Discovery of Novel 11-Membered Templates as Squalene Synthase Inhibitors

Squalene synthase is one of the most promising pharmaceutical targets to treat hyperlipidemia. Inhibition of the squalene synthase causes a decrease in the hepatic cholesterol concentration. We have already reported the design and synthesis of highly potent benzhydrol-type squalene inhibitors. Although these templates showed unique and potent cyclic active conformations via intramolecular hydrogen bonds, the in vivo cholesterol-lowering efficacy was insufficient. We attempted to improve their potential as an orally active medicine. In our medicinal chemistry effort, cyclized 11-membered ring templates were acquired. The novel series of compounds exhibited potent squalene synthase inhibitory activity, and one of the derivatives, isomer A-(1S, 3R)-14i, showed plasma lipid-lowering efficacy in hamster and marmoset repeated-dose studies. Our findings provide valuable insights into the design and development of novel and unique 11-membered ring-type highly potent squalene synthase inhibitors.

Discovery of 1-[2-(1-methyl-1H-pyrazol-5-yl)-[1,2,4]triazolo[1,5-a]pyridin-6-yl]-3-(pyridin-4-ylmethyl)urea as a potent NAMPT (nicotinamide phosphoribosyltransferase) activator with attenuated CYP inhibition

Nicotinamide phosphoribosyltransferase (NAMPT) catalyzes the rate-limiting step of the NAD⁺ salvage pathway. Since NAD⁺ plays a pivotal role in many biological processes including metabolism and aging, activation of NAMPT is an attractive therapeutic target for treatment of diverse array of diseases. Herein, we report the continued optimization of novel urea-containing derivatives which were identified as potent NAMPT activators. Early optimization of HTS hits afforded compound 12, with a triazolopyridine core, as a lead compound. CYP direct inhibition (DI) was identified as an issue of concern, and was resolved through modulation of lipophilicity to culminate in 1-[2-(1-methyl-1H-pyrazol-5-yl)-[1,2,4]triazolo[1,5-a]pyridin-6-yl]-3-(pyridin-4-ylmethyl)urea (21), which showed potent NAMPT activity accompanied with attenuated CYP DI towards multiple CYP isoforms.

Discovery of DS68702229 as a Potent, Orally Available NAMPT (Nicotinamide Phosphoribosyltransferase) Activator

Nicotinamide phosphoribosyltransferase (NAMPT) catalyzes the rate-limiting step of the nicotinamide adenine dinucleotide (NAD+) salvage pathway. Because NAD+ plays a pivotal role in energy metabolism and boosting NAD+ has positive effects on metabolic regulation, activation of NAMPT is an attractive therapeutic approach for the treatment of various diseases, including type 2 diabetes and obesity. Herein we report the discovery of 1-(2-phenyl-1,3-benzoxazol-6-yl)-3-(pyridin-4-ylmethyl)urea 12c (DS68702229), which was identified as a potent NAMPT activator. Compound 12c activated NAMPT, increased cellular NAD+ levels, and exhibited an excellent pharmacokinetic profile in mice after oral administration. Oral administration of compound 12c to high-fat diet-induced obese mice decreased body weight. These observations indicate that compound 12c is a promising anti-obesity drug candidate.

Joint Space of the Human Knee and Hip Joint under a Static Load

In order to study the joint contact and joint space of statically loaded human knee and hip joints, observations of serial slices of joint specimens which were frozen during the application of a load were carried out. In the intact joints, the articular cartilage surfaces did not come into direct contact with each other even under a load of more than twice that of the body weight. The minimum distance between cartilage surfaces in each specimen ranged from 0.2 to 0.6 mm. The Indian ink which was injected into the joints before the load application was squeezed out of some areas of the remaining joint space, but a dye-free fluid apparently remained in this space.

Based on our findings, the definition of joint contact and the lubrication mechanism in the intact human joint have been discussed.

Discovery of DF-461, a Potent Squalene Synthase Inhibitor

We report the development of a new trifluoromethyltriazolobenzoxazepine series of squalene synthase inhibitors. Structure-activity studies and pharmacokinetics optimization on this series led to the identification of compound 23 (DF-461), which exhibited potent squalene synthase inhibitory activity, high hepatic selectivity, excellent rat hepatic cholesterol synthesis inhibitory activity, and plasma lipid lowering efficacy in nonrodent repeated dose studies.

Embolisation of the right gastric artery in patients undergoing hepatic arterial infusion chemotherapy using two possible approach routes

We used a retrospective non-randomised study to investigate the clinical effect of selective embolisation of the right gastric artery before hepatic arterial infusion chemotherapy (HAIC) using a port-catheter system. We evaluated whether the hepatic artery or the left gastric artery is the better approach for selecting the right gastric artery. A total of 367 patients (244 men and 123 women; mean age, 64.1 years) with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system. In 294 of these patients, right gastric arterial embolisation with microcoils was attempted before placement of the port-catheter system to prevent gastric mucosal lesions. Approach was either through the hepatic artery (175 patients) or through the left gastric artery (119 patients), with success rates in catheterising the right gastric artery of 78.3% and 77.3%, respectively. If the attempt was unsuccessful, the catheter was redirected to the alternative approach, which increased the final success rate to 96.3%. Only seven patients experienced gastroduodenal mucosal lesions acutely after HAIC, as revealed by endoscopy. Embolisation of the right gastric artery is a feasible procedure that can reduce the incidence of gastric mucosal lesions associated with HAIC. Approach through either the hepatic artery or the left gastric artery is equally acceptable.

DGAT1-dependent triacylglycerol storage by macrophages protects mice from diet-induced insulin resistance and inflammation

Diet-induced obesity (DIO) leads to inflammatory activation of macrophages in white adipose tissue (WAT) and subsequently to insulin resistance. PPARgamma agonists are antidiabetic agents known to suppress inflammatory macrophage activation and to induce expression of the triacylglycerol (TG) synthesis enzyme acyl CoA: diacylglycerol acyltransferase 1 (DGAT1) in WAT and in adipocytes. Here, we investigated in mice the relationship between macrophage lipid storage capacity and DIO-associated inflammatory macrophage activation. Mice overexpressing DGAT1 in both macrophages and adipocytes (referred to herein as aP2-Dgat1 mice) were more prone to DIO but were protected against inflammatory macrophage activation, macrophage accumulation in WAT, systemic inflammation, and insulin resistance. To assess the contribution of macrophage DGAT1 expression to this phenotype, we transplanted wild-type mice with aP2-Dgat1 BM. These mice developed DIO similar to that of control mice but retained the protection from WAT inflammation and insulin resistance seen in aP2-Dgat1 mice. In isolated macrophages, Dgat1 mRNA levels correlated directly with TG storage capacity and inversely with inflammatory activation by saturated fatty acids (FAs). Moreover, PPARgamma agonists increased macrophage Dgat1 mRNA levels, and the protective effects of these agonists against FA-induced inflammatory macrophage activation were absent in macrophages isolated from Dgat1-null mice. Thus, increasing DGAT1 expression in murine macrophages increases their capacity for TG storage, protects against FA-induced inflammatory activation, and is sufficient to reduce the inflammatory and metabolic consequences of DIO.

Role of manual aspiration in treating pneumothorax after computed tomography-guided lung biopsy

BACKGROUND

Pneumothorax is the most common complication after computed tomography (CT)-guided lung biopsy. The presence of a pneumothorax per se does not complicate patient management, but an increasing pneumothorax, making chest tube placement necessary, is highly problematic.

PURPOSE

To evaluate the efficacy and limitations of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy.

MATERIAL AND METHODS

The subjects of our study were 642 consecutive lung lesions in 594 patients for which percutaneous needle lung biopsies were performed using CT guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all patients with a non-small pneumothorax demonstrated on post-biopsy chest CT images. The frequency of pneumothorax, management of each such case, and factors influencing the incidence of worsening pneumothorax that finally required chest tube placement were evaluated.

RESULTS

Post-biopsy pneumothorax occurred in 243 of 642 (38%) procedures. Of the 243 cases, 112 were treated with manual aspiration immediately after biopsy. In 210 (86.4%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only 33 patients required chest tube placement. Requirement of chest tube insertion significantly increased in parallel with the degree of pneumothorax as shown on post-biopsy CT images. The rate of chest tube insertion was statistically higher in subjects with values for aspirated air above 543 ml.

CONCLUSION

Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent worsening of pneumothorax and avoid chest tube placement. The amount of aspirated air can be predictive of the requirement for chest tube placement.

Functional genomic screen reveals genes involved in lipid-droplet formation and utilization

Eukaryotic cells store neutral lipids in cytoplasmic lipid droplets enclosed in a monolayer of phospholipids and associated proteins. These dynamic organelles serve as the principal reservoirs for storing cellular energy and for the building blocks for membrane lipids. Excessive lipid accumulation in cells is a central feature of obesity, diabetes and atherosclerosis, yet remarkably little is known about lipid-droplet cell biology. Here we show, by means of a genome-wide RNA interference (RNAi) screen in Drosophila S2 cells that about 1.5% of all genes function in lipid-droplet formation and regulation. The phenotypes of the gene knockdowns sorted into five distinct phenotypic classes. Genes encoding enzymes of phospholipid biosynthesis proved to be determinants of lipid-droplet size and number, suggesting that the phospholipid composition of the monolayer profoundly affects droplet morphology and lipid utilization. A subset of the Arf1-COPI vesicular transport proteins also regulated droplet morphology and lipid utilization, thereby identifying a previously unrecognized function for this machinery. These phenotypes are conserved in mammalian cells, suggesting that insights from these studies are likely to be central to our understanding of human diseases involving excessive lipid storage.

Case report: adenosquamous carcinoma of the liver successfully treated with repeated transcatheter arterial infusion chemotherapy (TACE) with degradable starch microspheres

This report describes a 58-year-old female with adenosquamous carcinoma (ASC) of the liver presenting with right lower abdominal pain. In most ASC of the liver, surgery is the first choice of treatment. However, surgery often seems to be ineffective because of the aggressive behaviour of this disease. At surgical laparotomy in the present case, there was a large tumour occupying the entire right lobe of the liver and invading the diaphragm. Thus, partial hepatectomy was performed. For the residual tumour, we performed repeated transcatheter arterial infusion chemotherapy with degradable starch microspheres (DSM). After four sessions of transcatheter arterial infusion chemotherapy, tumour size decreased remarkably and tumour markers had also decreased. Despite the poor prognosis, the patient remains alive and well 12 months after laparotomy. It is suggested that minimally invasive transcatheter infusion chemotherapy with DSM can be an effective treatment preserving a high quality of life.

An auto-tuning method for focusing and astigmatism correction in HAADF-STEM, based on the image contrast transfer function

An auto-tuning method for high-angle annular detector dark field scanning transmission electron microscopy (HAADF-STEM) is proposed which corrects the defocus to the optimum Scherzer focus and compensates the astigmatism. Because the method is based on the image contrast transfer function formulated for the HAADF-STEM, the defocus and the astigmatism are accurately measured from input of two different defocus images. The method is designed to work independent of object function in the linear imaging model by analysing the spectral ratio between two Fourier spectra of their images, which is useful for cases where the spectrum of object function is not uniformly spread out over the reciprocal space. The method was preliminarily tested in a Hitachi HD-2000 STEM, and successful results of the auto-tunings from the viewpoint of verification of the algorithm were obtained using general specimens of Au fine particles and a thin section of a semiconductor device.

Primary Charnley total hip arthroplasty: a comparison of American and Japanese cohorts followed for 10-20 years

Primary Charnley total hip arthroplasties (THAs) followed for 10 to 20 years were compared between an American (183 sockets and 178 femoral prostheses) and a Japanese (145 sockets and 148 femoral prostheses) series, each performed by a single surgeon at a single hospital using similar techniques. The primary etiology was developmental dysplasia of the hip (70%) in the Japanese series and primary osteoarthrosis (50%) in the American series. Radiographic socket survival was inferior in the Japanese series at 4- to 11-year follow-up, which was attributed mainly to the etiologic difference. The American patients had higher levels of postoperative activity and developed more accelerated polyethylene wear, which may lead to an increased loosening rate of sockets > or = 10 years after THA. The American series had higher rates of femoral revision at > or = 9 years follow-up, which was attributed mainly to lower canal flare indices in that series.

The N-glycan acceptor specificity of a glucuronyltransferase, GlcAT-P, associated with biosynthesis of the HNK-1 epitope

The acceptor specificity of a rat brain glucuronyltransferase, GlcAT-P, associated with biosynthesis of the HNK-1 epitope on glycoproteins, was investigated using asialoorosomucoid as a model acceptor substrate. Structural analysis of N-linked oligosaccharides, to which glucuronic acid was transferred by GlcAT-P, by means of two-dimensional mapping of pyridylamino-oligosaccharides and MS spectrometry, demonstrated that the enzyme transferred glucuronic acid to bi-, tri-, and tetra-antennary complex type sugar chains, with almost equal efficiency, indicating that the enzyme has no preference as to the number of acceptor sugar branches. Next, we studied the branch specificity of this enzyme by means of the selective branch scission method involving two step exoglycosidase digestion using authentic pyridylamino-oligosaccharides. The GlcAT-P is highly specific for the terminal N-acetyllactosamine structure and no glucuronic acid was incorporated into a Galbeta1-3GlcNAc moiety. The GlcAT-P transferred glucuronic acid to the galactose residues in the N-acetyllactosamine branches of bi-, tri-, and tetra-antennary oligosaccharide chains, with different efficiencies and most preferentially to those in the Galbeta1-4GlcNAcbeta1-4Manalpha1-3 branch.

Nasal NK/T cell lymphoma presenting as transverse myelopathy

A case of nasal NK/T cell lymphoma with central nervous system (CNS) involvement is reported. A 56-year-old man presented with eyelid edema and transverse myelopathy. Cerebrospinal fluid examination revealed atypical lymphoid cells with azurophilic granules, which were positive for CD2, CD8, and CD56, and negative for CD3 and CD5 by flow cytometry. Because a tumor mass was found involving the ethmoid and maxillary sinuses, CNS involvement was considered to have resulted from local invasion by the nasal lymphoma. In spite of intensive chemotherapy including intrathecal infusion, the patient died 6 months after the initial diagnosis. Autopsy revealed that lymphoma cells were positive for cytotoxic molecules, granzyme B and TIA-1, and EB virus-encoded RNA-1 (EBER-1), and they showed no rearrangement of TCR-beta, -gamma, or -delta genes, suggesting an NK-cell origin of the lymphoma cells. They showed an angiocentric and angiodestructive pattern in the subarachnoid space, focally extending to the cerebral cortex and cranial and spinal nerve roots. Marked demyelination was found in the lateral and posterior funiculi of the spinal cord. Thus, the pathogenesis of this spinal demyelination might be attributed to ischemia secondary to angiocentric and angiodestructive infiltration by lymphoma cells.

Bamboo-joint-like appearance of the stomach: a histopathological study

A bamboo joint-like (BJL) appearance is an endoscopic finding characterized by swollen longitudinal folds transversed by erosive fissures or linear furrows, and it seems to be associated with Crohn's disease (CD). We performed gastroduodenoscopy in 1781 patients, and found BJL lesions in 15 (65.2%) of 23 CD patients and 20 (1.1%) of 1758 non-CD patients. Histological examination of the biopsy specimens showed sharp, fissure-like erosion or mucosal cleft in 7 (50%) out of 14 CD patients and one (20%) out of 5 non-CD patients. All cases with fissure-like erosion or, mucosal cleft revealed lymphoid aggregates, eosinophilic infiltration and edema in the superficial portion of the surrounding lamina propria. Epithelioid granuloma was seen at the base of the fissure-like erosion in two cases with CD. Our results indicated that fissure-like erosion or mucosal cleft in gastric biopsy specimens reflects the BJL appearance, and that such findings may provide a diagnostic clue to CD.

Solitary fibrous tumor of the spinal cord. Report of a case with scrape cytology

BACKGROUND

Solitary fibrous tumor is a rare spindle cell tumor and has been forced at a variety of sites. To the best of our knowledge, only two cases of solitary fibrous tumor arising in the spinal cord have been reported; no cytologic findings were documented.

CASE

A 62-year-old male presented with a spinal cord tumor. A scrape smear of the resected tumor revealed naked, spindle-shaped nuclei. Some nuclei were twisted or had long spindles. In the background, abundant, thin and thick collagen fibers were present. Immunohistochemically, the spindle cells were positive for CD34 and negative for S-100 protein and alpha-smooth muscle actin. Histologic diagnosis of the tumor was benign solitary fibrous tumor.

CONCLUSION

Our case indicates that solitary fibrous tumor can occur in the spinal cord and should be differentiated from other benign spindle cell tumors, such as meningioma and schwannoma. The key cytologic features of solitary fibrous tumor may be the presence of abundant thin and thick collagen fibers in scrape specimens.

Molecular cloning and expression of a second glucuronyltransferase involved in the biosynthesis of the HNK-1 carbohydrate epitope

A cDNA encoding a novel glucuronyltransferase was cloned from a rat brain cDNA library. The cDNA sequence contained an open reading frame encoding 324 amino acids, with type II transmembrane topology. The amino acid sequence revealed 49% homology to rat GlcAT-P, a glucuronyltransferase involved in the biosynthesis of the HNK-1 carbohydrate epitope of glycoproteins, [Terayama et al. (1997) Proc. Natl. Acad. Sci. USA 94, 6093-6098] and the highest sequence homology was found in the catalytic region. Northern blot analysis indicated that this newly cloned glucuronyltransferase is expressed in the nervous system, consistent with the selective localization of the HNK-1 carbohydrate epitope in the nervous system. Transfection of this cDNA into COS-1 cells induced the expression of the HNK-1 carbohydrate epitope on cell surfaces, and induced the morphological changes in these cells. These results indicated that this newly cloned cDNA is a second glucuronyltransferase involved in the biosynthesis of the HNK-1 carbohydrate epitope.

Purification and characterization of a glucuronyltransferase involved in the biosynthesis of the HNK-1 epitope on glycoproteins from rat brain

The glucuronyltransferase involved in the biosynthesis of the HNK-1 epitope on glycoproteins was purified to an apparent homogeneity from the Nonidet P-40 extract of 2-week postnatal rat forebrain by sequential chromatographies on CM-Sepharose CL-6B, UDP-GlcA-Sepharose 4B, asialo-orosomucoid-Sepharose 4B, Matrex gel Blue A, Mono Q, HiTrap chelating, and HiTrap heparin columns. The purified enzyme migrated as a 45-kDa protein upon SDS-polyacrylamide gel electrophoresis under reducing conditions, but eluted as a 90-kDa protein upon Superose gel filtration in the presence of Nonidet P-40, suggesting that the enzyme forms homodimers under non-denatured conditions. The enzyme transferred glucuronic acid to various glycoprotein acceptors bearing terminal N-acetyllactosamine structure such as asialo-orosomucoid, asialo-fetuin, and asialo-neural cell adhesion molecule, whereas little activity was detected to paragloboside, a precursor glycolipid of the HNK-1 epitope on glycolipids. These results suggested that the enzyme is specifically associated with the biosynthesis of the HNK-1 epitope on glycoproteins. Sphingomyelin was specifically required for expression of the enzyme activity. Stearoyl-sphingomyelin (18:0) was the most effective, followed by palmitoyl-sphingomyelin (16:0) and lignoceroyl-sphingomyelin (24:0). Interestingly, activity was demonstrated only for sphingomyelin with a saturated fatty acid, i.e. not for that with an unsaturated fatty acid, regardless of the length of the acyl group.

Macrofollicular variant of papillary thyroid carcinoma. Report of a case with fine needle aspiration biopsy findings

BACKGROUND

Macrofollicular variant of papillary thyroid carcinoma is defined as a combination of numerous macrofollicles occupying 50% of the tumor and foci of the conventional follicular variant of papillary carcinoma. To the best of our knowledge, there have been no English-language reports on its cytologic findings.

CASE

A fine needle aspiration specimen from a mass of the thyroid in a 59-year-old female showed a large collection of dense, inspissated colloid and a few sheets of tumor cells with nuclei characteristic of papillary carcinoma. There were no three-dimensional, branching papillae with fibrovascular cores.

CONCLUSION

Although macrofollicular variant of papillary carcinoma is very rare, fine needle aspiration cytology may contribute to its correct diagnosis.

Sertoli cell tumor of the testis. Report of a case with imprint cytology findings

BACKGROUND

Sertoli cell tumor of the testis is a relatively rare neoplasm, and few reports concerning its cytologic findings have been previously documented.

CASE

A 41-year-old male had Sertoli cell tumor in the left testis. An imprint smear revealed tumor cells showing a less cohesive or singly dispersed cell pattern. The cytoplasm was faintly stained, and most tumor cells were naked. The nuclei were oval or short and spindle in shape, and some of them showed coffee bean nuclei or nuclear indentation.

CONCLUSION

Coffee bean nuclei can be observed in Sertoli cell tumor.

Sarcomatoid renal cell carcinoma with chromophobe cell foci. Report of a case

We report a case of sarcomatoid renal cell carcinoma with chromophobe cell foci. The patient was a 57-year-old Japanese woman with a renal mass measuring 12x8x8 cm in diameter. Histologically, the tumor was composed predominantly of sarcomatoid renal cell carcinoma with foci of chromophobe cell carcinoma. The patient died of multiple metastases 2 months after operation. To the best of our knowledge, there have been only two reports of the coexistence of sarcomatoid renal cell carcinoma and chromophobe renal cell carcinoma in the literature. Our case indicates that chromophobe cell carcinoma may be connected with sarcomatoid renal cell carcinoma. In such a case, the prognosis may be related to the latter component.

Sclerosing lipogranuloma of the scrotum: report of a case with fine needle aspiration biopsy findings

BACKGROUND

Sclerosing lipogranuloma of the scrotum is a rare granulomatous lesion of the subcutis. To the best of our knowledge, there have been no English-language reports dealing with its cytologic findings.

CASE

A fine needle aspiration specimen from a mass in the scrotum in a 62-year-old male showed epithelioid cells, multinucleated giant cells and fibroblasts, which were suggestive of sclerosing lipogranuloma. The diagnosis was confirmed by histology of the resected specimen.

CONCLUSION

Fine needle aspiration cytology is useful for the diagnosis of sclerosing lipogranuloma. It is important, however, to interpret the fine needle aspiration cytology specimen in conjunction with the clinical information.

Papillary carcinoma of the thyroid with exuberant nodular fasciitis-like stroma

We describe a rare case of papillary carcinoma with extensive proliferation of stromal cells. The stromal cells were immunocytochemically positive for vimentin, alpha-smooth muscle actin and desmin, but negative for cytokeratin, epithelial membrane antigen, S-100, thyroglobulin and CD34. These results and the ultrastructure of the stromal cells, which exhibited the characteristics of both fibroblasts and smooth muscle cells, indicated an origin from myofibroblasts. We conclude that myofibroblastic proliferation may contribute to the stromal response in the slow growth of the papillary carcinoma.

Cloning and functional expression of a novel glucuronyltransferase involved in the biosynthesis of the carbohydrate epitope HNK-1

The HNK-1 carbohydrate epitope is characteristically expressed on a series of cell adhesion molecules and also on some glycolipids in the nervous system over a wide range of species from insect to mammal. The HNK-1 epitope is involved in cell-cell and/or cell-substrate interaction and recognition during the development of the nervous system. In this study, we isolated a novel glucuronyltransferase from rat brain, which is a key enzyme of the biosynthesis of the HNK-1 epitope on glycoproteins. Based on the partial amino acid sequences, we isolated cDNA encoding the glucuronyltransferase. The primary structure deduced from the cDNA sequence predicted a type II transmembrane protein with 347 amino acids and had no detectable similarity with any other proteins of known functions, including glucuronyltransferases of the liver and olfactory epithelium. Expression of a soluble recombinant form of the enzyme in COS-1 cells produced an active glucuronyltransferase. The selective expression of the glucuronyltransferase gene in the nervous system was consistent with the almost exclusive localization of the HNK-1 epitope in the nervous system. Transfection of the glucuronyltransferase cDNA into COS-1 cells induced not only expression of the HNK-1 epitope on the cell surface but also marked morphological changes of the cells, suggesting that the HNK-1 epitope associates with the cell-substratum interaction.

Comparative study of total hip arthroplasty between younger and older patients

Ten- to 20-year (average, 14 years) results of primary Charnley low friction arthroplasties performed in patients 50 years of age or younger (55 sockets and 53 femoral prostheses) were compared with those in patients older than 50 years (273 sockets and 273 femoral prostheses). The incidence of radiologic loosening of the socket, including revision cases, was higher in the younger (29.1%) than in the older patients (14.3%). The revision rate for aseptic loosening of the socket was higher in the younger (20%) than in the older group (4%). This poor performance of the socket may be attributable to the higher incidences of rheumatoid diseases and accelerated polyethylene wear in the younger patients. In contrast, only 3.8% of the femoral prostheses were radiologically loose, and none of them were revised in the younger patients. These figures were comparable with those in the older patients. Quality of structure of bone available for implant fixation may be important for the durability of the arthroplasty. It was considered inferior on the acetabular side and better on the femoral side in the younger patients than in the older. Continued use of the cemented Charnley femoral prostheses can be justified in young patients, although further research is required for the socket problem.

Long term bone remodeling around the Charnley femoral prostheses

Femoral bone remodeling after total hip replacement was studied by following patients who received 326 Charnley femoral prostheses for 10 to 20 years (mean, 13.3 years). The radiographic state of the bone remodeling was visually assessed and measured with a digitizer. Demineralization that started proximally and then progressed distally caused cortical thinning, which correlated with widening of the intramedullary canal, not with changes that developed in the periosteal width, and occurred in the medial femoral neck, around the proximal half of the stem, and around the distal half in 87%, 33%, and 10%, respectively. Cortical thinning around the distal half of the stem was always accompanied by proximal thinning, and extensive cortical thinning (both proximal and distal) correlated with both lower clinical scores and radiologic loosening of the femoral prosthesis. A low canal flare index of Noble, a large canal width, and a patient age of 60 years or more were risk factors for extensive cortical thinning. Accelerated polyethylene wear was related to resorption of the medial femoral neck but not to cortical thinning or radiological loosening. Cortical thickening occurred only around the distal half of the stem in 29%. These findings establish a basis for the performance of cemented femoral prostheses, and allow comparison of bone remodeling when evaluating other femoral prostheses.

Long-term results of congenital dislocation of the hip treated with the Pavlik harness

We present the radiographic and clinical results of 158 hips (127 congenital dislocations of the hip, 31 acetabular dysplasias) that were followed-up for > 20 years after the application of the Pavlik harness. The mean Sharp angle of these hips was larger than that of the normal Japanese hip, and the mean center-edge angle was smaller. Thirty hips (19%) were classified as class III, according to Severin's classification. Of 48 unaffected hips in the unilateral cases, 15 hips (31%) had steep acetabula. We believe an intrinsic factor disturbs the normal development of acetabular cartilage in both hips of the patients. Thirty-five hips (22.2%) showed variable grades of deformity of the femoral head, neck, or both. Clinically, most of the treated hips were good in the 3rd decade.

Effects of various types of extracellular matrices on adhesion, proliferation, differentiation, and c-fos protein expression of porcine thyroid follicle cells

Thyroid follicles in vivo are embedded in extracellular matrix (ECM). The composing epithelial cells are in close contact with ECM at the basal side. To examine cell-to-ECM interactions, we studied adhesion, proliferation and differentiation of porcine follicle cells monolayer-cultured on type I and IV collagen, fibronectin or laminin. At 3 h in culture, laminin had the lowest rate of cell adhesion. In proliferation, type IV collagen induced the highest level of nuclear bromodeoxyuridine intake. In a functional differentiation, laminin had about 3 times as much triiodothyronine production as the other ECM molecules. In confluent culture cells, we also examined an expression of c-fos protein, a transcription factor that plays crucial roles in signal transduction. Immunocytochemistry detected the protein mainly in the nuclei. Western blot showed that laminin induced the highest level of its expression. Thyrotropin (TSH, 10 mU/ml) did not affect adhesion of the cells on any of the substrata or proliferation of the cells on fibronectin; nor did TSH affect c-fos protein expression of the cells on the substrata except for fibronectin. Our results suggest that type IV collagen and laminin, major components of basement membrane, play positive roles in proliferation and differentiation of follicle cells, respectively, while laminin has no positive effect on adhesion of the cells at early culture; that the cells express c-fos protein even in contact inhibition of growth and its expression is regulated in part by ECM; and that ECM controls some behaviors of the cells in a TSH-dependent or TSH-independent manner.

A rare case of primary pulmonary choriocarcinoma in a male: immunohistochemical detection for human chorionic gonadotropin, epidermal growth factor (EGF) and EGF-receptor

a rare case of primary choriocarcinoma of the lung in a male is described with immunohistochemistry for human chorionic gonadotropin (hCG), epidermal growth factor (EGF) and EGF-receptor. The extragonadal trophoblastic origin of this pulmonary carcinoma was definitely confirmed by an autopsy examination, and hCG-production and hCG-positive staining of the tumor cells. Furthermore, the tumor cells clearly expressed EGF and its receptor which play an important role in the proliferation and differentiation of normal and neoplastic trophoblasts of the uterus. Our present case suggests that EGF may act in an autocrine manner in the tumor cells of primary pulmonary choriocarcinoma.

Decrease in surface charge density of Klebsiella pneumoniae treated with cefodizime and enhancement of the phagocytic function of human polymorphonuclear leucocytes stimulated by the drug-treated bacteria

Treatment of Klebsiella pneumoniae 109 with cefodizime, ceftazidime, cefbuperazone, cefotaxime or flomoxef at a sub-minimum inhibitory concentration (sub-MIC) (1/4 MIC) for 1 h altered its morphology. The bacteria treated with cefodizime at sub-MICs (1/8, 1/4 MIC) enhanced the chemiluminescencence (CL) of human polymorphonuclear leucocytes (PMNs), implying an increase in the production of active oxygen species in association with phagocytosis, whereas the cells treated with other cephalosporins at the same sub-MICs did not. Furthermore, a significant decrease in electrophoretic mobility was induced by the bacteria treated with cefodizime at sub-MICs (1/8, 1/4 MIC), but other cephalosporins neither increased nor decreased the electrophoretic mobility significantly. These findings suggested that cefodizime caused a morphological change, with a decrease in negative surface charge density of K. pneumoniae, more easily than ceftazidime, cefbuperazone, cefotaxime or flomoxef, followed by an increase in the phagocytic activity of PMNs.

Hydroxyapatite clay for gap filling and adequate bone ingrowth

In uncemented total hip arthroplasty, a complete filling of the gap between femoral prosthesis and the host bone is difficult and defects would remain, because the anatomy of the reamed intramedullary canal cannot fit the prosthesis. Therefore, it seems practical to fill the gap with a clay containing hydroxyapatite (HA), which has an osteoconductive character. The clay (HA clay) is made by mixing HA granules (size 0.1 mm or more) having a homogeneous pore distribution and a porosity of 35-48 vol%, and a viscous substance such as a saline solution of sodium alginate (SSSA). In the first experiment, the ratio of HA granules and sodium alginate in SSSA is set for the same handling properties of HA clay and polymethylmethacrylate bone cement (standard viscosity) before hardening. As a result, the ratio is set for 55 wt% of HA in the clay and 12.5 wt% of sodium alginate in SSSA (i.e., HA:sodium alginate:saline solution = 9.8:1:7). In the second study, the gap between the femoral stem and bone model is completely filled with HA clay. However, the gap is not filled only with HA granules or HA granules mixed with saline solution. In the third animal experiment, using an unloaded model, histology shows that HA clay has an osteoconductive property bridging the gap between the implant and the cortical bone without any adverse reaction. HA clay is considered a useful biomaterial to fill the gap with adequate bone ingrowth.

Predisposing factors in fixation failure of femoral prostheses following primary Charnley low friction arthroplasty. A 10- to 20-year followup study

To identify factors affecting radiologically detected loosening of the Charnley femoral prosthesis, 326 femoral prostheses with 10- to 20-year followup were studied. After observation of postoperative radiological changes, the criteria for fixation failure detected radiologically, of femoral prostheses were defined as progression or accompanying occurrences of subsidence, demarcation, separation of the prosthesis from cement, cement fracture, or endosteal cavitation. Sixteen femoral prostheses (4.9%) developed radiologically detected fixation failure. Male gender, low canal flare index, low femoral score, large medullary canal width, low implant (cement and stem)/canal ratio, low stem/canal ratio, and varus orientation of the stem affected fixation failure. Inadequate cementing techniques such as low implant/canal and stem/canal ratios and varus stem orientation might be within the surgeon's control and should be avoided. An unfavorable canal geometry (stovepipe canal) and osteopenia of the femur, indicated by a low femoral score, are risk factors that might be out of the surgeon's control, and require future research.

Risk factors affecting radiological failure of the socket in primary Charnley low friction arthroplasty. A 10- to 20-year followup study

To identify the factors affecting Hodgkinson Type 3 or 4 radiological demarcation (presence of complete demarcation or migration, respectively) of the Charnley socket, 328 sockets with 10- to 20-year followup were studied. Fifty-five sockets (16.8%) developed Type 3 or 4 demarcation. In the osteoarthrosis group (237 sockets), removal of eburnated bone at the acetabular roof, the presence of large acetabular angles before and after surgery, and high placement of the socket were related to development of Type 3 or 4 demarcation. In the rheumatoid group (32 sockets), young patient age predisposed the socket to Type 3 or 4 demarcation. Rapid polyethylene wear, correlated with young age, male gender, and thin cement mantle in Zones I and II, was another important factor related to Type 3 or 4 demarcation in both groups and in the entire series. These risk factors should be taken into account when assessing the indications for arthroplasty, when performing arthroplasty, and when educating the patient.

Arthroscopic reduction and fixation of a completely displaced fracture of the intercondylar eminence of the tibia

A simple method of arthroscopic reduction and fixation of a fracture of the intercondylar eminence of the tibia is described. A 23-year-old man with a completely displaced (Type IIIB) fracture was treated with arthroscopy. A satisfactory reduction was achieved by releasing the medial meniscus, which was entrapped in the fracture site. Link dynamic staples (W. Link, Hamburg, Germany) were used to firmly fix the fracture when the guide tube came downward from the medial mid-patellar portal. The secure fixation of the fragment and the prevention of the need for an arthrotomy facilitated early functional rehabilitation. One year after surgery the patient had a stable, painless joint with a full range of motion. The described method is technically straight-forward and can provide secure fixation of a bone fragment. The Link staples are useful in the fixation of a displaced fracture of the intercondylar eminence of the tibia.

Fracture of the tibial tray following PCA knee replacement. A report of two cases

We report two cases in which fracture of the tibial metal tray was thought to be due to improper design of the tray and heavy polyethylene wear. The bone beneath the fractured portion of the tray was deficient and had been replaced by granulomatous fibrous tissue including numerous polyethylene wear particles and foreign-body giant cells. Osteolysis occurred as a tissue reaction to these particles.