Outcome of autologous bone grafting with preservation of articular cartilage to treat osteochondral lesions of the talus with large associated subchondral cysts.

Aims: The aim of this study was to evaluate antegrade autologous bone grafting with the preservation of articular cartilage in the treatment of symptomatic osteochondral lesions of the talus with subchondral cysts. Patients and Methods: The study involved seven men and five women; their mean age was 35.9 years (14 to 70). All lesions included full-thickness articular cartilage extending through subchondral bone and were associated with subchondral cysts. Medial lesions were exposed through an oblique medial malleolar osteotomy, and one lateral lesion was exposed by expanding an anterolateral arthroscopic portal. After refreshing the subchondral cyst, it was grafted with autologous cancellous bone from the distal tibial metaphysis. The fragments of cartilage were fixed with 5-0 nylon sutures to the surrounding cartilage. Function was assessed at a mean follow-up of 25.3 months (15 to 50), using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot outcome score. The radiological outcome was assessed using MRI and CT scans. Results: The mean AOFAS score improved from 65.7 (47 to 81) preoperatively to 92 (90 to 100) at final follow-up, with 100% patient satisfaction. The radiolucent area of the cysts almost disappeared on plain radiographs in all patients immediately after surgery, and there were no recurrences at the most recent follow-up. The medial malleolar screws were removed in seven patients, although none had symptoms. At this time, further arthroscopy was undertaken, when it was found that the mean International Cartilage Repair Society (ICRS) arthroscopic score represented near-normal cartilage. Conclusion: Autologous bone grafting with fixation of chondral fragments preserves the original cartilage in the short term, and could be considered in the treatment for adult patients with symptomatic osteochondral defect and subchondral cysts. Cite this article: Bone Joint J 2018;100-B:590-5.

Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction: a second-look arthroscopic evaluation.

Aims: To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction. Patients and Methods: A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage. Results: In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors. Conclusion: Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285-93.

Evaluation of autologous skeletal muscle-derived factors for regenerative medicine applications.

OBJECTIVES: Regenerative medicine is an emerging field aimed at the repair and regeneration of various tissues. To this end, cytokines (CKs), growth factors (GFs), and stem/progenitor cells have been applied in this field. However, obtaining and preparing these candidates requires invasive, costly, and time-consuming procedures. We hypothesised that skeletal muscle could be a favorable candidate tissue for the concept of a point-of-care approach. The purpose of this study was to characterize and confirm the biological potential of skeletal muscle supernatant for use in regenerative medicine. METHODS: Semitendinosus muscle was used after harvesting tendon from patients who underwent anterior cruciate ligament reconstructions. A total of 500 milligrams of stripped muscle was minced and mixed with 1 mL of saline. The collected supernatant was analysed by enzyme-linked immunosorbent assay (ELISA) and flow cytometry. The biological effects of the supernatant on cell proliferation, osteogenesis, and angiogenesis in vitro were evaluated using human mesenchymal stem cells (hMSCs) and human umbilical cord vein endothelial cells (HUVECs). RESULTS: The supernatant contained several GFs/CKs, with especially high levels of basic fibroblast growth factor, and CD34+ cells as the stem/progenitor cell fraction. With regard to biological potential, we confirmed that cell proliferation, osteoinduction, and angiogenesis in hMSCs and HUVECs were enhanced by the supernatant. CONCLUSIONS: The current study demonstrates the potential of a new point-of-care strategy for regenerative medicine using skeletal muscle supernatant. This attractive approach and readily-available material could be a promising option for tissue repair/regeneration in the clinical setting.Cite this article: M. Yoshikawa, T. Nakasa, M. Ishikawa, N. Adachi, M. Ochi. Evaluation of autologous skeletal muscle-derived factors for regenerative medicine applications. Bone Joint Res 2017;6:277-283. DOI: 10.1302/2046-3758.65.BJR-2016-0187.R1.

Japanese experience of evolving nurses' roles in changing social contexts.

AIM: To discuss the evolving roles of Japanese nurses in meeting the goals and concerns of ongoing global sustainable development. BACKGROUND: Japanese nurses' roles have evolved as the needs of the country and the communities they served, changed over time. The comprehensive public healthcare services in Japan were provided by the cooperation of hospitals and public health nurses. INTRODUCTION: The nursing profession is exploring ways to identify and systemize nursing skills and competencies that address global health initiatives for sustainable development goals. METHODS: This paper is based on the summary of a symposium, (part of the 2015 annual meeting of the Japan Association for International Health) with panel members including experts from Japan's Official Development Assistance. FINDINGS: The evolving role of nurses in response to national and international needs is illustrated by nursing practices from Japan. Japanese public health nurses have also assisted overseas healthcare plans. In recent catastrophes, Japanese nurses assumed the roles of community health coordinators for restoration and maintenance of public health. DISCUSSION: The Japanese experience shows that nursing professionals are best placed to work with community health issues, high-risk situations and vulnerable communities. Their cooperation can address current social needs and help global communities to transform our world. CONCLUSION: Nurses have tremendous potential to make transformative changes in health and bring about the necessary paradigm shift. They must be involved in global sustainable development goals, health policies and disaster risk management. A mutual understanding of global citizen and nurses will help to renew and strengthen their capacities. IMPLICATIONS: Nursing professionals can contribute effectively to achieve national and global health goals and make transformative changes.

Responses of microRNAs 124a and 223 following spinal cord injury in mice.

STUDY DESIGN: We investigated microRNA (miRNA) expression after spinal cord injury (SCI) in mice. OBJECTIVES: The recent discovery of miRNAs suggests a novel regulatory control over gene expression during plant and animal development. MiRNAs are short noncoding RNAs that suppress the translation of target genes by binding to their mRNAs, and play a central role in gene regulation in health and disease. The purpose of this study was to examine miRNA expression after SCI. SETTING: Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University. METHODS: We examined the expression of miRNA (miR)-223 and miR-124a in a mouse model at 6 h, 12 h, 1 day, 3 days and 7 days after SCI using quantitative PCR. The miRNA expression was confirmed by in situ hybridization. RESULTS: Quantitative PCR revealed two peaks of miR-223 expression at 6 and 12 h and 3 days after SCI. MiR-124a expression decreased significantly from 1 day to 7 days after SCI. In situ hybridization demonstrated the presence of miR-223 around the injured site. However, miR-124a, which was present in the normal spinal cord, was not observed at the injured site. CONCLUSION: Our results indicate a time-dependent expression pattern of miR-223 and miR-124a in a mouse model of SCI. In this study, the time course of miRNA-223 expression may be related to inflammatory responses after SCI, and the time course of decreased miR-124a expression may reflect cell death.

[Preoperative radiotherapy of carcinoma of the stomach and breast].

Sixty-one patients with gastric cancer and thirty-seven with breast cancer who had undergone preoperative radiotherapy were analysed retrospectively for assessment of various radiotherapeutic effects and prognosis. Most of the sixty-one patients with gastric cancer were found to be stage III or more with borderline operable lesions on admission. Of the sixty-one patients, sixteen were evaluated postoperatively to be stage I by histopathological examination. The 3-year survival rate in these sixteen patients was an admirable 60%. Of the thirty-seven patients with breast cancer, the 3-year survival rate among twenty-four in Stage III exceeded 90%. This survival rate is very high in comparison with other reports. For radiotherapy we adopted a less-fractionated irradiation method with a large dose instead of the conventional fractionated one. This irradiation method has not only a direct radiotherapeutic effect, but also produces a favorable effect on the host's immunocompetence. For gastric cancer, twice weekly treatment with 5 Gy and 3 Gy per week, and irradiation twice with 20 Gy and 10 Gy for breast cancer were very suitable preoperative irradiation doses.