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Aims Bone metastasis ultimately occurs due to a complex multistep process, during which the interactions between cancer cells and bone microenvironment play important roles. Prior to colonization of the bone, cancer cells must succeed through a series of steps that will allow them to gain migratory and invasive properties; epithelial-to-mesenchymal transition (EMT) is known to be integral here. The aim of this study was to determine the effects of G protein subunit alpha Q (GNAQ) on the mechanisms underlying bone metastasis through EMT pathway. Methods A total of 80 tissue samples from patients who were surgically treated during January 2012 to December 2014 were used in the present study. Comparative gene analysis revealed that the GNAQ was more frequently altered in metastatic bone lesions than in primary tumour sites in lung cancer patients. We investigated the effects of GNAQ on cell proliferation, migration, EMT, and stem cell transformation using lung cancer cells with GNAQ-knockdown. A xenograft mouse model tested the effect of GNAQ using micro-CT analyses and histological analyses. Results GNAQ-knockdown showed down-regulation of tumour growth through mitogen-activated protein kinase (MAPK) signalling in lung cancer cells, but not increased apoptosis. We found that GNAQ-knockdown induced EMT and promoted invasiveness. GNAQ-knockdown cells injected into the bone marrow of murine tibia induced tumour growth and bone-to-lung metastasis, whereas it did not in control mice. Moreover, the knockdown of GNAQ enhanced cancer stem cell-like properties in lung cancer cells, which resulted in the development of resistance to chemotherapy. Conclusion The present study reveals that the GNAQ-knockdown induced cancer stem cell-like properties. Cite this article: Bone Joint Res 2021;10(5):310–320.

An isolated tibial component revision could be a treatment option for isolated tibial side loosening; however, few studies have proved its efficacy. This study aimed to compare the clinical and radiological outcomes between isolated (tibial component) and total (femoral and tibial component) revision total knee arthroplasty (TKA).Between January 2008 and February 2017, 31 patients underwent revision TKA for isolated tibial side loosening; 14 underwent an isolated tibial component revision (isolated group) and 17 underwent total (both femoral and tibial components) revision surgery (total group). The postoperative range of motion (ROM), Western Ontario and McMaster Universities osteoarthritis (WOMAC) index, Knee Society knee score (KSKS), Knee Society function score (KSFS), and mechanical axis (MA) were compared between the two groups. The intraoperative tourniquet time and amount of blood drainage were also compared.The mean follow-up durations in the isolated and total groups were 40.7 and 56.1 months, respectively. Both groups had similar postoperative ROM, WOMAC index, KSKS, KSFS, and MA; however, significantly shorter tourniquet time (105.2 vs. 154.6 min, P 0.001) and less blood drainage (417.2 vs. 968.1 ml, P 0.001) were noted in the isolated group than in the total group.Isolated tibial component revision TKA for tibial component loosening showed comparable clinical and radiological outcomes to those of total revision TKA. The advantages of the isolated tibial component revision surgery were short operation time and small blood loss.Level III, Retrospective comparative study.

Background The recent explosion of cancer genomics provides extensive information about mutations and gene expression changes in cancer. However, most of the identified gene mutations are not clinically utilized. It remains uncertain whether the presence of a certain genetic alteration will affect treatment response. Conventional statistics have limitations for causal inferences and are hard to gain sufficient power in genomic datasets. Here, we developed and evaluated a C-search algorithm for searching the causal genes that maximize the effect of the treatment. Methods The algorithm was developed based on the potential outcome framework and Bayesian posterior update. The precision of the algorithm was validated using a simulation dataset. The algorithm was implemented to a cBioPortal dataset. The genes discovered by the algorithm were externally validated within CancerSCAN screening data from Samsung Medical Center. Results Simulation data analysis showed that the C-search algorithm was able to identify nine causal genes out of ten. The C-search algorithm shows the discovery rate rapidly increasing until the 1500 data instances. Meanwhile, the log-rank test shows a slower increase in performance. The C-search algorithm was able to suggest nine causal genes from the cBioPortal Metabric dataset. Treating the patients with the causal genes is associated with better survival outcome in both the cBioPortal dataset and the CancerSCAN dataset which is used for external validation. Conclusions Our C-search algorithm demonstrated better performance to identify causal effects of the genes than multiple log-rank test analysis especially within a limited number of data. The result suggests that the C-search can discover the causal genes from various genetic datasets, where the number of samples is limited compared to the number of variables.

Background:Time-dependent changes in lower extremity alignment after an opening-wedge high tibial osteotomy (OWHTO) have been poorly investigated. Moreover, few studies have investigated risk factors of postoperative alignment change.Purposes:To investigate time-dependent alignment changes and identify predictive factors for postoperative alignment change after OWHTO.Study Design:Case-control study; Level of evidence, 3.Methods:This study included patients who underwent OWHTO between March 2010 and September 2018. A total of 142 knees with a mean follow-up of 42 months were included and classified as the change group when the amount of hip-knee-ankle (HKA) angle change was >1°; if otherwise, then as the no-change group. HKA angle was obtained at 6 time points: preoperatively and at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively. Multiple regression analysis was performed to identify the factors that were correlated with the changes in the HKA angle from 3 months to the final follow-up.Results:Among the 142 knees, 59 (42%) were included in the change group. The overall postoperative HKA angles progressed serially toward varus after OWHTO. The mean angles of the 6 time points were 8.5°, –3.7°, –3.6°, –3.3°, –3.1°, and –2.7°, respectively. The mean HKA angles of the change and no-change groups were 9.1°, –4.3°, –3.4°, –2.8°, –2.0°, and –1.4° and 8.1°, –3.3°, –3.8°, –3.6°, –3.8°, and –3.7°, respectively. Greater change in the HKA angle was predicted by preoperatively greater valgus stress joint line convergence angles and less medial joint space width.Conclusion:Of the cases of OWHTO, 42% showed correction loss of >1° at a mean follow-up of 42 months. The overall postoperative HKA angles progressed serially to varus angles after OWHTO. Preoperative greater valgus stress joint line convergence angles and less medial joint space width were predictive factors for greater change in alignment toward varus after OWHTO.

Various surgical techniques, such as corticocancellous or cancellous bone graft and other vascularized bone grafting techniques have been developed to treat scaphoid nonunion. However, open grafting with dissection of wrist capsule and ligaments damages the joint and hence can lead to increased stiffness of the wrist and hand. Arthroscopic assisted bone grafting and percutaneous fixation have advantages such as minimal surgical trauma to the scaphoid blood supply and its ligament connection and provide a thorough wrist assessment, comprehensive approach for scaphoid nonunion and its sequelae in a minimally invasive manner. This article briefly discusses the characteristic anatomy of the wrist and scaphoid, and reviews the technique of arthroscopic bone grafting and percutaneous fixation for the treatment of scaphoid nonunion.

Purpose: We evaluated results of arthroscopically assisted volar and dorsal scapholunate(SL) ligament reconstruction using flexor carpi radialis(FCR). Methods: We reviewed 31 cases who had been operated from August 2015 to June 2018. Two cases were excluded and 4 cases lost contact. Twenty five wrists were included. The average follow-up duration was 25.3months. Diagnostic arthroscopy was performed to evaluate EWAS stage of SL instability and the reparability of SL ligament. The SL reconstruction was performed for the cases which showed EWAS stage IIIC, IV having gap over 3mm and irreparable SL ligament. The interval between the diagnosis and operation was 5.9 days in average. We modified the arthroscopic Corella technique by repairing the graft tendon to FCR. Results: All SL joints were stabilized to EWAS stage I arthroscopically after reconstruction. DASH score changed from 32.7 to 9.7. Grip power changed from 74.1% to 93.3%. Modified Mayo Wrist score was 83.8. Preoperative SL angle was 53.8。, postoperative 49.6。 and the last was 51.2。. The improvement between preoperative and last follow-up SL angle was statistically significant(p

To report the clinical and radiological outcomes of arthroscopic bone grafting and percutaneous K-wire fixation without radial styloidectomy in patients with scaphoid nonunion advanced collapse (SNAC). We retrospectively analyzed the records of 15 patients with SNAC who were treated with arthroscopic bone grafting and percutaneous K-wire fixation and subsequently followed up for a minimum of 1 year between November 2009 and March 2018. The clinical outcomes were evaluated by comparing the range of motion (ROM), grip strength, the modified Mayo Wrist Score, and visual analog scale (VAS) scores for pain, all of which were measured preoperatively and at the last follow-up. The radiologic outcomes were evaluated by comparing the scapholunate (SL) and radiolunate (RL) angles preoperatively and at the last follow-up. All 15 cases of nonunion were resolved. The average radiologic union time was 9.7 ± 1.2 weeks. The average VAS score increased from 5.7 ± 2.3 (range, 2 - 10) preoperatively to 1.3 ± 1.3 (range, 0 - 3) at the last follow-up (P.05). The average modified Mayo wrist score increased from 58.3 ± 14.0 preoperatively to 80.0 ± 9.2 at the last follow-up (P.05). The mean ROM of the wrist improved, but there was no statistical significance. At the last follow-up, the mean flexion and radial deviation on the affected side were significantly decreased, and the mean extension on the affected side was significantly improved compared to the normal side (P.05). The mean preoperative SL and RL angles were 66 ± 11.9° and 7.2 ± 6.8°, respectively, and were decreased to 50.4 ± 7.5° and 6.4 ± 5.2°, respectively, at the last follow-up. The mean SL angle was significantly corrected (P = .01). Arthroscopic bone grafting and percutaneous Kerschner (K)-wire fixation without radial styloidectomy are considered to be very effective methods for correcting scaphoid deformities to treat SNAC stage I. However, caution may be needed during the surgery to prevent reductions in flexion and the radial deviation of the wrist.

When surgical treatment is indicated for primary trigger finger, open A1 pulley release has traditionally been recommended with generally good results. However, ganglion cysts of the flexor tendon sheath as a complication after an open A1 pulley release were rarely reported. Therefore, the purpose of this study is to report a case of multiple ganglion cysts arising from the flexor tendon sheath in a patient undergoing an open A1 pulley release for trigger finger disorder with a review of the relevant literature.A 65-year-old right-handed farmer was referred to our hospital for swelling in the left long finger (LLF). One year before the visit, the patient was diagnosed with trigger finger in the LLF at other hospital and an open A1 pulley release was performed, but the swelling of the finger persisted. The patient had no history of trauma or evidence of systemic disease such as rheumatoid or other inflammatory arthritis. The patient was diagnosed with multiple ganglion cysts of flexor tendon sheath after investigation.We successfully excised cystic masses and debrided the partially ruptured flexor digitorum superficialis (FDS) tendon and sutured it using 5/0 prolene. At 12-month follow-up, the patient was completely asymptomatic with excellent range of motion in the distal interphalangeal (DIP) joint (0°-60°) of his LLF, showing no recurrence of ganglion cyst.Trigger finger is a common condition that clinicians encounter frequently. However, this familiarity may lead to inattentive treatment. Nevertheless, through this case, clinicians should devote careful attention when performing open A1 pulley release to prevent partial rupture of the flexor tendon in the A1 pulley. If ganglion cysts occur, we believe that surgical excision can yield good results.

We report the arthroscopic and clinical findings of patients with chronic wrist pain following distal radius fracture (DRF) who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment. We retrospectively analyzed the records of 15 patients with chronic wrist pain following DRF, who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment from 2010 to 2017. The average patient age was 44 years (range, 20–68 years), average time from injury to treatment 21 ± 23.46 months (range, 3–96 months) and average follow up period 20.13 ± 8.71 months (range, 12–39 months). The functional outcome was evaluated by comparing the preoperative and final follow up values of the range of motion, grip strength, pinch strength, visual analogue scale for pain and quick disabilities of the arm, shoulder and hand score. Based on the arthroscopic findings, synovitis was found in all cases and the pathologic intra-articular lesions were classified into 4 patterns. Triangular fibrocartilage complex rupture was seen in 14 cases, intercarpal and radiocarpal ligament ruptures in 9 cases, ulnar impaction syndrome in 5 cases, and cartilage lesion in 9 cases. In terms of surgical treatment, 15 patients underwent arthroscopic synovectomy, 7 foveal or capsular repair of TFCC, 7 intercarpal Kirschner wires fixation or intercarpal thermal shrinkage, 1 intercarpal ligament reconstruction, 2 Sauve-Kapandji procedure, and 2 unlar shortening osteotomy. Postoperatively, the average range of motion, grip strength, and pinch strength increased significantly. From preoperative to final follow up values, the average visual analogue scale and quick disabilities of the arm score decreased from 5.93 ± 1.58 (range, 3–8) to 1.33 ± 1.29 (range, 0–3) (P = .001) and from 49.38 ± 19.09 to 12.63 ± 7.63 (P = .001), respectively. Diagnostic arthroscopy and arthroscopically-assisted tailored treatment of chronic wrist pain following DRF can provide an accurate diagnosis, significant pain relief, and functional improvement.

Objectives/Interrogation: The purpose of this study is to present secondary trigger finger caused by a neglected partial flexor tendon rupture including discussion of the mechanism and treatment. Methods: We retrospectively reviewed the records of six patients with trigger finger caused by[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Titanium dioxide (TiO2) nanotubes with vertically aligned array structures show substantial advantages in solar cells as an electron transport material that offers a large surface area where charges travel linearly along the nanotubes. Integrating this one-dimensional semiconductor material with plasmonic metals to create a three-dimensional plasmonic nanodiode can influence solar energy conversion by utilizing the generated hot electrons. Here, we devised plasmonic Au/TiO2 and Ag/TiO2 nanodiode architectures composed of TiO2 nanotube arrays for enhanced photon absorption, and for the subsequent generation and capture of hot carriers. The photocurrents and incident photon to current conversion efficiencies (IPCE) were obtained as a function of photon energy for hot electron detection. We observed enhanced photocurrents and IPCE using the Ag/TiO2 nanodiode. The strong plasmonic peaks of the Au and Ag from the IPCE clearly indicate an enhancement of the hot electron flux resulting from the presence of surface plasmons. The calculated electric fields and the corresponding absorbances of the nanodiode using finite-difference time-domain simulation methods are also in good agreement with the experimental results. These results show a unique strategy of combining a hot electron photovoltaic device with a three-dimensional architecture, which has the clear advantages of maximizing light absorption and a metal–semiconductor interface area.

Background It is controversial issue that heparin decreases thrombosis for microsurgical anastomosis, and its effective role is under discussion. This study is for proving whether low-dose heparin is preventing thrombosis in free flap reconstruction. Methods Through chart reviews of 134 patients, using low-dose heparin for free tissue transfer from 2011 to 2016, retrospective analysis was performed. 33 patients received low-dose heparin therapy after surgery. And 101 patients received no-heparin therapy. Complications included flap necrosis, hematoma formation, dehiscence and infection. Results In no-heparin therapy group, comparing the flap necrosis revealed 16 cases (15.84%). And, flap necrosis was 6 cases (18.18%) in low-dose heparin therapy group. The statistical analysis of flap necrosis rate showed no significant difference (p=0.75). The results showed that there was no significant difference of flap necrosis rate between two groups. Conclusion In this study, patients in the low-dose heparin group had no significantly lower rates of flap failure compared with no-heparin group. This suggests that low-dose heparin may not prevent thrombosis and subsequent flap failure to a significant extent.

We developed a design of Intelligent Healthcare Data Management System using nanosensors (IHDMS) and composed an application for mobile device. The proposed IHDMS will coordinate the healthcare data of the patients from nanosensors and transforms it into a worldwide consumed standard HL7 (Health Level Seven) for conversion of healthcare data. This converted data dispatches to a server of its system. The battery lifetime of the facility is feasible to increase, the memory usage is less than 100 KB, and it operates all data by employing few and far between resources. Moreover, the proposed system decreases the waiting time in the transposing data, and secured channel was used for the server of the healthcare center in the running HL7 format data.

The purpose of this study is to report the clinical results of the arterialized venous free flaps in reconstructing soft tissue defects of the finger and to extend the indications for the use of the flaps based on clinical experiences of the authors. We retrospectively reviewed the records of 35 patients who underwent an arterialized venous free flaps for a finger reconstruction, between May 2007 and August 2015. The mean size of flap was 4.8 ± 1.23 × 3.1 ± 0.84 cm. The donor site was the ipsilateral volar aspect of the distal forearm in all cases. There were 17 (48.6%) cases of venous skin flaps, 9 (25.7%) cases of innervated venous flaps, 7 (20%) cases of tendocu taneous flaps, and 2 (5.7%) case of innervated tendocutaneous flap. The vascularity of recipient beds was good except 8 (22.9%) cases (partial devascularity in 3, more than 50% avascularity [bone cement] in 3, and chronic infected bed in 2). Of the 35 cases, 29 (82.9%) cases (including 3 cases who had more than 50% avascularity recipient bed) showed complete survival. 3 (8.6%) cases, which had partially devascularity of distal phalanx in recipient bed, showed partial necrosis (P = .015). The mean number of included veins was 2.4 ± 0.5 for a flap. A forearm arterialized venous free flap is a useful procedure for single-stage reconstructing of a soft tissue or combined defect of a finger, we consider that this technique could be applied to fingers despite an avascular or insufficient vascular recipient bed if the periphery of recipient bed vascularity was good and if the recipient beds were free from infection.

Rationale The treatment methods of pediatric scaphoid nonunion are still controversial. To our knowledge, arthroscopic-assisted treatments for pediatric scaphoid nonunion has not been reported in the English-language literature. Therefore, the purpose of this study is to report the use of arthroscopic-assisted bone grafting for scaphoid nonunion fracture in 3 patients and present a literature review. Patients concerns Two 15-year-old patients developed carpal joint injuries over a year, prior to their hospital presentation, since they had not received adequate treatment. The third patient, 12 years of age, was diagnosed with scaphoid fracture after a traffic accident and underwent conservative treatment but presented to the hospital due to issues related with bone union. Diagnosis All 3 patients were diagnosed with scaphoid nonunion at our hospital, using plain wrist radiographs and computed tomography. Interventions All the patients underwent arthroscopic debridement; 2 patients received autogenous iliac cancellous bone graft, while the other patient received a bone substitute graft. The internal fixation of the scaphoid was performed with K-wires. Outcomes Bone unions were achieved in all patients, and the final follow-up resulted in successful outcomes. Lessons Arthroscopic-assisted bone grafting and percutaneous K-wire fixation can be considered as a good method for the treatment of pediatric scaphoid nonunion fractures. Therefore, it is a primary treatment option for symptomatic scaphoid nonunion fracture and displaced fractures.

Background: Patients who sustain a rotator cuff retear after arthroscopic rotator cuff repair are generally considered to have worse clinical outcomes compared with patients with an intact rotator cuff. However, some patients have good clinical outcomes, even with a retorn rotator cuff. Purpose: To report the clinical outcomes of nonoperative treatment for rotator cuff retears and analyze the factors affecting clinical outcomes after a retear. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic rotator cuff repair between 2011 and 2017 were reviewed, and those with a full-thickness retear on postoperative magnetic resonance imaging (MRI) were included in this study. According to their pre- and postoperative scores on the pain visual analog scale (pVAS) and functional visual analog scale (fVAS), the patients were divided into 3 groups: (1) mild group (pVAS ≤ 1 and fVAS ≥ 8), (2) moderate group (pVAS ≤ 1 and fVAS ≤ 7 or pVAS 2-3 and fVAS ≥ 8), and (3) severe group (pVAS ≥ 3 and fVAS ≤ 7). Preoperative data (dominant hand involvement, heavy labor) and tear size on 6-month postoperative MRI were analyzed as factors affecting clinical outcomes. Results: A total of 712 patients were reviewed, and a retear was observed in 62 patients (8.7%). Of the patients with retears, 52 were included in this study: 25 men and 27 women with a mean age of 62.6 years (range, 49-80 years) and mean follow-up period of 40 months (range, 24-88 months). According to the pVAS and fVAS scores, 25 patients (48.1%) were classified into the mild group, 9 (17.3%) into the moderate group, and 18 (34.6%) into the severe group. There were no significant differences in preoperative data among the 3 groups. The tear size in the coronal and sagittal planes decreased by 5.1 and 6.6 mm, respectively, in the mild group but increased by 2.8 and 1.4 mm, respectively, in the severe group. Conclusion: In patients with retears, 48.1% had only mild symptoms at a mean of 40 months postoperatively. Patients with severe symptoms tended to have an increased tear size on postoperative MRI.

Rationale: The extensor tendon of the proximal interphalangeal (PIP) joint is highly complex, and failure to ensure suitable balance during treatment following an injury is likely to produce poor outcomes. We have achieved good outcomes with the primary repair of neglected extensor tendon rupture in the PIP joint, and thus report the case along with a review of the relevant literature. Patients concern: A 40-year-old right-handed female who works at a meat shop visited our clinic due to pain and active limitation of the range of motion (ROM) of the PIP joint of her left long finger. She had previously experienced a cut on the dorsal aspect of the third PIP joint while cutting meat about a year earlier but did not receive any specific treatment for the injury. Diagnosis: The patient was diagnosed with complete rupture of the central slip and lateral band in the PIP joint after investigation. Intervention: We successfully debrided the ruptured tendon and performed extensor tendon repair using the modified Kessler technique and epitendinous cross-over repair technique. Outcome: At the 12-month follow-up, the patient was completely asymptomatic and had optimal PIP joint ROM (0°–90°) in her left long finger. Lessons: Although the treatment of an extensor injury of the PIP joint area is difficult, satisfactory outcomes can still be achieved, even in cases of injuries which are neglected for over a year, using a repair technique that can properly balance the length and tension between the central slip and lateral bands with the selection of appropriate postoperative treatment strategies.

Information technology (IT) security has become a major concern due to the growing demand for information and massive development of client/server applications for various types of applications running on modern IT infrastructure. How has security been taken into account and which paradigms are necessary to minimize security issues while increasing efficiency, reducing the influence on transmissions, ensuring protocol independency and achieving substantial performance? We have found cryptography to be an absolute security mechanism for client/server architectures, and in this study, a new security design was developed with the MODBUS protocol, which is considered to offer phenomenal performance for future development and enhancement of real IT infrastructure. This study is also considered to be a complete development because security is tested in almost all ways of MODBUS communication. The computed measurements are evaluated to validate the overall development, and the results indicate a substantial improvement in security that is differentiated from conventional methods.

College of Pharmacy, Chungnam National University, Daejeon 305-764, Korea. E-mail: kangjss@cnu.ac.kr College of Pharmacy, Korea University, Chungnam 339-700, Korea. E-mail: yjbyun1@korea.ac.kr Daejeon Health Sciences College, Daejeon 300-711, Korea Daejeon Oriental Hospital, Daejeon University, Daejeon 301-724, Korea College of Oriental Medicine, Dongguk University, Gyeongju, Republic of Korea Received October 31, 2012, Accepted February 21, 2013

Carrier multiplication (i.e. generation of multiple electron–hole pairs from a single high-energy electron, CM) in graphene has been extensively studied both theoretically and experimentally, but direct application of hot carrier multiplication in graphene has not been reported. Here, taking advantage of efficient CM in graphene, we fabricated graphene/TiO2 Schottky nanodiodes and found CM-driven enhancement of quantum efficiency. The unusual photocurrent behavior was observed and directly compared with Fowler’s law for photoemission on metals. The Fowler’s law exponent for the graphene-based nanodiode is almost twice that of a thin gold film based diode; the graphene-based nanodiode also has a weak dependence on light intensity—both are significant evidence for CM in graphene. Furthermore, doping in graphene significantly modifies the quantum efficiency by changing the Schottky barrier. The CM phenomenon observed on the graphene/TiO2 nanodiodes can lead to intriguing applications of viable graphene-based light harvesting.

Two marker compounds of Achyranthis Radix, ecdysterone and inokosterone, were analyzed by HPLCon an ODS column (250 × 4.6 mm, 5 µ m) with a mobile phase of 15% acetonitrile containing 0.08% formicacid at a flow rate of 1.0 mL/min and a detection wavelength of UV 254 nm. The method was validated byICH guideline and applied to the monitoring of marker compounds in 93 samples of Achyranthis Radix collectedat various areas in Korea and China. The new content criteria of ecdysterone and inokosterone, establishedusing linear regression method were 0.033% and 0.020%, respectively. When the new content criteria wereapplied to the quality control test of commercial Achyranthis Radix, 95.4% of total samples including 100%of Korean and 92.6% of Chinese samples were passed the test. Application of new content criteria could protectthe Korean products and decrease the distribution of Chinese products with lower quality. : ecdysterone inokosterone HPLC . ODS 0.08% 15% !"# $% ' &$ , ) ( 1.0 mL/n, mi -) *+, 254 nm . . &$ ICH 2 01 / 31 4 ' 5 , 67 8 97 : ;2 . ?@ 93 A2 B6 DE2 C! F$ . GHIJ 2 K . + ecdysterone inokosterone 2 B6 LM P) NO :: 0.033% Q 0.020% RST , LM OP UV ? 2 F$ W 7 ) / CX ' YZ 7 ) 9 92.6% / YZ [F \] ^) YZ 95.4% . M L OP) N _) 7 9 ` ?c ab de7 fg j hi = k l . Um .Key words: content criteria, ecdysterone, inokosterone, Achyranthis Radix, HPLC

Many web-sites provide a variety of electronic mapping services. Currently, many studies are underway to develop vehicle navigation software for PDA maps using GPS data. Popular among these services is one that computes the optimal route between two locations input by a user. This service of computing the optimal route plays an important role in vehicular navigation and distribution and delivery industries. The calculation and manipulation of the optimal route for navigation and vehicular delivery system improve the efficiency of vehicle use and delivery times, thereby reducing costs. The purpose of this study is to compute the optimal route by considering the direction of distribution vehicles and the delivery location and develop a genetic based algorithm that quickly generates the shortest route for delivery. The algorithm also generates the optimal route for itineraries having several destinations.

The pharmacokinetics of prunasin after oral administration of amygdalin or a decoction of peach seeds was determined and compared in rats. A column was used for separation at a column temperature of . The mobile phase consisted of 20% aqueous acetonitrile, and the flow rate was 0.5 mL/min. After oral administration of a decoction of peach seeds, prunasin was absorbed rapidly, reaching a maximum plasma concentration () of 62.1 mg/L within 45 min. After oral administration of amygdalin, the absorption of prunasin was delayed. The of prunasin was 42.9 mg/L and was reached at 60 min. Values for the pharmacokinetic parameters of prunasin, including , , AUC, , CL/F, and V1/F, were significantly different for the oral administration of amygdalin compared with that of a decoction of peach seeds.

Sixteen-chain sequentially rotated fed antenna array on low-temperature cofired ceramic substrate is presented. A 60 GHz broadband circular polarised (CP) stacked rectangular patch antenna is implemented as an element. All the feedlines have the same length which is differentiated from conventional T-junction divider feeder. By this way, several drawbacks of conventional sequential rotated array can be overcome such as phase error occurrence, amplitude mismatch, and axial ratio bandwidth degradation. Moreover, digitally controlled by phase shifters, beamforming performance can be evaluated. The simulated and measured S 11 shows broad bandwidth from 57 to 66 GHz. In addition, the radiation patterns show a peak gain of 17.2 dBi and a wide coverage of ±63°.

Rationale Anomalous course and tenosynovitis of extensor pollicis longus (EPL) tendon is a rare condition that presents clinical symptoms very similar to de Quervain's disease. Herein we report a case of anomalous course and tenosynovitis of the extensor pollicis longus (EPL) tendon associated with symptoms of de Quervain's disease. Patient concerns A 44-year-old right-handed man visited the clinic because of radial pain associated with the left wrist, which was aggravated during the previous 10 days. The patient tested positive on the Finkelstein's test and displayed a limited range of motion of the left wrist. Motion of the thumb and wrist aggravated pain. Diagnoses Magnetic resonance imaging (MRI) of the left wrist suggested mild tenosynovitis at the third extensor compartment and intersection syndrome. However, clinical symptoms failed to match the MRI findings. Interventions A zig-zag skin incision on the radial styloid process was made. The operative findings revealed stenosing tenosynovitis with partial tearing. Retraction of the tendon extended the thumb interphalangeal joint, suggesting that the tendon was the EPL tendon rather than EPB tendon. After operation, we reviewed the MRI of the patient, which revealed that the oblique course of the EPL tendon originated from the ulnar side of the forearm to the radial styloid at the radial and proximal site of Lister's tubercle. No EPB tendon was present. Outcomes At 12 months of follow-up, the patient's radial styloid process was completely asymptomatic and resumed full daily activities. Lessons Anomalous course of the EPL tendon is rarely reported associated with similar symptoms of de Quervain's disease. However, the knowledge and understanding of this potential anomaly in the course of EPL tendon is very important for the treatment of de Quervain's disease to decrease patient dissatisfaction after surgery.

Rationale: Spontaneous flexor pollicis longus (FPL) tendon rupture is rarely reported. Although there are several studies investigating spontaneous FPL tendon rupture, the exact etiology of spontaneous rupture is unclear. Here, we present a case of unusual spontaneous FPL tendon rupture due to tendolipomatosis. Patient concerns: A 64-year-old right-handed retired male teacher was referred to our clinic with an inability to flex the interphalangeal joint of his left thumb. Diagnosis: Magnetic resonance imaging (MRI) revealed complete FPL tendon rupture at the level of the distal one-third of the proximal phalanx. Interventions: With the patient under general anesthesia, the FPL tendon was explored through a volar zig-zag incision. During the operation, the FPL tendon was found to be ruptured completely. Gross examination revealed a slightly yellowish denaturated tissue at the distal end of the ruptured tendon. We excised the denaturated tissue from the distal end of the ruptured tendon and sent it for histological examination. FPL tendon was repaired primarily via modified Becker method. Histopathological examination revealed normal vasculature in the tendon tissue and degenerative changes associated with lipid deposits in the tendon tissue. Outcomes: At 12-month follow-up, the patient was completely asymptomatic and had excellent IP joint range of motion (0° to 40°) in his left thumb. The wrist grip strength was 30 kg (28 kg in the Rt.) and the thumb pinch strength was 5.7 kg (4.7 kg in the Rt.). The Quick DASH score was 0. Lessons: Spontaneous rupture of the FPL tendon, attributed to degenerative changes caused by tendolipomatosis, is the first report of its kind, in the authors’ opinion. Hence we recommend to perform the histopathological examination of the debrided tissue from the ends of the ruptured tendon, if the physicians couldn’t know the exact cause of the spontaneous intratendinous rupture of the FPL. And early diagnosis followed by debridement and primary tendon repair provides an effective outcome.

Introduction: Infected segmental loss of the Achilles tendon with overlying soft tissue and skin defect remains a more complex reconstructive challenge. Here, we present a functional reconstruction of infected Achilles tendinitis with combined soft tissue defects using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata in an elderly patient. Case presentation: A 71-year-old male patient was transferred to our department due to soft tissue defect of the left lower leg and infected Achilles tendinitis. The patient underwent incision and drainage of both lower legs with necrotizing fasciitis in another hospital 2 months ago. Physical examination revealed a 12 × 5 cm wound with exposed Achilles tendon over the posteromedial aspect of lower one-third of the leg. His wound culture grew methicillin-resistant Staphylococcus aureus (MRSA). All infected necrotic Achilles tendon with proximal muscle tissue was excised. The patient underwent successful Achilles tendon reconstruction and soft tissue coverage procedure with a 14 × 7 cm ALT flap with the fascia lata. At the 12-month follow-up, the patient resumed full daily activities, was able to squat, showed a range of motion at the ankle in the 15° dorsiflexion and 45° plantar flexion, and the American Orthopaedic Foot and Ankle Society (AOFAS) score was 94. Conclusion: A free ALT composite flap with the vascularized fascia lata, was successfully used for the treatment of infected Achilles tendinitis with overlying soft tissue defect even in an elderly patient. Furthermore, it provided satisfactory functional and cosmetic outcomes. Hence, the use of free ALT composite flap is highly recommended in such patients.

The purpose of this study is to analyze the clinical results of patients with scaphoid nonunion treated with arthroscopic bone grafting and K (Kirschner)-wires fixation. We retrospectively reviewed the records of 27 patients with scaphoid nonunion who had been treated with arthroscopic bone grafting and K-wires fixation method from November 2008 to February 2014. The average patient age was 35 years. The time from injury to treatment averaged 45 months. The average follow-up period was 18 months. Bone union was assessed using serial plain radiographs. The functional outcome was evaluated by comparing the modified Mayo wrist score with the visual analog scale (VAS) for pain, which were measured at the time of preoperation and at final follow-up. Union was achieved in 26 of the 27 nonunions (96.29%). The average radiologic union time was 10 weeks. The average VAS score decreased from 6.38 (range, 3–10) preoperatively to 1.59 (range, 0–3) at the final follow-up. The average modified Mayo wrist score improved from 60.19 preoperatively to 83.46 at the final follow-up. According to this score, there were 12 excellent, 6 good, and 9 fair results at the final follow-up. Arthroscopic bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion and has the advantages of allowing thorough assessment, enabling a comprehensive management approach for scaphoid nonunion in a minimally invasive manner, and this method can also be used for the scaphoid nonunion with SNAC stage I.