Atypical periprosthetic femoral fracture: a case report.

We report an 82-year-old woman who underwent fixation with a long-spanning cable-plate for a bisphosphonate-induced Vancouver B1 periprosthetic femoral fracture. Non-union and breakage of the plate occurred at 16 months and necessitated revision surgery using a long-stem femoral prosthesis augmented with a cable-plate construct. Bone union was achieved eventually after 10 months.

Serum leucine-rich α2-glycoprotein is a useful biomarker for monitoring disease activity in patients with adult-onset Still's disease.

OBJECTIVE: To investigate whether serum leucine-rich α2-glycoprotein (LRG) levels are elevated in patients with adult-onset Still's disease (AOSD) and determine their correlation with disease activity parameters. METHOD: We enrolled 39 patients with AOSD, 47 patients with rheumatoid arthritis (RA), and 39 controls. Forty-five serum samples from the patients with AOSD were assayed for LRG using an enzyme-linked immunosorbent assay (ELISA). Comprehensive AOSD activity was determined by a modified Pouchot score. RESULTS: Serum LRG levels were significantly elevated in patients with AOSD (128.8±40.8 ng/mL) compared to those in patients with RA and in controls (33.9±15.2 ng/mL, p<0.001 and 22.4±6.1 ng/mL, p<0.001, respectively). Patients with active AOSD had significantly higher LRG levels than those with inactive disease (141.4±31.3 ng/mL vs. 79.8±37.1 ng/mL, p=0.002). Serum LRG levels were positively correlated with C-reactive protein (CRP; γ=0.387, p=0.015), lactate dehydrogenase (LDH; γ=0.370, p=0.026), ferritin (γ=0.687, p<0.001) levels, and the modified Pouchot score (γ=0.756, p<0.001). Serum LRG levels decreased significantly after treatment in all six patients with active AOSD who had follow-up evaluations (p=0.007). The best cut-off value for LRG to distinguish AOSD from RA was 67.9 ng/mL, with a sensitivity of 92.3% and a specificity of 97.9%. CONCLUSIONS: Serum LRG levels were increased in patients with AOSD and correlated well with disease activity measures. LRG may be a useful biomarker for distinguishing AOSD from RA and for monitoring the disease activity of AOSD.

Analysis of rheumatoid factor according to various hepatitis B virus infectious statuses.

OBJECTIVES: Rheumatoid factor (RF) can be seen in hepatitis B virus (HBV) infection. We investigated RF positive rates according to various HBV infectious statuses and vaccination, and the relationship between RF titers and serum HBV DNA levels. METHODS: We examined 13,670 individuals who visited the Severance Hospital in Seoul, Korea, for a routine health check-up, and obtained serum samples from all individuals. RESULTS: RF was positive in 3.5% of all subjects, and HBsAg was positive in 4.3%. HBsAg was positive in 21.7% of all RF positive subjects. RF was positive in 17.5% of the HBsAg positive group, while it was positive in 2.9% of the HBsAg negative group (p<0.001). The RF positive rate was increased in positive HBsAg, female sex, and older age. The RF positive rate was lower in those who had anti-HBs after HBV vaccination than in HBsAg positive subjects (2.7% vs. 17.5%, p<0.001). Among the RF positive patients, the RF titer in HBsAg positive patients were higher than that in HBsAg negative patients (159.7±217.1IU/mL vs. 83.0±179.2 IU/mL, p=0.001). The load of HBV DNA may be closely correlated with RF titer in patients with chronic hepatitis B (r=0.508, p=0.005). CONCLUSIONS: Persistent HBV infection is an important cause for the positive RF in HBV endemic areas. Hepatitis B viral load is associated with RF titer. HBV vaccination may reduce the risk of RF formation.

Immunological impact of Taekwondo competitions.

Immunological changes in elite adolescent female athletes during Taekwondo competitions were investigated on-field. 6 female athletes (16.7 ± 0.8 year-old) volunteered and performed 5 bouts of demonstration Taekwondo competitions simulating real tournaments in intensity, duration, and break-time intervals on the same day. Blood samples were taken before, after the competitions and during the recovery, respectively. Immunological changes and oxidative stress in peripheral blood mononuclear cells were evaluated by flow-cytometry. During the competitions, exercise intensity was 92.2 ± 3.8% (86.1~95.7) of the maximal heart rate. Blood lactate increased immediately after the competitions (p=0.0165) and decreased to baseline during recovery. Intracellular reactive oxygen species (ROS) in the peripheral blood increased continuously during recovery (p<0.05, respectively). Natural killer cells increased immediately after the competitions (p=0.0006), and decreased during recovery. B and T cells increased immediately after the competitions and remained elevated throughout recovery (p<0.05, respectively). CD4/CD8 ratio after the competitions was decreased (p=0.0091) and returned to baseline during recovery. These results suggest that the immunological function of the elite female adolescent athletes could be attenuated after Taekwondo competitions. Further large-scaled Taekwondo studies on immunologic and apoptotic changes related to oxidative stress should be performed for improving and protecting the health of adolescent athletes.

Factors affecting mortality in Hong Kong patients with upper limb necrotising fasciitis.

OBJECTIVE: To identify predictive factors for mortality of patients with upper limb necrotising fasciitis. DESIGN: Retrospective study. SETTING: Six hospitals in Hong Kong. PATIENTS: Clinical records of 29 patients treated in the hospitals were traced and analysed. MAIN OUTCOME MEASURES: Possible predictive factors for mortality as evaluated by application of Fisher's test. RESULTS: Overall mortality was 28%. Digital infections conferred a lower mortality, but progressive necrosis necessitated amputation. Vibrio vulnificus was the commonest organism identified in association with marine injury and in patients with cirrhosis. Prognostic indicators with decreasing significance include deranged renal and liver function, thrombocytopaenia, proximal involvement (elbow or above) initially, and presence of hypotension upon admission. CONCLUSION: With a P value of less than 0.05, deranged renal and liver function, thrombocytopaenia, initial proximal involvement, and hypotension on admission were predictors of mortality in necrotising fasciitis affecting the upper limbs. The ALERTS (Abnormal Liver function, Extent of infection, Renal impairment, Thrombocytopenia, and Shock) score with a cutoff of 3 appeared to predict mortality.

E/E' ratio is more sensitive than E/A ratio for detection of left ventricular diastolic dysfunction in patients with systemic sclerosis.

OBJECTIVES: To investigate the efficiency of early filling (E) and early diastolic mitral annular velocity (E') ratio (E/E' ratio) assessed by tissue Doppler imaging (TDI) on early detection of diastolic left ventricular (LV) dysfunction in systemic sclerosis (SSc) patients without congestive heart failure (CHF) symptoms. METHODS: Thirty-five Korean SSc patients without CHF symptoms and 35 healthy, age-sex matched controls were studied. Two-dimensional and M-mode echocardiography including conventional and tissue Doppler imaging was performed and pulmonary function test with diffusing capacity of lung for carbon monoxide was assessed. RESULTS: Mean E and late filling (A) ratio (E/A ratio) showed no significant difference between the two groups, while TDI showed that SSc patients had significantly elevated E/E' ratio (10.6+/-4.2 vs. 8.8+/-2.2, p=0.032), in comparison with controls. SSc patients who had taken angiotensin converting enzyme inhibitor or angiotensin II receptor blocker had significantly lower E/E' than those who had not (8.0+/-2.4 vs. 11.9+/-4.3, p=0.01). CONCLUSIONS: E/E' ratio is more sensitive than E/A ratio for identifying LV diastolic dysfunction in SSc patients without CHF symptoms. Furthermore, SSc patients who had received ACEI or ARB treatment showed significantly better preservation of LV diastolic function than those who had not received these medications.

Comparison of total knee arthroplasty using computer-assisted navigation versus conventional guiding systems: a prospective study.

PURPOSE: To compare knee alignments in total knee arthroplasty (TKA) using computer-assisted navigation versus conventional guiding systems. METHODS: Five men and 49 women aged 49 to 79 years underwent TKA for primary osteoarthritis of the knee with varus deformity. All valgus knees were associated with inflammatory arthritis and thus excluded. Computer-assisted navigation was used for the first 35 TKAs, whereas conventional extramedullary tibial and intramedullary femoral guiding systems were used for the next 35 TKAs. The mechanical axis, coronal tibial and femoral angles, sagittal tibial and femoral angles in the 2 groups were compared. RESULTS: Sagittal tibial and femoral angles aligned more optimally in TKAs using computer-assisted navigation. In the respective computer-assisted navigation and conventional guiding systems, 33 (94%) and 26 (74%) of the TKAs attained a postoperative mechanical axis of <3 degrees varus/valgus. CONCLUSION: Computer-assisted navigation gives a more consistent alignment correction and reduces outliers during implant positioning.

Osteopontin might be involved in bone remodelling rather than in inflammation in ankylosing spondylitis.

OBJECTIVES: To determine whether osteopontin (OPN) is increased in patients with AS and to investigate its relationship to inflammatory disease activity and bone remodelling process. METHODS: This cross-sectional study included 30 patients with AS and 23 age- and sex-matched healthy controls. We assessed clinical characteristics and laboratory parameters including the ESR, CRP, lipid profiles, the Bath AS disease activity index (BASDAI) and the Bath AS radiographic index (BASRI). To evaluate bone metabolism, we tested ALP, OCN and C-telopeptide of type I collagen (CTX-I). Plasma levels of OPN, TNF-alpha and IL-6 were measured by ELISA, and mRNA expression in peripheral blood mononuclear cells (PBMCs) was performed by RT-PCR. Changes in OPN level were also evaluated in eight patients after the treatment with a TNF-alpha blocker. RESULTS: Patients with AS had significantly higher plasma OPN, TNF-alpha and IL-6 levels and more mRNA expression than healthy controls. Plasma OPN levels were correlated with serum ALP, OCN and CTX-I levels, but not with ESR, CRP, lipid profiles, BASDAI or BASRI. Treatment with a TNF-alpha blocker did not alter OPN levels, although it reduced the disease activity. CONCLUSIONS: Patients with AS had higher levels of OPN compared with controls. The plasma OPN level was correlated with serum ALP, OCN and CTX-I levels, but not with disease activity in AS. OPN might be involved in bone remodelling rather than in inflammation in AS.

Serum leptin levels correlate with interleukin-6 levels and disease activity in patients with ankylosing spondylitis.

OBJECTIVE: To determine whether serum leptin levels are elevated in men with ankylosing spondylitis (AS) and whether the levels correlate with serum cytokine profiles and disease activity of AS. METHODS: Forty-two male patients with newly diagnosed AS were enrolled. Their Bath AS Disease Activity Index (BASDAI), body mass index (BMI), and acute phase reactants, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, were assessed. Serum leptin levels were determined using radioimmunoassay (RIA) and serum cytokine profiles, including tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, and interferon (IFN)-gamma, were determined using enzyme-linked immunosorbent assay (ELISA). These results were compared with those from 42 age-matched healthy men. After a follow-up period of 31.0+/-20.1 months, clinical and biochemical variables were reassessed in the men with AS. RESULTS: At baseline, patients with AS had significantly elevated serum levels of leptin, leptin adjusted for BMI (leptin/BMI), TNFalpha, and IL-6, but not IFN-gamma, as compared to the controls. Serum leptin/BMI levels correlated well with IL-6 levels, and both leptin/BMI and IL-6 levels correlated well with BASDAI and CRP levels in patients with AS. The changes in leptin/BMI and IL-6 levels between the baseline and follow-up measurements correlated well with one another (p<0.05) and both correlated well with the changes in BASDAI (p<0.05). CONCLUSION: Serum leptin/BMI levels were increased and significantly associated with IL-6 levels and disease activity in men with AS, suggesting a possible role for leptin in the inflammatory reactions of AS.

Arthroscopic procedures for the treatment of anterior shoulder instability: local experiences.

OBJECTIVE: To review the outcomes of arthroscopic stabilisation procedures for the treatment of recurrent anterior shoulder dislocation. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Patients receiving arthroscopic stabilisation procedures for recurrent anterior shoulder dislocation between 1999 and 2003. MAIN OUTCOME MEASURES: Functional outcomes including pain, range of motion, and activity level were assessed using the Constant score. Intra-operative findings were also discussed. RESULTS: A total of 18 arthroscopic stabilisation procedures were performed for the treatment of recurrent shoulder instability. Two cases converted to open procedures were excluded from this review. The overall outcomes were good and seven patients reported a full recovery. Fourteen out of 16 patients reported minimal or no pain, and the mean Constant score was 80. There were no cases of re-dislocation and no major complication was noted. CONCLUSION: All the reviewed patients had a satisfactory functional recovery. Therefore, we believe that the use of arthroscopic stabilisation procedure can produce a favourable outcome for appropriate shoulder pathologies.

Low birth weight is associated with elevated serum lipoprotein(a) in white and black American children ages 5-11 y.

Nutritional insults experienced by the mother have a life-long imprint on organ size and function of the fetus. Infant low birth weight (LBW) is one of the consequences of such maternal undernutrition. The physiological consequences of nutritional insults can lead to adverse metabolic consequences after birth, including hypertension, diabetes and dyslipidemia. The objective of this study was to determine the association and contribution of LBW to serum concentration of lipoprotein(a) [Lp(a)] in a representative sample of white and black American children aged 5-11 y. Data (n=666) from the Third US National Health and Nutrition Examination Survey were used in this investigation. Racial/ethnic-specific trends in mean values of Lp(a) were compared across tertile distribution of birth weight. Multiple linear regression analysis was employed to determine the association of birth weight with Lp(a), controlling for age, sex and sum of four skinfold thicknesses (SUM). A consistent trend of increasing values of Lp(a) with decreasing birth weight emerged for both white and black children (P<0.001). Black children presented with higher values of serum concentrations of Lp(a) at each level of birth weight distributions than white children (P<0.01). Black race/ethnicity was associated with approximately 0.4 mg/dl greater serum concentration of Lp(a) than white, adjusting for birth weight, age, sex and SUM (P<0.001). LBW sub-population in black children appeared to be relevant to elevated Lp(a) concentration, while a similar scenario did not appear in white children. Since interactions between in utero factors and risk exposures after birth are likely, definitive studies evaluating these interactions are warranted.

Growth promotion of rice seedlings by allelopathic polysaccharide from Welsh onion.

The underground portion of the Welsh onion (Allium fistulosum) was extracted and separated into seven fractions to purify allelopathic compounds that were found to promote the growth of rice seedlings (Oryza sativa). The 80% (v/v) ethanol-insoluble fraction of the hot water extract showed the highest growth-promoting effect. Purification by DEAE-cellulose chromatography gave four fractions, AD-1, 2, 3 and 4. AD-3 at 1000 ppm stimulated root and shoot growth by about 2.4 and 1.5 times over the respective water and sucrose-treated controls. The molecular weight of AD-3 was roughly estimated as 630 kDa by gel permeation chromatography. Seventy two percent (by wt.) of AD-3 was a carbohydrate and no proteins were detected. A GC analysis of the neutral sugar composition revealed the presence of Gal (50.1%), Man (17.9%), Ara (10.4%), Rha (8.8%), Glc (7.2%) and Xyl (5.6%). About 3% (by wt.) of the total carbohydrate was uronic acid, which was identified as GalU by a GC analysis. The remainder of AD-3 was extracted in ethyl acetate after its hydrolysis with 2 M HCl. The major component of the ethyl acetate-soluble fraction was identified as unsaturated linear primary alcohols, 1-tetradecanol and 1-octadecanol (16% and 84% by peak areas from GC, respectively) by means of NMR and GC-MS. Sole or combined treatment of these alcohols did not affect the growth of rice seedlings. After partial hydrolysis with 0.2 M trifluoroacetic acid or by a sodium periodate treatment, the activity of AD-3 had completely disappeared, suggesting that the sugar moiety and/or molecular size were important for the activity.

Epidemiology of HIV and AIDS among Asian and Pacific Islander Americans.

As of June 1997 the Centers for Disease Control and Prevention reported 4,370 AIDS cases among Asian and Pacific Islander Americans (APIs) in the U.S. It also reported that the rate of new AIDS cases among APIs men who have sex with men (MSM) per 100,000 population increased by 55% from 1989 (4.0) to 1995 (6.2). Focusing on the relatively low numbers of APIs with AIDS in the U.S. has resulted in complacency among API communities and government officials, despite reports of increased seroprevalence and exponential growth in diagnosed AIDS cases. However, because of the geographic and social isolation of many Asian and Pacific Islander American communities, the effect of HIV is magnified once it takes hold. The low numbers of reported AIDS cases among API and the perception of them as the "model minority" has reinforced their denial of AIDS as a threat. Data collection and surveillance tools must be modified to accurately capture the range of HIV-related and social issues that affect Asian/Pacific Islander communities in the United States. Notwithstanding sample limitations, ethnic-specific data are needed to identify HIV trends in each of the Asian Pacific Islander American communities, which can inform prevention and intervention programs.

Asian and Pacific Islander American HIV community-based organizations: a nationwide survey.

A national survey was conducted to (a) ascertain the status of HIV prevention among community-based organizations targeting APIs in the United States, (b) define technical assistance needs among these organizations, and (c) determine their involvement in the HIV community planning process. Of the 80 surveys sent out, 49 (61%) completed responses were received. Filipinos, Chinese, Vietnamese, Cambodians, and multiracials were the subpopulations targeted the most often, and, not surprising, Tagalog, Cantonese, Mandarin, Vietnamese, Cambodian, Korean and Japanese were the Asian languages most widely in use. Gay men, bisexual men, and youth were targeted most frequently by HIV prevention efforts. Of all the largest ethnic subpopulations, Asian Indian is the only group with no community-based organization that exclusively targets them for HIV prevention. More than 95% of respondents reported conducting some type of evaluation; the size of the budget and organization often determined the evaluation strategies used. Program development, staff development, and program evaluation were the most frequently reported areas of technical assistance requested. A majority of the respondents (79%) reported being involved with the HIV prevention community planning process where APIs were represented on state/local community planning groups, they did not rate the performance of the community planning process highly. We recommend providing technical assistance in fund-raising, program evaluation, and participation in the HIV community planning process.

The acceptability of oral fluid testing for HIV antibodies. A pilot study in gay bars in a predominantly rural state.

BACKGROUND: One barrier for individuals desiring human immunodeficiency virus (HIV) antibody testing has been the lack of alternatives to blood HIV testing. Oral fluid HIV testing provides another testing option. OBJECTIVES: To evaluate the acceptability of oral fluid testing for HIV antibodies in a gay bar outreach setting. STUDY DESIGN: This pilot study was conducted using the HIV Risk Behavior Survey (HRBS) and OraSure acceptability survey in gay bars in Columbia, South Carolina during July and August, 1997. RESULTS: Of the 118 HRBS participants, 54% agreed to take the oral fluid test with 6% testing positive. A majority (91%) of participants felt comfortable with the oral HIV antibody testing in gay bars. Also, 21.8% of individuals in the OraSure study were tested for the first time. CONCLUSION: This study indicates that oral fluid testing for HIV antibodies in an outreach setting is acceptable and effective in reaching individuals who do not usually access traditional testing sites.

Experimentally induced intrauterine infection causes fetal brain white matter lesions in rabbits.

OBJECTIVE: Periventricular leukomalacia, a common brain white matter lesion in preterm neonates, is a major risk factor for cerebral palsy. Epidemiologic studies have demonstrated an association between infection and periventricular leukomalacia. The purpose of this study was to determine whether ascending intrauterine infection could cause brain white matter lesions in the fetal rabbit. STUDY DESIGN: Rabbits with timed pregnancies underwent hysteroscopy at 20 to 21 days of gestation (70%). Animals were allocated in a ratio of 2:1 for inoculation with either Escherichia coli (0.2 ml containing 10(3) to 10(4) colony-forming units) or sterile saline solution. Both groups were treated with ampicillin-sulbactam (Unasyn, 100 mg/kg per day; Pfizer, Seoul) every 8 hours until they were killed 5 to 6 days after hysteroscopy. Histologic examination of the placentas and fetal brains was conducted. RESULTS: Forty-five animals underwent hysteroscopy; 31 were inoculated with E. coli and 14 with sterile saline solution. At the time the animals were killed, the rate of intrauterine infection was higher and there were fewer live fetuses in the E. coli-inoculated animals than in the saline solution group. Histologic evidence of brain white matter damage was identified in 12 fetuses born to 10 E. coli-inoculated rabbits but none in the saline solution group (p < 0.05). All rabbits with brain white matter lesions had evidence of intrauterine infection. Evidence of white matter damage included increased karyorrhexis, rarefaction, and disorganization of white matter. Apoptosis was demonstrated in areas of white matter damage by immunohistochemical studies. CONCLUSION: Experimental ascending intrauterine infection can cause fetal brain white matter lesions.