Urinary Retention as the Presenting Clinical Manifestation of Unstable Thoracic Spinal Fracture with Diffuse Idiopathic Skeletal Hyperostosis

Patients with diffuse idiopathic skeletal hyperostosis (DISH) are at high risk for unstable vertebral fracture, which can be frequently missed. An 80-year-old man with pre-existing muscle lower limb weakness due to frailty was referred from another hospital, presenting with progressive urinary retention and its related symptoms, which had been treated as a urinary tract infection at previous hospital. One week prior to our visit, he had fallen. On arrival, he appeared lethargic and unable to follow commands. He denied any back pain. Computed tomography identified a T10 fracture and dislocation associated with DISH. Although immediate surgical fixation was performed, the patient did not recover from the neurological deficits. Diagnostic delay of DISH-associated vertebral fracture can occur due to both patients' and clinicians' delayed action. We believe this case report can help clinicians recognize this potentially devastating condition

RANKL expression in chondrocytes and its promotion by lymphotoxin-alpha in the course of cartilage destruction during rheumatoid arthritis

We investigated the expression and localization of the receptor activator nuclear factor kappa B ligand (RANKL) in cartilage from patients with rheumatoid arthritis (RA) of relevance to cartilage degeneration. We also examined the role of exogenous lymphotoxin (LT)-alpha on RANKL expression in human chondrocytes and its effect on in vitro osteoclast differentiation. Cartilage and synovial fluid samples were obtained from 45 patients undergoing total joint replacement surgery or joint puncture, including 24 patients with osteoarthritis (OA) and 21 patients with RA. RANKL expression in articular cartilage was examined by immunohistochemistry. LT-alpha concentrations in synovial fluid were measured using an enzyme-linked immunosorbent assay (ELISA). Normal human chondrocytes were stimulated with LT-alpha, and the relative mRNA levels of RANKL, osteoprotegerin (OPG), matrix metalloproteinase-9, and vascular endothelial growth factor were examined by real-time polymerase chain reaction. Soluble RANKL protein in culture media was measured using ELISA, and membrane-bound RANKL protein in cells was examined by western blotting. Co-cultures of human chondrocytes with peripheral blood mononuclear cells (PBMCs) were stimulated with macrophage-colony stimulating factor and LT-alpha, and osteoclast differentiation was evaluated by staining for tartrate-resistant acid phosphatase. LT-alpha concentrations were higher in RA synovial fluid than in OA samples. The population of RANKL-positive chondrocytes of RA cartilage was higher than that of OA cartilage, and correlated with cartilage degeneration. Stimulation of cultured human chondrocytes by LT-alpha increased RANKL expression, the RANKL/OPG ratio, and angiogenic factors. Membrane-bound RANKL in chondrocytes was up-regulated after stimulation of LT-alpha, whereas soluble RANKL in culture medium did not increase. Co-cultures of human chondrocytes and PBMCs demonstrated that LT-alpha stimulated human chondrocytes to produce RANKL and induced osteoclastic differentiation of PBMCs. RANKL produced by chondrocytes may contribute to cartilage destruction during RA and LT-alpha could promote the expression of RANKL in human chondrocytes

Adipose-Derived Extract Suppresses IL-1 beta-Induced Inflammatory Signaling Pathways in Human Chondrocytes and Ameliorates the Cartilage Destruction of Experimental Osteoarthritis in Rats

We investigated the effects of adipose-derived extract (AE) on cultured chondrocytes and in vivo cartilage destruction. AE was prepared from human adipose tissues using a nonenzymatic approach. Cultured human chondrocytes were stimulated with interleukin-1 beta (IL-1 beta) with or without different concentrations of AE. The effects of co-treatment with AE on intracellular signaling pathways and their downstream gene and protein expressions were examined using real-time PCR, Western blotting, and immunofluorescence staining. Rat AE prepared from inguinal adipose tissues was intra-articularly delivered to the knee joints of rats with experimental osteoarthritis (OA), and the effect of AE on cartilage destruction was evaluated histologically. In vitro, co-treatment with IL-1 beta combined with AE reduced activation of the p38 and ERK mitogen-activated protein kinase (MAPK) pathway and nuclear translocation of the p65 subunit of nuclear factor-kappa B (NF-kappa B), and subsequently downregulated the expressions of matrix metalloproteinase (MMP)-1, MMP-3, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4, IL-6, and IL-8, whereas it markedly upregulated the expression of IL-1 receptor type 2 (IL-1R2) in chondrocytes. Intra-articular injection of homologous AE significantly ameliorated cartilage destruction six weeks postoperatively in the rat OA model. These results suggested that AE may exert a chondroprotective effect, at least in part, through modulation of the IL-1 beta-induced inflammatory signaling pathway by upregulation of IL-1R2 expression

Results of Total Elbow Arthroplasty with Cementless Implantation of an Alumina Ceramic Elbow Prosthesis for Patients with Rheumatoid Arthritis

We investigated the long-term clinical results of total elbow arthroplasty (TEA) by cementless fixation of alumina ceramic unlinked elbow prostheses (J-alumina ceramic elbows: JACE) for the reconstruction of elbow joints with rheumatoid arthritis (RA). Seventeen elbows in 17 patients (aged 44-72 years, average 54.8) replaced by JACE TEA without bone cement were investigated. The average follow-up period was 10.7 (range, 1.0-19.3) years. Clinical conditions of each elbow before and after surgery were assessed according to the Mayo Elbow Performance Index (MEPI). Radiographic loosening was defined as a progressive radiolucent line of more than 1 mm that was completely circumferential around the intramedullary stem. The average MEPI significantly improved from 46.8 points preoperatively to 66.8 points at final follow-up (p=0.0226). However, aseptic loosening was noted in 10 of 17 elbows (58.8%) and revision surgery was required in 7 (41.2%). Most loosening was observed on the humeral side. With radiographic loosening and revision surgery defined as the end points, the likelihoods of prosthesis survival were 41.2% and 51.8%, respectively, up to 15 years by Kaplan-Meier analysis. The clinical results of JACE implantation without bone cement were disappointing, with high revision and loosening rates of the humeral component

Composites of Eu³⁺-Doped Calcium Apatite Nanoparticles and Silica Particles: Comparative Study of Two Preparation Methods

We synthesized composites of Eu³⁺-doped calcium apatite (CaAp:Eu³⁺) nanoparticles and silica particles via two methods: (i) <i>in situ</i> synthesis of CaAp:Eu³⁺ in the presence of silica particles and (ii) electrostatic adsorption of CaAp:Eu³⁺ nanoparticles on silica particle surfaces. In both methods, submicrometer spherical silica particles were covered with CaAp:Eu³⁺ nanoparticles without forming any impurity phases, as confirmed by X-ray diffractometry, Fourier-transform infrared spectroscopy, and scanning electron microscopy. In method i, part of the silica surface acted as a nucleation site for apatite crystals and silica particles were inhomogeneously covered with CaAp:Eu³⁺ nanoparticles. In method ii, positively charged CaAp:Eu³⁺ nanoparticles were homogeneously adsorbed on the negatively charged silica surface through electrostatic interactions. The bonds between the silica surface and CaAp:Eu³⁺ nanoparticles are strong enough not to break under ultrasonic irradiation, irrespective of the synthetic method used. The composite particles showed red photoluminescence corresponding to 4f → 4f transitions of Eu³⁺ under near-UV irradiation. Although the absorption coefficient of the forbidden 4f → 4f transitions of Eu³⁺ was small, the red emission was detectable with a commercial fluorescence microscope because the CaAp:Eu³⁺ nanoparticles accumulated on the silica particle surfaces

Reconstruction of new field development process in the late Edo era using interdisciplinary approach: A case of Sanjobara in the southern part of Saijo Basin, Hiroshima Prefecture, southwestern Japan

広島県東広島市西条盆地南部の段丘面上にある三升原を対象に，古文書や古絵図の読解，SfM-MVS技術を活用した圃場整備前の地形復元，現地調査といった学際的な手法を用いて，近世後期における新田開発の進展過程を実証的に明らかにした。三升原の新田開発は，1808年から1819年の12年間において，唐櫨の植え付けと失敗までの前半の3年間，3年の空白期間を挟んで，稲作と畑作を進めた後半の6年間という流れであった。三升原では，地表の高さよりも用水路の底面が高い「揚溝」の割合が大きい。これは，集落より上流側にあたる地域が低かったためである。三升原の新田開発の進展は，同様に広島藩が主導した柏原の進展と一致し，藩の国益事業の一環とみなせる。両地区の住民の就業を比較すると，柏原は純農村的な集落であるが，三升原は農村・商業・原料指向型製造業が混合した集落である。地形・交通などの地理的条件によって，集落の性格が分かれたと見なせる。We studied the process of new field development in the late Edo period in Sanjobara, located on a fluvial terrace in the southern part of the Saijo Basin in Higashi-Hiroshima City, central Hiroshima Prefecture. For this purpose, we used interdisciplinary methods such as reading old documents and drawings, reconstructing the topography by the SfM-MVS technology using aerial photographs before post-war land reform, and field surveys. The development of new fields in Sanjobara lasted for 12 years, from 1808 to 1819. The first half of the period comprised three years of failure due to the planting and death of the wax tree, and the second half consisted of six years of rice and field cultivation after a three-year gap. In Sanjobara, the percentage of “lift ditches,” where the irrigation channel was higher than the surrounding ground surface, was high. This was because the area to the east, upstream from the village, was lower than that of Sanjobara, and hence the irrigation channels were raised. The timing of the development of new rice paddies in Sanjobara was consistent with that in Kashobara, also led by the Hiroshima Domain, and can be regarded as part of the domain’s interest project. A comparison of the employment of both villages’ residents shows that Kashobara was a purely rural settlement, while Sanjobara was a mixture of farming, commerce, and raw material-oriented manufacturing. The differences in geographical conditions, such as topography and transportation, have resulted in different characteristics of both villages