Search

A 70-year-old Japanese man with chronic kidney disease under treatment with oral prednisolone for organizing pneumonia developed pulmonary aspergilloma. The patient was started on micafungin (MCFG), with no addition of any other new drug. About 5 weeks later, aggravation of his normocytic anemia associated with a low reticulocyte count was observed. Bone marrow puncture and biopsy revealed intense hypoplasia of the erythroblasts. As there was no evidence of malignancy, human parvovirus B19 infection, autoimmune diseases or hemorrhage, the patient was diagnosed as having acquired pure red cell aplasia (PRCA). The anemia improved along with an increase of the reticulocyte count to the normal level within 12 weeks of discontinuation of the MCFG therapy. The patient showed no evidence subsequently of any recurrence of the normocytic normochromic anemia or relapse of the PRCA. This is the first reported case of PRCA associated with MCFG.

Objective: Early studies have indicated that body fat shifts from peripheral stores to central stores with aging. The objective of this study was to investigate age-related changes in abdominal fat distribution of Japanese men and women of the general population over a wide range of body mass indices (BMI)., Methods: A total of 2,220 non-diabetic, apparently healthy Japanese adults (1,240 men and 980 women; age range 40-69 years) were included in the study sample. All subjects underwent a CT scan at the level of the umbilicus, and the areas of visceral adipose tissue (AT) and subcutaneous AT were quantified., Results: When the subjects were stratified by BMI into 18.5-23.0 kg/m(2), 23.0-27.5 kg/m(2), and 27.5 kg/m(2) or higher, visceral AT was positively correlated with age in all of the BMI strata in both genders (p<0.01). In contrast, subcutaneous AT was negatively correlated with age in men with BMIs in excess of 23.0 kg/m(2) (p<0.01) and not at all in women. The mean levels of subcutaneous AT were over 2-fold greater than visceral AT in women aged 60-69 years in any BMI stratum., Conclusion: In Japanese men and women, visceral AT was increased with age in all BMI strata in both genders, whereas subcutaneous AT was decreased with age in men with BMIs in excess of 23.0 kg/m(2) and not at all in women. Even with these age-related changes in abdominal fat distribution, women retained the subcutaneous-dominant type of fat distribution up to 70 years.

Combined pegylated interferon (PEG-IFN)+ribavirin (RBV) therapy has been used as a primary treatment for chronic hepatitis C. However, IFN-induced autoimmune disease, including type 1 diabetes mellitus, has been highlighted as one of the problems with this therapy. Here we report the case of a patient who developed type 1 diabetes mellitus during combined PEG-IFN+RBV therapy for hepatitis C but who showed no exacerbation of diabetes despite continued use of IFN. A 63-year-old man with chronic hepatitis C and a nonresponder to previous IFNα treatments, was admitted to our hospital because of excessive thirst, polydipsia, and polyuria 24 weeks after the start of PEG-IFNα+RBV therapy. High levels of blood glucose and glycosylated hemoglobin and low levels of C-peptide and immunoreactive insulin were observed. The serum antiglutamic acid decarboxylase antibody titer was 27,700 U/mL. We diagnosed IFN-induced type 1 diabetes mellitus; however PEG-IFNα+RBV therapy was continued for 48 weeks. Serum HCV remains negative five years after this treatment. Intensive insulin therapy was started immediately after the diagnosis of type 1 diabetes. Although the patient initially required 22 U/day of insulin, the dosage could be gradually reduced after completion of PEG-IFNα+RBV therapy and blood glucose remained well controlled. Prediction of onset of type 1 diabetes mellitus on the basis of baseline measurement of pancreas-associated autoantibodies is difficult. Therefore, it would be advisable to consider the possibility of onset of type 1 diabetes mellitus in all patients receiving IFN+RBV therapy.

Objectives: The purpose of this study was to gain insight into the effect of plate location and screw type for fixation of extra-articular distal radius fractures with dorsal comminution (Orthopaedic Trauma Association Type 23-A3.2)., Methods: Sixteen pairs of cadaver radii were randomized to four plating configurations: dorsal locking, dorsal nonlocking, volar locking, and volar nonlocking. A standard 1-cm dorsal wedge osteotomy was used. Cyclic axial loads were applied for 5000 cycles. Stiffness and fragment displacement were recorded at 500 cycle-intervals. Pre- and postcyclic loading radiographs were analyzed. An axial load to failure test followed and construct stiffness and failure strength recorded. Biomechanical data were analyzed using a two-way analysis of variance (P < 0.05). Failure modes were descriptively interpreted., Results: Cyclic testing data revealed no difference between constructs at any interval. Within all construct groups, displacement that occurred did so within the first 500 cycles of testing. Pre- and postcyclic loading radiographic analysis showed no differences in construct deformation. Load to failure testing revealed no differences between groups, whereas volar constructs approached significance (P = 0.08) for increased failure strength. Dorsal constructs failed primarily by fragment subsidence and fragmentation, whereas volar constructs failed by plate bending., Conclusions: No difference in all measured biomechanical parameters supports equivalence between constructs and surgeon discretion in determining operative method. Minimal fragment displacement and construct deformation during physiological testing support previous data that early postoperative motion can be recommended. Fragment displacement that occurs does so in the early periods of motion.

Preoperative massive subcutaneous emphysema before intubation is extremely rare. However, this complication may be potentially lethal, depend on the condition of air spreading. Subcutaneous emphysema which occurs intra- or postoperative period is sometimes iatrogenic because the air is introduced into the tissue space through the hole injured by the operation. But the emphysema in this case occurred preoperatively by the pressure of the bag valve mask, because the patient had an intra-oral wound, which reaches the submental space. In this report, we describe an extremely rare case of preoperative massive emphysema of the patient with the mandibular fracture.

We investigated the relative impacts of visceral adiposity and insulin resistance on the metabolic risk profile in middle-aged Japanese men. A cross-sectional study was conducted in 636 nondiabetic Japanese men with a mean age of 51.6 years. Visceral adipose tissue (AT) was assessed using computed tomography, and insulin resistance was determined by the homeostasis model assessment of insulin resistance (HOMA-IR). Metabolic risk factors were diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III metabolic syndrome criteria: (1) hypertriglyceridemia, (2) low high-density lipoprotein cholesterol, (3) hypertension, (4) impaired fasting glucose, and (5) impaired glucose tolerance. Visceral AT and HOMA-IR were significantly and positively correlated with each other (r = 0.41, P < .001). Using the 75th percentile value as a cut point, those with isolated large visceral AT showed significantly greater odds ratios for each of the 5 risk factors measured except impaired fasting glucose, whereas those with isolated high HOMA-IR showed significantly greater odds ratios for each of the 5 risk factors except hypertriglyceridemia and impaired glucose tolerance, compared with the control group. The combined group (increased visceral AT and HOMA-IR) had the highest odds ratios for all studied risk factors. On logistic regression analysis using visceral AT and HOMA-IR as continuous independent variables, they were each independently associated with most of the metabolic risk factors and their clustering. In conclusion, neither visceral AT nor HOMA-IR stands out as the sole driving force of the risk profile; each makes a significant contribution to metabolic abnormalities in Japanese men.

Regional fat distribution rather than overall fat volume has been considered to be important to understanding the link between obesity and metabolic disorders. We aimed to evaluate the independent associations of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with metabolic risk factors in apparently healthy middle-aged Japanese. Participants were 1,119 men and 854 women aged 38-60 years who were not taking medications for diabetes, hypertension, or dyslipidemia. VAT and SAT were measured by use of computed tomography (CT) scanning. VAT and SAT were significantly and positively correlated with each other in men (r = 0.531, P < 0.001) and women (r = 0.589, P < 0.001). In multiple regression analyses, either measure of abdominal adiposity (VAT or SAT) was positively associated with blood pressure, fasting plasma glucose, and log triglyceride (P < 0.001) and inversely with high-density lipoprotein (HDL)-cholesterol (P < 0.001). When VAT and SAT were simultaneously included in the model, the association of VAT with triglycerides was maintained (P < 0.001) but that of SAT was lost. The same was true for HDL-cholesterol in women. For fasting plasma glucose, the association with VAT was strong (P < 0.001) and the borderline association with SAT was maintained (P = 0.060 in men and P = 0.020 in women). Both VAT and SAT were independently associated with blood pressure (P < 0.001). Further adjustment for anthropometric indices resulted in the independent association only with VAT for all risk factors. In conclusion, impacts of VAT and SAT differed among risk factors. VAT showed dominant impacts on triglyceride concentrations in both genders and on HDL-cholesterol in women, while SAT also had an independent association with blood pressure.

Objective: High-normal, the intermediate category between normal fasting glucose (NFG) and impaired fasting glucose (IFG), was introduced in the criteria of the disordered glucose metabolism in 2008. The aim of this study was to investigate the risk for future incidence of type 2 diabetes of the subjects with high-normal and to examine how other metabolic variables could be useful for their risk stratification., Methods: A historical cohort study was conducted from 2001 to 2008, inclusive, in 4,165 non-diabetic employees at public schools (2,229 men and 1,936 women; age 45.8+/-5.9 years, range 25-55 years). They were classified at baseline as NFG with fasting plasma glucose (FPG)<100 mg/dL, high-normal with FPG 100-109 mg/dL, and IFG with FPG 110-125 mg/dL. The incidence of type 2 diabetes (defined either by FPG > or = 126 mg/dL or by receiving treatments) was measured., Results: The cumulative incidence during a mean follow-up of 5.1 years were 16/3,364 (0.5%), 40/613 (6.5%), and 53/188 (28.2%) in subjects with NFG, high-normal, and IFG, respectively. Multivariate-adjusted odds ratios for the incidence were still significant both in high-normal and IFG compared to NFG. Body mass index (BMI) and alanine aminotransaminase (ALT) were associated with the incidence of type 2 diabetes independently of FPG categories (p<0.05)., Conclusion: The future incidence of type 2 diabetes in subjects with high-normal was significantly higher than in those with NFG in this population. BMI and ALT can improve risk stratification in high-normal subjects.

Aim: Postprandial hypertriglyceridemia is recognized as an independent risk factor for cardiovascular disease. The aim of this study was to identify differences between fasting and postprandial TG levels, focusing on the influence of waist circumference., Methods: Subjects included 1,505 men and 798 women aged 3865 years who were not taking medications for diabetes or dyslipidemia. Fasting TG levels were measured after an overnight fast, and postprandial TG levels were measured 2 hours after a standardized rice-based lunch (total 740 kcal, 20 g fat, 30 g protein, and 110 g carbohydrates) in the afternoon on the same day., Results: Fasting and postprandial TG levels were highly correlated in both men (r=0.86, p<0.001) and women (r=0.84, p<0.001). Waist circumference was positively correlated with fasting TG (r=0.38 in men and r=0.36 in women) and postprandial TG (r=0.42 in men and r=0.45 in women), respectively. On multiple regression analyses, the association of waist circumference with postprandial TG was still significant (standardized beta=0.10 in men and standardized beta=0.15 in women, p<0.001) after the inclusion of HbA1c, age, high-density-lipoprotein (HDL)-cholesterol, alcohol consumption, and fasting TG in the regression model., Conclusion: Postprandial TG has a better relation with waist circumference than fasting TG.

One of the important roles of pharmacists as members of a nutrition support team is nutritional prescription support. We developed a nutritional prescription support system (NPSS) that facilitates prescription support and analysis and evaluated its usefulness in nutritional therapy. An NPSS for prescription support and the management of patient information was created. With this NPSS, the nutritional status was assessed, and, on the basis of the results, such variables as the total energy expenditure were calculated. This system allows prescription support for parenteral nutrition (PN) therapy, enteral nutrition (EN) therapy, and the transition period between them. This system was used for 2 representative patients and evaluated. In a malnourished patient receiving oral warfarin, EN solutions were compared by means of the NPSS, and an appropriate EN solution was selected. In addition, the prothrombin time-international normalized ratio was monitored, and favorable results were obtained regarding the adjustment of the warfarin dose and nutritional management. In a patient with aspiration pneumonia, continuous nutritional management to EN from PN therapy was straightforwardly performed with the NPSS. This NPSS allows rapid, comprehensive nutritional management during the transition period to EN from PN therapy, despite these therapies being considered separately in conventional nutritional management. The NPSS is useful for simplifying prescription support and facilitating information sharing among members of a nutrition support team.

Beta-galactoside alpha2,6-sialyltransferase (ST6Gal I), which is highly expressed in the liver, is mainly cleaved by Alzheimer's beta-site amyloid precursor protein-cleaving enzyme 1 (BACE1) and secreted into the serum. During our studies to elucidate the molecular mechanism underlying the cleavage and secretion of ST6Gal I, we hypothesized that plasma ST6Gal I may represent a sensitive biomarker for hepatopathological situations. In the present study, we used recently developed sandwich ELISA systems that specifically detect the soluble cleaved form of ST6Gal I in plasma. We found that the level of plasma ST6Gal I was increased in two different types of liver injury models. In zone 1 hepatocyte-injured rats, the level of plasma ST6Gal I was increased together with acute phase reactions. Meanwhile, in zone 3 hepatocyte-injured rats, ST6Gal I secretion was most likely triggered by oxidative stress. Taken together, we propose two possible mechanisms for the upregulation of plasma ST6Gal I in hepatopathological situations: one accompanied by acute phase reactions to increase hepatic ST6Gal I expression and the other triggered by oxidative stress in the liver. We also found that the serum level of ST6Gal I in hepatitis C patients was correlated with the activity of hepatic inflammation.

Previous reports, including our work, have shown that plasma beta-galactoside alpha2,6-sialyltransferase (ST6Gal I) activity is significantly increased in particular hepatopathological situations, suggesting that it may represent a sensitive biomarker for diagnosing hepatic diseases. So far, activity of ST6Gal I have been measured by using radioactive tracer method in place of measuring amount of ST6Gal I. However, this method is tangled and cannot exclude other sialyltransferase activities. Thus, simple and specific methods for measuring plasma ST6Gal I had been unavailable. Here, we developed two kinds of sandwich enzyme-linked immunosorbent assay (ELISA) systems that specifically detect the soluble cleaved form of ST6Gal I in plasma. In one sandwich ELISA, we detected rat specific sequence, EFQMPK, which is N-terminus of soluble ST6Gal I. In the other sandwich ELISA, we detected internal common sequence among rat, mouse and human ST6Gal I in plasma (M2 ELISA). Using the M2 ELISA, we observed that elevation of plasma ST6Gal I was much faster than elevation of plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in a carbon tetrachloride (CCl(4))-induced mouse liver injury model. Our data suggest that these ELISA systems are very useful tools for measuring plasma ST6Gal I, which represents a potential biomarker for diagnosing hepatic diseases.

Intractable aspiration is a life-threatening medical problem. Sixteen patients with intractable aspiration underwent surgical management. Their underlying diseases were cerebral palsy (n = 6), degenerative diseases (n = 5), acquired hypoxic ischemic encephalopathy (n = 4), and congenital myopathy (n = 1). Laryngotracheal separation was performed in nine patients with median age of 2 years 6 months (range: 7 mo - 13 y 5 mo), and laryngectomy was performed in seven with median age of 7 years 4 month (range: 1 y 6 mo - 17 y 1 mo). Surgical interventions were effective in all patients with respiratory distress. The most common complication was increased drawling in six patients, who recovered within 6 months of clinical follow-up. Other complications were tracheal granulations (n = 4), bleeding (n = 2), narrowing of the tracheal hole (n = 2), tracheomalacia (n = 2), ruptured suture (n = 1), and tracheal abscess (n = 1). Considering the underlying diseases and age, surgical management for intractable aspiration should be performed at appropriate timing.

Background/aims: This study was performed to examine the changes in rapid turnover proteins (RTPs), such as retinol-binding protein, transthyretin and transferrin, which are known nutritional parameters, during the perioperative period for digestive system operations., Methodology: The study was performed with 62 subjects who underwent elective surgery of the digestive system. The RTP measurements were performed approx. seven times for each subject (approx. 20 times in total) from the preoperative period to the 14th postoperative day. For 20 subjects who exhibited no recurrence of a malignant tumor, additional measurements were performed 6 to 12 months after the operation. RTPs were measured more than 1,400 times in total for all subjects., Results: The three types of RTPs all exhibited similar changes, but the largest change was observed for retinol-binding protein. The changes in RTPs were significantly larger than those for albumin. RTP levels were lowest on the 3rd postoperative day and gradually increased thereafter. The RTP levels recovered to approx. 80% of the preoperative values on the 14th postoperative day. In the measurements performed 6 to 12 months after the operation, the levels recovered to 90% or higher of the preoperative values. No significant differences were observed between the cases utilizing different operation methods. The administration of fresh frozen plasma had no impact on the postoperative changes. No correlation was observed between the calories obtained by oral intake during the period from the 5th to 10th postoperative days and the changes in RTPs., Conclusion: The study results suggested that changes in RTPs would not affected by the calories obtained by oral intake during the early postoperative days. In patients who returned to their daily life after an invasive surgery or reconstruction of the digestive tract, RTP levels were restored to the preoperative values 6 to 12 months after the operation.

Background: The stable fractions of glycated hemoglobin (Hb), particularly HbA(1c), and glycated albumin (GA) were measured to monitor chronic glycemic control. Haptoglobin (Hp) is a Hb-binding protein, which plays a major role in preventing free Hb-induced tissue oxidative damage. The aim of this study was to clarify the relationships of serum Hp concentration with HbA(1c) and GA concentrations., Methods: A cross-sectional study to determine the relationship of serum Hp concentration with GA and HbA(1c) concentrations was conducted. The subjects were 125 Japanese type 2 diabetic patients with stable HbA(1c) levels for more than 3 consecutive months. Patients with altered albumin and red blood cell turnover, which are observed in those with chronic renal failure, liver cirrhosis, and anemia among others, were excluded from the study., Results: Serum Hp concentration positively correlated with HbA(1c) concentration (r=0.30, p<0.001), but not with GA concentration (r=0.15, p=0.10). There was a weak inverse correlation between serum Hp concentration and GA/HbA(1c) ratio (r=-0.19, p=0.03). Moreover, GA /HbA(1c) ratio inversely correlated with body mass index (BMI) (r=-0.31, p<0.001). In contrast, there was no significant correlation between Hb concentration and HbA(1c) (r=0.01, p=0.88) or GA (r=0.12, p=0.21) concentrations. We also analyzed the correlation of serum Hp concentration with GA and HbA(1c) concentrations in patients with the Hp 2-1 and Hp 2-2 genotypes, separately. Hp concentration positively correlated with HbA(1c) concentration in patients with the Hp 2-1 (r=0.32, p=0.03) and Hp 2-2 (r=0.29, p=0.02) phenotypes. Multiple regression analysis revealed that the observed correlation between Hp and HbA(1c) concentrations was significant after adjustment for age, gender, and BMI. In contrast, there was no significant correlation between GA and Hp concentrations in patients with either phenotype. Then, we analyzed how Hp concentration affects GA/HbA(1c) ratio in patients with these Hp phenotypes. There was an inverse correlation between Hp concentration and GA/HbA(1c) ratio in patients with Hp 2-1 (r=-0.44, p=0.003), but not in those with Hp 2-2 (r=-0.03, p=0.75). Multiple regression analysis revealed that the inverse correlation between Hp concentration and GA/HbA(1c) ratio in patients with Hp 2-1 was independent of age, gender, and BMI., Conclusions: Hp phenotype and concentration should be considered in interpreting HbA(1c) and GA levels as glycemic control indicators in diabetic patients. We suggest that in type 2 diabetic patients with Hp 2-1 and high Hp concentrations, HbA(1c) level may be overestimated relative to GA level.

Aims: To compare waist circumference (WC) with body mass index (BMI) for the prediction of abdominal adipose tissues in Japanese men and women., Methods: 1432 men and 1038 women aged 38-60 years were recruited. WC, BMI, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) using CT scans were measured., Results: Women had a lower mean VAT than men (79.3 cm(2) vs. 132.3 cm(2); p<0.001) and a higher mean SAT (196.2 cm(2) vs. 139.7 cm(2); p<0.001). The correlation with WC or BMI was greatest for total adipose tissue (TAT), followed by SAT, and least for VAT. The correlation coefficients were not significantly different between WC and BMI for any adipose tissue except for VAT in men (p<0.05). Age was positively correlated with VAT in both genders (p<0.001). Using multiple regression analyses on VAT, R(2) values using WC and age were 0.45 in men and 0.48 in women. For SAT, the values were 0.57 in men and 0.59 in women., Conclusions: The relationship with WC or BMI was greatest for TAT and SAT, and least for VAT. WC and BMI provided essentially similar estimates of TAT, VAT, and SAT in both genders.

Background: Spinal growth modulation by tethering the anterolateral aspect of the spine, as previously demonstrated in a nonscoliotic calf model, may be a viable fusionless treatment method for idiopathic scoliosis. The purpose of the present study was to evaluate the radiographic, histologic, and biomechanical results after six and twelve months of spinal growth modulation in a porcine model with a growth rate similar to that of adolescent patients., Methods: Twelve seven-month-old mini-pigs underwent instrumentation with a vertebral staple-screw construct connected by a polyethylene tether over four consecutive thoracic vertebrae. The spines were harvested after six (n = 6) or twelve months (n = 6) of growth. Monthly radiographs, computed tomography and magnetic resonance imaging scans (made after the spines were harvested), histologic findings, and biomechanical findings were evaluated. Analysis of variance was used to compare preoperative, six-month postoperative, and twelve-month postoperative data., Results: Radiographs demonstrated 14 degrees +/- 4 degrees of coronal deformity after six months and 30 degrees +/- 13 degrees after twelve months of growth. Coronal vertebral wedging was observed in all four tethered vertebrae and progressed throughout each animal's survival period. Disc wedging was also created; however, in contrast to the findings associated with vertebral wedging, the tethered side was taller than the untethered side. Magnetic resonance images revealed no evidence of disc degeneration; however, the nucleus pulposus had shifted toward the side of the tethering. Midcoronal undecalcified histologic sections showed intact bone-screw interfaces with no evidence of implant failure or loosening. With the tether cut, stiffness decreased and range of motion increased in lateral bending away from the tether at both time-points (p < 0.05)., Conclusions: In this porcine model, mechanical tethering during growth altered spinal morphology in the coronal and sagittal planes, leading to vertebral and disc wedging proportional to the duration of tethering. The resulting concave thickening of the disc in response to the tether was not anticipated and may suggest a capacity for the nucleus pulposus to respond to the compressive loads created by growth against the tether.

Study Design: In vitro biomechanical investigation using human cadaveric cervical spines., Objective: Evaluate differences in biomechanical stability between typical lateral mass screw + rod constructs compared to transfacet screw fixation with and without rods., Summary of Background Data: Lateral mass screw + rod constructs have reported efficacious arthrodesis rates/quality but risk damaging the lateral neurovascular structures. Transfacet screw fixation has been studied in the lumbar spine, but little data exists regarding its potential utility in the cervical spine., Methods: Sixteen human cadaveric cervical spines were stripped of soft tissue leaving the occiput and ligamentous structures intact. Spines were randomized to lateral mass or transfacet groups (n = 8/group). Spines were prepared in typical surgical fashion and instrumented with the appropriate devices. In the case of the transfacet constructs, the occiput was left intact to simulate the potential surgical difficulty of screw insertion. The transfacet screw group was initially instrumented with rods. Once instrumented (C3-C6) for each group, spines were further dissected to isolate the instrumented levels. End vertebral bodies were rigidly fixed and constructs biomechanically tested in flexion/extension, lateral bending, and axial torsion between +/-2 Nm. After testing for the transfacet screw + rod group, rods were removed and spines retested. All instrumentation was then removed and spines tested in their destabilized state as would occur with surgical preparation. Stiffness data were calculated for each test direction for all groups. Raw and normalized data were each compared across techniques with a 1-way ANOVA (P < 0.05)., Results: The transfacet screw groups (with and without rods) were found to have statistically similar biomechanical stability to lateral mass screw + rod constructs for each test direction., Conclusion: Transfacet screws (without rods) were found to have similar biomechanical stability compared to typical lateral mass screw + rod constructs. However, transfacet fixation eliminates the risk to the neurovascular structures and lowers the overall implant profile.

Background Context: Children with early onset scoliosis benefit from early operative treatment with dual growing rods as they provide an "internal brace" for the spine and allow curve correction and sequential lengthenings to maximize thoracic cage development. The foundations that provide anchor points for the dual growing rods may incorporate hooks, screws, or a hybrid construct. It is unclear how stable different types of foundation constructs are with regard to pullout., Purpose: This study was to determine the differences in stability between four foundation configurations used in the pediatric dual growing rod technique. Eight porcine spines were sectioned and randomly assigned to one of four foundation groups: 1) hook-hook with cross-link; 2) hook-screw with cross-link; 3) screw-screw with cross-link; and 4) screw-screw without cross-link. After instrumentation, biomechanical pullout tests were conducted. Ultimate failure loads, modes of failure, and level of instrumentation were analyzed., Study Design/setting: Controlled in vitro laboratory investigation., Results: Screw-screw with cross-link constructs demonstrated the greatest failure load but this was not statistically significant compared with the screw-screw without cross-link constructs. Both screw-screw constructs were statistically stronger than either construct containing hooks. There was no difference between the hook-screw and hook-hook constructs that was statistically significant. Hook-containing constructs sustained higher failure loads in lumbar versus thoracic vertebrae., Conclusions: A foundation composed of four pedicle screws implanted in two adjacent vertebral bodies provides the strongest construct in pullout testing. A cross-link does not seem to enhance fixation. Hook constructs are stronger in lumbar versus thoracic laminae.

Study Design: In vitro biomechanical investigation using human cadaveric vertebrae., Objective: Evaluate the biomechanical differences in transverse plane vertebral body derotation maneuvers of thoracic pedicle screws in both medial and lateral directions., Summary of Background Data: Thoracic pedicle screws are thought to have better vertebral rotation control and better segmental scoliosis correction compared to hooks and wires. Little data exists regarding the biomechanical stability of pedicle screws when derotated in either medial or lateral directions., Methods: Vertebral bodies (T4-L5) from 12 cadavers were instrumented with appropriate length pedicle screws while measuring insertion torque. Each body was anchored for independent loading in medial or lateral directions. Each screw was rotated around a rod using a constant length lever arm (30.5 cm) rigidly attached to the screw head simulating the posterior vertebral derotation maneuver. Yield torques (Nm) were analyzed using a one-way analysis of variance (P < 0.05)., Results: Yield torques for both directions were significantly related to screw insertion torque (both P < 0.01). There were no statistical differences in yield torque between medial (12.0 +/- 4.9 Nm) or lateral (11.5 +/- 5.1 Nm) directions. There were no significant differences after normalization for insertion torque or screw length. Tests rotating the screw tip laterally demonstrated structural failure in the following percentages (anterolateral failure = 67%, posterior element failure = 33%, additional screw bending = 42%). Rotation medially demonstrated structural failures in the following percentages (canal penetration = 51%, posterior element failure = 49%, additional screw bending = 44%)., Conclusion: From these data, a surgeon performing a direct vertebral derotation using a 30 cm (12 in) lever would need to apply roughly 40 N (9 lbs) to causeanatomic failure. Adolescent patients would likely tolerate a greater force without bone failure given a greater bone density, yet, extreme caution is still recommended to prevent screw rotation either medially into the spinal canal or laterally into the chest.

Purpose: The purpose of this study was to examine coronary heart disease (CHD) risk perception, risk factor status, and factors associated with CHD risk perception in Korean immigrants with type 2 diabetes mellitus., Methods: A community sample of 143 Korean adults with type 2 diabetes, aged 30 to 80 years old, completed questionnaires and biological measures. A multiple regression analysis was conducted to evaluate the relationships between CHD knowledge, general health, smoking, medications for CHD risk factors, demographic variables (independent variables), and the perception of CHD risk (dependent variable)., Results: Participants had low perception of CHD risk, with most (76.9%) indicating their risk to be the same or lower than people of the same age and sex in the general population. Overall, CHD risk factor control was suboptimal according to American Diabetes Association guidelines. Only 41.3% of participants met the HbA1c goal of less than 7%. More than half (55%) had uncontrolled blood pressure, and a similar proportion (53.6%) had higher low-density lipoprotein cholesterol than the target goal. CHD knowledge and self-reported general health influenced the perception of CHD risk. More CHD knowledge and poor general health were associated with higher perception of CHD risk., Conclusions: To increase the perception of CHD risk in Korean immigrants with type 2 diabetes, diabetes educators and clinicians should educate such patients about CHD risk factors and discuss their risk status at every visit. Those who report their health to be good deserve particular attention.

Objectives: To evaluate the biomechanical properties of both plate location (superior versus anterior-inferior) and plate type Small Fragment Contourable Dual Compression Plate (CDCP) versus 3.5 mm Universal Locking System Contourable Dual Compression Plate (Locked CDCP) in a synthetic midshaft transverse clavicle fracture model., Methods: Twenty-four pre-osteomized synthetic clavicles were repaired with either CDCP or locked CDCP technology 3.5 mm plates in either the superior or anterior-inferior position to form 4 groups of 6 clavicles. These were subsequently tested to evaluate torsional and axial construct stiffness, as well as bending load to failure, bending failure stiffness, and method of failure., Results: In axial compression, locked CDCP constructs were significantly more stiff than CDCP constructs (p < 0.001), but no statistically significant effect of plate location was observed. Torsional tests demonstrated a significant 2-way interaction favoring locked CDCP plates in the superior position and standard CDCP plates in the anterior-inferior position (p < 0.001). Bending failure testing revealed that the superior plate location had higher load to failure and bending failure stiffness than the anterior-inferior location (p < 0.0001). In addition, the superior locked CDCP plates demonstrated significantly greater bending failure stiffness than superior CDCP plates (p < 0.0001)., Conclusions: Biomechanically, repairing a midshaft clavicle fracture with a superior plate was more favorable compared to anterior-inferior plating in terms of both load to failure and bending failure stiffness. Furthermore, superior locked CDCP plates show improved bending failure stiffness over superior CDCP plates.

Background: Several different methods have been used to repair tibial eminence avulsion fractures. It is not clear which is the best stabilization method. The purpose of this study was to compare the biomechanical stability of tibial eminence avulsion fractures using suture, resorbable screw, resorbable nail, and metal screw techniques., Methods: Sixteen immature bovine knees were dissected leaving just the anterior cruciate ligament. A fracture was created using a curved osteotome, The knees were randomly stabilized with either 2 single-armed #2 Ethibond sutures, 3 bioabsorbable nails, a single resorbable screw, or a single metal screw. Femurs were tested with the knee flexed to 35 degrees to simulate anterior tibial translation. Tests involved loading between 5 N and 150 N for 200 cycles, then a tensile failure test at 0.5 mm/sec. Cyclic fragment deformation, initial fragment stiffness, and failure load were compared using a 1-way analysis of variance (p < 0.05)., Results: There were no significant mechanical differences across groups. The variability in performance was much greater for both the suture and resorbable screw repairs. Both sutures and resorbable screw constructs resulted in a deformation that was 1 mm greater than that of the resorbable nails or a metal screw., Conclusions: Increased fracture separation for sutures and resorbable screw groups indicates a potential loss in reduction during cyclic, physiologic loads. Each group could withstand up to 85 lb of tensile force before failure, but it is unlikely that this force would occur with incidental loads during the early rehabilitation period., Clinical Relevance: There was not a clear biomechanical advantage to performing any particular fixation method in this study. This suggests that the surgeon can use their clinical judgment and experience to determine the fixation technique.

In the new world-wide criteria for metabolic syndrome (MetS) by the International Diabetes Federation (IDF) in 2006, the Japanese is the only ethnicity in which the recommended waist circumference (WC) cutoff value is higher in women (>or=90cm) than in men (>or=85cm), and its validity appears to be controversial. We investigated the optimal cutoff points for the diagnosis of central obesity in Japanese men and women, using the receiver operating characteristic (ROC) curve analysis for both of WC and visceral fat area (VFA) in 1870 middle-aged Japanese. VFA was superior to WC and Body mass index (BMI) for discriminating the subjects with two or more nonadipose components of MetS. The optimal cutoff points of VFA and WC were 132.6cm(2) and 89.8cm for men and 91.5cm(2) and 82.3cm for women. The stratifications of MetS components more than 1.0 in average occurred more steeply by the accumulation of VFA in women than in men. In conclusion, setting the cutoff points of WC and VFA lower values in women than in men for the definition of central obesity is needed to identify the subjects with MetS in Japanese, as in other Asian populations.

Background: Previous data have shown that an equal number of threads on each side of the physis maximizes stability for slipped capital femoral epiphysis (SCFE) fixation. The purpose of the current study was to determine if a fully threaded cancellous screw provides greater stability compared with a partially threaded screw in a porcine model., Methods: Twenty skeletally immature porcine femurs were sectioned, and a 30-degree angular wedge was resected from the femoral neck to simulate SCFE. Femora were randomly assigned to partially threaded (16 mm) or fully threaded screw groups (n = 10/group). Kirschner wires were inserted in a retrograde fashion to stabilize the proximal fragment. Each 7.3-mm-diameter screw was placed using fluoroscopic guidance to obtain 3 threads crossing the physis. Specimens were fixed in custom fixation rigs, and the epiphyseal fragment was loaded at 0.5 mm/s in a posterior-inferior direction to simulate slip progression. Data for displacement (in millimeters) and force (in newtons) were collected for the entire test. Forces at 2, 4, 6, and 8 mm of fragment displacement were compared between groups using a 1-way analysis of variance (p < 0.05)., Results: Increasing epiphyseal displacements were associated with incremental increases in loading. There were no significant differences between fully threaded or partially threaded screws for loads at each displacement. Each stepwise increase in displacement was associated with approximately 325 N of force., Conclusion: There was no biomechanical benefit when using a fully threaded screw for stabilization of an in vitro SCFE model., Clinical Relevance: Although there were no differences between screw types in an in vitro model, bone healing around the fully threaded screw may eventually provide greater stability. The use of fully threaded screw remains a reasonable option in the treatment of SCFE, and implant removal may be easier with such a system. Further studies are warranted to verify these 2 points.

Background: Cigarette smoking is the most preventable risk factor for many negative health consequences, such as cancer, heart disease, and lung disease. In the United States, the prevalence rate in Asian immigrants is high (26%-70%), with Southeast Asian men having the highest rate. Acculturation has been associated with smoking behavior in this ethnic group., Objective: The purposes of this meta-analysis are to describe the extent to which acculturation affects smoking behavior in Asian immigrants and to compare the direction and magnitude of the effect between subgroups by gender and age., Methods: Databases within PubMed, CINAHL, The Cochrane Library, and PsycINFO were searched. Twenty-one studies published in English or Korean from 1994 through 2005 met criteria, and 9 of these studies contained sufficient data. Among the 9 studies, 3 presented gender-specific data; thus, these studies were entered separately for men and women, making a total of 12 entries for final analysis. The odds ratio was used as an effect size statistic. The values of odds ratios were calculated from the data in the studies., Results: The average effect size for men was 0.53 (95% confidence interval, 0.28-0.99), indicating that acculturated men are 53% less likely to smoke than nonacculturated or "traditional" men. The average effect size for women was 5.26 (2.75-10.05), suggesting that acculturated women are 5 times more likely to smoke than traditional women. In adolescents, the average effect size was 1.92 (1.22-3.01), indicating that acculturated adolescents are almost 2 times more likely to smoke than traditional adolescents., Conclusions: Acculturation may have a protective effect on smoking behavior in Asian men and a harmful effect in Asian women and adolescents. The magnitude of effect is larger in women and adolescents than in men. Smoking cessation programs should target acculturated women, adolescents, and traditional men.

Background: Retrograde stabilization of mid-diaphysis adolescent femur fractures has shown excellent biomechanical stability. However, it is unclear whether adequate stability is maintained for distal femur fractures using the retrograde approach compared with the clinically recommended antegrade approach. The purpose of this study was to evaluate the biomechanical stability of retrograde and antegrade nailing for mid-diaphyseal and distal diaphysis femoral fractures., Methods: Twenty adolescent-sized synthetic femurs were randomly assigned to fracture location and surgical approach groups. Comminuted fractures were simulated at the mid-diaphysial level and 4 cm proximal to the distal physis. The retrograde approach used 2 c-shaped 3.5-mm titanium nails. The antegrade used c and s 3.5-mm nail configurations. Both techniques achieved maximum nail divergence at the level of the fracture. Biomechanical testing was conducted to determine differences in torsional range of motion (degrees)and failure load (N) at 5 mm. These data were analyzed with a 2-way analysis of variance (p < 0.05)., Results: In torsion, there were no differences related to surgical approach or fracture level. For axial compression to 5 mm, the antegrade approach required significantly greater force to achieve 5 mm of compression compared with the retrograde approach. The mid-diaphyseal fracture required significantly greater force to achieve 5 mm of compression compared with the distal diaphysis group., Conclusions: For maximum stabilization of a distal femur fracture, c- and s-shaped nails placed in the antegrade position is suggested., Clinical Relevance: Surgical decision making regarding the use of either the antegrade or retrograde approach will be influenced by both the stability provided (antegrade) and the ease of insertion (retrograde).

Purpose: The purpose of this study was to determine biomechanical differences in cyclic elongation and ultimate strength between double-row rotator cuff repair and single-row repair for partial rotator cuff repairs., Methods: We randomly assigned 18 immature bovine specimens (aged 12 to 16 weeks) to 3 repair groups (6 per group). A 1 x 2-cm defect was created at the infraspinatus tendon insertion site. Two suture anchors were implanted 1 cm apart at the anatomic insertion area for the lateral row. Two suture anchors were implanted 1 cm medial to the lateral row and 1 cm apart from each other for the medial row. Repair groups were constructed as follows: single-row repair with double-loaded suture anchors (group 1), double-row repair with single-loaded medial row and double-loaded lateral row (group 2), and double-row repair with single-loaded medial row and single-loaded lateral row (group 3). Specimens were cyclically loaded from 10 N to 90 N for 500 cycles and then loaded at 0.5 mm/s to failure. Data for cyclic elongation, with loads at 3 mm, 5 mm, and 10 mm, were analyzed via a 1-way analysis of variance (P < .05)., Results: There were no significant differences for peak elongation after cyclic loading between groups. There were no significant differences between repair groups for loads at 3 mm, 5 mm, and 10 mm of elongation. Constructs typically failed by knot slippage (83%), with a single sample having tendon-suture failure (17%)., Conclusions: Double-row repair did not show a biomechanical advantage compared with single-row repair. With this result in mind, the theoretic advantage of a potentially larger footprint must be balanced against the added surgical time, complexity, and cost of double-row repair., Clinical Relevance: Arthroscopic surgeons should choose the best form of fixation for a given patient, without undue emphasis on single-row repair versus double-row repair. The clinical and biologic impact of footprint restoration was not addressed in this study.

BACE1 (beta-site amyloid precursor protein-cleaving enzyme-1) is a membrane-bound aspartic protease that cleaves amyloid precursor protein to produce a neurotoxic peptide, amyloid beta-peptide, and has been implicated in triggering the pathogenesis of Alzheimer disease. We showed previously that BACE1 cleaves beta-galactoside alpha2,6-sialyltransferase I (ST6Gal I) to initiate its secretion, but it remained unclear how BACE1 affects the cellular level of alpha2,6-sialylation. Here, we found that BACE1 overexpression in Hep3B cells increased the sialylation of soluble secreted glycoproteins, but did not affect cell-surface sialylation. The sialylation of soluble glycoproteins was not increased by ST6Gal I overexpression alone, but was increased by co-overexpression of ST6Gal I and BACE1 or by expression of the soluble form of ST6Gal I, suggesting that soluble ST6Gal I produced by BACE1 plays, at least in part, a role in the sialylation of soluble glycoproteins. We also found that plasma glycoproteins from BACE1-deficient mice exhibited reduced levels of alpha2,6-sialylation compared with those from wild-type mice. We propose a novel regulatory mechanism in which cleavage and secretion of ST6Gal I enhance the sialylation of soluble glycoprotein substrates.

The relationship between post-prandial plasma glucose (PPG) and post-challenge plasma glucose (PCG) within individuals was investigated in Japanese population. The oral glucose tolerance test (OGTT) and measurements of PPG 2h after ingestion of a standardized rice-based meal (PPG2h), were performed in 4471 middle-aged Japanese subjects (2774 men and 1697 women, 50.7+/-8.5 years). There was a loose correlation between PPG2h and PCG2h (r=0.327, p<0.001). The diabetes group (n=170) showed the highest PPG2h, followed by the IGT group (n=786) and the NGT group (n=3414) (p<0.05). At the cutoff point of 140 mg/dl (7.8 mmol/l) for PPG2h, specificities were 94.9% for IGT plus diabetes and 92.9% for diabetes, but sensitivities were as low as 23.2% for IGT plus diabetes and 44.7% for diabetes. The correlation of PPG2h with PCG2h was stronger in the obese group (BMI>or=25 kg/m2) than in the lean group (BMI<20 kg/m2). We conclude that the correlation between PPG2h and PCG2h was significant but not very tight. In evaluating PPG2h, if the cutoff point of 140 mg/dl (7.8 mmol/l) for PCG2h is extrapolated, the majority of subjects with dysglycemia could be overlooked.

Purpose: The purpose of this study was to compare the biomechanical stability generated when utilizing increasing sizes of titanium (Ti) flexible nails for fixation of simulated comminuted femur fractures., Methods: Five synthetic adolescent-sized femur models were reamed to create a 9-mm canal. A 2-cm section was removed in the mid-diaphysis to simulate comminution. Each femur was first stabilized with bilateral, retrograde 3.0-mm titanium elastic nails. Femurs were tested in axial rotation and axial compression. The constructs were removed, and femurs were re-nailed with 3.5-mm nails. Identical testing was conducted. These nails were then removed, and femurs were re-nailed with 4.0-mm nails. This provided data on "canal fill" representing 67, 78 and 89% of the reamed canal diameter. Data for axial rotation (degrees) and failure load (N) required to produce 5 mm of fracture shortening were analyzed with a one-way ANOVA (P < 0.05) and a Tukey's post-hoc test for multiple comparisons., Results: For axial rotation, there were statistically significant improvements in rotational control for each increase in nail size. For axial stability, each increase in nail size resulted in increased axial failure loads to 5 mm, although these data were not statistically different. A specific comparison between 3.0- and 3.5-mm nails for compressive stability found significantly greater stability afforded by using 3.5-mm nails., Conclusions: Data from this study demonstrate that increasing the amount of canal fill provides significant improvements in rotational control. The largest improvement was seen when increasing from 3.0- to 3.5-mm nails. While increasing the nail size from 3.5 to 4.0 mm again provided greater stability, larger nails may be more difficult to insert. Thus, increasing the nail size for femoral fracture fixation should be considered after measuring the diameter of the canal and evaluating the potential difficulty of insertion as well as specific demands of the fracture pattern.

The anatomic and histological characteristics of the ligamentum teres and its vascular contributions to the femoral head have been well described. The function of the ligamentum teres remains poorly understood. Although excision is the current standard in treating complete developmental hip dysplasia, we developed an interest in maintaining, shortening, and reattaching the ligament to assure early postoperative stability in developmental hip dysplasia. To analyze its potential for providing hip joint stability, we investigated the biomechanical properties of the ligamentum teres in an in vitro porcine model. Six immature porcine hips were dissected, with the proximal femur and acetabular anatomy kept intact, isolating the ligamentum teres. Specimens were loaded in tension using custom fixation rigs at 0.5 mm/s in line with the fibers. Data for displacement and force were collected and sampled at 10 Hz for duration of each test. The ligamentum teres failed in a stepwise fashion. The mean ultimate load to failure was 882 +/- 168 N. Mean stiffness and failure stress were calculated as 86 +/- 25 N/mm and 10 +/- 2 MPa, respectively. The biomechanical function of the ligamentum teres is not inconsequential. We found the ultimate load of the ligamentum teres in the porcine model to be similar to those reported for the human anterior cruciate ligament. The strength of the ligamentum teres may confirm its potential for providing early stability in childhood hip reconstructions. In the setting of dysplasia, the preservation and the transfer of the ligamentum teres to augment stability should be considered as an adjunct to open reduction.

The purpose of this study was to compare the biomechanical stability of triple innominate osteotomies fixed with either bioabsorbable or stainless steel screws. Triple innominate osteotomies were performed on composite hemipelves and fixed with either three 4.5-mm bioabsorbable screws or three stainless steel 4.5-mm screws. Two screws were placed from the iliac wing into the acetabular fragment, and 1 screw was placed from below the acetabular fragment into the iliac wing. Eight specimens for each screw type were biomechanically tested in an anatomical position (replicating weight bearing) and in a flexed and abducted position (replicating spica cast positioning). Specimens were cyclically loaded between 10 and 450 N to simulate the hip contact force in this population. Lower screws were then removed, and specimens were tested under identical conditions. Fragment displacement (mm) and construct stiffness (N/mm) were compared with a 2-way analysis of variance (P < 0.05). There were no significant differences between materials for fragment displacement or construct stiffness. Anatomical position showed significantly less displacement than spica position for both materials. Initial displacement in the spica position was significantly less during lower loads for stainless steel fixation. Bioabsorbable screws demonstrate comparable biomechanical stability to stainless steel screws in anatomical and spica positions at physiological loads. Flexion and abduction of the femur adversely affect the stability of the construct for both materials. Bioabsorbable screws behave similarly to steel screws when stabilizing triple innominate osteotomies and would have the advantage of not requiring a second surgery for screw removal. Confirmation of biocompatibility should be completed before widespread clinical application.

Background: Fixation strength of metal and bioabsorbable interference screws has not been evaluated while varying the anterior cruciate ligament graft tension angle., Hypothesis: There is no difference in fixation strength between 2 types of interference screws for anterior cruciate ligament graft fixation while the graft tension angle is varied relative to the femoral tunnel., Study Design: Controlled laboratory study., Methods: Forty-eight anterior cruciate ligament reconstructions were performed using immature porcine femurs stripped of soft tissue and doubled-over porcine flexor digitorum profundus tendon grafts. Specimens were randomized to bioabsorbable or titanium interference screw fixation. Specimens were randomized to one of three pull angles (0 degrees , 30 degrees , 60 degrees ) representing loading at different knee flexion angles (n = 8/group). Reconstructed ligaments were tensioned to 10 N followed by 200 loading cycles between 10 and 150 N and a final failure test. Construct elongation (mm) at 100 and 200 cycles and failure load (N) were analyzed using a 2-way analysis of variance (P < .05)., Results: Screw material interacted significantly with graft tension angle, as the bioabsorbable screw specimens demonstrated significantly greater fixation strength when tensioned at greater angles. Specimens fixed with bioabsorbable screws showed significantly less elongation at both 100 and 200 cycles and significantly greater failure load compared with titanium screws., Conclusion: Bioabsorbable interference screws acutely have increased fixation strength compared with titanium interference screws for anterior cruciate ligament grafts loaded at greater tension angles., Clinical Relevance: The strength of anterior cruciate ligament reconstruction fixation increases with increasing divergence between the tension angle and femoral tunnel, a condition seen when the knee approaches full extension.

Object: Biomechanical testing and fluoroscopic imaging were used to study an extension-limiting device that has been developed to support and cushion the facet complex. It is a titanium screw-based system with a polycarbonate-urethane bumper that lies against the inferior articular process and is anchored into the pedicle by the screw for posterior dynamic stabilization (PDS)., Methods: Six human cadaveric spines were dissected from L-2 to L-5, leaving all ligamentous structures intact. The intact spines were first tested in flexion and extension, lateral bending, and axial rotation at 67.5 Nm. The PDS devices were inserted at L3-4 and testing was repeated. Fluoroscopic analysis of posterior disc height and foraminal area of the intact and instrumented spines while loaded was performed. All test data were compared using a one-way analysis of variance (statistical significance was set at p < 0.05). Instrumented spines had 62% less motion during flexion and 49% less motion during extension compared with the intact spines. Neuroimaging analysis showed 84% less compression of the posterior disc of the instrumented spines during extension, and no difference during flexion compared with intact spines. After instrumentation was affixed, the foraminal area was 36% larger than in intact spines during extension and 9% larger during flexion. During axial loading, compression of the posterior disc was decreased by 70%, and analysis showed 10% decompression prior to loading just from implanting the devices., Conclusions: The PDS system has the benefit of being a completely percutaneous one, which can be used at all levels of the lumbar spine, including S-1. The PDS system limits spinal motion, enlarges the foramina, and achieves discal decompression.

Posterior spinal fusions are indicated for a variety of spinal disorders. Transfacet fixation minimizes soft tissue disruption and preserves the adjacent facet joint. This technique is uncommon due to concerns with biomechanical stability and proper implant placement. For these reasons, a length adjustable implant may obviate the clinical concerns but necessitates biomechanical study. This study evaluated the in vitro biomechanical stability between a novel transfacet fixation device compared with standard pedicle screws during cyclic physiologic loading in a human cadaveric model. Cadaveric L4-L5 lumbar motion segments from 16 human spines were tested in cyclic flexion/extension, lateral bending, and torsion after insertion of either transfacet fixation devices or 5.5 mm pedicle screw instrumentation. A load cell was used to measure the compressive forces on the anterior column during testing. Motion segment stiffness and anterior column compression were analyzed with a 1-way analysis of variance (P<0.05). The transfacet device demonstrated a statistically similar stiffness when compared with the pedicle screw system for each test direction. For anterior column loading during physiologic testing, there were no biomechanical differences between stabilization systems. Percutaneous transfacet fixation is an attractive surgical option for single-level spinal fusions. A biomechanical evaluation of a novel device for this application demonstrated similar stability to a pedicle screw system. The length adjustability of the device may alleviate concerns for precise device placement and the biomechanical stability may produce similar rates and quality of posterior spinal fusions.

Since a nutrition support team (NST) began to work in our hospital in March, 2003, we constructed our original nutrition assessment system that supports the prescription formulation of total parenteral nutrition (TPN). However, in daily NST activities, the re-evaluation of this system became necessary because of a high incidence of enteral nutrition (EN) and marked revisions in the dietary reference intakes in Japanese (7th revision). Therefore, we improved this system and added a prescription formulation support function that is also applicable to EN, and also added a function that automatically calculates the necessary doses of nutrients that tend to become deficient in patients with decubituses. This new system allowed the selection/evaluation of EN solutions in a short time with consideration of the 7th revision, and readily identified deficient nutrients and their levels in decubitus patients. We used this system in patients with high-level malnutrition complicated by decubituses and observed certain treatment effects.

Background: Complex intra-articular distal humerus fractures are relatively uncommon injuries but are fraught with poor outcomes such as malunion, elbow stiffness and deformity. Various types of internal fixation screw-plate constructs have been developed to improve fixation. Specifically, a 90 degrees offset periarticular system lowers the profile on the lateral epicondyle, yet it is unclear how this design compares to other plate constructs. This study compared the mechanical stiffness and plate surface strains between two types of constructs for stabilization of complex distal humerus fractures., Methods: Identical bi-columnar segmental intra-articular fractures were created in ten epoxy composite left humeri. Models were randomly assigned to two groups (n=5/group) with either parallel plates or perpendicular plates. Rosette strain gages were placed at the most distal possible space on the lateral plate for both constructs. Models were mechanically tested with estimates of physiologic loads in flexion, extension, varus, valgus axial compression and axial torsion. Data for mechanical stiffness, transverse plate strain and longitudinal plate strain were compared with a one-way ANOVA (P<0.05)., Findings: There was no statistical difference in stiffness in any direction. The longitudinal strain for the 90 degrees construct was significantly lower in axial compression. The 180 degrees system demonstrated significantly lower transverse strains during axial torsion., Interpretation: Both systems demonstrated similar mechanical stiffness theoretically providing similar fracture stabilization. Plate strain differences may affect fragment position, but it is unclear how much plate loading occurs in vivo. Surgeon experience and preference may dictate the choice of a plate construct for this fracture configuration.

Since 1999, we have been trying to establish a reliable method for evaluating social functioning ability (SFA) of physically handicapped children, in cooperation with the Project of Comprehensive Study of Disability, Social Health, and Welfare supported by the Ministry of Health, Labor and Welfare, Japan. In this study, we investigated the reliability and accuracy of the 4th edition of "The Evaluation of SFA". This evaluation consists of 40 items in 15 areas. We examined 45 disabled patients (26 males and 19 females) aged 12-27 years (mean age, 16 years). The reliability was checked by agreement of evaluations of the same patient carried out by two examiners. The results showed good reliability (kappa value of 0.42). According to the results of questionnaires, 97% of the examiners regarded this evaluation to be useful. Although the score of SFA correlated with intelligent quotient/development quotient, the score did not correlate with motor disability level. We hope that this evaluation will be widely used to upgrade SFA of disabled children.

Purpose: To biomechanically evaluate single screw and varying 2 screw fixations for an unstable slipped capital femoral epiphysis (SCFE) model using physiologically relevant loading., Study Design: In vitro biomechanical study., Methods: Twenty-four immature porcine proximal femurs were prepared to simulate a mild-to-moderate unstable SCFE. The femurs were randomized into 4 fixation groups: single screw, 2 screws horizontally placed, 2 screws vertically placed, and 2 oblique screws. Biomechanical testing determined maximum load to failure (N), load (N) at 2, 4, 6, and 8 mm of femoral head displacement, and stiffness (newtons per millimeter) for each group., Results: No significant differences were found among the 3 different 2 screw configurations. The 2 screw constructs were 66% stiffer and 66% stronger than the single screw construct. In addition, whereas there was no difference at 2 mm of femoral head displacement, each subsequent displacement (4, 6, and 8 mm) demonstrated significantly higher failure loads when 2 screws were used for stabilization., Conclusions: Slipped capital femoral epiphysis stabilization with 2 screws leads to increased stability over single screw fixation; however, none of the 3 configurations/placement patterns of the 2 screw constructs seemed to be superior in fixation stability., Clinical Relevance: These data support the use of a 2 screw construct in acute/unstable SCFE fixation. The biomechanical benefit of 2 screws needs to be considered in the face of greater potential for inadvertent penetration into the joint with an increased number of screws.

Study Design: In vitro biomechanical investigation of 1 and 2-screw anterior scoliosis constructs with varying screw diameters., Objective: To determine a possible optimal configuration of screw number and diameter at varying levels within the thoracic spine for anterior vertebral body fixation., Summary of Background Data: Single-rod systems are typical in anterior thoracic and thoracolumbar correction of adolescent idiopathic scoliosis; although dual rod systems may offer more flexural stability. Loss of fixation remains problematic, particularly in the proximal thoracic vertebrae, and it remains unclear how screw diameter or the number of screws within the vertebrae affect fixation., Methods: Individual vertebral levels from 10 cadaveric thoracic spines were randomly assigned to either 1 or 2 screws of 5, 6, or 7-mm diameter. Bone-screw interface failures were created in coronal plane cantilever plow, and failure loads were compared across vertebral levels for each instrumentation method., Results: Two-screw constructs had significantly higher failure loads than single-screw constructs, while increasing screw diameter also produced significant changes in fixation strength. Two-screws had improved performance in the mid and lower thoracic spine, while a single screw was more stable in the upper thoracic spine., Conclusions: Failure modes for 1-screw constructs almost entirely (89%) showed gradual plowing through the bone, whereas acute fracture through the vertebral body or pedicles were common forms of failure (85%) for 2-screw constructs.

Deposition of amyloid beta-peptide (Abeta) and neurofibrillary tangles in the brain are hallmarks of Alzheimer's disease (AD) pathogenesis. BACE1, a membrane-bound aspartic protease that cleaves amyloid precursor protein (APP) to produce Abeta, has been implicated in triggering the pathogenesis of the disease. We previously reported that BACE1 also cleaved alpha2,6-sialyltransferase (ST6Gal I) in the Golgi apparatus and induced its secretion from the cell. Since most glycosyltransferases show Golgi localization and many of these are cleaved and secreted from the cell, we hypothesized that other glycosyltransferases may also be BACE1 substrates. Here, we focused on a series of sialyltransferases as candidates for BACE1 substrates. We found that BACE1 cleaved polysialyltransferase ST8Sia IV (PST) in vitro. We further found that BACE1 overexpression in COS cells enhanced the secretion of ST3Gal I, II, III and IV, although these sialyltransferases were not cleaved by BACE1 in vitro. These results suggest that BACE1 expression affects glycosylation not only by directly cleaving glycosyltransferases but also by modifying the secretion of glycosyltransferases via some other mechanisms.

Objective: The objective of this study was to compare psychophysiological and cortisol reactions to psychological stress in older depressed and nondepressed patients at risk for cardiovascular disease (CVD)., Methods: Forty-eight depressed participants and 20 controls with elevated cardiovascular risk factors underwent a psychological stress test during which cardiovascular variables were measured. Salivary cortisol was collected after each test segment. Traditional (e.g., lipids) and atypical (e.g., C-reactive protein) CVD risk factors were also obtained., Results: At baseline, the groups did not differ on lipid levels, flow-mediated vasodilation, body mass index, or asymmetric dimethylarginine. However, the depressed patients had significantly higher C-reactive protein levels. Contrary to our hypothesis, there were no differences in baseline cortisol levels or diurnal cortisol slopes, but depressed patients showed significantly lower cortisol levels during the stress test (p = .03) and less cortisol response to stress. Compared with nondepressed subjects, depressed subjects also showed lower levels of respiratory sinus arrhythmia (RSA(TF)) during the stress test (p = .02)., Conclusions: In this sample, older depressed subjects with elevated risk for CVD exhibited a hypocortisol response to acute stress. This impaired cortisol response might contribute to chronic inflammation (as reflected in the elevated C-reactive proteins in depressed patients) and in other ways increase CVD risk. The reduced RSA(TF) activity may also increase CVD risk in depressed patients through impaired autonomic nervous system response to cardiophysiological demands.

Purpose: To evaluate single screw fixation stability, in the treatment of slipped capital femoral epiphysis, as a function of screw thread distribution across the physis., Study Design: In vitro biomechanical study., Methods: Thirty porcine proximal femurs were sectioned through the physeal line and stabilized with a cannulated 7.3-mm stainless steel AO screw. The distal 16 mm of each screw was threaded (5 threads). The femurs were randomized into 5 groups (1, 2, 3, 4, or 5 threads across the physis) and biomechanically tested to determine failure load (N) and stiffness (N/mm)., Results: Femurs with 2 or 3 threads across the physis had a significantly greater load to failure and stiffness compared with femurs with 1, 4, or 5 threads across the physis (P < 0.05)., Conclusions: Thread distribution across the physis seems to be important. When using screws with a 16-mm thread, greatest strength and stiffness are achieved when 40%-60% of threads engage the epiphysis, with a significant decrease when greater than 80% of threads cross the physis. Too few threads in the epiphysis as well as too few in the metaphysis both lead to decreased stability., Clinical Relevance: This study challenges the belief that compression across the physis maximizes slipped capital femoral epiphysis fixation stability. We recommend equal distribution of threads across the physis when using 16-mm thread screws, and we postulate that screws with a greater thread length (32 mm or fully threaded) would increase fixation stability even further. Optimizing purchase may decrease the incidence of slip progression, especially as the prevalence of obesity increases in the adolescent population.

Study Design: In vitro biomechanical comparison of two methods of pedicle screw placement in cadaveric thoracic spine vertebrae., Objective: Compare the biomechanical integrity of extrapedicular and transpedicular screw fixation under axial and sagittal pullout loads., Summary of Background Data: Extrapedicular screw placement has been advocated as a safe and effective alternative to the transpedicular screw in thoracic vertebrae. Rigorous biomechanical comparison of these two techniques is presently lacking in the literature., Methods: Thirty-seven vertebral bodies were dissected from six cadaveric thoracic spines. Each body had two polyaxial 5.0-mm screws placed: one transpedicular and one extrapedicular. The 62 screws were randomly designated for one of two loading methods: axial or sagittal. Failure load (N), taken as maximum force on the load-deformation curve, and stiffness (N/mm), calculated between 50 N and 400 N, were measured. RESULTS.: Transpedicular screws were statistically stronger in both testing methods (P = 0.008). Load direction, whether axial or sagittal, had no bearing on pullout strength (P = 0.6)., Conclusions: These data indicate that transpedicular screws are biomechanically superior to extrapedicular screws. This difference is small, however, and we think that extrapedicular screws offer an excellent alternative when anatomy dictates their use with other screws in segmental spinal constructs.

Whereas the increase in insulin requirement in late gestation is well described in diabetic pregnancy, a decrease in insulin dosage in the end of the third trimester has also been noted in clinical experience and the prevention of hypoglycaemia is important. Here we report a large decrease (over 50%) in the final few weeks of her two gestations in a woman with type 1 diabetes mellitus.

Alzheimer's disease (AD) is characterized by amyloid-beta peptide (Abeta) deposition in the brain. Abeta is produced by sequential cleavage of amyloid precursor protein (APP) by beta-secretase (BACE1: beta-site APP-cleaving enzyme 1) and gamma-secretase. Previously, we demonstrated that BACE1 also cleaves beta-galactoside alpha2,6-sialyltransferase (ST6Gal-I) and down-regulates its transferase activity. Here, we report that overexpression of ST6Gal-I in Neuro2a cells enhanced alpha2,6-sialylation of endogenous APP and increased the extracellular levels of its metabolites [Abeta by two-fold, soluble APPbeta (sAPPbeta) by three-fold and sAPPalpha by 2.5-fold). Sialylation-deficient mutant (Lec-2) cells secreted half as much Abeta as wild-type Chinese hamster ovary (CHO) cells. Furthermore, wild-type CHO cells showed enhanced secretion of the APP metabolites upon ST6Gal-I overexpression, whereas Lec-2 cells did not, indicating that the secretion enhancement requires sialylation of cellular protein(s). Secretion of metabolites from a mutant APP (APP-Asn467,496Ala) that lacked N-glycosylation sites was not enhanced upon ST6Gal-I overexpression, suggesting that the N-glycans on APP itself are required for the enhanced secretion. In the mouse brain, the amount of alpha2,6-sialylated APP appeared to be correlated with the sAPPbeta level. These results suggest that sialylation of APP promotes its metabolic turnover and could affect the pathology of AD.