Macrophage colony-stimulating factor (M-CSF) is known as one of the factors essential for osteoclast development. In the present study, we examined effects of M-CSF on the apoptotic pathway of osteoclast precursors and their underlying molecular mechanisms. Osteoclast precursors underwent apoptosis in the absence of M-CSF, even in the presence of receptor activator of NF-kB ligand (RANKL). Active caspase-3 and -9 were detected in the osteoclast precursors and treatments of precursors with their specific inhibitors (Z- DEVD-FMK and Z-LEHD-FMK) decreased the apoptosis. M-CSF decreased apoptosis in a dose-dependent manner with decreasing in active caspases-3 and -9 levels and up-regulating Bcl-XL. Those effects of M-CSF on inhibiting apoptosis of osteoclasts precursor by regulating anti-apoptotic signals was more effective when combined with RANKL. These results demonstrate that M-CSF acts as a survival factor for the osteoclast precursors. Furthermore, it is believed that the apoptosis of osteoclast precursors may be involved in the activation of caspase-9 and that M-CSF may promote their survival through Bcl-XL-induced inhibition of caspase-9 activation.
Animals ; Apoptosis/drug effects/physiology ; Carrier Proteins/pharmacology ; Caspases/antagonists & inhibitors/drug effects/metabolism ; Cell Survival/drug effects ; Cells, Cultured ; Cysteine Proteinase Inhibitors/pharmacology ; Enzyme Activation/drug effects ; Female ; Macrophage Colony-Stimulating Factor/*pharmacology ; Membrane Glycoproteins/pharmacology ; Mice ; Mice, Inbred ICR ; Oligopeptides/pharmacology ; Osteoclasts/*cytology/drug effects ; Proto-Oncogene Proteins c-bcl-2/drug effects/*metabolism ; Stem Cells/cytology/*drug effects ; Up-Regulation

PURPOSE: With the better understanding of cuff function, partial repair or "force couple repair" for treating massive irreparable rotator cuff tear has gained some popularity. However, there were few reports on the results of partial repair. The purpose of this study was to report the clinical outcome of massive irreparable rotator cuff tears who received arthroscopic force-couple repair or partial repair. MATERIALS AND METHODS: From June 2005 to Feb 2008, arthroscopic partial repairs were performed for 16 irreparable rotator cuff tears among the 101 large to massive rotator cuff tears that were operated on. Clinical and radiographic evaluation were done at the final follow-up RESULTS: There were 7 men and 9 women with a mean age of 66.6 years. The mean follow-up period was 27.3 month (range: 15-46). The pain VAS improved from 4.4 (+/-2.50) to 2.1 (+/-2.26) and the functional VAS improved from 46.9 (+/-16.64) to 70.0 (+/-22.80). The ASES score improved from 39.0 (+/-10.80) to 80.3 (+/-16.78) and the KSS score was 81.9 (+/-16.74) at the final follow-up. The acromio-humeral distance was 6.6 cm (+/-1.74) preoperatively and 6.2 cm (+/-1.69) postoperatively without significant change (p=0.3874). The degenerative changes had no statistically progressed (p=0.2663). CONCLUSION: Partial repair for massive rotator cuff injury patients showed improvement in the clinical score without progression of arthritic change at a mean of 2.3 years follow-up.
Female ; Follow-Up Studies ; Humans ; Male ; Rotator Cuff ; Shoulder

Thymic carcinoid or neuroendocrine tumor of thymus is a very rare disease and has poor prognosis due to frequent recurrence and distant metastasis. A 43-year-old man was refered to our hospital because of Rt. chest pain and tightness. Chest X-ray revealed 7 X 8cm sized mass on Rt. anterior mediastinum. Surgical excision was performed and light microscopic, immunohistochemical and electron microscopic findings were confirmed as atypical thymic carcinoid tumor with thymic cyst. The patient has been followed up without recurrence or distant metastasis postoperatively for 3 months to now. We report a case of atypical thymic carcinoid with thymic cysts.
Adult ; Carcinoid Tumor* ; Chest Pain ; Humans ; Mediastinal Cyst* ; Mediastinum ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Prognosis ; Rare Diseases ; Recurrence ; Thorax ; Thymus Gland

Osteoprotegerin (OPG), a member of the tumor necrosis factor receptor superfamily, is known to inhibit osteoclastogenesis by acting as a soluble decoy receptor for the receptor activator of NF-kB ligand (RANKL). We report the presence of OPG on the membrane of osteoclasts and the possibility of the direct action of OPG on them. Highly pure osteoclast precursors were isolated from mouse long bones and induced to differentiate into mature osteoclasts by M-CSF and soluble RANKL (sRANKL). The presence of OPG on the membrane of these cells was confirmed by western blotting and immunostaining. Furthermore, sRANKL was found to be bound to the OPG on the osteoclast precursors. These results suggest that OPG might have a new role during the differentiation of osteoclasts beyond its role as a soluble decoy receptor. The mechanism of the existence of OPG on osteoclast precursors remains to be found.
Animals ; Bone and Bones/cytology/*metabolism ; Carrier Proteins/immunology/metabolism ; Cell Differentiation/drug effects/physiology ; Cell Membrane/*metabolism ; Cells, Cultured ; Glycoproteins/drug effects/*metabolism ; Macrophage Colony-Stimulating Factor/pharmacology ; Membrane Glycoproteins/immunology/metabolism ; Mice ; Mice, Inbred ICR ; Osteoclasts/drug effects/*metabolism ; Receptors, Cytoplasmic and Nuclear/drug effects/*metabolism ; Stem Cells/drug effects/metabolism

PURPOSE: Total knee arthroplasty using the extramedullary technique for alignment has some difficulty for detecting the center of the femoral head intra-operatively. In this study we tried to evaluate the usefulness and accuracy of a newly developed Mechanical Axis Marker that synchronizes the center of the knee joint and femoral head with the mechanical axis for the distal femoral cutting and femoral prosthesis alignment. MATERIALS AND METHODS: Between October 2008 and January 2009, 255 knees in 156 patients underwent total knee arthroplasty. We measured the distance between each centers of the femoral head using the PACS system and we applied the distance to the newly developed Mechanical Axis Marker. Subsequently, we applied the new marker to patients to align the centers of knee, the femoral head and the marker in line with the mechanical axis intra-operatively. The accuracy of the marker was validated with C-arm fluoroscopy pre-operatively in 20 patients. Post-operatively we measured and analyzed the frontal femoral component angle to evaluate the coronal alignment of the femoral implant. The accuracy was rated as excellent when the alignment was <3degrees, as good when the alignment was 3-5degrees, and as poor when the alignment was >5degrees. RESULTS: The pre-operative validation study with the C-arm fluoroscopy showed that the distance between the femoral head center and the metal peg of the marker was within 5 mm in 95% of the patients, which implied acceptable accuracy. The average frontal femoral component angle against the mechanical axis was 89.0degrees+/-1.1 (range 86degrees-96.6degrees). The proportion of excellent, good, and poor alignments was 90.6% (231 cases), 8.6% (22 cases), and 0.8% (2 cases), respectively. The intraclass correlation coefficient between the two observers for the frontal femoral component angle was 0.972 which showed high concordance. CONCLUSION: Our results indicate that the extramedullary technique assisted by our new Mechanical Axis Marker can easily identify the center of femoral head and improve the accuracy of frontal femoral component alignment with the proper mechanical axis.
Arthroplasty ; Axis, Cervical Vertebra ; Fluoroscopy ; Head ; Humans ; Knee ; Knee Joint ; Prostheses and Implants

PURPOSE: Although nonunion is a relatively common complication in the management of subtrochanteric fractures, there are few studies regarding the treatment of nonunion. The purpose of this study was to evaluate clinical and radiological results for the treatment of subtrochanteric nonunions with a blade plate. MATERIALS AND METHODS: We retrospectively analyzed 16 cases of subtrochanteric nonunions that were treated with a blade plate between April 1997 and June 2008 and were followed for at least one year after the index operation. There were 8 males and 8 females with an average age of 58 years (range, 42-77 years). Outcome variables included the time to union, postoperative complications, Harris hip score, and the functional rating scale of Sanders. The average follow-up period was 26 months (range, 12-63 months). RESULTS: Union was achieved in 15 (94%) of 16 subtrochanteric nonunions after an average of 7 months (range, 4-11 months). One patient who did not reach union after the index operation underwent repeated surgery with a longer blade plate and bone graft, but this patient was eventually treated with total hip arthroplasty because of persistent nonunion and breakage of the blade plate. Two patients developed complications. One patient had bursitis around the greater trochanter and the other developed avascular necrosis of the femoral head. Of these, the patient with avascular necrosis of the femoral head was treated with total hip arthroplasty because of persistent hip pain 2 years after the index operation. At latest follow-up, the mean Harris hip score was 88 points (range, 36-100 points) and the functional rating scale of Sanders was good or excellent in 14 (88%) of 16 patients. CONCLUSION: The treatment of subtrochanteric nonunions with a blade plate is associated with a very high union rate and good clinical results.
Arthroplasty ; Bursitis ; Female ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Fractures ; Humans ; Male ; Necrosis ; Postoperative Complications ; Retrospective Studies ; Transplants

A case in which a 0.014" wire was broken during the sheath placement in the radial artery for transradial coronary procedure is described here, and a successful retrieval of it using conventional methods is also described. Through the left femoral artery, the 6 Fr guiding catheter was advanced down to the tip of the broken wire at the brachial artery, and the distal part of the broken guidewire was captivated into the guiding catheter. By inflating the balloon catheter inside of the guiding catheter, seized broken guidewire between the inflated balloon and the guiding catheter was removed successfully by withdrawing the whole system en bloc.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary/*adverse ; effects/instrumentation/*methods ; Brachial Artery ; Coronary Arteriosclerosis/diagnosis ; Equipment Failure ; Female ; Femoral Artery ; Foreign Bodies/*etiology/*therapy ; Humans ; Radial Artery

Aneurysm formation and rupture of the anterior mitral leaflet is a rare complication of infectious aortic valve endocarditis. Prompt diagnosis and early surgical treatment can prevent complications such as embolization and cardiogenic shock. It is also related to the acute and severe mitral regurgitation. We describe a case of aneurysm of the anterior mitral leaflet secondary to bicuspid aortic valve endocarditis.
Aneurysm* ; Aortic Valve* ; Bicuspid* ; Diagnosis ; Echocardiography, Transesophageal ; Endocarditis* ; Mitral Valve Insufficiency ; Mitral Valve* ; Rupture* ; Shock, Cardiogenic

As part of an initial inquiry into the function of the outer membrane proteins (OMPs) of Helicobacter pylori Korean strain 51, we have conducted an extensive proteome analysis via quadrupole time of flight (Q-TOF) mass spectrometry (MS). Fifty one OMPs of H. pylori were purified using sarcosine and resolved via two-dimensional electrophoresis with immobilized pH gradient strips. The most abundant proteins were observed in the alkaline pI regions (6.0~11.0) at molecular masses between 10~100 KDa. Here, 15 spots were identified, representing 9 types of genes (KHP0852, KHP0853, KHP1353, KHP1017, KHP0172, KHP0076, KHP0617, KHP1069, KHP0614) from the sarcosin-insoluble fraction of H. pylori 51. These may be employed in the characterization of the OMPs of H. pylori 51, which will help to identify new potential target proteins for vaccine development and drug therapy.
Electrophoresis ; Helicobacter ; Helicobacter pylori ; Mass Spectrometry ; Membrane Proteins ; Membranes ; Proteins ; Proteome ; Proton-Motive Force ; Sarcosine ; Sprains and Strains

BACKGROUND: Subclinical hypothyroidism is frequently discovered from hypercholesterolemic adults. It is defined as an asymptomatic state which characterized by normal free thyroxine (FT4) and elevated thyroid stimulating hormone (TSH) level. Hypercholesterolemia is a major risk factor for coronary heart disease, however hypercholesterolemia caused by hypothyroidism can be easily managed by thyroid hormone replacement. The screening of thyroid disease in hypercholesterolemia patient must be emphasized in order to find out correctable hypothyroidism. So we screened the prevalence of overt and subclinical hypothyroidism at different hypercholesterol levels in middle-aged men and women and also analyzed the correlation between TSH and total cholesterol level. METHODS: We measured serum TSH levels and FT4 by radioimmunoassay from 491 patients with hypercholesterolemia. The subjects were divided into two groups according to serum cholesterol level. Group I was serum cholesterol > or = 240 -<300 mg/dL and group II was > or = 300 mg/dL. Subclinical hypothyroidism was defined as TSH levels higher than 4 mU/L, in the presence of normal FT4 concentration. RESULTS: The overall prevalence of subclinical and overt hypothyroidism was 3.4% and 2.5% in men and 4.7% and 3.5% in women of middle age. In men the prevalence of overt and subclinical hypothyroidism increased from 2.3% of group I to 16.1% in the group II (p<0.05). In women that increased from 5.2 % to 12.9 % (p<0.05). After age correction, an increase of 1 mU/L TSH in men was associated with an increase of 3.2 mg/dL total cholesterol (p<0.01). A similar trend was also found in women (2.1 mg/dL p=0.052). CONCLUSION: In this population, the prevalence of hypothyroidism is up to 16.1% in middle-aged men, 12.9% in middle-aged women with high total cholesterol and it may justify screening of thyroid disease in hypercholesterolemic patients especially in clinical practice.
Adult* ; Asymptomatic Diseases ; Cholesterol* ; Coronary Disease ; Female ; Humans ; Hypercholesterolemia ; Hypothyroidism* ; Male ; Mass Screening ; Middle Aged ; Prevalence* ; Radioimmunoassay ; Risk Factors ; Thyroid Diseases ; Thyroid Gland ; Thyrotropin ; Thyroxine