Design of soft x-ray varied-line-spacing (VLS) high-dispersion laminar-type grating coated with super-mirror-type (SMT) multilayer for flat-field spectrograph in a region of 2-4 keV

A soft x-ray varied-line-spacing (VLS) laminar-type spherical grating with a super-mirror-type (SMT) multilayer was designed for a soft x-ray high resolution flat-field spectrograph in a region of 2-4 keV. The effective groove density of the designed VLS grating is 3200 lines/mm, and the local groove density varies from 2700 to 3866 lines/mm. The geometrical imaging property was evaluated by numerical calculations. The resolving power estimated by means of ray tracing was up to ∼103. For the evaluation of diffraction efficiency, the SMT multilayer structure designed for 3200 lines/mm in our previous work, Koike et al., Rev. Sci. Instrum. 94, 045109 (2023), was employed, and the numerical calculation was performed considering the local groove density of VLS grooves and the local incidence angle being affected by the curvature of the spherical surface and the geometrical relation between the source and incidence point on the grating. The results showed that the SMT multilayer-coated grating exhibited about an order of magnitude higher diffraction efficiency compared with an Au-coated grating.

Laminar-type gratings overcoated with carbon-based materials to enhance analytical sensitivity of flat-field emission spectrograph in the VUV region

Laminar-type spherical diffraction gratings overcoated with carbon-based materials were designed, fabricated, and evaluated for the purpose of enhancing the analytical sensitivity of the flat-field spectrograph in a vacuum ultraviolet region of 35-110 eV. As the design benchmark for numerical calculations, diffraction efficiency (DE) and spectral flux, which are defined by the product of the DE and numerical aperture and correlate with the analytical sensitivity of the spectrograph, were used. To simplify the feasibility study on the overcoating effects, we assumed a laminar-type grating having a grating constant of 1/1000 mm and coated with a Au layer of 30.0 nm thickness and an incidence angle of 84.0°. The optimized groove depth and duty ratio were 30.0 nm and 0.3, respectively. In addition, the optimum thicknesses of the overcoating layer were 44, 46, 24, and 30 nm for B4C, C, diamond-like-carbon, and SiC, respectively. Based on these results, we have fabricated a varied-line-spacing holographic grating overcoated with B4C with a thickness of 47 nm. For the experimental evaluation, we used the light source of Mg-L and Al-L emissions excited by the electron beam generated from an electron microscope, an objective flat-field spectrograph, and a CCD imaging detector. The experimental results showed that the spectrograph employing a new grating overcoated with the B4C layer indicated almost the same spectral resolution and 2.9-4.2 times higher analytical sensitivity compared with those obtained with a previously designed Au-coated grating having a grating constant of 1/1200 mm and used at an incidence of 86.0°.

Associations of fat mass index with hot flashes and lean mass index with insomnia in middle-aged women

OBJECTIVE

This cross-sectional study examined the relationship between body composition and physical and mental symptom severity in middle-aged women.

METHODS

The first-visit records of 554 women aged 40-64 years were examined. The fat mass index (FMI) and lean mass index (LMI) were defined as fat mass and lean mass divided by the height squared, respectively. The participants were divided into two groups according to their median values.

RESULTS

The only menopausal symptom with significantly different severity between the high and low FMI groups was hot flashes (HF) on the Menopausal Health-Related Quality of Life Questionnaire. The factors associated with severe HF were investigated using multiple logistic regression analysis. After adjusting, the FMI (kg/m²) was independently positively associated with severe HF (odds ratio, 1.08; 95% confidence interval, 1.02-1.15). Insomnia was the only menopausal symptom with significantly different severity between the LMI groups (defined as Athens Insomnia Scale score ≥10 points). The factors associated with moderate-to-severe insomnia were investigated using multiple logistic regression analysis. After adjusting, the LMI (kg/m²) was independently negatively associated with moderate-to-severe insomnia (odds ratio, 0.72; 95% confidence interval, 0.55-0.94).

CONCLUSIONS

The FMI was positively associated with severe HF, whereas the LMI was negatively associated with moderate-to-severe insomnia in middle-aged women.

Improvement of precision in refinements of structure factors using convergent-beam electron diffraction patterns taken at Bragg-excited conditions

A local structure analysis method based on convergent-beam electron diffraction (CBED) has been used for refining isotropic atomic displacement parameters and five low-order structure factors with sin θ/λ ≤ 0.28 Å^-1 of potassium tantalate (KTaO₃). Comparison between structure factors determined from CBED patterns taken at the zone-axis (ZA) and Bragg-excited conditions is made in order to discuss their precision and sensitivities. Bragg-excited CBED patterns showed higher precision in the refinement of structure factors than ZA patterns. Consistency between higher precision and sensitivity of the Bragg-excited CBED patterns has been found only for structure factors of the outer zeroth-order Laue-zone reflections with larger reciprocal-lattice vectors. Correlation coefficients among the refined structure factors in the refinement of Bragg-excited patterns are smaller than those of the ZA ones. Such smaller correlation coefficients lead to higher precision in the refinement of structure factors.

Chilliness in Japanese middle-aged women is associated with anxiety and low n-3 fatty acid intake

Objective: This cross-sectional study investigated chilliness, which is the most prevalent sexual-vasomotor symptom in middle-aged Japanese women.Methods: First-visit records of 475 Japanese women (age 40-65 years) enrolled in the health and nutrition education program at a menopause clinic were analyzed. Chilliness was estimated based on responses to the Menopausal Symptom Scale. Effects of age, menopausal status, body composition, cardiovascular parameters, resting energy expenditure, physical fitness, menopausal symptoms, lifestyle, and estimated daily intake of nutrients were assessed using a multivariate logistic regression analysis.Results: Severe chilliness was found in 28.4% of women. It was not related to age, menopausal status, body mass index, or body fat percentage. The anxiety subscale score of the Hospital Anxiety and Depression Scale was the sole background characteristic independently associated with severe chilliness (adjusted odds ratio, 1.09; 95% confidence interval, 1.04-1.15 per point). Daily intakes of vitamin D and n-3 fatty acids were significantly lower in women with severe chilliness. Daily intake of n-3 fatty acids was negatively associated with severe chilliness after adjustment (odds ratio, 0.54; 95% confidence interval, 0.29-0.95 per g/1000 kcal intake).Conclusions: Chilliness is associated with anxiety and low intake of n-3 fatty acids.

Severity of hot flushes is inversely associated with dietary intake of vitamin B6 and oily fish

Objectives: This study investigated the links between the severity of vasomotor symptoms (VMS) and the dietary consumption of a variety of nutrients. Method: A cross-sectional analysis of the first-visit records of 262 women aged 40-65 years was conducted. The severity of their hot flushes (HF) and night sweats (NS) and their dietary consumption of nutrients were evaluated using the Menopausal Health-Related Quality of Life Questionnaire and the brief-type self-administered Diet History Questionnaire, respectively. The relationships between severity of HF/NS and dietary intake were analyzed separately for 43 major nutrients. We then evaluated different food items as sources of the nutrients. Results: After adjustment for age, body mass index, menopausal status, and background factors significantly related to VMS, only vitamin B₆ (VB₆) was significantly related to severity of HF (adjusted odds ratio per 10 μg/MJ in VB₆ intake, 0.92; 95% confidence interval, 0.86-0.97). Moreover, a significant inverse relationship was found between the consumption of oily fish as a source of VB₆ and the severity of HF. Conclusions: VB₆ and oily fish intake is inversely associated with the severity of HF in middle-aged women. Therefore, increased intake of VB₆ could help attenuate HF.

Subjective insomnia is associated with low sleep efficiency and fatigue in middle-aged women

OBJECTIVES

Many middle-aged women are affected by sleep disturbance. We investigated how subjective insomnia is associated with objective sleep parameters and other background characteristics.

METHODS

This cross-sectional study used baseline data obtained from 95 women aged 40-59 years who participated in another study assessing the effects of a dietary supplement. Participants wore an actigraph unit for 3 days to collect information concerning physical activities and objective sleep parameters and were then evaluated for body composition, cardiovascular parameters, and menopausal symptoms including insomnia and fatigue, and lifestyle factors. Stratifying Athens Insomnia Scale scores as low (0-5 points, control group) and high (≥ 6 points, subjective insomnia group), we sought to identify the parameters that are independently associated with subjective insomnia.

RESULTS

Women with subjective insomnia (n = 30) had lower sleep efficiency than did the controls. They were also older; had more live births, lower height, higher body mass index, lower ankle brachial index, and more severe menopausal symptoms including fatigue; took more naps; smoked more cigarettes; and more of them were full-time workers. Multivariate logistic regression analysis revealed that low sleep efficiency (adjusted odds ratio, 1.44 per 1% decrease in sleep efficiency; 95% confidence interval 1.06-2.05) and fatigue assessed with Brief Fatigue Inventory (BFI) (adjusted odds ratio, 1.57 per 1-point increase in BFI score; 95% confidence interval 1.19-2.13) were independent contributors to subjective insomnia.

CONCLUSIONS

Low sleep efficiency and feeling of fatigue were found to be independently associated with subjective insomnia in middle-aged women.

Spontaneous osteonecrosis of the knee: histopathological differences between early and progressive cases

We prospectively examined the physical and imaging findings, including MRI, of 23 patients with spontaneous osteonecrosis of the knee after obtaining informed consent to acquire tissue specimens at surgery. There were four men and 19 women, with a mean age of 67.5 years (58 to 77). Plain radiographs were designated as stages 1, 2, 3 or 4 according to the classification of Koshino. Five knees were classified as stage 1, five as stage 2, seven as stage 3 and six as stage 4. The histological specimens were stained with haematoxylin and eosin and tetrachrome. In the early stages of the condition, a subchondral fracture was noted in the absence of any features of osteonecrosis, whereas in advanced stages, osteonecrotic lesions were confined to the area distal to the site of the fracture which showed impaired healing. In such cases, formation of cartilage and fibrous tissue, occurred indicating delayed or nonunion. These findings strongly suggest that the histopathology at each stage of spontaneous osteonecrosis is characterised by different types of repair reaction for subchondral fractures.

Expression of Twist increases the risk for recurrence and for poor survival in epithelial ovarian carcinoma patients

Twist is a transcription factor that regulates the expression of tumour suppressors such as E-cadherin. We examined the distribution and expression of Twist in human epithelial ovarian carcinoma (EOC) to examine its clinical significance. Paraffin sections from EOC tissues (n=82) were immunostained with Twist antibody, and the staining intensity was evaluated. The clinicopathological factors examined were age, International Federation of Gynecology and Obstetrics staging, histological type, tumour grade, preoperative value of CA125, peritoneal cytology, volume of ascites and residual tumour after cytoreductive surgery. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method, and multivariate analysis was performed using the Cox proportional hazard analysis. Of the 82 carcinomas, 49 (59.8%) cases were negative for Twist immunoexpression, and 33 (40.2%) were positive immunoexpression. When categorized into negative vs positive expression, Twist was not associated with any of the clinicopathological parameters examined. However, positive Twist expression significantly predicted poorer OS and PFS when compared with negative expression (P<0.0001). In the multivariate analyses, positive Twist expression was the only independent prognostic factor for survival in this study (P<0.0001). Positive Twist expression seems to be a useful marker in patients with EOC likely to have an unfavourable clinical outcome.

Indoleamine 2,3-dioxygenase is a novel prognostic indicator for endometrial cancer

Indoleamine 2,3-dioxygenase (IDO) is a tryptophan-catabolising enzyme inducing immune tolerance. The present study aimed to investigate IDO expression and its prognostic significance in endometrial cancer. Indoleamine 2,3-dioxygenase expression in endometrial cancer tissues (n = 80) was immunohistochemically scored as four groups (IDO-, 1+, 2+, and 3+). The high IDO expression (IDO2+ or 3+) in tumour cells was found in 37 (46.3%) of the 80 cases, and was positively correlated with surgical stage, myometrial invasion, lymph-vascular space involvement, and lymph node metastasis, but not with the histological grade. Patients with high IDO expression had significantly impaired overall survival and progression-free survival (PFS) (P = 0.002 and P = 0.001, respectively) compared to patients with no or weak expression of IDO (IDO- or 1+). The 5-year PFS for IDO-/1+, 2+, and 3+ were 97.7, 72.9, and 36.4%, respectively. Even in patients with early-stage disease (International Federation of Gynecology and Obstetrics I/II, n = 64), the PFS for IDO2+/3+ was significantly poor (P = 0.001) compared to that for IDO-/1+. On multivariate analysis, IDO expression was an independent prognostic factor for PFS (P = 0.020). These results indicated that the high IDO expression was involved in the progression of endometrial cancer and correlated with the impaired clinical outcome, suggesting that IDO is a novel and reliable prognostic indicator for endometrial cancer.

Electronic structure analyses of BN network materials using high energy-resolution spectroscopy methods based on transmission electron microscopy

Electronic structures of boron-nitride (BN) nanotubes and a BN cone-structure material were studied by using a high energy-resolution electron energy-loss spectroscopy (EELS) microscope. A trial of the whole electronic structure study of hexagonal BN (h-BN), which consists of flat BN honeycomb layers, was conducted by a combination of EELS and X-ray emission spectroscopy (XES) based on transmission electron microscopy (TEM) (TEM-EELS/XES). The pi and pi+sigma plasmon energies of BN nanotubes (BNT) were smaller than those of h-BN. The pi+sigma energy was explained by the surface plasmon excitation. The spectrum of a two-wall BNT of 2.7 nm in diameter showed a new spectral onset at 4 eV. The valence electron excitation spectra obtained from the tip region of the BN cone with an apex angle of 20 degrees showed similar intensity distribution with those of BNTs. The B K-shell electron excitation spectra obtained from the bottom edge region of the BN cone showed additional peak intensity when compared with those of h-BN and BNT. The B K-shell electron excitation spectra and B K-emission spectra of h-BN were compared with a result of a LDA band calculation. It showed that high symmetry points in the band diagram appear as peak and/or shoulder structures in the EELS and XES spectra. Interband transitions appeared in the imaginary part of the dielectric function of h-BN experimentally obtained were assigned in the band diagram. The analysis also presented that the LDA calculation estimated the bandgap energy smaller than the real material by an amount of 2 eV. Those results of TEM-EELS/XES analysis presented that high energy-resolution spectroscopy methods combined with TEM is a promising method to analyze whole electronic structures of nanometer scale materials.

Changes in biochemical parameters after anterior cruciate ligament injury

We studied the biochemical characteristics of human knees with deficient anterior cruciate ligaments (ACL) and analysed their relationship to the time after ligamentous injury. Thirty-two patients with isolated ACL-injured knees and six healthy volunteers were enrolled. Synovial fluid samples were centrifuged after aspiration during arthroscopic examination, and aliquots of supernatant were frozen and stored at -80 degrees C. The samples were analysed for interleukin (IL)-1beta, tumour necrosis factor (TNF)-alpha, IL-6, matrix metalloproteinase (MMP)-3, and tissue inhibitor of metalloproteinase (TIMP)-1 using commercially available sandwich enzyme-linked immunosorbent assay. In fluid from ACL-injured knees, the average concentrations of IL-6, MMP-3 and TIMP-1 were highly elevated in comparison with normal controls. There was a statistically significant correlation between the concentrations of MMP-3 and IL-6. The IL-6 and TIMP-1 concentrations were interrelated. The concentration of MMP-3 remained high, independent of the duration since the injury, whereas the TIMP-1 and IL-6 levels decreased. The results suggest that the timing of the treatment of an ACL-injured knee might be of importance.

Quantitative evaluation of anterior tibial translation during isokinetic motion in knees with anterior cruciate ligament reconstruction using either patellar or hamstring tendon grafts

We studied 79 patients with unilateral injury to the anterior cruciate ligament (ACL). The patients were randomly allocated to reconstruction with autologous patellar bone-tendon-bone (BTB) grafts (49 knees) or hamstring tendon (ST) grafts (30 knees). We measured anterior tibial translation (ATT) during isokinetic concentric contraction exercise 18-20 months after surgery using a computerized electrogoniometer. In both groups the highest ATT during exercise was observed at a knee flexion of about 20 degrees and was 13.5+/-3.0 mm in the BTB group and 13.9+/-3.4 mm in the ST group. There was no difference in the ATT between the reconstructed and healthy knees. For a range of knee flexion between 30 and 50 degrees the ATT in the ST group was significantly higher on the reconstructed side than on the healthy side. In the BTB group, the mean ATT in the reconstructed group was similar to that on the healthy side at a knee flexion angle between 0 and 90 degrees .

Retroperitoneoscopic Living Donor Nephrectomy: A Safe and Minimally Invasive Procedure for the Donor

A living kidney donor surgery must be safe and minimally invasive. In addition the removed kidney must be in good condition. Retroperitoneoscopic nephrectomy has the advantage that it does not risk intra-abdominal organ injuries and provides direct access to the renal artery/vein despite the small working space. An abdominal wall-lifting method combined with the pneumoretroperitoneum provides sufficient space to use a hand skillfully in retroperitoneoscopic surgery. Introduction of hand-assisted retroperitoneoscopic living donor nephrectomy with the abdominal wall-lifting method yielded safer and easier operations as well as shorter warm ischemia (mean: 3 minutes; 7 seconds) and operative times (mean: 3 hours; 28 minutes) in the current 10 cases. The procedure is a useful alternative to procure a kidney graft.

Muscle performance after anterior cruciate ligament reconstruction

We measured muscle strength in 36 patients after anterior cruciate ligament (ACL) reconstruction with autogenous bone-patellar tendon-bone graft. Quadriceps and hamstring isokinetic strength was assessed during concentric contraction at 60 and 180 degrees /s and was measured at 1, 6, 12 and 24 months postoperatively. At 24 months quadriceps muscle strength had recovered to approximately 90% of the level of the uninvolved side, both at 60 and 180 degrees /s. In contrast, hamstring muscle strength had already recovered to approximately 90% at 6 months. Age, gender, activity level, and anterior tibial laxity did not affect the muscle performance. However, the recovery of muscle strength was delayed in patients with anterior knee pain.

Interactions of HLA-DRB4 and CTLA-4 genes influence thyroid function in Hashimoto's thyroiditis in Japanese population

Hashimoto's thyroiditis (HT) is an autoimmune disease of the thyroid gland, and like many other autoimmune diseases, it is associated with the HLA and CTLA-4 gene. We have examined the distribution of the HLA DRB4*0101 allele and a CTLA-4 exon 1 A/G polymorphism in Japanese HT patients and controls and investigated possible interactions of these genes with thyroid function. Seventy Japanese HT patients and 105 controls were included in this study. HT was diagnosed on the basis of positivity for thyroid peroxidase (TPO) autoantibodies and the presence of a palpable diffuse goiter. Genotyping was performed by polymerase chain reaction (PCR)-based methods. CTLA-4-GG or -AG was more prevalent in the patients, and the odds ratio for the G allele was 4.95. The frequency of DRB4*0101-positive individuals was significantly higher in HT (odds ratio=2.17). The TSH values of HT patients at the time of diagnosis were compared to CTLA-4 genotype and HLA-DRB4*0101 positivity. They were slightly higher in the CTLA-4-AG group than in the -GG group and significantly higher in the HLA-DRB4*0101-positive group than in the -negative group (p<0.01). When the TSH values were compared in 4 groups based on positivity or negativity for HLA-DRB4*0101 and CTLA-4 GG or AG, they were found to be significantly higher in the CTLA-4-AG and HLA-DRB4*0101-positive group than in the 3 other groups (F=5.75, 3 degrees of freedom, p<0.01). These findings suggest that the interaction between the HLA-DRB4 and CTLA-4 genes determines the thyroid function of TPO-positive goitrous Japanese HT patients.

Varus inclination of the distal femur and high tibial osteotomy

We have analysed retrospectively the relationship between the axial parameters of alignment of the lower limb and the recurrence of varus deformity after high tibial osteotomy. We studied 29 patients (37 knees) with a mean age at surgery of 66 years. The mean follow-up was for 7.4 years (5 to 10.5). Recurrence of varus deformity was defined as an increase in the femorotibial angle of 3° or more, compared with that obtained six months after the operation. There were four patients (four knees) with recurrence of varus deformity. They had a greater varus inclination of the distal femur than those without varus recurrence.

An association between varus inclination of the distal femur and horizontal obliquity of the joint surface was observed. Excessive obliquity prevents the shift of weight-bearing to the lateral compartment, and may cause a recurrence of varus deformity after high tibial osteotomy.

Varus inclination of the distal femur and high tibial osteotomy

We have analysed retrospectively the relationship between the axial parameters of alignment of the lower limb and the recurrence of varus deformity after high tibial osteotomy. We studied 29 patients (37 knees) with a mean age at surgery of 66 years. The mean follow-up was for 7.4 years (5 to 10.5). Recurrence of varus deformity was defined as an increase in the femorotibial angle of 3 degrees or more, compared with that obtained six months after the operation. There were four patients (four knees) with recurrence of varus deformity. They had a greater varus inclination of the distal femur than those without varus recurrence. An association between varus inclination of the distal femur and horizontal obliquity of the joint surface was observed. Excessive obliquity prevents the shift of weight-bearing to the lateral compartment, and may cause a recurrence of varus deformity after high tibial osteotomy.

Skin rash in the hypogastric region during a regional chemotherapy for bladder carcinoma: CT and scintigraphic demonstration of a potential collateral pathway between the internal iliac and inferior epigastric arteries

A 70-year-old man developed a skin rash in his right lower abdominal wall after an intra-arterial infusion chemotherapy for carcinoma of the bladder. A CT with a direct infusion of contrast material via the implanted reservoir showed a marked enhancement of the right inferior epigastric artery and a significantly large artery in the right inguinal region. Radionuclide imaging with a direct infusion of Tc-99m macroaggregated albumin (MAA) revealed an abnormal accumulation in the right anterior abdominal wall. These findings implied a collateral pathway from the right internal iliac artery to the right inferior epigastric artery, i.e., the corona mortis.

Knee stability after repair of isolated midsubstance tears of the posterior cruciate ligament

This study was made to compare the results after operative versus non-operative management for tears in the substance of posterior cruciate ligament. The subjects were 40 patients, half of whom were managed operatively and the other half non-operatively. End-to-end suture was performed on the operated group. The procedure was followed by cast immobilization for 4 weeks. Non-operative management consisted of immobilization in a cast for 4 weeks after arthroscopy. The average follow-up periods were 6 years 7 months and 4 years 3 months. The operated knees were significantly more stable than those of the non-operated group on stress radiographs (p<0.0001), but not to the extent of an age-matched control group (p<0.0001). The knee rating scores did not indicate any improvement of the functional outcome in the operated group. Surgery resulted in better posterior laxity than non-operative management; the achieved stability, however, was clearly less than in controls.

Distinction between space groups having principal rotation and screw axes, which are combined with twofold rotation axes, using the coherent convergent-beam electron diffraction method

23 sets of space groups remain indistinguishable by the convergent-beam electron diffraction (CBED) method. Recently, Tsuda, Saitoh, Terauchi, Tanaka & Goodman [Acta Cryst. (2000), A56, 359-369] demonstrated that the coherent CBED method can distinguish two space-group pairs (I23, I2(1)3) and (I222, I2(1)2(1)2(1)) by observing the relative arrangements of 2-fold-rotation and 2(1)-screw axes. The other ten space-group sets, which are composed of principal rotation and screw axes and other 2-fold-rotation axes such as P321 and P3(1)21 (P3(2)21), are shown to be distinguishable using the coherent CBED method.

Development of a sub-eV resolution soft-X-ray spectrometer for a transmission electron microscope

We constructed a grazing-incidence soft-X-ray spectrometer for a transmission electron microscope. The spectrometer, which was composed of a grating and a CCD detector, was attached to a JEM2000FX transmission electron microscope. B K-emission spectra of hexagonal boron-nitride, which give the density of states of the valence band of the material, were obtained with an energy resolution of about 0.6 eV.

Factors affecting long-term results after arthroscopic partial meniscectomy

The purpose of this study was to determine functional and radiographic changes on long-term followup of knees with isolated meniscal tears. Sixty-seven patients were evaluated retrospectively with an average of 12.2 years' followup using the scale of Tapper and Hoover. The criteria for the radiographic results were the Fairbank's changes as the standard comparing the preoperative and the postoperative conditions of the affected knee with the contralateral knee. Seventy-nine percent of the patients had a satisfactory outcome in terms of function. The amount of meniscus removed and the Outerbridge classification of the articular cartilage at the time of the meniscectomy were determining factors for long-term functional results. Osteoarthritic deterioration was seen in 48% of patients after the surgery, but radiographic deterioration after arthroscopic partial meniscectomy was mild on long-term followup. Medial meniscectomy and the amount of meniscus removed were risk factors for postoperative radiographic change. Age, gender, and the degree of cartilage degeneration at the time of operation, in contrast, showed no significant association. Arthroscopic partial meniscectomy for isolated meniscal injury yields favorable functional results but leads to significantly increased osteoarthritic change in the long-term.

The management of medial ligament tears in patients with combined anterior cruciate and medial ligament lesions

The management of patients with combined medial collateral (MCL) and anterior cruciate (ACL) rupture remains controversial. We studied 25 such patients who elected to have the ACL lesion treated conservatively; 14 underwent MCL repair with early mobilization and 11 were treated with immobilization for two weeks. The mean follow up was 5.9 years (2 to 11). There was no difference in the clinical assessment of ligamentous laxity, KT-1000 measurements or Tegner activity scores between the two groups but there were significantly higher Lysholm function scores in the operated group.

Atomic Structures of Oxygen-associated Defects in Sintered Aluminum Nitride Ceramics

: Convergent-beam electron diffraction and Z-contrast imaging are used to study oxygen-associated defects, flat inversion domain boundaries, dislocations, and interfaces in sintered AlN ceramics. The structures of these defects are directly derived from atomic-resolution Z-contrast images. The flat inversion domain boundaries contain a single Al-O octahedral layer and have a stacking sequence of.bAaB-bAc-CaAc., where -cAb- indicates the single octahedral layer. The expansion at the flat inversion domain boundaries is measured to be 0.06 (+/-0.02) nm. The interfaces between 2H- and polytypoid-AlN are found to be also inversion domain boundaries but their stacking sequence differs from that of the flat inversion domain boundaries.

A new 200 kV Omega-filter electron microscope

A new 200 kV Omega-filter electron microscope was developed under a project supported by a Grant-in-Aid for Specially Promoted Research of the Ministry of Education, Science, Sports and Culture of Japan. The performance of the microscope is described.

Development of a high energy resolution electron energy-loss spectroscopy microscope

We have developed a high energy resolution electron energy-loss spectroscopy (EELS) microscope, which can take spectra from specified small specimen areas and specified small reciprocal space areas to investigate detailed electronic structures. The EELS microscope is equipped with retarding Wien filters as the monochromator and the analyser. The filters are designed to achieve a stigmatic focus. The energy resolutions are 12 meV and 25 meV for cases without and with a specimen, respectively. Spatial and momentum resolutions are 30-110 nm in diameter and 1.1 nm-1 in angular diameter, respectively. EELS spectra are presented to show the performance of this instrument.

Lack of association between CTLA-4 gene polymorphism and IDDM in Japanese subjects

Susceptibility to insulin-dependent diabetes mellitus (IDDM) is determined by both environmental and genetic factors. The main gene associated with predisposition to IDDM is HLA. Recent studies have described linkage and association of IDDM to the CTLA-4 gene (IDDM12) in Caucasians. CTLA-4 is a candidate gene for T-cell-mediated autoimmune diseases because it is a negative regulator of T-cell proliferation. We investigated the distribution of a CTLA-4 gene polymorphism in 110 Japanese patients with IDDM and 200 control subjects. In 84 patients, we also investigated associations between this CTLA-4 gene polymorphism and GAD65 antibody positivity. An A/G transition at position 49 of exon 1 was analyzed by the polymerase chain reaction-restriction fragment length polymorphism method. GAD65 antibody was detected using a radioligand binding assay. There was no significant difference in the distribution of CTLA-4 alleles in patients and controls and no difference was observed in prevalence of CTLA-4 alleles when GAD65 antibody-positive and -negative individuals in the IDDM groups were compared. The present study did not support an association between the CTLA-4 gene and IDDM in the Japanese population.

Median raphe (parameatal) cysts of the penis

PURPOSE

Although median raphe cysts of the penis have been widely reported the pathogenesis is obscure. We describe the microstructural detection of 3 cases of median raphe to study the true pathogenesis.

MATERIALS AND METHODS

Three patients presented to our clinic of plastic surgery complaining of abnormal shape of the penis or mass recurrence. High magnification light microscopy and electron microscopy were performed.

RESULTS

Microstructural study revealed that all 3 cases had similar findings to those of the common urethral mucosa.

CONCLUSIONS

Median raphe cysts are derived from the external paraurethral ducts and contain features that to our knowledge have not been previously reported.

The influence of osteoporosis on varus osteoarthritis of the knee

We studied 37 patients with varus osteoarthritis of the knee to determine the influence of the bone mineral density (BMD) on the varus deformity. There were 15 men (21 knees) and 22 women (38 knees). The mean age of the men was 69 years and of the women 68 years. BMD was measured in the L1-L4 spinal region using dual X-ray absorptiometry. In the women a low level of BMD was associated with varus deformity originating at the proximal tibia, but a high level was predominantly linked with deformity originating in the joint space. Similar findings were obtained in the men. Our results suggest that a low BMD predisposes to trabecular microfractures and consequently increased stress on the articular cartilage. A low BMD does not preclude osteoarthritic change in the knee.

The influence of osteoporosis on varus osteoarthritis of the knee

We studied 37 patients with varus osteoarthritis of the knee to determine the influence of the bone mineral density (BMD) on the varus deformity. There were 15 men (21 knees) and 22 women (38 knees). The mean age of the men was 69 years and of the women 68 years. BMD was measured in the L1–L4 spinal region using dual X-ray absorptiometry.

In the women a low level of BMD was associated with varus deformity originating at the proximal tibia, but a high level was predominantly linked with deformity originating in the joint space. Similar findings were obtained in the men.

Our results suggest that a low BMD predisposes to trabecular microfractures and consequently increased stress on the articular cartilage. A low BMD does not preclude osteoarthritic change in the knee.

The natural history of untreated anterior cruciate tears in recreational athletes

A followup study was performed to elucidate the natural course of acutely torn anterior cruciate ligaments in recreational athletes. Fifty-six consecutive patients had arthroscopy within 2 weeks of their initial injuries; however, no surgery was done on the torn anterior cruciate ligament. Twenty anterior cruciate ligament and medial collateral ligament combined ruptures occurred. Patient ages ranged from 14 to 50 years old (mean, 28.9 years). Followup periods ranged from 2 to 10 years (mean, 5 years 6 months). Through examination with the KT-1000 arthrometer, side-to-side differences of anterior translation of the tibia of > or = 3 mm in 72% patients at reexamination were seen. Eight of 46 patients had mild osteoarthritic changes of Grade 1 visible on radiographs, but only 1 patient reported knee trouble. Nine patients had repeat injuries, 3 of whom had late reconstructions and 4 late meniscectomies. Functional scores averaged 95 +/- 6.5 points. Activity scores averaged 4.8 +/- 1.6 points. Operative management for the medial structure did not improve the stability better than nonoperative management. Anterior translation and functional scores of patients with medial meniscectomies showed significant differences from those of other patients. Anterior cruciate ligament reconstruction for recreational athletes should be considered when the patients have reparable meniscal tears, and meniscal repairs should be performed simultaneously.

Axial parameters affecting lower limb alignment after high tibial osteotomy

Lower limb alignment of 46 knees treated with high tibial osteotomy was studied to find a method for determining the precise correction angle. The femorotibial angle was divided into several axial alignment parameters. Before the operations, the femorotibial angle correlated with the tilting angle of the femoral shaft toward the horizontal (femoral shaft-horizontal angle) and that of the tibial shaft toward the horizontal (tibial shaft-horizontal angle). After the operations, the femorotibial angle correlated with the tibial shaft-horizontal angle, but not with the femoral shaft-horizontal angle. The postoperative femoral shaft-horizontal angle tends to be constant regardless of the degree of valgus. In preoperative varus knees, the varus deformity increases the degree of shift of the femoral and tibial shaft toward the varus direction. In postoperative valgus knees, the more valgus the knee the more the tibial shaft shifted toward the valgus direction, which was not true for the femoral shaft. The femorotibial angle was influenced more by the tibial axial alignment in the postoperative valgus knee. The slope of the distal femoral articular surface influenced the tilt of tibial articular surface toward the horizontal which, in turn, influenced the tibial shaft-horizontal angle. The authors recommend relying on the tibial axial alignment parameter to determine the amount of correction. The slope of the distal femoral articular surface should be considered in preoperative planning.