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Summary: Purpose: To evaluate the course of the cutaneous nerve regarding the first extensor compartment to determine whether the dorsal or volar approach is safer for local injection into the first extensor compartment guided by ultrasound. Methods: We dissected the radial side of the wrists from 28 cadavers (52 wrists). Four-points along the imaginary line were set: the styloid process and 1 cm, 2 cm, and 3 cm proximal to the styloid process. The numbers of superficial radial nerve (SRN) and lateral antebrachial cutaneous nerve (LACN) branches were counted, and distances from the imaginary line at these points and nerve diameters were recorded. Digital images were superimposed to observe overall distribution of cutaneous nerve. Results: There were means of 3.3 SRN and 0.9 LACN branches observed in each wrist. The mean number of both SRN and LACN branches was 2.3 on the dorsal side and 1.9 on the volar side. The superimposed images indicated that both the dorsal and volar sides comprised abundant cutaneous nerves and that their paths varied markedly between patients. However, we observed that larger nerves with meaningful diameters were more abundant on the dorsal than the volar side. Conclusion: There were similar numbers of cutaneous nerves on both the dorsal and volar sides; however, we observed greater abundance of thicker cutaneous nerves on the dorsal side, and these were closer to the reference line than on the volar side. This anatomical study suggests that the risk imposed to cutaneous nerves would therefore be reduced when injection on the volar side.

ObjectiveMany potential predictors have been identified and proposed for predicting late reduction loss in distal radius fractures. However, no report exists on whether the bone mineral density (BMD) of the forearm correlates with the loss of reduction in distal radius fractures. This study aimed to investigate whether forearm BMD can be used as a predictor of reduction loss in distal radius fractures treated with cast immobilization.MethodsNinety patients with distal radius fractures were divided into two groups according to the maintenance or loss of reduction evaluated from radiographs taken at least 6 weeks after their injury. Lumbar and forearm BMD (total and metaphysis) T-scores were measured and compared between the maintenance of reduction (MOR) group and the loss of reduction (LOR) group. Additionally, serologic markers (C-terminal telopeptide, osteocalcin, vitamin D) and radiologic risk factors (intra-articular fracture, ulnar fracture, dorsal comminuted fracture, volar hook) were evaluated and a logistic multiple regression analysis was performed to know the main risk factors of reduction loss.ResultsReduction loss was observed in 38 patients (42.2%). The total and metaphyseal BMD of the forearm was less in the LOR group than in the MOR group. However, the difference was not statistically significant [−2.9 vs. −2.5 for total (p = 0.18), −2.3 vs. −2.0 for metaphysis (p = 0.17)]. Multiple logistic regression analysis showed initial dorsal comminution (p = 0.008) and ulnar variance (p = 0.01) were the main risk factors for reduction loss.ConclusionsForearm BMD was not a valuable prognostic factor for reduction loss in distal radius fractures. Initial dorsal comminution and ulnar variance rather than forearm BMD should be considered preferentially when predicting which patients are at high risk of reduction loss in distal radius fractures.

Abstract Background Vitamin B12 (Vit B12) deficiency results in elevated homocysteine levels and interference with collagen cross-linking, which may affect tendon integrity. The purpose of this study was to investigate whether serum Vit B12 levels were correlated with degenerative rotator cuff (RC) tear. Methods Eighty-seven consecutive patients with or without degenerative RC tear were enrolled as study participants. Possible risk factors (age, sex, medical history, bone mineral density, and serum chemistries including glucose, magnesium, calcium, phosphorus, zinc, homocysteine, Vitamin D, Vit B12, homocysteine, and folate) were assessed. Significant variables were selected based on the results of univariate analyses, and a logistic regression model (backward elimination) was constructed to predict the presence of degenerative RC tear. Results In the univariate analysis, the group of patients with degenerative RC tear had a mean concentration of 528.4 pg/mL Vit B12, which was significantly lower than the healthy control group (627.1 pg/mL). Logistic regression analysis using Vit B12 as an independent variable revealed that Vit B12 concentrations were significantly correlated with degenerative RC tear (p = 0.044). However, Vit B12 levels were not associated with tear size. Conclusion Low serum levels of Vit B12 were independently related to degenerative RC tear. Further investigations are warranted to determine if Vit B12 supplementation can decrease the risk of this condition.

ObjectiveNumerous attempts have been made to devise treatments for ischemic foot ulcer (IFU), which is one of the most severe and fatal consequences of diabetes mellitus (DM). Pericytes, which are perivascular multipotent cells, are of interest as a treatment option for IFU because they play a critical role in forming and repairing various tissues. In this study, we want to clarify the angiogenic potential of pericytes in DM-induced wounds.MethodsWe evaluated pericyte stimulation capability for tube formation, angiogenesis, and wound healing (cell migration) in human umbilical vein endothelial cells (HUVECs) with in-vivo and in-vitro models of high glucose conditions.ResultsWhen HUVECs were co-cultured with pericytes, their tube-forming capacity and cell migration were enhanced. Our diabetic mouse model showed that pericytes promote wound healing via increased vascularization.ConclusionThe findings of this study indicate that pericytes may enhance wound healing in high glucose conditions, consequently making pericyte transplantation suitable for treating IFUs.

Background and Objectives: A reduction forced toward the posterior side during graft fixation may help to lessen anterior tibial translation after ACL reconstruction. The purpose was to compare the clinical and radiological outcomes of graft fixation when a posterior draw was used and when it was not used during anterior cruciate ligament (ACL) reconstruction surgery. Materials and Methods: Of 110 patients who had undergone primary arthroscopic ACL reconstruction between January 2017 and August 2020, in all, 76 patients had been operated on without a posterior draw (non-draw group), and 34 patients had received surgery with a posterior draw (draw group). The results of the Lachman test and the pivot-shift test, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) indexes, the Lysholm scores, the International Knee Documentation Committee (IKDC) subjective scores, and side-to-side difference (STSD) on stress radiography were compared between the two groups. Results: The postoperative WOMAC indexes, Lysholm scores, and IKDC subjective scores were similar across both groups. Postoperative STSD (2.4 ± 2.2 for the non-draw group vs. 2.0 ± 2.2 for the draw group; p = 0.319) and change in STSD (3.5 ± 3.5 for preoperative STSD vs. 4.3 ± 4.4 for postoperative STSD; p = 0.295) were not superior in the draw group. Conclusions: The take-home message is that graft fixation with a posterior draw during ACL reconstruction did not result in significantly better postoperative stability. The postoperative clinical outcomes were similar between both groups.

Purpose: To identify the structural integrity of the healing site after medial open wedge high tibial osteotomy (MOWHTO) in patients with a posterior root tear of the medial meniscus (PRTMM) and chondral lesion by second-look arthroscopy and to determine the clinical and radiological findings. Materials and Methods: From August 2010 to June 2016, 52 consecutive patients underwent MOWHTO and arthroscopic examination without a chondral resurfacing procedure and meniscal treatment for PRTMM. Twenty-four patients were available for second-look arthroscopic evaluation. The mean follow-up period was 19.5 months (range, 5 to 46 months). Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. Results: There were 5 lax healing, 6 scar tissue, 13 failed healing of PRTMM. Definite change of chondral lesion was not observed. The Kellgren- Lawrence grade did not improve according to the follow-up plain radiograph. The mean Lysholm score improved from 34.7 preoperatively to 77.1 at the last follow-up, and the mean HSS score significantly increased from 36.5 to 82.4. Conclusions: This study revealed a low rate of healing potency of PRTMM and chondral lesion after MOWHTO without any attempt for meniscal treatment or chondral resurfacing. The cartilage and healing status of PRTMM was not associated with improved clinical outcomes and radiological findings. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (2x2 anchor with 4x4 suture stands). Methods: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using 2x2 anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medial- row stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre- and postoperative MRI. Results: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. Conclusions: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to evaluate the risk of sequential bilateral total knee arthroplasty (TKA) under 1 anesthesia in patients 75 years or older. Materials and Methods: Patients aged 75 years or older who underwent sequential bilateral TKA (bilateral group, n=159) and unilateral TKA (unilateral group, n=159) between 2002 and 2012 were selected. All patients were evaluated for underlying medical diseases, such as cardiac, pulmonary, and renal problems, and high-risk patients were recommended to postpone the surgery. We compared the underlying diseases, major postoperative complications, and the length of hospital stay between bilateral and unilateral groups. Results: The prevalence of underlying diseases of the bilateral group was 74.8% and major complications occurred in 6 patients (3.8%). The prevalence of underlying diseases of the unilateral group was 52.4% and complications were observed in 4 patients (2.4%). Although the complication rate of the bilateral group was slightly higher than that of the unilateral group, the difference was not statistically meaningful (p=0.204). The length of hospital stay was 21.9 days for the bilateral group and 24.9 days for the unilateral group. Conclusions: There was no significant difference in postoperative complications between groups. The result shows that bilateral TKA can be relatively safe compared with unilateral TKA in patients 75 years or older. However, careful selection of low-risk patients is advised. [ABSTRACT FROM AUTHOR]

Background The purposes of this study were to evaluate the clinical results of arthroscopic débridement and to identify preoperative factors that influence the outcome. Methods Forty-three elbows with primary osteoarthritis in 43 patients treated with arthroscopic débridement were retrospectively evaluated. At a mean follow-up of 38 months (range, 18-77 months), the visual analog scale (VAS) score for pain, the arc of elbow motion, and the Mayo Elbow Performance Index (MEPI) score were assessed. The relationships between postoperative MEPI score and postoperative motion arc and preoperative factors including age, sex, involvement of the dominant arm, duration of symptoms, demand of elbow activity, VAS score, previous history of failed surgery, and arc of elbow motion were statistically evaluated. Results The mean VAS score for pain, the mean arc of flexion-extension, and the mean MEPI score significantly improved after the operation (all P values < .001). Multivariate regression analysis revealed that among preoperative variables, arc of motion was found to be the only independent prognostic factor that affected both postoperative elbow function (P = .024) and final arc of motion (P < .001). The cutoff value of preoperative arc of motion for the final arc of motion was determined to be 80° (P < .001). Involvement of the dominant arm was found to be another independent factor that affected postoperative MEPI scores (P = .016). Conclusions Arthroscopic débridement for elbow osteoarthritis provides satisfactory pain relief, improvement of elbow motion, and good functional outcome. Based on the fact that preoperative motion arc is the independent factor that can predict clinical outcome, arthroscopic treatment is highly recommended for patients who have a motion arc of 80° or more as it yields reliable results. [ABSTRACT FROM AUTHOR]

We found a unique anatomical variant of the distal ulnar nerve, a neural loop encompassing the flexor carpi ulnaris during Guyon's canal exploration. Compression by the flexor carpi ulnaris during active wrist movement was suspected as the cause of ulnar neuropathy. The symptom was relieved after neurolysis and release of surrounding tissue. With regard to the ulnar side wrist pain, which is suspicious for ulnar compression syndrome at the wrist level, the surgeon should always suspect anomalous nerve branch as source of compressive neuropathic pain. [ABSTRACT FROM AUTHOR]

Water balance components of a bare soil with slope varying from 5% to 30% in Chuncheon, South Korea, were simulated using the E-DiGOR model, which proposed an interactive way to quantify runoff, drainage, soil water storage, and evaporation. Daily computations were carried out during the period of 1980 to 2009 for the identified soil-topography-climate combination. A strong correlation between measured pan evaporation and calculated potential soil evaporation was observed (R² = 63.8%, P < 0.01) based on the monthly data of the past 30 years (hereafter 'long-term'). When examining long-term dynamics of simulated soil evaporation, monthly mean potential and actual soil evaporations ranged from 9.1 and 9.0 mm in December to 110.5 and 75.2 mm in June and July, respectively. The ratio of actual to potential soil evaporation (Ea/Ep) had a close linkage with soil water content. The higher the soil water amount, the greater the Ea/Ep ratio was. A nonlinear relationship between rainfall and surface runoff was obtained at a given slope. Excess surface runoff and subsurface flow (percolation + interflow) occurred throughout the rainy months from July to September, with peaks in July. The ratio of direct surface runoff to rainfall increased with the natural logarithm of slope. The long-term mean annual direct surface runoff and subsurface flow at the maximum slope were 408.1 and 437.6 mm, respectively. Furthermore, mean annual surface runoff from the slope of 30% was approximately 2 times higher than that from the slope of 5%. [ABSTRACT FROM AUTHOR]

The treatment outcome of synovial sarcoma is poor owing to its resistance to radiation and chemotherapy. The Transducin-like Enhancer of Split 1 (TLE1) is a co-repressor that involves many signaling pathways like cell survival, hematopoiesis and differentiation. Although TLE1 is uniquely expressed in synovial sarcomas, the biological role of TLE1 is not completely understood. This study evaluated the function of TLE1 in synovial sarcomas using knock-down of TLE1, and examined whether the inhibition of TLE1 suppresses the proliferation of synovial sarcomas and enhances the cytotoxicity caused by doxorubicin (doxo). The over-expression of TLE1 was first confirmed in synovial sarcoma cells (HS-SYII). When the HS-SYII cells and normal fibroblast were transiently transfected with TLE1 siRNA, the MTT assay revealed growth inhibition in the HS-SY-11 cells but not in the normal fibroblast. TLE1 silencing also potentiated the cytotoxic effects of doxo against HS-SYII cells. This effect of TLE1 silencing was attributed mainly to the induction of apoptosis. Subsequent analysis revealed that Bcl-2 is a possible downstream target of TLE1 signaling. This study demonstrated that TLE1 is a critical factor for the survival of synovial sarcomas. Overall, the inhibition of TLE1 affects cell proliferation and the apoptosis pathway by suppressing the expression of Bcl-2. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29: 1131-1136, 2011 [ABSTRACT FROM AUTHOR]

The gene encoding a catalase–peroxidase (KatG) was cloned from chromosomal DNA of a fast-growing Mycobacterium sp. strain JC1 DSM 3803. The nucleotide sequence of a 5.7 kb EcoRI fragment containing the katG and its flanking regions was determined. The fragment (5,706 bps) contained two complete open reading frames (ORFs) encoding putative ferric uptake regulator A (FurA) and KatG proteins. The cloned gene, katG, had an ORF of 2241 nt, encoding a protein with calculated molecular mass of 81,748 Da. The furA was located in the upstream of the katG with the same transcriptional direction and there was a 38 bp gap space between them. The deduced KatG and FurA protein sequences showed significant homologies to KatG2 and Fur2 of Mycobacterium smegmatis and clustered with other mycobacterial KatG and Fur-like proteins in phylogenetic trees, respectively. The recombinant KatG overproduced in Escherichia coli was nearly indistinguishable from the native JC1 catalase–peroxidase in enzymatic properties and also possessed the resistance to organic solvents, indicating that the cloned katG truly encodes the Mycobacterium sp. JC1 catalase–peroxidase. Difference spectroscopy revealed Mn(II) binding near the haem of the KatG. Transcript analysis of the furA–katG using RT–PCR suggests that the katG is independently transcribed from the furA. [ABSTRACT FROM PUBLISHER]

A bacterial semicarbazide-sensitive amine oxidase (SSAO) was purified and characterized from Mycobacterium sp. strain JC1 DSM 3803 grown on benzylamine. During the purification procedures, the enzyme was tending to aggregate and exhibited heterogeneity in native PAGE. The heterogeneous forms having amine oxidase (AO) activity could be separated by their native molecular weights using gel-filtration chromatography. Most of the AOs behaved as dimers (Mr 150,000) composed of a 75-kDa subunit, but some aggregated to form tetramers (Mr 300,000). Besides their native molecular weight, subunit composition and Vmax value, both forms (dimer and tetramer) have almost identical biochemical properties (e.g. subunit size, optimum pH and temperature, activation energy, Km value on benzylamine, substrate and inhibitor specificities). When AO activity was observed by activity staining, the best-oxidized substrate was benzylamine, although the AO also oxidized tyramine and histamine. The AO was strongly inhibited by semicarbazide and isoniazid, but KCN did not affect its activity. The purified enzyme was shown to contain 2.39 mol of copper per mole of subunit, but there were no evidences of topaquinone co-factor involvement, when tested by absorption spectrum analysis and redox-cycling staining for quinoprotein detection. [ABSTRACT FROM PUBLISHER]

The sand-cone method is commonly used to measure the in situ density of compacted soils. While determining field density with this method, differences in the sand-filling process between the test hole and the calibration container can cause errors. The differences can result from various in situ conditions such as the shape and size of the test hole and the moisture conditions of the filling sand and test ground. Temporary rainfall can increase the moisture content of both in situ soils and filling sand. This study examined the effect of wetting conditions on the accuracy of the sand-cone method in a laboratory. Compacted soils with different water contents (2–16%) were prepared in a small circular container in the laboratory, and the sand-filling process was simulated for cylindrical, conical, and roof-shaped test holes with depths of 10 and 15 cm. As the water content of the compacted soils increased, the sand-cone method underestimated the volume of sand accumulated in the test holes by up to 20%, resulting in the calculated density being overestimated by an identical amount. Slightly moist sand was poured into artificial test holes. When the water content of the filling sand was below 1%, no significant error was observed in the calculated volume.