Carpal Tunnel Syndrome Caused by Scaphoid Non-Union

A 57-year-old male with carpal tunnel syndrome following the scaphoid non-union with dorsal intercalated segmental instability is described. It was considered that the dorsiflexed and palmarly dislocated lunate led the friction of the flexor tendons and tenosynovitis and resulted in carpal tunnel syndrome

Pathology of Avascular Necrosis in the Femoral Head of Spontaneously Hypertensive Rats

Naturally occurring avascular necrosis in the femoral head of SHR, which resembles Perthes\u27 disease in man, was observed histologically. Of 96 epiphyses from 48 SHR, 34 epiphyses from 27 SHR showed a hallmark of necrosis during the period of 10 to 40 weeks after birth. The complete necrosis over the whole epiphyseal nucleus without revascularization was seen at the age of 10 and 15 weeks. Then the necrotic epiphysis was gradually repaired by the invasion of vascularized granulation tissue, and finally the healing of the necrosis was complete before the age of 40 weeks. An investigation into the pathogenesis of the healing infarction seemed that it would be of use in elucidating the cause of Perthes\u27 disease

Immunolocalization of Adhesion Molecules in Rheumatoid and Osteoarthritic Synovial Tissues

To elucidate the potential role of adhesion molecules in the pathogenesis of rheumatoid arthritis (RA), we stained specimens of synovial tissue from patients with RA and osteoarthritis (OA) with monoclonal antibodies against adhesion molecules using an immunohistochemical method. Positive staining with anti-ICAM-1 monoclonal antibody was detected on the synovial lining cells, the sublining cells and the capillary endothelial cells in the synovium from patients with RA, and, to a lesser degree, in that from patients with OA. The capillary endothelial cells from patients with RA intensively expressed both ELAM-1 and VLA-5α molecules, in contrast to that from OA patients. The intensity of both ICAM-1 and ELAM-1 on the capillary endothelial cells in RA synovium was comparable to disease activity and to the degree of synovial proliferation. A high density of expression of LFA-1α , VLA-4α and VLA-5α was observed on the mononuclear cells that infiltrated the RA synovium, especially in the lesions with aggregated mononuclear cells. The findings clearly demonstrated an up-regulation of the expression of adhesion molecules on synovial cells, capillary endothelial cells and infiltrated mononuclear cells in the synovial tissues of patients with RA. This enhanced expression of adhesion molecules may play an important role in the migration of mononuclear cells into the synovial tissues and thus perpetuate the inflammatory response in these tissues

Treatment of congenital dislocation of the hip by the Pavlik harness. Mechanism of reduction and usage.

The Pavlik harness was used in the treatment of complete congenital dislocation of one or both hips in a series of infants, on either an outpatient or an inpatient basis. The results in the two groups were compared. For the children treated as outpatients the incidence of avascular necrosis of the femoral head was 7.2 per cent and for the group treated as inpatients the rate was 28 per cent. Application of the Pavlik harness allowed reduction of the hip by shifting the femoral head first to the posterior part of the acetabulum through flexion of the hip, followed by movement of the femoral head anteriorly into the acetabulum through abduction of the hip, which is possible because of stretching of the adductor muscles by the weight of the lower extremity. When the reduction is obtained by forced abduction there is a greater danger of avascular necrosis of the femoral head

An acellular bioresorbable ultra-purified alginate gel promotes intervertebral disc repair : A preclinical proof-of-concept study

Background: The current surgical procedure of choice for lumbar intervertebral disc (IVD) herniation is discectomy. However, defects within IVD produced upon discectomy may impair tissue healing and predispose patients to subsequent IVD degeneration. This study aimed to investigate whether the use of an acellular bioresorbable ultra-purified alginate (UPAL) gel implantation system is safe and effective as a reparative therapeutic strategy after lumbar discectomy. Methods: Human IVD cells were cultured in a three-dimensional system in UPAL gel. In addition, lumbar spines of sheep were used for mechanical analysis. Finally, the gel was implanted into IVD after discectomy in rabbits and sheep in vivo. Findings: The UPAL gel was biocompatible with human IVD cells and promoted extracellular matrix production after discectomy, demonstrating sufficient biomechanical characteristics without material protrusion. Interpretation: The present results indicate the safety and efficacy of UPAL gels in a large animal model and suggest that these gels represent a novel therapeutic strategy after discectomy in cases of lumbar IVD herniation. Fund: Grant-in-Aid for the Ministry of Education, Culture, Sports, Science, and Technology of Japan, Japan Agency for Medical Research and Development, and the Mochida Pharmaceutical Co., Ltd

Bone marrow mesenchymal stem cells combined with ultra-purified alginate gel as a regenerative therapeutic strategy after discectomy for degenerated intervertebral discs

Background: Because the regenerative ability of intervertebral discs (IVDs) is restricted, defects caused by discectomy may induce insufficient tissue repair leading to further IVD degeneration. An acellular bioresorbable biomaterial based on ultra-purified alginate (UPAL) gel was developed to fill the IVD cavity and prevent IVD degeneration. However, an acellular matrix-based strategy may have limitations, particularly in the elderly population, who exhibit low self-repair capability. Therefore, further translational studies involving product combinations, such as UPAL gel plus bone marrow-derived mesenchymal stem cells (BMSCs), are required to evaluate the regenerative effects of BMSCs embedded in UPAL gel on degenerated IVDs. Methods: Rabbit BMSCs and nucleus pulposus cells (NPCs) were co-cultured in a three-dimensional (3D) system in UPAL gel. In addition, rabbit or human BMSCs combined with UPAL gel were implanted into IVDs following partial discectomy in rabbits with degenerated IVDs. Findings: Gene expression of NPC markers, growth factors, and extracellular matrix was significantly increased in the NPC and BMSC 3D co-culture compared to that in each 3D mono-culture. In vivo, whereas UPAL gel alone suppressed IVD degeneration as compared to discectomy, the combination of BMSCs and UPAL gel exerted a more potent effect to induce IVD regeneration. Similar IVD regeneration was observed using human BMSCs. Interpretation: These findings demonstrate the therapeutic potential of BMSCs combined with UPAL gel as a regenerative strategy following discectomy for degenerated IVDs. Funding: Ministry of Education, Culture, Sports, Science, and Technology of Japan, Japan Agency for Medical Research and Development, and the Mochida Pharmaceutical Co., Ltd. (c) 2020 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/

Ultra-purified alginate gel implantation decreases inflammatory cytokine levels, prevents intervertebral disc degeneration, and reduces acute pain after discectomy

Abstract Lumbar intervertebral disc (IVD) herniation causes severe low back pain (LBP), which results in substantial financial and emotional strains. Despite the effectiveness of discectomy, there is no existing treatment for post-operative LBP induced by progressive IVD degeneration. Two key factors of LBP are intradiscal inflammation, indicated by tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6), and sensory nerve ingrowth into the inner layer of the annulus fibrosus, triggered by nerve growth factor/high-affinity tyrosine kinase A (TrkA) signalling. In an animal models of discectomy, the bioresorbable ultra-purified alginate (UPAL) gel with an extremely low-toxicity has been effective in acellular tissue repair. We aimed to investigate whether UPAL gel can alleviate LBP using a rat nucleus pulposus (NP) punch model and a rabbit NP aspirate model. In both models, we assessed TNF-α and IL-6 production and TrkA expression within the IVD by immunohistochemistry. Further, histological analysis and behavioural nociception assay were conducted in the rat model. UPAL gel implantation suppressed TNF-α and IL-6 production, downregulated TrkA expression, inhibited IVD degeneration, and reduced nociceptive behaviour. Our results suggest the potential of UPAL gel implantation as an innovative treatment for IVD herniation by reducing LBP and preventing IVD degeneration after discectomy