Clinical and Arthroscopic Findings of Acute Anterior Cruciate Ligament Tears of the Knee

Clinical, arthrographic, and arthroscopic findings in 53 patients with acutely torn anterior cruciate ligaments (ACLs) were documented. Arthroscopy and instability tests under anesthesia were performed on all patients within 2 weeks after the initial injury. Twenty-three patients complained of extension blocks, and localized tenderness on the medial side was revealed in 26 patients at the initial examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond's fractures, 26 meniscus tears (8 medial and 18 lateral), 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full extension. Statistical analysis showed that tenderness on the medial side was not revealed more frequently in knees with medial collateral ligament injuries than in the others. The volume of aspirated fluids in knees with no leakage in arthrography significantly increased over those with leakages (p < 0.05). Diagnosis of ACL injuries should be completed by clinical, arthrographic, and arthroscopic examinations

環状重合乳酸のガン細胞増殖抑制効果

乳酸を環状に重合した化合物である環状重合乳酸（CPL）が、ガン細胞の増殖を強力に抑制することが見出されている。CPLのこの特異な生理活性が脚光を浴び、CPLを新しいタイプの機能性食品や抗ガン剤として応用するための試みが精力的に実施されている。　CPLはガン細胞のピルビン酸キナーゼおよび乳酸脱水素酵素の活性阻害に効果を示し、ガン細胞の解糖系を特異的に抑制する特長を示す。この結果、解糖系の機能が低下したガン細胞においては、エネルギーおよび細胞構成成分の産生・供給が停滞状態に陥る。また、CPLの作用によりガン細胞ではアポトーシスも誘導されることから、ガンの成長が抑制されることが示されている。現在では、ガン患者を対象としたCPLの臨床試験も実施されており、腫瘍の縮小や症状の改善に関する症例報告がある。A novel supramolecular oligomer, cyclic polylactate (CPL), was originally discovered in the culture medium of tumor cells. CPL suppresses the growth of tumor cells by inhibiting the activities of enzymes involved in the glycolytic pathway, pyruvate kinase and lactate dehydrogenase. Application of CPL was found to induce apoptosis in tumor cells through 7A6 antigen expression and DNA ladder formation. In addition, CPL is reported to prolong significantly the survival period of tumor bearing mice. These findings suggest that CPL might be a useful chemotherapeutic agent for cancers

Immunopathological Characterization of liposome Adjuvant Coated with Mannan

The adjuvant activity of liposomes coated with mannan-cholesterol was studied in mice. Ovalbumin (OVA) was reconstituted into liposomes as a model antigen. The adjuvant activity was assessed by the following two immunological responses: delayed-type hypersensitivity (DTH) footpad swelling responses and in vitro release of interferon-γ and interleukin-4 by regional lymph node cells. First, we studied dose effects on DTH responses of total lipid, mannan-cholesterol and OVA used for liposomes. The minimal doses per mouse required for the induction of optimal responses were as follows; 1μg of OVA, 10μg of mannan-cholesterol and 336μg of total lipid. Second, immunological and histopathological studies showed the following two points: 1) mannan-coated liposomes induced a tuberculintype DTH response while non-coated liposomes elicited a Jones-Mote reaction, and 2) mannan-coated liposomes induced obvious microabscesses but non-coated liposome did not. Third, the inoculation of mannan-coated liposomes rendered the regional lymph node cells to release a large amount of interferon-γ with little IL-4 against OVA while non-coated lipo-some released neither of the lymphokines. These results indicated that mannan-coated lipo-somes are a potent adjuvant to induce type 1 helper T cells but have a disadvantage to form microabscesses at the inoculation sites

Need for Flexible Adjustment of the Treatment Schedule for Aprepitant Administration against Erlotinib-Induced Refractory Pruritus and Skin Rush

Common dermatological side-effects associated with erlotinib, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), include pruritus and skin rash, which are mediated by substance P, leading to the occasional discontinuation of cancer treatment. Aprepitant is an antagonist of neurokinin-1 receptor, through which substance P activates the pruritogens. Thus, aprepitant is expected to offer a promising option for the treatment of erlotinib-induced pruritus. However, the appropriate treatment schedule for aprepitant administration is under consideration. Here, we discuss the need for flexible adjustment of the treatment schedule for aprepitant administration against erlotinib-induced refractory pruritus and skin rush. A 71-year-old female smoker presented with stage IV EGFR-mutated lung adenocarcinoma. She was started on erlotinib at 150 mg/day. However, by 28 days, severe pruritus and acneiform skin rush resistant to standard therapies occurred, resulting in the interruption of erlotinib therapy. After recovery, she was restarted on erlotinib at 100 mg/day. However, severe pruritus and skin rush developed again within 2 weeks. Then, we started the first 3-day dose of aprepitant (125 mg on day 1, 80 mg on day 3, and 80 mg on day 5) based on the results of the previous prospective study, which showed the success rate of 100% with at least the second dose of aprepitant. However, the pruritus and skin rush exacerbated again within 4 weeks. Therefore, we started the second 3-day dose of aprepitant, but in vain. At this point, as the patient-centered medicine, bi-weekly schedule of the 3-day dose of aprepitant was considered and, then, adopted. As the results, the pruritus and skin rush remained well-controlled throughout the subsequent treatment with erlotinib

Exopolysaccharides Isolated from Milk Fermented with Lactic Acid Bacteria Prevent Ultraviolet-Induced Skin Damage in Hairless Mice

Background: We studied the mechanism by which fermented milk ameliorates UV-B-induced skin damage and determined the active components in milk fermented with lactic acid bacteria by evaluating erythema formation, dryness, epidermal proliferation, DNA damage and cytokine mRNA levels in hairless mice exposed to acute UV-B irradiation. Methods: Nine week-old hairless mice were given fermented milk (1.3 g/kg BW/day) or exopolysaccharide (EPS) concentrate (70 mg/kg BW/day) orally for ten days. Seven days after fermented milk or EPS administration began, the dorsal skin of the mice was exposed to a single dose of UV-B (20 mJ/cm2). Results: Ingestion of either fermented milk or EPS significantly attenuated UV-B-induced erythema formation, dryness and epidermal proliferation in mouse skin. Both fermented milk and EPS were associated with a significant decrease in cyclobutane pyrimidine dimers and upregulated mRNA levels of xeroderma pigmentosum complementation group A (XPA), which is involved in DNA repair. Furthermore, administration of either fermented milk or EPS significantly suppressed increases in the ratio of interleukin (IL)-10/IL-12a and IL-10/interferon-gamma mRNA levels. Conclusion: Together, these results indicate that EPS isolated from milk fermented with lactic acid bacteria enhanced DNA repair mechanisms and modulated skin immunity to protect skin against UV damage