Postoperative evaluation of modified abductor pollicis longus suspensionplasty using two anchors: Preliminary results

Among the various surgical treatments for basal joint arthritis, we modified abductor pollicis longus (APL) suspensionplasty by using two anchors. We hypothesized that this modification would prevent not only subsidence but also lateral migration of the first metacarpal. Thirteen thumbs that underwent APL suspensionplasty were investigated. Mean follow-up was 25 months (range, 12-69 months). Clinical and radiographic parameters were assessed preoperatively and postoperatively. Progression of subsidence (trapezial space) and lateral migration of the first metacarpal were investigated sequentially and with the thumb abducted or adducted against stress in a specifically designed mold. Clinical improvement was assessed by decrease in QuickDASH score (from 49.6 to 19.7). The immediate postoperative trapezial space decreased significantly by 39% (p = 0.003), and lateral migration was improved significantly by 14% (p = 0.007). At final follow-up, subsidence and lateral migration had not significantly progressed (p = 0.059 and 0.278, respectively). Under stress, the trapezial space ratio decreased significantly with the thumb in abduction (from 0.63 to 0.59, p = 0.011). APL suspensionplasty using two anchors in patients with basal joint arthritis maintained the position of the first metacarpal bone, and especially lateral subluxation. LEVEL OF EVIDENCE: IV.

POS1144 INCREASED EXPRESSION OF RECEPTOR FOR ADVANCED GLYCATION END-PRODUCTS IN SARCOPENIC PATIENT SKELETAL MUSCLE

Background

Animal studies suggest that advanced glycation end-products (AGEs) and their interaction with receptor for AGEs (RAGE) are involved in sarcopenia, but their relationship in human skeletal muscles has yet to be elucidated.

Objectives

We aimed to determine whether RAGE expression in human skeletal muscle is associated with serum AGE levels and sarcopenia-related changes.

Methods

We reviewed 33 consecutive women (mean age, 65 years) with distal radius fracture who had consented to donate a sample of forearm flexor muscle for research purposes, which was taken during surgical fracture repair. The muscle RAGE expression was measured with immunohistochemistry staining and serum AGE levels using ELISA method. We compared RAGE expression and AGE levels in patients with and without sarcopenia. We also correlated RAGE expression with such clinical parameters as age, body mass index, bone mineral density (BMD), as well as sarcopenia-related changes, including grip strength, appendicular skeletal muscle mass, and muscle cross-sectional area (CSA) ratios.

Results

Twelve patients (36%) were diagnosed with sarcopenia according to the Asian Working Group for Sarcopenia. They had a significantly higher RAGE expression (p = 0.044) and AGE level (p < 0.001) than those without sarcopenia. The RAGE expression correlated significantly with a high serum AGE level (r = 0.510, p = 0.011) and correlated inversely with a muscle CSA ratio (r = -0.696, p < 0.001).

Conclusion

This study shows that RAGE expression increases in sarcopenic patient skeletal muscles. This expression also correlates positively with serum AGE levels and inversely with muscle CSA ratios. Further studies are necessary to determine whether targeting RAGEs can be a therapeutic option for sarcopenia.

References

[1]Singh R, Barden A, Mori T, Beilin L. Advanced glycation end-products: a review. Diabetologia. 2001; 44: 129-46.

[2]Tabara Y, Ikezoe T, Yamanaka M et al. Advanced glycation end product accumulation is associated with low skeletal mass, weak muscle strength, and reduced bone density: the Nagahama study. J Gerontol A Biol Sci Med Sci. 2019; 74: 1446-53.

[3]Riuzzi F, Sorci G, Sagheddu R, Chiappalupi S, Salvadori L, Donato R. RAGE in the pathophysiology of skeletal muscle. J Cachexia Sarcopenia Muscle. 2018; 9: 1213-34.

Figure 1.

Skeletal muscle tissue (x 7.0) obtained from (a) a 76-year-old female with receptor for advanced glycation end-products (RAGE) expression scoring 14, and (b) a 75-year-old female with RAGE expression scoring 50. Disparity between the percentage of fibers with signal intensity of 1+ (arrow) and those with signal intensity of 2+ (arrowhead) is obvious. Difference in the diameter and homogeneity of the muscle fibers imply the role of RAGE hyperexpression in sarcopenia.

Disclosure of Interests

None declared

Ulnar nerve morphology on magnetic resonance imaging predicts nerve recovery after surgery for cubital tunnel syndrome

Magnetic resonance imaging (MRI) can evaluate nerve morphology in cubital tunnel syndrome (CuTS), but its value in predicting surgical outcome is unclear. The purpose of this study was to determine whether ulnar nerve morphology on MRI correlated with outcome after CuTS surgery. We reviewed 40 patients who had preoperative MRI and electrodiagnostic (EDX) examinations for CuTS and outcome evaluation 6 months and 2 years postoperatively. Using MRI, ulnar nerve cross-sectional area (UNCSA), changes in signal intensity, and any space-occupying lesion were evaluated. Other factors assessed were age, symptom duration and severity, type-2 diabetes and EDX parameters. Factors associated with unfavorable surgical outcome were identified. At 6 months postoperatively, 12 patients (30%) had excellent, 19 (47.5%) good, 8 (20%) fair and 1 (2.5%) poor results on modified Wilson-Krout criteria. On univariate analysis, unfavorable outcomes were associated with increased UNCSA, space-occupying lesion, and decreased motor nerve conduction velocity (mNCV), and on multivariate analysis with increased UNCSA 1 cm distal from the epicondyle only (model 1) or increased UNCSA 1 cm proximal from the epicondyle and decreased mNCV (model 2). At 2 years, 15 patients (37.5%) had excellent, 21 (52.5%) good, 3 (7.5%) fair and 1 (2.5%) poor results, and no factors correlated with unfavorable outcome. Increased UNCSA on MRI was associated with unfavorable outcome at 6 months but not at 2 years. This study suggests that morphologic ulnar nerve changes can predict delayed nerve recovery after surgery for CuTS.

Improvement in lunate perfusion after radial closing-wedge osteotomy in patients with Kienböck's disease

Radial closing-wedge osteotomy is a widely accepted treatment for Kienböck's disease. However, despite favorable long-term clinical outcomes, its impact on lunate perfusion has not been documented. The purpose of this study was to determine whether radial closing wedge osteotomy improved lunate perfusion on gadolinium (Gd)-enhanced magnetic resonance imaging (MRI). We conducted a retrospective review of 12 patients with Kienböck's disease who received radial closing wedge osteotomy. Mean age at surgery was 25 years. Preoperative Gd-enhanced MRI was performed in 7 patients. After bone union, implants were removed and MRI was repeated. Two patients were classified as Lichtman stage IIIA, and 5 as stage IIIB. Percentage pre- to post-operative perfused lunate volume was compared on MRI. At last follow-up, mean QuickDASH score improved from 43.7 to 6.2. Pre- to post-operative lunate fragmentation, collapse and perfusion were compared qualitatively on MRI. On quantitative analysis, perfusion increased from 24% to 54% (p = 0.018) using our method of measuring percentage perfused lunate volume. The method showed satisfactory reproducibility. Investigation using Gd-enhanced MRI suggested that radial closing wedge osteotomy increases lunate perfusion.

Tunable quad-band transmission response, based on single-layer metamaterials

We investigated the electromagnetically induced transparency (EIT)-like effects in planar metamaterials (MMs) at microwave (GHz) frequencies. The specific MMs that were used in this study consist of cut-wire resonator/ring resonator, which achieved the dual EIT-like effects in a single-layer through the bright- and quasi-dark-mode coupling and the lattice mode coupling. In addition, by varying the distance between the two resonators, the quad-band EIT spectral response in the microwave region was obtained, and the group refractive index at the EIT-like resonance of proposed design reached up to 4,000. This study provides the design approach to the multispectral EIT-like effects and might suggest potential applications in a variety of fields, for example, low-loss slow-light device, multiple switching sensor, and other sensing devices.

Recombinant growth hormone therapy for prepubertal children with idiopathic short stature in Korea: a phase III randomized trial

PURPOSE

Several studies have evaluated the effects of growth hormone (GH) on auxological and biochemical parameters in children with non-GH-deficient, idiopathic short stature (ISS). This study evaluated the efficacy and safety of Growtropin^®-II (recombinant human GH) in Korean patients with ISS.

METHODS

This was a 1-year, open-label, multicenter, phase III randomized trial of Growtropin^®-II in Korean patients with ISS. In total, 70 prepubertal subjects (39 males, 31 females) between 4 and 12 years of age were included in the study. All patients were naive to GH treatment.

RESULTS

Annual height velocity was significantly higher in the treatment group (10.68 ± 1.95 cm/year) than the control group (5.72 ± 1.72, p < 0.001). Increases in height and weight standard deviation scores (SDSs) at 26 weeks were 0.63 ± 0.16 and 0.64 ± 0.46, respectively, for the treatment group, and 0.06 ± 0.15 and 0.06 ± 0.28, respectively, for the control group (p < 0.001). Serum insulin-like growth factor (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) increased significantly in the treatment group at week 26 compared to baseline. However, the SDS for body mass index (BMI) at 26 weeks did not change significantly in either group. Growtropin^®-II was well tolerated and safe over 1 year of treatment.

CONCLUSIONS

One-year GH treatment for prepubertal children with ISS demonstrated increased annualized velocity, height and weight SDSs, and IGF-1 and IGFBP-3 levels, with a favorable safety profile. Further evaluations are needed to determine the optimal dose, final adult height, and long-term effects of ISS treatment.

Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity

PURPOSE

The purpose of this study was to review pelvic fractures and concomitant orthopaedic injuries in children who have a patent triradiate cartilage (TRO) compared with children whose triradiate cartilage has closed (TRC). We hypothesise that these injuries will differ, leading to correlated alterations in management.

PATIENTS AND METHODS

Using a database, we retrospectively reviewed patients aged below 18 years with pelvic fractures presenting to our Level 1 trauma center. Radiographs and CT scans were reviewed to identify orthopaedic injuries and categorise pelvic injuries using the modified Torode classification between the two groups.

RESULTS

A total of 178 patients met inclusion criteria (60 TRO and 118 TRC). Mean age ± SD for TRO and TRC groups were 8 ± 4 years and 16 ± 2 years, respectively. TRO patients were more likely to present as a pedestrian struck by a vehicle (odds ratio (OR) 6.0; p < 0.001) and less likely to present after a motor vehicle collision (OR 0.2; p < 0.001). TRO patients were more likely to sustain rami fractures (OR 2.1; p = 0.020) and Torode IIIA injuries (OR 3.6; p < 0.001). They were less likely to sustain acetabular fractures (OR 0.5; p = 0.042), sacral fractures (OR 0.4; p = 0.009), hip dislocations (p = 0.002) and Torode IV injuries (OR 0.4; p = 0.004). TRO patients were less likely to be treated operatively for their pelvic (OR 0.3; p = 0.013) and orthopaedic injuries (OR 0.4; p = 0.006).

CONCLUSION

We suggest that patients with open triradiate cartilage are unique. Their pelvic injuries may be treated more conservatively as they have a greater potential for periosteal healing and bone remodelling. Patients with closed triradiate cartilage should be treated similarly to adults, as they share a similar mechanism of injury and need for operative fixation.

Multifractal anisotropic swimming: the optimal foraging behaviour of grouper larvae

It was hypothesized that the Malabar grouper Ephinephelus malabaricus larvae have developed search patterns adapted to the distribution of their prey to maximise their net energy intake per unit time. Analysis of the swimming behaviour of E. malabaricus larvae in both the presence and absence of Artemia sp. nauplii is presented to test this hypothesis. A method derived from turbulence studies (the moment function of the displacements) was used to characterize the behaviour. The results revealed that larval swimming pattern was multifractal (intermittent and long-range-correlated) and isotropic (i.e. uniform in all directions) in the presence of prey, but multifractal and anisotropic (i.e. more frequent long displacement on the vertical axis) in the absence of prey. It is suggested that the search behaviour observed in the absence of prey is an adaptive response to prey distribution pattern, which is often characterised by multifractality and anisotropy (i.e. larger patches on the horizontal axes). In the presence of prey, E. malabaricus shifted to intensive search behaviour. Other possible contributors to the observed patterns are discussed. It is concluded that multifractality and anisotropy of swimming patterns observed in the experiment are mainly explained in an optimal foraging theory framework.

Low Frequency of MKRN3 Mutations in Central Precocious Puberty Among Korean Girls

Mutations of MKRN3, the gene encoding makorin RING-finger protein 3, lead to central precocious puberty (CPP). The aim of this study was to investigate mutations of the MKRN3 gene in Korean girls with CPP. Two hundred-sixty Korean girls with idiopathic CPP were included. Auxological and endocrine parameters were measured, and the entire MKRN3 gene was directly sequenced. MKRN3 gene analysis revealed one novel nonsense mutation (p.Gln281 *) and 6 missense variants (p.Ile100Phe, p.Gly196Val, p.Ile204Thr, p.Gln226Pro, p.Lys233Asn, and p.Ser396Arg). The novel nonsense mutation (p.Gln281 *) was a heterozygous C>T nucleotide change (c.841C>T) predicted to result in a truncated protein due to a premature stop codon in the MKRN3 gene. The nonsense mutation (p.Gln281 *) was only identified in one of the girls and her younger brother. Compared to previous reports on MKRN3 mutations in familial and sporadic cases of CPP, the present study reveals a relatively low number of MKRN 3 mutations in Korean girls with CPP. Larger samples of children with CPP and MKRN3 mutations are necessary in order to clarify whether the clinical course of puberty may differ as compared to idiopathic CPP.

Peroxisome proliferator-activated receptor δ inhibits Porphyromonas gingivalis lipopolysaccharide-induced activation of matrix metalloproteinase-2 by downregulating NADPH oxidase 4 in human gingival fibroblasts

We investigated the roles of peroxisome proliferator-activated receptor δ (PPARδ) in Porphyromonas gingivalis-derived lipopolysaccharide (Pg-LPS)-induced activation of matrix metalloproteinase 2 (MMP-2). In human gingival fibroblasts (HGFs), activation of PPARδ by GW501516, a specific ligand of PPARδ, inhibited Pg-LPS-induced activation of MMP-2 and generation of reactive oxygen species (ROS), which was associated with reduced expression of NADPH oxidase 4 (Nox4). These effects were significantly smaller in the presence of small interfering RNA targeting PPARδ or the specific PPARδ inhibitor GSK0660, indicating that PPARδ is involved in these events. In addition, modulation of Nox4 expression by small interfering RNA influenced the effect of PPARδ on MMP-2 activity, suggesting a mechanism in which Nox4-derived ROS modulates MMP-2 activity. Furthermore, c-Jun N-terminal kinase and p38, but not extracellular signal-regulated kinase, mediated PPARδ-dependent inhibition of MMP-2 activity in HGFs treated with Pg-LPS. Concomitantly, PPARδ-mediated inhibition of MMP-2 activity was associated with the restoration of types I and III collagen to levels approaching those in HGFs not treated with Pg-LPS. These results indicate that PPARδ-mediated downregulation of Nox4 modulates cellular redox status, which in turn plays a critical role in extracellular matrix homeostasis through ROS-dependent regulation of MMP-2 activity.

Early menarche increases the risk of Type 2 diabetes in young and middle-aged Korean women

AIMS

To investigate the association between early menarche (menarche age < 12 years) and Type 2 diabetes mellitus in young and middle-aged Korean women.

METHODS

We analysed data for 4657 women aged 20-50 years from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) (2007-2009).

RESULTS

The prevalence of Type 2 diabetes was 2.8%. Women with early menarche had a higher prevalence of impaired fasting glucose than did women with later menarche (age ≥ 12 years) in the 20-30 age group (7.4% vs. 3.0%), and a higher prevalence of diabetes in the 30-40 (6.3% vs. 1.7%) and 40-50 (18.5% vs. 4.4%) age groups. The odds ratio (OR) of Type 2 diabetes in women with early menarche was 3.61 [95% confidence interval (CI), 1.90-6.88] after adjusting for age. In multivariate regression, the OR of Type 2 diabetes decreased to 2.52 (95% CI, 1.29-4.94) after further adjusting for BMI. However, the OR decreased to 2.04 (95% CI, 0.95-4.39) without significance after adjusting for HOMA-IR.

CONCLUSIONS

Early menarche increased the risk of Type 2 diabetes in young and middle-aged Korean women although adulthood adiposity attenuated the relationship. Knowledge of age at menarche is important in identifying women at risk for diabetes.

Ligand-activated peroxisome proliferator-activated receptor-δ and -γ inhibit lipopolysaccharide-primed release of high mobility group box 1 through upregulation of SIRT1

Peroxisome proliferator-activated receptors (PPARs) inhibit lipopolysaccharide (LPS)-primed release of high mobility group box 1 (HMGB1), a late proinflammatory mediator, but the underlying molecular mechanism is not completely understood. In this study, we demonstrated that the inhibition of HMGB1 release by PPAR-δ and -γ is associated with the deacetylase activity of SIRT1. Ligand-activated PPAR-δ and -γ inhibited LPS-primed release of HMGB1, concomitant with elevation in SIRT1 expression and promoter activity. These effects were significantly reduced in the presence of small interfering (si)RNAs against PPAR, indicating that PPAR-δ and -γ are involved in both HMGB1 release and SIRT1 expression. In addition, modulation of SIRT1 expression and activity by siRNA or chemicals correspondingly influenced the effects of PPARs on HMGB1 release, suggesting a mechanism in which SIRT1 modulates HMGB1 release. Furthermore, we showed for the first time that HMGB1 acetylated in response to LPS or p300/CBP-associated factor (PCAF) is an effective substrate for SIRT1, and that deacetylation of HMGB1 is responsible for blockade of HMGB1 release in macrophages. Finally, acetylation of HMGB1 was elevated in mouse embryonic fibroblasts from SIRT1-knockout mice, whereas this increase was completely reversed by ectopic expression of SIRT1. These results indicate that PPAR-mediated upregulation of SIRT1 modulates the status of HMGB1 acetylation, which, in turn, has a critical role in the cellular response to inflammation through deacetylation-mediated regulation of HMGB1 release.

No effect of the estrogen receptor α gene polymorphisms in the etiology of precocious puberty in girls

Estrogen plays a crucial role in the development and function in reproductive physiology. Estrogens regulate cellular activity through binding to estrogen receptor α (ERα) and β (ERβ). ERα polymorphisms have been associated with changes in age at menarche, menopause onset, and fertility. The aim of this study is to investigate the relationship of ERα gene polymorphisms with central precocious puberty (CPP) in girls. Two hundred and one (201) Korean girls with idiopathic CPP were included in this study along with 100 healthy Korean female adults with pubertal maturation within normal age who served controls. Auxological and endocrine parameters were measured, and both patients and controls were genotyped for PvuII (397 T→C) and XbaI (351 A→G) polymorphisms in the ERα gene. A significantly lower incidence of the CC genotype with PvuII polymorphism were noted among CPP girls than controls (11.9% vs. 22%, P=0.021). However, the clinical parameters did not differ among the 3 genotypes. In addition, there was no significant difference in patients with the XbaI polymorphism compared to controls. The present study reveals that neither PvuII nor XbaI polymorphisms in the ERα gene are associated with onset and progression of puberty. However, further studies are needed to validate the exact function of these polymorphisms.

Utility of Basal luteinizing hormone levels for detecting central precocious puberty in girls

The hallmark of puberty is the progressive increase in gonadotropin-releasing hormone (GnRH) activity, reflected by an increase in the circulating concentration of luteinizing hormone (LH). The GnRH stimulation test is widely used in the evaluation of precocious puberty. The aim of our study was to assess the diagnostic utility of basal LH for the diagnosis of central precocious puberty (CPP) in girls. A total of 803 girls were referred to Ajou University Hospital for evaluation of precocious puberty between 2008 and 2011. All subjects underwent GnRH-stimulation tests as part of their evaluation. Serum LH and follicle stimulating hormone (FSH) were measured by immunoradiometric assay before and after the GnRH injection. Of the 803 subjects, 505 (62.9%) were included in the pubertal response group and 298 (37.1%) were in the prepubertal response group. Basal LH level was identified as a significant predictor for CPP. Based on the ROC curve, the optimal cut off point of basal LH related to 'pubertal response' was 1.1 IU/l, which was associated with 69.1% sensitivity and 50.5% specificity, with an area under the ROC curve of 0.620 (95% CI, 0.581-0.660). It is concluded that a single basal LH measurement can be used as a screening test to identify girls with CPP and to determine who should undergo GnRH stimulation test.

HbA1c and glucose intolerance in obese children and adolescents

AIMS

Childhood obesity is associated with an increased likelihood for having impaired glucose tolerance, dyslipidaemia and diabetes. The aim of the study was to evaluate HbA(1c) as a screening test for impaired glucose tolerance in obese children and adolescents and identify the optimal HbA(1c) threshold.

METHODS

We studied 126 obese and overweight children (BMI > 85 th percentile for age and gender) 4-17 years of age referred to the endocrine clinic at Ajou University Hospital in Korea. All subjects underwent HbA(1c) and oral glucose tolerance test.

RESULTS

Thirty-four patients (27%) out of 126 had impaired glucose tolerance. Silent diabetes was diagnosed in 10 adolescents (7.9%). Based on the receiver operating characteristic curve, the optimal cut point of HbA(1c) related to impaired glucose tolerance diagnosed by oral glucose tolerance test was 40 mmol/mol (5.8%), which was associated with a 64.7% sensitivity and 61.6% specificity, with an area under the receiver operating characteristic curve of 0.651 (95% CI 0.529-0.772).

CONCLUSIONS

Obesity is associated with an increased risk of impaired glucose tolerance. An HbA(1c) value of 40 mmol/mol (5.8%) should be used as a screening tool to identify children and adolescents with impaired glucose tolerance.

Long-term bisphosphonate usage and subtrochanteric insufficiency fractures: a cause for concern?

For over a decade, bisphosphonate administration has evolved and become the cornerstone of the prevention and treatment of fragility fractures. Millions of post-menopausal women have relied on, and continue to depend on, the long-acting, bone density-maintaining pharmaceutical drug to prevent low-energy fractures. In return, we have seen the number of fragility fractures decrease, along with associated costs and emotional benefits. However, with any drug, there are often concerns with side effects and complications, and this unique drug class is seeing one such complication in atypical subtrochanteric femoral fracture, counterproductive to that which it was designed to prevent. This has created concern over long-term bisphosphonate administration and its potential link to these atypical fractures. There is controversial evidence surrounding such a definitive link, and no protocol for managing these fractures. This review offers the latest information regarding this rare but increasingly controversial adverse effect and its potential connection to one of the most successful forms of treatment that is available for the management of fragility fractures.

Fabrication and radio frequency characterization of carbon nanotube field effect transistor: evidence of quantum capacitance

We fabricated an radio frequency (RF) carbon nanotube field effect transistor (CNTFET) whose electrode shapes were standard RF designed ground-signal-ground (GSG)-type pads. The S-parameters measured from our RF CNTFET in the frequency range up to 6 GHz were fitted with an RF equivalent circuit, and the extracted gate capacitance was shown to be the capacitance value of the series combination of the electrostatic capacitance and the quantum capacitance. The effect of the channel resistance and the kinetic inductance was also discussed.

Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors

BACKGROUND AND AIM

Although perforation of the colon is known as one of the main complications of endoscopic submucosal dissection (ESD) for colorectal tumor management, factors predictive of perforation have not been fully evaluated. This study aimed to determine the factors associated with perforation during colorectal ESD.

METHODS

Patients with colorectal tumors undergoing ESD were enrolled and their records were reviewed retrospectively. Age, sex, co-morbidity, medication history, procedure time, resection method, tumor size, location, gross morphology, the presence of fibrosis, and histologic findings were included as possible risk factors. In the cases where perforation had occurred, factors associated with the duration of hospitalization were analyzed.

RESULTS

One hundred eight lesions in 108 patients were eligible for inclusion in the study (68 patients were male; mean patient age was 63.01 ± 10.71 years). Mean tumor size was 27.59 ± 10.10 mm (range: 8 - 53 mm). Laterally spreading tumor was the most common type (75 %), followed by the protruding type (25 %). Procedure time was 61.95 ± 41.90 minutes (range: 5 - 198 minutes). Complete en bloc resection was achieved for 85 lesions (78.7 %). Perforation occurred in 22 patients (20.4 %). Multivariate analysis confirmed that tumor size [odds ratio (OR): 1.084; 95 % confidence interval (CI): 1.015 - 1.158; P = 0.017] and the presence of fibrosis (OR: 4.551; 95 %CI: 1.092 - 18.960; P = 0.037) were independent risk factors for perforation. All cases of perforation were managed with nonsurgical treatment. Younger age and abdominal pain appeared to be related to prolonged hospitalization.

CONCLUSION

Tumor size and fibrosis are important factors related to complications during colorectal ESD. Younger age and development of abdominal pain can predict the hospital course in patients with perforation after ESD.

Cerebral infarction associated with transient visual loss in child with diabetic ketoacidosis

BACKGROUND

Diabetic ketoacidosis is a metabolic disorder caused by insulin deficiency and is the most important cause of mortality and morbidity in children with Type 1 diabetes mellitus. Acute neurological complications related to diabetic ketoacidosis include cerebral oedema, cerebral infarction, brain herniation, cortical venous thrombosis and cerebral haemorrhage. Cerebral infarction is rare in juvenile diabetic ketoacidosis.

CASE REPORT

We report a girl with a newly diagnosed Type 1 diabetes mellitus who presented with diabetic ketoacidosis and developed cerebral infarction with transient visual loss.

CONCLUSIONS

Our findings emphasize the importance of prompt evaluation and proper management of intracranial crises in diabetic ketoacidosis.

Probing the continuous radio frequency spectrum of water relaxation using a carbon nanotube

We have obtained the continuous radio frequency spectrum of water molecule relaxation using carbon nanotubes (CNT) as a high-speed nanoprobe. Three sets of characteristic time scales are clearly identified. Two sets are attributed to the electric-field-driven polarization of water molecules bound to CNTs and the collective relaxation of water layers in the vicinity of CNTs, respectively. The third set is appreciable only in air, and can be related to triplet oxygen relaxation.

PPARdelta inhibits IL-1beta-stimulated proliferation and migration of vascular smooth muscle cells via up-regulation of IL-1Ra

Activation of peroxisome proliferator-activated receptor (PPAR) delta by GW501516, a specific PPARdelta ligand, significantly inhibited interleukin (IL)-1beta-induced proliferation and migration of vascular smooth muscle cells (VSMCs). This effect of GW501516 was dependent on transforming growth factor-beta, and was mediated through the up-regulation of IL-1 receptor antagonist. The inhibitory effect of GW501516 on VSMC proliferation was associated with cell cycle arrest at the G1 to S phase transition, which was accompanied by the induction of p21 and p53 along with decreased cyclin-dependent kinase 4 expression. Inhibition of cell migration by GW501516 was associated with the down-regulation of matrix metalloproteinase (MMP)-2 and MMP-9 in IL-1beta-treated VSMCs. Inhibition of extracellular signal-regulated kinase significantly reduced the GW501516-mediated inhibition of IL-1beta-stimulated VSMC proliferation. These results suggest that PPARdelta plays an important role in the pathophysiology of diseases associated with the proliferation and migration of VSMCs.

Self-assembled growth of catalyst-free GaN wires by metal-organic vapour phase epitaxy

A catalyst-free method for growing self-assembled GaN wires on c-plane sapphire substrates by metal-organic vapour phase epitaxy is developed. This approach, based on in situ deposition of a thin SiN(x) layer (approximately 2 nm), enables epitaxial growth of c-oriented wires with 200-1500 nm diameters and a large length/diameter ratio (>100) on c-plane sapphire substrate. Detailed study of the growth mechanisms shows that a combination of key parameters is necessary to obtain vertical growth. In particular, the duration of the SiN(x) deposition prior to the wire growth is critical for controlling the epitaxy with the substrate. The GaN seed nucleation time determines the mean size diameter and structural quality, and a high Si-dopant concentration promotes vertical growth. Such GaN wires exhibit UV-light emission centred at approximately 350 nm and a weak yellow band (approximately 550 nm) at low temperature.

Coarsening kinetics of a spinodally decomposed vicinal Si(111) surface

The coarsening kinetics of the stepped-and-terrace groove structure formed on a vicinal Si(111) surface was investigated by in-situ synchrotron x-ray scattering. The time evolution of the groove period L at various temperatures below the (1 x 1)-to-(7 x 7) transition falls onto a universal curve when the annealing time is scaled by a scale factor. Distinctive stages of spinodal decomposition, coarsening, and saturation are identified in the evolution of the groove period. L increases following a power law, L approximately t;{n} with n = 1/6 and 0.29 in the initial stage and the late stage of coarsening, respectively. The initial coarsening proceeds via collective motion of step bunches while the late stage is dominated by the diffusion of individual steps.

The effects of strontium ranelate in Asian women with postmenopausal osteoporosis

The aim of this study was to assess the efficacy and safety of strontium ranelate in the treatment of postmenopausal women with osteoporosis in Taiwan. In this 12-month multicenter, randomized, double-blind, placebo-controlled study, 125 women with osteoporosis were randomly given either strontium ranelate 2 g daily or placebo. Lumbar spine, femoral neck, and total-hip bone mineral density (BMD) and biochemical markers of bone turnover were measured; adverse events and tolerability were recorded and assessed. Subjects treated with strontium ranelate showed significant increases in BMD of 5.9% at the lumbar spine, 2.6% at the femoral neck, and 2.7% at the total hip, while the placebo group exhibited no significant change at 12 months. Serum level of a formation marker (bone-specific alkaline phosphatase) was also significantly increased at 6 and 12 months. Thus, although the sample size and the treatment duration of this study could not show its effect of reducing osteoprotic fractures, strontium ranelate showed bone protection effects by increasing BMD and concentrations of a bone formation marker. Safety assessment revealed adverse events were mild and not significantly different from placebo.

Fabrication of one-dimensional devices by a combination of AC dielectrophoresis and electrochemical deposition

We demonstrate a hybrid process for fabricating one-dimensional wire devices. The process is a combination of an alignment procedure using dielectrophoresis and subsequent contact metal formation utilizing electrochemical deposition with non-toxic organic-based Au electrolytes. Several devices have been successfully made from GaN nanowires or multi-walled carbon nanotubes (MWCNTs) using our hybrid technique. We demonstrate that rapid thermal annealing improves the ohmic characteristics by five orders of magnitude in the case of the GaN devices and ∼300% in the case of the MWCNT devices. One of the reasons for this improvement is enhanced gold wetting due to the reduction of grain size at the annealing temperature.

Life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy

BACKGROUND

Limited data are available on the life expectancy of patients with newly-diagnosed HIV infection in the era of highly active antiretroviral therapy (HAART).

AIM

To provide such an estimate using a semi-parametric projection.

DESIGN

Statistical analysis.

METHODS

Follow-up data for patients newly diagnosed with HIV infection in Taiwan (HIV/AIDS Cohort) from 1 May 1997 to 30 April 2003 (n = 3351, only 1% are injecting drug users) were analysed using the Kaplan-Meier method. The survival function for an age- and gender-matched reference population was generated by the Monte Carlo method from the life-table of the general population. A constant excess hazard model was used to project long-term survival of HIV-infected patients, with linear extrapolation of a logit-transformed curve of survival ratio between HIV-infected patients and the reference population.

RESULTS

The 5-year survival rate was 58% in patients who had already developed AIDS at diagnosis (AIDS group), and 89% in those who had not (non-AIDS group). Extrapolation yielded an expected mean survival time of 10.6 years after diagnosis for the AIDS group, and 21.5 years after diagnosis for the non-AIDS group.

DISCUSSION

Our results support the expansion of HIV screening programs to minimize delay in diagnosis. With continuing advances in HAART, this estimate of survival in initially asymptomatic patients may be conservative. Their long life expectancy raises questions about what kind of preventive heath services should be offered. These should be addressed through further analysis of overall benefit and cost-effectiveness.

The mitochondrial genome of the Korean hairstreak, Coreana raphaelis (Lepidoptera: Lycaenidae)

We determined the complete nucleotide sequences of the mitochondrial genome (mitogenome) of the Korean hairstreak, Coreana raphaelis (Lepidoptera: Lycaenidae). The entire mitochondrial DNA (mtDNA) molecule was 15,314 bp long. The C. raphaelis genes were in the same order and orientation as the completely sequenced mitogenomes of other lepidopteran species, except for the presence of an extra copy of tRNA(Ser)(AGN). High similarity in primary sequence and secondary structure between the two tandemly located copies of the tRNA(Ser)(AGN) suggest a recent duplication of an original single tRNA(Ser)(AGN). The DHU arm of the two copies of tRNA(Ser)(AGN) formed a simple loop as seen in many other metazoan mt tRNA(Ser)(AGN). The putative initiation codon for the C. raphaelis COI gene appears to be a tetranucleotide, TTAG, found commonly in the sequenced lepidopterans. ATPase8, ATPase6, ND4L and ND6 genes, which are next to another protein-coding gene at their 3' end all had the sequences potential to form a hairpin structure, suggesting the importance of such a structure for precise cleavage of the mature protein-coding genes.

The dermal stem cell factor and c-kit are overexpressed in melasma

BACKGROUND

The pathogenesis of melasma has not yet been clearly demonstrated. We tried to determine whether the stem cell factor (SCF) and its receptor c-kit are involved in the mechanism of hyperpigmentation of melasma because this factor is highly implicated in the stimulation of melanocyte function in vitro and in vivo.

OBJECTIVES

The present study was conducted to investigate the expression of SCF and c-kit on the lesions of melasma compared with nonlesional skin.

PATIENTS/METHODS

Skin samples were obtained from lesional and nonlesional facial skin of 60 Korean women with melasma. Immunohistochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR) analysis was performed to determine the expression of SCF and c-kit in melasma.

RESULTS

The expression of SCF was significantly increased at the lesional dermis compared with nonlesional dermis. However, there was no significant difference in the expression of SCF in lesional and nonlesional epidermis. The expression of c-kit was significantly increased at lesional epidermis compared with nonlesional skin. RT-PCR of SCF and c-kit mRNAs demonstrated increased expression of both types of transcripts in the lesional skin compared with nonlesional skin.

CONCLUSIONS

These results suggest that the increased expression of SCF in the dermis and of c-kit in the epidermis play an important role in the mechanism of hyperpigmentation in melasma.

Teriparatide vs. calcitonin in the treatment of Asian postmenopausal women with established osteoporosis

This study compared the clinical efficacy, safety, and tolerability of daily subcutaneous injections of teriparatide and salmon calcitonin in the treatment of postmenopausal women with established osteoporosis in Taiwan. This 6-month, multicenter, randomized, controlled study enrolled 63 women with established osteoporosis. They were randomized to receive either teriparatide 20 microg or calcitonin 100 IU daily in an open-label fashion. Lumber spine, femoral neck, total hip bone mineral density (BMD), and biochemical markers of bone turnover were measured, and adverse events and tolerability were recorded. The results at 6 months showed that patients using teriparatide had larger mean increases in spinal BMD than those who used calcitonin (4.5% vs. 0.1%), but the BMD changes in these two groups at the femoral neck and the total hip were not significant. There were also larger mean increases in bone markers in the teriparatide group than in the calcitonin group (bone specific alkaline phosphatase 142% vs. 37%; osteocalcin 154% vs. 23%). We conclude that teriparatide has more positive effects on bone formation than salmon calcitonin, as shown by the larger increments of lumbar spine BMD and bone formation markers, and caused only mild adverse events and no significant change in liver, kidney or hematological parameters. Compared with the published global results, teriparatide seems to be equally effective and safe to use in this Asian population.

Ifosfamide-induced encephalopathy with or without using methylene blue

Ifosfamide is one of the most widely used alkylating chemotherapeutic agents. Before mesna was introduced, its dose-limiting toxicity was hemorrhagic cystitis, but at present, neurotoxicity is one of its most worrisome side effects. A total of 10%-15% of patients treated with ifosfamide develop an encephalopathy. The exact pathophysiologic mechanisms responsible for the development of ifosfamide-induced encephalopathy (IIE) are not known. However, accumulation of chloracetaldehyde, toxic metabolite of ifosfamide, in the central nervous system is theorized to be the cause of the neurotoxicity. No standard treatment has been available for IIE. Recently, many reports suggested that methylene blue (MB) may be an effective treatment of this lethal complication. We report two cases of IIE and their treatment outcomes. The first patient recovered completely with MB. The other patient showed slow and incomplete improvement without using MB. We suggest that MB can be used as an initial treatment for the encephalopathy related to ifosfamide infusion. Thus, we present these two cases with brief review of related literature.

Clinical implications of N epsilon-(carboxymethyl)lysine, advanced glycation end product, in children and adolescents with type 1 diabetes

AIM

The aim of this study was to investigate the relationship between serum levels of the glycoxylation product N(epsilon)-(carboxymethyl)lysine (CML) and development of chronic diabetic complications and degree of diabetic control in children and adolescents with type 1 diabetes.

METHODS

The serum levels of CML were measured in 87 patients with uncomplicated type 1 diabetes mellitus (12.7 +/- 4.6 years of age) and in seven patients with background retinopathy, microalbuminuria or neuropathy (18.2 +/- 5.2 years of age) and compared with those in 64 normal control subjects (12.6 +/- 5.2 years of age). The mean durations of diabetes in uncomplicated and complicated patients were 5.0 +/- 3.4 years (0.1-14 years), and 8.6 +/- 5.0 years (3.1-18 years), respectively. The serum levels of CML were measured by enzyme-linked immunosorbent assay using a monoclonal anti-CML antibody (6D12).

RESULTS

The serum levels of CML were significantly higher in the patient group than those in the control group; 0.85 +/- 0.37 (0.37-1.93) U/ml vs. 0.56 +/- 0.23 (0.15-1.05) U/ml (p < 0.001) and significantly higher in the patient group with chronic complications than those in patient group without chronic complications; 1.06 +/- 0.39 (0.72-1.78) U/ml vs. 0.83 +/- 0.36 (0.37-1.93) U/ml (p < 0.05). Weak, but statistically significant relationship between CML levels and haemoglobin A(1c) levels at the measurement of CML was observed (r = 0.29, p < 0.05).

CONCLUSIONS

Our data are suggesting that higher serum levels of CML are involved in the development of chronic diabetic complications, and serum levels of CML reflect the degree of diabetic control for a long duration in type 1 diabetic children and adolescents.

Effects of polyhemoglobin-antioxidant enzyme complex on ischemia-reperfusion in kidney

INTRODUCTION

The kidney suffers ischemia-reperfusion (I/R) injury during transplantation. The purpose of the present study was to investigate the therapeutic effect of artificials cells on renal I/R injury through biochemical assays and histological examination.

METHODS

We prepared artificial cells using cross-linked hemoglobin (Hb), superoxide dismutase (SOD), and catalase. Normal male Sprague-Dawley rats were divided into 6 groups: the sham-operated control group, the group treated with polyHb,and the group treated with polyHb-SOD-catalase (PSC) (per groups were subjected to ischemia for 1 hour or 2 hours). After reperfusion for 4 hours, kidney and blood samples were obtained.

RESULTS

The levels of SOD and catalase in the PSC group were 15 and 50 times higher than those of the control group, respectively. In the polyHb group, the levels of blood urea nitrogen (BUN), serum creatinine, renal hydrogen peroxide, and renal malondialdehyde were increased. However, their levels were significantly decreased by PSC administration. Renal SOD activity did not show any significant changes in the polyHb group, but renal catalase activity was decreased by polyHb treatment in comparison with the control group. The activities of renal SOD and catalase were increased using PSC treatment. In the histological findings, the PSC group showed no evidence of acute tubular necrosis in proximal convoluted tubules; their microvilli and cytoplasmic microorganelles were relatively well preserved.

CONCLUSIONS

These results show that PSC effectively reduces renal damage via diminished oxygen free radical-mediated injury after I/R.

Effect of artificial cells on hepatic function after ischemia–reperfusion injury in liver

BACKGROUND

The liver suffers from ischemia/reperfusion injury during transplantation. Reactive oxygen species generated by xanthine oxidase during reperfusion of the ischemic liver may be partially responsible for the hepatic injury. Oxygen free radicals are removed by antioxidant enzymes such as superoxide dismutase (SOD), catalase, and glutathione peroxidase. Using glutaraldehyde and lysine we constructed crosslinked hemoglobin, containing SOD and catalase, and assessed its ability to protect against ischemia/reperfusion injury during transplantation.

METHODS

In contrast to the sham-operated control groups, blood was exchanged using crosslinked hemoglobin (polyHb) a PolyHb-SOD-catalase (PSC) group. After ischemia/reperfusion injury, several parameters of hepatic damage and oxygen free radicals were measured as well as microscopic examination.

RESULTS

Alanine aminotransferase, aspartate aminotransferase, superoxide production, hydrogen peroxide, and malondialdehyde levels were higher among the PolyHb group than sham-operated controls. The PolyHb group revealed a few apoptotic bodies, some acute inflammatory infiltrates in the sinusoids, nuclear fragmentations, cell shrinkage, and chromatin clumping with formation of apoptotic bodies in the apoptotic cells under microscopic examination. Alanine aminotransferase, aspartate aminotransferase, superoxide production, and hydrogen peroxide levels were lower in the PSC than the PolyHb group. Hepatic structures were well preserved in the PSC group.

CONCLUSIONS

Reactive oxygen species contribute to hepatic dysfunction with morphologic changes. PSC is effective to reduce hepatic damage by lowering oxygen free radical-mediated injury after ischemia/reperfusion in the liver.

Pigment-lightening effect of N,N'-dilinoleylcystamine on human melanoma cells

BACKGROUND

Cystamine and linoleic acid have been reported to reduce melanin synthesis in vitro and in vivo. N,N'-dilinoleylcystamine (DLC) is a compound of cystamine and linoleic acid connected by an ester bond.

OBJECTIVES

To investigate the effects of DLC on melanin synthesis using cultured human melanoma cells.

METHODS

Levels of total melanin, eumelanin and phaeomelanin, tyrosinase protein and tyrosinase activity in situ were measured in HM3KO melanoma cells. Changes in degree of pigmentation were quantified by image analysis and compared with absorbance values. Tyrosinase from HM3KO cells was used to measure the direct effect of DLC on DOPA and DOPAchrome production.

RESULTS

At concentrations of 1.4-14 micromol L-1, DLC reduced the pigmentation of HM3KO melanoma cells but did not affect cell growth. The visual decrease in pigmentation produced by DLC was more dramatic than the decrease in total melanin content as measured by absorbance at 500 nm. DLC treatment decreased eumelanin synthesis and increased phaeomelanin synthesis in HM3KO melanoma cells. An in situ tyrosinase assay showed that DLC inhibited tyrosinase activity, as well as the level of tyrosinase protein.

CONCLUSIONS

These results suggest that DLC has pigment-lightening effects on HM3KO melanoma cells, produced by reducing the level of eumelanin while increasing the level of phaeomelanin.

Wax moth, Galleria mellonella, high density lipophorin receptor: alternative splicing, tissue-specific expression, and developmental regulation

A lipophorin (Lp) receptor cDNA from the fat body of Galleria mellonella (Lepidoptera) was cloned and sequenced. This is the first result in this order, Lepidoptera. It showed the pattern of the VLDL receptor belonging to the LDL receptor family. Sequence homology with other Lp receptors in insects, Locusta migratoria and Aedes aegypti, was 70 and 61%, respectively and each domain was highly conserved. Polyclonal anti-Lp receptor antibody prepared against expressed Lp receptor fragment between ligand binding domain and EGF-precursor homology domain (R305-D549 of amino acid residues) specifically detected the Lp receptor. Through immuno-blotting, the Lp receptor of larval fat body has an approximate molecular mass of about 97 and 110 kDa under non-reducing and reducing conditions, respectively. This result was in agreement with that of the ligand-blotting. The variant Lp receptors were expressed in the fat body of G. mellonella; one is an Lp receptor which lacks 84 bp of O-linked sugar domain and the other is a full length form of the Lp receptor. Both forms were detected by the polyclonal anti-Lp receptor antibody. The Lp receptor from the fat body of G. mellonella was differently expressed depending on the tissue and the developmental stage with specific abundance in prepupal stage. A steroid hormone, 20-hydroxyecdysone (20-HE) plays a crucial role in insect development. With regards to this conception, day 1-2 last instar larvae were treated with 20-HE and drastic induction of the Lp receptor was observed 48 h after treatment. It was also observed that cholesterol caused an induction of the Lp receptor.

An efficient motion estimation and compensation method for ultrasound synthetic aperture imaging

This paper describes a method for overcoming motion artifacts in synthetic aperture imaging. The method is based on a computer simulation study on the influence of target motion on synthetic aperture techniques. A region-based motion compensation approach is used in which only the axial motion is estimated and compensated for a given region of interest under the assumption that the whole ROI moves uniformly. The estimated axial motion is calculated with a crosscorrelation method at the point where the focused signal has the maximum energy within the ROI. We also present a method for estimating axial motion using the autocorrelation method that is widely used to estimate average Doppler frequency. Both computer simulations and in vivo experiments show that the proposed crosscorrelation-based method can greatly improve the spatial resolution and SNR of ultrasound imaging by implementing SA techniques for two-way dynamic focusing without motion artifacts. In addition, the autocorrelation-based motion compensation method provides almost the same results as the crosscorrelation-based method, but with a dramatically reduced computational complexity.

Isolation, identification and field tests of the sex pheromone of the carambola fruit borer, Eucosma notanthes

Two components, (Z)-8-dodecenyl acetate (Z8-12:Ac) and (Z)-8-dodecenol (Z8-12:OH), were isolated from sex pheromone glands of the carambola fruit borer, Eucosma notanthes, and were identified by GC, and GC-MS, chemical derivatization, and comparison of retention times. The ratio of the alcohol to acetate in the sex pheromone extracts was 2.7. However, synthetic mixtures (1 mg) in ratios ranging from 0.5 to 1.5 were more effective than other blends in trapping male moths in field tests.

Case report of a granular cell tumour in the nasal septum of a child

A six-year-old child with a nasal septal polyp presents with pain and nasal discharge. The diagnosis of a granular cell tumour was made histologically on excision of the polyp. This interesting case of an uncommon lesion presenting in a relatively rare paediatric age group is, as far as we know, the first report of a granular cell tumour involving the nasal septum.