No description available.

The final publication is available at http://dx.doi.org/10.1111/pcmr.12297. Natsuko Okamoto et al. A melanocyte–melanoma precursor niche in sweat glands of volar skin. Pigment Cell & Melanoma Research. Volume 27, Issue 6, pages 1039–1050, November 2014 / 京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12890号 / 論医博第2090号 / 新制||医||1007(附属図書館) / 31644 / 京都大学大学院医学研究科医学専攻 / (主査)教授 野田 亮, 教授 羽賀 博典, 教授 鈴木 茂彦 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Distal radius fracture (DRF) is the most common fracture encountered in clinical practice. Every year, more than 20000 people in Sweden suffer from this injury. It has been shown that there is a correlation between malalignment and function following distal radial fractures and malunion may cause persistent pain and disability. A problem has been in making a correct initial assessment of the fracture. Many fractures are unstable despite an acceptable position on the initial radiographic examination or following a successful closed fracture reduction. Numerous classification systems have been developed for evaluation of DRF in order to predict the outcome. However, the values of these are limited since they have not shown satisfactory reliability. Furthermore, the utility of these systems to predict radiographic or clinical outcome is not yet proven. These shortcomings may be one reason why optimal DRF management is still controversial. Requests for a new classification system of DRF, predictive of outcome and easy to use, have been made. Improvement in initial assessment of DRF will benefit a large group of patients, as well as the society, by reducing persistent symptoms and disability. Study I: In this study we evaluated the interobserver and intraobserver reliability of a new classification system (the Buttazzoni classification). Two hundred and thirty-two patients with acute DRF were blindly evaluated using the new classification by three orthopaedic surgeons twice with a 1-year interval. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable with other commonly used classification systems. Study II: This was a prospective multicenter study of fracture stability in 428 DRF. The study investigated whether cortical comminution and intra-articular involvement, as well as the new classification system, could predict displacement in DRF. Logistic regression analysis showed that initial position of the fracture and volar or dorsal comminution predicted later displacement, while intra-articular involvement did not. Volar comminution was the strongest predictor of displacement. The new classification system, which is the first to include volar comminution as a separate parameter, was highly predictive of fracture instability. Furthermore we found that it is quite common for non-operatively treated fractures to displace at a later stage than two weeks. Study IV: In study II it was found that late displacement of DRF, still in acceptable radiologic position after 10-14 days, occurred in approximately 1/3 of cases. Despite this, we have not been able to find any study focusing on evaluating the clinical outcome in patients with late displacement. Two hundred and nine unilateral DRF from study II were still in good position after 10-14 days and were included in the study. One hundred and seventy five patients had radiographs taken at a minimum of 3 months and a clinical examination 1 year after the fracture. Late displaced distal radius fractures had significantly higher loss of ROM and grip strength compared to fractures that didn’t displace. No significant differences were seen in subjective outcome. In conclusion, initial position of the fracture predicted later displacement and was the most important parameter in predicting clinical outcome. Comminution of the fracture also affected radiological stability and clinical outcome. Volar comminuted fractures are highly unstable and need surgical intervention if displacement is to be avoided. Intra-articular involvement affected clinical outcome. Late displacement is common in DRF and may result in loss of range of motion and grip strength. To detect late displacement, DRF should be followed for more than 2 weeks. The new classification system had a moderate reliability and reproducibility. The classification was found predictive of radiologic and objective clinical outcome. However, it was not predictive of subjective outcome. The classification system was also predictive of fractures at risk for late displacement.

Avaliar as propriedades mecânicas em dois sistemas de osteossíntese com o emprego de placa volar de rádio distal, alterando-se o tipo de parafuso utilizado quais sejam: bloqueados ou corticais, na fileira distal da placa bem como a colocação ou não de enxerto ósseo em modelos ósseos Sawbone(TM). Trata-se de um estudo experimental de fraturas do rádio distal extra articular, consideradas instáveis, com dois fragmentos e com uma cunha dorsal de 11 mm (classificação AO 23 A3) e também com modelo de osteotomia de cunha aberta, frequentemente empregado por cirurgiões ortopédicos, na prática clínica. Foram usados 10 (dez) ossos rádios Sawbone(TM) esquerdos (Código: 3407), validados para estudo biomecânico, os quais foram divididos em dois grupos de cinco ossos cada. Os grupos foram submetidos a dois sistemas de osteossíntese: sistema de fixação 1, placa volar de ângulo variável esquerda VA-LCP, dupla coluna, seis/três furos, com quatro parafusos bloqueados distais, dois parafusos bloqueados proximais e mais um parafuso cortical proximal e o sistema de fixação 2, utilizou a mesma placa volar de rádio, porém apenas trocou na fileira distal os quatros parafusos corticais. Os modelos foram submetidos a testes mecânicos de flexão dorsal de 30 N e compressão axial de 250 N para avaliar a deflexão e a rigidez dos sistemas, alternando a colocação do enxerto ósseo. A seguir, houve o ensaio de carregamento cíclico de compressão de 250 N por 1000 HZ, simulando-se um pós-operatório de 6 semanas. Na segunda parte do estudo, foram realizados os mesmos testes de compressão axial e flexão dorsal, usando as mesmas forças de carregamento empregadas na primeira fase dos ensaios mecânicos, para avaliar as possíveis alterações na deflexão e rigidez. Para se comparar as medidas aferidas entre os testes de flexão dorsal e compressão axial antes e depois do carregamento cíclico foi empregado o teste de U de Mann-Whitney, considerando-se um nível de significância de 5%. Ao analisar os resultados obtidos, o sistema de fixação com parafuso cortical com enxerto (CC) se mostrou mais rigído, tanto na deflexão quanto na compressão ao ser comparado com os demais sistemas de fixação, principalmente com o bloqueado sem enxerto (BS). Quanto a relevância clínica do estudo placas volar de rádio distal são comumente usadas nos tratamentos das fraturas do rádio distal, porém a configuração ideal dos parafusos distais não foi determinada. O sistema de fixação com quatro parafusos corticais com enxerto ósseo do ponto de vista biomecânico in vitro, os resultados se mostraram bastante confiáveis como uma proposta de tratamento. / Evaluating the biomechanical properties in two osteosynthesis systems using a volar distal radius plate by changing the type of screw used, whether locked or cortical, in the distal row of the plate, with or without bone grafting in Sawbone (TM) models. This is an experimental study of fractures of the extra articular distal radius, considered to be unstable, with two fragments and a dorsal wedge of 11 mm (AO 23 A3 classification), as well as the open-wedge osteotomy model frequently used by Orthopedic surgeons, in clinical practice. Ten left-hand radios bones, Sawbone (TM) (Code: 3407), validated for biomechanical studies were used. These were then divided into two groups of 5 bones each. The groups were submitted to two osteosynthesis systems: fixation system 1, VA-LCP left variable-angle volar plate, double-column, 6/3 holes, with four distal locked screws, two proximal locked screws and one proximal cortical screw. The fixation system 2 used the same volar plate, but only the four cortical screws were changed in the distal row. The models were submitted to mechanical tests of dorsal flexion of 30 N and axial compression of 250 N to evaluate the deflection and stiffness of the systems, changing the placement of the bone graft. Next, there was the cyclic loading test of 250 N per 1000 HZ, simulating a 6-week post-op. In the second part of the study, the same tests of axial compression and dorsal flexion were performed, using the same loading forces used in the first phase of the mechanical tests to evaluate the possible changes in deflection and stiffness. In order to compare the results between the dorsal flexion tests and axial compression before and after the cyclic loading, the Mann-Whitney U test was used, considering a level of significance of 5%. When analyzing the results obtained, the cortical screw fixation system with graft was shown to be more rigid, both in deflection and in compression when compared to the other fixation systems, especially with the locked system without graft. Regarding the clinical relevance of the study, the volar distal radius plate is commonly used in the treatments of distal radius fractures, however the ideal configuration of the distal screws has not yet been determined. The results of the fixation system with four cortical screws with bone graft, from a biomechanical point of view in vitro, proved to be a reliable form of treatment.

Stipinkaulio distalinės dalies lūžiai yra vienas iš dažniausių kaulų ir raumenų sistemos pažeidimų. Literatūroje nurodoma, kad distalinės stipinkaulio dalies lūžiai yra 1/10 visų lūžių, kuriuos patiria vyresni nei 35 metų amžiaus asmenys. Apie 3 % pacientų, po šios traumos išlieka ilgalaikė negalia. Siekiant optimizuoti stipinkaulio distalinės dalies lūžių gydymą, buvo atliktas tyrimas, kuriame buvo iškelti trys uždaviniai. Vertinome 2 savaičių imobilizacijos įtaką rankos funkcijai, po stipinkaulio distalinės dalies lūžio ir osteosintezės delnine rakinama plokštele. Taip pat vertinome,radiologinio lūžio tipo, pagal AO klasifikaciją, įtaką rankos funkcijai. Sugijus kaului, tirta metalinių konstrukcijų pašalinimo įtaka rankos funkcijai. Vertinant rezultatus, nustatyta, kad riešo judesių amplitudė ir rankos funkcija tarp pacientų, patyrusių stipinkaulio distalinės dalies lūžį su poslinkiu ir operuotų delnine rakinama plokštele, kuriems buvo taikyta pooperacinė 2 savaičių riešo imobilizacija ir kuriems pooperacinė riešo imobilizacija nebuvo taikyta, nesiskyrė. Tiriamiesiems, patyrusiems C tipo lūžį pagal AO radiologinę klasifikaciją nustatyta prastesnė funkcija. Riešo judesių amplitudė ir rankos funkcija po delninės rakinamos plokštelės pašalinimo nepakito. / Distal radius fracture is one of the most common injuries of the skeletal and muscular system. It has been reported in literature that distal radius fractures account for one-tenth of all the fractures experienced by people older than 35 years. Long-term disability remains in approximately 3% of patients after a distal radius fracture. In order to optimise treatment of distal radius fractures, a study with three objectives was performed. We evaluated the effect of immobilisation for the period of 2 weeks on the hand function after a distal radius fracture and osteosynthesis with a volar locking plate. The effect of the fracture type according to the AO classification on the hand function was also assessed. After the bone has healed, the effect of the removal of metal constructions on the hand function was evaluated. The analysis of the results demonstrated that there were no differences in the range of wrist motions and the hand functionbetween the patients after a displaced distal radius fracture operated with a volar locking plate and post-surgery immobilisation of the wrist applied for the period of 2 weeks and the patients who did not have post-surgery wrist immobilisation applied. A worse function was determined in the patients after type C fracture according to the AO radiological classification. The range of wrist motions and the hand function after the removal of a volar locking plate did not differ.

Avaliar as propriedades mecânicas em dois sistemas de osteossíntese com o emprego de placa volar de rádio distal, alterando-se o tipo de parafuso utilizado quais sejam: bloqueados ou corticais, na fileira distal da placa bem como a colocação ou não de enxerto ósseo em modelos ósseos Sawbone(TM). Trata-se de um estudo experimental de fraturas do rádio distal extra articular, consideradas instáveis, com dois fragmentos e com uma cunha dorsal de 11 mm (classificação AO 23 A3) e também com modelo de osteotomia de cunha aberta, frequentemente empregado por cirurgiões ortopédicos, na prática clínica. Foram usados 10 (dez) ossos rádios Sawbone(TM) esquerdos (Código: 3407), validados para estudo biomecânico, os quais foram divididos em dois grupos de cinco ossos cada. Os grupos foram submetidos a dois sistemas de osteossíntese: sistema de fixação 1, placa volar de ângulo variável esquerda VA-LCP, dupla coluna, seis/três furos, com quatro parafusos bloqueados distais, dois parafusos bloqueados proximais e mais um parafuso cortical proximal e o sistema de fixação 2, utilizou a mesma placa volar de rádio, porém apenas trocou na fileira distal os quatros parafusos corticais. Os modelos foram submetidos a testes mecânicos de flexão dorsal de 30 N e compressão axial de 250 N para avaliar a deflexão e a rigidez dos sistemas, alternando a colocação do enxerto ósseo. A seguir, houve o ensaio de carregamento cíclico de compressão de 250 N por 1000 HZ, simulando-se um pós-operatório de 6 semanas. Na segunda parte do estudo, foram realizados os mesmos testes de compressão axial e flexão dorsal, usando as mesmas forças de carregamento empregadas na primeira fase dos ensaios mecânicos, para avaliar as possíveis alterações na deflexão e rigidez. Para se comparar as medidas aferidas entre os testes de flexão dorsal e compressão axial antes e depois do carregamento cíclico foi empregado o teste de U de Mann-Whitney, considerando-se um nível de significância de 5%. Ao analisar os resultados obtidos, o sistema de fixação com parafuso cortical com enxerto (CC) se mostrou mais rigído, tanto na deflexão quanto na compressão ao ser comparado com os demais sistemas de fixação, principalmente com o bloqueado sem enxerto (BS). Quanto a relevância clínica do estudo placas volar de rádio distal são comumente usadas nos tratamentos das fraturas do rádio distal, porém a configuração ideal dos parafusos distais não foi determinada. O sistema de fixação com quatro parafusos corticais com enxerto ósseo do ponto de vista biomecânico in vitro, os resultados se mostraram bastante confiáveis como uma proposta de tratamento. / Evaluating the biomechanical properties in two osteosynthesis systems using a volar distal radius plate by changing the type of screw used, whether locked or cortical, in the distal row of the plate, with or without bone grafting in Sawbone (TM) models. This is an experimental study of fractures of the extra articular distal radius, considered to be unstable, with two fragments and a dorsal wedge of 11 mm (AO 23 A3 classification), as well as the open-wedge osteotomy model frequently used by Orthopedic surgeons, in clinical practice. Ten left-hand radios bones, Sawbone (TM) (Code: 3407), validated for biomechanical studies were used. These were then divided into two groups of 5 bones each. The groups were submitted to two osteosynthesis systems: fixation system 1, VA-LCP left variable-angle volar plate, double-column, 6/3 holes, with four distal locked screws, two proximal locked screws and one proximal cortical screw. The fixation system 2 used the same volar plate, but only the four cortical screws were changed in the distal row. The models were submitted to mechanical tests of dorsal flexion of 30 N and axial compression of 250 N to evaluate the deflection and stiffness of the systems, changing the placement of the bone graft. Next, there was the cyclic loading test of 250 N per 1000 HZ, simulating a 6-week post-op. In the second part of the study, the same tests of axial compression and dorsal flexion were performed, using the same loading forces used in the first phase of the mechanical tests to evaluate the possible changes in deflection and stiffness. In order to compare the results between the dorsal flexion tests and axial compression before and after the cyclic loading, the Mann-Whitney U test was used, considering a level of significance of 5%. When analyzing the results obtained, the cortical screw fixation system with graft was shown to be more rigid, both in deflection and in compression when compared to the other fixation systems, especially with the locked system without graft. Regarding the clinical relevance of the study, the volar distal radius plate is commonly used in the treatments of distal radius fractures, however the ideal configuration of the distal screws has not yet been determined. The results of the fixation system with four cortical screws with bone graft, from a biomechanical point of view in vitro, proved to be a reliable form of treatment.

Fracture of the distal radius is one of the most frequent injuries, and it represents about 20% of all adults taken into emergency rooms. A number of studies suggest various methods to reduce the dislocation and to secure fragments of the distal radius. In this study, the Non-Bridging External Wrist Fixator System (NBX), a pre-market-released product manufactured by NUTEK Inc. was biomechanically assessed by comparing with the Universal Distal Radius System (Volar Plate Fixator: VPF), a market-released product manufactured by Stryker Co. The comparison was performed in several parameters, which were wrist motion, radial tilt angle, radial length, volar tilt angle, stiffness, and failure load. Five pairs of fresh human cadaver arms were used for this study. The wrists were tested to obtain x-ray images for 1 normal and 2 injury conditions (intact, fractured, and fixed), 2 load conditions (gravity only and torque applied), and 4 postural conditions (volar flexion, dorsiflexion, ulnar deviation, and radial deviation). These tests yielded 24 (3×2×4) x-ray images for each wrist, and the images were analyzed to obtain the data for each parameter. Although the results were not statistically significant in some conditions, NBX fixation limited wrist motion more than VPF fixation. This result can be explained not only by the difference in the ability of fixation, but also by the difference in the surgical trauma (NBX is less invasive than VPF). Furthermore, in the measurement of radial tilt angle, radial length, and volar tilt angle, NBX was more effective than VPF to reduce and secure the bone fragments of the distal radius. In destructive test, the NBX is less strong than VPF. However, NBX is strong enough to sustain the expected forces of daily activity.

En el primer trabajo se diseñó un estudio prospectivo aleatorizado. El objetivo era comparar los resultados entre tratamiento conservador (reducción cerrada e inmovilización enyesada) y quirúrgico (reducción abierta y fijación interna con placa volar) en pacientes de edad con fractura de radio distal. Método: 97 pacientes mayores de 60 años fueron aleatorizados a tratamiento conservador (47 pacientes) o quirúrgico (50 pacientes). A lo largo de 2 años postoperatorios fueron evaluados con la escala funcional PRWE (patient-rated wrist evaluation), el cuestionario DASH (Disability Arm, Shoulder and Hand), dolor, rango de movilidad de la muñeca, fuerza del puño y parámetros radiográficos. Resultados: los resultados funcionales y de calidad de vida fueron significativamente mejores tras el tratamiento quirúrgico con placa volar que con el conservador. Se observó que la restauración de la superficie articular, ángulo de inclinación radial y varianza cubital afectaban a los resultados, pero no el escalón articular. El 25% de los pacientes con tratamiento conservador tuvieron pérdida secundaria de la reducción. Conclusión: la placa quirúrgica resultaba en mejor resultado que el tratamiento conservador para pacientes de edad con fractura intraarticular del radio distal. En el segundo trabajo, el objetivo era evaluar la capacidad de la placa volar bloqueada para mantener los parámetros radiográficos a lo largo del tiempo en pacientes de edad con fractura compleja intraarticular del radio distal. Método: cohorte prospectiva de 66 pacientes consecutivos, con edad media de 68 años (rango 60-81) y fractura tipo C de AO tratados con placa volar bloqueada. Se realizaron mediciones radiográficas pre y postoperatorias en cada visita. La valoración clínica se realizó mediante la escala PRWE (Patient-Rated Wrist Evaluation), el cuestionario DASH (Disabilities Arm, Shoulder and Hand), movilidad de la muñeca y fuerza del puño. Resultados: el seguimiento postoperatorio medio fue de 31 meses (rango, 24-47). Los parámetros más difíciles de restaurar con la cirugía fueron el ángulo radial volar y la altura radial, mientras que la inclinación radial y varianza cubital se restauró en la mayoría de los pacientes. Hubo una significativa pérdida de reducción en los primeros 4 meses respecto al ángulo radial volar y altura radial, y sin cambios a partir de dicha fecha. Al seguimiento final, el 50,1% de los pacientes tenían los parámetros radiográficos restaurados de acuerdo a la muñeca contralateral, pero el 83,3% tuvieron todos los parámetros dentro del rango funcional. Conclusión: la fijación con placa volar bloqueada para fracturas intraarticulares del radio distal fue un efectivo procedimiento para obtener resultados funcionales satisfactorios. Aunque hubo pérdida de reducción precoz del ángulo radial volar y altura radial, la placa volar fue capaz de mantener a lo largo del tiempo la estabilización de la fractura con parámetros radiográficos dentro del rango funcional en estos pacientes de edad avanzada.

After the Vietnam War, increased defense funds assigned to the Army National Guard stimulated and supported small communities in Louisiana. Recruits from economically depressed regions lined up to join the Guard because of the competitive pay and the generous education benefits it offered. In the mid-1980s, when a state budgetary shortfall threatened to limit the stream of federal funds and close local armories, communities in Louisiana rallied to keep the doors of their armories open. This paper examines how the readiness efforts of the Louisiana Army National Guard affected the economies of small communities as defense dollars increased following the shift from a draft army to an all-volunteer force and the implementation of Total Force Policy.