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Cervical spine injuries, especially upper cervical, have increased in the elderly [1]. In the elderly, stiffness of the lower cervical spine, caused by degenerative changes and osteopenia, might contribute to upper cervical spine injury, such as odontoid fracture, in response to low energy trauma such as a fall from standing height [2]. Anderson type II odontoid fractures are associated with high rates of mortality in elderly patients regardless of intervention [3]. Teriparatide, for the treatment of osteoporosis, has two types of medications: 1) 20 mg given once daily by self-administration (ForteoR, Eli Lilly and Company, Indianapolis, IN, USA). This medication has been widely used in many countries; 2) 56.5 mg given once weekly, administered by nurse or staff (TeriboneR, Asahi Kasei Pharma, Tokyo, Japan). This once-weeklymedication has been used only in Japan. With intermittent use, teriparatide has an anabolic action on the bone, and the effect of bone turnover markers has been shown to differ between these two medications [4]. Although once-daily injection increases bone formation and bone resorption, once-weekly injection increases bone formation moderately and decreases or maintains bone resorption [4]. The effects of both medications on bone mineral density are similar [4].

Telomere dynamics have been reported extensively as a critical component of cancer, and established evidence exists an important relationship between telomere biology and cancer. Although more than 85% of all carcinomas rely on telomerase activity to maintain stable telomere length, most normal somatic cells are telomerase negative. Therefore, effective methods for specific diagnostic and prognostic utility by telomerase detection have been described, and, to date, ideal targeting telomerase therapy with minimal adverse effects on normal somatic cells have been attempted. In this mini review, we summarize the role of telomeres and telomerase in cancer, clinical use, and targeted telomerase cancer therapies.

New surgical wound closure methods have been developed, and octyl-2- cyanoacrylate has been used for wound closure after surgery. In this study, we compared clinical outcomes for total knee arthroplasty with a new wound closure using cyanoacrylate glue without drain and conventional skin suture procedure with drain. Complications in the group of cyanoacrylate included one case of delayed skin healing. No case of blood transfusion, pulmonary embolism, deep-venous thrombosis, or deep infection existed. Concerning estimated blood loss, the group of cyanoacrylate decreased significantly at the time of post-op; 1 day and post-op, 3 days. This procedure had some benefits for patients and clinical staff.

Vaccination against Streptococcus pneumoniae is recommended for rheumatoid arthritis (RA) patients receiving immunosuppressive treatments. The objective of this study was to evaluate the humoral response to 23-valent pneumococcal polysaccharide vaccination (PPSV23) in RA patients receiving methotrexate (MTX) alone or in combination with a tumor necrosis factor inhibitor, golimumab (GOM). PPSV23 was given to 114 RA patients, who were classified into three groups: RA control (n = 35), MTX alone (n = 55), and GOM + MTX (n = 24). Before and 4 to 6 weeks after vaccination, concentrations of antibodies against pneumococcal serotypes 6B and 23F were measured using an enzyme-linked immunosorbent assay and antibody functionality was determined using a multiplexed opsonophagocytic killing assay, reported as the opsonization index (OI). The IgG concentrations and OIs were both significantly increased in all treatment groups in response to PPSV23 vaccination. In the GOM + MTX group, the IgG responses were lower than those in the MTX alone or control groups, whereas the OI responses were similar to those in the other 2 groups. Furthermore, discrepancies between the IgG and OI responses were found in GOM + MTX group. No severe adverse effect was observed in any treatment groups. OI responses indicate that antibody functionality rather than antibody quantity is important. The similarity of these measurements between all 3 groups suggests that RA patients receiving MTX + GOM still benefit from receiving the PPSV23 vaccination, even though they produce less IgG in response to it. These results can help clinicians to better schedule and evaluate pneumococcal vaccination for RA patients.

Four patients, all males aged 40-64 years, presented with toxoplasmic encephalitis associated with human immunodeficiency virus (HIV) infection manifesting as nonspecific neurological deficits such as epilepsy or hemiparesis. Magnetic resonance imaging showed single or multiple lesions with ring enhancement, mimicking metastatic brain tumor or brain abscess. Marked eosinophilia was noted in three patients. Two patients who received anti-toxoplasma chemotherapy in the early stage had a good outcome. However, the other two patients suffered rapid neurological deterioration and needed decompressive surgery, resulting in a poor outcome. Toxoplasma diffusely infects the whole central nervous system from the early stage. The outcome for patients who needed emergency surgery was poor. Therefore, this rare but increasingly common infectious disease must be considered in the differential diagnosis of a patient with neuroimaging findings similar to those of metastatic tumor or brain abscess. Appropriate chemotherapy should be started immediately after HIV-positive reaction is identified in patients with single or multiple mass lesions with ring enhancement.

We report here a case of an unusual spindle cell tumour of the palm with myofibroblastic differentiation, which was surgically excised. Histologically and immunohistochemically, it was a low-grade myofibroblastic sarcoma. After 25 months follow-up the patient is well and free of recurrence.

A 60-year-old woman had a total hip arthroplasty for arthrosis in 1990, using a dual-bearing hip prosthesis (Omniflex, 52mm outer head, 22mm inner head; Os-teonics, Allendale, New Jersey, USA) with...

Three-dimensional analysis of 220 cadaveric hands to the submacroscopic level was done with clear stereoscopic arteriographs. The superficial palmar arch could be grouped into complete (96.4%) and incomplete (3.6%) arches. The complete arch was divided into four types on the basis of the terminal formation of the deep palmar arch. In the deep palmar arch, the complete arch was seen in 76.9% of the hands. This rate was smaller than that in other reports. The second dorsal metacarpal artery was seen in 92%. With regard to formation of the deep palmar arch, half of all the cases exhibited collateral pathways for the palmar side from the dorsum, sometimes the main arterial source of the deep palmar arch. The blood supply of the thumb comes mainly from the princeps pollicis artery, the terminal branch of the superficial palmar arch, and the first dorsal metacarpal artery, which originates from the radial artery or from different combinations of these arteries. The arteries of the thumb are classified by their anatomic course. The princeps pollicis artery (first palmar metacarpal artery) was absent in 2.4%.

Introduction Patients with rheumatoid arthritis (RA) treated with abatacept (ABT) are at increased risk for vaccine-preventable infections. The aim of the present study is to evaluate the humoral response to 23-valent pneumococcal polysaccharide (PPSV23) vaccination in RA patients receiving ABT. Methods The immunogenicity study was nested within a randomized, double-blind placebo-controlled study, designed to evaluate the efficacy of the PPSV23. PPSV23 was given to 111 RA patients, who were classified into three groups: RA control (n = 35), methotrexate (MTX) alone (n = 55), and ABT (n = 21). Before and 4–6 weeks after vaccination, we measured the patients’ concentrations of antibodies against pneumococcal serotypes 6B and 23F using an enzyme-linked immunosorbent assay and determined their antibody functionality using a multiplexed opsonophagocytic killing assay, reported as the opsonization index (OI). Results The pneumococcal serotype-specific IgG concentrations and OIs were both significantly increased in all treatment groups in response to PPSV23 vaccination. In the ABT group, the IgG responses for the 6B serotype were lower compared with those in the MTX alone or control groups, whereas the OI responses were similar to those in the other two groups. In a subgroup analysis, the pneumococcal serotype-specific IgG responses were significantly lower in both serotypes (6B and 23F) in the ABT/MTX group; however, the OI responses in the ABT group were not different from the control group. There was no association between the pneumococcal serotype-specific IgG and OI responses for the 6B serotype in patients receiving ABT in contrast to the control or MTX alone patients. No severe adverse effects were observed in any of the treatment groups. Conclusions OI responses indicate antibody functionality rather than simply their amount, so the similarity of these measurements between all three groups suggests that RA patients receiving ABT still benefit from receiving the PPSV23 vaccination, even though they produce less IgG in response to it. The results suggest an influence of ABT on the humoral response to PPSV23 vaccination under MTX treatment; however, preserved opsonin responses are expected in RA patients treated with ABT plus MTX. Trial registration University Hospital Medical Information Network Clinical Trials Registry: UMIN000009566. Registered 12 December 2012.