fields who are interested in worker injury prevention programs, based on cases of patients who had suffered refractory injuries requiring hand surgery because of industrial accidents. The patients were asked to write their thoughts and ideas on the theme, "Measures that must be implemented to prevent arm injuries." The content obtained was classified into different categories, using the KJ method, and was scripted to sort out the items. As a result, the following eleven points were identified as measures to prevent serious hand surgery-related injuries: 1. Purchase safe machinery, 2. Create a list of machines that require caution, 3. Enclose a machine's various rotating parts, 4. Carry out periodic maintenance work on the machines, 5. Indicate dangerous areas by putting up signs that attract attention, 6. Illuminate the rotating parts more brightly and avoid placing objects around them, 7. Systematically carry out safety education that creates a strong impact, 8. Encourage workers to look after their own health, 9. Announce policies on health and safety, 10. Re-examine the operational procedures, and 11. Be prepared in case an accident occurs. A perspective based on the results of this research is deemed important in creating a workplace improvement manual in the future.

The purpose of this study was to compare the postoperative radiologic and clinical outcomes of conventional plate osteosynthesis (C) with minimally invasive plate osteosynthesis (M) using a transverse skin incision without cutting the pronator quadratus muscle for distal radius fractures.Retrospective consecutive cohort with prospective data collection.One community teaching hospital. Surgical treatment was performed by a single surgeon.Sixty-six patients (C group, 36; M group, 30) underwent open reduction and internal fixation of dorsally displaced distal radius fractures with the volar locking plating system from June 2006 to August 2008. Their mean age was 63.5 years and the mean follow-up period was 22.7 months.Radiologic parameters (volar tilt, radial inclination, ulnar variance), range of motion, grip strength, and Disability of the Arm, Shoulder, and Hand score were evaluated at each examination. The visual analog scale of wrist pain and evaluations of cosmetic problems were assessed at the final follow-up.The groups did not differ significantly in all main outcomes. In the M group, the mean values of the Disability of the Arm, Shoulder, and Hand score at 2 weeks postoperatively (P = 0.06) and visual analog scale (P = 0.07) were lower and the mean value of the patient's satisfaction score of cosmetic problems (P = 0.08) was higher than those in the C group, but no statistically significant differences were apparent in these values.No significant differences were found between the minimally invasive plate osteosynthesis and conventional plating for distal radius fractures based on the data from postoperative radiologic and clinical outcomes.

Introduction High consumption of alcohol is one of the risk factors for osteoporosis. Approximately 45% of Chinese and Japanese individuals have the inactive aldehyde dehydrogenase 2 (Aldh2) phenotype. The absence of the ALDH2*2 allele is found to adversely influence the risk of osteoporosis. The aim of this study is to clarify the effects of alcohol consumption on osteoblast differentiation in bone marrow and trabecular bone formation in Aldh2-disrupted mice. Materials and methods Seven-week-old male Aldh2 knockout mice (Aldh2−/−) and wild-type (Aldh2+/+) mice were fed with water (groups Aldh2−/−/Wa and Aldh2+/+/Wa) or with 5% ethanol (groups Aldh2−/−/Al and Aldh2+/+/Al) for 4 weeks. At the age of 12 weeks, bone histomorphometry was performed at the secondary spongiosa of the tibias. Bone marrow cells from the bilateral femurs and tibias were used for mRNA expression analysis. Results Histomorphometrical study revealed that trabecular bone was significantly reduced in the Aldh2−/−/Al group compared with that in the Aldh2−/−/Wa and Aldh2+/+/Wa groups. Bone formation rate was significantly decreased in Aldh2−/−/Al compared with the other three groups. Quantitative RT-PCR revealed a significant decrease in type I collagen, osterix, osteopontin, and osteocalcin mRNA expressions in Aldh2−/−/Al compared with Aldh2−/−/Wa. In bone marrow cell cultures, mineralized nodule formation in Aldh2−/−/Al was significantly decreased compared with that in Aldh2+/+/Wa and Aldh2−/−/Wa, while PAK18, a p21-activated kinase inhibitor, recovered the decreased mineralized nodule formation in Aldh2−/−/Al. Conclusion Alcohol consumption suppressed the differentiation and mineralization of osteoblasts and then reduced trabecular bone formation and bone volume in association with the elevated p21 expression in bone marrow cells, especially in aldehyde dehydrogenase 2-disrupted mice.

Beyond the recent advances of intra-articular hip arthroscopy, this review article introduces endoscopic assisted osteotomies including periacetabular osteotomy and shelf acetabuloplasty, management for snapping hip and nerve entrapment in the deep gluteal space using innovative strategies.

Alcohol consumption is known to have opposing effects on carcinogenesis: promotion and prevention. In this study, we examined the effects of 12% ethanol on oxidative DNA damage accumulation and its repair in mouse livers treated with 3'-methyl-4-dimethylaminoazobenzene (3'-MeDAB), a well-known hepatic carcinogen. We previously reported that 3'-MeDAB increased 8-hydroxyguanine (8-OH-Gua) accumulation and its repair activity, accompanied by the fragmentation of 8-oxoguanine DNA glycosylase 1 (OGG1), the main repair enzyme of 8-OH-Gua. The present results showed that 12% ethanol intake attenuated the 8-OH-Gua accumulation, but not the fragmentation of OGG1 induced by 3'-MeDAB. Additionally, no significant changes in oxidative status, as monitored by lipid peroxidation (LPO), were observed among the 3'-MeDAB-treated mouse livers with/without alcohol administration. These findings suggested that 12% ethanol consumption may reduce the risk of 3'-MeDAB-induced carcinogenesis by decreasing 8-OH-Gua accumulation.

The aim of this study was to test the effect of unipedal standing exercise on bone mineral density (BMD) of the hip in postmenopausal women. Japanese postmenopausal women (n = 94) were assigned at random to an exercise or control group (no exercise). The 6-month exercise program consisted of standing on a single foot for 1 min per leg 3 times per day. BMD of the hip was measured by dual-energy X-ray absorptiometry. There was no significant difference in age and baseline hip BMD between the exercise group (n = 49) and control group (n = 45). Exercise did not improve hip BMD compared with the control group. Stepwise regression analysis identified old age as a significant determinant (p = 0.034) of increased hip total BMD at 6 months after exercise. In 31 participants aged/=70 years, the exercise group (n = 20) showed significant increase in the values of hip BMD at the areas of total (p = 0.008), intertrochanteric (p = 0.023), and Ward's triangle (p = 0.032). The same parameters were decreased in the control group (n = 11). The percent changes in hip BMD of the exercise group were not significantly different from those of the control group either in the participants with low baseline hip total BMD (80% of the young adult mean) or high baseline hip total BMD (or =80% of the young adult mean). In conclusion, unipedal standing exercise for 6 months did not improve hip BMD in Japanese postmenopausal women. Effect of exercise on hip total BMD was age dependent. In participants agedor =70 years, the exercise significantly increased hip total BMD.

We hypothesized that the anabolic action of parathyroid hormone (PTH) with the anti-catabolic agents cathepsin K inhibitor and alendronate differs depending on the remodeling status in the bone. C57/BL/6J mice, 8 weeks of age, were subjected to ovariectomized (OVX) or sham surgery. At 6 weeks after surgery, the mice were treated with cathepsin K inhibitor, alendronate, or a vehicle (daily, for 8 weeks), with or without PTH (1-34) (5 times/week, for the last 4 weeks). We assessed the bone chemical markers of the serum and urine, bone mineral density (BMD), histomorphomery in the primary and secondary spongiosa of the proximal tibia after fluorescence labeling, primary cell culture, and mRNA expressions in bone marrow cells. Cathepsin K inhibitor and alendronate significantly increased the BMD and the bone volume of the primary and secondary spongiosa, with a reduction of the urinary C-telopeptide of type I collagen that was increased by OVX, respectively. Cathepsin K inhibitor augmented the anabolic action of PTH on the BMD and bone volume at both the primary and secondary spongiosa, while alendronate had the same effect on the BMD and bone volume only at the primary spongiosa. Cathepsin K inhibitor did not decrease serum osteocalcin with or without PTH, while alendronate did decrease it. Cathepsin K inhibitor did not decrease the values of osteoclast number or bone formation rate with or without PTH, while alendronate decreased those values and increased osteoclast apoptosis. The combination of PTH and cathepsin K inhibitor increased alkaline phosphatase-positive CFU-f formation and c-fos, osterix, and osteocalcin mRNA expressions of bone marrow cells as well as PTH alone, while the combination of PTH and alendronate decreased those values. This study demonstrated that alendronate enhances the anabolic action of PTH at the primary spongiosa, but blunts it in the remodeling trabecular bone, while cathepsin K inhibitor enhances the action at both sites in OVX mice. In conclusion, the anabolic action of intermittent PTH in combination with cathepsin K inhibitor or alendronate differs depending on the remodeling status of bone in OVX mice.

Bone mineral density (BMD) and physical performance of the lower extremities decrease with age. In community-dwelling Japanese women, unipedal standing time, timed up and go test, and age are associated with BMD while in women aged 70 years and over, unipedal standing time is associated with BMD.The aim of this study was to clarify whether unipedal standing time is significantly associated with BMD in community-dwelling women.The subjects were 90 community-dwelling Japanese women aged 54.7 years. BMD of the second metacarpal bone was measured by computed X-ray densitometry. We measured unipedal standing time as well as timed up and go test to assess physical performance of the lower extremities.Unipedal standing time decreased with increased age. Timed up and go test significantly correlated with age. Low BMD was significantly associated with old age, short unipedal standing time, and long timed up and go test. Stepwise regression analysis revealed that age, unipedal standing time, and timed up and go test were significant factors associated with BMD. In 21 participants aged 70 years and over, body weight and unipedal standing time, but not age, were significantly associated with BMD.BMD and physical performance of the lower extremities decrease with older age. Unipedal standing time, timed up and go test, and age are associated with BMD in community-dwelling Japanese women. In women aged 70 years and over, unipedal standing time is significantly associated with BMD.

We developed previously a mouse voluntary climbing exercise model as a physiological mechanical loading model and reported that climbing exercise increased bone formation, but its effect on adipogenesis is unknown. We assessed the effects of loading and PTH/PTHrP receptor (PTHR1) on bone marrow adipocyte differentiation in relation with osteoblast differentiation. 8-week-old C57BL/6J male mice were divided into ground control (GC) and climbing exercise (EX) group. Mice were housed in 100-cm towers and climbed up toward a bottle placed at the top of the cage to drink water. The values of bone volume and osteoblast number were significantly higher while those of marrow adipocyte volume and number were significantly lower in the 28dayEX group than 28dayGC group. The mRNA expression levels of adipocyte differentiation genes CCAAT/enhancer-binding proteins (C/EBP) beta and delta were lower in 4dayEX mice, while the adipocyte specific genes fatty acid binding protein (aP2) and phosphoenolpyruvate carboxykinase (PEPCK) expressions were lower in 7dayEX mice. In primary bone marrow cell cultures, the number of alkaline phosphatase-positive colony forming units-fibroblastic (ALP+ CFU-f) and Oil-red-O-positive cells were both increased in the 4dayEX group. Climbing exercise transiently increases both osteogenic and adipogenic potential in bone marrow stromal cells, and inhibits terminal adipocyte differentiation and promotes osteoblast differentiation. Immunoreactivity for the PTHR1 was intense on osteoblastic cell lineage in the endosteal tibial metaphysis. PTHR1 mRNA expression was increased in 4dayEX mice and PTHR1-positive cells were increased after 7 days in the experimental group. Ex vivo addition of PTHR1 antibody decreased and that of PTHrP(1-34) increased the number of ALP+ CFU-f in bone marrow cell cultures obtained at 4 days after the exercise, while the addition of PTHR1 antibody increased and PTHrP(1-34) decreased the number of Oil-red-O-positive cells. Our results indicate that climbing exercise enhanced osteoblast differentiation and inhibited terminal differentiation of adipocyte progenitors with high expression of PTHR1 in bone marrow cells.

Purpose To compare the clinical and radiological outcomes of intrafocal pinning (IFP) and volar locking plating (VLP) of dorsally angulated, unstable distal radius fractures in elderly patients. Methods The subjects were 62 consecutive patients over 60 years of age with dorsally angulated, unstable distal radius fractures treated with IFP or VLP. Bone mineral density (BMD) of the lumbar spine was measured by dual-energy x-ray absorptiometry at first examination. The range of motion and grip strength were measured at follow-up examinations, and ulnar variance (UV) was measured on radiographs at baseline and follow-up postoperative examinations. Results There were no notable differences in gender, age, follow-up period, baseline UV, BMD, and AO classification between IFP and VLP groups. There was no difference between the UV in VLP immediately after surgery and at the final follow-up examination; however, IFP showed a significant loss of reduction as measured by UV. In patients with UV more than 5 mm or BMD less than 70% of young adult mean (YAM) at first examination, UV increased again at the final follow-up examination in IFP, while surgically corrected UV was maintained in VLP, independent of the degree of baseline UV and BMD. VLP resulted in earlier recovery of postoperative range of motion and grip strength compared with IFP. The range of flexion and the grip strength value were significantly larger in VLP at final examination. Conclusions VLP, but not IFP, can maintain surgically corrected UV in distal radius fractures, independent of the degrees of initial UV and BMD. VLP enhances earlier recovery in range of motion and grip strength than IFP. Type of study/level of evidence Therapeutic II.