Effect of radioprotective curtain length on the scattered dose rate distribution and endoscopist eye lens dose with an over-couch fluoroscopy system.

Sufficient dose reduction may not be achieved if radioprotective curtains are folded. This study aimed to evaluate the scattered dose rate distribution and physician eye lens dose at different curtain lengths. Using an over-couch fluoroscopy system, dH*(10)/dt was measured using a survey meter 150 cm from the floor at 29 positions in the examination room when the curtain lengths were 0% (no curtain), 50%, 75%, and 100%. The absorbed dose rates in the air at the positions of endoscopist and assistant were calculated using a Monte Carlo simulation by varying the curtain length from 0 to 100%. The air kerma was measured by 10 min fluoroscopy using optically stimulated luminescence dosimeters at the eye surfaces of the endoscopist phantom and the outside and inside of the radioprotective goggles. At curtain lengths of 50%, 75%, and 100%, the ratios of dH*(10)/dt relative to 0% ranged from 80.8 to 104.1%, 10.5 to 61.0%, and 11.8 to 24.8%, respectively. In the simulation, the absorbed dose rates at the endoscopist's and assistant's positions changed rapidly between 55 and 75% and 65% and 80% of the curtain length, respectively. At the 0%, 50%, 75%, and 100% curtain lengths, the air kerma at the left eye surface of the endoscopist phantom was 237 ± 29, 271 ± 30, 37.7 ± 7.5, and 33.5 ± 6.1 µGy, respectively. Therefore, a curtain length of 75% or greater is required to achieve a sufficient eye lens dose reduction effect at the position of the endoscopist.

Effects of high antibiotic concentrations applied to continuous local antibiotic perfusion on human bone tissue-derived cells.

Aims: Continuous local antibiotic perfusion (CLAP) has recently attracted attention as a new drug delivery system for orthopaedic infections. CLAP is a direct continuous infusion of high-concentration gentamicin (1,200 µg/ml) into the bone marrow. As it is a new system, its influence on the bone marrow is unknown. This study aimed to examine the effects of high-concentration antibiotics on human bone tissue-derived cells. Methods: Cells were isolated from the bone tissue grafts collected from six patients using the Reamer-Irrigator-Aspirator system, and exposed to different gentamicin concentrations. Live cells rate, apoptosis rate, alkaline phosphatase (ALP) activity, expression of osteoblast-related genes, mineralization potential, and restoration of cell viability and ALP activity were examined by in vitro studies. Results: The live cells rate (the ratio of total number of cells in the well plate to the absorbance-measured number of live cells) was significantly decreased at ≥ 500 µg/ml of gentamicin on day 14; apoptosis rate was significantly increased at ≥ 750 µg/ml, and ALP activity was significantly decreased at ≥ 750 µg/ml. Real-time reverse transcription-polymerase chain reaction results showed no significant decrease in the ALP and activating transcription factor 4 transcript levels at ≥ 1,000 µg/ml on day 7. Mineralization potential was significantly decreased at all concentrations. Restoration of cell viability was significantly decreased at 750 and 1,000 µg/ml on day 21 and at 500 µg/ml on day 28, and ALP activity was significantly decreased at 500 µg/ml on day 28. Conclusion: Our findings suggest that the exposure concentration and duration of antibiotic administration during CLAP could affect cell functions. However, further in vivo studies are needed to determine the optimal dose in a clinical setting.

Activity of Daily Living and Walking Ability of Patients with Severe COVID-19 at Discharge from an Acute Care Hospital.

Objectives: The effectiveness of acute rehabilitation treatment for severe coronavirus disease 2019 (COVID-19) has not yet been established. This study examined the efficacy of treatment provided to patients with severe COVID-19 in an acute care facility. Methods: A total of 98 patients with severe COVID-19 requiring inpatient management in our intensive care unit (ICU) were included between December 2020 and October 2021. They were divided into two groups: those who received physiotherapy (PT group; n=44) and those who did not receive physiotherapy (non-PT group; n=54). Their backgrounds, clinical characteristics, and activities of daily life (ADL) at discharge were compared to examine factors that influenced the need for physiotherapy (PT). We also evaluated the effect of PT on ADL by comparing the Barthel Index (BI) before PT and at discharge. Results: The PT group patients were significantly older, had longer hospital and ICU stays, and used invasive mechanical ventilators (IMV) more frequently than those in the non-PT group. More patients in the non-PT group were able to walk at discharge than in the PT group. The PT group patients showed significant improvement in BI and ADL at discharge when compared with BI at the start of PT, regardless of whether an IMV was used. Conclusions: Older patients with severe COVID-19 with prolonged hospitalization or ICU stay or on an IMV are prone to a decline in ADL and may need to be considered for early PT.

Effect of Bone Metastasis Cancer Board on Spinal Surgery Outcomes: A Retrospective Study.

Background and Objectives: Bone metastasis cancer boards (BMCBs) focusing on the management of bone metastases have been gathering much attention. However, the association of BMCBs with spinal surgery in patients with spinal metastases remains unclear. In this retrospective single-center observational study, we aimed to clarify the effect of a BMCB on spinal metastasis treatment. Materials and Methods: We reviewed consecutive cases of posterior decompression and/or instrumentation surgery for metastatic spinal tumors from 2008 to 2019. The BMCB involved a team of specialists in orthopedics, rehabilitation medicine, radiation oncology, radiology, palliative supportive care, oncology, and hematology. We compared demographics, eastern cooperative oncology group performance status (ECOGPS), Barthel index (BI), number of overall versus emergency surgeries, and primary tumors between patients before (2008-2012) and after (2013-2019) BMCB establishment. Results: A total of 226 patients including 33 patients before BMCB started were enrolled; lung cancer was the most common primary tumor. After BMCB establishment, the mean patient age was 5 years older (p = 0.028), the mean operating time was 34 min shorter (p = 0.025), the mean hospital stay was 34.5 days shorter (p < 0.001), and the mean BI before surgery was 12 points higher (p = 0.049) than before. Moreover, the mean number of surgeries per year increased more than fourfold to 27.6 per year (p < 0.01) and emergency surgery rates decreased from 48.5% to 29.0% (p = 0.041). Patients with an unknown primary tumor before surgery decreased from 24.2% to 9.3% (p = 0.033). Postoperative deterioration rates from 1 to 6 months after surgery of ECOGPS and BI after BMCB started were lower than before (p = 0.045 and p = 0.027, respectively). Conclusion: The BMCB decreased the emergency surgery and unknown primary tumor rate despite an increase in the overall number of spinal surgeries. The BMCB also contributed to shorter operation times, shorter hospital stays, and lower postoperative deterioration rates of ECOGPS and BI.

Investigation of Changes in Skeletal Muscle Mass and Muscle Quality and Factors Affecting Changes in Deceased Donor Liver Transplantation.

BACKGROUND: In Japan, there are very few cases of deceased donor liver transplantation (DDLT) and even fewer studies on the effects of DDLT on sarcopenia. This study examined the changes in skeletal muscle mass and quality in DDLT, the factors related to these changes, and survival rates. METHODS: Using computed tomography (CT), we retrospectively measured L3 skeletal muscle index (L3SMI) and intramuscular adipose tissue content (IMAC) at admission, discharge, and 1-year post-DDLT in 23 patients with DDLT from our hospital between 2011 and 2020. We investigated the relationships between changes in L3SMI and IMAC associated with DDLT and between various admission factors and survival. RESULTS: Patients with DDLT showed significant decreases in L3SMI during hospitalization (P < .05). Although L3SMI tended to increase postdischarge, in 11 (73%) cases, it was lower at 1-year post-DDLT than that on admission. Moreover, decreases in L3SMI during hospitalization were correlated to L3SMI on admission (r = 0.475, P < 0.05). Intramuscular adipose tissue content increased from admission to discharge and decreased 1-year post-DDLT. Admission L3SMI and IMAC were not significantly correlated with survival. CONCLUSIONS: This study suggests that the skeletal muscle mass of DDLT patients decreased during hospitalization and showed a slight tendency to improve after discharge, but the decrease tended to be prolonged. In addition, patients with higher skeletal muscle mass at admission tended to lose more skeletal muscle mass during hospitalization. Deceased donor liver transplantation was identified as a potential contributor to improved muscle quality, whereas skeletal muscle mass and quality on admission did not affect post-DDLT survival.

Predictors of Activities of Daily Living in Intensive Care Unit Survivors: A Propensity Score Matching Analysis.

Objectives: Increased long-term impairment is common among intensive care unit (ICU) survivors. However, predictors of activities of daily living (ADL) in ICU survivors are poorly understood. We aimed to focus on the trajectory of physical function and explore the clinical variables that affect ADL at hospital discharge. Methods: We enrolled 411 patients admitted to the ICU from April 2018 to October 2020. Physical function was evaluated at ICU admission, ICU discharge, and hospital discharge. We assessed physical function (grip strength, arm and calf circumference, quadriceps thickness, and Barthel index). Patients were assigned to the high or low ADL group based on their Barthel index at discharge. Propensity score matching analysis was performed to minimize selection biases and differences in clinical characteristics. Results: After matching propensity scores, 114 of the 411 patients (aged 65±15 years) were evaluated. The high ADL group showed better physical function at ICU discharge and hospital discharge than the low ADL group. An overall decreasing trend in muscle mass was observed over time; the rates of decline were lower in the high ADL group than in the low ADL group. The cutoff values for relative changes in calf circumference and quadriceps thickness to predict high ADL were -7.89% (sensitivity: 77.8%, specificity: 55.6%) and -28.1% (sensitivity: 81.0%, specificity: 58.8%), respectively. Conclusions: The relative decreases in calf circumference and quadriceps thickness during hospitalization were lower in patients who maintained their ADL. Assessment of the trajectory of physical function can predict ADL status at hospital discharge among ICU survivors.

Effect of low-intensity pulsed ultrasound on osteogenic differentiation of human induced membrane-derived cells in Masquelet technique.

INTRODUCTION: The Masquelet technique is a relatively new method for large bone defect treatment. In this technique, grafted bone tissue is used, and after the cement is removed, the induced membrane (IM; that form around the cement spacers placed in the bone defect region) is thought to play an important role in promoting bone formation. On the other hand, low-intensity pulsed ultrasound (LIPUS) is known to promote fracture healing and angiogenesis through mechanical stimulation. This study aimed to investigate the in vitro effects of LIPUS on the osteogenic differentiation of human induced membrane-derived cells (IMCs). METHODS: Seven patients who had been treated using the Masquelet technique were enrolled. The IM was harvested during the second stage of the technique. IMCs were isolated, cultured in growth medium, and then divided into two groups: (1) control group, IMCs cultured in osteogenic medium without LIPUS, and (2) LIPUS group, IMCs cultured in osteogenic medium with LIPUS treatment. Adherent cells from the IM samples were harvested after the first passage and evaluated for cell surface protein expression using immunostaining. A cell proliferation assay was used to count the number of IMCs using a hemocytometer. Osteogenic differentiation capability was assessed using an alkaline phosphatase (ALP) activity assay, Alizarin Red S staining, and real-time reverse transcription-polymerase chain reaction. RESULTS: Cell surface antigen profiling revealed that the IMCs contained cells positive for the mesenchymal stem cell-related markers CD73, CD90, and CD105. No significant difference in cell numbers was found between the control and LIPUS groups. The ALP activity of IMCs in the LIPUS group was significantly higher than that in the control group on days 7 and 14. Alizarin red S staining intensity was significantly higher in the LIPUS group than in the control group on day 21. Runx2 and VEGF expression was significantly upregulated on days 7 and 14, respectively, compared with levels in the control group. CONCLUSION: We demonstrated the significant effect of LIPUS on the osteogenic differentiation of human IMCs. This study indicates that LIPUS can be used as an additional tool for the enhancement of the healing process of the Masquelet technique.

Reliability and Validity of Quadriceps Muscle Thickness Measurements in Ultrasonography: A Comparison with Muscle Mass and Strength.

Objectives: Measurement of skeletal muscle using ultrasonography (US) has received considerable attention as an alternative method of muscle assessment. However, intra- and inter-rater reliability remains controversial. Furthermore, there is no consensus regarding the relationship between muscle assessment using US and muscle mass or physical assessment. We aimed to verify the validity and reliability of muscle measurements using US and its relationships with muscle strength and physical assessment. Methods: The 22 participants were all healthy men. Quadriceps muscle thickness was measured by US by three different raters. Intraclass correlation coefficient (ICC) was used to assess inter- and intra-rater reliability. The maximum isokinetic strength of the quadriceps and handgrip strength were used as measures of lower and upper muscle strength, respectively. Leg muscle mass was assessed using the leg skeletal muscle index (SMI), measured by body impedance analysis, and calf circumference. Results: The intra-rater reliability was excellent which the ICC(1,1) ranges 0.957-0.993, and ICC(1,3) ranges 0.985-0.998. For inter-rater reliability, the values of 0.904 for ICC(2,1) and 0.966 for ICC(2,3) indicated excellent reliability. Leg SMI was significantly correlated with quadriceps thickness (r=0.36). Maximum isokinetic strength and handgrip strength showed weak but statistically significant correlations with quadriceps thickness (r=0.20, r=0.30, respectively). The correlation between quadriceps thickness and calf circumference was not statistically significant. Conclusions: Quadriceps muscle assessment using US is a valid and reliable technique for healthy individuals. Quadriceps muscle thickness was significantly positively correlated with upper and lower muscle strength and leg SMI. Muscle thickness assessment could replace full body muscle assessment in clinical settings.

[Accuracy Evaluation of Air Kerma-area Product of Over-couch-type X-ray Fluoroscopic System].

PURPOSE: The purpose of this study was to evaluate the accuracy of incident air kerma (Ka,r) and air kerma-area product (PKA) displayed on over-couch-type X-ray fluoroscopic systems by comparing them with the measured values. METHODS: An ionizing chamber was placed at the patient entrance reference point to measure the Ka,r. The PKA was calculated by multiplying the Ka,r by the irradiation area. These measured values were compared with the displayed values. RESULTS: The differences between measured and displayed Ka,r and PKA were less than ±35%, which was the criteria of the Japanese Industrial Standards (JIS). However, the accuracy of the displayed values differed depending on the manufacturer and the device. CONCLUSION: Although no error exceeding the JIS criteria was observed, it is necessary to understand the characteristics of the X-ray fluoroscopic systems related to displayed dose and to manage the systems by performing dose measurements periodically.

Human Non-Hypertrophic Nonunion Tissue Contains Osteoblast Lineage Cells and E-BMP-2 Activates Osteogenic and Chondrogenic Differentiation.

In this study, we examined the proliferation capability and osteogenic and chondrogenic differentiation potential of non-hypertrophic nonunion cells (NHNCs), and the effect of Escherichia coli-derived BMP-2 (E-BMP-2) on them. We enrolled five patients with non-hypertrophic nonunion. NHNCs isolated from nonunion tissue sampled during surgery were cultured, passaged, counted every 14 days, and analyzed. NHNCs were homogenous fibroblastic adherent cells and long-lived through at least 10 passages, with a slight decline. The cells were consistently positive for mesenchymal stem cell-related markers CD73 and CD105, and negative for the hematopoietic markers CD14 and CD45. NHNCs could differentiate into osteoblast lineage cells; however, they did not have strong calcification or sufficient chondrogenic differentiation capability. E-BMP-2 did not affect the proliferative capability of the cells but improved their osteogenic differentiation capability by increasing alkaline phosphatase activity and upregulating the gene expression of osterix, bone sialoprotein, and osteocalcin. E-BMP-2 enhanced their chondrogenic differentiation capability by upregulating the gene expression of aggrecan and collagen type II. We showed, for the first time, that NHNCs have the capacity to differentiate into osteoblast-lineage cells, although the chondrogenic differentiation potential was poor. Local application of E-BMP-2 with preservation of nonunion tissue is a potential treatment option for non-hypertrophic nonunion.

TresLock for Unstable Proximal Femoral Fractures: Morphological Compatibility and Clinical Results: A Case Series.

Introduction: A new device, TresLock (KISCO DIR Co., Ltd., Kobe), has been used for the treatment of unstable proximal femoral fractures and was designed based on Japanese anatomical characteristics. It has three sliding hip screws with one side plate. The angle of all screws relative to the plate has been set to 128°, and each hip screw has a short thread (15 mm) to prevent crossing of the fracture line. In this study, we evaluated the morphological compatibility of TresLock. Methods: We treated 10 patients with hip fractures using TresLock at our institution between September 2016 and December 2017. The average age of the patients was 83.8 years (range, 73-93 years). Fractures included five proximal neck transcervical shear fractures (Orthopaedic Trauma Association [OTA] type-31B2.3, Pauwels III) and five basicervical fractures (OTA type-31B3). The clinical course and three-dimensional computed tomography were evaluated postoperatively. Results: In all cases, all three screws were inserted within the femoral neck. The screws were inserted at an axis of 2.5 ± 1.3° varus to the femoral neck axis. The distance from the subcapital line to the three (proximal-anterior, proximal-posterior, and distal) screw thread ends was 12.0 ± 1.8 mm, 10.4 ± 2.4 mm, and 11.6 ± 4.0 mm, respectively and was sufficient to actuate compression force. However, one case (Pauwels III) required reoperation because of non-union. Conclusion: Careful follow-up is needed, but TresLock shows good anatomical compatibility for femurs among the Japanese population.

Clinical Outcome of Patients with Bone Metastases in a Convalescent Rehabilitation Ward: A Case Series of Six Patients.

Background: Advances in cancer treatment have led to an increase in the number of cancer survivors and, likewise, cancer patients in convalescent rehabilitation wards. It is difficult for patients with bone metastases to recover their motor functions and be discharged. However, cancer treatments, such as anti-cancer drug therapy and radiation therapy, are not generally provided in convalescent rehabilitation wards. Cases: This study retrospectively reviewed six cases of bone metastases in our convalescent rehabilitation ward from April 2018 to October 2019. The ages of the patients ranged from 58 to 85 years, and all patients were male. The primary cancers were lung cancer (two cases), renal cancer (one case), esophageal cancer (one case), prostate cancer (one case), and double lung and kidney cancer (one case). Bone metastases were observed in the spine (six cases), pelvis (two cases), and femur (one case). All patients were admitted to our convalescent rehabilitation ward for postoperative management of imminent fracture risk and rehabilitation of pathological fracture or spinal cord compression caused by bone metastasis. None of the patients received treatment for primary cancer or bone metastases during their hospitalization. Two patients had new bone metastases in load-bearing bones. Five patients were transferred to acute care hospitals for the treatment of cancer or infection. Discussion: Before transferring patients with bone metastases to convalescent rehabilitation wards, clinicians should assess the risk of skeletal-related events and the rate of progression of their cancer. Indications for hospitalization should be carefully determined in cooperation with acute care hospitals.

Low-Intensity Pulsed Ultrasound Promotes Osteogenic Differentiation of Reamer-Irrigator-Aspirator Graft-Derived Cells in Vitro.

Recently, reamer-irrigator-aspirator (RIA) systems have been increasingly used to harvest autologous bone grafts. RIA graft materials contain bone marrow, which provides a viable source to derive large numbers of mesenchymal stem cells. Low-intensity pulsed ultrasound (LIPUS) significantly accelerates the differentiation of stem cells derived from bone marrow. This in vitro study investigated the effect of LIPUS on the osteogenic activity and differentiation of RIA graft-derived cells. A small amount of RIA graft was obtained from seven patients. After the cells derived from RIA grafts were cultured, they were divided into two groups: the LIPUS and control groups. LIPUS was applied once daily for 20 min (1.5 MHz, pulse duration: 200 µs, pulse repetition rate: 1 kHz, spatial average-temporal average intensity: 30 mW/cm2). Alkaline phosphatase activity (113.4% and 130.1% on days 7 and 14), expression of osteoblast-related genes (ALP, Runx2) and mineralization (135.2% on day 21) of the RIA graft-derived cells were significantly higher in the LIPUS group than in the control group. However, LIPUS did not affect the cell proliferation of RIA graft-derived cells. This study indicates that LIPUS may enhance the healing of non-union and critical bone defects treated by autologous bone grafting using the RIA system.

[A Simple Measurement Method for Verifying the Accuracy of the Displayed Dose on an Over-couch-type X-ray Fluoroscopic System].

The purpose of this study was to establish a simple measurement method to verify the accuracy of incident air kerma (Ka, r) and air kerma area product (PKA) displayed on an over-couch-type X-ray fluoroscopy system. A dosimeter was located at the patient entrance reference point, and the irradiation field size was set to 10×10 cm. A lead plate was placed on the couchtop to protect the image receptor, and the duration of fluoroscopy was set to 1 min. The Ka, r was measured with the proposed method and the Japanese Industrial Standards (JIS) method on three X-ray fluoroscopy units of different manufactures. The effect of backscattered X-rays from the lead plate was calculated using Monte Carlo methods. The errors of the displayed Ka, r and PKA to the measured Ka, r and PKA with our proposed method were calculated. There was no significant difference in the measured Ka, r between the proposed method and the JIS method in all units. The effect of backscattered X-ray was ≤0.5%. The errors of displayed Ka, r and PKA to those measured were in the range of 3.4 to 15.7% and -4.1 to 20.3%, respectively, which met the tolerance for accuracy of ±35% in accordance with the JIS method. We found that our proposed method was simple and that the accuracy of measured values was comparable to that of the JIS method.

The multi-kinase inhibitor dasatinib suppresses autoinflammation and increases bone density in a mouse model for chronic recurrent multifocal osteomyelitis.

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease that presents with bone destruction and pain. Although genetic studies have identified signalling pathways involving CRMO, molecularly targeted drugs remain unavailable. We used an animal model of CRMO as an in vivo screening system for candidate therapeutic agents. A gain-of-function mutation in Fgr, a member of Src family kinases (SFKs), causes peripheral paw inflammation and reduced bone mineral density (BMD) in Ali18 mice. The SFK inhibitor dasatinib was selected for administration to Ali18 mice daily for 2 weeks. Local inflammation and BMD were assessed by clinical scoring and computed tomography, respectively. Pilot studies in a small number of animals showed that dasatinib administration effectively suppressed the early phase of autoinflammation in Ali18 mice. Serial oral gavage of dasatinib to a group of Ali18 mice confirmed significant suppression of paw swelling with no side effects. Histological analysis revealed that abnormal proliferative bone marrow cells and inflammatory infiltration into the skin in the affected area were clearly reduced in the animals with dasatinib administration. Further, trabecular BMD in Ali18 long bones was restored to levels similar to that found in wild type mice. Our results indicate that autoinflammation and related-bone phenotypes were completely suppressed by the dasatinib kinase inhibitor in CRMO model animals. Thus, it is strongly suggested that dasatinib can be used for clinical treatments of CRMO with the combination of molecular diagnosis of the FGR locus. SIGNIFICANCE OF THE STUDY: Autoinflammation and related-bone phenotypes were effectively suppressed by the kinase inhibitor dasatinib in CRMO model animals. In combination with molecular analysis of the FGR locus, dasatinib is a strong candidate for the clinical treatments of CRMO. We propose that the animal model employed in this study can be used to screen this and other potential drugs for CRMO.

Hydration Status of Junior Tennis Players and the Difference after a Lecture on Its Practice.

Dehydration reduces exercise performance and causes heat-related illness. However, the fact that dehydration is a serious sports injury is often forgotten, especially among junior tennis players, who engage in tennis matches alone without receiving advice from others. Our objective was to investigate the hydration status of junior tennis players and the difference after attending a lecture on the importance of hydration. In total, 157 junior tennis players attending a training camp participated in this study. The duration of the camp was two days, and a lecture was organized on the first night to educate the players about hydration using a body mass scale. Body mass (BM) was measured immediately before and after practice on the first and second day. The water loss rate (WLR) was calculated by dividing the loss in BM during practice by the BM before practice. In total, 34.4% of players had attended a lecture on hydration in the past. These players had a lower WLR than those who had not, but the difference was not significant. The WLR was significantly lower after attending our lecture than that before. This study suggests that a lecture on hydration could immediately improve the hydration status of the junior tennis players; however, this effect may not be lasting. They may need help from their coaches and parents to implement what they have learned in lecture.

Transcutaneous CO2 application accelerates fracture repair in streptozotocin-induced type I diabetic rats.

INTRODUCTION: Diabetes mellitus (DM) negatively affects fracture repair by inhibiting endochondral ossification, chondrogenesis, callus formation, and angiogenesis. We previously reported that transcutaneous CO2 application accelerates fracture repair by promoting endochondral ossification and angiogenesis. The present study aimed to determine whether CO2 treatment would promote fracture repair in cases with type I DM. RESEARCH DESIGN AND METHODS: A closed femoral shaft fracture was induced in female rats with streptozotocin-induced type I DM. CO2 treatment was performed five times a week for the CO2 group. Sham treatment, where CO2 was replaced with air, was performed for the control group. Radiographic, histologic, genetic, and biomechanical measurements were taken at several time points. RESULTS: Radiographic assessment demonstrated that fracture repair was induced in the CO2 group. Histologically, accelerated endochondral ossification and capillary formation were observed in the CO2 group. Immunohistochemical assessment indicated that early postfracture proliferation of chondrocytes in callus was enhanced in the CO2 group. Genetic assessment results suggested that cartilage and bone formation, angiogenesis, and vasodilation were upregulated in the CO2 group. Biomechanical assessment revealed enhanced mechanical strength in the CO2 group. CONCLUSIONS: Our findings suggest that CO2 treatment accelerates fracture repair in type I DM rats. CO2 treatment could be an effective strategy for delayed fracture repair due to DM.

Staged Bilateral Total Knee Arthroplasty in a Patient with Charcot Knees: A Case Report.

INTRODUCTION: Charcot arthropathy causes severe progressive and destructive joint disease. With the development of prostheses and surgical techniques, orthopedic surgeons have a greater opportunity to use total knee arthroplasty (TKA) to treat Charcot knee. However, consensus is lacking regarding prosthesis choice. Here, we present a case of staged bilateral TKA in a patient with bilateral Charcot knees in a different way. CASE REPORT: We report a case of a 64-year-old woman with bilateral Charcot knees. Her knee joints had become increasingly unstable with severe deformity over 1 year, and she has been unable to walk for1 month before hospitalization. We performed the first TKA of the right knee using rotating hinge prosthesis with a combination of autologous bone graft and metal tibial block augmentation; lateral release and patellar replacement were also performed. Three months after the first surgery, we performed the second TKA for her left knee using a constrained condylar prosthesis with a combination of lateral retinaculum release and patella replacement. At the 6-month follow-up, both knees were stable and in good alignment. There were no signs of loosening or fracture. The patient experienced no pain and was able to ambulate in her household using a walker. CONCLUSION: TKA using constrained condylar or rotating hinge prosthesis effectively treats Charcot knee. Surgeons must acquire both appropriate alignment and ligament stability rather than the range of motion to ensure increased longevity of the prosthesis by performing various surgical techniques. Careful follow-up is needed, but Charcot knee patients can have good outcomes with TKA.

Physicochemical Properties of Acylglutamic Acid-Alkylamine Complexes in Aqueous Media.

We studied the physicochemical properties of 1:1 stoichiometric complexes of acylglutamic acids (CnGlu) with tertiary alkylamines (CnDMA) in water at their low and high concentrations. Static surface tensiometry suggested that the critical micelle concentration (cmc) decreased with increasing hydrophobic chain length of the complexes. In addition, CnGlu-CnDMA yielded lower cmc than the C12Glu single system. In the region of high concentrations, several phase states including isotropic liquid (L1) phase, hexagonal liquid crystal (H1) phase, bicontinuous cubic liquid crystal (V1) phase, and lamellar liquid crystal (Lα) phase were observed. Assemblies with lesser positive curvature tend to be formed with increasing complex concentration, increasing temperature, and increasing hydrophobic chain length. Additionally, the complex formation resulted in the molecular assemblies with lesser positive curvature.