Effects of applying high-pass filtering in pelvimetry with Martius images.

AIM: The aim of this study is to investigate whether the results of pelvimetry using original radiographic Martius images and the same images with high-pass filtering applied ("edge images") would be consistent. METHODS: A total of 30 primagravidas were included in this study. Three obstetricians independently measured the anteroposterior and transverse diameters of the pelvic inlet in the original and the edge images, recording the x- and y-coordinates of the four endpoints. A Wilcoxon signed rank sum test was performed on the coordinate data to evaluate differences between the original and edge images. RESULTS: In the analysis of all coordinate data, statistically significant differences were found in both x- and y-coordinates of the sacral promontory point (SPP). In the y-coordinate of the SPP, a statistically significant difference was found in 9 of 30 pairs of images, and in all 9 the anteroposterior diameter was shorter in the edge images compared to the original images due to the more caudal placement of the SPP. CONCLUSIONS: The coordinates of the SPP on original radiographs and their edge images were not consistent in pelvimetry using Martius images. Our results suggest that improved image contrast will allow obstetricians to better assess pelvic narrowing and cephalopelvic disproportion and even reduce radiographic dose, thereby reducing risks for pregnant women and their fetuses.

Midterm outcomes of autologous bridging of rotator cuff tears with an autologous tendon patch (TEAR patch).

BACKGROUND: Large and massive rotator cuff tears and tears after failed surgical repair are a challenging clinical problem with different treatment options. The purpose of the study was to evaluate the midterm outcomes after rotator cuff repair (RCR) with autologous hamstring tendon graft bridging (tissue-enhanced autologous rotator cuff repair [TEAR] patch) with the hypothesis that outcomes would be reasonable and complication rates would be low. METHODS: This is a retrospective case series study of patients who underwent open RCR using a TEAR patch from June 2015 to March 2019. The exclusion criteria included evidence of cuff tear arthropathy, advanced fatty infiltration, moderate-to-severe arthropathy, and workers compensation board or litigation involved. Clinical outcome measures were Constant score; Disabilities of the Arm, Shoulder and Hand score; Simple Shoulder Test; Subjective Shoulder Value; range of motion (ROM); and manual muscle test for forward elevation, abduction, external and internal rotation, patient satisfaction, and willingness to perform the operation again. Radiographic outcome measures were magnetic resonance imaging, ultrasound, and radiographs: graft integrity and acromiohumeral distance (AHD). RESULTS: A total of 44 patients were followed (89%) for ≥2 years (45 shoulders, mean age 60.3 years [48-76 years], mean follow-up 4.3 years [2-6 years]). All clinical outcome measures (Constant score, Disabilities of the Arm, Shoulder and Hand score, Simple Shoulder Test, Subjective Shoulder Value, ROM, and manual muscle test) demonstrated significant improvement except active external and internal rotation. At 2 years of follow-up, the mean patient satisfaction was high (12.2 of 15 points), and 33 of 38 patients (73.3%) would perform the operation again. A perfect graft integration was observed in 30 (66.7%), a small gap in 7 (15.6%), a retear in 3 (7%), and a complete failure of the tendon patch in 5 (11%) patients. Graft integrity was strongly correlated with the postoperative AHD (r = 0.599, P = .001) and the gain in AHD (r = 0.599, P = .001) but not with ROM or patient-reported outcome measures or patient satisfaction. Four patients required revision surgeries (3 due to deep infection and 1 for poor function and pain). CONCLUSIONS: Midterm clinical and radiographic outcomes after RCR with graft bridging using a TEAR patch were reasonable. The procedure resulted in improved shoulder function and a high level of patient satisfaction. The revision rate is acceptable in view of the specific patient group and treatment alternatives. The described technique of the TEAR patch can be a valuable alternative to existing methods and a new autograft source for rotator cuff surgeries that need bridging of a tendon defect.

Nonplanar Nanographene: A Hydrocarbon Hole-Transporting Material That Competes with Triarylamines.

Hole-transporting materials (HTMs) are essential for optoelectronic devices, such as organic light-emitting diodes (OLEDs), dye-sensitized solar cells, and perovskite solar cells. Triarylamines have been employed as HTMs since they were introduced in 1987. However, heteroatoms or side chains embedded in the core skeleton of triarylamines can cause thermal and chemical stability problems. Herein, we report that hexabenzo[a,c,fg,j,l,op]tetracene (HBT), a small nonplanar nanographene, functions as a hydrocarbon HTM with hole transport properties that match those of triarylamine-based HTMs. X-ray structural analysis and theoretical calculations revealed effective multidirectional orbital interactions and transfer integrals for HBT. In-depth experimental and theoretical analyses revealed that the nonplanarity-inducing annulative π-extension can achieve not only a stable amorphous state in bulk films, but also a higher increase in the highest occupied molecular orbital level than conventional linear or cyclic π-extension. Furthermore, an in-house manufactured HBT-based OLED exhibited excellent performance, featuring superior curves for current density-voltage, external quantum efficiency-luminance, and lifetime compared to those of representative triarylamine-based OLEDs. A notable improvement in device lifetime was observed for the HBT-based OLED, highlighting the advantages of the hydrocarbon HTM. This study demonstrates the immense potential of small nonplanar nanographenes for optoelectronic device applications.

Lithium-Mediated Mechanochemical Cyclodehydrogenation.

Cyclodehydrogenation is an essential synthetic method for the preparation of polycyclic aromatic hydrocarbons, polycyclic heteroaromatic compounds, and nanographenes. Among the many examples, anionic cyclodehydrogenation using potassium(0) has attracted synthetic chemists because of its irreplaceable reactivity and utility in obtaining rylene structures from binaphthyl derivatives. However, existing methods are difficult to use in terms of practicality, pyrophoricity, and lack of scalability and applicability. Herein, we report the development of a lithium(0)-mediated mechanochemical anionic cyclodehydrogenation reaction for the first time. This reaction could be easily performed using a conventional and easy-to-handle lithium(0) wire at room temperature, even under air, and the reaction of 1,1'-binaphthyl is complete within 30 min to afford perylene in 94% yield. Using this novel and user-friendly protocol, we investigated substrate scope, reaction mechanism, and gram-scale synthesis. As a result, remarkable applicability and practicality over previous methods, as well as limitations, were comprehensively studied by computational studies and nuclear magnetic resonance analysis. Furthermore, we demonstrated two-, three-, and five-fold cyclodehydrogenations for the synthesis of novel nanographenes. In particular, quinterrylene ([5]rylene or pentarylene), the longest nonsubstituted molecular rylene, was synthesized for the first time.

Graft Healing Is More Important Than Graft Technique: Superior Capsular Reconstruction Versus Bridging Grafts-A Prospective Randomized Controlled Trial.

PURPOSE: To compare superior capsular reconstruction (SCR) versus bridging graft (BG) for massive irreparable rotator cuff tears (RCTs). METHODS: A prospective double-blind randomized study was conducted to compare SCR versus BG for massive irreparable RCTs. Fifty patients (mean age: 60.2 ± 6.0 years) with chronic tears (mean duration of symptoms: 5 ± 5.2 years) were intraoperatively randomized following partial repair to SCR or BG using human dermal allograft. All patients underwent standardized rehabilitation and were followed at 3, 6, 12, and 24 months clinically and radiographically. Magnetic resonance imaging were obtained at 12 months to determine graft integrity. RESULTS: At 2 years, 46 patients were available for follow-up. Mean American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff (WORC), and Quick Disabilities of the Arm, Shoulder and Hand scores were 74.8 ± 23.9, 66.0 ± 28.3, and 24.7 ± 26.1 for the SCR group, and 77.9 ± 19.9, 69.5 ± 24.5, and 25.0 ± 19.1 for the BG group, respectively, with no significant difference between groups. Magnetic resonance imaging demonstrated 18 of 24 (75%) in the SCR group and 14 of 22 (64%) in the BG group were intact at 12 months (P = .53). Patients with intact grafts compared with those with retorn grafts, whether SCR or BG, had greater ASES and WORC scores at 24 months (ASES 81.0 ± 18.7 vs 65.7 ± 24.4, P = .021 and WORC 72.3 ± 24.6 vs 53.7 ± 26.7, P = .04) and greater acromiohumeral intervals on radiographs at all follow-up time points. CONCLUSIONS: When performing arthroscopic reconstruction using human dermal allograft for an irreparable RCT, whether the proximal edge of the graft is attached on the glenoid bone or to the torn tendon does not significantly change short-term clinical and radiographic outcomes. LEVEL OF EVIDENCE: I, therapeutic.

Full-Thickness Rotator Cuff Tears: What Is the Rate of Tear Progression? A Systematic Review.

PURPOSE: To systematically review the literature and determine the rate of radiographic tear progression of nonoperatively treated full-thickness rotator cuff tears. METHODS: The PubMed, Embase, and Cochrane Library databases were systematically reviewed to identify all articles related to nonoperatively treated rotator cuff tears. English-language studies of Level I through IV evidence examining chronic, full-thickness rotator cuff tears in adults were included. Partial-thickness tears were excluded. Rotator cuff tears were analyzed according to the presence or absence of symptoms. The primary outcome was radiographic tear progression defined as an increase in tear size of 5 mm or greater on magnetic resonance imaging or ultrasound. RESULTS: Eight studies were included for statistical analysis, and 411 tears were analyzed for progression. No difference in the rate of tear progression was detected between the asymptomatic and symptomatic groups (40.6% at 46.8 months and 34.1% at 37.8 months, respectively; P = .65). Calculation of the number needed to treat showed that for an 8% retear rate at 2-year follow-up, approximately 7 patients with rotator cuff tears would have to undergo operative repair to prevent 1 tear from progressing radiographically. CONCLUSIONS: This study showed that with the data available, asymptomatic and symptomatic rotator cuff tears carry similar rates of tear progression over time. Most of these tears will not progress significantly over short- to intermediate-term follow-up. LEVEL OF EVIDENCE: Level IV, systematic review of Level I through IV evidence.

Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up.

PURPOSE: To report the long-term outcomes of medial open wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis in patients younger than 45 years old. It was hypothesized that the correction of knee alignment would result in preservation of knee function in a long-term follow-up. METHODS: Patients under 45 years old, who underwent MOWHTO for symptomatic medial compartment knee osteoarthritis between 2001 and 2005 were retrospectively reviewed after a minimum of 10 years. The osteotomy was performed utilizing a locking plate without the use of bone graft. Patients were evaluated pre- and postoperatively using the International Knee Documentation Committee Score, the Oxford Knee Score, the Knee injury Osteoarthritis Outcome Score and the Short Form-12 Score. Standardized standing whole-limb radiographs were also obtained to assess mechanical tibiofemoral angle (mTFA) and the grade of osteoarthritis. RESULTS: A total of 20 patients (18 males, 2 females, mean age 35.4 years) with a mean follow-up of 12.3 years were included in the study. During the follow-up period, one patient required conversion to total knee replacement (95% survival rate). All clinical outcome scores (IKDC, KOOS, OKS, and SF-12) significantly improved postoperatively (p < 0.05), with no significant deterioration over time. Preoperative varus alignment with an mTFA of - 5.8 ± 2.4° was corrected to 2.5 ± 1.9° immediately after surgery (p < 0.05), and remained 2.2 ± 1.7° at the last follow-up. Furthermore, no significant radiographic progression of osteoarthritis was observed. CONCLUSIONS: MWOHTO with a locking plate is an effective joint preservation method to treat medial compartment OA in active patients less than 45 years. Clinical and radiological results are satisfactory and the survival rate is 95%, 12 years after the procedure. LEVEL OF EVIDENCE: Level IV therapeutic, retrospective, cohort study.

Mechanical and imaging evaluation of the effect of sutures on tendons: tape sutures are protective to suture pulling through tendon.

BACKGROUND: High-strength sutures, including #2 and tape-type, are popular when performing arthroscopic rotator cuff repair. Although the most common mechanism of anatomic failure of rotator cuff repair is suture pulling through tendon, the effect of sutures on the suture-tendon interface has rarely been investigated. We evaluated the effect of commercially available modern high-strength standard #2 and tape-type sutures on tendon. METHODS: Isolated sutures (FiberTape, #2 FiberWire [Arthrex Inc., Naples, FL, USA], Ultratape, and #2 Ultrabraid [Smith & Nephew, Andover, MA, USA]) and suture-tendon constructs using sheep infraspinatus tendons were evaluated using mechanical testing and imaging (microcomputed tomography) techniques. RESULTS: For the 4 suture-tendon constructs evaluated, maximum and residual displacements were all less than 3 mm. Whether evaluating isolated sutures or suture-tendon constructs, tape-type sutures had smaller displacements than standard #2 sutures when products from the same company were compared. On initial suture passing and after mechanical testing, hole volume was larger in constructs with tape-type rather than standard #2 sutures comparing within the same company. Collectively, constructs with larger hole volumes after mechanical testing had stiffer sutures. The percentage difference in hole volume was larger for standard #2 than tape-type sutures: FiberWire (43%), Ultrabraid (17%), FiberTape (11%), and Ultratape (9%). CONCLUSIONS: Tape-type sutures created larger final holes than standard #2 sutures from the same company. When initially passed through the tendon, tape-type sutures produced larger holes than standard #2 sutures; however, standard #2 sutures enlarged their initially smaller holes more and displaced more than tape-type sutures during cyclic loading, which suggests that tape-type sutures may be protective to suture pulling through tendon.

The utility of apoptosis inhibitor of macrophages as a possible diagnostic marker in patients with Crohn's disease.

BACKGROUND: Apoptosis inhibitor of macrophages (AIM) was initially identified as an apoptosis inhibitor that supports the survival of macrophages against various apoptosis-inducing stimuli, and AIM produced by macrophages may contribute to the pathogenesis of inflammatory bowel diseases (IBDs). However, there have been no reports on the kinetics of AIM in IBD and the impact of AIM on the pathogenesis of IBD. In this study, we aimed to investigate the diagnostic utility of levels of AIM and their correlation with the activity of Crohn's disease (CD) and IBD. METHODS: We used an enzyme-linked immunosorbent assay (ELISA) to examine AIM serum levels in 16 healthy subjects and 90 patients with inflammatory bowel diseases, namely 39 with CD and 51 with ulcerative colitis (UC), as well as 17 patients with Behcet's disease (BD) as intestinal disease controls. We compared serum AIM levels among groups and examined whether there were correlations between serum AIM levels and disease activity and type. We also performed immunohistochemical staining of AIM in intestinal tissues of patients with CD. RESULTS: Serum AIM levels were significantly higher in patients with CD than in patients with UC, BD, and controls (3.27 ± 2.14, 1.88 ± 1.43, 2.34 ± 1.37, and 2.13 ± 0.64 µg/ml, respectively; P < 0.01). There was no difference in serum AIM levels before and after treatment in patients with CD. However, in these patients the diagnostic rate using AIM was better than that based on anti-Saccharomyces cerevisiae antibodies. AIM was expressed in macrophages that were positive for CD14, CD16, or both in the intestinal tissues of patients with CD. CONCLUSIONS: AIM is a novel biomarker of CD that can distinguish CD from UC or BD. It is suggested that AIM may contribute to intestinal inflammation by inhibiting the apoptosis of macrophages.

Graft Augmentation Versus Bridging for Large to Massive Rotator Cuff Tears: A Systematic Review.

PURPOSE: To systematically review the literature on the healing rates and clinical outcomes of the 2 different graft indications (i.e., augmentation vs bridging) during rotator cuff repair. METHODS: A systematic literature review was performed for clinical studies of rotator cuff repair using grafts for large to massive tears. The primary outcome was tendon healing on either magnetic resonance imaging or ultrasound. The secondary outcomes included visual analog scale for pain, American Shoulder and Elbow Surgeons score, and University of California at Los Angeles score, and forward elevation. Studies were divided into augmentation and bridging groups, and outcomes were compared statistically. RESULTS: Twelve studies with 13 study groups were included: 167 repairs in the augmentation group and 247 repairs in the bridging group. For augmentation and bridging groups, the mean age was 62.2 and 62.8 years and the mean follow-up was 28.5 and 37.7 months, respectively. The estimated healing rates were 64.0% for augmentation and 77.9% for bridging. Although both procedures had improved clinical outcomes, no statistical difference between groups was detected except lower visual analog scale in the bridging group at follow-up. CONCLUSIONS: Bridging grafts had no significant difference in healing or clinical outcomes when compared with a graft used for augmentation. Bridging grafts may be considered for this difficult patient population with large to massive rotator cuff tears. LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.

Semi-Automated Quantification of Finger Joint Space Narrowing Using Tomosynthesis in Patients with Rheumatoid Arthritis.

The purpose of the study is to validate the semi-automated method using tomosynthesis images for the assessment of finger joint space narrowing (JSN) in patients with rheumatoid arthritis (RA), by using the semi-quantitative scoring method as the reference standard. Twenty patients (14 females and 6 males) with RA were included in this retrospective study. All patients underwent radiography and tomosynthesis of the bilateral hand and wrist. Two rheumatologists and a radiologist independently scored JSN with two modalities according to the Sharp/van der Heijde score. Two observers independently measured joint space width on tomosynthesis images using an in-house semi-automated method. More joints with JSN were revealed with tomosynthesis score (243 joints) and the semi-automated method (215 joints) than with radiography (120 joints), and the associations between tomosynthesis scores and radiography scores were demonstrated (P < 0.001). There was significant, negative correlation between measured joint space width and tomosynthesis scores with r = -0.606 (P < 0.001) in metacarpophalangeal joints and r = -0.518 (P < 0.001) in proximal interphalangeal joints. Inter-observer and intra-observer agreement of the semi-automated method using tomosynthesis images was in almost perfect agreement with intra-class correlation coefficient (ICC) values of 0.964 and 0.963, respectively. The semi-automated method using tomosynthesis images provided sensitive, quantitative, and reproducible measurement of finger joint space in patients with RA.

Osteoarthritis-derived chondrocytes are a potential source of multipotent progenitor cells for cartilage tissue engineering.

The natural healing capacity of damaged articular cartilage is poor, rendering joint surface injuries a prime target for regenerative medicine. While autologous chondrocyte or mesenchymal stem cell (MSC) implantation can be applied to repair cartilage defects in young patients, no appropriate long-lasting treatment alternative is available for elderly patients with osteoarthritis (OA). Multipotent progenitor cells are reported to present in adult human articular cartilage, with a preponderance in OA cartilage. These facts led us to hypothesize the possible use of osteoarthritis-derived chondrocytes as a cell source for cartilage tissue engineering. We therefore analyzed chondrocyte- and stem cell-related markers, cell growth rate, and multipotency in OA chondrocytes (OACs) and bone marrow-derived MSCs, along with normal articular chondrocytes (ACs) as a control. OACs demonstrated similar phenotype and proliferation rate to MSCs. Furthermore, OACs exhibited multilineage differentiation ability with a greater chondrogenic differentiation ability than MSCs, which was equivalent to ACs. We conclude that chondrogenic capacity is not significantly affected by OA, and OACs could be a potential source of multipotent progenitor cells for cartilage tissue engineering.

Hypoxia-inducible factor-2α induces expression of type X collagen and matrix metalloproteinases 13 in osteoarthritic meniscal cells.

OBJECTIVES: To evaluate whether Hypoxia-inducible factor-2α (HIF-2α) regulates expression of endochondral ossification-related molecules in human OA meniscus. METHODS: Expressions of HIF-2α, type X collagen (COL10), matrix metalloproteinase (MMP)-13, and vascular endothelial growth factor (VEGF) in non-OA and OA menisci were analyzed by real-time RT-PCR and immunohistochemistry (IHC). Meniscal cells from OA patients were treated with interleukin-1ß (IL-1ß) and gene expression was analyzed. After knockdown of HIF-2α in OA meniscal cells, COL10 and MMP-13 expression were analyzed by RT-PCR, western blotting, immunofluorescence and ELISA. RESULT: Histological analysis demonstrated weak staining of the superficial layer and large round cells in OA meniscus. RT-PCR analysis showed that HIF-2α, COL10, MMP-13, and VEGF mRNA expressions were higher in OA than non-OA meniscal cells. IHC showed a coordinated staining pattern of HIF-2α, COL10, and MMP-13 in OA meniscus. IL-1ß treatment increased HIF-2α, COL10, and MMP-13 expressions in OA meniscal cells, and knockdown of HIF-2α suppressed IL-1ß-mediated increase in COL10 and MMP-13 expression. CONCLUSIONS: These results suggested that HIF-2α may cause meniscal matrix degradation by transactivation of MMP-13. HIF-2α may be a therapeutic target for modulating matrix degradation in both articular cartilage and meniscus during knee OA progression.

Expression of tenocyte lineage-related factors in regenerated tissue at sites of tendon defect.

BACKGROUND: The healing mechanism of ruptured or injured tendons is poorly understood. To date, some lineage-specific factors, such as scleraxis and tenomodulin, have been reported as markers of tenocyte differentiation. Because few studies have focused on tenocyte lineage-related factors with respect to the repaired tissue of healing tendons, the aim of this study was to investigate their expression during the tendon healing process. METHODS: Defects were created in the patellar tendons of rats, and the patellae and patellar tendons were harvested at 3 days and at 1, 2, 3, 6, 12, and 20 weeks after surgery. They were studied using micro-computed tomography, and paraffin-embedded sections were then prepared for histological evaluation. Reverse transcription-polymerase chain reactions were performed to analyze the expression of genes related to the tenocyte lineage, chondrogenesis, and ossification. RESULTS: Repaired tissue became increasingly fibrous over time and contained a greater number of vessels than normal tendons, even in the later period. Safranin O staining revealed the existence of proteoglycan at 1 week and its persistence through 20 weeks. Ossification was detected in all tendons at 12 weeks. The expression of tenocyte lineage-related genes was high at 1 and 2 weeks. Chondrogenic genes were up-regulated until 6 weeks. Runt-related transcription factor 2, an osteogenic gene, was up-regulated at 20 weeks. CONCLUSIONS: In our tendon defect model, cells participating in the tendon healing process appeared to differentiate toward tenocyte lineage only in the early phase, and chondrogenesis seemed to occur from the early phase onward. To improve tendon repair, it will be necessary to promote and maintain tenogenesis and to inhibit chondrogenesis, especially in the early phase, in order to avoid erroneous differentiation of stem cells.

Arthroscopic subscapularis repair using the subscapularis interlocking (SICK)-stitch technique leads to restoration of clinical function with low complication and revision rates.

Background: The purpose of this study is to determine the mid-term outcome after arthroscopic subscapularis tendon (SCP) reconstruction using the subscapularis interlocking (SICK)-stitch technique. The hypotheses are that arthroscopically repaired SCP lesions using the SICK-stitch show a good restoration of shoulder function with low complication and failure rates. Methods: This is a retrospective monocentric study of n = 199 patients (n = 106 female) with arthroscopically treated SCP tears with the interlocking (SICK) stitch technique from July 2013 to October 2018. Inclusion criteria: minimum follow-up of 2 years. Exclusion criteria: irreparable and massive cuff tears, osteoarthritis, and fractures. The postoperative assessment consisted of the range of motion, constant score, simple shoulder test, simple shoulder value, disability of the shoulder and arm score, short form 12, and patient satisfaction. Results: Mean age was 61 years (25-83); n = 4 (2%) patients were lost to follow-up with mean follow-up time of 63.6 months (36-96). Additional supraspinatus tendon lesions (n = 147) were repaired in n = 101 cases. SCP grading (n = 69) (35% traumatic) (Fox/Romeo): n = 113 grade II, n = 71 grade III, n = 11 grade IV. A positive preoperative lift-off test (n = 132, 68%) was corrected in n = 124 (94%) of cases. Ninety seven percent of patients would undergo surgery again with a mean satisfaction score of 14.4/15. Results at final follow-up (data: mean pre; post; P value): lexion (130; 166; .001), abduction (123;159; .001), external rotation (35;82; .001), internal rotation (52; 68; .07), constant score (50; 82; .001), disability of the shoulder and arm score (40; 19; .001), simple shoulder test (5; 10; .001), and simple shoulder value (44; 83; .001) significantly improved. The mean physical health scale short form 12 was 46 (24-63) and 51 (15-66) for mental health. Age, body mass index, SCP-grading, and supraspinatus tendon repair did not significantly affect any outcome parameter. Three (1.5%) patients underwent revision surgery, of which 1 (0.5%) had an infection. Conclusion: Two years after arthroscopic SCP repair using the SICK-stitch technique, we observed excellent restoration of clinical function with low complication and revision rates. The SICK-stitch technique thus represents a good and reliable therapeutic option for the arthroscopic repair of SCP lesions.

Chondrogenic capacity and alterations in hyaluronan synthesis of cultured human osteoarthritic chondrocytes.

During osteoarthritis there is a disruption and loss of the extracellular matrix of joint cartilage, composed primarily of type II collagen, aggrecan and hyaluronan. In young patients, autologous chondrocyte implantation can be used to repair cartilage defects. However, for more elderly patients with osteoarthritis, such a repair approach is contraindicated because the procedure requires a large expansion of autologous chondrocytes in vitro leading a rapid, perhaps irreversible, loss of the chondrocyte phenotype. This study investigates whether osteoarthritic chondrocytes obtained from older patients can be expanded in vitro and moreover, induced to re-activate their chondrocyte phenotype. A decrease in chondrocyte phenotype markers, collagen II, aggrecan and SOX9 mRNA was observed with successive expansion of cells in monolayer culture. However, chondrogenic induction in three-dimensional pellet culture successfully rescued the expression of all three marker genes to native levels, even with 4th passage cells-cells representing an approximate 625-fold expansion in cell number. This data supports the use of osteoarthritic cells for autologous implantation repair. In addition, another set of gene products were explored as useful markers of the chondrocyte phenotype. Differentiated primary chondrocytes exhibited a common pattern of hyaluronan synthase isoforms that changed upon cell expansion in vitro and, reverted back to the original pattern following pellet culture. Moreover, the change in isoform pattern correlated with changes in the molecular size of synthesized hyaluronan.

Surface markers and gene expression to characterize the differentiation of monolayer expanded human articular chondrocytes.

Autologous chondrocyte implantation (ACI) is a method of cartilage repair. To improve the quality of regenerated tissue by ACI, it is essential to identify surface marker expression correlated with the differentiation status of monolayer expanded human articular chondrocytes and to define the index for discriminating dedifferentiated cells from monolayer expanded human articular chondrocytes. Normal human articular chondrocytes were cultured in monolayer until passage 4. At each passage, mRNA expression of collagen type I, II, and X and aggrecan was analyzed by real-time quantitative PCR, and the surface marker expression of CD14, CD26, CD44, CD49a, CD49c, CD54, and CD151 was analyzed by fluorescence-activated cell sorting (FACS). The ratios of mRNA levels of collagen type II to I (Col II/Col I) represented the differentiation status of chondrocytes more appropriately during monolayer culture. The surface marker expression of CD44, CD49c, and CD151 was upregulated according to the dedifferentiation status, whereas that of CD14, CD49a, and CD54 was downregulated. The most appropriate combination of the ratio of Col II/Col I was CD54 and CD44. Cell sorting was performed using a magnetic cell sorting system (MACS) according to CD54 and CD44, and real-time quantitative PCR was performed for the cell subpopulations before and after cell sorting. The expression of collagen type II and aggrecan of the chondrocytes after MACS was higher than that before sorting, but not significantly. The mean fluorescence intensity (MFI) ratio of CD54 to CD44 could be an adequate candidate as the index of the differentiation status.

[Non-contact measurement of eye movements in the detection of deception].

The effectiveness of detecting deception by measuring eye movements without making contact was investigated. A deception-detection protocol was used with two conditions based on the stimulus similarity to the critical image. Volunteer participants (N = 63) were randomly assigned to either the high or the low-similarity condition. They were randomly presented with critical and non-critical images and their eye movements were measured without contact. High-similarity images were presented in the high-similarity condition and low-similarity images were presented in the low-similarity condition. The results showed no significant differences in eye movements between the critical and non-critical images in the high-similarity condition. In contrast, in the low-similarity condition, the frequency and total length of time for glancing at critical images were significantly lower than for glancing at non-critical images. These results are suggestive of the effectiveness of the non-contact measurement of eye movements for the detection of deception.

Long Head of the Biceps Pediculated Autograft Augmentation of Arthroscopic Subscapularis Repair.

Subscapularis (SSc) repairs are not free of failure and continues to pose a challenging problem. Although various biological and structural augmentation methods are available for the posterosuperior rotator cuff, few options have been explored for the anterior one. In the Technical Note, we describe an all-arthroscopic technique in which we use the long head of the biceps tendon (LHBT) as a pediculated autograft to reinforce an SSc repair. After SSc repair and LHBT tenodesis, the intra-articular portion of the LHBT is placed on the upper part of the SSc tendon at the rotator interval. Repurposing the otherwise-discarded tendon brings several biological and mechanical advantages at a lower cost without donor-site morbidity.

A Deep Learning-Based Model for Classifying Osteoporotic Lumbar Vertebral Fractures on Radiographs: A Retrospective Model Development and Validation Study.

Early diagnosis and initiation of treatment for fresh osteoporotic lumbar vertebral fractures (OLVF) are crucial. Magnetic resonance imaging (MRI) is generally performed to differentiate between fresh and old OLVF. However, MRIs can be intolerable for patients with severe back pain. Furthermore, it is difficult to perform in an emergency. MRI should therefore only be performed in appropriately selected patients with a high suspicion of fresh fractures. As radiography is the first-choice imaging examination for the diagnosis of OLVF, improving screening accuracy with radiographs will optimize the decision of whether an MRI is necessary. This study aimed to develop a method to automatically classify lumbar vertebrae (LV) conditions such as normal, old, or fresh OLVF using deep learning methods with radiography. A total of 3481 LV images for training, validation, and testing and 662 LV images for external validation were collected. Visual evaluation by two radiologists determined the ground truth of LV diagnoses. Three convolutional neural networks were ensembled. The accuracy, sensitivity, and specificity were 0.89, 0.83, and 0.92 in the test and 0.84, 0.76, and 0.89 in the external validation, respectively. The results suggest that the proposed method can contribute to the accurate automatic classification of LV conditions on radiography.