Serologic status and vaccine response against hepatitis B virus after allogeneic hematopoietic cell transplantation in pediatric patients.

BACKGROUND: Although vaccination against hepatitis B virus (HBV) is recommended for hematopoietic cell transplantation (HCT) recipients, previous studies evaluating serologic status and immunologic response to HBV vaccination in pediatric allogeneic HCT recipients are not enough. OBJECTIVE: This study aimed to evaluate serologic status against HBV and immunologic responses to HBV vaccination in children and adolescents receiving allogeneic HCTs. METHODS: Medical records of the enrolled 61 pediatric patients < 19 years of age who received their first allogeneic HCTs were retrospectively reviewed. RESULTS: Twenty-two (36.1%) of the enrolled patients were positive for hepatitis B surface antibody (HBsAb) after HCT. Chronic graft-versus-host disease was significantly associated with negative HBsAb status after HCT (p = 0.01). With one dose of HBV vaccination after HCT, 40.5% of the vaccinated patients became positive for HBsAb. No clinical factor was associated with the positive conversion of HBsAb after vaccination. CONCLUSIONS: Considering the unsatisfactory seropositive rate and vaccine response against HBV and the lack of significant clinical and laboratory factors predicting serostatus in HCT recipients, universal three doses of HBV vaccination should be necessary after allogeneic HCT.

Efficacy and Safety of Functional Medial Ligament Balancing With Stepwise Multiple Needle Puncturing in Varus Total Knee Arthroplasty.

BACKGROUND: The aims of this study were to (1) describe our functional stepwise multiple needle puncturing (MNP) technique as the final step in medial ligament balancing during total knee arthroplasty (TKA) and (2) evaluate whether this technique can provide sufficient medial release with safety. METHODS: A total of 137 patients with 212 consecutive knees who underwent TKAs with or without functional stepwise MNP of superficial medial collateral ligament was recruited in this prospective cohort. Eighty-one patients with 129 knees who performed serial stress radiographs were enrolled in the final assessment. Superficial medial collateral ligament was punctured selectively (anteriorly or posteriorly or both) and sequentially depending on the site and degree of tightness. Mediolateral stability was assessed using serial stress radiographs and comparison was performed between the MNP and the non-MNP groups at postoperative 6 months and 1 year. Clinical outcomes were also evaluated between 2 groups. RESULTS: Fifty-five TKAs required additional stepwise MNP (anterior needling 19, posterior needling 3, both anterior and posterior needling 33). Preoperative hip-knee-ankle angle and the difference in varus-valgus stress angle showed significant difference between the MNP and the non-MNP groups, respectively (P = .009, P = .037). However, there was no significant difference when comparing the varus-valgus stress angle between the MNP and the non-MNP groups during serial assessment. Clinical outcomes including range of motion also showed no significant differences between the 2 groups. CONCLUSION: Functional medial ligament balancing with stepwise MNP can provide sufficient medial release with safety in TKA with varus aligned knee without clinical deterioration or complication such as instability. LEVEL OF EVIDENCE: Level II, Prospective cohort study.

Comparative analysis of fixation configurations and their effect on outcome after medial open-wedge high tibial osteotomy.

PURPOSE: The purposes of this study were to analyze and compare 1) the postoperative fixation configurations, and 2) radiological and clinical outcomes between the new conceptual fixation device (LCfit) and the conventional locking plates. METHODS: Retrospective comparative analysis of 304 cases who underwent open-wedge high tibial osteotomy with four different locking plate systems including the LCfit system was conducted. In analyzing the fixation configuration of each locking plate system, the plate position, the gap between plate and bone, screw angle, and screw length were evaluated from postoperative CT scans. The clinical outcomes and radiological parameters of four patient groups corresponding to the four locking plate systems were also compared. RESULTS: In the analysis of the fixation configurations, the LCfit system showed more posteromedial plate position, decreased gap between plate and bone, reduced screw angle, and longer screw length compared to the other three locking plates. However, there were no significant differences in clinical outcomes and radiological parameters such as hip-knee-ankle angle, weight-bearing line position, medial proximal tibial angle, and posterior slope between the four groups. CONCLUSION: The newly designed fixation system (LCfit) for open-wedge high tibial osteotomy showed fixation configurations that have theoretical mechanical advantages over conventional anatomical locking plates. However, there were no significant differences in clinical outcomes and radiological parameters between LCfit and the other locking plate systems. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Cytotoxic effects of ex vivo-expanded natural killer cell-enriched lymphocytes (MYJ1633) against liver cancer.

BACKGROUND: Adoptive transfer of immune cells such as T cells and natural killer (NK) cells has emerged as a targeted method of controlling the immune system against cancer. Despite their significant therapeutic potential, efficient methods to generate adequate numbers of NK cells are lacking and ex vivo-expansion and activation of NK cells is currently under intensive investigation. The primary purpose of this study was to develop an effective method for expansion and activation of the effector cells with high proportion of NK cells and increasing cytotoxicity against liver cancer in a short time period. METHODS: Expanded NK cell-enriched lymphocytes (NKL) designated as "MYJ1633" were prepared by using autologous human plasma, cytokines (IL-2, IL-12 and IL-18) and agonistic antibodies (CD16, CD56 and NKp46) without an NK cell-sorting step. The characteristics of NKL were compared to those of freshly isolated PBMCs. In addition, the cytotoxic effect of the NKL on liver cancer cell was examined in vitro and in vivo. RESULTS: The total cell number after ex vivo-expansion increased about 140-fold compared to that of freshly isolated PBMC within 2 weeks. Approximately 78% of the expanded and activated NKL using the house-developed protocol was NK cell and NKT cells even without a NK cell-sorting step. In addition, the expanded and activated NKL demonstrated potent cytotoxicity against liver cancer in vitro and in vivo. CONCLUSION: The house-developed method can be a new and effective strategy to prepare clinically applicable NKL for autologous NK cell-based anti-tumor immunotherapy.

Case report: migration of a broken screw to the knee joint after hardware failure following closing wedge distal femoral osteotomy.

BACKGROUND: We report a case of hardware failure after distal femoral osteotomy (DFO) with a broken screw pulled out from the locking hole and positioned within the knee joint. CASE PRESENTATION: A 57-year-old man presented to our orthopedic outpatient department with 3-months history of an unusual painful swelling at the operated area following DFO. The leakage of joint fluid from the penetrated suprapatellar pouch was assumed to be the reason for this complication. CONCLUSIONS: The overall aim of this case report is to provide a lesson to budding surgeons who might experience a similar situation that cannot be easily explained, like the unexpected complication in the present case.

Morphometric Assessment of Resected Femoral Cut Surface in Korean Knees and Its Fitting With Western-Designed Femoral Components.

BACKGROUND: This study aimed at assessing the morphometry of resected femurs in Korean patients during total knee arthroplasty (TKA) and comparing these measurements with current Western-designed femoral component dimensions. METHODS: This single-blind, prospective, randomized, controlled trial involved intraoperative measurements for 271 femoral component implantations from 3 contemporary TKA systems, with 2 systems offering narrow sizing options. The difference between femoral component dimensions and the resected surface of distal femur was measured in millimeters at 5 distinct zones. RESULTS: Overhang of standard femoral component was common in the anterior-medial condyle and anterior-lateral condyle ranging from 50.8% to 99.0% and 21.5% to 88.0%, respectively. With narrow femoral components, the rate of overhang reduced to 21.5%-30.2% and 9.2%-32.1%. Conversely, underhang rates were higher over the anterior flange width, middle medial-lateral and posterior medial-lateral zones. Standard components displayed higher underhang rates at these zones compared to narrow components. The good fit rate for femoral component was low among the 3 systems ranging from 1.0% to 56.0%. System with narrow option sizing increases the underhang rates in males, while improving the component fit among females at similar zones with rate ranging from 5.2% to 52.9%. CONCLUSION: Currently available TKA implant designs may not provide a perfect match for the distal femoral shape of the Korean population. The availability of implants with standard and narrow options can substantially improve the optimal fitting of femoral components in the Korean population.

Different Strategies in Making Transseptal Portal for the Different Purposes.

The purpose of this study was to find the most suitable and safe position of the transseptal portal in anatomic anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions. The hypothesis of this study was that area and position of the transseptal portal are different between ACL and PCL reconstructions for the observation of native footprint. A matched-pair comparison study was conducted on the arthroscopic images of 100 consecutive patients who underwent ACL reconstruction and 50 consecutive patients who underwent PCL reconstruction. The transseptum was divided into six compartments. The opened compartments for each surgery were then evaluated to find which anatomical structures are well seen. The anterior middle and upper parts were necessary for the ACL reconstruction, whereas middle and lower portions of the anterior and posterior compartments were necessary for the PCL reconstruction. A larger opening was necessary for PCL reconstruction than that for ACL reconstruction. The ACL posterior one-third, ACL femoral attachment, and apex of the deep cartilage margin (DCM) were viewed in 100% of the patients during ACL reconstruction. The PCL posterior one-third, PCL tibial attachment, PCL fovea margin, and medial meniscus around posterior margin were always viewed during PCL reconstruction. The anterior part of the septum, from the middle to the upper portions of the transseptum, was necessary to be opened for visualization of the femoral footprint and DCM of the lateral femoral condyle during ACL reconstruction. The anterior and posterior parts of the septum, from the middle to the lower portions of the transseptum, were necessary for excellent visualization of the PCL tibial footprint during PCL reconstruction. These paths of the transseptal portal for each surgery will help surgeons obtain both anatomic footprint restoration and maximal remnant preservation through the most suitable and safe means. This is a case-control study; level of evidence is 3.

Disparity between Preoperative Target Correction Amount and Postoperative Correction Amount in Open Wedge High Tibial Osteotomy.

PURPOSE: The purpose of this study was to evaluate the disparity between the preoperative target correction amount and the postoperative correction amount in open wedge high tibial osteotomy (OWHTO) in patients divided according to the planned osteotomy gap. MATERIALS AND METHODS: Seventy-two patients were divided into two groups (group 1 with the planned opening gap lager than the mean opening gap length of total patients and group 2 with a smaller opening gap). The opening gap was determined according to the target weight bearing line (WBL) ratio on the preoperative whole leg radiograph. Absolute and relative values of the disparity between the target and postoperative WBL ratios were compared between groups in order to clarify whether the disparity was deviated toward over- or under-correction. RESULTS: The absolute value of disparity between the target and postoperative WBL ratios in group 1 was significantly larger than that in group 2 (6.01%±5.68% vs. 3.32%±3.38%; p=0.02). However, there was no statistically significant difference in relative values between groups (p=0.54). CONCLUSIONS: The postoperative WBL ratio after OWHTO was different from the preoperative target WBL ratio if the planned osteotomy gap was large. This mismatch was not deviated toward one side, either over- or under-correction.

Femoral tunnel placement in single-bundle, remnant-preserving anterior cruciate ligament reconstruction using a posterior trans-septal portal.

BACKGROUND: Anatomic tunnel formation and remnant preservation are valuable aspects of anterior cruciate ligament (ACL) reconstruction. However, anatomic landmarks are difficult to observe during remnant-preserving ACL reconstruction (ACLR). The aims of this study were to evaluate the: 1) femoral tunnel location created with guidance from the apex of the deep cartilage margin (ADC) and footprint compared to anatomical reference; and 2) relationship between femoral tunnel location and outcomes of ACLR. METHODS: A total of 109 ACLR patients without revision ACLR, multi-ligament reconstruction, peri-knee fracture, and osteotomy were included. The femoral tunnel was formed at the most proximal corner of the femoral footprint using a posterior trans-septal portal as the viewing portal. The distance from the tunnel center to ADC was measured by computed tomography and arthroscopy. The two measurements were then compared. Finally, femoral tunnel location was compared to the anatomic reference and correlated with the outcomes. RESULTS: The average distance from ADC to the femoral tunnel center was 7.0 ±â€¯1.4 mm as measured by arthroscopy, and 7.2 ±â€¯2.0 mm using three-dimensional computed tomography. There was no statistically significant difference between the two methods (P = 0.420). Clinical and stability outcomes were significantly improved postoperatively. Clinical outcome was not related to femoral tunnel location; however, stability outcome was related to femoral tunnel location: the more proximally located femoral tunnels showed better stability. CONCLUSION: The ADC can be a possible landmark in remnant-preserving ACLR using a trans-septal portal. A more proximal femoral tunnel, which is located at the proximal corner of the ACL remnant, can provide stability advantage during remnant-preserving ACLR.

Serological Changes against Hepatitis B Surface Antigen in Children and Adolescents Receiving Chemotherapy for Acute Leukemia.

BACKGROUND: Vaccination for hepatitis B virus (HBV) after chemotherapy among pediatric patients with acute Leukemia is still a debated issue. We investigated HBV immunity before and after chemotherapy and assessed immune response to re-vaccination after chemotherapy. METHODS: We retrospectively analyzed data of children and adolescents aged <19 years requested for vaccination after chemotherapy for acute leukemia to evaluate hepatitis B surface antibody (HBsAb) status before and after chemotherapy and to identify factors related to HBsAb positivity after chemotherapy. RESULTS: Of 89 enrolled patients, 61 (68.5%) with acute leukemia were HBsAb positive before chemotherapy. Of these 61 patients, 48 (78.7%) seroconverted to HBsAb negative status after chemotherapy; there were 76 (85.4%) HBsAb negative patients after chemotherapy. HBsAb positive patients when compared to HBsAb negative patients after chemotherapy had a significantly higher HBsAb positive rate (100.0% vs. 63.2%, p=0.008) before chemotherapy. Following HBsAb testing after one dose of the HBV vaccination, 33 (43.4%) of the 76 HBsAb negative patients seroconverted to an HBsAb positive status. HBsAb positive patients after a single dose of HBV vaccination had a significantly higher HBsAb positive rate at the time of diagnosis compared to HBsAb negative patients (84.8% vs. 48.8%, p=0.001). CONCLUSIONS: Based on these results, HBV re-vaccination after chemotherapy is recommended for all children and adolescents with acute leukemia. In addition, further investigation is required to improve the immunogenicity of HBV re-vaccination.

Seroprevalence of Hepatitis A Virus in Pediatric Patients with Hematologic Malignancies after Chemotherapy and Hematopoietic Cell Transplantation.

This retrospective study was performed to determine the seroprevalence of hepatitis A virus (HAV) in children and adolescents with hematologic malignancies after the completion of chemotherapy and hematopoietic cell transplantation (HCT). Of 97 enrolled patients, 60 (61.9%) were seropositive for HAV. The seroprevalences in patients undergoing chemotherapy and HCT were 60.3% (41/68) and 65.5% (19/29), respectively (P = 0.628). No significant factors associated with seropositivity for HAV after chemotherapy and HCT were identified. Anti-HAV tests and HAV re-vaccinations can be considered in children and adolescents with underlying hematologic malignancies after chemotherapy and HCT based on the anti-HAV results.

Effects of pork/beef levels and various casings on quality properties of semi-dried jerky.

The aim of this study was to investigate the effects of pork/beef levels and the casings on the quality properties of semi-dried jerky. The pork/beef levels in the four test formulations were as follows: T-1 (pork: beef=100:0), T-2 (95:5), T-3 (90:10), and T-4 (80:20). After tumbling for 30min with curing solution, the cured meats were stuffed into natural sheep casings, collagen casings, or cellulose casings, and then dried. The restructured jerky with cellulose casing had the lowest water content and the highest protein content, with no significant differences between various formulations. There were no significant differences among all formulations with regard to pH and total microbial counts, and jerky with cellulose casing had the lowest value of water activity. The processing yields of jerky made from the T-3 formulation were not significantly different with the various casings. The shear force of jerky with cellulose casing was lower than with other casings, and the metmyoglobin contents were more than 85% in all formulations. With regard to sensory properties, jerky made with the T-3 formulation and cellulose casings rated most favorable in evaluations than other treatments.

Oxidative and color stability of cooked ground pork containing lotus leaf (Nelumbo nucifera) and barley leaf (Hordeum vulgare) powder during refrigerated storage.

This study aimed to evaluate the oxidative and color stability of cooked ground pork containing lotus leaf powder at 0.1 (LP1) and 0.5% (LP2) as well as barley leaf powder at 0.1 (BP1) and 0.5% (BP2) during refrigerated storage for 10 days. The oxidative stability of these powders was compared with butylhydroxytoluene (BHT). LP1 had higher a* and lower b* values than the control (-) over 4 days (p<0.05). The pH values of the ground pork samples made with addition of LP and BHT decreased until day 4 and then increased. Thiobarbituric acid-reactive substance (TBARS) values were lowest in LP2 on day 10 (p<0.05). The ground pork samples containing LP and BP had lower peroxide values (POVs) and conjugated dienes (CD) compared to the control (-).These results indicate that LP or BP can be incorporated into ground pork to effectively retard oxidation after cooking.

Effect of bamboo salt on the physicochemical properties of meat emulsion systems.

This study was conducted to determine the effects of various bamboo salts on meat batter. To accomplish this, three different batters were prepared and compared: CON, which was prepared with NaCl, BS-2, which was prepared with bamboo salt that was baked twice, BS-9, which was prepared with bamboo salt that was baked nine times. The pH of both the uncooked and cooked BS-2 and BS-9 was higher than that of the CON (P<0.05). The emulsion stability, cooking yield, water holding capacity (WHC) and apparent viscosity of BS-2 and BS-9 were higher than those of CON. The correlation coefficient between the viscosity value and WHC was high and positive (R(2)=0.672). The hardness of all treatments was significantly increased with increased cooking temperature (P<0.05). The hardness, gumminess and chewiness of CON were higher than that of BS-9 and BS-2. The overall acceptability score between CON and BS-9 was significantly different (P<0.05). The bamboo salts effectively improved the physicochemical properties of the meat batter.