A Case Report of Synovial Osteochondromatosis of the Knee Joint with neither Calcification nor a Synovial Lesion on Imaging

Synovial osteochondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that ultimately break free, mineralize, and even ossify. The most commonly involved joint is the knee. Typically, radiographs can be diagnostic and mineralized nodules are pathognomonic. In as many as one-third of cases, however, no calcification or ossification of the cartilage occurs in the early stage of the disease because mineralization is time-dependent. In such cases, gadolinium-enhanced MRI can be useful. Unmineralized nodules are typically peripherally enhanced because they are attached to and derive a vascular supply from the synovium. We experienced an unmineralized case of synovial osteochondromatosis of the right knee joint, in which imaging diagnosis was difficult. Neither calcification nor ossification was observed, but all nodules were released from the synovium as loose bodies and there was no vascular supply. Therefore, MRI did not show a typical appearance. These findings suggest that synovial osteochondromatosis should be considered as a differential diagnosis in a case in which unmineralized loose bodies without a synovial lesion are found in an imaging examination.

A Case of Rectus Sheath Hematoma Due to Anticoagulants after Total Knee Arthroplasty

Background: Hematoma in the rectus sheath is not common but if happens it will become major bleeding. Sometimes anticoaglation of deep vein thrombosis (DVT) causes the hematoma in the rectus sheath. Case Report: A 74-year-old female patient after total knee arthroplasty (TKA) due to osteoarthritis. Postoperation, residual DVT was noted in the right soleus vein on ultrasonography of the veins of the lower limbs. Anticoaglation was started 7.5 mg/day Arixtra for treatment of DVT. Anticoaglation was administered throughout rehabilitation, and abdominal pain developed on postoperative day 9. Since respiratory distress developed on day 10, then thoracoabdominal contrast CT was performed. Although no PE was observed, a hematoma was detected in the rectus sheath, and it perforated into the abdominal cavity. The hemoglobin level was reduced by about 4 g/dL, and the patient was admitted to the ICU. Surgical treatment was not performed, anticoagulant treatment was discontinued, and conservative treatment was administered. During management in the ICU, a total of 24 units of red blood cells were transfused. Conclusions: Rectus sheath hematoma should be in mind of surgeons during differential diagnosis of acute abdominal pain especially in patients receiving anticoagulants. Early recognition can be of great importance for patients’ recovery, preventing from severe complications. Management is usually supportive although surgical intervention in some patients should be considered.

Radioprotective Effect of Lyophyllum Decastes and the Effect on Immunological Functions in Irradiated Mice

In this study, to explore the radiation protection effects of Lyophyllum Decastes Sing （LDS）, a hot distilled-water extract of LDS was orally administered at a dosage of 250mg/kg every other day for a period of 2 weeks in irradiated mice. An automatic blood cell counter was used to measure white blood cells （lymphocytes, monocyte, and granulocytes） one day before X-ray irradiation, and 3 hours, 12 hours, 24 hours, 3 days, 7 days, 15 days and 30 days after irradiation. The Dunnett test was used to examine statistical significance of differences. The peripheral blood cell counts in the Lyophyllum-administered non-irradiation group revealed an increase in the numbers of ieukocytes, lymphocytes and monocytes. For 2 Gy whole body radiation, a significant statistical difference was found between the X-ray group and the Lyophyllum plus X-ray group in the numbers of leukocytes, lymphocytes and monocytes. The results suggest that Lyophyllum restrains blood cell-count falling after irradiation, which is probably mediated at least in part by hemopoietic function, and NK and LAK activities seems to play a role in preventing secondary irffections associated with irradiation.

Simultaneous augmentation of muscle and bone by locomomimetism through calcium-PGC-1αsignaling

Impaired locomotion has been extensively studied worldwide because those afflicted with it have a potential risk of becoming bedridden.Physical exercise at times can be an effective remedy for frailty,but exercise therapy cannot be applied in all clinical cases.Medication is safer than exercise,but there are no drugs that reinforce both muscle and bone when administered alone.Multiple medications increase the risk of adverse events;thus,there is a need for individual drugs targeting both tissues.To this end,we established a novel sequential drug screening system and identified an aminoindazole derivative,locamidazole(LAMZ),which promotes both myogenesis and osteoblastogenesis while suppressing osteoclastogenesis.Administration of this drug enhanced locomotor function,with muscle and bone significantly strengthened.Mechanistically,LAMZ induced Mef2c and PGC-1αin a calcium signaling–dependent manner.As this signaling is activated upon physical exercise,LAMZ mimics physical exercise.Thus,LAMZ is a promising therapeutic drug for locomotor diseases,including sarcopenia and osteoporosis.

Globoside accelerates the differentiation of dental epithelial cells into ameloblasts

Tooth crown morphogenesis is tightly regulated by the proliferation and differentiation of dental epithelial cells. Globoside （Gb4）, a globo-series glycosphingolipid, is highly expressed during embryogenesis as well as organogenesis, including tooth development. We previously reported that Gb4 is dominantly expressed in the neutral lipid fraction of dental epithelial cells. However, because its functional role in tooth development remains unknown, we investigated the involvement of Gb4 in dental epithelial cell differentiation. The expression of Gb4 was detected in ameloblasts of postnatal mouse molars and incisors. A cell culture analysis using HAT-7 cells, a rat-derived dental epithelial cell line, revealed that Gb4 did not promote dental epithelial cell proliferation. Interestingly, exogenous administration of Gb4 enhanced the gene expression of enamel extracellular matrix proteins such as ameloblastin, amelogenin, and enamelin in dental epithelial cells as well as in developing tooth germs. Gb4 also induced the expression of TrkB, one of the key receptors required for ameloblast induction in dental epithelial cells. In contrast, Gb4 downregulated the expression of p75, a receptor for neurotrophins （including neurotrophin-4） and a marker of undifferentiated dental epithelial cells. In addition, we found that exogenous administration of Gb4 to dental epithelial cells stimulated the extracellular signal-regulated kinase and p38 mitogen-activated protein kinase signalling pathways. Furthermore, Gb4 induced the expression of epiprofin and Runx2, the positive regulators for ameloblastin gene transcription. Thus, our results suggest that Gb4 contributes to promoting the differentiation of dental epithelial cells into ameloblasts.

Development of ulcerative colitis during the course of rheumatoid arthritis: Association with selective IgA deficiency

A 56-year-old woman with a 29-year history of rheumatoid arthritis （RA） was admitted to the hospital, complaining of high fever, abdominal pain and severe bloody diarrhea. Colonoscopy revealed friable and edematous mucosa with spontaneous bleeding, diffuse erosions and ulcers extending from the rectum to the distal transverse colon. Histopathological findings of rectal biopsies were compatible with ulcerative colitis （UC）. Being diagnosed as having severe active leftside UC, she was successfully treated with intravenous methylprednisolone followed by prednisolone and leukocytapheresis. Laboratory tests revealed low serum and saliva IgA levels, which might play a role in the development of UC. To our knowledge, this is the first case of UC occurring during the course of RA, accompanied by selective IgA deficiency.

Organogermanium (Ge-132) Suppresses Activities of Stress Enzymes Responsible for Active Oxygen Species in Monkey Liver Preparation

Assays of stress enzymes related to active oxygen species were performed by using an in vitro preparation from the liver of a monkey (Japanese Macaque). Ge-132, an organic germanium compound, viz. poly-trans-[(2-carboxyethyl) germasesquioxane] [(GeCH2CH2COOH)2O3]n, suppressed the activities of NADH-dependent oxidase and NADPH-dependent oxidase [NAD(P)H-OD] and xanthine oxidase (XOD) as superoxide-forming enzymes, while promoting the activities of superoxide dismutase (SOD) as a superoxide-scavenging enzyme and catalase (CAT) as an enzyme responsible for degradation of hydrogen peroxide (H2O2). The evidence suggests that the levels of active oxygen species such as and H2O2 would be reduced by Ge-132. The possible connection between Ge-132 and activities of stress enzymes is discussed on the basis of these results.

Tool Temperature and Process Modeling of Friction Stir Welding

Friction stir welding (FSW) has many advantages rather than fusion welding, but details of internal phenomena during its processes have not yet been clarified. In this study, a thermo-mechanically coupled process model was developed to investigate FSW phenomena inside a tool and workpiece. As a workpiece, 6061-T6 aluminum alloy was employed. The system of FSW process model includes several thermal boundaries. Among heat flows through these boundaries, heat transfers into the exterior of the system become more sensitive to tool and workpiece temperatures than heat transfers within the system. This paper especially focused on a heat transfer coefficient at a workpiece bottom, and optimized it through experiments and finite element method (FEM) analyses. The tool temperatures during FSW were measured with a special tooling system with imbedded thermocouples within a tool. As a result, an analysis model that is able to investigate details at a wide range of traverse speeds was developed for practical high speed welding. Then, the accuracy of developed FEM model was validated with them. Finally, the temperatures and stress distribution around workpiece/tool interfaces were investigated with the developed model.

Effects of K. Lysolecithin on Blood Levels of Monoamines in Mice

In this research, Lysolecithin-a substance made with 100% natural ingredients - was given to ICR mice as medication to measure its periodic effect on the noradrenalin (NA), dopamine (DA), and serotonin (5-HT) levels of the brain. Both ICR and SAM mice were separated into two groups - control group and Lysolecithin (K. Lysolecithin: hydrolytic lysolecithin) medicated group, and given 1-week preparation period. The K. Lysolecithin group was given 500mg/kg of K. Lysolecithin at 0.2mL per dosage for 4 weeks, and the control group was given the same amount of dosage of water during the same period. NA, DA and 5-HT concentrations were measured from the blood before medication and 8 weeks / 12 weeks / 16 weeks after the first medication. For the SAM mice, 8 weeks after they were medicated with K .Lysolecithin, Morris Water Maze Test was conducted for 7 consecutive days and then the concentrations were measured by drawing blood from the heart. The K. Lysolecithin medicated group showed a tendency to have a statistically significant higher concentrations of 5-HT and NA in the blood. Also, periodic examination showed that the monoamine levels were highest in the 12th week and declined thereafter.

Effects of Propolis on Peripheral White Cells, Antioxidative Activity and Tumor Growth in Irradiated mice

The effect of continuous water-soluble propolis administration on radioactivity-induced reduction of hemocytes, and the antioxidant and antitumor effects were investigated. Following a 1-week adjustment period, water-soluble propolis was administered intraperitoneally to male ICR mice at a dose of 100 mg/kg every other day for 2 weeks. Following administration, 2 Gy whole-body irradiation was performed and the counts of leukocytes, lymphocytes, and granulocytes and monocytes in the peripheral blood were determined 1, 3, 7, 15 and 30 days after irradiation. In the second experiment, water-soluble propolis was similarly administered to the mice for 2 weeks after a 1-week adjustment period, and 2 Gy whole-body irradiation was performed. The antioxidant effects in hemocytes were then investigated using 2,2＇-azobis（2-amidinopropane） dihydrochloride （AAPH）, a radical generator. In the third experiment, 1×10^6 Sarcoma-180 cells were inoculated into the right thigh of mice, which were divided into four groups： control, water-soluble propolis-treated, 6 Gy irradiated and water-soluble propolis-treated ＋ 6 Gy irradiated groups, and changes in tumor size were measured for 20 days. Results show that administration of water-soluble propolis inhibits the reduction of hemocytes caused by whole-bodv irradiation, enhances antioxidant effects against radioactivity, and inhibits tumor growth.

Physico-Chemical and Oxygen-Hydrogen Isotopic Assessment of Bagmati and Bishnumati Rivers and the Shallow Groundwater along the River Corridors in Kathmandu Valley, Nepal

The direct dumping of solid wastes into the rivers, discharge of industrial effluents together with direct discharge of domestic sewage have excessively polluted the major rivers Bagmati and Bish-numati. Groundwater along these river corridors is also affected from pollution of these rivers. Two major rivers: Bagmati and Bishnumati and shallow tube wells adjacent to these rivers were monitored for 2 years. Samples were analysed for the stable isotopes of hydrogen and oxygen (δD and δ18O) and selected physico-chemical parameters to investigate the possible interrelationship between river water and shallow groundwater along these river corridors. The physico-chemical values revealed that shallow groundwater and river water along the Bishnumati River corridor were heavily mineralized due to direct discharge of sewage wastes into this river. The isotope compositions of river water and shallow groundwater clustered together revealed possible interrelationship between them. Some of the isotopic compositions of groundwater and river water deviated below the Local Meteoric Water Line (LMWL) indicating that the water has undergone evaporation. The isotopic and chemical results suggested possible interrelationship between river water and groundwater. Fractional contribution of the river water to groundwater was calculated based on isotopic data using mass balance approach. Results showed that shallow groundwater SG1, along the Bagmati River corridor (in September 2013), was composed of approximately 30% - 40% Bagmati River water. Similarly, shallow groundwater SG5 of Bishnumati River corridor (in September 2013), was composed of approximately 45% - 50% river water. This result indicated that high portion of river water mixed-up with adjoining shallow groundwater along the river corridors. Further, the mix-up of the river water with groundwater can be harmful when rivers are polluted. These findings can be useful for a better understanding of hydrogeological processes at the river-aquifer interface and eventually benefit water management of the Kathmandu Valley in future.

Microwave-Assisted Facile and Rapid Esterification of Amino Acids I: Esterification of L-Leucine from Batch to Flow Processes and Scale-Up

We herein report our studies into the effects of microwave irradiation on the solvent-free esterification of L-leucine with alcohols. In the absence of solvent, microwave irradiation accelerated the reaction compared to conventional oil bath heating. Measurement of the dielectric properties under the reaction conditions revealed that the high dielectric loss factor of the reaction mixture containing L-leucine, n-butanol, and a p-toluene sulfonic acid catalyst could be attributed to the acceleration of the reaction. The depth of microwave penetration into the reaction mixture as derived from the in-situ measurement of the dielectric properties was ~13 mm, which suggested that a thinner reaction vessel was favorable for the esterification of L-leucine. In addition to the batch reaction using a desktop microwave reactor, two types of flow reaction were also performed using a desktop tubular reactor and a semi-bench-scale tubular reactor. These flow reactions also exhibited high performances, thus allowing the scale-up of this reaction system for industrial use.

A Case of Simultaneous Total Knee Arthroplasty in Congenital Dislocation of the Patella

The gonarthrosis with congenital dislocation of the patella is rare condition. This paper will report about total knee arthroplasty (TKA) for the valgus knee with bilateral congenital dislocation of the patella. A 52-year-old woman presented to our hospital with progressive pain in bilateral knees. Both knee showed severe valgus deformity and lateral dislocation of the patella. Anteroposterior weight-bearing radiographs showed osteoarthritic changes in the lateral compartment with 7 valgus deformity at the right and 15 at the left. A bilateral TKA with cruciate retained components (NAKASHIMA FINE) was performed. Good tracking of the patella was achieved by using a lateral parapatellar approach and vastus medialis plication. There are no normative guidelines of operative procedure about TKA for osteoarthritis of valgus knee with congenital dislocation of the patella. With some referencing to current literature, strategies to good patella tracking are discussed.

Posterior Cruciate Ligament Ganglion: Case Report

Intra-articular ganglion of the knee is uncommon and it shows non-specific symptoms. In this report, we present for a treatment of the ganglion arising from the PCL and the mechanism of pain. The case is a 33-year-old male with pain in his left knee. On presentation, he had no history of locking or giving way of the knee, but had pain on standing. At the first medical examination, the range of motion of his knee was full, with no loss of extension, and there was no effusion or swelling, but the terminal knee flexion was painful. McMurray’s test was negative, and the collateral and cruciate ligaments were clinically stable. On MRI, ganglion cysts droved from PCL appear as well-defined cystic multiloculated masses. The patient underwent arthroscopy through the standard anteromedial and anterolateral portals. Consequently, it was diagnosed as a ganglion cyst. The pain disappeared completely after the surgery and neither PCL ganglion nor symptoms recurred up to 9 months post-surgery. The intra-articular ganglion of the knee often is asymptomatic and discovered incidentally. But the reports of ganglion cysts of the knee have been increasing with the increasing availability and use of MRI. We considered that the mechanism of the pain due to ganglion in the cruciate ligament was stimulation of the synovial nerve terminal. One key point for consideration in this study is that arthroscopy should be performed through posterior portal to observe the whole of the PCL and ganglion cysts because it was difficult to observe both the PCL and ganglion cysts with anterior portal. While arthroscopy did not confirm continuity of the ACL and meniscus, it was considered that the ganglion cysts developed in the PCL because of the continuity with the PCL.

无邻面预备的前牙瓷修复体：病例报告

全瓷修复体最主要的优点是能逼真地模仿天然牙的色泽和半透明性。另外，运用粘接技术能够使一些病人不需要牙体预备即可完成全瓷修复。这个病例描述了在没有邻面牙体预备的条件下采用粘接全瓷修复体关闭前牙间隙的情况。粘接时采用的是硅烷偶联剂和树脂水门汀。用全瓷修复体关闭牙间隙，使其恢复了牙齿的自然外观。因此，只要病例选择合适，没有邻面预备的全瓷修复体也能很有效的改善美观。