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Background and aims Exercise training (ET) helps treat atherosclerosis. However, many patients stop regular ET for various reasons. The effect of detraining on atherosclerosis is not well studied. We examined the effects of ET vs. short-term detraining on atheromatous matrix-metalloproteinase (MMP) activity in preexisting plaque and circulating cytokines/lipids. Methods and results Eighteen-week-old apolipoprotein-E−/− mice (n = 56) on a Western diet underwent: 1) ET for 6-weeks (ET5+1), 2) ET for 5-weeks and detraining for 1-week (ET5+0), 3) ET for the last 1-week (ET0+1), or 4) no treadmill ET at all for 6-weeks (ET0+0). Atheromatous MMP-activity was visualized using molecular imaging with an MMP-2/9-activatable near-infrared-fluorescent probe. Compared with no ET (ET0+0), regular ET (ET5+1) decreased carotid atheromatous MMP activity, but this protective effect was significantly blunted by short-term detraining (ET5+0). Short-term detraining after longer-term ET showed a reduction in MMP-activity similar to short-term ET (ET0+1). Blood levels of lipids and cytokines paralleled the molecular imaging results: exercise caused higher levels of high-density lipoprotein, adiponectin, and interleukin-10 and lower levels of vascular cell adhesion molecule, monocyte chemoattractant protein-1, interleukin-1β, and low-density lipoprotein. However, this beneficial effect was short-lived, with the ET5+0 group being similar to the ET0+0 group, and the ET0+1 group being similar to the ET5+1 group. The effect of exercise can be modeled with an exponential-decay of the protective factor of about 15%/day. Conclusions Even short-term detraining reduces atheroprotective effects, and tips the balance towards atherosclerosis. This suggests that ET, to be effective, needs to be prolonged and regular, and that detraining should be avoided.

Although many radiographic measurements of the foot and ankle have been used, reference values for normal functional groups are rarely reported. These can change according to sex and age; therefore, this study aimed to: (1) determine reference values for radiographic foot and ankle angles in an asymptomatic healthy Korean population, and (2) compare differences in the measurements according to sex and age. A total of 200 healthy volunteers were recruited, including 100 young adults (50 males, 50 females) aged 20 to 35 years, and 100 older adults (50 males, 50 females) aged 60 to 69 years. Weightbearing ankle anteroposterior views, talar tilt, and tibiotalar angles were measured. On the weightbearing foot anteroposterior views, the hallux valgus, hallux interphalangeal, and talo-first metatarsal angles were measured. On the weightbearing lateral foot views, the calcaneal pitch, lateral talo-calcaneal, lateral talo-first metatarsal, and lateral calcaneo-first metatarsal angles were measured. Values were stratified by sex and age, and statistically compared. The hallux valgus, calcaneal pitch, and lateral calcaneo-first metatarsal angles were affected by both sex and age; the hallux interphalangeal angle was affected by age and the lateral talo-first metatarsal angle by sex. We presented reference values for foot and ankle radiographic measurements in a healthy Korean population; several radiographic indices varied significantly by sex or age, which were grossly similar to previous studies based on white race. The study data can serve as a basis for evaluation of foot and ankle disorders.

Background We have found that infarcted brain regions exhibit green channel autofluorescence (GCAF). Here, we compare ex vivo GCAF-imaging with 2,3,5-triphenylteterazolium chloride (TTC)-staining. New method C57BL/6 mice (n = 120) underwent GCAF-imaging after transient or permanent middle cerebral artery occlusion (tMCAO or pMCAO). Comparison with existing methods TTC-staining may not reflect subtle ischemic injury. TTC-stained tissues, when reused, are prone to processing artifacts related to prior TTC-staining. GCAF imaging requires little experimental manipulation of animals and brain tissues, and allows for more consistent measurements of infarct volume and reliable reuse of the fresh unstained tissues. Results Lesion volumes measured at 24-h after 1-h tMCAO by using GCAF-images were similar to those using TTC-staining: 87.6 ± 13.6 mm 3 vs. 83.8 ± 12.8 mm 3 in 1 mm-thick sections (n = 9 mice, 10 slices/mouse, p = 0.88; Pearson’s r = 0.91, p 0.001) and 75.1 ± 7.6 mm 3 vs. 73.6 ± 6.7 mm 3 in 2 mm-thick sections (n = 9 mice, 5 slices/mouse, p = 0.99; Pearson’s r = 0.87, p 0.001), respectively. In serial ex vivo imaging performed at 1, 2, 3, 6, 12, and 24-h after tMCAO, GCAF-imaging correlated well with TTC-staining at all time-points. In the pMCAO model however, the correlation was strong at later time-points (6–24-h); but at time points up to 3-h, GCAF-imaging was more sensitive than TTC-staining to detect ischemic areas, as verified by histology, where ischemic damage was observed in the GCAF-positive areas of the cerebral cortex and striatum, even in the face of normal TTC-staining. Conclusion GCAF-imaging is a reliable alternative to TTC-staining in the qualitative and quantitative assessments of focal brain ischemia, and more sensitive for detecting early ischemic damage in pMCAO.

Background Low-grade chondrosarcoma of long bones can be treated successfully with extended intralesional curettage using adjuvants. However, there is no study reporting the use of anhydrous alcohol as an adjuvant in the treatment of low-grade chondrosarcoma. We asked (1) whether intralesional curettage and anhydrous alcohol adjuvant for low-grade chondrosarcoma is associated with good oncologic outcomes; and we report (2) the complications of the procedure. Methods Thirty-six patients (13 men, 23 women) with a mean age of 46 years (range, 18–67 years) were treated for low-grade chondrosarcoma and followed up for a median of 62 months (range, 24–169 months). After intralesional curettage, and additional burring, anhydrous alcohol was used as an adjuvant therapy. Results At the time of last follow-up, there were no local recurrences or distant metastases. Six patients developed complications: 4 postoperative fractures (11%), 1 intra-articular loose body (3%) and 1 postoperative joint stiffness (3%). Conclusion Anhydrous alcohol is a reasonable adjuvant for the curettage of low-grade chondrosarcoma of long bones. A long-term follow-up study is necessary, considering the slow biological progression of low-grade chondrosarcoma.

article i nfo Background: Endothelial nitric oxide synthase (eNOS) gene variants are known to play a role in atherosclerotic development. However, whether interplay between eNOS polymorphisms and metabolic syndrome (MetS) affects ischemic stroke (IS) risk has yet to be discovered. We investigated whether the combined effects of eNOS polymorphisms and MetS influence ischemic stroke risk in Koreans. Methods: We genotyped the eNOS −922A N G, −786T N C, 4a4b, and 894G N T polymorphisms in 531 IS cases and 502 controls using polymerase chain reaction-amplified DNA. We then investigated whether the presence of MetS and the number of MetS risk factors worked with eNOS polymorphisms to influence IS risk. Results: IS patients had a significantly higher prevalence of MetS than controls (adjusted odds ratio (AOR) = 2.943, 95% confidence interval (CI), 2.256-3.840, P b 0.0001), and MetS prevalence did not differ between stroke subtypes. The 894GT + TT genotypes were positively associated with IS (AOR = 1.670, 95% CI, 1.208-2.308, P = 0.002), and the −786TC + CC genotypes showed co-morbidity with MetS (AOR = 1.448, 95% CI, 1.401-2.015, P = 0.028). Among subjects with three or more MetS risk factors, the highest AOR value (28.490, 95% CI, 3.162-256.688) was observed for the eNOS −786TC + CC genotypes. Conclusions: The eNOS 894T allele and interplay between the eNOS −786C allele and MetS may predispose Koreans to IS.

Although metabolic syndrome (MS) is recognized as a risk factor for ischemic stroke, little is known about genetic variants that confer susceptibility to ischemic stroke among individuals with or without MS. This study was completed to investigate whether the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism is associated with MS as a risk factor for ischemic stroke in the Korean population. The prevalence of MS was significantly higher in ischemic stroke patients than controls (adjusted odds ratio [AOR]=1.420; 95% confidence interval [CI]=1.017-1.982, P=0.040). MS prevalence was also significantly different between patients with subtypes of small-artery occlusion (AOR=1.707; 95% CI=1.081-2.695, P=0.022) and large-artery occlusion (AOR=1.661; 95% CI=1.089-2.534, P=0.019) versus controls. The frequencies of the MTHFR 677 TT genotype (AOR=3.001; 95% CI=1.487-6.057, P=0.002) and CT genotype (AOR=1.772; 95% CI=1.053-2.983, P=0.031) of the MS group, and for the CC genotype in those without MS were significantly different between the ischemic stroke patients and controls. The MTHFR 677C>T polymorphism was associated with a higher risk of MS among ischemic stroke patients in the Korean population.

We investigated the expression of the epithelial sodium channel (ENaC) and aquaporins (AQPs) in the middle ear mucosa of a rat model of otitis media with effusion caused by surgical obstruction of the Eustachian tube.Sixty-four rats were randomly assigned to either undergo unilateral Eustachian tube obstruction (groups 1, 2, and 3) or to undergo no procedure (control group). Bony Eustachian tubes were approached through ventral incisions and obstructed with electrocautery. On days 14, 28, and 56, the ears were evaluated, and the rats were sacrificed for otoscopic evaluation and real-time RT-PCR. Immunohistochemistry was done for ENaC-alpha and AQP-1.The level of ENaC-alpha expression decreased 0.28- and 0.73-fold at 2 and 4 weeks, respectively, but increased 1.48-fold at 8 weeks (p0.05). The change in ENaC-beta expression at 2 weeks was insignificant. However, the level of ENaC-beta expression increased 3.17- and 7.85-fold at 4 and 8 weeks, respectively (p0.05). The level of ENaC-gamma expression increased 1.51-, 4.82- and 14.79-fold at 2, 4 and 8 weeks, respectively (p0.05). The level of AQP-1 expression decreased 0.10- and 0.04-fold at 4 and 8 weeks, respectively (p0.05). The change in AQP4 expression at 4 and 8 weeks was insignificant (p0.05). The pattern of immunoreactivity of ENaC-alpha and AQP-1 was similar with that of gene expression.The experimental methods provoked reproducible otitis media with effusion. This model is well suited for studies of middle ear homeostasis during disease pathogenesis. Middle ear mucosa homeostasis is altered significantly by ETO, and the subunits of AQP proteins show a characteristic expression pattern over time.

Sa1647 Clinical and Endoscopic Characteristics of Gastric Tumors Diagnosed in Serial Screening Endoscopy Hyoun Woo Kang*, Hyoung Jung Na, Jae Hak Kim, Jun Kyu Lee, Yun Jeong Lim, Moon Soo Koh, Jin Ho Lee, Eo-Jin Kim Internal Medicine, Dongguk University College of Medicine, Goyang, Republic of Korea; Pathology, Dongguk University College of Medicine, Goyang, Republic of Korea Background: Although biennial upper endoscopy is recommended for screening gastric cancer in Korea, there has been little study on the characteristics of clinical and endoscopic characteristics of gastric tumors diagnosed in screening endoscopy. Material and Methods: We retrospectively reviewed clinical and endoscopic characteristics of gastric cancer or adenoma cases which were diagnosed as during serial screening endoscopy and in which prediagnostic endoscopy was negative from October 2005 to July 2011 at our hospital. Clinical characteristics including mean follow up periods and endoscopic characteristics including location, pathology and prediagnostic endoscopic findings were analyzed. Results: A total of 56 lesions with a histologic diagnosis of gastric epithelial neoplasms (31 early gastric cancers, 4 advanced gastric cancers and 21 gastric adenomas) were included. All cases were consecutively treated with endoscopic submucosal dissection or operation. Mean interval between two endoscopies was 688 day (1501775 day), so we divided into less than 2 years group (n 33) and more than 2 years groups (n 20) by interval between 2 serial examinations. The locations of tumors were antrum 31, body 23 and cardia 2. The initial endoscopic findings were normal 3, gastritis 5, erosion 7, ulcer 7, atrophy 23, and intestinal metaplasia 11. The initial pathologic findings were Helicobacter pylori colonization 68.4% (13/19), neutrophils 52.6 % (10/19), mononuclear cells 84.2% (16/19), atrophy 94.7% (18/19), and intestinal metaplasia 68.8%(11/19). Among 53 cases(except 3 cases due to follow up loss), 3 patients were not cured because of metastasis at the time of diagnosis or recurrence during follow up period. In less than 2 years group, all patients were cured, but in more than 2 years group, 2 patients had distant metastasis at the time of diagnosis and 1 patient had recurrence during follow up period. It showed the statistical difference (p 0.022). Conclusions: In conclusions, findings of atrophy during screening upper endoscopy, especially in location of antrum, should necessitate precautious follow up endoscopy. Screening endoscopy for cancer detection may be done within every 2 years.

90.0% (180/200). Interobserver agreement for histological predictions before and after the lecture was good (kappa 0.575 and 0.699, respectively). Conclusions: These results support the validity of the NICE classification for predicting submucosal invasion in colorectal tumors. Using the NICE classification, raters inexperienced in NBI can determine lesion histology with a high degree of accuracy even without lecture, which is further enhanced by focused education and the use of confidence levels.