Effect of humeral head rotation on bony glenohumeral stability

BackgroundThe humeral head and glenoid cavity are not perfectly spherical, nor do they have matching radii of curvature. We hypothesized that glenohumeral stability is dependent on axial humeral rotation.MethodsSeven cadaveric shoulders were investigated. For each test, the humeral head was translated relative to the glenoid in 2 directions (starting from neutral), anterior and anteroinferior. Contact forces and lateral humeral displacement were recorded. Joint stability was quantified using the stability ratio and energy to dislocation. The humerus was set in 60° of abduction for all tests. Testing was performed in neutral rotation and 60° of external rotation.FindingsThe force displacement curves differed between rotations. In both displacement directions, the peak translational force occurred with less displacement in neutral rotation than in external rotation. The stability ratio and energy to dislocation in the anteroinferior direction were greater than in the anterior direction for both rotation positions. While there were no significant differences in the stability ratio or energy to dislocation between rotation conditions at complete dislocation, the energy required to move the humeral head 10% of the glenoid width was significantly greater with the arm in neutral rotation.InterpretationThe energy to dislocation, a new parameter of dislocation risk, and the stability ratio, indicate that the glenohumeral joint is more stable in the anteroinferior direction than the anterior direction. During initial displacement, axial rotation of the humeral head contributes to glenohumeral geometrical stability. However, humeral head rotation does not have a significant effect when looking at complete dislocation.     

Current status of hip bone densitometry in Japan: a nationwide survey

Hip fracture greatly impairs quality of life in patients with osteoporosis. Measurement of bone mineral density (BMD) in the hip, which is closely related to fracture risk, is therefore diagnostically important. Furthermore, since in some elderly individuals lumbar BMD may be overestimated because of vertebral fracture or spondylosis deformans, measurement of hip BMD is also important. However, hip BMD is unlikely to be measured as often as lumbar BMD in Japan. A questionnaire survey was conducted to determine how many institutions measure hip BMD. A total of 861 institutions responded to the survey, 596 (69%) of which performed hip bone densitometry. The number of such institutions per million population was calculated to be 4.7. Measurement of hip BMD was more frequent in university hospitals than in general hospitals, clinics, and non-medical institutions. Furthermore, 298 (51%) of 590 institutions measured hip BMD in more than 75% of all bone densitometry examinees. This is the first report on the current status of utilization of hip bone densitometry in Japan.     

Host affinity and phylogenetic position of a new anamorphic fungus Beltraniella botryospora from living and fallen leaves of evergreen oaks

A new anamorphic fungus, Beltraniella botryospora, is described and illustrated with line drawings and photographs. This fungus was isolated frequently from living and fallen leaves of Quercus acuta, but rarely or never from other evergreen oaks and Castanopsis sieboldii grown at the same investigation site, suggesting that this new fungus might have strong host affinity to Quercus acuta. The phylogenetic relationships of Beltraniella botryospora and allied beltranioid fungi, such as Beltrania rhombica, Beltraniella sp. and Beltraniopsis sp., were estimated by molecular phylogenetic analysis using 28S rDNA D1/D2 region sequences. The constructed phylogenetic tree suggests that beltranioid fungi, including Beltraniella botryospora, an ascomycete Pseudomassaria carolinensis, which has a Beltraniella anamorphic stage, and a hyphomycete Subramaniomyces fusisaprophyticus, make a monophyletic group. This clade is located in the Xylariales lineage and is closely related to Amphisphaeriaceae. The phylogenetic relationships of the new anamorphic species and allied fungi are briefly discussed and a polyphyly of the anamorphic genus Beltraniella is suggested.     

Varicose veins associated with CADASIL result from a novel mutation in the Notch3 gene

No genetically diagnosed cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) pedigrees with venous insufficiency have been described. In a CADASIL pedigree with varicose veins, the authors have identified a novel heterozygous mutation in the 3' splice acceptor site of intron 15 of the Notch3 gene. This, based on mRNA analysis, resulted in skipping of exon 16 including eight cysteine residues of EGF-like repeats.     

Regulation of RANKL‐induced osteoclastogenesis by TGF‐β through molecular interaction between Smad3 and Traf6

Previous studies have shown that transforming growth factor β (TGF‐β) promotes receptor activator of nuclear factor‐κB ligand (RANKL)–induced osteoclastogenesis. However, the underlying molecular mechanisms have not been elucidated. When TGF‐β signals were blocked either by a specific inhibitor of TGF‐β type 1 receptor kinase activity, SB431542, or by introducing a dominant‐negative mutant of TGF‐β type 2 receptor, RANKL‐induced osteoclastogenesis was almost completely suppressed. Blockade of Smad signaling by overexpression of Smad7 or c‐Ski markedly suppressed RANKL‐induced osteoclastogenesis, and retroviral induction of an activated mutant of Smad2 or Smad3 reversed the inhibitory effect of SB431542. Immunoprecipitation analysis revealed that Smad2/3 directly associates with the TRAF6‐TAB1‐TAK1 molecular complex, which is generated in response to RANKL stimulation and plays an essential role in osteoclast differentiation. TRAF6‐TAB1‐TAK1 complex formation was not observed when TGF‐β signaling was blocked. Analysis using deletion mutants revealed that the MH2 domain of Smad3 is necessary for TRAF6‐TAB1‐TAK1 complex formation, downstream signal transduction, and osteoclast formation. In addition, gene silencing of Smad3 in osteoclast precursors markedly suppressed RANKL‐induced osteoclast differentiation. In summary, TGF‐β is indispensable in RANKL‐induced osteoclastogenesis, and the binding of Smad3 to the TRAF6‐TAB1‐TAK1 complex is crucial for RANKL‐induced osteoclastogenic signaling. © 2011 American Society for Bone and Mineral Research.     

Adenocarcinoma in an intrapancreatic accessory spleen: Report of a case

We report a case of adenocarcinoma in an intrapancreatic accessory spleen (IPAS). A 78-year-old woman presented with abdominal discomfort, and investigations revealed an elevated serum carbohydrate antigen 19-9 level, to 161.8 U/ml (normal, <37 U/ml). Ultrasonography showed a heterogeneous echogenic tumor with a vascular hilum. Computed tomography showed a heterogeneously enhanced tumor, 8 cm in diameter, adjacent to the pancreatic body, accompanying a feeding artery arising from the splenic artery, and a drainage vein flowing into the splenic vein. We performed a distal pancreaticosplenectomy. The tumor was surrounded by a fibrous capsule and was in contact with the pancreatic body. Histological examinations revealed invasive growth of adenocarcinoma in a structure identical to the spleen. The results of both radiological and histological examinations suggested that the tumor originated from an intrapancreatic accessory spleen. Extensive examinations revealed no other malignancy, based on which we concluded that the adenocarcinoma was primary. Surgical intervention is strongly recommended when a malignancy in an IPAS cannot be ruled out.     

Case of urachal cancer treated by neoadjuvant chemotherapy with FOLFOX4 (oxaliplatin, 5-FU and leukovolin)

A 52-year-old woman was referred to our hospital for treatment of urachal cancer. She complained of supurapubic dull pain and gross hematuria. Computed tomography and magnetic resonance imaging showed a non-papillary sessile tumor, which was located on the dome of the bladder and invaded the small intestine. The tumor was diagnosed as Sheldon's stage IIIC urachal cancer. After three courses of neoadjuvant chemotherapy with FOLFOX4 (oxaliplatin, 5-FU and leukovolin), the tumor was reduced from 7 x 6 cm to 5.5 x 5 cm in size. Consequently, the patient underwent an en-bloc resection of the urachal tumor with the dome of the bladder and the parts of the ileum invaded by the tumor. One course of adjuvant chemotherapy (FOLFOX4) was performed. Surgical specimen revealed histologically well differentiated squamous carcinoma and invasion to the propria of the ileum. The surgical margins were negative for the cancer. For 1.5 years after the surgery, no local recurrence or distant metastasis has been observed.