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We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-oldgirl presented with EN as an initial manifestation of KD. At the initial visit, she showed high fever of 40°C, injection of the oropharynx,cervical lymphadenopathy, and red-purple cutaneous nodules, particularly on the lower limbs. She complained of severepain in the neck and cutaneous lesions. Initially, the development of EN was attributed to Salmonella spp infection, which wasdetected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the Salmonella spp issensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the leftanterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should beconsidered in the differential diagnosis of refractory EN in pediatric patients.
In this study, the cutting characteristics of a drill reamer, which has conventional twist drill cutting edges appended for reaming, wereinvestigated. A drill reamer has three types of cutting edges, whose roles are drilling, semi-finishing, and finishing. The cutting characteristicsof a conventional twist drill were compared to those of the drill reamer. The cutting characteristics were evaluated using the thrustforce, cutting torque, surface roughness, wear behavior of the cutting edges, and cutting edge temperature. The study used a workpiecemade of carbon steel. The temperature of the cutting edge for reaming reached a maximum value of approximately 420°C, even thoughthe depth of the cut was very small. The inner surface roughness with the drill reamer was superior to that with the conventional drill,even under dry and low-speed cutting conditions. The abrasive wear observed on the margin face of the cutting edge used for reaming.
Study Design: Experimental human study. Purpose: To determine whether angiopoietin-like protein 2 (ANGPTL2) is highly expressed in the hyperplastic facet joint (FJ) synovium and whether it activates interleukin-6 (IL-6) secretion in FJ synoviocytes. Overview of Literature: Mechanical stress-induced synovitis is partially, but significantly, responsible for degenerative and subsequently osteoarthritic changes in the FJ tissues in patients with lumbar spinal stenosis (LSS). However, the underlying molecular mechanism remains unclear. IL-6 is highly expressed in degenerative FJ synovial tissue and is responsible for local chronic inflammation. ANGPTL2, an inflammatory and mechanically induced mediator, promotes the expression of IL-6 in many cells. Methods: FJ tissues were harvested from five patients who had undergone lumbar surgery. Immunohistochemistry for ANGPTL2, IL-6, and cell markers was performed in the FJ tissue samples. After cultured synoviocytes from the FJ tissues were subjected to mechanical stress, ANGPTL2 expression and secretion were measured quantitatively using real-time quantitative reverse-transcription–polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA), respectively. Following ANGPTL2 administration in the FJ synoviocytes, anti-nuclear factor-κB (NF-κB) activation was investigated using immunocytochemistry, and IL-6 expression and secretion were assayed quantitatively with or without NF-κB inhibitor. Moreover, we assessed whether ANGPTL2-induced IL-6 modulates leucocyte recruitment in the degenerative process by focusing on the monocyte chemoattractant protein-1 (MCP-1) expression. Results: ANGPTL2 and IL-6 were highly expressed in the hyperplastic FJ synovium samples. ANGPTL2 was co-expressed in both, fibroblast-like and macrophage-like synoviocytes. Further, the expression and secretion of ANGPTL2 in the FJ synoviocytes increased in response to stimulation by mechanical stretching. ANGPTL2 protein promoted the nuclear translocation of NF-κB and induced IL-6 expression and secretion in the FJ synoviocytes. This effect was reversed following treatment with NF-κB inhibitor. Furthermore, ANGPTL2-induced IL-6 upregulated the MCP-1 expression in the FJ synoviocytes. Conclusions: Mechanical stress-induced ANGPTL2 promotes chronic inflammation in the FJ synovium by activating IL-6 secretion, leading to FJ degeneration and subsequent LSS.