Abstract This is the first case report of an iatrogenic anterior hip dislocation after arthroscopic surgery for femoroacetabular impingement with over 1 year of follow-up. This case report describes ...the clinical course of a patient with symptomatic cam-pincer femoroacetabular impingement. She underwent arthroscopic rim trimming, labral debridement after a failed attempt at labral refixation from suture cut-through, and femoral head-neck resection osteoplasty. The procedure involved supranormal hip distraction for extraction of an iatrogenic loose body (detached metallic radiofrequency probe tip). The patient had an anterior hip dislocation in the recovery room. Immediate closed reduction under general anesthesia and bracing were performed but failed despite the ability to obtain a concentric but grossly unstable reduction. After 3 failed attempts, a mini-open capsulorrhaphy was performed that successfully restored stability. Her postoperative management and outcome are presented. All of the major static stabilizers of the hip (osseous, labral, and capsuloligamentous) were surgically altered, and a multifactorial causation is proposed. Lessons learned are discussed in hopes of minimizing the occurrence of this rare but dramatic complication.
Asia, the Pacific Islands and the coasts of the Americas have long been studied separately. This essential single-volume history of the Pacific traces the global interactions and remarkable peoples ...that have connected these regions with each other and with Europe and the Indian Ocean, for millennia. From ancient canoe navigators, monumental civilisations, pirates and seaborne empires, to the rise of nuclear testing and global warming, Matt Matsuda ranges across the frontiers of colonial history, anthropology and Pacific Rim economics and politics, piecing together a history of the region. The book identifies and draws together the defining threads and extraordinary personal narratives which have contributed to this history, showing how localised contacts and contests have often blossomed into global struggles over colonialism, tourism and the rise of Asian economies. Drawing on Asian, Oceanian, European, American, ancient and modern narratives, the author assembles a fascinating Pacific region from a truly global perspective.
Abstract Arthroscopic hip capsular repair is an area of intense interest. Basic science studies suggest that adverse changes in capsular stability/restraint may occur with capsulotomy and ...capsulectomy, that repair may ameliorate these changes, and, most recently, that the repaired capsule usually heals. Clinical studies suggest that in some conditions, most notably mild dysplasia, capsular repair or plication may improve short-term outcomes, but in general, the role of capsular closure is less clear. At present, perhaps a selective approach is merited, with capsular closure performed in patients with dysplasia, focal or generalized hyperlaxity, and/or increased femoral anteversion. The comparative outcomes from smaller, more vertically oriented capsulotomies with less violation of the iliofemoral ligament deserve investigation.
Abstract Recent reports of poor clinical outcomes after arthroscopic surgery in hips with marked dysplasia have emerged. Arthroscopic resection of the hypertrophic labrum in cases of dysplasia, ...especially in the absence of periacetabular osteotomy (PAO), has been implicated. Some patients will refuse PAO because it is a major open procedure, opting for a less invasive arthroscopic procedure. We present the cases of 2 young adults with marked dysplasia who had rapidly progressive osteoarthrosis despite arthroscopic labral repair. Though perhaps beneficial as an isolated procedure in borderline or mild dysplasia cases, arthroscopic hip surgery, even labral repair, may best be performed with PAO in cases with more severe dysplasia. Albeit attractive as a less invasive labral-preserving surgery, arthroscopic labral repair not only may fail to provide symptomatic improvement but may compromise or preclude a later PAO if rapidly progressive osteoarthrosis ensues. Hip arthroscopy may best be performed concurrently with or after PAO but not proceeding PAO in patients requiring both procedures.
Abstract Protrusio acetabuli has been considered a contraindication for hip arthroscopy. We present the case of a 33-year-old man with bilateral symptomatic protrusio acetabuli—the most extreme form ...of global pincer femoroacetabular impingement—and cam femoroacetabular impingement. We demonstrate the feasibility of the arthroscopic correction of severe deformities and describe key surgical steps permitting central compartment access, subtotal acetabuloplasty, labral reconstruction, and femoroplasty of the right hip, followed by later subtotal acetabuloplasty, labral refixation, and femoroplasty of the left hip, with improved outcomes at 2 and 1 years, respectively, as measured by the nonarthritic hip score. Though challenging, global pincer impingement, even acetabular protrusion, may be successfully treated with dual-portal outpatient hip arthroscopy. The modified midanterior portal enables central compartment access and extended posterior “reach” in the arthroscopic treatment of major global pincer femoroacetabular impingement, potentially making this contraindication a historical one while respectfully challenging the “global” recommendation for open surgery in this setting.
Genome-wide association studies (GWASs) have identified several susceptibility loci for bipolar disorder (BD) and shown that the genetic architecture of BD can be explained by polygenicity, with ...numerous variants contributing to BD. In the present GWAS (Phase I/II), which included 2964 BD and 61 887 control subjects from the Japanese population, we detected a novel susceptibility locus at 11q12.2 (rs28456, P=6.4 × 10
), a region known to contain regulatory genes for plasma lipid levels (FADS1/2/3). A subsequent meta-analysis of Phase I/II and the Psychiatric GWAS Consortium for BD (PGC-BD) identified another novel BD gene, NFIX (P
=5.8 × 10
), and supported three regions previously implicated in BD susceptibility: MAD1L1 (P
=1.9 × 10
), TRANK1 (P
=2.1 × 10
) and ODZ4 (P
=3.3 × 10
). Polygenicity of BD within Japanese and trans-European-Japanese populations was assessed with risk profile score analysis. We detected higher scores in BD cases both within (Phase I/II) and across populations (Phase I/II and PGC-BD). These were defined by (1) Phase II as discovery and Phase I as target, or vice versa (for 'within Japanese comparisons', P
~10
, R
~2%), and (2) European PGC-BD as discovery and Japanese BD (Phase I/II) as target (for 'trans-European-Japanese comparison,' P
~10
, R
~0.27%). This 'trans population' effect was supported by estimation of the genetic correlation using the effect size based on each population (liability estimates~0.7). These results indicate that (1) two novel and three previously implicated loci are significantly associated with BD and that (2) BD 'risk' effect are shared between Japanese and European populations.
Neuropeptide Y (NPY) is a potent orexigenic neuropeptide implicated in feeding regulation in mammals. However, except for the case of the goldfish, the involvement of NPY in the feeding behaviour of ...teleost fish has not well been studied. Therefore, we investigated the role of NPY in food intake using a zebrafish (Danio rerio) model because the molecular bases of NPY and its receptor have been well studied in this species. We examined the effect of feeding status on NPY‐like immunoreactivity and the expression level of the NPY transcript in the brain. The number of neuronal cells showing NPY‐like immunoreactivity in the hypothalamic regions, including the periventricular nucleus of posterior tuberculum and the posterior tuberal nucleus, was significantly increased in fish fasted for 7 days. NPY mRNA levels in the hypothalamus, but not the telencephalon, obtained from fish fasted for 7 days were higher than those in fish that had been fed normally. We then investigated the effect of i.c.v. administration of NPY on food intake. Cumulative food intake was significantly increased by i.c.v. administration of NPY (at 1 and 10 pmol/g body weight; BW) during a 60‐min observation period. The NPY‐induced orexigenic action (at 10 pmol/g BW) was blocked by treatment with a NPY Y1 receptor antagonist, BIBP‐3226, at 100 pmol/g BW. These results indicate that NPY acts as an orexigenic factor in the zebrafish.
The p53 protein inhibits malignant transformation through direct and indirect regulation of transcription of many genes related to cell cycle, apoptosis and cellular senescence. A number of genes ...induced by p53 have been well characterized, but biological significance of genes whose expression was suppressed by p53 is still largely undisclosed. To clarify the roles of p53-suppressive genes in carcinogenesis, we analysed two data sets of whole-genome expression profiles, one for cells in which wild-type p53 was exogenously introduced and the other for a large number of clinical cancer tissues. Here, we identified CDC20 that was frequently upregulated in many types of malignancies and remarkably suppressed by ectopic introduction of p53. CDC20 expression was suppressed by genotoxic stresses in p53- and p21-dependent manners through CDE-CHR elements in the CDC20 promoter. Furthermore, small interference RNA (siRNA)-mediated silencing of p53 induced CDC20 expression in normal human dermal fibroblast cells. As we expected, treatment of cancer cells with siRNA against CDC20 induced G(2)/M arrest and suppressed cell growth. Our results indicate that p53 inhibits tumor cell growth through the indirect regulation of CDC20 and that CDC20 might be a good potential therapeutic target for a broad spectrum of human cancer.
Summary
Because there are more elderly people than ever before and because they are living for longer periods of time, it is essential to understand the determinants of healthy ageing. This study ...examined changes in oral health‐related quality of life (OHRQoL) among Japanese elderly over a 7‐year period. A sample of independently living individuals (aged 60+ years) underwent a questionnaire and dental examination at baseline and 7 years afterwards. The Geriatric Oral Health Assessment Index (GOHAI) was used to assess the impact of oral conditions. Occlusal force and salivary flow were also assessed. Of the 411 participants assessed at baseline, 130 (31·6%) accepted to participate after 7 years. There were no significant differences between those lost to follow‐up and those assessed at 7 years, except that a higher proportion of the latter rated their baseline general health as good. Among the latter, the overall mean GOHAI score did not change significantly (11·8 at baseline and 11·1 at follow‐up; P = 0·16). However, after controlling for age, gender and baseline GOHAI score, participants who had lost teeth or experienced a decline in occlusal force after 7 years had higher follow‐up GOHAI scores (indicating poorer OHRQoL). Unfavourable changes in clinical oral status over time are reflected in poorer self‐rated oral health.
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