The incidence of deep vein thrombosis after anterior cruciate ligament reconstruction: An analysis using routine ultrasonography of 260 patients.

BACKGROUND: Recent studies regarding deep vein thrombosis (DVT) after anterior cruciate ligament (ACL) reconstruction investigated only symptomatic complications. The purpose of this study was to assess the true incidence of DVT after ACL reconstruction, regardless of symptom manifestation. MATERIALS AND METHODS: Medical records of 260 patients who underwent isolated ACL reconstruction between January 2014 and December 2019 were retrospectively reviewed. Regardless of symptom manifestation, DVT was examined for all patients at 1 week postoperatively using ultrasonography. Demographics, injury mechanism (high energy direct injury and low energy indirect injury), soft tissue injury, preoperative anterior laxity, tourniquet time, and surgical technique (transtibial, anteromedial portal, and outside-in techniques) were investigated. Soft tissue injury was evaluated on magnetic resonance imaging (MRI) scans, based on the Tscherne classification. Risk factors for proximal DVT were identified using logistic regression analyses. RESULTS: A total of 21 (8.1%) patients showed DVT. 5 (1.9%) patients had thrombosis at the popliteal vein; however, none of them exhibited symptoms. The other 16 patients had thrombosis at the distal veins: 1 patient at the anterior tibial vein, 5 patients at the posterior tibial vein, 3 patients at the peroneal vein, 6 patients at the soleal vein, and 1 patient at the muscular branch vein. The risk factors for proximal DVT included high energy direct injury (p = 0.013, odds ratio = 10.62) and grade 2 soft tissue injury (p = 0.039, odds ratio = 6.78). CONCLUSIONS: The true incidence of DVT, including symptomatic and asymptomatic complications, were 8.1% after ACL reconstruction. This rate is higher than the previously known incidence which has been investigated only for symptomatic patients. Injury mechanism and soft tissue injury should be assessed when considering thromboprophylaxis.

Topical Tranexamic Acid Can Be Used Safely Even in High Risk Patients: Deep Vein Thrombosis Examination Using Routine Ultrasonography of 510 Patients.

Background and Objectives: Previous studies regarding tranexamic acid (TXA) in total knee arthroplasty (TKA) investigated only symptomatic deep vein thrombosis (DVT), or did not include high risk patients. The incidence of DVT including both symptomatic and asymptomatic complications after applying topical TXA has not been evaluated using ultrasonography. Materials and Methods: The medical records of 510 patients who underwent primary unilateral TKA between July 2014 and December 2017 were retrospectively reviewed. Because TXA was routinely applied through the topical route, those who had a history of venous thromboembolism, myocardial infarction, or cerebral vascular occlusive disease, were not excluded. Regardless of symptom manifestation, DVT was examined at 1 week postoperatively for all patients using ultrasonography, and the postoperative transfusion rate was investigated. The study population was divided according to the use of topical TXA. After the two groups were matched based on the propensity scores, the incidence of DVT and the transfusion rate were compared between the groups. Results: Of the 510 patients, comprising 298 patients in the TXA group and 212 patients in the control group, DVT was noted in 22 (4.3%) patients. Two patients had DVT proximal to the popliteal vein. After propensity score matching (PSM), 168 patients were allocated to each group. In all, 11 patients in the TXA group and seven patients in the control group were diagnosed with DVT, which did not show a significant difference (p = 0.721). However, the two groups differ significantly in the transfusion rate (p < 0.001, 50.0% in the TXA group, 91.7% in the control group). Conclusions: The incidence of DVT, whether symptomatic or asymptomatic, was not affected by the use of topical TXA. The postoperative transfusion rate was reduced in the TXA group. Topical TXA could be applied safely even in patients who had been known to be at high risk.

Subluxation of the extensor carpi ulnaris on magnetic resonance imaging on neutral wrist position: correlation with tenosynovitis of the extensor carpi ulnaris and translation of the distal radioulnar joint.

OBJECTIVE: To identify the subluxation degrees of extensor carpi ulnaris (ECU) tendon on neutral wrist MRI in patients with ulnar-sided wrist pain and to evaluate the relationships of ECU subluxation with accompanying imaging findings such as ECU tenosynovitis, distal radioulnar joint (DRUJ) stability, and triangular fibrocartilage complex (TFCC) pathology. MATERIALS AND METHODS: A total of 297 MRIs of 292 patients having ulnar side pain were reviewed retrospectively. Degrees of ECU subluxation was classified into four grades: grade 0, no subluxation; grade 1, tendon displacement < 50% of the tendon width; grade 2, tendon displacement 51 to 99% of the tendon width; and grade 3, tendon displacement of 100% of the tendon width. ECU tenosynovitis, ECU tendinosis, injuries of triangular fibrocartilage and distal radioulnar ligaments (DRUL), translation ratio of the DRUJ, rotation angle of the DRUJ, and the width, depth, and length of the ulnar groove were assessed on wrist MRI. The relationships between degree of ECU subluxation and these imaging findings were investigated. RESULTS: Women had higher subluxation degrees of the ECU tendon (p = 0.001). Tenosynovitis of the ECU, sprain of the dorsal DRUL, dorsovolar translation ratio and rotation angle of the DRUJ, and depth and length of the ulnar groove were statistically significantly related to the subluxation degree of the ECU tendon (p = 0.000). CONCLUSION: High-grade subluxation of the ECU tendon was strongly correlated with ECU tenosynovitis and DRUJ translation. Clinicians and radiologists should scrutinize imaging findings, particularly when patients with ulnar-sided wrist pain have high-grade subluxation of the ECU tendon.

Early postoperative magnetic resonance imaging findings after arthroscopic rotator cuff repair: T2 hyperintensity of the capsule can predict reduced shoulder motion.

INTRODUCTION: The purpose of this study was to investigate whether postoperative shoulder magnetic resonance imaging (MRI) findings correlate with postoperative shoulder range of motion (ROM) at about 4 months after arthroscopic rotator cuff repair (ARCR). MATERIALS AND METHODS: Signal-intensity changes of the capsule, pericapsular soft tissue at the axillary recess, and subcoracoid fat triangle, as well as the thickness of the capsule at the axillary recess and coracohumeral ligament were assessed on preoperative and postoperative MR images of 232 patients. The ROM was evaluated preoperatively and at about 4 months after ARCR. RESULTS: T2 hyperintensity of the capsule, pericapsular soft tissue at the axillary recess, and signal change of the subcoracoid fat triangle were detected in 155, 107, and 89 cases, respectively, on postoperative MRI. Among these cases, 129, 98, and 69 cases, respectively, showed newly developed signal changes. The mean thicknesses of the capsule and coracohumeral ligament were 1.89 ± 0.69 and 1.64 ± 0.51 mm, respectively, on preoperative MRI and 3.74 ± 1.12 and 2.42 ± 0.56 mm, respectively, on postoperative MRI. At the 4-month follow-up, the mean external rotation (ER), internal rotation (IR), abduction, forward flexion, and extension were 77, 73, 76, 83, and 82%, respectively, of the contralateral side. Newly developed T2 hyperintensity of the capsule and pericapsular soft tissue at the axillary recess on postoperative MRI significantly correlated with the postoperative limitation of ER (p = 0.039) and IR (p = 0.020). CONCLUSIONS: Newly developed signal changes of the capsule, pericapsular soft tissue at the axillary recess, and subcoracoid fat triangle were often detected on postoperative MRI at 4 months after ARCR. Furthermore, newly developed T2 hyperintensity of the capsule and pericapsular soft tissue at the axillary recess correlated with limited ROM in ER and IR at 4 months after ARCR.

Invagination of intra-abdominal structures in the lumbar intervertebral disc space.

Invagination of peritoneal or retroperitoneal structures into the intervertebral disc space of the lumbar spine is extremely rare. In this article the imaging features and clinical findings are demonstrated in four patients with intervertebral invagination of intra-abdominal structures. Plain radiographs, CT scans, and MR images showed disruption of the anterior ligamentous complex (ALC) and invagination of various structures into the disc space, including the vena cava, iliac vessels, intestine, the torn redundant anterior longitudinal ligament, retroperitoneal fat, and the psoas muscle. The invaginations occurred at the level of L3-L4 and L4-L5 in one case each and at L5-S1 in two cases. Follow-up imaging in three cases (1, 5, and 8 years respectively) showed the progression of the invagination. These cases demonstrate that a close evaluation of this condition is necessary, particularly for older patients who show disruption or laxity of the ALC, degenerative spondylosis with chronic segmental instability, and osteoporosis of the lower lumbar spine.

Isolate Dependency of Brassica rapa Resistance QTLs to Botrytis cinerea.

Generalist necrotrophic pathogens including Botrytis cinerea cause significant yield and financial losses on Brassica crops. However, there is little knowledge about the mechanisms underlying the complex interactions encoded by both host and pathogen genomes in this interaction. This potentially includes multiple layers of plant defense and pathogen virulence mechanisms that could complicate in breeding broad spectrum resistance within Brassica species. Glucosinolates (GSLs) are a diverse group of defense metabolites that play a key role in interaction between Brassica and biotic attackers. In this study, we utilized a collection of diverse B. cinerea isolates to investigate resistance within the Brassica rapa R500 × IMB211 recombinant inbred line population. We tested variation on lesion development and glucosinolate accumulation in parental lines and all population lines. We then mapped quantitative trait loci (QTL) for both resistances to B. cinerea and defense metabolites in this population. Phenotypic analysis and QTL mapping demonstrate that the genetic basis of resistance to B. cinerea in B. rapa is isolate specific and polygenic with transgressive segregation that both parents contribute resistance alleles. QTLs controlling defensive GSLs are highly dependent on pathogen infection. An overlap of two QTLs identified between resistance to B. cinerea and defense metabolites also showed isolate specific effects. This work suggests that directly searching for resistance loci may not be the best approach at improving resistance in B. rapa to necrotrophic pathogen.

Diagnostic and Prognostic Implications of Spine Magnetic Resonance Imaging at Diagnosis in Patients with Multiple Myeloma.

PURPOSE: The aim of this study is to determine the diagnostic and prognostic role of baseline spinal magnetic resonance imaging (MRI) in patients with multiple myeloma. MATERIALS AND METHODS: We enrolled patients newly diagnosed with multiple myeloma from 2004-2011 at a single center. Abnormal MRI findings that were not detected in radiographs have been analyzed and categorized as malignant compression fractures or extramedullary plasmacytoma. The bone marrow (BM) infiltration patterns on MRI have been classified into five categories. RESULTS: A total of 113 patients with a median age of 65 years (range, 40 to 89 years) were enrolled in the study. Malignant compression fractures not detected in the bone survey were found in 26 patients (23.0%), including three patients (2.6%) with no related symptoms or signs. Extramedullary plasmacytoma was detected in 22 patients (19.5%), including 15 (13.3%) with epidural extension of the tumor. Of these 22 patients, 11 (50.0%) had no relevant symptoms or signs. The presence of malignant compression fractures did not influence overall survival; whereas non-epidural extramedullary plasmacytoma was associated with poor overall survival in the multivariate analysis (hazard ratio, 3.205; 95% confidence interval [CI], 1.430 to 9.845; p=0.042). During the follow-up for a median of 21 months (range, 1 to 91 months), overall survival with the mixed BM infiltrative pattern (median, 24.0 months; 95% CI, 22.9 to 25.1 months) was shorter than those with other patterns (median 56 months; 95% CI, 48.9 to 63.1 months; p=0.030). CONCLUSION: These results indicate that spine MRI at the time of diagnosis is useful for detecting skeletal lesions and predicting the prognosis in patients with multiple myeloma.

Chinese yam extracts containing ß-sitosterol and ethyl linoleate protect against atherosclerosis in apolipoprotein E-deficient mice and inhibit muscular expression of VCAM-1 in vitro.

Atherosclerosis is a chronic inflammatory disease, which is associated with increased expression of adhesion molecules and monocyte recruitment into the arterial wall. This study evaluated whether hexane extracts from the edible part (DB-H1) or bark region (DB-H2) of Dioscorea. batatas Decne have anti-atherosclerotic properties in vivo and in vitro experiments. We also identified bioactive components in the hexane extracts. Thirty-six apolipoprotein E (ApoE(-/-) ) mice and 12 control (C57BL/6J) mice were given a Western-type diet for 11 or 21 wk. To examine the effects of yam extracts on lesion development, ApoE(-/-) mice were orally administered DB-H1 or DB-H2 for the duration of the study (200 mg/kg b.w./day, 3 times per wk). Both DB-H1 and DB-H2 significantly reduced the total atherosclerotic lesion area in the aortic root. In addition, plasma concentrations of total cholesterol, oxidized-low-density lipoprotein, and c-reactive protein were decreased by administration of DB-H1 and DB-H2. Consistent with the in vivo observations, DB-H1 and DB-H2 inhibited tumor necrosis factor (TNF)-α-induced vascular cell adhesion molecule-1 expression and adhesion of THP-1 monocytes to TNF-α-activated vascular smooth muscle cells. It was also found that treatment with DB-H1 or DB-H2 resulted in the inhibition nitric oxide (NO) and reactive oxygen species production and iNOS expression in macrophages. Thus, DB-H1 and DB-H2 seem to influence atherosclerosis by affecting the production of inflammatory mediators in vivo. Our results suggest that yam extracts have the potential to be used in the prevention of atherosclerosis.

Suppression of adhesion molecule expression by phenanthrene-containing extract of bulbils of Chinese Yam in vascular smooth muscle cells through inhibition of MAPK, Akt and NF-κB.

Atherosclerosis is a chronic inflammatory disease associated with increased expression of adhesion molecules in vascular smooth muscle cells (VSMCs). The objective of this study was to examine the in vitro effects of extract from aerial Bulbil of Dioscorea batatas Decne (Db-Ex) on the ability to suppress the expression of adhesion molecules induced by TNF-α. We also identified bioactive components from a methanol extract. VSMCs pre-exposed to Db-Ex (10-100 µg/ml) were stimulated with TNF-α (10 ng/ml). Preincubation of VSMCs for 2 h with Db-Ex dose-dependently inhibited TNF-α-induced adhesion of THP-1 monocytic cells and mRNA and protein expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1). Db-Ex treatment decreased ROS production and the amount of phosphorylated form of p38, ERK, JNK and Akt in TNF-α-stimulated cells, suggesting that Db-Ex inhibits adhesion molecule expression possibly through MAPK and Akt regulation. Db-Ex also suppressed TNF-α-activation NK-κB. This effect was mediated through degradation of IκBα and nuclear translocation of the p65 subunit of NF-κB. These results suggest that Db-Ex inhibits monocyte adhesion and the TNF-α-mediated induction of adhesion molecules in VSMC by downregulating the MAPK/Akt/NF-κB signaling pathway, which may explain the ability of Db-Ex to suppress inflammation within the atherosclerotic lesion.

Safety and diagnostic image quality of iopromide: results of a large non-interventional observational study of European and Asian patients (IMAGE).

BACKGROUND: Iodine-based contrast agents such as iopromide play a central role in improving the diagnostic quality of imaging modalities using ionizing radiation. PURPOSE: To investigate the safety and diagnostic image quality of iopromide in the routine clinical setting. MATERIAL AND METHODS: This was an international, multicenter, prospective, single-arm, non-interventional study (NIS). The study was performed in out- and inpatients in 738 study centers in 21 countries in Europe and Asia. Iopromide was administered in a routine manner, in compliance with the local package insert. The use of premedication was at the discretion of the attending physician. Case report forms for 44,835 patients were analyzed (57.4% men). The median age of the patients was 55 years. RESULTS: For the vast majority of patients (94.8%), the contrast quality was rated as 'good' (55.8%) or 'excellent' (39.0%). For 1265 (2.8%) patients, there were reports of adverse drug reactions (ADRs) excluding tolerance indicators (TIs) (i.e. injection site warmth, feeling hot, or injection site pain of mild intensity). At least one ADR including TIs was reported in 2415 (5.4%) patients. There were 11 (0.02%) patients with serious ADRs, and no drug-related deaths. Events of injection site warmth and/or feeling hot were reported by 3.5%, nausea and/or vomiting by 0.96%, and urticaria, erythema, and/or rash by 0.54% of patients. Patients at risk for an acute idiosyncratic reaction (i.e. patients with a history of bronchial asthma, allergies, and/or contrast media reaction) had a higher incidence of ADRs compared with the overall study population. At-risk patients who did not receive premedication reported distinctly more ADRs compared with those who received premedication (12.0% versus 5.9%). CONCLUSION: Iopromide was shown to be a well-tolerated contrast agent whose usage resulted in high image quality. No unknown ADRs were observed. Premedication with antiallergy drugs should be considered in at-risk patients.

Diosgenin stimulates osteogenic activity by increasing bone matrix protein synthesis and bone-specific transcription factor Runx2 in osteoblastic MC3T3-E1 cells.

Diosgenin, a steroid saponin extracted from the root of wild yam (Dioscorea villossa) is claimed to have osteogenic property. However, detailed studies providing evidence to this claim have not been fully undertaken. In this study, we investigated the effect of diosgenin on the osteogenesis of murine MC3T3-E1 osteoblastic cells. Cells were cultured with varying levels of diosgenin (0-10 µM) within 25 days of bone formation period. Diosgenin was found to stimulate proliferation within the range of 0.01-5 µM using MTT assay. The medium and cellular levels of Type 1 collagen and alkaline phosphatase (ALP), both of which are major bone matrix proteins, increased within the low range of diosgenin concentration (>0-3 µM), and this pattern was further confirmed by collagen and ALP staining of the extracellular matrix (ECM). The cellular protein expression of ALP and collagen Type 1 was also increased at 0.1-1 µM diosgenin treatment as analyzed by Western blot. Calcium deposition within the ECM also showed the same pattern as assessed by Alizarin Red S and Von Kossa staining. Bone-specific transcription factor runt-related transcription factor 2 (Runx2) and Runx2-regulated osteopontin protein expressions were induced at low concentration (0.1-1 µM) and again decreased with high diosgenin concentrations. Based on our findings, our study suggests that diosgenin can enhance bone formation by stimulating the synthesis and secretion of Type 1 collagen and ALP and bone marker proteins Runx2 and osteopontin expression. The increased levels of these marker proteins, in turn, can increase the formation of calcium deposits within the ECM thereby increasing bone formation.

Serial MR imaging of intramuscular hematoma: experimental study in a rat model with the pathologic correlation.

OBJECTIVE: We wanted to demonstrate the temporal changes of the magnetic resonance imaging (MRI) findings in experimentally-induced intramuscular hematomas in rats and to correlate these data with the concurrent pathologic observations. MATERIALS AND METHODS: Intramuscular hematoma was induced in 30 rats. The MR images were obtained at 1, 4, 7 and 10 days and at 2, 3, 4, 6 and 8 weeks after muscle injury. The characteristic serial MRI findings were evaluated and the relative signal intensities were calculated. Pathologic specimens were obtained at each time point. RESULTS: On the T1-weighted imaging (T1WI), the intramuscular hematomas exhibited isointensity compared to that of muscle or the development of a high signal intensity (SI) rim on day one after injury. The high SI persisted until eight weeks after injury. On the T2-weighted imaging (T2WI), the hematomas showed high SI or centrally low SI on day one after injury, and mainly high SI after four days. A dark signal rim was apparent after seven days, which was indicative of hemosiderin on the pathology. The gradient echo (GRE) imaging yielded dark signal intensities at all stages. CONCLUSION: Unlike brain hematomas, experimentally-induced intramuscular hematomas show increased SI on both the T1WI and T2WI from the acute stage onward, and this is pathologically correlated with a rich blood supply and rapid healing response to injury in the muscle. On the T2WI and GRE imaging, high SI with a peripheral dark signal rim is apparent from seven days to the chronic stage.

Antioxidant activity in essential oils of Cnidium officinale makino and Ligusticum chuanxiong Hort and their inhibitory effects on DNA damage and apoptosis induced by ultraviolet B in mammalian cell.

BACKGROUND: Owing to their high volatile aroma, the dried rhizomes of Cnidium officinale (C. officinale) and Ligusticum chuanxiong (L. chuanxiong) are used as herbal drugs to treat blood pressure depressant, a deficiency disease of antivitamin, inhibition of small intestine sympathetic nerve and as cosmetics for skin care. However, little has been known about the protective effect of their essential oils against ultraviolet B (UVB)-induced DNA damage. METHODS: In this study, we report antioxidant activity of their essential oils using DPPH and ABTS scavenging assay. In addition, the composition of essential oils was measured by GC/MS. We also investigated whether these essential oils could inhibit UVB-induced DNA damage and apoptosis in the mammalian cell using intracellular DNA migration and expression level of phospho-H2A.X. RESULTS: Twenty constituents in the essential oil were identified and they showed good antioxidant properties, in that IC(50) value in DPPH and ABTS showed 6.79 and 7.33microg/ml and 1.58 and 1.58microg/ml in C. officinale and L. chuanxiong. Their treatment inhibited the migration of damaged DNA induced by UV-B; furthermore, they decreased p21 expression and increased cyclin D1 expression as apoptosis-regulatory genes. CONCLUSIONS: These results suggest that essential oils in C. officinale and L. chuanxiong may exert inhibitory effects on DNA damage and apoptosis induced by UVB through their high free radical scavenging ability.

Perineural air injection as a means of prevention of thermal injury of the sciatic nerve during radio frequency ablation: a preliminary experimental study in rabbits.

OBJECTIVE: The purpose of this study was to determine whether perineural air injection before radio frequency (RF) ablation of thigh muscles can minimize thermal injury to the sciatic nerve. METHODS: Eighteen percutaneous RF ablation procedures were performed in the thighs of 9 rabbits (control, n = 9, right thigh; experimental, n = 9, left thigh) with an internally cooled electrode (1-cm active tip). In the control group, the tip of the electrode was located in posterior muscles 5 mm away from the sciatic nerve before ablation. In the experimental group, sonographically guided air injection into the perineural space was performed just before ablation. Animals were killed 7 days after ablation, and the presence or absence of pathologic changes of the sciatic nerves (axonal necrosis, myelin digestion, endoneurial fibrosis, perineurial fibrosis, and dystrophic calcification) in both groups were compared under an optical microscope. RESULTS: Perineural air injection was achieved successfully with a single puncture in all rabbits in the experimental group. All of the pathologic findings were observed much more frequently in the control group, and the differences in the frequencies of axonal necrosis and myelin digestion of the sciatic nerve between the groups were clinically significant (P < .05). CONCLUSIONS: Perineural air injection may be useful for reducing the frequency of thermal injury during RF ablation of lesions adjacent to nerves.

Marginal zinc deficiency in rats decreases leptin expression independently of food intake and corticotrophin-releasing hormone in relation to food intake.

Zn deficiency reduces food intake and growth rate in rodents. To determine the relationship between Zn deficiency and the regulation of food intake, we evaluated leptin gene expression in epididymal white adipose tissue (eWAT), and hypothalamic corticotropin-releasing hormone (hCRH) and hypothalamic neuropeptide Y (hNPY) of rats Zn-deficient only to show reduced food intake and growth rate but not food intake cycling. Growing male Sprague-Dawley rats (240 g) were randomly assigned to one of four dietary groups: Zn-adequate (ZA; 30 mg/kg diet), Zn-deficient (ZD; 3 mg/kg diet), pair-fed with ZD (PF; 30 mg/kg diet) and Zn-sufficient (ZS; 50 mg/kg diet) (n 8), and were fed for 3 weeks. Food intake and body weight were measured, as were blood mononuclear cells and pancreas Zn levels. eWAT leptin, hCRH and hNPY mRNA levels were determined. Food intake was decreased by about 10 % in ZD and PF rats compared to ZA and ZS rats. Growth and eWAT leptin mRNA levels were unaffected in PF rats but were significantly (P < 0.05) decreased in ZD rats. However, hNPY showed a tendency to increase, and hCRH significantly (P < 0.05) decreased, in both ZD and PF rats. These results suggest that while leptin gene expression may be directly affected by Zn, hNPY and hCRH are likely responding to reduced food intake caused by Zn deficiency.

Inferolateral parapatellar synovial fold causing patellofemoral impingement in both knee joints.

Impingement syndrome developing on the lateral side of the patellofemoral joint (PFJ) resulting from soft tissues is extremely rare, and impingement syndrome resulting from an intra-articular synovial fold located in the inferolateral, parapatellar area has never been reported. We experienced a case in which a thickened, intra-articular synovial fold, which showed fibrous change and was located in the inferolateral parapatellar area in both knee joints, impinged on the PFJ, producing clinical symptoms. On physical examination, there was tenderness and a positive mediopatellar plica (MPP) test, which is a test of impingement, with no palpable cord-like painful thickening in the inferolateral parapatellar area of either knee joint. Magnetic resonance imaging showed entrapment of the intra-articular soft tissue in the PFJ in the inferolateral parapatellar area of both knee joints. On arthroscopy, thickened, whitish synovial tissue located in the inferolateral parapatellar area with fibrous change, which was well demarcated with an anterior fat pad, was seen causing impingement of the PFJ during knee extension. Histologically, there was no fatty tissue, just thick, fibrous tissue lined by synovial membrane. After its complete removal, the patient became asymptomatic.

Partially ruptured posterior cruciate ligament causing medial tibiofemoral joint impingement.

Impingement syndrome resulting from a partially torn posterior cruciate ligament (PCL) stump has not been reported in the English-language literature. We present 2 cases of impingement caused by the torn stump of a partially ruptured PCL. Both patients suffered from severe knee joint pain during knee flexion over 70 degrees to 90 degrees and medial joint-line tenderness after the injury. Magnetic resonance imaging (MRI) showed the partial rupture of the PCL, mainly in the posteromedial (PM) bundle. In both cases, arthroscopic examination revealed that the rupture of the PCL involved the femoral side of the PM bundle, and the torn stump of the PCL was entrapped in the medial tibiofemoral joint (TFJ). The torn stump was removed completely, and the symptoms improved significantly. Partial ruptures of the PCL occur frequently, and it is anticipated that many patients may suffer from pain arising from impingement of a partially torn PCL entrapped in the medial TFJ. Therefore, studies on this subject should continue.

Influence of femoroacetabular impingement on results of hip arthroscopy in patients with early osteoarthritis.

To ascertain whether better results could be obtained using hip arthroscopy, we retrospectively reviewed the radiographic and clinical aspects of anterior femoroacetabular impingement in 43 patients diagnosed with early osteoarthritis with acetabular labral tears who previously had arthroscopic treatment. The average followup was 50 months. The patients were divided into two groups: patients who had no osteoarthritis seen on simple radiographs, but had degenerative changes of the labrum and cartilage seen on magnetic resonance arthrograms and arthroscopy, and patients who had osteoarthritic findings seen on simple radiographs. Both groups were examined retrospectively for signs of anterior femoroacetabular impingement at the acetabulum and proximal femur. Postoperative improvement was evaluated using the Japanese Orthopaedic Association pain score. Six of 21 patients in Group I and 12 of 22 of patients in Group II showed radiographic evidence of femoroacetabular impingement. The score improved from 0.76 preoperatively to 2.38 postoperatively in Group I and from 0.75 preoperatively to 1.90 postoperatively in Group II. Arthroscopic débridement produced improved results seen during short-term and midterm followups. However, in patients with femoroacetabular impingement the results were considered inadequate. We found that arthroscopic treatment of osteoarthritis of the hip fails if there is detectable femoroacetabular impingement.

Prefemoral fat pad: impingement and a mass-like protrusion on the lateral femoral condyle causing mechanical symptoms. A case report.

We describe a case of prefemoral fat pad impingement between the anterior aspect of the distal femur and the patella undersurface, and a mass-like fatty tissue protrusion on the lateral femoral condyle that caused mechanical symptoms.

Molecular characterization of a cDNA encoding copper/zinc superoxide dismutase from cultured cells of Manihot esculenta.

Superoxide dismutase (SOD) cDNA, mSOD2, encoding cytosolic copper/zinc SOD (CuZnSOD) cDNA was isolated from suspension-cultured cells of cassava (Manihot esculenta Crantz) by cDNA library screening, and its expression was investigated in relation to environmental stress. mSOD2 is 774 bp in length with an open reading frame (ORF) of 152 amino acids, corresponding to a protein of predicted molecular mass 15 kDa and a pI of 5.22. One copy of the mSOD2 gene was found to be present in the cassava genome by Southern analysis using an mSOD2 cDNA-specific probe. Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis revealed diverse expression patterns for the mSOD2 gene in various tissues of intact cassava plants, at various stages of the growth in suspension cultures, and in the leaf tissues exposed to different stresses. The mSOD2 gene was highly expressed in suspension-cultured cells and in the stems of intact plants. However, it was expressed at low levels in leaves and roots. During suspension cell growth, the mSOD2 transcript progressively increased during culture. Moreover, the mSOD2 gene in excised cassava leaves responded to various stresses in different ways. In particular, it was highly induced in leaf tissue by several abiotic stresses, including high temperature (37 degrees C), chilling (4 degrees C), methyl viologen (MV) exposure, and wounding treatment. These results indicate that the mSOD2 gene is involved in the antioxidative process triggered by oxidative stress induced by environmental change.