Review article: anatomic double bundle anterior cruciate ligament reconstruction

The anterior cruciate ligament (ACL) consists of 2 bundles: a slightly larger anteromedial bundle and a posterolateral bundle, named according to their relative tibial insertion sites. Both bundles are crucial to knee stability. Although it is more technically demanding, a double bundle ACL reconstruction restores the knee biomechanics better and provides more rotational stability than a single bundle ACL reconstruction. Intermediate and long-term clinical investigation including the measurement of rotational laxity and the evaluation of osteoarthritic change is needed to confirm biomechanical and short-term clinical outcomes.

Tobacco use among individuals presenting for cancer risk assessment

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Background: An important component of cancer risk assessment (CRA) is the evaluation of exposures and preventive health behaviors. Tobacco use (TU) remains a significant contributor to cancer risk and decreasing tobacco use is a major national health objective. Methods: Clinical charts were reviewed to evaluate the incidence of TU and characteristics of tobacco users (TUs) among individuals presenting to the University of Chicago Cancer Risk Clinic for cancer risk assessment (CRA). Results: Among 98 individuals (97% female) presenting for CRA from 12/05–10/06, 51% (50/98) reported no TU, 38% (37/98) reported prior TU and 11% (11/98) reported current TU. Current tobacco users included 10% (7/73) of whites and 18% (4/22) of blacks with no TU among other racial groups (0/3). 45% of TUs (5/11) had a personal history of cancer. 45% of TUs reported compliance with self-breast examination, 73% with cervical cancer screening. Among TUs over 40 years old (YO), 67% (6/9) reported a mammogram in the last year and the 2 TUs over 50 YO reported a screening colonoscopy. All TUs reported interest in tobacco cessation interventions. Conclusions: Tobacco use among individuals presenting for CRA is lower than reported general population rates of TU (23%). Despite this, a proportion of individuals presenting for CRA report current TU, despite engaging in other cancer prevention behaviors. Continued review of clinical encounters from 2004- 06 (n=425) will allow for multi-variate analysis of predictors of current TU, which will inform future research employing cancer risk assessment encounters as “teachable moments” to optimize tobacco cessation outcomes.

No significant financial relationships to disclose.

Impairment of Na(+),K(+)-ATPase in CD95(APO-1)-induced human T-cell leukemia cell apoptosis mediated by glutathione depletion and generation of hydrogen peroxide

Human T-cell leukemia is a malignant disease that needs various regimens of cytotoxic chemotherapy to overcome drug resistance. Recently, Na(+),K(+)-ATPase has emerged as a potential target for cancer therapy. However, its exact signaling pathway in human T-cell leukemia cell death has not been well defined. In the current study, we found CD95(APO-1) was able to trigger the internalization of plasma membrane Na(+),K(+)-ATPase in Jurkat cells or primary T cells as a mechanism to suppress its activity. This internalization was closely relevant to intracellular glutathione (GSH) depletion in Jurkat cells downstream of Fas-associated death domain protein (FADD) and caspase 8. GSH depletion in Fas L-treated Jurkat cells induced the generation of hydrogen peroxide (H(2)O(2)), which subsequently increased the serine phosphorylation of Na(+),K(+)-ATPase alpha1 subunit. Exogenous H(2)O(2) even mimicked the effect of Fas L to upregulate the serine phosphorylation of Na(+),K(+)-ATPase alpha1 subunit and suppress Na(+),K(+)-ATPase activity. Overall, our results indicate that CD95(APO-1) induces the FADD- and caspase 8-dependent internalization of Na(+),K(+)-ATPase through intracellular GSH loss, and the subsequent generation of H(2)O(2)-mediated serine phosphorylation of Na(+),K(+)-ATPase alpha1 subunit. Taken together, this study presents a novel regulatory mechanism of Na(+),K(+)-ATPase in CD95(APO-1)-mediated human T-leukemia cell apoptosis.

MRI-measured bone marrow adipose tissue is inversely related to DXA-measured bone mineral in Caucasian women

INTRODUCTION

Recent studies suggest that bone marrow adipose tissue (BMAT) might play a role in the pathogenesis of osteoporosis. Previous research using regional magnetic resonance spectroscopy methods to measure BMAT has reported inconsistent findings on the relationship between BMAT and dual-energy absorptiometry (DXA)-measured bone mineral density (BMD).

METHODS

In the present study, total body and pelvic BMAT were evaluated in 56 healthy women (age 18-88 yrs, mean +/- SD, 47.4 +/- 17.6 yrs; BMI, 24.3 +/- 4.2 kg/m(2)) with T1-weighted whole-body magnetic resonance imaging (MRI). BMD was measured using the whole-body DXA mode (GE Lunar DPX, software version 4.7).

RESULTS

A strong negative correlation was observed between pelvic BMAT and BMD (total-body BMD, R = -0.743, P < 0.001; pelvic BMD, R = -0.646, P < 0.001), and between total-body BMAT and BMD (total-body BMD, R = -0.443, P < 0.001; pelvic BMD, R = -0.308, P < 0.001). The inverse association between pelvic BMAT and BMD remained strong after adjusting for age, weight, total body fat, and menopausal status (partial correlation: total-body BMD, R = -0.553, P < 0.001; pelvic BMD, R = -0.513, P < 0.001). BMAT was also highly correlated with age (pelvic BMAT, R = 0.715, P < 0.001; total-body BMAT, R = 0.519, P < 0.001).

CONCLUSION

MRI-measured BMAT is thus strongly inversely correlated with DXA-measured BMD independent of other predictor variables. These observations, in the context of DXA technical concerns, support the growing evidence linking BMAT with low bone density.

Renal artery aneurysm: diagnosis and surveillance with multidetector-row computed tomography

PURPOSE

To investigate the prevalence of renal artery aneurysms, and to assess the value of multidetector-row computed tomography (MDCT) in diagnosing renal artery aneurysms.

MATERIAL AND METHODS

Altogether, 862 patients underwent arterial-phase contrast-enhanced CT scan of the abdomen in the period November 2003 to October 2005. A search for renal artery aneurysms was performed in our reporting system and revealed six patients with renal artery aneurysm (RAA).

RESULTS

The incidence of RAA was 0.7%. All renal artery aneurysms were solitary, located in the main trunk or the first branch of the renal artery, with sizes from 1.5 cm to 3.4 cm. Five aneurysms were saccular, one fusiform. No underlying thrombosis was seen. Extensive calcification was found in one aneurysm. Three aneurysms were diagnosed using axial images, while three aneurysms were only displayed by volume rendering and maximum-intensity projection images.

CONCLUSION

This study demonstrates a 0.7% incidence of renal artery aneurysms in a total of 862 patients. MDCT has an important role in detecting and assessing renal artery aneurysms. Some aneurysms can only be displayed by post-processing techniques such as volume rendering and maximum-intensity projection.

Interaction of embryonic cortical neurons on nanofibrous scaffolds for neural tissue engineering

The interaction of murine embryonic cortical neurons on randomly orientated electrospun scaffolds of poly(L-lactide) (P(L)LA) and poly(lactide-co-glycolide) (PLGA) is investigated in this study. The scaffolds were surface treated with different concentrations of KOH to partially hydrolyze the surface and therefore change the surface tension. Hydrophilicity did not significantly influence the number of primary and secondary branches; however, it had a considerable effect on neurite extension. For scaffolds with surface tensions of 40-47 dyn cm(-1) there was a significantly greater overall neurite length for both the primary and secondary branches compared with more hydrophilic scaffolds. Another major finding of this work was that the interfibre distance influenced how the neurites extended. When the interfibre distance was greater than approximately 15 microm the neurites followed the fibres and avoided regions of very high fibre density. At interfibre distances less than approximately 15 microm, the neurites traversed between the fibres. Therefore, this study provided little evidence that contact guidance was the dominating cue in directing neurite extension, instead inferring that chemical cues, possibly from adjacent neurons had induced directional change.

Enhancement of oblique effect in the cat's primary visual cortex via orientation preference shifting induced by excitatory feedback from higher-order cortical area 21a

It is often suggested that the oblique effect, the well-known phenomenon whereby both humans and animals are visually more sensitive to vertical and horizontal contours than to oblique ones, is due to the overrepresentation of cardinal orientations in the visual cortex. The functional role of feedback projections from higher-order cortical areas to lower-order areas is not fully understood. Combining the two issues in a study using optical imaging here, we report that the neural oblique effect was significantly enhanced (3.7 times higher than the normal) in the cat's primary visual cortex through orientation shifting induced by excitatory feedback from the higher-order cortical area 21a. This suggests that a reciprocal co-excitatory mechanism may underlie the perceptual oblique effect.

Study on the relationship between lymphatic vessel density and distal intramural spread of rectal cancer

BACKGROUND

The smallest safe margin of distal clearance for lower rectal cancer is very important for the operation. In a previous study, a few factors were found to play a role in distal intramural spread (DIS), but there are few data regarding the influence of lymphangiogenesis. We studied the relationship between lymphatic vessel density (LVD) and DIS of rectal cancer, analyzing the probable value of LVD in determining the length of distal resection of lower rectal cancer.

METHODS

Nine-two patients who had undergone curative resection of lower rectal cancer were included. The length of DIS, LVD and other clinicopathological factors were evaluated. Immunohistochemical lymphatic vessel staining with LYVE-1 (lymphatic vessel endothelial hyaluronan receptor) were performed to detect the LVD.

RESULTS

44 cases had DIS (range 0.1-2.44, mean 0.31 cm), and cancer emboli were the most common modalities of DIS. The LVD of a peritumoral lesion was significantly higher than that of an intratumoral lesion; the LVD of the DIS subgroup was significantly higher than that of the no DIS subgroup, and the LVD of the 2 subgroups was significantly higher than that of normal rectal tissue. A significant correlation was shown by a rank correlation test between the length of DIS and the LVD at the periphery of the rectal cancer (n = 44, r = 0.755, p < 0.01). The LVD was also related to the extent of infiltration, lymphatic invasion and lymph node metastases.

CONCLUSIONS

Lymphangiogenesis plays an important role in rectal cancer cell metastasis and patients with a higher LVD have a better prognosis. The LVD is closely correlated with DIS. These findings may be helpful in determining the distal clearance length of rectal cancer.

Interleukin-21 induces T-cell activation and proinflammatory cytokine secretion in rheumatoid arthritis

Interleukin (IL)-21 is a CD4+ T-cell-derived cytokine, which is involved in innate and adaptive immune response. In this study, we analysed IL-21 receptor (IL-21R) expression in peripheral blood and synovial fluid mononuclear cells, and investigated the role of IL-21 in the induction of proinflammatory cytokine production by peripheral blood T cells (PB-T) and synovial fluid T cells (SF-T) from patients with rheumatoid arthritis (RA). Immunohistochemical staining demonstrated that IL-21R-positive cells were significantly increased in inflamed synovial tissues of RA patients compared with osteoarthritis (OA) and healthy controls. Flow cytometric analysis confirmed that IL-21R was mainly expressed in freshly isolated CD4, CD8, B and NK cells from peripheral blood and synovial fluid, but decreased gradually in T cells 24 h after anti-CD3 stimulation. PB- and SF-T cells from RA patients were more responsive to IL-21 when compared with controls. Importantly, isolated PB- or SF-T cells from RA patients, when stimulated with IL-21 and anti-CD3 MoAb, secreted markedly higher levels of TNF-alpha and IFN-gamma than controls. These data indicate that IL-21R is overexpressed in the inflamed synovial membrane and in peripheral blood or synovial fluid leukocytes of RA patients, and that IL-21 enhances local T-cell activation, proliferation and proinflammatory cytokine secretion. Thus, blockade of IL-21R signalling pathway may have a therapeutic potential in acute RA patients.

Establishment of an HPA-1- to -16-typed platelet donor registry in China

In order to determine gene frequencies of human platelet antigen (HPA) and establish a panel of accredited HPA-1a, -2a, -4a, -5a and -6a-negative donors as well as an HPA-typed platelet donor registry, a total of 1000 Chinese donors of Han nationality (500 from north China and 500 from south China) were typed for HPA-1 through -16 using a DNA-based polymerase chain reaction with sequence-specific primers genotyping method. The gene frequencies of HPA-1b, -2b, -3b, -4b, -5b, -6bw, -10bw and -15b were 0.0060, 0.0485, 0.4055, 0.0045, 0.0140, 0.0135, 0.0005 and 0.4680, respectively. The HPA-7bw, -8bw, -9bw, -11bw, -12bw, -13bw, -14bw and -16bw alleles were not found. The HPA-2b and -5b homozygous donors were detected at low frequencies. The HPA mismatch probabilities potentially leading to alloimmunization in random platelet transfusion vary with a region from 0.1% to 37% depending on the distribution patterns of common and less common alleles in each system. This study provides a useful HPA-typed plateletpheresis donor registry in China and could improve platelet antibody detection and HPA-matched platelet transfusion in alloimmune thrombocytopenic patients.

Imaging of primary adrenal lymphoma: case report and literature review

Primary adrenal lymphoma is very rare, and correct preoperative diagnosis is difficult because of its nonspecific imaging findings. We report a case of bilateral primary adrenal lymphoma, with the largest dimension of 18 cm, which is the largest one reported so far, to our knowledge. Computed tomography (CT) and magnetic resonance (MR) findings were not specific enough to establish a correct diagnosis, but positron emission tomography/CT (PET/CT) showed high fluorodeoxyglucose (FDG) uptake, indicating its malignant nature. We describe the imaging findings and review the related literature to highlight this uncommon entity.

Visceral adipose tissue: relationships between single slice areas at different locations and obesity-related health risks

BACKGROUND

Visceral adipose tissue (VAT) is widely recognized as conveying the highest health risk in humans among the currently measurable adipose tissue compartments. A recent study indicated that the traditionally measured VAT area at L(4)-L(5) is not the VAT area with the highest correlation with total VAT volume. At present, it is unknown whether the area with the highest correlation is also the most strongly associated with obesity-related health risk.

OBJECTIVE

The study aim was to establish which VAT slice area(s) are most strongly associated with obesity-related health risk indicators.

DESIGN

The subjects were a convenience sample of healthy adults who completed whole-body magnetic resonance imaging (MRI) scans. The correlations, with appropriate adjustments, were examined between individual MRI slice VAT areas and fasting serum/plasma triglycerides (TG), high-density lipoprotein cholesterol (HDL), glucose, insulin and blood pressure.

RESULTS

The sample consisted of 283 healthy men (age (mean+/-s.d.) 41.9+/-15.8 years; BMI, 26.0+/-3.2 kg/m(2); VAT, 2.7+/-1.8 L) and 411 women (age, 48.1+/-18.7 years; BMI 27.0+/-5.4 kg/m(2); VAT, 1.7+/-1.2 L). After adjusting for age, race, menopause status, scan position and specific blood analysis laboratory, VAT area at L(4)-L(5) had lower correlations with most metabolic risk factors including serum/plasma TG, HDL, glucose, insulin and blood pressure than VAT volume in both men and women. The VAT areas 10 and 15 cm above L(4)-L(5) in men had higher or equal correlations with health risk measures than VAT volume. In women, the VAT area 5 cm above or below L(4)-L(5) and total VAT volume had similar correlations with health risk measures.

CONCLUSIONS

An appropriately selected single slice VAT area is an equally reliable phenotypic marker of obesity-related health risk as total VAT volume. However, in both men and women the VAT slice area at the traditional L(4)-L(5) level is not the best marker of obesity-related health risk.

Posteromedial lateral suprasylvian motion area modulates direction but not orientation preference in area 17 of cats

In visual cortices of cats there are two major, largely parallel, feedforward processing streams which conduct visual information from the primary visual cortices to the parietal and temporal visual cortices, processing motion and form information, respectively. In addition to the feedforward streams, there exist many feedback projections from higher-order visual cortices to lower-order visual cortices. Using the intrinsic signal optical imaging, this study has examined the influence of feedback signals originating from area posteromedial lateral suprasylvian (PMLS), the dominant motion-processing region of the parietal cortex, on responses of neurons, orientational maps, and directional maps in cats' area 17 (striate cortex). The inactivation of area PMLS by local application of GABA resulted in the reduction of the magnitude of responses of area 17 cells though area 17 of the cat is mainly involved in form information processing rather than motion. Furthermore, inactivation of area PMLS abolished the global layout of direction maps in area 17 but did not affect the basic structure of the orientation maps in area 17. Thus, it appears that higher-order cortical areas along one information processing stream may exert cross-stream modulatory effects on fundamental properties of neurons located in the lower-order areas along distinct information processing streams.

Improved glutathione production by gene expression in Escherichia coli

AIMS

To improve glutathione (GSH) production in Escherichia coli by different genetic constructions containing GSH genes.

METHODS AND RESULTS

GSH production was very low in E. coli by the expression of gshI gene. An increase of GSH production was achieved by the expression of both gshI and gshII genes in E. coli. A higher GSH production, namely 34.8 mg g(-1) wet cell weight, was obtained by simultaneous expression of two copies of gshI gene and one copy of gshII gene.

CONCLUSIONS

The simultaneous expression of two copies of gshI gene and one copy of gshII gene resulted in a significant increase in GSH production.

SIGNIFICANCE AND IMPACT OF THE STUDY

The expression strategy for GSH production described here can be used to increase gene expression and obtain high production rates in other multienzyme reaction systems.

The effect of surface hydrophilicity on the behavior of embryonic cortical neurons

The aim of this study was to investigate the interaction of mouse embryonic cortical neurons on P(L)LA and PLGA substrates, which were partially hydrolysed using potassium hydroxide (KOH). The chemical and topographical properties of the surfaces were characterized, and it was discovered that there was a decrease in the hydrophilicity for the P(L)LA with increasing concentration of KOH. This was due to chemical modifications to the surfaces of the substrates. Alternatively for the PLGA substrate, only the 0.1 M KOH treated sample had a significantly different hydrophilicity highlighting that surface erosion resulted at higher concentrations. The morphology of the neurons grown on the two substrates were compared to poly(D)lysine (positive control). The neurons formed colonies on all of the substrates, but were dramatically reduced in size in the case of the 0.1 M KOH treated substrates. This finding was attributed to the increases in cell spreading and the size of the cells, as they were larger, more elongated and bipolar like those on the positive control. However, there was a significant decrease in the total number of live cells per unit area. Therefore, on these materials when there was increased cellular spreading there was significantly higher cell death. Furthermore, unlike the 0, 0.2, and 0.4 M KOH treated substrates, there was an absence of large bundles of axons that extended between colonies on the 0.1 M sample, instead exhibiting short axons that grew in free space.

Discovery and structure-activity relationship of antagonists of B-cell lymphoma 2 family proteins with chemopotentiation activity in vitro and in vivo

Development of a rationally designed potentiator of cancer chemotherapy, via inhibition of Bcl-X(L) function, is described. Lead compounds generated by NMR screening and directed parallel synthesis displayed sub-microM binding but were strongly deactivated in the presence of serum. The dominant component of serum deactivation was identified as domain III of human serum albumin (HSA); NMR solution structures of inhibitors bound to both Bcl-X(L) and HSA domain III indicated two potential optimization sites for separation of affinities. Modifications at both sites resulted in compounds with improved Bcl-X(L) binding and greatly increased activity in the presence of human serum, culminating in 73R, which bound to Bcl-X(L) with a K(i) of 0.8 nM. In a cellular assay 73R reversed the protection afforded by Bcl-X(L) overexpression against cytokine deprivation in FL5.12 cells with an EC(50) of 0.47 microM. 73R showed little effect on the viability of the human non small cell lung cancer cell line A549. However, consistent with the proposed mechanism, 73R potentiated the activity of paclitaxel and UV irradiation in vitro and potentiated the antitumor efficacy of paclitaxel in a mouse xenograft model.

Discovery of a potent inhibitor of the antiapoptotic protein Bcl-xL from NMR and parallel synthesis

The antiapoptotic proteins Bcl-x(L) and Bcl-2 play key roles in the maintenance of normal cellular homeostasis. However, their overexpression can lead to oncogenic transformation and is responsible for drug resistance in certain types of cancer. This makes Bcl-x(L) and Bcl-2 attractive targets for the development of potential anticancer agents. Here we describe the structure-based discovery of a potent Bcl-x(L) inhibitor directed at a hydrophobic groove on the surface of the protein. This groove represents the binding site for BH3 peptides from proapoptotic Bcl-2 family members such as Bak and Bad. Application of NMR-based screening yielded an initial biaryl acid with an affinity (K(d)) of approximately 300 microM for the protein. Following the classical "SAR by NMR" approach, a second-site ligand was identified that bound proximal to the first-site ligand in the hydrophobic groove. From NMR-based structural studies and parallel synthesis, a potent ligand was obtained, which binds to Bcl-x(L) with an inhibition constant (K(i)) of 36 +/- 2 nM.