Rectangular tapered short stem excellently preserves proximal bone mineral density preservation than tapered wedge short stem.

Fitmore stem is a rectangular, tapered, short, cementless stem. A characteristic feature of this stem is that it provides rotational stability due to the high medullary occupancy achieved by its rectangular cross-section and thick antero- posterior width. We aimed to investigate the differences in periprosthetic bone remodelling between a rectangular- tapered short stem and a short tapered-wedge stem. Eighty patients who underwent primary total hip arthroplasty using a rectangular-tapered short stem (Fitmore) or a short tapered-wedge stem (Tri-Lock BPS) were enrolled in this study. Bone mineral densities (BMDs) in the seven Gruen zones were evaluated using dual-energy X-ray absorptiometry at baseline, and at 6 and 24 months postoperatively. Peri-prosthetic BMD and clinical factors were assessed and compared. In addition, correlations between periprosthetic BMD changes and stem anteversion error were analyzed using Pearson's correlation coefficient in the two groups. A significantly better postoperative periprosthetic BMD change was found in zones 1 and 7 in the rectangular-tapered group. Additionally, no significant correlation was observed between stem anteversion error and periprosthetic BMD changes in the rectangular-tapered groups. However, in the tapered-wedge group, there were significant negative correlations between the stem anteversion error and BMD changes at 6 months and 24 months in zones 1 and 7. In the rectangular-tapered group, a significantly better postoperative periprosthetic BMD change was found particularly in the region proximal to the stem. Rectangular-tapered short stem can be more resistant to rotation due to higher medullary occupancy and may lead to better periprosthetic BMD than the tapered-wedge short stem, especially in the proximal region of the stem.

The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement?

PURPOSE: Objectives in scoliosis corrective surgery include restoration of normal sagittal and coronal parameters to achieve patient satisfaction. HRQLs improvements remain limited after corrective surgery. The aim of this study was to evaluate the HRQL subclass variability specific to the sagittal and coronal correction in adult scoliosis surgery. METHODS: This multi-centre prospective analysis of consecutive adult spinal deformity (ASD) patients, from five European centres, only included multilevel instrumentation for scoliosis. d-(delta) values for each parameter represented pre to post-operative changes. Parameters included demographics, baseline, 1- and 2-year. HRQL outcomes (Oswestry disability index (ODI), Scoliosis Research Society (SRS)-22 and Short Form (SF36)), sagittal correction including relative spinopelvic alignment (dRSA) and coronal correction including major Cobb (dCobb) angles. RESULTS: A total of 353 patients reached 1-year and 2-year follow up. All HRQL total scores significantly improved postoperatively, including ODI, SRS-22 and SF36. HRQL subclasses which displayed persistent improvements correlated to dRSA included sex-life, self-image, fatigue, vitality, social functioning. The only HRQL subclass improvement that correlated with dCobb was self-image. CONCLUSION: Adult scoliosis surgery improves overall HRQL, having a minimal effect on each variable. Importantly, greater coronal deformity correction affects only greater self-image scores, whereas with greater sagittal correction there are many greater HRQL sub-class impacts. Correction and restoration of coronal balance is one of the surgical goals in adult scoliosis but the degree to which Cobb angle is corrected, apart from self-image, does not correlate with gains in sub-classes of HRQL. These results need to be taken into account when planning surgery.

Akt phosphorylation in human chondrocytes is regulated by p53R2 in response to mechanical stress.

OBJECTIVE: The p53 tumor-suppressor protein p53R2 is activated in response to various stressors that act on cell signaling. When DNA is damaged, phosphorylation of p53 at its Ser 15 residue induces p53R2 production. The role of p53R2 in chondrocytes remains poorly understood. In this study, we evaluated in chondrocytes, p53R2 expression and its regulation in response to mechanical stress. Furthermore, we investigated the function of p53R2 in relation to mechanotransduction. METHODS: Osteoarthritis (OA) cartilage obtained from total knee replacements and normal cartilage obtained from femoral neck fractures was used to measure p53R2 expression by using immunohistochemistry, western blotting, and real-time polymerase chain reaction (PCR). The OA chondrocytes were subjected to a high magnitude of cyclical tensile strain by using an FX-2000 Flexercell system. Next, sulfated glycosaminoglycan (sGAG) production was quantified in these cells. Protein expression of p53R2, and phosphorylation of Akt, p38MAPK, ERK1/2, and JNK was also detected using western blotting. Moreover, Akt phosphorylation was detected after transfecting the cells with p53R2-specific small interfering RNA (siRNA). RESULTS: Expression of p53R2 was significantly increased in OA chondrocytes and in chondrocytes after applying 5% tensile strain to the cells. However, Akt phosphorylation was down-regulated in OA chondrocytes after the strain, and was up-regulated after transfection of p53R2. sGAG protein as well as collagen type II and aggrecan mRNA was increased following transfection of p53R2-specific siRNA after 5% tensile strain. CONCLUSIONS: p53R2 could regulate matrix synthesis via Akt phosphorylation during chondrocyte mechanotransduction. Down-regulation of p53R2 may be a new therapeutic approach in OA therapy.

Central 10-degree visual field change following trabeculectomy in advanced open-angle glaucoma.

PURPOSE: To prospectively examine changes in the central visual field (VF) in patients with advanced open-angle glaucoma (OAG) with advanced late stage after trabeculectomy for 12 months. DESIGN: Prospective interventional case series. METHODS: In all, 27 eyes of 27 OAG patients at a single center with a best-corrected visual acuity (BCVA) of ≥40/200 and a mean total deviation of test locations of the 10-2 program of the Humphrey VF analyzer of ≤-20 dB preoperatively were enrolled. Intraocular pressure (IOP), VF parameters of the 10-2 program, and BCVA were examined for 12 months after trabeculectomy with mitomycin C. Slopes of VF parameters and their correlation with presumed risk factors were studied. RESULTS: IOP decreased from 19.7±5.8 to 9.7±2.6 mm Hg (P<0.001) over postoperative 1 year. The slopes of all VF parameters did not significantly differ from zero (P>0.33), and none of the presumed factors significantly correlated with the slopes of those parameters (P>0.14). There were two eyes (7%) and one eye (4%) with ≥2 lines of deterioration in BCVA (decimal fraction) at 1 and 12 months, respectively, after surgery with no apparent causes. CONCLUSIONS: Trabeculectomy resulted in little change in the central 10-degree VF, but significant decrease in BCVA without apparent causes might occur approximately 5% of the cases.

DcR3 induces cell proliferation through MAPK signaling in chondrocytes of osteoarthritis.

INTRODUCTION: Decoy receptor 3 (DcR3), a soluble receptor belonging to the tumor necrosis factor (TNF) receptor superfamily, competitively binds and inhibits the TNF family including Fas-ligand (Fas-L), lymphotoxin-like inducible protein that competes with glycoprotein D for binding herpesvirus entry mediator on T-cells (LIGHT) and TNF-like ligand 1A (TL1A). In this study, we investigated the functions of DcR3 on osteoarthritis (OA) chondrocytes. METHODS: Expressions of DcR3 in chondrocytes were measured by realtime Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Expression of DcR3 in sera and joint fluids was measured by enzyme-linked immunosorbent assay (ELISA). Chondrocytes were incubated with DcR3-Fc chimera protein (DcR3-Fc) before induction of apoptosis by Fas-L and apoptosis was detected with terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labelling labeling (TUNEL) staining and Western blotting of caspase 8 and poly (ADP-ribose) polymerase (PARP). Chondrocytes were incubated with DcR3-Fc and the proliferation was analyzed by 4-[3-(4-iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate (WST) assay. Phosphorylation of Extracellular Signal-Regulated Kinase (ERK), P38 mitogen-activated protein kinase (MAPK) and Jun N-terminal Kinase (JNK) in chondrocytes was measured by Western blotting after incubation with DcR3-Fc, Mitogen-activated protein kinase kinase (MEK1/2) inhibitor, or P38 MAPK inhibitor. Chondrocytes were treated with DcR3-Fc after pre-incubation with blocking antibody of Fas-L, LIGHT and TL1A, and proliferation or phosphorylation of ERK was analyzed. RESULTS: DcR3 was expressed in OA and normal chondrocytes. DcR3-Fc protects chondrocytes from Fas-induced apoptosis. DcR3-Fc increased chondrocytes proliferation and induced the phosphorylation of ERK specifically. DcR3-induced chondrocytes proliferation was inhibited by pre-incubation of PD098059 or blocking Fas-L antibody. DcR3 increased chondrocytes proliferation in OA chondrocytes, but did not in normal. CONCLUSION: DcR3 regulates the proliferation of OA chondrocytes via ERK signaling and Fas-induced apoptosis.

Magnetic stimulation of the sacral roots for the treatment of stress incontinence: an investigational study and placebo controlled trial.

PURPOSE: We designed an investigational study and placebo controlled trial to evaluate the potential efficacy of magnetic stimulation of the sacral roots for the treatment of stress incontinence. MATERIALS AND METHODS: A total of 75 patients with stress incontinence were studied. A 15 Hz. repetitive magnetic stimulation of the sacral roots with 50% intensity output and duration of 5 seconds per minute was applied for 30 minutes. Urodynamic investigations under magnetic stimulation were performed in 13 patients to evaluate acute effects to lower urinary tract function. There were 62 women (mean age 58 years) enrolled in a placebo controlled study to investigate the short-term efficacy of magnetic stimulation. The number of leaks for 3 days, amount of urine loss on a pad test and quality of life score were evaluated before and 1 week after stimulation. RESULTS: The urodynamic investigations revealed an apparent elevation of urethral closure pressure induced by stimulation (mean 8.2 +/- 3.0 cm H2O, p = 0.0000004) and a significant increase in bladder capacity after stimulation (mean 40.0 +/- 51.0 ml., p = 0.0152). In the placebo controlled study the number of leaks and amount of urine loss on a pad test significantly decreased more in the active than in the sham stimulation group (p = 0.0023 and 0.0377, respectively). The quality of life score significantly improved in the active stimulation group (p = 0.0006) in contrast to no significant improvement in the sham stimulation group. The improvement rate in the active stimulation group was 74%, which was significantly higher than the 32% in the sham stimulation group (p = 0.0009). No adverse effects were noted in any patients. CONCLUSIONS: These results suggest that magnetic stimulation of the sacral roots may be useful for the treatment of stress incontinence. Further studies are needed to evaluate the long-term efficacy of this potential treatment.

Characteristics of collagen-induced Ca2+ mobilization in bovine platelets.

We characterized the collagen-induced increase in cytosolic Ca2+ ([Ca2+]i) of bovine platelets loaded with the Ca2+ indicator Fura-PE3/AM. Collagen (10 micrograms/ml)-induced increase in [Ca2+]i was only partially inhibited by aspirin, a cyclooxygenase inhibitor, or adenosine 3'-phosphate 5'-phosphosulfate (A3P5PS, a P2Y1 receptor antagonist), while in human platelets it was almost completely suppressed by aspirin. Collagen-induced increase in [Ca2+]i of bovine platelets was inhibited by U73122 (0.3-5 microM), a phospholipase C inhibitor. Collagen (10 micrograms/ml) increased production of inositol 1,4,5-trisphosphate, which was prevented by pretreatment with U73122 (5 microM). Collagen (10 micrograms/ml) accelerated Mn2+ entry, since the rate of Fura-PE3 quenching by Mn2+ was enhanced by 13-fold following stimulation with collagen. U73122 inhibited the acceleration of Mn2+ entry induced by collagen. PGE1 (2.5 microM) partially inhibited the collagen (50 micrograms/ml)-induced increase in [Ca2+]i in bovine platelets but not in human platelets. The data suggest that collagen-induced Ca2+ mobilization in bovine platelets is mediated by phospholipase C. The Ca2+ mobilization in bovine platelets is different from that in human ones as to the dependency on arachidonic acid metabolites and sensitivity to PGE1.

Electromyographic study of the striated urethral sphincter in type 3 stress incontinence: evidence of myogenic-dominant damages.

OBJECTIVES: To determine the electromyographic features of the striated urethral sphincter in patients with type 3 stress incontinence (SI) due to intrinsic sphincteric deficiency (ISD). METHODS: We performed electromyography (EMG) of the striated urethral sphincter muscle and urodynamic studies in a total of 51 women, 41 female patients with type 3 SI and 10 women with normal urinary control (NUC). The results were analyzed in both groups, and the correlation of EMG findings with the patient characteristics and urodynamic parameters was evaluated. RESULTS: Motor unit potentials (MUP) of SI patients showed significantly shorter duration (P = 0.0014), lower amplitude (P = 0.0008), and larger number of phases (P = 0.0022) compared with those in the NUC group. Thirty (73%) of the SI patients showed an obvious low amplitude (less than 350 microV)/short duration (less than 4.5 milliseconds)/polyphasic pattern and early recruitment of interference activity with low amplitude at voluntary contraction of the striated sphincter, both indicating existence of myogenic damages. These patients showing myogenic damages had significantly lower Valsalva leak point pressure (P = 0.002) and more leakage in the pad-weigh test (P = 0.010) compared with the SI patients without myogenic damage findings. CONCLUSIONS: These results suggested that myogenic-dominant damages of the striated urethral sphincter may contribute to the etiology of ISD in most patients with type 3 SI.

Organization of a large gene cluster encoding ribosomal proteins in the cyanobacterium Synechococcus sp. strain PCC 6301: comparison of gene clusters among cyanobacteria, eubacteria and chloroplast genomes.

The structure of a large gene cluster containing 22 ribosomal protein (r-protein) genes of the cyanobacterium Synechococcus sp. strain PCC6301 is presented. Based on DNA and protein sequence analyses, genes encoding r-proteins L3, L4, L23, L2, S19, L22, S3, L16, L29, S17, L14, L24, L5, S8, L6, L18, S5, L15, L36, S13, S11, L17, SecY, adenylate kinase (AK) and the alpha subunit of RNA polymerase were identified. The gene order is similar to that of the E. coli S10, spc and alpha operons. Unlike the corresponding E. coli operons, the genes for r-proteins S4, S10, S14 and L30 are not present in this cluster. The organization of Synechococcus r-protein genes also resembles that of chloroplast (cp) r-protein genes of red and brown algal species. This strongly supports the endosymbiotic theory that the cp genome evolved from an ancient photosynthetic bacterium.

Organization and transcription of a putative gene cluster encoding ribosomal protein S14 and an oligopeptide permease-like protein in the cyanobacterium Synechococcus sp. strain PCC 6301.

A 2.0-kbp Pst I DNA fragment of the unicellular cyanobacterium Synechococcus sp. strain PCC 6301 genome contains two open reading frames (ORFs). The first ORF of 100 codons potentially encodes a polypeptide having 47% amino acid identity to Escherichia coli ribosomal protein S14, suggesting it as a ribosomal protein S14 gene (rps14). The second ORF of 351 codons is located 81 bp downstream of rps14 and its deduced amino acid sequence is in part similar to that of the Salmonella typhimurium oligopeptide permease membrane protein OppC. Northern blot analysis showed that rps14 is expressed as a 0.48-kb transcript whereas no transcript was detected from ORF351. Pulsed-field electrophoresis and blot hybridization analysis revealed that rps14 is a single-copy gene and is found within a 165-kbp region located upstream of rrnA on the circular genome.

Effect of hemodialysis on plasma levels of vasoactive peptides: endothelin, calcitonin gene-related peptide and human atrial natriuretic peptide.

To determine the role of vasoactive peptides such as endothelin (ET), calcitonin gene-related peptide (CGRP) and human atrial natriuretic peptide (hANP) in the regulation of blood pressure in uremic patients, and to determine the effect of various types of dialyzer membranes on hemodialysis (HD)-induced changes in plasma levels of such peptides, plasma ET, CGRP and hANP were measured in HD patients and patients on continuous ambulatory peritoneal dialysis (CAPD). Plasma levels of ET, CGRP, and hANP were significantly higher in HD and CAPD patients than in healthy subjects. There were no significant differences in plasma levels of ET, CGRP, and hANP between hypertensive and normotensive HD patients, and no significant correlation was observed between HD-induced changes in plasma levels and changes in blood pressure. Plasma levels of ET decreased when HD was performed using high-flux membranes, such as polyacrylonitrile (PAN), polymethyl methacrylate (PMMA) and cellulose triacetate (CTA), but did not decrease using a saponified cellulose (SC) membrane. Plasma levels of CGRP decreased in the case of PAN, but increased significantly with PMMA and showed no change with SC and CTA. Plasma levels of hANP decreased in all types of dialyzer membranes due to decreased secretion. These results indicate that the effect of HD on plasma levels of ET and CGRP, but not hANP, depends on the type of dialyzer membrane used.

[A case report: occurrence of bladder carcinoma in the defunctionalised bladder in a patient after operation of left ureteral carcinoma].

An eighty year-old woman was diagnosed as left ureteral carcinoma and right dysfunctional kidney in 1984. Left partial ureterectomy, partial cystectomy, and left ureterocutaneostomy were performed and her bladder was left behind after the operation. In 1990 (72 months after the operation), she was aware of bleeding from the urethra. A bladder wash was performed, demonstrating malignant cells on cytological examination, and cystoscopy revealed a papillary tumor in the defunctionalized bladder. Total cystectomy was performed and the histological findings of the surgical specimen showed transitional cell carcinoma, grade 2, pTaNoMo. This case shows the need for periodic examinations of the defunctionalized bladder, because renal pelvic and ureteral carcinoma tends to recur in the bladder within two years after operation and because tumors rarely developed in the defunctionalized bladder.

[An aggressive angiomyxoma of the vulva].

A case of an aggressive angiomyxoma of the vulva in a 38-year-old lady is reported. The tumor was gelatinous and 12 x 8 x 7 cm in size. Histologically, spindle or stellate-shaped tumor cells and blood vessels were found distributed in a myxoid stroma. It was found that the tumor cells were immunoreactive to vimentin but negative to desmin and smooth muscle specific actin. Ultrastructurally the tumor cells had an intercellular junction, an abundant, rough endemic reticulum, and intracytoplasmic filaments, but no focal densities of the filaments and the basal lamina. These findings have revealed that this tumor consisted of myofibroblastic cells resembling fibroblasts rather than myofibroblasts.

Recovery of vestibulo-ocular reflex and gaze disturbance in patients with unilateral loss of labyrinthine function.

Vestibulo-ocular reflex (VOR) gain and the ability of gaze fixation were investigated in patients with unilateral loss of labyrinthine function during the time course of compensation (four days to 6 months). A marked directional difference in the VOR gain in the acute stage (0.51 to 0.73 at four days) decreased proportionately to the logarithm of time on rotations to the affected side and to the intact side by an increase and a slight decrease of the gain, respectively. Gaze disturbance, which occurred only on rotations to the affected side, recovered in parallel with the decrease of directional difference in the VOR gain; it was still found at 1 Hz at 6 months. Recovery of gaze disturbance in unilateral lesions seems to be accomplished not only by the change in the VOR gain, but also by intensified amplification of this gain to make up for a low VOR gain.

Compensatory eye movement and gaze fixation upon passive head- and body rotation and active head rotation.

To detect differences in compensatory eye movement and gaze fixation, normal subjects and patients with bilateral loss of labyrinthine functions were subjected to passive head-and-body rotation and performed active head rotation. In normal subjects, there was no difference between passive and active rotation with respect to compensatory eye movement in the dark and spatial gaze fixation; on the other hand, the ability to gaze fixedly on a head-fixed target was better during passive than active rotation. In our patients, the findings obtained upon passive rotation resembled those already reported for active rotation, indicating that observing compensatory eye movements and gaze fixation during passive rotation is useful in the detection of disorders of the vestibulo-ocular reflex.

Quantitative analysis of pursuit eye movements by unidirectional target motion.

The effects of a change in target speed (10 degrees-100 degrees/s) and amplitude (10 degrees-80 degrees) on smooth pursuit eye movements were analyzed in normal subjects by moving a target unidirectionally. The limit of pursuit speed adaptation changed according to changes in the target amplitude, being about 40 degrees-50 degrees/s at a target amplitude of 40 degrees-80 degrees. The minimum target amplitude needed to induce rhythmic pursuit eye movements markedly increased from 3.7 degrees at 10 degrees/s to 55.0 degrees at 100 degrees/s. The relationship between the gain (the ratio of eye speed to target speed) and the pursuit time suggested that pursuit eye speeds may depend on the pursuit time rather than absolute target speeds and that the gain might become unity even at fast target speeds, provided the critical pursuit time is given.