Influence of anterior talofibular ligament injury and mechanical ankle anterior displacement on symptoms in individuals with chronic ankle instability.

CONTEXT: Repeated ankle sprains can lead to injuries, including those of the anterior talofibular ligament; however, the extent to which these ligament injuries are associated with symptoms of chronic ankle instability remains unclear. OBJECTIVE: To examine the influence of anterior talofibular ligament injury and ankle anterior displacement on symptoms of chronic ankle instability. DESIGN: Case-Control Study. SETTING: A university laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 426 college students completed a questionnaire survey on the history of ankle sprain. Thirty-four (24 males, 10 females; age = 20.6 ± 0.5 years), 49 (38 males, 11 females; age = 20.2 ± 1.2 years), and 39 (24 males, 15 females; age = 20.1 ± 1.1 years) participants were enrolled in the healthy, coper, and chronic ankle instability groups, respectively. DATA COLLECTION AND ANALYSIS: One examiner measured the anterior talofibular ligament delineation using ultrasound and anterior ankle displacement using a capacitance-type sensor device. The Cumberland Ankle Instability Tool was applied to assess pain and perceived instability. RESULTS: The anterior talofibular ligament was normal significantly more frequently in healthy participants and abnormal significantly more frequently in patients with chronic ankle instability (p < 0.001). Anterior ankle displacement was significantly greater in the coper and chronic ankle instability groups than in healthy individuals (p < 0.001), but no significant difference was observed between the coper and chronic ankle instability groups. There was no significant correlation between the anterior ankle displacement and Cumberland Ankle Instability Tool scores (p = 0.709) in participants with previous ankle sprains. CONCLUSION: Observation of an abnormal anterior talofibular ligament on ultrasonography is associated with anterior displacement of the ankle joint. However, it is assumed that the influence of anterior ankle displacement due to damage to the anterior talofibular ligament on the pain and perceived instability in chronic ankle instability is small.

Structural basis for the broad substrate specificity of the human tyrosylprotein sulfotransferase-1.

Tyrosylprotein sulfotransferases (TPSTs) are enzymes that catalyze post-translational tyrosine sulfation of proteins. In humans, there are only two TPST isoforms, designated TPST1 and TPST2. In a previous study, we reported the crystal structure of TPST2, which revealed the catalytic mechanism of the tyrosine sulfation reaction. However, detailed molecular mechanisms underlying how TPSTs catalyse a variety of substrate proteins with different efficiencies and how TPSTs catalyze the sulfation of multiple tyrosine residues in a substrate protein remain unresolved. Here, we report two crystal structures of the human TPST1 complexed with two substrate peptides that are catalysed by human TPST1 with significantly different efficiencies. The distinct binding modes found in the two complexes provide insight into the sulfation mechanism for these substrates. The present study provides valuable information describing the molecular mechanism of post-translational protein modifications catalysed by TPSTs.

Predictive factors for body weight loss and its impact on quality of life following gastrectomy.

AIM: To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life (QOL). METHODS: We applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45, which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments, in addition to 22 newly selected items. Between July 2009 and December 2010, completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage I gastric cancer at one of 52 participating institutions. Of those, we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure (TGRY) or distal gastrectomy with Billroth-I (DGBI) or Roux-en-Y (DGRY) procedures. RESULTS: A total of 393, 475 and 909 patients underwent TGRY, DGRY, and DGBI, respectively. The mean age of patients was 62.1 ± 9.2 years. The mean time interval between surgery and retrieval of the questionnaires was 37.0 ± 26.8 mo. On multiple regression analysis, higher preoperative body mass index, total gastrectomy, and female sex, in that order, were independent predictors of greater body weight loss after gastrectomy. There was a significant difference in the degree of weight loss (P < 0.001) among groups stratified according to preoperative body mass index (< 18.5, 18.5-25 and > 25 kg/m2). Multiple linear regression analysis identified lower postoperative body mass index, rather than greater body weight loss postoperatively, as a certain factor for worse QOL (P < 0.0001) after gastrectomy, but the influence of both such factors on QOL was relatively small (R2, 0.028-0.080). CONCLUSION: While it is certainly important to maintain adequate body weight after gastrectomy, the impact of body weight loss on QOL is unexpectedly small.

Antibacterial activities of sulfamethoxazolyl-azo-phenols and their Cu(II) complexes along with molecular docking properties.

Sulfamethoxazolyl-azo-phenols [SMX-N=N-C6H2(R)(R/)-OH] (1a, 2a) and their Cu(II) complexes, [Cu(SMX-N=N-C6H2(R)(R/)-O)2] (1b, 2b) (R = p-OMe, R/ = H, 1a/1b; R = p-Cl, R/ = m-CH3, 2a/2b) show antibacterial sensitivity against Gram-positive bacteria, B. subtillis; IC50: 281.47 ± 1.84 µM (1a), 126.39 ± 1.66 µM (1b), and 279.94 ± 3.15 µM (2a), 123.62 ± 1.27 µM(2b), and Gram-negative bacteria, E. coli; IC50: 204.66 ± 3.31 µM (1a) and 89.05 ± 1.48 µM (1b), 223.13 ± 2.71 µM (2a), and 98.26 ± 1.59 µM (2b). Interaction of DNA with free ligand (1a and 2a) is insignificant, while the complexes (1b and 2b) interact strongly and the binding constants are K b, 8.413 × 104 M-1 (1b) and 6.56 × 105 M-1 (2b). Optimized structures of the compounds are docked with protein structure of DHPS (E. coli) to propose the most favoured binding mode of the drugs in the active site. The in silico test of the compound helps to understand drug metabolism, drug-protein interactions, and toxicity (ADMET).

Crystal structure of hexa-kis-(urea-κO)chromium(III) dichromate bromide monohydrate from synchrotron X-ray data.

The title bromide salt, [Cr{CO(NH2)2}6](Cr2O7)Br·H2O, is isotypic to the corresponding chloride salt. Within the complex cation, the Cr(III) atom is coordinated by six O atoms of six urea ligands, displaying a slightly distorted octa-hedral coordination environment. The Cr-O bond lengths involving the urea ligands are in the range 1.9534 (13)-1.9776 (12) Å. The Cr2O7 (2-) anion has a nearly staggered conformation, with a bridging angle of 130.26 (10)°. The individual components are arranged in rows extending parallel to [100]. The Br(-) anion links the complex cation, as well as the solvent water mol-ecule, through N-H⋯Br and O-H⋯Br hydrogen-bonding inter-actions. The supra-molecular architecture also includes N-H⋯O and O-H⋯O hydrogen bonding between urea N-H and water O-H donor groups and the O atoms of the Cr2O7 (2-) anion as acceptor atoms, leading to a three-dimensional network structure.

MK-1 expression in gastric carcinoma with liver metastasis.

OBJECTIVE: The prognosis for gastric carcinoma patients with liver metastasis is very poor. This retrospective study investigated the prognostic significance of MK-1 expression in gastric carcinoma patients with liver metastasis. METHODS: Immunohistochemical staining using monoclonal antibody FU-MK-1 against MK-1 antigen was performed on paraffin-embedded tissues from 64 gastric carcinoma patients with liver metastasis. We attempted to determine the presence of any relationship between pathological prognostic factors and the expression of MK-1 in 64 gastric carcinoma patients with liver metastasis. RESULTS: MK-1 expression was found in 43 (67%) of 64 tumor samples. MK-1 expression was significantly higher in the intestinal type (73%) than in the diffuse type carcinoma (33%, P = 0.049). Multivariate analysis showed that MK-1 expression and lymph node metastasis were significant factors for overall survival. The difference between overall survival rates with positive or negative MK-1 expression was statistically significant as shown by Kaplan-Meier survival analysis (P < 0.0001; log-rank). In addition, the difference between cumulative disease-free survival rates with positive or negative MK-1 expression in gastric carcinoma patients with metachronous liver metastasis was statistically significant as well, as shown by Kaplan-Meier survival analysis (P = 0.0006; log-rank). CONCLUSIONS: The prognostic significance of MK-1 expression as a biological tumor marker was demonstrated in a series of gastric carcinoma patients with liver metastasis. MK-1 positivity may be a reliable marker for predicting and taking measures to control liver metastasis after curative gastrectomy for gastric carcinoma.

Laparoscopic distal gastrectomy with intracorporeal handsewn Billroth-I anastomosis (ICHSA).

BACKGROUND: The number of cases of laparoscopic surgery has been increasing. Lymph node dissection has been standardized, and the enlarged view provided by laparoscopes allows for the procedure to be performed successfully entirely within the abdominal cavity, but many cases of reconstruction using the Billroth-I method are performed under direct vision through a small incision. In this study, by placing an anchor thread on a suture line on the lesser curvature of the stomach, we simplified the procedure for handsewn anastomosis and safely performed gastroduodenal anastomosis at low cost to obtain good results. METHODS: From January 2009 to December 2010, we performed handsewn gastroduodenal anastomosis in 18 cases. After performing lymph node dissection, the duodenum and the stomach were separated using an automatic stapling device. Anchor sutures were placed on the suture line of the lesser curvature of the stomach. First, the seromuscular layer of the stomach and the seromuscular layer of the duodenum were sutured by performing interrupted suturing using an extracorporeal knot-tying method. With the stomach and the duodenum in a fixed state, the anastomosis area was opened. The thread of the anchor suture was pulled toward the abdominal wall, and then all layers of the stomach and the duodenum at the posterior wall were continuously sutured. Similarly, for the anterior wall, all layers were continuously sutured from the lesser curvature toward the greater curvature. RESULTS: We performed this anastomotic procedure in 18 patients with early gastric carcinoma. The mean time required for the anastomosis was 64.6 ± 17.1 min, and the estimated blood loss was 53.1 ± 91 g. All operations were curative, and the mean number of retrieved lymph node was 27.1 ± 10.8. A nasogastric tube was removed on the first or second day. An upper gastrointestinal series performed on postoperative days 5-6 showed no anastomotic leakage and normal transit. Oral intake was started on days 6-7. Postoperative complications included one case of a ruptured suture, but this was resolved through a conservative approach. There was no mortality. Postoperative endoscopy revealed that the anastomosis area was extremely soft, and no abnormalities were observed. Moreover, the only costs related to the anastomosis were for the thread and needles, and although more time was required compared with mechanical anastomosis, the cost was extremely low. CONCLUSIONS: We performed gastroduodenal anastomosis under a total laparoscopic approach by handsewn. This method is economical, because it does not require the use of machinery for anastomosis, and the duodenal stump is short. We believe that this method, which can be performed in a similar manner even for obese patients, can be used as a standard method of anastomosis.

Early start of chemotherapy after resection of primary colon cancer with synchronous multiple liver metastases: a case report.

The start of chemotherapy treatment usually requires a delay of about 4 weeks after surgical resection in patients with primary colorectal cancer and synchronous distant metastasis. However, there is no evidence to indicate the required length of this delay interval. In addition, there is a chance that a patient may die because postoperative chemotherapy was not started soon enough and a metastatic tumor was able to develop rapidly. Here, we present a case in which combination chemotherapy with capecitabine and oxaliplatin (XELOX) was started within 1 week after a right hemicolectomy for synchronous multiple liver metastases. To our knowledge, this is the first report of the start of chemotherapy, involving treatments such as folinic acid, fluorouracil, and oxaliplatin (FOLFOX); folinic acid, fluorouracil, and irinotecan (FOLFIRI); and XELOX, within 1 week after a colorectal cancer operation with anastomosis. The findings suggest possible changes in the start time of chemotherapy after surgery in the future.

Clinical outcomes of Roux-en-Y and Billroth I reconstruction after a distal gastrectomy for gastric cancer: What is the optimal reconstructive procedure?

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical advantages of Roux-en-Y (R-Y) and Billroth-I (B-I) reconstruction after distal gastrectomy for gastric cancer by examining the postoperative symptoms based on a patient questionnaire and patient nutrition. In addition, this study determined which of the R-Y or B-I procedures is preferable following distal gastrectomy. METHODOLOGY: Fifty-one patients who had undergone R-Y reconstruction and 50 patients who had undergone B-I reconstruction were retrospectively enrolled in this study. The operative and postoperative findings such as operating time, blood loss, complications, and postoperative hospital stay were evaluated as short-term clinical outcomes. Postoperative serum nutrition parameters, transition of body weight, incidence of residual gastritis, and clinical symptoms were evaluated as mid-term clinical outcomes. An assessment of symptoms was based on a questionnaire concerning dumping symptoms, reflux symptoms, food intake, and satisfaction with the operation. RESULTS: No significant differences were observed in the operative and postoperative clinical parameters without stage grouping. The transition of serum nutrition parameters revealed no significant differences between the two groups for the preoperative and postoperative states. Dumping symptoms, reflux symptoms, and abdominal symptoms were less frequent in R-Y patients, but there were no significant differences between the two groups. Moreover, the differences in body weight recovery rates were not found to be statistically significant between two groups. However, the incidence of residual gastritis was significantly less in R-Y patients (21.2%) than in B-I patients (68.8%) (p < 0.05). The questionnaire results regarding food intake and surgery satisfaction were not significantly different between the two groups. CONCLUSIONS: Definite clinical advantages were not recognized in patients with R-Y reconstruction. B-I and R-Y reconstructive procedures should be selected according to the condition of each patient. However, the advantages of these reconstruction procedures following distal gastrectomy would only be revealed in large randomized controlled trials.

Clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing Crohn's disease: when and how were the seton drains removed?

BACKGROUND/AIMS: Perianal fistulas are often found in patients with Crohn's Disease (CD), however, the complete management of such fistulas tends to be difficult. The aim of this study is to critically evaluate the clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing CD. METHODOLOGY: Fourteen patients (9 males, 5 females) were evaluated for perianal fistulizing CD with the seton and infliximab therapy. Almost all patients were examined for the presence of either an abscess or fistulas by computed tomography (CT) and/or Magnetic Resonance Imaging (MRI) in addition to their physical findings. Seton placement was performed under general anesthesia, following the administration of inflixmab at a dose of 5 mg/kg for weeks 0, 2 and 6, and then about every 8 weeks as a maintenance therapy. RESULTS: For all patients average number of inserted drains was 4.5 and the average number of infliximab infusions was 9.4 times. The mean follow-up period was 12.1 months. A redness and/or swelling in perianal lesion were seen in 12 patients, moreover, pus discharge was seen in 7 patients, and serous exudate was seen in 7 patients. After the administration of these treatments, a reversal of the redness and/or swelling was seen in the exudate and a wet-to-dry wound change was found in all patients. Furthermore, the seton drains were completely removed in 11 patients. In most patients, seton drains were completely removed after 5 rounds of infliximab infusion. Following the removal of the seton drains from all the patients, they reported their post-treatment health and well-being to be good while also reporting a good quality of life (QOL). In addition, no serious adverse events were observed. CONCLUSIONS: The combined seton placement and infliximab maintenance therapy for perianal fistulizing CD was therefore found to be effective in terms of fistula closure and the removal of seton drains. This treatment modality is therefore considered to be a safe clinical procedure which improves the QOL in patients with CD.

[Evaluation of bevacizumab for advanced colorectal cancer].

BACKGROUND: Recently, Bevacizumab became one of the major therapeutics in the care of advanced and recurrent colorectal cancer patients in Japan. The present study evaluated the efficacy and the adverse events in 23 patients who were treated with Bevacizumab. METHODS: From April, 2007 to February, 2009, 23 colorectal cancer patients were treated with Bevacizumab. We evaluated the adverse events and the time to progression (TTP). RESULTS: The median age of the patients was 60 years old. Advanced cases were 14 and recurrence cases were 9. The basic combination chemotherapy with Bevacizumab included FOLFOX (14 patients), FOLFIRI (8 patients), and IFL (1 patient). Although grade 3 of melena was recognized in one patient, the other mild adverse events were treated without accident. The median TTP was 108 days, and was not significantly different between combination with mFOLFOX6 or FOLFIRI. In combination therapy of Bevacizumab and mFOLFOX6, the TTP of Bevacizumab first-line treatment was significantly longer than that of second-line treatment (p<0. 05). In contrast, the TTP was no different in FOLFIRI therapy with or without Bevacizumab. CONCLUSION: Although one grade 3 side effect was observed, most patients were treated safely with Bevacizumab. mFOLFOX6 with Bevacizumab was recommended for first-line therapy of advanced or metastatic colorectal cancer.

Prospective randomized trial of a closed-suction drain versus a Penrose drain after a colectomy.

BACKGROUND/AIMS: Prospective studies in the gastroenterological surgery literature have shown fewer wound related complications with a closed-suction drainage than with an open passive drainage. This study compared the SSI and cost of closed-suction drainage and open passive drainage in a randomized trial. METHODOLOGY: This study involved 112 patients undergoing colectomy from December, 2003 through April, 2007. A closed-suction or an open (Penrose) drainage was used based on the surgeon's preference. The cost and the incidence of complications including SSI was compared in the two drain types. RESULTS: The SSI rate was 13/112 cases 11.6%, but there was no significant difference between the drain groups. In addition, 18 laparoscopic surgery cases did not show any wound infection or drain infections. The closed-suction drain was not expensive regarding personnel expenses and the cost of changing the dressings. CONCLUSIONS: No statistically significant postoperative differences were observed between a closed-suction drain or an open drain after a colectomy. However, a closed-suction drain management is useful for the reduction of a cost, labor saving, and the decrease of medical waste.

[A case of gastric cancer with posterior mediastinal lymph node metastasis responding to combination therapy of Paclitaxel and S-1].

The patient was a 73-year-old man who was hospitalized with advanced gastric cancer. Computer tomography showed multiple liver and mediastinum lymph node metastases. Therefore, he was diagnosed as unresectable gastric cancer(Stage IV). We attempted low-dose combination therapy of CDDP and S-1, but it was ineffective against advance gastric cancer. We decided to change the chemotherapy, using combination therapy of paclitaxel and S-1. In the regimen, paclitaxel (60 mg/m/2) was administered on day 1, day 8, and day 15. S-1 (80 mg/m2) was administered 4 weeks with a 2-week rest. After the 2 courses, computer tomography showed reduction of the liver metastasis and disappeared of the lymph node metastases. Therefore, he could undergo total gastrectomy and radiofrequency ablation of liver metastases. He continued this combination therapy one year after the operation. The cancer has not recurred thus far. When combination chemotherapy of paclitaxel and S-1 was effective against Stage IV gastric cancer, we suggested that radical surgery is possible for those cases.

Clinical outcomes and advantages of laparoscopic surgery for primary Crohn's disease: are they significant?

BACKGROUND/AIMS: The clinical outcomes and advantages of laparoscopic surgery for Crohn's disease have not yet been recognized in general. The aim of this study was to critically assess the clinical outcomes, safety, cosmesis, quality of life (QOL) and feasibility of laparoscopic surgery for primary Crohn's disease. METHODOLOGY: The study subjects consisted of 48 patients who had primary surgical treatment for Crohn's disease, 28 through conventional laparotomy and 20 in whom surgery was laparoscopically assisted. The short-term and long-term outcomes, cosmesis, and postoperative QOL were evaluated in both groups. RESULTS: There were no statistically significant differences in the patient characteristics between the two groups. In the laparoscopic group, non-resected procedures were significantly more frequent (p < 0.05), blood loss was less (p < 0.05), oral intake was started earlier (p < 0.05) and the length of the skin incision was shorter (P < 0.01). The C-reactive protein values and leukocyte counts were not significantly different in the two groups. The cosmetic results were very satisfactory in 11 patients (64.7%). There were no severe complications and no increase of the recurrence rate for laparoscopic surgery. Moreover, there was no definite clinical disadvantage and no prolonged operating time in the laparoscopic procedures. CONCLUSIONS: Laparoscopic surgery for primary Crohn's disease is safe and feasible in selected patients without severe adhesion, fistula or abscess, and was associated with better cosmesis than conventional open surgery. Therefore, laparoscopic procedures should be considered as the preferred operative approach for a primary bowel resection.