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Autosomal-dominant polycystic kidney disease (ADPKD) is the most common genetic renal disease, primarily caused by germline mutation of PKD1 or PKD2, leading to end-stage renal disease. The Hippo signaling pathway regulates organ growth and cell proliferation. Herein, we demonstrate the regulatory mechanism of cystogenesis in ADPKD by transcriptional coactivator with PDZbinding motif (TAZ), a Hippo signaling effector. TAZ was highly expressed around the renal cyst-lining epithelial cells of Pkd1- deficient mice. Loss of Taz in Pkd1-deficient mice reduced cyst formation. In wild type, TAZ interacted with PKD1, which inactivated β-catenin. In contrast, in PKD1-deficient cells, TAZ interacted with AXIN1, thus increasing β-catenin activity. Interaction of TAZ with AXIN1 in PKD1-deficient cells resulted in nuclear accumulation of TAZ together with β-catenin, which up-regulated c-MYC expression. Our findings suggest that the PKD1-TAZ-Wnt-β-catenin- c-MYC signaling axis plays a critical role in cystogenesis and might be a potential therapeutic target against ADPKD. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the anatomical similarity of three-dimensional (3D) morphometric parameters between right and left knees. Materials and Methods: Ten fresh-frozen paired cadaveric knees were tested. Following dissection, footprint areas of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were measured. Surface scanning was performed using a 3D scanner. Scanned data were reproduced and morphometric parameters were measured on specialized software. After making mirror models, we compared footprint center positions of the ACL and PCL of both sides and calculated the average deviation of 3D alignment between the right- and left-side models. Results: No significant side-to-side differences were found in any morphometric parameters. Bony shapes displayed a side-to-side difference of <1 mm. Distal femoral and proximal tibial volumes did not present side-to-side differences, either; the average 3D deviations of alignment between the right and left sides were 0.8±0.4/1.1±0.6 mm (distal femur/proximal tibia). Center-to-center distances between the right and left ACL footprints were 2.6/2.7 mm (femur/tibia) for the anteromedial bundle and 2.4/2.8 mm for the posterolateral bundle. They were 1.9/1.5 mm for the anterolateral bundle and 2.2/1.8 mm for the posteromedial bundle of the PCL. Conclusions: There was a remarkable 3D morphometric similarity between right and left knees. Our results might support the concept of obtaining morphologic reference data from the uninvolved contralateral knee. [ABSTRACT FROM AUTHOR]

Background Although free-vascularized long-bone transfer is useful for reconstruction of a large segmental bone defect, it is limited by availability of transplantable bone, meticulous microsurgical technique, and donor-site morbidities. Hence, easier, readily available, and safer surgical procedures are warranted. This study evaluated the effects of vascularized small corticocancellous bone grafting for reconstruction of a large segmental rabbit femur defect. Methods A 1.5 cm defect was created in the femurs of 40 New Zealand white rabbits and divided into a control group (n = 10, bone defect without graft), group A (n = 10, bone defect filled with morselized autogenous bone), group B (n = 10, bone defect grafted with a vascularized small corticocancellous bone and morselized autogenous bone), and group C (n = 10, bone defect grafted with a vascularized small corticocancellous bone). Simple radiographs were taken postoperatively, and bone healing ability was scored using Taira's radiologic scale. Histologic examinations were scored using Emery's histologic scale. The expression of osteogenesis-related growth factors (BMP-2, -4, and -7, VEGF, and RANKL) was analyzed. Results Radiologically, group B showed superior biological efficacy in bone formation and consolidation over the other groups. Histologically, the defect in group B was filled with more abundant mature bone than the other groups. Group B showed higher gene expression of BMP-2, -4, and -7, and VEGF. Conclusions The grafting of the morselized autogenous bone (MSB) combined with the vascularized small corticocancellous bone is more effective than that of the MSB alone for repairing a large segmental bone defect. [ABSTRACT FROM AUTHOR]

There are several reported disadvantages with conventional-length femoral stems in cementless total hip arthroplasty (THA). Therefore, various efforts have been made to develop a specific femoral short stem to improve physiologic bone remodeling at the femoral aspect of a cementless THA. However, there are potential disadvantages with specific femoral short stems, such as malalignment, inadvertent subsidence, and potential proximal femoral fracture. Therefore, the authors quantitatively compared radiographic and clinical outcomes as well as component-specific complications between 2 groups of patients following primary cementless THA. A matched comparison was made between specific femoral short stems (n=50) and conventional-length femoral stems (n=50) in cementless THA procedures performed between January 2008 and January 2012. Patients were matched for age, sex, body mass index, height, surgical approach, and surgeon. No significant differences were found between the 2 groups in mean postoperative radiographic outcomes, functional outcomes, or complications. Both groups showed satisfactory performance at 5-year follow-up. Specific femoral short stems resulted in a higher incidence of malalignment and subsidence and a lower incidence of thigh pain and proximal bone resorption compared with conventional-length femoral stems. Although longer follow-up is required, specific femoral short stems may have clinical and radiographic advantages with equivalent perioperative complications relative to conventional-length femoral stems. However, this technique requires proper patient selection in combination with careful preoperative planning and meticulous surgical technique. [ABSTRACT FROM AUTHOR]

Objective: Pineal parenchymal tumors (PPTs) in adults are rare, and knowledge regarding their optimal management and treatment outcome is limited. Herein, we present the clinical results of our series of PPTs other than pineoblastomas managed by stereotactic radiosurgery (SRS) at upfront setting. Methods: Between 1997 and 2014, nine consecutive adult patients with the diagnosis of PPTs, either pineocytoma or pineal parenchymal tumor of intermediate differentiation, were treated with SRS. There were 6 men and 3 women. The median age was 39 years (range, 31-53 years). All of the patients presented with symptoms of hydrocephalus. Endoscopic third ventriculostomy and biopsy was done for initial management. After histologic diagnosis, patients were treated with Gamma Knife with the mean dose of 13.3 Gy (n=3) or fractionated Cyberknife with 32 Gy (n=6). Results: After a mean follow-up of 78.6 months (range, 14-223 months), all patients were alive and all of their tumors were locally controlled except for one instance of cerebrospinal fluid seeding metastasis. On magnetic resonance images, tumor size decreased in all patients, resulting in complete response in 3 patients and partial response in 6. One patient had experienced temporary memory impairment after SRS, which improved spontaneously. Conclusion: SRS is effective and safe for PPTs in adults and can be considered as a useful alternative to surgical resection at upfront setting. [ABSTRACT FROM AUTHOR]

Study Design: Radiographic review of healthy volunteers. Purpose: To determine the ideal sitting positions by measuring changes in lumbar lordosis (LL) and pelvic parameters (PPs) in various positions. Overview of Literature: Prolonged sitting is generally accepted as an important risk factor for low back pain (LBP). It is now recognized that spinopelvic alignment is important for maintaining an energy-efficient posture. Methods: Lateral spine radiographs of thrirty healthy volunteers (male participants) were taken in standing and five sitting positions. Radiographic measurement of LL and PPs was performed in each position. Statistical analysis was performed to identify a correlation between changes in the LL and PPs in each positions. Results: LL in standing was 48.5°±8.7°. Sitting significantly decreased LL and segmental angle when compared with standing (p <0.05). The lower lumbar segmental angles (L4-5 and L5-S1) significantly decreased in all sitting positions (p <0.05), but the decrease was relatively less on the chair with lumbar support and in the 90°-angled chair. The sacral slope (SS) decreased and the pelvic tilt increased with decreasing LL in the sitting positions. Conclusions: Sitting causes a reduction in LL and SS when compared with standing. It might cause a spinopelvic imbalance and result in chronic LBP. Our study showed that sitting on a chair with back support induced minimal changes to LL. Consequently, it is proposed that sitting on a chair with back support would be a much more ideal position than sitting on other types of chairs. [ABSTRACT FROM AUTHOR]

Autosomal polycystic kidney disease (ADPKD) is a highly prevalent genetic renal disorder in which epithelial-lining fluid-filled cysts appear in kidneys. It is accompanied by hyperactivation of cell proliferation, interstitial inflammation, and fibrosis around the cyst lining cells, finally reaching end-stage renal disease. Previously, we found high expression of ligands stimulating the receptor for advanced glycation end products (RAGE) in ADPKD mice. Furthermore, gene silencing of RAGE was revealed to cause reduction of cystogenesis via down-regulation of cell proliferation in vitro, and intravenous administration of anti-RAGE adenovirus in vivo also displayed alleviation of the disease. Here, we attempted to identify the role of soluble RAGE (sRAGE) in inhibiting the progression of ADPKD using 2 different ADPKD mouse models. sRAGE is an endogenously expressed form of RAGE that has no membrane-anchoring domain, thereby giving it the ability to neutralize the ligands that stimulate RAGE signals. Both overexpression of sRAGE and sRAGE treatment blocked RAGE-mediated cell proliferation in vitro. In addition, sRAGE-injected ADPKD mice showed reduced cysts accompanied by enhanced renal function, inhibition of cell proliferation, inflammation, and fibrosis. These positive therapeutic effects of sRAGE displayed little liver toxicity, suggesting it as a new potential therapeutic target of ADPKD with low side effects. [ABSTRACT FROM AUTHOR]

Oseteoid osteoma is a well-known type of benign bone-forming tumor, which has previously been diagnosed using plain radiograph imaging. However, diagnosis of osteoid osteoma may be delayed due to ambiguities on plain radiograph images; despite the increasing use of magnetic resonance imaging (MRI), this type of misdiagnosis is not uncommon. The aim of the present study was to evaluate the effectiveness of radionuclide imaging scans for the diagnosis of osteoid osteoma, as this form of imaging was proposed to be a more sensitive test. The characteristics of 18 cases of osteoid osteoma were analyzed based on diagnostic imaging and the time from initial recognition of symptoms by the patient to diagnosis. Diagnostic modalities included plain radiograph, computed tomography (CT), MRI and radionuclide imaging. Among the 18 patients, 14 patients had unique positive findings in plain radiographs. The mean duration between initial cognition of symptoms to the diagnosis for these patients was 5.2 months (range, 3.8-9.3 months). A total of 4 patients exhibited no radiographic abnormalities in the initial plain radiographs and were diagnosed a mean of 18.5 months (range, 17-20 months) following the onset of symptoms. Overall, radionuclide imaging was performed on 16 patients and all of the cases demonstrated positive findings. In these cases, 28.6% of osteoid osteoma patients with clinical indications revealed no abnormal findings in plain radiographs. Therefore, in situations such as these, radionuclide imaging may be a useful indicator for diagnosis, as these results have demonstrated that it positively identified all cases of osteoid osteoma. In addition, the results of the present study indicated that if the radionuclide imaging was positive, CT scan was a more valuable diagnostic tool, whereas if the radionuclide imaging was negative, MRI should be recommended for the diagnosis of other undiscovered disease entities. [ABSTRACT FROM AUTHOR]

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by abnormal proliferation of renal tubular epithelial cells, resulting in the loss of renal function. Despite identification of the genes responsible for ADPKD, few effective drugs are currently available for the disease. Thus finding additional effective drug targets is necessary. The functions of multidrug- resistance-associated protein 3 (MRP3) have been reported only in the field of drug resistance, and the renal functions of MRP3 are mostly unknown. In this study, we found that MRP3 was significantly downregulated in kidneys of human patients with ADPKD and polycystic kidney disease (PKD) mouse models. Our results suggest that downregulated MRP3 stimulated renal epithelial cell proliferation through the B-Raf/MEK/ERK signaling pathway. In contrast, we found that restoring MRP3 reduced cell proliferation and cystogenesis in vitro. These results suggest that the renal function of MRP3 is related to renal cell proliferation and cyst formation and that restoring MRP3 may be an effective therapeutic approach for PKD. [ABSTRACT FROM AUTHOR]

Anorectal melanoma is a rare neoplasm that accounts for less than 1-4% of anorectal malignant tumors. The main therapeutic modality for anorectal melanoma is surgical treatment, with abdominoperineal resection or wide local excision being the most common approaches. A 77-year-old male with a history of cerebral infarction and hypertension presented with anal bleeding. Here, we report a case of anorectal melanoma treated by endoscopic mucosal resection with adjuvant interferon therapy rather than surgical resection. The patient has been disease-free for 5 years after endoscopic treatment. [ABSTRACT FROM AUTHOR]

Chondroblastoma of the proximal tibia is difficult to treat because of its epiphyseal predilection. This condition can be treated by curettage, which results in immediate restoration of stability and a reduced recurrence rate, followed by cement filling of the bone defect. Nevertheless, contact with cement can damage articular cartilage, potentially leading to severe knee osteoarthritis. Most previous reports regarding this complication described patients with giant cell tumors of the proximal tibia. We present here a patient who underwent arthroscopic treatment for cement exposure caused by articular cartilage loss of the tibial plateau, which occurred after initial curettage and cementation for chondroblastoma of the proximal tibia. To our knowledge, this is the first report on arthroscopic treatment of this condition. [ABSTRACT FROM AUTHOR]

Presbyopia is the progressive reduction in the ability to focus on near objects, and as an age-related condition, the prevalence of presbyopia is expected to increase with the aging of society. A number of corneal surgical procedures are available for the treatment of presbyopia, including monovision laser in situ keratomileusis (LASIK)/ laser-assisted subepithelial keratomileusis (LASEK), conductive keratoplasty, presbyopic LASIK, and corneal inlay. Implantation of presbyopiacorrecting intraocular lenses (IOLs), such as refractive/diffractive IOLs or accommodating IOLs, is also an option. Despite the variety of treatment options available, a perfect solution has yet to be developed and patients may present with visual or optical complications such as halos, glare, or decreased contrast sensitivity. As such, careful selection and customization of treatment is essential, based on patients' individual needs and requirements for vision. [ABSTRACT FROM AUTHOR]

Multiple total knee arthroplasty (TKA) failure resulting from a recurrent infection is a challenging problem. Knee arthrodesis is one treatment option that normally involves the application of an external fixator, plate fixation, and intramedullary nailing. However, these approaches are not always successful, and a reinfection is a risk, particularly in older, medically compromised patients. This paper reports a new arthrodesis technique that uses a bundle of flexible intramedullary rods and an antibiotic-loaded cement spacer. This technique was used in two cases of multiple TKA failure that resulted from a recurrent infection. The procedure was successful in both cases with no evidence of rod or cement failure. Two advantages of this procedure are infection eradication and mechanical strength. However, this procedure should only be used for medically compromised elderly patients at high risk of rerevision TKA failure resulting from persistent periprosthetic infection because rod fracture or loosening can occur with time. [ABSTRACT FROM AUTHOR]

Background: Some studies have shown that dietary hydrolyzed collagen peptides (HC) effectively prevent age-related bone loss. However, it is not known whether the intake of HC also has positive effect on bone mass or strength when combined with exercise during growth phase. Methods: We examined the effects of 11 weeks of HC intake and running exercise on bone mass and strength in growing rats. Rats were randomized into four groups, the 20% casein group (Casein20), the 40% casein group (Casein40), the 20% HC group (HC20), and the 40% HC group (HC40). Each group was further divided into exercise groups (Casein20 + Ex, Casein40+Ex, HC20 + Ex, HC40 + Ex) and non-exercise group (Casein20, Casein40, HC20, HC40). In the HC intake groups, 30% of casein protein was replaced with HC. Exercise group rats were trained 6 days per week on a treadmill (25-30 m/min, 60 min) for 60 days. After being sacrificed, their bone mineral content (BMC) and bone strength were evaluated. Results: Exercise and dietary HC effects were observed in the adjusted BMC of lumbar spine and tibia among the 20% protein groups (p < 0.001 for exercise; p < 0.05 for dietary HC, respectively). These effects were also noted in the adjusted wet weight and dry weight of femur among the 20% protein groups (p < 0.001, p < 0.01 for exercise; p < 0.01, p < 0.001 for dietary HC, respectively). On the other hand, in adjusted bone breaking force and energy, dietary HC effect was not significant. Among the 40% protein groups, similar results were obtained in the adjusted BMC, femoral weight, bone breaking force, and energy. There were no differences between the 20% protein groups and the 40% protein groups. Conclusions: The present study demonstrated that moderate HC intake (where the diet contains 20% protein, of which 30% is HC) increased bone mass during growth period and further promoted the effect of running exercise. On the other hand, a higher HC intake (where the diet contains 40% protein, of which 30% is HC) had no more beneficial effect on bone mass than the moderate HC intake. [ABSTRACT FROM AUTHOR]

We report a case of localized nodular synovitis of the infrapatellar fat pad impinging on the patellofemoral joint causing limitation of extension. Arthroscopy involved use of a superolateral portal because location of lesion hindered access via a conventional anterior portal. The infrapatellar mass impinged in the patellofemoral joint upon knee extension and retracted upon flexion. Superior-superior triangulation allowed for complete excision of the mass. [ABSTRACT FROM AUTHOR]

Deposition of polysilicon (poly-Si) was tried to increase productivity of poly-Si by using two different types of gas nozzle in a monosilane Bell-jar Siemens (MS-Siemens) reactor. In a mass production of poly-Si, deposition rate and energy consumption are very important factors because they are main performance indicators of Siemens reactor and they are directly related with the production cost of poly-Si. Type A and B nozzles were used for investigating gas nozzle effect on the deposition of poly-Si in a MS-Siemens reactor. Nozzle design was analyzed by computation cluid dynamics (CFD). Deposition rate and energy consumption of poly-Si were increased when the type B nozzle was used. The highest deposition rate was 1 mm/h, and the lowest energy consumption was 72kWh ⋅ kg-1 in this study. [ABSTRACT FROM AUTHOR]

Background: Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts. Methods: Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1 years (range, 3-19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15-36 months). Results: Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3-12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up. Conclusions: A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts. [ABSTRACT FROM AUTHOR]

Purpose: The influence of soft tissue balancing on femoral component rotation in the gap technique remains unclear. The present study therefore compared the reliability of femoral component rotation determined by rectangular and trapezoidal gaps in total knee arthroplasty (TKA) using a navigation-assisted gap-balancing technique. The study also determined the correlation between femoral component rotation and gap measurement. Methods: This prospective study included 99 patients (108 knees) who underwent postoperative CT after TKA with the navigation-assisted gap-balancing technique. A trapezoidal flexion or extension gap was defined as a >3 mm difference between the medial and lateral sides in 90° flexion or extension. An outlier of femoral component rotation was defined as >3° deviation from the transepicondylar axis. Results: Postoperative CT showed that the femoral component had a tendency to rotate externally, with a mean 1.88 ± 2.49° from the surgical transepicondylar axis. Outliers and mean values of femoral component rotation were similar in the trapezoidal and rectangular flexion/extension gap groups. The medial flexion gap ( r = −0.49, P = 0.007) and flexion gap differences ( r = −0.59, P = 0.027) showed statistically significant negative correlations with the femoral component rotation. Multiple linear regression analysis also showed that the femoral component rotation was independently related to the flexion gap difference ( β = −0.27, P = 0.031). Conclusion: In the gap technique, the rotation of the femoral component is affected more by the flexion gap than by the extension gap. However, neither the trapezoidal nor rectangular flexion gap influenced femoral component rotation. Level of evidence: Prospective study, Level I. [ABSTRACT FROM AUTHOR]

The Korean Healthcare Accreditation System began to be applied to most Korean hospitals this year, yet it remains unfamiliar to us. There has been much criticism regarding the Hospital Evaluation Program that began in 2004 because of its formalities and its perceived ineffectiveness in improving the healthcare environment. Because of these issues, the new healthcare accreditation system was adopted to continuously improve the quality of the healthcare fields. Many countries, including the United States, are employing accreditation systems and have developed their systems with consideration for their own cultural backgrounds and medical environments. Unlike the evaluation program, which ranks hospitals, the new accreditation system tries to see the root of every behavior rather than focusing on formalities like the size of and facilities available at hospitals. The appraiser s ability to correctly judge is very important. For the hospitals, understanding the significance of accreditation, which follows quality improvement, is most important. Besides, the accreditation system is a volunteer system, which is unfamiliar to us (we are used to a passive evaluation system) and can cause confusion. It also has a risk of falling into disuse like the past evaluation system if we try to obtain quick results from the new system. Ample time is needed to make adjustments through trial and error, and for medical professionals to discover how to properly use the new accreditation system. It is important to consider its meaning and principles first. [ABSTRACT FROM AUTHOR]

Several methods are used to measure lumbar lordosis. In adult scoliosis patients, the measurement is difficult due to degenerative changes in the vertebral endplate as well as the coronal and sagittal deformity. We did the observational study with three examiners to determine the reliability of six methods for measuring the global lumbar lordosis in adult scoliosis patients. Ninety lateral lumbar radiographs were collected for the study. The radiographs were divided into normal (Cobb < 10°), low-grade (Cobb 10°–19°), high-grade (Cobb ≥ 20°) group to determine the reliability of Cobb L1–S1, Cobb L1–L5, centroid, posterior tangent L1–S1, posterior tangent L1–L5 and TRALL method in adult scoliosis. The 90 lateral radiographs were measured twice by each of the three examiners using the six measurement methods. The data was analyzed to determine the inter- and intra-observer reliability. In general, for the six radiographic methods, the inter- and intra-class correlation coefficients (ICCs) were all ≥0.82. A comparison of the ICCs and 95% CI for the inter- and intra-observer reliability between the groups with varying degrees of scoliosis showed that, the reliability of the lordosis measurement decreased with increasing severity of scoliosis. In Cobb L1–S1, centroid and posterior tangent L1–S1 methods, the ICCs were relatively lower in the high-grade scoliosis group (≥0.60). And, the mean absolute difference (MAD) in these methods was high in the high-grade scoliosis group (≤7.17°). However, in the Cobb L1–L5 and posterior tangent L1–L5 method, the ICCs were ≥0.86 in all groups. And, in the TRALL method, the ICCs were ≥0.76 in all groups. In addition, in the Cobb L1–L5 and posterior tangent L1–L5 method, the MAD was ≤3.63°. And, in the TRALL method, the MAD was ≤3.84° in all groups. We concluded that the Cobb L1–L5 and the posterior tangent L1–L5 methods are reliable methods for measuring the global lumbar lordosis in adult scoliosis. And the TRALL method is more reliable method than other methods which include the L5–S1 joint in lordosis measurement. [ABSTRACT FROM AUTHOR]

The present report describes a case of septic knee arthritis secondary to reactivated chronic osteomyelitis. The osteolytic lesion observed on the initial radiographs resulted in further imaging studies including CT and MRI, which confirmed the diagnosis. Based on the patient’s history, physical findings and imaging studies, we performed open debridement rather than arthroscopic surgery in order to treat the infected intraarticular knee joint and ream the femur intramedullary canal. Additionally, an antibiotic-impregnated cement rod was inserted into the medullary cavity to fill the dead space and eradicate the infection. A high index of suspicion combined with adequate comprehension of initial plain radiographs is essential for accurate diagnosis of septic knee arthritis with adjacent chronic osteomyelitis. [ABSTRACT FROM AUTHOR]

Equalized rectangular extension and flexion gaps are considered desirable to ensure proper kinematics in total knee arthroplasty (TKA). We compared soft tissue balancing in TKAs performed using navigation-assisted gap-balancing (60 knees) and conventional measured resection (56 knees). The outlier of soft tissue balancing was defined as a gap difference >3 mm between the medial and lateral sides in 90° flexion and extension. Medial or lateral outliers in extension or flexion were observed in 12% (7 of 60) navigation TKAs and 25% (14 of 56) conventional TKAs ( p = 0.028). There were more outliers in flexion–extension gap difference on the medial side in the conventional (23%) than in the navigation-assisted (5%) group ( p = 0.025). However, the proportion of flexion gap difference, extension gap difference, and lateral gap difference outliers did not differ significantly between the two groups ( n.s.). Additionally, clinicoradiologic outcomes were similar for the two groups except for the postoperative mechanical axis outlier ( p = 0.012). Navigation-assisted soft tissue balancing in TKA reduced not only the postoperative alignment outlier, but also the medial gap difference and achieved a more rectangular flexion and extension gap compared with conventional TKA. [ABSTRACT FROM AUTHOR]

Literature has described treatment of flaccid neuromuscular scoliosis using different instrumentation; however, only one article has been published using posterior-only pedicle screw fixation. Complications using pedicle screws in paralytic neuromuscular scoliosis has not been described before. To present results and complications with posterior-only pedicle screws, a retrospective study was carried out in 27 consecutive patients with flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy), who were operated between 2002 and 2006 using posterior-only pedicle screw instrumentation. Immediate postoperative and final follow-up results were compared using t test for Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis. Perioperative and postoperative complications were noted from the hospital records of each patient. Complications, not described in literature, were discussed in detail. Average follow-up was 32.2 months. Preoperative, immediate postoperative and final follow-up Cobb angle were 79.8°, 30.2° (63.3% correction, p < 0.0001) and 31.9°, respectively; and pelvic obliquity was 18.3°, 8.9° (52% correction, p < 0.0001) and 8.9°. Postoperative thoracic kyphosis remained unchanged from 27.6° to 19.9° ( p = 0.376); while lumbar lordosis improved significantly from +15.6° to −22.4° lordosis ( p = 0.0002). Most patients had major to moderate improvement in postoperative functional and ambulatory status compared to the preoperative status. Thirteen (48.1%) perioperative complications were noted with five major complications (four respiratory in the form of hemothorax or respiratory failure that required ventilator support and one death) and eight minor complications (three UTI, two atelectasis, two neurological and one ileus). Postoperatively, we noted complications, such as coccygodynia with subluxation in 7, back sore on the convex side in 4 and dislodging of rod distally in 1 patient making a total of 12 (44.4%) postoperative complications. Of 12 postoperative complications, 6 (50%) required secondary procedure. We conclude that although flaccid neuromuscular scoliosis can be well corrected with posterior-only pedicle screw, there is a high rate of associated complications. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the characteristics of highly malignant soft tissue sarcoma of the extremity with a delayed diagnosis. Materials and methods: The clinical and radiological characteristics of 18 cases of highly malignant soft tissue sarcomas of the extremity with a delayed diagnosis were determined. Results: Ten men and eight women of mean age 44.8 years (range, 15-79 years) were included in this study. Seven cases of synovial sarcoma, three cases each of alveolar soft part sarcoma and malignant fibrous histiocytoma, two cases each of highly malignant leiomyosarcoma and myxofibrosarcoma, and one case of clear cell sarcoma were enrolled. Times from tumor detection to diagnosis ranged from 1 to 3 years in most cases; three of the seven synovial sarcoma cases took more than 10 years to diagnose. Of the seven cases of synovial sarcoma, five cases of small, superficial located masses were simply excised without a pre-surgical biopsy. Three cases of alveolar soft part sarcoma showed characteristic T1- and T2-weighted high signal intensities with signal voids in MR images. In addition, one synovial sarcoma patient and one alveolar soft part sarcoma patient showed evidence of calcification on plain radiographs. However, no general characteristic clinical findings were found to be common to the 18 cases. Conclusions: Contrary to general expectations, some soft tissue tumors that grow slowly are painless, and those that occur in superficial limbs may be highly malignant. Thus, even when a slow growing, painless superficial mass is encountered in a limb, physicians should keep the possibility of highly malignant soft tissue sarcoma in mind. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to evaluate the fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) findings in patients with T-lymphoblastic lymphoma (T-LBL). In total, 9 patients with histopathologically confirmed T-LBL were included in the study. Bone marrow (BM) involvement and leukemic transformation (LT) were evaluated through iliac crest marrow biopsy and peripheral blood blast count. FDG-PET scans were performed at the initial pre-treatment point. Two experienced nuclear medicine physicians evaluated the FDG-PET images by visual analysis and using the maximum standardized uptake values (SUVmax) of the malignant lesions. Overall, 8 out 9 patients presented with BM involvement; 7 showed LT, while 1 showed BM involvement without LT. All involved T-LBL lesions were FDG-avid with variable uptake. The mean SUVmax was 6.4±3.3. T-LBL patients with BM involvement showed diffuse or nodular marrow uptake. In addition, all the patients with LT showed diffuse marrow FDG activity. However, the patient with BM involvement but no LT showed nodular FDG uptake in the marrow. In conclusion, the present study indicates that it is possible to use FDG-PET for the evaluation of the disease extent of T-LBL. Furthermore, the imaging technique could provide a diagnostic clue for determining BM involvement or LT. [ABSTRACT FROM AUTHOR]

Complete dorsal dislocation of the carpal scaphoid combined with dorsal perilunate dislocation is an extremely rare carpal injury. We describe the case of a 23-year-old man who presented with a complete dorsal dislocation of the carpal scaphoid, combined with a perilunate dislocation. Surgical treatment was performed with open reduction and interosseus ligament repair. At 4 years follow up, the patient's wrist pain had completely resolved without limitations of wrist joint motion and without evidence of avascular necrosis of the carpal scaphoid. [ABSTRACT FROM AUTHOR]

Mice were fed either 13 nm silver nanoparticles or 2–3.5 μm silver microparticles. The livers were then obtained after 3 days and subjected to a histopathological analysis. The nanoparticle-fed and microparticle-fed livers both exhibited lymphocyte infiltration in the histopathological analysis, suggesting the induction of inflammation. In vitro, a human hepatoma cell line (Huh-7) was treated with the same silver nanoparticles and microparticles. The mitochondrial activity and glutathione production were hardly affected. However, the DNA contents decreased 15% in the nanoparticle-treated cells and 10% in the microparticle-treated cell, suggesting a more potent induction of apoptosis by the nanoparticles. From a microarray analysis of the RNA from the livers of the nano- and micro-particle-fed mice, the expression of genes related to apoptosis and inflammation was found to be altered. These gene expression changes in the nanoparticle-treated livers lead to phenotypical changes, reflecting increased apoptosis and inflammation. The changes in the gene expression were confirmed by using a semi-quantitative RT-PCR. [ABSTRACT FROM AUTHOR]

An embryonic stem cell is a powerful tool for investigation of early development in vitro. The study of embryonic stem cell mediated neuronal differentiation allows for improved understanding of the mechanisms involved in embryonic neuronal development. We investigated expression profile changes using time course cDNA microarray to identify clues for the signaling network of neuronal differentiation. For the short time course microarray data, pattern analysis based on the quadratic regression method is an effective approach for identification and classification of a variety of expressed genes that have biological relevance. We studied the expression patterns, at each of 5 stages, after neuronal induction at the mRNA level of embryonic stem cells using the quadratic regression method for pattern analysis. As a result, a total of 316 genes (3.1%) including 166 (1.7%) informative genes in 8 possible expression patterns were identified by pattern analysis. Among the selected genes associated with neurological system, all three genes showing linearly increasing pattern over time, and one gene showing decreasing pattern over time, were verified by RT-PCR. Therefore, an increase in gene expression over time, in a linear pattern, may be associated with embryonic development. The genes: Tcfap2c, Ttr, Wnt3a, Btg2 and Foxk1 detected by pattern analysis, and verified by RT-PCR simultaneously, may be candidate markers associated with the development of the nervous system. Our study shows that pattern analysis, using the quadratic regression method, is very useful for investigation of time course cDNA microarray data. The pattern analysis used in this study has biological significance for the study of embryonic stem cells. [ABSTRACT FROM AUTHOR]

Epidemiological studies have reported an association between arterial calcification and bone loss after menopause. However, the underlying mechanism of the association remains unclear. Therefore, to explore the possible mechanisms of the association, we tried to develop a new combined model rat of ovariectomy (OVX, an animal model of osteoporosis) and vitamin D3 plus nicotine (VDN rat, an animal model of arterial calcification). We tested them by using sham-operated control rats (SC), OVX control rats (OC), and OVX plus VDN-treated rats (OVN). Dissections were performed twice at 4 (4SC, 4OC, and 4OVN) and 8 (8SC, 8OC, and 8OVN) weeks after treatment. 8OVN showed bone loss and arterial calcification, although 8OC showed only bone loss. Moreover, arterial calcium content was associated with indexes of bone loss at 8 weeks. Thus, the OVN rat is considered a good model to examine the relationship of the two disorders after menopause. Additionally, the arterial endothelin-1 (ET-1, a potent regulator of arterial calcification) levels increased in both 4OVN and 8OVN, and the level was associated with arterial calcium content at 8 weeks. Furthermore, the arterial endothelial nitric oxide synthase (eNOS) protein, which is an enzyme that produces nitric oxide (an antiatherosclerotic substance), was significantly reduced in only 8OVN. Estrogens affect the alterations of the eNOS and ET-1 proteins. Therefore, we suggest that impairment of the ET-1- and NO-producing system in arterial tissue during periods of rapid bone loss by estrogen deficiency might be a mechanism of the relationship between the two disorders seen in postmenopausal women. [ABSTRACT FROM AUTHOR]

Methamphetamine (MAP) is a commonly used, addictive drug, and a powerful stimulant that dramatically affects the central nervous system. In this study, we used the conditioned place preference (CPP) paradigm in order to study the reinforcing properties of MAP and the herewith associated changes in proteins within the mesolimbic dopamine system. A CPP was induced by MAP after three intermittent intraperitoneal injections (1 mg/kg) in rats and protein profiles in the nucleus accumbens, striatum, prefrontal cortex, cingulate cortex and hippocampus were compared with a saline-treated control group. In addition, a group of animals was run through extinction and protein profiles were compared with a non-extinguished group. Protein screening was conducted using two-dimensional electrophoresis analysis which identified 27 proteins in the group that showed MAP-induced CPP. Some of the proteins were confirmed by Western lot analysis. Identified proteins had functions related to the cytoskeleton, transport/endocytosis or exocytosis (e.g. profilin-2 and syntaxin-binding protein), and signal transduction, among others. [ABSTRACT FROM AUTHOR]

Methamphetamine, a commonly used addictive drug, is a powerful addictive stimulant that dramatically affects the CNS. Repeated METH administration leads to a rewarding effect in a state of addiction that includes sensitization, dependence, and other phenomena. It is well known that susceptibility to the development of addiction is influenced by sources of reinforcement, variable neuroadaptive mechanisms, and neurochemical changes that together lead to altered homeostasis of the brain reward system. These behavioral abnormalities reflect neuroadaptive changes in signal transduction function and cellular gene expression produced by repeated drug exposure. To provide a better understanding of addiction and the mechanism of the rewarding effect, it is important to identify related genes. In the present study, we performed gene expression profiling using microarray analysis in a reward effect animal model. We also investigated gene expression in four important regions of the brain, the nucleus accumbens, striatum, hippocampus, and cingulated cortex, and analyzed the data by two clustering methods. Genes related to signaling pathways including G-protein-coupled receptor-related pathways predominated among the identified genes. The genes identified in our study may contribute to the development of a gene modeling network for methamphetamine addiction. [ABSTRACT FROM AUTHOR]

Abstract  Many epidemiological studies have reported that the severity of arterial diseases such as arterial calcification and stiffness is inversely related to bone loss, i.e., osteoporosis. However, the nature of this relationship is unclear. The purpose of the present study was to examine the influences of estrogen deficiency and/or low-calcium diet (0.1% Ca) on bone metabolism and calcium balance, as well as aortic wall composition and stiffness in young female rats. Twenty-eight 6-week-old female rats were randomized into four groups: OVX-Low calcium (OL) and OVX-Normal calcium groups (ON) were ovariectomized, and Sham-Low calcium (SL) and Sham-Normal calcium groups (SN) were sham-operated. After 12 weeks, the bone mineral density of the lumbar spine and tibial proximal metaphysis were significantly lower in ON than in SN, and also significantly lower in OL than in ON. Additionally, OL rats had significant higher (vs. SN and SL) urinary deoxypyridinoline, but not urinary calcium, excretion at 4 weeks after ovariectomy. However, at 12 weeks after ovariectomy, urinary calcium excretion was significantly higher in OL than in SL, with corresponding increases in two bone turnover markers, bone-type alkaline phosphatase and tartrate-resistant acid phosphatase. Neither estrogen deficiency nor low-calcium diet affected aortic stiffness or elastin degeneration and calcium deposition over the course of the present study, although changes of bone metabolism occurred rapidly. Taken together, these results show that bone loss and arterial stiffness did not progress simultaneously in the present experimental protocol. [ABSTRACT FROM AUTHOR]