In the developing human musculoskeletal system, cell death with macrophage accumulation occurs in the thigh muscle and interdigital area. To comprehensively clarify the distribution of macrophages, we immunohistochemically examined 16 pairs of upper and lower extremities without the hip joint (left and right sides) obtained from 8 human fetuses at approximately 10-15 weeks of gestation. Rather than in muscles, CD68-positive macrophages were densely distributed in loose connective tissues of the flexor aspects of the extremities, especially in the wrist, hand and foot. In contrast, no or fewer macrophages were evident in the shoulder and the extensor aspects of the extremities. The macrophages were not concentrated at the enthesis of the tendon and ligament, but tended to be arranged along other connective tissue fibers. Deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling revealed apoptosis in the hand lumbricalis muscles, but not in the area of macrophage accumulation. Likewise, podoplanin-positive lymphatic vessels were not localized to areas of macrophage accumulation. Re-organization of the connective tissue along and around the flexor tendons of the hand and foot, such as development of the bursa or tendon sheath at 10-15 weeks, might require the phagocytotic function of macrophages, although details of the mechanism remain unknown.
Apoptosis ; Cell Death ; Connective Tissue ; Deoxyuracil Nucleotides ; Deoxyuridine ; Extremities ; Fetus ; Foot ; Hand ; Hip Joint ; Humans ; Ligaments ; Lower Extremity ; Lymphatic Vessels ; Macrophages ; Muscles ; Musculoskeletal System ; Pregnancy ; Shoulder ; Tendons ; Thigh ; Wrist

Objectives: This study surveyed Japanese anesthesiologists’ knowledge of the cost of medicine and their attitudes toward cost containment to determine how these factors may affect their choice of medication and provide insight into reducing healthcare expenditures.Materials and Methods: In this cross-sectional study, Japanese anesthesiologists’ knowledge of medicine prices and their attitudes toward cost containment were surveyed to identify barriers in lowering the cost of anesthesia. The proportion of participants who correctly guessed the cost of the five most frequently used types of drugs within 25% of the actual price was determined, and their attitudes regarding drug prices and barriers to achieving cost containment were analyzed.Results: In total, responses to 60 questionnaires were analyzed. The proportion of participants correctly guessing the price within 25% of the actual price for each of the five drug categories, including neuromuscular blocking agents, inhaled anesthetics, intravenous anesthetics, opioids, and neuromuscular blockade reversal agents, was 30% (n=18), 18.3% (n=11), 6.67% (n=4), 30.0% (n=18), and 63.3% (n=38), respectively. Participants believed they had adequate access to information on prices, that the cost of a product influenced their decisions regarding product use, and that more information about cost might change their use of the drugs but did not believe that they had adequate knowledge about product prices.Conclusion: The proportion of participants with acceptable price estimates is small. Educating anesthesiologists about the cost of anesthetic agents may be required to encourage cost-containing behaviors. This study is the first survey to assess Japanese anesthologists’ knowledge of the cost of medicines.