Surgical Treatment for Longitudinal Epiphyseal Bracket of the Finger / 대한정형외과학회잡지

Purpose@#To describe the clinical and radiology results of a surgical treatment for clinodactyly due to a longitudinal epiphyseal bracket. @*Materials and Methods@#This study analyzed the records of 11 patients (27 case) with clinodactyly due to a longitudinal epiphyseal bracket who underwent an osteotomy or physiolysis between March 1999 and April 2017. The preoperative range of motion of the proximal and distal interphalangeal joints, the subjective satisfaction of the patient, and the degree of angulation to the ulnar side were examined. The patients were classified into two groups: osteotomy and physiolysis. The results were reviewed retrospectively and compared according to the surgical method. @*Results@#The mean age of the patients who underwent osteotomy was 10.3 years. The average preoperative angle was 25.7° and the average postoperative angle was 13.5° the mean correction rate was 47.4%. The mean age of the patients who underwent physiolysis was 6.0 years the mean preoperative angle was 24.5° and the postoperative angle was 10.7°. The average correction rate was 59.4%. No significant difference in the correction angles was observed between the group who underwent the correction osteotomy and the group who underwent the osteotomy. In each group, the postoperative correction was statistically significant. The range of motion at the last follow-up was not significantly different from the preoperative range of motion. @*Conclusion@#In patients with clinodactyly due to longitudinal epiphyseal bracket, osteotomy or physiolysis may be performed selectively according to age, bone age, and radiological progression. Both surgical methods showed good clinical results and deformity correction.

Usefulness of Percutaneous Transluminal Angioplasty before Operative Treatment in Diabetic Foot Gangrene / 대한족부족관절학회지

PURPOSE: Diabetic foot gangrene has a high morbidity rate and a great influence on the quality of life. Amputation is an appropriate treatment if conservative treatment is impossible according to the severity of gangrene and infection. The purpose of this study was to evaluate the usefulness of preoperative percutaneous transluminal angioplasty for the postoperative outcome. MATERIALS AND METHODS: From February 2013 to April 2016, among 55 patients with diabetic foot gangrene, who require surgical treatment, percutaneous transluminal angioplasty was performed on patients with an ankle brachial index (0.9 and stenosis) 50% on angiographic computed tomography. The study subjects were 49 patients, comprised of 37 males (75.5%) and 12 females (24.5%). The mean age of the patients was 70.0±9.6 years. The treatment results were followed up according to the position and length of the lesion and the changes during the follow-up period. RESULTS: As a result of angiography, there were 13 cases of atherosclerotic lesions in the proximal part, 11 cases in the distal part and 25 cases in both the proximal and distal parts. As a result of the follow-up after angiography, in 13 patients, the operation was not performed and only follow-up and dressing were performed around the wound. Sixteen patients underwent debridement for severe gangrene lesions and 20 patients, in whom the gangrene could not be treated, underwent amputation (ray amputation or metatarsal amputation, below knee amputation). CONCLUSION: Preoperative percutaneous angioplasty in diabetic foot gangrene patients with peripheral vascular occlusive disease is simple, and 59.2% of the patients with diabetic foot gangrene could be treated by conservative treatment or debridement.

Small molecules that allosterically inhibit p21-activated kinase activity by binding to the regulatory p21-binding domain

p21-activated kinases (PAKs) are key regulators of actin dynamics, cell proliferation and cell survival. Deregulation of PAK activity contributes to the pathogenesis of various human diseases, including cancer and neurological disorders. Using an ELISA-based screening protocol, we identified naphtho(hydro)quinone-based small molecules that allosterically inhibit PAK activity. These molecules interfere with the interactions between the p21-binding domain (PBD) of PAK1 and Rho GTPases by binding to the PBD. Importantly, they inhibit the activity of full-length PAKs and are selective for PAK1 and PAK3 in vitro and in living cells. These compounds may potentially be useful for determining the details of the PAK signaling pathway and may also be used as lead molecules in the development of more selective and potent PAK inhibitors.

Small molecules that allosterically inhibit p21-activated kinase activity by binding to the regulatory p21-binding domain

p21-activated kinases (PAKs) are key regulators of actin dynamics, cell proliferation and cell survival. Deregulation of PAK activity contributes to the pathogenesis of various human diseases, including cancer and neurological disorders. Using an ELISA-based screening protocol, we identified naphtho(hydro)quinone-based small molecules that allosterically inhibit PAK activity. These molecules interfere with the interactions between the p21-binding domain (PBD) of PAK1 and Rho GTPases by binding to the PBD. Importantly, they inhibit the activity of full-length PAKs and are selective for PAK1 and PAK3 in vitro and in living cells. These compounds may potentially be useful for determining the details of the PAK signaling pathway and may also be used as lead molecules in the development of more selective and potent PAK inhibitors.

Involvement of betaPIX in angiotensin II-induced migration of vascular smooth muscle cells

Angiotensin II (Ang II) stimulates migration of vascular smooth muscle cell (VSMC) in addition to its contribution to contraction and hypertrophy. It is well established that Rho GTPases regulate cellular contractility and migration by reorganizing the actin cytoskeleton. Ang II activates Rac1 GTPase, but its upstream guanine nucleotide exchange factor (GEF) remains elusive. Here, we show that Ang II-induced VSMC migration occurs in a betaPIX GEF-dependent manner. betaPIX-specific siRNA treatment significantly inhibited Ang II-induced VSMC migration. Ang II activated the catalytic activity of betaPIX towards Rac1 in dose- and time-dependent manners. Activity reached a peak at 10 min and declined close to a basal level by 30 min following stimulation. Pharmacological inhibition with specific kinase inhibitors revealed the participation of protein kinase C, Src family kinase, and phosphatidylinositol 3-kinase (PI3-K) upstream of betaPIX. Both p21-activated kinase and reactive oxygen species played key roles in cytoskeletal reorganization downstream of betaPIX-Rac1. Taken together, our results suggest that betaPIX is involved in Ang II-induced VSMC migration.

beta PAK-interacting exchange factor may regulate actin cytoskeleton through interaction with actin

p21-activated kinase (PAK)-interacting exchange factor (PIX) is known to be involved in regulation of Cdc42/Rac GTPases and PAK activity. PIX binds to the proline-rich region of PAK, and regulates biological events through activation of Cdc42/Rac GTPase. To further investigate the role of PIX we produced monoclonal antibodies (Mab) against beta PAK. Three clones; N-C6 against N-terminal half and C-A3 and C-B7 against C- terminal half of beta PAK were generated and characterized. N-C6 Mab detected beta PAK as a major band in most cell lines. C-A3 Mab recognizes GIT-binding domain (GBD), but it does not interfere with GIT binding to beta PAK. Using C-A3 Mab possible beta PAK interaction with actin in PC12 cells was examined. beta PAK Mab (C-A3) specifically precipitated actin of the PC12 cell lysates whereas actin Mab failed to immunoprecpitate beta PAK. Co-sedimentation of PC12 cell lysates with the polymerized F-actin resulted in the recovery of most of beta PAK in the cell lysates. These results suggest that beta PAK may not interact with soluble actin but with polymerized F-actin and revealed that beta PAK constitutes a functional complex with actin. These data indicate real usefulness of the beta PAK Mab in the study of beta PAK role(s) in regulation of actin cyoskeleton.

Changes in the Mechanoreceptors of the Anterior Cruciate Ligament of Patients with Degenerative Arthritis / 대한정형외과학회잡지

PURPOSE: To clarify the morphologic and quantitative changes of mechanoreceptors of the human ACL with degenerative arthritis. MATERIALS AND METHODS: Eleven fresh specimens of anterior cruciate ligament (ACL) were obtained from patients with degenerative arthritis during TKA. As a control, two fresh specimens were taken from healthy men at the time of a traumatic above knee amputation. The whole ligaments were serially frozen and sectioned at a thickness of 40 mum. After immunohistochemical staining, the mechanoreceptors were observed under a light microscope. The ratios of sections showing mechanoreceptors were calculated. Statistical analyses were performed using the chi-square test. RESULTS: In the two control specimens, nineteen mechanoreceptors were found, evenly distributed at the femoral and tibial ends. However, the average number of mechanoreceptors was 1.4 (total 15) in the arthritic ligaments (p<0.05), and these were located near the femoral side rather than the tibial end. The percentage of sections showing mechanorecptors was 8.3% in the arthritic group and 40.2% in the control group (p<0.05). All receptors were round or fusiform shaped Ruffini corpuscles; Pacinian corpuscles could not be found in either group. Nine of 15 mechanoreceptors in the arthritic groups were "necrotic" in shape. CONCLUSION: Mechanoreceptors in arthritic ACL were significantly reduced in number and mainly necrotic in shape. Our findings suggest that the numerical and morphological changes of mechanoreceptors are closely related with reduced proprioception in degenerative arthritis.

Diagnostic Usefulness of Fine Needle Aspiration Cytology on Lymphadenopathy: An analysis of 1,216 Cases / 대한세포병리학회지

Clinical lymphadenopathies are subjected to fine needle aspiration cytology(FNAC) for diagnosing not only benign lesions but also malignant ones, as the first diagnostic procedure. While the diagnostic reliability in metastatic carcinoma is high, it is difficult to differentiate malignant lymphoma from reactive conditions. We evaluated the diagnostic reliability of FNAC in lymphadenopathy, and discuss the diagnostic limitation and its place in clinical practice in this study. Over 8 years from January 1988, FNAC of 1,216 lymphadenopathies were analyzed and among them 170 cases were compared with histopathology. The results are as follows. 1. Of all the cases, 890 cases(73.2%) were diagnosed cytologically as benign, 312 cases(25.7%) as malignant, and 14 cases(1.1%) as unsatisfactory material. Reactive hyperplasia was diagnosed in 585 cases(65.7%) of the benign lesions, and among the malignant diseases, metastatic carcinoma was diagnosed in 248 cases(79.5%), and malignant lymphoma in 62 cases(19.9%). 2. The overall diagnostic accuracy was 89.2%, and no false positive case and 9 false negative results were observed among 170 cases which were proven by histopathology. Six cases of sampling error of false negative diagnoses included 3 of metastatic carcinomas and 3 of malignant lymphomas. The causes were difference between aspiration and biopsy site, poor fixation, or scanty cellularity with bloody smear. All 3 cases of misinterpretation error were malignant lymphomas, one of mixed type on biopsy which was diagnosed as reactive hyperplasia cytologically. In summary, FNAC technique is thought to be useful in the initial diagnosis of lymphadenopathies as well as in the follow-up of patients with known malignancy. Although the results of malignant lymphoma was less accurate than other malignant lesions, the application of strict cytologic criteria or lymphoid marker studies of aspiration material will reduce the false negative rate.

A Clinical study on Non-union of the Femoral Shaft Fractures in Adults / 대한정형외과학회잡지

Femoral shaft fractures are usually accompanied with extensive soft tissue injury due to high energy force and are difficult to manage for functional stress with weight bearing. According to Boyd(1965), femoral shaft is the first of non-union among the long bone shafts. And because of inadequate internal fixation, poor immobilization and infection, non-union of femoral shaft is still of interest to all the orthopaedic surgeons. During past 10 years, 19 cases of non-union of the femoral shaft were treated at dept. of Orthopaedic Surgery, Ewha Womans University hospital and following results were obtained. l. Of 19 cases, male between 20-40th age group was predominent. Prevalent type and site was mid. 1/3 comminuted fractures(p > 0.05). 2. Initial treatment was 10 cases of intramedullary nailing; 8 of plate fixation; 1 of screw fixation. Bone graft was added to 10 cases. 3. The probable causes of non-union were complex; 11 of inadequate interal fixation, 4 of poor external immobilization and 4 of infection. 4. 4 cases of infection were managed with control of infection and fixation. And 11 cases were fixed with plate and the other 4, with intramedullary nailing. All were supplemented with autogenous bone graft. 5. Postoperative immobilization was done with 15 cases of hip spica cast and 4 of long leg cast for average 9.3 weeks. 6. All were united at average 8.9 months. Limitation of motion of knee was remained in 3 cases in spite of physiotherapy. Severe osteoporosis was noted in 3 cases and leg length shortening with limping was found in 1 case.