Hip preserving surgery with concentrated autologous bone marrow aspirate transplantation for the treatment of asymptomatic osteonecrosis of the femoral head: retrospective review of clinical and radiological outcomes at 6 years postoperatively

BackgroundWe had previously established concentrated autologous bone marrow aspirate transplantation (CABMAT), a one-step, low-invasive, joint-preserving surgical technique for treating osteonecrosis of the femoral head (ONFH). The present study aimed to evaluate the effects of CABMAT as a hip preserving surgical approach, preventing femoral head collapse in asymptomatic ONFH.MethodsIn total, 222 patients (341 hips) with ONFH were treated with CABMAT between April 2003 and March 2013. Based on magnetic resonance imaging, we determined that 119 of these patients had bilateral asymptomatic ONFH (238 hips), and 38 further patients had unilateral asymptomatic ONFH (38 hips). In this series, we retrospectively examined 31 hips in 31 patients with unilateral asymptomatic ONFH treated surgically between 2003 and 2012 and followed up for more than 2 years. Clinical and radiological evaluation were performed immediately before the procedure and at the final follow-up. The two-year follow-up rate among patients with unilateral ONFH was 82% (31/38). Therefore, the present study included 31 patients (19 males and 12 females), with a mean age and follow-up period of 40 and 5.8 years, respectively. Of the 31 asymptomatic hips, 5, 6, 10, and 10 had osteonecrosis of types A, B, C1, and C2, respectively. The diagnosis, classification, and staging of ONFH were based on the 2001 Japanese Orthopaedic Association (JOA) classification.ResultsSecondary collapse of the femoral head was observed in 6/10 hips and 5/10 hips with osteonecrosis of types C1 and C2, respectively. Total hip arthroplasty was performed in 9.6% of patients (3/31 hips), at an average of 33 months after surgery. Clinical symptoms improved after surgery, and the secondary collapse rate at a mean of 5.8 years after CABMAT was lower than that reported in several previous studies on the natural course of asymptomatic ONFH.ConclusionsEarly diagnosis of ONFH (i.e., before femoral head collapse) and early intervention with CABMAT could improve the clinical outcome of corticosteroid and alcohol-induced ONFH

Aluminum Silicate Nanotube Coating of Siloxane-Poly(lactic acid)-Vaterite Composite Fibermats for Bone Regeneration

In our earlier work, a flexible fibermat consisting of a biodegradable composite with soluble silicate species, which has been reported to enhance bone formation, was prepared successfully using poly(L-lactic acid) and siloxane-containing calcium carbonate particles by electrospinning. The fibermat showed enhanced bone formation in an in vivo test. In the present work, to improve the hydrophilicity of skeletal fibers in a fibermat, they were coated with nanotubular aluminum silicate crystals, which have a hydrophilic surface that has excellent affinity to body fluids and a high surface area advantageous for pronounced protein adsorption. The nanotubes were coated easily on the fiber surface using an electrophoretic method. In a conventional contact angle test, a drop of water rapidly penetrated into the nanotube-coated fibermat. The culture test using murine osteoblast-like cells (MC3T3-E1) showed that the cell attachment to the nanotube-coated fibermat at an early stage after seeding was enhanced in comparison with that to the noncoated one. This approach may provide a new method of improving the surface of polymer-based biomaterials

Tara up-regulates E-cadherin transcription by binding to the Trio RhoGEF and inhibiting Rac signaling

In the absence of Tara, Trio binds to E-cadherin and increases activation of the E-cadherin transcriptional repressor Tbx3

HbA1c and telemedicine during COVID-19

Aims/Introduction: To investigate whether the COVID-19 pandemic affected behavioral changes and glycemic control in patients with diabetes and to conduct a survey of telemedicine during the pandemic. Materials and Methods: In this retrospective study, a total of 2,348 patients were included from 15 medical facilities. Patients were surveyed about their lifestyle changes and attitudes toward telemedicine. Hemoglobin A1c (HbA1c) levels were compared among before (from June 1 to August 31, 2019) and in the first (from June 1 to August 31, 2020) and in the second (from June 1 to August 31, 2021) year of the pandemic. A survey of physician attitudes toward telemedicine was also conducted. Results: The HbA1c levels were comparable between 2019 (7.27 ± 0.97%), 2020 (7.28 ± 0.92%), and 2021 (7.25 ± 0.94%) without statistical difference between each of those 3 years. Prescriptions for diabetes medications increased during the period. The frequency of eating out was drastically reduced (51.7% in 2019; 30.1% in 2020), and physical activity decreased during the pandemic (48.1% in 2019; 41.4% in 2020; 43.3% in 2021). Both patients and physicians cited increased convenience and reduced risk of infection as their expectations for telemedicine, while the lack of physician–patient interaction and the impossibility of consultation and examination were cited as sources of concern. Conclusions: Our data suggest that glycemic control did not deteriorate during the COVID-19 pandemic with appropriate intensification of diabetes treatment in patients with diabetes who continued to attend specialized diabetes care facilities, and that patients and physicians shared the same expectations and concerns about telemedicine

Features of and Mechanisms Underlying Insulitis In aly/aly Male Mice as an Animal Model of Autoimmune Pancreatitis: Activation of CD11c+, CD4+, and Th2 Cells and Predominant Destruction of β-cells

Diabetes mellitus (DM) is observed in patients with autoimmune pancreatitis (AIP). The development of DM in AIP is believed to be due to blood flow obstruction of the endocrine gland that accompanies pancreatitis, as well as injury to the islets caused by inflammation. The latter is called insulitis and the detailed mechanisms underlying its development are not yet clear. The aim of the present study was to elucidate the mechanisms involved in the development of insulitis in AIP using aly mice as an animal model of AIP: results in aly/aly male mice, as the AIP group, were compared with those inaly/+ male mice as a control group. Mice in both groups were killed between 16 and 48 weeks of age, and pancreatitis and insulitis were evaluated histologically. Inflammatory and endocrine cells were evaluated by immunofluorescence staining with anti-CD4, anti-CD8, anti-CD11b, and anti-CD11c antibodies, as well as immunohistochemical analyses using insulin and glucagon antibodies. Plasma levels and the pancreatic content of interferon (IFN)-γ (as a Th1-secreted cytokine) and interleukin (IL)-4 (as a Th2-secreted cytokine) were determined. Pancreatitis was seen in aly/aly mice from 16 weeks of age and it developed gradually thereafter. Insulitis also developed gradually and was seen in mice after 24 weeks of age in association with a decrease in the number of islets. CD11c+ cells and CD4+ T cells were seen to infiltrate into the islets. Although the number of β-cells decreased with time, the number of α-cells was maintained until mice were 48 weeks of age. IFN-γ content peaked in mice at 16 weeks of age and declined rapidly from 20 weeks. There were two peaks in IL-4 content, one at 16 weeks and the other at 32 weeks, suggesting an association between IL-4 content and advanced insulitis after 32 weeks. In conclusion, the results suggest that insulitis in AIP is induced predominantly by the infiltration of CD11c+ cells and CD4+ T cells into the islets, and progression is facilitated by the imbalance of the activation of Th2 rather than Th1. Furthermore, insulitis in AIP predominantly involves β-cells rather than α-cells

間歇的伸張運動によるラットヒラメ筋廃用性萎縮の変化: 筋萎縮抑制効果の経時的変化に関して

〔目的〕廃用性萎縮筋に対する間歇的伸張運動の筋萎縮抑制効果を，経時的および長軸部位別に検討すること．〔対象と方法〕対象は，8週齢Wistar系ラットのヒラメ筋とした．通常飼育をするC群，後肢懸垂を行うHS群，後肢懸垂中に伸張運動を行うST群に分けた．さらにそれぞれ0・3・7・10・14日時点に群分けした．実験期間終了後，筋の近位・中央・遠位部で凍結切片を作成，HE染色を行い，筋線維横断面積（CSA）を測定した．〔結果〕伸張運動開始14日目でHS 群のCSAがST群と比較し有意に高値を示した．また，14日目のST群で，中央・遠位部での筋線維横断面積の減少率がHS群に比べて小さかった．〔結語〕廃用性萎縮筋は伸張運動により経時的に変化し，萎縮抑制効果は長軸部位により異なることが示唆された． [Purpose] The purpose of this study was to investigate the effects of intermittent stretching exercise on disuse atrophy of the rat soleus muscle with respect to site and the change over time in the inhibitory effect on atrophy. [Subjects and Methods] Eighty-three 8-week-old male Wistar rats were divided into 3 groups: a control group which was reared under standard conditions (C0/3/7/10/14), a hind-limb suspension group (HS3/7/10/14), and a stretching exercise group (ST3/7/10/14). After the completion of each experimental period the soleus muscle was cut into proximal, middle, and distal samples, which were stained with hematoxylin and eosin, and the cross-sectional area (CSA) was measured. [Results] The CSA of ST14 was significantly greater than that of HS14. The reduction rate of the CSA in the middle and distal regions of ST14 was small compared to that of HS14. [Conclusion] The results suggest that disuse atrophy is altered over time by stretching exercise, and that there are differences in effect among the longitudinal sites of the soleus muscle.出版者照会後に全文公

A case of thoracic disc herniation characterized by marked posture-related dynamic changes in neurological symptoms

Thoracic disc herniation is less common than lumbar and cervical disc herniations. It is usually accompanied by severe myelopathy, which often leads to surgery. Because the thoracic spine is less mobile, thoracic disc herniation is considered to be minimally affected by dynamic spine factors in cases with myelopathy. We experienced a case of thoracic disc herniation (T4/5 and T6/7) characterized by posture-related dynamic changes in neurological symptoms; that is, numbness extending from the trunk to the entire lower limbs was deteriorated in the standing and sitting positions, was relieved in the supine position, and disappeared in the prone position. In addition, the patient reported dysuria with a delay when attempting to urinate in the standing position. Computed tomographic myelography revealed diffuse idiopathic skeletal hyperostosis extending from T3 to T11, and the kyphosis angles at T1 to T11 levels were 68 degrees in the half-sitting position and 58 degrees in the prone position, showing posture-related changes. The patient underwent the posterior fusion in the prone position, by which symptoms disappeared, without undergoing disc herniotomy or laminectomy, and favorable outcomes were achieved. Thoracic disc herniation with marked posture-related neurological symptoms is extremely rare. Here we report a case presentation and literature review of pathophysiology observed in our patient