Extra-articular factors of the femur and tibia affecting knee balance in mechanically aligned total knee arthroplasty

PURPOSE

Although the joint gap distance and compartment loading of the knee are different parameters for obtaining balanced knees in patients with total knee arthroplasty (TKA), the extent to which a balanced knee is achieved in patients with mechanically aligned TKA (MA-TKA) is unclear. This study aimed to investigate the anatomical factors that affect the ligament balancing in MA-TKA according to a gap balancing technique by measured resection technique.

METHODS

The relationship between compartment loading, gap distance, and lower limb alignment was analysed in forty-three patients who underwent navigation-assisted MA-TKA with the minimum soft-tissue release. Radiographic parameters included hip-knee-ankle (HKA) angle, femorotibial angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, posterior tibial slope, varus and valgus joint line convergence angle, femoral valgus angle, femoral shaft curve, and tibial shaft curve (TSC).

RESULTS

The postoperative HKA angle was 0.4±1.5°, with one coronal alignment outlier (2.3%). The gap distance showed four unbalanced knees for extension (9.3%) and flexion (9.3%), whereas the compartment loading identified 17 unbalanced knees (39.5%) at extension, 8 (18.6%) at 45° flexion, 7 (16.2%) at 90° flexion, and 10 (23.2%) at full flexion in MA-TKA. Mediolateral differentials of compartment loading correlated with femoral valgus angle (0°, 45°, and 90° flexion), mLDFA (45° and 90° flexion), and TSC (45° and 90° flexion). Femoral valgus angle and TSC were risk factors of the mediolateral differentials of compartment loading.

CONCLUSION

Extra-articular factors of femoral valgus angle, mLDFA, and TSC were associated with the mediolateral imbalance of compartmental loading, suggesting there is a limit to obtaining balanced knees in MA-TKA due to these unadjustable extra-articular factors.

LEVEL OF EVIDENCE

IV, therapeutic case series.

Recovery of motor function in patients with subaxial cervical spine injury relevant to the fracture pattern

In this study, we studied the relationship between fracture patterns and motor function recovery in 70 consecutive patients with cervical spinal cord injury. Fractures were categorized into 6 fracture types and subdivided into stages according to the Allen-Ferguson classification system:compressive flexion (CF), distractive flexion (DF), compressive extension (CE), distractive extension (DE), vertical compression (VC) and lateral flexion (LF). Paralysis was evaluated using the American Spinal Injury Association (ASIA) impairment scale at the time of injury and 3 months afterwards. The residual rate of complete motor palsy (ASIA grade A or B) at the final examination was higher in those patients with DE fractures than those with CF, DF or CE. The final outcomes were as follows. Of the 14 patients who were classified with CF fractures, residual palsy was frequently seen in patients who had stage 5 injury. Of the 27 patients with DF fractures, residual palsy occurred in about half of the patients who had stage 4 or 5 injury. Of the 18 patients with CE fractures, residual palsy occurred in half of the patients with stage 3 injury or higher. Finally, of the 7 patients with DE fractures, the rate of residual palsy was high even for the stage 1 and 2 cases;indeed, all DE patients who had complete motor palsy at the first examination had residual palsy at the final examination. Accordingly, we conclude that motor recovery may be related to fracture pattern.

Assessment of leg muscle activity using toe tapping in patients with Parkinson's disease: comparison of two types of toe tapping

[Purpose] This study investigates two types of toe tapping, i.e., “closed,” with both feet on the floor, and “open,” in which the foot does not touch the ground, and evaluates their usefulness in combination with monitoring of muscle activity during toe tapping. [Subjects and Methods] The study enrolled 11 patients with Parkinson’s disease (PD) and 9 controls (Controls). The tibialis anterior (TA) and gastrocnemius (GS) muscle activity during toe tapping was measured using surface electromyography. [Results] In closed tapping, the minima in GS activation with the first tap was significantly higher in patients with PD than in Controls. In open tapping, the coefficient of variation (CV) of local maxima in TA activation was significantly higher in patients with PD than in Controls. In both types of tapping, the CV of extrema in GS activities increased with disease duration, but this may be due to the long-term administration of Levodopa, which itself tends to cause excessive GS activities. [Conclusion] Closed tapping is suitable for the assessment of GS activity and can detect excessive activities, which is observed as visible movement. Open tapping, on the other hand, is suitable for assessment of TA activity.

A randomized controlled phase III trial to evaluate the effect of preoperative enteral immunonutrition on the surgical site infection after total gastrectomy (OGSG0507)

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Background: To investigate the effect of preoperative enteral immunonutrion on the incidence of surgical site infection (SSI) after total gastrectomy for gastric cancer, we conducted a prospective randomized controlled trial.

Methods: Eligibility criteria included: (1) histologically proven adenocarcinoma of stomach, (2) scheduled total gastrectomy, (3) aged less than 80 years, (4) not malnourished, (5) possible to ingest liquid diet, (6) written informed consent. Eligible patients (pts) wereassigned to the immunonutrition (I) group or the control (C) group. In the C group pts freely accessed to regular diet until surgery. In the I group, pts were supplemented with 1,000 ml/day of immunonutrient enriched with arginine, omega-3 fatty acids and RNA (Impact) in addition to the regular diet for 5 days before surgery. The primary endpoint was the incidence of SSI and the secondary endpoints were other infectious complications and serum CRP level on POD 3 or 4.

Results: From 02/2004 to 12/2009, 240 gastric cancer patients (pts) who underwent gastric surgery were enrolled. 125 pts assigned to the I group and 115 pts assigned to the C group. Age, sex, body weight, serum albumin and general nutritional status were well balanced between the two groups. 223 pts underwent total gastrectomy, 6 pts proximal gastrectomy, 4 pts distal gastrectomy, and 7 pts simple laparotomy. In terms of tumor status, there were no significant difference between the groups in histological type, T stage, and lymph node metastasis. 104 of 125 pts assigned to the I group tolerated a daily intake 1,000 ml of Impact for 5 days. The incidence of SSI was 26 (20.8%) in the I group and 24 (20.9%) in the C group (R.R: 1.00, 95% C.I: 0.61-1.63). Postoperative morbidity was 36 (28.8%) in the I group and 30 (26.1%) in the C group. There was no difference in days of hospital stay after surgery between the groups.

Conclusions: The oral administration of immunonutrient for 5 days before surgery did not contributed to the reduction of infectious complications after total gastrectomy in gastric cancer pts.

No significant financial relationships to disclose.

Revisiting the infracardiac bursa using multimodal methods: topographic anatomy for surgery of the esophagogastric junction

In embryology, the infracardiac bursa (ICB) is a well-known derivative separated from the omental bursa. During surgeries around the esophagogastric junction (EGJ), surgeons often encounter a closed space considered to be equivalent to the ICB, but the macroscopic anatomy in adults is hardly known. This study aimed to revisit the ICB using multimodal methods to show its development from the embryonic to adult stage and clarify its persistence and topographic anatomy. Histological sections of 79 embryos from Carnegie stage (CS) 16 to 23 and magnetic resonance (MR) images of 39 fetuses were examined to study the embryological development of the ICB. Horizontal sections around the EGJ obtained from three adult cadavers were examined to determine the topographic anatomy and histology of the ICB. Further, 32 laparoscopic surgical videos before (n = 16) and after (n = 16) the start of this study were reviewed to confirm its remaining rate and topographic anatomy in surgery. The ICB was formed in 1 out of 10 CS17 samples, and in 8 out of 10 CS18 samples. Further, it was observed in all CS19-23 except one CS23 sample and in 25 (64%) out of 39 fetus samples. Three-dimensional reconstructed MR images of fetuses revealed that the ICB was located at the right alongside the esophagus and the cranial side of the diaphragmatic crus. In one adult cadaver, the caudal end of the ICB arose from the level of the esophageal hiatus and the cranial end reached up to the level of the pericardium. The inner surface cells of the space consisted of the mesothelium. In laparoscopic surgery, the ICB was identified in only 11 (69%) out of 16 surgeries before. However, subsequently we were able to identify the ICB reproducibly in 15 (94%) out of 16 surgeries. Thus, the ICB is the structure commonly remaining in almost all adults as a closed space located at the right alongside the esophagus and the cranial side of the diaphragmatic crus. It may be available as a useful landmark in surgery of the EGJ.

Lectin binding pattern of gastric mucosa of pacific white-sided dolphin, Lagenorhynchus obliquidens

The stomach of the Pacific white-sided dolphin is divided into three parts: forestomach, proper gastric gland portion, and pyloric chamber. The histological features of the dolphin stomach are similar to those of terrestrial mammal stomachs, although the distribution of glycoconjugates in mucosal cells of the dolphin stomach is unknown. To learn about glycoconjugates in cetacean gastric mucosa, the glycoconjugate distribution in the mucous epithelium of the Pacific white-sided dolphin was studied using 21 lectins. Among the lectins tested, GSL-I and DBA specifically labelled the superficial layer of the forestomach epithelium. GSL-I, SBA, RCA-I, VVA, GSL-II, DSL, LEL, STL, s-WGA, WGA, PNA, and Jacalin labelled the luminal surface of the chief cells in the proper gastric gland. GSL-I, SBA, RCA-I, DSL, LEL, STL, s-WGA, PNA, and LCA labelled tubular structures in the cytoplasm of parietal cells. The surface portion of the pits in the pyloric chamber strongly reacted with RCA-I, GSL-II, WGA, PNA, LCA, PHA-L, and UEA-I, whereas the neck portion reacted weakly. Although lining one tubular portion, individual secretory cells in the pyloric gland displayed a heterogeneous reaction. This is the first report on the lectin histochemistry of a cetacean stomach and reveals GSL-I and DBA as specific marker lectins for the cornified stratified squamous epithelium cells of the Pacific white-sided dolphin. The stomachs of cetaceans and terrestrial mammals have similar histological features and mucous glycoconjugate content.

Prestimulus Low-Alpha Frontal Networks Are Associated with Pareidolias in Parkinson's Disease

Background: Pareidolias are visual phenomena wherein ambiguous, abstract forms or shapes appear meaningful due to incorrect perception. In Parkinson's disease (PD), patients susceptible to visual hallucinations experience visuo-perceptual deficits in the form of pareidolias. Although pareidolias necessitate top-down modulation of visual processing, the cortical dynamics of internally generated perceptual priors on these visual misperceptions is unknown. Objectives: To study prestimulus-related electroencephalography (EEG) spectral and network abnormalities in PD patients experiencing pareidolias. Methods: Twenty-one PD in-patients and 10 age-matched controls were evaluated. Neuropsychological assessments included tests for cognition, attention, and executive functions. Pareidolias were quantified by using the "noise pareidolia test" with simultaneous EEG recording. The PD patients were subdivided into two groups-those with high pareidolia counts (n = 10) and those without (n = 11). The EEG was analyzed 1000 msec before stimulus presentation in the spectral domain (theta, low-alpha, and high-alpha frequencies) with corresponding graph networks to evaluate network properties. Statistical analysis included analysis of variance and multiple regression to evaluate the differences. Results: The PD patients with high pareidolia counts were older with lower scores on neuropsychological tests. Their prestimulus EEG low-alpha band showed a tendency toward higher frontal activity (p = 0.07). Graph networks showed increased normalized clustering coefficient (p = 0.05) and lower frontal degree centrality (p = 0.005). These network indices correlated positively to patients' pareidolia scores. Discussion: We suggest that pareidolias in PD are a consequence of an abnormal top-down modulation of visual processing; they are defined by their frontal low-alpha spectral and network alterations in the prestimulus phase due to a dissonance between patients' internally generated mental processing with external stimuli. Impact statement Pareidolias in Parkinson's disease (PD) are considered to be promising early markers of visual hallucinations and an indicator of PD prognosis. In certain susceptible PD patients, pareidolias can be evoked and studied. Here, via electroencephalography, we aimed at understanding this visual phenomenon by studying how neural information is processed before stimulus presentation in such patients. Using spectral and graph network measures, we revealed how top-down modulated internally generated processes affect visual perception in patients with pareidolias. Our findings highlight how prestimulus network alterations in the frontal cortex shape poststimulus pareidolic manifestations in PD.

Successful chemotherapy on a pregnant non-Hodgkin's lymphoma patient

We report a case of a non-Hodgkin's lymphoma (NHL) patient treated successfully with combination chemotherapy during pregnancy who delivered a full-term baby. A 29 year-old patient with cervical and inguinal lymphadenopathy in the 27th week of gestation was referred to our hospital. The diagnosis of lymph node biopsy was NHL (diffuse, large cell type with B-cell phenotype). Three courses of CHOP regimen (adriamycin, cyclophosphamide, vincristine and prednisolone) were given before delivery. The patient has been in complete remission for three years and her baby has been in normal development. Our case supports previous reports that chemotherapy in the third trimester may be given safely on NHL patients.

Differential expressions of toll-like receptor genes in the vagina of pregnant mice

The mammalian immune system is classified into two categories, innate and adaptive immunity, and innate immunity is an immunological first line of defense for the mucosal immune system. Toll-like receptors (TLRs) play critical roles in innate immunity, as they recognize specific molecular patterns found in microbial pathogens, and the activation of TLRs is an important step not only for the innate immune response, but also for the development of the subsequent antigen-specific adaptive immune response. Despite the importance of TLRs in mucosal immunity, little is known about their expression in the female genital mucosa during gestation. In the present study, gene expressions of TLRs 1 to 9 were investigated together with NF-κB and FoxP3 gene expressions in the vaginae of pregnant mice to understand the immune response of the female genital mucosa during pregnancy. We found that mRNA expressions of TLR4, TLR5, TLR6, TLR7 and TLR9 were significantly decreased during the late gestation period, whereas temporary increases were seen in the middle gestation period. Gene transcriptions of TLR1, TLR2, TLR3 and TLR8 were not changed specifically during the gestation period. The mRNA expression of NF-κB was not changed at any time during the gestation period, while the FoxP3 mRNA expression was increased in the middle gestation period. These results suggest that expressions of particular TLRs would be down-regulated during gestation so as to maintain the pregnant state.

Medial proximal tibial angle at the posterior tibial plateau represents the pre-arthritic constitutional medial proximal tibial angle in anterior cruciate ligament-intact, advanced osteoarthritis of the knee

PURPOSE

In kinematically aligned total knee arthroplasty (TKA), it is necessary to infer the pre-arthritic constitutional medial proximal tibial angle (MPTA) in advanced osteoarthritis (OA) of the knee with bone loss. The aim of this study was to investigate whether MPTA at the posterior tibial plateau represents the pre-arthritic constitutional MPTA in anterior cruciate ligament (ACL)-intact, advanced OA knees. It was hypothesized that MPTA at the posterior tibial plateau represents the pre-arthritic constitutional MPTA of ACL-intact, advanced knee OA.

METHODS

One hundred varus, anterior cruciate ligament (ACL)-intact, advanced OA knees were analysed. The hip-knee-ankle (HKA) angle and MPTA were assessed on computed radiography (CR) and MPTAs at the anterior, middle, and posterior part of the tibial plateau were assessed on computed tomography (CT) images. The association between these parameters was also analysed.

RESULTS

CR images showed an HKA angle of 172.4 ± 4.1° and MPTA of 84.3 ± 2.5°. CT images showed different MPTAs in the three regions, ranging from 83.9 ± 2.4° to 85.9 ± 2.8°. The middle MPTA was the lowest at 83.9 ± 2.4°. HKA angle correlated with the middle MPTA (r = 0.3355, 95% confidence interval [CI] 0.1489-0.4991, p = 0.0006) and ΔMPTA (Middle-Posterior) (r = 0.5128, 95% CI 0.3518-0.6443, p < 0.0001).

CONCLUSION

The MPTA at the posterior tibial plateau represents the pre-arthritic constitutional MPTA in ACL-intact, advanced OA knees.

LEVEL OF EVIDENCE

III, retrospective cohort study.

Quantitative and qualitative comparative analysis of gradient-separated hematopoietic cells from cord blood and chemotherapy-mobilized peripheral blood

Some of the uncertainty regarding the use of cord blood (CB) in transplant settings includes the suspected relative rarity of hematopoietic stem cells (SC) in CB and the feasibility of incorporating a cell separation protocol to remove red blood cells, which may result in an unacceptable loss of SC. To address this uncertainty, we isolated a SC fraction by Percoll or Ficoll gradients from CB and peripheral blood (PB), which had been mobilized by chemotherapy. The frequencies of mononuclear cells (MNC), CD34+ cells, colony-forming units granulocyte-macrophage (CFU-GM), and the output of colony-forming cells (CFC) after five weeks in long-term culture (LTC) assay were then evaluated. The mean numbers of these cells per ml of CB sample before gradient separation were, respectively, 4.9 x 10(6), 13.8 x 10(4), 3.0 x 10(3) and 681 (n = 37). In the recovery phase of PB, these numbers were, respectively, 2.0 x 10(6), 14.9 x 10(4), 3.5 x 10(3) and 270 per ml of processed blood at apheresis (n = 35). After Percoll separation, the recovery rates of these cells were, respectively, 29%, 92%, 97% and 95% in CB, and 65%, 87%, 123% and 102% in PB. After Ficoll separation of CB, the rates were, respectively, 55%, 107%, 92% and 105%. These results suggest that CB contains an adequate number of more immature progenitors which can be retained after cell separation with Percoll or Ficoll, thereby making it feasible to incorporate a cell processing procedure into a CB transplant protocol. Percoll separation provided a greater enrichment of cells than Ficoll.

Species specificity in the blood cholesterol-lowering effect of YM-16638

1. The compound YM-16638, [[5-[[3-(4-acetyl-3-hydroxy-2-propylphenoxy)propyl] thio]-1,3,4-thiadiazol-2-yl]thio] acetic acid was developed in a series of in vitro and in vivo studies as a leukotriene D4 receptor antagonist. 2. In a clinical trial as a leukotriene antagonist drug, this compound was found to have a potent serum cholesterol lowering effect in normolipidaemic healthy male volunteers. 3. In the present study, we investigated the serum cholesterol lower effect of this compound in various species of experimental animals. 4. Administration of YM-16638 did not cause a significant decrease in serum total cholesterol (TC) in mice (up to 200 mg kg-1, body weight per day for 28 days), rats (200 mg kg-1 for 15 days) or rabbits (90 mg kg-1 for 18 days). In hamsters, administration of YM-16638 orally or by peritoneal injection at 50 mg kg-1 or more daily for 7 days caused a significant decrease in serum TC and the rate of body weight gain. In monkeys, serum TC did not change in YM-16638-administered squirrel monkeys (50 mg kg-1 daily for 3 weeks), but a significant decrease in serum TC was observed in cynomolgus monkeys (33% decrease at 30 mg kg-1 for 4 weeks) and rhesus monkeys (27% decrease at 30 mg kg-1 for 3 weeks) without any serious decrease in body weight. These results were consistent with those in a phase I study with human subjects. In contrast, serum alanine aminotransferase (ALT) level decreased in all animals after YM-16638 treatment. 5. From these results, we conclude that YM-16638 has a potent hypocholesterolaemic effect, but that this effect if species-specific and is only recognized clearly in human subjects and old-world monkeys.

Cooperation and competition between the default mode network and frontal parietal network in the elderly

Recent research has shown that the Default Mode Network (DMN) typically exhibits increased activation during processing of social and personal information but shows deactivation during working memory (WM) tasks. Previously, we reported the Frontal Parietal Network (FPN) and DMN showed coactivation during task preparation whereas the DMN exhibited deactivation during task execution in working memory tasks. Aging research has shown that older adults exhibited decreased functional connectivity in the DMN relative to younger adults. Here, we investigated whether age-related cognitive decline is related to a reduced relationship between the FPN and DMN using a working memory task during the execution period. First, we replicated our previous finding that the FPN and DMN showed coactivation during the preparation period, whereas the DMN showed deactivation during the execution period. The older adults showed reduced DMN activity during task preparation and reduced deactivation during task execution; however, they exhibited a higher magnitude of activation in the FPN than the young individuals during task execution. Functional connectivity analyses showed that the elderly group, compared to the young group, showed weaker correlations within the FPN and the DMN, weaker positive correlations between the FPN and DMN during task preparation, and weaker negative correlations between the FPN and DMN during execution. The results suggest that cognitive decline in the older adults might be related to reduced connectivity within the DMN as well as between the FPN and DMN.

[The effect of intraoperative high-dose tranexamic acid on blood loss after operation for acute aortic dissection]

The effect of high dose tranexamic acid on blood loss after operations for acute aortic dissection was evaluated. Twenty-eight patients undergoing emergent operations for acute aortic dissection were studied. There were two groups, group T with 13 patients (group T) who were given 7 g of tranexamic acid after induction of anesthesia and 3 g of it after CPB and group C with 15 patients who did not receive tranexamic acid. There was a tendency that group T had less bleeding during operation and after operation (559.6 +/- 865.8 ml in group T and 805.8 +/- 442.9 ml in group C, 1719.2 +/- 1008.7 ml in group T and 3547.7 +/- 4580.1 ml in group C, respectively), but there was no significant difference between two groups. The removal of drainage tubes after operation was significantly earlier in group T (5.0 +/- 2.3 post operative day in group T and 8.1 +/- 5.2 post operative day in group C; p < 0.05). FDP and D-dimer level as measures of fibrinolytic activity were elevated at pre- and postoperative period in both groups, but they tended to be lower in group T at postoperative period. One patient required reexploration because of excessive bleeding and no mediastinal infection was reported in group T, whereas 4 patients underwent reexploration and 2 patients developed mediastinitis in group C. There were 5 hospital death (33.3%) in group C and 2 (15.4%) in group T. High dose of tranexamic acid seems to control fibrinolytic activity, thereby reducing blood loss and requirements, which may contribute to lower morbidity and mortality in operations for acute aortic dissection.

Isolation of multiple activities from mouse FM3A cells which promote homologous pairing of DNA molecules

We describe the detection and partial purification of three homologous pairing activities from extracts of mouse mammary carcinoma FM3A cells. These activities, designated MHP1a, 1b, and 1c, form joint molecules between circular single-stranded DNA and homologous linear duplex DNA and are distinguished from one another by their chromatographic behaviors or isoelectric properties. The reactions promoted by these activities require homologous substrates but not ATP. All the reactions also show Mg2+ dependence in the absence of exogenous ATP. Analysis of the reaction products has revealed that strand exchange proceeds for lengths of up to at least 271 bp during the homologous pairing reaction. The finding of multiple types of homologous pairing and strand exchange activity in mouse cells may facilitate the elucidation of the mechanism of homologous recombination in somatic mammalian cells.

Nervous branch passing through an accessory canal in the sphenozygomatic suture: the temporal branch of the zygomatic nerve

A nervous branch which passes through a small canal in the sphenozygomatic suture is sometimes observed during dissection. To examine the origin, course and distribution of this nervous branch, 42 head halves of 21 Japanese cadavers (11 males, 10 females) and 142 head halves of 71 human dry skulls were used. The branch was observed in seven sides (16.7%); it originated from the communication between the lacrimal nerve and the zygomaticotemporal branch of the zygomatic nerve or from the trunk of the zygomatic nerve. In two head halves (4.8%), the branch pierced the anterior part of the temporalis muscle during its course to the skin of the anterior part of the temple. The small canal in the suture was observed in 31 head halves (21.8%) of the dry skulls. Although this nervous branch is inconstantly observed, it should be called the temporal branch of the zygomatic nerve according to the constant positional relationship to the sphenoid and zygomatic bones. According to its origin, course and distribution, this nervous branch may be considered to be influential in zygomatic and retro-orbital pain due to entrapment and tension from the temporalis muscle and/or the narrow bony canal. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00276-002-0027-4.

Coincidence of a right retroaortic circumflex coronary artery and a right-sided aortic arch with a retroesophageal course of the left subclavian artery (arteria lusoria)

An anomalous branch of the right coronary artery was found in a 71-year-old male cadaver with a right-sided aortic arch. The anomalous artery arose from the proximal portion of the right coronary artery and ran in a retroaortic course, before reaching the posterior wall of the heart. It was recognized as the right-sided variation of the circumflex coronary artery. The aortic arch had as branches the left common carotid, right common carotid, right subclavian, and left subclavian arteries, in that order, and the descending aorta was located in the right thorax. The left subclavian artery arose from a Kommerell's diverticulum and ran behind the esophagus, and the left-sided ligamentum arteriosum was also connected at the diverticulum. Therefore, the right aortic arch was classified as type N according to Adachi-Williams-Nakagawa and type III-B1 in accordance with Stewart-Edwards. The Kommerell's diverticulum in this case seemed to press on the posterior wall of the esophagus.

Relationship between histological changes of the anterior cruciate ligament and knee function in osteoarthritis patients

BACKGROUND

The function of the anterior cruciate ligament (ACL) in osteoarthritis (OA) of the knee remains to be elucidated. The purpose of this study is to evaluate histological changes of the ACL in end-stage knee OA and to clarify the relationship between histological changes in the ACL and knee function.

HYPOTHESIS

The hypothesis in this study was that ACL degeneration in knee OA is associated with decreased knee function.

PATIENTS AND METHODS

Eighty-two ACL specimens from 65 patients who underwent primary total knee arthroplasty (TKA) were investigated. The correlation between histological changes of the ACL (myxoid changes, chondroid metaplasia, total collagen degeneration, microcyst formation, vascular proliferation, and inflammatory cell infiltration) and knee function (range of motion, anterior tibial translation test, knee extension muscle strength, one-leg standing time, and functional reach test) were investigated. Age, body mass index, joint space narrowing, osteophyte formation, lower extremity alignment, and knee medial/lateral instability were also evaluated.

RESULTS

Myxoid change in the ACLs was significantly negatively correlated with one-leg standing time. Chondroid metaplasia was not correlated with knee function. Collagen degeneration in the ACL was significantly negatively correlated with knee flexion angle and one-leg standing time. In addition, a negative correlation between microcyst formation and knee flexion angle was noted. Osteophyte formation, particularly lateral femoral intercondylar osteophytes, was correlated with myxoid changes. The other parameters did not correlate with ACL histological changes.

DISCUSSION

Myxoid changes in the ACL were shown to correlate with knee function. The osteophyte score, particularly as related to lateral femoral intercondylar osteophytes, correlated with the severity of myxoid changes in the ACL in knee OA. Precise ACL evaluation should be included in the indications for ACL-retaining surgeries because ACL degeneration may be related to decreased knee function after surgery.

LEVEL OF EVIDENCE

IV, Diagnostic case series.

Prosaposin in the rat oviductal epithelial cells

Prosaposin (PSAP) has two forms: a precursor and a secreted form. The secreted form has neurotrophic, myelinotrophic, and myotrophic properties. The precursor form is a precursor protein of saposins A-D. Although the distribution of PSAP in male reproductive organs is well known, its distribution in female reproductive organs, especially in the oviduct, is unclear. Immunoblots and immunohistochemistry of oviducts showed that oviductal tissues contain PSAP proteins, and a significant increase in PSAP was observed in the estrus-metestrus phase compared to the diestrus-proestrus phase in the ampulla. To identify PSAP trafficking in cells, double-immunostaining was performed with antibodies against PSAP in combination with sortilin, mannose 6 phosphate receptor (M6PR), or low-density lipoprotein receptor-related protein 1 (LRP1). PSAP and sortilin double-positive reactions were observed near the nuclei, as well as in the apical portion of microvillous epithelial cells, whereas these reactions were only observed near the nuclei of ciliated epithelial cells. PSAP and M6PR double-positive reactions were observed near the nuclei of microvillous and ciliated epithelial cells. PSAP and M6PR double-positive reactions were also observed in the apical portion of microvillous epithelial cells. PSAP and LRP1 double-positive reactions were observed in the plasma membrane and apical portion of both microvillous and ciliated epithelial cells. Immunoelectron staining revealed PSAP immunoreactive small vesicles with exocytotic features at the apical portion of microvillous epithelial cells. These findings suggest that PSAP is present in the oviductal epithelium and has a pivotal role during pregnancy in providing an optimal environment for gametes and/or sperm in the ampulla.

Spatiotemporal distribution patterns of oligosaccharides during early embryogenesis in the starfish Patiria pectinifera

To examine embryogenic mechanisms in the starfish Patiria (Asterina) pectinifera, we histochemically analyzed several larval stages using Alcian Blue (AB, which stains acidic mucins), Periodic Acid Schiff (PAS, which stains neutral mucins), and 21 types of lectins. Carbohydrate distribution patterns were observed in the cytoplasm, basement membrane, and blastocoel as follows: (1) The first group of lectins showed granular signals in the mesendodermal cells, and these lectins may be useful as mesendoderm markers. (2) The second class of lectins showed diffuse signals across the entire cytoplasm from the hatched blastula until the mid gastrula. These signals became localized to the basal cytoplasm of archenteron cells at the early bipinnaria. (3) Lectin reactivity in the basement membrane peaked at the early-to-mid gastrula and was nearly gone by the early bipinnaria. These results suggest the existence of various substances in the basement membrane and imply the importance of these substances during archenteron elongation and the induction of mesenchyme differentiation. (4) Signal colors with AB-PAS double staining in the blastocoel changed from magenta (by PAS staining) into blue (by AB staining) during these stages, thus, indicating that mucin located in the blastocoel changed from neutral to acidic. The most significant part of this report is the first description regarding temporal changes in the characteristics of intra- and extracellular components with the combination of many different lectins and stains.

Increase in the Posterior Tibial Slope Provides Better Joint Awareness and Patient Satisfaction in Cruciate-Retaining Total Knee Arthroplasty

The effect of the posterior tibial slope (PTS) in cruciate-retaining total knee arthroplasty (CR-TKA) on clinical outcomes remains unclear. We aimed to investigate (1) the effect of alteration of the PTS on clinical outcomes, including patient satisfaction and joint awareness, and (2) the relationship between the patient-reported outcomes, the PTS, and compartment loading. Based on the alteration of the PTS after CR-TKA, 39 and 16 patients were stratified into increased and decreased PTS groups, respectively. Clinical evaluation was performed by the Knee Society Score (KSS) 2011 and the Forgotten Joint Score-12 (FJS-12). Compartment loading was intraoperatively assessed. KSS 2011 (symptoms, satisfaction, and total score) was significantly higher (p = 0.018, 0.023, and 0.040, respectively), and FJS ("climbing stairs?") was significantly lower (p = 0.025) in the increased PTS group compared with the decreased PTS group. The decrease in both medial and lateral compartment loading of Δ45°, Δ90°, and ΔFull was significantly greater in the increased PTS group than in the decreased PTS group (p< 0.01 for both comparisons). Medial compartment loading of Δ45°, Δ90°, and ΔFull significantly correlated with KSS 2011 for "symptom" (r = - 0.4042, -0.4164, and -0.4010, respectively; p = 0.0267, 0.0246, and 0.0311, respectively). ΔPTS significantly correlated with medial compartment loading differentials of Δ45°, Δ90°, and ΔFull (r = - 0.3288, -0.3792, and -0.4424, respectively; p = 0.0358, 0.01558, and 0.0043, respectively). Patients with increased PTS showed better symptoms and higher patient satisfaction compared with those with decreased PTS following CR-TKA, possibly due to a greater decrease in compartment loading during knee flexion.Level of evidence:level IV, therapeutic case series.