Drought stress-induced the formation of heteromorphic leaves of Populus euphratica Oliv: evidence from gene transcriptome.

Populus euphratica Oliv., a dominant species of arid desert community, grows heteromorphic leaves at different crown positions. Whether heteromorphic leaves are a strategy of plant adaptation to drought stress is rarely reported. This study sequenced the transcriptome of three typical heteromorphic leaves (lanceolate, ovate and broad-ovate leaves) of P. euphratica, and measured their drought stress. We wanted to reveal the molecular mechanisms underlying the formation of heteromorphic leaves. Drought stress was increased significantly from lanceolate to ovate to broad-ovate leaves. Gene ontology (GO) and KEGG enrichment analysis showed that the MADs-box gene regulated the expression of peroxidase (POD) in the phenylpropane biosynthetic pathway. The up-regulated expression of the chalcone synthase (CHS) gene in broad-ovate leaves significantly activated the flavonoid biosynthetic pathway. In the process of leaf shape change, the different expressions of homeodomain leucine zipper (HD-ZIP) among the three heteromorphic leaves had potential interactions on the AUX and ABA pathways. The expression of Sucrose phosphate synthase (SPS) and sucrose synthase (SUS) increased from lanceolate to broad-ovate leaves, resulting in a consistent change in starch and sucrose content. We concluded that these resistance-related pathways are expressed in parallel with leaf formation genes, thereby inducing the formation of heteromorphic leaves. Our work provided a new insights for desert plants to adapt to drought stress.

[CLINICAL OUTCOMES OF LAPAROSCOPIC SACROCOLPOPEXY FOR PELVIC ORGAN PROLAPSE: A RETROSPECTIVE ANALYSIS OF 500 CASES FROM A SINGLE INSTITUTION].

(Objectives) Laparoscopic sacrocolpopexy (LSC) is becoming a more popular alternative for pelvic organ prolapse (POP) repair in Japan in the recent years. This study aimed to evaluate the safety and efficacy of LSC. (Patients and methods) This is a retrospective study on all the LSC cases that were performed in Urogynecology center, Kameda Medical Center, Japan from January 2013 to March 2016. Medical records of all the patients were retrieved and details on operating time, estimated blood loss, perioperative complications, anatomical recurrence (postoperative POP-Q stage≥II) rate and reoperation rate were assessed.Our procedure of LSC used two pieces of polypropylene mesh placed on the vesico-vaginal and recto-vaginal space in which the dissection was extended to the level of the bladder neck and levator ani muscle. Subtotal hysterectomy was performed in almost all patients with uterus except in 39 women who chose to preserve their uterus. Additionally, multivariate analysis of risk factors for recurrence-free survival was performed using the Cox regression method. (Results) Five hundred and five patients who were diagnosed as POP (cystocele, rectocele, enterocele, uterine prolapse, vaginal vault prolapse) were included. The mean operating time and estimated blood loss were 236 min and 27.2 ml. There were 2.6% perioperative complication rate and 1.0% severe complication rate (Clavien grade≥IIIa). With a median follow-up of 12 months, anatomical recurrence rate was 8.0%, significant anatomical recurrence (stage≥III) rate was 1.2% and reoperation rate was 1.0%. Preoperative POP-Q stage IV was found as independent risk factors for anatomical recurrence. (Conclusions) The present study demonstrated a relatively low complication rate, low significant anatomical recurrence rate and low reoperation rate. Therefore, LSC is a safe and effective surgical treatment for various types of POP.

Radiographic assessment of the knee after patellar tendon reconstruction for chronic anterior cruciate ligament deficiency.

BACKGROUND: The aim of this study was to evaluate the patellar height and degenerative changes of the knee by radiographic assessment after patellar tendon reconstruction for chronic anterior cruciate ligament deficiency. METHODS: This series included 44 patients (44 knees) with an average age of 31 years and an average follow up of 58 months. The central one third of the patellar bone-tendon-bone was used to reconstruct the anterior cruciate ligament in all patients. Radiographic assessment of the patellar height was measured using the Insall-Salvati method, and the degenerative changes of the knee using the Ahlback classification. RESULTS: After harvesting the mid-third of the patellar tendon, 28 of 44 cases (64%) showed a shortening with an average of 9.1%, whereas 12 cases (27%) showing a lengthening of the patellar tendon with an average of 9.4%. Four patients (9%) showed no change in patellar tendon length. Despite the changes in patellar tendon length, the pre- and post-operative patellar height changes were only marginally significant (p = 0.061). Patella baja was noted in eight knees (18.2%) and patella alta in four (9.1%). Of the 12 knees with patella alta or baja, knee pain was observed in one patient (8.3%). The incidence of degenerative changes was 74% in knees with anterior cruciate ligament (ACL) reconstruction plus meniscectomy, versus 41% with ACL reconstruction without meniscectomy (p = 0.031). CONCLUSION: Harvesting of the mid-third of the patellar tendon resulted in changes in the patellar tendon length, however, it only marginally affected the patellar height. Meniscectomy was associated with a higher rate of degenerative changes, however, ACL injury alone significantly contributed to the development of degenerative changes of the knee.

Clinical outcome and patient satisfaction in aseptic and septic revision total knee arthroplasty.

This study compares clinical outcome and patient satisfaction in 33 aseptic and 15 septic revision total knee arthroplasties across a 30-130-month follow-up. Aseptic revisions included only knees in which the femoral, tibial and patellar components had been exchanged, and excluded knees in which only isolated patellar components had been revised or only the tibial insert exchanged. Septic revisions included only knees in which there had been successful revision for chronic infection without recurrence of infection for at least 2 years from the index revision. The evaluation included pain scores, knee scores, functional scores, SF-12 functional surveys and radiographs of the knee. The results for the aseptic group were excellent in 26 (78.8%), good in 3 (9.0%), fair in 2 (6.1%) and poor in 2 (6.1%); those for the septic group were excellent in 5 (33.3%), good in 7 (46.7%), fair in 2 (13.3%) and poor in 1 (6.7%). The overall results of septic revision were less satisfactory than for aseptic revision. Aseptic revisions achieved significantly better knee scores and ranges of motion than septic revisions, but their pain and functional scores were similar. Despite the difference in knee scores, 85% of the patients from both groups were equally satisfied with the results of treatment. There was no discernible radiographic difference between the two groups, including radiolucency.

Outcome of arthroscopic single bundle reconstruction for complete posterior cruciate ligament tear.

PURPOSE: To evaluate the clinical outcome and correlate the results and degenerative change of the affected knees with the duration of injury, ligament laxity and follow-up time in 30 patients with 31 knees undergoing arthroscopic single bundle reconstruction for complete posterior cruciate ligament (PCL) tear with 2-9-year follow-up. MATERIALS AND METHODS: This series included 22 men and 8 women with an average age of 32 years. High-energy trauma accounts for 93.5% of PCL injury, while only 6.5% are sports related. Arthroscopic single bundle PCL reconstruction was performed in all knees. The average follow-up time was 40 (range: 24-108) months. The methods of evaluation included functional assessment, ligament laxity and radiograph of the knee. RESULTS: The overall clinical results showed 77.4% satisfactory (61.3% excellent and 16.1% good) and 22.6% unsatisfactory (16.1% fair and 6.5% poor). Complete restoration of ligament stability was noted in 52% of the knees with one third showing mild (0-5 mm) and 9.7% moderate (5-10 mm) ligament laxity. The incidence of radiographic degenerative changes was 52% (16/31), and it correlated with the duration of injury, severity of ligament laxity and length of follow-up time. CONCLUSION: Arthroscopic single bundle reconstruction produced 77.4% satisfactory clinical results in medium term follow-up. Despite good clinical results, complete restoration of ligament stability was achieved in only 52% of the knees. The incidence of degenerative changes of the affected knees was 52% that correlated with the duration of injury, ligament laxity and follow-up time.

Reducing the "killer turn" in posterior cruciate ligament reconstruction.

PURPOSE: Graft abrasion caused by sharp graft angulation at the graft-tunnel margin of the proximal tibia (the "killer turn") may cause graft failure after posterior cruciate ligament (PCL) reconstruction using the traditional anteromedial route tibial tunnel. One method to reduce the graft angulation is to use the anterolateral route tibial tunnel. However, less acute graft angulation may increase joint translation because of a decrease in graft compressive force. The purpose of this study was to compare the graft angulation and joint translation between anteromedial and anterolateral route tibial tunnels. TYPE OF STUDY: Biomechanical study. METHODS: Twelve above-the-knee amputation specimens were used in this study. Anteromedial and anterolateral tibial tunnels were made at the desired locations, and the same femoral tunnel was used. Graft angulation was measured by inserting a malleable pin into the tibial and femoral tunnels. Measurements of graft angulation were performed with the knee in extension and in 90 degrees of flexion. The joint translation was measured by the posterior translation of the tibia on the femur at 90 degrees of flexion with a 15-lb posterior force applied to the anterior proximal tibia after PCL reconstruction through the respective tunnels. RESULTS: The difference in graft angulation between anterolateral and anteromedial route tibial tunnels was statistically significant (P <.001); however, the difference in joint translation showed no statistical significance between the 2 tunnel routes. CONCLUSIONS: The anterolateral route tibial tunnel significantly reduced the sharp graft angulation ("killer turn") at the graft tunnel margin of the proximal tibia, but it did not increase the joint translation as compared with the traditional anteromedial route tibial tunnel. The anterolateral route tibial tunnel is thought to be a better choice when arthroscopic PCL reconstruction is performed with the tunnel technique.

Polyethylene-induced pes anserinus bursitis mimicking an infected total knee arthroplasty: a case report and review of the literature.

Polyethylene-induced pes anserinus bursitis after total knee arthroplasty (TKA) with the clinical manifestations mimicking an infected TKA is a very rare occurrence. We report such a case in a 74-year-old woman. She developed recurrent draining papules on the anterolateral aspect of the knee because of polyethylene-induced chronic pes anserinus bursitis 8 years after TKA. The diagnosis was established with a sinography study and confirmed by histopathologic examination of the surgical specimen. The symptoms were resolved after surgical excision of the lesion. Pes anserinus bursitis should be included in the differential diagnosis in knees with a draining sinus after TKA, and sinogram is considered the best method to establish the diagnosis.

Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee.

PURPOSE: To evaluate the clinical outcome and the incidence of degenerative changes in 25 patients with 25 knees undergoing surgical reconstruction for combined posterior cruciate ligament (PCL) and posterolateral instabilities of the knee with 2-5-year follow-up. MATERIALS AND METHODS: This series included 16 men and 9 women with an average age of 28 years. The average time from injury to surgery was 10 (range 2-24) months, and the average follow-up time was 40 (range 32-60) months. The mechanisms of injury were 88% due to trauma, and 12% sports related. Arthroscopic single bundle posterior cruciate reconstruction and reconstruction of the posterolateral structures were performed in all cases. Clinical evaluations included functional assessment, ligament laxity and radiograph of the knee. The results were correlated with the duration of injury, the severity of ligament laxity and the follow-up time. RESULTS: The overall results were 68% satisfactory (28% excellent and 40% good) and 32% unsatisfactory (20% fair and 12% poor). Despite functional improvement, complete restoration of ligament stability was observed in only 44% of the knees, while 36% of the knees showed mild (<5 mm), and 20% moderate (5-10 mm) ligament laxity. There was no correlation of the clinical outcome with the duration from injury to surgery. The incidence of degenerative changes of the affected knee was 44%, and the rate correlated with the severity of ligament laxity, the duration from injury to surgery and the length of follow-up time. CONCLUSION: Despite the functional improvement, the currently devised surgical techniques only have modest success in restoration of ligament stability in knees with combined PCL and posterolateral instabilities. Further improvement in surgical technique including a dynamic reconstruction of the popliteus tendon complex seems necessary. The rate of degenerative changes of the affected knee appeared proportional to the duration of injury, the severity of ligament laxity and the length of follow-up time. The results of this study led us to recommend early surgical reconstruction for knees with combined posterior cruciate and posterolateral instabilities.

The often poor clinical outcome of infected total knee arthroplasty.

The clinical outcomes of various options of treatment in 26 infected total knee arthroplasties (TKAs) with successful eradication and no recurrence of infection for at least 2 years were compared. There were 20 women and 6 men with an average age of 67.7 years. The average follow-up time was 48 months (range, 24-83 months). The evaluation parameters included pain score, knee score, functional score, and radiograph of the knee. The TKAs with acute infection showed significantly better outcome and clinical results when compared with noninfected TKAs. The clinical outcome of chronic infection was less favorable. Arthrodesis achieved better pain relief, whereas reimplantation TKA showed better function. No significant difference in knee scores was observed, however, between reimplantation TKA and arthrodesis. Approximately 50% of reimplantation TKAs had mild-to-moderate knee pain.

Effects of knee position, graft tension, and mode of fixation in posterior cruciate ligament reconstruction: a cadaveric knee study.

PURPOSE: Many knees exhibit residual ligament laxity after posterior cruciate ligament (PCL) reconstruction, which is believed to be technique related. The purpose of this study was to investigate the optimal graft tension, the best angle of knee flexion, and the mode of fixation in PCL reconstruction. TYPE OF STUDY: Anatomic biomechanical study. METHODS: A testing apparatus with frictionless bearing that allows other degrees of freedom except for flexion and extension of the knee joint was designed. The normal PCL tension at different angles of knee flexion was measured with a force transducer, and the optimal tension of the PCL graft that allows full range of knee motion was studied with a tensiometer in 12 cadaver knees. The modes of fixation failure between interference screw fixation and post fixation were studied with an Instron (Canton, MA) machine in 8 cadaver knees. RESULTS: The lowest PCL tension in normal knees was noted at 20 degrees to 30 degrees of knee flexion and the highest at 90 degrees. The optimal tension of PCL graft, which allows full range of knee motion, was 15 lb (68 N). The average load of graft failure was 417 (179-730) N with interference screw fixation and 367 (149-701) N with post fixation when the patellar bone-tendon-bone graft was tested. There was no statistical difference in the failure load between interference screw fixation and post fixation (P =.753); however, the modes of failure differ. The sites of failure for interference screw fixation were 25% caused by rupture of ligament substance and 75% bone plug pullout; those of post fixation were 25% caused by rupture of ligament substance, 37.5% caused by fracture, and 37.5% as a result of suture breakage. CONCLUSIONS: The results of this study suggested that a 15-lb tension to the graft at 20 degrees to 30 degrees of knee flexion is optimal in PCL reconstruction. There was no statistical difference in the failure load between interference fixation and post fixation despite different modes of fixation failure.

Shockwave therapy for patients with plantar fasciitis: a one-year follow-up study.

The effect of shockwave therapy was investigated in 79 patients (85 heels) with plantar fasciitis with one-year follow-up. There were 59 women and 20 men with an average age of 47 (range, 15-75) years. Each patient was treated with 1000 impulses of shockwave at 14 kV to the affected heel. A 100-point scoring system was used for evaluation including 70 points for pain and 30 points for function. The intensity of pain was based on a visual analogue scale from 0 to 10. The overall results were 75.3% complaint-free, 18.8% significantly better, 5.9% slightly better and none unchanged or worse. The effect of shockwave therapy seemed cumulative and was time-dependent. The recurrence rate was 5%. There were no device-related problems, systemic or local complications. Shockwave therapy is a safe and effective modality in the treatment of patients with plantar fasciitis.