Immediate reconstruction using inframammary adipofascial flap of the anterior rectus sheath after partial mastectomy

Treatment of early breast cancer using breast conservative therapy (BCT) usually ensures local control and acceptable cosmetic results. To repair defects caused by partial mastectomy in the lower region of the breast, some reconstruction should be used. We developed a procedure involving the cranial based adipofascial (anterior rectus sheath) flap from immediately below the inframammary area for the reconstruction of defect due to partial mastectomy for patients with early breast cancer. In this procedure, a skin incision is made at the inframammary line, and the inframammary skin area is undermined. A tongue shaped flap composed of the subcutaneous fat and the anterior sheath of rectus abdominis muscle is pulled up and a C-shaped flap is rotated, gathered, and inserted to reconstruct the breast defect.     

CHANGES IN NITRIC OXIDE,SUPEROXIDE, AND BLOOD CIRCULATION IN MUSCLES OVER TIME AFTER WARM ISCHAEMIC REPERFUSION IN RABBIT RECTUS FEMORIS MUSCLE

We present the sequence of changes in nitric oxide (NO) and superoxide (O₂-) over time in reperfusion injuries. We examined both the changes in NO and O₂- over time and the blood flow in an isolated ischaemia-reperfusion muscle model in rabbits. The ischaemic group comprised 8 animals which had had vascular pedicles clamped on to their rectus femoris muscles for 4 hours. The control group (n = 6) had a sham operation. Blood samples from the femoral vein proximal to the clamping point were collected before the operation, before clamping, before reperfusion, immediately after reperfusion, and 5, 15, 30, 60, and 120 minutes after reperfusion. NO was measured by Griess' method, and O₂- by chemiluminescence. Blood flow was measured with a laser Doppler flowmeter. The amount of NO increased significantly immediately after reperfusion, and 15 and 30 minutes after reperfusion in the ischaemic group, compared with the control group (p < 0.05). O₂- increased significantly at 5, 15, 60, 90 and 120 minutes after reperfusion, compared with the control group (p < 0.05). The blood flow volume curve increased by 1.4 times about four minutes after reperfusion compared with previously. After this it gradually decreased. The adverse effects of O₂- became apparent when NO was extinguished by O₂-.     

Low-intensity pulsed ultrasound treatment for postoperative delayed union or nonunion of long bone fractures

Background Postoperative delayed union and nonunion is the most common complication in fracture treatment. Recent studies have shown an accelerating effect of low-intensity pulsed ultrasound (LIPUS) on fracture repair. However, the indications for delayed union and nonunion are not clear. To clarify the factors which influence the effects of LIPUS, the data from a previous prospective multicenter study on LIPUS treatment for postoperative delayed union and nonunion of long bone fractures were reanalyzed. Methods Seventy-two cases of long bone fracture, including those of the femur, tibia, humerus, radius, and ulna, were analyzed. The mean time from the most recent operation to the beginning of LIPUS treatment was 11.5 (3–68) months. The relationship between the background factors and the union rate was analyzed using a logistic regression method. In addition, long bone fractures in an upper extremity or in a lower extremity were analyzed separately. Results The union rate was 75% in all the cases of long bone fracture. There was a significant relationship between the union rate and the period from the most recent operation to the beginning of LIPUS treatment in all cases and in those that had long bone fracture of an upper extremity. There was also a significant relationship between the union rate and the time when a radiological improvement was first observed after the beginning of the treatment in all cases and in those with fractures in a lower extremity. When LIPUS treatment was started within 6 months of the most recent operation, 89.7% of all fractures healed. When an improvement in the radiological changes at the fracture site was observed after 4 months in those cases, then the sensitivity and specificity for union were more than 90%. Conclusions LIPUS treatment should be started within 6 months of the most recent operation. Because LIPUS has been shown to be effective without causing either serious invasiveness or any undue risk to the patient, it may be considered the treatment of first choice for cases of postoperative delayed union or nonunion.     

Rotational stability based on displacements obtained by simulation and measurement when torsion loading is applied to hip stems

BACKGROUND: The rotational stability of cementless hip prostheses corresponds to the design of the fixation parts. The appropriate design of a femoral stem is important for secure primary fixation. The relative displacement of the bone and stems in the rotational direction should be used to evaluate the initial fixability and stability of stems. This article addresses the issue of the fixation method of hip stems and their rotational stability. METHODS: Specimens comprised four kinds of hip prosthesis. Rotational displacement that reproduced a torsion moment was analyzed and measured. Various finite element models (FEMs) of the four femoral stems were constructed for computer simulation. The measurement models consisted of an artificial femur and real stems used clinically. Common conditions of analyses and measurements were as follows: (1) a torsion load of 18.9 Nm was applied to the proximal femur as the intrarotation; (2) a stepping load of 1800 N was applied to the proximal tip of the stem; and (3) rigid contact existed between the distal end of the model femur and the rigid base. RESULTS: It was found that the relative rotational displacement obtained by FEMs was 0.21 mm for the Intra-Medullary Cruciate stem, 0.10 mm for the VerSys stem, 0.67 mm for the PerFix SV stem, and 0.03 mm for the Duetto SI stem. The relative rotational displacement obtained by the laser sensor was 0.37 mm for the Intra-Medullary Cruciate stem, 0.25 mm for the VerSys stem, 1.87 mm for the PerFix SV stem, and 0.17 mm in the Duetto SI stem. CONCLUSIONS: Judging from rotational displacement values obtained by the two approaches, three types of stem (Intra-Medullary Cruciate stem, VerSys stem, Duetto SI stem) provided rotational stability.     

Genetic evidence for Plasmodium falciparum resistance to chloroquine and pyrimethamine in Indochina and the Western Pacific between 1984 and 1998

Plasmodium falciparum resistance to chloroquine and pyrimethamine is widely distributed in malaria-endemic areas. The origin and geographic spread of this drug resistance have been inferred mainly from records of clinical resistance (treatment failure). Identification of the Plasmodium falciparum chloroqunie resistance transporter (pfcrt) gene and the dihydrofolate reductase (dhfr) gene as target genes of chloroquine and pyrimethamine, respectively, has made it possible to trace the history of genetic resistance to these two drugs. However, evidence for genetic resistance has been limited because of scarcity of archival specimens. We examined genotypes of pfcrt and dhfr in Indochina (Thailand, Myanmar, and Laos) and the Western Pacific (the Philippines, Indonesia, and Papua New Guinea) between 1984 and 1998 by testing samples obtained from malaria cases imported to Japan. Results show that 96% (28 of 29) and 77% (20 of 26) of samples had resistant genotypes of pfcrt and dhfr, respectively, substantiating the inferred history of clinical resistance in these geographic areas during this period.     

Inhibition of miR‐92a Enhances Fracture Healing via Promoting Angiogenesis in a Model of Stabilized Fracture in Young Mice

MicroRNAs (miRNAs) are endogenous small noncoding RNAs regulating the activities of target mRNAs and cellular processes. Although no miRNA has been reported to play an important role in the regulation of fracture healing, several miRNAs control key elements in tissue repair processes such as inflammation, hypoxia response, angiogenesis, stem cell differentiation, osteogenesis, and chondrogenesis. We compared the plasma concentrations of 134 miRNAs in 4 patients with trochanteric fractures and 4 healthy controls (HCs), and the levels of six miRNAs were dysregulated. Among these miRNAs, miR‐92a levels were significantly decreased 24 hours after fracture, compared to HCs. In patients with a trochanteric fracture or a lumbar compression fracture, the plasma concentrations of miR‐92a were lower on days 7 and 14, but had recovered on day 21 after the surgery or injury. To determine whether systemic downregulation of miR‐92a can modulate fracture healing, we administered antimir‐92a, designed using locked nucleic acid technology to inhibit miR‐92a, to mice with a femoral fracture. Systemic administration of antimir‐92a twice a week increased the callus volume and enhanced fracture healing. Enhancement of fracture healing was also observed after local administration of antimir‐92a. Neovascularization was increased in mice treated with antimir‐92a. These results suggest that plasma miR‐92a plays a crucial role in bone fracture healing in human and that inhibition of miR‐92a enhances fracture healing through angiogenesis and has therapeutic potential for bone repair. © 2014 American Society for Bone and Mineral Research.     

Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head

Purpose

Bipolar hemiarthroplasty (BHA) for idiopathic osteonecrosis of the femoral head (ONFH) is performed at our institution. The purpose of this study was to evaluate the clinical and radiographic findings after BHA for the treatment of steroid -induced ONFH.

Methods

Thirty-seven hips in 27 patients were assessed (seven men, 11 hips; 20 women, 26 hips), average patient age at the time of surgery of 42.6?(range 20–83)?years, with steroid-induced ONFH treated with BHA between 1995 and 2005. The mean follow-up duration was approximately ten?(range five to15)?years. Patients were evaluated according to the Japan Orthopaedic Association (JOA) hip score. Kaplan–Meier survivorship was calculated to examine revision arthroplasty failure rate. Radiographic analysis of loosening included radiolucent lines and osteolysis of the acetabulum or femur. Causes of loosening were analysed using multiple logistic regression.

Result

JOA hip score increased from 53 points (preoperative) to 87 points (final follow-up). Survival rates were 96.8?% and 78.6?% at ten and 15?years, respectively. Prosthesis loosening occurred on the acetabular side in five hips (13.5?%). No femoral-component loosening was observed. BHA had poor results in patients with Association Research Circulation Osseous (ARCO) stage IV ONFH and in patients under 40?years of age.

Conclusion

BHA, with strict surgical indications, may be a good option for treating ONFH. Based on these results, total hip arthroplasty is recommended for patients with ARCO stage IV ONFH or for patients under 40?years of age.     

Ethanol enhances both action potential-dependent and action potential-independent GABAergic transmission onto cerebellar Purkinje cells

Ethanol (EtOH) modulates synaptic efficacy in various brain areas, including the cerebellum, which plays a role in motor coordination. Previous studies have shown that EtOH enhances tonic inhibition of cerebellar granule cells, which is one of the possible reasons for the alcohol-induced motor impairment. However, the effects of EtOH on molecular layer interneurons (MLIs) in the mouse cerebellum have remained unknown. Here we found that MLIs were depolarized by EtOH through enhancement of hyperpolarization-activated cationic currents (I_h). Under physiological conditions, a low EtOH concentration (3-50 mM) caused a small increase in the firing rate of MLIs, whereas, in the presence of blockers for ionotropic glutamate and GABA receptors, EtOH (≥10 mM) robustly enhanced MLI firing, suggesting that synaptic inputs, which seem to serve as the phasic inhibition, could suppress the EtOH-mediated excitation of MLIs and Purkinje cells (PCs). Even in the absence of synaptic blockers, a high EtOH concentration (100 mM) markedly increased the firing rate of MLIs to enhance GABAergic transmission. Furthermore, 100 mM EtOH-facilitated miniature IPSCs via a mechanism that depended on intracellular cyclic AMP, voltage-dependent Ca²⁺ channels, and intracellular Ca²⁺ stores, but was independent of I_h or PKA. The two distinct effects of a high EtOH concentration (≥100 mM), however, failed to attenuate the EtOH-induced strong depolarization of MLIs. These results suggest that acute exposure to a low EtOH concentration (≤50 mM) enhanced GABAergic synaptic transmission, which suppressed the EtOH-evoked excitation of MLIs and PCs, thereby maintaining precise synaptic integration of PCs.