First Report of Powdery Mildew Caused by Golovinomyces biocellatus on Monarda didyma in Korea

Bergamot (Monarda didyma L.), which is native to eastern North America, is an aromatic herb in the family Lamiaceae. It is widely planted in gardens and parks for ornamental purposes and also grown indoors as a fragrant houseplant in Korea. In October 2007, several dozen bergamots planted outdoors in Bonghwa, Korea were found to be heavily infected with a powdery mildew. Symptoms first appeared as thin, white colonies, which subsequently developed into abundant growth on both sides of the leaves. Severe infections often caused leaf distortions and premature senescence. The same symptoms have also been found in bergamot plots in Osan, Suwon, Incheon, and Seoul from 2007 to 2011. Voucher specimens were deposited at Korea University, Seoul, Korea. Hyphae were septate, branched, and 4 to 8 μm wide. Appressoria on the mycelium were nipple shaped. Conidiophores arose from the lateral part of the hyphae, measured 100 to 180 × 10 to 12 μm, were simple, and produced two to four immature conidia in chains, followed by two to three cells. Conidia were hyaline, ellipsoid to barrel shaped, measured 28 to 40 × 16 to 20 μm (length/width ratio = 1.4 to 2.2), lacked distinct fibrosin bodies, and produced germ tubes on the subterminal position, with reticulate wrinkling of the outer walls. No chasmothecia were observed. The structures described above were typical of the Oidium subgenus Reticuloidium anamorph of the genus Golovinomyces, and the fungus measurements were compatible with those of Golovinomyces biocellatus (Ehrenb.) V.P. Heluta as described previously (1,4). The only other powdery mildew known on Monarda spp. is Neoerysiphe galeopsidis (1), which is clearly distinguished by its lobed hyphal appressoria and fine striations on conidial surfaces. To confirm the tentative identification based on morphological characteristics, internal transcribed spacer (ITS) rDNA sequences from two representative isolates (KUS-F23070 and F23117) were obtained using primers ITS5 and P3 as described by Takamatsu et al. (3). The resulting sequences of 523 bp were deposited in GenBank (Accession Nos. JN228358 and JN228359). A GenBank BLAST search produced an exact match for the sequences of G. biocellatus on several plants belonging to the Lamiaceae, with a 100% sequence similarity. Pathogenicity was confirmed through inoculation by gently pressing diseased leaves onto leaves of five healthy potted bergamot plants. Five noninoculated plants served as controls. Plants were maintained in a greenhouse at 25 ± 2°C. Inoculated plants developed signs and symptoms after 6 days, whereas the control plants remained healthy. The fungus present on the inoculated plants was morphologically identical to that originally observed on diseased plants. The powdery mildew infections of bergamot plants associated with G. biocellatus have been known in Europe (2) and Japan (4). The current work confirmed the occurrence of G. biocellatus infecting M. didyma in Korea. References: (1) U. Braun. Beih. Nova Hedw. 89:1, 1987. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Mycology and Microbiology Laboratory. ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , July 12, 2011, (3) S. Takamatsu et al. Mycol. Res. 113:117, 2009. (4) S. Tanda. J. Agric. Sci. Tokyo Agric. Univ. 47:274, 1997.

Normal mitral cell dendritic development in the setting of Mecp2 mutation

Rett syndrome (RTT) is an autism spectrum disorder caused by mutation in the gene encoding methyl CpG binding protein 2 (MECP2). Evidence to date suggests that these disorders display defects in synaptic organization and plasticity. A hallmark of the pathology in RTT has been identified as decreased dendritic arborization, which has been interpreted to represent abnormal dendritic formation and pruning during development. Our previous studies revealed that olfactory axons display defective pathfinding and targeting in the setting of Mecp2 mutation. In the present work, we use Mecp2 mutant mouse models and the olfactory system to investigate dendritic development. Here, we demonstrate that mitral cell dendritic development proceeds normally in mutant mice, resulting in typical dendritic morphology at early postnatal ages. We also failed to detect abnormalities in dendritic inputs at symptomatic stages when glomeruli from mutant mice appear smaller in area than the wild type (WT) (6 weeks postnatally). Collectively, these findings suggest that the initial defects in glomeruli impairment seen with Mecp2 mutation do not result from abnormal dendritic development. Our results using the olfactory system indicate that dendritic abnormalities are not an early feature in the abnormalities incurred by Mecp2 mutation.

First Report of Powdery Mildew Caused by Golovinomyces ambrosiae on Ambrosia trifida in Korea

Ambrosia trifida L., commonly known as giant ragweed, is native to North America and was introduced to Korea in the 1970s (3). It is now widely naturalized, and since 1999, has been designated as one of 11 'harmful nonindigenous plants' by the Korean Ministry of Environment because of its adverse effects on native plants. Various strategies to eradicate this noxious weed have been tried without any success (3). In September 2009, powdery mildew infections of giant ragweed were found for the first time in Dongducheon, Korea, and specimens were isolated and deposited in the Korea University Herbarium (KUS-F24683). White mycelial and conidial growth was present mostly on adaxial leaf surfaces with sparse growth on abaxial leaf sides. Severely infected leaves were malformed. Slight purplish discoloration occurred on the leaves contiguous with colony growth. Mycelial colonies were conspicuous, amphigenous, and epiphytic with indistinct to nipple-shaped appressoria. Conidiophores were 80 to 180 μm long and produced two to five immature conidia in chains. Conidia were ellipsoid or doliiform, 28 to 38 × 16 to 24 μm, and lacked distinct fibrosin bodies. Chasmothecia were amphigenous, scattered or partly clustered, dark brown, spherical, 95 to 130 μm in diameter, and contained 6 to 16 asci. Appendages were mycelioid, numbering 10 to 24 per chasmothecium, 0.5 to 2.5 times as long as the chasmothecial diameter, 1 to 4 septate, and were brown at the base and becoming paler toward the tip. Asci were short stalked, 50 to 75 × 32 to 42 μm and contained two spores. Ascospores were ellipsoid-ovoid with a dimension of 22 to 30 × 15 to 18 μm. On the basis of these morphological characteristics, this fungus was identified as Golovinomyces ambrosiae (Schwein.) U. Braun & R.T.A. Cook (= G. cichoracearum var. latisporus (U. Braun) U. Braun) (1). To confirm the identification, the complete internal transcribed spacer (ITS) region of rDNA from KUS-F24683 was amplified with the primers ITS5 and P3 and sequenced (4). The resulting sequence of 508 bp was deposited in GenBank (Accession No. JF907589) and was identical to the ITS sequences of G. ambropsiae on A. artemisiifolia var. elatior from Japan (AB077631) and Korea (JF919680) as well as on A. trifida from the United States (AF011292). Therefore, the sequence analysis verified the pathogen to be G. ambrosiae. To our knowledge, this is the first record of powdery mildew infections on giant ragweed outside of North America (2). Although the disease incidence is still low, the disease could be a limiting factor to suppress the expansion of this noxious weed in Korea. References: (1) U. Braun and R. T. A. Cook. Mycol. Res. 113:616, 2009. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , May 5, 2011. (3) S. M. Oh et al. Impacts of Invasive Alien Weeds and Control Strategies of Noxious Weeds in Korea. National Institute of Agricultural Science and Technology, Suwon, Korea, 2007. (4) S. Takamatsu et al. Mycol. Res. 111:117, 2009.

Predicting complete loss to follow-up after a health-education program: number of absences and face-to-face contact with a researcher

Background

Research on health-education programs requires longitudinal data. Loss to follow-up can lead to imprecision and bias, and complete loss to follow-up is particularly damaging. If that loss is predictable, then efforts to prevent it can be focused on those program participants who are at the highest risk. We identified predictors of complete loss to follow-up in a longitudinal cohort study.

Methods

Data were collected over 1 year in a study of adults with chronic illnesses who were in a program to learn self-management skills. Following baseline measurements, the program had one group-discussion session each week for six weeks. Follow-up questionnaires were sent 3, 6, and 12 months after the baseline measurement. A person was classified as completely lost to follow-up if none of those three follow-up questionnaires had been returned by two months after the last one was sent.

We tested two hypotheses: that complete loss to follow-up was directly associated with the number of absences from the program sessions, and that it was less common among people who had had face-to-face contact with one of the researchers. We also tested predictors of data loss identified previously and examined associations with specific diagnoses.

Using the unpaired t-test, the U test, Fisher's exact test, and logistic regression, we identified good predictors of complete loss to follow-up.

Results

The prevalence of complete loss to follow-up was 12.2% (50/409). Complete loss to follow-up was directly related to the number of absences (odds ratio; 95% confidence interval: 1.78; 1.49-2.12), and it was inversely related to age (0.97; 0.95-0.99). Complete loss to follow-up was less common among people who had met one of the researchers (0.51; 0.28-0.95) and among those with connective tissue disease (0.29; 0.09-0.98). For the multivariate logistic model the area under the ROC curve was 0.77.

Conclusions

Complete loss to follow-up after this health-education program can be predicted to some extent from data that are easy to collect (age, number of absences, and diagnosis). Also, face-to-face contact with a researcher deserves further study as a way of increasing participation in follow-up, and health-education programs should include it.

Surgical Release for Posttraumatic Loss of Elbow Flexion

Introduction

We describe a surgical release for patients who have a lack of elbow flexion limiting the ability to perform activities of daily living after trauma.

Step 1 Mobilize the Ulnar Nerve

Mobilize the ulnar nerve through the cubital tunnel with the accompanying superior ulnar collateral vessels.

Step 2 Dissect the Triceps and Resect the Posterior Aspect of the Capsule

Dissect the triceps from the distal part of the humerus and resect the posterior aspect of the capsule to expose the olecranon tip and fossa.

Step 3 Resect the Posterior Band of the Medial Collateral Ligament

Release the posterior band of the medial collateral ligament while continually checking the flexion arc until >130° of flexion can be achieved.

Step 4 Resect the Anterior Aspect of the Capsule

Perform an anterior approach if there is persistent flexion contracture or any impingement restricting full flexion.

Step 5 Lengthen the Triceps If Indicated

Consider triceps lengthening if you cannot achieve >130° of passive flexion with two fingers.

Step 6 Transpose the Ulnar Nerve Anteriorly

Locate the released ulnar nerve over the medial humeral epicondyle on the fascia overlying the common flexor-pronator muscles.

Step 7 Postoperative Management

Physical therapy consists of active-assisted and gentle passive flexion and extension exercises of the elbow, usually for two to six months.

Results

Forty-two patients with <100° of elbow flexion as an extrinsic contracture following trauma had a surgical release of the elbow at a median of ten months postinjury.

What to Watch For

IndicationsContraindicationsPitfalls & Challenges.

Corrective osteotomy for cubitus varus in middle-aged patients

BACKGROUND

We reviewed the results of corrective osteotomy for cubitus varus in middle-aged patients to investigate whether it is recommended in this age group.

MATERIALS AND METHODS

We studied 20 consecutive patients who underwent 3-dimensional corrective osteotomy at an average age of 47.9 years (range, 41-55 years). The osteotomy was fixed with single plating in 8 patients and with double plating in 12. The average follow-up was 23 months (range, 18-109 months).

RESULTS

The average humerus-elbow-wrist angle improved from 21.4° (range, 15°-35°) varus to 8.7° (range, -4°-20°) valgus. Osseous union was radiographically demonstrated in all patients at an average of 17.5 weeks (range, 8-36 weeks). Delayed union of longer than 12 weeks was observed in 15 patients (75%). The average time to union in the single-plating group was 21.0 weeks compared with 15.1 weeks in the double-plating group (P = .012). Failure of fixation occurred in 2 patients who had single plating. The preoperative and postoperative arc of motion was similar. According to Oppenheim criteria, results were excellent in 10, good in 8, and poor in 2. The average final Mayo Elbow Performance Score was 90.3 points (range, 70-100 points).

CONCLUSION

Cubitus varus in middle-aged patients can be treated by a closing wedge osteotomy and fixation with double plating. This provides satisfactory deformity correction, maintenance of the elbow motion, and good functional outcome, although healing of the osteotomy tends to be delayed.

Dual reconstruction of the radial collateral ligament and lateral ulnar collateral ligament in posterolateral rotator instability of the elbow

Recent studies have found that the radial collateral ligament (RCL) plays a key role in the lateral stability of the elbow joint, and there is no truly isometric location for LUCL tendon graft reconstruction tunnels using the original technique. However, no report has been issued on the treatment including RCL reconstruction and the modification of LUCL reconstruction in patients with posterolateral rotatory instability (PLRI). Three patients with PLRI were treated using two different ways and produced good results. First, dual reconstruction of the LUCL and RCL was performed, and second, the insertion of the reconstructed LUCL was shifted to the AL instead of to the original ulna to produce a more flexible isometric point setting. We want to report on the management of PLRI by dual reconstruction of the RCL and LUCL and a modification of the original technique of LUCL reconstruction.

Altered expression of costimulatory molecules in Behçet's disease according to clinical activity

BACKGROUND

The reduced expression of molecules limiting excessive immune responses has been considered a pathogenic mechanism associated with autoimmune diseases.

OBJECTIVES

To understand the implications of costimulatory molecules in Behçet's disease (BD), the expression of CTLA-4 and PD-1 on T-cell subsets and of their ligands CD80, CD86 and PD-L1 on antigen-presenting cells (APCs) was investigated.

METHODS

Peripheral blood mononuclear cells (PBMC) from 11 patients with active BD, eight patients with inactive BD, eight patients with recurrent aphthous ulcers and 10 healthy volunteers as healthy controls (HC) were stimulated with phorbol myristate acetate and ionomycin. The expression of costimulatory molecules was then analysed by flow cytometry. Soluble CTLA-4 (sCTLA-4) concentrations were determined by enzyme-linked immunosorbent assay and the transcript level of PD-L1 was measured by real-time polymerase chain reaction. The PD-L1 expression in skin lesions of patients with BD was evaluated by immunohistochemistry.

RESULTS

Compared with the HC group, reduced expression of CTLA-4 in CD4+ T cells after stimulation was observed in the active BD group, with no difference in the production of sCTLA-4. CD86 expression, in the resting APCs, was reduced in the active BD group compared with the HC group. PD-L1 expression in the APCs was decreased in the active BD group with or without stimulation of cells. Concordantly, the mRNA levels of PD-L1 in PBMC, and PD-L1 expression in the cutaneous lesions, were low in the active BD group.

CONCLUSIONS

The results of this study suggest that altered expression of PD-L1, CTLA-4 and CD86 may be involved in the pathogenesis of BD.

Surgical release for posttraumatic loss of elbow flexion

BACKGROUND

Several surgical approaches have been suggested for the treatment of posttraumatic elbow stiffness; however, the optimal approach to elbows with considerable loss of flexion has not been well described. We investigated the pathologic lesions causing posttraumatic loss of elbow flexion and analyzed the results of surgical release.

METHODS

Forty-two patients with <100° of elbow flexion due to an extrinsic contracture following trauma underwent surgical release at a median of ten months after injury. To achieve maximum flexion, release of the posterior band of the medial collateral ligament was mandatory in all patients, and only four patients required additional anterior procedures. The ulnar nerve was transposed anteriorly in forty patients, including three who had had a previous transposition. To evaluate the results, we compared preoperative and postoperative elbow motion, Mayo Elbow Performance Index (MEPI) scores, and radiographs.

RESULTS

Intraoperatively, heterotopic ossification was observed in forty patients. It was located predominantly in the posteromedial aspect of the capsule. Heterotopic bone was more commonly found during surgery than it was identified preoperatively on radiographs. Mean flexion increased significantly from 89° preoperatively to 124° (range, 90° to 140°) at a mean of thirty-nine months postoperatively. The mean size of the flexion contracture decreased from 34° preoperatively to 9° (range, 0° to 30°) postoperatively. Overall, ≥120° of final flexion and a total arc of ≥100° were regained by 88% of the patients. The mean MEPI score improved significantly from 73 points preoperatively to 94 points (range, 72 to 100 points) postoperatively, with the result rated as excellent in thirty-two patients, good in eight, and fair in two. Two patients had clinical recurrence of heterotopic ossification associated with a failure to obtain an increase in flexion.

CONCLUSIONS

This study demonstrates that posttraumatic heterotopic ossification, particularly in the posteromedial aspect of the capsule, is closely associated with loss of elbow flexion. Satisfactory restoration of elbow flexion can be obtained in the majority of patients by surgical release of the posterior band of the medial collateral ligament and excision of heterotopic bone.

The relationship between stress positions and pain intensity in triangular fibrocartilage lesions

We investigated the relationship between stress applied in several positions of the wrist and pain intensity in triangular fibrocartilage lesions in sixty-one patients who were diagnosed as having triangular fibrocartilage lesions and had a wrist arthroscopy. Before arthroscopy, we stressed the wrist with an axial load applied in four different wrist positions, and the evoked pain was graded into four levels. The patients who had a triangular fibrocartilage lesion on arthroscopy were divided into those with a traumatic tear and those with degenerative changes. While hypersupination and extension of wrist position evoked the most severe pain in patients with a traumatic tear, the intensity of pain did not relate to wrist rotation in patients with degenerative changes.

Arthroscopic synovectomy for the rheumatoid elbow

PURPOSE

To describe an arthroscopic technique for complete removal of the synovium from the elbow joint and to investigate the clinical outcomes of arthroscopic synovectomy in patients with rheumatoid elbow.

METHODS

Arthroscopic synovectomy was performed on 26 rheumatoid elbows in 25 patients with radiographic changes of Larsen grade 3 or less. We performed total synovectomy of the elbow using multiple portals and by dividing the elbow into the anterior, posterior, and radiocapitellar compartments. At a mean follow-up of 33.9 months (range, 13 to 68 months), pain was evaluated with a visual analog scale and range of motion was measured. The Mayo Elbow Performance Score was used to assess total elbow function. Radiologic changes were determined according to the Larsen grading system.

RESULTS

The mean visual analog scale score for pain decreased from 6.5 to 3.1, and the mean flexion arc increased from 98.1 degrees to 113.3 degrees after the operation. The mean Mayo Elbow Performance Score improved from 58.5 to 77.4 points. There were 2 excellent, 17 good, 4 fair, and 3 poor results. Radiologic assessment showed no change in 13 elbows, improvement in 6, and progression in 7. Clinically apparent synovitis recurred in 4 elbows, in which the result was considered unsuccessful.

CONCLUSIONS

Arthroscopic synovectomy of the elbow by use of multiple portals is a technically feasible procedure. It can effectively relieve pain, increase range of motion, improve Mayo Elbow Performance Score, and delay radiologic progression in rheumatoid elbows, resulting in a high satisfaction rate, although recurrent synovitis occurs in some patients.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Rapid method for direct extraction of mRNA from seeded soils

A protocol for direct extraction of mRNA from soil samples was developed. Soil samples (10 g) were washed twice with 120 mM phosphate buffer (pH 5.2). The lysis of cells, fixation of RNA, and hydrolysis of DNA were achieved by vigorously shaking the washed soil in a 4 M guanidine thiocyanate solution containing 25 mM sodium citrate, 0.5% sarcosyl, and 0.1 M 2-mercaptoethanol. The pH of the homogenized mixture was adjusted with 2 M sodium acetate (pH 4.0); the mRNA was then extracted with phenol and chloroform. Total RNA was precipitated with isopropanol. This method extracts up to 17 mug of total RNA per g (wet weight) of soil containing 8.0 x 10 cells of Pseudomonas aeruginosa PU21, and mRNA has been detected in 160-ng total RNA fractions. This method has been used for the detection of mRNA transcribed from specific biodegradative genes, including the nah and mer operons, in contaminated soils. This extraction method can be completed within a few hours and has tremendous potential for ecological studies of in situ gene expression among soil microbiotas.

Neurological deficit after surgical enucleation of schwannomas of the upper limb

We evaluated 56 patients for neurological deficit after enucleation of a histopathologically confirmed schwannoma of the upper limb. Immediately after the operation, 41 patients (73.2%) had developed a new neurological deficit: ten of these had a major deficit such as severe motor or sensory loss, or intolerable neuropathic pain. The mean tumour size had been significantly larger in patients with a major neurological deficit than in those with a minor or no deficit. After a mean 25.4 months (12 to 85), 39 patients (70%) had no residual neurological deficit, and the other 17 (30%) had only hypoaesthesia, paraesthesiae or mild motor weakness. This study suggests that a schwannoma in the upper limb can be removed with an acceptable risk of injury to the nerve, although a transient neurological deficit occurs regularly after the operation. Biopsy is not advised. Patients should be informed pre-operatively about the possibility of damage to the nerve: meticulous dissection is required to minimise this.

Anatomic reconstruction of the distal radioulnar ligament for posttraumatic distal radioulnar joint instability

Background

To analyze clinical outcomes after anatomical reconstruction of distal radioulnar ligaments in patients with chronic post-traumatic instability of the distal radioulnar joint.

Methods

Anatomical reconstruction was performed in 16 patients with subluxation or dynamic instability of distal radioulnar joint following trauma. Osteotomy was performed simultaneously in 10 patients with radial malunion. The average follow-up period was 18.9 months. For clinical outcome assessment, we performed the anteroposterior stress test, measured the range of motion and grip strength, and performed radiological examination. For assessment of the pain and function, we used the Patient Rated Wrist Evaluation, the Disabilities of the Arm, Shoulder and Hand, and the Modified Mayo Wrist Score.

Results

Anteroposterior stress test performed at the last follow-up showed normal in 12 patients, mild laxity in 3, and residual subluxation in one. The average Patient Rated Wrist Evaluation was 9.1 for pain and 11.2 for function. The average Disabilities of the Arm, Shoulder and Hand score was 10.5. The average Modified Mayo Wrist Score was 92.8; there were 10 excellent, 5 good, and 1 poor case. The average grip strength improved from 69.7 1b to 80.9 1b. A revision osteotomy was performed on the patient with residual subluxation in order to obtain normal alignment of the joint.

Conclusions

Anatomical reconstruction of the distal radioulnar ligaments is recommended to restore distal radioulnar joint stability. In addition to ligament reconstruction, realignment of the distal radioulnar joint seems critical when the instability is combined with malunion of the radius.

Semiquantitative assessment of intratumoral susceptibility signals using non-contrast-enhanced high-field high-resolution susceptibility-weighted imaging in patients with gliomas: comparison with MR perfusion imaging

BACKGROUND AND PURPOSE

It has been reported that high-resolution susceptibility-weighted imaging (HR-SWI) may demonstrate brain tumor vascularity. We determined whether the degree of intratumoral susceptibility signal intensity (ITSS) on HR-SWI correlates with maximum relative cerebral blood volume (rCBVmax) and to compare its diagnostic accuracy for glioma grading with that of dynamic susceptibility contrast (DSC) perfusion MR imaging.

MATERIALS AND METHODS

Forty-one patients with diffuse astrocytomas underwent both non-contrast-enhanced HR-SWI and DSC at 3T. We correlated the degree and morphology of ITSS with rCBVmax within the same tumor segment. The degree of ITSS and rCBVmax were compared among 3 groups with different histopathologic grades. Spearman correlation coefficients were determined between the degree of ITSS, rCBVmax, and glioma grade. Receiver operating characteristic (ROC) curve analyses were performed to determine the diagnostic accuracy for glioma grading.

RESULTS

The degree of ITSS showed a significant correlation with the value of rCBVmax in the same tumor segments (r = 0.72, P < .0001). However, the areas of densely prominent ITSSs did not accurately correspond with those of rCBVmax. Spearman correlation coefficients between ITSS degree and glioma grade were 0.88 (95% confidence interval, 0.79-0.94). In the ROC curve analysis of histopathologic correlation by using the degree of ITSS, the optimal sensitivity, specificity, positive predictive value, and negative predictive value for determining a high-grade tumor were 85.2%, 92.9%, 95.8%, and 76.5%, respectively.

CONCLUSIONS

The degree of ITSS shows a significant correlation with the value of rCBVmax in the same tumor segments, and its diagnostic performance for glioma grading is comparable with that of DSC.

Effect of citral, eugenol, nerolidol and alpha-terpineol on the ultrastructural changes of Trichophyton mentagrophytes

The antifungal effects of citral, eugenol, nerolidol and alpha-terpineol on Trichophyton mentagrophytes were investigated. Citral over 0.1 mg/ml strongly inhibited the hyphal growth of T. mentagrophytes, and the antifungal activity of alpha-terpineol was less effective. The morphological changes of the fungus exposed to the terpenes were observed by electron microscopy. The hyphae were distorted and collapsed at 0.2, 0.4 and 1 mg/ml of eugenol, nerolidol and alpha-terpineol respectively, and cell membrane and organelles were irreversibly damaged at 0.2 mg/ml citral. These suggested that four terpenes possess antifungal activity against T. mentagrophytes, and the activity might lead to irreversible cellular disruption.

Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case-control study of 7078 Koreans undergoing health check-ups

BACKGROUND

Obesity has been associated with reflux oesophagitis. However, the relationship between metabolic syndrome characterised by visceral obesity and reflux oesophagitis is unclear.

AIM

To investigate whether metabolic syndrome or visceral obesity is a risk factor for reflux oesophagitis.

METHODS

A cross-sectional study of 7078 subjects undergoing upper endoscopy during health check-ups was conducted (3539 patients with reflux oesophagitis vs age- and sex-matched controls). We further analysed according to categories of visceral adipose tissue and subcutaneous adipose tissue area with 750 cases and age-, sex- and waist circumference-matched controls who underwent abdominal CT scan.

RESULTS

The prevalence of metabolic syndrome was higher in cases than controls (26.9% vs 18.5%, p<0.001). Multivariate analysis demonstrated that metabolic syndrome is associated with reflux oesophagitis (odds ratio (OR) = 1.42; 95% confidence interval (CI), 1.26 to 1.60). Among the individual components of metabolic syndrome, waist circumference (OR = 1.47; 95% CI, 1.30 to 1.65) and triglyceride (OR = 1.20; 95% CI, 1.05 to 1.36) independently increased the risk for reflux oesophagitis. On sub-analysis, cases showed higher mean visceral adipose tissue area (cm(2)) (136.1 (SD 57.8) vs 124.0 (SD 54.7), p<0.001) and subcutaneous adipose tissue area (cm(2)) (145.9 (SD 56.8) vs 133.5 (SD 50.7), p<0.001). However, only visceral adipose tissue area was an independent risk factor for reflux oesophagitis after adjusting for multiple confounders including smoking, alcohol, body mass index (BMI) and subcutaneous adipose tissue area (OR = 1.60; 95% CI, 1.03 to 2.48, lowest quartile vs highest quartile).

CONCLUSIONS

Metabolic syndrome was associated with reflux oesophagitis. Abdominal obesity, especially visceral obesity, was an important risk factor for reflux oesophagitis.

Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation

BACKGROUND

Several techniques have been proposed to measure translation of the distal radioulnar joint on computed tomography scans, but the criteria for diagnosing abnormal subluxation have not been standardized. The aims of this study were to evaluate the reliability of the current methods and to derive normal population values with these methods.

METHODS

Computed tomography scans of forty-five asymptomatic wrists were performed with the hand in supination, neutral, and pronation. Four methods for diagnosing subluxation of the distal radioulnar joint were used: the radioulnar line method; the epicenter method; the radioulnar ratio method; and the subluxation ratio method, which is a modification of the radioulnar line method that involves use of a line perpendicular to the sigmoid notch. Three observers measured all of the scans independently and repeated the measurements three months later to determine the interobserver and intraobserver reliability. All of the measurements for each subject were averaged, and the average was considered to be the normal value for that subject.

RESULTS

Interobserver reliability was best (substantial to almost perfect) with use of the subluxation ratio method. The intraclass correlation coefficients showed substantial to almost perfect reliability of the radioulnar line method, substantial reliability of the radioulnar ratio method, and moderate to substantial reliability of the epicenter method. The intraobserver reliability of all methods was almost perfect. The radioulnar line and subluxation ratio methods always showed the ulnar head to be located outside of the dorsal line in pronation and outside of the volar line in supination. The normal epicenter values indicated that the center of rotation of the distal radioulnar joint fell in the middle half of the sigmoid notch in all positions. The normal ranges derived with the radioulnar ratio method demonstrated larger variation than originally reported.

CONCLUSIONS

This study suggests that the subluxation ratio method is the most useful technique for measuring translation of the distal radioulnar joint as a result of its reliability and simplicity. Substantial variations in normal values derived with the current methods should be considered in a computed tomography evaluation of the distal radioulnar joint in symptomatic patients.

Lack of management of cardiovascular risk factors in type 2 diabetic patients

Effective management of diabetic patients includes comprehensive control for not only blood sugar, but also other cardiovascular risk factors. We assessed whether haemoglobin A1c (A1C) concentrations, blood pressure, low density lipoprotein (LDL) cholesterol levels and microalbuminuria were regularly measured in 281 patients with type 2 diabetes who received care for over 1 year in the Department of Family Medicine located in an urban area of Korea. Subsequently, in patients with A1C > 7%; blood pressure >130/80 mmHg; LDL cholesterol levels >100 mg/dl; or microalbuminuria, we evaluated the status of management for those cardiovascular risk factors. Physicians were most likely to measure A1C levels (98.6%), but less likely to measure microalbuminuria (56.2%), LDL cholesterol (73.7%), or blood pressure (74.4%). Patients whose A1C levels were above the goal (78.2%) were likely to receive optimal therapy. In contrast, only 21.1% of patients with uncontrolled blood pressure and 5.3% of patients with LDL cholesterol levels above the target range received optimal management. Of the 36 patients with microalbuminuria or overt proteinuria, 66.7% took angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Measurement of parameters indicating cardiovascular risk factors in type 2 diabetic patients was not optimal, particularly regular measurements for microalbuminuria and for controlling LDL-cholesterol and blood pressure. These findings indicate a need for greater education of comprehensive cardiovascular management in type 2 diabetic patients and their physicians.

Molecular characterization of the porcine endogenous retrovirus subclass A and B envelope gene from pigs

Xenotransplantation of porcine organs has the potential to overcome the current critical shortage of allogenic organs for transplantation in humans. However, the existence of porcine endogenous retroviruses (PERVs) presents a problem for the clinical use of xenografts from pigs. In an attempt to understand the molecular characteristics of PERVs, we cloned the PERV env gene from six pig breeds (ie, Berkshire, Duroc, Landrace, Yorkshire, and two types of miniature pigs) in Korea. A total of 141 env clones were isolated and their sequences were analyzed. Phylogenetic analyses of these genes revealed the presence of PERVs, from both classes A and B, in 54% and 46% of the env clones, respectively. Among these clones, 37 isolates had the correct open reading frame (ORF; 27 clones in subclass A and 10 clones in subclass B), while the others had premature termination. These PERV nucleotide sequences can be used in a database for comparisons of PERV distribution among different pig breeds and for monitoring PERV infection using isolates with functional ORFs. Recombinant envelope of subclass A and B with functional ORF was expressed by vaccinia virus systems. Additionally isolated env clones can be used for various experiments, such as PERV control and infectivity tests, and may enhance the understanding of molecular mechanisms through pseudotyped PERV viruses.

Dihydroartemisinin enhances radiosensitivity of human glioma cells in vitro

PURPOSE

The antimalarial agent, artemisinin, also confers cancer-specific cytotoxic effects by reacting with ferrous iron atoms to form free radicals. Here, we investigated the radiosensitizing effects of dihydroartemisinin on glioma cells and assessed some possible mechanisms for these effects.

MATERIALS AND METHODS

U373MG glioma cells treated with various concentrations of dihydroartemisinin plus radiation, and efficiency of radiosensitization was assessed by clonogenic survival assay. Expression and activity of antioxidant enzymes, glutathione-S-transferase (GST) were quantified by western blot and enzymatic activity analyses, respectively.

RESULTS

Dihydroartemisinin showed higher cytotoxicity in the glioma cell lines than in the liver, breast or cervical cancer cell lines. In clonogenic survival assays, treatment with dihydroartemisinin alone dose-dependently reduced the number of U373MG colonies, while treatment with dihydroartemisinin plus gamma-irradiation showed far lower clonal survival than cultures treated with radiation or dihydroartemisinin alone. The radiosensitizing effect of dihydroartemisinin was blocked significantly by the free radical scavengers, NAC and TIRON, indicating association with dihydroartemisinin-induced ROS generation. In addition, the radiation-induced expression of endogenous GST was suppressed by treatment with dihydroartemisinin. The radiosensitizing effect of dihydroartemisinin was also markedly enhanced by the addition of holotransferrin

CONCLUSION

Taken together, our results strongly suggest that dihydroartemisinin triggers production of ROS and inhibits GST activity, leading to effective and therapeutically relevant radiosensitization of human glioma cells.

Arthroscopically assisted reduction and percutaneous fixation of dorsal perilunate dislocations and fracture-dislocations

Perilunate injuries are severe disruptions of the wrist joint that produce variable patterns of injury to the carpal anatomy. Most surgeons advocate an open reduction followed by ligament repair or internal fixation. We tried to reduce and fix the carpal bones under arthroscopic control to minimize surgical trauma and to preserve blood supply. While viewing the articular surface with the arthroscope, the disrupted proximal carpal row was anatomically reduced using Kirschner wires as joysticks, and fixed percutaneously without any repair of the capsuloligamentous tears. Three patients with dorsal perilunate dislocations or fracture-dislocations were treated by this technique. All the patients achieved accurate reduction and stable fixation, and showed successful healing of the carpal fractures with proper alignment after 10 to 12 weeks of immobilization. At 16 to 22 months follow-up, all patients showed normal radiographic findings with no evidence of instability or arthritis. The arthroscopic treatment of acute dorsal perilunate injuries is technically feasible in achieving anatomic reduction and stable fixation. Our preliminary clinical results were encouraging, but the long-term results need to be observed.

Surgical treatment of post-traumatic stiffness of the elbow

Surgical release of the elbow was performed in 27 patients with post-traumatic stiffness at a mean of 14.5 months after the initial injury. The outcome was related to whether there had been heterotopic ossification, which had occurred in 18 elbows and to whether, if there had been a fracture, it had involved the articular surface, which had occurred in 13 elbows. The final range of movement and the ratio of desired gain in each group were compared at a mean follow-up period of 22.5 months (12 to 43). The arc of movement of the elbow improved in all patients after the operation. The mean final arc was 110 degrees in those with heterotopic ossification and 86 degrees in those without (p = 0.001). The ratios of desired gain were significantly higher in patients with heterotopic ossification (88.2% vs 54.9%; p < 0.001). There was no significant difference in relation to involvement of the articular surface. Careful assessment of the cause of stiffness is important in order to achieve a satisfactory result from surgery for post-traumatic stiffness of the elbow.

Arthroscopic synovectomy of the wrist in rheumatoid arthritis

We analysed the results of arthroscopic synovectomy of the wrist in 18 patients (19 wrists) with rheumatoid arthritis who had not responded to conservative treatment. The patients’ symptoms were assessed using visual analogue scales for pain and satisfaction. Standard posteroanterior radiographs which were taken pre-operatively and at final follow-up were analysed using a modified Larsen scoring system (normal, 0; total destruction, 40). The mean follow-up period was 29.2 months (24 to 45). The mean pre-operative pain score was 8.58 which decreased to 3.58 one year after surgery and increased again to 4.42 at final follow-up. This suggested a gradual increase in pain with time. The mean satisfaction score was 6.26. The mean modified Larsen’s score was 9.8 pre-operatively and 13.9 at final follow-up, which demonstrated the slow progression of degenerative changes.

Arthroscopic synovectomy for rheumatoid arthritis of the wrist allows effective pain relief and high patient satisfaction, although any prolonged benefits will require long-term follow-up.