Comparison of Intra-articular Knee Injection of Corticosteroid between Hemodialysis and Non-hemodialysis Patients.

Introduction: Hemodialysis patients have various complications, and orthopedic diseases include carpal tunnel syndrome, spinal canal stenosis, spondylosis destruction, fractures, and osteoarthritis. As a treatment for knee osteoarthritis, intra-articular injections of hyaluronic acid and steroids are performed. In general, steroid injections have a strong short-term anti-inflammatory effect, but there is a risk of complications, such as infection. In addition to aging, dialysis patients are prone to weakened immune systems and susceptibility to infection. Therefore, more attention should be paid to the treatment of osteoarthritis in dialysis patients. This study aimed to compare the effects of steroid and complication of infection of dialysis and non-dialysis patients who underwent intra-articular steroid injection. Methods: A total of 20 dialysis patients (23 knees) and 20 non-dialysis patients (24 knees) with knee osteoarthritis who underwent steroid injections were investigated. All patients underwent radiographic diagnosis and were evaluated for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analog scale (VAS), range of motion (ROM), and side effects before, and at 3, and 6 months after injection. Results: The mean body mass index (BMI) was 21.3 (±standard deviation (SD) 2.8) and 24.9 (±SD 2.6) in dialysis and non-dialysis patients, respectively, showing a significant difference. Both dialysis and non-dialysis patients showed statistically significant improvement in VAS and WOMAC scores after steroid injection. There were no significant differences between dialysis and non-dialysis patients in the gender differences and mean age. There were no infection complications in both groups. Conclusions: This study revealed the analgesic effect of steroids on knee osteoarthritis in dialysis and non-dialysis patients. On the other hand, there were no infection complications in either patient. These findings suggest that intra-articular steroid injection is safe for dialysis patients.

Transient osteoporosis of the hip with a femoral neck fracture during follow-up: a case report.

We report a case of transient osteoporosis of the hip with a femoral neck fracture found during follow-up. A 53-year-old man presented with left hip pain without trauma. The pain did not improve after 2 weeks and he was brought to our hospital by ambulance. Magnetic resonance imaging (MRI) of the left hip joint showed diffuse edema in the bone marrow, which was identified by low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and increased signal intensity on short tau inversion recovery. This edema extended from the femoral head and neck to the intertrochanteric area. He was diagnosed with transient osteoporosis of the left hip. Rest gradually improved his pain; however, 3 weeks later, his left hip pain worsened without trauma. X-ray, computed tomography, and MRI results of the hip joint demonstrated a left femoral neck fracture, and osteosynthesis was performed. Differential diagnoses included avascular necrosis of the femoral head, infection, complex regional pain syndrome, rheumatoid arthritis, leukemia, and other cancers. Transient osteoporosis of the hip generally has a good prognosis with spontaneous remission within a few months to 1 year. However, a sufficient length of follow-up from condition onset to full recovery is necessary to avoid all probable complications such as fractures.

The Relationship between Perivertebral Venous Cement Embolism and Balloon Expansion Pressure in Balloon Kyphoplasty.

INTRODUCTION: Osteoporotic vertebral compression fractures (OVCFs) are common fractures in the elderly suffering osteoporosis. Most patients have bone fusion with deformity of vertebral collapse; however, some patients suffer nonunion and persistent pain at the fracture site. Due to the limitations of conservative treatment, balloon kyphoplasty (BKP) has been recently performed for OVCFs. This study aimed to investigate the relationship between cement embolization and balloon expansion pressure (BEP) in patients who underwent BKP. METHODS: We investigated 62 patients who underwent BKP for cement embolization into the perivertebral veins among the 155 patients admitted to our hospital due to thoracolumbar vertebral compression fractures between April 1, 2019, and March 31, 2020. Surgery was indicated for patients who had severe back or low back pain and whose daily life was severely impaired, and in whom the shape of the vertebral body was clearly changed on functional X-ray. RESULTS: Intraoperative X-ray and postoperative CT revealed cement embolization into the perivertebral veins in three cases (4.83%). The BEP was significantly higher in the group with cement embolism than in the group without cement embolism (P < 0.001). Pulmonary cement embolism (PCE) and infection were not observed. One case of cement leakage into the spinal canal was observed (1.61%). CONCLUSIONS: While the surgical intervention of BKP can contribute to the treatment of OVCFs, careful attention should be paid to the prevention of complications, including cement embolization into the perivertebral veins, and such complications should be appropriately managed.

Both microRNA-455-5p and -3p repress hypoxia-inducible factor-2α expression and coordinately regulate cartilage homeostasis.

Osteoarthritis (OA), the most common aging-related joint disease, is caused by an imbalance between extracellular matrix synthesis and degradation. Here, we discover that both strands of microRNA-455 (miR-455), -5p and -3p, are up-regulated by Sox9, an essential transcription factor for cartilage differentiation and function. Both miR-455-5p and -3p are highly expressed in human chondrocytes from normal articular cartilage and in mouse primary chondrocytes. We generate miR-455 knockout mice, and find that cartilage degeneration mimicking OA and elevated expression of cartilage degeneration-related genes are observed at 6-months-old. Using a cell-based miRNA target screening system, we identify hypoxia-inducible factor-2α (HIF-2α), a catabolic factor for cartilage homeostasis, as a direct target of both miR-455-5p and -3p. In addition, overexpression of both miR-455-5p and -3p protect cartilage degeneration in a mouse OA model, demonstrating their potential therapeutic value. Furthermore, knockdown of HIF-2α in 6-month-old miR-455 knockout cartilage rescues the elevated expression of cartilage degeneration-related genes. These data demonstrate that both strands of a miRNA target the same gene to regulate articular cartilage homeostasis.

Reverse Z-effect phenomenon in a basicervical femoral fracture using cephalomedullary nail with two superior antirotation screws: A case report and procedure evaluation.

We present a case of reverse Z-effect phenomenon in a basicervical femoral fracture using a cephalomedullary nail together with two superior antirotation screws and evaluate the procedure. An 86-year-old woman fell in her home and could not stand due to right hip joint pain. X-ray and CT imaging showed a right basicervical femoral fracture (AO/OTA classification; 31B3), and open reduction and internal fixation (OR/IF) was performed with a cephalomedullary nail and two superior antirotation screws (TES Nail, HOMS, Tokyo, Japan). Two months later, X-ray showed penetration of the femoral head by the inferior lag screw with lateral migration of the two superior antirotation screws; the so-called "reverse Z-effect"; without any trauma. We performed the exchange of a shorter inferior lag screw for the longer one, and replaced the sliding type end cap with one of rocking type. The reverse Z-effect has been reported in cases with two lag screws, i.e. one inferior and one superior, in the past; however, to our knowledge, there has been no case reported in the literature using two superior antirotation screws together with one inferior lag screw.

Transcriptional, epigenetic and microRNA regulation of growth plate.

Endochondral ossification is a critical event in bone formation, particularly in long shaft bones. Many cellular differentiation processes work in concert to facilitate the generation of cartilage primordium to formation of trabecular structures, all of which occur within the growth plate. Previous studies have revealed that the growth plate is tightly regulated by various transcription factors, epigenetic systems, and microRNAs. Hence, understanding these mechanisms that regulate the growth plate is crucial to furthering the current understanding on skeletal diseases, and in formulating effective treatment strategies. In this review, we focus on describing the function and mechanisms of the transcription factors, epigenetic systems, and microRNAs known to regulate the growth plate.

Nitrogen, phosphorus and potassium utilization and their cycling in a beef-forage production system.

The objective of this study was to quantify nitrogen (N), phosphorus (P) and potassium (K) utilization and their cycling in a beef-forage production system. A survey was conducted at the Kyoto University experimental farm in Kyoto Prefecture, Japan, and included 9.5 ha of meadow and about 160 head of beef cattle. Forages cultivated on the meadow were ensiled and offered to breeding cows. The whole farm was regarded as a beef-forage production system. The system consisted of three components: animals, manure and soil/crop. Nutrient inputs, flows through the soil-plant-animal pathway and outputs were quantified for 2 periods for the whole farm. Nutrient utilization was evaluated by nutrient balances, utilization efficiencies (ratio of nutrient export to nutrient input) and cycling index. The average nutrient balances of N, P and K for the whole farm (kg/year/ha) were 435.7, 136.3, and 262.8, and the average nutrient utilization efficiencies were 0.08, 0.06, and 0.01, respectively. The characteristics of nutrient balances and utilization efficiencies for each component differed among the nutrients. The average cycling indices for N, P and K were 0.19, 0.17 and 0.49, respectively. This study illustrates the importance of internal nutrient cycling for improving nutrient utilization in beef production systems.

Application of cycling index and input-output environs for interpretation of nutrient flows in mixed rice-beef production systems in Japan.

The objective of the present study was to apply two methods developed in ecology, the cycling index and input-output environs, to interpret nutrient flows in mixed rice-beef production systems. The cycling index (CI) was a quantitative measure of nutrient cycling. It was defined as the proportion of cycled nutrients to the total amount of nutrient flows. On the other hand, the input-output environs provide a quantitative distribution on a particular input or output. In this study, these methods were applied to the nutrient flows in the mixed rice-beef production systems in Japan. The results of CI provided information on the effects of nutrient cycling on the efficient conversion of nutrient imports to nutrient export. The results of input-output environs indicated that the indices represent indirect effects provided by the interaction between rice and beef production. In conclusion, these methods indicated new findings on nutrient utilization in the systems. The results of this study implied the further applicability of these two methods to the study of nutrient flows in mixed crop-animal production systems.