Differential acoustic properties of early cartilage lesions in living human knee and ankle joints

OBJECTIVE: Although numerous studies have been performed to determine whether there are histologic, biochemical, biomechanical, and metabolic differences between knee and ankle cartilage, none have investigated the presence of such differences in living human cartilage. We previously developed an ultrasonic evaluation system for articular cartilage that analyzes the A-mode echogram using wavelet transformation. The current study was undertaken to determine whether the acoustic properties of living human cartilage differ between knee and ankle joints. METHODS: Twenty-eight patients were subjected to ultrasonic evaluation under arthroscopy. After arthroscopic grading, the cartilage was measured using an ultrasonic probe. Two quantitative parameters were used, i.e., the maximum magnitude and the echo duration at the 95% interval of the maximum magnitude. RESULTS: In intact cartilage, the maximum magnitude and echo duration did not differ between the knee and the ankle. In lesional cartilage, in contrast, the maximum magnitude was higher, and the echo duration was shorter, in the ankle than in the knee. These differences were statistically significant. CONCLUSION: Ultrasound findings could be used to judge the degree of early cartilage degeneration in vivo on the basis of objective data such as the maximum magnitude and echo duration. Because we were unable to quantitatively analyze the biochemical and biomechanical properties of the cartilage in this study, our biochemical and biomechanical findings are based only on qualitative assessment. Nevertheless, the results indicate that this ultrasonic evaluation system may be useful for elucidating the processes of articular cartilage degeneration in osteoarthritis.     

Lack of antigen-specific tissue remodeling in mice deficient in the macrophage galactose-type calcium-type lectin 1/CD301a

Macrophage galactose-type C-type lectins (MGLs), which were recently named CD301, have 2 homologues in mice: MGL1 and MGL2. MGLs are expressed on macrophages and immature dendritic cells. The persistent presence of granulation tissue induced by a protein antigen was observed in wild-type mice but not in mice lacking an endogenous, macrophage-specific, galactose-type calcium-type lectin 1 (MGL1) in an air pouch model. The anti-MGL1 antibody suppressed the granulation tissue formation in wild-type mice. A large number of cells, present only in the pouch of MGL1-deficient mice, were not myeloid or lymphoid lineage cells and the number significantly declined after administration of interleukin 1 alpha (IL-1alpha) into the pouch of MGL1-deficient mice. Furthermore, granulation tissue was restored by this treatment and the cells obtained from the pouch of MGL1-deficient mice were incorporated into the granulation tissue when injected with IL-1alpha. Taken together, MGL1 expressed on a specific subpopulation of macrophages that secrete IL-1alpha was proposed to regulate specific cellular interactions crucial to granulation tissue formation.     

ERK1/2 are involved in low potassium-induced apoptotic signaling downstream of ASK1-p38 MAPK pathway in cultured cerebellar granule neurons

We have recently reported that the ASK1-p38 MAPK pathway has an important role in the low potassium (LK)-induced apoptosis of cultured cerebellar granule neurons. In the present study, we observed that ERK1/2 were significantly activated 6 h after a change of medium from HK (high potassium) to LK. In addition, U0126, a specific inhibitor of MEKs, remarkably prevented the apoptosis of cultured cerebellar granule neurons. Then, we examined the mechanism underlying the activation of ERK1/2 in the LK-induced apoptotic pathway. The addition of SB203580, an inhibitor of p38 MAPK, suppressed the increase in the phosphorylation of ERK1/2 after the change to LK medium. Furthermore, we found that the expression of a constitutively active mutant of ASK1, an upstream kinase of p38 MAPK, enhanced the phosphorylation of ERK1/2. These results suggest that ERK1/2 play a crucial role in LK-induced apoptosis of cultured cerebellar granule neurons and that the LK-stimulated activation of ERK1/2 is regulated by the ASK1-p38 MAPK pathway.     

Constant and severe involvement of Betz cells in corticobasal degeneration is not consistent with pyramidal signs: a clinicopathological study of ten autopsy cases

This report concerns a clinicopathological study of three additional patients with corticobasal degeneration (CBD), described here for the first time, and a clinicopathological correlation between pyramidal signs and upper motor neuron involvement, in ten autopsy cases of CBD, including seven cases reported by us previously. We investigated pyramidal signs, including hyperreflexia, Babinski sign, and spasticity, and involvement of the primary motor cortex and pyramidal tract, focusing on the astrocytosis of the fifth layer of the primary motor cortex. Pyramidal signs were observed in six (60%) of the ten cases. Hyperreflexia was evident in six patients (60%), with spasticity being observed in three patients (30%). Loss of Betz cells associated with prominent astrocytosis and presence of ballooned neurons in the fifth layer of the primary motor cortex was observed in all ten cases. In all cases, involvement of the pyramidal tract was obvious in the medulla oblongata, without involvement of the pyramidal tract in the midbrain. Constant and severe involvement of the fifth layer of the primary motor cortex, including the Betz cells, has not previously been reported in CBD. We suggest that the pyramidal signs in CBD have been disregarded.     

Performance of the automated motion correction program for the calculation of left ventricular volume and ejection fraction using quantitative gated SPECT software

The effectiveness of the automated motion correction software (INSTILL, Philips Medical Systems Co. Ltd., Andover, USA) proposed by Matsumoto et al. to prevent motion artifact in quantitative gated SPECT, was tested with a technetium-99m point source and cardiac phantom. INSTILL well corrected the error due to point source movement during acquisition up to a distance of 5 pixels (32.8 mm) in the right and caudal directions, as well as with a distance of up to 7 pixels (45.9 mm) of oblique (caudal-right 45 degree) movement inside the coronal plane. End-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were also well adjusted with INSTILL, for up to 3 pixels (19.7 mm) movement of the dynamic cardiac phantom during acquisition in the right, caudal and oblique directions. The respective maximum error with one, two and three pixel movement was 9, 24 and 23 ml in EDV, and 8, 22 and 21 ml in ESV. The maximum error of EF was 3% in all conditions without INSTILL. After using INSTILL, the maximum residual errors of both EDV and ESV were 7 ml and that of EF was 3% in all conditions. Quantitative gated SPECT software with INSTILL will calculate EDV, ESV and EF against movement of patients in the coronal plane. INSTILL is therefore concluded to be a reliable software for motion correction in clinical use.     

Extraosseous accumulation of99mTc-HMDP to radiation nephropathy, mimicking recurrent neuroblastoma

OBJECTIVE: The aim of this study is to clarify the period of extraosseous accumulation of (99m)Tc-hydroxymethylenediphosphonate (HMDP) to radiation nephropathy mimicking recurrent or remnant neuroblastoma in the pararenal region. METHODS: We reviewed five neuroblastoma and one ganglioneuroblastoma patients (2 boys and 4 girls aged 1-9 years) who underwent (99m)Tc-HMDP bone scintigraphies periodically before and after radiation therapy. RESULTS: Increased renal uptake coincident with the radiation port appeared in 5 of 6 patients from 0 to 3 months (mean 1.7 months), and persisted up to 7 months after the completion of radiotherapy. Renal uptake of (99m)Tc-HMDP was gradually decreased, and eventually became accumulation defects in 5 of 6 patients from 6 to 17 months (mean 8.9 months) after radiotherapy. CONCLUSION: When extraosseous accumulation is found after radiation therapy in neuroblastoma patients, radiation nephropathy would be a candidate in the differential diagnosis besides recurrent or remnant tumor.     

Regional cerebral blood flow in a patient with Nasu-Hakola disease

We report a functional neuroimaging study of a 43-year-old woman with Nasu-Hakola disease (NHD). Regional cerebral blood flow (rCBF) images were measured with technetium-99m ethyl cysteinate dimer single photon emission computed tomography (SPECT). rCBF was decreased in the bilateral frontal lobes and thalamus. This finding was consistent with the known underlying neuropathology in patients with NHD. Brain SPECT is useful for demonstrating the pathophysiologic brain region in patients with NHD.     

Serous retinal detachment in an elderly patient with Philadelphia-chromosome-positive acute lymphoblastic leukemia

PURPOSE: To describe an elderly woman who presented with a serous retinal detachment (SRD) as the first sign of Philadelphia-chromosome-positive acute lymphoblastic leukemia (Ph(+) ALL). DESIGN: Observational case report. METHODS: A complete ophthalmic and systemic evaluation was performed on a 62-year-old woman because of decreased vision of 20/60 OD and 20/25 OS. RESULTS: Fundus examination revealed a SRD involving the fovea, OU. Fluorescein angiography disclosed multifocal spots of hyperfluorescence in the early phase, and diffuse subretinal accumulation of fluorescein in the late phase. She was diagnosed with Ph(+) ALL because of systemic findings. She underwent systemic chemotherapy and went into complete remission. Visual acuity improved to 20/20 in both eyes with resolution of the bilateral SRD. CONCLUSIONS: Our observations indicate that a sudden appearance of SRD, even in an elderly patient, warrants a thorough systemic screening for underlying leukemia. This is especially important, because prompt systemic chemotherapy can improve the visual acuity and the prognosis.