Search

Background: Intramuscular hemangioma (IMH) is an uncommon type of hemangioma, and primary IMH of the intercostal muscle is even rarer. Only a few reports describe IMH of the intercostal muscle, and there are no review articles on this topic. We report our experience with a younger female patient, who underwent video-assisted thoracic surgery with tumor resection and review the previous literatures of intercostal IMH. Case presentation: An asymptomatic 17-year-old woman showed a 29-mm, homogeneous, intrathoracic nodule in the left chest wall, attached to the second and third ribs on computed tomography. We performed exploratory thoracoscopic surgery and the tumor was excised without surrounding rib resection. Histopathologic examination of the surgical specimen revealed proliferation of small blood vessels within the surrounding striated muscle, leading to the diagnosis of intercostal IMH. The surgical margin was negative. The patient's postoperative course was uneventful, and there has been no evidence of recurrence for more than 18 months after surgery. Conclusions: We describe a case of intercostal IMH, who received tumor resection with clear excision margin without surrounding rib resection. Preoperative diagnosis is challenging due to its rarity, but intercostal IMH should be recalled as a differential diagnosis of chest wall tumor. Tumor excision without surrounding rib resection is acceptable for intercostal IMH, when there is a good possibility of achieving negative surgical margin. [ABSTRACT FROM AUTHOR]

Background: Thoracic endometriosis-related pneumothorax is a secondary spontaneous pneumothorax caused by thoracic endometriosis. Diaphragmatic endometriosis is well-studied, but visceral and/or parietal pleural lesions are not. Although surgery is an effective treatment, postoperative recurrence rates are unsatisfactory probably due to inadequate understanding of underlying pathophysiology. We aimed to clarify the clinicopathological features of thoracic endometriosis. Methods: In total, 160 patients who underwent thoracoscopic surgery from a single institution with histopathologically proven thoracic endometriosis from January 2015 to December 2019 were included. Clinicopathological characteristics and surgical outcomes were assessed retrospectively. Results: The cohort median age was 41 (range 22–53) years. Pneumothorax was right-sided in 159 (99.4%) and left-sided in only 1 (0.6%) case. Visceral and parietal pleural lesions were diagnosed in 79 (49.4%) and 71 (44.4%) patients, respectively. In total, 104 visceral pleural lesions and 101 parietal pleural lesions were detected. The S4 region and the dorsal 6th intercostal space contained the largest number of visceral pleural (66 lesions) and parietal pleural lesions (25 lesions), respectively. Histopathological evaluation revealed endometriotic tissues, existing in the outer external elastic layer in all lesions, were localized or invaded deeply. The median follow-up period was 370 (range, 6–1824) days. The Kaplan-Meier method revealed that the 1- and 2-year postoperative recurrence rates were 13.8% and 19.3%, respectively. Conclusions: Visceral pleural endometriotic lesions may be disseminated from the visceral pleural surface and infiltrate into the pleura. Intraoperatively, careful observation of the specific sites, such as the visceral pleura of S4 and the parietal pleura of 6th intercostal space, is important to reduce postoperative recurrence. [ABSTRACT FROM AUTHOR]

Background: A pulmonary arteriovenous malformation is an abnormal dilated blood vessel that makes direct communication between a pulmonary artery and pulmonary vein and can be associated with hypoxemia or neurological complications, including brain abscess and cerebral infarction. Treatment of pulmonary arteriovenous malformation includes surgical resection and transcatheter embolotherapy, however the adaptation of therapies should be considered when a patient is in bad condition.Case Presentation: A 51-year-old man was admitted after developing fever, consciousness disorder, and hypoxemia. Magnetic resonance imaging of the brain showed a brain abscess. Bilateral pulmonary arteriovenous malformations were found by contrast computed tomography. Because of a family history of pulmonary arteriovenous malformation, a history of epistaxis, and the existence of oral mucosa telangiectasia, he was diagnosed with hereditary hemorrhagic telangiectasia and brain abscess caused by intrapulmonary right-to-left shunt. The brain abscess improved with antibiotic treatment; however, the administration of oxygen did not ameliorate his hypoxemia. His hypoxemia was exacerbated by positive pressure ventilation. Considering his systemic and respiratory condition, we considered surgery to involve a high degree of risk. After controlling his brain abscess and pneumonia, transcatheter embolotherapy was performed. This improved his systemic condition, enabling surgical treatment.Conclusions: This middle-aged patient suffering from brain abscess and severe hypoxemia with multiple pulmonary arteriovenous malformations was successfully treated by a combination of transcatheter embolotherapy and surgery. The adaptation and combination of therapies, as well as the sequence of treatments, should be considered depending on the patient status and lesions. [ABSTRACT FROM AUTHOR]

Abstract: The p-type (Bi0.25Sb0.75)2Te3 and n-type Bi2(Te0.94Se0.06)3 ingots were prepared by cooling at various cooling rates C after melting so that they have an intermediate state between the polycrystalline and Bridgman ingots which lowers their thermal conductivity κ, where C was changed from 0.10 to 2375K/min in an evacuated glass tube. When the ingots were cooled at C =0.50K/min under the uniaxial temperature gradient of 5K/cm, it was observed that the c axis of some grains points to the freezing direction. The electrical resistivity ρ, Seebeck coefficient α and κ of ingots were measured at 298K along the freezing direction, so that ρ and κ at C =0.50 K/min were lower by 20–30% and 9% than those of the corresponding Bridgman ingots. The thermoelectric figure of merits ZT(=α2 T/ρκ) estimated for the p- and n-type ingots then reached high values of 1.27 and 1.25 at 298K, respectively. [Copyright &y& Elsevier]

A systematic review of randomized controlled clinical trials of nonsteroidal antiinflammatory drugs (NSAIDs) in rheumatoid arthritis (RA) patients was conducted to evaluate the risk of NSAID-induced adverse reactions. Double-blind, randomized, controlled trials with 6-week treatments for RA patients were included in the study. The endpoints for the analysis included any adverse reactions, digestive adverse reactions, and upper gastrointestinal (GI) adverse reactions. A fixed-effect model was used for estimation of the risk. Time-to-event analysis of the incidence of adverse reactions was also conducted. A total of 28 trials was included for the analysis, and a total of 30 NSAIDs were used in the trials. The proportion of patients who experienced any adverse reaction was as follows: piroxicam 18.9% (3 trials), diclofenac 18.8% (4 trials), indomethacin 22.1% (14 trials), and aspirin 25.0% (4 trials). The proportion of patients who experienced digestive adverse reactions was as follows: piroxicam 10.2%, diclofenac 10.6%, indomethacin 13.1%, and aspirin 14.1%. Most withdrawals due to adverse reaction occurred during the first 3 weeks after administration of the NSAID. Although the risk of NSAID-induced adverse reaction was different from drug to drug, the risk of adverse reaction was clinically significant. [ABSTRACT FROM AUTHOR]

Background: Giant cervicomediastinal goiter extending to the bifurcation of the trachea mostly requires median sternotomy in addition to a cervical collar incision for resection. Sternotomy provides a good operative field, although it is one of the most invasive thoracic approaches. We herein report a case of giant cervicomediastinal goiter resected by a less-invasive and highly effective method with a thoracoscopic and cervical approach. Case presentation: A 71-year-old Japanese woman with giant cervicomediastinal goiter extending to the bifurcation of the trachea was introduced and admitted to our hospital with dyspnea. Chest computed tomography showed tumor-induced airway narrowing due to the giant goiter of the right side of the thyroid lobe. We safely performed resection of the giant goiter through a cervical collar incision and thoracoscopic approach, and this combined approach contributed to the early discharge of the patient from the hospital. Conclusion: A combined approach of cervical collar incision and thoracoscopy is useful for resection of giant goiter. [ABSTRACT FROM AUTHOR]

The local Seebeck coefficient α L and the resultant Seebeck coefficient α R of M/Bi0.88Sb0.12/M (M = Cu and Ni) composites with different thicknesses tBi–Sb of Bi–Sb alloy were measured as functions of z and T, where T is the absolute temperature, z is the distance from a center of Bi–Sb alloy to the middle point of two probes and α L and α R were measured using two probes separated by s=1.0 mm and s= tBi−Sb+0.1 mm, respectively. As a result, α L was enhanced extremely at the position of 0.2–0.3 mm away from the interfaces, while the local temperature along a composite varies linearly with changes in z within Bi–Sb alloy. The local maximum of α R at 344 K appeared at tBi−Sb≈0.9 mm, so that it is expected to increase up to −167 μV/K at tBi−Sb=0.87 mm from the expression fitted well to the experimental data, which is 2.1 times as large as the intrinsic α at 344 K of Bi–Sb alloy. Such a local enhancement in α L would probably be caused by a temperature gradient across the depletion layer formed at the interface. The thermoelectric figure of merit ZT of a composite with an optimum tBi−Sb of 0.87 mm is expected to reach the large value of 0.98 at 344 K, which corresponds to 4.5 times as high a value as ZT=0.22 at 344 K of Bi–Sb alloy. It is thus considered that the increase in α L at the interface is available as a useful mean of further increase in ZT of thermoelectric devices. [ABSTRACT FROM AUTHOR]

Abstract: It was reported recently by us that the energy conversion efficiency η ATG of thermoelectric (TE) generators working under the alternating temperature gradient (ATG) produced by switching at an optimum period of τ =120 or 240s is several times higher than η STG of them operating under the steady temperature gradient (STG), where the generators are sandwiched between two Peltier modules. However, the reason for η ATG > η STG has not yet been explained explicitly. In order to clarify the relation between the optimum τ and η ATG or η ATG/η STG in the wide range of τ, long p- and n-type Cu/Bi–Te/Cu composites with t Bi–Te =4.0mm and t Cu =5.0mm were fabricated so that they have an optimum τ longer than the previous periods. The maxima η ATG of the p- and n-type composites were 0.073% at τ =960s and 0.057% at τ =480s, respectively, and their η ATG/η STG were approximately 1.4. Owing to this experimental result, η ATG/η STG is related closely to the thermal diffusion time τ D of a composite or a generator, so that η ATG and η ATG/η STG were found to be in inverse proportion to τ D. The reason for this low η ATG results from the high external resistance and the long τ caused by a thick t Bi–Te, in addition to too fat Bi–Te sample giving the high thermal conductance. The maximum η ATG was also found to be expressed successfully by a theoretical expression. [Copyright &y& Elsevier]

The resultant local Seebeck coefficient α R (= α S− α T) at the interface of a thermoelement has not yet been measured, although it is an important factor governing the thermoelectric efficiency, where α S is the local Seebeck coefficient and α T is the one caused by the Thomson effect. It is shown in this paper that α S, α T, and α R of the p- and n-type Cu/Bi–Te/Cu composites are obtained analytically and experimentally on the assumption that the local temperature of the composite on which the temperature difference Δ T is imposed varies linearly with changes in position along the composite. They were indeed estimated as a function of position from the local experimental data of R,Δ I,Δ T, and V generated by applying an additional current of ± I to the composite, where R is the electrical resistance and Δ I is a current generated by the composite. As a result, it was found that the absolute values of α S at the hot interface of the p- and n-type composites are approximately 1.5 and 1.4 times higher than their lowest values in the middle region of the composite, respectively, while those of α T are less than 8% of α S all over the composite and are so small that the relation α R≈ α S can be held. We thus succeeded in measuring α R at the interfaces of the composite. [ABSTRACT FROM AUTHOR]

Abstract: The thermo-emf ΔV and current ΔI generated by imposing the alternating temperature gradients (ATG) at a period of T and the steady temperature gradient (STG) on a thermoelectric (TE) composite were measured as a function of t, where t is the lapsed time and T was varied from 60 to or ∞s. The STG and ATG were produced by imposing steadily and alternatively a source voltage V in the range from 1.0 to 4.0V on two Peltier modules sandwiching a composite. ΔT, ΔV, ΔI and V P oscillate at a period T and their waveforms vary significantly with a change of T, where ΔV and V P are the voltage drops in a load resistance R L and in resistance R P of two modules. The resultant Seebeck coefficient |α|=|ΔV|/ΔT of a composite under the STG was found to be expressed as |α|=|α 0|(1− R comp/R T), where R T is the total resistance of a circuit for measuring the output signals and R comp is the resistance of a composite. The effective generating power ΔW eff has a local maximum at T =960s for the p-type composite and at T =480s for the n-type one. The maximum energy conversion efficiency η of the p- and n-type composites under the ATG produced by imposing a voltage of 4.0V at an optimum period were 0.22 and 0.23% at ΔT eff =50K, respectively, which are 42 and 43% higher than those at ΔT =42K under the STG. These maximum η for a TE composite sandwiched between two Peltier modules, were found to be expressed theoretically in terms of R P, R T, R L, α P and α, where α P and α are the resultant Seebeck coefficients of Peltier modules and a TE composite. [Copyright &y& Elsevier]

The thermo-emf Δ V of the touching p- and n-type Cu/Bi-Te/Cu composites with different thicknesses of t Bi-Te and t Cu was measured as a function of time by alternating the temperature difference Δ T at periods of T = 20, 60, 120, 240 and ∞ sec, where t Bi-Te was varied from 0.1 to 2.0 mm and t Cu from 0 to 4.0 mm. As a result, Δ V changes significantly with t Bi-Te, t Cu and T. The effective thermo-emf Δ V eff increases significantly with an increase of 1/ T and exhibited a local maximum at 1/ T = 1/240 s−1. The resultant | α | and the effective temperature difference Δ T eff were increased significantly by optimizing t Bi-Te and t Cu at 1/ T = 1/240 s−1. The power generation Δ W eff (= Δ V /4 R calc) estimated using the measured Δ V eff and calculated R calc also exhibited a local maximum at 1/240 s−1 for an optimum combination of t Bi-Te = 0.1 mm and t Cu = 2.0 mm, so that the maxima Δ W eff at 1/ T = 1/240 s−1 for the p- and n-type composites were 2.28 and 2.92 times higher than those obtained at 1/ T = 0 s−1. This significant increase in Δ W eff is owing to both the increase in Δ T eff and the increase in ZT due to the increase in |α|. The power generation was thus found to be enhanced significantly by imposing the alternating temperature gradients on touching Cu/Bi-Te/Cu composites. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop and evaluate a novel strategy for establishing a deep learning‐based gamma passing rate (GPR) prediction model for volumetric modulated arc therapy (VMAT) using dummy target plan data, one measurement process, and a multicriteria prediction method. Methods: A total of 147 VMAT plans were used for the training set (two sets of 48 dummy target plans) and test set (51 clinical target plans). The dummy plans were measured using a diode array detector. We developed an original convolutional neural network that accepts coronal and sagittal dose distributions to predict the GPRs of 36 pairs of gamma criteria from 0.5%/0.5 mm to 3%/3 mm. Sixfold cross‐validation and model averaging were performed, and the mean training result and mean test result were derived from six trained models that were produced during cross‐validation. Results: Strong or moderate correlations were observed between the measured and predicted GPRs in all criteria. The mean absolute errors and root mean squared errors of the test set (clinical target plan) were 0.63 and 1.11 in 3%/3 mm, 1.16 and 1.73 in 3%/2 mm, 1.96 and 2.66 in 2%/2 mm, 5.00 and 6.35 in 1%/1 mm, and 5.42 and 6.78 in 0.5%/1 mm, respectively. The Pearson correlation coefficients were 0.80 in the training set and 0.68 in the test set at the 0.5%/1 mm criterion. Conclusion: Our results suggest that the training of the deep learning‐based quality assurance model can be performed using a dummy target plan. [ABSTRACT FROM AUTHOR]

Background: Shoulder and elbow examinations for pitchers have been performed in Japan's National High School Baseball Invitational Tournaments (NHSBITs) and National High School Baseball Championships (NHSBCs) since 1993. However, for years the results have not been analyzed. The purpose of this study was to evaluate changes in the condition of shoulders and/or elbows of pitchers from 1993 to 2016.Materials and Methods: Pitchers in NHSBITs and NHSBCs, 1994-2016, were examined together with those who received a trial examination (Trial) in the NHSBC 1993. Shoulder and elbow symptoms were comprehensively graded into five categories; none, mild, moderate, severe and dysfunction. Standard plain radiographs of the shoulder and elbow were obtained. Average Annual Percent Changes (AAPCs) in the percentages of pitchers with symptoms and positive radiographic findings were analyzed.Results: The percentages of pitchers with moderate or worse symptoms in the shoulder or elbow were 14.6% and 13.8%, respectively, in the Trial, 1.1% and 1.1% in NHSBITs and 1.3% and 2.0% in NHSBCs. The AAPC of pitchers with a symptomatic shoulder in NHSBITs was reduced over the study period, at -3.36% (P < 0.05), but that in NHSBCs was unchanged at -1.01%. The AAPCs of pitchers with a symptomatic elbow in NHSBITs and in NHSBCs decreased, at -3.13% and -3.33%, respectively (P < 0.05), while that of pitchers with residual apophyseal fragmentation at the ulnar collateral ligament insertion increased at +2.79% (P < 0.05). The decreased percentages of symptomatic pitchers suggest that joint condition is well controlled in high school days; however, the increased frequency of radiographic findings suggests the necessity of protection against overuse in younger players.Conclusions: The percentages of pitchers with symptomatic shoulders and elbows in NHSBITs and those with symptomatic elbows in NHSBCs have decreased over the 23 years. However, the increased frequency of residual medial humeral epicondyle apophyseopathy should be noted. [ABSTRACT FROM AUTHOR]

To evaluate the advantages of combination of two advanced electron microscopic technologies such as serial block-face scanning electron microscopy and double-axis electron beam tomography, we analyzed the three-dimensional morphology of cellular relationships between dendritic and plasma cells in the synovial membrane from patients with rheumatoid arthritis, using the combined approach. [ABSTRACT FROM PUBLISHER]

Objective. To examine the views of rheumatology physicians concerning clinical practice guidelines in Japan, and changes to them following the dissemination of new guidelines for rheumatoid arthritis (RA) in 2004. [ABSTRACT FROM PUBLISHER]

The article presents a study on the effects of Osteopontin (OPN) on the interactions between fibroblast-like synoviocytes (FLS) and B lymphocytes in rheumatoid arthritis (RA). It is stated that OPN supports bone resorption and assists in the migration of macrophages. It notes that the study analyzed the OPN expression and its effects on B cell adhesion to FLS. It also mentions that the study found the expression of 75-kd OPN by RA FLS, which affected FLS-B cell interactions.

Abstract: In order to overcome disadvantages of the DIA type press in squeezing the Kawai-cell, such as uneven compression between the upper and lower anvils and the four surrounding anvils and frictional loss of applied load in the guide block, we have developed a new 6-axis apparatus in which the movements of the six anvils are controlled by a servo mechanism. It is possible to keep the Kawai-cell cubic within an accuracy of ±2μm during compression and decompression. Pressure generation using sintered diamond cubic anvils with edge length of 14.0mm and a truncation of 1.5mm has been carried out up to ca. 60GPa by measuring electrical resistance of GaP, Zr, and Fe2O3. The results are compared with our previous calibration, carried out using an almost the same sample setup for identical anvils at SPring-8, by means of in situ X-ray observation. It is demonstrated that a significant amount of the applied load is lost by friction when the Kawai-cell is squeezed in the DIA type press. The load loss increases with increasing load, or pressure, and amounts to 45% at ca. 60GPa. Therefore the 6-axis apparatus is very advantageous to generate higher pressures in the Kawai-cell. However, individual control of the anvils sometimes induces a runaway advancement of the anvils which brings about an abrupt increase of pressure. [Copyright &y& Elsevier]

Adiponectin is a hormone released by adipose tissue with antidiabetic, antiatherogenic, and anti-inflammatory properties. The present observational study focused on the relation between serum adiponectin level and the disease severity of established rheumatoid arthritis (RA). Ninety patients with more than 5-year diagnosis of RA and 42 age- and BMI-matched control were enrolled. The severity of RA was evaluated according to the number of destructed joints of overall 68 joints on plain radiographs (37 patients had mild RA and 53 had severe RA). Serum adiponectin level was significantly higher in the severe RA group (17.7 ± 6.7 μg/ml) than in the control (9.1 ± 3.8 μg/ml) and mild RA groups (13.9 ± 6.5 μg/ml) (control vs. mild RA group, P < 0.001; mild RA vs. severe RA group, P < 0.01). These results suggest that increased number of joint destruction is associated with hyperadiponectinemia in established RA patients. [ABSTRACT FROM AUTHOR]

Abstract: Adiponectin (APN) is a hormone released by adipose tissue with anti-inflammatory properties. The purpose of this study was to examine the therapeutic effects of systemic delivery of APN in murine arthritis model. Collagen-induced arthritis (CIA) was induced in male DBA1/J mice, and adenoviral vectors encoding human APN (Ad-APN) or beta-galactosidase (Ad-β-gal) as control were injected either before or during arthritis progression. Systemic APN delivery at both time points significantly decreased clinical disease activity scores of CIA. In addition, APN treatment before arthritis progression significantly decreased histological scores of inflammation and cartilage damage, bone erosion, and mRNA levels of pro-inflammatory cytokines in the joints, without altering serum anti-collagen antibodies levels. Immunohistochemical staining showed significant inhibition of complement C1q and C3 deposition in the joints of Ad-APN infected CIA mice. These results provide novel evidence that systemic APN delivery prevents inflammation and joint destruction in murine arthritis model. [Copyright &y& Elsevier]

To examine the clinical features of vertebral and non-vertebral fractures in patients with rheumatoid arthritis (RA), including insufficiency fractures, and to assess the risk factors for fracture, we prospectively studied 209 outpatients with rheumatoid arthritis for 1 year. The age, gender, Steinbrocker’s functional class, glucocorticoid use, history of lower limb surgery, serum C-reactive protein (CRP), and use of bisphosphonates were evaluated. Examination for fractures was performed by radiography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scanning. Thirty-three fractures occurred in 24 patients over the 1-year study period, and the incidence was 15.8 fractures per 100 patient-years. Fractures occurred at various sites. The majority (70%) was insufficiency fracture, and more than 50% caused ambulatory dysfunction. Radiographic findings were absent in 39% of the fractures at the onset of pain. The functional class and glucocorticoid dose were significantly associated with fracture development. This prospective study showed that the incidence of fractures, especially insufficiency fractures, was very high in patients with rheumatoid arthritis and that most of their fractures caused gait disturbance. Early intervention to prevent secondary osteoporosis is recommended to maintain the quality of life in patients with rheumatoid arthritis, especially those with functional impairment or undergoing glucocorticoid therapy. [ABSTRACT FROM AUTHOR]

The article presents a study which determined the change in metabolic activity of chondrocytes in osteoarthritic (OA) cartilage, considering regional difference and degree of cartilage degeneration. The study separated the OA cartilage samples obtained from knee joints with end-stage OA into superficial, middle, and deep zones using laser capture microdissection. It was found that in OA cartilage, gene expression changed markedly with the site.

A new method for fluoroscopic tracking of a proximal bone fragment in femoral fracture reduction is presented. The proposed method combines 2-D and 3-D image registration from single-view fluoroscopy with tracking of the head center position of the proximal femoral fragment to improve the accuracy of fluoroscopic registration without the need for repeated manual adjustment of the C-arm as required in stereo-view registrations. Kinematic knowledge of the hip joint, which has a positional correspondence with the femoral head center and the pelvis acetabular center, allows the position of the femoral fragment to be determined from pelvis tracking. The stability of the proposed method with respect to fluoroscopic image noise and the desired continuity of the fracture reduction operation is demonstrated, and the accuracy of tracking is shown to be superior to that achievable by single-view image registration, particularly in depth translation. [ABSTRACT FROM AUTHOR]

The effect of celecoxib, a selective cyclooxygenase-2 inhibitor, on juxta-articular osteopenia and growth plate destruction adjacent to inflamed joints was investigated in rats with collagen-induced arthritis. Forty rats were assigned to the following six groups: (1) an untreated arthritis group; (2–5) arthritis rats receiving indomethacin (3 mg/kg per day), dexamethasone (0.2 mg/kg per day), or celecoxib (5 or 50 mg/kg per day), and (6) normal control rats. Drugs were administered for 2 weeks from the onset of arthritis. Then the hind paws were measured. Juxta-articular osteopenia and growth plate destruction adjacent to inflamed joints were also assessed using plain radiography, bone mineral density measurement, histology, and histomorphometry. Each treatment reduced inflammation, but only dexamethasone and high-dose celecoxib prevented bone loss adjacent to inflamed joints and significantly decreased bone resorption. In contrast, no treatment affected bone formation parameters. Growth plate destruction adjacent to inflamed joints was prevented by indomethacin, dexamethasone, and high-dose celecoxib. Although dexamethasone abolished inflammation, growth plate destruction was still observed. In conclusion, among the various drugs tested, only celecoxib had a preventive effect on both growth plate destruction and bone loss adjacent to inflamed joints in this arthritis model. [ABSTRACT FROM AUTHOR]

In articular chondrocytes, the inflammatory cytokine tumor necrosis factor-α (TNF-α) induces the expression of bone morphogenetic protein-2 (BMP-2), a growth factor known to be involved in the induction of cartilage and bone. A study was performed to clarify the mechanism(s) underlying the induction of BMP-2 in chondrogenic ATDC5 cells and primary cultured adult human articular chondrocytes. In ATDC5 cells, the endogenous BMP-2 expression was consistently low throughout the process of chondrogenic differentiation, and TNF-α induced BMP-2 expression only after the cells acquired the chondrogenic phenotype. The results of nuclear run-off assay and cycloheximide treatment consistently indicated that ATDC5 cells acquire the capacity to synthesize BMP-2 mRNA in the nuclei during the differentiation process. In an attempt to explain the discrepancy between the active nuclear mRNA synthesis and the observed low expression level in differentiated ATDC5 cells, the stability of BMP-2 mRNA was evaluated, and the cells were found to regulate the expression of BMP-2 at the post-transcriptional level. Human chondrocytes were confirmed to have a similar post-transcriptional regulation. The result of 3′-rapid amplification of cDNA end revealed that both human and mouse BMP-2 mRNAs contain multiple pentameric AUUUA motifs in a conserved manner in the 3′-untranslated regions, and transient transfection experiments demonstrated that TNF-α increases the stability of BMP-2 mRNA through the pentameric motifs. Further experiments revealed that TNF-α modulates mRNA stability via p38 signal transduction pathway, whereas the cytokine also augmented the expression of BMP-2 through transcriptional up-regulation via the transcriptional factor NF-κB. [ABSTRACT FROM AUTHOR]

Aim: To clarify the efficacy of infliximab (INF) for active rheumatoid arthritis (RA) in Japan by nationwide postmarketing surveillance (PMS) data. Method: The data of 5000 cases with active RA, despite treatment with methotrexate, were collected to Tanabe Seiyaku Co., Ltd and all of these were analysed in detail for efficacy and adverse reactions. Overall efficacy was evaluated by physicians to three grades: markedly improved, improved and unchanged. Results: Overall efficacy was 34.0% markedly improved, 57.6% improved and 8.4% unchanged at 22 weeks after INF therapy, respectively. Overall of adverse reactions were 28.0% and serious adverse reactions were 6.2%. Conclusion: Iinfliximab was proven to be very effective and safe by nationwide PMS data in Japan. Longer observation is needed for further evaluation of INF therapy, especially efficacy forpreventing joint damage. [ABSTRACT FROM AUTHOR]

To assess adrenal function with respect to the presence or absence of steroid therapy, we investigated differences in the blood levels of adrenocorticotropic hormone (ACTH) and dehydroepiandrosterone sulfate (DHEAS) in relation to steroid (prednisolone) administration in 123 patients with rheumatoid arthritis (RA). Levels of ACTH and DHEAS were significantly lower in the steroid-treated group than in the non-treated group (ACTH: 11.79 pg/ml vs 27.92 pg/ml) (DHEAS: 418.12 ng/ml vs 883.91 ng/ml) ( P < 0.0001). We observed no steroid dose-related differences in ACTH levels. However, DHEAS levels showed a slight decrease at a prednisolone dose of 2.5 mg/day, with a significant decrease being observed at a dose of 5 mg/day when statistical adjustments were made for age and sex ( P < 0.0001). At doses of 7.5 mg/day or greater, DHEAS levels were significantly lower than those for 5 mg/day ( P < 0.0006). These results suggest that low-dose prednisolone reduces adrenal function in patients with RA. We recommend that doses of prednisolone should be limited to 5 mg/day or less in consideration of adrenal function when treating RA patients. The measurement of ACTH and DHEAS may be useful for evaluating adrenal function in patients with RA. [ABSTRACT FROM AUTHOR]

The effects of growth and differentiation factor-5 (GDF-5) on ligament healing were studied using a gap injury model of the medial collateral ligament in rat knee joints. The administration of GDF-5 once at the time of surgery significantly improved the mechanical properties of the femur-ligament-tibia complex. At 3 weeks after surgery, 30 µg of GDF-5 improved the ultimate tensile strength of the complex by 41%, and the stiffness by 60%, compared with the vehicle control ( p < 0.05 for both; Fisher's PLSD test). The observation with a transmission electron microscopy revealed that GDF-5 increased the diameter of collagen fibrils in the repair tissue, which was considered to be a possible mechanism for the positive result in the biomechanical testing. Quantitative PCR and in situ hybridization revealed enhanced type I procollagen expression by GDF-5, and the PCR analysis also revealed that the GDF-5 treatment reduced the expression of type III procollagen relative to type I procollagen. The PCR analysis further showed that the expression of decorin and fibromodulin was relatively reduced against type I procollagen by the growth factor, which was considered to be responsible for the increase of collagen fibril diameter in the repair tissue. No adverse effects were observed, and the use of GDF-5 was considered a promising approach to facilitate ligament healing. © 2005 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [ABSTRACT FROM AUTHOR]

It has been reported that nurse-like cells (NLCs) play a critical role in the pathogenesis of rheumatoid arthritis (RA). The interaction between NLCs established from RA patients (RA-NLCs), and freshly isolated blood monocytes was analyzed to further elucidate the pathogenesis of RA. RA-NLC lines were established from the synovium of RA patients. The RA-NLCs were cultured with monocytes freshly isolated from peripheral blood of healthy donors, and induction of interleukin (IL)-6 and IL-8 as well as the mRNA expression of these cytokines was examined. The levels of IL-6 were over 400 times higher in the supernatant from coculture of RA-NLCs and monocytes than in those from cultures of RA-NLCs alone. Anti-tumor necrosis factor (TNF)-α monoclonal antibody inhibited the induction of both cytokine in a dose-dependent fashion, although there was no detectable level of TNF-α in the supernatant from coculture. In addition, coculture of RA-NLCs and monocytes without direct cell contact did not induce cytokine production. To determine IL-6 producing cells, RA-NLCs and monocytes were separated into each fraction after coculture for 24 h. Cocultured RA-NLCs contained approximately 80 times higher IL-6 mRNA than the RA-NLCs cultured alone. The levels of IL-8 were also much higher (about 900 times) in the supernatant from coculture than in those from cultures of RA-NLCs alone. Cocultured RA-NLCs expressed IL-8 mRNA about 620 times higher than those cultured alone. These results indicate that NLCs produce high levels of IL-6 and IL-8 after cell–cell interaction with monocytes/macrophages via membrane-bound TNF-α, and that activation of NLCs by monocytes/macrophages may be involved in the pathogenesis of RA through maintenance of synovial inflammation. [ABSTRACT FROM AUTHOR]

Abstract: We have developed a four-dimensional (4D) model of the lower extremities after total hip arthroplasty in patients. The model can aid in preventing complications such as dislocation and wearing of the sliding surface. The skeletal structure and implant alignment were obtained from CT data. We applied registration method using CAD data to estimate accurate implant alignment from scattered CT data. The reconstructed three-dimensional (3D) skeletal model was combined with motion capture data that were acquired by an optical tracking system. We displayed the patient''s skeletal movement and analyzed several parameters that relate to complications. The patient''s skeletal model was superimposed onto video footage that was taken by a synchronized and calibrated digital video camera. For validation of the measurement error in this system, we used open MRI to evaluate the relative movement between skin markers and bones. This system visually represents not only the 3D anatomical structure, but also 4D dynamic functions that include the time sequential transitions of components and their positions. The open MRI results indicated that the average error in hip angle was within 5° for each static posture. This system enables clinicians to analyze patient''s motions on the basis of individual differences. We found that our system was an effective tool in providing precise guidance of daily postoperative motions that was individualized for each patient. This system will be applicable for surgical planning, assessment of postoperative activities, and the development of new surgical techniques, materials, and prosthetic designs. [Copyright &y& Elsevier]

Abstract: This study represents a new attempt to non-invasively analyze three-dimensional motions of the wrist in vivo. A volume-based registration method using magnetic resonance imaging (MRI) was developed to avoid radiation exposure. The primary aim was to evaluate the accuracy of volume-based registration and compare it with surface-based registration. The secondary aim was to evaluate contributions of the scaphoid and lunate to global wrist motion during flexion–extension motion (FEM), radio-ulnar deviation (RUD) and radial-extension/ulnoflexion, “dart-throwing” motion (DTM) in the right wrists of 12 healthy volunteers. Volume-based registration displayed a mean rotation error of 1.29°±1.03° and a mean translation error of 0.21±0.25mm and was significantly more accurate than surface-based registration in rotation. Different patterns of contribution of the scaphoid and lunate were identified for FEM, RUD, and DTM. The scaphoid contributes predominantly in the radiocarpal joint during FEM, in the midcarpal joint during RUD and almost equally between these joints during DTM. The lunate contributes almost equally in both joints during FEM and predominantly in the midcarpal joint during RUD and DTM. [Copyright &y& Elsevier]

The purpose of this study was to visualise the locus of the dynamic loading axis on the knee joint, and to evaluate changes in this locus during gait after high tibial osteotomy (HTO) in three patients who underwent HTO for medial compartment osteoarthritis (OA) of a varus knee. The bone structure of the lower limb and the relative position of skin markers were acquired from CT images. Motion capture data was acquired using spherical skin markers. Skeletal model movement during gait was calculated based on the movement of the markers. The locus of the dynamic loading axis on the knee joint was defined as the point on the proximal tibia joint surface that intersected with the loading axis of the lower limb, which passed through the centre of the femoral head and the centroid of multiple points surrounded by the distal tibia joint surface contour. This system was able to visualise the locus of the dynamic loading axis on the knee joint and not only lateral but also anterior–posterior direction movement. After HTO, the locus shifted from a medial and posterior area of the medial joint edge of the knee to a central area of the knee joint surface. This indicates that HTO shifted the dynamic loading axis. Lateral movement of the dynamic loading axis in the early stance phase of gait was reduced within a year after HTO. [Copyright &y& Elsevier]

Registration is a critical and important process in maintaining the accuracy of CT-based image-guided surgery. The aim of this study was to evaluate the effects of the area of intraoperative data sampling and number of sampling points on the accuracy of surface-based registration in a CT-based spinal-navigation system, using an optical three-dimensional localizer. A cadaveric dry-bone phantom of the lumbar spine was used. To evaluate registration accuracy, three alumina ceramic balls were attached to the anterior and lateral aspects of the vertebral body. CT images of the phantom were obtained (1-mm slice thickness, at1-mm intervals) using a helical CT scanner. Twenty surface points were digitized from five zones defined on the basis of anatomical classification on the posterior aspects of the target vertebra. A total of 20 sets of sampling data were obtained. Evaluation of registration accuracy accounted for positional and rotational errors. Of the five zones, the area that was the largest and easiest to expose surgically and to digitize surface points was the lamina. The lamina was defined as standard zone. On this zone, the effect of the number of sampling points on the positional and rotational accuracy of registration was evaluated. And the effects of the additional area selected for intraoperative data sampling on the registration accuracy were evaluated. Using 20 surface points on the posterior side of the lamina, positional error was 0.96 mm±0.24 mm root-mean-square (RMS) and rotational error was 0.91°±0.38°RMS. The use of 20 surface points on the lamina usually allows surgeons to carry out sufficiently accurate registration to conduct computer-aided spine surgery. In the case of severe spondylosis, however, it might be difficult to digitize the surface points from the lamina, due to a hypertrophic facet joint or the deformity of the lamina and noisy sampling data. In such cases, registration accuracy can be improved by combining use of the 20 surface points on the lamina with surface points on other zones, such as on the both sides of the spinous process. [ABSTRACT FROM AUTHOR]

The purpose of this study was (1) to demonstrate a computer-assisted gait analysis system that can visualize the locus of the dynamic loading axis on the proximal tibia joint surface, and (2) to assess the accuracy of this system in a patient with bilateral knee osteoarthritis (OA). This system uses force plate data, CT skeletal structure data and motion capture data obtained from an infrared position sensor. The relative positions between bones and markers were used to calculate skeletal model movement based on movement of the markers. The locus of the dynamic loading axis on the knee joint was defined as the point on the proximal tibia joint surface that intersected with the loading axis of the lower limb, which passed through the centre of the femoral head and the centroid of multiple points surrounded by the distal tibia joint surface contour. To assess the accuracy of this system, open MRI was used to evaluate positions of skin markers against bones in six healthy volunteers. The locus in a patient was affected by differences between the varus knee with medial compartment OA on the non-operative side and the knee treated with high tibial osteotomy (HTO) on the opposite side. At knee flexion angles of 0°, 15° and 30°, the mean value of measurement error for point locations on the locus was within 5.6% of joint width in the lateral direction (JWLD) on the proximal tibia joint. This system can provide clinically useful information for evaluation of the dynamic loading axis on the knee joint surface. [Copyright &y& Elsevier]

The purposes of this study were to clarify the effects of rotation on two-dimensional measurement of lower limb alignment for knee osteotomy using a three-dimensional method and to determine whether this 3-D simulation method could help with planning of knee osteotomy. We developed computer software to calculate femorotibial angle (FTA) and hip–knee–ankle angle (HKA) and simulate knee osteotomy from a CT-based 3-D bone model of the lower limb. Lower limb rotation on anteroposterior long-standing radiographs was measured by superimposing the 3-D bone models. Changes in alignment with limb rotation were calculated using the software. FTA after virtual closed-wedged osteotomy was measured for a hypothetical case of a rotation error of the osteotomy plane in reattaching the proximal cutting surface to the distal cutting surface. For 31 varus knees in 20 patients with medial compartment arthritis, the mean rotation angle, relative to the epicondylar axis, with variable limb position was 7.4 ± 3.9° of internal rotation (mean ± SD), ranging from 8° of external rotation to 14° of internal rotation; the mean changes in FTA and HKA were 3.5 ± 2.2° (range, 0.4–8.6) and 1.6 ± 1.3° (range, 0.2–4.9), respectively. The FTA “flexion angle” (lateral view alignment from neutral AP) and the absolute HKA “flexion angle” correlated with the change in FTA and HKA with limb rotation, respectively (FTA, R=0.999; HKA, R=0.993). The mean change in FTA after virtual closed-wedged osteotomy was 3.2° for internal and external 10° rotation errors in reattaching the osteotomy plane. Rotation may affect measurement of lower limb alignment for knee osteotomy, and 3-D methods are preferable for surgical planning. [Copyright &y& Elsevier]

Background: Opening-wedge high tibial osteotomy by hemicallotasis for osteoarthritis in the medial compartment of the knee requires external fixation for a long time, until callus maturation is complete. The aim of this study was to determine if low-intensity pulsed ultrasound would accelerate callus maturation when applied after distraction to limbs treated with opening-wedge high tibial osteotomy by hemicallotasis.Methods: Twenty-one patients with symmetric grades of osteoarthritis and similar degrees of varus deformity in the two knees underwent bilateral one-stage opening-wedge high tibial osteotomy by hemicallotasis. After completion of distraction, the bone mineral density of the distraction callus was measured. Then, one randomly selected limb was subjected to ultrasound treatment for twenty minutes daily until removal of the external fixator. The contralateral limb was left untreated to serve as the control. After four weeks of treatment, bone mineral density was measured again.Results: During the four-week treatment period, the mean increase in callus bone mineral density was significantly greater in the ultrasound-treated tibiae (0.20 +/- 0.12 g/cm(2)) than in the control tibiae (0.13 +/- 0.10 g/cm(2)) (p = 0.02, unpaired t test). In eighteen patients the increase in the bone mineral density was greater in the ultrasound-treated limb than in the control limb, whereas in three patients the increase was greater in the control limb.Conclusions: We found that low-intensity pulsed ultrasound applied during the consolidation phase of distraction osteogenesis accelerates callus maturation after opening-wedge high tibial osteotomy by hemicallotasis in elderly patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to clarify differences in tendon graft-to-bone tunnel healing between bone-attached tendon grafts with interference-screw fixation and bone-free tendon grafts with extra-articular suture fixation. In 42 Japanese White rabbits, anterior half replacement of the medial collateral ligament was performed using half of the ipsilateral patellar tendon. At the femoral attachment, the bone-plug-attached graft was fixed with an interference screw (group A). The bone-plug-free graft was fixed by the extra-articular suture fixation technique with sutures tied over a button (group B). Biomechanical and histological evaluations were performed at 2, 4 and 8 weeks postoperatively. In biomechanical evaluation, at 2 or 4 weeks 27 of 28 specimens (96%) were pulled out from the femoral tunnel, while one 4-week specimen and all four 8-week specimens failed at the graft's mid-substance. At 2 weeks, the maximum failure load was 25+/-10 N and 24+/-6 N for group A and group B respectively (mean+/-SD). At 4 weeks, the maximum failure load was 42+/-17 N and 35+/-15 N respectively. There were no significant differences in maximum pullout failure load between the groups at 2 or 4 weeks postoperatively. (P=0.887 at 2 weeks and P=0.339 at 4 weeks using ANOVA measurement). Histologically, the bone-attached grafts showed partial bone-to-bone union at the graft-bone tunnel interface at 4 weeks, and complete bony union at 8 weeks. The bone-free grafts exhibited newly formed Sharpey-like collagen fibers at 4 weeks, and strong connection by mature granulation tissue at 8 weeks. Graft-to-bone tunnel healing of bone-attached graft with screw fixation and bone-free graft with extra-articular suture fixation are comparable in terms of biomechanical evaluation during the early postoperative periods. [ABSTRACT FROM AUTHOR]

The current study aimed to analyze kinematics during deep knee bending motion by subjects with fully congruent mobile-bearing total knee arthroplasties allowing axial rotation and anteroposterior (AP) gliding. Twelve subjects were implanted with Dual Bearing Knee prostheses (DBK, slot type: Finsbury Orthopaedics, Surrey, UK). These implants include a mobile-bearing insert that is fully congruent with the femoral component throughout flexion and allows axial rotation and limited AP translation. Sequential fluoroscopic images were taken in the sagittal plane during loaded knee bending motion. In vivo kinematics were analyzed using a two- to three-dimensional registration technique, which uses computer-assisted design models to reproduce the spatial position of femoral and tibial components from single-view fluoroscopic images. The average femoral component demonstrated 13.4° external axial rotation for 0–120° flexion. On average, the medial condyle moved anteriorly 6.2 mm for 0–100° flexion, then posteriorly 4.0 mm for 100–120° flexion. On average, the lateral condyle moved anteriorly 1.0 mm for 0–40° flexion, then posteriorly 8.7 mm for 40–120° flexion. The typical subject exhibited a lateral pivot pattern from extension to 60° flexion and a central pivot pattern from 60° to 100° flexion, patterns that are not usually observed in normal knees. Subsequently from 100° to 120° flexion, a rollback pattern was reproduced in which bilateral condyles moved backward. [Copyright &y& Elsevier]

We have developed a novel system of four-dimensional motion analysis after total hip arthroplasty (THA) that can aid in preventing dislocation by assessing safe range of motion for patients in several daily activities.This system uses skeletal structure data from CT and motion capture data from an infrared position sensor. A 3-D model reconstructed from CT data is combined with the motion capture data. Using this system, we analyzed hip motion when getting up from and sitting down in a chair or picking up an object while sitting in a chair in 17 patients (26 hips) who underwent THA. To assess the accuracy of this system''s measurements, open MRI was used to evaluate positions of skin markers against bones in five healthy volunteers in various postures.No impingement between bones and/or implants was found in any subjects during any activities. However, mean angle at the point of maximum hip flexion was different for each patient. The open MRI results indicated that average error in hip angle of the present system was within 5° for each static posture.The functional position of the pelvis during daily activities must be taken into account when assessing the real risk of dislocation. The present system enables dynamic analysis involving not only alignment of components and bones of each patient, but also individual differences in characteristics of daily motions. Further investigation using this system can help determine safe ranges of motion for preventing hip dislocation, improving the accuracy of individualized guidance for patients regarding postoperative activities. [Copyright &y& Elsevier]

Measuring the thickness of sheet-like thin anatomical structures, such as articular cartilage and brain cortex, in three-dimensional (3-D) magnetic resonance (MR) images is an important diagnostic procedure. This paper investigates the fundamental limits on the accuracy of thickness determination in MR images. We defined thickness here as the distance between the two sides of boundaries measured at the subvoxel resolution, which are the zero-crossings of the second directional derivatives combined with Gaussian blurring along the normal directions of the sheet surface. Based on MR imaging and computer postprocessing parameters, characteristics for the accuracy of thickness determination were derived by a theoretical simulation. We especially focused on the effects of voxel anisotropy in MR imaging with variable orientation of sheet-like structure. Improved and stable accuracy features were observed when the standard deviation of Gaussian blurring combined with thickness determination processes was around √2/2 times as large as the pixel size. The relation between voxel anisotropy in MR imaging and the range of sheet normal orientation within which acceptable accuracy is attainable was also clarified, based on the dependences of voxel anisotropy and the sheet normal orientation obtained by numerical simulations. Finally, in vitro experiments were conducted using an acrylic plate phantom and a resected femoral head to validate the results of theoretical simulation. The simulated thickness was demonstrated to be well-correlated with the actual in vitro thickness. [ABSTRACT FROM AUTHOR]

The purpose of this investigation is to evaluate the diagnostic ability of three-dimensional spoiled gradient-echo (3D SPGR) magnetic resonance (MR) imaging in cases of osteonecrosis of the femoral head (ONFH), and to determine the accuracy of 3D SPGR imaging in area and volume measurement of ONFH. T1-weighted spin-echo (SE) and 3D SPGR imaging were performed on 20 femoral heads obtained from patients with ONFH. After MR imaging, the femoral heads were cut parallel to the imaging plane and were evaluated histologically. Areas and volumes of necrotic lesions were measured with a computer program and the deviation between MR images and anatomical measurements was evaluated. A low signal intensity band on 3D SPGR MR images was observed in all femoral heads and corresponded histologically to repaired marrow with viable fibrous mesenchymal tissue. The area proximate to the low band area coincided with the necrotic region. Both area and volume measurements by T1-weighted SE and 3D SPGR images showed a strong correlation to histological measurements. The discrepancies between histological and imaging results were minimal in 3D SPGR imaging, especially at the anterior and posterior portions of the femoral head. Three-dimensional SPGR imaging provides more accurate measurements of the area and volume of a necrotic lesion than T1-weighted SE imaging. [Copyright &y& Elsevier]

This paper presents a novel high-performance computing (HPC) system for compute-intensive medical applications. Our system provides surgeons a framework for utilizing remote HPC resources with a secure execution environment by a public key cryptography and a high-speed data transmission by a real-time lossless data compression algorithm. Our implementation on a cluster of 64 off-the-shelf PCs with 128 processors has successfully demonstrated HPC benefits by reducing the turn-around time for the nonrigid registration of liver CT images of 512×512×159 voxels from about 17 h on a sequential system to about 12 min. [Copyright &y& Elsevier]

The aim of this study was to elucidate the utility and limitation of gadopentetate (Gd)-enhanced MRI as a method for evaluating the anterior cruciate ligament (ACL) in the rheumatoid arthritis (RA) knee, using both surgical macro findings and histological findings to ascertain the pathological condition of the affected knee. Thirty-six knees of 25 RA patients were studied in this study. Four imaging protocols were employed: protocol A, T1-weighted and T2-weighted sagittal images; protocol B, T1-weighted sagittal image, after infusion of Gd-DTPA (0.2 mmol/kg, i.v.); protocol C, T1-weighted angled coronal image, parallel to the ACL; and protocol D, T1-weighted angled coronal image, parallel to the ACL, after infusion of Gd-DTPA. Sagittal image was determined as previously described. Angle coronal image was newly determined as coronal image parallel to the ACL. Surgical and MRI findings of the ACL were classified into four types: Type I (normal group) indicated that the thickness of the ACL was almost normal, adequate tension was maintained (surgical findings),and the ACL had thick and a more complex appearance with a homogeneous signal intensity and well-defined borders (MRI findings). Type II (degenerated group): the ACL had degenerated and tension was reduced (surgical findings), and the ACL had thin and a more complex appearance with a less homogeneous signal intensity and less well-defined borders. This appearance was more evident on Type II than Type I (MRI findings). Type III (ruptured group): the parenchyma of the ACL remained but lacked continuity (surgical findings), and the ACL appeared as partial lack of low signal intensity (MRI findings). Type IV (absent group): the parenchyma of the ACL was practically absent (surgical findings), and the ACL appeared as complete lack of signal low signal intensity (MRI findings). The concordance rate between surgical and MRI findings was investigated. Moreover, we investigated the extent to which histological changes of the ACL could be discriminated using MRI. In RA knees, the overall concordance rate between surgical and MRI findings was 41.7% under imaging protocol A. The overall rate improved up to 69.4% under imaging protocol B. But the overall rate dropped to 36.1% under imaging protocol C. The overall rate improved up to 83.3% under imaging protocol D. Especially, significant differences between imaging protocols A and B ( p<0.05), and imaging protocols C and D ( p<0.01), with respect to ACL degenerated group, were recognized. But significant differences between imaging protocols A and C, and imaging protocols B and D, with respect to ACL degenerated group, were not recognized. The concordance rate between histological and MRI findings was 41.7% in ACL normal group, and 61.5% in ACL degenerated group. The concordance rate between surgical and MRI findings was 100% in ACL normal group, and 78.9% in ACL degenerated group. There was a significant difference in the concordance rates between histological, surgical, and MRI findings in normal group ( p<0.05). The results of this study suggested that with Gd-enhanced MRI, the degree of synovial proliferation around the ACL and the degree of degradation of the ACL in the RA knee can be evaluated more accurately than with conventional MRI; however, in RA knees with severe synovial proliferation, it may be difficult to discriminate between the invasive synovium going into the ligament from synovium surrounding the ligament. This may be a limitation of Gd-enhanced MRI at present. In the clinical setting, the present imaging technique does allow the ligament to be evaluated to a certain degree, and may prove useful in the evaluation of temporal changes in the RA knee. [ABSTRACT FROM AUTHOR]

Intraoperative pulmonary embolism occurs not only during cemented but also during cementless total hip arthroplasty (THA). We determined whether the ROBODOC femoral milling system can reduce intraoperative pulmonary embolism, by using of transesophageal echocardiography and hemodynamic monitoring. We did a prospective clinical trial with 71 patients (75 hips) who were divided into 2 groups: group 1, 46 patients (50 hips) who underwent cementless THA with preparation of the femoral canal using ROBODOC; group 2, 25 patients (25 hips) who underwent conventional cementless THA surgery in whom separate measurements were made during preparation of the femur, insertion of the stem and relocation of the hip. The incidence of severe embolic events was lower in group 1 than in group 2. Our findings suggest that the ROBODOC femoral milling system may reduce the risk of clinically significant pulmonary embolism during cementless THA. [ABSTRACT FROM AUTHOR]

SRCL /CL-P1 was recently identified as a scavenger receptor with a C-type lectin domain, which was expressed in vascular endothelial cells and could bind to Gram-positive and Gram-negative bacteria, yeast and oxidized LDL. We found that SRCL was expressed in some but not all nurse-like cells examined. Furthermore, to characterize the C-type lectin domain of SRCL, the secreted form of the C-type lectin domain (LEC-AP) of SRCL, which was fused to the signal sequence of IgG and alkaline phosphatase, was expressed in 293/EBNA-1 cells and the culture medium was used for the in vitro binding assay. LEC-AP specifically bound to GalNAc-conjugated gel in a Ca2+-dependent manner, and this binding was inhibited by free GalNAc, l-, d-fucose, d-galactose, lactose, and especially T antigen and Tn antigen. Furthermore, we examined whether or not SRCL could take up saccharide-conjugated particles. 293/EBNA-1 cells stably expressing SRCL were found to take up GalNAc but not mannose-conjugated particles on confocal microscopy. The binding of GalNAc-conjugated particles to these cells was quantitatively measured by comparing the x-means of individual cell populations. An approximately 2.1-fold increase in immunofluorescence intensity was observed for the SRCL transfectants compared to control vector transfectants. Our results provide a basis for understanding the scavenger function of SRCL as to carbohydrate-containing ligands. [ABSTRACT FROM PUBLISHER]

In order to determine whether there is a difference in effect on cell morphology and function between two common arthroscopic irrigation solutions, primary cultures of cells derived from the surgically excised human menisci were incubated for 3 or 6 h in lactated Ringer’s solution, isotonic sodium chloride solution, or serum-free cell culture medium (negative-control condition). Cell integrity was blindly evaluated by three independent examiners scoring photomicrographs of the cell cultures on a battery of five-point scales for abnormality of cell shape, irregularity of cell membrane, change of cell size and cell density. Cell cultures were also quantitatively assayed by semi-quantitative reverse-transcription–polymerase-chain-reaction for mRNA of α1 (I) procollagen, α1 (II) procollagen, aggrecan and heat-shock protein 70 to assess functional consequences of exposure to the solutions. There was a statistically significant difference in cell integrity scores between either lactated Ringer’s solution or serum-free cell-culture medium and isotonic sodium chloride solution with greater damage to cells displayed. Scores for lactated Ringer’s solution did not differ from those for serum-free cell-culture medium. There were no significant differences in mRNA expression level among the treatment conditions. It was concluded that the lactated Ringer’s solution better maintained human meniscus cell integrity than the isotonic saline. [Copyright &y& Elsevier]

In our previous papers [e.g. Sato et al., J. Biol. Chem. 273 (1998) 21455–21462], we have shown that prodigiosins can uncouple various H+-ATPases through their H+/Cl− symport activity. BE-18591 is an enamine of 4-methoxy-2,2′-bipyrrole-5-carboxyaldehyde (tambjamine group antibiotics) which resembles the prodigiosins. We found that BE-18591 was a new group of antibiotics that uncouples various H+-ATPases: it inhibited proton pump activities with IC50s of about 1–2 nM (about 20 pmol/mg protein) for submitochondrial particles as well as gastric vesicles and of 230 nM (about 230 pmol/mg protein) for lysosomes, but it had little effect on their ATP hydrolyses (up to 10 μM), a property of H+/Cl− symport activity. At low concentrations (<1 μM), BE-18591 inhibited immunoproliferation, the IC50 of lipopolysaccharide-stimulated mouse splenocytes was 38 nM, that of Concanavalin A-stimulated cells was 230 nM. Gastritis of rabbits was also inhibited. At higher concentrations (>1 μM), BE-18591 induced neurite outgrowth (15% induction in 48 h at 4 μM), inhibited bone resorption (∼35% in 48 h at 10 μM) and caused cell death (∼30% in 48 h at 4 μM) but with little apoptosis. [Copyright &y& Elsevier]

The purpose of this study is to investigate the expression of tumor necrosis factor-α converting enzyme (TACE) in the synovium and subchondral bone region of patients with rheumatoid arthritis (RA) and to determine the contribution of the enzyme to the pathogenesis of RA. Joint tissues were obtained during total knee arthroplasty from patients with RA and osteoarthritis (OA). The expression of TACE and TNF-α mRNA was detected by in situ hybridization. Characterization of TACE expressing cells was performed by immunohistochemistry using serial sections. We found that TACE mRNA was expressed in both synovium and subchondral bone region and co-localized with TNF-α mRNA in RA. On the other hand, TACE mRNA expression was scarcely detectable in OA samples. TACE was expressed in mononuclear cells, such as CD3 and CD14 positive cells in RA samples. In conclusion, the expression of TACE is up-regulated in the rheumatoid synovium and subchondral bone region, and the results in this study demonstrate that TACE may be involved and play a role in the pathogenesis of RA. [ABSTRACT FROM AUTHOR]

Presents information on a study which examined the role of genetic variants of interleukin-3 (IL-3) in the pathophysiology of rheumatoid arthritis (RA) in Japan. Association between RA and a single-nucleotide polymorphism in the IL-3 promoter region; Methodology; Results and discussion.

Background: The purpose of this study was to assess the usefulness of bone scintigraphy in predicting progressive collapse of the femoral head after transtrochanteric rotational osteotomy for the treatment of osteonecrosis of the femoral head. Methods: We studied thirty-three hips in thirty patients with osteonecrosis of the femoral head who had undergone transtrochanteric rotational osteotomy. There were twenty male and ten female patients, with a mean age of 34.4 years at the time of the operation. The mean duration of follow-up was 10.0 years. According to the staging system of Ficat and Arlet, there were nineteen stage-2 hips and fourteen stage-3 hips at the time of the operation. Conventional anteroposterior and lateral radiographs were assessed. In addition, bone scans were performed at three weeks after the operation to predict the outcome with regard to the rotated femoral head. On the basis of the location of low scan activity within the femoral head, the scintigraphic findings were classified into one of two categories: type A if there was no low scan activity in the weight-bearing area of the femoral head or type B if low scan activity occupied the entire weight-bearing area. Six hips with collapse were studied histologically. Results: Postoperative scintiscans revealed sixteen type-A hips and seventeen type-B hips. Of the type-A hips, only three exhibited progressive collapse of the femoral head after the osteotomy, whereas fourteen of the type-B hips exhibited progressive collapse. A significant association was found between the postoperative scintigraphic findings and the final radiographic result (p < 0.01). Conclusions: Bone scintiscans made three weeks after transtrochanteric rotational osteotomy were useful for predicting the final clinical result. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty changes the levels of stress within the proximal part of the femur, and the femur remodels adjacent to the prosthesis. The stem size and the initial bone-mineral density around the distal portion of the stem affect postoperative boneremodeling after the insertion of a fully porous-coated metal-cancellous prosthesis. The purpose of this study was to evaluate the influence of the extent of porous coating of this prosthesis on femoral bone-remodeling. Methods: A longitudinal examination of sixty-one hips in fifty-four patients was performed. Thirty-one hips in twenty-seven patients with a fully porous-coated stem (Group A) and thirty hips in twenty-seven patients with a proximally porous-coated stem (Group B) were followed for twenty-four to thirty months. Periprosthetic bone-mineral density was measured with dualenergy x-ray absorptiometry at specific intervals after the operation. Results: In both groups, the greatest loss of bonemineral density, compared with the initial (three-week) value, was approximately 20 percent in zone 7 at twelve to eighteen months. In other zones, bone-remodeling appeared to cease by twelve months. At the last followup evaluation, the loss of bone-mineral density in the distal and middle regions in Group A was significantly greater than that in Group B (p < 0.01 for zone 3 and p < 0.05 for zone 6). In contrast, with the numbers available, there were no significant differences in loss of bone-mineral density in the proximal regions (zones 1 and 7) between the two groups at any follow-up period. Conclusions: The extent of porous coating affects bone-remodeling in the distal periprosthetic region rather than in the proximal region. The results in the present report are specific to the particular implants that were studied. [ABSTRACT FROM AUTHOR]