Evaluation of flexor digitorum superficialis function in adolescent baseball players.

Hypothesis and/or Background: Increased flexor digitorum superficialis (FDS) tendon activity can be a therapeutic target for elbow disorders in adolescent baseball players. The proportion of adolescent baseball players who can use FDS independently is unknown, and which finger is most often used remains unclear. This study investigated whether adolescent baseball players intentionally used FDS on each finger. Methods: Adolescent baseball players were recruited and assessed for FDS function for each finger using the standard technique. Results: Sixty-nine participants (mean age: 10.4 years) were recruited. Participants numbered 33, 56, 59, and 25 on the throwing side and those numbered 28, 46, 54, and 33 on the nonthrowing side could independently flex the proximal interphalangeal joint while holding their palms in the index, middle, ring, and small fingers, respectively. When assessing both throwing and nonthrowing participants, a significant number of participants could independently flex the proximal interphalangeals of the ring and middle fingers but had difficulty with the index and small fingers (P < .001). No significant difference was noted between the throwing and nonthrowing participants in any finger (P > .05). Discussion and/or Conclusion: One study reported that participating baseball players with elbow pain have more medial elbow joint space than those without pain symptoms. In another study on finger movements during pitching motion, the force of the thumb, index, middle, and ring fingers was greatest immediately before maximum external rotation. According to both reports, FDS function, especially in the index finger, can be a therapeutic target for medial-sided elbow injuries in adolescent baseball players.

ß2-Microglobulin Elevates COL5A1 mRNA in the Subsynovial Connective Tissue of Patients Receiving Hemodialysis With Carpal Tunnel Syndrome.

Background Although carpal tunnel syndrome (CTS) is frequently observed in patients undergoing long-term hemodialysis (HD), exactly how CTS arises is unknown. Here, we examined levels of COL5A1 in the subsynovial connective tissue (SSCT) of patients receiving HD and studied its potential regulation by ß2-microglobulin (Β2-MG) in SSCT-derived cells (SSCTCs). Methods We extracted SSCT samples from 67 patients with CTS (49 non-HD and 18 HD) during carpal tunnel release. The samples were subjected to quantitative polymerase chain reaction (qPCR) to determine COL5A1 expression. Further, to examine the potential regulation of COL5A1 expression by Β2-MG, SSCTCs were stimulated in the absence (control) or presence of 10 µg/ml Β2-MG. Results The HD group showed significantly elevated COL5A1 levels compared to the non-HD group (P=0.027). Moreover, treating SSCTCs with Β2-MG for 24 h increased the mRNA expression of COL5A1 relative to control conditions (P=0.013). Conclusions Elevated COL5A1 expression may form part of the mechanism underlying the development of CTS, and Β2-MG may play a role in promoting COL5A1 expression in HD patients.

Tenodesis with bone marrow venting under local anesthesia for recalcitrant lateral epicondylitis: results of 2 years of follow-up.

Hypothesis: We hypothesized that the treatment of recalcitrant lateral epicondylitis requires accurate identification of the painful area to promote remodeling of the degenerated extensor insertion and to stabilize the tendon origin during tendon healing. Thus, we performed tenodesis with bone marrow venting under local anesthesia for recalcitrant lateral epicondylitis. Methods: Twenty patients (21 elbows) were treated with bone marrow venting at the painful area of the lateral epicondyle of the elbow and tenodesis using 2 soft anchors lateral to the capitellum (immediately distal to the painful area) and were followed up for ≥2 years. Patients were assessed using the numerical rating scale for pain and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and objective evaluation included active range of motion. Results: The mean preoperative and postoperative pain scores were 7.5 and 0.5, respectively, indicating significant pain relief (P < .001). The mean preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 44.2 and 1.0, respectively (P < .001). Two elbows had a slightly positive Thomsen test at the final visit. No recurrence of intra-articular symptoms induced by synovial fringe impingement was observed. Patients experienced more pain at the bone-tendon junction of extensors than at the tendon parenchyma. Conclusion: Tenodesis with bone marrow venting under local anesthesia was effective for subjective patient satisfaction and positive clinical outcomes at ≥2 years of follow-up in patients with recalcitrant lateral epicondylitis. Intra-articular symptoms can be improved by stabilization of the lateral soft tissue without treatment for intra-articular lesions.

Virus-host interactions in carcinogenesis of Epstein-Barr virus-associated gastric carcinoma: Potential roles of lost ARID1A expression in its early stage.

Epstein-Barr virus (EBV)-associated gastric carcinoma (EBVaGC) is a distinct molecular subtype of gastric cancer characterized by viral infection and cellular abnormalities, including loss of AT-rich interaction domain 1A (ARID1A) expression (lost ARID1A). To evaluate the significance of lost ARID1A in the development of EBVaGC, we performed in situ hybridization of EBV-encoded RNA (EBER) and immunohistochemistry of ARID1A in the non-neoplastic gastric mucosa and intramucosal cancer tissue of EBVaGC with in vitro infection analysis of ARID1A-knockdown and -knockout gastric cells. Screening of EBER by in situ hybridization revealed a frequency of approximately 0.2% EBER-positive epithelial cells in non-neoplastic gastric mucosa tissue samples. Six small foci of EBV-infected epithelial cells showed two types of histology: degenerated (n = 3) and metaplastic (n = 3) epithelial cells. ARID1A was lost in the former type. In intramucosal EBVaGC, there were ARID1A-lost (n = 5) and -preserved tumors (n = 7), suggesting that ARID1A-lost carcinomas are derived from ARID1A-lost precursor cells in the non-neoplastic mucosa. Lost ARID1A was also observed in non-neoplastic mucosa adjacent to an ARID1A-lost EBVaGC. In vitro experiments using siRNA knockdown and the CRISPR/Cas9-knockout system demonstrated that transient reduction or permanent loss of ARID1A expression markedly increased the efficiency of EBV infection to stomach epithelial cells. Taken together, lost ARID1A plays a role in initiating EBV-driven carcinogenesis in stomach epithelial cells, which develop to a distinct subtype of EBVaGC within the proper mucosal layer. Lost ARID1A is one of the constituents of virus-host interactions in the carcinogenesis of EBVaGC.

Displaced isolated coronal shearing fracture of the trapezoid: a case report.

We present a case of a displaced isolated coronal shearing trapezoid fracture, treated with open reduction and internal fixation using a headless compression screw after temporary second metacarpal-trapezoid and trapezium-trapezoid ligament detachment. Complete functional recovery was achieved. For trapezoid fractures, lateral and oblique X-ray views in supination are important.

Polymicrobial Extensor Tenosynovitis Including Mycobacterium chelonae Caused by a Dog Bite: A Case Report.

CASE: A nonimmunocompromised 77-year-old man was bitten in the hand by his dog; redness, swelling, and exudate developed. Despite debridement and medications administered at another hospital, his symptoms did not improve. He was referred to us after 3 months. Debridement and negative-pressure wound therapy was performed. Cultures were positive for multiple bacterial organisms, including Mycobacterium chelonae. Polymicrobial extensor tenosynovitis including M. chelonae was diagnosed. Clarithromycin was given for 7 months based on drug sensitivity. His symptoms did not recur. CONCLUSION: Mycobacterium chelonae infections after dog bites are rare; however, mycobacterial culture tests are important, especially if tissue shows granulomatous inflammation.

Flexor Tenosynovitis Caused by Mycobacterium arupense: A Case Report and Review of the Literature.

CASE: A 64-year-old man presented with swelling of his right hand and forearm. This swelling had been recurring for 5 years. He liked sea fishing and frequently injured his fingers with fishhooks. He had difficulty bending his right little and ring fingers for 2 years and experienced finger numbness for several months. We diagnosed nontuberculous mycobacterial flexor tenosynovitis after Mycobacterium arupense was detected in a tissue sample. After surgery and 2 years of multidrug therapy, he has been recurrence-free for 3 years. CONCLUSION: Nontuberculous mycobacteriosis should be considered in chronic tenosynovitis cases.

Bilateral Solitary Osteochondroma of the Bicipital Tuberosity Accompanied with Painful Clicking: A Case Report and Literature Review.

Although osteochondroma is a benign bone tumor often observed in daily practice, solitary osteochondroma of the bicipital tuberosity is rarely observed. Herein, we report a case of bilateral solitary osteochondroma of the bicipital tuberosity. A 76-year-old woman experienced crackling and painful clicking bilaterally in her proximal forearms during pronation-supination. X-ray imaging, computed tomography, and magnetic resonance imaging revealed that the symptom was caused by bilateral solitary osteochondroma of the bicipital tuberosity. Bone tumor resection was performed on both sides. After surgery, the symptoms improved. X-ray imaging performed 2 years after surgery revealed no tumor recurrence. When painful clicking occurs around the elbow joint, a solitary osteochondroma of the bicipital tuberosity should be suspected; this symptom should be examined, and the surgeon should consider surgery positively. Exposed subchondral bone may rub against, collide with, or impinge upon the ulna during forearm pronation-supination and induce pain.

A dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures.

INTRODUCTION: Two methods using cannulated headless screws can be used for scaphoid fractures: Inserting the screw through the distal fragment and then into the proximal fragment through a palmar approach under direct vision or fluoroscopic guidance and inserting the screw in the proximal-to-distal direction through a dorsal approach with fluoroscopic guidance. These methods are sometimes difficult to use in oblique fractures when trying to achieve screw fixation perpendicular to the fracture plane.The most common mechanism of injury in the scaphoid fracture is forceful wrist hyperextension and punching something. Less commonly, a direct blow to the wrist also can cause a fracture. The mechanism of fracture by a direct blow to the wrist is not completely clear. CASE PRESENTATION: We experienced two rare cases of scaphoid fracture in goalkeepers sustained when they saved a goal by contacting the soccer ball with the palm of their hand. Both fractures were proximal oblique fractures. We performed through a dorsal approach to insert the screws in the distal-to-proximal direction under direct vision assisted with fluoroscopy. Bone union was noted after surgery in both cases. They returned to their occupations without wrist pain.We investigated the relationship between the fracture line and wrist position using a fresh cadaver. The experiment revealed that the fracture line of the scaphoid matched the dorsal edge of the articular surface of the radius with the wrist in 30° of dorsiflexion and 20° of ulnar deviation. CONCLUSION: In this report, we reported rare cases of scaphoid fracture due to contact with the soccer ball on the palm. We propose a surgical approach for an oblique fracture of the proximal scaphoid that used guide wires and screws, but was performed through a dorsal, and not palmar, approach to insert the screws in the distal-to-proximal direction.We presume that coronal shear stress to the scaphoid bone occurred when the palm contacted the ball with the wrist positioned at 30° dorsiflexion and 20° ulnar deviation.

ARID1A expression loss in gastric cancer: pathway-dependent roles with and without Epstein-Barr virus infection and microsatellite instability.

The AT-rich interactive domain 1A gene (ARID1A), which encodes one of the subunits in the Switch/Sucrose Nonfermentable chromatin remodeling complex, carries mutations and is responsible for loss of protein expression in gastric carcinoma, particularly with Epstein-Barr virus (EBV) infection and a microsatellite instability-high phenotype. We used immunohistochemistry to investigate the significance of ARID1A loss in 857 gastric carcinoma cases, including 67 EBV(+) and 136 MLH1-lost gastric carcinomas (corresponding to a microsatellite instability-high phenotype). Loss of ARID1A expression was significantly more frequent in EBV(+) (23/67; 34 %) and MLH1-lost (40/136; 29 %) gastric carcinomas than in EBV(-)MLH1-preserved (32/657; 5 %) gastric carcinomas (P < 0.01). Loss of ARID1A correlated with larger tumor size, advanced invasion depth, lymph node metastasis, and poor prognosis in EBV(-)MLH1-preserved gastric carcinoma. A correlation was found only with tumor size and diffuse-type histology in MLH1-lost gastric carcinoma, but no correlation was observed in EBV(+) gastric carcinoma. Loss of ARID1A expression in EBV(+) gastric carcinoma was highly frequent in the early stage of gastric carcinoma, although EBV infection did not cause downregulation of ARID1A: EBV-positive nasopharyngeal carcinomas (n = 8) and lymphomas (n = 15) failed to show loss of ARID1A, and EBV infection did not cause loss of ARID1A in gastric carcinoma cell lines. Taken together, loss of ARID1A may be an early change in carcinogenesis and may precede EBV infection in gastric epithelial cells, while loss of ARID1A promotes cancer progression in gastric cancer cells without EBV infection or loss of MLH1 expression. Loss of ARID1A has different and pathway-dependent roles in gastric carcinoma.

High-molecular-mass isoform of aminopeptidase N/CD13 in serum from cholestatic patients.

BACKGROUND: Because non-denaturing electrophoresis and aminopeptidase activity staining often detect noncovalent multi-enzyme complexes, we adopted procedures to specifically detect the aminopeptidase N (APN) molecule itself in liver disease serum. METHODS: Sera or their immunoprecipitate with anti-APN monoclonal antibody were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) or two-dimensional electrophoresis and subsequent Western blotting with rabbit anti-APN serum. RESULTS: In all the patient sera examined, the 140-kDa APN isoform was predominant. In all the sera from 10 patients with cholestatic diseases (8 with extra-hepatic cholestasis and 2 with primary biliary cirrhosis), we observed the 260-kDa isoform that was immunoprecipitated with monoclonal APN antibodies and had a similar isoelectric point to the 140-kDa isoform. However, the 260-kDa isoform was observed faintly in 2 out of 12 patients with other liver diseases, including chronic hepatitis and cirrhosis. CONCLUSIONS: We found a novel high-molecular-mass APN isoform (260-kDa) in serum, which is highly likely to be a homodimer of APNs bound covalently and a promising marker of cholestasis. This suggests increased cross-linking reaction between two APN molecules in cholestatic patients.