The difference in joint instability affects the onset of cartilage degeneration or subchondral bone changes.

OBJECTIVE: It has been debated whether the onset of knee osteoarthritis is initiated in cartilage or subchondral bone. The purpose of this study was to clarify the effects of increasing or decreasing joint instability on cartilage degeneration and subchondral bone changes in knee OA by comparing different models of joint instability. DESIGN: We used the anterior cruciate ligament transection (ACL-T) model and the destabilization of the medial meniscus (DMM) model. In addition, we created a controlled abnormal tibial translation (CATT) model and a controlled abnormal tibial rotation (CATR) model. We performed joint instability analysis, micro-computed tomography analysis, histological and immunohistological analysis in 4 and 6 weeks. RESULTS: The CATT group suppressed joint instability in the ACL-T group (6 weeks; P = 0.032), and the CATR group suppressed joint instability in the DMM group (6 weeks; P = 0.032). Chondrocyte hypertrophy in the ACL-T and DMM groups was increased compared to the Sham group (6 weeks; [ACL-T vs Sham], P = 0.002, 95%CI [5.983-33.025]; [DMM vs Sham], P = 0.022, 95%CI [1.691-28.733]). In the subchondral bone, the BV/TV in the DMM and CATR groups was increased compared to the ACL-T and CATT groups (6 weeks; [DMM vs ACL-T], P = 0.002, 95%CI [7.404-37.582]; [DMM vs CATT], P = 0.014, 95%CI [2.881-33.059]; [CATR vs ACL-T], P = 0.006, 95%CI [4.615-34.793]; [CATR vs CATT], P = 0.048, 95%CI [0.092-30.270]). CONCLUSIONS: This study showed that joint instability promotes chondrocyte hypertrophy, but subchondral bone changes were influenced by differences in ACL and meniscus function.

Usefulness of Muscle Synergy Analysis in Individuals With Knee Osteoarthritis During Gait.

OBJECTIVE: To clarify whether there are any muscle synergy changes in individuals with knee osteoarthritis, and to determine whether muscle synergy analysis could be applied to other musculoskeletal diseases. METHODS: Subjects in this study included 11 young controls (YC), 10 elderly controls (EC), and 10 knee osteoarthritis patients (KOA). Gait was assessed on a split-belt treadmill at 3 km/h. A non-negative matrix factorization (NNMF) was applied to the electromyogram data matrix to extract muscle synergies. To assess the similarity of each module, we performed the NNMF analysis assuming four modules for all of the participants. Further, we calculated joint angles to compare the kinematic data between the module groups. RESULTS: The number of muscle modules was significantly lower in the EC (2-3) and KOA (2-3) groups than in the YC group (3-4), which reflects the merging of late swing and early stance modules. The EC and KOA groups also showed greater knee flexion angles in the early stance phase. Contrarily, by focusing on the module structure, we found that the merging of early and late stance modules is characteristic in KOA. CONCLUSION: The lower number of modules in the EC and KOA groups was due to the muscle co-contraction with increased knee flexion angle. Contrarily, the merging of early and late stance modules are modular structures specific to KOA and may be biomarkers for detecting KOA. SIGNIFICANCE: Describing the changes in multiple muscle control associated with musculoskeletal degeneration can serve as a fundamental biomarker in joint disease.

Controlling joint instability after anterior cruciate ligament transection inhibits transforming growth factor-beta-mediated osteophyte formation.

OBJECTIVE: Abnormal joint instability contributes to cartilage damage and osteophyte formation. We investigated whether controlling joint instability inhibited chronic synovial membrane inflammation and delayed osteophyte formation and examined the role of transforming growth factor-beta (TGF-ß) signaling in the associated mechanism. DESIGN: Rats (n = 94) underwent anterior cruciate ligament (ACL) transection. Anterior tibial instability was either controlled (CAM group) or allowed to continue (SHAM group). At 2, 4, and 8 weeks after surgery, radiologic, histopathologic, immunohistochemical, immunofluorescent, and enzyme-linked immunosorbent assay examinations were performed to evaluate osteophyte formation and TGF-ß signaling. RESULTS: Joint instability increased cartilage degeneration score and osteophyte formation, and cell hyperplasia and proliferation and synovial thickening were observed in the synovial membrane. Major findings were increased TGF-ß expression and Smad2/3 following TGF-ß phosphorylation in synovial membarene, articular cartilage, and the posterior tibial growth plate (TGF-ß expression using ELISA: 4 weeks; P = 0.009, 95% CI [260.1-1340.0]) (p-Smad2/3 expression density: 4 weeks; P = 0.024, 95% CI [1.67-18.27], 8 weeks; P = 0.034, 95% CI [1.25-25.34]). However, bone morphogenetic protein (BMP)-2 and Smad1/5/8 levels were not difference between the SHAM model and the CAM model. CONCLUSIONS: This study showed that the difference between anterior tibial instability caused a change in the expression level of TGF in the posterior tibia and synovial membrane, and the reaction might be consequently involved in osteophyte formation.

Controlling joint instability delays the degeneration of articular cartilage in a rat model.

OBJECTIVE: Joint instability induced by anterior cruciate ligament (ACL) transection is commonly considered as a predisposing factor for osteoarthritis (OA) of the knee; however, the influence of re-stabilization on the protection of articular cartilage is unclear. The aim of this study was to evaluate the effect of joint re-stabilization on articular cartilage using an instability and re-stabilization ACL transection model. DESIGN: To induce different models of joint instability, our laboratory created a controlled abnormal joint movement (CAJM) group and an anterior cruciate ligament transection group (ACL-T). Seventy-five Wistar male rats were randomly assigned to the CAJM (n = 30), ACL-T (n = 30), or no treatment (INTACT) group (n = 15). Cartilage changes were assessed with soft X-ray analysis, histological and immunohistochemistry analysis, and real-time polymerase chain reaction (PCR) analysis at 2, 4, and 12 weeks. RESULTS: Joint instability, as indicated by the difference in anterior displacement between the CAJM and ACL-T groups (P < 0.001), and cartilage degeneration, as evaluated according to the Osteoarthritis Research Society International (OARSI) score, were significantly higher in the ACL-T group than the CAJM group at 12 weeks (P < 0.001). Moreover, joint re-stabilization maintained cartilage structure (thickness [P < 0.001], surface roughness [P < 0.001], and glycosaminoglycan stainability [P < 0.001]) and suppressed tumor necrosis factor-alpha (TNF-α) and caspase-3 at 4 weeks after surgery. CONCLUSION: Re-stabilization of joint instability may suppress inflammatory cytokines, thereby delaying the progression of OA. Joint instability is a substantial contributor to cartilage degeneration.

Effect of position of electrodes relative to the innervation zone onsurface EMG.

We investigated the effect of the position of electrodes relative to the innervation zone (IZ) of the biceps brachii muscle during isometric elbow flexion using eight-channel surface array electrodes. We estimated the location of the IZ near the centre of the muscle in 20 male subjects. The pulse peaks from electromyogram (EMG) waveforms were detected for each channel and averaged, the triphasic pulse was determined, and the peak values of the first and third phases were compared. The results showed significantly greater pulse values for the first phase when the electrode placement was proximal to the estimated IZ, and for the third phase when the electrode placement was distal to the estimated IZ. Using this method, the positional relationship between electrodes and IZ can be determined using a surface EMG waveform recorded with a pair of bipolar electrodes. This method may be clinically useful in confirming the reliability of a recorded surface EMG.

Contrasting alteration patterns of different cartilage plates in knee articular cartilage after spinal cord injury in rats.

STUDY DESIGN: Experimental, controlled trial, animal study. OBJECTIVE: To assess morphologic changes in different cartilage plates after spinal cord injury and identify the localization of these alterations. SETTING: Saitama, Japan. METHODS: A total of 16 Wistar rats were used. Eight rats underwent a spinal cord injury and eight rats had no intervention as control. The cartilage alterations of the knee joint were evaluated with radiography and histomorphometric analysis. To quantify cartilage alterations, we selected the histologic characteristics: thickness of the articular cartilage, number of chondrocytes, matrix staining to toluidine blue as a reflection of proteoglycan content and surface irregularity. RESULTS: No differences in knee joints were found between the groups by radiography. In the medial knee joint, cartilage thickness of spinal-cord-injured knees increased at the anterior femoral region and decreased at the tibial and posterior femoral regions; however, in the lateral knee, that of spinal cord injuries did not change compared with control knees. Spinal cord injuries decreased the number of chondrocytes, especially at the anterior femoral regions. Matrix staining increased partially at the tibial regions. Surface irregularity of spinal-cord-injured knees was comparable to that of control knees in all cartilage plates. CONCLUSION: The present findings exhibit characteristics of the cartilage after spinal cord injury. These alterations were different in nature between the medial and lateral regions. Future studies should assess separately different cartilage plates, to overestimate these severities when the changes at the medial knee were examined and to underestimate when the changes at the lateral knee were examined.

[Multiple myeloma complicated by bilateral abducens nerve palsy due to a tumor in the clivus].

A 62-year-old woman was admitted to our hospital because of double vision. Bone marrow aspiration revealed normal cellularity with 21.6% atypical plasma cells. Immunoelectrophoresis revealed a monoclonal component of IgG kappa in the patient's serum. Coronal and sagittal cranial MRI images showed a tumor in the clivus behind the sella turcica. The patient was diagnosed as having multiple myeloma complicated by double vision due to compression of the bilateral abducens nerve by a plasmacytoma. VAD therapy consisting of vincristine, doxorubicin and dexamethasone, followed by irradiation of the clivus tumor achieved only a transient therapeutic effect, and the double vision and bone disease worsened. Cranial nerve palsy may be a significant complication of multiple myeloma.

Intrahepatic cholangiocarcinoma arising 10 years after the excision of congenital extrahepatic biliary dilation.

A 52-year-old woman was found to have a liver tumor during treatment for a liver abscess. The tumor was diagnosed as intrahepatic cholangiocarcinoma by closer examinations, including a percutaneous needle biopsy. Ten years previously, she had undergone excision of a choledochal cyst, with reconstruction by Roux-en-Y hepaticojejunostomy, as treatment for Todani's type Ia congenital biliary dilation, which had been confined only to the extrahepatic bile duct. The significant association between congenital biliary dilation and hepatobiliary malignancies is well known. Some patients have been reported to develop biliary cancer long after the excision of the entire extrahepatic bile duct and hepaticoenterostomy. However, in these patients, the development mostly took place in the remnant choledochal cyst, the anastomotic site, or in the dilated intrahepatic bile duct of Todani's type IV-A congenital biliary dilation. The development of intrahepatic cholangiocarcinoma after operation has not been reported previously in a patient with Todani's type I congenital biliary dilation. This case suggests that the entire biliary tree may have a high risk of field cancerization, even in extrahepatic congenital biliary dilation.

Time course of influence by ovariectomy and calcium diet on bone properties in mice.

This study was investigated the influence by ovariectomy (OVX) and calcium diet on bone properties in eighty-one female ICR strain mice with age of 5 weeks. The animals were randomly assigned to sham operation (SHAM), OVX, SHAM+low Ca intake (L.Ca) and OVX+L.Ca group. They were euthanized with lethal dose of pentobarbital sodium at day 50, 100 and 140 post-operatively. For determining the bone properties, both femur and tibial bones were excised from the hind limb, and removed off surrounding tissues. Thereafter, bone length, bone dry weight, and also mechanical strength and ash content of the bones were determined. The bone length on both femur and tibia was significantly longer in OVX group than in the other groups after 50 day of experiment, this situation was continued to the end of the experiment. Bone dry weight, mechanical strength, and ash content were significantly decreased by OVX and L.Ca over the time of the experiment, and those of OVX+L.Ca group were the lowest in all groups. OVX and L.Ca have a great potential for weakening the mechanical strength and have an additive effect when combined. OVX and L.Ca block the gain of bone mass.

Three-dimensional measurement of rolling in tetraplegic patients.

OBJECTIVE: To investigate the differences between traumatic tetraplegic patients who can roll and those who cannot. DESIGN: Motion analysis using 3-dimensional measurement. SETTING: Rehabilitation centers in southwestern Japan. PARTICIPANTS: Nineteen male participants, all of whom had traumatic C6 complete injury. METHODS: We used an electromagnetic device to examine the degree of spinal movement in axial rotation during rolling (shifting from supine to side lying). This system (3-Space Win) measures the position and orientation of sensors in space. Two sensors were mounted on a subject over the spinous process of T1 and L5. RESULTS: The spinal rotation of patients who could not roll was significantly lower than that of patients who could roll. (The average rotation of non-rollers was 31.5+/-17.5 degrees, while the average rotation of rollers was 66.3+/-17.3degrees). In this study, there were no statistically significant differences in the members of the two groups in terms of age, height, weight or time after injury. CONCLUSION: Rolling requires greater and adequate flexibility in the back of tetraplegic patients.

Comparative microtensile bond strength and SEM analysis of bonding to wet and dry dentin.

PURPOSE: To compare bond strengths of resins to acid-etched wet vs. dry dentin. MATERIALS AND METHODS: Human third molars were bonded with One-Step (OS), Single Bond (SB) or Clearfil PhotoBond (PB) under control moist or air-dried (5 s air blast) conditions. Tensile bond strengths were tested using the microtensile bond testing method. Scanning electron microscopy was done to evaluate the quality and thickness of the hybrid layers following polishing and acid plus NaOCl-challenge. RESULTS: The tensile bond strengths of OS, SB and PB were significantly (P < 0.01) lower (8-19 MPa) to air-dried dentin than to moist dentin (39-50 MPa). No hybrid layers were seen in the air-dried specimens bonded with OS or SB, while relatively thin hybrid layers were produced by PB. In contrast, moist dentin produced high bond strengths with all bonding systems and created thicker, acid/NaOCl-resistant hybrid layers. These results support the predictions of a previously published morphologic model and offer a morphologic explanation for the differences in bond strengths between wet vs. dry bonds.

The effect of low calcium diet on bone in ovariectomized mice.

This study investigates the effects of Ca on bone in the ovariectomized mice. Twenty-six female ICR mice aged 5 weeks were used. They were ovariectomized (OVX) or sham-operated (SHAM) and fed standard mouse diet (SF) or special low calcium diet (L.Ca), respectively. All animals were sacrificed at day 100 after operation. Mechanical strength of the left femur and tibia was measured by the three-point bending strength test. The bones were dried, weighed and burned to ash. Correlation between mechanical strength and ash content was found. A specimen of the right tibia was prepared. Mechanical strength, ash content and ratio of dry bone weight to body weight of the femur and tibia in OVX and L.Ca mice were significantly less than in SHAM and SF mice. SHAM/SF mice and OVX/L.Ca group showed highest and lowest values in all cases. The values for the femur and tibia in OVX/SF mice were lower than in SHAM/SF group and in OVX/L.Ca group were less than in OVX/SF mice. Correlation coefficients for mechanical strength and ash content were 0.704 and 0.776 for the femur and tibia. Ca is thus related to inhibition of bone loss and maintenance of bone mass and effective prevention of osteoporosis.

Modification of postural response caused by footwear conditions.

The purpose of this study was to clarify the effect of changing footwear conditions on postural response against postural perturbation. Twenty-three healthy subjects participated in this study. Postural response was induced by moving a platform forward, hereafter referred to as forward-perturbation of a platform. The center of pressure (COP) from the force plate and the electromyograms (EMG) of the tibialis anterior (TA) and quadriceps femoris (QUAD), which are both agonists of the response, were measured. The effect of plantar material and shape of footwear on postural response was examined as footwear condition. Changing plantar materials had an effect on integrated EMG of the agonists (IEMG) but not on the response pattern. On the other hand, the shape of footwear had an effect on the response pattern but not on IEMG. It was supposed from this result that changes in somatosensory input, caused by coupling of plantar material and shape of footwear, modifies postural response variously.

Tensile bond strength to and SEM evaluation of ground and intact enamel surfaces.

OBJECTIVES: The aim of this study was to evaluate the bonding of four commercially available adhesive systems to ground and intact enamel surfaces. METHODS: Extracted human teeth were used to measure the microtensile bond strength to enamel and a field-emission scanning electron microscopy (FE-SEM) was used to observe the bonded interface and the effect of the surface conditioning of each material. Intact buccal enamel surfaces were cleansed with tooth paste using a rotary dental brush, and the ground enamel surfaces were prepared by reducing approximately 0.5 mm from the buccal enamel surfaces using a high-speed diamond bur. One-Step (OS, Bisco), Single Bond (SB, 3M), Clearfil Liner Bond II (LBII, Kuraray), and Tokuso Mac Bond II (MBII, Tokuso) were evaluated for their ability to bond to enamel. RESULTS: There was no significant difference in bond strengths between the materials when they were applied to ground enamel surfaces (p > 0.05). However, the bond strengths of the self-etching systems, LBII and MBII, had significantly lower bond strengths to intact enamel than the bonding systems OS and SB using phosphoric acid etching (p < 0.05). FE-SEM revealed that the etching pattern of self-etching primers was not deep enough to obtain good penetration of bonding resin when applied to intact enamel surfaces. CONCLUSIONS: Phosphoric acid etching produced good resin adhesion to ground and intact enamel. The self-etching/self-priming systems also produced good adhesion to ground enamel, but had lower bond strengths to intact enamel.

Long-term durability of dentin bonds made with a self-etching primer, in vivo.

The long-term durability of bonds between adhesive resins and dentin is of significant importance for the longevity of bonded restorations. We carried out an in vivo one-year study to evaluate the durability of resin-dentin bonds in the oral cavity, as well as to test the hypothesis that the adhesive interface would show morphological changes in vivo over time. Very shallow saucer-shaped dentin cavities were prepared in 12 intact teeth of one Japanese monkey (Macaca fuscata) under general anesthesia. The cavities were restored with Clearfil Liner Bond II and Clearfil Photo Posterior resin composite. The teeth were extracted at three different times: immediately, and 180 and 360 days after placement of the restorations. One day after the monkey was killed, specimens of the three time periods were subjected to the micro-tensile bond test at a crosshead speed of 1 mm/min. The surfaces of the failed bonds were observed under a field emission scanning electron microscope (FE-SEM). Bond strength measurements in this study were successfully performed and were stable at approximately 19 MPa during the one-year testing. Scanning electron microscopic observations of the failed surfaces revealed, at the top of the hybrid layer and within the adhesive resin, porosity which increased over time. Long-term bonds can be assessed in vivo by the combined evaluation of the microtensile bond strength and SEM morphological examination of the adhesive interface.

Adhesion between collagen depleted dentin and dentin adhesives.

PURPOSE: To determine the influence of sodium hypochlorite treatment of dentin on shear bond strength and morphology. MATERIALS AND METHODS: Shear bond strengths of several dentin bonding agents were compared following specific surface treatments that included manufacturer's directions, etching plus sodium hypochlorite, and sodium hypochlorite alone. The treated surfaces and interfaces between bonding materials and treated surfaces were observed using an FE-SEM. RESULTS: Acetone-containing systems yielded equivalent or higher shear bond strengths when sodium hypochlorite was used following etching, as compared with normal procedures. In these cases it is proposed that the adhesive interacts strongly with the treated surface, that contains a high mineral content.

Effect of operator variability on dentin adhesion: students vs. dentists.

The purpose of this study was to evaluate the operator variability of two dentin bonding systems. Fourteen undergraduate students and ten dentists of different levels of clinical experience were selected. Tensile bond strengths between resin composite and bovine dentin using dentin adhesive systems (Clearfil Liner Bond II: LB II; Scotchbond Multi-Purpose: MP) bonding systems showed a large scatter among students and dentists. The dentists group demonstrated no statistically significant differences for mean bond strengths between LB II and MP. The student group recorded a statistically greater bond strength using LB II. The mean coefficient of variation of the dentists group showed no statistically significant difference between LB II and MP, however that of the students group was lower with LB II. When using MP, the dentist group demonstrated a lower coefficient of variation than that of the student group. In order to obtain optimal bonding performance, or when beginning the use of a new system, the operator should be aware of the technique sensitivity of some adhesive systems and sensitivity to operator variability.

Possibility of independence in ADL (Activities of Daily Living) for patients with cervical spinal cord injuries--an evaluation based on the Zancolli Classification of Residual Arm Functions.

For patients with cervical spinal cord injuries to become independent in their ADL (Activities of Daily Living), residual arm function is very important. Also, age, sex, physical strengths, obesity, spasticity, pain, contracture and motivation are related. We investigated the possibility of independence in ADL for patients with cervical spinal cord injuries, carrying out our evaluation based on the Zancolli Classification of Residual Arm Functions. Zancolli classification C6BII is taken as the boundary level for ADL independence. Rehabilitation is not only controlled by the patients with cervical spinal cord injuries themselves but also by the ability of the rehabilitation staff. This implies that taking responsibility in rehabilitation important.

Shear bond strengths of a single-step bonding system to enamel and dentin.

An experimental primer was developed as a single-step bonding system for resin-modified glass ionomer cements (GIC). Efficacy of this primer on adhesion of resin-modified GICs and resin composite to enamel and dentin was evaluated by shear bond test and SEM observation. Good bond strengths to enamel were obtained (> 11 MPa), whereas significantly low bond strengths to dentin were obtained using a single coat of the primer. However, double-coating improved the bond strengths to dentin (> 8 MPa). SEM observations indicated that the primer functioned as a mild conditioner to remove the smear layer on enamel or dentin surfaces. A hybrid layer was observed at the cross-sectional view of the GIC/dentin interface. These findings suggested that good adhesion to enamel and dentin could be achieved using a single-step bonding system.