Cadmium increases ferroportin-1 gene expression in J774 macrophage cells via the production of reactive oxygen species

Cadmium intoxication has been associated with the dysregulation of iron homeostasis. In the present study, we investigated the effect of cadmium on the expression of ferroportin 1 (FPN1), an important iron transporter protein that is involved in iron release from macrophages. When we incubated cadmium with J774 mouse macrophage cells, FPN1 mRNA levels were significantly increased in a dose- and time-dependent manner. Furthermore, the cadmium-induced FPN1 mRNA expression was associated with increased levels of FPN1 protein. On the other hand, cadmium-mediated FPN1 mRNA induction in J774 cells was completely blocked when cells were co-treated with a transcription inhibitor, acitomycin D. Also, cadmium directly stimulated the activity of the FPN1-promoter driven luciferase reporter, suggesting that the cadmium up-regulates FPN1 gene expression in a transcription-dependent manner. Finally, cadmium exposure to J774 macrophages increased intracellular reactive oxygen species (ROS) levels by ~ 2-fold, compared to untreated controls. When J774 cells were co-treated with antioxidant N-acetylcystein, the cadmium-induced FPN1 mRNA induction was significantly attenuated. In summary, the results of this study clearly demonstrated that cadmium increased FPN1 expression in macrophages through a mechanism that involves ROS production, and suggests another important interaction between iron and cadmium metabolism.

Effects of various metal ions on the gene expression of iron exporter ferroportin-1 in J774 macrophages

Macrophages play a key role in iron metabolism by recycling iron through erythrophagocytosis. Ferroportin-1 (FPN1) is a transporter protein that is known to mediate iron export from macrophages. Since divalent metals often interact with iron metabolism, we examined if divalent metals could regulate the expression of FPN1 in macrophages. J774 macrophage cells were treated with copper, manganese, zinc, or cobalt at 10, 50, or 100 microM for 16 to 24 h. Then, FPN1 mRNA and protein levels were determined by quantitative real-time PCR and Western blot analyses, respectively. In addition, effects of divalent metals on FPN1 promoter activity were examined by luciferase reporter assays. Results showed that copper significantly increased FPN1 mRNA levels in a dose-dependent manner. The copper-induced expression of FPN1 mRNA was associated with a corresponding increase in FPN1 protein levels. Also, copper directly stimulated the activity of FPN1 promoter-driven reporter construct. In contrast, manganese and zinc had no effect on the FPN1 gene expression in J774 cells. Interestingly, cobalt treatment in J774 cells decreased FPN1 protein levels without affecting FPN1 mRNA levels. In conclusion, our study results demonstrate that divalent metals differentially regulate FPN1 expression in macrophages and indicate a potential interaction of divalent metals with the FPN1-mediated iron export in macrophages.

Sacral Perineural cyst: report of 3 cases / 대한정형외과학회잡지

Sacral perineural cyst is one group of extradural meningeal cyst at the sacral region. These lesions are distinguished from other spinal cysts because perineural cyst does not communicate with subarachnoidal space. Fluid filled cysts may compress adjacent nerve roots causing low back pain and sciatica which are dramatically improved by surgical excision. Differential diagnosis from other cysts can be accomplished by failure of collection of dye into cyst by initial myelography. C-T myelography rules out other mass lesions and often reveals communication of perineural cyst that filled with contrast medium. Magnetic resonance imaging well demonstrates three dimensinnal configures of an intraspinal cystic mass in initial study. However it is important to recognize that these cysts are one of causes of radiculopathy. We report three cases of sacral perineural cysts with radiculopathy.

Open Reduction and Internal Fixation of Intraarticular Calcaneal Fractures by the Extended Lateral Approach / 대한정형외과학회잡지

The operative treatment of intraarticular calcaneal fractures has three principal aims; restoration of the height and width of the calcaneus, reconstruction of the subtalar and calcaneocuboid joint surfaces, and stable osteosynthesis. The purpose of this study is to demonstrate the effectiveness of the open reduction and internal fixation by the extended lateral approach for the treatment of the intraarticular calcaneal fractures. Twenty-one calcaneal fractures of 20 patients were treated by open reduction and internal fixation using an extended lateral approach from April, 1993 to March, 1994. The autogenous iliac bone graft was done in all patients. These patients were evaluated from 12 to 24 months (average 15.2 months) after surgery. The following results were obtained; 1. Seventecn cases (80%) out of 21 were estimated as good or excellent result. 2. Preoperative Bohler's angles, Gissane's angles and inclination angles were observed as average -0.5degrees, 101degrees and 38degrees respectively, and these were improved as average 23.3degrees, 117degrees and 54degrees, postoperatively. 3. There were two cases of skin necrosis as complication. In conclusion, the extended lateral approach is one of the good methods for the treatment of intraarticular calcaneal fractures. We think that accurate reduction of the posterior facet, acceptable recovery of Bohler's angle and early postoperative mobilization are the most important things for the best result of the intraarticular calcaneal fracture surgery.

Radiologic Changes after Lumbar Discectomy / 대한정형외과학회잡지

Open discectomy is one of usual treatment for herniated intervertebral disc. We may expect the reduction of height of intervertebral disc due to decreased volume by partial resection of herniated disc. But the effect of decreased height of intervertebral disc space to posterior joint and spinal canal has not been identified, and the correlation between the amount of reduced height and the changes of range of motion has been undetermined. Thus, we analyzed radiologic changes of disc height and segmental motion by the flexion-extension view in 20 patients who had undergone discetomy for prolapsed intervertebral disc from June 1989 to January 1991 who could be followed up for 3 years or more. As a result, lumbar discetomy associates with 1) significant decrement of disc height (average 14%), 2) decreased disc motion of involved segment without hypermobility (average 34%), 3) hypermobility of adjacent segment, 4) and posterior facet overriding consistent with recurred low back pain.

A New Design of Miniplate Staple for High Tibial Osteotomy: Biomechanical Study / 대한정형외과학회잡지

Colles' fracture is a common injury encountered in emergency departments. Despite the frequent experience of every orthopedic surgeon with Colles' fracture, considerable variation remains in the treatment of fracture of the distal radius. Everyone nearly agress that reduction of the fracture is not difficult, but maintenance of reduction is the problem. Eighty patients with Colles' fracture were treated with closed reduction and percutaneous pinning under the C-arm fields and followed up more than 1 year, from January 1990 to May 1993 at the Department of Orthopedic Surgery, Dae Han Hospital. The results of this study were as follows: 1. The fractures were classified according to the system of Gartland and Werley. Of the 80 cases, 12(5%) were type 1; 25(31%) type 2; and 43(54%) type 3. 2. Complications were such as; temporary neuropathy of median nerve 2 cases, redisplacement 2 cases, radiocarpal arthritis 1 cases, stiff hand 1 case and shoulder hand syndrome 1 case. 3. The overall assessment showed exellent in 29 patients(36.2%), good in 44 patients(55,0%) and poor in 7 patients(8.8%) under the subjective and objective criteria of Gartland and Werley and the objective criteia of Scheck. 4. The results were mainly correlated with maintenance of an anatomical reduction. 5. The percutaneous pinning was suitable for anatomical restoration and maintence, had less com plication and more advantage such as the early range of joint and simple technique. Conclusively, it was considered to be one of ideal method for the treatment of Colles' fracture in selected cases.

Hand and Wrist Tuberculosis / 대한정형외과학회잡지

Hand and wrist tuberculosis in adults are relatively rare disease. The purpose of treatment is to minimize the limitation of motion and to relieve the pain and swelling of involved joints. The treatments consist of curettage of bone, synovectomy and arthrodesis, which were combined with chemotherapeutic agents for tuberculosis. In the period from June 1989 to Oct. 1993, we performed operative treatment in twelve cases of hand and wrist tuberculosis(hand in 3, wrist in 9). We performed curettage and synovectomy in eight cases and arthrodesis in four. The length of follow up was over one year in all cases. Patients were evaluated by clinical examination, radiography and the Robins criteria for clinical results. The results were analysed, as follows, l. Eight patients who had tenosynovitis with moderate joint destruction were treated by curettage and synovectomy, and seven patients(87.5%) of them were evaluated "good" by Robins criteria. 2. Arthrodesis was performed in four patients who had severe joint destruction, and demonstrates "good" results in 75% of cases. 3. One patient who was treated by synovectomy, complaint intermittent pain after three years postoperatively, but no active lesion was visible on the bone scanning. 4. One patient who was performed wrist arthrodesis feels discomfort during lift up heavy products due to insufficient grip power. In conclusion, the synovectomy and curettage in early diagnosed and not so much advanced hand wrist tuberculsis is more preferable, but arthrodesis is inevitable in advanced cases with profound degree of bony destruction and nonviable cartilage in operative findings, for painless and powerful joint.

Autotranfusion of the Autologous Shed Blood after Total Knee Replacement / 대한정형외과학회잡지

The major purpose for the use of autotransfusion is to prevent the transmission of blood borne infectious agents, such as human immunodeficiency virus and non-A & non-B hepatitis virus. To evaluate the efficacy and quality of autolgous shed blood for autotransfusion, eighty patients who had total knee arthroplasty from Dec. 1992 to Mar. 1994, were included in one of two groups: Group I, who received the autotransfusion, or Group II, who did not. Each group included 20 patients of unilateral TKR and 20 patients of bilateral TKR. The Orth-evac system(Deknatel, USA) was used to salvage drained blood in the first six hours after the operation. All of the patients were evaluated for the postoperative blood loss, transfusion requirements, hemoglobin, hematocrit, platelet count, blood pressure and body temperatures. l. In bilateral TKR, the reinfusion of shed blood reduced the requirements for homologous blood by 41.4%(1.2 pints in group I versus 2.9 pints in group II). In unilateral TKR, it was decreased to 36.4%(0.4 pint in group I vs 1.1 pint in group II). 2. In bilateral TKR, the requirements for homologous transfusion was decreased from 95% of patients in control group to 55% in group I .In unilateral TKR, it was decreased from 60% to 20%. 3. There were four patients who had high fever above 39℃ after autotransfusion. 4. At the immediate postoperative period there were two patients who had hypovolemic shock in group I patients who had bilateral TKR. 5. There was no clotting abnormality, no transfusion reaction and no thromboembolic disease in group I patients. In conclusion, the reinfusion of autologous shed blood after TKR is an acceptable alternative to the homologous transfusion without untoward effect.

Snapping Knee caused by the Gracilis and Semitendinosus tendon / 대한정형외과학회잡지

There are many reports about the snapping syndrome in the hip, shoulder, ankle, but the snapping knee has rarely been reported. In general, the symptom of this disease was relatively tolerable for that seldom requires operative treatment. We experienced one case of snapping knee, for which the pain, easy fatigability and feeling of instability on both knee joint were main complaints. During an exploratory operation, we confirmed the gracilis and semitendinosus tendon passing over the medial tibial condyle. The clinical, radiologic and operative findings were reviewed.

TKR in Fused Knee / 대한정형외과학회잡지

There are many difficulties in operative technique of total knee replacement of bony ankylotic knee, because it accompanies the deformity of the knee, contracture of soft tissue and bony ankylosis. It is said that there are poor gaining of post-operative range of motion and development of many problems in wound healing. We performed conversion TKR in seventeen patients who had fused knee between Jan. 1985 and Dec. 1991. After follow up of average three years and four months, we analyse the results. Sixteen patients were women and one was man. There were eight cases of tuberculosis knees, seven cases of septic knees and two cases of posttraumatic arthritis. Thirteen cases had previous knee surgery and in another four cases knee fusion developed spontaneously. Average age of patients were 35 years old. Operation was performed between ten months and twenty years averaging nine years after knee fusion. When blood chemistry and physical examination showed no findings of infection, operation was performed. We used bone cement in 8 cases and autogenous bone graft in 4 cases for large bone defect. For release of soft tissue contracture, in 8 cases, we lengthened quadriceps tendon with the method of V-Y advancement technique and in another 4 cases, performed patella tendon transfer from tibial tuberosity. Operative time was between three hours and four hours fifteen minutes, average three hours and fourty minutes. The results of these patients were as follows; 1. The postoperative average range of motion was 72° (20°-125°). The average extension lag was 9. 2. The average Hospital for Special Surgery knee rating score improved from 57 preoperatively to 84 postoperatively. 3. There were two patients who had pain on walking, but radiologically and clinically there were no loosening signs. 4. In three patients who had poor gaining of range of motion after operation, we performed arthroscopic adhesiolysis. There were two cases of transient peroneal nerve palsy which were recovered within 1 month and in another two case of deep infection with β-hemolytic streptococcus and pseudomonas, we performed knee fusion after one year ten months and one month after TKR. In conclusion, conversion TKR is a successful procedure which can obtain the restoration of function of the fused knee, especially in the cases that have adequate soft tissue condition, extensor mechanism and good bone stock.

Survivorship Analysis of Implants in Total Knee Replacement / 대한정형외과학회잡지

Survivorship analysis is a useful way of expressing the long term results of joint replacement. With the increase of follow up period in total knee replacement, it has became possible to predict the survival rate of implants in total knee replacement. The survivorship of total knee replacement in 145 consecutive patients(209 knees) between 1982 and 1988 with follow-up period of up to 10 years was estimated by Dobbs' method(1980), and we analyzed, clinically and radiologically, 116 patients(177 knees) which were followed up more than 2 years(from 2 years to 10 years, average 6 years and 4 months). Also, we evaluated the knee function according to the functional knee scores of Hospital for Special Surgery. 1. The average age at operation was 55.6 years(from 19 years to 75 years). Male was 12 patients and female was 104 patients. 2. There were osteoarthritis in 83 knees(46.5%), rheumatoid arthritis in 71 knees(40.0%), secondary osteoarthritis in 18 knees(10.0%), tuberculous arthritis in 3 knees (2.0%), and Charcot joint in 2 knees(1.5%). 3. The Hospital for Special Surgery functional knee and pain scores was improved from average 43 points preoperatively to average 84 points postoperatively. The results were satisfactory in 162 knees(91.4%, excellent in 64.0% and good in 27.4%). 4. Revision surgery was performed in 15 knees of the 209 knees(7.2%), due to aseptic loosening in 9 knees(4.3%) and septic loosening in 6 knees(2.9%). 5. Survival rate of total knee replacement with reliability was 87.7%, 8 years after operation for 145 patients, 209 knees. In summary, total knee replacement is a relatively satisfying and predictable procedure which can obtain the relief of pain, restoration of function, and long term survivorship.

Tumors in the Sacrum: 7 cases report / 대한정형외과학회잡지

Tumors of the sacrum are relatively uncommon. The diagnosis is difficult, especially in the early phase of the disease, because the clinical manifestations are nonspecific, the clinical signs may be vague and the radiologic changes are needed to differentiate from intestinal gas shadow. The clinical features are sacral pain, sensory change on perineum, urination difficulty, constipation, and sciatica. Seven cases of sacral tumor were treated at the Department of Orthopaedic Surgery, Kyung Hee University, from October 1981 to October 1992, and the results were as follows: 1. Because of the variability of the sacral tumor, we cannot define the most common tumor. 2. There is difficult in early diagnosis of the tumor, because the symptoms of tumor are similar to that of lumbar disc herniation and the radiologic findings are subtle. 3. CT and MRI are very effective methods to detect the tumor in the sacrum. 4. Curettage, excision, resection, sacrectomy and internal fixation were done according to the kinds of tumors and the amount of bony destruction.