Is a short arm cast appropriate for stable distal radius fractures in patients older than 55 years? A randomized prospective multicentre study

We conducted a prospective randomized, multicentre study to compare short arm and long arm plaster casts for the treatment of stable distal radius fracture in patients older than 55 years. We randomly assigned patients over the age of 55 years who had stable distal radius fracture to either a short arm or long arm plaster cast at the first review 1 week after their injury. Radiographic and clinical follow-up was conducted at 1, 3, 5, 12 and 24 weeks following their injury. Also, degree of disability caused by each cast immobilization was evaluated at the patient's visit to remove the cast. There were no significant differences in radiological parameters between the groups except for volar tilt. Despite these differences in volar tilt, neither functional status as measured by the Disabilities of the Arm, Shoulder and Hand, nor visual analogue scale was significantly different between the groups. However, the mean score of disability caused by plaster cast immobilization and the incidence rate of shoulder pain were significantly higher in patients who had a long plaster cast. Our findings suggest that a short arm cast is as effective as a long arm cast for stable distal radius fractures in the elderly. Furthermore, it is more comfortable and introduces less restriction on daily activities.

LEVEL OF EVIDENCE

II.

Strong familial association of bone mineral density between parents and offspring: KNHANES 2008-2011

Bone mineral density (BMD) of offspring was significantly associated with their parents' BMD. Parental BMD Z-score ≤-1 was a significant predictor for BMD Z-score ≤-1 in their offspring. Peak bone mass acquisition during early adulthood is more substantially influenced by genetic factors rather than lifestyle or environmental factors.

INTRODUCTION

A person's BMD is affected by both genetic and environmental factors. Family history of osteoporosis or fragility fracture is a well-known risk factor for low bone mass or fracture. The purpose of the present study was to investigate the familial association of BMD between parents and offspring in Korean population.

METHODS

This is a cross-sectional study based on the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2011. A total of 5947 subjects (3135 parents and 2812 offspring) were included.

RESULTS

In age-adjusted partial correlation analyses, all BMD values acquired from the lumbar spine, femur neck, total hip, and whole body showed significant associations between parents and offspring. Among these associations, whole-body BMD showed the strongest relationship between offspring and parents. The narrow-sense heritability of BMD ranged from 0.203 to 0.542 in male offspring and from 0.396 to 0.689 in female offspring. Multiple linear regression analyses showed that offspring's BMD was independently associated with BMD of both parents after adjusting for covariates. Lifestyle or environmental factors including dietary calcium intake, serum 25-hydroxyvitamin D level, regular exercise, current smoking, and alcohol intake showed only moderate or no associations with BMD. In multiple logistic regression analyses in offspring aged 19-25 years, the son's risk of having BMD Z-score ≤-1 was associated with both parents' BMD Z-score ≤-1, while the daughter's risk was only associated with maternal BMD Z-score ≤-1.

CONCLUSIONS

Our findings confirm the strong familial association of BMD between parents and offspring in Korean population and suggest that peak bone mass acquisition during early adulthood is more substantially influenced by genetic factors rather than lifestyle or environmental factors.

Incidence of toxic optic neuropathy with low-dose ethambutol

OBJECTIVE

To investigate the incidence of ethambutol (EMB) induced optic neuropathy prescribed at a relatively low dose of ≤ 15 mg/kg/day for the treatment of tuberculosis (TB) or Mycobacterium avium complex (MAC) lung disease.

DESIGN

Patients diagnosed with TB or MAC lung disease received multidrug regimens including EMB at a single institution from August 2003 to July 2009. Visual monitoring was performed at baseline and at regular follow-up. The incidence of EMB-induced visual disturbances was evaluated.

RESULTS

Of the 415 patients included in the study, three (0.7%) developed toxic optic neuropathy over the 6-year period. Of the 289 patients prescribed a dose of ≤ 15 mg/kg/day EMB, only one (0.3%) developed toxic optic neuropathy.

CONCLUSIONS

The incidence of EMB-induced optic neuropathy among Koreans is estimated to be 0.7%, and can be reduced with lower doses of EMB.

A1 Pulley Release of Locked Trigger Digit by Percutaneous Technique

We performed 118 percutaneous releases of the locked trigger digits in an office setting using a specially designed knife. Thirty-five digits were locked in flexion, 79 digits in extension and the remaining four were fixed in a semiflexed position. Successful percutaneous release was achieved for 107 digits (91%), with the remaining 11 digits requiring an open surgical procedure. Although there were no persistent triggering in 98 digits with a follow-up of at least 6 months, painful stiffness at the interphalangeal joints remained in ten digits despite of physical therapy. No neurovascular injury occurred. We suggest that a locked trigger digit can be successfully released with the percutaneous technique.

Quantifying accessibility and use of improved sanitation: towards a comprehensive indicator of the need for sanitation interventions

To prevent diseases associated with inadequate sanitation and poor hygiene, people needing latrines and behavioural interventions must be identified. We compared two indicators that could be used to identify those people. Indicator 1 of household latrine coverage was a simple Yes/No response to the question “Does your household have a latrine?” Indicator 2 was more comprehensive, combining questions about defecation behaviour with observations of latrine conditions. Using a standardized procedure and questionnaire, trained research assistants collected data from 6,599 residents of 16 rural villages in Indonesia. Indicator 1 identified 30.3% as not having a household latrine, while Indicator 2 identified 56.0% as using unimproved sanitation. Indicator 2 thus identified an additional 1,710 people who were missed by Indicator 1. Those 1,710 people were of lower socioeconomic status (p < 0.001), and a smaller percentage practiced appropriate hand-washing (p < 0.02). These results show how a good indicator of need for sanitation and hygiene interventions can combine evidences of both access and use, from self-reports and objective observation. Such an indicator can inform decisions about sanitation-related interventions and about scaling deworming programmes up or down. Further, a comprehensive and locally relevant indicator allows improved targeting to those most in need of a hygiene-behaviour intervention.

Worm-free children: an integrated approach to reduction of soil-transmitted helminth infections in Central Java

Among children, infections with soil-transmitted helminths (STH) can cause anemia, impaired growth, and absence from school. Sustainable control of STH infection requires that appropriate latrines be integrated with health-promotion education. We report a pilot study of the effects of a combined latrine-education intervention in Central Java, Indonesia. The participants were 99 children (3-13 years old) in two villages (intervention and control) south of Semarang city. Stool samples were collected from the children and were examined for the presence of helminth eggs. After baseline data were collected, latrines were constructed and health education was given in the intervention village. Then, in both villages, all children who had STH infection at baseline were given 400 mg of albendazole. Eight months later, follow-up stool samples were collected and examined. In both villages, 20% of the children had STH infection at baseline. At follow-up, the incidence of STH infection was much lower in the intervention village than in the control village (4.0% vs. 20.4%; p<0.02). The results of this small pilot study give some confidence that a scaled-up study involving many more children and cluster-randomization of the intervention will be feasible and could provide more conclusive evidence of the intervention's effectiveness.

Reverse Sural Artery Island Flap With Skin Extension Along the Pedicle

The distally based sural flap is an efficient flap for reconstruction of soft tissues defects of lower limb. The unstable vascular pedicle, however, is prone to compression by the subcutaneous tunnel, especially when a long pedicle covers the distal area of the foot. The aim of the present study was to introduce a modified surgical technique that leaves the skin extension over the pedicle and to report the clinical results of this modification. A total of 25 consecutive patients with a mean age of 51.7 ± 14.7 years underwent surgery. We modified the conventional sural flap technique by leaving a skin extension over the entire length of the pedicle, creating a fasciocutaneous vascular pedicle. The postoperative flap survival rates, complications, and the characteristics of the flaps such as flap size, pedicle length, and the most distal area that could be covered with this modification, were reviewed. At the last clinical follow-up examination, all the flaps survived, although partial necrosis was observed in 2 (8%) cases. Four cases of venous congestion developed but healed without additional complications. The mean flap size was 5.9 ± 1.8 × 9.2 ± 2.7 cm. With this modification, the sural flap could cover the defect located in extreme distal areas, such as the medial forefoot and dorsum of the first metatarsophalangeal joint, with a longer pedicle (≤27 cm) in 7 patients (28%). A skin extension along the pedicle achieved the favorable survival rate of the sural flap and successfully extended the surgical indications to more distal areas.

Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury

BACKGROUND

Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair.

MATERIALS AND METHODS

Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14-25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work.

RESULTS

Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain.

CONCLUSIONS

Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability.

Comparison of Flexor Tendon Suture Techniques Including 1 Using 10 Strands

PURPOSE

To compare mechanical properties of a multistrand suture technique for flexor tendon repair with those of conventional suture methods through biomechanical and clinical studies.

METHODS

We describe a multistrand suture technique that is readily expandable from 6 to 10 strands of core suture. For biomechanical evaluation, 60 porcine flexor tendons were repaired using 1 of the following 6 suture techniques: Kessler (2-strand), locking cruciate (4-strand), Lim/Tsai's 6-strand, and our modified techniques (6-, 8-, or 10-strand). Structural properties of each tenorrhaphy were determined through tensile testing (ultimate failure load and force at 2-mm gap formation). Clinically we repaired 25 flexor tendons using the described 10-strand technique in zones I and II. Final follow-up results were evaluated according to the criteria of Strickland and Glogovac.

RESULTS

In the biomechanical study, tensile properties were strongly affected by repair technique; tendons in the 10-strand group had approximately 106%, 66%, and 39% increased ultimate load to failure (average, 87 N) compared with those in the 4-, 6-, and 8-strand groups, respectively. Tendons in the 10-strand group withstood higher 2-mm gap formation forces (average, 41 N) than those with other suture methods (4-strand, 26 N; 6-strand, 27 N; and 8-strand, 33 N). Clinically, we obtained 21 excellent, 2 good, and 2 fair outcomes after a mean of 16 months (range, 6-53 mo) of follow-up. No patients experienced poor results or rupture.

CONCLUSIONS

The 10-strand suture repair technique not only increased ultimate strength and force at the 2-mm gap formation compared with conventional suture methods, it also showed good clinical outcomes. This multistrand suture technique can greatly increase the gap resistance of surgical repair, facilitating early mobilization of the affected digit.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Arthroscopic treatment of perilunate dislocations and fracture dislocations

Background The key to a successful result in the treatment of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) is the restoration of normal alignment of the carpal bones, followed by stable maintenance until healing. This article aimed to assess whether arthroscopic techniques are a reliable surgical option for the treatment of this challenging injury. Materials and Methods Twenty patients with an acute PLD or PLFD were treated by an arthroscopic technique. They were retrospectively reviewed at an average follow-up of 31.2 months (range 18-61 months). Functional outcomes were assessed with the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and Patient-Rated Wrist Evaluation (PRWE) score as well as radiographic evaluations. Description of Technique Arthroscopic reduction and percutaneous fixation was performed to the scapholunate and lunotriquetral intervals using Kirschner wires (K-wires) as joysticks as well as to the scaphoid using a cannulated headless screw for transscaphoid-type injuries. The K-wires were removed at 10 weeks postoperation. Results Overall functional outcomes according to the MMWS were rated as excellent in three patients, good in eight, fair in seven, and poor in two. The mean DASH score was 18, and the mean PRWE score was 30. On the basis of radiographic parameters, reduction obtained at the operation was maintained within normal ranges in 15 patients. No patient had developed arthritis by the last follow-up. Conclusions The medium-term results show that arthroscopic treatment can provide proper restoration and stable fixation of carpal alignment and results in satisfactory functional and radiologic outcomes for acute perilunate injuries. Level of Evidence Level IV.

Alanine aminotransferase and metabolic syndrome in adolescents: the Korean National Health and Nutrition Examination Survey Study

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Adolescent NAFLD has increased in parallel with obesity. Elevated serum ALT level is a surrogate marker for NALFD. Increased ALT levels are closely related to NAFLD and metabolic syndrome.

WHAT THIS STUDY ADDS

Increased ALT within normal range are associated with an increased risk of metabolic syndrome. All of the five components of metabolic syndrome were associated with high ALT within normal range. By elevation of ALT, the prevalence of metabolic syndrome increased in obese adolescents and normal-weight adolescents as well.

BACKGROUND/AIMS

The potential interactions between alanine aminotransferase (ALT) and components of metabolic syndrome (MetS) have not been fully investigated in healthy adolescents. This study investigated the impact of a mild ALT elevation on the risks of MetS in healthy Korean adolescents.

METHODS

From the Korean National Health and Nutrition Examination Surveys 1998-2009, the data of 5026 adolescents aged 10-18 years (2604 boys and 2422 girls) were analysed. Individuals who had ALT levels equal or more than 40 IU L(-1) were excluded.

RESULTS

Subjects in the upper ALT tertile had higher mean values of body mass index (BMI), homeostasis model assessment-insulin resistance and prevalence of MetS than subjects in the lower tertile. The risk of each five components of MetS was significantly higher than subjects in the lower tertile. Compared with the subjects in the lower ALT tertile, the prevalence of MetS was higher in the upper tertile among obese adolescents (44.6-50.7% vs. 31.2-40.0%) as well as normal-weight adolescents (5.2-7.7% vs. 2.7-3.2%). Subjects in the upper ALT tertile were at a higher risk of MetS than those in the lower tertile (odds ratio [OR] = 1.95 for boys, OR = 2.00 for girls) after controlling for age and BMI.

CONCLUSIONS

A high serum ALT within normal range increased the risk of all the components of MetS. The prevalence of MetS increased with the elevation of obesity level, and it increased further with the elevation of ALT tertile. Thus, serum ALT levels in addition to BMI might be useful as a marker for early detection of MetS.

Arthroscopic débridement for primary osteoarthritis of the elbow: analysis of preoperative factors affecting outcome

BACKGROUND

The purposes of this study were to evaluate the clinical results of arthroscopic débridement and to identify preoperative factors that influence the outcome.

METHODS

Forty-three elbows with primary osteoarthritis in 43 patients treated with arthroscopic débridement were retrospectively evaluated. At a mean follow-up of 38 months (range, 18-77 months), the visual analog scale (VAS) score for pain, the arc of elbow motion, and the Mayo Elbow Performance Index (MEPI) score were assessed. The relationships between postoperative MEPI score and postoperative motion arc and preoperative factors including age, sex, involvement of the dominant arm, duration of symptoms, demand of elbow activity, VAS score, previous history of failed surgery, and arc of elbow motion were statistically evaluated.

RESULTS

The mean VAS score for pain, the mean arc of flexion-extension, and the mean MEPI score significantly improved after the operation (all P values < .001). Multivariate regression analysis revealed that among preoperative variables, arc of motion was found to be the only independent prognostic factor that affected both postoperative elbow function (P = .024) and final arc of motion (P < .001). The cutoff value of preoperative arc of motion for the final arc of motion was determined to be 80° (P < .001). Involvement of the dominant arm was found to be another independent factor that affected postoperative MEPI scores (P = .016).

CONCLUSIONS

Arthroscopic débridement for elbow osteoarthritis provides satisfactory pain relief, improvement of elbow motion, and good functional outcome. Based on the fact that preoperative motion arc is the independent factor that can predict clinical outcome, arthroscopic treatment is highly recommended for patients who have a motion arc of 80° or more as it yields reliable results.

First Report of Powdery Mildew Caused by Erysiphe heraclei on Parsley in Korea

Parsley, Petroselinum crispum (Mill.) Nyman, is a minor but important leaf crop in Korea. In June 2010, parsley plants (cv. Paramount) showing typical symptoms of powdery mildew were found with approximately 90% incidence (percentage of plants showing symptoms) in polyethylene-film-covered greenhouses in an organic farm in Icheon County of Korea. Symptoms first appeared as thin white colonies, which subsequently showed abundant growth on the leaves with chlorosis and crinkling. Most diseased plantings were unmarketable and shriveled without being harvested. The damage due to powdery mildew infections on parsley has reappeared in Icheon County and Gangneung City with confirmation of the causal agent made again in 2011 and 2012. Voucher specimens were deposited in the Korea University Herbarium (KUS). Appressoria on the mycelium were multilobed or moderately lobed. Conidiophores were cylindrical, 75 to 125 × 8 to 10 μm, straight in foot-cells, and produced conidia singly, followed by 2 to 3 cells. Conidia were oblong-elliptical to oblong, 32 to 55 × 14 to 20 μm with a length/width ratio of 1.7 to 2.9, lacked fibrosin bodies, and produced germ tubes on the perihilar position, with angular/rectangular wrinkling of the outer walls. First-formed conidia were apically conical, basally subtruncate to rounded, and generally smaller than the secondary conidia. Chasmothecia were not found. These structures are typical of the powdery mildew Pseudoidium anamorph of the genus Erysiphe. The specific measurements and morphological characteristics were consistent with those of E. heraclei DC. (1). To confirm the identity of the causal fungus, the complete ITS region of rDNA from isolate KUS-F25037 was amplified with primers ITS5 and P3 (3) and sequenced directly. The resulting 606-bp sequence was deposited in GenBank (Accession No. KF680162). A GenBank BLAST search of this sequence revealed 100% identity with that of E. heraclei on Anethum graveolens from Korea (JN603995) and >99% similarity with those of E. heraclei on Daucus carota from Mexico (GU252368), Pimpinella affinis from Iran (AB104513), Anthriscus cerefolium from Korea (KF111807), and many other parsley family (Apiaceae) plants. Pathogenicity was verified through inoculation by gently pressing diseased leaves onto leaves of five healthy potted parsley plants. Five non-inoculated plants served as negative controls. Inoculated plants developed symptoms after 7 days, whereas the control plants remained symptomless. The fungus present on the inoculated plants was morphologically identical to that originally observed on diseased plants. Parsley powdery mildew caused by E. heraclei has been known in Europe, North America, Brazil, and Japan (2,4). To our knowledge, this is the first report of powdery mildew infections by E. heraclei on parsley in Korea. Since cultivation of parsley was only recently started on a commercial scale in Korea, powdery mildew infections pose a serious threat to safe production of this herb, especially those grown in organic farming where chemical options are limited. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No. 11. CBS, Utrecht, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, retrieved September 17, 2013. (3) S. Takamatsu et al. Mycol. Res. 113:117, 2009. (4) Y. Tsuzaki and K. Sogou. Proc. Assoc. Plant Prot. Shikoku 24:47, 1989.

Multidetector CT imaging features of solid pseudopapillary tumours of the pancreas in male patients: distinctive imaging features with female patients

OBJECTIVE

To describe multidetector CT imaging features of solid pseudopapillary tumours (SPTs) in male patients and to compare these imaging features with those found in female patients.

METHODS

The institutional review board approved this retrospective study. We included the CT images of 72 patients (M:F = 12:60; mean age, 35.0 years) diagnosed with SPT by histology. CT images were reviewed on the following: location of the tumour, maximal diameter, shape, margin and the fraction of the tumour composition. Statistical differences in CT imaging features were analysed.

RESULTS

Male patients with SPTs were significantly older than female patients (42.4 years vs 33.4 years, p = 0.0408) and the mean size of the SPTs in male patients was larger (6.3 cm vs 4.6 cm, p = 0.0413) than that of SPTs in female patients. Lobulated shape of the SPTs was most frequent in male patients, whereas oval shape was most frequent in female patients (p = 0.0133). SPTs in male patients tended to have a solid component (p = 0.0434). Progressive enhancement in the solid portion of the tumour was seen in 9 (81.8%) of 11 SPTs in male patients and in 30 (79.0%) of 38 SPTs in female patients on multiphasic CT.

CONCLUSION

The imaging features of SPTs in male patients usually appeared as a somewhat large-sized solid mass with a lobulated margin and progressive enhancement. These imaging features may help to differentiate SPTs from other pancreatic tumours for their proper management.

ADVANCES IN KNOWLEDGE

SPTs in male patients appear as somewhat large-sized solid masses with lobulated margins, and this form occurs more frequently in older male patients than in female patients.

Arthroscopy during ulnar shortening for idiopathic ulnar impaction syndrome

Arthroscopy during ulnar shortening osteotomy for ulnar impaction syndrome is subject to debate regarding its clinical usefulness. The purposes of this study were to analyze the arthroscopic findings in patients who underwent ulnar shortening osteotomy and to assess the role of arthroscopic evaluation during osteotomy. Medical records and arthroscopic findings of 50 consecutive patients who had been diagnosed with idiopathic ulnar impaction syndrome were retrospectively evaluated. Pathologic changes of the articular disk of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, and tears of the lunotriquetral interosseous ligament (LTIL) were evaluated during arthroscopy. Palmer’s classification was used to classify the TFCC lesions. Perforation of the TFCC was observed in 20 patients, and central tears were observed in 10. Thirty-eight patients exhibited chondromalacia of the lunate, including 4 unstable cartilage flaps. Partial tears of the LTIL were detected in 24 patients, including 9 unstable flap tears. In 21 (42%) of 50 patients, arthroscopic findings were not appropriate to define the disease stage with Palmer’s original description. Eight wrists exhibited tears or perforations of the TFCC without evidence of chondromalacia. Seven patients had an LTIL tear without perforation of the TFCC. Lunotriquetral interosseous ligament tears without lunate chondromalacia were found in 7 patients. Arthroscopic debridement was performed in 23 patients based on the clinical judgment that the procedure would help alleviate symptoms postoperatively. Arthroscopy during ulnar shortening osteotomy addresses intra-articular pathologies and may be helpful for symptom improvement.

First Report of Corynespora Leaf Spot on Beach Vitex Caused by Corynespora cassiicola in Korea

Beach vitex, Vitex rotundifolia L. fil., is a perennial that grows in temperate and tropical areas of the Pacific. In areas where it has been introduced outside of its native range, beach vitex has proven to be an invasive species. This plant dominates dune ecosystems leading to a reduction in the prevalence of native species (1). In October 2010, previously unknown leaf spots were observed on the beach vitex growing on sand dunes in Incheon City of Korea. The same symptoms were repeated in 2011 and 2012. In September 2012, the same leaf spots were found on the beach vitex in Samcheok and Gyeongju in Korea. The symptoms usually started as small, dark brown to purplish leaf spots with more or less concentric rings, eventually causing leaf blights or yellowing with 50% or more defoliation by the end of September. Representative samples (n = 6) were deposited in the Korea University Herbarium (KUS). Conidiophores of the fungus observed microscopically on the leaf spots were erect, brown to dark brown, single or occasionally in clusters, 80 to 500 × 5 to 9 μm, and mostly arose on the abaxial surface of symptomatic leaves. Conidia were borne singly or in short chains of 2 to 4, ranging from cylindrical to broadest at the base and tapering apically, straight to slightly curved, pale olivaceous brown, 1 to 12 pseudoseptate, 50 to 250 × 8 to 18 μm, each with a conspicuous thickened hilum. On potato dextrose agar (PDA), single-spore cultures of two isolates were identified as Corynespora cassiicola (Berk. & M.A. Curtis) C.T. Wei on the basis of morphological and cultural characteristics (3). Two monoconidial isolates were preserved at the Korean Agricultural Culture Collection (Accession Nos. KACC45712 and KACC46953). Isolate KACC45712 was used for molecular works and pathogenicity test. Genomic DNA was extracted using the DNeasy Plant Mini DNA Extraction Kit (Qiagen Inc., Valencia, CA). The complete internal transcribed spacer (ITS) region of rDNA was amplified with the primers ITS1/ITS4 and sequenced. The resulting sequence of 520 bp was deposited in GenBank (Accession No. KC987359). A BLAST search in GenBank revealed that the sequence showed 100% identity with those of C. cassiicola (e.g., JQ801302). To conduct a pathogenicity test, a conidial suspension (ca. 2 × 10⁴ conidia/ml) was prepared by harvesting conidia from 2-week-old cultures, and the suspension was sprayed onto the leaves of three healthy seedlings. Inoculated plants were kept in humid chambers for 48 h in a glasshouse. After 5 days, typical leaf spot symptoms started to develop on the leaves of all three inoculated plants. C. cassiicola was reisolated from the lesions, confirming Koch's postulates. Control plants treated with sterile water remained symptomless. C. cassiicola is cosmopolitan with a very wide host range (2,4). To our knowledge, C. cassiicola has not been reported on Vitex spp. anywhere in the world. According to field observations in Korea, Corynespora leaf spot was most severe in August and September, especially following a prolonged period of moist weather. C. cassiicola may be a potential biocontrol agent for this highly invasive species. References: (1) M. C. Cousins et al. Invasive Plant Sci. Manag. 3:340, 2010. (2) L. J. Dixon et al. Phytopathology 99:1015, 2009. (3) M. B. Ellis. Dematiaceous Hyphomycetes. Commonw. Mycol. Inst.: Kew, UK, 1971. (4) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, Retrieved April 30, 2013.

Treatment of avascular proximal pole scaphoid nonunions with vascularized distal radius bone grafting

PURPOSE

To investigate the outcomes of vascularized distal radius pedicled bone grafting secured with K-wires for scaphoid nonunions with small avascular proximal fragments.

METHODS

We included patients with scaphoid nonunions and small, avascular proximal fragments that were too small for screw fixation. The mean size of the proximal pole fragments was 21% (range, 9% to 28%) of the entire scaphoid, based on quantitative radiographic measurement. All patients had distal radius bone grafting based on the 1,2-intercompartmental supraretinacular artery pedicle and fixation with K-wires. There were 21 wrists in 18 men and 2 women with the mean age of 34 years (range, 22 to 57 y). The mean duration of postoperative follow-up was 40 months (range, 12 to 103 mo). Radiographic union and clinical outcomes, including the ranges of wrist motion, grip strength, and the modified Mayo wrist score, were evaluated.

RESULTS

Union was achieved in 18 of 21 wrists (86%) at a mean time of 14 weeks after surgery (range, 8 to 28 wk). Nonunions with proximal fragments less than 20% of the total scaphoid healed in 6 of 8 wrists. In a subset of these 8 wrists in which the proximal fragment was less than 15%, healing occurred in 2 of 4. The modified Mayo wrist score significantly improved from 46 to 78 points, and final wrist functions were rated as excellent in 5, good in 5, fair in 10, and poor in 1. Ranges of motion and grip strengths did not show significant changes after surgery.

CONCLUSIONS

Vascularized distal radius bone grafting and K-wire fixation can heal scaphoid nonunions with small avascular proximal fragments, although motion and grip strength remain unchanged. Healing may be related to the size of the proximal pole fragment.

Surgical treatment of elbow stiffness caused by post-traumatic heterotopic ossification

BACKGROUND

Heterotopic ossification (HO) is considered as a common extrinsic cause of elbow stiffness. The purpose of this study was to show the results of surgical treatment for post-traumatic elbow stiffness caused by HO in a large, consecutive series of patients in a single unit.

METHODS

We retrospectively reviewed 77 surgically treated patients with post-traumatic elbow stiffness caused by HO. Final motion arc and Mayo Elbow Performance Index (MEPI) were assessed as final results. Univariable and multivariable analyses were done to determine which factors had an effect on the final motion arc.

RESULTS

The average arc of elbow motion increased from 45° preoperatively to 112°, with an improvement of 67° at the final follow-up evaluation. The mean MEPI score was 91.9. At the final evaluation, 65 patients (84.4%) obtained a total motion arc of ≥100°. Recurrent HO was observed in 16 patients postoperatively, and 6 underwent repeated surgical release. The time from the initial injury to surgical release with a cutoff value of 19 months was the only independent factor affecting the final range of motion (ROM) in multivariable median regression analysis. With the numbers studied, no significant association was found between the final ROM and other clinical variables except for the recurrence of HO (93° vs 117°).

CONCLUSIONS

From the results of our study, we can support the surgical treatment of elbow stiffness caused by post-traumatic HO regardless of preoperative ROM. However, recurrence of heterotopic bone and delay in surgery of more than 19 months are associated with less favorable results.

Electron beam irradiated ITO films as highly transparent p-type electrodes for GaN-based LEDs

We have investigated the effect of electron beam irradiation on the electrical and optical properties of ITO film prepared by magnetron sputtering method at room temperature. Electron beam irradiation to the ITO films resulted in a significant decrease in sheet resistance from 1.28 x 10(-3) omega cm to 2.55 x 10(-4) omega cm and in a great increase in optical band gap from 3.72 eV to 4.16 eV, followed by improved crystallization and high transparency of 97.1% at a wavelength of 485 nm. The overall change in electrical, optical and structural properties of ITO films is related to annealing effect and energy transfer of electron by electron beam irradiation. We also fabricated GaN-based light-emitting diodes (LEDs) by using the ITO p-type electrode with/without electron beam irradiation. The results show that the LEDs having ITO p-electrode with electron beam irradiation produced higher output power due to the low absorption of light in the p-type electrode.

Whitening and antioxidant activities of bornyl acetate and nezukol fractionated from Cryptomeria japonica essential oil

OBJECTIVES

The aim of this study was to investigate the whitening and antioxidant activities of essential oils from Cryptomeria japonica by determining their tyrosinase inhibition, 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging and superoxide dismutase (SOD)-like activities.

METHODS

Essential oils of C. japonica leaves were extracted with distilled water, and after condensation of volatile constituents, the condensates were extracted with ethyl acetate. Crude essential oils of C. japonica were divided into six fractions by thin layer chromatography and open column chromatography, and their chemical analysis was performed by GC/MS. Major compounds of fractions were composed of kaurene, bornyl acetate, nezukol, (-)-4-terpineol, δ-cadinene, α-terpineol, γ-eudesmol, α-eudesmol and elemol.

RESULTS

For tyrosinase inhibitory activity using two substrates, l-tyrosine and 3,4-dihydroxyphenylalanine (l-DOPA), kaurene, bornyl acetate and nezukol were highly effective. In antioxidant activity, (-)-4-terpinenol and δ-cadinene showed high DPPH radical scavenging activity, and bornyl acetate and nezukol indicated extremely high SOD-like activity.

CONCLUSION

Therefore, bornyl acetate and nezukol fractionated from C. japonica essential oil, which showed highly active whitening and antioxidant activities, have potential applications in cosmeceutical materials.

Decay of impact after self-management education for people with chronic illnesses: changes in anxiety and depression over one year

BACKGROUND

In people with chronic illnesses, self-management education can reduce anxiety and depression. Those benefits, however, decay over time. Efforts have been made to prevent or minimize that "decay of impact", but they have not been based on information about the decay's characteristics, and they have failed. Here we show how the decay's basic characteristics (prevalence, timing, and magnitude) can be quantified. Regarding anxiety and depression, we also report the prevalence, timing, and magnitude of the decay.

METHODS

Adults with various chronic conditions participated in a self-management educational program (n = 369). Data were collected with the Hospital Anxiety and Depression Scale four times over one year. Using within-person effect sizes, we defined decay of impact as a decline of ≥0.5 standard deviations after improvement by at least the same amount. We also interpret the results using previously-set criteria for non-cases, possible cases, and probable cases.

RESULTS

Prevalence: On anxiety, decay occurred in 19% of the participants (70/369), and on depression it occurred in 24% (90/369). Timing: In about one third of those with decay, it began 3 months after the baseline measurement (6 weeks after the educational program ended). Magnitude: The median magnitudes of decay on anxiety and on depression were both 4 points, which was about 1 standard deviation. Early in the follow-up year, many participants with decay moved into less severe clinical categories (e.g., becoming non-cases). Later, many of them moved into more severe categories (e.g., becoming probable cases).

CONCLUSIONS

Decay of impact can be identified and quantified from within-person effect sizes. This decay occurs in about one fifth or more of this program's participants. It can start soon after the program ends, and it is large enough to be clinically important. These findings can be used to plan interventions aimed at preventing or minimizing the decay of impact.

Effect of wrist position on the measurement of carpal indices on the lateral radiograph

The purpose of this study was to find out whether the carpal indices measured on lateral radiographs with a slightly malpositioned wrist are the same as those measured in the true neutral position. Lateral radiographic views of 25 wrists were taken with 5° intervals from 20° of flexion to 20° of extension. Most carpal indices measured in the flexed or extended position were significantly different from the wrist in zero flexion-extension, except scapholunate angle at 5° of extension and scaphocapitate angle at 5° and 10° of flexion. Starting from the flexed position, there was an average of -4.0° change in radioscaphoid angle, -1.0° in scapholunate angle, -1.0° in scaphocapitate angle, +3.0° in radiolunate angle, and +2.0° in lunocapitate angle for each 5° of extension with linear trends. The results from this study suggest that even minimal degrees of flexion-extension can affect the measurements of carpal indices on lateral radiographs.