Evaluation of the efficacy of Escherichia coli-derived recombinant human bone morphogenetic protein-2 in a mini-pig spinal anterior interbody fusion model

We evaluated the efficacy of Escherichia coli-derived recombinant human bone morphogenetic protein-2 (E-BMP-2) in a mini-pig model of spinal anterior interbody fusion. A total of 14 male mini-pigs underwent three-level anterior lumbar interbody fusion using polyether etherketone (PEEK) cages containing porous hydroxyapatite (HA). Four groups of cages were prepared: 1) control (n = 10 segments); 2) 50 μg E-BMP-2 (n = 9); 3) 200 μg E-BMP-2 (n = 10); and 4) 800 μg E-BMP-2 (n = 9). At eight weeks after surgery the mini-pigs were killed and the specimens were evaluated by gross inspection and manual palpation, radiological evaluation including plain radiographs and micro-CT scans, and histological analysis. Rates of fusion within PEEK cages and overall union rates were calculated, and bone formation outside vertebrae was evaluated. One animal died post-operatively and was excluded, and one section was lost and also excluded, leaving 38 sites for assessment. This rate of fusion within cages was 30.0% (three of ten) in the control group, 44.4% (four of nine) in the 50 μg E-BMP-2 group, 60.0% (six of ten) in the 200 μg E-BMP-2 group, and 77.8% (seven of nine) in the 800 μg E-BMP-2 group. Fusion rate was significantly increased by the addition of E-BMP-2 and with increasing E-BMP-2 dose (p = 0.046). In a mini-pig spinal anterior interbody fusion model using porous HA as a carrier, the implantation of E-BMP-2-loaded PEEK cages improved the fusion rate compared with PEEK cages alone, an effect that was significantly increased with increasing E-BMP-2 dosage.

Cite this article: Bone Joint J 2013;95-B:217–23.

Non-coding rRNA-mediated preferential killing in cancer cells is enhanced by suppression of autophagy in non-transformed counterpart

Interest to anticancer agents targeting rRNA biogenesis is growing. Cis-non-coding rRNAs, alternative to primary rRNA, have been shown to regulate rRNA biogenesis. We have recently detected bidirectional non-coding rRNAs that carry ribozyme-like properties. Anti-antisense oligonucleotides complementary to antisense non-coding rRNAs markedly stabilized the bidirectional transcripts and induced cell death in mouse lung cells. Here, we demonstrated that the same oligonucleotide killed mouse lung-cancer cells preferentially, compared with non-cancer sister lines, suggesting its potential utility for cancer treatment. A human version of anti-antisense oligonucleotide, complementary to an rDNA intergenic site, mediated apoptosis primarily in cancer cells. Autophagic activation was largely undifferentiable between the anti-antisense and other oligonucleotides and accounted for the undesired cytotoxicity in non-cancer cells. Co-treatment with chloroquine, an autophagy inhibitor, reduced cytotoxicity in the non-cancer cells, but retained the anti-antisense-mediated killings in cancer cells. Furthermore, the anti-antisense oligonucleotide stabilized bidirectional non-coding rRNAs predominantly in human cancer cells and perturbed rRNA biogenesis. Contributions of non-coding rRNAs to cell death were proven by transfection of in –vitro-synthesized transcripts. Taken together, cancer/non-cancer cells respond differently to stabilization of non-coding rRNAs, and such differential responses provide a window of opportunity to enhance anticancer efficacy.

CT scan assessment of the pathway of the true lateral approach for transforaminal endoscopic lumbar discectomy

We performed a prospective study to examine the influence of the patient’s position on the location of the abdominal organs, to investigate the possibility of a true lateral approach for transforaminal endoscopic lumbar discectomy. Pre-operative abdominal CT scans were taken in 20 patients who underwent endoscopic lumbar discectomy. Axial images in parallel planes of each intervertebral disc from L1 to L5 were achieved in both supine and prone positions. The most horizontal approach angles possible to avoid injury to the abdominal organs were measured. The results demonstrated that the safe approach angles were significantly less (i.e., more horizontal) in the prone than in the supine position. Obstacles to a more lateral approach were mainly the liver, the spleen and the kidneys at L1/2 (39 of 40, 97.5%) and L2/3 (28 of 40, 70.0%), and the intestines at L3/4 (33 of 40, 82.5%) and L4/5 (30 of 30, 100%). A true lateral approach from each side was possible for 30 of the 40 discs at L3/4 (75%) and 23 of the 30 discs at L4/5 (76.7%). We concluded that a more horizontal approach for transforaminal endoscopic lumbar discectomy is possible in the prone position but not in the supine. Prone abdominal CT is more helpful in determining the trajectory of the endoscope. While a true lateral approach is feasible in many patients, our study shows it is not universally applicable.

Geosmin and 2-methylisoborneol from cyanobacteria in three water supply systems

Three Oscillatoria strains and one Anabaena species were isolated from three different water supply systems in California that experienced earthy-musty taste and odor problems in their drinking water. Unialgal cultures, free of actinomycetes, were purged using the Grob closed-loop stripping analysis method, and the resulting methylene chloride extracts were analyzed on a gas chromatograph/mass spectrometer. Geosmin was produced by Oscillatoria simplicissima and Anabaena scheremetievi, and 2-methylisoborneol was produced by O. curviceps and O. tenuis. These compounds are the two major causes of earthy-musty tastes and odors in water. In three instances, the major odorant found in culture was previously identified in the water or sediment sample from which the respective organism was isolated. O. curviceps was implicated in a taste and odor episode involving 2-methylisoborneol in a major reservoir. Geosmin and 2-methylisoborneol were easily detected with culture samples of only 4 to 25 ml.

Metal release from simulated fixed orthodontic appliances

Most orthodontic appliances and archwires are stainless steel or nickel-titanium (NiTi) alloys that can release metal ions, with saliva as the medium. To measure metal released from the fixed orthodontic appliances currently in use, we fabricated simulated fixed orthodontic appliances that corresponded to half of the maxillary arch and soaked them in 50 mL of artificial saliva (pH 6.75 +/- 0.15, 37 degrees C) for 3 months. We used brackets, tubes, and bands made by Tomy (Tokyo, Japan). Four groups were established according to the appliance manufacturer and the type of metal in the .016 x .022-in archwires. Groups A and B were stainless steel archwires from Ormco (Glendora, Calif) and Dentaurum (Ispringen, Germany), respectively, and groups C and D were both NiTi archwires with Ormco's copper NiTi and Tomy's Bioforce sentalloy, respectively. Stainless steel archwires were heat treated in an electric furnace at 500 degrees C for 1 minute and quenched in water. We measured the amount of metal released from each group by immersion time. Our conclusions were as follows: (1) there was no increase in the amount of chromium released after 4 weeks in group A, 2 weeks in group B, 3 weeks in group C, and 8 weeks in group D; (2) there was no increase in the amount of nickel released after 2 weeks in group A, 3 days in group B, 7 days in group C, and 3 weeks in group D; and (3) there was no increase in the amount of iron released after 2 weeks in group A, 3 days in group B, and 1 day in groups C and D. In our 3-month-long investigation, we saw a decrease in metal released as immersion time increased.

Hepatic resection for bilobar multicentric hepatocellular carcinoma: is it justified?

BACKGROUND

Hepatic resection for multiple hepatocellular carcinomas (HCCs) involving both lobes of the liver is rarely recommended because of high operative risks and low radicality. Thus the justification of hepatic resection for bilobar multicentric HCC remains undefined.

METHODS

Two hundred eleven patients with HCC, who underwent curative hepatic resection, were studied retrospectively. The patients were divided into two groups. Group A consisted of 39 patients with bilobar (both sides of Cantlie's line) multicentric HCCs. Group B consisted of 172 patients with HCC with solitary or unilobar lesions. The backgrounds and resectional results of patients in groups A and B were compared.

RESULTS

Patients in group A usually required multiple separate liver resections and a longer operative time. However, the operative blood loss, amount of blood transfused, and operative morbidity and mortality rates were not significantly different. Patients in group A showed higher incidences of associated satellite nodules, microscopic vascular invasion, and a lack of capsules. The 6-year disease-free and actuarial survival rates of patients in groups A and B were 30.5% and 41.8% (p = 0.17) and 42.9% and 51.4% (p = 0.12), respectively. For patients in group A the presence of satellite nodules in any resected tumor was the only independent unfavorable feature that influenced the actuarial survival rate after multivariate analysis.

CONCLUSIONS

Liver resection is justified for bilobar multicentric HCCs in selected patients, if the tumors can be totally resected. Postoperative adjuvant therapies should be considered when satellite nodules are present in any resected tumor.

Hydrosonography in the evaluation of colorectal polyps

Prewarmed saline enemas and transabdominal ultrasound (hydrosonography) were used to evaluate 17 consecutive children with rectal bleeding before colonoscopy. Twelve patients with polyps were identified (10 by ultrasound, 10 by endoscopy): these included multiple hyperplastic polyps (1), multiple polyps (1), solitary polyps (9), and pseudopolyps (1). Ultrasound identified 11 polyps in 10 patients, missing two patients with small polyps less than 0.5 cm in diameter. The polyps were hyperechoic ovoid masses fixed to the colonic wall, with a stalk (7), submucosal infolding (5), and intraluminal floating (5). There was one false positive. Colonoscopy was refused by one patient and failed to reach beyond the distal sigmoid in another following previous surgery for malrotation. Colonoscopy was superior in identifying finer mucosal detail (colitis, ulcers, proctitis, anal fissure) and in detecting smaller polyps (sessile polyps, hyperplastic polyps). Hydrosonography of the colon is a simple, relatively non-invasive procedure that provides an alternative, radiation-free examination of the whole colon before colonoscopy. It is complementary to colonoscopy in the management of rectal bleeding in children.

Definitive surgical treatment for cholelithiasis in selected patients with liver cirrhosis

To determine whether definitive surgery such as cholecysectomy or extraction of bile duct stones is appropriate in cirrhotic patients the results of definitive surgery have been reviewed retrospectively in a group of 112 cirrhotic patients with cholelithiasis. Eighty-seven of these patients underwent definitive surgery for gallstones and the remaining 25 were treated conservatively. Child's criteria were applied to each patient. Patients with Child's grade A disease had fewer emergency procedures, operative blood loss and transfusion were less and they had a shorter hospital stay compared with patients with grades B and C. There were 4 deaths after definitive surgery for emergency conditions and these were all in Child's grade C. Of the 83 survivors after definitive procedures 78 patients (93.9%) were still alive 52.8 months later without any biliary tract symptoms. Of the 25 patients undergoing conservative treatment 2 were Child's B and 23 were Child's C grade. We suggest that definitive surgery can be carried out safely, in Child's A and B cirrhotic patients, either electively or as an emergency. However, a more conservative approach is advisable in Child C patients with acute conditions and definitive surgery is recommended as an elective procedure after the liver function has improved.

Preliminary results of hepatic resection for centrally located large hepatocellular carcinoma

Resection of large hepatocellular carcinoma (HCC) located in the central portion of the liver remains a surgical challenge. Over a 2 year period, from July 1989, 19 HCC patients whose main tumour (mean diameter 11.3 cm, range 6-19 cm) was located in the central part of the liver (defined as Couinaud's segments IV, V, VIII) had liver resections. Liver cirrhosis was found in 14 patients (73.7%). Extended major hepatectomy could be performed in only three patients. The operative morbidity and mortality were 26.3% and 0%, respectively. The resection margin in 14 patients was less than 1 cm. At the time this paper was written 11 patients were alive and disease free, five patients survived longer than 30 months. The 1 year disease free rate and survival rate were 73.7% and 84.2%, respectively. The preliminary results reveal that with careful preservation of non-tumourous liver, resection of centrally located large HCC is still advocated even in a cirrhotic liver, and that the resection margin width should not be a major concern.

Definitive surgical treatment of cholelithiasis in selective patients with liver cirrhosis

A review of 132 cirrhotic patients with cholelithiasis was carried out. Of the 87 patients who underwent definitive surgical procedures for gallstones, patients of Child's A grade had less operative blood loss, blood transfusion and shorter hospital stay than those of B and C grades. No mortality in cirrhotic patients with Child's A and B grade was found in both emergency and elective surgery. Emergency operation in patients with Child's C grade resulted in more operative blood loss and requirement than elective surgery. Patients in this grade had also a higher morbidity rate and four deaths ensued. Of the 83 survivals after definitive procedures, 78 patients (93.9%) were still alive in the following 62.8 months without any biliary tract symptoms. Of patients who survived after cholecystolithotomy, 6 patients (33.3%) had recurrent stones in the same follow-up period. Therefore, we recommend that definitive biliary surgery be selectively carried out in cirrhotic patients in Child's A and B grade. However, a conservative approach is more suitable in Child's C patients in emergency conditions and definitive procedures should be considered when their liver function improves.

[Bleeding secondary duodenal diverticulum: a rare late complication following nephrolithotomy]

Secondary duodenal diverticula are due primarily to traction upon that section from some other cause such as ulcer, cholecystitis and so forth. It accounts for 1.6 to 20% of all duodenal diverticula. Numerous reports of gastrointestinal hemorrhage from duodenal diverticula have appeared in the literature. But massive UGI bleeding due to secondary duodenal diverticulum, caused by nephrolithotomy, was a rare late complication. Here we present a case of a 63-year-old male patient who underwent a right side nephrolithotomy 10 and 8 years previously, then developed massive UGI bleeding suddenly. Pre-operative UGI series and gastroscopy showed chronic duodenal ulcer and duodenal diverticulum at second section where much blood clot was noted. In time, a successful operation was performed. This complication of secondary duodenal diverticulum was rare, so consideration regarding management and surgical approach was discussed.

[Retrograde jejuno-jejunal intussusception. A rare complication following total gastric resection]

Jejunogastric intussusception is an infrequent complication following simple gastrojejunostomy or Billroth II anastomosis. Jejunojejunal intussusception through enteroenteric anastomosis following total gastrectomy, however, was reported in 2 cases. Here we present a case of a 59-year-old male patient with gastric ulcer who received a total gastrectomy with loop esophagojejunostomy and Braun's anastomosis 10 years previously, then developed retrograde jejunojejunal intussusception through Braun's anastomosis. The patient presented after a day of acute attacks of left upper quadrant pain with bilious vomiting. In-time, an operation was performed with successful results. This complication of retrograde jejunojejunal intussusception has never been reported. Clinical history, diagnosis, and treatment are discussed.

[Case reports of orthodontic treatment related to facial patterns]

This present paper describes 3 clinical cases which were treated according to facial patterns. First, facial pattern of each patient was classified by Ricketts's analysis and then, treatment objects and mechanics were determinded. Brachyfacial patterns are showed a resistant to mandibular rotation during treatment can accept a more prutrusion denture and primary treatment by nonextraction, whereas dolichofacial patterns were tended to open during treatment require a more retracted denture in order to assure post-treatment stability. Brachyfacial pattern would better treat to use extrusive force system, whereas dolichofacial pattern treat to use intrusive force system with head gear and intermaxillary elastics.

[Case reports and discussion on anterior open bite]

Anterior openbites cause impaired masticatory, malfunction of tongue, speech defects, disuse atrophy of teeth and periodontal tissue, esthetic problem. It is corrected by some available orthodontic methods according to its etiologic factors and growth stage. Removable appliances with tongue crib, spring loaded occlusal bite block, M.E.A.W. with rubber elastics, vertical chin cap and high pull head gear are selected for its correction. Extraction is considered for preventing wedging effect and Adenoidectomy is performed as adenoid cause mouth breathing. In the case of treatment of anterior openbites, combined therapy acquire better results than single treatment method. Removal of etiologic factors and accurate diagnosis is the best way of prevention of its recurrence.

Isolation of ketoses or nonreducing sugars from a sugar mixture containing aldoses by aniline treatment

A method for the isolation of ketoses and nonreducing sugars from sugar mixtures by the addition of aniline, in the presence of acetic acid as a catalyst, is described. The aldoses react readily to form aniline derivatives, which are then removed using standard procedures: extraction with organic solvents, and treatment with activated charcoal and with a cation-exchange resin. The ketoses and nonreducing sugars are retained in aqueous solution.

Characterization of angiotensin II binding sites on neuroblastoma X glioma hybrid cells

Mouse neuroblastoma X rat glioma hybrid cells, NG108-15, have recently been shown to contain immunoreactive angiotensin II (AII). In the present study, we have examined this hybrid cell line for the presence of specific AII binding sites using [125I] AII. Specific AII binding was saturable and reversible. Scatchard analysis revealed a linear plot with an affinity constant (Kd) of 0.323 nM and a binding capacity (Bmax) of 7.13 fmol/mg protein. Kinetic studies demonstrated an association rate constant (K+1) of 3.55 X 10(6) M(-1) sec-1 and a dissociation rate constant (K-1) of 4.18 X 10(-4) sec-1. Displacement curves, using concentrations of 10(-11) M to 10(-4) M of unlabeled AII, revealed high and low affinity components of the AII binding site with IC50's of 0.46 nM and 1.75 microM respectively. The AII antagonist, saralasin, had approximately equal potency with unlabeled AII at the high affinity site. Furthermore, structurally related and unrelated peptides had no significant inhibitory effect on AII binding. This study demonstrates that specific AII binding sites are present on NG108-15 cells, and that these binding sites are similar in kinetic character to the AII receptor that has been previously identified in membranes from mammalian brain. It is concluded that the NG108-15 hybrid cells may provide a useful continuous cell line model for investigating both the biochemical and molecular properties of the AII binding site.

LINKAGE OF MUTATIONS AFFECTING MINUS FLAGELLAR MEMBRANE AGGLUTINABILITY TO THE mt - MATING-TYPE LOCUS OF CHLAMYDOMONAS

Two independently isolated mutant strains, imp-10 and imp-12, were obtained by UV irradiation of wild-type mating-type minus (wt-). Each fails to agglutinate sexually with gametes of either mating type, but mating and zygote formation can be elicited by agglutinating either strain to wt+ gametes by means of anti-flagellar antiserum. Tetrad analysis of the resultant zygotes shows that both imp-10 and imp-12 are very closely linked to mt  -, with no recombinants observed. Diploid strains constructed between imp-10 or imp-12 and wt+ gametes are wt-, that is, they agglutinate and fuse like normal minus cells. Tetrad analysis of triploids from imp-10 diploid x wt+ haploid crosses shows that only imp-10 and wt+ products are recovered. A model is proposed to account for these results.