Pulsed and Continuous Ultrasound Increase Chondrogenesis through the Increase of Heat Shock Protein 70 Expression in Rat Articular Cartilage

[Purpose] The present study was aimed to investigate the effects of pulsed and continuous ultrasound (US) irradiation on heat shock protein (HSP) 70 and mRNA levels of chondrogenesis-related gene expression in rat tibial articular cartilage. [Subjects and Methods] Forty-eight rats with body weights of 200−250 g were randomly divided into three groups. In the control (CON) group, three rats were treated with sham sonication. The pulsed US irradiation group was irradiated with a pulse rate of 20%, a frequency of 1 MHz, and an intensity of 1.5 W/cm² for 10 minutes. The continuous US irradiation group was continuously with a frequency of 1 MHz and an intensity of 1.5 W/cm² for 10 minutes. Immunohistochemistry for evaluation of HSP 70 and RT-PCR for expression of the chondrogenesis-related mRNA were used. [Results] The expression of HSP70 protein was increased in the pulsed and continuous US groups. The increase in the continuous US group was more prominent than in the pulsed US group. In addition, pulsed and continuous US irradiation increased the expression of Mustn1 and Sox9. [Conclusion] The results of this study show that US increases chondrogenesis via the increase of HSP 70 and chondrogenesis-related mRNA expressions in rat articular cartilage.Key words: Articular cartilage, Heat shock protein 70, Ultrasound     

Signal-averaged P-wave analysis of normal controls and patients with paroxysmal atrial fibrillation: a study in gender differences,age dependence,and reproducibility

BACKGROUND: Atrial fibrillation is often first recognized after a complication such as embolic stroke has occurred. Limited data are available for the prospective identification of patients at risk for developing atrial fibrillation. HYPOTHESIS: Demonstration of areas of slow conduction in the atrium by means of P-wave signal averaging may identify individuals at risk for atrial fibrillation. METHODS: P-wave signal averaging from the surface electrocardiogram was performed in 199 normal controls and 81 patients with paroxysmal atrial fibrillation using an automated, P-triggered, high-resolution signal for analysis. RESULTS: Of the variables measured, the filtered P-wave duration and P-wave integral were significantly different between controls and patients (filtered P-wave duration 120 +/- 9 vs. 145 +/- 21 and P-wave integral 666 +/- 208 vs. 868 +/- 352), whereas the terminal root-mean-square (RMS) voltages (RMS 20, RMS 30, RMS 40) showed no significant differences between the two groups. Regression analysis of the first and second measurement of the filtered P-wave duration obtained during consecutive tests showed excellent reproducibility (r and r2 of 0.96 and 0.92). The duration of the filtered P wave showed no age dependence but was shorter in women. CONCLUSION: Utilizing the 90th percentile value of the filtered P-wave duration of 133 ms in men and 130 ms in women, the sensitivity was 80 and 81%, the specificity 92 and 90%, the positive predictive value 84 and 73%, and the negative predictive value 90 and 93%, respectively.     

Treatment of intertrochanteric fractures in geriatric patients with a modified external fixator

Forty-two geriatric patients who had an intertrochanteric fracture were treated with a semicircular modification of the Ilizarov frame designed by Cattaneo and Catagni between January 1997 and September 2001. Twenty-five of the patients were female, 17 male. The average age of the patients was 77.5 years (range, 63-99). No intraoperative complication occurred. Deep pin-track infection was found in four patients and varus deformity was observed in two patients and shortening of less than 2 cm in 10 patients. Fixator removal was achieved in a mean time of 12 weeks (range, 10-18). No implant failure, refracture or stiffness of knee and hip joint movements was recorded. We concluded that the treatment of intertrochanteric fractures of the elderly patients with our modification provides significant advantages such as minimal operative and anaesthetic risks, no blood loss, early weight-bearing, short hospitalisation time and rapid union time.     

Complications following surgical treatment of shoulder instability and revision interventions for stabilization

A successful surgical intervention to restore glenohumeral stability should be based on the detection of all the problems and on a plan to correct all those that are reparable. Contribution of arthroscopy to better understand the pathological anatomy and to evaluate coexisting intra-articular problems, and advances in imaging modalities and in implant technology have increased the success rates and decreased complications. The best way to avoid complications is to gather all the relevant data preoperatively and during surgery to draw the correct diagnosis and to employ the most appropriate approach or approaches accordingly. Complication rates are lower with open surgical techniques, where problems mainly arise from limited joint movements, implant deficiency, and degenerative changes. Although arthroscopic surgery is associated with significantly fewer complications seen with open techniques, it results in higher recurrence rates. Revision surgery for stabilization of the shoulder should be directed to well-defined pathologies using appropriate techniques. The most common complication encountered is the recurrence of instability, which should primarily be dealt with by open surgical techniques.     

Roughness perception in sounds: behavioral and ERP evidence

The mismatch negativity (MMN) correlates of the perception of roughness, the unpleasant character of sounds caused by the perception of amplitude fluctuation in the range of 20-200 Hz, were studied on the basis of a variation in the degree of modulation (=modulation index m), which is a main parameter influencing roughness. A psychophysical study showed that perceived roughness of tones increased with modulation index for m-values from 0 up to 1.2. For larger values of m, roughness perception remained stable. In a subsequent ERP-study, infrequent amplitude modulated (AM) tones with varying modulation index were presented in the context of a series of pure tones in an ignore condition. The amplitude of the mismatch negativity correlated highly with the roughness ratings (r = -0.93) and did not increase monotonously with increasing modulation index. We conclude that perceived roughness rather than its physical correlate in sounds is reflected by the MMN and that roughness is thus preattentively encoded.     

Symptomatic adenomyomatosis of the gallbladder--report of a case

Adenomyomatosis of the gallbladder is a benign and degenerative condition of the gallbladder, characterized by proliferation of the mucosa of the gallbladder wall, forming invaginations and diverticula, penetrating a thickened muscular layer: the so-called Rokitansky-Aschoff sinuses (RAS). Most of the patients with adenomyomatosis remain asymptomatic. Hence adenomyomatosis is usually an incidental finding, either on ultrasonography performed for the detection of stones or by histologic examination of surgical gallbladder specimens. Only occasionally does adenomyomatosis not associated with cholelithiasis cause right upper quadrant pain. We report a case of symptomatic adenomyomatosis of the gallbladder. Clinical findings, etiology, diagnosis and therapy are discussed.     

Stomal recurrence in patients with T1 glottic cancer after salvage laryngectomy for radiotherapy failures: role of p53 overexpression and subglottic extension

The role of p53 overexpression in the development of stomal recurrence was studied in patients with T1 glottic cancer who had undergone salvage laryngectomy after primary radiotherapy failure (first recurrence). The role of subglottic extension of the recurrent tumor in the development of stomal recurrence was also studied. One hundred fourteen patients with T1 squamous cell carcinoma of the glottic larynx were irradiated with curative intent. A local recurrence (first recurrence) developed in 23 patients (20%), and salvage laryngectomy was performed for 20 of these patients. No postlaryngectomy radiation therapy was included in the treatment of recurrences. Several risk factors thought to be significant in the development of stomal recurrence were analyzed in these 20 patients. Prognostic factors analyzed include: p53 overexpression in the preradiation biopsy specimen, subglottic extension of the first recurrence, thyroid cartilage and lymph node involvement at the time of first recurrence, emergency tracheostomy performed before salvage laryngectomy, and the laryngectomy procedure performed for first recurrence. Presence of p53 protein in the preradiation biopsy specimen of laryngeal cancer did not show any adverse effect on the development of stomal recurrence. Stomal recurrence developed in 27% of patients with positive biopsies and in 20% of patients with negative biopsies (p = 1.00). Subglottic extension of the first recurrence was associated with an increased incidence of stomal recurrence. Rates of stomal recurrence were 6% in patients without subglottic extension and 100% in patients with subglottic extension (p = 0.001). All other risk factors studied showed no effect on stomal recurrence. In this study, p53 overexpression showed no effect on the development of stomal recurrence after salvage laryngectomy in patients with T1 glottic cancer. Conversely, subglottic extension of the recurrence was found to be strongly associated with stomal recurrence. All other factors analyzed showed no effect on stomal recurrence.