Comprehensive understanding of the life history of harmful raphidophyte Heterosigma akashiwo: Integrating in situ and in vitro observations.

Heterosigma akashiwo (Raphidophyceae) is widely recognized as a species responsible for harmful algal blooms worldwide. The species has long been speculated to possess a more complex life history, attributed to the diverse morphological variations observed during cell cultivation. However, the understanding of its life history has remained insufficient due to limitations in observing transitions between life cycle stages in vitro and challenges associated with in situ investigations. In this study, a combination of in vitro (laboratory-based) and in situ (field-based) observations was employed to define the life cycle stages of H. akashiwo and elucidate the pathways of transition between these stages. Notably, novel homothallic sexual reproduction processes involving the fusion of hologametes and the subsequent formation of zygotes were observed for the first time in vitro. These zygotes were found to either divide into vegetative cells (Pathway I) or undergo enlargement, resulting in the formation of multiple cells with multiple nuclei (Pathway II). Furthermore, this study provides the first documentation of large cells and cell clusters in situ, including intermediate stages referred to as large cells with ongoing cytoplasmic division that serve as a bridge between these two cell types. The observed zygotes in vitro exhibited a large size (21.9-51.8 µm) and multinucleated characteristics, similar to the large cells (38.2-45.8 µm) and cell clusters observed in situ. This finding suggests that the large cells observed in situ were zygotes undergoing cell division to form cell clusters (Pathway III). Moreover, based on the striking similarities in cell morphology and nuclear size between the cells comprising the cell cluster (2.7-4.4 µm) and the cyst clusters of this species, along with the synchronized germination characteristics of cyst clusters, it is proposed that the cell cluster serves as a precursor to cysts. By integrating the in situ and in vitro observations, this study provides a comprehensive understanding of the previously poorly understood life history of H. akashiwo.

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy.

BACKGROUND: Achieving the postoperative mechanical axis passing through 62.5% of the tibial plateau is considered successful osteotomy surgery. Despite precise preoperative planning and surgical techniques, some procedures result in under- or overcorrection. Few studies have investigated the relationship between clinical outcomes and unintentional under- or overcorrection after open wedge high tibial osteotomy (OWHTO) using whole-leg standing radiographs. PURPOSE: To investigate the relationship between postoperative alignment using whole-leg standing radiographs and clinical outcomes after OWHTO. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 89 knees (72 patients) that underwent OWHTO between October 2013 and September 2018 were included. Patients with postoperative weightbearing line (WBL) ratios within 57% to 67% were classified as appropriate correction (group A; 45 cases), whereas ratios <57% and >67% were classified as undercorrection (group U; 20 cases) and overcorrection (group O; 24 cases), respectively. The following patient-reported outcomes (PROs) were investigated: International Knee Documentation Committee (IKDC) subjective score, Kujala score, and Knee injury and Osteoarthritis Outcome Score (KOOS). The correlation between postoperative WBL and PROs was analyzed. PROs were compared among the 3 groups. RESULTS: Regarding the correlation between postoperative WBL ratio and PROs, a larger postoperative WBL ratio was significantly correlated with a poor IKDC subjective score (P = .002), Kujala score (P = .009), and KOOS. Group O showed inferior postoperative PRO scores when compared with group A or U, whereas group U showed a similar result to group A (mean IKDC subjective scores: group U, 62.0; group A, 61.2; group O, 47.6; P = .004). CONCLUSION: Overcorrection after OWHTO surgery correlated with inferior PROs; therefore, overcorrected alignment should be avoided for patient satisfaction. Knees with an undercorrected alignment showed clinical results similar to those with appropriate correction.

Molecular Phylogeny and Historical Biogeography of Goodyera R. Br. (Orchidaceae): A Case of the Vicariance Between East Asia and North America.

Understanding of intercontinental distribution in the Northern Hemisphere has attracted a lot of attention from botanists. However, although Orchidaceae is the largest group of angiosperms, biogeographical studies on the disjunctive pattern have not been sufficient for this family. Goodyera R. Br. (tribe Cranichideae, subfamily Orchidoideae, family Orchidaceae) is widely distributed in temperate and tropical regions. Although the phylogenetic relationship of Goodyera inferred from both morphological and molecular data has been conducted, the sampled taxa were mainly distributed in Asia regions that resulted in non-monophyly of this genus. In this study, the complete plastid genomes of Goodyera, generated by next-generation sequencing (NGS) technique and sampled in East Asia and North America, were used to reconstruct phylogeny and explore the historical biogeography. A total of 18 Goodyera species including seven newly sequenced species were analyzed. Based on 79 protein-coding genes, the phylogenetic analysis revealed that Goodyera could be subdivided into four subclades with high support values. The polyphyletic relationships among Goodyera taxa were confirmed, and the unclear position of G. foliosa was also resolved. The datasets that are composed of the 14 coding sequences (CDS) (matK, atpF, ndhK, accD, cemA, clpP, rpoA, rpl22, ndhF, ccsA, ndhD, ndhI, ndhA, and ycf 1) showed the same topology derived from 79 protein-coding genes. Molecular dating analyses revealed the origin of Goodyera in the mid-Miocene (15.75 Mya). Nearctic clade of Goodyera was diverged at 10.88 Mya from their most recent common ancestor (MRCA). The biogeographical reconstruction suggests that subtropical or tropical Asia is the origin of Goodyera and it has subsequently spread to temperate Asia during the Miocene. In addition, Nearctic clade is derived from East Asian species through Bering Land Bridge (BLB) during the Miocene. The speciation of Goodyera is most likely to have occurred during Miocene, and climatic and geological changes are thought to have had a part in this diversification. Our findings propose both origin and vicariance events of Goodyera for the first time and add an example for the biogeographical history of the Northern Hemisphere.

Ficus erecta Thunb. Leaves Ameliorate Cognitive Deficit and Neuronal Damage in a Mouse Model of Amyloid-ß-Induced Alzheimer's Disease.

Alzheimer's disease (AD) pathogenesis is linked to amyloid plaque accumulation, neuronal loss, and brain inflammation. Ficus erecta Thunb. is a food and medicinal plant used to treat inflammatory diseases. Here, we investigated the neuroprotective effects of F. erecta Thunb. against cognitive deficit and neuronal damage in a mouse model of amyloid-ß (Aß)-induced AD. First, we confirmed the inhibitory effects of ethanol extracts of F. erecta (EEFE) leaves on Aß aggregation in vivo and in vitro. Next, behavioral tests (passive avoidance task and Morris water maze test) revealed EEFE markedly improved cognitive impairment in Aß-injected mice. Furthermore, EEFE reduced neuronal loss and the expression of neuronal nuclei (NeuN), a neuronal marker, in brain tissues of Aß-injected mice. EEFE significantly reversed Aß-induced suppression of cAMP response element-binding protein (CREB) phosphorylation and brain-derived neurotrophic factor (BDNF) expression, indicating neuroprotection was mediated by the CREB/BDNF signaling. Moreover, EEFE significantly suppressed the inflammatory cytokines interleukin 1beta (IL-1ß) and tumor necrosis factor alpha (TNF-α), and expression of ionized calcium-binding adaptor molecule 1 (Iba-1), a marker of microglial activation, in brain tissues of Aß-injected mice, suggesting anti-neuroinflammatory effects. Taken together, EEFE protects against cognitive deficit and neuronal damage in AD-like mice via activation of the CREB/BDNF signaling and upregulation of the inflammatory cytokines.

Comparative analysis and implications of the chloroplast genomes of three thistles (Carduus L., Asteraceae).

BACKGROUND: Carduus, commonly known as plumeless thistles, is a genus in the Asteraceae family that exhibits both medicinal value and invasive tendencies. However, the genomic data of Carduus (i.e., complete chloroplast genomes) have not been sequenced. METHODS: We sequenced and assembled the chloroplast genome (cpDNA) sequences of three Carduus species using the Illumina Miseq sequencing system and Geneious Prime. Phylogenetic relationships between Carduus and related taxa were reconstructed using Maximum Likelihood and Bayesian Inference analyses. In addition, we used a single nucleotide polymorphism (SNP) in the protein coding region of the matK gene to develop molecular markers to distinguish C. crispus from C. acanthoides and C. tenuiflorus. RESULTS: The cpDNA sequences of C. crispus, C. acanthoides, and C. tenuiflorus ranged from 152,342 bp to 152,617 bp in length. Comparative genomic analysis revealed high conservation in terms of gene content (including 80 protein-coding, 30 tRNA, and four rRNA genes) and gene order within the three focal species and members of subfamily Carduoideae. Despite their high similarity, the three species differed with respect to the number and content of repeats in the chloroplast genome. Additionally, eight hotspot regions, including psbI-trnS_GCU, trnE_UUC-rpoB, trnR_UCU-trnG_UCC, psbC-trnS_UGA, trnT_UGU-trnL_UAA, psbT-psbN, petD-rpoA, and rpl16-rps3, were identified in the study species. Phylogenetic analyses inferred from 78 protein-coding and non-coding regions indicated that Carduus is polyphyletic, suggesting the need for additional studies to reconstruct relationships between thistles and related taxa. Based on a SNP in matK, we successfully developed a molecular marker and protocol for distinguishing C. crispus from the other two focal species. Our study provides preliminary chloroplast genome data for further studies on plastid genome evolution, phylogeny, and development of species-level markers in Carduus.

POCU1b, the n-Butanol Soluble Fraction of Polygoni Cuspidati Rhizoma et Radix, Attenuates Obesity, Non-Alcoholic Fatty Liver, and Insulin Resistance via Inhibitions of Pancreatic Lipase, cAMP-Dependent PDE Activity, AMPK Activation, and SOCS-3 Suppression.

This study investigated the effects of the n-BuOH soluble fraction of Polygoni Cuspidati 80% ethanol extract (POCU1b) on high-fat diet (HFD)-induced obesity, non-alcoholic fatty liver (NAFL), and insulin resistance (IR) to find a safe and more effective agent. HPLC profiling of POCU1b identified seven marker compounds. POCU1b increased glycerol release, cyclic adenosine monophosphate (cAMP) level, and inhibited phosphodiesterase (PDE) activity. Seven weeks of POCU1b treatment decreased body weight gain, weight and adipocyte size in fat tissues, serum lipids, and triglyceride and lipid droplets in the livers of HFD-fed rats. POCU1b improved blood glucose, insulin sensitivity, and impaired insulin secretion in the pancreas. Further, POCU1b ameliorated adiponectin, leptin, IL-6 and TNF-α levels, increased AMPK and p-ACC expression, activated CPT-1 activity, and suppressed FAS mRNA, SOCS-3 protein expression, and NF-κB DNA-binding activity. When compared with the Xenical®-treated group, a positive group, the action of POCU1b on body weight was more effective than that of Xenical. POCU1b did not show side effects, such as oily spotting and loss of appetite. These results suggest that POCU1b possesses therapeutic or preventive potential for obesity, NAFL and IR via inhibitions of pancreatic lipase and cAMP-dependent PDE activity, AMPK activation, and SOCS-3 suppression, without oily spotting and loss of appetite.

Discoid lateral meniscus: importance, diagnosis, and treatment.

Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Snapping and pain are common symptoms, with occasional limitations of extension, in patients with DLM. Examination of the contralateral knee is necessary as DLM affects both knees. While simple radiographs may provide indirect signs of a DLM, magnetic resonance imaging (MRI) is essential for diagnosis and treatment planning. Although DLM was traditionally classified into three categories, namely, complete, incomplete, and Wrisberg DLM, a recent MRI classification provides useful information for surgical planning because the MRI classification was based on the peripheral detachment in patients with DLM, as follows: no shift, anterocentral shift, posterocentral shift, and central shift. Asymptomatic patients require close follow-up without surgical treatment, while patients with symptoms often require surgery. Total or subtotal meniscectomy, which has been traditionally performed, leads to an increased risk of degenerative arthritis; thus, partial meniscectomy is currently considered the treatment of choice for DLM. In addition to partial meniscectomy, meniscal repair of peripheral detachment is recommended for stabilization in patients with DLM to preserve the function of the meniscus. Previous studies have reported that partial meniscectomy with or without meniscal repair is effective and shows superior clinical and radiological outcomes to those of total or subtotal meniscectomy during the short- to long-term follow-up. Our preferred principle for DLM treatment is reduction, followed by reshaping with reference to the midbody of the medial meniscus and repair as firm as possible.

Hip resurfacing arthroplasty for osteonecrosis of the femoral head: Implant-specific outcomes and risk factors for failure.

BACKGROUND: Hip resurfacing arthroplasty (HRA) may be a suitable option for treating osteonecrosis of the femoral head (ONFH). However, concerns regarding the extent of osteonecrosis, amount of defect under the prosthesis, and implant-related complications remain. This study aimed to report implant-specific outcomes and risk factors for failure of HRA in ONFH. METHODS: A total of 202 HRAs (166 patients) performed by a single surgeon were investigated. The stage, size, and location of ONFH were evaluated using preoperative radiographs and magnetic resonance images. Clinical, radiographic results, and serum metal concentrations of articular surface replacement (ASR) and non-ASR devices were compared. Logistic regression analysis was performed to identify the contributors of failures. The mean follow-up duration was 10.6 years. RESULTS: Twenty-six hips (12.9%) were operated with Birmingham Hip Resurfacing (BHR), 99 (49.0%) with ASR, and 77 (38.1%) with Conserve Plus. The mean Harris Hip Score improved from 52.1 to 93.2 at the final follow-up (P < 0.001). Revision-free survivorships of non-ASR and ASR implants were 99.0% and 82.4%, respectively (P < 0.001). In multivariate analysis, the use of ASR prosthesis, greater combined necrotic angle, and smaller head size were associated with revision surgery. A large combined necrotic angle was the only independent risk factor for mechanical failure at the femoral side (P = 0.029). CONCLUSION: HRA for ONFH using BHR and Conserve Plus implants demonstrated favourable clinical outcomes with high revision-free survival rates at 10 years. However, care should be taken for large necrotic lesions that can lead to femoral neck fracture or aseptic femoral loosening. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: This study suggests HRA performed for appropriately selected patients with ONFH can show excellent long-term clinical results. Therefore, HRA should remain as one of the treatment options for ONFH, and further development of HRA implants should be continued.

Difference in joint line convergence angle between the supine and standing positions is the most important predictive factor of coronal correction error after medial opening wedge high tibial osteotomy.

PURPOSE: Coronal correction errors after medial opening wedge high tibial osteotomy (MOWHTO) occasionally occur even with the assistance of navigation. The purpose of the present study was to determine the navigation accuracy in MOWHTO and to identify factors that affect the coronal correction error after navigation-assisted MOWHTO. METHODS: A total of 114 knees treated with navigation-assisted MOWHTO were reviewed retrospectively. Mechanical axis (MA) on standing radiograph and medial proximal tibial angle (MPTA) were measured preoperatively and at 6 months postoperatively, and the differences (ΔMA and ΔMPTA) were calculated. Joint line convergence angle (JLCA) on supine and standing radiographs was measured preoperatively, and their difference (ΔJLCA) was calculated. To assess the navigation accuracy, ΔMA and ΔMPTA were compared with the coronal correction by navigation (ΔNMA) using intraclass correlation coefficients (ICCs). Univariable and multivariable regression analyses were used to identify factors that affect coronal correction discrepancy (ΔMA - ΔNMA). RESULTS: The reliability of navigation was good in terms of bony correction (ICC between ΔNMA and ΔMPTA, 0.844) and fair in terms of MA correction (ICC between ΔNMA and ΔMA, 0.706). The mean coronal correction discrepancy was 2.0° ± 2.4°. In the multivariable analysis, ΔJLCA was shown to be a predictive factor of coronal correction discrepancy (unstandardized coefficient, 1.026; R2, 0.470). CONCLUSION: Navigation in MOWHTO provided reliable information about bony correction; however, MA tended to be overcorrected. The difference in JLCA between the supine and standing radiographs was the most important preoperative factor that predicted the coronal correction discrepancy after MOWHTO. In patients with larger ΔJLCA, each degree of ΔJLCA should be subtracted from the planned amount of correction angle when preoperative planning is performed using standing radiographs. LEVEL OF EVIDENCE: IV.

Difficulties During Ponseti Casting for the Treatment of Idiopathic Clubfoot.

The Ponseti method has resulted in excellent outcomes in the treatment of idiopathic clubfoot. To evaluate the process of serial casting, most studies previously used the number of casts required to achieve correction. In contrast, difficulties that occurred during serial casting were rarely studied. We reviewed 47 patients with severe idiopathic clubfoot (Dimeglio score ≥10) and a follow-up period of ≥4 years by focusing on difficulties during the Ponseti casting and their related factors. All events requiring temporary discontinuation and/or delay of scheduled casting were considered difficulties. Among the 47 patients, difficulties occurred in 18 patients (38.3%). Initial Dimeglio score (14.9 ± 2.5 [vs 13.5 ± 2.3, p = .042]), its subcomponent of equinus (3.8 ± 0.4 [vs 3.3 ± 0.6, p = .005]), and the number of casts (6.3 ± 2.0 [vs 4.9 ± 1.2, p = .009]) in the 18 patients with difficulties were greater than those of the remaining 29 patients. In addition, the foot length was shorter (7.2 ± 0.6 cm [vs 7.7 ± 0.8 cm, p = .030]) in patients with difficulties. In the regression analysis, both subcomponents of equinus and foot length showed the significance for the occurrence of difficulties. During 8.7 ± 3.8 years, further surgery was needed in 35 patients (74.5%) because of residual or recurrent deformity. The ratio was higher in patients with difficulties (94.4% [vs 62.1%, p = .017]). In our experience, difficulties frequently occurred in feet with rigid equinus and small length, and further surgery was required after the initial correction in almost all of the feet with difficulties.

Surgical Results of Limb Lengthening at the Femur, Tibia, and Humerus in Patients with Achondroplasia.

BACKGROUND: Results of limb lengthening in patients with achondroplasia were previously reported in many studies. However, the reports of comparison among the three long bones (femur, tibia, and humerus) are rare, especially for the results of crossed lengthening (lengthening of one femur and contralateral tibia followed by that of the opposite side) for the lower limbs. The purpose of this study was to report the surgical results of a series of limb lengthening in achondroplastic or hypochondroplasia patients at our institution. METHODS: Fifteen patients (14 with achondroplasia and 1 with hypochondroplasia) underwent lower limb lengthening of the femur (n = 32) and tibia (n = 28), and 12 of them underwent crossed lengthening. Humeral lengthening was performed in 14 patients (n = 28). The mean age at the first operation was 11.7 years, and the mean follow-up duration was 66.7 months. The healing index, consolidation period index (duration of consolidation period/gained length), and other radiographic indices were analyzed. Limb length discrepancy and hip-knee-ankle alignment in lower limbs, and the occurrence of difficulties were assessed. RESULTS: The average gain in length for the femur, tibia, and humerus was 8.3 cm, 8.5 cm, and 7.4 cm, respectively. The mean healing index was 29.6 days/cm for the femur, 29.0 days/cm for the tibia, and 27.2 days/cm for the humerus. The mean consolidation period index was 14.7 days/cm for the humerus, which was significantly lower than that in the lower limb (17.3 days/cm for the femur and 17.8 days/cm for the tibia). Of the 12 who underwent crossed lengthening, five showed limb length discrepancy ≥ 1.0 cm. Among their 24 lower limbs, three showed valgus alignment ≥ 5° and one showed varus alignment ≥ 5°. Thirty-two pin site infections and three fractures were conservatively managed. Three femoral fractures, eight equinus deformities, and four cases with premature consolidation of the fibula were surgically treated. Obstacle and true complication related to humeral lengthening were not observed. CONCLUSIONS: Humeral lengthening was relatively effective and safe. Careful attention will be needed to avoid the occurrence of limb length discrepancy or malalignment in crossed lengthening.

A Minimum of 15-Year Results of Cementless Total Hip Arthroplasty Using a 28-mm Metal-On-Metal Articulation.

BACKGROUND: We previously reported unexpected early failures of total hip arthroplasty (THA) utilizing a 28-mm Ultima metal-on-metal (MoM) articulation. However, long-term results of small-diameter MoM THAs still remain unclear. The purpose of this study was to evaluate the clinical and radiographic outcomes of the previously reported cohort at a minimum follow-up of 15 years. METHODS: The original cohort consisted of 171 primary THAs (167 patients) using a 28-mm MoM articulation performed between April 2000 and March 2002. Of these, 130 hips (126 patients) were reviewed at an average follow-up of 17.1 (range, 15-18) years. Clinical score, complications, presence of osteolytic lesion, serum metal ion concentrations, and implant survivorships were evaluated. RESULTS: The mean Harris Hip Score improved from 44.9 points preoperatively to 90.5 points at the latest follow-up. During the entire period since the original surgery, a total of 5 revisions (3.8%) were associated with adverse reaction to metal debris (ARMD). The last revision surgery for symptomatic ARMD was performed at 6 years postoperatively. The implant survivorships with an end point of revision for aseptic failure and for any reason were 95.4% and 93.8%, respectively. Radiographic osteolytic lesions were detected in 27 hips (20.8%). The average serum metal concentration was 2.50 (range, 0.12-9.86) µg/L for cobalt and 2.81 (range, 0.82-12.3) µg/L for chromium. CONCLUSIONS: THA using a 28-mm MoM articulation showed favorable long-term outcomes with a relatively high revision-free survival rate. There was no significant symptomatic ARMD after the last acetabular revision performed at 6 years postoperatively.

Change in adduction moment following medial open wedge high tibial osteotomy: a meta-analysis.

BACKGROUND: This meta-analysis was designed to quantify adduction moment loss, to evaluate the relationship between changes in mechanical axis alignment and adduction moment, and to assess whether sagittal plane moment is altered after medial open wedge high tibial osteotomy (HTO). METHODS: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, all studies reporting preoperative and postoperative peak knee adduction moment or change in peak knee adduction moment from before to after surgery in patients who underwent medial open wedge HTO were included. RESULTS: Nine studies were included in the meta-analysis. The pooled mean difference in adduction moment from before to after medial open wedge HTO was 1.44% Nm/body weight (BW)xheight (HT) (95% confidence interval [CI]: 1.33 to 1.55% Nm/BWxHT; P < 0.001; I2 = 4%). However, flexion (0.18% Nm/BWxHT, 95% CI: -0.50 to 0.86% Nm/BWxHT; P = 0.61; I2 = 79%) and extension (0.15% Nm/BWxHT, 95% CI, - 0.37 to 0.68% Nm/BWxHT; P = 0.56; I2 = 46%) moments did not differ significantly from before to after surgery. Alignment correction amount and postoperative final valgus alignment were not significantly associated with difference in adduction moment from before to after surgery. CONCLUSION: Knee adduction moment after medial open wedge HTO decreased to 60% of the preoperative level. However, this adduction moment decrement was not affected by the magnitude of alignment correction. In addition, there was no change in sagittal plane knee moment, including flexion and extension moments, from before to after medial open wedge HTO. LEVEL OF EVIDENCE: Meta-analysis (Level II).

Autophagy Activation by Crepidiastrum Denticulatum Extract Attenuates Environmental Pollutant-Induced Damage in Dermal Fibroblasts.

Pollution-induced skin damage results in oxidative stress; cellular toxicity; inflammation; and, ultimately, premature skin aging. Previous studies suggest that the activation of autophagy can protect oxidation-induced cellular damage and aging-like changes in skin. In order to develop new anti-pollution ingredients, this study screened various kinds of natural extracts to measure their autophagy activation efficacy in cultured dermal fibroblast. The stimulation of autophagy flux by the selected extracts was further confirmed both by the expression of proteins associated with the autophagy signals and by electron microscope. Crepidiastrum denticulatum (CD) extract treated cells showed the highest autophagic vacuole formation in the non-cytotoxic range. The phosphorylation of adenosine monophosphate kinase (AMPK), but not the inhibition of mammalian target of rapamycin (mTOR), was observed by CD-extract treatment. Its anti-pollution effects were further evaluated with model compounds, benzo[a]pyrene (BaP) and cadmium chloride (CdCl2), and a CD extract treatment resulted in both the protection of cytotoxicity and a reduction of proinflammatory cytokines. These results suggest that the autophagy activators can be a new protection regimen for anti-pollution. Therefore, CD extract can be used for anti-inflammatory and anti-pollution cosmetic ingredients.

Clinical and Radiographic Characteristics of Atypical Slipped Capital Femoral Epiphysis.

BACKGROUND: Slipped capital femoral epiphysis (SCFEs) can be idiopathic or atypical (associated with renal failure, radiation therapy, and endocrine disorders). It is important to estimate the likelihood that atypical SCFE shows different clinical and radiographic characteristics and complications with typical SCFEs. METHODS: We retrospectively reviewed 53 patients (66 hips) with SCFEs managed between 1995 and 2016. Sex, age, weight, height, the duration of symptoms the laterality of the slip, and complications were recorded. Bilateral hip and lower extremity long bone radiographs were utilized to record slip angle, genu valgus deformity. Statistical analyses were performed. RESULTS: Among 53 children (32 boys and 21 girls) with 66 SCFEs, 22 children had 29 atypical SCFEs, and 31 children had 38 typical SCFEs. The average age at the time of presentation for the initial SCFEs was 10.9±0.3 years. The average duration of symptoms was 14.1±21.8 weeks. The average Southwick slip angle difference was 23.3±14.8 degrees. There are 43 mild, 13 moderate, and 10 severe SCFEs. 58 were classified as stable, and 8 were unstable. There were significant differences in terms of average age (10.4±2.6 y for atypical SCFEs, 11.2±1.4 for typical SCFEs; P=0.036), average weight (36.2±22.3 kg for patients with atypical slips, compared with 56.9±9.9 kg for those with typical slips; P<0.001), height (132.1±17.6 cm for those with atypical slips, compared with 148.9±12.1 for those with typical slips; P<0.001), and the body mass index (19.4±5.6 kg/cm for those with atypical slips, compared with 25.8±4.6 for those with typical slips; P<0.001). In the group of 22 children with atypical slipped capital epiphysis, there were 19 children with neoplasm (8 neuroblastomas, 3 medulloblastomas, 3 retinoblastomas, 2 ependymomas, 1 craniopharyngioma, 1 Wilms tumor, 1 immature teratoma), 4 children with primary endocrine disorder. We categorized atypical SCFEs in 3 groups by etiology; endocrine disorder-associated (ENDA) SCFEs, chemotherapy-associated (CTA) SCFEs, and radiation therapy-associated (RTA) SCFEs. Subjects of RTA were included if exposed to pelvic irradiation or total body irradiation. There were 4 ENDA, 9 RTA, and 16 CTA. Atypical SCFEs had significantly more valgus slips (P<0.001) and genu valgus deformity (P<0.001) compared with in the group of typical slipped capital epiphysis. Among the group of atypical SCFEs, children with CTA had significantly low body weight, height, and body mass index. CONCLUSIONS: The markedly greater incidence of valgus displacement of proximal femoral epiphysis and genu valgum in childhood cancer survivors with pelvic irradiation and chemotherapy may be associated with atypical SCFE. The authors conclude that in pediatric cancer survivors with hip pain, consideration should be given to atypical SCFE with valgus slip and long-term follow-up of lower extremity alignment. LEVEL OF EVIDENCE: Level III-retrospective comparative study. See instructions for authors for a complete description of levels of evidence.

New method for an evaluation of the esthetical improvements resulting from a mandibular angle reduction.

OBJECTIVES: This paper proposes Han's ratio as an objective and quantitative comparative result obtained from pre and postoperative data in patients with a mandibular angle reduction. MATERIALS AND METHODS: Thirty patients, 12 men and 18 women, who visited the Department of Oral and Maxillofacial Surgery with the chief complaints of skeletal mandibular prognathism and prominent mandibular angle were selected. The subjects were classified into 3 groups according to the types of surgical procedures involved. Group A consisted of patients who underwent mandibular angle resection and mandibular setback. Group B was comprised of patients with mandibular angle resection, mandibular setback and genioplasty. Group C consisted of patients with mandibular angle resection, mandibular setback, Le Fort I osteotomy, and genioplasty. The landmarks placed in pre and postoperative frontal photographs were used to obtain the Han's ratio in each group. The Han's ratios were compared pre- and postoperation and according to the surgical techniques applied. RESULTS: Of the 3 groups who had undergone a mandibular angle resection, all showed a statistically significant increase in Han's ratio. On the other hand, there was no statistically significant difference based on the surgical techniques used. CONCLUSION: The ratio of the lateral lower face proposed in this study is a potential indicator of postoperative esthetic enhancement in mandibular angle reduction surgery.

An Improved Quantitative Real-Time PCR Assay for the Enumeration of Heterosigma akashiwo (Raphidophyceae) Cysts Using a DNA Debris Removal Method and a Cyst-Based Standard Curve.

The identification and quantification of Heterosigma akashiwo cysts in sediments by light microscopy can be difficult due to the small size and morphology of the cysts, which are often indistinguishable from those of other types of algae. Quantitative real-time PCR (qPCR) based assays represent a potentially efficient method for quantifying the abundance of H. akashiwo cysts, although standard curves must be based on cyst DNA rather than on vegetative cell DNA due to differences in gene copy number and DNA extraction yield between these two cell types. Furthermore, qPCR on sediment samples can be complicated by the presence of extracellular DNA debris. To solve these problems, we constructed a cyst-based standard curve and developed a simple method for removing DNA debris from sediment samples. This cyst-based standard curve was compared with a standard curve based on vegetative cells, as vegetative cells may have twice the gene copy number of cysts. To remove DNA debris from the sediment, we developed a simple method involving dilution with distilled water and heating at 75°C. A total of 18 sediment samples were used to evaluate this method. Cyst abundance determined using the qPCR assay without DNA debris removal yielded results up to 51-fold greater than with direct counting. By contrast, a highly significant correlation was observed between cyst abundance determined by direct counting and the qPCR assay in conjunction with DNA debris removal (r2 = 0.72, slope = 1.07, p < 0.001). Therefore, this improved qPCR method should be a powerful tool for the accurate quantification of H. akashiwo cysts in sediment samples.

Oxidation of pyrene, 1-hydroxypyrene, 1-nitropyrene and 1-acetylpyrene by human cytochrome P450 2A13.

1. The polycyclic hydrocarbons (PAHs), pyrene, 1-hydroxypyrene, 1-nitropyrene and 1-acetylpyrene, were found to induce Type I binding spectra with human cytochrome P450 (P450) 2A13 and were converted to various mono- and di-oxygenated products by this enzyme. 2. Pyrene was first oxidized by P450 2A13 to 1-hydroxypyrene which was further oxidized to di-oxygenated products, i.e. 1,8- and 1,6-dihydroxypyrene. Of five other human P450s examined, P450 1B1 catalyzed pyrene oxidation to 1-hydroxypyrene at a similar rate to P450 2A13 but was less efficient in forming dihydroxypyrenes. P450 2A6, a related human P450 enzyme, which did not show any spectral changes with these four PAHs, showed lower activities in oxidation of these compounds than P450 2A13. 3. 1-Nitropyrene and 1-acetylpyrene were also found to be efficiently oxidized by P450 2A13 to several oxygenated products, based on mass spectrometry analysis. 4. Molecular docking analysis supported preferred orientations of pyrene and its derivatives in the active site of P450 2A13, with lower interaction energies (U values) than observed for P450 2A6 and that several amino acid residues (including Ala-301, Asn-297 and Ala-117) play important roles in directing the orientation of these PAHs in the P450 2A13 active site. In addition, Phe-231 and Gly-329 were found to interact with pyrene to orient this compound in the active site of P450 1B1. 5. These results suggest that P450 2A13 is one of the important enzymes that oxidizes these PAH compounds and may determine how these chemicals are detoxicated and bioactivated in humans.

Geranylated flavanones from Paulownia coreana and their inhibitory effects on nitric oxide production.

The activity-guided fractionation of the MeOH extract of the flower of Paulownia coreana led to the isolation of a new geranylated flavanone, 3'-O-methyl-5'-hydroxydiplacol (1), along with 10 known compounds (2-11). Their structures were determined using spectroscopic techniques, which included one and two dimensional (1- and 2D)-NMR. Among the isolates, compounds 1-6 showed potent inhibitory activities against lipopolysaccharide (LPS)-induced nitric oxide production with IC50 values ranging 1.48 to 16.66 µM.

A case of benign meningioma presented with subdural hemorrhage.

Meningiomas are the most common benign intracranial tumors and make up 13-26% of all primary intracranial tumors. Clinical presentation of hemorrhage is rare in these tumors occurring in approximately 1.3% of cases and subdural hemorrhages are even more uncommon. The mechanism of hemorrhage is still unclear and may vary according to histologic type, location and the type of hemorrhage. We experienced a case of 61-year-old woman with a benign meningioma presenting as a subdural hemorrhage. She developed sudden onset of headache right after aggressively coughing. Her headache persisted for a week before she was admitted to the emergency room of National Cancer Center. She had a past medical history of ovarian cancer which had been treated and was allegedly recurrence-free for 2 years. At the time of admission, a headache was the only symptom and imaging studies showed a right frontal hemorrhagic subdural mass lesion accompanying an ipsilateral subdural hematoma. Elective surgery was performed and intraoperative findings revealed the hallmark characteristics of a meningioma with mixed stage diffuse subdural hematoma. Permanent pathology result determined it was a conventional meningioma (World Health Organization grade I). From this case, we discuss the rare presentation of subdural hemorrhage in meningioma and related points by reviewing the literature of previous studies.