Sectioning of the Anterolateral Ligaments in Anterior Cruciate Ligament Sectioned Knees Increases Internal Rotation of the Knee Joint: A Systematic Review and Meta-analysis of Cadaveric Studies.

PURPOSE: To investigate whether anterolateral ligament (ALL) sectioning (sALL) in the anterior cruciate ligament (ACL)-sectioned (sACL) knee increases the anterior tibial translation (ATT) or internal rotation (IR) of the knee from previous cadaveric biomechanical studies. METHODS: Multiple comprehensive literature databases, including PubMed (MEDLINE), EMBASE, and Cochrane Library, were searched for studies evaluating the in vitro biomechanical function of ALL. This meta-analysis compared the increased ATT and IR between the sACL and sACL + sALL knees at 30°, 60°, and 90° of knee flexion. Thresholds of 2 mm for the difference in ATT and 2° for the difference in IR were considered to be clinically significant. RESULTS: Thirteen cadaveric biomechanical studies were included. All 13 studies satisfied the threshold for a satisfactory methodological quality (Quality Appraisal for Cadaveric Studies score >75%). At 30° of knee flexion, the meta-analysis showed a greater increase in ATT in the sACL + sALL knees than in the sACL knees by 1.23 mm (95% confidence interval [CI], 0.62-1.84; P < .0001). However, the mean difference was less than the minimal clinically significant difference (<2 mm). The meta-analysis also showed a greater increase in IR in the sACL + sALL knees than in the sACL knees at 30° (mean difference [MD]: 2.24°; 95% CI: 1.39-3.09; P < .00001), 60° (MD: 2.77°; 95% CI: 1.88-3.67; P < .00001), and 90° (MD: 2.29°; 95% CI: 1.42-3.15; P < .00001) of knee flexion. The differences in IR at 30°, 60°, and 90° of knee flexion were clinically relevant (>2°). CONCLUSIONS: Despite the different experimental setups and protocols between studies, the meta-analysis of biomechanical cadaveric studies showed that sectioning of the ALL in sACL knees increased IR at 30°, 60°, and 90° of knee flexion. CLINICAL RELEVANCE: The results of this systematic review and meta-analysis suggest that ALL contributes to IR in ACL-deficient knees at 30°, 60°, and 90° of flexion.

Plasma homocysteine level and hepatic sulfur amino acid metabolism in mice fed a high-fat diet.

PURPOSE: Obesity, a feature of metabolic syndrome, is a risk factor for cardiovascular disease, and elevated plasma homocysteine is associated with increased cardiovascular risk. However, little published information is available concerning the effect of obesity on homocysteine metabolism. METHODS: Hepatic homocysteine metabolism was determined in male C57BL/6 mice fed a high-fat diet for 12 weeks. RESULTS: High-fat diet increased plasma homocysteine but decreased hepatic homocysteine levels. Hepatic S-adenosylhomocysteine hydrolase levels were down-regulated in the obese mice, which was in part responsible for the decrease in hepatic S-adenosylmethionine/S-adenosylhomocysteine, which served as an index of transmethylation potential. Despite the decrease in hepatic cysteine, hepatic taurine synthesis was activated via up-regulation of cysteine dioxygenase. Hepatic levels of methionine adenosyltransferase I/III, methionine synthase, methylene tetrahydrofolate reductase, and gamma-glutamylcysteine ligase catalytic subunit were unchanged. Obese mice showed elevated betaine-homocysteine methyltransferase and decreased cystathionine beta-synthase activities, although the quantities of these enzymes were unchanged. CONCLUSION: This study suggests that plasma homocysteine level is increased in obesity-associated hepatic steatosis, possibly as a result of increased hepatic homocysteine efflux along with an altered sulfur amino acid metabolism.

Histopathological Findings and Metagenomic Analysis of Esophageal Papillary Proliferation Identified in Laying Broiler Breeders.

White or pale-yellow nodules 2-7 mm in length were observed in the esophageal lumen in a number of laying broiler breeders with reduced laying rates. Metaplasia of the mucosal epithelial layer and mucous gland, as well as lymphocyte infiltration under the esophageal mucous gland and epithelial cell layer, were observed, which we found were caused by vitamin A deficiency. In one chicken, however, the stratified squamous epithelial cells of the esophagus were completely replaced by increased numbers of ducts/ductules, lymphocytes, and connective tissue, resulting in a papillary morphology. The ducts were surrounded by a fibrous stroma. Multiple hyperplasia of the esophageal gland was also observed and the esophageal glands were lined by a single layer of columnar cells, and a large number of lymphocytes were infiltrated into the submucosal layer. Based on the gross findings, this papillary proliferation was considered papilloma, but histopathologically, a mass composed of squamous epithelium was not observed. Therefore, the papillary lesion appeared as adenoma with squamous metaplasia of the esophageal gland and ectasia, or mucosal epithelial papillary hyperplasia, associated with chronic esophagitis. A metagenomic analysis of the esophagus samples from this chicken was performed to determine the infectious etiology. No viral cause was identified; however, a contributing role of Bradyrhizobium sp. could not be excluded. In this study, we report the first histopathological examination of a rare case of esophageal papillary proliferation in a chicken and highlight the importance of histopathological results for a definitive diagnosis of such cases.

Association between colorectal adenoma and coronary atherosclerosis detected by CT coronary angiography in Korean men; a cross-sectional study.

BACKGROUND: Colorectal adenoma and coronary artery disease (CAD) appear to share common risk factors, such as male gender, diabetes mellitus, smoking, and obesity. We investigated the relationship between colorectal adenoma and coronary atherosclerosis, as a risk factor for colorectal adenoma. METHODS: A cross-sectional study was conducted on Korean men who presented for a health check-up. The subjects were 488 men (217 colorectal adenoma and 271 normal colonoscopic findings) who underwent colonoscopy and coronary computed tomography angiography (CTA) on the same day as a screening examination. Advanced colonic lesion was defined as a presence of adenoma with villous component, high-grade dysplasia, and/or with size of ≥1 cm. CTA findings were classified as normal, mild (low-grade atherosclerosis or <50% stenosis), and significant CAD (≥50% stenosis). Abnormal CTA findings included mild and significant CAD. RESULTS: Patients with abnormal CTA findings were more likely to have colorectal adenoma compared with those with normal CTA findings (P < 0.005). Furthermore, presence of advanced adenoma was significantly associated with significant CAD (P < 0.01). On multivariate analyses, abnormal CTA findings (OR = 1.66, 95% CI: 1.14-2.41, P < 0.01) and significant CAD (OR = 1.96, 95% CI: 1.15-3.35, P < 0.05) were found to be independent risk factors for colorectal adenoma after adjusting for age, current smoking, and metabolic syndrome. CONCLUSIONS: In this study, in the population who underwent CTA and colonoscopy for health check-up, prevalence of colorectal adenoma was greater in subjects with low-grade coronary atherosclerosis or significant CAD. The presence of advanced adenoma was significantly associated with significant CAD.

Development of in situ hybridization for the detection of Mycoplasma hyorhinis in formalin-fixed paraffin-embedded tissues from naturally infected pigs with polyserositis.

The aim of this study was to develop in situ hybridization for detection of Mycoplasma hyorhinis in formalin-fixed, paraffin-wax-embedded tissues from pigs with polyserositis. M. hyorhinis was isolated from the spleen (2 pigs) and pericardium (1 pig). M. hyorhinis DNA was detected 16 out of 20 pigs with polyserositis. In situ hybridization produced a distinct positive signal for the M. hyorhinis p37 gene in inflammatory cells in the polyserositis. In situ hybridization developed in the present study present diagnostic tools capable of detection of M. hyorhinis in formalin-fixed, paraffin-wax-embedded tissues from the naturally infected pigs.

Expression of mucins in the mucosal surface of small intestines in 1 week-old pigs.

The aim of this study was to determine the immunoexpression of mucins in jejunal and ileal villous epithelium using six antibodies against MUC1, MUC2, MUC4 MUC5AC, MUC5B and MUC6. The immunohistochemical score for MUC1 has significantly intense staining compared with MUC2 (P=0.008) and the immunohistochemical socre for MUC4 and MUC 6 has significantly intense staining compared with MUC2 (P=0.032) in ileal villous surface. The immunohistochemical score for MUC4 (P=0.008), MUC5AC (P=0.016) and MUC6 (P=0.016) in ileal villous surface has significantly intense staining compared with ileal cryptic surface. The results of this study demonstrated that six mucins gave distinctly different expression patterns throughout the 1 week-old porcine small intestinal tract.

The relation between non-alcoholic fatty liver disease and the risk of coronary heart disease in Koreans.

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is known to be related to factors that predict the development of coronary heart disease (CHD), such as dyslipidemia, central obesity, and metabolic syndrome (MS). The aim of this study was to determine whether individuals with NAFLD have an elevated risk of CHD, as estimated using the Framingham risk score (FRS). METHODS: A total of 21,130 individuals who underwent a voluntary general health examination were recruited. NAFLD was diagnosed among these individuals on the basis of typical sonographic findings and a level of alcohol consumption of <20 g/day. Of the 21,130 individuals, 3,780 were excluded because they had known causes of liver disease (1,690 were alcoholics, 975 had hepatitis B virus, 242 had hepatitis C virus, 91 had other hepatitis history, and 593 were taking medication known to produce fatty liver) or a history of heart disease (189). RESULTS: NAFLD was diagnosed in 5,769 of the 17,350 individuals (33.3%). The 11,581 normal individuals constituted the control group. The 5,769 individuals with NAFLD were split into two groups on the basis of ultrasonographic findings, that is, into a mild NAFLD group (n=3,278) and a moderate-severe NAFLD group (n=2,491). Individuals with NAFLD had an elevated risk of CHD, as estimated using FRS. Multivariable regression analysis, adjusted for confounding factors, showed a strong association between a higher FRS and NAFLD. CONCLUSIONS: Individuals with ultrasonographically detected NAFLD have an elevated 10-year risk of developing CHD as estimated using FRS. Furthermore, NAFLD was found to be independently related to the risk of developing CHD, regardless of classical risk factors and other components of MS.

Anti-gastric cancer effects of celecoxib, a selective COX-2 inhibitor, through inhibition of Akt signaling.

BACKGROUND AND AIM: Previously, we showed that treatment with celecoxib significantly reduced the number of viable gastric cancer cells, in a dose- and time-dependent manner. However, the specific anti-cancer effects of celecoxib on gastric cancer cells have not been clarified. The present in vitro study was carried out to investigate the mechanism involved in the anti-gastric cancer effects of celecoxib. METHODS: 3-(4,5-Dimethyl-2 thiazoyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay was carried out after treating AGS cells (human gastric cancer cell line, ATCC CRL 1739) with celecoxib or indomethacin, and the effect of prostaglandin E(2) or LY294002 (PI3K inhibitor) was evaluated. Western blot analysis of tAkt (total Akt), pAkt (phosphorylated Akt), pGSK3beta (phosphorylated glycogen synthase kinase-3beta), pFKHR (phosphorylated forkhead transcriptional factor), and caspase-9 was carried out at various concentrations (0, 5, 10, 25, or 50 micromol/L) of celecoxib or indomethacin-treatment for 24 or 48 h in AGS cells. RESULTS: Celecoxib- or LY294002-induced cell death was found to occur in a dose-dependent manner in AGS cells, and these decreases were slightly recovered by the addition of PGE(2) (25 or 50 micromol/L). The expression of pAkt but not tAkt was lower in the celecoxib treated-AGS cells and the response was dose dependent (P < 0.05). The expression of pGSK3beta and pFKHR was also significantly decreased in the celecoxib treated-AGS cells. Procaspase 9 (47 kDa) was frequently cleaved into 37, 35 and 17 kDa fragments in the celecoxib-treatment group. However, these changes in cell signal transduction were not observed in the indomethacin treated-AGS cells. CONCLUSION: The anti-cancer effects of celecoxib on gastric cancer cells might be partly mediated by downregulation of Akt, GSK3beta, FKHR, and upregulation of caspase-9, in the mitochondrial apoptotic pathway.

Multilocus genotyping and risk factor analysis of Giardia duodenalis in dogs in Korea.

Giardia duodenalis (syn. G. intestinalis, G. lamblia), a protozoan parasite that infects most mammals (including humans), has recently been classified into eight different groups/assemblages (A to H) based on host range and genetic characteristics. Assemblages A and B have been reported in humans and in many other animals, including dogs. This study analyzed Giardia infections, implementing multilocus genotyping, including the 18S rRNA, gdh, and ß-giardin genes, in sheltered, companion, and special-purpose dogs throughout Korea. Of 640 dog stool samples, 99 (15.5%) were G. duodenalis-positive; this prevalence was similar to that previously reported in Korean calves. In addition, the prevalence was significantly higher in the southern region, and lower in non-sheltered dogs, older dogs, and in the autumn season. Phylogenetic analysis revealed that all G. duodenalis-positive samples belonged to assemblages C and D. Although no G. duodenalis assemblages A and B (mainly found in humans) were identified in this study, assemblage C was detected in the main types of dogs in contact with humans. Assemblage C, thought to be dog-specific, was recently identified in humans. As Giardia (including zoonotic assemblages) is distributed throughout Korea, dog living environments and the potential for dog-human transmission should be monitored.

Can Alarming Improve Compliance with Weekly Bisphosphonate in Patients with Osteoporosis?

BACKGROUND: Although bisphosphonate is effective for the prevention and treatment of osteoporosis, poor medication compliance is a key-limiting factor. We determined whether alarm clock could improve compliance with weekly bisphosphonate in patients with osteoporosis, by comparing with age- and gender-matched control group. METHODS: Fifty patients with osteoporosis were recruited and participated in alarm clock group. Patients were asked to take orally weekly risedronate for 1 year, and received alarm clock to inform the time of taking oral bisphosphonate weekly. Using the propensity score matching with age and gender, 50 patients were identified from patients with osteoporosis medication. We compared the compliance with bisphosphonate using medication possession ratio (MPR) between two groups. RESULTS: Although there was no significant difference of baseline characteristics between both groups, the mean MPR (0.80±0.33) of alarm clock group was higher than that (0.56±0.34) of control group (P<0.001). CONCLUSIONS: Alarming could improve the compliance with weekly oral bisphosphonate in patients with osteoporosis.

Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur.

Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Although the current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips.

The Kato-Katz method is reliable for diagnosis of Clonorchis sinensis infection.

We evaluated the sensitivity of three fecal examination methods, the Kato-Katz (KK) method, formalin-ether technique (FE) and direct smear, for the diagnosis of clonorchiasis. The KK method proved to be most sensitive in six groups with different egg counts. In cases of extremely light infection FE was found to be more sensitive than KK.

Expression of secreted mucins (MUC2, MUC5AC, MUC5B, and MUC6) and membrane-bound mucin (MUC4) in the lungs of pigs experimentally infected with Actinobacillus pleuropneumoniae.

The expression patterns of different secreted (MUC2, MUC5AC, MUC5B, and MUC6) and membrane-bound (MUC4) mucins were determined immunohistochemically in the lungs of pigs experimentally infected with Actinobacillus pleuropneumoniae. Forty-seven-week-old colostrum-deprived pigs were randomly allocated to infected (n=20) or control groups (n=20). Five infected and uninfected pigs were euthanized at 0, 6, 12, and 48 h post-inoculation (hpi). In the infected pigs, the expression of both types of mucins, which were invariably observed, was associated with bronchiolar and respiratory bronchiolar lesions. Strong positive mucin signals were seen on the surface of bronchiolar and respiratory bronchiolar epithelium with neutrophil infiltration. The mean mucin-positive area peaked at 6 hpi and decreased significantly to control levels by 48 hpi on the surface of the bronchiolar and respiratory bronchiolar epithelium. Further studies are needed to establish the functional relationship between mucin expression and the host defense mechanism against A. pleuropneumoniae in the lungs of infected pigs.

Expression of mucins on the mucosal surface of lungs of 4-week-old pigs.

The aim of this study was to determine the immunoreactivity of normal small bronchial, bronchiolar, respiratory bronchiolar, and interalveolar epithelium using antibodies to six mucins: MUC1, MUC2, MUC4, MUC5AC, MUC5B, and MUC6. The large, gel-forming secreted mucins MUC2, MUC5AC, and MUC5B were widely expressed in the lower respiratory tract. The results of this study demonstrate that these secreted mucins form a gel to cover and protect the mucosal surface in the lower respiratory tract of pigs.

Distribution of capsular serotypes and virulence markers of Streptococcus suis isolated from pigs with polyserositis in Korea.

The objective of this study was to determine the capsular serotypes and potential virulence factors of Streptococcus suis isolated from pigs with polyserositis. Among the 24 isolates evaluated, serotype 3 [7 (29%) of the isolates] and serotype 4 [5 (21%)] were the most common. The isolates were also studied for the presence of the genes mrp, epf, and sly, which encode muramidase-released protein (MRP), extracellular factor (EF), and suilysin (SLY), respectively. Of the 24 isolates, 8 carried mrp: 4 of serotype 3, 2 of serotype 2, and 2 of serotype 4. One mrp(+) isolate (serotype 2) also carried the epf gene. All 24 isolates carried the sly gene. The serotype and genotype distribution greatly differed from that reported for isolates from pigs with other clinical manifestations of S. suis infection in other countries.

Is Metabolic Syndrome One of the Risk Factors for Gallbladder Polyps Found by Ultrasonography during Health Screening?

BACKGROUND/AIMS: We conducted this study to identify the risk factors for finding gallbladder polyps (GBP) in Korean subjects during health screening, and to determine the nature of the association between the presence of metabolic syndrome (MS) and the development of GBP METHODS: A total of 1,523 subjects were enrolled, comprising 264 with GBP (81 women and 183 men) and 1,259 controls (696 women and 563 men with normal GB). Body mass index (BMI), waist circumference (WC), blood pressure (BP), insulin, fasting blood sugar (FBS), lipids, liver enzymes, hepatitis B antigens (HBs Ag), and hepatitis C antibodies (HCV Ab) were measured. MS was considered to be present when three or more of the NCEP-ATPIII (National Cholesterol Education Program-Adult Treatment Panel III) criteria were satisfied. Insulin resistance was calculated by homeostasis model assessment of insulin resistance (HOMA-IR). Independent risk factors were analyzed by logistic regression analysis. RESULTS: Univariate analysis revealed that the risk factors for GBP were age, sex, WC, smoking history, BP, BMI, FBS, serum lipids, HOMA-IR score, and MS. Multivariate logistic regression analysis revealed that the risk factors for GBP were presence of MS (Odds Ratio (OR)=2.35, 95%Confidence Interval (CI)=1.53-3.60), being male (OR=2.34, 95%CI=1.72-3.18), HOMA-IR score>2.5 (OR=1.64, 95%CI=1.19-2.26), and higher WC (OR=1.4, 95%CI=1.05-1.88). MS was present in 20.8% and 5.9% of GBP patients and controls, respectively, and was the highest risk factor for GBP. CONCLUSIONS: MS, male, insulin resistance, and abdominal obesity are probably risk factors for GBP, with MS appearing to be strongly associated with GBP in Koreans.

Institutional difference of antibiotic resistance of Helicobacter pylori strains in Korea.

GOALS: This study was performed to evaluate whether the prevalence rates of primary antibiotic resistance in Helicobacter pylori isolates could be different between 2 institutions, which are located in the different areas in Korea, and to evaluate the effect of antibiotic resistance on the eradication rate of H. pylori. STUDY: H. pylori were isolated from gastric mucosal biopsy specimens obtained from 113 Koreans, who did not have any eradication history. The susceptibilities of the H. pylori isolates to amoxicillin, clarithromycin, metronidazole, tetracycline, levofloxacin, and moxifloxacin were examined according to the agar dilution method by 1 technician. RESULTS: All of these patients were treated with the same regimen, proton pump inhibitor-amoxicillin-clarithromycin triple therapy. There was a statistical difference in resistance to metronidazole, levofloxacin, and moxifloxacin among 6 antibiotics between 2 institutions located in Seoul and Gyeonggi province. The rates of eradication were 94.2% for the clarithromycin and amoxicillin-susceptible strains, and 42.8% for the amoxicillin-susceptible and clarithromycin-resistant strains. In contrast, eradication rate was 100% for the amoxicillin-resistant strains. CONCLUSIONS: These results show that there is institutional difference of antibiotic resistance of H. pylori, explaining the institutional difference of eradication rate of H. pylori. The resistance to clarithromycin seems to be an important determinant for the eradication by proton pump inhibitor triple therapy but resistance to amoxicillin does not have any effect.