Risk assessment of hexachlorobutadiene (HCBD) in the Korean diet.

Hexachlorobutadiene (HCBD) is a persistent organic pollutant (POP), and a toxin whose primary target organ is the kidney. Consequently, quantifying the amount of HCBD in food is essential for determining whether it poses a health risk. The current study established and validated an analytical method for assessing HCBD in food using gas chromatography/mass spectrometry (GC/MS). Subsequently, we conducted for the first time a risk assessment of HCBD through Korean food consumption. The ranges of HCBD concentration in 595 food samples were as follows: not detectable (nd)-0.947 ng/g for agricultural products, nd-0.920 ng/g for animal products, nd-1.323 ng/g for fishery products and nd-1.081 ng/g for processed food products. The daily intakes of HCBD for the general population were 0.22 ng/kg body weight (b.w.)/day for agricultural products, 0.30 ng/kg b.w./day for animal products, 0.07 ng/kg b.w./day for fishery products and 0.33 ng/kg b.w./day for processed food products. These exposure levels are below the tolerable daily intake (TDI, 2 µg/kg body weight/day) established by the National Institute of Food and Drug Safety Evaluation (NiFDS) in the Republic of Korea. Taking into account the risk index of 0.011%, we can, therefore, conclude that there are no health concerns for the Korean population.

Hemovac blood after total knee arthroplasty as a source of stem cells.

BACKGROUND: With increasing life expectancy, stem cell therapy is receiving increasing attention. However, its application is restricted by ethical concerns. Hence a need exists for design of safe procedures for stem cell procurement. Here, we investigated whether hemovac blood (HVB) is an appropriate stem cell source. METHODS: HVB concentrates (HVBCs) from 20 total knee arthroplasty (TKA) patients and bone marrow aspirate (BMA) concentrates (BMACs) from 15 patients who underwent knee cartilage repair were comparatively evaluated. A bone marrow aspiration needle was inserted into the anterior superior iliac spine. Aspiration was performed using a 50-mL syringe, including 4 mL of anticoagulant, followed by centrifugation to obtain BMACs. To obtain HVBCs, blood was aspirated from the hemovac immediately after TKA surgery. Different cell types were enumerated. Isolation of BMA and HVB mononuclear cells was performed using density gradient centrifugation. Non-hematopoietic fibroblast colonies were quantified by colony forming unit-fibroblast assay surface marker analysis of HVB, HVBC, BMA, and BMAC was performed via flow cytometry. Mesenchymal stem cells (MSCs) isolated from HVBCs and BMACs were examined for osteogenic, adipogenic, and chondrogenic differentiation potential. Gene expression analysis was performed by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: The number of cells from HVB and HVBC was significantly lower than from BMA and BMAC; however, the number of colonies in HVBC and BMAC did not differ significantly (P>0.05). Isolated cells from both sources had a fibroblast-like appearance, adhered to culture flasks, and formed colonies. Under different culture conditions, MSC-specific surface markers (CD29, CD44, CD90, CD105), osteogenic markers [RUNX2, osteopontin, osteocalcin, and alkaline phosphatase (ALP)] and adipogenic markers (PPARγ and C/EBPα) were expressed. Moreover, SOX9, type II collagen, and aggrecan were significantly upregulated upon chondrogenic differentiation. CONCLUSIONS: HVB from TKA patients is a useful source of stem cells for research.

Articular cartilage repair using autologous collagen-induced chondrogenesis (ACIC): a pragmatic and cost-effective enhancement of a traditional technique.

PURPOSE: The autologous collagen-induced chondrogenesis technique is described, and the results of a 6-year follow-up clinical study using this technique are presented. METHODS: 30 patients with International Cartilage Repair Society (ICRS) Grade III/IVa symptomatic chondral defects of the knee treated with enhanced microdrilling using atelocollagen were prospectively examined in this clinical series. The median age of the patients was 39.0 years (range 19-61 years). Patients were followed up to 72 months. Clinical evaluation was performed using functional knee scores and radiologically. Both quantitative and qualitative assessments were performed. RESULTS: Statistically significant and clinically relevant improvement was observed in 2 years and was sustained for the 6 years of the study observation. At 6 years, the mean Lysholm score was 79.7 (SD 6.8) compared to 52.6 (SD 10.7) pre-operatively (p < 0.05). The symptomatic Knee Injury and Osteoarthritis Outcome Score (KOOS) improved from 68.3 (SD 11.4) to 90.2 (SD 4.3) (p < 0.05). The subjective International Knee Documentation Committee (IKDC) also showed improvement from 39.1 (SD 4.1) to 81.6 (SD 7.8) (p < 0.05). The calculated T2* relaxation times were 26.0 (SD 4.2) seconds and 30.3 (SD 6.2) seconds for the repair tissue and native cartilage, respectively. The average magnetic resonance observation of cartilage repair tissue (MOCART) score was 78.5 (SD 9.6) for all lesions. CONCLUSION: The enhanced microdrilling using atelocollagen is an enhancement of the traditional microfracture method using an off-the-shelf product. When used to treat moderate to severe chondral lesions, this enhancement produces hyaline-like cartilage with a corresponding improvement in symptoms. LEVEL OF EVIDENCE: IV.

Tibial tubercle avulsion fracture according to different mechanisms of injury in adolescents: Tibial tubercle avulsion fracture.

Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture.Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups.There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients' BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile.Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.

Radiographic Results and Complications of 3 Guided Growth Implants.

BACKGROUND: Temporary, implant-mediated hemiepiphysiodesis (ie, guided growth) is an effective and popular treatment method for lower extremity angular deformities. The purpose of this study was to retrospectively evaluate the safety profile of 3 different implants used to correct lower extremity angular deformities in pediatric patients. METHODS: We retrospectively reviewed a consecutive series of pediatric patients with lower extremity angular deformities who underwent implant-mediated guided growth by 2 surgeons at our institution between 2004 and 2014. Implants were selected according to surgeon preference and included the Biomet peanut plate, Orthofix eight-plate, and Pega Medical hinge plate. Medical records and radiographs were reviewed to assess deformity correction, implant integrity, and complications. RESULTS: During the study period, 115 plates (63 Biomet peanut plates, 30 Orthofix eight-plates, and 22 Pega Medical hinge plates) were implanted in 52 patients (24 males, 28 females). Average age at implantation was 11.7 years (12.3 y in males, 11.1 y in females). Average length of follow-up was 18.4 months. There was no significant difference in rate of deformity correction between the implant types (P=0.08).Three broken screws (2.6%) were observed, all of which involved cannulated screws in peanut plates. Four peanut plates (6.3%) had an implant-related complication: 3 broken screws and 1 screw pullout. Three eight-plates (10.0%) had screw pullout. No complications were observed within either the hinge plate or solid screw groups. Implant-related complications were significantly associated with increased body weight and cannulated screw use (P=0.02 and 0.03, respectively), but not bone age, sex, plate type, or rate of deformity correction. No deep infections, premature growth arrests, or plate breakages were observed. CONCLUSIONS: Implant-mediated guided growth is a safe technique for pediatric lower extremity angular deformity correction with a low complication rate. This study demonstrated that overweight patients had a significantly higher rate of implant-related complications. Screw breakages were only observed with cannulated screws in peanut plates. Thus, we recommend using solid, noncannulated screws in overweight children who are at an increased risk of implant failure. LEVEL OF EVIDENCE: Level IV-retrospective case series.

Reliability of predictive models for non-operative healing potential of stable juvenile osteochondritis dissecans knee lesions.

BACKGROUND: While juvenile osteochondritis dissecans (JOCD) lesions have greater healing potential than equivalent lesions in adults, only 50% of JOCD lesions demonstrate radiographic healing after six months of non-operative treatment. Two previous studies have produced nomograms to predict a patient's probability of healing with non-operative treatment based on patient and lesion characteristics. The purpose of this study was to determine inter- and intra-observer reliability of the predictive nomograms. METHODS: A consecutive series of 34 skeletally immature patients (40 knees), who underwent non-operative treatment for stable JOCD lesions was retrospectively reviewed. At two time points at least one week apart, two medical students, two orthopaedic surgeons, and a radiologist made measurements of the JOCD lesions. These measurements, along with patient ages and pain type, were used to generate a point value for each lesion based on both nomograms. Intra-class correlations (ICCs) were calculated to determine inter- and intra-rater reliability. RESULTS: We found near perfect intra-rater correlation (ICC) for all raters' individual OCD measurements, as well as total point score for the two nomograms (ICC range, 0.780-0.929). Additionally, there was near perfect inter-rater reliability among raters for total scores and individual components of each nomogram (ICC range, 0.721-0.974). CONCLUSIONS: There is high inter- and intra-rater reliability for both point systems for predicting healing of JOCD lesions. Clinicians should be aware of these as tools to help guide decision making in patients with JOCD lesions.

The tibial eminence fracture in skeletally immature patients.

PURPOSE OF REVIEW: Although tibial eminence fractures are uncommon, their importance cannot be overemphasized in skeletally immature patients because of the fracture's close proximity to both the tibial physis as well as the attachment between the tibial eminence and the anterior cruciate ligament, the latter being a key component in maintaining knee stability. This review focuses on recent trends in treatment concepts and devices. RECENT FINDINGS: Recent literature on this topic addresses the existence of a variety of treatment modalities, but the majority of these articles analyzed a limited number of cases and insisted on the merits of their own methods. Nevertheless, some consensus has been reached regarding treatment direction and how much laxity should be considered acceptable. SUMMARY: Although the review failed to reveal a gold standard modality in treating tibial eminence fractures, most studies agreed on several issues. Displaced intra-articular fractures should be fixed operatively.

A comparative study of DA-9601 and misoprostol for prevention of NSAID-associated gastroduodenal injury in patients undergoing chronic NSAID treatment.

Misoprostol is reported to prevent non-steroidal anti-inflammatory drug (NSAID)-associated gastroduodenal complications. There is, however, limited information regarding the efficacy of DA-9601 in this context. We performed a comparative study on the relative efficacy of DA-9601 and misoprostol for prevention of NSAID-associated complications. In this multicenter, double-blinded, active-controlled, stratified randomized, parallel group, non-inferiority trial, 520 patients who were to be treated with an NSAID (aceclofenac, 100 mg, twice daily) over a 4-week period were randomly assigned to groups for coincidental treatment with DA-9601 (60 mg, thrice daily) (236 patients for full analysis) or misoprostol (200 µg, thrice daily) (242 patients for full analysis). [corrected]. The primary endpoint was the gastric protection rate, and secondary endpoints were the duodenal protection rate and ulcer incidence rate. Endpoints were assessed by endoscopy after the 4-week treatment period. Drug-related adverse effects, including gastrointestinal (GI) symptoms, were also compared. At week 4, the gastric protection rates with DA-9601 and misoprostol were 81.4 % (192/236) and 89.3 % (216/242), respectively. The difference between the groups was -14.2 %, indicating non-inferiority of DA-9601 to misoprostol. Adverse event rates were not different between the two groups; however, the total scores for GI symptoms before and after administration were significantly lower in the DA-9601 group than in the misoprostol group (-0.2 ± 2.8 vs 1.2 ± 3.2; p < 0.0001). DA-9601 is as effective as misoprostol in preventing NSAID-associated gastroduodenal complications, and has a superior adverse GI effect profile.

A multi-center, randomized, clinical study to compare the effect and safety of autologous cultured osteoblast(Ossron) injection to treat fractures.

BACKGROUND: We performed a multicenter, open, randomized, clinical study of autologous cultured osteoblast injection for long-bone fracture, to evaluate the fracture healing acceleration effect and the safety of autologous cultured osteoblasts. METHODS: Sixty-four patients with long-bone fractures were randomly divided into two groups, i.e. those who received autologous cultured osteoblast injection and those who received no treatment. The sum of the difference in the callus formation scores after four and eight weeks, was used as the first efficacy variable. RESULTS: The autologous cultured osteoblast injection group showed fracture healing acceleration of statistical significance, and there were no specific patient complications when using this treatment. CONCLUSION: Autologous cultured osteoblast injection should therefore be considered as a successful treatment option for treating long-bone fracture.

Open lateral collateral ligament injury of the interphalangeal joint of the great toe in adolescents during Taekwondo.

BACKGROUND: Sports-related open lateral collateral ligament injury of the interphalangeal joint of the great toe has not been previously described in the English literature. HYPOTHESIS: This injury can occur in adolescents while performing barefooted high-kicking or fast-running exercises involving rapid, 180 degrees turns on a dry, rough, wooden floor in a Taekwondo gymnasium. Injury occurs when the whole body turns quickly while supported only by the plantar aspect of the distal phalanx of the great toe. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The 7 study subjects consisted of 6 boys and 1 girl between 10 and 16 years old. Causes, pattern, mechanism of injury, treatment, and outcomes were investigated. RESULTS: All patients showed the same injury pattern and mechanism. They all had an open wound on the dorsolateral aspect of the interphalangeal joint. It was postulated that rapid whole body turning supported only by the distal phalanx of the great toe produces nonphysiologic varus stress at the interphalangeal joint, which results in open detachment of the lateral collateral ligament and adjoining periosteum from the proximal phalanx and interphalangeal joint subluxation. All 7 patients regained full great toe function after surgical repair. CONCLUSION: This unique sports-related open interphalangeal joint injury should be recognized. Participants, trainers, and health providers engaged in Taekwondo or similar sports should understand the pathomechanism of this injury and develop preventive measures.

Lafutidine versus lansoprazole in combination with clarithromycin and amoxicillin for one versus two weeks for Helicobacter pylori eradication in Korea.

BACKGROUND AND AIMS: Lafutidine is a novel H(2)-receptor antagonist with gastroprotective activity that includes enhancement of gastric mucosal blood flow. The aim of the present study was to test the efficacy of 7- or 14-day lafutidine-clarithromycin-amoxicillin therapy versus a lansoprazole-based regimen for Helicobacter pylori eradication. METHODS: Four hundred and sixty-three patients with H. pylori-infected peptic ulcer disease were randomized to one of four regimens: (1) lafutidine (20 mg b.i.d.), clarithromycin (500 mg b.i.d.) and amoxicillin (1000 mg b.i.d.) for 7 days (the 7LFT group) or (2) for 14 days (the 14LFT group); (3) lansoprazole (30 mg b.i.d.), clarithromycin (500 mg b.i.d.), and amoxicillin (1000 mg b.i.d.) for 7 days (the 7LPZ group); or (4) for 14 days (the 14LPZ group). The eradication rates, drug compliance, and adverse effects among the four regimens were compared. RESULTS: The eradication rates by the intention-to-treat and per-protocol analyses in the 7LFT and 7LPZ groups were 76.5% and 81.6%, and 76.9% and 82.0% (p = .94 and .95), respectively. The eradication rates by intention-to-treat and per-protocol analyses in the 14LFT and 14LPZ groups were 78.2% and 82.2%, and 80.4% and 85.9% (p = .70 and .49), respectively. The treatment duration for 7 days or 14 days did not affect the eradication rates. In addition, the adverse effect rates and discontinuation rates were similar among the four groups. Furthermore, the ulcer cure rate and symptom response rate were similar in the lafutidine and lansoprazole groups. CONCLUSION: The results of this study showed that lafutidine-clarithromycin-amoxicillin therapy was a safe and effective as lansoprazole-based triple therapy for the eradication rate of H. pylori, and could be considered as an additional treatment option.

Do adipose tissue-derived mesenchymal stem cells have the same osteogenic and chondrogenic potential as bone marrow-derived cells?

OBJECTIVE: Adipose tissue-derived mesenchymal stem cells (ATMSCs) have been shown to differentiate into bone, cartilage, fat or muscle. However, it is not certain that ATMSCs are equal to bone marrow-derived mesenchymal stem cells (BMMSC) for their bone and cartilage forming potential. The purpose of this study was to answer the question. METHODS: BMMSCs were obtained from the medullary canal of femur and ATMSCs were isolated from the fat harvested during liposuction procedures. After cell expansion in culture media and two passages, the immunofluorescent studies for STRO-1 and CD34 were performed to characterize the BMMSCs and ATMSCs. Osteogenesis was induced on a monolayer culture with osteogenic medium containing dexamethasone, beta-glycerophosphate and ascorbate. After 2-3 weeks, alkaline phosphatase (AP) and Von Kossa staining were done. To test for chondrogenesis, mesenchymal stem cells (MSCs) were cultured in a pellet culture and in a fibrin scaffold with a chondrogenic medium (CM) containing transforming growth factor-beta(2) and insulin-like growth factor-I. After 4 weeks, Safranin-O staining and immunohistochemical staining for type II collagen were done to evaluate the chondrogenic differentiation and the matrix production. A histological scale was used to semiquantitatively assess the degree of chondrogenesis. RESULTS: Both BMMSCs and ATMSCs were STRO-1 positive and CD34 negative. On the test of osteogenesis, the osteoblastic differentiation of ATMSCs as demonstrated by AP staining was much less than that of the BMMSCs (P=0.002). The amount of matrix mineralization shown by Von Kossa staining also showed statistical differences between the two MSCs (P=0.011). On the test for chondrogenesis by the pellet culture ATMSCs showed much weaker presentation as chondrogenic cells in both cell morphology and the matrix production. The histological score was 6.5 (SD1.3) for the BMMSCs, and 4.3 (SD1.6) for the ATMSCs cultured in CM, which was statistically significant (P=0.023). The results from fibrin gel paralleled those from the pellet culture in general. CONCLUSION: The results of our study suggest that the ATMSCs may have an inferior potential for both osteogenesis and chondrogenesis compared with the BMMSCs, and these cast doubts on the value of adipose tissue as a source of MSCs.

Littoral cell angioma (LCA) associated with liver cirrhosis.

A littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen. A 60-year-old man, with multiple nodules in imaging study and liver cirrhosis graded as Child-Pugh classification class A, was transferred for splenomegaly. A thrombocytopenia was found on hematological evaluation. Because there was no evidence of hematological and visceral malignancy, a splenectomy was performed for a definitive diagnosis. The histological and immunohistochemical features of the splenic specimens were consistent with a LCA. After the splenectomy, the thrombocytopenia recovered to the normal platelet count. There has been no previous report of a LCA combined with liver cirrhosis. Herein, the first case of a LCA in Korea, diagnosed and treated by a splenectomy, is reported.

Fractures to the posterior wall of the acetabulum managed with screws alone.

BACKGROUND: The use of a buttress plate in addition to lag screws has been recommended for fractures to the posterior wall of the acetabulum. However, there is a lack of possible criteria for the use of screws alone. This study aimed to evaluate the use of screws alone for fixation of posterior wall fractures to the acetabulum. METHODS: This study retrospectively examined 15 patients with a single fragmented or moderately comminuted posterior wall fracture of the acetabulum who had been treated with internal fixation using screws alone. The modified D'Aubigne and Postel's score system was used for the functional evaluation. RESULTS: The clinical results were excellent for nine hips, very good for one hip, good for four hips, and poor for one hip after follow-up period of more than 2 years. CONCLUSION: The use of screws alone can produce acceptable results for selected posterior wall fractures of the acetabulum.

Potentially unstable intertrochanteric fractures.

OBJECTIVES: Evaluation of risk factors for loss of reduction in initially stable intertrochanteric fractures. DESIGN: Retrospective database analysis. SETTING: University teaching hospital. PATIENTS/PARTICIPANTS: Sixty-six patients over the age of 55 years presenting with fractures of the trochanteric region caused by a low-energy injury, classified as AO/OTA type 31-A1 (stable fracture in Evans classification). INTERVENTION: Treatment with a sliding compression hip screw. MAIN OUTCOME MEASUREMENT: The outcome examined in this study was loss of reduction as measured by the amount of medialization of the femoral shaft. RESULTS: Increased age (P = 0.01) and comminution of the lateral cortex (P = 0.0001) were factors significantly associated with excessive displacement. These 2 factors had a high degree of correlation (r = 0.76). CONCLUSIONS: A surgeon must be aware of iatrogenic fragmentation of the lateral cortex at the time of surgery in apparently stable intertrochanteric fractures in older patients because of the potential for subsequent loss of reduction.

Significance of non-erosive minimal esophageal lesions in gastro-esophageal reflux disorder.

BACKGROUND: Non-erosive reflux disorder, which represents more than 60% of gastro-esophageal reflux disorders, lacks objective parameters for diagnosis. The purpose of this study was to evaluate the correlation between non-erosive minimal lesions at the lower esophagus and gastro-esophageal reflux disorder. METHODS: Patients were asked to answer a symptom questionnaire. The endoscopic findings were either graded by LA classification or recorded as non-erosive minimal lesions. Patients with minimal lesions were treated with rabeprazole or a placebo and responses were evaluated at weeks 1 and 4. RESULTS: In 8 centers, 3454 patients were screened. In patients with heartburn or acid regurgitation as the most bothersome symptom, 23.7% had endoscopy negative reflux disorder, 40.1% showed minimal lesions, and 36.20% had mucosal break esophagitis. Thirty-four percent of patients with minimal lesions and 39.1% of patients with LA 'grade A' mild esophagitis reported typical reflux symptoms as their main symptom. In patients with minimal lesions, medication with rabeprazole reduced symptoms significantly at weeks 1 and 4, but not with the placebo. CONCLUSION: Patients with non-erosive minimal esophageal lesions had similar reflux symptoms comparable to those with mild erosive reflux esophagitis, and reflux symptoms were improved with a short-term proton pump inhibitor. Thus, non-erosive minimal esophageal lesion constitutes a great part of gastro-esophageal reflux disorder.