Mosaicplasty With High Tibial Osteotomy for Knee Subchondral Insufficiency Fracture Had Better Magnetic Resonance Observation of Cartilage Repair Tissue Scores With Less Bone Marrow Edema and Better Plug Union and Less Plug Necrosis Compared With Mosaicplasty Alone.

PURPOSE: To determine the magnetic resonance imaging (MRI) findings after mosaicplasty (MOS) for knee subchondral insufficiency fracture (SIFK), and to analyze the relationship between MRI findings and clinical outcomes. METHODS: We retrospectively reviewed the cases of consecutive patients who underwent MOS for SIFK with/without high tibial osteotomy (HTO) between January 1998 and December 2015. The MRI findings at 12 months after the surgery were assessed by the modified magnetic resonance observation of cartilage repair tissue (MOCART) score to determine the degree of bone marrow edema (BME), plug union, and plug necrosis. The clinical outcomes were assessed by Lysholm score to clarify the minimal clinically important difference (MCID) and patient acceptable symptom state analysis. RESULTS: In total, 58 patients (17 men and 41 women) were enrolled in this study. Among them, 30 knees were treated by MOS alone and 28 knees were treated by MOS with HTO. The MOCART scores of patients who received MOS alone were significantly lower in BME score (P = .0060), plug union score (P = .0216), and in plug necrosis score (P = .0326) than patients who received MOS with HTO. BME lesion was less likely to persist among elderly (odds ratio 1.20, P = .0248) and female (OR 41.8, P = .0118) patients. The MCID of Lysholm score was 6.6 in MOS alone and 8.4 in MOS with HTO cases, but there were no significant association between MRI findings and the postoperative Lysholm score. CONCLUSIONS: The MOS with HTO cases had better MOCART scores with less BME, better plug union, and less plug necrosis compared with MOS alone cases. Female and older patients had better resolution of BME, but there was no significant correlation between MRI findings and the postoperative Lysholm score. All cases in both groups showed improvement of Lysholm score exceeding MCID; thus, MOS may be effective as a joint preserving surgery for SIFK. LEVEL OF EVIDENCE: Level IV, clinical case series.

[Relationship between neurotransmitter blood noradrenalin and nausea/emesis after chemotherapy for lung cancer].

A clinical study was conducted to investigate the relationship between nausea/emesis after chemotherapy for lung cancer (docetaxel 60 mg/m(2), cisplatin 80 mg/m(2)) and blood serotonin (S), blood catecholamine (adrenaline) (A), noradrenaline (NA) and dopamine (D) in effective and non-effective patients treated with anti-emetic agents. All 37 patients received preventive combination administration of granisetron (GR) 3 mg, methylprednisolone 500 mg and metoclopramide (ME) 40 mg immediately before chemotherapy, followed by GR 3 mg and ME 40 mg on Day 2 and 3. Sixteen patients who were classified as emotionally unstable according to the YG character test additionally received prochlorperazine 15 mg thrice daily starting after their last meal prior to chemotherapy, until nausea/emesis disappeared. Blood concentration was measured on the day before chemotherapy and on Day 2, 4, and 14 after administration of the anticancer agents. As a result, a significant difference was demonstrated for NA on the day before chemotherapy (p<0.05), NA on Day 14 (p<0.01) and D on Day 14 (p<0.01) between effective and non-effective patients receiving anti-emetic treatment. In addition to conventional neurotransmitters S and D, NA is also worthy of attention in connection with nausea/emesis.