AI-Driven Segmentation and Automated Analysis of the Whole Sagittal Spine from X-ray Images for Spinopelvic Parameter Evaluation.

Spinal-pelvic parameters are utilized in orthopedics for assessing patients' curvature and body alignment in diagnosing, treating, and planning surgeries for spinal and pelvic disorders. Segmenting and autodetecting the whole spine from lateral radiographs is challenging. Recent efforts have employed deep learning techniques to automate the segmentation and analysis of whole-spine lateral radiographs. This study aims to develop an artificial intelligence (AI)-based deep learning approach for the automated segmentation, alignment, and measurement of spinal-pelvic parameters through whole-spine lateral radiographs. We conducted the study on 932 annotated images from various spinal pathologies. Using a deep learning (DL) model, anatomical landmarks of the cervical, thoracic, lumbar vertebrae, sacrum, and femoral head were automatically distinguished. The algorithm was designed to measure 13 radiographic alignment and spinal-pelvic parameters from the whole-spine lateral radiographs. Training data comprised 748 digital radiographic (DR) X-ray images, while 90 X-ray images were used for validation. Another set of 90 X-ray images served as the test set. Inter-rater reliability between orthopedic spine specialists, orthopedic residents, and the DL model was evaluated using the intraclass correlation coefficient (ICC). The segmentation accuracy for anatomical landmarks was within an acceptable range (median error: 1.7-4.1 mm). The inter-rater reliability between the proposed DL model and individual experts was fair to good for measurements of spinal curvature characteristics (all ICC values > 0.62). The developed DL model in this study demonstrated good levels of inter-rater reliability for predicting anatomical landmark positions and measuring radiographic alignment and spinal-pelvic parameters. Automated segmentation and analysis of whole-spine lateral radiographs using deep learning offers a promising tool to enhance accuracy and efficiency in orthopedic diagnostics and treatments.

The influence of different hinge position on PTS during HTO: comparison between open-wedge and closed-wedge HTO.

PURPOSE: The purpose of this study was to determine the significance of hinge position through comparison between open-wedge and closed-wedge high tibial osteotomy (HTO) and to determine the ideal hinge position to minimize the effect of HTO on the posterior tibial slope (PTS) and medial proximal tibial angle (MPTA). METHODS: Procedures were performed on 32 cadaveric knees using open-wedge HTO with the standard hinge position or a low hinge position or closed-wedge HTO with the standard hinge position or a low hinge position. To define the standard hinge position in open wedge HTO, we drew a line 3-cm inferior to the medial tibial plateau toward the fibular head and located the intersection of this line with a longitudinal line 1-cm medial to fibular shaft. The low hinge position was then defined as the point 1-cm inferior to the standard position. For the standard hinge position for closed-wedge HTO, we drew a line parallel with joint line from 2-cm inferior to the lateral tibial plateau. The low hinge position was then defined as the point 1-cm inferior to the standard position. RESULTS: For the open-wedge procedure, osteotomy through the low hinge position resulted in a significantly greater PTS compared to osteotomy through the standard hinge position. MPTA was also significantly greater for the low hinge position compared to standard hinge position. In the closed-wedge HTO, neither the PTS nor MPTA was significantly different for the low and standard hinge positions. CONCLUSIONS: Hinge position significantly affects changes in the PTS and MPTA following open-wedge but not closed-wedge HTO. Understanding how to hinge position affects the PTS and MPTA is critical for surgeons performing open-wedge HTO procedures. Adopting an accurate hinge position is crucial for preventing complications, especially in open-wedge osteotomy, due to postoperative changes in the PTS and MPTA.

Surgical decompression timing for patients with foot drop from lumbar degenerative diseases: a meta-analysis.

OBJECTIVE: To compare the outcomes of early (within 1 month after foot drop) decompression versus late (1 month or more after foot drop) decompression in order to determine the optimal surgical intervention timing for lumbar degenerative diseases. METHODS: The MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and SCOPUS electronic databases were searched for relevant articles published until May 2021 were conducted. Cochrane Collaboration guidelines were used for data extraction and quality assessment. Outcomes of interest were manual muscle testing (MMT) and recovery rate (MMT ≥ 4) for foot drop in lumbar degenerative diseases. RESULTS: Six clinical studies were retrieved, including 312 randomized participants. One hundred fifty-seven patients underwent early decompression surgery, and 155 underwent late decompression surgery. There were significant differences between the two groups in recovery rate (95% confidence interval [CI] 1.59, 2.57) and neurological improvement (95% confidence interval [CI] 0.21, 1.66). Early surgical decompression provided better recovery rate and neurological improvement for foot drop in lumbar degenerative diseases than late surgical decompression. CONCLUSION: Early surgical decompression within was beneficial in terms of recovery rate and neurological improvement compared with late surgery. Early surgical decompression (within 1 month) is recommended for patients with foot drop in lumbar degenerative diseases.

Femoral neck stress fractures after trampoline exercise: A case report.

BACKGROUND: Femoral neck stress fractures (FNSFs) are commonly found in long-distance running athletes. For FNSFs, early diagnosis and proper treatment are important. The objective of this study was to report FNSFs that occurred after excessive exercise using trampoline in middle-aged women. CASE SUMMARY: The patient was a 43-year-old woman who exercised jumping on a trampoline for 6 wk for 1-3 h a day to diet. Exercise includes repeated flexion-extension of the hip joint. The patient was admitted to the hospital due to sudden bilateral groin pain that occurred suddenly during a trampoline exercise. Hip magnetic resonance imaging (MRI) revealed bilateral FNSFs. After 2 wk of follow-up with conservative treatment, the pain slightly decreased. However, it did not disappear completely. It was determined that it was difficult to control symptoms only by conservation treatment. Thus, closed reduction and internal fixation using a cannulated screw were performed for the more painful left hip joint. After operation, the pain was improved. Walking using crutches was possible. Follow-up MRI showed that the right femoral head signal was decreased compared to the left femoral head signal. Therefore, nonsteroidal anti-inflammatory drug and conservative treatment were provided. CONCLUSION: In middle-aged people, excessive trampoline exercise can repeat hip flexion and extension for a short period of time, leading to FNSFs.

A prospective randomized controlled trial to evaluate effect of chewing gum on postoperative ileus in elderly patient after hip fracture.

ABSTRACT: Factors related to developing postoperative ileus (POI) vary from pharmacologic, inflammatory, hormonal, metabolic, gastrointestinal physiology, neurologic, to psychological factors. Although orthopedic-related incidence of postoperative ileus is about 10%, these studies are limited to spine surgery and pelvic surgery. The purpose of this study was to investigate prevalence of POI and to analyze effect of chewing gum on POI and bowel function in elderly patients after hip fracture surgery.A prospective randomized controlled trial was conducted at the Gyeongsang National University Hospital. Elderly patients with hip fracture who underwent surgery from March 2017 to June 2018 were eligible to participate. Patients were excluded if they had a mastication disability, impaired cognitive function, previous history of gastrointestinal disease, respiratory disease and low oxygen saturation, hip arthroplasty with causes other than hip fractures, acetabular fractures, periprosthetic fractures, or pathological fractures. Patients with consciousness problem by excessive anesthesia were also excluded. Patients were classified into 2 groups by randomization. Group I received sugar-free gum and were encouraged to chew 6 hours following surgery until the first intestinal gas is released. Group II was given the same postoperative procedure and encouraged to consume water after 6 hours.After applying exclusion criteria, 74 patients were finally included. Thirty-one patients were classified to Group I and 43 patients were classified to the Group II. Prevalence of POI in all patients with hip fracture was 63.5% (47/74). Prevalence of POI in Group I was statistically significant lower than that in Group II (Group I: 41%, Group II: 79.1%, P = .01)The prevalence of POI in elderly patients with hip fracture was 63.5%. Chewing gum had a significant effect on reduction of POI in elderly patients with hip fractures.

Langerhans cell histiocytosis in the adult clavicle: A case report.

INTRODUCTION: Langerhans` Cell Histiocytosis (LCH) is a rare disease involving proliferation of Langerhans-type cells, which shares immunophenotypic and ultrastructural similarities. In this article, we report a case of Langerhans cell histiocytosis in solitary involvement of clavicle of adult male. PRESENTATION OF CASE: A 21-year-old male visited outpatient department on account of solitary palpable tumorous lesion in right clavicle. The lesion was found 2 weeks before the visit, and it triggered pain but no tenderness. Findings on X-ray, and CT were suggestive of homogeneous osteolytic lesion of the clavicle, and hot uptake was found in right clavicle on bone scan which is commensurate with site of the lesion. Based on findings on MRI, Ewing's sarcoma, osteomyelitis and malignant hematologic malignancies were initially suspected for differential diagnosis. For the purpose of excision and histologic analysis, excisional biopsy was performed. Biopsy concluded with diagnosis of LCH. DISCUSSION: LCH is widely renowned for its frequent occurrence in pediatric ages, and it occurs usually between ages of one and four. It occasionally occurs in adults. LCH in skeletal system usually involves cranium, vertebrae, rib and so forth. It is very rare for LCH to occur exclusively in clavicle when it involves skeletal system. For diagnosis of LCH, sole imaging studies are inadequate, and histologic, immunochemical analyses are confirmative modalities. Treatment of LCH is not currently standardized. CONCLUSIONS: Most of the solitary tumorous lesions in clavicle in adults call for various differential diagnoses. LCH should be considered in the diagnosis of a adult patient with a clavicle mass.

Molecular Pathophysiology of Ossification of the Posterior Longitudinal Ligament (OPLL).

Ossification of the posterior longitudinal ligament (OPLL) can be defined as an ectopic ossification in the tissues of spinal ligament showing a hyperostotic condition. OPLL is developed mostly in the cervical spine and clinical presentations of OPLL are majorly myelopathy and/or radiculopathy, with serious neurological pathology resulting in paralysis of extremities and disturbances of motility lowering the quality of life. OPLL is known to be an idiopathic and multifactorial disease, which genetic factors and non-genetic factors including diet, obesity, physical strain on the posterior longitudinal ligament, age, and diabetes mellitus, are involved into the pathogenesis. Up to now, surgical management by decompressing the spinal cord is regarded as standard treatment for OPLL, although there might be the risk of development of reprogression of ossification. The molecular pathogenesis and efficient therapeutic strategy, especially pharmacotherapy and/or preventive intervention, of OPLL has not been clearly elucidated and suggested. Therefore, in this review, we tried to give an overview to the present research results on OPLL, in order to shed light on the potential pharmacotherapy based on molecular pathophysiologic aspect of OPLL, especially on the genetic/genomic factors involved into the etiology of OPLL.

Arthroscopic meniscal surgery versus conservative management in patients aged 40 years and older: a meta-analysis.

INTRODUCTION: The efficacy of arthroscopic meniscus surgery in old aged patients remains controversial. The purpose of the present study was to review published studies comparing arthroscopic meniscal surgery with conservative management to treat meniscal injuries in patients 40 years of age and older. MATERIALS AND METHODS: Several electronic databases were queried for articles published until July 2017 that evaluated outcomes of arthroscopic meniscal surgery in patients aged 40 years and older. Data searches, extraction, analysis, and quality assessment were performed according to the Cochrane Collaboration guidelines, and the clinical outcomes were evaluated using various outcome values. The results are presented as the standard mean difference (SMD) for continuous outcomes with 95% confidence intervals (CIs). RESULTS: Nine randomized controlled trials (RCTs) were included. There were no significant differences in clinical outcomes such as relief in knee pain (SMD = 0.01, 95% CIs = - 0.15 to 0.18, I2 = 38%) and improved knee function (SMD = 0.01, 95% CIs = - 0.19 to 0.21, I2 = 57%) between arthroscopic meniscal surgery and conservative management for degenerative meniscal tears. CONCLUSIONS: The efficacy of arthroscopic surgery was not superior to conservative management in this type of patients. Therefore, arthroscopic meniscal surgery should not be recommended as a first choice of treatment for degenerative meniscal tears. In patients over 40 years of age, arthroscopic surgery should be cautiously considered for degenerative meniscal tears and only when there has not been a satisfactory response to conservative management.

Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas.

PURPOSE: Upper extremity musculoskeletal disorders (UEMDs), such as rotator cuff tear, epicondylitis, and hand osteoarthritis, have a negative impact on quality of life (QOL). In this study, we evaluated the prevalence of rotator cuff tear, lateral and medial epicondylitis, and hand osteoarthritis in the dominant side and the impact of these UEMDs on the disabilities of the arm, shoulder, and hand (DASH) outcome measure, which assesses upper extremity-related QOL. MATERIALS AND METHODS: In 2013-2015, 987 participants from rural areas completed a questionnaire and underwent physical examinations, laboratory tests, simple radiographic evaluations of bilateral upper extremities, and magnetic resonance imaging studies of bilateral shoulders. Based on data from these participants, researchers evaluated DASH and performed a functional assessment of each region of the dominant side and related UEMDs. RESULTS: The prevalences of epicondylitis, rotator cuff tear, and hand osteoarthritis were 33.7%, 53.4%, and 44.6%, respectively. Univariate regression analysis results revealed that epicondylitis, epicondylitis+rotator cuff tear, epicondylitis+hand osteoarthritis, and epicondylitis+rotator cuff tear+hand osteoarthritis were significantly associated with DASH score. Multiple regression analysis, including DASH, UEMD, and regional functional assessments, showed that only epicondylitis and epicondylitis+rotator cuff tear were associated with DASH score. CONCLUSION: Epicondylitis significantly affected QOL, while other UEMDs, such as hand osteoarthritis and rotator cuff tear, had no significant impact. When a patient's QOL is affected by a UEMD, there is an increased possibility of the simultaneous presence of other UEMDs.

The role of isolated posterior cruciate ligament reconstruction in knees with combined posterior cruciate ligament and posterolateral complex injury.

PURPOSE: This is a meta-analysis comparing biomechanical outcomes to determine whether an isolated posterior cruciate ligament (PCL) reconstruction can restore normal knee kinematics in a combined PCL/posterolateral complex (PLC) injury and whether double-bundle (DB) PCL reconstruction is superior in controlling posterior and rotational laxity compared with single-bundle (SB) PCL reconstruction in a PCL/PLC-deficient knee. METHODS: A number of electronic databases were searched for relevant articles published through August 2016 that compared biomechanical outcomes of PCL reconstruction in patients who underwent reconstruction for combined PCL/PLC deficiencies. Data were searched, extracted, analysed, and assessed for quality according to Cochrane Collaboration guidelines, and biomechanical outcomes were evaluated using various outcome values. The results are presented as relative ratios for binary outcomes and standard mean differences for continuous outcomes with 95% confidence intervals. RESULTS: Five biomechanical studies were included in this meta-analysis. There were significant differences in laxities such as posterior tibial translation (PTT), external rotation, varus rotation, and PTT coupled with external rotation in the isolated PCL reconstruction group compared with the native PCL group. Furthermore, there were no significant differences in laxities such as PTT, external rotation, or varus rotation between the SB and DB PCL reconstruction groups. CONCLUSION: Isolated PCL reconstruction, whether SB or DB, could not restore normal knee kinematics in the PCL/PLC-deficient knee. In such cases, residual laxity after isolated PCL reconstruction can be controlled successfully with PLC reconstruction. Therefore, simultaneous PCL and PLC reconstruction is recommended for patients with combined PCL/PLC injury.

Biomechanical Comparison of Single-Bundle and Double-Bundle Posterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis.

BACKGROUND: Of the many issues regarding surgical techniques for posterior cruciate ligament (PCL) reconstruction, the choice between single-bundle (SB) and double-bundle (DB) reconstruction is one of the most debated. However, it is unclear which of the reconstruction techniques yields better outcomes in knees with a PCL injury. The purpose of this meta-analysis was to compare the benefits of SB and DB PCL reconstruction in terms of biomechanical outcomes. METHODS: The MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and SCOPUS electronic databases were searched for relevant articles comparing the outcomes of SB and DB PCL reconstruction that were published up until August 2016. Data searching, extraction, analysis, and quality assessment were performed on the basis of the Cochrane Collaboration guidelines. Biomechanical outcomes of both techniques were evaluated using various outcomes. Results involving continuous outcomes are presented as standardized mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS: Ten biomechanical studies were included. There were no significant biomechanical differences between the groups with respect to external rotation, varus rotation, or coupled external rotation of the tibia with posterior drawer force at any knee flexion angle. However, posterior laxity measured using the posterior drawer test showed significantly better results after DB compared with SB reconstruction at low flexion (SMD = -0.90, 95% CI = -1.24 to -0.56, I = 0%), 30° (SMD = -0.79, 95% CI = -1.28 to -0.31, I = 48%), 60° (SMD = -0.87, 95% CI = -1.33 to -0.40, I = 33%), and 90° (SMD = -0.73, 95% CI = -1.11 to -0.35, I = 27%). CONCLUSIONS: Anatomic DB reconstruction of the PCL is superior to anatomic SB reconstruction in terms of restoration of anteroposterior stability. However, it remains unclear which technique yields better improvement in terms of external rotation laxity, varus laxity, and coupled external rotation of the tibia with posterior drawer force. High-quality randomized controlled trials are required to confirm and expand on these results.

A Review of the Literature on Culture-Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment.

Purpose: The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI. Methods: MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI. Only clinical studies written in English were included. Basic science studies, letters to the editor, case reports and review articles on PJI were excluded. Results: Seven studies were included in this study. The prevalence of CN PJI ranged from 0% to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Two-stage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes. Conclusions: In most clinical studies on CN PJI, a definite diagnostic method for identifying causative microorganisms or optimal treatment strategy for CN PJI were not clearly described. Therefore, further studies are needed to establish standard diagnostic methods for identifying infecting organisms and treatment strategies for CN PJI.

Erratum to: Betulin suppressed interleukin-1b-induced gene expression, secretion and proteolytic activity of matrix metalloproteinase in cultured articular chondrocytes and production of matrix metalloproteinase in the knee joint of rat.

[This corrects the article on p. 19 in vol. 21, PMID: 28066137.].

Betulin suppressed interleukin-1ß-induced gene expression, secretion and proteolytic activity of matrix metalloproteinase in cultured articular chondrocytes and production of matrix metalloproteinase in the knee joint of rat.

We investigated whether betulin affects the gene expression, secretion and proteolytic activity of matrix metalloproteinase-3 (MMP-3) in primary cultured rabbit articular chondrocytes, as well as in vivo production of MMP-3 in the rat knee joint to evaluate the potential chondroprotective effect of betulin. Rabbit articular chondrocytes were cultured and reverse transcription-polymerase chain reaction (RT-PCR) was used to measure interleukin-1ß (IL-1ß)-induced gene expression of MMP-3, MMP-1, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4), ADAMTS-5 and type II collagen. Effect of betulin on IL-1ß-induced secretion and proteolytic activity of MMP-3 was investigated using western blot analysis and casein zymography, respectively. Effect of betulin on MMP-3 protein production was also examined in vivo. The results were as follows: (1) betulin inhibited the gene expression of MMP-3, MMP-1, MMP-13, ADAMTS-4, and ADAMTS-5, but increased the gene expression of type II collagen; (2) betulin inhibited the secretion and proteolytic activity of MMP-3; (3) betulin suppressed the production of MMP-3 protein in vivo. These results suggest that betulin can regulate the gene expression, secretion, and proteolytic activity of MMP-3, by directly acting on articular chondrocytes.

Cytoprotective Mechanism of Cyanidin and Delphinidin against Oxidative Stress-Induced Tenofibroblast Death.

Age-related rotator cuff tendon degeneration is related to tenofibroblast apoptosis. Anthocyanins reduce oxidative stress-induced apoptotic cell death in tenofibroblasts. The current study investigated the presence of cell protective effects in cyanidin and delphinidin, the most common aglycon forms of anthocyanins. We determined whether these anthocyanidins have antiapoptotic and antinecrotic effects in tenofibroblasts exposed to H2O2, and evaluated their biomolecular mechanisms. Both cyanidin and delphinidin inhibited H2O2-induced apoptosis in a dose-dependent manner. However, at concentrations of 100 µg/ml or greater, delphinidin showed cytotoxicity against tenofibroblasts and a decreased antinecrotic effect. Cyanidin and delphinidin both showed inhibitory effects on the H2O2-induced increase in intracellular ROS formation and the activation of ERK1/2 and JNK. In conclusion, both cyanidin and delphinidin have cytoprotective effects on cultured tenofibroblasts exposed to H2O2. These results suggest that cyanidin and delphinidin are both beneficial for the treatment of oxidative stress-mediated tenofibroblast cell death, but their working concentrations are different.

The rs662 polymorphism of paraoxonase 1 affects the difference in the inhibition of butyrylcholinesterase activity by organophosphorus pesticides in human blood.

OBJECTIVES: Organophosphorus pesticides (OPs) are a human health hazard. OPs inhibit acetylcholinesterase (AChE) at nerve endings and accumulate acetylcholine (ACh) at these sites. High levels of ACh and long exposure promote cholinergic crisis. The hydrolysis of OPs by serum paraoxonase 1 (PON1) plays a role in cholinergic crisis in humans. Human serum PON1 can break down organophosphate before binding to ChE. We investigated the effect of PON1 polymorphisms on AChE activity after OP treatment. METHODS: 50 healthy volunteers were randomly recruited with informed consent. We investigated butyrylcholinesterase (BuChE) activity changes in plasma as a biomarker of AChE after OP treatment in human blood samples immediately following blood sampling. After the standardization of BuChE activity in human blood, we correlated changes in BuChE activity with changes in blood pH. We analyzed the PON1 polymorphisms (rs854560 and rs662) of 50 participants to retrospectively investigate the interindividual variability of changes in BuChE activity. RESULTS: Changes in BuChE activity are strongly correlated with pH changes after OP treatment (R2 = 0.913). We used changes in pH as a surrogate marker for BuChE inhibition after OP treatment. OP treatment significantly decreased BuChE activity by 56.4 ± 5.1% (p < 0.001). The degree of BuChE inhibition was significantly different in the PON1 rs662 genotype (56.10 ± 4.74% vs. 57.96 ± 5.67% vs. 52.34 ± 1.51%; GG vs. GA vs. AA, respectively). CONCLUSION: Changes in pH can be used as a surrogate marker for the detection of BuChE inhibition after OP exposure. The rs662 polymorphism of PON1 may explain the inter-individual variability in BuChE inhibition.

Effects of prunetin on the proteolytic activity, secretion and gene expression of MMP-3 in vitro and production of MMP-3 in vivo.

We investigated whether prunetin affects the proteolytic activity, secretion, and gene expression of matrix metalloproteinase-3 (MMP-3) in primary cultured rabbit articular chondrocytes, as well as in vivo production of MMP-3 in the rat knee joint to evaluate the potential chondroprotective eff ect of prunetin. Rabbit articular chondrocytes were cultured in a monolayer, and reverse transcription-polymerase chain reaction (RT-PCR) was used to measure interleukin-1ß (IL-1ß)-induced expression of MMP-3, MMP-1, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4), and ADAMTS-5. In rabbit articular chondrocytes, the effects of prunetin on IL-1ß-induced secretion and proteolytic activity of MMP-3 were investigated using western blot analysis and casein zymography, respectively. The eff ect of prunetin on MMP-3 protein production was also examined in vivo. The results were as follows: (1) prunetin inhibited the gene expression of MMP-3, MMP-1, MMP-13, ADAMTS-4, and ADAMTS-5; (2) prunetin inhibited the secretion and proteolytic activity of MMP-3; (3) prunetin suppressed the production of MMP-3 protein in vivo. These results suggest that prunetin can regulate the gene expression, secretion, and proteolytic activity of MMP-3, by directly acting on articular chondrocytes.

A new surgical technique for traumatic dislocation of posterior tibial tendon with avulsion fracture of medial malleolus.

We introduce a case of traumatic dislocation of the posterior tibial tendon with avulsion fracture of the medial malleolus in a 52-year-old female patient who was treated surgically with periosteal flap and suture anchor fixation. Based in the posteromedial ridge of the distal tibia, a quadrilateral periosteal flap was created and folded over the tendon, followed by fixation on the lateral aspect of the groove by use of multiple suture anchors. Clinical and radiological findings 25 months postoperatively showed well-preserved function of the ankle joint with stable tendon gliding.

The value of diagnostic ultrasonography in the assessment of a glomus tumor of the subcutaneous layer of the forearm mimicking a hemangioma: a case report.

INTRODUCTION: A glomus tumor is a rare, benign tumor with atypical clinical symptoms. Because of its small size, it is difficult to diagnose and treat early; therefore, it leads to poor quality of life. Glomus tumors are known to commonly affect the hand and rarely manifest in other areas. Because they simulate neuromas, hemangiomas, and neurofibromatosis, the differential diagnosis is difficult. We performed marginal resection of a solitary forearm mass previously suspected to be a hemangioma or glomus tumor on the basis of ultrasound findings and histologically diagnosed to be a glomus tumor afterward. We report this case to demonstrate the good prognosis of the procedure we used, and we review the relevant literature. CASE PRESENTATION: A 68-year-old Asian man without a particular medical history visited our hospital with a mass with focal tenderness in his left distal forearm that had developed 8 years earlier. The tumor was observed with suspicion of being a hemangioma or glomus tumor based on the location, clinical symptoms, and ultrasound findings taken into consideration together. The biopsy results led us to conclude that the lesion was a glomus tumor. CONCLUSIONS: A glomus tumor located in the forearm is very rare. It is often clinically overlooked and is likely to be misdiagnosed as another disease. The patient's quality of life deteriorates, and, though the disease is rare, it has serious sequelae. Therefore, a quick diagnosis and appropriate treatment must be conducted early. If a mass occurs with serious pain in subcutaneous soft tissue of not the hands but the limbs, it is important to conduct examinations with suspicion of a glomus tumor. Ultrasonography performed quickly may be useful for making the differential diagnosis.

Chondroprotective Effects of Wogonin in Experimental Models of Osteoarthritis in vitro and in vivo.

We evaluated the chondroprotective effects of wogonin by investigating its effects on the gene expression and production of matrix metalloproteinase-3 (MMP-3) in primary cultured rabbit articular chondrocytes, as well as on production of MMP-3 in the rat knee. Rabbit articular chondrocytes were cultured in a monolayer, and RT-PCR was used to measure interleukin-1ß (IL-1ß)-induced expression of MMP-3, MMP-1, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4), and type II collagen. In rabbit articular chondrocytes, the effects of wogonin on IL-1ß-induced production and proteolytic activity of MMP-3 were investigated using western blot analysis and casein zymography, respectively. The effect of wogonin on MMP-3 protein production was also examined in vivo. In rabbit articular chondrocytes, wogonin inhibited the expression of MMP-3, MMP-1, MMP-13, and ADAMTS-4, but increased expression of type II collagen. Furthermore, wogonin inhibited the production and proteolytic activity of MMP-3 in vitro, and inhibited production of MMP-3 protein in vivo. These results suggest that wogonin can regulate the gene expression and production of MMP-3, by directly acting on articular chondrocytes.