Immunohistochemical expression of podoplanin in so-called hard α-keratin-expressing tumors, including calcifying cystic odontogenic tumor, craniopharyngioma, and pilomatrixoma

Podoplanin, a transmembrane sialomucin-like glycoprotein, is a specific marker of lymphatic vessels, and its expression is also considered to be associated with tumor invasion and tooth development. In this study, we examined the expression of podoplanin in calcifying cystic odontogenic tumor (CCOT) in comparison with that in other so-called hard α-keratin-expressing tumors such as craniopharyngioma (CP) and pilomatrixoma (PM). Immunohistochemical staining for podoplanin was carried out using surgical specimens of 15 CCOTs of the jaw, 19 CPs of the pituitary gland, and 15 PMs of the skin. Positivity for hard α-keratin was evident in ghost, shadow and transitional cells in all of these tumors (100%). The podoplanin expression in CCOTs was evident in the periphery of ameloblastoma-like epithelium (86.6%) and the epithelial cells adjacent to ghost cells (60%). On the other hand, in adamantinomatous-type CPs, podoplanin expression was observed in epithelial components corresponding to the stratum intermedium (100%), but not in the periphery of ameloblastoma-like epithelium (0%). In squamous-type CPs podoplanin was expressed in basal cells (100%), but all of the PMs were podoplanin-negative (0%). In the periphery of the ameloblastoma-like epithelium or basophilic cell layer, podoplanin was expressed more strongly in CCOTs than in CPs or PMs. These findings suggest that the expression of podoplanin in CCOTs may reflect rapid turnover of cytoskeletal filaments and local invasiveness.     

Anteroposterior and varus–valgus laxity of the knee increase after stair climbing in patients with mild osteoarthritis

The aim of this study was to measure exercise-induced changes in knee joint laxity in patients with knee osteoarthritis (OA). The study subjects were 46 female patients with OA and 22 age- and sex-matched normal controls. Radiographs of the knee were taken in all subjects, and the disease severity was graded according to the Kellgren and Lawrence (K-L) grading system. The K-L grade of the control subjects (non-OA group) was 0-1. The OA patients were divided into those with mild OA (K-L grade 2, n = 20) and advanced OA (K-L grade 3-4, n = 26). The subject climbed up and down 8 steps on a staircase apparatus over a period of 10 min. The anteroposterior (A-P) translation was measured with KT2000 arthrometer, and varus-valgus (V-V) rotation was measured on stress radiographs before and after the stair climbing. The Δchange in A-P translation after the exercise was significantly larger in mild OA group than other groups (P < 0.005). The Δchange in V-V rotation after exercise was significantly larger in mild and advanced OA groups than the control (P < 0.003). There were no significant differences in A-P laxity and V-V laxity before exercise among the non-OA, mild OA and advanced OA groups. Exercise resulted in significant changes in A-P knee joint laxity in patients with mild OA relative to the control. The results suggest that daily physical activities (e.g., knee bending or squatting) play a role in the development of knee laxity, particularly in patients with mild OA, and that progression of knee OA seems to correlate with increments of A-P knee joint laxity.     

Clinical evaluation of peginterferon α plus ribavirin for patients co-infected with HIV and HCV at Nagoya Medical Center

At Nagoya Medical Center, 10 patients co-infected with HIV and HCV received peginterferon α (PEG-IFNα) plus ribavirin therapy. Three of the cases were HCV genotype 1b, 2 cases were HCV 3b, and 1 case each were 2b, 2c, 3a, 4a and 6n. Nine patients received anti HIV therapy from the beginning. In 5 of these patients, anti HIV therapy was modified when PEG-IFNα plus ribavirin treatment was started. Of the above, 7 patients completed the protocol. No patients had severe adverse effects. Sustained virological response was achieved in 1 of 4 (25%) of the patients with genotypes 1 or 4, and in 5 of 6 (83%) of the patients with other genotypes. PEG-IFNα plus ribavirin therapy is considered a safe and efficacious treatment for patients co-infected with HIV and HCV.     

Perspectives On the Role of the Lateral Pterygoid Muscle and the Sphenomandibular Ligament in Temporomandibular Joint Function

The lateral pterygoid muscle plays an important role in the movement of the mandible and has been studied from several points of view, including structural and functional anatomy. What matters clinically is the relative position of the muscle fibers attached medially to the mandibular condyle. In the following study, we observed not only the attachment of the lateral pterygoid muscle fibers to the articular disk, but also the relative position of the mandibular condyle to a base line set up on the mandibular condyle. According to our observations, the lateral pterygoid muscle fibers attach to the articular disk at the inner point of the medial pole. Based on this finding, we can say that the muscle fibers can both draw the articular disk anteriorly and balance it by supporting it posteriorly. That is to say, the lateral pterygoid muscle has two actions: to elevate the articular disk anteriorly and to support the articular disk. Furthermore, the sphenomandibular ligament has continuity with the articular disk tissue medially. This relationship suggests that the ligament fibers attached to the articular disk draw the disk posteriorly in its course of mandibular closing, thus enabling the articular disk to move smoothly.     

An Anatomical Study of a Muscle Bundle Separated from the Medial Pterygoid Muscle

When mandibular dentures are fabricated, marginal sealing should be taken into consideration for the stability of the denture. We selected specimens of the medial pterygoid muscle showing insertion of an independent small muscle bundle at its insertion site, and evaluated the anatomical relationship between the morphology of the insertion site and the denture. The insertion of the pterygoid muscle was classified according to the insertion morphology of the independent small muscle bundle into three types using the retromolar pad as a reference: Type I, insertion of the independent muscle bundle posterior to the retromolar pad; Type II, insertion immediately below the retromolar pad; and Type III, insertion into the fascia of the mylohyoid muscle. Types II and III muscles seem to affect the denture because of their closeness to the mandibular denture. In the oral cavity, the independent small muscle bundle studied appeared as a streak-like structure. When such a structure is detected during examination for denture fabrication, the following consideration is necessary. Since the medial pterygoid muscle is a mouth-closing muscle, this independent small muscle bundle may contract during mouth closing, appearing more markedly in the oral cavity. Therefore, examination should be performed not only with the mouth closed but also with assumed centric occlusion.     

Risk factors for hepatocellular carcinoma in Japanese patients with autoimmune hepatitis type 1

Background

Hepatocellular carcinoma (HCC) is occasionally seen even in patients with autoimmune hepatitis (AIH) without prior infection either with hepatitis C virus (HCV) or hepatitis B virus. The aim of this study was to identify the incidence of and risk factors for HCC with AIH in a large-scale population with a long-term follow-up in Japan.

Methods

One hundred and eighty patients diagnosed with AIH were enrolled (F/M?=?159/21; mean age, 59.9?years; mean observation period, 80.2?months). Patients with positive HCV antibody/serum HCV RNA and/or positive HBs Ag were excluded. Initial treatment included immunosuppressant therapy (n?=?147), other drugs (n?=?28), and no drug (n?=?5). Patients underwent abdominal ultrasonography at intervals of 3–6?months during observation. Patients’ demographic factors, biochemical data, liver histology, medications, response to treatment, and complications were evaluated in relation to HCC.

Results

During the observation period, six patients (3.3%) developed HCC. Univariate analysis showed that risk factors for HCC were cirrhosis at diagnosis with AIH (p?=?0.0002), absence of a treatment response (p?=?0.033), abnormal alanine aminotransferase (ALT) at the final observation (p?=?0.0002), and diabetes (p?=?0.0015). Multivariate analysis showed that risk factors for HCC were cirrhosis at diagnosis of AIH (odds ratio 4.08) and abnormal ALT at final observation (odds ratio 3.66).

Conclusion

This retrospective study showed that cirrhosis at diagnosis of AIH and abnormal ALT at final observation were independently associated with HCC development. It is important to pay attention to the presence of cirrhosis at diagnosis of AIH and to normalize ALT.