The Effect of Cervical Fusion on Functional Sagittal Spinal Alignment Based on the Inflection Point: Case Series Study.

STUDY DESIGN: A retrospective radiologic study. OBJECTIVE: The inflection point is the disc space between a lordotic and kyphotic segment of spine. To our knowledge, there has been no study evaluating changes in functional sagittal alignment determined by inflection points after cervical fusion surgery. The purpose is to identify changes in functional sagittal alignment after cervical fusion as determined by functional segments between cervicothoracic and thoracolumbar inflection points. METHODS: Standing radiographs of the sagittal whole spine were taken in 62 patients who underwent cervical fusion procedures. We identified cervicothoracic and thoracolumbar inflection points in the sagittal plane and measured Cobb angles of resulting "functional" cervical, thoracic, and lumbar segments. We also measured the C2 and T1 sagittal vertical axis (SVA) distance to S1 and the anatomic cervical lordosis, thoracic kyphosis, lumbar lordosis, spinopelvic parameters, and T1 sagittal slope. We compared the pre- and post-op values. RESULTS: The functional cervical segment and T1 sagittal slope increased postoperatively. C2 and T1 SVA distance to S1 decreased postoperatively. In patients with a single level fusion or lower instrumented vertebra (LIV) proximal or equal to C6, functional cervical segment, and anatomic cervical lordosis increased postoperatively. In those with multiple level fusion or LIV distal or equal to C7, the C2 SVA distance to S1 decreased postoperatively. CONCLUSIONS: After cervical fusion surgery, functional cervical sagittal parameters determined by the inflection point improve without changes in the anatomic sagittal parameters. Postoperative changes in functional sagittal parameters were affected by the number of fused levels and LIV.

Excessively Increased Joint-Line Obliquity After Medial Opening-Wedge High Tibial Osteotomy Is Associated With Inferior Radiologic and Clinical Outcomes: What Is Permissible Joint-Line Obliquity.

PURPOSE: This study aimed to evaluate the permissible joint-line obliquity (JLO) based on radiologic and clinical outcomes with midterm follow-up after medial open-wedge high tibial osteotomy (MOWHTO). METHODS: Patients who had undergone MOWHTO from March 2014 to May 2016 were retrospectively evaluated. They were divided into 4 groups based on JLO as represented by postoperative medial proximal tibial angle (MPTA). Radiologic parameters including MPTA, joint-line orientation angle (JLOA), joint-line convergence angle (JLCA), posterior tibial slope, weightbearing line ratio (WBLR), and coronal translation were analyzed. Clinical outcomes were evaluated with American Knee Society Score (AKSS), Western Ontario and McMaster University Index, and short-form 36 health survey (SF-36). The changes between preoperation and final follow-up in JLOA and MPTA were defined as ΔJLOA and ΔMPTA. RESULTS: A total of 135 knees were finally included (MPTA ≤90.32° as group I; 90.33° to 92.62° as group II; 92.74° to 95.22° as group III; and ≥95.23° as group IV). The last follow-up MPTA, JLOA, and JLCA values were different between the groups (P < .001, P < .001, and P = .015, respectively). WBLR and JLOA positively correlated with MPTA; however, WBLR showed an abrupt increase at MPTA >96.5°, and the JLOA distribution tended to be greater than the regression line at MPTA >96°. Moreover, ΔJLOA was not as large as ΔMPTA. The percentage of patients attaining a minimal clinically important difference was significantly lower in the AKSS-functional score and SF-36 physical component summary in group IV (P = .008 and 0.021, respectively). CONCLUSION: The JLOA did not change as much as the MPTA, but an MPTA >95.2° abruptly increased the JLOA and valgus overcorrection after MOWHTO. Poor clinical outcomes were more evident in excessive MPTA (>95.2°) than in mildly undercorrected or properly corrected MPTA (<95.2°). LEVEL OF EVIDENCE: III, retrospective cohort study.

Repeat decompression and fusions following posterolateral fusion versus posterior/transforaminal lumbar interbody fusion for lumbar spondylosis: a national database study.

There is a low incidence of reoperation after surgery. It is difficult to detect statistical differences between reoperation rates of different lumbar fusion surgeries. National population-based databases provide large, longitudinally followed cohorts that may help overcome this challenge. The purpose is to compare the repeat decompression and fusion rate after surgery for degenerative lumbar diseases according to different surgical fusion procedures based on national population-based databases and elucidate the risk factor for repeat decompression and fusions. The Korean Health Insurance Review & Assessment Service database was used. Patients diagnosed with degenerative lumbar diseases and who underwent single-level fusion surgeries between January 1, 2011, and June 30, 2016, were included. They were divided into two groups based on procedure codes: posterolateral fusion or posterior/transforaminal lumbar interbody fusion. The primary endpoint was repeat decompression and fusion. Age, sex, the presence of diabetes, osteoporosis, associated comorbidities, and hospital types were considered potential confounding factors. The repeat decompression and fusion rate was not different between the patients who underwent posterolateral fusion and those who underwent posterior/transforaminal lumbar interbody fusion. Old age, male sex, and hospital type were noted to be risk factors. The incidence of repeat decompression and fusion was independent on the fusion method.

Anatomic double-bundle medial patellofemoral ligament reconstruction with aperture fixation using an adjustable-length loop device: a 2-year follow-up study.

BACKGROUND: To assess the clinical availability of an adjustable-length loop device for use in the double-bundle technique with aperture fixation at the patella and femur during anatomic double-bundle medial patellofemoral ligament reconstruction (DB-MPFLR) for recurrent patellar dislocation. METHODS: We retrospectively investigated 11 patients (12 knees) with recurrent patellar dislocation who underwent anatomic DB-MPFLR with an ipsilateral semitendinosus tendon autograft. The graft was folded in half, and its central portion was hanged using the adjustable-length loop device. Both free ends of the graft were fixed at the proximal and distal ends of the medial edge of the patella by using suture anchors, and the hanged graft loop was pulled into the femoral tunnel while maintaining equal tension on both bundles. Manual traction of the suture loops was applied to fix the graft appropriately in full range of motion (ROM) of the knee joint under arthroscopic guidance. Clinical outcomes such as re-dislocation, ROM, clinical scores (Kujala score, Lysholm score, and visual analogue scale score for anterior knee pain), and complications were assessed preoperatively and at 2 years postoperatively. Radiographic parameters indicating patellar position, including congruence angle and lateral patellofemoral angle, were measured at 4 different angles of knee flexion (30°, 45°, 60°, and 90°). RESULTS: At 4 different flexion angles of the knee joint, the preoperative congruence angle decreased significantly and the lateral patellofemoral angle increased significantly at the final follow-up (P <  0.001). Notably, the improvements in these angles were maintained with no significant differences at the 4 different flexion angles. None of the patients experienced subluxation or re-dislocation after surgery. The patellar instability symptoms improved, as confirmed on the basis of radiographic and other clinical outcomes. CONCLUSION: New DB technique with aperture fixation at the patella and femur by using an adjustable-length loop device offers high stability with full ROM of the knee joint, can be considered as a feasible procedure and technique for recurrent patellar dislocation.

Cadaver skin allograft may improve mortality rate for burns involving over 30% of total body surface area: a propensity score analysis of data from four burn centers.

Cadaver skin is used for temporary wound covering, but there is insufficient evidence regarding its clinical usefulness in patients with major burns. We aimed to analyze the effect of cadaveric skin allograft on mortality rates in patients with burns involving > 30% of total body surface area (TBSA). Our study included 1282 patients with > 30% of TBSA burned admitted to four hospitals in Korea between June 1, 2008 and December 31, 2016. Of these, 698 patients underwent cadaver skin allograft (cadaver group), and 584 were treated with conventional treatment (non-cadaver group). We corrected the differences between the two groups using propensity score matching, and generated 474 propensity score-matched pairs. Overall 90-day in-hospital mortality rate among all patients was 35.3% (453/1282). There was a significant difference in 90-day in-hospital mortality between the two groups for both unmatched [cadaver vs. conventional, 31.7 vs. 39.7%; difference, 8.0; 95% confidence interval (CI) 2.8-13.3] and propensity-matched groups (37.8 vs. 47.3%; difference, 9.5; 95% CI 3.2-15.8). Logistic regression analyses showed a significant association between cadaver skin allograft and lower 90-day in-hospital mortality in the propensity-matched groups (odds ratio, 0.42; 95% CI 0.29-0.62). Patients with major burns who underwent cadaver skin allograft had a lower mortality rate compared to those who did not. Cadaver skin allograft may improve the survival of patients with major burns, especially in the early phase of injury.

Propofol-ketamine or propofol-remifentanil for deep sedation and analgesia in pediatric patients undergoing burn dressing changes: a randomized clinical trial.

OBJECTIVE: In this study, we compared the propofol-ketamine and propofol-remifentanil combinations for deep sedation and analgesia during pediatric burn wound dressing changes. METHODS: Fifty pediatric patients aged 12-36 months, undergoing burn wound dressing changes, were randomly assigned to receive propofol-remifentanil (group PR) or propofol-ketamine (group PK) for deep sedation and analgesia. Patients in the group PR received 2 mg·kg(-1) propofol and 0.1 µg·kg(-1) remifentanil, and 0.05 µg·kg(-1) ·min(-1) remifentanil was infused continuously until the end of the procedure. Patients in the group PK received 2 mg·kg(-1) propofol and 1 mg·kg(-1) ketamine, and the same volume of isotonic saline was infused continuously until the end of the procedure. Additional propofol with remifentanil or ketamine was administered when required. Hemodynamic variables, drug requirements, occurrence of patient movement, surgeon's satisfaction score, recovery time, and the incidence of adverse events were recorded throughout the procedure and recovery. RESULTS: Recovery time was significantly shorter in the group PR compared to that in the group PK (10.3 [9.1-11.5] min vs 22.5 [20.3-25.6] min, median [interquartile range], respectively; P < 0.001). No significant hypotension or bradycardia occurred throughout the procedure. No significant differences were observed in terms of drug requirements, occurrence of patient movement, surgeon's satisfaction, incidence of respiratory depression, hypoxia, or nausea and vomiting CONCLUSIONS: The combinations of propofol-ketamine and propofol-remifentanil were effective for sedation and analgesia in pediatric patients undergoing burn dressing changes, but the propofol-remifentanil combination provided faster recovery compared to the propofol-ketamine combination.

The influence of post-operative surveillance on the prognosis after curative surgery for gastric cancer.

BACKGROUND/AIMS: Although routine post-operative surveillance after curative resection for gastric cancer is recommended, there are few reports on the value of postoperative follow-up. The aim of this study was to assess the possible role of post-operative surveillance as a prognostic factor after curative resection for gastric cancer. METHODOLOGY: A total of 192 gastric cancer patients who suffered recurrences after curative resection between January 2001 and June 2012 were included in this study. Clinicopathological factors and survival were retrospectively analyzed according to the presence or absence of symptoms related to tumor recurrence at the time of relapse. RESULTS: One-hundred-and-twenty-six of the patients (65.6%) had asymptomatic recurrences. Peritoneal recurrence (60.6%) predominated among the symptomatic recurrences, whereas locoregional recurrences (42.1%) were dominant among the asymptomatic recurrence. Median recurrence-free survival times did not differ between the two groups (p=0.507). However, median post-recurrence (p<0.001) and overall survival times (p=0.022) were longer in the asymptomatic group. CONCLUSIONS: Time to recurrence did not differ between the symptomatic and asymptomatic recurrence groups, but post-recurrence survival and overall survival were better in the asymptomatic group. Prior to the execution of a large scale randomized controlled trial, close follow-up should be considered.

Isolation and characterization of a novel thermostable alpha-amylase from Korean pine seeds.

Amylases have significant importance in broad industrial application including bio-ethanol production. Although amylases are widely distributed in microbes, plants and animals, it has been sought for new amylases from various sources with special industrial potential. In this study we firstly isolated and characterized a novel thermostable alpha-amylase from Korean pine seed. Enzyme was purified to homogeneity level with purification fold of 1286.1 using several techniques such as self-precipitation, (NH(4))(2)SO(4) fractionation, DEAE anion exchange and starch affinity chromatography. The purified alpha-amylase showed two bands in SDS-PAGE with molecular weight of 44 and 45 kDa. The apparent molecular weight of native enzyme was calculated to be 46.7 kDa. Internal peptide sequencing confirmed that the purified alpha-amylase was a novel enzyme. The optimum pH and temperature for enzyme activity were pH 4.5 and 65 degrees C, respectively. This enzyme was fully stable for 48h at 50 degrees C and retained 80% activity up to 96h. The K(m) and V(max) were 0.84 mg/ml and 3.71 micromol/min, respectively. On the basis of high thermal stability and a broad range of pH stability, the pine seed alpha-amylase showed a good prospect of industrial application.

A new colorimetric method for determining the isomerization activity of sucrose isomerase.

A new colorimetric method for determining the isomerization activity of sucrose isomerase was developed. This colorimetric method is based on the enzymatic reactions of invertase and glucose oxidase-peroxidase (GOD-POD). The main scheme for assaying sucrose isomerase activity is to degrade sucrose in the reaction mixture to glucose and fructose by invertase and to detect the concentration of glucose generated using GOD-POD. The concentrations of trehalulose and isomaltulose, reaction products of sucrose isomerase, are calculated from the concentration of glucose. This method allows rapid and accurate determination of the isomerization activity of sucrose isomerase without inhibition by hydrolysis activity.

Conversion of sucrose into isomaltulose by Enterobacter sp. FMB1, an isomaltulose-producing microorganism isolated from traditional Korean food.

Over 500 microorganisms isolated from Korean traditional foods, Maeju (source of soybean paste) and Nuruk (Korean koji), were screened to obtain an isomaltulose-producing microorganism. It was identified as Enterobacter sp. FMB-1 by 16S rRNA sequencing and the API 20E system. It had a greater than 90% conversion of sucrose (as 4 g/l) to isomaltulose in 2 days. Small amounts of trehalulose, glucose, and fructose were produced as byproducts, implying that this strain could be possibly employed in the production of isomaltulose in industry.

Molecular consequences of PHOX2B missense, frameshift and alanine expansion mutations leading to autonomic dysfunction.

Heterozygous mutations of the PHOX2B gene account for a broad variety of disorders of the autonomic nervous system, either isolated or combined, including congenital central hypoventilation syndrome (CCHS), tumours of the sympathetic nervous system and Hirschsprung disease. In CCHS, the prevalent mutation is an expansion of a 20-alanine stretch ranging from +5 to +13 alanines, whereas frameshift and missense mutations are found occasionally. To determine the molecular basis of impaired PHOX2B function, we assayed the transactivation and DNA binding properties of wild-type and mutant PHOX2B proteins. Furthermore, we investigated aggregate formation by proteins with polyalanine tract expansions ranging from +5 to +13 alanines using immunofluorescence of transfected cells and gel filtration of in vitro translated proteins. We found that transactivation of the dopamine beta-hydroxylase promoter by PHOX2B proteins with frameshift and missense mutations was abolished or severely curtailed, as was in vitro DNA binding although the proteins localized to the nucleus. The transactivation potential of proteins with polyalanine tract expansions declined with increasing length of the polyalanine stretch, and DNA binding was affected for an expansion of +9 alanines and above. Cytoplasmic aggregation in transfected cells was only observed for the longest expansions, whereas even the short expansion mutants were prone to form multimers in vitro. Such a tendency to protein misfolding could explain loss of transactivation for alanine expansion mutations. However, additional mechanisms such as toxic gain-of-function may play a role in the pathogenic process.

Anti-obesity effect of Dioscorea nipponica Makino with lipase-inhibitory activity in rodents.

In the process of screening for pancreatic lipase inhibitors, which could be used as an anti-obesity measure, the methanol extract of Dioscorea nipponica Makino powder (DP) appeared to have potent inhibitory activity against porcine pancreatic lipase with an IC50 value of 5-10 microg/ml, where the enzyme activity was assayed by using 4-methylumbelliferyl oleate as a substrate. Further purification of active components present in the herb generated dioscin that belongs to the saponin family. Dioscin and its aglycone, diosgenin, both suppressed the time-dependent increase of blood triacylglycerol level when orally injected with corn oil to mice, suggesting their inhibitory potential against fat absorption. Sprague-Dawley rats fed on a high-fat diet containing 5% Dioscorea nipponica Makino and 40% beef tallow gained significantly less body weight and adipose tissue than control animals fed on a high-fat diet alone during an 8-week experimental period (P<0.05).

Orphan nuclear receptor Nurr1 directly transactivates the promoter activity of the tyrosine hydroxylase gene in a cell-specific manner.

Tyrosine hydroxylase (TH) catalyzes the first and rate-limiting step of catecholamine synthesis and its expression is necessary for neurotransmitter specification of all catecholaminergic neurons, while dopamine beta-hydroxylase (DBH) is essential for the noradrenergic phenotype. In the present study, we show that Nurr1, an orphan nuclear receptor critical for dopaminergic (DA) neuron development, directly transactivates the promoter activity of the TH gene in a cell type-dependent manner, while it does not regulate the DBH promoter. Consistent with these results, only the TH promoter contains multiple sequence motifs homologous to the known Nurr1-binding motif, NBRE. TH promoter deletional analysis indicates that < 1.0 kb upstream sequences, encompassing three NBRE-like motifs (i.e. NL1, NL2 and NL3) are mostly responsible for the effects of Nurr1. Among these potential motifs, site-directed mutational analysis showed that NL1, residing from - 35 to - 28 bp, was most critical for mediating the transactivation by Nurr1. Strikingly, however, both DNase I footprinting and electrophoretic mobility shift assays showed that NL3, but not NL1 or NL2, has high binding affinity to Nurr1. To determine whether the proximity of these motifs may be important for transactivation by Nurr1 in the transient transfection assay, we generated reporter gene constructs in which NL3 is immediately proximal to the TATA box. Indeed, NL3 was more efficient in this position than NL1 or NL2 for mediating the transactivation by Nurr1. Our results suggest that Nurr1 may play a direct role for specification of DA neurotransmitter identity by activating TH gene transcription in a cell context-dependent manner.

Regulation of male sex hormone levels by soy isoflavones in rats.

Several studies have suggested that soybean intake is associated with a lower risk of prostate cancer. However, the mechanism of prostate cancer prevention by soybeans remains unclear. Because prostate cancer is reported to have an association with an increased level of dihydrotestosterone (DHT) and soybean isoflavones are known to inhibit 5 alpha-reductase, which is involved in the conversion of testosterone to DHT, the effects of soybean extract and isoflavones on the plasma levels of male sex hormones were investigated using male rats. In Experiment I, Sprague-Dawley rats were fed diets with and without soy flour; in Experiment II, rats were fed diets containing 2% soy methanol extract or 0.2% semipurified isoflavones or a control diet. The study showed a reduction of plasma DHT along with an increase in total plasma androgen in rats fed soy flour or semipurified isoflavones for 1 wk. These results suggest that soy isoflavone intake may reduce plasma DHT level.

The distribution and morphology of calbindin D28K- and calretinin-immunoreactive neurons in the visual cortex of mouse.

We studied the distribution and morphology of calbindin D28K- and calretinin-immunoreactive (IR) neurons in the mouse visual cortex with immunocytochemistry. Most of the calbindin D28K-IR neurons were located in layers II/III and V, while calretinin-IR neurons were predominantly located in layers II/III. The labeled neurons showed variations in morphology. The majority of the calbindin D28K-IR neurons were stellate and round or oval cells with multipolar dendrites. The majority of calretinin-IR neurons were vertical fusiform cells with long processes traveling perpendicular to the pial surface. In the mouse visual cortex, 20.2% of calbindin D28K-IR neurons contained calretinin and 27.2% of calretinin-IR neurons contained calbindin D28K. These results indicate that the calcium-binding proteins, calbindin D28K and calretinin are distributed in specific layers and in selective cell types of the mouse visual cortex.

Changes of calretinin, calbindin D28K and parvalbumin-immunoreactive neurons in the superficial layers of the hamster superior colliculus following monocular enucleation.

We studied the effects of monocular enucleation on the patterned distribution of calretinin-, calbindin D28K- and parvalbumin-immunoreactive (IR) neurons in the superficial layers of the hamster superior colliculus (SC). The calcium-binding proteins were localized using antibody immunocytochemistry. Almost complete depletion of the calretinin-IR fibers in the superficial layers of the contralateral SC was found following unilateral enucleation. Quantitative analysis showed that on the experimental side of the SC, an enormous number of calretinin-IR cells newly appeared (716%). On the experimental side of the SC, the number of parvalbumin-IR cells also increased (32%). By contrast, on the experimental side of the SC, the number of calbindin D28K-IR cells exhibited a reduction (43%). Two-color immunofluorescence revealed that none of the newly appeared calretinin-IR cells were labeled with antibodies to calbindin D28K or parvalbumin. The present results demonstrate that retinal projection may control the activity of the expression of these calcium-binding proteins in the hamster SC but in different manners. The results also show that the patterned change of calretinin and parvalbumin in the hamster SC is comparable with other animals, but the change of calbindin D28K is not identical.