What Injury Mechanism and Patterns of Ligament Status Are Associated With Isolated Coronoid, Isolated Radial Head, and Combined Fractures?

BACKGROUND: Isolated coronoid, isolated radial head, and combined coronoid and radial head fractures are common elbow fractures, and specific ligamentous injury of each fracture configuration has been reported. However, the osseous injury mechanism related to ligament status remains unclear. QUESTIONS/PURPOSES: The objectives of this study were: (1) to determine what ligamentous injury patterns (medial or lateral collateral) and bone contusion patterns (medial or lateral) are associated with isolated coronoid, isolated radial head, and combined coronoid and radial head fractures; (2) to correlate the osseous injury mechanism based on these findings with isolated coronoid, isolated radial head, and combined coronoid and radial head fractures; and (3) to determine whether isolated and combined coronoid fractures have different fracture lines through the coronoid (tip or anteromedial facet), speculated to be caused by different injury mechanisms. METHODS: Between June 2007 and June 2012, 100 patients with elbow fractures were included in the cohort, with 46 of these patients being excluded owing to incongruity for our surgical indication. Finally, 54 patients with surgically treated elbow fractures who had MRI preoperatively were assessed retrospectively. There were 17 elbows with isolated coronoid fractures, 22 with isolated radial head fractures, and 15 with combined coronoid and radial head fractures. Collateral ligament injury pattern and existence of distal humerus bone contusion were reviewed on MR images. RESULTS: Patients with isolated radial head fractures were at greater risk of medial collateral ligament rupture compared with patients with isolated coronoid fractures (radial head only: 15 of 22 [68%]; coronoid only: three of 17 [18%]; odds ratio [OR], 10.0; 95% CI, 2.2-46.5; p = 0.002). Patients with isolated coronoid fractures had greater risk of lateral ulnar collateral ligament ruptures (coronoid: 16 of 17 [94%]; radial head: seven of 22 [32%]; OR, 3.5; 95% CI, 3.8-333.3; p < 0.001). The presence of radial head fractures was associated with the risk of lateral bone bruising (isolated radial head fracture: 32 of 37 [86%], isolated coronoid fracture: four of 17 [24%]; OR, 29.6; 95% CI, 5.2-168.9; p < 0.001). Medial bone bruising was only detected in isolated coronoid fractures (isolated coronoid fracture: 12 of 17 [71%], others: zero of 37 [0%]). All isolated coronoid fractures involved the anteromedial facet of the coronoid (17 of 17; 100%). However, combined coronoid and radial head fractures often involved the tip (13 of 15; 87%). CONCLUSIONS: Isolated coronoid fractures mostly involved the anteromedial facet of the coronoid process associated with lateral ulnar collateral ligament rupture and medial bone bruising. However, isolated radial head fractures were associated with medial collateral ligament rupture and lateral bone bruising. Combined coronoid and radial head fractures mostly involved a tip fracture of the coronoid with lateral ulnar collateral ligament rupture and lateral bone bruising. Thus surgeons may predict which ligament they should be aware of in the surgical field. LEVEL OF EVIDENCE: Level III, prognostic study.

Abiotic stress of ambient cold temperature regulates the host receptivity to pathogens by cell surfaced sialic acids.

Ambient cold temperature, as an abiotic stress, regulates the survival, stability, transmission, and infection of pathogens. However, the effect of cold temperature on the host receptivity to the pathogens has not been fully studied. In this study, the expression of terminal α-2,3- and α-2,6-sialic acids were increased in murine lung tissues, especially bronchial epithelium, by exposure to cold condition. The expression of several sialyltransferases were also increased by exposure to cold temperature. Furthermore, in human bronchial epithelial BEAS-2B cells, the expressions of α-2,3- and α-2,6-sialic acids, and mRNA levels of sialyltransferases were increased in the low temperature condition at 33 °C. On the other hand, the treatment of Lith-Gly, a sialyltransferase inhibitor, blocked the cold-induced expression of sialic acids on surface of BEAS-2B cells. The binding of influenza H1N1 hemagglutinin (HA) toward BEAS-2B cells cultured at low temperature condition was increased, compared to 37 °C. In contrast, the cold-increased HA binding was blocked by treatment of lithocholicglycine and sialyl-N-acetyl-D-lactosamines harboring α-2,3- and α-2,6-sialyl motive. These results suggest that the host receptivity to virus at cold temperature results from the expressions of α-2,3- and α-2,6-sialic acids through the regulation of sialyltransferase expression.

Effects of humeral component retroversion on functional outcomes in reverse total shoulder arthroplasty for cuff tear arthropathy.

BACKGROUND: The currently recommended 0° to 30° humeral component retroversion angle for reverse total shoulder arthroplasty (RTSA) is based on expert opinion rather than anatomical or clinical evidence. METHODS: Sixty-two patients who underwent RTSA for cuff tear arthropathy were reviewed retrospectively. The humeral component was inserted with 20° retroversion in 30 patients (group A) and with 0° retroversion in 32 (group B). The mean age at the time of operation was 66.2 years and 68.9 years, and the mean follow-up period was 43.3 months and 38.4 months in groups A and B, respectively. RESULTS: At the last follow-up, external rotation at the side was 47.2° ± 8.4° in group A and 43.9° ± 7.0° in group B, whereas internal rotation to the posterior was L3 and L2, respectively (P = .102 and P = .092). The ranges of motion between the 2 groups at the last follow-up were not significantly different. Most daily movements related to activities of daily living showed no significant differences between the 2 groups, with the exception of back washing/back doing up bra (1.5 ± 1.2 in group A vs 2.1 ± 0.8 in group B of 3 points, P = .026). CONCLUSIONS: Range of motion after RTSA did not significantly differ between 20° and 0° humeral component retroversion angle. Most daily movements did not differ between the 2 groups, but patients in the 0° retroversion angle group scored better on activities related to internal rotation.

Drop sign of the elbow joint after surgical stabilization of an unstable simple posterolateral dislocation: natural course and contributing factors.

BACKGROUND: We performed this study to investigate the natural course and factors affecting the incidence of drop sign immediately after stabilization of an unstable posterolateral (PL) dislocation of the elbow. METHODS: Twenty-three patients who underwent a stabilization procedure for persistent instability after closed reduction of PL dislocation of the elbow were enrolled. The natural course was evaluated with simple radiographs taken at regular intervals after the operation. Primary repair of medial or lateral ligaments and overlying muscles, degree of adjacent muscle injury, and type of anesthesia were analyzed to determine their relationship to postoperative drop sign. Functional outcomes were evaluated by the Disabilities of the Arm, Shoulder, and Hand score and Mayo Elbow Performance Score. RESULTS: A postoperative drop sign was observed in 4 cases (17%) and resolved within 1 week after the operation. There was no significant relationship between preoperative factors and drop sign except method of anesthesia. All drop signs were found in patients who had received a regional block (P = .006). There were no statistically significant differences in functional outcome between the drop sign group and the non-drop sign group. CONCLUSIONS: A postoperative drop sign was observed in 17% of patients who underwent a surgical stabilization procedure for an unstable PL elbow dislocation; this sign spontaneously disappeared in all 4 patients within 1 week of the operation. The drop sign was possibly caused by delayed return of muscle tone. A postoperative drop sign did not indicate the need to perform an additional stabilization procedure, nor did it affect postoperative functional outcome.

Light and scanning electron microscopy of aecia and aeciospores of Cronartium ribicola on Pinus koraiensis branch tissues.

Morphological characteristics of aecia and aeciospores of Cronartium ribicola on Pinus koraiensis branch tissues were investigated using light and field emission scanning electron microscopy (FESEM). Mature P. koraiensis trees in Jeongseon, Korea, showed yellowish aecia on stems and branches. Aecia and surrounding tissues were excised from the lesions and vapor-fixed for FESEM imaging, which revealed morphology including intact blister-shaped, flattened, and burst forms. Light microscopy revealed yellowish aeciospores having surface projections. Aeciospores were mostly ovoid and measured approximately 20 µm long. The FESEM showed irregularly shaped cracks on the aecia that had erupted through the bark of P. koraiensis. Some aeciospores had germinated, producing two germ tubes from a spore in a burst aecium. Aeciospores had both smooth and verrucose regions on the surface, and some had concave or convex regions. Aeciospore layers and underlying fungal matrices including aecial columns were obvious in the cross-sections of aecia. Approximately 1 µm-high wart-like surface projections could be resolved and comprised less than 10 angular platelets stacked in vertical rows. Remains of the primary spore wall were present between surface projections. These results provide insights into the morphology of the heteroecious rust fungus with the help of vapor fixation and high-resolution surface imaging.

Comparative study of tibial posterior slope angle following cruciate-retaining total knee arthroplasty using one of three implants.

PURPOSE: Pre- and postoperative tibial posterior slope angles (PSAs) were assessed in patients who underwent cruciate-retaining total knee arthroplasty (TKA). MATERIAL AND METHODS: A total of 386 cruciate retaining TKA were performed in 308 patients and retrospectively reviewed. Based on the prostheses, 202 cases using NexGen were classified as group I, 120 cases using PFC sigma as group II, and 64 cases using Vanguard as group III. Postoperative PSA of groups I, II, and III were compared. RESULTS: In groups I, II, and III, postoperative PSA was 6.0˚, 6.0˚, and 4.5˚, respectively (p < 0.001). Between preoperative measurement and final follow-up examination, mean knee score (59.7 to 97.3), function score (54.2 to 90.5), and range of motion (ROM; 126.7° to 132.2°) improved. These three values did not differ significantly among groups. CONCLUSIONS: The 3° slope of the Vanguard polyethylene insert caused the difference in PSAs. This design characteristic should be considered when using this implant in TKA.

Sorbus commixta water extract induces apoptotic cell death via a ROS-dependent pathway.

The stembark of Sorbus commixta Hedl. has been used for treating asthma, bronchitis, gastritis and edema. However, the anticancer and proapoptotic effects of the water extract of the stembark of S. commixta (SCE) remain unknown. In the present study, it was shown that SCE inhibited the cell viability of the hepatocellular carcinoma cell lines Hep3B and HepG2, and of the colon carcinoma cell line HCT116. DNA content analysis indicated that SCE increased the sub-G1 population of HCT116 cells. In addition, degradation of nuclear DNA and levels of proapoptotic cascade components, including caspase-9, caspase-3 and poly ADP-ribose polymerase, were augmented by SCE treatment. Mitochondrial membrane potential and the ratio of B-cell lymphoma-2 (Bcl-2)/Bcl-2-associated X protein (Bax) were also reduced. Furthermore, SCE increased the expression of proapoptotic proteins, including p21, p27 and p53. Mouse double minute 2 homology, a negative regulator of p53, was cleaved by SCE treatment. Intracellular reactive oxygen species (ROS) production was also increased by SCE treatment. However, the SCE-induced cytotoxic effects and the increased expression of proapoptotic proteins, including p53 and p21, and reduced Bcl-2/Bax ratio, could be attenuated by N-acetyl cysteine, an ROS inhibitor. Taken together, these results indicate that SCE is a potent proapoptotic herbal medicine, which exerts its effects via the ROS-mediated mitochondrial pathway.

Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable.

BACKGROUND: The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears. PURPOSE: To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: One hundred eighty-one shoulders available for magnetic resonance imaging (MRI) at least 6 months after arthroscopic rotator cuff repair, with a minimum 1-year follow-up, were enrolled. The anterior attachment of the rotator cable was disrupted in 113 shoulders (group A) and intact in 68 shoulders (group B). The mean age at the time of surgery in groups A and B was 59.6 and 59.2 years, respectively, and the mean follow-up period was 24.2 and 25.1 months, respectively. RESULTS: There were statistically significant differences in the preoperative tear size and pattern and muscle fatty degeneration between the 2 groups ( P = .004, P = .008, and P < .001, respectively). At final follow-up, the mean visual analog scale (VAS) for pain score during motion was 1.31 ± 0.98 and 1.24 ± 0.90 in groups A and B, respectively ( P = .587). The mean Constant score was 77.5 ± 11.2 and 78.0 ± 11.9 points in groups A and B, respectively ( P = .875). The mean University of California, Los Angeles score was 30.5 ± 4.1 and 31.0 ± 3.0 points in groups A and B, respectively ( P = .652). In assessing the repair integrity on postoperative MRI, the retear rate was 23.9% and 14.7% in groups A and B, respectively ( P = .029). CONCLUSION: Irrespective of involvement in the anterior attachment of the rotator cable, the mean 24-month follow-up demonstrated excellent pain relief and improvement in the ability to perform activities of daily living after arthroscopic rotator cuff repair. However, tears with anterior disruption of the rotator cable showed a significantly larger and more complex tear pattern and more advanced fatty degeneration. Additionally, the retear rate was significantly higher in patients with a tear involving the anterior attachment of the rotator cable.

Inhibition of lung cancer growth by HangAmDan-B is mediated by macrophage activation to M1 subtype.

Re-education of tumor-associated macrophages (TAMs) toward antitumor effectors may be a promising therapeutic strategy for the successful treatment of cancer. HangAmDan-B (HAD-B), a herbal formula, has been used for stimulating immune function and activation of vital energy to cancer patients in traditional Korean Medicine. Previous studies have reported the anti-angiogenic and anti-metastatic effects of HAD-B; however, evidence on the immunomodulatory action of HAD-B was not demonstrated. In the present study, immunocompetent mice were used to demonstrate the suppression of the in vivo growth of allograft Lewis lung carcinoma (LLC) cells, by HAD-B. In addition, HAD-B inhibited the in vitro growth of LLC cells by driving macrophages toward M1 polarization, but not through direct inhibition of tumor cell growth. Furthermore, culture media transfer of HAD-B-treated macrophages induced apoptosis of LLC cells. Results of the present study suggest that the antitumor effect of HAD-B may be explained by stimulating the antitumor function of macrophages. Considering the importance of re-educating TAMs in the regulation of the tumor microenvironment, the present study may confer another option for anti-cancer therapeutic strategy, using herbal medicines such as HAD-B.

Scutellaria baicalensis Georgi induces caspase-dependent apoptosis via mitogen activated protein kinase activation and the generation of reactive oxygen species signaling pathways in MCF-7 breast cancer cells.

Scutellaria baicalensis Georgi extract (SBGE) is used in traditional herbal medicine and has also been used clinically to ameliorate the symptoms of various inflammatory diseases and cancer. In women, breast cancer is one of the most common diseases and numerous women succumb to it. The present study was undertaken to investigate the mechanism responsible for the SBGE­induced apoptosis of MCF­7 human breast cancer cells. SBGE was administered to cells at concentrations between 100 and 500 mg/ml, and cell viabilities were identified using an MTT assay. B­cell lymphoma 2 (Bcl-2) and Bcl-2 X­associated protein (Bax) family members were identified by western blotting, and the mRNA expression levels of the pro­apoptosis genes Fas, Fas ligand (FasL) and tumor necrosis factor (TNF)­α were assessed by reverse transcription­polymerase chain reaction. It was identified that SBGE treatment for 24 h inhibited MCF­7 proliferation and increased the sub­G1 phase ratio. SBGE suppressed mitochondrial membrane potentials and SBGE­induced apoptotic cell death was identified to be associated with downregulation of Bcl­2, but upregulation of Bax. SBGE­activated caspases 3 and 9, and increased reactive oxygen species generation. However, SBGE had no effect on the expression levels of Fas, FasL or TNF­α. Furthermore, mitogen­activated protein kinase and C­Jun N­terminal kinase inhibitors inhibited SBGE­induced cell death. These results suggested that SBGE be considered as an agent for the treatment of breast cancer.

Immediate loading of an implant following implant site development using forced eruption: a case report.

In restoring periodontally involved hopeless teeth, implant treatment has been widely used with combinations of various grafting techniques or guided bone regeneration. Instead of traditional surgical procedures, forced tooth eruption may be used successfully for implant site development. In this case, the authors orthodontically erupted a hopeless central incisor with an angular bony defect. Subsequently, they placed an implant immediately after tooth extraction and immediately loaded it with a temporary resin restoration.

Analysis of "hidden lesions" of the extra-articular biceps after subpectoral biceps tenodesis: the subpectoral portion as the optimal tenodesis site.

BACKGROUND: In biceps tenodesis for intra-articular tears, determining the distal extension of the lesions through the biceps groove is important in choosing the optimal tenodesis site. PURPOSE: To determine the optimal tenodesis site by analyzing the extension and delamination of an extra-articular lesion, or a "hidden lesion," in the retrieved biceps after subpectoral biceps tenodesis. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 36 subpectoral tenodeses were performed, and the retrieved biceps were analyzed. The biceps lesions were divided into zones according to their location as follows: the proximal intra-articular (zone A), middle intragroove (zone B), and distal extra-articular portions (zone C); the lesions in zones B and C were called "hidden lesions." The length and delamination depth of the biceps tears were examined, and the severity of the accompanying tenosynovitis and degeneration was assessed. RESULTS: Tears invaded zone B in all the cases and extended to zone C in 28 cases (77.8%). Tenosynovitis was observed along the tear in 28 cases (77.8%) and extended to zone C in 26 cases (72.2%). The mean tear length in the hidden lesions, including the tear and tenosynovitis, was 34.2 mm. Degenerative changes in the proximal intra-articular and middle intragroove portions were observed in all the cases and up to the distal extra-articular portion in 29 cases (80.6%). CONCLUSION: In approximately 80% of the intra-articular biceps tears evaluated in this study, a "hidden lesion" was observed going beyond the bicipital groove and extending to the distal extra-articular portion. Therefore, the subpectoral portion may be considered the optimal tenodesis site for the complete removal of all hidden biceps lesions.

Quantitative assessment of the latarjet procedure for large glenoid defects by computed tomography: a coracoid graft can sufficiently restore the glenoid arc.

BACKGROUND: Coracoid transfer to a large glenoid defect is considered an excellent method to restore the surface area of the anteroinferior glenoid. However, there is little quantitative evidence supporting whether a coracoid graft can sufficiently restore the glenoid arc. PURPOSE: To assess whether the Latarjet procedure can sufficiently restore the surface area of the glenoid. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 44 patients who underwent a Latarjet operation for a large glenoid defect between February 2009 and July 2011 were enrolled in this study. Three-dimensional computed tomography was used to calculate the surface areas of the preoperative glenoid defect size and the reconstructed glenoid. Preoperative and postoperative clinical results also were assessed. RESULTS: At the last follow-up, the mean visual analog scale score for instability during motion improved significantly from 5.1 points (range, 3-10 points) preoperatively to 1.3 points (range, 0-4 points) (P<.001). The mean deficit in external rotation at the side, external rotation at 90° of abduction, and internal rotation to the posterior were 10°±20°, 7°±16°, and 1.9°±4°, respectively (P=.004, .022, and .009, respectively). The overall recurrence rate was 4.5% (2 of 44 shoulders). The mean preoperative glenoid defect size was 157±38 mm2 (range, 141-239 mm2; 25.3%±6% of the intact glenoid surface). The mean surface area of the coracoid graft used for reconstruction was 152±34 mm2 (range, 146-236 mm2; 24.8%±5% of the intact glenoid surface). After the Latarjet procedure, the mean surface area of the reconstructed glenoid was 706±32 mm2 (range, 639-749 mm2). Finally, postoperative glenoid defect size was 5±11 mm2 (range, 3-28 mm2; 1.5%±2% of the intact glenoid surface). CONCLUSION: The Latarjet procedure can provide satisfactory outcomes, including a low recurrence rate and reliable functional recovery. Defects at the anteroinferior glenoid were restored to nearly normal after coracoid transfer by use of the Latarjet procedure, which is an anatomically matched reconstruction.

The influence of diabetes mellitus on clinical and structural outcomes after arthroscopic rotator cuff repair.

BACKGROUND: The clinical effect of sustained hyperglycemia on tendon-to-bone healing after rotator cuff repair has not been well characterized. PURPOSE: To compare the clinical and structural outcomes between diabetic and nondiabetic patients after arthroscopic rotator cuff repair and to determine the effect of a diabetic phenotype on tendon-to-bone healing. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study retrospectively evaluated a total of 335 shoulders that were available for magnetic resonance imaging (MRI) evaluation at least 6 months after arthroscopic rotator cuff repair using the suture-bridge technique with a minimum follow-up of 1 year. Only patients who had medium- to large-sized tears with supraspinatus of fatty infiltration <2 and no or mild atrophy were enrolled in this study. There were 271 nondiabetic patients (group A) and 64 diabetic patients (group B). The mean age at the time of operation for groups A and B was 57.7 and 58.2 years, respectively, and the mean duration of follow-up after surgery was 27.8 and 24.8 months, respectively. RESULTS: At the last follow-up, there were no statistically significant differences between the 2 groups with regard to pain at rest and during motion (P = .212 and .336, respectively). Both groups reported statistically significant improvement in Constant and Shoulder Rating Scale of the University of California at Los Angeles scores (P = .323 and .241, respectively), but there was no statistically significant difference between the 2 groups. In assessing the repair integrity with postoperative MRI scans, 39 of 271 cases in group A (14.4%) and 23 of 64 cases in group B (35.9%) had retears, and the difference between the 2 groups was statistically significant (P < .001). In analyzing the retear rates according to the severity of sustained hyperglycemia in group B, retear was found in 16 of 37 (43.2%) uncontrolled diabetic patients with poor glycemic control (≥7.0% of preoperative serum glycosylated hemoglobin [HbA1c] levels) and in 7 of 27 (25.9%) controlled diabetic patients (<7.0%) (P < .001). CONCLUSION: Pain, range of motion, and function all significantly improved after arthroscopic rotator cuff repair using the suture-bridge technique, regardless of the presence of diabetes. However, sustained hyperglycemia increased the possibility of anatomic failure at the repaired cuff. In diabetic patients, an effective glycemic control was associated with better rate of healing after rotator cuff repair.

Synthesis and SAR studies for the inhibition of TNF-alpha production. Part 2. 2-[3-(Cyclopentyloxy)-4-methoxyphenyl]-substituted-1-isoindolinone derivatives.

This study describes the synthesis and in vitro evaluation of 2-[3-(cyclopentyloxy)-4-methoxyphenyl]-1-isoindolinone derivatives substituted on benzene moiety of isoindoline ring for the inhibition of TNF-alpha production. From this study, we have found the 6-C position on isoindolinone ring is an optimal derivatization site. Among the compounds synthesized, 6-amino-2-[3-(cyclopentyloxy)-4-methoxyphenyl]-1-isoindolinone (6) was the most potent in inhibitory activity of TNF-alpha production in LPS-stimulated RAW264.7 cells.

Synthesis and sar studies for the inhibition of tnf-α production. part 2. 2-[3-(cyclopentyloxy)-4-methoxyphenyl]-substituted-1 -isoindolinone derivatives.

This study describes the synthesis andin vitro evaluation of 2-[3-(cyclopentyloxy)-4-methox-yphenyl]-1-isoindolinone derivatives substituted on benzene moiety of isoindoline ring for the inhibition of TNF-α production. From this study, we have found the 6-C position on isoindolinone ring is an optimal derivatization site. Among the compounds synthesized, 6-amino-2-[3-(cyclopentyloxy)-4-methoxyphenyl]-1 -isoindolinone (6) was the most potent in inhibitory activity of TNF-α production in LPS-stimulated RAW264.7 cells.