Risk of Cephalic Vein Injury During the Creation of an Anterior Portal in Shoulder Arthroscopy.

Background: There is a risk of cephalic vein injury during shoulder arthroscopy. However, limited data regarding its anatomic course are available. Purpose: To analyze the positional relationship and factors affecting the distance between the coracoid tip and cephalic veins. Study design: Case series; Level of evidence, 4. Methods: A total of 80 contrast-enhanced computed tomography images from 80 patients (mean age, 49.6 ± 20.3 years; 61 men) were retrospectively analyzed. The distance between the center of the coracoid tip and the vertical line through the cephalic vein was measured in the axial (D1) and sagittal (D2) planes. The distance between 1 cm lateral to the center of the coracoid tip and the vertical line through the cephalic vein was measured in the sagittal plane (D3). Each distance was compared according to patient sex and laterality. Associations between each distance and the patient's age, height, weight, and body mass index were investigated. Results: The mean D1 was 18.4 ± 7.3 mm in 59 patients. The mean D2 was 23.4 ± 11.6 mm, and it was within 10 mm in 10 patients (12.5%). The mean D3 was 33.7 ± 12.2 mm. There was no significant difference in D1, D2, and D3 according to patient sex or laterality. A positive correlation was observed only between D3 and patient height (r = 0.320; P = .034). Conclusion: The cephalic vein was found to travel a mean of 23.4 mm distal and 33.7 mm distal to 1 cm lateral to the coracoid tip. Therefore, Care should be taken to avoid cephalic vein injury when creating an anterior inferior portal or 5-o'clock portal around these areas.

Treatment of Lateral Tibial Condylar Fractures Using Bioactive, Bioresorbable Forged Composites of Raw Particulate Unsintered Hydroxyapatite/Poly-L-Lactide Screws.

Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) devices possess high mechanical strength, bioactivity, and radio-opacity. The aim of this study was to assess the efficacy of F-u-HA/PLLA screws in the treatment of lateral tibial condylar fractures. From January 2005 to December 2010, a total of 7 patients with displaced closed lateral tibial condylar fractures (Schatzker type II) were treated using F-u-HA/PLLA screws. Open reduction and internal fixation was performed using 2 or 3 F-u-HA/PLLA screws. After surgery, weight bearing was not allowed for 6 weeks. Range of motion exercise was initiated after removal of the plaster splint. Radiographs were evaluated for fracture healing, joint depression, and the radioopacity of F-u-HA/PLLA screws. Clinical outcomes and postoperative complications were also assessed. Average follow-up was 44 months. All fractures were successfully healed. Average values for joint depression were 4.7 mm (range, 2-9 mm) preoperatively, 0.4 mm (range, 0-1 mm) postoperatively, and 0.4 mm (range, 0-1 mm) at final follow-up. Whole shadows of F-u-HA/PLLA screws were observed during the follow-up period. Breakage of screws, osteolysis, and a radiolucent zone around the screws were not observed at final follow-up. Average knee flexion and extension were 134° (range, 110° to 150°) and -1° (range, -10° to 0°), respectively. No patient had wound infection, late aseptic tissue response, or foreign body reaction postoperatively. None of the patients reported pain at final follow-up. These results suggest that F-u-HA/PLLA screws could be an alternative option for the treatment of lateral tibial condylar fractures. [Orthopedics. 2018; 41(3):e365-e368.].

Accumulation of mannitol in the cytoplasm and vacuole during the expansion of sepal cells associated with flower opening in Delphinium × belladonna cv. Bellamosum.

MAIN CONCLUSION: The role of mannitol differs from that of glucose, fructose and sucrose in sepal cell expansion associated with flower opening in Delphinium × belladonna. Sepals of Delphinium × belladonna are colored and much larger than the petals. To determine whether the role of mannitol in sepal growth associated with flower opening differs from those of ubiquitous metabolic sugars including glucose, fructose and sucrose, we investigated changes in cell number, subcellular concentrations of soluble carbohydrates, and osmotic potential in sepals during flower opening in Delphinium × belladonna cv. Bellamosum. The number of epidermal cells in the sepals did not increase from the stage when sepal pigmentation started, whereas the cell area increased during flower opening, indicating that petal growth during flower opening depends on cell expansion. Mannitol concentrations in the vacuole at three different stages were approximately 100 mM, which were much higher than the other carbohydrate concentrations, but they decreased slightly at open stage. In contrast, mannitol concentration in the cytoplasm was 56 mM at bud stage, but it increased to 104 mM at open stage. Glucose and fructose concentrations in the vacuole at open stage increased to 45 and 56 mM, respectively. Total osmotic potential in apoplast and symplast, which was partially due to soluble carbohydrates, was almost constant during flower opening. Therefore, mannitol may be acting constitutively as the main osmoticum in the vacuole where it may contribute to the maintenance of the osmotic balance between the cytoplasm and vacuole in open flowers. The role of mannitol differs from those of glucose, fructose, and sucrose in sepal cell expansion in Delphinium × belladonna.

Leg lymphedema caused by iliopectineal bursitis associated with destruction of a rheumatoid hip joint: A case report.

The present study describes a case of leg lymphedema due to iliopectineal bursitis associated with rheumatoid arthritis (RA), which was satisfactorily controlled by surgery and combination therapy with methotrexate (MTX) and tacrolimus. A 68-year-old male, who had a six-year history of RA, developed an iliopectineal bursa associated with destruction of the hip joint. The mass gradually increased in size, and there was swelling in his right lower extremity. The patient was subsequently hospitalized with increasing right hip pain and leg edema. A colorless transparent lymph fluid leaked from his leg, and leg lymphedema was thus diagnosed. The patient also had a 20-year history of myelodysplastic syndrome. Therefore, the extensive or total resection of the bursa was considered to be too invasive, so a partial bursal excision was performed via an anterior approach. Following the partial bursal excision, total hip arthroplasty (THA) was performed using the Hardinge approach. The leg lymphedema disappeared following the surgery, and the iliopectineal bursa was no longer enlarged. MTX and tacrolimus were postoperatively administered to strictly control the RA. The RA was subsequently well controlled, without any increases in the levels of inflammatory markers, such as C-reactive protein and matrix metalloproteinase-3. This case demonstrated that iliopectineal bursitis was resolved following THA, without complete excision of the intrapelvic bursa, and that strict RA control led to a good clinical course without recurrent inflammation of the bursa. Similar procedures may be beneficial in other patients contraindicated for resection of the entire bursa.

Pediatric displaced fractures of the lateral condyle of the humerus treated using high strength, bioactive, bioresorbable F-u-HA/PLLA pins: a case report of 8 patients with at least 3 years of follow-up.

OBJECTIVES: The purpose of this report is to present our surgical technique using forged composites of unsintered hydroxyapatite particles/poly-L-lactide (F-u-HA/PLLA) pins for pediatric displaced fractures of the lateral condyle of the humerus, to retrospectively evaluate clinical outcomes, and to verify the advantages of this device by using postoperative radiographs. DESIGN: Retrospective (level IV) case series. SETTING: Academic medical center. PATIENTS: From October 2004 to September 2006, 8 pediatric displaced closed fractures of the lateral condyle of the humerus (AO/OTA 13-B1) were treated. INTERVENTION: Lateral condyle fractures were fixed using 2 threaded pins. All the patients were placed in a long arm cast for 4 weeks after surgery. MAIN OUTCOME MEASUREMENTS: Radiographic and clinical outcomes and postoperative complications were evaluated. RESULTS: The average follow-up period was 52.5 months. All fractures were successfully united. All shadows of pins were observed, and there were no radiolucent zones around the pins at the final radiographic follow-up. No patients experienced pain or cosmetic deformity at the most recent follow-up. Loss of reduction, malunion, deep infection, implant failure, osteolysis, skin ulcer, and foreign body reaction were not observed postoperatively. No patient required secondary operation. CONCLUSIONS: Radioopacity of F-u-HA/PLLA devices is a major advantage of this device. No radiolucent zones were present around the pins, no osteolysis was observed on postoperative radiographs, and there were no postoperative complications. Reoperation for removal was unnecessary. Open reduction, internal fixation using F-u-HA/PLLA pins offers several advantages in treating pediatric displaced fractures of the lateral condyle of the humerus. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Determination of subcellular concentrations of soluble carbohydrates in rose petals during opening by nonaqueous fractionation method combined with infiltration-centrifugation method.

Petal growth associated with flower opening depends on cell expansion. To understand the role of soluble carbohydrates in petal cell expansion during flower opening, changes in soluble carbohydrate concentrations in vacuole, cytoplasm and apoplast of petal cells during flower opening in rose (Rosa hybrida L.) were investigated. We determined the subcellular distribution of soluble carbohydrates by combining nonaqueous fractionation method and infiltration-centrifugation method. During petal growth, fructose and glucose rapidly accumulated in the vacuole, reaching a maximum when petals almost reflected. Transmission electron microscopy showed that the volume of vacuole and air space drastically increased with petal growth. Carbohydrate concentration was calculated for each compartment of the petal cells and in petals that almost reflected, glucose and fructose concentrations increased to higher than 100 mM in the vacuole. Osmotic pressure increased in apoplast and symplast during flower opening, and this increase was mainly attributed to increases in fructose and glucose concentrations. No large difference in osmotic pressure due to soluble carbohydrates was observed between the apoplast and symplast before flower opening, but total osmotic pressure was much higher in the symplast than in the apoplast, a difference that was partially attributed to inorganic ions. An increase in osmotic pressure due to the continued accumulation of glucose and fructose in the symplast may facilitate water influx into cells, contributing to cell expansion associated with flower opening under conditions where osmotic pressure is higher in the symplast than in the apoplast.

Cloning of two isoforms of soluble acid invertase of Japanese pear and their expression during fruit development.

Soluble acid invertase (S-AIV; EC 3.2.1.26) in Japanese pear fruit has an important role in accumulating hexoses during fruit enlargement and regulates the sucrose-to-hexose ratio in the vacuole. Full-length cDNA of PsS-AIV1 and PsS-AIV2 isoforms were cloned from Japanese pear fruit and their amino acid sequences share 40% identity; PsS-AIV1 was confirmed to code S-AIV isozyme purified previously. The roles of PsS-AIV1 and PsS-AIV2 genes throughout fruit development and in sugar composition were investigated by semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) analysis using specific primers of their transcripts. PsS-AIV1 transcript had a maximum level at 34 days after full bloom (DAFB) and decreased rapidly during fruit development; PsS-AIV2 transcript increased gradually during fruit growth from 34 DAFB, had its maximum level at 79 DAFB and remained high until 107 DAFB at active fruit enlargement. The activity of S-AIV was highest at 34 DAFB, decreased during fruit growth until 66 DAFB, remained almost the same during early fruit enlargement until 79 DAFB and then decreased again. Soluble sugars fructose and glucose began accumulating predominantly during fruit enlargement from 66 DAFB; sucrose began increasing rapidly during fruit maturation from 121 DAFB. High expression of PsS-AIV1 transcript and high enzyme activity in the young fruit stage seems to have an important role in supplying a lot of substrate for energy needed for cell division and growth by hydrolyzing sucrose to hexoses. Increasing PsS-AIV2 expression during fruit enlargement may lead to rapid cell expansion through increased osmotic pressure by accumulation of a large amount of hexose in the vacuole.

An engineered sorbitol cycle alters sugar composition, not growth, in transformed tobacco.

Many efforts have been made to engineer stress tolerance by accumulating polyols. Transformants that accumulate polyols often show growth inhibition, because polyols are synthesized as a dead-end product in plants that do not naturally accumulate polyols. Here, we show a novel strategy in which a sorbitol cycle was engineered by introducing apple cDNA encoding NAD-dependent sorbitol dehydrogenase (SDH) in addition to sorbitol-6-phosphate dehydrogenase (S6PDH). Tobacco plants transformed only with S6PDH showed growth inhibition, and very few transformants were obtained. In contrast, many transgenic plants with both S6PDH and SDH were easily obtained, and their growth was normal despite their accumulation of sorbitol. Interestingly, the engineered sorbitol cycle enhanced the accumulation of sucrose instead of fructose that was expected to be increased. Sucrose, rather than fructose, was also increased in the immature fruit of tomato plants transformed with an antisense fructokinase gene in which the phosphorylation of fructose was inhibited. A common phenomenon was observed in the metabolic engineering of two different pathways, showing the presence of homeostatic regulation of fructose levels.

Fruit-specific V-ATPase suppression in antisense-transgenic tomato reduces fruit growth and seed formation.

The vacuole is a large, multifunctional organelle related to the processes of cell expansion, solute accumulation, regulation of cytoplasmic ion concentrations, pH homeostasis and osmoregulation, which are directly or indirectly achieved by vacuolar H+-pumps: vacuolar H+-ATPase (V-ATPase; EC 3.6.1.3) and vacuolar H+-pyrophosphatase (V-PPase; EC 3.6.1.1). In this study, we produced antisense-transgenic tomatoes (Lycopersicon esculentum L.) of the V-ATPase A subunit, which is under the control of the fruit-specific 2A11 promoter. One beta-glucuronidase (GUS)-transgenic line (GUS control) and seven A subunit antisense-transgenic lines were obtained. The amount of V-ATPase A subunit mRNA in fruit decreased in all antisense-transgenic lines, but in leaves showed no difference compared with the GUS control line and the nontransformant, suggesting that suppression of the V-ATPase A subunit by a 2A11 promoter is limited to fruit. The antisense-transgenic plants had smaller fruits compared with the GUS control line and the nontransformant. Surprisingly, fruits from the antisense-transgenic plants, except the fruit that still had relatively high expression of A subunit mRNA, had few seeds. Sucrose concentration in fruits from the antisense-transgenic plants increased, but glucose and fructose concentrations did not change. These results show the importance of V-ATPase, not only in fruit growth, but also in seed formation and in sugar composition of tomato fruit.

Spectral imaging of the area of internal limiting membrane peeling.

PURPOSE: To evaluate a spectral imaging technique to detect the area of internal limiting membrane (ILM) peeling after vitrectomy for idiopathic macular hole. MATERIALS AND METHODS: In a prospective study, 15 eyes of 15 patients with idiopathic macular holes were tested. After vitrectomy with ILM peeling, retinal images were taken with color fundus photography, red-free fundus photography, and scanning laser ophthalmoscope imaging at 488 nm, 514 nm, 633 nm, and 780 nm. We calculated the Michelson contrast at the margin of ILM peeling, and each image was rank ordered for the ability to discern the margin of ILM peeling. RESULTS: The Michelson contrasts in scanning laser ophthalmoscope images at 488 nm and 514 nm were significantly larger than those in images at 633 nm and 780 nm and in the red-free fundus photograph. The scanning laser ophthalmoscope images at 488 nm and 514 nm were rated superior to images at 633 nm and 780 nm, the color fundus photograph, and the red-free fundus photograph. CONCLUSION: The scanning laser ophthalmoscope images at 488 nm and 514 nm provide a better tool than some of the common clinical means for detection of the area of ILM peeling. This may assist with rapid, noninvasive assessment of ILM peeling.

Identification of sorbitol transporters expressed in the phloem of apple source leaves.

Sorbitol is a major photosynthetic product and a major phloem-translocated component in Rosaceae (e.g. apple, pear, peach, and cherry). We isolated the three cDNAs, MdSOT3, MdSOT4, and MdSOT5 from apple (Malus domestica) source leaves, which are homologous to plant polyol transporters. Yeasts transformed with the MdSOTs took up sorbitol significantly. MdSOT3- and MdSOT5-dependent sorbitol uptake was strongly inhibited by xylitol and myo-inositol, but not or only weakly by mannitol and dulcitol. Apparent K(m) values of MdSOT3 and MdSOT5 for sorbitol were estimated to be 0.71 mM and 3.2 mM, respectively. The protonophore, carbonyl cyanide m-chlorophenylhydrazone (CCCP), strongly inhibited the sorbitol transport. MdSOT3 was expressed specifically in source leaves, whereas MdSOT4 and MdSOT5 were expressed in source leaves and also in some sink organs. MdSOT4 and MdSOT5 expressions were highest in flowers. Fruits showed no or only weak MdSOT expression. Although MdSOT4 and MdSOT5 were also expressed in immature leaves, MdSOT expressions increased with leaf maturation. In addition, in situ hybridization revealed that all MdSOTs were expressed to high levels in phloem of minor veins in source leaves. These results suggest that these MdSOTs are involved in sorbitol loading in Rosaceae.

Birefringence of intraocular lenses.

PURPOSE: To determine the polarization properties of intraocular lenses (IOLs) in vitro and whether these properties contribute to significant intraindividual differences in the optical performance of the eye, including retinal imaging. SETTING: Tokyo Medical University, Shinjuku, Tokyo, Japan. METHODS: The single-pass linear birefringence was evaluated at 546.5 nm for the central 1.5 mm of the following IOLs: poly(methyl methacrylate) (MZ30BD, EZE55, UV-60SB, 824C, LS-106S), acrylic (MA60BM, VA-60CB, AR40e), and silicone (SI-40NB). To evaluate the influence of folding, models MA60BM, VA-60CB, AR40e, and SI-40NB were folded, unfolded, and measured for retardation values. To evaluate glistenings in vitro, experimental manipulation using the MA60BM was done to produce regions of glistenings. Retardation values were measured at the center of the micro-opacities and the adjacent clear areas. RESULTS: Striking polarization patterns were seen only in the compression-molded IOL, model 824C. Its retardation values ranged from 2.8 to 41.0 nm in the 30.0 diopter model. In other IOLs, the in vitro retardation values were minimal, even with folding, and barely nonuniform with glistening formation. CONCLUSIONS: The birefringence of the 824C IOL could be a source of error during polarization measurements of the fundus or with instruments that transmit polarized light through the IOL.

Linkage guide for rotational alignment during total knee arthroplasty.

A linkage guide was devised for use in conjunction with knee arthroplasty instruments to achieve proper component rotation. The femoral component was rotationally aligned to the surgical epicondylar axis using one guide. The other guides were used after all bone surfaces were cut and soft tissue balancing was completed. A Kirschner wire was guided into the proximal tibial aspect parallel to the sagittal plane of the femoral component with the patella in its normal position and the knee in full extension. The wire was used as a reference to determine tibial component rotation. The relative rotational alignment of 21 knees in 19 patients who had undergone cruciate-retaining total knee arthroplasty utilizing this guide was assessed using the modified Eckhoff method. The results of radiographic analysis were compared with those in a control group of 25 knees where the guide was not employed. The external rotation of the femoral component relative to the tibial component was 1.3 degrees +/- 2.0 degrees (mean +/- SD) in the guided group and 1.1 degrees +/- 4.4 degrees in the control group. The relative rotational angle was significantly more consistent using the guide. Implant malrotation can be reduced using our technique.