New intramedullary nail for the surgical neck fracture of the proximal humerus in elderly patients

Background Fractures of the proximal humerus are common and the repair of displaced fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have developed a new intramedullary nail (pin lock nail) for the repair of surgical neck fractures of the proximal humerus in patients with osteoporotic bones. A retrospective review is presented of the cases of 19 elderly patients with two-part or three-part fractures of the proximal humerus treated using the pin lock nail. Methods We treated 19 elderly patients with a mean age of 70.5 years. There were 13 two-part surgical neck fractures, 3 two-part surgical neck fractures with non-displaced greater tuberosity fracture, and 3 three-part surgical neck fractures with greater tuberosity fracture. All fractures were treated using the pin lock nail. Clinical results were evaluated using the Japanese Orthopaedic Association score at the last follow-up examination. On radiographic evaluation, duration to bone union of the fracture, backing out of the pin and screw, penetration of the proximal pin, and varus angulations of the humeral neck were examined. Results Mean duration of follow-up was 14 months (range 6–54 months). All fractures had united at an average of 3.3 months after surgery. No backing out of the pin and screw or penetration of the proximal locking pin was seen at the time of last follow-up. Thirteen of the 16 patients had no or minimal varus angulations of the humeral neck (≤10°). The mean overall JOA score was 84.3 points (range 65.5–100). Conclusions Our data show that using the pin lock nail for the treatment of two-part and three-part humeral fractures is a reliable procedure, providing good results with careful postoperative management.     

Mathematical Model to Predict Skin Concentration of Drugs: Toward Utilization of Silicone Membrane to Predict Skin Concentration of Drugs as an Animal Testing Alternative

Purpose  

To calculate the skin concentration of active ingredients in cosmetics and topical pharmaceuticals using silicone membrane permeation.     

Association between lumber bone mineral density and vascular stiffness as assessed by pulse wave velocity in postmenopausal women

Recent studies have showed a significant correlation between vascular calcification and bone mineral density (BMD). Therefore, an investigation was carried out on the association between arterial stiffness, lumbar BMD and bone metabolic markers in Japanese postmenopausal women. Brachial-ankle PWV (baPWV) and BMD of the lumbar spine and serum bone-specific alkaline phosphatase (BAP) levels in 143 postmenopausal women were measured, where there was a significant negative correlation between baPWV and BMD (r = −0.21; P = 0.0135). An additional analysis included the remaining 75 subjects, but excluded subjects with hypertension and obesity. Here, a more negative correlation between baPWV and BMD (r = −0.315; P = 0.006), and a positive correlation between baPWV and BAP (r = 0.248; P = 0.032) were also significant. A group analysis, where the women were age matched and stratified into three groups of different bone density, i.e., normal BMD, osteopenic and osteoporotic, were further made. This showed lower PWV values in the normal BMD group than in the other two groups. A study also showed that the tertile with the highest BAP was associated with significantly higher PWV values than the other tertiles. However, when the multiple linear regression analysis was carried out, there was no correlation between PWV and BAP values. Low BMD and arterial stiffness show some correlation, suggesting that BAP may reflect the degree of arterial stiffness present.     

Neuroimaging studies in patients with Charles Bonnet Syndrome

Charles Bonnet Syndrome (CBS) is characterized by complex formed and recurrent visual hallucinations in psychologically normal people, and is often associated with eye pathology. Many psychiatrists have taken an interest in CBS because this syndrome could provide clues to the mechanisms underlying visual hallucinations. In the present paper, we review previous neuroimaging studies in patients with CBS and summarize the results of these studies. There could be a fundamental dysfunction in the primary and secondary visual cortices in some patients with CBS, and transient cortical activation occurs in the inferior lateral temporal cortex during the appearance of visual hallucinations in CBS patients. External visual stimuli are perceived in the retina and are transmitted to the primary visual cortex (Brodmann area (BA) 17). The stimuli are transmitted from BA 17 to the secondary visual cortex (BA 18) and then to the visual association cortices (BA 19 and BA 37). In general, our perception of external visual stimuli normally has an inhibitory effect on the endogenous activation of the visual cortex. Visual loss due to certain conditions, of which eye pathology is the most commonly postulated in CBS patients, produces a state of sensory deprivation that releases the visual cortex from regulation by external stimuli, resulting in visual hallucinations (cortical release phenomenon). The results of previous neuroimaging studies suggest that the cortical release phenomenon hypothesis for the occurrence of visual hallucinations in patients with CBS is plausible. In addition, the results indicate that not only eye pathology, but also dysfunction in the primary and secondary visual cortices could result in deprivation of external visual stimuli.     

Cardiovascular Effects of Azelnidipine in Comparison with Those of Amlodipine Assessed in the Halothane‐Anaesthetized Dog

Abstract: Azelnidipine is a new dihydropyridine Ca²⁺ channel blocker with long plasma half‐life. To understand the in vivo cardiovascular profile of azelnidipine, it was assessed in the halothane‐anaesthetized, closed‐chest canine model and compared with the effect of amlodipine. We administered azelnidipine in doses of 10, 20 and 70 μg/kg, i.v. or amlodipine in doses of 30, 70 and 200 μg/kg, i.v. cumulatively to the animals. The hypotensive effects of azelnidipine and amlodipine were slow in onset and long‐lasted, while their extents of dose‐related hypotensive effects were similar. Azelnidipine hardly affected the heart rate or plasma noradrenaline concentration at any doses, whereas the high dose of amlodipine increased these parameters. Azelnidipine as well as amlodipine tended to increase the ventricular contraction, which did not achieve statistical significance. During autonomic receptor blockade with atropine and propranolol, neither drug affected the heart rate, ventricular contraction or plasma noradrenaline concentration, although a more significant hypotensive action was observed. These results indicate that azelnidipine and amlodipine do not directly affect cardiac function. Amlodipine may induce sinus tachycardia via reflex‐mediated increase in sympathetic tone. Such lack of reflex tachycardia with azelnidipine will provide potential therapeutic strategy for treatment of patients with cardiovascular diseases, being more beneficial than amlodipine.     

New Frontiers in Gut Nutrient Sensor Research: Monosodium l-Glutamate Added to a High-Energy,High-Protein Liquid Diet Promotes Gastric Emptying: a Possible Therapy for Patients With Functional Dyspepsia

Functional dyspepsia is a clinical syndrome that features abdominal symptoms centered in the upper abdomen without an organic basis. Three possible mechanisms of gastric dysfunction could be related to functional dyspepsia: 1) delayed gastric emptying, 2) impaired gastric accommodation to food intake, and 3) hypersensitivity to gastric distention. Delayed gastric emptying has been suggested to lead to prolonged antral distension that causes dyspeptic symptoms. Delayed gastric emptying is therefore a focal point of debate about anorexia caused by dyspepsia, and prokinetic agents are often administered in Japan for its treatment. Recently, we found that addition of monosodium l-glutamate (MSG) to a high-energy liquid diet rich in casein promoted gastric emptying in healthy men. Therefore, another potential method to improve delayed gastric emptying could be enhancement of chemosensors that activate the autonomic nervous system innervating the gastrointestinal tract. In conclusion, enrichment with glutamate promoted gastric emptying after intake of a high-protein meal, suggesting that free glutamate is important for protein digestion and that MSG may be helpful for management of delayed gastric emptying in patients with functional dyspepsia.     

A Case of Intraluminal Duodenal Diverticulum Associated with Congenital Biliary Dilatation: A Review of the Literature in Japan

A case of intraluminal duodenal diverticulum (IDD) associated with congenital biliary dilatation is reported. Patients with intraluminal duodenal diverticulum often have congenital anatomical abnormalities or acquired diseases. The treatment of the intraluminal duodenal diverticulum itself is easy, but it is important to detect and treat other disorders also present.     

Effects of aerial spraying of insecticides on nontarget macrobenthos in a mountain stream

The effects of aerial spraying of an insecticide were investigated in a mountain stream using a drift net. The concentration of fenitrothion (organophosphorus insecticide) in the river water increased to ca. 20 micrograms liter-1 3 hr after the spraying and decreased exponentially to half the peak value after 2 hr. A large number of aquatic insects were found drifting after the spraying. The total number of individuals which drifted in the daytime after spraying reached nine times the number found the previous night. The total number of species which drifted during the 24 hr following the spray increased to 43 from 17 on the previous day. Before the insecticide spraying, the drifting benthos were almost entirely made up of three species of Baetis (Ephemeroptera). However, many individuals of several species of Heptageniidae (Ephemeroptera), Apsilochorema sutshanum (Trichoptera), and Chironomidae (Diptera) drifted in addition to Baetis after the spray. A large number of young Baetis, which had not been seen in the natural night drift samples, were found drifting due to the insecticide. Natural night drift almost disappeared from the day following insecticide spraying. At the second insecticide spraying, conducted 20 days after the first, the number of individuals which drifted during the 24 hr following spraying decreased to only 0.85% of that in the first spraying although changes in insecticide concentration showed a similar pattern. Several species of Ephemeroptera were dominant among the fauna in the studied stream, and the causal relationships of this are discussed.