An experimental study of the effects of nerve root retraction on the posterior ramus

STUDY DESIGN

The histologic and ultrastructural changes in the posterior ramus after posterior lumbar surgery were studied in rabbits.

OBJECTIVE

To investigate the structural changes in the posterior ramus after posterior lumbar surgery that may cause injury to the posterior ramus after the procedure.

SUMMARY OF BACKGROUND DATA

Investigators in previous studies have pointed out that low back discomfort after lumbar discectomy relates to neurogenic changes and/or myogenic changes of paravertebral muscle. However, no previous study has demonstrated the effects of excessive nerve root retraction on spinal posterior rami.

METHODS

Eighteen male Japanese White rabbits were used. The posterior ramus arising from the S1 nerve root was examined after exposure of the lamina only, fenestration, or retraction of the S1 nerve root, with light microscopy and transmission electron microscopy at 2, 4, and 6 weeks after the procedure. Results were compared with a those in control specimens that did not undergo the procedure.

RESULTS

In the exposed group, no distinct difference was found compared with the control specimen. In the fenestration group, especially at 6 weeks, some attenuation and splitting of myelin sheaths was observed. In the retraction group, the structural alteration was most severe. Even at 2 weeks, fragmentation of many myelin sheaths was detected. Examination of specimens by electron microscopy indicated phagocytosis of myelinated fibers at 4 and 6 weeks.

CONCLUSIONS

Findings showed that posterior lumbar procedures, including retraction of paravertebral muscle, fenestration of the lamina, and retraction of the nerve root affect the posterior ramus. Excessive retraction of the nerve root has an especially disastrous effect on the posterior ramus. Such a violent maneuver within the spinal canal must be avoided.

Changes in conduction, blood flow, histology, and neurological status following acute nerve-stretch injury induced by femoral lengthening

The effects of an acute stretch on evoked potential, blood flow, histological change, and clinical neurological state were studied in a rat model of acute nerve stretch induced by femoral lengthening. The purposes of this study were to assess, in a model of acute limb lengthening, the safe limits of nerve stretch for nerve function, the pathogenesis of nerve dysfunction, the sensitivity of spinal somatosensory evoked potential, and one of the proposed criteria for irreversible compromise of the sciatic nerve. Thirty-two rats were assigned to one of four groups defined by the degree of acute femoral lengthening (8, 16, 24, and 32%). Spinal somatosensory evoked potential at L5/6 following stimulation of the sciatic nerve was recorded before, immediately after, and 30 minutes after lengthening. Sciatic nerve blood flow was measured by laser Doppler flowmetry at the stretched site before and after lengthening. One week after the operation and without further lengthening, clinical neurological status was evaluated by the functional index of the sciatic nerve and histological examination was performed. At the measurement immediately after the procedure, amplitude changed significantly in all groups except for the group with 8% lengthening. In all groups, sciatic nerve blood flow also dropped significantly compared with values for the control side. Moreover, a greater percentage increase in acute lengthening corresponded with more marked changes in spinal somatosensory evoked potential and sciatic nerve blood flow. The groups that underwent acute lengthening of 24 and 32% had significant neurological deficits and histological changes and demonstrated a significant and profound (50%) drop in amplitude and blood flow. We concluded that spinal somatosensory evoked potential is very sensitive and may serve as an effective tool for the early detection of impending acute nerve-stretch injury and that a 50% reduction in amplitude indicates irreversible damage.

Determination of mechanical properties of impacted human morsellized cancellous allografts for revision joint arthroplasty

This paper deals with the characterization of mechanical properties of impacted morsellized cancellous allograft (IMCA) produced by dynamic compaction of allograft femoral heads ground by commercially available bone mills, i.e. rotating rasp and reciprocating type bone mills. Various ranges and profiles of particle size in the graft aggregates were obtained using these bone mills, and the effect of number of compaction as well as the distribution of particle sizes on the mechanical properties of IMCA under quasistatic compression and shear loading conditions was discussed. The morsellized cancellous allograft prepared by the reciprocating type bone mill showed a broad distribution of particle sizes, and gave IMCA superior mechanical properties to the graft with a more uniform size distribution, or prepared by the rotating rasp type bone mills. The increase of number of compaction also improved the mechanical properties of IMCA in compression.

Effect of sliding locus on subsurface crack formation in ultra-high-molecular-weight polyethylene knee component

The objective of this study was to evaluate the effect of sliding locus on fatigue destruction of ultra-high-molecular-weight polyethylene (UHMWPE) in order to design a durable total knee arthroplasty (TKA) articulation. Two-dimensional sliding fatigue testing was performed under two simplified patterns of articulating interface sliding locus. Scanning acoustic tomography (SAT) was used for observation of subsurface cracks in UHMWPE specimens. A high rate of subsurface crack formation was observed when the movement was reciprocated on two different loci, in contrast with that on a single linear locus. This finding suggests that crack formation or propagation in UHMWPE components is accelerated not only by the compressive stress but also by complicated articulating movement locus.

Differences between changes in serum thyrotropin-binding inhibitory antibodies and thyroid-stimulating antibodies in the course of antithyroid drug therapy for Graves' disease

There has recently been controversy regarding whether the measurement of thyrotropin-binding inhibitory antibodies (TBIAb) is useful in the management of Graves' disease. Another method of assessing Graves' disease by measuring adenylate cyclase activity in thyroid cells, known as thyroid-stimulating antibodies (TSAb), differs from TBIAb not only in terms of assay but also in immunoglobulin type according to recent studies. In this study, the concentrations of TBIAb and TSAb were compared in serial serum samples collected from 29 patients with Graves' hyperthyroidism during 12 months of antithyroid drug therapy. Before therapy, there was a correlation between TBIAb and TSAb (r = 0.59). The radioactive iodine uptake (RAIU) was not significantly correlated with either TBIAb or TSAb (r = 0.20 and r = 0.29, respectively), and the serum free thyroxine (FT4) concentration was also not significantly correlated with either TBIAb or TSAb (r = 0.06 and r = 0.22, respectively). In patients with Graves' ophthalmopathy, TSAb levels were higher than in patients without ophthalmopathy (1015%+/-851% vs. 456%+/-323%, p<0.01), but the TBIAb levels were not significantly different. After antithyroid treatment, TBIAb did not decrease significantly (from 42.1%+/-20.8% to 20.5%+/-19.5%, p = 0.29). On the other hand, TSAb was significantly decreased after 12 months of treatment (from 649%+/-611% to 294%+/-205%, p< 0.05). These findings indicate that TBIAb and TSAb are not identical, and that TSAb has a closer relationship to thyroid function than TBIAb. In the clinical setting, determination of the serum TSAb level may provide a more accurate index of the thyroid status in Graves' disease patients receiving antithyroid therapy.

Expression of cartilage specific genes by human capsular cartilaginous cells

The amount of proteoglycan production in tissue that was considered to have cartilaginously differentiated due to mechanical stress and cartilage specific gene expression were investigated. The inner layer of the joint capsule which forms a sliding surface with the femoral head in the case of dislocated hip arthoropathy showed higher proteoglycan production compared to that in the surrounding non-cartilaginous tissue. On examining gene expression, although large cartilaginous proteoglycan is originally absent in this region, gene expression of aggrecan and versican which are able to bind to hyaluronan was observed. Further, gene expression of decorin and link protein was also examined. These findings in the inner layer of joint capsule forming sliding surface with the femoral head suggested the importance of mechanical stress in cartilaginous differentiatiog of mesenchymal tissue.

Anteroposterior and rotational movement of femur during knee flexion

This study was designed to analyze anteroposterior and rotational movement of femoral condyles during knee flexion from 15 degrees to 90 degrees using magnetic resonance imaging. After a pilot study, scans were made in 10 healthy male Japanese volunteers. When centers of the circular profiles of posterior femoral condyles were used as reference points, the medial and lateral femoral condyles displaced posteriorly 1.9 +/- 0.8 mm and 2.3 +/- 0.5 mm, respectively (mean +/- standard error). Duplicate examinations on two separate occasions revealed the accuracy of this procedure was in the range of 1 to 2 mm. These results have confirmed that femoral rollback occurs in the unloaded normal knee during flexion from 15 degrees to 90 degrees, but its magnitude is small (2 mm). The results obtained in this in vivo measurement of anteroposterior movement of the femoral condyles have relevance for total knee replacement design.

Estrogen supplementation for bone dematuration in young epileptic man treated with anticonvulsant therapy; a case report

We encountered a young man treated with anticonvulsant therapy who had greatly reduced bone mineral density. An 18-year-old man was admitted to our hospital for shoulder pain and further evaluation of decreased bone mineral density. He had been treated with anticonvulsants, including phenytoin, phenobarbital, valproic acid and zonisamide for seizures. Although testosterone was found within the normal range for adult men, the serum estrogen concentration was below the detection limit (< 10 pg/ml) and his wrist epiphyses were not yet closed. After 10 months of treatment with the conjugated estrogen, both his height and weight showed improvement, while his bone mineral density and bone age were increased. These findings suggested that estrogen therapy had a significant effect on his skeletal growth and bone maturation in man. This is the first report showing the beneficial effect of estrogen supplementation in an epileptic man receiving treatment with anticonvulsants.

Localization of metallothioneins-I & -II and -III in the brain of aged dog

Localization of metallothionein (MT) -I & -II and MT-III and its significance in the brain aging in dogs were examined using immunohistological and molecular pathological techniques. MT-I & -II immunohistochemistry showed positive staining in the hypertrophic astrocytes throughout the aged dog brains; these MT-I & -II immunoreactive astrocytes were predominant in the cerebral cortex and around the blood vessels in the brain. These findings dominated in the brain regions with severe age-related morphological changes. In situ hybridization using MT-I mRNA riboprobes also demonstrated signals for MT-I mRNA in these hypertrophic astrocytes. Immunohistochemistry using a guinea pig antiserum against a synthetic polypeptide of canine MT-III demonstrated positive MT-III immunoreactivity predominantly in neurons in the Zn-rich regions such as hippocampus and parahippocampus. The findings were supported by in situ hybridization using MT-III mRNA riboprobes. Both MT-III immunoreactivity and signals for MT-III mRNA were demonstrated in neurons in the brain regardless of the intensity of the age-related changes. These results suggest, first, MT-I & -II may be induced in relation to the progress of the age-related morphological changes in the brain, playing an important role in the protection of the brain tissue from the toxic insults responsible for the brain aging, and second, MT-III may play a role in maintenance of Zn-related essential functions of the brain.

Minimum structure of peptidoglycan required for induction of antibacterial protein synthesis in the silkworm, Bombyx mori

Various peptidoglycan fragments, different in mode of cross-linking and molecular size, were isolated, and the elicitor activity was tested for induction of antibacterial protein synthesis in larvae of Bombyx mori. Linear uncross-linked peptidoglycans from Bacillus licheniformis and Micrococcus luteus were effective elicitors, similar to the directly cross-linked peptidoglycan from B. licheniformis cell wall. The fragments of uncross-linked peptidoglycan with a sugar chain length of four or more were active elicitors, but the disaccharide unit had no elicitor activity. The minimum structure of peptidoglycan required for induction of antibacterial protein synthesis was determined to be two repeating N-acetylglucosamine-N-acetylmuramic acid units with peptide side chains.

Isolation of 9Z beta-carotene from Dunaliella bardawil and its stereoselective synthesis

An isolation of 9Z beta-carotene from Dunaliella bardawil was accomplished by low-pressure column chromatography with Ca(OH)2 column. Furthermore, it was stereoselectively synthesized by Wittig reaction between the C10-phosphonium salt 2 and 9Z beta-apo-8'-carotenal 1, which was prepared by Emmons-Horner reaction of 9Z beta-ionylideneacetaldehyde 3 with phosphonates 6 and 7 or 8a and 9.

Cartilaginous differentiation in the joint capsule

The proliferation and differentiation of cells are greatly influenced by their environment. Many growth factors and cytokines are reported to be environmental factors that affect the proliferation and differentiation of cells. Mechanical stress is also considered to influence these physiological reactions. The joint capsule, which is a part of the joint tissue, plays a very important role in the stability of the joint and in maintaining the intracapsular phenomenon. In patients with dislocated hip arthropathy, this capsule is involved in the weightbearing function by forming a sliding surface between the capsule and the femoral head articular cartilage. The surface of the tissue macroscopically shows cartilaginous change, which indicates cartilaginous differentiation caused by mechanical stress. We examined the cartilage-specific proteoglycan component, which is composed of cartilaginou matrix at the differentiation site. We investigated proteoglycan production, molecular size, and the gene expression of cartilaginous substrate. At the inner layer of the weightbearing area of the joint capsule, proteoglycan production was significantly higher than that of other noncartilaginous tissue. We also identified the gene expression of cartilaginous proteoglycan using the reverse transcription polymerase chain reaction (RT-PCR) method.

Experimental stationary potential recorded with using spine and skull model

This study aims at investigating experimentally the structural effects of various shapes of volume conductors, which are surrounded by an insulated skull and spinal canal model, on nerve action potentials (NAP). NAP were recorded through volume conductors inside and outside a model. We noted stationary potentials emerged at where the volume conductor made structural transitions. These results were analyzed using the field diagram of isopotential curves. The diagrams of the electrical field demonstrated that the stationary potentials arise owing to abrupt disequilibrium of the electrical field brought about by the change of the volume conductor surrounded by the insulated model.

Measurements of zeta potentials of particulate biomaterials in protein-rich hyaluronan solution with changes in pH and protein constituents

This study was undertaken to determine the zeta potentials of particulate biomaterials in three types of protein-rich hyaluronan solution with changes in pH; a microelectrophoretic method was used. For the purpose of determining the pH value of synovial fluid in various inflammatory conditions, we collected synovial fluid samples from joints with osteoarthritis (OA), rheumatoid arthritis (RA), and those undergoing revisions arthroplasties. The mean values of the pH in the synovial fluid from joints with OA, RA, and revision arthroplasty were shown to be 7.9, 7.5, and 8.1, respectively. The pH-zeta potential curves obtained differed, depending on the biomaterial and the medium. Addition of gamma-globulin to the medium reduced the absolute value of the zeta potentials of some of the biomaterials. The findings of this study suggest that the electrophoretic behaviors of the particulate biomaterials tested in this study are affected by the protein constituents of and pH changes in protein-rich synovial fluid. The values we obtained will be useful as reference standards and will also aid in the study of the surface phenomena of biomaterials.

Local application of basic fibroblast growth factor minipellet induces the healing of segmental bony defects in rabbits

Fibroblast growth factor (FGF) has been reported to increase the volume of callus in a fracture model of rats. There are, however, no reports of successful repair of segmental bony defects by application of an FGF solution. In this study, the effects of basic FGF on the repair of segmental bony defects in the rabbit femur were examined. Minipellet, a new drug delivery system using atelocollagen, was employed to ensure effective delivery of FGF. Segmental bony defects (10 mm in length) were created in the right femurs of 19 rabbits. In pilot studies, no defects of this size healed spontaneously within 6 weeks. Bones were stabilized with miniexternal fixators. Minipellets containing basic FGF were implanted between fragments so as to bridge the two fragments. The healing processes were monitored radiographically and studied histologically. In rabbits in which FGF was added to the defect site at doses of 1.4 microgram or higher, approximately 90% of the defects were filled with new bone and cartilage within 6 weeks after minipellet implantation. In rabbits receiving placebo minipellets, however, approximately 15% of the defects were filled by callus within 6 weeks. Furthermore, this callus did not change into mature bone. An injection of 2 microgram of FGF solution to bony defects had no effect on the repair of segmental bony defects. These findings suggest that FGF plays a role in the production of adequate volumes of callus particularly in the initial stages of fracture healing and that sustained local release enables FGF to be effective at a low dose. In summary, large segmental bony defects healed after insertion of low-dose FGF minipellets. An adequate dose of FGF and an appropriate delivery system are required for successful healing of large bony defects. These findings imply the potential value of FGF minipellets in clinical practice.

Alteration in the differentiated phenotypes of cultured chondrocytes from human articular cartilage under various culture conditions

Chondrocytes produce proteoglycans and type II collagen as their main matrix components, which can also be considered to be indices of their differentiated phenotype. Each differentiation step occurs in accordance with the environment of each cell. The analysis of the properties of chondrocytes has mostly been performed in cultured cells. In this report, we examined the effects of the culture media and fetal calf serum on cultured human articular chondrocytes. It was confirmed that the quantity of proteoglycan produced by the chondrocytes changed according to the different kinds of media used, and that the molecular size of the proteoglycans showed a tendency towards de-differentiation with decreasing fetal calf serum concentrations. We conclude that our experimental results which are obtained in cultured human articular chondrocytes should be discussed with consideration to the finding of this report.

A study of multiple biomarkers in coke oven workers--a cross-sectional study in China

We conducted a cross-sectional molecular epidemiological study of coke oven workers exposed to the established carcinogen polycyclic aromatic hydrocarbons (PAHs) to evaluate the relationships between both traditional 'exposure markers' and a series of biomarkers, including urinary 1-hydroxypyrene as a marker of internal dose, leukocyte aromatic DNA adducts as markers of biologically effective dose, serum p53 protein as a response marker and genetic polymorphisms of cytochrome P4501A1 and glutathione S-transferase MI as susceptibility markers. Twenty-five male subjects each were randomly selected from the top, middle and bottom work areas of the oven, and the control plant. They were matched for age and smoking status. The mean levels of PAH exposure, monitored by stationary and personal samplers, and of worker urinary 1-hydroxypyrene differed significantly between the top, middle and bottom of the oven and control work areas. The highest stationary and personal PAH concentrations and 1-hydroxypyrene levels were demonstrated at the top work area. Good correlations were found between the stationary PAH levels, personal PAH levels and urinary 1-hydroxypyrene levels. No positive correlations were demonstrated between aromatic DNA adduct levels and current or cumulative PAH exposure dose. In the presence of genetic polymorphisms of cytochrome P4501A1, a positive correlation was demonstrated between aromatic DNA adducts and urinary 1-hydroxypyrene levels. There was also a significant correlation between serum p53 protein levels and the cumulated benzo[a]pyrene exposure dose. Although these biomarkers have certain limitations, they are applicable to cancer epidemiology, and may contribute to our understanding of the mechanisms of carcinogenesis.

Involvement of the RpoN protein in the transcription of the oprE gene in Pseudomonas aeruginosa

OprE is a channel-forming outer membrane protein of Pseudomonas aeruginosa, the expression of which is induced under anaerobic conditions. We constructed various mutants and observed the effects on oprE expression. Deficiency in RpoN, an alternative sigma factor for RNA polymerase, abolished oprE expression under aerobic conditions, but did not affect the expression under anaerobic conditions. One mutation on the putative RpoN recognition site also caused reduction of oprE expression. The region 500 nucleotides upstream of the mRNA start site was required for optimal oprE transcription, which contains an AT-rich region including a putative integration host factor binding site. These results indicate that OprE production is directly or indirectly controlled by RpoN but also require some other regulatory proteins bound to the upstream region.

Contrast enhanced magnetic resonance imaging for femoral neck fracture

Femoral head perfusion was evaluated in 29 patients after acute femoral neck fracture using contrast enhanced fat saturation magnetic resonance imaging. The patients were followed up with T1 and T2 weighted spin echo magnetic resonance imaging without fat saturation, which is suitable in detecting avascular necrosis. The mean interval from injury to the initial contrast enhanced fat saturation magnetic resonance imaging was 24.5 hours. The mean age at the time of injury was 69 years, and the mean followup was 26.9 months. Three distinct patterns of femoral head enhancement were recognized in the acute phase after fracture. When the whole femoral head was well enhanced (Type 3, n = 11), no avascular necrosis developed. In contrast, when the head showed no enhancement (Type 1, n = 6), avascular necrosis developed in all patients. In patients with partial enhancement (Type 2, n = 12), avascular necrosis developed in five patients. These data showed the current method provided an accurate prediction of the development of avascular necrosis in the patients with Type 1 and Type 3 enhancement. However, overall predictive value was 59% (17 of 29 patients) because of the uncertainty in the patients with partial enhancement (Type 2), and additional study is needed for this method to become routine in clinical use.

Molecular cloning and expression of the canine metallothionein-III gene

We have isolated and determined the complete nucleotide sequence of canine metallothionein-III (MT-III) cDNA. The predicted amino acid sequence of the canine MT-III showed a high homology (93%, 87% identity) to that of human and mouse MT-III. The canine MT-III had 2 insertions relative to known mammalian MT-I and MT-II: a threonine after the 4th amino acid and a block of 6 amino acids near the carboxyl terminus. Expression of the canine MT-III mRNA was found exclusively in the central nervous system, where neurons in the olfactory bulb, hippocampus and cerebral cortex showed predominant signals.

Reflux of HTLV-I infected lymphocytes from the privileged compartment(s) to peripheral blood flow in patients with HTLV-I-associated myelopathy

To understand the mechanisms involved in the pathogenesis of human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), three in vivo phenomena which have been observed in the peripheral blood of patients and differing from that in asymptomatic HTLV-I carriers must be taken into consideration: (a) the presence of increased HTLV-I viral load, (b) a higher immune responsiveness against HTLV-I antigens, and (c) biased nucleotide substitutions in the HTLV-I pX region which indicate a decreased selection pressure for viral amino acid changes. We now propose a hypothesis which focuses on the in vivo dynamics of HTLV-I infected lymphocyte migration and which incorporates these features. In addition, the hypothesis assumes the existence of a deviation in immune surveillance for HTLV-I in the central nervous system (CNS) in spite of the presence of frequent specific immune effectors. We suggest that in the active phase of HAM/TSP, accompanied with or following autoaggressive interactions between infected lymphocytes and immunocompetent cells in the CNS, there is a consequential reflux of the infected lymphocytes to the peripheral blood. The reflux of infected cells would be expected to provide peripheral blood with tissue-derived HTLV-I proviruses which have been indulged and propagated in an immune-privileged site. This process would result in and account for the observed increase in viral load and the substitution bias in HTLV-I sequences in the peripheral blood.

Structure of genes for cecropin A and an inducible nuclear protein that binds to the promoter region of the genes from the silkworm, Bombyx mori

Cecropins are a family of antibacterial peptide synthesized in insects as a response to bacterial infection. To study the regulation of the immune genes in insects, two cecropin A genes were cloned and sequenced from the silkworm, Bombyx mori. The two genes, CecA1 and CecA2, encoded identical preprocecropin A, having one intron of 609 bp and 929 bp, respectively. The 5'-upstream regions of the genes contained a NF-kappa B like element and IL-6-RE Type I element. Electrophoretic mobility shift assay revealed that a nuclear protein of fat body which specifically bound to the kappa B-like element was activated by injection of the larvae with peptidoglycan.

Human CD4+ T lymphocytes recognize a highly conserved epitope of human T lymphotropic virus type 1 (HTLV-1) env gp21 restricted by HLA DRB1*0101

HTLV-1 causes two distinct human diseases, HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T cell leukaemia/lymphoma (ATL). Persistently infected individuals carry a risk of <1% of developing either disease. These basic epidemiological data imply that virus-host interactions, especially immunogenetic factors, influence the outcome of infection. Several studies showed that the HLA class II DR1 DQ5 haplotype is over-represented in HAM/TSP, but rare in ATL. Therefore, we selected four patients with HAM/TSP and one seronegative control who all carried the HLA DR1 DQ5 haplotype. We analysed the CD4+ T lymphocyte response against eight synthetic peptides of HTLV-1 envelope (env) glycoprotein gp21, a crucial target antigen in HAM/TSP. The first of two immunodominant epitopes corresponded to a domain of the HTLV-1 envelope protein which had previously been shown to be essential for HTLV-1 envelope function. The second immunodominant epitope overlapped a highly conserved sequence of the retroviral transmembrane envelope protein. DR1 (DRB1*0101)-restricted T lymphocytes were activated by the conserved peptide sequence in nanomolar concentrations. In contrast, this conserved sequence can also induce non-specific, cAMP-mediated immunosuppressive effects on T cells when added in micromolar concentrations to culture media, as shown by Haraguchi S, Good RA, James-Yarish M, Cianciolo GJ, Day NK, Proc Natl Acad Sci USA 1995; 92:5568-71. Hence, HTLV-1 env gp21 might exert either stimulating immunological or immunosuppressive effects in HTLV-1-infected individuals, depending on the level of its expression and the presence of HLA DRB1*0101.

Eicosanoids mediate induction of immune genes in the fat body of the silkworm, Bombyx mori

The expression of cecropin and lysozyme genes is induced in response to bacterial peptidoglycan in the fat body of the silkworm, Bombyx mori. Specific inhibitors of either phospholipase A2, cyclooxygenase or lipoxygenase significantly inhibit the induction of the immune genes both in vivo and in cultured fat body as detected by means of Northern hybridization. Arachidonic acid injected into the larvae induces the expression of the cecropin and lysozyme genes. The findings support the idea that eicosanoids mediate some process leading to the expression of immune genes in the fat body following recognition of peptidoglycan as a signal for invading bacteria.

Clinical studies of second revision in total hip replacement

Eleven patients (12 hips) underwent the second revision of total hip replacement. The mean age at the second revision was 61 years (range: 31 to 79); 2 patients were men and 9 women. Loosening of components was the most common reason for the revision surgery. Supplemental ring or wire-mesh reinforcement was used for the revision of the acetabular that had poor bone stock. On the acetabular side, an allograft was used in 4 hips; on the femoral side, a long stem was used in 11 hips. The mean operative time was 298 minutes (range: 195 to 525), and the mean bleeding volume was 2278 ml (range: 810 to 4800) which was about twofold more than that of the primary operation. The mean length of follow up after the second revision was approximately 5 years. In the clinical results, the mean total Japan Orthopaedic Association score was 56 points before the second revision and it was 70 points during the follow-up period. Pain score was especially improved after the second revision. On final roentgenographic examination there was noted a clear zone in three acetabular components and five femoral components. As yet, we have not experienced any case requiring a third revision.