Normative values for maximum power during motor function assessment of jumping among physically active Japanese

OBJECTIVES

To determine the relationship between maximum power relative to body weight (Pmax-rel) and the aging process, and to indicate the target values of improvement of motor function in Japanese individuals.

METHODS

In 410 physically active Japanese subjects (7-79 years) with no impairment of daily activities were performed counter-movement jumps. We evaluated the correlation between age and Pmax-rel, mean Pmax-rel by age group, and the percentage Esslinger Fitness Index score relative to 100% for same-age Europeans (%EFI), by gender.

RESULTS

Age and Pmax-rel were correlated in both males aged <18 and >or=18 years old (both p<0.01) and females aged <18 and >or=18 years old (both p<0.01). Pmax-rel declined gradually with age, reaching 53.5% of the peak in subjects in their 70s. There was no significant difference in %EFI scores in most age groups.

CONCLUSION

Similar to Europeans, Pmax-rel in Japanese individuals is closely correlated with age, declining to 53% of the peak in subjects in their 70s. Thus, Pmax-rel and the %EFI appear to be suitable as normative indices applicable to different human populations for the assessment of physical function.

Different changes of quantity due to aging in the psoas major and quadriceps femoris muscles in women

Bone fractures cause disabilities that leave the elderly bedridden and strengthening the muscles of the lower limbs, especially the quadriceps femoris, is the main kinematical method of preventing falls. Recently, however, it has become clear that the psoas major is critical for walking ability. We examined changes due to aging in the size of the psoas major compared with changes in the quadriceps femoris. Bone fractures are more frequent in women than in men; our participants (n=210) were therefore exclusively women ranging in age from 20 to 79 and divided into 6 age groups (n=35 each) in 10-year increments. Cross-sectional areas of the two muscles were measured by an MR scanner for a comparative estimation of muscle size. The psoas major showed the greatest quantity in subjects in their 20s, after which it declined steadily until the 60s and dramatically in the 70s, while the area of the quadriceps femoris was preserved until the 40s and showed no dramatic later decline. Exercise beyond regular daily activities is recommended to prevent the psoas major from decreasing in volume. We also recommend the development of a method of maintaining its muscle volume which would target women younger than 40 and older than 60.

Trabecular minimodeling in human iliac bone

In adult human beings, remodeling creates nearly all of new bone tissue. However, Frost hypothesized that modeling can go on in trabeculae throughout life. As this hypothesis has not been verified, we looked for histologic evidence of trabecular modeling (minimodeling) during bone histomorphometry of transiliac bone biopsy specimens obtained from 34 patients (age range, 38-81 years; mean age, 58.4 years; female, 31/34) at the time of total hip arthroplasty. Before the bone biopsy study, we performed quantitative bone scintigraphy of bilateral hip joints and bilateral iliac crests in 10 other patients with unilateral hip disease and confirmed that the bone biopsy site was not affected by ipsilateral hip joint disease. Patients who had metabolic bone diseases or who had taken medications known to affect bone metabolism were excluded from the study. During modeling where bone formation and bone resorption are not coupled, bone formation can occur on quiescent bone surfaces without preceding bone resorption and create smooth cement lines. Therefore, the combination of fluorochrome labeling and a smooth cement line without interruption of surrounding collagen fibers was regarded as evidence of minimodeling. Histologic evidence of minimodeling was detected in 21 of the entire 34 specimens (62%) and 17 of 27 specimens obtained from postmenopausal patients (63%). Bone volume of minimodeling sites was less than 1% of the trabecular bone volume, and these sites accounted for less than 2% of the entire bone surface on average. However, osteoid volume of minimodeling sites comprised approximately one-tenth of the entire osteoid volume, and their labeled surface constituted one-fourth to half of the entire labeled surface on average. Therefore, when performing bone histomorphometry of adult cancellous bone, minimodeling should be taken into account when dealing with parameters related to osteoid volume and mineralization. A comparison of specimens with and without minimodeling demonstrated that the presence of minimodeling was correlated with smaller physique of patients, accelerated mineralization (as indicated by the higher mean MS/BS and MAR values and the shorter mean Omt), and higher metabolic turn-over of bone (as indicated by the higher mean BFR/BV value). Although the findings still need to be verified in a larger number of normal subjects without hip joint disease, they support Frost's hypothesis that minimodeling can continue throughout human life.

Retroperitoneal malignant peripheral nerve sheath tumor associated with scoliosis in neurofibromatosis

Neurofibromatosis 1 is an autosomal dominant disorder characterized by distinctive clinical problems including scoliosis and malignant peripheral nerve sheath tumors. We present two cases of retroperitoneal malignant peripheral nerve sheath tumor associated with scoliosis in neurofibromatosis. Presence of spinal deformity resulted in delay of the diagnosis of the sarcoma.

Relief from pain after Bombelli's valgus-extension osteotomy, and effectiveness of the combined shelf operation

Between 1979 and 1993, we treated 67 hips in 58 patients with severe osteoarthritis caused by congenital dislocation of the hip, employing Bombelli's valgus-extension osteotomy. The mean age of the patients was 43.6 years (range, 23-59 years). The mean follow-up period was 9.7 years (range, 5-16 years). Thirty-three of the 67 joints were followed-up for more than 10 years after the operation. Of the 67 joints, 31 were operated on by Bombelli's valgus-extension osteotomy combined with a shelf operation (combined group), and 36 by Bombelli's valgus-extension osteotomy alone (single group). Clinical evaluation was made according to the Japanese Orthopaedic Association (JOA) hip score system (JOA hip score). In order to assess the effectiveness of this operation in regard to sustained relief from pain after the operation, Kaplan-Meier survivor analysis was performed on the basis of pain score on the JOA hip score. The end-point of the Kaplan-Meier analysis was defined as a score of less than 20 points on the pain score at the time of follow-up or conversion to total hip arthroplasty. In order to analyze the factors that exacerbated pain and to assess the effectiveness of the combined shelf operation, the degree of superior displacement of the femoral head (measured from roentgenograms) after the operation was examined in relation to the pain score. The mean JOA hip score improved, from 56.1+/-11.0 before the operation to 77.0+/-16.1 at the latest follow-up. Kaplan-Meier analysis showed a survival rate of 79.4% 10 years after the operation. Superior displacement of the femoral head had gradually progressed with time after the operation in patients with and without the combined shelf operation. Displacement of the femoral head was positively correlated with the acetabular angle of the weight-bearing surface (WBS angle) (sourcil) preoperation. The mean pain score in the combined group was significantly higher than that in the single group 6 to 9 years after the operation. The results of our assessments led us to conclude that Bombelli's valgus-extention osteotomy is satisfactory as far as clinical and radiological evaluations are concerned, as relief from the pain has continued for more than 10 years after the operation. The combined shelf operation is effective for relieving pain in severe osteoarthritis caused by congenital dislocation of the hip.

Mineral density and histomorphometric assessment of bone changes in the proximal tibia early after induction of type II collagen-induced arthritis in growing and mature rats

Bone changes in both actively growing (6-week-old) and mature (6-month-old) rats with collagen-induced arthritis (CIA) were investigated in order to clarify the mechanisms of osteoporosis near inflamed joints in patients with early rheumatoid arthritis (RA) and juvenile RA. In female Sprague-Dawley rats, the proximal tibiae from the CIA and control groups early after immunization, when any influence of immobilization due to joint pain and swelling is minimal, were studied using dual X-ray absorptiometry and histomorphometry after double-labeling with tetracycline. Arthritis developed within 10-14 days after immunization in both growing and mature rats. Physical activity, growth, and body weight continued to resemble that of the control group for at least 10 days. The bone mineral density in the proximal tibia did not differ significantly between the CIA and control groups. In growing rats, a highly significant increase in bone resorption, and decreases in bone formation and trabecular bone volume became evident histomorphometrically before visible signs of arthritis had developed. In mature rats, bone formation was markedly decreased without an increase in bone resorption. The differences in the reaction between growing and mature rats reflected a difference in the number of remodeling sites (units) and an uncoupling between osteoblasts and osteoclasts. We conclude that osteoporosis near inflamed joints results from an imbalance between bone resorption and formation caused by immune reactions in the CIA rats. Moreover, a decrease in bone formation may, in part, precede the clinical onset of arthritis.

In vivo bone-forming capacity of human bone marrow-derived stromal cells is stimulated by recombinant human bone morphogenetic protein-2

In the present study, we investigated whether the in vivo bone-forming capacity of human bone marrow-derived stromal cells (HMSCs) could be enhanced by recombinant human bone morphogenetic protein-2 (rhBMP-2). The HMSCs obtained from seven donors (5-54 years of age) were passaged three to six times. Passaged HMSCs exhibited the osteoblastic phenotype in vitro, including: (a) an increase in alkaline phosphatase (ALP) activity in response to dexamethasone, ascorbic acid, and beta-glycerophosphate: and (b) mRNA expression for markers of osteoblastic lineage (ALP, osteopontin, osteocalcin, and parathyroid hormone-receptor) and BMP-2, -4, and -6 detected by reverse transcription-polymerase chain reaction. For the in vivo assay, transplants were subcutaneously implanted into nude mice as follows: group A (vehicle); group B (rhBMP-2); group C (HMSCs with vehicle); and group D (HMSCs with rhBMP-2). Transplants were obtained 2 and 4 weeks after implantation. Correlated radiographic findings, histological observations, and in situ hybridization using species-specific probes showed that the group B transplants contained bone tissue of mouse origin, which was observed at the periphery of the transplants. Four weeks after implantation, small amounts of HMSCs-derived bone tissue were detected at the periphery in two of seven transplants in group C. In contrast, five of seven group D transplants exhibited HMSCs-derived bone tissue, which was located at the center of the transplants and was surrounded by mouse bone tissue. Furthermore, HMSCs-derived chondrogenesis was detected in two of seven group D transplants. The results of the present study demonstrate that culture-expanded HMSCs preserve the osteoblastic phenotype, and the in vivo bone-forming capacity can be promoted by rhBMP-2.

Deep-seated segmental neurofibromatosis without café au lait spots

Segmental neurofibromatosis is a rare disease characterized by neurofibromas with or without café au lait spots localized to one segment of the body. The majority of reported cases have had cutaneous neurofibromas, and patients with deep involvement have rarely been described. We report on two patients with deep-seated segmental plexiform neurofibromatosis and review the literature. All reviewed cases including the present two had no café au lait spots, axillary freckling, Lisch nodules, family history or malignant progression of disease. Differential diagnoses from neuro-fibromatosis 1 (von Recklinghausen disease) and malignant peripheral nerve sheath tumor are important for genetic counseling and avoiding overtreatment.

Progression of rheumatoid arthritis of the cervical spine: radiographic and clinical evaluation

Cross-sectional and longitudinal studies were conducted to observe progression of rheumatoid arthritis in the cervical spine. Two hundred and ninety-seven patients were enrolled in the cross-sectional study. Both upper and lower cervical spine involvement increased with disease duration. The relationship between atlanto-axial motion and the development of subaxial subluxation was inconclusive. Eighty-seven patients were enrolled in the longitudinal study and were followed for at least 5 years. In about half of these patients, rheumatoid changes started from the upper cervical spine, with rheumatoid changes beginning from the lower cervical spine in about 8% of patients. Neurological deficits were correlated with radiographic changes but neck pain did not correlate with radiographic changes. As to the upper cervical spine, the parameter most influencing neurological deficits was found to be the minimum value of the atlanto-axial angle in flexion, by multivariate analysis using a multiple logistic model. Neurological deficits were seen in more than half the patients when the atlanto-axial angle in flexion was 5 degrees or less.

Epidemiology of cervical and trochanteric fractures of the proximal femur in 1996 in Kaohsiung City, Taiwan

The goal of this study was to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1996 in Kaohsiung City, Taiwan. Kaohsiung City is the industrial and commercial center of southern Taiwan, with a population of 1,433,621 in 1996. The number of individuals over 65 years of age accounted for 6.2% of the total population. Data from the archives of reimbursement of the National Health Insurance program were used to investigate the incidence of fractures of the proximal femur. This study detected 580 cervical and trochanteric fractures (40.5 fractures per 100,000 population per year) in 261 males (35.8 fractures per 100,000 men per year) and 319 females (45.3 fractures per 100,000 women per year), with 420 (72%) of these fractures occurring in individuals over 65 years of age. The age-specific incidences of cervical and trochanteric fractures increased exponentially with age in both genders. The overall ratio of cervical to trochanteric fractures was 1:1.04. The mean ages of women with cervical or trochanteric fractures (71.6 and 74.0 years, respectively) were significantly higher than those of males (59.9 and 64.8 years, respectively; P < 0.01). The age-adjusted incidences of fractures of the proximal femur in Kaohsiung City were higher than in other Asian countries, but were lower than in Western countries such as the United States and Norway. The urban lifestyle and low daily calcium intake may be responsible for this increased incidence of proximal femoral fractures in Kaohsiung City.

Spatiotemporal change of rat collagenase (MMP-13) mRNA expression in the development of the rat femoral neck

The interepiphyseal region between the greater trochanter and the capital femoral epiphysis and the medioproximal portion of the femoral neck exhibit extensive morphological changes during the first 4 weeks after birth in rats. Previous reports show that matrix metalloproteinase-13 (MMP-13, rat collagenase) mRNA is expressed in bone and cartilage during embryonal development and fracture healing. We examined MMP-13 mRNA expression and compared it with the distribution of osteopontin and osteocalcine mRNA in the femoral neck. Moreover, we examined histomorphometric analysis in the femoral neck where the morphology changes rapidly. Histomorphometric analysis of the 4-week-old rat femoral neck showed a high rate of bone formation and resorption in the region where shape changed rapidly. Osteopontin mRNA was expressed diffusely along the endosteum. In contrast, MMP-13 mRNA expression was restricted to the medial endosteal portion near the cartilage-bone interface of the femoral neck in 15- and 28-day-old rats and in the deepest endosteal interepiphyseal region of 15-day-old rats. MMP-13 mRNA-expressing osteoblastic cells were also expressing osteopontin but not osteocalcin mRNA. MMP-13 mRNA-expressing cells differ from tartrate-resistant acid phosphatase (TRAP)-positive cells, and MMP-13 mRNA-positive cells are located adjacent to TRAP-positive cells. The results of the site- and cell-specific expression of MMP-13, taken together with its enzymatic property, suggest that MMP-13 plays an important role in morphological changes in the rat femur, at least during the third and fourth week after birth, and that MMP-13 itself is involved in the interaction between osteoblastic and TRAP-positive cells.

Epidemiology of cervical and trochanteric fractures of the proximal femur in 1994 in Tangshan, China

The purpose of this study was to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1994 in Tangshan City, China. There are many reports on hip fracture incidence in many countries, suggesting that there are many factors affecting hip fractures. We visited 15 hospitals with an orthopaedic department within Tangshan City, and reviewed the medical records and radiographs of all patients with hip fractures occurring between January 1 and December 31, 1994. The population of Tangshan in 1994 was determined to be 1,454,543 (746,015 males and 708,528 females). The population of those over 65 years of age was 88,490 (41,519 males and 46,971 females), representing 6.08% of the total population. This study detected 184 cervical and trochanteric fractures of the proximal femur in 1994 in Tangshan (127 men and 57 women). The overall incidence or rate of the combined number of cervical and trochanteric fractures was 25 fractures per 100,000 population per year for men and 12 for women. There were a total of 147 cervical fractures (80%) and 37 trochanteric fractures (20%). The incidence of the combined number of cervical and trochanteric fractures in patients over 70 years of age increased to 108 for men and 156 for women. The incidence of hip fractures increased with age in both sex groups, especially in women over 65. Severe trauma fractures happened more often in younger groups, and mainly occurred in men, which may be a result of the particular composition of the population in Tangshan, which is young and male dominated. In addition, because Tangshan is an industrial city, many of its citizens are involved in occupations requiring a high level of physical activity.

Peripheral quantitative computed tomography of the femoral neck in 60 Japanese women

Peripheral quantitative computed tomography (pQCT) is able to evaluate trabecular and cortical bone separately, and to determine geometric properties from cross-sectional images for noninvasive assessments of mechanical strength. In order to assess the diagnostic value of pQCT of the femoral neck, 60 healthy women were examined with a new pQCT machine, XCT-3000 (Norland-Stratec, Germany), which is suitable for direct measurement of the hip. The region of interest chosen was the center of the femoral neck. pQCT of the distal radius and dual energy X-ray absorptiometry (DXA) of the lumbar spine and femoral neck were also performed. The study demonstrated that total bone mineral density (BMD) (femoral MD) and trabecular BMD (femoral-TBD) decreased with advancing age. Percent cortical area showed a small but significant decrease with advancing age and % trabecular area increased slightly. Both the endosteal perimeter and the periosteal perimeter were relatively constant with aging. Bone strength index (BSI) and stress-strain index (SSI), which reflect the mechanical strength of bone, declined with advancing age, especially after menopause. Femoral TBD correlated strongly with femoral neck BMD by DXA and L2-L4 BMD by DXA but femoral-CBD did not correlate with femoral neck BMD by DXA. Volumetric BMD of the femoral neck and distal radius were closely correlated. It is concluded that (1) cortical thinning occurs with aging by endocortical resorption and loss of femoral-TBD; (2) loss of femoral-CBD occurred at a slower rate than radial CBD, perhaps due to the weight-bearing effect; (3) biomechanical parameters such as the BSI and SSI may reflect increasing fragility of the femoral neck in pre- and postmenopausal women; (4) pQCT of the femoral neck had diagnostic value at least equivalent to that of DXA or pQCT of the distal radius.

Nitric oxide release from substantia gelatinosa of the rat spinal cord in vitro

To study characteristics of nitric oxide (NO) release from substantia gelatinosa (SG) in the spinal cord, we measured NO concentration in transverse spinal cord slices of rats using electrochemical NO probes. Electrical stimulation of the dorsomedial white matter adjacent to SG elicited transient current changes in NO probes placed on SG and the amplitude corresponded to a NO concentration of 200-300 pM. This NO release was not affected by the application of antagonists of glutamate or substance P receptors. The NO release in the rats, which were neonatally treated with capsaicin for denervating C-fibers, was significantly smaller than that in control rats. These data suggest that NO is mainly derived from the unmyelinated afferent nerves in the SG of the spinal cord.

Arthrodesis of the hip joint using an external fixator

Arthrodesis of the hip has been plagued by high rates of nonunion, and by complications associated with prolonged cast immobilization. To prevent these problems, we devised a procedure for hip arthrodesis using an external fixator in combination with internal fixation at the fusion site. We have treated nine patients with this technique. All of the arthrodeses were solidly united without wound infections at the most recent follow-up. Patients were able to leave their hospital bed and walk on the affected limb with a cane shortly after surgery. This was possible because the external fixator was low in profile, as it was applied from the anterosuperior iliac spine to the femoral shaft, and provided rigid stabilization of the arthrodesis. The technique resulted in a reduction in the period of bed rest, immediate postoperative mobilization, shorter periods of hospitalization, no limitation in the range of knee and ankle motion, improvement in the patient's ability to carry out the personal hygiene, and fewer complications.

Three-dimensional microstructural analysis of human trabecular bone in relation to its mechanical properties

The purpose of this preliminary study is to explore the relationship between elastic modulus, bone mineral density (BMD), and trabecular microstructure in three dimensions. Twenty cubes of trabecular bone were processed from two lumbar vertebrae obtained from one individual. The BMD of each cube was measured by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Each cube was serially scanned by microcomputed tomography to produce three-dimensional data sets. By analyzing these data sets, three-dimensional trabecular microstructural indices of connectivity density and fractal dimension were calculated as well as histomorphometric parameters. The cubes were tested mechanically in a nondestructive manner for measurement of their elastic modulus. This preliminary study showed that: (1) bone mass index is correlated with mechanical properties, with coefficients of correlation ranging from 0.552 to 0.601; and (2) when controlling for BMD, no association could be detected between measures of structural complexity (connectivity density and fractal dimension) and elastic modulus in the craniocaudal direction of human vertebral bodies.

Specific loss of chondromodulin-I gene expression in chondrosarcoma and the suppression of tumor angiogenesis and growth by its recombinant protein in vivo

Chondromodulin-I (ChM-I) was previously identified as an angiogenesis inhibitor in cartilage. Here, we demonstrated that the level of ChM-I transcripts was substantially reduced to 100 or even less in the lower-grade chondrosarcomas, in articular cartilage or other benign cartilage tumors. We implanted human chondrosarcoma OUMS-27 cells into nude mice that reproducibly produced tumors with cartilaginous matrix. Tumor-induced angiogenesis was evident when the tumors were excised 30 days after implantation. However, the local administration of recombinant human ChM-I almost completely blocked vascular invasion and tumor growth in vivo. Moreover, ChM-I also inhibited the growth of HT-29 colon adenocarcinoma in vivo, implying its therapeutic potential for solid tumors.

Expression of metalloproteinase-13 (Collagenase-3) is induced during fracture healing in mice

In fracture healing, a large amount of cartilage is formed, then rapidly replaced by osseous tissue. This process requires the transition of extracellular matrix component from type II to type I collagen. We investigated the expression of matrix metalloproteinase-13 (MMP-13), which has a high potential to cleave type II as well as type I collagen, during fracture repair in mouse ribs. In situ hybridization demonstrated that MMP-13 mRNA was present throughout the healing process. It was detected in the cells of the periosteum at day 1. As fracture callus grew, strong MMP-13 mRNA signals were detected in cells of the cartilaginous callus. In the reparative and remodeling phases, both hypertrophic chondrocytes and immature osteoblastic cells in the fracture callus expressed MMP-13 mRNA strongly. These cells were located adjacent to tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts at the sites of cartilage/bone transition. In osteoclasts, MMP-13 expression was not detected. The level of MMP-13 mRNA peaked at day 14 postfracture by northern blotting. Immunohistochemical staining showed that MMP-13 was detected primarily in hypertrophic chondrocytes. These results indicate that MMP-13 is induced during fracture healing. The site- and cell-specific expression of MMP-13 and its enzymatic property suggest that MMP-13 initiates the degradation of cartilage matrix, resulting in resorption and remodeling of the callus. In conclusion, MMP-13 plays an important role in the healing process of fractured bone in mice.

Solitary infantile myofibromatosis involving the clavicle

A rare case of solitary infantile myofibromatosis of bone is reported in the right clavicle of a 15-year-old boy. A radiograph demonstrated an osteolytic lesion with a sharp margin and a sclerotic rim. CT revealed a circumscribed lesion with slight expansion of the cortex. On MRI the lesion appeared isointense to muscle on T1-weighted images, bright on T2-weighted images, and showed marked gadolinium enhancement. The patient was well, without evidence of recurrence or metastasis, 4 years and 5 months following resection.

Structural mechanisms of bone loss in iliac biopsies: comparison between rheumatoid arthritis and postmenopausal osteoporosis

To assess the mechanisms that cause generalized osteoporosis in rheumatoid arthritis (RA), 40 postmenopausal women with RA (46-74 years) and 40 age-matched controls with osteopenia underwent iliac bone biopsies. A structural analysis of histomorphometry and two-dimensional strut analysis were performed. As compared to those with primary osteoporosis, there were a few unique characteristics in those with RA. Trabecular thickness and wall thickness declined with age, and this decline was especially accelerated by glucocorticoids. Decreased connectivity of the trabecular (Nd.Nd) was more prominent than the disappearance of the nodes. The connectivity of cortical bone to the nodes (Ct.Nd) and cortical thickness significantly decreased with age. With glucocorticoid therapy, the disappearance of the nodes was accelerated. In the case of vertebral compression fractures, the parameters of Nd.Nd and Ct.Nd significantly decreased. Although a bone biopsy is needed to analyze strut, this method is useful to evaluate the quality or intensity of the bone.

Is bone density in the distal femur affected by use of cement and by femoral component design in total knee arthroplasty?

The objective of this study was to evaluate changes in bone density in the distal femur 2 years after total knee arthroplasty with four different implant designs using cemented or cementless femoral components. Bone density was measured retrospectively from radiographs of 114 knees, using a densitometer. A decrease in bone density of up to 57% was identified in the distal femora with a cemented femoral component 2 years after surgery, compared with a decrease of up to 28% with a cementless, porous-coated component of the same design. The differences between the four implant designs in the changes in bone density in the anterior distal femur were significant at 2 years (P < 0.001). A possible cause of this result may be a difference in load transfer due to the different methods of fixation. The surgeon should expect decreased bone density in the distal femur at the time of revision surgery, especially with a cemented femoral component.

Histomorphometric assessment of bone changes in rats with type II collagen-induced arthritis

Numerous studies have demonstrated bone loss in rats following immobilization by tenotomy or nerve sectioning and following ovariectomy. However, few experiments have focused on bone change in rats with arthritis. We investigated bone loss in the proximal tibia and lumbar vertebra in rats with type II collagen-induced arthritis, an experimental model of rheumatoid arthritis, using histomorphometry. Bone loss in the early phase after immunization reflected a significant increase in numbers of osteoclasts and temporarily decreased bone formation. In the proximal tibia, near an arthritic joint, osteoclast numbers associated with bone trabeculae were increased four times over control numbers 4 weeks after immunization. In the lumbar vertebra, where arthritis was not shown, recruitment of osteoclasts occurred later than in the proximal tibia. With time, in both the proximal tibia and lumbar vertebra bone resorption normalized, but bone formation rate and double-label surface by tetracycline, a parameter reflecting bone formation, were increased above control values. We conclude that differences between the proximal tibia and lumbar vertebra probably reflected resumption of function as well as distance from areas of inflammation. These findings indicate that collagen-induced arthritis in rats is a useful model not only of autoimmunity, but also of juxta-articular and generalized osteoporosis in rheumatoid arthritis.

Molecular cloning of human chondromodulin-I, a cartilage-derived growth modulating factor, and its expression in Chinese hamster ovary cells

Bovine chondromodulin-I (ChM-I) purified from fetal cartilage stimulated the matrix synthesis of chondrocytes, and inhibited the growth of vascular endothelial cells in vitro. The human counterpart of this bovine growth regulating factor has not been identified. We report here the cloning of human ChM-I precursor cDNA and its functional expression in Chinese hamster ovary (CHO) cells. We first identified a genomic DNA fragment which encoded the N-terminus of the ChM-I precursor, and then isolated human ChM-I cDNA from chondrosarcoma tissue by PCR. The deduced amino acid sequence revealed that mature human ChM-I consists of 120 amino acids. In total, 16 amino acid residues were substituted in the human sequence, compared to the bovine counterpart. Almost of all the substitutions were found in the N-terminal hydrophilic domain. In the C-terminal hydrophobic domain (from Phe42 to Val120), the amino acid sequence was identical except for Tyr90, indicating a functional significance of the domain. Northern blotting and in situ hybridization indicated a specific expression of ChM-I mRNA in cartilage. We also successfully determined the cartilage-specific localization of ChM-I protein, using a specific antibody against recombinant human ChM-I. Multiple transfection of the precursor cDNA into CHO cells enabled us to isolate the mature form of human ChM-I from the culture supernatant. Purified recombinant human ChM-I stimulated proteoglycan synthesis in cultured chondrocytes. In contrast, it inhibited the tube morphogenesis of cultured vascular endothelial cells in vitro and angiogenesis in chick chorioallantoic membrane in vivo.

Cerebrospinal fluid nitric oxide metabolites in painful diseases

To elucidate the involvement of NO in pain transmission in humans, we measured NO metabolites (nitrite/nitrate) in the CSF of patients with painful diseases using an NO analyzer based on the Griess method. The nitrite/nitrate levels in patients with degenerative lumbar disease (DLD), but not those with fracture or appendicitis, were significantly higher than those in an age-matched control group. The duration of pain in the DLD group was much longer than that in the fracture or appendicitis group. The nitrite/nitrate levels in the middle-aged and elderly DLD patients depended on the duration of pain. These data probably suggest that the duration of pain is critical for the elevation in nitrite/nitrate levels.

Treatment with active vitamin D metabolites and concurrent treatments in the prevention of hip fractures: a retrospective study

The purpose of this study was to determine the effect of treatment with active vitamin D metabolites and other concurrent medication on the prevention of hip fractures in elderly women. We inspected the medical records of the entire female population over 65 years of age on Sado Island, and followed a total of 11,377 women for a 3-year period. Of these, 1208 osteoporotic patients were treated with either 1,25-(OH)2D3 or 1 alpha-(OH)D3. The 765 patients who received the minimum effective dosage for more than 6 months made up the 'treatment group'. Nearly half these patients were also treated with either calcitonin or calcium. The 443 patients who received treatment with active vitamin D metabolites, but at a dosage or for a duration that did not meet the criteria for the treatment group, were deemed the 'ineffective group'. The remaining 10,169 women were the 'non-treatment group'. Fractures in the non-treatment group occurred at a rate of 39.8 fractures/10,000 person-years. The rate in the treatment group was 10.8, which was significantly lower (p = 0.039). Interestingly, the fracture rate after ceasing treatment was 52.1, which was significantly higher (p = 0.002) than the rate in patients receiving treatment. No statistical differences in the fracture rate were found between the ineffective, non-treatment and post-treatment groups. A reduction in the fracture rate was observed only in the treatment subgroup that did not also receive calcitonin (p = 0.042), and not in the subgroup that also received calcitonin therapy (p = 0.333). However, there was no statistical difference in the hip fracture rates between these two subgroups (p = 0.157) and the actual number of fractures was minimal (0 vs 2). Therefore, in this study, the advantage of treatment with active vitamin D alone over combined treatment with calcitonin seems to be marginal.

IN CONCLUSION

(1) treatment with active vitamin D metabolites and with combined therapy may be marginally effective in preventing hip fractures, and (2) stopping the treatment clearly increases the risk of hip fractures.

Origin of histiocyte-like cells and multinucleated giant cells in malignant fibrous histiocytoma: neoplastic or reactive?

The origin of histiocyte-like cells in malignant fibrous histiocytoma (MFH) remains controversial. To determine whether histiocyte-like cells and multinucleated giant cells show reactive or neoplastic proliferation, we transplanted human storiform-pleomorphic MFH to nude mice and investigated the origin of histiocyte-like cells using the DNA in situ hybridization (ISH) system. In addition, we analyzed the mRNA expression of mouse c-fms and human colony stimulating factor-1 (CSF-1); immunohistochemical expression of markers detectable in cells of monocyte/macrophage lineage. The DNA ISH revealed neoplastic proliferation of fibroblastic cells and bizarre multinucleated giant cells of human origin. Monocyte/macrophage lineage cells were seen in parental tumors, whereas they did not participate in neoplastic proliferation in transplanted tumors. The parental tumors expressed human CSF-1 mRNA and the histiocyte-like cells in transplanted tumors expressed 'mouse' c-fms mRNA. These results suggest that MFH induce infiltration of monocyte/macrophage and CSF-1 is one of the mediators involved in this phenomenon, because the human CSF-1 can act as a ligand to the mouse c-fms. Histiocyte-like cells in MFH should be considered as a reactive monocyte/macrophage lineage rather than as an element of neoplasm.

Local effects of transforming growth factor-beta1 on rat calvaria: changes depending on the dose and the injection site

Transforming growth factor-beta1 (TGF-beta1) has opposite effects on osteoblastic cells in vitro, namely an inhibitory or stimulatory effect on cell differentiation. Because these effects are dependent on TGF-beta1 concentration or culture condition, we investigated whether the in vivo effects of TGF-beta1 on bone formation in infant rat calvaria were affected by the dose or the injection site. Human platelet-derived TGF-beta1 was injected subcutaneously onto the periosteal surface of parietal bone of 4-week-old rats at doses of 5 or 20ng/100microl per animal for 14 days, and the local effect on bone formation was examined by bone histomorphometry. TGF-beta1 treatment for 7 days decreased the mineral apposition rate, bone formation rate, and elongated mineralization lag time at the injection site. This change became more prominent when treatment continued for 14 days. These changes were restricted to the TGF-beta1-exposed area. Multiple subcutaneous injections of a relatively high dose (200ng/100microl per animal) of TGF-beta1 induced woven bone formation, in addition to marked inhibition of bone formation rate and prolongation of mineralization lag time. On the other hand, direct exposure of TGF-beta1 in the subperiosteal layer induced woven bone with periosteal cell proliferation even at a single injection of a low dose (5 or 50ng/25 microl) of TGF-beta1. In conclusion, the in vivo effects of TGF-beta1 on bone formation varied depending on its concentration and injection site. Also, subcutaneous injection of relatively low doses of TGF-beta1 inhibited local lamellar bone formation.

Number of osteoprogenitor cells in human bone marrow markedly decreases after skeletal maturation

Pluripotent mesenchymal stem cells in bone marrow differentiate to osteoblast progenitor cells. When the bone marrow cells are cultured in vitro, they form colony-forming units-fibroblastic (CFU-Fs) with exhibiting osteoblastic features such as expression of alkaline phosphatase (ALP) and formation of calcified nodules ex vivo. This article describes the effect of growth, maturation, and aging of the skeleton on human CFU-Fs harvested from human iliac bone marrow. Human bone marrow cells were harvested from the ilia of 49 women, and were cultured ex vivo for examination. The 49 subjects ranged in age from 4 to 88 years and were without metabolic bone disease. These aspirated bone marrow cells from human ilium exhibited osteoblastic phenotype such as alkaline phosphatase (ALP) activity, expression of osteocalcin (OSC) and parathyroid hormone-receptor (PTH-R) mRNA, and the formation of calcified nodules in vitro. The number of ALP-positive CFU-Fs and the ALP activity were quantified. The highest levels of ALP-positive CFU-Fs were observed in the young group, particularly in those under 10 years of age. The levels of ALP-positive CFU-Fs declined sharply after 10 years of age; those above 20 years of age exhibited a lower number of ALP-positive CFU-Fs, with a gradual decline with increasing age. These results indicate that change in the number of ALP-positive CFU-Fs may be associated with skeletal growth and maturation. The results also show that osteoblastic features such as ALP activity and capability of formation of calcification nodules were maintained even in the older subjects. These findings suggest that decreased activity of bone formation in the aged subjects could be, in part, caused by the decreased number of osteoprogenitor cells differentiating into osteoblasts because the number of ALP-positive CFU-Fs was one of the indices exhibiting bone-forming activity in the human marrow stromal cells.

Increase in the incidence of cervical and trochanteric fractures of the proximal femur in Niigata Prefecture, Japan

This study aimed to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1994 in Niigata Prefecture, Japan, and to compare this incidence with those previously reported in Niigata in 1985, 1987, and 1989. We visited all hospitals within Niigata Prefecture having an orthopedic department and reviewed the medical records and radiographs of all patients who sustained such fractures in 1994. The population of Niigata Prefecture was determined in 1994 to be 2,483,879 (1,205,151 males and 1,278,728 females). The population over 65 years of age was 428,795 (172,788 males and 256,007 females), representing 17.3% of the total population. In 1994, there were 1,468 cervical or trochanteric fractures in 378 males and 1,090 females, with a male-to-female ratio of 1:2.9. The incidence of these fractures in persons over 65 years of age was 304 fractures per 100,000 population per year. Of 528 cervical and 940 trochanteric fractures, the latter accounted for 64% of the total number. The age-specific incidence of the fractures in Niigata exhibited an exponential increase with age, similar to those reported in Sweden and the United States. However, the incidence was lower than in those countries. When comparing the number of cervical and trochanteric fractures in 1994 with the numbers reported in 1985, 1987, and 1989, it is evident that the overall number and incidence of these fractures has been increasing over this period. Even if the difference of the age-specific population among these years is adjusted, the fractures have been increasing.

Microstructure of the trabecula and cortex of iliac bone in primary hyperparathyroidism patients determined using histomorphometry and node-strut analysis

The purpose of this study was to use histomorphometry to compare the microstructure of trabecular and cortical bone in patients with primary hyperparathyroidism (PH) with that seen in osteoporosis. Histomorphometric and node-strut analyses of iliac bones were performed on 11 female patients with PH (61.3 +/- 8.0 years old) and 61 age-matched female patients with involutional osteoporosis (OP) (63.6 +/- 5.6 years old). Cancellous bone volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and wall thickness (W.Th) were not significantly different in these two groups. The bone formation rate (BFR) tended to be higher in the PH group than in the OP group. The number of nodes (N.Nd/TV) and node-to-node strut length (Nd.Nd/TV) were significantly higher in the PH group than in the OP group. The number of termini (N.Tm/TV) and terminus-to-terminus strut length/total strut length (Tm.Tm/TSL) were significantly lower in the PH group; cortical porosity was significantly higher in the PH group than in the OP group. No correlation was found between age and N.Nd in the PH group, but there was a negative correlation between age and N.Nd in the OP group. Our results show that trabecular connectivity was maintained while cortical porosity deteriorated in patients with PH compared with OP. These results suggest that there are microstructural differences between PH and OP in cancellous and cortical bone that result from the bone remodeling sequence in humans.

Effect of an intermittent weekly dose of human parathyroid hormone (1-34) on osteoporosis: a randomized double-masked prospective study using three dose levels

To test the effect of amino-terminal peptide 1-34 of human parathyroid hormone (hPTH (1-34)) as a possible bone anabolic agent in the treatment of osteoporosis, weekly subcutaneous injection of 50 units (L group), 100 units (M group) or 200 units (H group) of hPTH (1-34) was started in 220 patients with osteoporosis at 71 institutions randomly divided into three groups in a double-masked system. Lumbar spine bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) increased by 0.6%, 3.6% and 8.1% after 48 weeks in groups L, M and H respectively, responses in groups M and H being significantly higher than in L (p<0.05, Mann-Whitney U-test). Since the coefficient of variation for lumbar spine measurement stayed at 1-2.5%, increases of 3.6% and 8.1% appeared significant. Metacarpal BMD and cortical thickness measured by radiogrammetry did not change significantly. Serum calcium decreased in each group and serum phosphorus decreased in groups M and H. Urinary calcium/creatinine decreased at the 12th week in group H and at the 24th and 48th weeks in groups M and L. Serum 25(OH) vitamin D and 1,25(OH)(2) vitamin D decreased in each group at the 48th week (p<0.05). Serum bone-type alkaline phosphatase was increased at the fourth week in groups H and M and decreased at the 48th week in group H. Urinary hydroxyproline, pyridinoline and deoxypyridinoline declined significantly in each group. Backache improved in 30-40% of each group. No serious adverse effects were found during the test period. Intermittent weekly injection of hPTH (1-34) increased lumbar BMD in osteoporosis, suggesting usefulness in the treatment of osteoporosis.

Effects of human PTH(1-34) and bisphosphonate on the osteopenic rat model

It has been demonstrated that the intermittent administration of human parathyroid hormone (hPTH) is beneficial for restoration of bone mass in osteoporotic patients. The mechanisms of anabolic effects of hPTH have been determined by ovariectomized rat models and other larger remodeling animals. However, treatment with hPTH may increase the cancellous bone mass at the expense of cortical bone mass and cessation of the treatment results in rapid bone loss. Efforts have been made to maintain newly formed bone mass after withdrawal of the hPTH treatment. These issues are not well understood. In this article, the authors would like to represent previous studies of their own and others concerning these issues.

Gait analysis after total knee arthroplasty. Comparison of posterior cruciate retention and substitution

: The objective of this study was to measure three-dimensional knee motion during gait in patients with total knee replacements which either retained the posterior cruciate ligament (n = 11), or required sacrifice of the posterior cruciate ligament and replacement of its function with a posterior stabilizing articular surface (n = 9). Clinically meaningful translations (anterior and posterior, medial and lateral, proximal and distal) and rotations (flexion and extension, internal and external rotation, abduction and adduction) were measured using an instrumented spatial linkage. Although patients from both groups were able to achieve passive full extension and a minimum of 95 degrees flexion, some of their translations and rotations during free speed walking were consistently less than those in a group of healthy controls. Motion during the swing phase of gait was similar for both knee replacement groups. However, abduction and adduction and proximal and distal translation were larger (but neither difference was significant) for the patients with implants with a posterior stabilizing surface, which suggests that the stabilizing surface may not reliably provide as much stability in these directions as does retention of the posterior cruciate ligament.

Characterization and chemosensitivity of two human malignant peripheral nerve sheath tumour cell lines derived from a patient with neurofibromatosis type 1

Two new cell lines, designated NMS-2 and NMS-2PC, were established in vitro from a malignant peripheral nerve sheath tumour (MPNST) in the right thigh and a retroperitoneal lesion of a 30-year-old man with neurofibromatosis type 1 (NF1). The NMS-2 cell line was derived from the first tumour, and the NMS-2PC cell line from a retroperitoneal metastatic tumour detected 9 months later. Cultured NMS-2 cells showed epithelioid features, while NMS-2PC cells showed fibroblast-like features. However, both cell lines were strongly positive for S-100 protein. The transplanted NMS-2 and NMS-2PC tumours showed the same histological features typical of MPNST. Chromosomal analysis revealed that only the NMS-2 cells had a t (1;2) chromosomal translocation. Chemosensitivity tests demonstrated that NMS-2PC cells were far more sensitive than NMS-2 cells to Adriamycin and etoposide, which had been used clinically. All-trans-retinoic acid induced a morphological change in NMS-2PC cells so that they were no longer fibroblast-like, but epithelioid cells. We believe the epitheloid components in the MPNST were derived from typical spindle cells.

cAMP-dependent long-term potentiation of nitric oxide release from cerebellar parallel fibers in rats

Nitric Oxide (NO) is released from parallel fibers (PFs) after PF stimulation. NO-cGMP signaling is essential for long-term depression (LTD) in cerebellar PF-Purkinje cell synapses, which also exhibit presynaptic long-term potentiation (LTP) after tetanic PF stimulation. This LTP is dependent on cAMP but not NO-cGMP signaling. In this study, we analyzed long-term changes of NO release from PFs in rat cerebellar slices using electrochemical NO probes. Repetitive PF stimulation at 10 Hz for 2 sec elicited a transient increase in NO concentration (2.2 +/- 0.1 nM; mean +/- SEM; n = 116). This NO release exhibited long-term potentiation (LTPNO) by 36 +/- 3% (n = 15) after tetanic PF stimulation. Induction of LTPNO was not affected by Glu receptor antagonists. NO release from PFs was also potentiated by L-Arg (ARG) (100 microM), forskolin (50 microM), and 8-bromo-cAMP (Br-cAMP) (1 mM) but not by 1,9-dideoxyforskolin (50 microM), a biologically inactive analog of forskolin. The potentiation induced by forskolin was significantly suppressed by H89 (10 microM), a blocker of cAMP-dependent protein kinase. The potentiation induced by forskolin, but not that induced by Arg, interfered with LTPNO. H89 (10 microM) and KT5720 (1 microM), another blocker of cAMP-dependent protein kinase, but not KT5823 (300 nM), a blocker of cGMP-dependent protein kinase, significantly suppressed LTPNO. These data indicate that neural NO release is under activity-dependent control, just as synaptic transmitter release is. LTPNO might play a role in cross talk between presynaptic and postsynaptic plasticity by facilitating NO-cGMP-dependent postsynaptic LTD after induction of cAMP-dependent presynaptic LTP and LTPNO.

Ultrafine flexible spinal endoscope (myeloscope) and discovery of an unreported subarachnoid lesion

STUDY DESIGN

Introduction of a new diagnostic procedure and a report on its usefulness.

OBJECTIVES

To introduce a new endoscope (myeloscope) developed for the examination of the spinal canal and to present a previously unreported subarachnoid condition as a cause of paraparesis revealed by it.

SUMMARY OF BACKGROUND DATA

In spite of the availability of advanced imaging technology, there still exists a significant number of patients with spinal diseases in whom a diagnosis cannot be made. Direct visualization of the pathologic area is required in these patients. Recent advances in fiberoptics have made this possible.

METHODS

The endoscope consisted of a fiberscope with an external diameter of 0.5, 0.9, or 1.4 mm. It was inserted into the subarachnoid space in the lumbar spine and carefully advanced cranially. Since 1987, this examination has been performed on 18 patients aged 7 to 69 years who had pain or other neurologic symptoms of unknown origin.

RESULTS

The surface of the spinal cord, roots, properties of the arachnoid membrane, and small vessels could be observed clearly. The scope could be advanced as far as the upper cervical spine. Cotton-candy-like proliferation of fibrous tissue was identified by myeloscopy in four paraparetic patients who had clinical and radiologic features similar to those of a spinal cord herniation. The fibrous tissue beat on the spinal cord with the pulsation of the spinal fluid. Resection of the fibrous tissue with conventional surgery resulted in neurologic improvement. Complications included one case of meningitis in the early period and five cases of postspinal headache. No nerve injury was apparent.

CONCLUSIONS

Myeloscopy provides detailed information about the subarachnoid space and even reveals dynamic conditions that cannot be identified during open surgery or at autopsy. It will bring new concepts to the diagnosis of spinal diseases.

Effects of single and concurrent intermittent administration of human PTH (1-34) and incadronate on cancellous and cortical bone of femoral neck in ovariectomized rats

The purpose of this study is to determine the efficacy of concurrent treatment with human parathyroid hormone, hPTH (1-34), and bisphosphonate (incadronate) in augmenting cortical and cancellous bone mass of femoral neck in ovariectomized (OVX) rats. Forty-eight 11-week-old female Sprague-Dawley rats were divided into eight groups (six animals in each group). The baseline control group was killed at the beginning of the experiment, at 11 weeks of age. An ovariectomy was performed in thirty rats and twelve rats were subjected to a sham surgery. OVX rats were untreated for the first four weeks of postsurgery to allow for the development of moderate osteopenia. These animals were then subjected to various treatments with either PTH, incadronate, or PTH+ incadronate for a period of 4 weeks. Right proximal femora (femoral necks) were used for bone histomorphometry. After OVX 8 weeks, there was a significant decrease in cancellous bone mass and cortical bone area of femoral neck in the OVX rats when compared to the sham control rats. In OVX rats treated with PTH alone or PTH+ incadronate were completely restored lost cancellous and cortical bone mass of femoral neck by increase bone formation. The bone formation parameters (OS/ BS, MS/BS) and bone turnover (BFR/BV) seen with PTH plus incadronate were similar to those seen with PTH treatment alone. This indicates that incadronate did not blunt the anabolic action of PTH when used concurrently. Our results suggest the followings: 1) the femoral neck of OVX rats is a suitable sample site for preclinical studies of the prevention of bone loss induced by estrogen depletion; 2) concurrent use of incadronate did not blunt the anabolic effect of PTH; 3) concurrent treatment showed the best results in restoring cancellous and cortical bone mass; and 4) it had additional benefits for bone strength independent of that achieved by the increase in bone mass.

Origin of bone-forming cells in human osteosarcomas transplanted into nude mice--which cells produce bone, human or mouse?

Osteosarcomas are malignant tumours producing osteoid and/or bone. It is difficult to distinguish tumour bone formation from reactive, based on their morphological features alone. The objective of this study was two-fold: to clarify the origins of bone-forming cells in human osteosarcoma transplanted into nude mice; and to examine the role of bone morphogenetic proteins (BMPs) in the tumour-induced osteogenesis. DNA in situ hybridization was carried out with digoxigenin (DIG) polymerase chain reaction (PCR) labelled DNA probes for human-specific 'Alu' and mouse-specific 'mouse L1 (m-L1)' genes. Human osteosarcoma cells, established cell lines of NOS-1, NOS-2, and HuO9, were transplanted separately into nude mice. Bone-forming cells of the bone in the NOS-1 or NOS-2 tumours were positive for Alu, while they were negative for m-L1. The cells lining the surface of trabeculae in the HuO9 tumour were positive for Alu, but a few of them were also positive for m-L1. The m-L1-positive cells expressed mouse osteocalcin and type 1 collagen mRNAs. These facts suggest that the mouse cells were involved in osteoid synthesis of the HuO9 tumour. The NOS-1 or NOS-2 tumours expressed human BMP 2-7 mRNAs, whereas the HuO9 tumour expressed human BMPs 2, 4, 5, and 7. The osteogenetic potential of the tumours may depend on the expression patterns of BMPs. These results demonstrate two distinct types of bone formation, by tumour cells and by an admixture of tumour and non-tumour cells. The present study showed that the HuO9 tumour produces chimeric bone formation. This is the first report to demonstrate the relationships between tumour cells and non-tumour cells in bone formation, using genetic markers.

Rat tibial nerve regeneration after postoperative administration of cis-diaminedichloroplatinum

We investigated the results of postoperative administration of cis-diaminedichloroplatinum on nerve regeneration in rats. Forty-two Lewis rats were divided into two groups, receiving end-to-end suture or nerve grafting. Subgroups of the suture group included control, a one-time dose of cis-diaminedichloroplatinum (3 mg/kg), and four doses of the same amount of cis-diaminedichloroplatinum. Subgroups in the nerve grafting group included a control and a four-dose group. Functional recovery was measured by gait analysis using the tibial function index. Biopsies of nerve were taken distal to the suture site for histologic evaluation 20 weeks postoperatively. Tibial function index at 4, 6, and 20 postoperative weeks in the four-dose group was significantly inferior to that of the control group in the suture group. Tibial function index was inferior in the four-dose group until 10 weeks postoperatively compared with control in the nerve grafting group; however, there was no significant difference. The percentage of neural tissue in the one-dose suture group was significantly greater than in the four-dose suture group. These results suggest that postoperative cis-diaminedichloroplatinum administration may have a detrimental effect on nerve regeneration.

Increase of CD57+ T cells in knee joints and adjacent bone marrow of rheumatoid arthritis (RA) patients: implication for an anti-inflammatory role

The distribution of CD57+ T and CD56+ T cells in patients with RA was examined. In control osteoarthritis patients, these cells exist as a minor population in the peripheral blood. Our data show that in patients with RA, CD57+ T cell levels are elevated in peripheral blood, knee joint fluid, knee synovial membrane and bone marrow (BM), compared with peripheral blood of controls. CD57+ T cells are especially high in knee joint fluid and joint-adjacent BM, while CD56+ T cells show no such increase. CD57+ T cells contain a major population of CD8+ cells and higher proportions of CD4-8- cells and gammadelta T cells than do CD57- T cells. CD57+ T cells in peripheral blood and joint fluid increase with the duration of disease. Erythrocyte sedimentation rate (ESR) is inversely correlated with the proportion of CD57+ T cells in the joint fluid. Although RA frequently occurs in patients with CD3+57+ cell leukaemia, and some CD57+ T cells are likely to be involved in the onset of RA, we suggest that CD57+ T cells may rather suppress inflammation of RA, and other cellular components (e.g. granulocytes) may govern the severity of the inflammation of RA. These CD57+ T cells are probably generated extrathymically in the adjacent BM or joint space.

Effects of intermittent administration of low dose human PTH(1-34) on cancellous and cortical bone of lumbar vertebral bodies in adult beagles

This study assessed the effect of low dose human parathyroid hormone [hPTH(1-34)] administration on cancellous and cortical bone of lumbar vertebrae in intact male beagles. 16 19-20-month-old beagle dogs were randomized into four groups: in group 1, the vehicle control group, saline was injected daily; in group 2, the sequential group, 0.375 microg/kg of PTH was injected daily for 4 weeks, then off 8 weeks, and this sequence was once repeated for another 4 and 8 weeks; in group 3, the same dose of PTH was injected once per week for 24 weeks; and, in group 4, PTH was injected three times per week for 24 weeks. Histomorphometric assessment on cancelllous and cortical bone (both ventral and dorsal shell) and two-dimensional node-strut analysis were done on the fifth lumbar vertebral bodies after calcein double bone labeling. In intact adult beagles, on the group treated with 0.375 microg/kg per day three times per week (group 4): (1) had a higher mean value in cancellous bone formation parameters [osteoid surface (+74%), osteoid volume (twofold), mineral apposition rate (+21%), and bone formation rate (twofold)]; (2) exhibited no effect on cortical thickness and porosity in both the ventral and dorsal shell; and (3) showed a lower mean value of node to termini (0.11 +/- 0.02 vs. 0.22 +/- 0.09) and a higher mean value of cortex to node (0.18 +/- 0.06 vs. 0.08 +/- 0.02), but not in trabeculae to trabeculae node, than age-related controls. In conclusion, we found that a low dose of PTH administration: (1) stimulated cancellous bone formation; (2) improved connectivity of trabeculae joined to the cortex; (3) did not decrease cortical thickness; and (4) did not increase cortical porosity in both ventral and dorsal cortexal shell of the lumbar vertebrae during this dosage and period in intact male beagles.

A morphometric comparison of trabecular structure of human ilium between microcomputed tomography and conventional histomorphometry

Recently, an imaging technique using microcomputed tomography (micro-CT) has emerged as a method for nondestructively assessing the microarchitecture of unprocessed surgical bone biopsy specimens. Using micro-CT, two-dimensional (2D) axial images were obtained from undecalcified transiliac bone biopsies which were taken from 15 patients with various metabolic bone diseases. Total area, bone area, and bone perimeter were determined, from which the bone volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and trabecular separation (Tb.Sp) were calculated semiautomatically and instantaneously. To evaluate the validity of this technique as a useful tool, the results were compared with those obtained from conventional histomorphometry. There were significant correlations between the two techniques for all parameters, with correlation coefficients ranging from 0.759 (Tb.N, P < 0.005) to 0.949 (BV/TV, P < 0.0001). Different resolutions seem to lead to major differences in perimeter values measured by the two methods. These factors may explain why the correlation coefficients of Tb.N and Tb.Th estimated from the perimeter and area is lower than that of BV/TV. Our results show that the micro-CT based on 2D images is a useful tool for imaging and nondestructively quantifying the microarchitecture of trabecular bone in unprocessed surgical bone specimens.

Structural characteristics of the pedicle and its role in screw stability

STUDY DESIGN

Cross-sectional regional bone mineral density of the pedicle was measured by peripheral quantitative computed tomography. Biomechanical tests were performed to clarify the role of the pedicle in screw stability.

OBJECTIVES

To identify the structural characteristics of the pedicle that supports pedicle screw stability and the differences in these characteristics between normal and osteoporotic vertebrae.

SUMMARY OF BACKGROUND DATA

The pedicle screw is an essential component of many systems used to align the spine. The contribution of the pedicle to screw stability, however, has not been fully investigated.

METHODS

Trabecular, subcortical, and cortical bone mineral density and the area of the pedicle were measured by peripheral quantitative computed tomography. Bone mineral density also was recalculated in four circumferential layers. These parameters were compared between normal and osteoporotic individuals. The relative contribution of the pedicle to screw stability was evaluated by caudocephalad and pull-out loading in a vertebra with or without its body.

RESULTS

Inner trabecular, middle subcortical, and outer cortical bone mineral density and cortical bone area in the pedicle were significantly lower in osteoporotic vertebrae than those in normal vertebrae. In the pedicle, bone mineral density increased close to the outer layer. Bone mineral density not as thick even in the outer layer in osteoporotic subjects. Approximately 80% of the caudocephalad stiffness and 60% of the pullout strength of the pedicle screw depended on the pedicle rather than on the vertebral body.

CONCLUSION

Screw stability depends on the structural characteristics of the pedicle. The pedicle was denser in the subcortical bone, in which the threads of the screw engage, than in trabecular bone. In osteoporosis, bone mineral density was not as dense even in the outer layer, and the cortex was thinner than normal. A larger screw would not enhance screw stability and may break the thin cortex in osteoporotic vertebrae.

Neovascularization induced by anulus and its inhibition by cartilage endplate. Its role in disc absorption

STUDY DESIGN

A study of neovascularization with respect to the anulus and the endplate.

OBJECTIVES

To determine the ability of the anulus and the endplate to induce neovascularization and to study the effect of the endplate on the neovascularizing activity of the anulus.

SUMMARY OF BACKGROUND DATA

Previous studies showed that herniations contain varying amounts of nucleus pulposus, anulus fibrosus, and endplate. Results of recent studies have shown preferential neovascularization around the herniated anulus rather than the endplate.

METHODS

Human L4-L5 discs were harvested from three specimens. In the left cornea of New Zealand White rabbits, an anulus (AF group) or an endplate (EP group) was implanted 4 mm from the superior corneoscleral limbus. In a third group (AF and EP group), an endplate was implanted between the anulus and the limbus. Twelve assays were done for each group. Sham surgeries were done on a fourth group as a control. Neovascularization was monitored by stereomicroscopy and scored from 0 (no neovascularization) to +5 (capillaries growing around the implant). Histologic studies were done at weekly intervals.

RESULTS

In the AF group, the anulus induced neovascularization in 11 or 12 corneas. By the third week, the anulus appeared thinner, and the newly formed vessels regressed. In the EP group, only two corneas showed neovascularization; 10 corneas showed no vascularization. In the AF and EP group, three corneas showed no neovascularization, seven had sustained neovascularization, and two had vascularization. In the corneas containing the endplates, the implants remained unchanged. Control corneas did show vascularization. Histologic sections showed that neovascularization and cell infiltration were most abundant in the AF group, followed by the AF&EP and the EP groups.

CONCLUSION

The reactions to anulus fibrosus and to cartilage endplate differ. Anulus fibrosus may contain soluble substances that induce neovascularization, leading to its degradation and absorption. Cartilage endplate fails to induce neovascularization or diminishes the neovascular response, preventing its degradation. Disc herniations that contain a significant amount of endplate may not be degraded nor absorbed, leading to failure in spontaneous remission of symptoms.

Periosteal chondrosarcoma invading the medullary cavity

We present a case of periosteal chondrosarcoma of the femur, in which a tumor invaded the medullary cavity and the lesion was clearly demonstrated only on MRI. To the best of our knowledge, there have been no previous reports of an intramedullary lesion caused by periosteal chondrosarcoma demonstrated on MRI.

Osteosynthesis without instrumentation for vertebral pseudarthrosis in the osteoporotic spine

We have performed simple bone grafting in four elderly patients with pain due to unstable pseudarthroses in the osteoporotic spine after compression fracture. At operation, we observed abnormal movement of the affected vertebral body which was covered with a hypertrophic membrane; this seemed to inhibit the blood supply to the lesion. The thick membrane and avascular granulation in the false joint were excised and bone grafting carried out. Symptoms were dramatically improved immediately after operation and bony union was confirmed in the three surviving patients.

OSTEOSYNTHESIS WITHOUT INSTRUMENTATION FOR VERTEBRAL PSEUDARTHROSIS IN THE OSTEOPOROTIC SPINE

We have performed simple bone grafting in four elderly patients with pain due to unstable pseudarthroses in the osteoporotic spine after compression fracture.

At operation, we observed abnormal movement of the affected vertebral body which was covered with a hypertrophic membrane; this seemed to inhibit the blood supply to the lesion. The thick membrane and avascular granulation in the false joint were excised and bone grafting carried out. Symptoms were dramatically improved immediately after operation and bony union was confirmed in the three surviving patients.

An experimental study of a combination method using a pedicle screw and laminar hook for the osteoporotic spine

STUDY DESIGN

Using human cadaver spines, the authors compared the effect of using a combination of pedicle screw and laminar hook on the same vertebra with that of using a pedicle screw alone in reference to bone mineral density of the vertebra under nondestructive cyclic loading.

OBJECTIVES

To quantify stiffness obtained by pedicle screw alone and by the combination method and to clarify a relationship between stiffness obtained by each instrumentation method and bone mineral density of the vertebra.

SUMMARY OF BACKGROUND DATA

The use of pedicle screws apparently improves the union rate of spinal fusion. Instrumentation failures sometimes occur, however, such as loosening or loss of correction of the spine, especially in patients with osteoporosis. Some augmentation method in instrumentation is necessary to overcome bone fragility in the osteoporotic spine.

METHODS

Thirteen cadaver lumbar vertebrae were used for this study. Bone mineral density was measured by dual-energy X-ray absorptiometer. After separating each vertebrae, the pedicle screw was screwed into a vertebra. Five cycles of cephalocaudal loading were performed to the shank of the screw with a cross-head speed of 3 mm/min under a maximum load control of 29.4 N using an Instron type testing machine, and the stiffness obtained with the pedicle screw (Kj) was calculated from the load-deformation curve. Then, a laminar hook was set and connected to the screw via a rod. Mechanical testing was performed in the same way, and the stiffness obtained with the combination method (Kf) was determined. Kj and Kf were compared using the paired t test. The relationship between Kj, Kf, or the stiffness improvement ratio ([Kf-Kj]/Kj) by the combination method and bone mineral density was analyzed by linear regression analysis.

RESULTS

Stiffness obtained by the combination method was significantly greater than that obtained by pedicle screw alone (89.8 +/- 35.0 N/mm by the combination method, 60.2 +/- 19.6 N/mm by pedicle screwing alone; P < 0.0001). Stiffness, whether obtained by pedicle screw alone or by the combination method, was positively correlated with bone mineral density (with pedicle screw alone, R2 = 0.614, P < 0.0001; with the combination method, R2 = 0.645, P < 0.0001). However, there was no significant correlation between stiffness improvement ratio and bone mineral density.

CONCLUSION

Instrumentation stiffness obtained by the combination method was significantly greater than that obtained by the use of pedicle screw alone. There was no significant correlation between the improvement ratio by the combination method and bone mineral density. These results suggest that the combination method is valuable irrespective of the presence of spinal osteoporosis.

Vascularized iliac bone graft for avascular necrosis of the femoral head

This is a followup study of 31 hips in 24 patients from 2 to 11 years after receiving a vascularized iliac bone graft for nontraumatic avascular necrosis of the femoral head. The clinical results according to the Merle d'Aubigne score were satisfactory in 24 (77%) of the hips, whereas the radiographic success rate for all hips was 58%. The extent of the lesion as shown on anteroposterior radiographs was predictive of the eventual outcome. Seven (39%) of 18 hips with a lateral type lesion had satisfactory results, whereas 11 (85%) of 13 hips with a medial type lesion had satisfactory results. All of the hips with a medial type lesion and a lateral head index of greater than 12% had satisfactory results. For the success of this procedure, the lateral buttress of the normal portion in the femoral head was necessary.