EP4 agonist accelerates osteoinduction and degradation of beta-tricalcium phosphate by stimulating osteoclastogenesis

Porous beta-tricalcium phosphate (TCP) has been known to have osteoinductive potential in ectopic site implantation in canine models without the use of osteoinductive substances or cell transplantation. Prostaglandin E2 receptors, particularly EP4, are known to play an important role in osteogenesis. EP4 agonists have been demonstrated to have positive effects on bone remodeling and bone morphogenic protein-induced ectopic bone formation in rodent models. We examined the efficiency of porousbeta-TCP-induced osteoinduction in beagles by the graded-release EP4 agonist, which was injected at their buttocks intramuscularly. Newly formed bone was observed on and after 3 weeks in the EP4 agonist-injected, while on and after 6 weeks in control groups, respectively. After that the bone resorption and the beta-TCP degradation was accelerated in EP4 agonist-injected group. Tartarate-resistant acid phosphatase-positive cells appeared in each group before bone formation, and the number of these cells reduced gradually; however, more multinucleated and larger cells appeared, particularly in the injected group. Injection of an EP4 agonist was proved to accelerate the osteoinduction and degradation of beta-TCP in canine model. Histological analysis revealed that the EP4 agonist stimulated osteoclastogenesis before bone formation.     

Analysis of the frequency of ceftriaxone-induced encephalopathy using the Japanese Adverse Drug Event Report database

International Journal of Clinical Pharmacy - The profile of ceftriaxone-induced encephalopathy is not well understood. To identify risk factors associated with ceftriaxone-induced encephalopathy....     

T9 versus T10 as the upper instrumented vertebra for correction of adult deformity—rationale and recommendations

Background Context

Adult spinal deformity correction sometimes involves long posterior pedicle screw constructs extending from the lumbosacral spine to the thoracic vertebra. As fusion obliterates motion and places supraphysiological stress on adjacent spinal segments, it is crucial to ascertain the ideal upper instrumented vertebra (UIV) to minimize risk of proximal junctional failure (PJF). The T10 vertebra is often chosen to allow bridging of the thoracolumbar junction into the immobile thoracic vertebrae on the basis that it is the lowest immobile thoracic vertebra strut by the rib cage.

Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding

AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications after RYGB(1995-2009;n=609;116M:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131M:555F;37.2±0.4years)were extracted from prospective databases.RESULTS:Pre-operative BMI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,P<001);more patients with BMI<35 kg/m2underwent LAGB than RYGB(17.1%vs 4.1%,P<0.0001).BMI decrease was greater after RYGB.There were direct relationships between weight loss and pre-operative BMI(P<0.001).Although there was no difference in weight loss between genders during the first 3-year post-surgery,male LAGB patients had greater BMI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,P<0.001);majority related to wound infection.LAGB had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,P<0.001).Conversion to RYGB resulted in greater BMI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.CONCLUSION:RYGB produces substantially greater weight loss than LAGB.Whilst peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB.