The functional anatomy of the triangular fibrocartilage complex (TFCC) was investigated in 20 fresh cadavers. Dynamic changes in the TFCC during rotation were also examined from both the proximal and distal aspects. In our analysis, the TFCC was separated into three components. The distal component was stable, functioning like a hammock to suspend the ulnar carpus. The proximal component was the fan-shaped triangular ligament, the true radioulnar ligament. This was found to originate from the fovea of the ulna in a vertical fashion and was easily twisted during rotation. The third component, the ulnar collateral ligament, also twisted during rotation. When analysed by coronal section, the internal portion of the TFCC was found to be loose, and probably serves as a cushion to absorb local deformities in the TFCC during rotation.

PurposeCariprazine is a potent dopamine D3-preferring D3/D2 receptor partial agonist in development for the treatment of schizophrenia, bipolar mania, and depression. Pharmacokinetics of cariprazine and the two clinically relevant metabolites (desmethyl- and didesmethyl-cariprazine) was evaluated in a clinical pharmacology study.MethodsThis was a multicenter, randomized, open-label, parallel-group, fixed-dose (3, 6, or 9 mg/day) study of 28-week duration (≤4-week observation, 12-week open-label treatment, and 12-week follow-up). Once-daily cariprazine was administered to 38 adult patients with schizophrenia. The pharmacokinetics of cariprazine, metabolites, and total active moieties (sum of cariprazine and two metabolites) was evaluated; efficacy and safety were also assessed.ResultsSteady state was reached within 1–2 weeks for cariprazine and desmethyl-cariprazine, 4 weeks for didesmethyl-cariprazine, and 3 weeks for total active moieties. Cariprazine and desmethyl-cariprazine levels decreased >90% within 1 week after the last dose, didesmethyl-cariprazine decreased ~50% at 1 week, and total active moieties decreased ~90% within 4 weeks. Terminal half-lives of cariprazine, desmethyl-cariprazine, and didesmethyl-cariprazine ranged from 31.6 to 68.4, 29.7 to 37.5, and 314 to 446 hours, respectively. Effective half-life (calculated from time to steady state) of total active moieties was ~1 week. Incidence of treatment-emergent adverse events was 97.4%; 15.8% of patients discontinued due to adverse events. No abnormal laboratory values or major differences from baseline in extrapyramidal symptoms were observed.ConclusionCariprazine and its active metabolites reached steady state within 4 weeks, and exposure was dose proportional over the range of 3–9 mg/day. Once-daily cariprazine was generally well tolerated in adult patients with schizophrenia.

Both lateral wedged insoles significantly reduced the peak medial compartment load during gait. The subtalar strapping insole had a greater effect than the conventional insole, particularly in patients with moderate medial knee OA.

The proximal ligamentous component of the triangular fibrocartilage complex (TFCC) was studied anatomically using 15 fresh-frozen cadaver hand forearm specimens. Changes in the length of either side of this component were analysed during forearm rotation with the complete three-dimensional structure of the TFCC preserved. The proximal ligamentous component consists of three portions: dorsal, central and palmar. The dorsal and palmar portions connect the radius and ulna directly. These were recognized in all specimens whereas the central portion was not constant. The morphology of the proximal component was categorized into three types: fan-shaped, V-shaped, and funnel-shaped in five wrists each. Changes in ligament length during forearm rotation were measured using fine wires under slight tension that paralleled the ligaments from origin to insertion. The dorsal and palmar portions demonstrated three trends: the dorsal portion increased in length from supination to pronation whereas the palmar portion increased in length from pronation to supination; the length of the dorsal portion remained almost constant as the palmar portion increased in length from pronation to supination; the length of the palmar portion remained almost constant while the dorsal portion lengthened from supination to pronation. These variations appear to be related to which portion of the ligament was attached nearest to the centre of the ulnar fovea, where the rotational axis of the forearm passes. The portion attaching nearest to the fovea demonstrated a nearly isometric length pattern, whereas the portion which attached at a distance showed greater extensibility. These findings suggest that the proximal component of the TFCC corresponds to a true radioulnar ligament, and the isometric and eccentric fibres act mutually during forearm rotation.

During the course of the transformation of 1,3-dichloro-2-propanol (DCP) into (R)-3-chloro-1,2-propanediol