Studies of the humoral factors produced by layered chondrocyte sheets.

The authors aimed to repair and regenerate articular cartilage with layered chondrocyte sheets, produced using temperature-responsive culture dishes. The purpose of this study was to investigate the humoral factors produced by layered chondrocyte sheets. Articular chondrocytes and synovial cells were harvested during total knee arthroplasty. After co-culture, the samples were divided into three groups: a monolayer, 7 day culture sheet group (group M); a triple-layered, 7 day culture sheet group (group L); and a monolayer culture group with a cell count identical to that of group L (group C). The secretion of collagen type 1 (COL1), collagen type 2 (COL2), matrix metalloproteinase-13 (MMP13), transforming growth factor-ß (TGFß), melanoma inhibitory activity (MIA) and prostaglandin E2 (PGE2) were measured by enzyme-linked immunosorbent assay (ELISA). Layered chondrocyte sheets produced the most humoral factors. PGE2 expression declined over time in group C but was significantly higher in groups M and L. TGFß expression was low in group C but was significantly higher in groups M and L (p<0.05). Our results suggest that the humoral factors produced by layered chondrocyte sheets may contribute to cartilaginous tissue repair and regeneration.

[A multicenter cross-sectional study on the Health Related Quality of Life of patients with rheumatoid arthritis using a revised Japanese version of the Arthritis Impact Measurement Scales Version 2 (AIMS 2), focusing on physical disability and its associative factors].

OBJECTIVE: A multicenter cross-sectional survey was conducted to study the current status of Health Related Quality of Life (HRQL) of Japanese patients with rheumatoid arthritis using a revised Japanese version of the AIMS 2, to investigate the association among the self-report physical disability scores and demographic, socioeconomic, and clinical variables in these patients. METHODS: A Japanese version of the AIMS 2 was administered to the randomly chosen 1614 patients with classical and definite rheumatoid arthritis attending arthritis clinics at eleven hospitals across the country. Self-report functional disability scores (FDSs) were calculated, by which patients were classified into five groups with graded levels of disability. Univariate correlations were examined between FDSs and the scores of the other four components of AIMS-HRQL, disease duration, age, medical costs, and physical and laboratory measures. Analysis of variance was performed to test for among level differences of these variables in each group of patients. Mean values and standard deviations of FDSs were calculated and analysis of variance was used to test for among level differences of the following factors: demographic, socio-economic, clinical measures, and treatment status. RESULTS: Among four scales composing the AIMS 2-HRQL, work disability scores were most strongly correlated with FDSs, followed by the scores of pain, affection and social interaction. The more severely disabled group proved to have weaker grip strength, higher joint count, longer disease duration, higher ESR and blood level of CRP, and lower level of Hb. Patients with more disabilities proved to be older, pay more medical costs, have longer duration of morning stiffness, and higher level of RF. Patients with more advanced Steinbrocker's functional class, doctor's global assessment, Steinbrocker's anatomical stage, higher daily dose of prednisolone intake, lower level of annual income and formal education, and patients taking more kinds of NSAIDs proved to be more severely disabled. Separate, single (never married, widowed), and divorced patients proved to be more severely disabled compared with married ones. Overall, females were more disabled than males. CONCLUSION: Physical disability is associated with the other important aspects of QOL, clinical signs and symptoms, and socio-economic conditions in RA patients. Prevention and management of physical disability should be seriously planned in consideration of the changes in these conditions in RA patients.

Validity and reliability of a revised Japanese version of the Arthritis Impact Measurement Scales version 2 (AIMS2).

Abstract This study aims to evaluate the validity and reliability of a Japanese version of the Arthritis Impact Measurement Scales, version 2 (AIMS2) for patients with rheumatoid arthritis (RA). The Japanese version of the AIMS2 questionnaire was administered to 1643 patients with classical or definite RA at 11 hospitals nationwide in Japan. Reliability was assessed by a test-retest procedure, 4 weeks apart, using 75 randomly selected patients. Internal consistency was measured by Cronbach's α, and factor analysis was used to obtain the proportion of variance explained by the first factor in principal component analysis. The validity of the AIMS2 scales was assessed by internal standards. Internal consistency (α coefficients, 0.84-0.94), test-retest reliability (intraclass correlation coefficients, 0.75-0.93), and factor analysis (0.62-0.85) of the AIMS2 health status scales proved that they are highly reliable in the Japanese version. Validity, as measured by the relationships among the scores on the questionnaire items, was also sufficiently secured. The validity and reliability of the Japanese version of the AIMS2 are sufficient for all practical purposes when compared with the original and with other translated versions of the questionnaire.

[Quality of life, subjective health status and health and life satisfaction in rheumatoid arthritis].

A Japanese version of Arthritis Impact Measurement Scales (AIMS) was developed after the original AIMS Version 2 and utilized for Quality of Life (QOL) measurement in 691 patients with Rheumatoid Arthritis (RA). Various medical (physical and laboratory) examinations, which are widely used in the clinical settings for the assessment of RA activity and severity, were also performed by physicians. Interrelationships between QOL, patient subjective health status, and health and life satisfaction were analyzed with the following results: 1: The effect of QOL impairment by RA upon patients' subjective health rating and health satisfaction were not constant over the range of severity of disease status. Pain was found to lower overall subjective health and health satisfaction regardless of RA class. On the other hand, while the deterioration of mobility aspects of QOL had negative effects upon patients' subjective health status and satisfaction among less-disabled RA patients, any of physical aspects of QOL, including the degree of mobility impairment, showed no significant association with patients' subjective health status and satisfaction in the more disabled. 2: Psychological aspects of QOL (mood and tension) had significant associations with patients' subjective health status and satisfaction. In the less severe group, mood impairment had a significant effect on subjective health and satisfaction, while in the more severe group tension showed a significant association. It was indicated that management of psychological aspects of QOL is important in RA patients to improve and advance their subjective health status and satisfaction. 3: Although social aspects of QOL, i.e. social support, social life and job status, showed no significant relationship to subjective health rating and health satisfaction, those with less disease severity who lacked social support and who had a jobless state were likely to have lower disease acceptance and life satisfaction, while those with more severe disease who had less social interaction manifested lower life satisfaction. These results suggested that social aspects of QOL, while not directly associated with subjective health rating, could be important factors affecting disease acceptance and life satisfaction.

[The validity and reliability of a Japanese version of Arthritis Impact Measurement Scales in patients with rheumatoid arthritis].

A Japanese version of Arthritis Impact Measurement Scales (Japanese-AIMS) was developed after the original AIMS Version 2 (AIMS 2). We then conducted a Quality of Life measurement of 691 patients with Rheumatoid Arthritis (RA) with this newly developed questionnaire. Based on the data collected, the validity and reliability of the Japanese-AIMS was examined. The validity of the Japanese-AIMS, which was assessed by the examination of internal consistency among items and through factor analysis, was almost comparable with that of the original AIMS 2. QOL scales were also validated using internal standards based on the subject's responses to other items in the questionnaire. The test-retest reliability, which was the correlation of scale scores between two tests administered 4-5 weeks apart, was slightly lower than the original one. We conclude that the validity and reliability of the Japanese AIMS were comparable with those of the original one, though there could be possibly improved by the minor revision of phrasing. The large scale QOL measurement study with RA patients is under way, using the Japanese-AIMS with minor revision.

New concept of spinal orthosis for weakened back muscles.

An anterior bending posture of the trunk during walking is often seen among the elderly commonly due to weakened thoraco-lumbar and gluteal muscles. For the management of this debilitating condition, the authors have developed a modified design of thoraco-lumbosacral orthosis (TLSO). Incorporated in this device are pockets for the accommodation of lead weights, which are located posteriorly at the level of the lumbar region and an elasticated anterior abdominal band. The results and level of patient acceptance achieved with the use of this brace have both been excellent.

Formyl-ended heterobifunctional poly(ethylene oxide): synthesis of poly(ethylene oxide) with a formyl group at one end and a hydroxyl group at the other end.

Well-defined poly(ethylene oxide) (PEO) with a formyl group at one end and a hydroxyl group at the other terminus was synthesized by the anionic ring opening polymerization of ethylene oxide (EO) with a new organometallic initiator possessing an acetal moiety, potassium 3,3-diethoxypropyl alkoxide. Hydrolysis of the acetal moiety produced a formyl group-terminated heterobifunctional PEO with a hydroxyl group at the other end.

Vascularization and innervation of the canine wrist joint synovial membrane.

The correlation between vascular distribution and synovial structures was investigated using corrosion cast of the synovial fold of the dog antebrachiocarpal joint (wrist joint) under scanning electron microscopy. Arterial branches arose from a main artery deep in the subsynovial layer, ascended toward the free margin of the fold, dividing into several branches, and finally formed a dense capillary network beneath the lining layer. Immunohistochemical study and a retrograde axonal tracing experiment revealed that almost all nerve fibers were associated with the arterial tree and that: (1) proximal parts of the arterial tree were innervated with neuropeptide Y (NPY)-containing noradrenergic sympathetic fibers, vasoactive intestinal peptide-containing non-catecholaminergic sympathetic fibers from the stellate ganglion and substance P (SP)- and calcitonin gene-related peptide (CGRP)-containing sensory fibers from the C7-T1 segments of the dorsal root ganglia; (2) more distal parts of the arterial branches were associated with NPY-immunoreactive sympathetic fibers and SP- and CGRP-immunoreactive sensory fibers; and (3) the most peripheral precapillary arterioles were accompanied by only SP- and CGRP-containing sensory fibers. These results indicate that synovial blood flow is regulated by at least three different nerve systems which possess regional differences.

[Radiological changes in the femoral side after cementless total hip arthroplasty].

We investigated radiological and functional changes of the femurs with cementless total hip arthroplasty. Our particular attention was paid to the relationship between the thigh pain and the rate, period of its incidence and the progression of radiological changes. The cases studied consisted of 57 female patients with severe coxarthrosis who were implanted with a SUS316-L macroanchoring type of THP (JIAT). Clinical evaluations, radiographic findings in the femoral side, and osteometric observations were carried out periodically in the period before surgery until five years after surgery. The JOA criterion at the time of the final examination was average 91 points. However, we observed a high degree of bone change in the femur on the radiogram. Of 63 hips, there was 71% cortical bone atrophy, a 43% reduction of cortex thickness, 25% cortical bone hypertrophy, 94% endosteal bone bridging in the stem tip, a 64% linear sclerosis of the neighboring stem, and a 37% enlargement of the medullary cavity. Bone atrophy was manifested soon after surgery, and there was 34% recovery. Further, there was no connection between thigh pain and bone changes. We, therefore, concluded that such bone changes as atrophy would not immediately bring about adverse consequences.

Mechanical effects of a cushioned plate on bone fixation.

In vitro and in vivo experiments were carried out to study mechanical effects of the cushioned plate fixation in which a cushion was placed between a metal plate and bone. The cushioned plate fixation was found to be flexible in the physiological stress range and to reduce the stick slip between bone and the plate. A blood-soaked compression test indicated that the cushion moderates the stress shielding effect which occurs in the vicinity of the rigid plate, this being consistent with the result of in vivo experiments.

[Frequency and prognostic features of rheumatoid patients with remission-inducing agents--a comparison of different kinds of medication].

Recently, the disease activity has been believed to be effectively controlled by remission inducing agents such as gold salt and D-penicillamine in rheumatoid arthritis. However, there remain some doubts whether the prognosis of RA has been improved by these drugs or not. The frequency of complete remission in RA patients and their special features were studied to know the real state of the remission of RA under the present treatments. The subjects under investigation were 466 RA patients who were treated with remission-inducing agents for one to eight years. There were 90 male and 376 female patients diagnosed as definite or classical RA. Complete remission according to ARA criteria (Pinals R.S. et al. 1981) was noted in 33 (7.1%) of the 466 patients. However, relapse of the disease activity was observed in five patients during an observation period of two years on average. The followings were noted as the clinical and laboratory features of 26 cases with complete remission which could be observed for more than six months. A breakdown on sex revealed that the remission rate was 13.3% in male patients, compared to 5.6% in female patients. Duration of the disease for these complete remission cases was shorter for males than for females. Clinical examination of the cases with complete remission revealed that the most of them had no family history of RA, as well as no rheumatoid nodule or hip contracture.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mammary gland carcinoma treated by large-dose medroxyprogesterone acetate of which pulmonary metastases disappeared and a selection of hormone, chemoimmunological treatment].

A patient who underwent radical mastectomy was treated by tegafur and tamoxifen. Pulmonary metastases were found four months after operation. Lymphokine activated killer (LAK) and auxiliary interleukin-2 (IL-2) administration was performed, with no change (NC). However, administration of large-dose medroxyprogesterone acetate induced complete disappearance of pulmonary metastases after more than nine months.

Experimental studies on the use of a cushioned plate for internal fixation.

Internal fixation is widely used in the operative treatment of fractures, but various problems, such as local osteoporosis, may occur when living bone is fixed with a rigid metal plate. We propose a new method of immobilisation, which we have termed "cushioned plate fixation", in an attempt to solve some of these problems. Cushioned plate fixation involves a silicone rubber cushion placed between the steel plate and the bone. On the basis of data obtained from animal experiments in vivo and mechanical tests in vitro, we conclude that the cushion is effective in preventing osteoporosis without decreasing the strength of fracture fixation. We believe that this method might improve the mechanical biocompatibility of plate fixation.

Chemotactic activity for polymorphonuclear and mononuclear leukocytes in rheumatoid synovial fluids.

In order to why polymorphonuclear leukocytes (PMNs) are predominant and mononuclear leukocytes (MNLs) are few in rheumatoid synovial fluids, chemotactic factor(s) for PMNs and MNLs were studied in the synovial fluids of rheumatoid arthritis (RA-SF) and osteoarthritis (OA-SF) using both Boyden's and agarose methods. The RA-SF showed strong chemotactic activity for human peripheral blood PMNs compared with non-rheumatoid OA-SF. The chemotactic activity for PMNs was well correlated with the number of PMNs in RA-SF, suggesting that it was a natural mediator for PMN emigration into rheumatoid joint cavity. The major chemotactic factor for PMN in RA-SF was of apparent molecular weight of 14,000 and its activity was suppressed to less than 10 percent by anti-C5a antibody, but it failed to show any anaphylatoxin activity which was an attribute of C5a. It was, therefore, suggested to be C5a-like molecule but not C5a itself. The possibility that the factor may be a C5a des-Arg was discussed. On the contrary, the chemotactic activity for MNLs was not found neither in RA-SF nor OA-SF. These findings may explain the fact that PMNs are predominant in rheumatoid synovial fluids.

Contribution of calcium ion sequestration by polyoxyethylated nonionic surfactants to the enhanced colonic absorption of p-aminobenzoic acid.

Enhanced absorption of p-aminobenzoic acid (PABA) from the colon by polyoxyethylated nonionic surfactants was investigated using an in situ perfusion technique. The order of their absorption-enhancing effect was as follows: polyoxyethylene lauryl ether greater than polyoxyethylene sorbitan fatty acid esters approximately equal to polyoxyethylene fatty acid esters. The coexistence of calcium chloride in the perfusing solution caused a partial reverse in this enhancement. The calcium ion sequestration capacity of the surfactants was correlated with their ability to enhance colonic absorption of PABA. The findings suggest that calcium ion sequestration by the surfactants contributes to their enhancement of the colonic absorption of PABA.