Preoperative Scoring System for Prediction of Early Adjacent Vertebral Body Fracture After Balloon Kyphoplasty Using X-Rays Taken in a Non-Weight-Bearing Position

BACKGROUND

Prevention of adjacent vertebral body fracture (AVF) following balloon kyphoplasty (BKP) is a key challenge. The objective of this study was to develop a scoring system that could be more extensively and effectively used to determine the surgical indications for BKP.

METHODS

The study involved 101 patients aged 60 years or older who had undergone BKP. Logistic regression analysis was used to identify risk factors for early AVF within 2 months following BKP. Scoring was based on the odds ratio for risk factors, and cut-off values were determined from the receiver operating characteristics curve. The correlation between the total scores and the incidence of early AVF, and the area under the curve for the logistic regression model predicting early AVF using the scoring system were investigated.

RESULTS

29 cases (28.7%) experienced early AVF after BKP. The scoring system was created as follows: 1) age (<75 years: 0 points (P), ≥75 years: 1P), 2) number of previous vertebral fractures (0: 0P, 1 or more: 2P), and 3) local kyphosis (<7°: 0P, ≥7°: 1P). The total scores were found to be positively correlated with the incidence of early AVF (r = 0.976, P = 0.004). The area under the curve of the scoring system for predicting early AVF was 0.796. The incidence of early AVF was 4.2% at ≤1P and 44.3% at ≥2P (P < 0.001).

CONCLUSIONS

A scoring system which can be applied to a broader patient population was developed. In cases where the total score is 2P or more, alternatives to BKP should be considered.

The relationship between global sagittal balance and the incidence of early adjacent vertebral fractures following balloon kyphoplasty

BACKGROUND

Recently, it is widely known that global sagittal balance (GSB) influences the postoperative outcome of the spine. The purpose of this study was to investigate the relationship between GSB and the incidence of early adjacent vertebral fracture (AVF) following BKP.

METHODS

This study included 96 patients (19 males, 77 females, mean age 77.4±5.5 years) who underwent BKP for osteoporotic vertebral fracture and who were over 60 years old. We investigated the effect of GSB on early AVF within 2 months after surgery. Of the 96 patients, 76 patients (16 males, 60 females, mean age 77.0±5.4) underwent BKP at the thoracolumbar junction (T11-L2) and were investigated independently. After the two-group comparison, logistic regression analysis was performed.

RESULTS

During the observation period (18.3±14.7 months), 27 of 96 patients (28.1%) suffered AVF after BKP, and 24 of 96 patients (25.0%) suffered early AVF. In the logistic regression analysis, spinopelvic parameters were not detected as significant risk factors. In cases of BKP at the thoracolumbar junction (T11-L2), 24 of 76 patients (31.6%) suffered AVF after BKP during the observation period (15.3±19.5 months), and 21 of 76 patients (27.6%) suffered early AVF. Logistic regression analysis detected PT: odds ratio 1.087 (P = 0.046*) and local kyphosis: 1.147 (P = 0.003*) as risk factors for early AVF. The cutoff value was PT≥29° from the ROC curve.

CONCLUSIONS

At the thoracolumbar junction, PT equal to or greater than 29° is one of the risk factors of early AVF following BKP.

Preoperative scoring system for predicting early adjacent vertebral fractures after Balloon Kyphoplasty

BACKGROUND

Adjacent vertebral fracture (AVF) is a major complication following Balloon Kyphoplasty (BKP). There is no scoring system for predicting AVF using only preoperative elements. The purposes of this study were to develop a scoring system for predicting early AVF after BKP based on preoperative factors and to investigate the appropriate surgical indication for BKP.

METHODS

Of 220 patients who underwent BKP at a single institution since 2011, 65 patients over the age of 60 who had undergone a standing whole spine X-ray preoperatively were enrolled. Factors affecting the occurrence of early AVF were examined. A scoring system was created consisting of the factors exhibiting significant differences, and the correlation between the total score and the incidence of early AVF was investigated.

RESULTS

Twenty of the 65 patients (30.8%) had early AVF. In a univariate analysis, age, previous vertebral fracture, pelvic tilt, and Local kyphosis significantly influenced early AVF. In a multivariate logistic regression analysis, age had an odds ratio of 1.136 (95% CI 1.001-1.289), previous vertebral fractures 4.181 (1.01-17.309), and Local kyphosis 1.103 (1.021-1.191). The scoring system was set as follows: ①Age (<75 years: 0 points(P), 75years≦: 1P), ②The number of previous vertebral fractures (0: 0 P, 1: 1P, 2: 2P, 3 or more: 3P), and ③Local kyphosis (<10°: 0P, 10°≦: 1P). There was a correlation between the total score and the incidence of early AVF (r = 0.812, ∗P = 0.05). The incidence of early AVF was 6.4% (2 cases/31 cases) for a score of ≦1P and 54.5% (18 cases/33 cases) for a score of ≧2P.

CONCLUSIONS

There was a correlation between the total score and the incidence of early AVF. A score of 1 point or less may represent the appropriate surgical indication for BKP.

60Fe and 244Pu deposited on Earth constrain the r-process yields of recent nearby supernovae

Half of the chemical elements heavier than iron are produced by the rapid neutron capture process (r-process). The sites and yields of this process are disputed, with candidates including some types of supernovae (SNe) and mergers of neutron stars. We search for two isotopic signatures in a sample of Pacific Ocean crust-iron-60 (⁶⁰Fe) (half-life, 2.6 million years), which is predominantly produced in massive stars and ejected in supernova explosions, and plutonium-244 (²⁴⁴Pu) (half-life, 80.6 million years), which is produced solely in r-process events. We detect two distinct influxes of ⁶⁰Fe to Earth in the last 10 million years and accompanying lower quantities of ²⁴⁴Pu. The ²⁴⁴Pu/⁶⁰Fe influx ratios are similar for both events. The ²⁴⁴Pu influx is lower than expected if SNe dominate r-process nucleosynthesis, which implies some contribution from other sources.

Iodine-129 for determining the origin of salinity in groundwater in Pampanga, Philippines

Assessing groundwater vulnerability from salinity contamination is vital and relevant to meet the increasing demand for freshwater. Iodine-129 (¹²⁹I, half-life = 15.7 million years), a radioisotope of iodine, was used as an environmental tracer for the possible origin of salinization in groundwater (e.g., natural rock weathering, evaporated water, seawater, brine fossil water, contamination). In July 2017 (wet season), thirty-two (32) water samples were taken from production wells of different localities in Pampanga, a province in the Philippines that relies heavily on groundwater for freshwater sources. Hydrogeochemical (mainly Cl) and stable water isotopes (δ²H and δ¹⁸O) were able to identify seven samples potentially affected by seawater intrusion. The salinity origin of these samples was investigated using iodine-129 and iodine-127 isotopes by generating two graphs: ¹²⁹I vs. chloride and ¹²⁹I/¹²⁷I ratio vs. 1/¹²⁷I. ¹²⁹I vs. Cl graph was capable of showing a clear distinction between different salinity origins. Five out of the seven samples were being affected by evaporated water, one sample from possible wastewater, and one sample from brine fossil water. A conceptual model was produced to summarize the results. Compiled end-members (e.g., natural brine, seawater, modern rain) were plotted in the ¹²⁹I/¹²⁷I ratio vs. 1/¹²⁷I graph to show the interaction between two recharge sources. The results of this study will be helpful to the government, civil society, and other organizations for monitoring, policymaking, and management of the groundwater and the subsurface formations that will be crucial to continuously supply the freshwater needs of the present and future generation.

Functional analysis of a novel G87V TNFRSF1A mutation in patients with TNF receptor-associated periodic syndrome

Tumor necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) is an autoinflammatory disease that is caused by heterozygous mutations in the TNFRSF1A gene. Although more than 150 TNFRSF1A mutations have been reported to be associated with TRAPS phenotypes only a few, such as p.Thr79Met (T79M) and cysteine mutations, have been functionally analyzed. We identified two TRAPS patients in one family harboring a novel p.Gly87Val (G87V) mutation in addition to a p.Thr90Ile (T90I) mutation in TNFRSF1A. In this study, we examined the functional features of this novel G87V mutation. In-vitro analyses using mutant TNF receptor 1 (TNF-R1)-over-expressing cells demonstrated that this mutation alters the expression and function of TNF-R1 similar to that with the previously identified pathogenic T79M mutation. Specifically, cell surface expression of the mutant TNF-R1 in transfected cells was inhibited with both G87V and T79M mutations, whereas the T90I mutation did not affect this. Moreover, peripheral blood mononuclear cells (PBMCs) from TRAPS patients harboring the G87V and T90I mutations showed increased mitochondrial reactive oxygen species (ROS). Furthermore, the effect of various Toll-like receptor (TLR) ligands on inflammatory responses was explored, revealing that PBMCs from TRAPS patients are hyper-responsive to TLR-2 and TLR-4 ligands and that interleukin (IL)-8 and granulocyte-macrophage colony-stimulating factor (GM-CSF) are likely to be involved in the pathogenesis of TRAPS. These findings suggest that the newly identified G87V mutation is one of the causative mutations of TRAPS. Our findings based on unique TRAPS-associated mutations provide novel insight for clearer understanding of inflammatory responses, which would be basic findings of developing a new therapeutic and prophylactic approach to TRAPS.

Compensatory mechanism of the spine after corrective surgery without lumbar-sacral fixation for traumatic thoracolumbar kyphotic spine deformity

BACKGROUND

It remains unclear whether long fusion including lumbar-sacral fixation is needed in corrective surgery to obtain good global sagittal balance (GSB) for the treatment of traumatic thoracolumbar kyphotic spine deformity. The purposes of this study were to evaluate compensatory mechanism of the spine after corrective surgery without lumbar-sacral fixation and to evaluate the parameters affecting the achievement of good GSB post-operatively.

METHODS

Twenty (20) subjects requiring corrective surgery (distal end of fixation was L3) were included in this study. The radiographic parameters were measured pre-operatively and at one month after surgery. Sagittal Vertical Axis (SVA), Lumber Lordosis angle altered by fracture (fLL), Thoracic Kyphosis angle altered by fracture (fTK), Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Segmental Lumbar Lordosis (sLL: L3-S/L4-S), and local kyphotic angle were measured. The correlation between correction of local kyphotic angle (CLA) and the change in radiographic parameters was evaluated. Post-operatively, subjects with SVA<50 mm and PI-fLL<10°were regarded as the "good GSB group (G group). The radiographic parameters affecting the achievement of G group were statistically evaluated.

RESULTS

fLL, sLL:L3-S and sLL:L4-S were decreased indirectly because the local kyphosis was corrected directly (CLA: 26.5 ± 8.6°) (P < 0.001). CLA and the change in fLL showed significant correlation (r = 0.821), the regression equation being: Y = -0.63X+3.31 (Y: The change in fLL, X: CLA). The radiographic parameters significantly affecting the achievement of G group were: SVA, PT, PI-fLL, sLL: L3-S, and sLL: L4-S (P < 0.01).

CONCLUSION

The main compensatory mechanism was the decrease of lordosis in the lumbar spine. fLL was decreased to approximately 60% of CLA after surgery. SVA was not corrected by the compensatory mechanism.

Prevalence and risk factors of deep vein thrombosis in patients undergoing lumbar spine surgery

BACKGROUND

Spinal surgery is classified as a moderate risk for DVT. The occurrence of DVT after various spinal surgical procedures was reviewed retrospectively, and the perioperative risk factors in the high-risk group were identified. In addition, the administration of the factor Xa inhibitor to DVT subjects with unstable thrombosis was evaluated to reveal its effectiveness in the prevention of PTE and postoperative complications.

METHODS

This study included 588 subjects who underwent lumbar spine surgery. The patient population consisted of the following four groups: the fracture group (F group), the laminectomy group (La group), the TLIF group (T group), and the long fusion group (Lo group). Bilateral lower limb venous ultrasonography was performed on the day before surgery, the day after surgery, and one week after surgery. The incidence of DVT was determined for each group and potential risk factors were evaluated in the group with the highest incidence of DVT. Subjects with DVT who had unstable thrombosis received anticoagulant therapy (factor Xa inhibitor) and their treatment results were assessed.

RESULTS

The overall incidence of DVT was 32.3% (190/588). A significantly high incidence of DVT was observed in the Lo group (54.3%; 75/138). Logistic regression and ROC analysis of potential risk factors in the Lo group identified a D-dimer value of 19.5 ug/ml at one week postoperatively as a risk factor of DVT (p = 0.02; odds ratio, 4.09; 95% CI, 2.82-7.88). Overall, 15.8% of subjects (30/190) received anticoagulant therapy. These subjects experienced neither PTE nor epidural hematoma. A follow-up ultrasonography performed at three weeks postoperatively detected the disappearance/resolution of DVT in 86.7% of these subjects (26/30).

CONCLUSION

The incidence of DVT varied according to the invasiveness of the procedure. Successful management of DVT hinges on preoperative risk management involving prophylactic treatment and early diagnosis, in order to avoid PTE and other complications.

Experience of Quatro-Therapy With Everolimus to Minimize Calcineurin Inhibitor for Kidney Transplant Recipients

BACKGROUND

This study was divided into three phases, on the occasion of the introduction of everolimus (EVR) in our hospital.

METHODS

In the first phase, a study group of six maintenance patients (three living related donors, three deceased donors) who had a history of malignant disease with less than 500 mg/day of proteinuria were enrolled; a high serum creatinine and upper limit of duration after kidney transplant operation was not considered. EVR was discontinued in four of the six patients because of side effects or worsening renal function. The second phase comprised a study group of 12 maintenance patients (12 living related donors) who were more than 5 years after kidney transplant operation with serum creatinine <3 ng/mL and proteinuria <500 mg/day. In two patients, EVR was discontinued because of a skin rash or general fatigue, but EVR was continued in 10 cases. Calcineurin inhibitor (CNI) dosage was reduced and renal function improved, and mean estimated glomerular filtration rate recovered from 42.3 mL/min to 44.8 mL/min, with no rejections occurring. In the third phase, a study group of eight de novo transplant patients who were 2 to 3 weeks after transplant operation were examined. In one case, EVR was discontinued because of proteinuria but was restarted with a stepwise increasing method after 4 months and was continued without any side effects.

RESULTS

Our study indicates that EVR was a useful drug for the maintenance of kidney transplant recipients for the optimal patients.

CONCLUSIONS

In de novo cases, EVR plus a high dose of mizoribine and low CNI protocol was a useful regimen without serious adverse effects.

Abstract P1-07-15: The outcomes for super elderly patients over 80 years old after breast cancer surgery

(Purpose)

Considering the dramatic increase in average life expectancy throughout the world, the management of super-elderly patients over 80 years old (SEP) with breast cancer has become a global issue. However, there have been few clinical trials for SEP until now. The reasons for this were a small population, unpredictable prognosis, a large number of non-cancer-related deaths and a lower function of multiple organs in SEP. Surgical treatment or post-operative treatment based on evidence of clinical trials for SEP has also not been unclear. We hypothesized that the outcome of SEP with breast cancer compared with other ages were similarly depended on the breast cancer subtypes.

The aim of this study was to clarify the breast cancer related survival (BRS) rate and overall survival (OS) rate at 5years for SEP according to breast cancer subtype.

(Methods)

We retrospectively analyzed 407 patients over 80 years old at initial operation between April, 1994 and April 2015 from 4 institutions of Chiba Youth Breast Oncology Research Group.

Overall, 366 patients with stage I to Stage IIIc were included.

41 patients with Stage 0 or IV were excluded in this study.

We compared the clinical characteristics, OS and BRS rates among the breast cancer subtype: such as ER positive HER2 negative (ER group), ER negative HER2 negative (TN group), ER negative HER2 positive (HER2 group) and ER positive HER2 positive (ER/HER2 group).

Univariate and multivariate analyses were performed to identify the factors of Tumor size, Lymph node, Ly, ER, HER2 and characteristics, associated with the OS and BRS.

(Results)

The median age of the 366 patients was 83 years (range 80-96 years).The median follow-up duration was 32 months (range, 2-120).

During the follow-up period, 25 (9.4%) patients in the ER group, 19 (27.5%) in TN group, 4 (22.2%) in HER2 group and 2 (20.0%) patients in ER-HER2 group died.

The 5 year OS and BRS rates were 89.2%, 97.1% in ER group, 64.6%, 81.2% in TN group, 61.5%,33.3% in HER2 group and 83.3%, 100% in ER-HER2 group, respectively.

Univariate and multivariate analyses revealed that ER was one prognostic factor to OS and BRS.

ER positive patients treatment with Aromatase inhibitor had significantly longer survival rates than treatment with Tamoxifen or no treatment (p=0.05).

There were no significant differences in OS or BRS of TN patients according to the use of chemotherapy (n=7) versus non treatment (n=61).

(Conclusions)

The prognosis and clinical course of super elderly patients with breast cancer depended on subtype.

Adjuvant therapy for ER group was one prognostic factor to OS and BRS.

Citation Format: Nakamura R, Matsuzaki H, Sakamoto M, Suda K, Hayama S, Sangai T. The outcomes for super elderly patients over 80 years old after breast cancer surgery. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-15.

Excitation-photon-energy selectivity of photoconversions in halogen-bridged Pd-chain compounds: Mott insulator to metal or charge-density-wave state

Ultrafast photoinduced transitions of a one-dimensional Mott insulator into two distinct electronic phases, metal and charge-density-wave (CDW) state, were achieved in a bromine-bridged Pd-chain compound [Pd(en)2Br](C5-Y)2H2O (en=ethylenediamine and C5-Y=dialkylsulfosuccinate), by selecting the photon energy of a femtosecond excitation pulse. For the resonant excitation of the Mott-gap transition, excitonic states are generated and converted to one-dimensional CDW domains. For the higher-energy excitation, free electron and hole carriers are produced, giving rise to a transition of the Mott insulator to a metal. Such selectivity in photoconversions by the choice of initial photoexcited states opens a new possibility for the developments of advanced optical switching and memory functions.

Diagnostic value of MRI for odontogenic tumours

OBJECTIVES

To evaluate the diagnostic value of MRI for odontogenic tumours.

MATERIALS AND METHODS

51 patients with odontogenic tumours were subjected to pre-operative MRI examinations. For tumours with liquid components, i.e. ameloblastomas and keratocystic odontogenic tumours (KCOTs), the signal intensity (SI) uniformity of their cystic components (UΣ) was calculated and then their UΣ values were compared. For tumours with solid components that had been examined using dynamic contrast-enhanced MRI (DCE-MRI), their CImax (maximum contrast index), Tmax (the time when CImax occurred), CIpeak (CImax × 0.90), Tpeak (the time when CIpeak occurred) and CI300 (i.e. the CI observed at 300 s after contrast medium injection) values were determined from CI curves. We then classified the odontogenic tumours according to their DCE-MRI parameters.

RESULTS

Significant differences between the UΣ values of the ameloblastomas and KCOT were observed on T1 weighted images, T2 weighted images and short TI inversion recovery images. Depending on their DCE-MRI parameters, we classified the odontogenic tumours into the following five types: Type A, CIpeak > 2.0 and Tpeak < 200 s; Type B, CIpeak < 2.0 and Tpeak < 200 s; Type C, CI300 > 2.0 and Tmax < 600 s; Type D, CI300 > 2.0 and Tmax > 600 s; Type E, CI300 < 2.0 and Tmax > 600 s.

CONCLUSION

Cystic component SI uniformity was found to be useful for differentiating between ameloblastomas and KCOT. However, the DCE-MRI parameters of odontogenic tumours, except for odontogenic fibromas and odontogenic myxomas, contributed little to their differential diagnosis.

Relaxation dynamics of photoexcited excitons in rubrene single crystals using femtosecond absorption spectroscopy

The relaxation dynamics of an exciton in rubrene was investigated by femtosecond absorption spectroscopy. Exciton relaxation to a self-trapped state occurs via the coherent oscillation with 78 cm(-1) due to a coupled mode of molecular deformations with phenyl-side-group motions and molecular displacements. From the temperature dependence of the decay time of excitons, the energy necessary for an exciton to escape from a self-trapped state is evaluated to be ~35 meV (~400 K). As a result, a self-trapped exciton is stable at low temperatures. At room temperature, excitons can escape from a self-trapped state and, subsequently, they are dissociated to charged species. The exciton dissociation mechanism is discussed on the basis of the results.

THE PURE CULTIVATION OF SPIROCHAETA ICTEROHAEMORRHAGIAE (INADA)

Pure cultures of the spirochætal causative agent of the disease known as Weil's disease, or febrile icterus, in Japan, have been obtained by us in a solid, a semisolid, and a fluid medium. The spirochæta thus isolated remains pathogenic for guinea pigs for many generations. Up to the present time we have succeeded through the courtesy of Professor Nagayo, Dr. Konuma, and Dr. Ishihara, in cultivating three different strains. The spirochæta is a facultative anaerobe. The solid and semisolid culture media possess one disadvantage, in that they are opaque on account of the addition of red blood corpuscles; but it is hoped that this drawback may soon be overcome by further studies. We shall report later the results of investigations regarding various questions in immunity as well as further details regarding the biological properties of the spirochæta.

Impact of passive smoking on the bones of rats

Many epidemiological surveys have identified smoking as a risk factor for osteoporosis, but it is unclear whether smoking has a direct effect on bone metabolism and if such an effect could cause osteoporosis. Therefore, we examined whether smoking causes osteoporosis based on the impact of smoke exposure on the bones of rats. A rat model of passive cigarette smoking was prepared by breeding rats in a cigarette-smoking box for 4 or 8 weeks. Histological changes, micro-computed tomographic (CT) analysis, mechanical bone strength, and bone mineral density of the femur and lumbar vertebrae were examined in these rats and in control rats that were not exposed to smoke. Lower mechanical bone strength was observed in smoke-exposed rats, but these differences were not significant. Significantly lower bone mineral density was found in the femur (P<.01) and lumbar bones (P<.001) of 8-week smoke-exposed rats compared to controls. In a micro-CT scan of lumbar vertebrae, the bone volume, trabecular thickness, trabecular number, and trabecular separation differed significantly between smoke-exposed rats and controls. Histologically, the osteocytes in the smoke-exposed rats were small (approximately 25% of the size in controls), and decreased numbers of marrow cells and osteoblasts (P<.01), as well as a black carbon dust-like substance, were found in the bone of smoke-exposed rats. These results indicate that smoking significantly decreases bone mineral density, which causes osteoporosis, and the organizational changes in the bone suggest a direct effect of smoking on bone structure. Fewer marrow cells were present in the smoke-exposed rats, and a black carbon dust-like substance was observed.

Evaluation of biomechanical and histological features of vertebrae following vertebroplasty using hydroxyapatite blocks

Vertebroplasty was performed using hydroxyapatite blocks to examine the course of compressive strength and histological features in a dog model. The vertebral fracture model was prepared by punching a hole in the center of the vertebra and at 4 sites around the vertebra (5 holes in total) from the front side of the vertebra using an air drill and hollowing the holes. Measurements were made on healthy vertebrae, vertebrae from the vertebral fracture model, vertebrae removed from animals immediately after vertebroplasty, vertebrae collected 1 and 2 months after vertebroplasty, and vertebrae untreated for 1 month after vertebral fracture. Histological examinations were also performed 1 and 2 weeks and 1 and 2 months after vertebroplasty with hydroxyapatite blocks. The strength of vertebrae in the fracture model immediately after vertebroplasty was significantly higher than that in the untreated fracture, and the strength of vertebrae 1 month after the procedure was equivalent to that of healthy vertebrae. Histologically, new bone formation was found around hydroxyapatite blocks 2 weeks after the procedure, and strong crosslinking between neighboring hydroxyapatite blocks was found after 1 month.These results suggest that hydroxyapatite blocks may be effective as filling material for vertebral fracture from both biomechanical and histological perspectives.

Evaluation of panoramic radiographs taken at the initial visit at a department of paediatric dentistry

OBJECTIVES

To examine oral and maxillofacial lesions other than those related to the chief complaint in panoramic radiographs taken at the department of paediatric dentistry at our hospital.

METHODS

We retrospectively reviewed all 1092 patients who had visited the department of paediatric dentistry at our hospital and had a panoramic radiograph taken between August 1999 and October 2004. The following information was obtained from the patients' files and panoramic radiographs: gender, age, chief complaints and the presence or absence of lesions.

RESULTS

Lesions were observed in 140 of the 1092 panoramic radiographs (12.8%). Among the 140 patients discovered to have lesions in the panoramic radiographs, 66 (47.1%, or 6.05% of the entire group of 1092 patients) had different lesions from those underlying the chief complaint. These 66 patients ages ranged from 3 years to 14 years and the lesions involved 39 (59.1%) missing teeth, 20 (30.3%) mesiodentes, 4 supernumerary teeth, 1 odontoma, 1 radicular cyst and 1 impacted tooth. The missing teeth were observed in the central and lateral incisor, canine, and first and second premolar positions of both jaws, especially in the lower lateral incisor and upper central incisor positions.

CONCLUSIONS

We were able to detect incidental lesions at a rate of 6.05% (66 of 1092 patients) and at a relatively early age (mean 6.8 years) in the present study. Early treatment of these lesions could avoid maxillofacial deformity and other complications.

A comparative study for wide excision of malignant tumors distal to S2

BACKGROUND AND AIM

We conducted a retrospective study comparing 5 patients (Group A) who underwent posterior excision of tumors distal to S2 using a modified threadwire saw (MT-saw) with 5 similar patients (Group B) who underwent tumor excision using chisels and airtomes.

PATIENTS AND METHODS

The data of 10 patients were obtained from intra-operative records. A flexible silver guide probe connected to an MT-saw by a suture thread was devised for use in osteotomy passing through the S1 sacral canal in the lateral sacrum. Operative time, blood loss and excisional margins were compared between the two groups.

RESULTS

Group A had a shorter average operative time (2 hours 24 minutes) and smaller average blood loss (2,124.6 ml) than Group B. In Group A, one patient incurred an S1 nerve root injury, and all patients had wide histological margins. In Group B, one patient had an S1 nerve root injury and another tumor contamination due to a fracture.

CONCLUSION

The MT-saw greatly facilitated lateral sacral osteotomy and reduced the risk of tumor cell spread, permitting faster, safer excision with a wider margin.

Serum levels of P-selectin in men with high-functioning autism

Immune dysfunction has been proposed as a mechanism for the pathophysiology of autistic-spectrum disorders. The selectin family of adhesion molecules plays a prominent role in immune/inflammatory responses. We determined the serum levels of three types of soluble-form selectin (sP, sL and sE) in 15 men with high-functioning autism and 22 age-matched healthy controls by enzyme-linked immunosorbent assay. Levels of sP-selectin and sL-selectin were significantly lower in patients than in controls. Furthermore, sP-selectin levels were negatively correlated with impaired social development during early childhood.

p53AIP1 expression can be a prognostic marker in non-small cell lung cancer

AIMS

p53AIP1 is a potential mediator of p53-dependent apoptosis that is mutated in many kinds of carcinoma. To investigate the role of this gene for non-small cell lung cancer, we compared the relationship between p53AIP1 gene expression and clinicopathological status of lung cancer.

MATERIALS AND METHODS

Seventy samples from non-small cell lung cancer patients were obtained between 1997 and 2003. For quantitative evaluation of RNA expression by polymerase chain reaction (PCR) we used the Taqman PCR methods. Exons 5-8 of the p53 gene were analysed using PCR-single-stranded conformation polymorphism and sequenced for mutation analysis.

RESULTS

p53AIP1 gene expression levels in the lymph node metastasis-positive group were significantly lower than in the negative group (positive 35.1+/-83.9; negative 64.2+/-113.4; P=0.0486). The overall survival of the p53AIP1 low expression group was significantly worse than that of the p53AIP1 high expression group (P=0.0206). In the multivariate Cox proportional hazard model, p53AIP1 (P=0.0489) was the independent predictor for overall survival. When we investigated mutation analyses of the p53 gene, we could find several point mutations in 15.7% of all samples. However, there was no relationship between p53AIP1 expression and p53 status.

CONCLUSIONS

These data suggest that the p53AIP1 gene is important for non-small cell lung cancer progression and may be a possible prognostic marker.

Current trends in bone grafting and the issue of banked bone allografts based on the fourth nationwide survey of bone grafting status from 2000 to 2004

BACKGROUND

The Japanese Orthopaedic Association Committee on Tissue Transplantation and Regenerative Medicine has conducted a nationwide survey of the status of bone grafting in Japan every 5 years from 1985. We report here the status of bone grafting from 2000 to 2004, show the trends in bone grafting from 1985 to 2004, and draw attention to the issues affecting banked bone allografts.

METHODS

Questionnaires devised by the Committee were sent to all educational and training hospitals (2239 institutions) approved by the Japanese Orthopaedic Association.

RESULTS

Survey responses were obtained from 1263 institutions (56%). Of these, 875 institutions performed tissue transplantation during this period. A total of 163 564 tissue transplantations were performed, and 134 782 (82.4%) of them were bone grafts. Of the bone grafts, 76 015 (56.4%) were autografts, 53 735 (40%) used a synthetic bone substitute, and 4886 (3.6%) were banked bone allografts. The proportion of synthetic bone substitutes increased, and the proportion of autografts decreased year by year. Synthetic bone substitutes were most frequently used for replacement arthroplasty (31%). Fifty percent of banked bone allografts were performed for joint disorders requiring replacement arthroplasty. During this period, 271 institutions performed banked bone allografts, with 210 preserving allografts in their own institutions. Donor selection criteria, processing and preservation methods, and management of the bone bank were not the same in all banks.

CONCLUSIONS

Most bone grafts performed in Japan during the four surveys were still autografts. However, the proportion of autografts decreased, and the proportion of synthetic bone substitutes increased. The number of synthetic bone substitutes and banked bone allografts used for replacement arthroplasty increased significantly. However, the total number of banked bone allografts reported in the fourth survey was still low. Quality control of banked bone allografts and management of bone banks were not satisfactory, although they were improved.

Osteopontin as biomarker in early invasion by squamous cell carcinoma in tongue

BACKGROUND

Osteopontin (OPN) expression in squamous cell carcinoma (SCC) of the tongue has not been clearly elucidated.

METHODS

We selected 46 cases of tongue SCC and investigated the expression of OPN by immunohistochemical staining. The immunopositive reaction and score for each case were semiquantitatively evaluated.

RESULTS

Scores were significantly higher in carcinoma nests than in neighboring normal epithelium or epithelial dysplasia. The OPN was expressed clearly in the cytoplasm of carcinoma cells. In cases of early invasive carcinoma, in particular, expression of OPN showed a remarkable increase at the invasion front compared with the non-invaded regions. However, there was no significant correlation between expression of OPN in the primary tumor nest and lymphatic metastasis, recurrence, or survival rate.

CONCLUSION

This suggests that OPN is a useful biomarker of early invasion by SCC in tongue.

Photoinduced metallic state mediated by spin-charge separation in a one-dimensional organic Mott insulator

Charge dynamics in a one-dimensional (1D) Mott insulator was investigated by fs pump-probe reflection spectroscopy on an organic charge-transfer compound, bis(ethylenedithio)tetrathiafulvalene-difluorotetracyanoquinodimethane (ET-F2TCNQ). The analyses of the transient reflectivity changes demonstrate that low-energy spectral weight induced by photocarrier doping is concentrated on a Drude component being independent of the doping density, and midgap state is never formed. Such phenomena can be explained by the concept of spin-charge separation characteristic of 1D correlated electron systems.

Onset of nephrocalcinosis depends on dietary phosphorus concentration in male rats fed a magnesium-deficient diet

Although a magnesium (Mg)-deficient diet is generally known to induce nephrocalcinosis, our previous study observed that despite the administration of a Mg-deficient diet, the kidney calcium (Ca) and phosphorus (P) concentrations were not increased in male rats. We speculated that this result was due to the P concentration of the experimental diet based on the AIN-93G formula used in the previous study. In the present study, male rats were fed modified AIN-93G diets containing the two different Mg concentrations [0.5 g per kg diet (normal-Mg) or Mg-free (Mg-deficient)] and three different P concentrations [3 (3-P), 5 (5-P) or 7 (7-P) g per kg diet]. By histological examination of the kidney, nephrocalcinosis was not observed in rats fed on the Mg-deficient diet containing 3-P While nephrocalcinosis appeared in rats fed on the Mg-deficient diet containing 5-P and 7-P The degree of nephrocalcinosis was severe in rats fed on the Mg-deficient diet containing 7-P compared with rats fed on the Mg-deficient diet containing 5-P These results demonstrated that the Mg-deficient diet based on AIN-93G formula dose not induce nephrocalcinosis and that the Mg-deficient diet based on AIN-93G formula with increased dietary P concentrations induces nephrocalcinosis in male rats. We suggest that the onset of nephrocalcinosis could depend on the dietary P concentration in male rats fed on a Mg-deficient diet.

Endoscopic Carpal Tunnel Release in the Elderly

The present study is aimed to clarify the postoperative outcome of endoscopic carpal tunnel release in elderly patients with carpal tunnel syndrome. Endoscopic carpal tunnel release was performed on 37 hands of 27 patients (2 men, 25 women) who were aged 70 years or older and clinically and electrophysiologically diagnosed with carpal tunnel syndrome. Mean age at the time of surgery was 74.5 years (range: 70-85 years). Mean postoperative follow-up was 35.5 months (range: 12-114 months). Pain was present preoperatively in 20 hands, but quickly resolved postoperatively in all cases. Numbness completely disappeared in 13 of 37 hands (35.1%), but some degree of numbness remained in the remaining cases. Preoperative severity of thenar muscle atrophy was none in 4 hands, mild in 7 hands, moderate in 12 hands and severe in 14 hands. Postoperative severity of thenar muscle atrophy at final follow-up was none in 13 hands, mild in 16 hands, moderate in 2 hands and severe in 6 hands, confirming that thenar muscle atrophy improves even in elderly patients. However, moderate or severe thenar muscle atrophy remained in 8 hands (21.6%). Endoscopic carpal tunnel release should be considered in the elderly, even though clinical symptoms may not improve substantially in advanced cases.

Extensor retinaculum graft for chronic boxer's knuckle

PURPOSE

Boxer's knuckle is a tear of the metacarpophalangeal (MCP) joint capsule that occurs while punching. Because of the nature of boxing, boxer's knuckle tends to be a chronic condition and often is associated with sagittal band rupture. Chronic cases often feature excessive scarring in the damaged area where the sagittal band and the MCP joint capsule become indistinguishable. The purpose of this study was to ascertain whether extensor retinaculum grafting to the defect is useful in treating chronic boxer's knuckle when direct repair of a capsular tear is not possible.

METHODS

In 5 professional boxers with chronic boxer's knuckle in whom capsular repair could have impaired MCP joint flexion, scar tissue of the damaged capsule and the sagittal band-if ruptured-were removed and an oval extensor retinaculum graft was sutured in the capsule/sagittal band defect. The mean age of the patients was 22 years. In all patients, surgery was performed on the middle finger. The capsule was damaged on the ulnar side in 3 patients and on the radial side in 2 patients.

RESULTS

All boxers reported alleviation of pain when punching. The range of motion for the MCP joint was not restricted after surgery in any patient. Tendon dislocation did not occur after surgery in any patient. All 5 patients were able to return to professional competition.

CONCLUSIONS

Extensor retinaculum grafting is useful in treating chronic boxer's knuckle if the damaged capsule cannot be repaired directly.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic, Level IV.

Phospho-regulation of human protein kinase Aurora-A: analysis using anti-phospho-Thr288 monoclonal antibodies

Mammalian Aurora-A is related to a serine/threonine protein kinase that was originally identified by its close homology with Saccharomyces cerevisiae Ipl1p and Drosophila melanogaster aurora that are key regulators in the orchestration of mitotic events. The protein level of Aurora-A, its peak kinase activity during mitosis, and its activation have been attributed to phosphorylation. Here we show that this enzyme is an arginine-directed kinase and define its substrate specificity. We also found that Thr288 within the activation loop is a critical residue for activating phosphorylation events in vitro and that it is spatiotemporally restricted to a brief window at mitosis on duplicated centrosomes and on spindle microtubules proximal to the poles in vivo. Immunodepletion assays indicated that an upstream kinase(s) of Aurora-A might exist in mammalian cells in addition to autophosphorylation. Furthermore, human activated Aurora-A forms complexes with the negative regulator protein serine/threonine phosphatase type 1 (PP1) that was negatively phosphorylated on Thr320. Interestingly, phospho-specific Aurora-A monoclonal antibodies restrain Aurora-A kinase activity in vitro, providing further therapeutic avenues to explore.

Magnesium-deficient diet-induced reduction in protein utilization in rats is reversed by dietary magnesium supplementation

We investigated the effect of dietary magnesium (Mg) level on protein utilization in rats. Male Wistar rats were fed a control diet (control group) and a Mg-deficient diet (Mg-deficient group) for 28 days. After 28 days, the diet of half of the Mg-deficient group (recovery group) was changed from the Mg-deficient diet to the control diet for either 7 or 14 days. After 28 days, final body weight, weight gain and food efficiency were significantly decreased due to the Mg-deficient diet. Apparent Mg absorption, Mg retention and serum Mg levels were also significantly decreased due to the Mg-deficient diet. Furthermore, the Mg-deficient group showed a significant increase in urinary nitrogen (N) excretion and significant decreases in N retention and serum albumin level. At day 7 and 14 after changing the Mg-deficient diet to the control diet, apparent Mg absorption, Mg retention and serum Mg levels were significantly increased in the recovery group as compared with those in the Mg-deficient group. However, with regard to final body weight, weight gain and food efficiency, no significant differences were observed between the Mg-deficient group and the recovery group. At day 14 after changing the diet, urinary N excretion was significantly decreased and N retention was significantly increased in the recovery group as compared with the Mg-deficient group. At day 7 and 14 after changing the diet, the serum albumin level was also significantly increased in the recovery group as compared with that in the Mg-deficient group. These results suggest that: 1) the Mg-deficient diet depresses protein utilization; 2) the Mg-deficient diet-induced impairment of protein utilization is reversed by dietary Mg supplementation; and 3) the Mg-deficient diet-induced growth retardation is not completely reversed after 14 days of Mg supplementation.

Gene expression changes in an early stage of intervertebral disc degeneration induced by passive cigarette smoking

STUDY DESIGN

This study attempts to determine the molecular changes in intervertebral disc degeneration of rats induced by passive cigarette smoking.

OBJECTIVES

To quantitate and compare the gene expression levels in intervertebral discs from passively cigarette smoking rats and nonsmoking rats.

SUMMARY OF BACKGROUND DATA

The molecular mechanism of intervertebral disc degeneration has been investigated mainly in vitro but little in vivo, and gene expression analysis has been performed in a few studies. The cigarette smoking is a risk factor of low back pain. We developed a smoking box to create a rat model of intervertebral disc degeneration induced by passive cigarette smoking.

METHODS

Total RNA was extracted from intervertebral discs of rats that were raised in a cigarette-smoking box for 2 to 7 weeks. After synthesis of cDNA, the quantitative analysis of gene expression was performed by the real-time PCR. The remaining spines were subjected to the histologic examination.

RESULTS

Histologic changes of the nucleus pulposus and the anulus fibrosus were detected after 2 weeks of smoking and were frequently found after 7 weeks. Collagen genes were downregulated remarkably after 7 weeks of smoking. No significant increase was observed in the expressions of matrix metalloproteinase-3, but the expression of tissue inhibitor of metalloproteinases-1 started to increase at 4 weeks of smoking. Aggrecan also started to be up-regulated at 4 weeks.

CONCLUSIONS

Changes in gene expression by passive cigarette smoking precede the histologic changes in the intervertebral discs. Reactions to suppress the destruction of tissue matrix and to regenerate the intervertebral discs are occurring at the same time as the degenerative histologic changes.

Histological changes in intervertebral discs after smoking and cessation: experimental study using a rat passive smoking model

BACKGROUND

Passive smoking has been reported to induce intervertebral disc degeneration in rats, and the objective of the present study was to histologically investigate changes in smoking-induced intervertebral disc degeneration after cessation of smoking.

METHODS

Four-week-old rats were subjected to passive smoking for 8 weeks in a smoking box [20 cigarettes a day: one cigarette an hour (inhaled over 3 minutes and followed by ventilation with room air for 5 minutes)] to induce intervertebral disc degeneration. Smoke-free periods of different lengths were then established, and intervertebral discs were histologically analyzed.

RESULTS

Immediately after 8 weeks of passive smoking, intervertebral discs exhibited cracks, tears, and misalignment of the annulus fibrosus, and increased fibrous tissue was seen in the nucleus pulposus. In addition, the level of interleukin-1beta in intervertebral discs was higher in the smoking group than in the non-smoking group. After cessation, progression of degeneration ceased, and the matrix of the nucleus pulposus and annulus fibrosus exhibited increased fibrous connective tissue and proteoglycan. However, there were no changes in annulus fibrosus misalignment. Interleukin-1beta levels also remained significantly elevated after 8 weeks of cessation.

CONCLUSIONS

While the annulus fibrosus degeneration caused by smoking was partially irreversible after cessation of smoking, the amount of mucin (proteoglycan) in the nucleus pulposus and annulus fibrosus tended to increase after cessation, thus suggesting the possibility that smoking-induced intervertebral disc degeneration can be repaired to some degree by cessation of smoking.

Moderate magnesium-restricted diet affects bone formation and bone resorption in rats

This study investigated the effects of moderate magnesium (Mg)-restricted diet on bone formation and bone resorption in rats. Weanling Wistar strain rats were randomly divided into three dietary groups of 6 rats each and fed their respective diets; a control diet containing 0.05% Mg (C), a half Mg diet containing 0.025% Mg (1/2Mg), or a one-fifth Mg diet containing 0.01% Mg (1/5Mg), for 21 days. Serum osteocalcin level was significantly reduced with decreasing dietary Mg level. Urinary excretion of C-terminal telopeptide of type 1 collagen was significantly higher in the 1/5Mg group than in the C group. Serum insulin-like growth factor-1 (IGF-1) level was significantly lower in the 1/2Mg and 1/5Mg groups than in the C group. Serum soluble receptor activator of nuclear factor-kappaB ligand (sRANKL) level was significantly higher in the 1/2Mg and 1/5Mg groups than in the C group. These results showed that a moderate Mg-restricted diet induced a decrease in bone formation and an increase in bone resorption. Furthermore, these changes of bone formation and bone resorption might be caused by serum IGF-1 and sRANKL levels, respectively.

Ultrafast photoinduced melting of a spin-Peierls phase in an organic charge-transfer compound, K-tetracyanoquinodimethane

Ultrafast photoinduced phase transition in a spin-Peierls (SP) system of K-tetracyanoquinodimethane (K-TCNQ) was studied by femtosecond (fs) reflection spectroscopy. Photocarriers destabilize the SP phase, resulting in a decrease in molecular dimerization within 400 fs. Such a melting of the SP phase drives three kinds of coherent oscillations. By comparing the oscillations with the Raman bands activated by the dimerization, we show that the oscillation of 20 cm-1 is due to an LO phonon, and it plays an important role for the stabilization of the SP phase.

Effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine: usefulness of the ossification-kyphosis angle on MRI

STUDY DESIGN

A reliability study was conducted.

OBJECTIVE

To report the utility of the ossification- kyphosis angle of a decompression site in the sagittal view of MRI in the preoperative evaluation of the effectiveness of posterior decompression for patients with ossification of the posterior longitudinal ligament in the thoracic spine.

SUMMARY OF BACKGROUND DATA

In patients with ossification of the posterior longitudinal ligament, in the thoracic spine, posterior decompression may not always be effective for those with physiologic kyphosis; however, posterior decompression is sometimes useful for patients with multilevel lesions or with ossification of the ligamentum flavum. Therefore, it is necessary to evaluate the indications or limitations of posterior decompression before surgery.

METHODS

The indications or limitations of posterior decompression for this disease were reviewed from the findings of intraoperative ultrasonography and various parameters on preoperative imaging in 22 patients with thoracic myelopathy.

RESULTS

Thirteen patients had echo-free space and 9 patients had no echo-free space in intraoperative ultrasonography after posterior decompression. In the kyphosis angle of the decompression site and the configuration of the maximal prominent OPLL, there was no significant difference between the group with echo-free space and the group without echo-free space (P = 0.49, P = 0.55). On the other hand, the ossification-kyphosis angle of the decompression site was more than 23 degrees in all patients with no echo-free space (23 degrees -34 degrees , 28.2 degrees +/- 3.6 degrees ), and it was less than 23 degrees in all patients with echo-free space (10 degrees -23 degrees , 17.4 degrees +/- 4.1 degrees ). There was also significant difference between the groups statistically (P < 0.01, P = 1.50789E-06). In addition, in the occupation rate of the greatest prominence of the OPLL, there was statistically significant difference between the groups (P = 0.032).

CONCLUSION

The ossification-kyphosis angle in the sagittal view of MRI has potential as an indicator of the effectiveness of posterior decompression in this disease. It is thought that there is a critical point of posterior decompression at nearly 23 degrees of the ossification-kyphosis angle of the decompression site. When the ossification-kyphosis angle is more than 20 degrees , the presence of echo free space should be carefully confirmed in intraoperative ultrasonography.

A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis

STUDY DESIGN

A semi-prospective clinical study was conducted.

OBJECTIVES

To evaluate the accuracy of a revised scoring system predicting metastatic spinal tumor prognosis and the suitability of the subsequent treatment strategy.

SUMMARY OF THE BACKGROUND DATA

We used a scoring system for the preoperative evaluation of the prognosis of metastatic spinal tumors and selected treatment methods for the predicted prognosis. In the previous version of our scoring system, the reliability of the predicting prognosis was 63.3% in 128 patients with metastatic spinal tumors.

METHODS

The study participants were 164 patients who died after surgery and 82 who died after conservative treatment. Six parameters were used in the revised scoring system. Each parameter ranged from 0 to 5 points, and the total score was 15 points. In principle, conservative treatment or palliative procedures were indicated in patients with a total score of 8 or less (predicted survival period, less than 6 months) or those with multiple vertebral metastases, while excisional procedures were performed in patients with a total score of 12 or more (predicted survival period, 1 year or more) or those with a total score of 9 to 11 (predicted survival period, 6 months or more) and with metastasis in a single vertebra. The selection of treatment modality was followed faithfully according to the criteria of the revised scoring system after 1998. The prognosis predicted by the revised scoring system and the actual survival period after treatment were compared, and the reliability of the prognostic criteria was analyzed for the group subjected to it prospectively after 1998 (n = 118) and for all 246 patients it was applied to retrospectively.

RESULTS

The total score for each patient could be correlated with the survival period. This correlation was also observed in each treatment group. The consistency rate between the predicted prognosis from the criteria of the total scores and the actual survival period was high in patients within each score range (0-8, 9-11, or 12-15), 86.4% in the 118 patients evaluated prospectively after 1998, and 82.5% in the 246 patients evaluated retrospectively. Furthermore, a similar result was also observed in both the surgical procedure group and conservative treatment group. The rate of consistency between the predicted prognosis and the actual survival period in each local extension of the lesion was 75% or more in all types, excluding Type 6 in the surgical classification of Tomita et al.

CONCLUSION

The prognostic criteria using the total scores from our revised scoring system were useful for the pretreatment evaluation of metastatic spinal tumor prognosis irrespective of treatment modality or local extension of the lesion.

Ultrasonography in tarsal tunnel syndrome

OBJECTIVE

The purpose of this study was to clarify the diagnostic value of ultrasonography in tarsal tunnel syndrome.

METHODS

Seventeen patients (17 feet) with tarsal tunnel syndrome were treated between 1988 and 2003. Preoperative ultrasonography was performed, and the cause of the syndrome was confirmed intraoperatively in all cases. Long and short axes of the tarsal tunnel were scanned to ascertain the presence of any space-occupying lesion.

RESULTS

The causes of tarsal tunnel syndrome, as confirmed by surgery, were ganglia (n = 10), talocalcaneal coalition (n = 1), talocalcaneal coalition associated with ganglia (n = 3), and varicose veins (n = 3). Among the cases involving ganglia, hypoechoic or anechoic regions were observed. The mean sizes +/- SD of these regions were 19.4 +/- 8.8 mm in the long axis, 15.2 +/- 6.3 mm in the short axis, and 10.4 +/- 3.8 mm in depth. Of these, 3 ganglia were not clearly palpable before surgery and were small: 10 x 10 x 7, 13 x 11 x 9, and 9 x 8 x 7 mm. Among the cases involving talocalcaneal coalition, ultrasonography indicated a beak-shaped bony process on the short axis images. Although these 3 cases were associated with ganglia, this could not be determined by preoperative palpation.

CONCLUSIONS

As a diagnostic imaging technique for tarsal tunnel syndrome, ultrasonography is extremely useful for identifying space-occupying lesions. Ultrasonography should be performed routinely in patients with suspected tarsal tunnel syndrome.

Trapeziometacarpal joint instability after Bennett's fracture-dislocation

BACKGROUND

Investigation of trapeziometacarpal joint instability was undertaken following Bennett's fracture-dislocation.

METHODS

We treated six patients who were experiencing trapeziometacarpal joint instability following Bennett's fracture-dislocation. The average age of the patients at the initial visit was 22.2 years. There were four men and two women. All six patients complained of trapeziometacarpal joint pain and instability preoperatively. Fluoroscopy confirmed that the beak fragment moved with the shaft fragment. The length of time from injury to surgery ranged from 1 to 29 months (average 10.7 months). Ligament reconstruction based on Eaton's method was performed on five patients, and in one patient the fracture site was osteotomized and reduced and the dorsoradial ligament repaired.

RESULTS

Over an average follow-up observation period of 20 months, none of the patients complained of severe joint pain or instability.

CONCLUSIONS

When treating Bennett's fracture-dislocation, it is necessary to pay careful attention not only to accurate anatomic reduction of the joint surface but also to joint instability.

Alteration of gene expression in intervertebral disc degeneration of passive cigarette- smoking rats: separate quantitation in separated nucleus pulposus and annulus fibrosus

OBJECTIVE

We constructed a passive cigarette-smoking model with rats to investigate the molecular mechanism of intervertebral disc degeneration, and found by gene expression analysis that passive cigarette smoking stimulated the stress-responsive signal pathway and inhibited the apoptotic pathway. In this study, to clarify that these changes were derived from either nucleus pulposus (NP) or annulus fibrosus (AF), we separately collected NP and AF and quantitatively analyzed gene expression.

METHODS

Total RNA was extracted from NP and AF of the lumbar intervertebral discs from rats which were kept in a smoking box for 4 and 8 weeks. Gene expression was measured by real-time PCR of cDNA synthesized from the total RNA.

RESULTS

Stress-responsive protein, heat shock protein 70, was expressed similarly in NP and AF, and was upregulated to the same degree after 8 weeks of passive cigarette smoking. The protein tyrosine phosphatase gene was expressed more strongly in AF than in NP, and was upregulated after 8 weeks of smoking in both tissue parts. The type II collagen and aggrecan genes were predominantly expressed in AF and NP, respectively.

CONCLUSION

These results indicate that passive cigarette smoking stimulates both NP and AF, and induces the stress-responsible genes such as heat shock protein 70 and protein tyrosine phosphatase in both.