Importance of the changes in joint effusion shown by magnetic resonance imaging before and after arthroscopic lysis and lavage of the temporomandibular joint

We investigated the changes in the amount of joint effusion estimated from T2-weighted magnetic resonance imaging (MRI) before and after arthroscopic lysis and lavage of the temporomandibular joint (TMJ). We studied 29 consecutive patients, each with internal derangement and osteoarthritis in one TMJ. Before operation, the MRI showed joint effusions in 22 of the patients (76%). After operation, the amount of the effusion decreased in 16 and increased in 2 patients. Effusions developed postoperatively in four of the seven patients who had no effusion before operation. In four of the six patients in whom the effusion increased, the symptoms had almost resolved by the time the MRI was taken. There was no significant correlation between changes in the amount of joint effusion and the clinical condition of the patients before and after the operation. In conclusion, changes in the amount of joint effusion in the TMJ are not related to the patient's clinical condition.     

Levels of soluble cytokine factors in temporomandibular joint effusions seen on magnetic resonance images

OBJECTIVE: To elucidate the correlations between joint effusion (JE) on T2-weighted magnetic resonance images (MRI) of the temporomandibular joint (TMJ) and the levels of various cytokine receptors, cytokine antagonists, and protein in the synovial fluid of patients with temporomandibular joint disorders (TMD). STUDY DESIGN: Fifty-five TMJs of 55 patients with TMD were scanned by MRI, and synovial fluid samples were obtained on the same day. The grade of JE was evaluated on a scale of 0 to 3: Grades 0 and 1 indicated absence, and grades 2 and 3 indicated the presence of JE. Correlations were evaluated between JE and the concentrations of soluble tumor necrosis factor receptors I and II (sTNFR-I and sTNFR-II, respectively), IL-6 soluble receptor (IL-6sR), IL-1 soluble receptor type II, and IL-1 receptor antagonist and protein in the synovial fluid of patients with TMD. RESULTS: The concentrations of sTNFR-I and protein in the group with JE (18 joints) were significantly higher than in the group without JE (37 joints). In addition, there were significant positive correlations between the grade of JE and the levels of sTNFR-I, sTNFR-II, and protein. CONCLUSIONS: sTNFRs and protein may play important roles in the pathogenesis of TMD. These mediators seem to influence the expression of JE, which may reflect synovial inflammation of the TMJ.     

Effects of parenteral soybean oil lipid emulsion on the long-chain polyunsaturated fatty acid profile in very-low-birth-weight infants

Aim: Conventional soybean lipid emulsions contain no docosahexaenoic acid (DHA) or arachidonic acid (AA). We investigated the relationship between blood DHA and AA status in 27 very‐low‐birth‐weight (VLBW) infants with or without parenteral lipid emulsion. Methods: Sixteen infants received parenteral lipid emulsion, and 11 infants were control group. The fatty acid composition of the erythrocyte membrane was analysed at birth and at 2 weeks of age. Results: No significant difference in AA levels was observed in the lipid emulsion group between the two time points, whereas the AA levels at 2 weeks were significantly lower than at birth in the control group. The DHA levels in both groups at 2 weeks were significantly lower than at birth, but no group differences were observed at both time points. Conclusion: The use of parenteral soybean oil lipid emulsions in VLBW infants in the postnatal period may prevent the decline in the AA level but does not appear to influence the DHA level.     

Non-deep-seated primary CNS lymphoma: therapeutic responses and a molecular signature

The survival of patients with primary CNS lymphoma (PCNSL) has been improved by high-dose methotrexate (HD-MTX). Since the combination therapy of HD-MTX and whole-brain radiotherapy (WBRT) carries a significant risk for delayed neurotoxicity, it is important to know the therapeutic potential and prognostic factors for HD-MTX without WBRT. We retrospectively reviewed 46 consecutive patients with PCNSL treated with a HD-MTX (3.5 g/m²) and deferred WBRT. Patients who achieved complete response or partial response after three courses of HD-MTX were cautiously followed-up without additional treatment. Patients who had either stable disease, progressive disease, or disease relapse were offered salvage therapy. The median progression-free survival period was 10 months and the median overall survival period was 52 months, with a 5-year survival rate of 39 %. Nineteen patients (49 % of the evaluable patients) achieved a complete response at the initial response assessment. Involvement of deep structures of the brain (corpus callosum, basal ganglia and brainstem) was significantly associated with the worse progression-free survivals (p = 0.0058) and overall survivals (p = 0.0177). Gene expression profiling analysis by microarray was compared in eight patients between PCNSLs located in the deep structures of the brain and non-deep-seated tumors. The result showed that up-regulation of signal transduction-related genes and down-regulation of catalytic activity-related genes in the non-deep-seated PCNSL compared with the deep-seated tumors. The present study shows that PCNSL located in non-deep structures of the brain responds better to HD-MTX alone than those involved deep-structures.     

Membrane-anchored growth factors, the epidermal growth factor family: beyond receptor ligands

The epidermal growth factor (EGF) family and the EGF receptor (EGFR, ErbB) tyrosine kinase family have been spearheading the studies of signal transduction events that determine cell fate and behavior in vitro and in vivo . The EGFR family and their signaling pathways are giving us tremendous advantages in developing fascinating molecular target strategies for cancer therapy. Currently, two important types of EGFR inhibitors are in clinical use: neutralizing antibodies of EGFR or ErbB2, and synthetic small compounds of tyrosine kinase inhibitors designed for receptors. On the other hand, basic research of the EGF family ligands presents new challenges as membrane-anchored growth factors. All members of the EGF family have important roles in development and diseases and are shed from the plasma membrane by metalloproteases. The ectodomain shedding of the ligands has emerged as a critical component in the functional transactivation of EGFRs in interreceptor cross-talk in response to various shedding stimulants such as G-protein coupled receptor agonists, growth factors, cytokines, and various physicochemical stresses. Among the EGFR-ligands, heparin-binding EGF-like growth factor (HB-EGF) is a prominent ligand in our understanding of the pathophysiological roles of ectodomain shedding in cancer, wound healing, cardiac diseases, etc. Here we focus on ectodomain shedding of the EGF family ligands, especially HB-EGF by disintegrin and metalloproteases, which are not only key events of receptor cross talk, but also novel intercellular signaling by their carboxy-terminal fragments to regulate gene expression directly. ( Cancer Sci 2008; 99: 214–220)     

Case of right-neck tumor that appears to be ectopic thymus

A 7-year-old female infant presented with an asymptomatic soft tissue mass in the right neck. The tumor was considered to be a benign one because it had a smooth margin and no change in its size was observed. Ultrasonography showed a 4.5-cm-diameter solid tumor with a smooth, well-defined border. Inside the tumor, flow signals were observed on color Doppler and there were numerous echogenic spots. Magnetic resonance imaging (MRI) examination showed findings consistent with an ectopic thymus, i.e., T1- and T2-weighted images showed thymus-like signals. The course of the case is being continuously followed.     

Low-grade myxofibrosarcoma invaded into the underlying skeletal muscle

Myxofibrosarcoma is a rare, soft-tissue sarcoma which is classified into three main subtypes according to cellularity and cell atypia: low, intermediate and high grade. A 44-year-old Japanese female presented with a low-grade myxofibrosarcoma on the left forearm. The lesion was completely resected. Histopathologically, the tumor was remarkably hypocellular and exhibited only mild atypia. However, it rapidly invaded into the underlying brachioradial muscle. The present case clearly indicated that a low-grade myxofibrosarcoma can invade into the deeper tissues including muscle even though its histological grade is very low.     

Reliability of measurement using Image J for reach distance and movement angles in the functional reach test

[Purpose] The purpose of this study was to examine the test-retest reliability and minimal detectable change (MDC) of reach distance and movement angle analyses using Image J. [Participants and Methods] Thirty-eight healthy young males performed the functional reach test (FRT) twice, and their reach movements were recorded using a digital video camera. Image J was used to combine the digital photographs taken at the start position and maximum reach and to measure each movement. The measurements recorded were the movement distance of the third metacarpal bone (reach distance), anterior-superior iliac spine, and trochanter major, and the angles recorded were the acromion-malleolus lateralis, acromion-trochanter major, and trochanter major-malleolus lateralis. The reliability of all the measurements was analyzed using intraclass correlation coefficients (ICCs), Bland-Altman plots, and MDCs. [Results] The ICCs (1, 1) were >0.80 for all the outcomes. The Bland-Altman analysis revealed no systematic bias in any outcome. The MDC of reach distance was 18.3 mm. [Conclusion] Measurement using Image J for reach distance and movement angles in the FRT showed acceptable high test-retest reliability. Measurement of the FRT and the MDC calculated in this study could be used as a reference for further research.Key words: Reliability, Image J, Functional reach test