IL-38: A new factor in rheumatoid arthritis.

The newly characterized cytokine IL-38 (IL-1F10) belongs to the IL-1 family of cytokines. Previous work has demonstrated that IL-38 inhibited Candida albicans-induced IL-17 production from peripheral blood mononuclear cells. However, it is still unclear whether IL-38 is an inflammatory or an anti-inflammatory cytokine. We generated anti-human IL-38 monoclonal antibodies in order to perform immunohistochemical staining and an enzyme-linked immunosorbent assay. While human recombinant IL-38 protein was not cleaved by recombinant caspase-1, chymase, or PR3 in vitro, overexpression of IL-38 cDNA produced a soluble form of IL-38 protein. Furthermore, immunohistochemical analysis showed that synovial tissues obtained from RA patients strongly expressed IL-38 protein. To investigate the biological role of IL-38, C57BL/6 IL-38 gene-deficient (-/-) mice were used in an autoantibody-induced rheumatoid arthritis (RA) mouse model. As compared with control mice, IL-38 (-/-) mice showed greater disease severity, accompanied by higher IL-1ß and IL-6 gene expression in the joints. Therefore, IL-38 acts as an inhibitor of the pathogenesis of autoantibody-induced arthritis in mice and may have a role in the development or progression of RA in humans.

Isolated fracture of the lesser tuberosity of the humerus: a case report.

Fracture of the lesser tuberosity of the humerus often occurs concomitant with posterior shoulder dislocation or proximal humeral fracture, while isolated fractures are extremely rare. We report a case in which an isolated fracture of the lesser tuberosity of the humerus occurred due to a distinctive pathogenic mechanism. A 43-year-old male had his right shoulder forced into internal-rotation (i.e. back reach position) when he fell into a ditch approximately 70 cm wide and 1.5 m deep. Subcutaneous bleeding and tenderness were detected anteriorly in the shoulder, with restricted range of motion. Radiographs indicated a fracture of the lesser tuberosity of the humerus. Three-dimensional computed tomography (CT) confirmed an isolated fracture of the lesser tuberosity, which was displaced anteromedially by more than 5 mm from its previous anatomical position. During operation, the fractured fragment of the lesser tuberosity was reduced easily and fixed by a cancellous bone screw. At postoperative 2 years, the patient has recovered full range of motion with sufficient muscle strength, and has returned to work. The pathogenic mechanisms in this case were unique, differing from those that have been previously reported.

Current status of navigated cup replacement in dysplastic cases.

From the authors' experiences, several challenges exist in creating accurate cup positioning in patients with dysplastic hip due to anatomic abnormalities. B. Braun Aesculap (Tuttlingen, Germany) developed an advanced OrthoPilot software module for dysplastic cup positioning that has several advantages over the normal cup software as a solution to cup inaccuracies. The following study is a preliminary report on the new software version, which provides more specific functionality than the previous software system, a precondition or successful dysplastic cup navigation. This new functionality increase usefulness of navigation and the safety of the procedure.

Vertebral deformities in female patients with osteoporosis: influence of trauma and bone mineral density.

Aging societies have an increased incidence of fractures caused by osteoporosis. Vertebral compression fractures occur most frequently in the thoracolumbar vertebrae of elderly individuals. The severe pain caused by this type of fracture causes many patients to become bedridden. However, the initial pain generally diminishes after around 1 month and is replaced by dull pain in the lumbar and lumbosacral regions. We carried out a cross-sectional and longitudinal study of these fractures in 328 female outpatients with osteoporosis. All subjects initially presented at our hospital with back pain and bone mineral density measurements were taken using both dual energy X-ray absorptiometry and quantitative computed tomography. Our main findings were as follows. Decreased BMD appears to be one cause of vertebral body deformities. However, we found it difficult to predict whether deformities will progress or cause additional deformities of adjacent vertebral bodies, because the key contributing factors include not only BMD and age but also lifestyle and activity patterns. In addition, none of the drug administration methods investigated here resulted in a notable increase in BMD.