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Background Osteoarthritis (OA) is the most common disease of the hip in adults and its etiology is divided into two groups: primary or idiopathic. Although acetabular dysplasia is the most frequent reason for total hip arthroplasty (THA) in Japan, primary OA has increased recently. Although there are two types of femoral head migration in primary OA: superior and medial, there are some patients with prominent femoral head lateralization. This study aimed to evaluate the relationship between femoral head lateralization and bone morphology of the acetabulum and proximal femur using radiographic factors in primary OA of the hip. Methods A retrospective study was conducted between 2008 and 2017 to assess 1308 hips with OA who underwent primary THAs at our institute. The diagnostic criteria for primary OA were Crowe type 1, Sharp’s angle 25°. We classified patients with primary OA into two groups based on femoral head lateralization: group L with lateralization or group N without. Radiographic factors included Sharp’s angle, CE angle, acetabular inclination, acetabular depth ratio (ADR), acetabular head index (AHI), and femoral neck-shaft angle (FNA), all examined on an anteroposterior pelvic radiograph. Femoral neck anteversion was calculated using computerized axial tomography. Results Primary OA was diagnosed in 210/1308 hips (16.1%) (group L: 112 hips [8.6%]; group N: 98 [7.5%]). Patient demographics were not significantly different. Radiographic factors with observed significant differences between group L and group N were average CE angle (33.0° vs 35.1°, respectively, p = 0.009), ADR (251.6 vs 273.4, p p p = 0.012). Conclusions This investigation suggests that primary OA with femoral head lateralization demonstrated specific identifiable radiographic characteristics in the acetabulum and proximal femur that might contribute to hip joint instability such as the dysplastic hip. Trial registration: The research protocol for this study was approved by the Institutional Review Board of the authors’ affiliated institutions in compliance with the principles of the Helsinki Declaration. Written informed consent was obtained from all participating subjects.

OBJECTIVES The pain of hip osteoarthritis is generally recognized as nociceptive in origin because of the local pathology. However, some patients with osteoarthritis experience a neuropathic pain component as an essential part of some nociplastic pain subtype. Here, we sought to examine the mechanism of chronic pain of symptomatic hip osteoarthritis by association of its distribution, complex pain mechanism screening, and the prevalence of lumbar spinal stenosis (LSS). METHODS We conducted a prospective cross-sectional study of 100 hips in 100 patients with symptomatic hip osteoarthritis in a chronic state. We examined all baseline clinical characteristics including clinical and functional score, location of pain and numbness, and pain score (PainDETECT questionnaire (PDQ) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)), and magnetic resonance imaging of the hip and lumbar spine. RESULTS The PDQ and LANSS revealed that 23% of the patients had a neuropathic pain component. There were 24 variations of the pain pattern. By contrast, the pain localized around the hip joint was only 15%. Pain distal to the thigh and any numbness was significantly more frequent in the group with neuropathic pain (P

AimsThe main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA.MethodsA retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis.ResultsRLLs were detected in 27.2% of patients one year postoperatively. In multivariate regression analysis controlling for confounders, atrophic osteoarthritis (odds ratio (OR) 2.17 (95% confidence interval (CI), 1.04 to 4.49); p = 0.038) and 26 mm (OR 3.23 (95% CI 1.85 to 5.66); p < 0.001) or 28 mm head diameter (OR 3.64 (95% CI 2.07 to 6.41); p < 0.001) had a significantly greater risk for any RLLs one year after surgery. Structural bone graft (OR 0.19 (95% CI 0.13 to 0.29) p < 0.001) and location of the hip centre within the true acetabular region (OR 0.15 (95% CI 0.09 to 0.24); p < 0.001) were significantly less prognostic. Improvement of the cement-bone interface including complete disappearance and poorly defined RLLs was identified in 15.1% of patients. Kaplan-Meier survival analysis for the acetabular component at ten years with revision of the acetabular component for aseptic loosening as the end point was 100.0% with a RLL and 99.1% without a RLL (95% CI 97.9 to 100). With revision of the acetabular component for any reason as the end point, the survival rate was 99.2% with a RLL (95% CI 97.6 to 100) and 96.5% without a RLL (95% CI 93.4 to 99.7).ConclusionThis study demonstrates that acetabular bone quality, head diameter, structural bone graft, and hip centre position may influence the presence of the any RLL. Cite this article: Bone Joint Open 2021;2(5):278–292.

The Trilliance stem (B. Braun-Aesculap, Tuttlingen, Germany), a novel collarless triple-tapered polished stem, was introduced in 2009. The aim of this study is to evaluate the long-term clinical and radiological results of the Trilliance stem with line-to-line implantation in primary total hip arthroplasty using a direct anterior approach.A consecutive retrospective series of 130 patients (151 hips) who underwent total hip arthroplasty between February 2009 and August 2011 were evaluated for a minimum of 10 years. Of these, 87.4% had a diagnosis of secondary osteoarthritis based on developmental hip dysplasia. Clinical and radiological results, complications were evaluated and survival analysis was performed.The mean follow-up was 10.7 years (range, 10.0-12.1). Thirteen hips (13 patients, 6.8%) were lost to follow-up. Adequate cementation (Barrack grade A) was achieved in 136 hips (93.8%) 1 week post-operatively. Nearly all (144 hips, 99.3%) had been inserted within the range of 3°. No significant differences were identified between high- (≥30 procedures/year) and low- (30 procedures/year) volume surgeons. The Kaplan-Meier survival analysis with revision of the femoral component for aseptic loosening, revision of the femoral component for any reason and revision of either component for any reason as the end points, cumulative survivorship was 100.0%, 97.6% (95% confidence interval (CI) 95.4-100.0) and 96.5% (95% CI 93.8-99.3) at 10 years, respectively.The Trilliance stem with line-to-line implantation using a direct anterior approach has an excellent clinical and radiological outcome at a minimum of 10 years' follow-up.Level IV, Retrospective cohort study.

A well-fixed cement–bone interface is a crucial factor for acetabular and femoral components in cemented total hip arthroplasty (THA). The aim of the present study was to evaluate the middle-term clinical and radiological results of fixing the acetabular component with an interface bioactive bone cement (IBBC) technique in primary cemented THA. We undertook a retrospective review was undertaken of 193 primary cemented THAs in 174 patients using acetabular components cemented with an IBBC technique and followed for a minimum of 5 years (mean 8.3 years; range 5–17 years). Baseline data, clinical and radiological outcomes were evaluated. Japanese Orthopedic Association hip score and modified Harris hip scores demonstrated significant clinical improvement in all patients (p

Little is known about the association between well-fixed polished tapered cemented stems (PTCS) implanted by the line-to-line technique and changes of stem migration, or the change of functional anteversion of the femur after total hip arthroplasty (THA). This retrospective study included 422 two-stage bilateral primary THAs performed using PTCS implanted by the line-to-line technique. CT scans were made on both the target side (first postoperative CT) and on the contralateral side (second postoperative CT) 1 week postoperatively. The mean follow-up was 7.8 months. CT data for each scan were transferred to 3D template software (Zed hip, Lexi, Japan). The postoperative changes of anatomical stem anteversion (ASA), functional femoral anteversion (FFA), and stem subsidence were evaluated. A total of 20 THAs with CT scans were available on 3D template software. The ASA and the FFA had migrated − 0.68° ± 0.62° and − 5.5° ± 9.7°, respectively, over the follow-up period. A significant positive correlation was observed between the change of subsidence and ASA (r2 = 0.34, p = 0.007), between the FFA on the second postoperative CT and ASA on the first postoperative CT (r2 = 0.26, p = 0.02) and between the FFA on the second postoperative CT and FFA on the first postoperative CT (r2 = 0.52, p = 0.0003). This study indicates that the change in axial rotation of a PTCS implanted by the line-to-line technique was less than that reported by other studies and the preoperative external rotation contracture was substantially improved after THA.

Chronic hyperglycemia causes pancreatic β-cell dysfunction, impaired insulin secretion and the suppression of insulin gene expression. This phenomenon is referred to as glucotoxicity, and is a critical component of the pathogenesis of type 2 diabetes. We previously reported that the expression of candidate plasticity gene 16 (CPG16) was higher in rat pancreatic INS-1 β-cells under glucotoxic conditions and CPG16 suppressed insulin promoter activity. However, the molecular mechanisms of the CPG16-mediated suppression of insulin gene expression are unclear. In this study, we found that CPG16 directly bound and phosphorylated jun dimerization protein 2 (JDP2), an AP-1 family transcription factor. CPG16 co-localized with JDP2 in the nucleus of INS-1 cells. JDP2 bound to the G1 element of the insulin promoter and up-regulated promoter activity. Finally, CPG16 suppressed the up-regulation of insulin promoter activity by JDP2 in a kinase activity-dependent manner. These results suggest that CPG16 suppresses insulin promoter activity by phosphorylating JDP2.

Introduction Ceramic-on-ceramic (COC) total hip arthroplasty (THA) was developed to reduce wear debris, and consequently the occurrence of osteolysis and aseptic loosening. The purpose of the present study was to determine the incidence and natural history of noise including squeaking after COC THA, and to clarify whether clinical outcomes and any demographic and implant-related factors are associated with noise from these ceramic bearings. Methods This was a retrospective observational study of 137 primary COC THAs between 2004 and 2009 at our institute. The Mean follow-up was for 10.5 years. All patients were followed up with an office visit to obtain information regarding noise, pain, and function. The correlations between the noise, and patient demographic, radiographic, and implant-related factors were evaluated. Results Noise developed in 30 hips (21.9%), specifically squeaking in 2 (1.5%) of the 137 hips during the follow-up period. Noise including squeaking was not associated with pain or functional outcomes. There was significant correlation between noise and cup anteversion, in that cup anteversion of patients with noise was smaller than that in those without noise. No significant correlation was found between noise and any other patient demographic including age, sex, height, body weight, or body mass index. Kaplan–Meier survivorship analysis with revision for any reason and an aseptic loosening of either component as the end point, revealed a cumulative survival rate at 10 years of 98.4% and 99.1% respectively. Conclusion The long-term clinical and radiographic outcome of cementless COC THA is excellent, but we should be vigilant for noise from COC bearings.

A 71-year-old male presented with abdominal distension and fever to our hospital. Abdominal CT revealed a huge tumor in abdomen, and non-curative surgery was performed. Peritoneal dissemination was widespread and the tumor invaded the bladder and sigmoid-colon mesenterium. Two months after the initial surgery, CT showed liver metastasis, and oral administration of imatinib mesylate was started. The peritoneal dissemination and liver metastasis showed a decrease, and this was well controlled for 45 months without severe side effects. Abdominal CT revealed peritoneal dissemination in the ileocecum after 43 months since the administration of imatinib. Therefore, sunitinib treatment was initiated. After 3 months of sunitinib administration, the tumor perforated. Emergency operation was performed to resect the ileocecum, and sunitinib was continued for 1 year. In GIST with liver metastasis and peritoneal dissemination, repeated surgical resection combined with chemotherapy is important to improve the patient's survival.

Background Little is known about how bone cement and American Society of Anesthesiologists (ASA) classification influence the cardiovascular system in elderly patients with femoral-neck fractures treated with cemented hemiarthroplasty. Therefore, we performed a case-control study to investigate these questions and compared the following: ≥ ASA III with ≤ ASA II patients who underwent cemented hemiarthroplasty; and cemented with cementless hemiarthroplasty in ≥ ASA III patients. Hypothesis ASA classification influences the cardiovascular system during cemented hemiarthroplasty and bone cement influences intraoperative blood pressure [IBP] in patients rated ≥ ASA III. Materials and methods This multicenter, prospective study included patients with acute displaced femoral-neck fractures. Baseline data, medical history, anesthesia, FiO2, vasopressor use, femoral component, IBP, SpO2, and complications were evaluated. Of 200 patients, 100 were cemented (mean age, 77 ± 10 years), and 100 were cementless (mean age, 78 ± 9 years). Cemented hemiarthroplasty employed a third-generation technique (plugging, irrigating, drying and filling the canal with cement under pressurization). Results Systolic blood pressure (SBP) decreased significantly during cementing, versus pre-rasping in ≤ ASA II patients (from 117.9 ± 24.5 [range, 65–199] to 106.9 ± 20.3 [range, 59–172]; p = 0.007), in ≥ ASA III patients (from 129.5 ± 21.0 [range, 90–169] to 110.4 ± 17.9 [range, 79–157]; p = 0.006), and post-stem-insertion, versus pre-rasping in ≤ ASA II patients (from 117.9 ± 24.5 [range, 65–199] to 103.9 ± 20.7 [range, 53–178]; p = 0.0004), and in ≥ ASA III patients (from 129.5 ± 21.0 [range, 90–169] to 111.2 ± 24.6 [range, 70–156]; p = 0.009). In ≥ ASA III patients, SBP decreased significantly during cementing or rasping, versus pre-rasping in cemented patients (from 129.5 ± 21.0 [range, 90–169] to 110.4 ± 17.9 [range, 79–157]; p = 0.006), in cementless patients (from 115.0 ± 17.7 [range, 85–150] to 100.7 ± 15.7 [range, 75–142]; p = 0.004), and post-stem-insertion, versus pre-rasping in cemented patients (from 129.5 ± 21.0 [range, 90–169] to 111.2 ± SD [range]; p = 0.009), and in cementless patients (from 115.0 ± 17.7 [range, 85–150] to 89.4 ± 17.5 [range, 58–140]; p Conclusions This study indicate a similar hemodynamic change intraoperatively between ≤ ASA II patients and ≥ ASA III patients in the cemented group, and between patients with cemented and cementless hemiarthroplasty in the ≥ ASA III patients. With modern hemiarthroplasty techniques, bone cement might be as safe as cementless techniques in elderly, ≥ ASA III patients. Level of evidence III, multicenter case-control cohort study.

Study DesignRetrospective observational study.PurposeWe examined change in lumbrosacral spine alignment and low back pain (LBP) following total hip arthroplasty (THA) in patients with severe hip osteoarthritis (OA).Overview of LiteratureSevere hip osteoarthritis has been reported to cause spine alignment abnormalities and low back pain, and it has been reported that low back pain is improved following THA.MethodsOur target population included 30 patients (29 female, mean age 63.5 years) with hip OA who underwent direct anterior approach THA. There were 12 cases with bilateral hip disease and 18 cases with unilateral osteoarthritis. Visual analogue scale (VAS) scores for LBP and coxalgia, the Roland-Morris Disability Questionnaire (RDQ), and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed before and after surgery. Spinal alignment metrics were measured before and after surgery.ResultsVAS for LBP change from preoperative to final postoperative observation was significantly improved (p ppppppppp=0.29).ConclusionsThe present study demonstrates improvements in VAS for LBP, RDQ, and all domains of JOABPEQ. There were also significant reductions in lumbar scoliosis and an observed correlation of RDQ improvement with lumbar scoliosis improvement. We were able to observe improvements in lumbar scoliosis and low back pain only in cases of unilateral OA. It has been suggested that the mechanism of low back pain improvement following THA is related to compensatory lumbar scoliosis improvement.

The purpose of this study was to clarify the difference in implant alignment between the direct anterior approach (DAA) and the anterolateral approach in the supine position (ALS). A retrospective comparative study consisted of 215 consecutive primary total hip arthroplasties using tapered polished and straight cemented-stems via two different minimally invasive approaches (DAA group in 106 hips and ALS group in 109 hips). The cup radiographic anteversion angle was significantly lower in the ALS group than in the DAA group (12.9° versus 16.9°, p = 0.001). The frequency of the safe zone tended to be more favourable in the ALS group than in the DAA group (95% versus 87%, p = 0.052). Stem alignment in the sagittal plane was significantly better in the ALS group than in the DAA group (84% versus 71%, p = 0.022). Both cup and stem alignments were better in the ALS group than the DAA group.

We report a case of unresectable pancreas cancer. A 70-year-old woman presented with worsening diabetes and serum CA19-9 elevation. A tumor with portal vein and supra-mesenteric vein invasion was observed by computed tomography. She was diagnosed with unresectable pancreas head cancer that was locally advanced. Chemotherapy was administered with gemcitabine and nab-paclitaxel for 19 courses, followed by gemcitabine alone for 4 courses. After the addition of 6 courses of chemotherapy, a 60%dose of chemotherapy was administered for 13 courses due to severe neutropenia. The patient died 32 months after the first visit. The 60% dose of gemcitabine and nab-paclitaxel also inhibited tumor growth. These findings suggest the effective and safe long-term use of gemcitabine and nab-paclitaxel.

Glucagon-mediated gene transcription in the liver is critical for maintaining glucose homeostasis. Promoting the induction of gluconeogenic genes and blocking that of insulin receptor substrate (Irs)2 in hepatocytes contributes to the pathogenesis of type 2 diabetes. However, the molecular mechanism by which glucagon signalling regulates hepatocyte metabolism is not fully understood. We previously showed that a fasting-inducible signalling module consisting of general control non-repressed protein 5, co-regulator cAMP response element-binding protein binding protein/p300-interacting transactivator with Glu/Asp-rich carboxy-terminal domain 2, and protein kinase A is required for glucagon-induced transcription of gluconeogenic genes. The present study aimed to identify the downstream effectors of this module in hepatocytes by examining glucagon-induced potential target genes. One of these genes was prolyl hydroxylase domain (PHD)3, which suppressed stress signalling through inhibition of the IκB kinase–nuclear factor-κB pathway in a proline hydroxylase-independent manner to maintain insulin signalling. PHD3 was also required for peroxisome proliferator–activated receptor γ coactivator 1α-induced gluconeogenesis, which was dependent on proline hydroxylase activity, suggesting that PHD3 regulates metabolism in response to glucagon as well as insulin. These findings demonstrate that glucagon-inducible PHD3 regulates glucose metabolism by suppressing stress signalling and optimising gluconeogenesis and insulin signalling in hepatocytes.

We retrospectively reviewed 47 hips with symptomatic acetabular dysplasia treated with shelf acetabuloplasty. The mean follow-up period was 17 years with a minimum of 5 years. Ten hips (21%) had been converted to total hip arthroplasty (THA) at a mean of 18.2 years. Survival analysis using conversion to THA as an endpoint showed survival rate of 97.8% at 10 years and 78% at 20 years. Forty hips without preoperative joint space narrowing had a survival rate of 90% at 20 years postoperatively. This was significantly higher (p < 0.01) than that of seven hips with joint space narrowing, which was 29% at 20 years. In 27 hips from patients aged

The purpose of this retrospective cohort study was to investigate the cementing effects on intraoperative blood pressure and the clinical and radiographic outcomes in elderly patients with femoral-neck fracture undergoing bipolar hemiarthroplasty using a polished, tapered stem. This retrospective cohort study included 38 patients with acute displaced femoral-neck fractures (mean age, 76.2 years; mean follow-up, 21.4 months (68 % follow-up rate)). Intraoperative systolic blood pressure decreased significantly, both during cementing (109.1 mmHg) and after stem insertion (101.6 mmHg), compared with the level before rasping (122.2 mmHg; p = 0.0036 and p = 0.0001, respectively). Diastolic blood pressure decreased significantly after stem insertion (57.9 mmHg versus 67.3 mmHg before rasping; p = 0.003). Hypoxia did not occur. Nineteen patients were Donaldson’s grade 1, 16 were grade 2, and none were grade 3. Twenty-three patients (74 %) maintained their preoperative activity level; 15 (26 %) worsened after surgery. Stem subsidence significantly increased over time: 0.32 mm at 6 months, 0.53 mm at 1 year, 0.91 mm at 2 years, 1.08 mm at 3 years, and 1.13 mm at 4 years. Cemented bipolar hemiarthroplasty for displaced femoral-neck fracture in elderly patients leads to hypotension, unchanged arterial oxygen saturation, favorable clinical outcomes, and acceptable stem subsidence.

The Mediator complex (Mediator) plays key roles in transcription and functions as the nexus for integration of various transcriptional signals. Previously, we screened for Mediator cyclin-dependent kinase (CDK)-interacting factors and identified three proteins related to chromatin regulation. One of them, SUZ12 is required for both stability and activity of Polycomb Repressive Complex 2 (PRC2). PRC2 primarily suppresses gene expression through histone H3 lysine 27 trimethylation, resulting in stem cell maintenance and differentiation; perturbation of this process leads to oncogenesis. Recent work showed that Mediator contributes to the embryonic stem cell state through DNA loop formation, which is strongly associated with chromatin architecture; however, it remains unclear how Mediator regulates gene expression in cooperation with chromatin regulators (i.e. writers, readers and remodelers). We found that Mediator CDKs interact directly with the PRC2 subunit EZH2, as well as SUZ12. Known PRC2 target genes were deregulated by Mediator CDK knockdown during neuronal differentiation, and both Mediator and PRC2 complexes co-occupied the promoters of developmental genes regulated by retinoic acid. Our results provide a mechanistic link between Mediator and PRC2 during neuronal differentiation.

PR domain-containing 16 (PRDM16) induces expression of brown fat-specific genes in brown and beige adipocytes, although the underlying transcription-related mechanisms remain largely unknown. Here, in vitro studies show that PRDM16, through its zinc finger domains, directly interacts with the MED1 subunit of the Mediator complex, is recruited to the enhancer of the brown fat-specific uncoupling protein 1 (Ucp1) gene through this interaction, and enhances thyroid hormone receptor (TR)-driven transcription in a biochemically defined system in a Mediator-dependent manner, thus providing a direct link to the general transcription machinery. Complementary cell-based studies show that upon forskolin treatment, PRDM16 induces Ucp1 expression in undifferentiated murine embryonic fibroblasts, that this induction depends on MED1 and TR, and, consistent with a direct effect, that PRDM16 is recruited to the Ucp1 enhancer. Related studies have defined MED1 and PRDM16 interaction domains important for Ucp1 versus Ppargc1a induction by PRDM16. These results reveal novel mechanisms for PRDM16 function through the Mediator complex.

In eukaryotes, holo-Mediator consists of four modules: head, middle, tail, and CDK/Cyclin. The head module performs an essential function involved in regulation of RNA polymerase II (Pol II). We studied the human head module subunit MED17 (hMED17). Recent structural studies showed that yeast MED17 may function as a hinge connecting the neck and movable jaw regions of the head module to the fixed jaw region. Luciferase assays in hMED17-knockdown cells showed that hMED17 supports transcriptional activation, and pulldown assays showed that hMED17 interacted with Pol II and the general transcription factors TFIIB, TBP, TFIIE, and TFIIH. In addition, hMED17 bound to a DNA helicase subunit of TFIIH, XPB, which is essential for both transcription and nucleotide excision repair (NER). Because hMED17 associates with p53 upon UV-C irradiation, we treated human MCF-7 cells with either UV-C or the MDM2 inhibitor Nutlin-3. Both treatments resulted in accumulation of p53 in the nucleus, but hMED17 remained concentrated in the nucleus in response to UV-C. hMED17 colocalized with the NER factors XPB and XPG following UV-C irradiation, and XPG and XPB bound to hMED17 in vitro. These findings suggest that hMED17 may play essential roles in switching between transcription and NER.

Malignant mesothelioma is a rare aggressive solid tumor that is invariably incurable. A 23-year-old female patient with ascites, anemia, and high levels of ferritin and CRP was diagnosed with pleural mesothelioma by exploratory laparotomy. She remained asymptomatic, but 7 years later, she developed intractable diarrhea and fever. Systematic chemotherapy with both cisplatin and pemetrexed was administered. However, the treatment was discontinued due to side effects, after which time the diarrhea, ascites, and fever became progressively more severe. Hepatomegaly and hepatic siderosis also developed. At the same time, the patient's serum interleukin 6(IL-6)levels were abnormally high. Although there was a temporary symptomatic improvement after intraperitoneal injection of cisplatin, the intractable mesothelioma-associated symptoms returned a few days later. The patient died of liver failure 1 week later. The poor prognosis in this case was due to symptoms associated with the high IL-6 level. There are limited medically proven treatments, and it is important to develop new treatments. Therefore, "anti-IL-6 therapy" may have to be tested as a potential treatment for symptoms associated with high IL-6 levels.

Background Little is known about how bone cement and American Society of Anesthesiologists (ASA) classification influence the cardiovascular system in elderly patients with femoral-neck fractures treated with cemented hemiarthroplasty. Therefore, we performed a case-control study to investigate these questions and compared the following: (1) ≥ ASA III with ≤ ASA II patients who underwent cemented hemiarthroplasty; (2) cemented with cementless hemiarthroplasty in ≥ ASA III patients. Hypothesis ASA classification influences the cardiovascular system during cemented hemiarthroplasty and bone cement influences intraoperative blood pressure [IBP] in patients rated ≥ ASA III. Materials and methods This multicenter, prospective study included patients with acute displaced femoral-neck fractures. Baseline data, medical history, anesthesia, FiO2, vasopressor use, femoral component, IBP, SpO2, and complications were evaluated. Of 200 patients, 100 were cemented (mean age, 77 ± 10 years), and 100 were cementless (mean age, 78 ± 9 years). Cemented hemiarthroplasty employed a third-generation technique (plugging, irrigating, drying and filling the canal with cement under pressurization). Results Systolic blood pressure (SBP) decreased significantly during cementing, versus pre-rasping in ≤ ASA II patients (from 117.9 ± 24.5 [range: 65–199] to 106.9 ± 20.3 [range: 59–172]; p = 0.007), in ≥ ASA III patients (from 129.5 ± 21.0 [range: 90–169] to 110.4 ± 17.9 [range: 79–157]; p = 0.006), and post-stem-insertion, versus pre-rasping in ≤ ASA II patients (from 117.9 ± 24.5 [range: 65–199] to 103.9 ± 20.7 [range: 53–178]; p = 0.0004), and in ≥ ASA III patients (from 129.5 ± 21.0 [range: 90–169] to 111.2 ± 24.6 [range: 70–156]; p = 0.009). In ≥ ASA III patients, SBP decreased significantly during cementing or rasping, versus pre-rasping in cemented patients (from 129.5 ± 21.0 [range: 90–169] to 110.4 ± 17.9 [range: 79–157]; p = 0.006), in cementless patients (from 115.0 ± 17.7 [range: 85–150] to 100.7 ± 15.7 [range: 75–142]; p = 0.004), and post-stem-insertion, versus pre-rasping in cemented patients (from 129.5 ± 21.0 [range: 90–169] to 111.2 ± SD [range]; p = 0.009), and in cementless patients (from 115.0 ± 17.7 [range: 85–150] to 89.4 ± 17.5 [range: 58–140]; p Conclusions This study indicate a similar hemodynamic change intraoperatively between ≤ ASA II patients and ≥ ASA III patients in the cemented group, and between patients with cemented and cementless hemiarthroplasty in the ≥ ASA III patients. With modern hemiarthroplasty techniques, bone cement might be as safe as cementless techniques in elderly, ≥ ASA III patients. Level of evidence III, multi-center case control cohort study.

The purpose of this magnetic resonance imaging (MRI)-based prospective study was to clarify the frequency of articular collapse in, and to define the frequency with which surgical interventions are performed for, osteonecrosis of the femoral head and the knee. MRI screening for osteonecrosis of the femoral head and the knee was prospectively performed within 1 year after corticosteroid administration. Those patients with osteonecrosis were conservatively followed with MRI to detect articular collapse by bone marrow edema. Several surgical interventions were considered after articular collapse. The frequencies of collapse and of surgical intervention were compared using the Kaplan–Meier method and the log-rank test. Of 1,239 joints (623 hips and 616 knees) surveyed in the study, osteonecrosis was identified in 370 (191 hips and 179 knees) by MRI. Thus, the incidence of osteonecrosis was 30 % (31 % in hip and 29 % in knee). Of 155 hips and 154 knees followed for more than 2 years, the frequency of articular collapse was significantly higher in osteonecrosis of the femoral head than in osteonecrosis of the knee (p

Objectives The purpose of the present study was to describe the long-term results of total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE).

We investigated the crystalline quality of supercritical-thickness strained silicon-on-insulator (SC-sSOI) wafers by synchrotron X-ray topography and its correlation with electrical characteristics by use of back-gate transistors. Several types of contrast showing crystalline imperfections were observed over the entirety of the wafers, such as macule and crosshatch patterns in X-ray topographs. From the analysis of a series of X-ray topographs obtained by changing the angle of incidence relative to the sample surface, we obtained two-dimensional distributions of lattice inclination and strain, indicating that the crosshatch patterns observed in the X-ray topographs were caused by fluctuation of the lattice inclination. Transistors located in an area of large lattice inclination deviated from the average drain current-gate voltage curves, showing a correlation between lattice inclination and electrical properties.

Patients reporting that their symptoms of urinary incontinence have decreased after total hip arthroplasty can be encountered in orthopedic practice. In this questionnaire-based study, we prospectively evaluated the symptoms of urinary incontinence before and after total hip arthroplasty. The International Consultation on Incontinence Questionnaire-Short Form was used to prospectively evaluate these symptoms in 189 consecutive female patients undergoing total hip arthroplasty. The patients were asked to fill in a questionnaire before and 3 months after surgery. A decrease in the International Consultation on Incontinence Questionnaire-Short Form score of ≥1 point was defined as an improvement, whereas an increase of ≥1 point was defined as worsening. A total of 81 (43%) patients reported urinary incontinence before total hip arthroplasty. At 3 months after surgery, symptoms of urinary incontinence were improved in 64% of these patients, remained unchanged in 32% and worsened in 4%. Mean International Consultation on Incontinence Questionnaire-Short Form score in patients with urinary incontinence before surgery significantly improved from 6.0 to 3.5 (P = 0.0002). These findings suggest a relationship between hip joint function and pelvic floor function, and consequently a hip dysfunction-related urinary incontinence.

A commercial supercritical thickness strained Si-on-insulator (SC-sSOI) wafer was characterized by large-area synchrotron x-ray topography at the glancing incident condition. Several kinds of contrast showing crystalline imperfections were observed all over the wafers, such as macule and crosshatch patterns. Similar crosshatch patterns were also observed in the x-ray topographs of a conventional strained Si-on-insulator (sSOI) wafer and a strained Si wafer that has the strained Si layer epitaxially grown on the relaxed SiGe layer on the insulator (SGOI) structure. This indicates that the crosshatch pattern of the SC-sSOI wafer originates from the lattice distortion in the original SiGe substrate of the strained Si layer.

We demonstrate two topics of the application of synchrotron X-ray diffraction methods to thin films used in gate stack structures. One is related to the structural change in the interfacial SiO2 layer between the high-k dielectric layer and the Si substrate. It is shown that O2 molecules dissociate into O atoms during diffusion through the HfO2 layer and these O atoms destroy the ordered SiO2 in the interfacial layer. The other is the characterization of strained Si wafers using a synchrotron X-ray microbeam diffraction and topography. The nonuniformity in micro- and centimeter scales is shown for the SiGe layer of the strained Si wafers.

Strained Si wafers made by layer transfer and Ge condensation methods were investigated by several X-ray diffraction techniques. From the reciprocal space map measurements, the angular distribution of the lattice plane was estimated to be 0.4°. X-ray microbeam diffraction showed that the size of the domains with different orientations is less than 2 μm2, and the existence of the strain in the substrate propagated through a buried oxide layer from the SiGe layer. In large-area X-ray topographs, two kinds of crosshatch patterns were observed, depending on the process used to manufacture the wafer.

We have observed dislocations in a CZ-silicon crystal using step-scanning white X-ray section topography and examined the feature of the dislocation images reconstructed by stacking 200 shots of section topographs. These topographs were obtained from symmetric 004-reflection in the Laue case using 20, 30, and 60 keV X-rays. Direct images, intermediary images, and dynamical images of dislocations were observed in a tomogram, i.e., a sliced image obtained from the stacked section topographs, and the contrast of the dynamical images was reduced with increasing X-ray energy. The stacked section topographs provided three-dimensional images of the dislocations based on the direct images, and the sliced image enabled us to observe the dislocations separately in a highly dislocated region of the CZ-silicon crystal.

Fatigue accumulation is one of the ageing phenomena considered in the plant design and maintenance. The degree of fatigue damage is evaluated by cumulative usage factor using design fatigue curve, which is determined from results of uniaxial fatigue tests. The stress caused by thermal transients is generally equibiaxial, not uniaxial. Fluid temperature fluctuation due to changes in plant conditions, such as plant start-up and shutdown, is the primary cause of fatigue damage. For accurate fatigue damage evaluation, it is important to be conducted under equi-biaxial condition. In this study, pressurized disc fatigue test was conducted in order to simulate the cyclic equi-biaxial stress. In order to clarify how the crack initiates and grows under the equi-biaxial stress condition. Cracking behavior was examined by replica observation method. The crack growth rates were identified by the change in the crack length. It was shown that the fatigue crack growth rate under equi-biaxial stress was faster than that under uniaxial stress for the same equivalent stress intensify factor. It was concluded that the reduction in the fatigue life under equi-biaxial stress was brought about by the accelerated crack growth.

The lattice undulation of a silicon-on-insulator (SOI) layer in bonded SOI wafers was observed by synchrotron white and monochromatic X-ray topographies. Pattern formation for white X-ray topography was discussed using the geometric relation among the Bragg streak and diffracted X-rays in reciprocal space. The diffraction images in white X-ray topographs were simulated using the angular distributions of the lattice inclination in SOI layers obtained by the analysis of monochromatic X-ray topographs. The results of this simulation were in very good agreement with observations including the dependences on camera distance and SOI layer thickness, indicating that the contrast is mainly formed by the divergence/convergence effect of the diffracted X-rays.

Granulocyte colony-stimulating factor (G-CSF) is a cytokine that stimulates myeloid progenitor cells to proliferate and differentiate into neutrophilic granulocytes. To identify genes induced by G-CSF during neutrophil differentiation, interleukin-3-dependent murine myeloid precursor FDC-P1 cells expressing the G-CSF receptor were stimulated with G-CSF, and the gene expression profile was characterized by DNA microarray analysis. In addition to known signal transducer and activator of transcription-3 target genes, such as suppressor of cytokine signaling-3 (SOCS3), JunB, and p19INK4D, we newly identified several G-CSF targets, including genes for the CC chemokine receptor-2 (CCR2), raft proteins flotillin-1 and flotillin-2, and immunoglobulin-like receptor gp49B. Real-time, quantitative polymerase chain reaction analyses revealed that the expression of these genes was induced in various myeloid cell lines by G-CSF. Furthermore, when HoxA9-immortalized bone marrow progenitors were induced by G-CSF to differentiate into mature neutrophils, all of these genes were strongly activated. These genes could be categorized into three groups based on their time-course of expression: immediate-early (∼20 min, SOCS3), mid-early (2–4 h, flotillin-1/2 and gp49B), and late (>12 h, CCR2). This suggests that different transcriptional mechanisms are involved in the regulation of these genes. We show that bone marrow neutrophils express functional CCR2, which suggest that CC chemokines may play previously unknown roles in neutrophil activation and chemotaxis.

We have studied the propagation and elimination of dislocations generated at the early stage of Czochralski silicon crystal growth using synchrotron white x-ray topography combined with a topo-tomographic technique. Two silicon crystals with [001] growth-axes were examined. One was intentionally grown without enlarging its diameter to easily observe the features of the dislocation propagation, and the other was grown with Dash necking, followed by a 2 inch enlargement of its diameter in order to observe the elimination of the dislocations. The three-dimensional structure of the individual dislocation, i.e. the direction of the dislocation line, its Burgers vector and the glide plane, were determined. These investigations revealed that dislocation half loops, which were generated from tangled dislocations, were expanded on their glide planes and were often deformed by their interaction, cross slip and collision with the crystal surface, followed by a gradual decrease in their density. The dislocation-elimination effect of the Dash necking was caused by the expansion of the dislocation half loops being terminated within the crystal and by their pinning on the crystal surface.