Arthroscopic Synovectomy and Excision of a Sesamoid in the Management of an Atypical Presentation of Avascular Necrosis of Bone: A Case Report.

Avascular necrosis of a sesamoid bone is a rare and incompletely understood entity. Furthermore, associated lesions secondary to sesamoid pathology have seldom been described in the literature. We report a case of avascular necrosis of the medial sesamoid, accompanied by severe synovitis of the first metatarsophalangeal joint, that was successfully managed with arthroscopic synovectomy and open excision of the sesamoid.

Effects of Human Placenta Extract (Laennec) on Ligament Healing in a Rodent Model.

Rich in bioactive substances such as amino acids and peptides, Laennec (human placenta hydrolysate) has been widely used to control various types of musculoskeletal pain. However, the effects of Laennec on tendon and ligament injuries are not clearly understood. In the present study, Laennec was tested to identify its in vivo effects on ligament injury in an animal model and its in vitro effects on tendon-derived fibrocytes. A total of 99 Sprague Dawley rats were divided into the negative control (normal) group (n = 11) and the ligament injury group (n = 88). The ligament injury group was subdivided into normal saline-treated group, Laennec-treated group, polydeoxyribonucleotide-treated group, and 20% dextrose-treated group. Ligaments were collected at 1 week and 4 weeks after treatment. Histologic and biomechanical properties were analyzed. In vitro effects of Laennec and polydeoxyribonucleotide on fibrocytes were also analyzed. Although all other treatment groups showed increased inflammatory cells, the Laennec-treated group maintained cell counts and activated macrophage levels that were similar to the normal group. Unlike the saline-treated group and dextrose-treated group, the Laennec-treated group had low levels of degenerative changes at 4 weeks after treatment. Supportively, in vitro results showed that the Laennec-treated group had increased collagen type I, scleraxis (Scx) and tenomodulin (Tnmd) expression (p < 0.05). Our study demonstrates that Laennec treatment enhances wound healing of damaged ligament by suppressing immune responses and reducing degenerative changes of damaged ligament. In addition, we found that Laennec induces the gene expression of type I collagen, Scx and Tnmd in fibrocytes, suggesting that Laennec may facilitate regeneration of damaged ligaments. Therefore, we expect that Laennec can be a useful drug to treat injured ligament.

Risk factors for recurrent lumbar disc herniation after discectomy.

PURPOSE: There are many reports about the risk factors for recurrence after lumbar disc surgery. However, there are none about whether lumbosacral transitional vertebrae (LSTV) are associated with recurrent lumbar disc herniation (LDH). We investigated various risk factors for recurrent LDH after discectomy including LSTV. METHODS: A total of 119 patients who had undergone a discectomy for L4-5 disc herniation were evaluated with a minimum follow-up of two years. Clinical parameters including age, gender, body mass index (BMI), and smoking status, and radiological parameters including type of herniated disc, degree of disc degeneration, LSTV, and sagittal range of motion (SROM) in flexion-extension radiography were evaluated. SROM was measured by the difference of the lordotic angle between the flexion and extension view. RESULTS: Recurrent disc herniation at L4-5 developed in 21 (17.6%) of the 119 patients. The mean period between primary surgery and recurrence was 17.6 ± 21.1 months. LSTV was found in 11 (52.4%) of the 21 patients who had recurrence and seven (7.1%) of the 98 patients in the non-recurrent group. SROM at L4-5 was 11.68 ± 4.24° in the recurrent group and 9.04 ± 3.65° in the non-recurrent group with a significant difference (p = 0.004). Multiple logistic regression analyses confirmed that LSTV and a larger SROM were significant risk factors for recurrent disc herniation at L4-5. CONCLUSIONS: Lumbosacral transitional vertebrae and a hypermobile disc in flexion-extension radiography were found to be risk factors for recurrent lumbar disc herniation.

Simultaneous determination of three acidic herbicide residues in food crops using HPLC and confirmation via LC-MS/MS.

2,4-D, dicamba and 4-CPA with auxin-like activity have been intensively used in agriculture, for the control of unwanted broadleaf weeds. An analytical method involving HPLC coupled with UVD was developed for the simultaneous analysis of these three analytes in Chinese cabbage, apple and pepper fruits (representative non-fatty samples) and brown rice and soybean (representative fatty samples) using liquid-liquid partitioning and column cleanup procedures. The residues were confirmed via tandem mass spectrometry (MS/MS) in ion electrospray ionization (ESI) mode. The standard curves were linear over the range of the tested concentrations (0.25-10 microg/mL), as shown by a marked linearity in excess of 0.9999 (r(2) ). The average recoveries (mean, n = 3) ranged from 94.30 to 102.63 in Chinese cabbage, from 94.76 to 108.47 in apple, from 97.52 to 102.27 in pepper, from 76.19 to 101.90 in brown rice, and from 74.60 to 107.39 in soybean. The relative standard deviations (RSDs) were <9% in all tested matrices. The limits of detection and quantitation were 0.006 and 0.02 mg/kg, respectively. Samples purchased from local markets were analyzed to evaluate the applicability of the methods developed herein. The concentration of the 2,4-D residue was measured at 0.102 mg/kg in the soybean sample; however, this level is exactly the same MRL set by the Korea Food and Drug Administration. This developed method deserves full and complete consideration, as it clearly displays the sensitivity, accuracy and precision required for residue analysis of 2,4-D, dicamba and 4-CPA in food crops.

Bufferized solvent extraction and HPLC fluorometric detection method for sarafloxacin in pig and chicken muscles.

In this study, a method for the detection of sarafloxacin in pig and chicken muscles was developed using HPLC-FLD as a regulatory residue technique. Good extraction efficiency was achieved using a mixture of 1% orthophosphoric acid-0.2 m MgCl(2) in water and acetonitrile as an extraction solvent, and n-hexane partitioning and centrifugation for cleanup was used in the absence of dehydration. Specificity, linearity, detection and quantification limits, recovery, accuracy and precision were all validated, and all results were sufficient for the SARA regulatory residue method in pig and chicken muscles. The method developed and described herein was not only simple but also reliable, and was applied to market samples to determine their residue contents.

Determination of field-incurred chlorfluazuron residues in the peach.

Chlorfluazuron residues were determined in the peaches that were sprayed at dosage (a.i. 0.0167 kg 10a(-1)), using an analytical method that was validated as follows; r (2) = 0.9999, 0.02 mg kg(-1) (LOQ) and 87.8-93.6% (recovery). The residues from all samples were lower than the MRL (0.5 mg kg(-1), Korea). A maximum 0.27 mg kg(-1) of chlorfluazuron was detected in the samples applied at 6 days before harvest. The results signify that the 10% SC product would be used safely as an insecticide if it is applied two or three times onto peaches, with applications given until 6 days prior to harvest.

Design and efficient synthesis of novel ascorbyl conjugated peptide with high collagen biosynthesis stimulating effects.

Collagen is critical for skin strength and elasticity, and its degradation leads to wrinkles that accompany aging. Based emphasis on the aesthetics, we tried to make a new compound that can highly stimulate collagen biosynthesis and synthesized ascorbyl conjugated peptide that is a complex form connected by succinoyl linker. We conducted several in vitro and in vivo experiments to identify if the compound has a potent activity, comparing to the ascorbic acid only for collagen biosynthesis. Our in vitro and in vivo result identified that ascorbyl conjugated peptide can stimulate collagen biosynthesis in human dermis and is assumably stable in the rat skin extracts. In conclusion, we strongly suggest that ascorbyl conjugated peptide can be used as a main ingredient for cosmetic products as well as wound healing agents.

Simultaneous determination of pyrethroids from pesticide residues in porcine muscle and pasteurized milk using GC.

The principal goal of this work was to develop an efficient method for the simultaneous determination of four pyrethroid (PYR) insecticides, cyfluthrin, cyhalothrin, cypermethrin, and deltamethrin, in porcine muscle and pasteurized milk using liquid-liquid extraction (LLE). Sample extraction was carried out with and without additional column cleanup procedures, and the final determination was made using GC with electron-capture detector (ECD). The pesticide identity was confirmed using GC-MS in the SIM mode. Since there were minor differences between the extraction procedures, extraction without the additional cleanup procedure was used throughout the work. The method was validated by fortifying blank samples with half, two, and four times the maximum residue limit (MRL) of each PYR. The average recoveries (n = 6) ranged from 83.5 to 99.2% and 82.9 to 109% in porcine muscle and pasteurized milk, respectively. The repeatability of measurements expressed as RSDs, was in the range of 1.7-11.9 and 1.5-10.3% in porcine muscle and pasteurized milk, respectively. The LODs ranged from 3.3 to 9 and 3 to 8.1 ppm, whereas the LOQs ranged from 10 to 27.4 and 9 to 24.6 ppm, in porcine muscle and pasteurized milk, respectively. The applicability of the method was demonstrated by analyzing real samples collected from major cities in the Republic of Korea. No residues of the selected pesticides were detected in any of the samples.

Multiresidue analysis of pesticides with hydrolyzable functionality in cooked vegetables by liquid chromatography tandem mass spectrometry.

It would be preferable for pesticide residues substituted by hydrolyzable functionality to be analyzed after cooking because their structures are apt to degrade during boiling and/or heating. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantitative determination of 44 pesticide residues with hydrolyzable functional group in five typical vegetable widely consumed in Republic of Korea is described. The sample clean-up was carried out according to the method of Food Code No. 83 established by the Korea Food and Drug Administration (KFDA). Zorbox XDB-C(18) column was selected for the analysis because of the best peak separation. The LC mobile phase consisted of water and 5 mm methanolic ammonium formate, which resulted in a peak shape with good symmetry at each run. Tandem mass spectroscopic (MS/MS) experiments were performed in ESI positive mode and the multiple reaction monitoring modes. A conventional matrix effect was modified to more comprehensive form 100gamma(ij) (%). A high matrix effect (<-30%) was detected for the seven polar pesticides, namely thiamethoxam, clothianidin, acetamiprid, aldicarb, thiacloprid, pirimicarb and methabenzthiazuron. The limits of detection were in the range of 0.1-8.1 microg/kg, indicating a good sensitivity. Most of the recoveries ranged from 70 to 131% with RSDs

Cementless total hip arthroplasty in young patients under the age of 30: a minimum 10-year follow-up.

PURPOSE: The purpose of this study was to evaluate the clinical and radiologic outcomes of young patients (under the age of 30) who received a total hip arthroplasty (THA) and in whom patients had been followed for more than 10 years. MATERIALS AND METHODS: This retrospective study was conducted for 51 hips (44 patients) that had undergone THA. The mean age for the index operation was 25.71 years, and the mean follow-up period was 13.7 years. Clinical outcomes were evaluated by Harris hip score (HHS), activity level, and complications. Radiographic evaluations were assessed according to osteolysis, loosening, and polyethylene wear. RESULTS: The average HHS improved from 67.47 pre-operatively to 97.42 at the final follow-up ( p < 0.001). The activity level changed from 1.92 pre-operatively to 1.33 at the final follow-up ( p < 0.001). Ten cases had undergone revision arthroplasty within the follow-up period, and the overall survival rate was 80.4% at the final follow-up with revision for any reason as the end point. Polyethylene liners were used in all revision cases ( p = 0.003). Patients with modular stem had a higher failure rate than patients with a fully porous coated stem ( p < 0.001). Furthermore, a small diameter head size was associated with a higher risk of revision surgery ( p = 0.003). Complications such as dislocations were found in three hips. CONCLUSION: Cementless THA yields encouraging clinical and radiological results in young and active patients under the age of 30. However, the bearing surface, type of stem, and head size influenced component durability and revision rate.

Long-term clinical outcome of two-stage revision surgery for infected hip arthroplasty using cement spacer: Culture negative versus culture positive.

INTRODUCTION: Periprosthetic joint infection (PJI) is a terrible complication after hip arthroplasty. Clinical feature of culture-negative PJI (CN-PJI) has not been well studied till now. In our study, we retrospectively analyzed long-term clinical results after two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for CN-PJI. The purpose of this study is to investigate the clinical features and prognosis of CN-PJI after hip arthroplasty and to compare these with those of culture-positive PJI (CP-PJI). METHODS: We retrospectively reviewed 15 CN-PJI cases and 70 CP-PJI cases following hip arthroplasty. The average follow-up period was 7.4 years (5-11.7 years). The demographics, laboratory findings, the time interval between antibiotic-impregnated cement spacer insertion and revision arthroplasty, and recurrence of infection were analyzed. RESULTS: The CN-PJI group showed a significantly higher incidence of prior antibiotic use ( p = 0.004) and lower serum C-reactive protein (CRP) level ( p = 0.001) than the CP-PJI group. Normalized time interval of CRP level in CN-PJI was shorter than that of CP-PJI group. The mean interval time for two-stage exchange arthroplasty was also significantly lower ( p = 0.049) in the CN-PJI group than the CP-PJI group. There was no case of treatment failure or major complication in CN-PJI group. CONCLUSION: The CN-PJI group after total hip arthroplasty could be treated successfully by two-stage exchange arthroplasty without any complications. Clinical course and prognosis of CN-PJI group was also better compared with that of CP-PJI group. Therefore, culture negativity of PJI cannot be always a poor prognostic factor for the treatment.

The optimal protocol to reduce blood loss and blood transfusion after unilateral total knee replacement: Low-dose IA-TXA plus 30-min drain clamping versus drainage clamping for the first 3 h without IA-TXA.

INTRODUCTION: Although intraarticular tranexamic acid (IA-TXA) administration or drainage clamping are popular methods used to reduce blood loss after total knee replacement (TKR), the protocol remains controversial. We aimed (1) to establish new protocols through investigating whether two methods, that is, low-dose (500 mg) IA-TXA plus 30-min drain clamping and drainage clamping for the first 3 h without IA-TXA, can reduce blood loss and blood transfusion after unilateral TKR and (2) to make recommendations related to clinical application. MATERIALS AND METHODS: This study, conducted from September 2014 to June 2016 related to enrolled 95 patients with primary osteoarthritis who were to have a unilateral cemented TKR, was nonrandomized and retrospective. In group A, the drain was released following tourniquet deflation. In group B, 500-mg TXA was injected into the knee joint via a drain tube after fascia closure and the drain was clamped for the first 30 min to prevent leakage. In group C, the drain was clamped for the first 3-h postoperation. Demographic characteristics and clinical data were collected, including the levels of hematocrit (Hct), the total blood loss (TBL), drained blood volume (BV), the amount of blood transfused, and any complications that developed. RESULTS: We found a significantly lower postoperative TBL, drained BV, decreasing Hct level, and less transfused BV in the IA-TXA injection group (group B) and the 3-h drainage clamping group (group C) compared to the conventional negative drainage group (group A; p < 0.001). There was no significant difference between groups B and C ( p = 0.99). CONCLUSIONS: The drainage clamping method can be safer than IA-TXA administration in patients with risk factor of venous thromboembolic complication. Furthermore, the IA-TXA administration can be more optimal than drainage clamping in patients with high bleeding tendency or lateral retinacular release during TKR, who would be concerned about postoperative wound complication.

Bilateral Idiopathic Chondrolysis of the Hip in an Adult: A Case Report and Review of the Literature.

Idiopathic chondrolysis of the hip usually develops in adolescents and is a disease characterized by gradual degenerative changes of the hyaline cartilage surrounding the head of the femur. It eventually decreases the hip joint space and causes limitations in the hip joint range of motion due to pain. The authors had experienced an unusual case of bilateral idiopathic chondrolysis of the hip in an 54 year-old male; thus, we report the treatment results and literature reviews in this case report.

Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures.

BACKGROUND: Subcapital femoral neck is known to cause many complications, such as avascular necrosis (AVN) of the femoral head or nonunion, compared with other femoral neck fractures. The purpose of this study was to analyze the incidence of AVN and fixation failures in patients treated with internal fixation using cannulated screws for the subcapital femoral neck fractures. METHODS: This study targeted a total of 84 cases of subcapital femoral neck fractures that underwent internal fixation using cannulated screws. The average follow-up time after surgery was 36.8 months (range, 24 to 148 months). RESULTS: Nine hips (10.7%) showing AVN of the femoral head and 6 hips (7.1%) showing fixation failures were observed. The factors affecting the incidence of AVN of the femoral head after sustaining fractures correlated well with fracture types in the Garden classification (p = 0.030). The factors affecting fixation failure were the degree of reduction (p = 0.001) measured by the Garden alignment index and firm fixation (p = 0.009) assessed using the technique of 3-point fixation through the inferomedial cortical bone of the femoral neck. CONCLUSIONS: The complication rates for subcapital femoral neck fractures were lower than those previously reported; hence, internal fixation could be a primary treatment option for these fractures.

Determination of Methoxyfenozide Residues in Water and Soil by Liquid Chromatography: Evaluation of its Environmental Fate Under Laboratory Conditions.

Pesticide residues play several key roles as environmental and food pollutants and it is crucial to develop a method for the rapid determination of pesticide residues in environments. In this study, a simple, effective, and sensitive method has been developed for the quantitative analysis of methoxyfenozide in water and soil when kept under laboratory conditions. The content of methoxyfenozide in water and soil was analyzed by first purifying the compound through liquid-liquid extraction and partitioning followed by florisil gel filtration. Upon the completion of the purification step the residual levels were monitored through high performance liquid chromatography (HPLC) using a UV absorbance detector. The average recoveries of methoxyfenozide from three replicates spiked at two different concentrations and were ranged from 83.5% to 110.3% and from 98.1% to 102.8% in water and soil, respectively. The limits of detection (LODs) and limits of quantitation (LOQs) were 0.004 vs. 0.012 ppm and 0.008 vs. 0.024 ppm, respectively. The method was successfully applied to evaluate the behavioral fate of a 21% wettable powder (WP) methoxyfenozide throughout the course of 14 days. A first-order model was found to accurately fit the dissipation of methoxyfenozide in water with and a DT50 value of 3.03 days was calculated from the fit. This result indicates that methoxyfenozide dissipates rapidly and does not accumulate in water.