Is the native ACL insertion site "completely restored" using an individualized approach to single-bundle ACL-R?

PURPOSE: The goal of individualized anatomic anterior cruciate ligament reconstruction (ACL-R) is to reproduce each patient's native insertion site as closely as possible. The amount of the native insertion site that is recreated by the tunnel aperture area is currently unknown, as are the implications of the degree of coverage. As such, the goals of this study are to determine whether individualized anatomic ACL-R techniques can maximally fill the native insertion site and to attempt to establish a crude measure to evaluate the percentage of reconstructed area as a first step towards elucidating the implications of complete footprint restoration. METHODS: This is a prospective pilot study of 45 patients who underwent primary single-bundle anatomic ACL-R from May 2011 to April 2012. Length and width of the native insertion site were measured intraoperatively. Using published guidelines, reconstruction technique and graft choice were determined to maximize the percentage of reconstructed area. Native femoral and tibial insertion site area and femoral tunnel aperture area were calculated using the formula for area of an ellipse. On the tibial side, tunnel aperture area was calculated with respect to drill diameter and drill guide angle. Percentage of reconstructed area was calculated by dividing total tunnel aperture area by the native insertion site area. RESULTS: The mean areas for the native femoral and tibial insertion sites were 83 ± 20 and 125 ± 20 mm(2), respectively. The mean tunnel aperture area for the femoral side was 65 ± 17, and 86 ± 17 mm(2) for the tibial tunnel aperture area. On average, percentage of reconstructed area was 79 ± 13 % for the femoral side, and 70 ± 12 % for the tibial side. CONCLUSION: Anatomic ACL-R does not restore the native insertion site in its entirety. Percentage of reconstructed area serves as a rudimentary tool for evaluating the degree of native insertion site coverage using current individualized anatomic techniques and provides a starting point from which to evaluate the clinical significance of complete footprint restoration. LEVEL OF EVIDENCE: IV.

Electronic screening-enhanced hole pairing in two-leg spin ladders studied by high-resolution resonant inelastic x-ray scattering at Cu M edges.

We study the electronic screening mechanisms of the effective Coulomb on-site repulsion in hole-doped Sr(14)Cu(24)O(41) compared to undoped La(6)Ca(8)Cu(24)O(41) using polarization dependent high-resolution resonant inelastic x-ray scattering at Cu M edges. By measuring the energy of the effective Coulomb on-site repulsion and the spin excitations, we estimate superexchange and hopping matrix element energies along rungs and legs, respectively. Interestingly, hole doping locally screens the Coulomb on-site repulsion reducing it by as much as 25%. We suggest that the increased ratio of the electronic kinetic to the electronic correlation energy contributes to the local superexchange mediated pairing between holes.

POEMS syndrome with Guillan-Barre syndrome-like acute onset: a case report and review of neurological progression in 30 cases.

POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes) syndrome is a rare cause of demyelinating neuropathy with monoclonal plasma cell proliferation, and POEMS neuropathy is usually chronically progressive. Herein, the authors report a 34-year-old woman with POEMS syndrome presenting as acute polyneuropathy. Within 2 weeks of disease onset, she became unable to walk with electrodiagnostic features of demyelination and was initially diagnosed as having Guillan-Barré syndrome. Other systemic features (oedema and skin changes) developed later, and an elevated serum level of vascular endothelial growth factor led to the diagnosis of POEMS syndrome. She received high-dose chemotherapy with autologous peripheral blood stem cell transplantation, resulting in good recovery. The authors also reviewed patterns and speed of progression of neuropathy in the 30 patients with POEMS syndrome; 22 (73%) of them were unable to walk independently with the median period of 9.5 months from POEMS onset (range 0.5-51 months). Whereas the speed of neuropathy progression varies considerably among patients, some POEMS patients can show acute or subacute polyneuropathy. The early diagnosis and treatment could result in rapid improvement as shown in the present patient.

Neuromuscular transmission is not impaired in axonal Guillain--Barré syndrome.

BACKGROUND: Previous studies have shown that anti-GQ1b antibodies induce massive neuromuscular blocking. If anti-GM1 and -GD1a antibodies have similar effects on the neuromuscular junction (NMJ) in human limb muscles, this may explain selective motor involvement in axonal Guillain--Barré syndrome (GBS). METHODS: Axonal-stimulating single-fibre electromyography was performed in the extensor digitorum communis muscle of 23 patients with GBS, including 13 with the axonal form whose sera had a high titre of serum IgG anti-GM1 or -GD1a antibodies. RESULTS: All patients with axonal or demyelinating GBS showed normal or near-normal jitter, and no blocking. CONCLUSION: In both axonal and demyelinating GBS, neuromuscular transmission is not impaired. Our results failed to support the hypothesis that anti-GM1 or -GD1a antibody affects the NMJ. In GBS, impulse transmission is presumably impaired in the motor nerve terminal axons proximal to the NMJ.

Experimental observation of the crystallization of a paired holon state.

An excitation at 201 meV is observed in the doped-hole ladder cuprate Sr14Cu24O41, using ultraviolet resonance Raman scattering with incident light at 3.7 eV polarized along the rungs. The excitation is of charge nature, with a temperature independent excitation energy, and can be understood via an intraladder pair-breaking process. The intensity tracks closely the order parameter of the charge density wave in the ladder CDW(L), but persists above its transition temperature T(CDW(L)), indicating a strong local pairing above the T(CDW(L)). The 201 meV excitation vanishes in La6Ca8Cu24O(41+δ), and La5Ca9Cu24O41 which are samples with no holes in the ladders. Our results suggest that the doped holes in the ladder are composite bosons consisting of paired holons that order below T(CDW).

Parasite egg contamination of vegetables from a suburban market in Hanoi, Vietnam.

Helminth egg contamination of vegetables purchased at suburban market in Hanoi, Vietnam was examined. A total of 317 vegetables were examined and 82 (26%) were revealed to be positive for parasite eggs. Of the 15 varieties, 13 were positive except for horseradish and cucumber. Contamination was highest in leafy vegetables (31%), followed by root vegetables (17%) and fruit vegetables (3%). Throughout the survey, five species of parasite eggs were found: Ascaris sp., Trichuris sp., Toxocara sp., Taenia sp. and Ascaridia galli. In the interview with the villagers, 121 (81%) of 149 adult villagers stated that they usually use not only animal feces but also human feces as a fertilizer. Throughout the survey, a total of 453 eggs were recovered. Number of eggs recovered from vegetables was higher in the dry season (355 eggs) than in the rainy season (98 eggs). The study revealed that vegetables purchased at a market in suburban Hanoi (Vietnam) were highly contaminated with parasite eggs excreted by humans and animals. Considering the eating habits of the Vietnamese and the 17% embryonation rate of detected parasites, vegetables seem to play an important role in soil-transmitted helminth infection in this country.

Distribution of ethenzamide and other ingredients on granule surfaces studied by Raman microspectroscopy and mapping.

Distributions of API and medical additives in granules were analyzed using Raman microspectroscopy and mapping. In order to clearly detect ingredients present at low levels, the characteristic peak for each ingredient was used for identification. Two granulation processes, tumbling granulation and high-shear granulation were selected to examine the feasibility of Raman microspectroscopy for investigating granules. Ethenzamide, lactose monohydrate, cornstarch and methylcellulose were used to make model granules. Methylcellulose was distributed homogeneously from the early stage in both granulation methods. Cornstarch and lactose showed similar distribution properties in high-shear granulation. It was presumed from this observation that similar chemical structures with high-hydrophilic groups in the two compounds determined their similar distribution properties. These results suggest that Raman microspectroscopy using the unique absorption peak of each ingredient can detect each ingredient in the individual pixel size (2 x 2 microm). This analytical method can contribute to evaluation of granular conditions and granulation processes.

Chemical mapping of tulobuterol in transdermal tapes using microscopic laser Raman spectroscopy.

Microscopic Laser Raman Spectroscopy and Mapping (MLRSM) technique was used to investigate the distribution of tulobuterol (TBR) crystals in transdermal tapes. TBR is one of suitable compounds for the transdermal pharmaceuticals because it has high permeability into skin. In case of TBR transdermal tapes, some commercial products also contain TBR crystals in order to control a release rate from a matrix. Therefore, the presence of TBR crystals in the matrix is a critical factor for quality assurance of this type of TDDS tapes. The model tapes prepared here employed two kinds of matrices, i.e., rubber or acrylic, which are generally used for transdermal pharmaceuticals. TBR crystals in the matrix were observed by MLRSM. Accurate observation of the distribution of TBR in the tapes was achieved by creating a Raman chemical map based on detecting unique TBR peak in each pixel. Moreover, differences in the growth of TBR crystals in the two kinds of matrices were detected by microscopic observation. MLRSM also enabled the detection of TBR crystals in commercial products. The present findings suggest that Raman micro-spectroscopic analysis would be very useful for verifying and/or assessing the quality of transdermal pharmaceuticals in development, as well as for manufacturing process control.

NIR spectroscopic investigation of two fluoroquinolones, levofloxacin and ofloxacin, and their tablets for qualitative identification of commercial products on the market.

A rapid and nondestructive identification method for ofloxacin (OFLX) and levofloxacin (LVFX) utilizing diffusion reflectance near-infrared (NIR) spectroscopy was developed. An obvious difference in spectral patterns between LVFX that is used for commercial tablets and LVFX HCl that can be purchased as a reagent at a low price was also observed. These quinolones are especially important for use as drugs against bio-terrorism because of their effectiveness against anthrax infection. Therefore, the possibility of a distribution of counterfeit drugs containing LVFX HCl on the market would be expected. NIR spectroscopic analysis would be applicable to on-site quality analysis that can be carried out easily and nondestructively.

Strain amplification of the 4k_(F) chain instability in Sr14Cu24O41.

We used resonant soft x-ray scattering to study the chain ordering in Sr14Cu24O41 (SCO). We observed, for the first time, both the chain and ladder orders in SCO with the same probe. We found that the chain modulation in SCO is incommensurate with wave vector L_(c)=0.318, is strongly temperature (T) dependent, and is accompanied by a substantial hole modulation. By contrast, the chain modulation in a hole-depleted control sample La6Ca8Cu24O41 was commensurate (L_(c)=0.3), T independent, and purely structural. We conclude that the chain charge order in SCO is a 4k_(F) charge density wave stabilized by the misfit strain between the ladder and chain substructures.

Studies on the influence of uniformity of particle size of powder, tapping and sample replacement for diffusion reflectance quantitative NIR spectrometric analysis.

The extent of deviation factors and the influence of pre-processing of spectra for a quantitative application of reflectance NIR measurement against powder sample were examined. Lactose monohydrate (NGLM), a medical additive was used for this study. Ground lactose monohydrate (GLM) and NGLM were measured by NIR reflectance spectroscopy. In the wave number range from 12000 cm(-1) to 4000 cm(-1), the ratios of absorbance values (a.v.) between the wave numbers of GLM and NGLM were almost the same and no influence of intensity of absorbance through the measurement range was observed concerning heterogeneity of particle size. Absorbance values of NGLM were decreased with increasing number of tapping without a bit difference of the change of a.v. The several statistical parameters of a.v. from both samples were estimated. The relative standard deviation (RSD) and 95% confidence intervals (CIs) of a.v. on successive measurements at a fixed position in GLM and NGLM vials were almost the same. However, the RSD and 95% confidence of absorbance value of NGLM were larger than these GLM, i.e., RSD: 0.66% for NGLM, 0.42% for GLM. The 95% of CI of NGLM was ten times larger than that of GLM in five replacement positions. The two kinds of baseline corrections, the SNV and MSC processing were examined to evaluate the extent of influence against a.v. The 95% CI calculated from a.v. by the SNV pre-processing showed a wider range compared with that from no pre-processing and MSC pre-processing. These results suggest that the statistical confidence of a.v. would also change by pre-processing. It is important to consider the statistical confidence of a.v. for precise quantitative application of the reflectance NIR spectroscopy.

Quantum melting of the hole crystal in the spin ladder of Sr(14-x)CaxCu24O41.

We have used resonant soft x-ray scattering to study the effects of discommensuration on the hole Wigner crystal (HC) in the spin ladder Sr(14-x)CaxCu24O41 (SCCO). As the hole density is varied the HC forms only with the commensurate wave vectors L(L) = 1/5 and L(L) = 1/3; for incommensurate values it "melts." A simple scaling between L(L) and temperature is observed, tau1/3/tau1/5 = 5/3, indicating an inverse relationship between the interaction strength and wavelength. Our results suggest that SCCO contains hole pairs that are crystallized through an interplay between lattice commensuration and Coulomb repulsion, reminiscent of the "pair density wave" scenario.

In vitro antiparasitic activity of extracts of Cardiospermum halicacabum against third-stage larvae of Strongyloides stercoralis.

Extracts of Cardiospermum halicacabum, medicinal plant, were tested in vitro for their effectiveness against third-stage larvae of Strongyloidesstercoralis. Third-stage larvae of S. stercoralis were isolated from cultures of dog's feces using agar plate culture method. The larvae (1,000 larvae/ml), suspended in phosphate buffer saline solution, pH 7.4, were exposed to aqueous and alcohol extracts (2,000 microg/ml) of C. halicacabum at 37 degrees C with 5% CO2. Ivermectin (250 microg/ml) and piperazine (2,000 microg/ml) were also used as the reference drugs. The survival of Strongyloides larvae based on its motility was determined daily for 7 days. Strongyloides larvae were viable after contact with ivermectin, piperazine and C. halicacabum (aqueous and alcohol) solutions, but most of them were immobilized, after exposure to aqueous and alcohol extracts of C. halicacabum within 72 and 48 h, respectively, while ivermectin took from 72 to 144 h, and piperazine more than 7 days, to achieve the same rate of nonmotility. Clearly, the viability of S. stercoralis larvae was significantly reduced when exposed to extracts of C. halicacabum. Further study is needed on the antiparasitic activity of aqueous and alcohol extracts of C. halicacabum against S. stercoralis.

Metabolism of the calmodulin antagonist DY-9760e in animals and humans.

The in vitro metabolism of the calmodulin antagonist DY-9760e was investigated using liver microsomes from humans and three other animal species and compared with the in vivo metabolism in rats after intravenous administration of DY-9760e. Seven major metabolites were produced by human liver microsomes by the following metabolic pathways: N-dealkylation, phenyl hydroxylation, O-demethylation and imidazole oxidation. These metabolites were also produced by liver microsomes from monkeys, dogs and rats; additionally, a hydroxylated derivative of the indazole moiety was produced only by rat microsomes. To identify the structures of two imidazole ring metabolites whose authentic compounds could not be obtained, Escherichia coli co-expressing human cytochrome P450 CYP3A4 and NADPH-P450 reductase was used to biosynthesize these metabolites. NMR spectra elucidated the precise structures; oxidation occurred at the imidazole ring, and the subsequent ring-opening resulted in the generation of amide and formylamine groups. Glucuronide conjugates of the hydroxylated and O-demethylated derivatives were major components in rat bile. Therefore, DY-9760e metabolites generated in vitro correspond to the aglycones of the major metabolites observed in rat bile.

Macrofilaricidal and microfilaricidal effects of Neurolaena lobata, a Guatemalan medicinal plant, on Brugia pahangi.

Twelve extracts of 11 Guatemalan medicinal plants were initially screened in vitro for potential macrofilaricidal activity against Brugia pahangi, a lymphatic dwelling filarial worm, using concentrations from 125 to 1000 microg ml(-1) of each extract that could be dissolved in the culture medium. Of 12 extracts used, the ethanol extract of leaves of Neurolaena lobata showed the strongest activity against the motility of adult worms. Subsequently, the extract of N. lobata was extensively examined in vitro for macro- and micro-filaricidal effects using a series of concentrations of 500, 250, 100, 50 and 10 microg ml(-1). The effects were assessed by worm motility, microfilarial release by female worms and a MTT assay. The effect on the motility of adult worms was observed in a concentration- and time-dependent manner. The time required to stop motility of both sexes of adult worms was 6 h at 500 microg ml(-1), 24 h at 250 microg ml(-1), and 3 days for females and 4 days for males at 100 microg ml(-1). The movement of females ceased at 4 days at a concentration of 50 microg ml(-1) whereas the motility of males was only reduced. The loss of worm's viability was confirmed by the MTT assay and was similar to the motility results. These concentrations, including 10 microg ml(-1), prevented microfilarial release by females in a concentration- and time-dependent manner. Concentrations higher than 100 microg ml(-1) even induced mortality of the microfilariae. The present study suggested that the ethanol extract of Neurolaena lobata has potential macro- and micro-filaricidal activities.

Delayed macrofilaricidal activity of diethylcarbamazine against Brugia pahangi in Mongolian jirds.

The macrofilaricidal activity of diethylcarbamazine (DEC) was confirmed in jirds infected with Brugia pahangi. Seventy jirds were inoculated subcutaneously with 100 infective larvae. At 20 weeks post-infection, the microfilaraemic jirds were divided into two groups, untreated and treated. For the treated group, 200 mg kg(-1) of DEC was injected intraperitoneally for 5 consecutive days. One, 4, 8, 12, 16 and 27 weeks after the final treatment, 4-7 jirds in each group were sacrificed to measure adult worm burdens. The number of adult worms recovered from treated jirds was comparable to controls at earlier necropsy (1 and 4 weeks post-treatment). However, at late necropsy (8 weeks and later) the recovery rate of adult worms in treated jirds was significantly lower than that in untreated controls, indicating an adultcidal effect of DEC. The present study demonstrates that DEC requires 8 weeks to kill B. pahangi adult worms in jirds and that the Mongolian jird is a useful model for screening antifilarial activity.

Serum IgE levels of tuberculosis patients in a tropical setup with high prevalence of HIV and intestinal parasitoses.

Tuberculosis remains a major health problem worldwide in the era of HIV/AIDS. Co-infection with intestinal parasites has been suggested to worsen the outcome of infection by polarizing the immune response towards Th2. This study investigated serum IgE levels of 241 tuberculosis patients and compared the IgE profiles in the tuberculosis patients either with or without intestinal helminthic infection and/or HIV infection. The serum levels of IgE in tuberculosis patients before initiation of antimycobacterial chemotherapy were found to be 1722 +/- 1290 IU/ml (Mean +/- SD) in HIV seronegatives and 2366 +/- 1849 IU/ml in HIV seropositives. Further, the IgE level was significantly higher in patients coinfected with intestinal helminthes and HIV compared to those infected with helminthes or without coinfection (P < 0.05). Anti-tuberculosis chemotherapy significantly reduced serum IgE levels in HIV seronegative tuberculosis patients (P < 0.05). These findings might indicate an active role of therapy in shifting the immune response towards Th1 which is crucial for prognosis in tuberculosis patients.

Simple and sensitive liquid chromatography-tandem mass spectrometry method for determination of the S(+)- and R(-)-enantiomers of baclofen in human plasma and cerebrospinal fluid.

A simple and sensitive liquid chromatography-tandem mass spectrometry (LC/MS/MS) method to determine the enantiomers of the muscle relaxant baclofen in human plasma and cerebrospinal fluid (CSF) has been developed. A commercially available ultrafiltration membrane is used to prepare the sample. A chiral CROWNPAK CR(+) stationary phase column is then used to perform complete resolution of the S(+)- and R(-)-enantiomers of baclofen. This method was used to analyze human plasma and CSF spiked with baclofen, and the calibration curves for both biologic samples were linear over a concentration range of 0.15-150 ng enantiomer/ml. The lower limit of quantification was 0.15 ng enantiomer/ml in both fluids. Finally, the method was tested with an artificial CSF as an alternative to authentic human CSF. The results showed that no matrix effects and no interfering peaks were observed using this artificial CSF.

Prevalence and levels of filaria-specific urinary IgG4 among children less than five years of age and the association of antibody positivity between children and their mothers.

An enzyme-linked immunosorbent assay (ELISA) to detect filaria-specific urinary IgG4 was tested in samples from 203 children less than five years old and their parents (165 mothers and 127 fathers) in Sri Lanka. There were four IgG4-positive children within 58 days after birth, suggesting the transfer of the antibody from mothers. No positive children were found between days 65 and 417. After day 1,000, the number of the positive individuals and the level of IgG4 increased quickly. The children of urinary IgG4-positive parents showed a higher IgG4 positive rate than those of negative parents. The children of positive mothers had a higher prevalence than those of negative mothers, whereas, the positivity of the fathers was not associated with that of their children. Collecting urine samples was easy to perform and well accepted because of its non-invasiveness. The ELISA will be useful for monitoring filarial infections in very young children, who are a sentinel population for evaluating the intensity of filariasis transmission and effectiveness of control measures.