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Osteosarcoma is the most prevalent bone malignant tumor in children and adolescents, and displays heterogeneous histology and high propensity for distant metastasis. Although adjuvant chemotherapy remarkably improved treatment outcome over the past few decades, prognosis for osteosarcoma patients with pulmonary metastasis is still unsatisfactory. To identify novel therapeutic targets for osteosarcoma, we investigated the gene expression profile of osteosarcomas by cDNA microarray analysis and found transactivation of receptor tyrosine kinase‐like orphan receptor 2 (ROR2) expression in the majority of osteosarcoma samples. Treatment of osteosarcoma cell lines with siRNA against ROR2 significantly inhibited cell proliferation and migration. We also identified wingless‐type MMTV integration site family, member 5B (WNT5B) as a putative ROR2 ligand and that the physiological interaction of WNT5B and ROR2 could enhance cell migration, indicating the possible roles of ROR2 and WNT5B in the metastatic property of osteosarcoma cells. Taken together, our findings revealed that the WNT5B/ROR2 signaling pathway is a promising therapeutic target for osteosarcoma. (Cancer Sci 2009; 100: 1227–1233)

Abstract We report a case of distal radius fracture after a Sauvé-Kapandji procedure combined with synovectomy and tendon transfer in a rheumatoid arthritis patient. This case shared several unusual features that were also seen in a previously reported case. Based on these features, we discuss favorable surgical treatment for the rheumatoid wrist with extensor tendon rupture, and also the optimal treatment for distal radius fracture after such procedures.

Abstract A 74-year-old woman diagnosed with Churg-Strauss syndrome (CSS) complained of difficulty in flexing her left thumb and index finger. Electromyography demonstrated isolated anterior interosseous nerve (AIN) palsy, with no other peripheral neuropathy. We diagnosed this case as spontaneous AIN palsy complicated with CSS, the first case of this kind. Surgical treatment should be considered if no sign of recovery is seen within six months of onset.

IntroductionManagement of a periprosthetic fracture after total knee arthroplasty is often challenging because it typically occurs in elderly patients, who often have osteoporotic bone with a high risk of delayed union and nonunion. Thus, administration of a medication that could effectively accelerate fracture healing to prevent a delayed union or nonunion should significantly improve treatment outcome and patient's quality of life.Case presentationWe report the case of a 74-year-old rheumatoid arthritis woman with nonunion of a periprosthetic fracture after total knee arthroplasty, in whom bone union could not be achieved even after she underwent internal fixation and bone grafting twice; however, successful bone fusion was achieved after simple once-weekly administration of teriparatide for 6 months.DiscussionAlthough we report only one patient, the present case may suggest the advantage of preventive administration of teriparatide in addition to surgical procedures for treating nonunion of a periprosthetic fracture after total knee arthroplasty.

We have performed a comprehensive analysis of gene-expression profiles in human articular cartilage (hyaline cartilage) and meniscus (fibrocartilage) by means of a cDNA microarray consisting of 23,040 human genes. Comparing the profiles of the two types of cartilage with those of 29 other normal human tissues identified 24 genes that were specifically expressed in both cartilaginous tissues; these genes might be involved in maintaining phenotypes common to cartilage. We also compared the cartilage profiles with gene expression in human mesenchymal stem cells (hMSC), and detected 22 genes that were differentially expressed in cells representing the two cartilaginous lineages, 11 specific to each type, which could serve as markers for predicting the direction of chondrocyte differentiation. Our data should also provide useful information about regeneration of cartilage, especially in support of efforts to identify cartilage-specific molecules as potential agents for therapeutic approaches to joint repair.

The case of a 29-year-old man who had osteochondritis dissecans on the medial aspect of the humeral head is reported. Repetitive micro-trauma at a low elevated arm position was thought to have induced the osteochondral lesion.

SummarySites, frequencies, and causes of self-reported fractures in Japanese patients with rheumatoid arthritis (RA) were evaluated in a prospective, observational cohort study. The incidence and cause of fracture differ by anatomical site, sex, and age. These differences may be considered in establishing custom strategies for preventing fractures in RA patients in the future.PurposeThe literature contains limited data describing the details of fractures at different skeletal sites in patients with RA.MethodsWe evaluated the details of fractures in Japanese RA patients on the basis of our Institute of Rheumatology Rheumatoid Arthritis cohort study in 9,720 RA patients (82 % women; mean age, 56 years) who were enrolled from 2000 to 2010. The details of fractures were obtained through biannual patient self-report questionnaires.ResultsOver a mean duration of 5.2 years, 1,317 patients (13.5 %) reported 2,323 incident fractures comprising 563 (24.2 %) clinical vertebral fractures and 1,760 (75.8 %) nonvertebral fractures. Rib fractures were the most common fractures in men, followed by clinical vertebral and hip fractures; the most common fractures in women were clinical vertebral fractures, followed by rib, foot, and hip fractures. There was a significant difference between sexes in the rates of rib, clavicle, shoulder, and ankle fractures. Spontaneous event was the primary cause of clinical vertebral fracture (65.4 %), whereas falls were the primary cause of upper extremity (76.5 %) and lower extremity (57.8 %) fractures. Rates of clinical vertebral and hip fractures increased, while those of rib and foot fractures decreased with increasing age. Incidence of falls, as causes of nonvertebral fractures, also increased in older age groups.ConclusionOur results suggest that the causes of fractures may differ depending on anatomical site and that prevention of falls may be the most effective way to reduce upper and lower extremity fractures, especially in older patients with RA.

The aims of this study were to evaluate the association between potential risk factors and the occurrence of distal radius fractures in Japanese patients with rheumatoid arthritis (RA). A total of 9,987 patients (82.0 % female; mean age, 55.7 years) with RA were enrolled in a prospective, observational study from 2000 to 2011. Self-reported distal radius fractures were verified using patient medical records. Cox proportional hazards models were used to analyze independent contributions of various risk factors to distal radius fracture occurrence. During a mean follow-up of 5.7 years, 139 patients reported 153 distal radius fractures. Among these patients, 85 distal radius fractures following minor trauma in 85 patients (6 men, 79 women) were verified with medical records. Female gender (hazard ratio [HR], 2.96; 95 % confidence interval [CI], 1.18–7.45; P  = 0.021), age (per 10 years, HR 1.55; 95 % CI, 1.24–1.95, P  = 0.00016), body mass index (BMI) (per 1 kg/m 2 , HR, 1.11; 95 % CI, 1.03–1.19; P  = 0.0034), daily prednisolone dose (per milligram per day, HR, 1.10; 95 % CI, 1.05–1.16; P  = 0.00015), and physician global visual analog scale (0–10 cm, HR, 0.98; 95 % CI, 0.96–1.00; P  = 0.034) were significantly associated with the occurrence of distal radius fractures in Japanese patients with RA. A reduction in the daily prednisolone dose, together with the prevention of falls in female patients of advanced age with RA and a high BMI may be important in preventing distal radius fractures.

To our knowledge, no prior report focused on the risk factors for proximal humerus fractures in patients with rheumatoid arthritis. The purpose of this study was to evaluate the association between potential risk factors and the occurrence of proximal humerus fractures in patients with rheumatoid arthritis. A total of 11,907 patients with rheumatoid arthritis were enrolled in our observational cohort rheumatoid arthritis study between 2000 and 2012. Self-reported proximal humerus fractures were verified using the patients’ medical records. Cox proportional hazard models were used to analyze the independent contribution of risk factors to the occurrence of proximal humerus fractures. During follow-up (mean 5.6 years), 92 proximal humerus fractures were verified in 91 patients. Multivariate Cox regression analyses estimated that the hazard ratios of sustaining a proximal humerus fracture were 1.37 for every 10-year increase in age [95 % confidence interval (CI) 1.10–1.70; P  < 0.01], 1.95 for increases in serum C-reactive protein levels (mg/100 mL; 95 % CI 1.15–3.34; P  < 0.05), 2.13 for a history of fractures (95 % CI 1.34–3.40; P  < 0.01), 1.07 for the daily prednisolone dose (per mg; 95 % CI 1.01–1.13; P  < 0.05), and 1.97 for oral bisphosphonate use (95 % CI 1.20–3.23; P  < 0.01). Better control of rheumatoid arthritis with a smaller daily prednisolone dose in elderly patients with a history of fractures may be important for preventing proximal humerus fractures.