Knee joint dysfunction in the patients immediately before arthroplasty was well reflected by locomotive syndrome, not physical frailty.

OBJECTIVES: We assessed physical function by three different methods in patients with knee osteoarthritis just before total knee arthroplasty (TKA) and investigated the relationship between impairment of mobility and preoperative factors. METHODS: All patients scheduled to undergo TKA at our hospital were assessed for basic attributes, clinical assessment, radiography, whole-body mode DXA, knee muscle strength. And frailty, sarcopenia, and locomotive syndrome (LS) were evaluated. RESULTS: Among 204 patients (213 knees),172 women, mean age 75.0 years, the overall distribution in frailty was ; in sarcopenia ; and in LS . Eighty-seven percent of the patients with frailty and 92% with LS stage 3 did not suffer from sarcopenia. Statistically significant relationships were observed between sarcopenia and frailty, while no relationship between LS and frailty or LS and sarcopenia. Multivariate analysis of related factors with severity level for frailty and LS revealed statistically significant correlations for frailty with gait speed and LS with KSS and muscle strength. CONCLUSION: In the patients with knee OA immediately before arthroplasty, physical frailty and LS was not related with by sarcopenia. Knee joint dysfunction without sarcopenia was well reflected by LS, not by physical frailty.

The genome folding mechanism in yeast.

The structure of the nucleosome has been solved at atomic resolution, and the genome-wide nucleosome positions have been clarified for the budding yeast Saccharomyces cerevisiae. However, the genome-wide three-dimensional arrangement of nucleosomal arrays in the nucleus remains unclear. Several studies simulated overall interphase chromosome architectures by introducing the putative persistence length of the controversial 30-nm chromatin fibres into the modelling and using data-fitting approaches. However, the genome-folding mechanism still could not be linked with the chromosome shapes, to identify which structures or properties of chromatin fibres or DNA sequences determine the overall interphase chromosome architectures. Here we demonstrate that the paths of nucleosomal arrays and the chromatin architectures themselves are determined principally by the physical properties of genomic DNA and the nucleus size in yeast. We clarified the flexibilities and persistence lengths of all linker DNAs of the organism, deduced their spatial expanses and simulated the architectures of all 16 interphase chromosomes in the nucleus, at a resolution of beads-on-a-string chromatin fibre. For the average spatial distance between two given loci in a chromosome, the model predictions agreed well with all experimental data reported to date. These findings suggest a general mechanism underlying the folding of eukaryotic genomes into interphase chromosomes.

Primary omental gastrointestinal stromal tumor (GIST).

BACKGROUND: We report herein a rare case of primary omental gastrointestinal stromal tumor (GIST). CASE PRESENTATION: A 65 year-old man was referred to our hospital with a huge abdominal mass occupying the entire left upper abdomen as shown by sonography. On computed tomography (CT), this appeared as a heterogeneous low-density mass with faint enhancement. Abdominal angiography revealed that the right gastroepiploic artery supplied the tumor. With such an indication of gastric GIST, liposarcoma, leiomyosarcoma or mesothelioma laparotomy was performed and revealed that this large mass measured 20 x 17 x 6 cm, arising from the greater omentum. It was completely resected. Histopathologically, it was composed of proliferating spindle and epithelioid cells with an interlacing bundle pattern. Immunohistochemically, the tumor was positive for myeloid stem cell antigen (CD34), weakly positive for c-KIT (CD117) and slightly positive for neuron-specific enolase (NSE), but negative for cytokeratin (CK), alpha-smooth muscle actin (SMA) and S-100 protein. A mutation was identified in the platelet-derived growth factor alpha (PDGFRA) juxtamembrane domain (exon 12, codon561) and the tumor was diagnosed as an omental GIST. The postoperative course was uneventful. The patient is treated by Glevec(R) and is alive well with no sign of relapse. CONCLUSION: Our case demonstrated a weak immunohistochemical expression of c-kit (CD117) and a point mutation in PDGFRA exon 12 resulting in an Asp for Val561 substitution. Imatinib therapy as an adjuvant to complete resection has been carried out safely. Because of the rarity of primary omental GISTs, it is inevitable to analyze accumulating data from case reports for a better and more detailed understanding of primary omental GISTs.

Clear cell carcinoid tumor of the distal common bile duct.

BACKGROUND: Carcinoid tumors rarely arise in the extrahepatic bile duct and can be difficult to distinguish from carcinoma. There are no reports of clear cell carcinoid (CCC) tumors in the distal bile duct (DBD) to the best of our knowledge. Herein, we report a CCC tumor in the DBD and review the literature concerning extrahepatic bile duct carcinoid tumors. CASE PRESENTATION: A 73-old man presented with fever and occult obstructive jaundice. Ultrasonography, computed tomography (CT) and magnetic resonance cholangiopancreaticography (MRCP) demonstrated a nodular tumor projection in the DBD without regional lymph node swelling. Under suspicion of carcinoma, we resected the head of the pancreas along with 2nd portion duodenectomy and a lymph node dissection. The surgical specimen showed a golden yellow polypoid tumor in the DBD (0.8 x 0.6 x 0.5 cm in size). The lesion was composed of clear polygonal cells arranged in nests and a trabecular pattern. The tumor invaded through the wall into the fibromuscular layer. Immunohistochemical stains showed that neoplastic cells were positive for neuron-specific enolase (NSE), chromogranin A, synaptophysin, and pancreatic polypeptide and negative for inhibin, keratin, CD56, serotonin, gastrin and somatostatin. The postoperative course was uneventful and he is living well without relapse 12 months after surgery. CONCLUSION: Given the preoperative difficulty in differentiating carcinoid from carcinoma, the pancreaticoduodenectomy is an appropriate treatment choice for carcinoid tumors located within the intra-pancreatic bile duct.

Comparative study of the water oxidizing reactions and the millisecond delayed chlorophyll fluorescence in photosystem II at different pH.

Water splitting activity, the multiline EPR signal associated with S(2)-state of the CaMn(4)-cluster and the fast and slow phases of the induction curve of the millisecond delayed chlorophyll fluorescence from photosystem II (PSII) in the pH range of 4.5-8.5 were studied in the thylakoid membranes and purified PSII particles. It has been found that O(2) evolution and the multiline EPR signal were inhibited at acidic (pK approximately 5.3) and alkaline (pK approximately 8.1) pH values, and were maximal at pH 6.0-7.0. Our results indicate that the loss of O(2) evolution and the S(2)-state multiline EPR signal associated with the decrease of the millisecond delayed chlorophyll fluorescence only in alkaline region (pH 7.0-8.5). Possible correlations of the millisecond delayed chlorophyll fluorescence components with the donor side reactions in PSII are discussed.

Factors associated with the development of reflux esophagitis after Helicobacter pylori eradication.

We investigated whether Helicobacter pylori (HP) eradication increases the incidence of reflux esophagitis (RE) in patients with peptic ulcers. From 2001-2005 consecutive out patients with peptic ulcers and HP received eradication and were followed endoscopically. HP was cured in 119 and RE developed in 33 of the 153 patients. RE developed in 24 of the 119 HP-eradicated patients and 9 of the 34 HP-persistent patients. The estimated RE occurrence rate within 1 year was higher in the HP-eradicated patients than in the HP-persistent patients, but it was reversed at 2 years by the Kaplan-Meier analysis. In 76 patients follow up for > or = 18 months, hiatal hernia, duodenal ulcer, and eradication failure were significantly associated with the increased RE rate by univariate and multivariate analysis. The follow-up period after HP eradication affected the RE occurrence rate, and eradication failure significantly increased the RE development in patients followed up for > or = 18 months.

The incidence of reflux oesophagitis after eradication therapy for Helicobacter pylori.

BACKGROUND: Although several studies have indicated that Helicobacter pylori eradication develops reflux oesophagitis, others reported that its eradication had a beneficial effect on reflux symptoms. The results are still controversial. OBJECTIVE: To study whether H. pylori eradication increases the occurrence rate of reflux oesophagitis in patients with peptic ulcers. METHOD: One hundred and two consecutive patients who had peptic ulcers and were H. pylori-positive by C-urea breath testing were followed prospectively. They all received 1-week triple therapy and underwent endoscopy at 1-year intervals or when relapse of the peptic ulcer or occurrence of reflux oesophagitis was suspected. RESULTS: Reflux oesophagitis developed in 32 (31.4%) out of 102 patients and they were of grade A (27 patients) and grade B (five patients) by the Los Angeles classification System. H. pylori infection was cured in 77 (75.5%) out of 102 patients. There was no significant difference in age (53.4+/-1.2 vs. 53.9+/-1.4 years, P = 0.43), gender (male/female, 29/3 vs. 53/17, P = 0.14), ulcer location (gastric/duodenal/both, 15/12/5 vs. 35/26/9, P = 0.97), H. pylori status (persistent/cured, 9/23 vs. 16/54, P = 0.57) or length of follow-up time (355+/-32 vs. 348+/-23 days, P = 0.30) between the 32 patients with reflux oesophagitis and the other 70 patients. Only the presence of hiatal hernia before therapy was significant for the prevalence of reflux oesophagitis by the log-rank test (P = 0.002), and the Cox proportional hazard models confirmed these findings (odds ratio, 3.46; 95% confidence interval, 1.64-7.30; P = 0.0012). CONCLUSIONS: The eradication of H. pylori did not increase the prevalence of reflux oesophagitis, and only the presence of hiatal hernia before therapy was significantly related to the development of reflux oesophagitis.

Effects of UV dose on formation of spontaneously developing pocks in Streptomyces azureus ATCC14921.

Spontaneously developing pocks (S pocks) of Streptomyces azureus ATCC14921 were formed by the both functions of conjugative plasmid pSA1 and lysogenic phage SAt2. The formation was affected by the dose of UV irradiation. The mean pock diameter in cultures treated with UV light at 0, 7.1, 14.2 and 21.3 x 10(2) microW. erg/cm, respectively, were 1.3, 0.4, 2.2, and 0.5 mm. The dose affected conjugative plasmid pSA1 related to pock formation. There was UV damage of autonomous pSA1 replicon and UV induction of the chromosomal integrated sequence. Increases and decreases in the amount of autonomous pSA1 replicon corresponded to increases and decreases, respectively, in the diameter of the pocks. Both pSA1 and SAt2 syntheses were developed in the large pocks (1.3 and 2.2 mm), but only SAt2 synthesis was developed in the pinhole pocks (0.4 and 0.5 mm).

Effect of contrast-enhanced computed tomography on diagnosis and management of acute abdomen in adults.

AIM: To determine the impact of computed tomography (CT) on the diagnosis and treatment plan in patients with acute abdominal pain. MATERIALS AND METHODS: A prospective study was undertaken in 125 adult patients presenting with acute abdominal pain (74 men and 51 women; 40.2 +/- 19.3 years; range, 18-92). Changes in diagnosis, gain in percentage diagnostic certainty and changes of treatment plan of the surgeons in the emergency department before and after CT were evaluated. Pre- and post-CT diagnoses were compared with the final diagnoses. RESULTS: CT findings changed the initial diagnosis in 40 (32.0%) patients. The diagnostic certainty was 58.3 +/- 22.9% before CT, and its gain after CT was 21.9 +/- 18.5 points (P < 0.0001). Post-CT diagnoses were consistent with the final diagnosis in 116 patients (92.8%), while pre-CT diagnoses were correct in 89 patients (71.2%; P < 0.0001). Initial treatment plans were changed in 31 (24.8%) patients after CT. In 57 (45.6%) patients, CT information changed diagnoses and/or treatment plans. No significant differences were observed in the diagnosis, diagnostic certainty and treatment plan among four surgeons. CONCLUSION: Contrast-enhanced CT frequently changed the clinical diagnoses with increased diagnostic certainty and the initial treatment plans.