Current Femoral Stem Fixation Selection in Hip-Fracture Bipolar Hemiarthroplasties, and Factors Affecting Surgeons’ Confidence in Their Ability to Teach about Cemented Stems: A Questionnaire in a Region of Japan with Super-Aged Patients

Japan’s hip fracture management guidelines now recommend the use of cemented stems in cases of bone fragility. However, the current stem selection practices in bipolar hemiarthroplasty (BHA) in a super-aging area in Japan remain unclear. This study aimed to examine the stem selection policies, the surgeons’ concerns about cemented stems, and factors affecting their confidence in their ability to coach others on cemented stem procedures. Ninety-four orthopedic surgeons (27 facilities) responded to our web-based questionnaire conducted in January/February 2022. Cementless stem was the first choice of 97.8% of the surgeons; <15% of the respondents expected to increase their use of cemented stems in the future. The cement technique was the greatest concern; almost half of the surgeons described having insufficient experience with cemented stems. The factor that most affected the surgeons’ expertise in using cemented stems is the number of surgeries they had conducted with a cemented stem (multivariable analysis odds ratio 8.42, p=0.001). Greater experience was associated with increased expertise of the surgeons in using cemented stems, with a threshold of 11 cases showing sensitivity of 41.7% and specificity of 98.3% for their confidence to instruct cemented stems

Massive Deposition and Accumulation of Hydroxyapatite Crystal after Total Hip Arthroplasty: A Case Report

We presented a case in which massive hydroxyapatite accumulation was observed around the artificial hip joint. A 66-year-old female showed a massive accumulation of fluid in and around the hip joint, and milk-like aspirate was obtained. Her aspirate culture was negative, and sediment analysis by X-ray diffraction showed that its component was hydroxyapatite. Since pain was mild, the patient was treated conservatively. To our knowledge, this is the first case in which liquid hydroxyapatite (milk of calcium) was accumulated around the artificial hip joint

Cardiac erosion after catheter closure of atrial septal defect: Septal malalignment may be a novel risk factor for erosion

AbstractPericardial tamponade occurred 3 days after the catheter closure of an atrial septal defect (ASD) using Amplatzer Septal Occluder (St. Jude Medical, St. Paul, MN, USA). Before the closure, two-dimensional and real-time three-dimensional transesophageal echocardiography demonstrated a deficient aortic rim and atrial septal malalignment. Perforation of the right atrium toward the non-coronary sinus of the aortic root was confirmed at the emergent surgery. Cardiac erosion is one of the most catastrophic complications in ASD patients undergoing catheter closure with Amplatzer Septal Occluder. Hence, several risk factors for this complication are discussed and identified. Oversized device deployment and a deficient aortic rim are accepted factors potentially causing cardiac erosion. Besides, atrial septal malalignment, which is a morphological characteristic of ASD, may be a novel risk factor for cardiac erosion.<Learning objective: Cardiac erosion is a potentially lethal complication when catheter closure of atrial septal defects using Amplatzer Septal Occluder (St. Jude Medical, St. Paul, MN, USA) is provided to the patients. However, mechanisms of this complication remain to be completely elucidated. Atrial septal malalignment may be one of the novel risk factors for this catastrophic complication.

Conformation and absolute configuration of (1S,2S)-2-(phenyl­selan­yl)cyclo­hexyl (R)-2-meth­oxy-2-(1-naphth­yl)propionate

The relative and absolute configurations of the title compound, C26H28O3Se, were assigned from the known configuration of (R)-(−)-2-meth­oxy-2-(1-naphth­yl)propionic acid used as starting material, and by examination of the Bijvoet (Friedel) pairs, using the anomalous dispersion data collected with Mo Kα radiation at low temperature. The geometry around the carbonyl group exists in the syn conformation, as reflected in torsion angles involving this group, and the stability of the structure is affected by weak bifurcated intra­molecular C—H⋯O hydrogen bonds

Clinical implications of DLL4 expression in gastric cancer

BACKGROUND: Delta-like ligand 4 (DLL4)-Notch signaling plays a key role in tumor neovascular development and angiogenesis during tumor growth. The clinical significance of DLL4 expression in gastric cancer has not been clarified. METHODS: Gastric cancer cell lines and 180 gastric cancer patients were enrolled. DLL4 expression in gastric cancer cells and stroma was identified and evaluated immunohistochemically. The association between DLL4 and clinicopathological factors was also assessed. RESULTS: DLL4 expression was identified in the cellular membrane and cytoplasm of gastric cancer cells by immunoblotting and immunohistochemical staining. DLL4 positivity in cancer cells and stroma was found in 88 (48%) and 41 (22%) of the 180 gastric cancer patients respectively. Both cancer and stromal DLL4 expression significantly correlated with more advanced tumor depth, nodal involvement, and lymphatic and venous invasion. A strongly positive association between cancerous and stromal DLL4 expression was identified (p < 0.01). Both cancerous and stromal DLL4 expression were prognostic markers in gastric cancer as determined by univariate analysis. CONCLUSIONS: Cancerous and stromal DLL4 expression was found in 48% and 22% in gastric cancer, and significantly affected postoperative clinical outcomes. Cancerous and stromal DLL4 expression may be an effective target of anti-DLL4 treatment in gastric cancer

Astrometry of Galactic Star Forming Region Sharpless 269 with VERA : Parallax Measurements and Constraint on Outer Rotation Curve

We have performed high-precision astrometry of H2O maser sources in Galactic star forming region Sharpless 269 (S269) with VERA. We have successfully detected a trigonometric parallax of 189+/-8 micro-arcsec, corresponding to the source distance of 5.28 +0.24/-0.22 kpc. This is the smallest parallax ever measured, and the first one detected beyond 5 kpc. The source distance as well as proper motions are used to constrain the outer rotation curve of the Galaxy, demonstrating that the difference of rotation velocities at the Sun and at S269 (which is 13.1 kpc away from the Galaxy's center) is less than 3%. This gives the strongest constraint on the flatness of the outer rotation curve and provides a direct confirmation on the existence of large amount of dark matter in the Galaxy's outer disk.Comment: 7 pages and 4 figures, Accepted by PASJ (Vol. 59, No. 5, October 25, 2007 issue

Astrometry of Water Maser Sources in Nearby Molecular Clouds with VERA - II. SVS 13 in NGC 1333

We report on the results of multi-epoch VLBI observations with VERA (VLBI Exploration of Radio Astrometry) of the 22 GHz H2O masers associated with the young stellar object SVS 13 in the NGC 1333 region. We have carried out phase-referencing VLBI astrometry and measured an annual parallax of the maser features in SVS 13 of 4.25+/-0.32 mas, corresponding to the distance of 235+/-18 pc from the Sun. Our result is consistent with a photometric distance of 220 pc previously reported. Even though the maser features were detectable only for 6 months, the present results provide the distance to NGC 1333 with much higher accuracy than photometric methods. The absolute positions and proper motions have been derived, revealing that the H2O masers with the LSR (local standard of rest) velocities of 7-8 km s-1 are most likely associated with VLA4A, which is a radio counterpart of SVS 13. The origin of the observed proper motions of the maser features are currently difficult to attribute to either the jet or the rotating circumstellar disk associated with VLA4A, which should be investigated through future high-resolution astrometric observations of VLA4A and other radio sources in NGC 1333.Comment: 9 pages, 5 figures. PASJ, in press (2008, Vol. 60, No. 1