[Relationship between body mass index and sexual development in Chinese children]

Objective: To investigate the relationship between body mass index (BMI) and sexual development in Chinese children. Methods: A nationwide multicenter and population-based large cross-sectional study was conducted in 13 provinces, autonomous regions and municipalities of China from January 2017 to December 2018. Data on sex, age, height, weight were collected, BMI was calculated and sexual characteristics were analyzed. The subjects were divided into four groups based on age, including ages 3-<6 years, 6-<10 years, 10-<15 years and 15-<18 years. Multiple Logistic regression models were used for evaluating the associations of BMI with sexual development in children. Dichotomous Logistic regression was used to compare the differences in the distribution of early and non-early puberty among normal weight, overweight and obese groups. Curves were drawn to analyze the relationship between the percentage of early puberty and BMI distribution in girls and boys at different Tanner stages. Results: A total of 208 179 healthy children (96 471 girls and 111 708 boys) were enrolled in this study. The OR values of B2, B3 and B4+ in overweight girls were 1.72 (95%CI: 1.56-1.89), 3.19 (95%CI: 2.86-3.57), 7.14 (95%CI: 6.33-8.05) and in obese girls were 2.05 (95%CI: 1.88-2.24), 4.98 (95%CI: 4.49-5.53), 11.21 (95%CI: 9.98-12.59), respectively; while the OR values of G2, G3, G4+ in overweight boys were 1.27 (95%CI: 1.17-1.38), 1.52 (95%CI: 1.36-1.70), 1.88 (95%CI: 1.66-2.14) and in obese boys were 1.27 (95%CI: 1.17-1.37), 1.59 (95%CI: 1.43-1.78), and 1.93 (95%CI: 1.70-2.18) (compared with normal weight Tanner 1 group,all P<0.01). Analysis in different age groups found that OR values of obese girls at B2 stage and boys at G2 stage were 2.02 (95%CI: 1.06-3.86) and 2.32 (95%CI:1.05-5.12) in preschool children aged 3-<6 years, respectively (both P<0.05). And in the age group of 6-10 years, overweight girls had a 5.45-fold risk and obese girls had a 12.54-fold risk of B3 stage compared to girls with normal BMI. Compared with normal weight children, the risk of early puberty was 2.67 times higher in overweight girls, 3.63 times higher in obese girls, and 1.22 times higher in overweight boys, 1.35 times higher in obese boys (all P<0.01). Among the children at each Tanner stages, the percentage of early puberty increased with the increase of BMI, from 5.7% (80/1 397), 16.1% (48/299), 13.8% (27/195) to 25.7% (198/769), 65.1% (209/321), 65.4% (157/240) in girls aged 8-<9, 10-<11 and 11-<12 years, and 6.6% (34/513), 18.7% (51/273), 21.6% (57/264) to 13.3% (96/722), 46.4% (140/302), 47.5% (105/221) in boys aged 9-<10, 12-<13 and 13-<14 years, respectively. Conclusions: BMI is positively correlated with sexual development in both Chinese boys and girls, and the correlation is stronger in girls. Obesity is a risk factor for precocious puberty in preschool children aged 3-<6 years, and 6-<10 years of age is a high risk period for early development in obese girls.

[Changing prevalence of overweight and obesity among Chinese children aged 6-15 from 2009-2019]

Objective: To analyze the trends of overweight and obesity prevalence in Chinese children, aged from 6 to 15 years old among 4 provinces and cities from 2009 to 2019. Methods: Reviewed the national multi-center epidemiological survey data of children from the National Key Technology R&D Program of China during the Eleventh Five-Year Plan (2009 to 2010) and the National Key Research and Development Program of China during the Thirteenth Five-Year Plan (2017 to 2019). The participants' data were selected from four provinces,municipalities and autonomous region,including Beijing, Tianjin (Northern region), Zhejiang (Eastern region), and Guangxi (Southern region). Totally 14 597 pairs of 6-15 year-old children were surveyed. According to the body mass index (BMI) and standard deviation score (SDS) of children among different genders, ages, and regions, t test or chi-square test was used to evaluate the changes in overweight and obesity over a 10-year span. Results: Totally 7 721 pairs of boys and 6 876 pairs of girls were collectted in this study, whose mean age was (10.7±2.5) years. In the past 10 years, the overall BMISDS were 0.39±1.24 and 0.36±1.31 and the overall obesity rate were 11.8% (n=1 773) anel 12.5% (n=1 813) of children in the 4 administrative regions did not have statistically significant differences (all P>0.05). However, the overall overweight rate rose from 17.1% (n=2 496) to 19.1% (n=2 781) (χ²=18.657, P<0.01), and the average annual growth rate was 0.20%. The BMISDS in the Eastern region increased from 0.10±1.07 to 0.19±1.22 (t=-4.095, P<0.01), and the overweight rate and obesity rate increased by 3.8% (n=202) and 3.1% (n=169) respectively (both P<0.01); the BMISDS in the Northern region and the obesity rate did not have statistically significant differences(all P>0.05), but the overweight rate rose from 20.5% (n=1 233) to 22.8% (n=1 365) significantly (χ²=7.431, P<0.01); BMISDS in the Southern region was significantly decreased from 0.30±1.19 to 0.09±1.25 (t=1.426, P<0.01), and the rate of obesity decreased from 9.8% (n=315) to7.9% (n=256) (χ²=6.46, P<0.05), the overweight rate was not stafistically significant (P=0.10), respectively. The obesity rate of boys had risen from 16.4% (n=1 265) to 18.2% (1 407) (χ²=8.997, P<0.01) in the past 10 years, and the overweight rate had risen from 18.0% (n=1 393) to 20.5% (n=1 579) (χ²=14.26, P<0.01). The overweight+obesity rate rose from 34.4% (n=2 658) to 38.7% (n=2 986) (χ²=29.859, P<0.01), and the weight problem in the age group of 8 to 11 years was particularly severe (all P<0.01). The obesity rate of girls dropped from 6.8% (n=468) to 5.9% (n=406) (χ²=4.546, P<0.05), the overweight rate rose from 16.0% (n=1 103) to 17.5% (n=1 202) (χ²=5.006, P<0.05), and the overall overweight+obesity rate rose from 22.8% (n=1 571) to 23.4% (n=1 608) (χ²=0.53, P>0.05). Conclusions: The growth rate of obesity among children in China had slowed down from 2009 to 2019, but the overweight rate was still on the rise. The overall base of overweight and obesity population continued to expand. The weight problem of peri-adolescent boys was particularly prominent. The current status of obesity epidemics in different regions, ages, and genders are significantly different and had their own characteristics. It is necessary to establish a personalized prevention and control strategy.

Arthroscopic release for frozen shoulder: Does the timing of intervention and diabetes affect outcome?

Purpose

To evaluate the effect of timing of arthroscopic release and manipulation under anesthesia for frozen shoulder in patients with diabetes and non-diabetes.

Methods

One hundred and twenty-seven patients with frozen shoulder were included in the study. Each patient was assigned to: 1) one of four groups according to the duration from symptom onset to surgery (group A: ≤3 months; group B: 3–6 months; group C: 6–12 months; group D: >12 months), 2) diabetic or nondiabetic group. The outcomes were measured by shoulder range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) Shoulder score, the period of pain relief, overall duration of disease, and satisfaction.

Results

All the patients got great improvement in shoulder ROM (P < .0001) after arthroscopic surgery, but there was no statistical difference in the pre-operative and post-operative shoulder ROM between the four groups and between diabetic and nondiabetic groups. The overall duration of disease was mean 55.4~68.7 weeks, which demonstrated much shorter disease course compared with nature course.

Improvement were also seen in shoulder ROM at one week to one month, and the period of total pain relief was at a mean time of 3.7 to 3.8 weeks. There were higher ASES Shoulder score in group B than in group C (P = 0.02) and higher DASH score in diabetic group in short term follow-up.

Conclusions

Arthroscopic release provides effective and rapid improvements to shoulder motion and function, unrelated to the timing of surgery, in patients with frozen shoulder. The diabetic patients do not have functional outcomes as good as the nondiabetic patient at short-term follow-up.

[Research progress in saliva collection, analysis and its relationship with oral diseases]

As one of the major body fluid, saliva has various components that can shift according to the systemic health state. With the atraumatic way of collection, saliva can be a promising media to help the detection of oral diseases. With the development of salivaomics and the application of unbiased, highly sensitive, and high throughout separation techniques for salivary components, there's now more possibilities for effective identification of biomarkers correlated with oral diseases. This review aimed to introduce the current state of saliva collection and detection techniques as well as their correlation with oral diseases, hoping to provide evidence for further research.

[Analysis of four carnitine-acylcarnitine translocase deficiency cases caused by homozygous mutation of SLC25A20 c.199-10T> G]

Objective: To investigate the clinical, biochemical and genetic features of four carnitine-acylcarnitine translocase deficiency cases. Methods: Four cases diagnosed with carnitine-acylcarnitine translocase deficiency from Guangxi Maternal and Child Health Hospital were studied. DNA was extracted from dry blood filter for gene analysis. SLC25A20 gene analysis was performed in 1 case and the whole exon sequence analysis was performed in 3 cases. Results: Retrospective study on unrelated carnitine-acylcarnitine translocase deficiency patients, the age of onset was 1-28 d, the age of death were 1.5-30 d, main clinical features were hypoglycemia (4 cases), arrhythmia (2 cases), sudden death (2 cases). Biochemical test showed hypoglycemia (1.2-2.0 mmol/L) , elevated creatine kinase (955-8 361 U/L) and creatine kinase isozyme(199-360 U/L), normal or decreased free carnitine level (3.70-27.07 μmol/L) , elevated long-chain acylcarnitine (palmityl carnitine 1.85-14.84 μmol/L). The gene tests showed that all 4 cases carried SLC25A20 gene c.199-10T> G homozygous mutation, inherited from their parents. By analyzing the haplotype, we found that the mutation loci of C. 199-10T> G were all in the same haplotype. Conclusion: The c.199-10T> G mutation is an important molecular cause of carnitine-acylcarnitine translocase deficiency, which has relatively high frequency in Guangxi population, and is related to the founder effect.

[Genetic analysis for 5 congenital hypothyroidism patients due to dyshormonogenesis]

OBJECTIVE

To analyze molecular characteristics of 5 congenital hypothyroidism (CH) patients due to dyshormonogenesis.

METHOD

We enrolled 5 CH patients due to dyshormonogenesis who were identified in Newborn Screening Center of Guangxi Zhuang Autonomous Region, China. Blood samples were collected from the patients and their parents, and genomic DNA was extracted from peripheral blood leukocytes. All exons of DUOX2, TG, TPO and NIS gene together with their exon-intron boundaries were screened by next-generation sequencing. Specimens from 100 normal controls were tested for these novel variations.

RESULT

No TPO, NIS or TG gene mutations were identified. Direct sequencing of the DUOX2 gene revealed that patient 1 had a compound heterozygote for c. 3340delC and p. R683L, patient 2 was homozygous for p. K530X and patient 3 was a heterozygote for p. E879K. Both biallelic and monoallelic heterozygous mutations in DUOX2 were associated with transient CH. Novel mutations included c. 3340delC and p. R683L, analysis of 100 healthy subjects without thyroid disease did not show the same change.

CONCLUSION

Genetic analysis of TPO, NIS, DUOX2 and TG gene in 5 unrelated CH patients with thyroid dyshormonogenesis revealed two novel DUOX2 mutations, both were biallelic and monoallelic heterozygous mutations in DUOX2 associated with transient CH.

Change in pitching biomechanics in the late-inning in Taiwanese high school baseball pitchers

Repetitive overhead throwing may result in overuse injuries and a change in the pitching mechanics of a baseball pitcher. Accordingly, the purpose of this study is to quantify the changes in the muscle strength and pitching motion kinematics in the late-innings stage of a baseball game. Sixteen healthy baseball pitchers (16.77 ± 0.73 years) recruited from a high school, which won the National High School Baseball Championship in Taiwan in 2011; each performed 100 pitches in a bullpen throwing session. Isometric muscle strength measurements and joint kinematic data were obtained before and after the throwing session. The mean Borg's Rating of Perceived Exertion index was found to have a value of 14.14, indicating a medium-to-large degree of perceived tiredness. The results showed that the ball velocity and horizontal abduction angle decreased significantly as the pitchers became tired. Moreover, the upper torso forward tilt and knee flexion angle both increased significantly at the moment of ball release. Finally, the muscle strength of the upper extremity remained decreased 2 days after the bullpen throwing session. Overall, the results suggest that an adequate amount of rest and specific strengthening programs for the shoulder external rotator, shoulder internal rotator, shoulder flexor, shoulder extensor, shoulder adductor, and shoulder abductor muscles are recommended to the coaches and for adolescent baseball pitchers. In addition, the changes in pitching mechanics noted in this study should be carefully monitored during the course of a baseball game to minimize the risk for overuse injuries.

Irreducible metatarsophalangeal joint dislocation of the lesser toes: a case report

Irreducible metatarsophalangeal joint dislocation of the lesser toes is a rare injury. We present a 37-year-old man who was injured in a motorcycle accident and dislocated the first to third metatarsophalangeal joints and fractured the fourth metatarsal head. The left first metatarsophalangeal joint was reduced successfully through the closed method, but multiple attempts at closed reduction under local anesthesia failed to reduce the dislocated second and third metatarsophalangeal joints. We performed a dorsal incision between the second and third metatarsals, and the metatarsal heads were found to be entrapped under the plantar plate. Dislocation reduction was performed without damage to the plantar plate, and one Kirschner wire was used to fix the fourth metatarsal head fracture. The pin was removed 8 weeks after surgery, and the patient regained normal gait and returned to work and his previous physical activity level without recurrent dislocation.

Arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction using patellar tendon graft compared with hamstring tendon graft

PURPOSE

The purpose of this study was to compare the outcomes of arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction using autologous patellar tendon and hamstring tendon grafts.

METHODS

From 1998 to 2007, 59 patients with symptomatic isolated posterior cruciate ligament injury were included in this retrospective study. Twenty-five knees were reconstructed using bone-patellar tendon-bone graft, and 34 knees were reconstructed using hamstring graft. In both groups, surgical techniques were similar, except material of fixation screws. Patients were evaluated pre-operatively and post-operatively at the latest follow-up with several parameters, including symptoms, physical examination, outcome satisfaction, functional scores, radiography and complications.

RESULTS

Average follow-up period was 51.6 months in patellar tendon group and 51.1 months in hamstring tendon group. Significantly more kneeling pain (32 vs. 3 %), squatting pain (24 vs. 3 %), anterior knee pain (36 vs. 3 %), posterior drawer laxity and osteoarthritic change were shown in patellar tendon group than in hamstring tendon group post-operatively. No significant differences were found in other parameters between both groups.

CONCLUSIONS

Several shortcomings, including anterior knee pain, squatting pain, kneeling pain and osteoarthritic change, have to be concerned when using patellar tendon autograft. In conclusion, hamstring tendon autograft may be a better choice for transtibial tunnel PCL reconstruction.

BIOMECHANICAL ANALYSIS OF THE ELBOW JOINT LOADING DURING PUSH-UP

The purpose of this study was to investigate the static and dynamic forces within the joints during push-up loading of the upper extremity.

Ten healthy male students volunteered for this study. They were asked to complete six sets of push-ups in five different hand positions. The Expert Vision Motion Analysis System with six CCD cameras, and a Kistler force plate was used to measure the relative joint position and ground reaction force.

Hand position was found to have a statistically significant effect on the axial force. The maximum axial force decreased from "normal" when hands were placed "apart" (45.0% BW, p = 0.012) or "superior" (44.5% BW, p = 0.01). Hand position had a significant effect on the flexion moment of the elbow joint. A greater reduction of flexion torque at 997.3 N-cm (p = 0.001) was experienced with hands "apart." Greater flexion torque existed throughout the cycle with hands "together" and equaled 2301.4 N-cm (p = 0.002).

This study provides information about the kinematic and kinetic patterns of the upper extremities, and how hand position affects intersegmental loading. Attention must be given to the valgus torque encountered during push-up exercises. Patients with medial collateral ligament repair and total elbow arthroplasty should be protected from such exercises immediately post-treatment.

Unfolded protein response suppresses cisplatin-induced apoptosis via autophagy regulation in human hepatocellular carcinoma cells

It has been shown that drug resistance is extremely common in hepatocellular carcinoma (HCC) and is one of the major problems in HCC chemotherapy. However, the detailed mechanisms remain largely unknown. We have previously shown that endoplasmic reticulum (ER) stress is involved in the tumorigenesis of HCC. Here, we demonstrated that the unfolded protein response (UPR) inhibits cisplatin-induced HCC cell apoptosis. In HCC cells, cisplatin treatment triggers the UPR, which subsequently inhibits cisplatin-induced apoptosis. Importantly, mild ER stress precondition suppresses the sensitivity of HCC cells to cisplatin-induced apoptosis through autophagy regulation. Furthermore, heat-shock protein 27 (Hsp27) is involved in the cytoprotective role of the UPR in cisplatin-induced apoptosis. We also demonstrated that Hsp27 inhibits cisplatin- induced HCC cell death through autophagy activation. Taken together, our results indicate that the UPR inhibits cisplatin-induced apoptosis in HCC cells, at least in part, by Hsp27-mediated autophagy activation.

The effect of chinese yuanji-dance on dynamic balance and the associated attentional demands in elderly adults

Walking performance changes with age. This has implications for the problem of falls in older adults. The aim of this study was to investigate the effects of Yuanji-Dance practice on walking balance and the associated attention demand in healthy elderly. Fifteen community-dwelling elderly (comparison group, no regular exercise habit) and fifteen Yuanji- Dance elderly (exercise group, dancing experience: 5.40 ± 1.95 years), aged 60-70 years, were included in this study. The subjects in exercise group participated in a 90-minute Yuanji-Dance practice at least three times per week and the comparison group continued their normal daily physical activity. Walking balance measures (including walking velocity, step length, step width, and percentage of time spent in double limb support, COM velocity and COM-COP inclination angles) and attentional demand tests (button reaction time and accuracy) were conducted under different conditions. Our results showed that stride lengths, walking velocities, peak A/P velocities (AP V) of the COM, medial COM-COP inclination (M angle) angles, reaction time, and accuracy decrease significantly as the dual-task (walking plus hand button pressing tasks) applied for either the comparison or exercise groups. These results demonstrated that walking performance is attenuated in our elderly participants as the cognitive tasks applied. Analysis also identified a significantly faster RT for our exercise group both in standing and walking conditions. This may indicate that physical exercise (Yuanji-Dance) may have facilitating effects on general cognitive and perceptual- motor functions. This implies that Chinese Yuanji-Dance practice for elderly adults may improve their personal safety when walking especially under the condition of multiple task demand. Key pointsThe purpose of this study was to investigate the training effects of a Chinese traditional exercise, Yuanji-Dance, on walking balance and the associated attention demand in the healthy elderly.Walking performance is attenuated in elderly participants as the cognitive tasks applied.A significantly faster reaction time for our exercise group both in standing and walking conditions.Yuanji-Dance exercise training can improve the information processing speed of elderly people and has no influence of the dynamic walking balance.

PI3K/Akt promotes GRP78 accumulation and inhibits endoplasmic reticulum stress-induced apoptosis in HEK293 cells

The potential pro-survival role of phosphatidylinositol 3-kinase (PI3K)/Akt during endoplasmic reticulum stress has been well-characterized. However, the detailed mechanisms remain largely unknown. Here, we showed that PI3K/Akt inhibition promoted endoplasmic reticulum stress-induced apoptosis in a glucose-regulated protein 78 (GRP78)-dependent manner. During endoplasmic reticulum stress, high levels of Akt phosphorylation were sustained for at least 18 h in HEK293 cells. Importantly, PI3K/Akt enhanced GRP78 accumulation through increasing its stability following endoplasmic reticulum stress. Furthermore, Akt1, but not Akt2 or Akt3, was involved in GRP78 stability regulation. These results suggest that PI3K/Akt inhibits endoplasmic reticulum stress-induced apoptosis in HEK293 cells, at least in part, by promoting GRP78 protein stability.

Treatment for frozen shoulder combined with calcific tendinitis of the supraspinatus

Calcific tendinitis of the shoulder is a process that involves calcium deposition in the rotator cuff tendons. It is usually a self-limiting process and is often chronic in nature. However, it can lead to acute pain resulting in frozen shoulder syndrome. We report 32 cases in which frozen shoulder was associated with calcific tendinitis of the supraspinatus. The aim of this study was to use arthroscopic brisement of the glenohumeral joint and make multiple punctures in the calcific spot to treat the frozen shoulder associated with calcific tendinitis of the supraspinatus. In our study, 30 patients had satisfactory results after a 2-year follow-up. Five patients experienced some postoperative calcium shadows, but there was also greater improvement in the range of motion and pain relief in this study compared with other reports in the literature of frozen shoulder cases.

Associations between VHL genotype and clinical phenotype in familial von Hippel-Lindau disease

BACKGROUND

Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary disorder associated with tumours and cysts in the central nervous system (CNS) and other visceral organs. Germline mutations in the VHL gene on chromosome 3p25-26 are considered the cause of this disease.

MATERIALS AND METHODS

We studied six patients with VHL disease and their relatives. Loss of heterozygosity (LOH) was determined by five flanking microsatellite polymorphic markers in the VHL locus. Multiplex ligation-dependent probe amplification (MLPA) and quantitative real-time polymerase chain reaction (qPCR) amplification were used to detect the genomic deletions. Single-strand conformation polymorphism (SSCP) analysis was applied to test for sequence variations.

RESULTS

Three germline deletions in the VHL gene (142.9, 53.3 and 3.3 kb) were found by MLPA. These deletions were defined clearly by qPCR analyses. The142.9 kb germline deletion was significantly associated with patients with CNS haemangioblastomas (P < 0.01 by Fisher's exact test), and one missense mutation (Gln209Arg) was detected from a patient with a pancreatic cyst in the same family. LOH was also detected from a patient with bilateral renal cell carcinomas.

CONCLUSION

Diverse genetic conditions are associated with the clinical manifestations of VHL disease. Genomic deletions that can be detected by MLPA or qPCR are major causes for this syndrome. Missense mutations and LOH accompanying the disease lead to complex clinical symptoms and genotypic determination can facilitate a clinical diagnosis because of their strong association.

Ulnar Nerve Palsy Following Fracture of the Distal Radius in an Adolescent: A Case Report

In adolescents, neurovascular injury, especially ulnar nerve injury, is rare with fracture of the distal radius. We present a 14-year-old boy who sustained fracture of the distal radius in his right wrist, who also had symptoms of ulnar nerve injury. Close reduction with percutaneous pinning and cast to fix the distal radius fracture was done immediately. Then, we decided to observe the recovery of the nerve injury without providing any emergent nerve exploration. Bone union was achieved after 8 weeks of fixation, and the function of the ulnar nerve was restored completely after 16 weeks of observation. The possibility of ulnar nerve injury should be considered following fracture of the distal aspect of the radius, and we recommend observing the recovery of nerve injury, with no need for emergent nerve exploration.

Angle analysis of Haglund syndrome and its relationship with osseous variations and Achilles tendon calcification

BACKGROUND

Haglund syndrome is a cause of posterior heel pain. The prominent posterosuperior projection into the retrocalcaneal bursa is thought to be a major etiology. Many methods have been proposed to measure the posterosuperior projection of the tuberosity into this bursa. The Fowler angle and the parallel pitch lines are the most frequently used. However, the relation between symptomatic Haglund syndrome and the measuring methods, especially the Fowler angle and parallel pitch lines, is not clear. The purposes of this paper were to study the predictive value of the most frequently used measurement methods to evaluate bursal impingement and to determine if other osseous variations and Achilles tendon calcification are associated with the development of Haglund syndrome.

METHODS

From October, 1996, to March, 2003, we evaluated 37 heels in 31 patients with symptomatic Haglund syndrome, and 40 heels in 27 individuals without posterior heel pain. On a lateral view radiograph, the Fowler angle, and the parallel pitch lines were measured, in addition to Achilles tendon calcification and the osseous variations, such as a posterior calcaneal step spur or plantar osseous projection.

RESULTS

The average Fowler angles in the control group and study group were 62.31 +/- 7.79 degrees and 60.14 +/- 7.01 degrees, respectively. There was no statistically significant difference (p = 0.490). The positive parallel pitch lines in the symptomatic group were 56.8% and in the control group 42.5%. There was no statistically significant difference (p = 0.474) between the groups.

CONCLUSIONS

No statistically significant differences were noted between the groups concerning the Fowler angle and parallel pitch lines. The posterior calcaneal step spur and Achilles tendon calcification were statistically significant between these two groups. The Fowler angle and parallel pitch lines were of little predictive value for the Haglund syndrome.

The results of articulating spacer technique for infected total knee arthroplasty

In 19 patients with infected total knee arthroplasties, 21 knees were treated with debridement, component removal, and insertion of articulating spacer followed by second-stage total knee arthroplasty revision. A modified V-Y quadricepsplasty was to obtain adequate exposure in 6 cases. Average length of follow-up was 52.2 months. The mean knee score with the articulating spacer was 60.5 points. The mean knee score after revision was 80.6, with good--to--excellent results achieved for 80.9% of the knees. The average range of motion was 85 degrees for the knees with articulating spacer and 97.6 degrees after reimplantation. There was one recurrence of infection at the final follow-up. We conclude that the articulating spacer can improve knee mobility and function during the interval between stages without incurring additional risk of infection.

Chondromalacia of trochlear notch after healing of olecranon stress fracture: a case report

INTRODUCTION

Chondromalacia of the trochlear notch and stress fracture of olecranon are uncommon injuries in the throwing athletes.

MATERIALS AND METHODS

We report an 18-year-old high school pitcher who had persistent postero-lateral elbow pain after a healed olecranon stress fracture of the right elbow. Diagnostic arthroscopy revealed chondromalacia of the trochlear notch.

RESULTS

After treatment with arthroscopic drilling and abrasion chondroplasty, he returned to competitive pitching 1 year later postsurgery. This rare association between chondromalacia and stress fracture of the olecranon has not been reported previously in the literatures.

CONCLUSION

Chondromalacia of the trochlear notch should be included as a differential diagnosis in evaluating athletes with persistent elbow pain after healed olecranon stress fractures.

Use of an External Fixation Combined with the Buttress-Maintain Pinning Method in Treating Comminuted Distal Radius Fractures in Osteoporotic Patients

BACKGROUND

It is difficult to keep the alignment of a distal radius fracture in patients with osteoporosis and prevent malunion. Therefore, we hoped to design better method to maintain alignment.

METHODS

Thirty-two patients over 65 years old with a displaced unstable distal radius fracture were treated by the external fixator combined with buttress-maintain pinning method and were compared with a group of 66 patients less than 60 years old treated by the same method.

RESULT

The radiologic results demonstrated that postoperative and final radial length and volar tilt were not statistically different between both groups. The functional result (excellent and good) in the elderly group was 87.5% and 89% to that of the control group. There was only one complication of pin tract infection in the elderly group.

CONCLUSIONS

External fixation for unstable distal radius fracture combined with buttress-maintain pinning method can be used in the osteoporotic bone of older adults with results similar to those for young adults at 18 months follow-up.

Investigation of management models in elite athlete injuries

This cross-sectional study investigated management models among elite athletes participating in sports including baseball, basketball, soccer, volleyball, tennis, softball, football, handball, track and field, swimming, judo, tae-kwon-do, gymnastics, archery, and weight lifting at the Tsoying National Sport Training Center. Data were collected by questionnaire. Of the 393 athletes investigated, 56% were male and 44% were female, with an average age of 20.9 years and average length of athletic experience of 9.8 years. At the time of the survey, 74.8% had sporting injuries and were being treated with Chinese and/or Western medicine. Among injured athletes, 14.5% chose Western treatment, 8.1% chose Chinese medicine, and 75.4% received combined treatment. There were various reasons for choosing the management model. Most athletes had ordinary self-recognition of sports injury prevention. Their qualified ability for sports injury prevention was 70%. This ability was significantly correlated with age, education, and sports experience. Within Taiwan's current medical and social environment, elite athletes prefer a combination of Eastern and Western treatments for sports injuries. Each of the medical approaches are widely accepted by elite athletes and their coaches. Doctors trained in Western medicine should learn these alternative treatment methods and apply them effectively in athletes, so that a better medical network can be established.

Revision of ankle arthrodesis

From 1989 to 1996, we treated 18 cases (10 males, eight females; average age 48.2 years) of failed ankle arthrodesis by revision of ankle arthrodesis and followed their progress for at least two years. The average time interval between original surgery and revision was 17.3 months. Revisions were needed due to infection in one case, nonunion in 10 cases, and malalignment in seven cases. The salvage operations included debridement in the infected case, refreshed pseudoarthrosis in nonunion cases, and corrective osteotomy in malalignment cases. Sixteen cases were fixed by crossed screws with internal compression, one infected case was fixed by an external fixator, and one case with bone loss was fixed with buttress plate. The average follow-up period was 40.4 months. There was one nonunion and two delayed unions, with an ultimate fusion rate of 94%. The average AOFAS ankle-hindfoot score was 70.9 at final follow up. There was one excellent result (5.6%), five good results (27.8%), 11 fair results (61%), and one poor result (5.6%), and the overall results were poorer compared with our series of primary arthrodesis. The time to fusion also took longer in the revision cases (average 2.7 months in primary cases and 4.8 months in revision cases). Fusion techniques that ensure solid union in a functional position are essential. If an ankle arthrodesis fails, however, revision is a salvage procedure that can achieve an acceptable result.

Langerhans cell histiocytosis of bone--a case report

Langerhans cell histiocytosis of bone causes bone destruction and frequent bone reactions that mimic benign and malignant neoplasms as well as osteomyelitis. The bony lesion of Langerhans cell histiocytosis consists of histiocytes with variable numbers of eosinophils, lymphocytes, and neutrophils. We present a rare case of Langerhans cell histiocytosis of bone, including imaging studies and pathology. In addition, we discuss the classification and pathology of Langerhans cell histiocytosis.

mRNA differential display identification of thyroid hormone-responsive protein (THRP) gene in association with early phase of long-term potentiation

The process of long-term potentiation (LTP) consists of the early induction and late maintenance phases. Few studies have examined the cellular mechanisms underlying these two phases; their respective mRNA expression profiles have not yet been elucidated. Here we used the technique of PCR differential display to identify genes that are differentially expressed between the early and late phases of LTP in vivo. Our results indicated that the cDNA fragment corresponding to one mRNA with preferentially increased expression during the early, but not late, phase of LTP encodes the rat thyroid hormone-responsive protein (THRP) gene. In situ hybridization analysis confirmed the results obtained from the PCR differential display. Prior NMDA receptor blockade with MK801 prevented induction of LTP and decreased THRP mRNA expression in the dentate gyrus, as assayed by quantitative RT-PCR analysis. THRP antisense oligonucleotide treatment before tetanic stimulation also prevented induction of LTP. However, when THRP antisense oligonucleotide was administered after induction of LTP, it did not affect expression and maintenance of LTP. THRP is known to be responsive to thyroid hormone. Our results indicate that direct thyroid hormone (T3) injection into the dentate gyrus produces a long-lasting enhancement of synaptic efficacy of these neurons. T3 injection also markedly increased THRP mRNA expression in the dentate gyrus. Taken together, our results suggest that THRP mRNA expression plays an important role in the early phase, but not the late phase, of LTP and that both THRP and thyroid hormone are involved in synaptic plasticity in hippocampal neurons.

Idiopathic frozen shoulder treated by arthroscopic brisement

Arthroscopic brisement serves as an useful procedure in the treatment of idiopathic frozen shoulder. This series included 186 shoulders with a diagnosis of idiopathic frozen shoulder who had symptoms for an average of 8 months and failed conservative treatment of at least 12 weeks. Using the arthroscopic brisement (distension, debride, release and manipulation) to treat the idiopathic frozen shoulder, it is beneficial not only to detect the inside lesion but also a solution to the problem of stiffness. The average follow-up time was 23 months from 6 months to 5 years. One hundred and seventy (92%) of 186 shoulders had yielded overall satisfactory results in this series. There was no relationship between the end result and the initial pathologic condition. We believe that arthroscopic brisement is an effective way of shortening the course of frozen shoulder and should be considered when conservative treatment has failed.

Management of oral and maxillofacial radiology clinics in Taiwan's dental schools

OBJECTIVES

To investigate management of Taiwanese dental school Oral and Maxillofacial Radiology (OMFR) clinics and to suggest alternative management strategies.

METHODS

A management questionnaire was designed for the faculty responsible for teaching the Oral and Maxillofacial Radiology curriculum.

RESULTS

Data from all seven Taiwanese schools indicated inadequate supervision of the prescription of radiological examinations in the absence of guidelines. Most schools are understaffed and not properly equipped. There is a significant shortage of trained dentists in the field of OMFR. In some schools no dentist is involved in the management of OMFR clinics. Some aspects of quality assurance procedures should be enhanced. An average of 21.4% of films were reported lost, with the highest rate at 40%, demonstrating serious problems in image archiving. Clinician satisfaction with clinic management averaged 74.3%, with a minimum of 50%.

CONCLUSION

A set of standards is recommended by the Taiwanese OMFR Association after reviewing the survey findings. Prescription for OMFR examination should be supervised by licensed clinicians, and there is a need for guidelines. Trained and dedicated personnel should be assigned for the management of OMFR clinics. More quality assurance procedures should be performed. A computer-based image archiving system is desirable.

The relationship between radiologic interpretation and root tip fracture during tooth extraction performed by junior clinicians

OBJECTIVES

The purpose of this study was to analyze the relationship between root tip fracture and radiologic interpretation of root morphology on periapical radiographs during third molar extraction performed by junior clinicians.

METHODS

Before tooth extraction, periapical radiographs of 107 patients with 116 third molars were evaluated by junior clinicians, all with less than 5 years of clinical experience. Radiologic interpretations of root morphology-including number, curvature, fusion, and accessory root-were recorded before each extraction. The clinicians were also asked to estimate the possibility of root fracture on a Visual Analogue Scale before the procedure. The exact morphology of the extracted teeth was recorded after the extraction for the purpose of comparison.

RESULTS

Twenty-nine of 116 teeth extracted were not correctly interpreted in at least 1 of the morphologic categories surveyed. The average expected fracture rate of nonfractured teeth was 23.1%, whereas the average expected fracture rate of fractured teeth was a significantly higher 50.3%. Misinterpretation of root morphology on radiographs decreased with increased clinical experience. Senior residents had the lowest misinterpretation and fracture rate. Logistic regression analysis showed that fracture is most closely related to the estimated fracture rate (4.95) and is also significantly related to underestimation of root curvature (0.95; 24.56 with 2 df of chi-square, P = .0001).

CONCLUSIONS

Misinterpretation of root morphology on radiographs occurred in 25% of the teeth. Root curvature was the most misinterpreted item studied. Fracture was most closely related to the estimated fracture rate. Junior clinicians in this study expected that only 50% of the fractured teeth would fracture, reflecting a general underestimation of root tip fracture. Further study should be performed to evaluate how to increase the accuracy of root curvature interpretation.

Determination of 8-Oxoguanine in Individual Cell Nucleus of Gamma-Irradiated Mammalian Cells

8-Oxoguanine, through its ability to mispair bases other than cytosine, is assumed to be one of the most potent premutagenic lesions in nuclear DNA damaged by reactive oxygen radicals. In this study, we examine whether the presence of residual 8-oxoguanine can be detected in mammalian cells after exposure to ionizing radiation. MOLT-4 human leukemia cells and CHO-K1 Chinese hamster cells were acutely irradiated in vitro with 0, 0.2, 0.4, 0.6 and 1.0 Gy gamma radiation at room temperature. The amounts of 8-oxoguanine and total DNA in the cell nucleus were detected by fluorescein-isothiocyanate (FITC)-labeled avidin, which binds specifically and directly to 8-oxoguanine, and propidium iodide, respectively. The intensity ratios between these two fluorescent dyes were then taken as indices to measure the content of 8-oxoguanine within individual cells. We found an apparent dose-dependent increase in the amount of 8-oxoguanine accumulated in cells of both lines. Moreover, the content of 8-oxoguanine decreased from 2 to 20 h after irradiation in CHO-K1 cells, which may reflect the time-dependent repair processes at the 8-oxoguanine lesions. This novel approach may provide a sensitive tool for in situ measurement of 8-oxoguanine in cells or even in the human body after exposure to ionizing radiation.

Group learning factors in a problem-based course in oral radiology

OBJECTIVES

To assess the development of group dynamics in students who participated in a problem-based learning (PBL) course in oral radiology and to evaluate the influence of the facilitators' experience.

METHODS

At the beginning and end of the course, students in three consecutive years (1997, 1998 and 1999) responded to a group learning factor questionnaire designed to measure group dynamics (engagement, interpersonal relationships, lack of commitment and disruptive behaviour, interpersonal learning and self-presentation). The answers were analysed with paired t-test and the effects of the facilitator's seniority, expertise in oral radiology, experience of PBL and single or rotating facilitators assessed.

RESULTS

Most groups in the three years reported above average group dynamic scores. There were significant changes in group dynamics. In the 1997 class, interpersonal relationships improved (P=0.014). In the 1998 class, interpersonal learning (P=0.021) and engagement (P=0.009) increased significantly, while disruptive behaviour decreased (P=0.031). In the 1999 class, lack of commitment and disruptive behaviour decreased (P=0.014). Groups led by a junior faculty member with no previous experience of PBL show less commitment and more disruptive behaviour.

CONCLUSIONS

More commitment and less disruptive behaviour and improved engagement, interpersonal relationships and self-presentation were found in a PBL course in oral radiology. Facilitators should have prior exposure to PBL to avoid disruptive behaviour among the students.

Integration of the digital imaging and communications in medicine standard into an oral and maxillofacial image management and communication system

OBJECTIVE

The purpose of this study was to provide developmental information about digital imaging and communications in medicine (DICOM) support applications for an image management and communication system (IMACS).

STUDY DESIGN

An oral and maxillofacial radiology IMACS that uses a proprietary image format was implemented in March 1997 in a general hospital dental clinic that supports more than 100 cubicles. DICOM was implemented into this system in 1998.

RESULTS

In March 1997, the clinic directly began processing oral and maxillofacial radiographs with digital image acquisition devices or converted them into proprietary digital format with a film digitizer. The digital images could then be viewed at workstations in the 11 different divisions of the department. A DICOM module was implemented to convert proprietary images into DICOM in June 1998. After the release of DICOM Supplement 32 on a digital x-ray, DICOM was implemented into the oral and maxillofacial radiology IMACS with a DICOM server and browser in June 1999. We describe the steps we took to implement this system in our institution with a brief report on the evaluation of this system.

CONCLUSION

We implemented a DICOM oral and maxillofacial IMACS that complies with the American College of Radiology and the National Electrical Manufacturers Association Standard DICOM, version 3.0. Most DICOM service classes and roles are supported.

Comparison of landmark identification in traditional versus computer-aided digital cephalometry

The aim of this study was to assess landmark identification on digital images in comparison with those obtained from original radiographs. Ten cephalometric radiographs were selected randomly. Seven orthodontic residents identified 19 cephalometric landmarks on both the original radiographs and the digital images. To assess the concordance between landmarks identified on the original radiographs and on their digital counterparts, the x, y coordinates for each landmark in the 2 modalities were transformed with the identical references. The placement differences for 19 landmarks between 2 methods were calculated and their components in horizontal and vertical directions were analyzed respectively. Multivariate analysis of variance showed that the "cephalometric radiograph" and "landmark" variation had greater influence than that from "method" (landmark identification on digital / original radiograph). It was also noted that the differences of landmark identification between original radiographs and their digital counterparts were statistically significant. The landmarks with significant differences of horizontal component on the x-axis were Me, Gn, ANS, PNS, LIA. The differences were generally under 1 mm with the exception of Or, Me, PNS, LIA. The landmarks with significant differences of vertical component on the y-axis were Po, Or, Gn. The inter-observer error for each landmark in digital images was generally larger than that in the original radiographs. However, statistically significant differences of inter-observer errors between 2 modalities were only found for 4 of the 19 landmarks. These 4 landmarks, Po, Ar, ANS, and UM, should be scrutinized more carefully during potential applications of digital cephalometry.

Splice site mutation in the type VII collagen gene (COL7A1) in a Taiwanese family with recessive dystrophic epidermolysis bullosa

BACKGROUND AND PURPOSE

Generalized recessive dystrophic epidermolysis bullosa (RDEB) is a severe inherited disease, in which patients suffer from blistering and scarring of the skin and mucous membranes after minor mechanical trauma. Tight genetic linkage has been established to the type VII collagen gene (COL7A1) at 3p21. The purpose of this study was to identify mutations in COL7A1 in one Taiwanese pedigree with generalized RDEB.

METHODS

Genomic DNA was used as the template for polymerase chain reaction (PCR) amplification of all 118 COL7A1 exons and the flanking splice junctions. PCR was followed by heteroduplex analysis of the products by single-strand conformation polymorphism (SSCP) studies, and direct nucleotide sequencing was used to search for mutations, which were verified by restriction endonuclease digestion.

RESULTS

We identified a homozygous intronic splice-site at the +1 position of intron 5 (682 + 1G-->A) of COL7A1 in the affected individual. His parents, who were cousins, were not affected by this disease. The mother was heterozygous for the mutation; the father had died before the study, of unrelated causes. This mutation results in a frameshift and downstream stop codons on both alleles, indicating an absence of functional protein. Restriction endonuclease BspHI can be used to verify this mutation and screen other members in the same family.

CONCLUSIONS

These molecular findings offer a genetic explanation for the skin fragility in this Taiwanese patient with RDEB. The immediate benefits gained by elucidating mutations in family members include the ability to assess whether they are carriers of this disease and the ability to use this DNA-based method for prenatal testing in subsequent pregnancies.

Correlation of genetic instability with mismatch repair protein expression and p53 mutations in non-small cell lung cancer

To examine the etiological association of genetic instability in lung tumorigenesis, we investigated the frequency of microsatellite instability (MI) of eight dinucleotide repeat markers in 68 patients with non-small cell lung cancer. Twenty-eight patients (41.2%) evidenced instability in multiple tested microsatellite markers ranging from 3-7 and were defined as MI-positive patients. MI occurred more frequently in patients suffering from squamous cell lung carcinoma (P = 0.004). We examined the association between MI and expression of hMLH1 mismatch repair protein by immunohistochemical analysis of hMLH1 protein in paraffin-embedded tumors from 64 patients. Twenty MI-positive patients (76.9%) had no expression of hMLH1 protein. The data showed that MI was associated with altered hMLH1 expression (P = 0.03). To examine the role of genetic instability in the previous identified small intragenic deletion of the p53 gene, we explored the association between MI and p53 gene mutations. All patients, except one, containing small intragenic deletion in p53 gene showed MI (P = 0.018). In addition, we found that MI was not associated with the prognosis. Our data suggest that MI plays a significant role in non-small cell lung cancer tumorigenesis in Taiwan and that MI is associated with the altered expression of hMLH1 mismatch repair protein. In addition, MI may be involved in frequent small intragenic deletions of p53 gene.

Greater tuberosity osteotomy for treatment of impinge rotator cuff tear

Forty-two consecutive patients in whom an impingement of rotator cuff tear had been treated with greater tuberosity osteotomy and repair were evaluated by relief of pain, return of range of motion and strength of shoulder. The oriental acromion is thin and easy to break during the traditional acromioplasty procedures. When the decompression is achieved by osteotomy on the greater tuberosity which is the common location of cuff tear, not only is adequate decompression achieved but also the coracoacromial ligament is preserved. Comparison of the results of greater tuberosity osteotomy with those of previous acromioplasty studies shows they are mostly similar. At present, these techniques can be recommended for use by Chinese orthopaedic surgeons who have to deal with the typical oriental bony structures.

An electronic survey of opinions on the compatibility of current X-ray generators with intra-oral digital X-ray systems

OBJECTIVES

To assess opinions on the compatibility of current X-ray generators with intra-oral digital X-ray systems.

METHODS

A questionnaire was posted in both English and in Japanese on oral and maxillofacial radiology electronic bulletin boards. The questionnaire was also mailed to selected researchers and manufacturers in oral and maxillofacial radiology. The replies were evaluated to determine opinion on the current and future status of digital intra-oral imaging with special reference to their compatibility with current X-ray generators.

RESULTS

Seventy-one replies were received from 19 countries: 39% from Japan and Korea, 27% from North America, 25% from Europe and 8% from the rest of the world. Eighty per cent of respondents were from academia, 15% from industry and the remainder largely in private practice. Respondents' experience was equally divided between solid state, mainly charge-coupled devices (CCDs) and photostimulable phosphor (IP) technologies. Sixty-eight per cent considered that current X-ray generators are compatible with intra-oral digital systems and many believed this was due to their gray scale flexibility. Twenty-eight per cent believed that existing X-ray generators are inconsistent with low exposure times. Many of the replies suggested that in future pixel size would decrease and bit depth and receptor sensitivity increase.

CONCLUSIONS

Most respondents are happy to use existing X-ray generators with digital X-ray systems. However, they also believe that increased sensitivity of receptors could lead to more stringent designs of X-ray generators to ensure more reliable outputs in the low exposure range.

Influence of polymorphism at p53, CYP1A1 and GSTM1 loci on p53 mutation and association of p53 mutation with prognosis in lung cancer

BACKGROUND

We previously found that the majority (9/11) of p53 tumor suppressor gene mutations in 60 lung cancer patients in Taiwan were small intragenic deletions and nonsense mutations. To gain insights into the possible etiologic factors involved in these mutations and the prognostic significance of p53 gene mutations in lung cancer in Taiwan, we investigated the influence of polymorphism at p53, cytochrome p450 1A1 (CYP1A1) and glutathione S-transferase M1 (GSTM1) loci on p53 gene mutation, and the association of p53 gene mutation with prognosis in these lung cancer patients.

METHODS

The polymorphism of these genes was determined by polymerase chain reaction followed by restriction enzyme digestion. The Pearson chi 2 test was used to compare allelic distributions between lung cancer patients and controls. The log-rank test was used to assess the significance of the survival differences between patients with and without p53 mutations.

RESULTS

There was no significant difference with respect to the genotype distribution of p53, CYP1A1 and GSTM1 polymorphisms between patients with and without p53 mutations, although a tendency toward increasing frequency of the wild-type homozygote genotype of p53 polymorphism was noted in lung cancer patients containing p53 mutations. We further analyzed the association of p53 mutation with prognoses in lung cancer patients for whom postoperative survival data were available. The estimated median survival times for patients with and without p53 mutation were 25 and 28 months, respectively. There was no significant correlation between p53 mutation and survival.

CONCLUSIONS

Our data suggest that p53 gene mutation may not be associated with polymorphisms of p53, CYP1A1 and GSTM1 genes, and it may have no significant effect on the prognosis of lung cancer patients in Taiwan.

Prognostic significance of p53 codon 72 polymorphism in lung carcinomas

Lung cancer is the leading cause of cancer death in Taiwan. Potential molecular markers associated with cancer susceptibility and prognosis are the genes involved in tumorigenesis. Therefore, we investigated the association of p53 codon 72 polymorphism with prognosis in 114 lung cancer patients. The estimated median survival times for patients with proline (Pro)/Pro, arginine (Arg)/Arg, and Arg/Pro genotypes were 25, 26 and 36 months, respectively. We also found that patients with the Pro/Pro genotype had a worse prognosis compared with those with Arg/Pro genotypes, especially for patients with squamous cell lung cancer (P = 0.013), male patients (P = 0.028) and those aged 60-69 years (P = 0.052). In patients with early stage lung cancer, patients with Pro/Pro and Arg/Arg genotypes had a tendency for a worse prognosis than those with the Arg/Pro genotype (P = 0.057). Our data suggest that p53 codon 72 polymorphism may be a potential prognostic factor in certain sub groups of lung cancer patients in Taiwan.

Radiographic evaluation of glenohumeral kinematics: a muscle fatigue model

The purpose of this study was to document the effect of muscle fatigue on glenohumeral kinematics. Twelve male volunteers without shoulder disease and with an average age of 27 years were studied. Glenohumeral anteroposterior radiographs were taken at 45 degrees intervals as the arm was abducted in the plane of the scapula from 0 degree to 135 degrees. This series of radiographs was performed both before and immediately after the subject performed a series of deltoid and rotator cuff fatiguing exercises. The average humeral head position or translation before and after muscle fatigue for each arm angle was compared. For all subjects, before fatigue, the position of the humeral head was below the center of the glenoid for all angles of abduction. There was essentially no change in position of the humeral head in the prefatigue state, as the arm was abducted from 0 degree to 135 degrees with no more than an average 0.3 mm of total humeral head excursion. After fatigue, excursion of the humeral head increased to an average of 2.5 mm between the tested positions. The position of the humeral head with the arm at 0 degree of abduction was lower or had migrated inferiorly compared with the rested state, with an average 1.2 mm significant increase in inferior translation. With the initiation of abduction, the humeral head demonstrated significant superior migration or translation in all positions tested. This result has important implications for conservative treatment of shoulder impingement and underscores the importance of rehabilitation to maximize the endurance and strength of the rotator cuff musculature.

p53 codon 72 polymorphism in Taiwanese lung cancer patients: association with lung cancer susceptibility and prognosis

An association between the BstUI (Pro/Pro) genotype of the p53 codon 72 polymorphism and lung cancer has been reported previously (X. Jin et al., Carcinogenesis (Lond.), 16: 2205-2208, 1995). However, the genotype distribution of p53 codon 72 polymorphism as well as the association of this polymorphism with lung cancer risk and prognosis remain undefined in the Taiwanese population. Therefore, we investigated the genotype distribution of p53 codon 72 polymorphism in 194 lung cancer patients and 152 noncancer controls. The genotype frequencies in Taiwanese noncancer controls were 0.56 (Arg) and 0.44 (Pro). Chi2 analysis indicated significant differences in genotype distribution of p53 from other reports in Swedish (P < 0.001), Spanish (P < 0.001), Caucasians in the United States (P = 0.002), and African-Americans (P = 0.027). In addition, our data suggest that the Pro allele of the p53 codon 72 polymorphism increased the risk of lung cancer among female Taiwanese. The female patients with genotype Pro/Pro showed a significantly increased odds ratio (3.14; confidence interval, 1.48-6.64; P = 0.003) of having lung adenocarcinoma, compared with normal controls with the other genotypes. Patients with the Pro/Pro genotype had an odds ratio of 2.63 (confidence interval, 1.22-5.68; P = 0.01) higher than those with the other genotypes to be diagnosed with lung cancer at the early ages. We further investigated the association of p53 codon 72 polymorphism with prognosis in 133 lung cancer patients. Patients with the Pro/Pro genotype tended to have poorer prognosis than those with the Arg/Pro genotype (P = 0.05, by the log-rank test). Our data suggested that p53 codon 72 polymorphism may play a role in cancer susceptibility and prognosis in specific classes of lung cancer patients in Taiwan.

Analysis of K-ras gene mutations in lung carcinomas: correlation with gender, histological subtypes, and clinical outcome

PURPOSE

Lung cancer is respectively the leading and second-leading cause of cancer deaths among women and men in Taiwan. The commonest pathological type of lung carcinoma found in Taiwan is adenocarcinoma. and it has been documented that K-ras oncogene mutation occurs in a subset of lung adenocarcinoma. We therefore investigated the mutation spectrum and clinicopathological significance of K-ras oncogene mutations in lung cancer patients in Taiwan.

METHODS

The lung tumors were surgically resected from 84 lung cancer patients. DNA was isolated and the mutation spectrum was examined by direct sequencing. These data were also correlated with the clinicopathological characteristics of patients.

RESULTS

K-ras gene mutations were detected in 5 cases among the 84 patients investigated (6.0%). The majority of mutations occurred in exon 1 (80%, 4 of 5) and were located mainly in codons 12 and 13. Two patients had G x C --> T x A transversions and 2 patients had G x C --> A x T transitions. Notably, 1 patient had a G x C base-pair deletion from the contiguous G x C base pairs located between codons 68 and 69. All mutations occurred in male patients who were smokers. The incidences of K-ras gene mutation among male and female patients with adenocarcinoma were 13% and 0% respectively. Patients with K-ras gene mutation survived for shorter periods than those without mutations (P = 0.08, by the log-rank test).

CONCLUSIONS

The incidence of K-ras gene mutations for male and female patients with adenocarcinoma was 13% and 0% respectively. Thus, the role of K-ras in the development of lung adenocarcinoma among Chinese men who are predominantly smokers is not significantly different from that in other populations worldwide. However, K-ras mutations may not be associated with adenocarcinoma among women in Taiwan, who are virtually all nonsmokers.

Implementation of an oral and maxillofacial radiology image management and communication system

OBJECTIVES

To implement an oral and maxillofacial radiology image management and communication system (OMFR IMACS) in the School of Dentistry, National Taiwan University.

METHODS

An OMFR IMACS has been implemented over 3 years in three phases: (1) Establishment of an OMFR image processing laboratory for research and graduate student training; (2) Installation of network infrastructure and (3) Total system integration.

RESULTS AND CONCLUSIONS

Intraoral, panoramic, cephalometric, and TMJ radiographs are directly processed with digital image acquisition devices or are converted into a digital format for viewing via UTP cable through FastEthernet in the eleven different divisions of the school. The system archives about 400 Mb of imaging data daily, representing 80% of the workload of the OMFR Division. The system is now used parallel to the conventional film-library system and has been integrated as part of the oral health service.

The effects of projection geometry and trabecular texture on estimated fractal dimensions in two alveolar bone models

OBJECTIVES

To study the effects of trabecular texture and projection geometry on estimates of fractal dimensions from simulated alveolar bone.

METHODS

Two models, one scale-variant and the other relatively scale-invariant, were used. Projections of 2-D slices through both the models were calculated, a uniform series of projections computed for the angular orientations between (0 degree and 180 degrees). Results of the 128 stacked projections are the projection of the 3-D object from different angles. Power spectra were produced by calculating the squared magnitude from the data and plotted as the logarithm of the power against the logarithm of the frequency, to give the fractal dimension.

RESULTS

In the scale-variant model, the alveolar trabecular texture produced with a relatively thicker cylindrical diameter yielded a smaller fractal dimension (t = 8.44, P = 0.00). Linear regression analysis showed that the correlation between projection angle and the resulting fractal dimension was low for both the thicker cylinder (r = 0.02, P = 0.82), and for thinner cylinder (r = 0.02, P = 0.84). The scale-invariant model, also yielded a relatively smaller estimated fractal dimension (t = 7.23, P = 0.00). However, the correlation between projection angle and the resulting estimate of the fractal dimension was found to be low for both trabecular configurations (r = 0.10, P = 0.29 and r = 0.07, P = 0.45 respectively).

CONCLUSIONS

Fractal dimensions increased when the diameter of the simulated cylindrical trabeculae decreased irrespective of the differences in self-similarity. The degree to which they varied with projection angle was relatively less for the scale-invariant (self-similar) model. However, fractal dimensions changed significantly with projection geometry.

High frequency of deletion mutations in p53 gene from squamous cell lung cancer patients in Taiwan

Lung cancer is the leading and second-leading cause of cancer deaths among women and men in Taiwan, respectively. However, the molecular mechanisms involved in lung tumorigenesis in Taiwan remain poorly defined. A study that analyzed the mutation spectrum of the p53 tumor suppressor gene in 35 female lung cancer patients in Hong Kong showed that a high proportion of the mutations observed were deletions, suggesting the possible involvement of a distinct mutagenic factor(s) in Chinese female lung cancer patients (Y. Takagi et al., Cancer Res., 55: 5354-5357, 1995). Therefore, to gain insight into the role of the p53 tumor suppressor gene and possible etiological factors in lung tumorigenesis in Taiwan, we investigated the mutation spectra of exons 4-11 in the p53 tumor suppressor gene of 60 lung cancer patients in Taiwan. These data were also correlated with clinical pathological characteristics of patients. Lung tumors were surgically resected, genomic DNA was isolated, and their mutation spectra were examined using PCR/single-strand conformational polymorphism analysis and direct sequencing. The frequency of p53 gene mutation was 18% (11 of 60). However, distinct patterns of p53 gene mutation were observed. Seven of 11 mutations detected (64%) were deletions of 1-12 bp at G:C bp or at bp in the immediate vicinity of repetitive sequences and/or tandem repeat sequences. In addition, two patients (2 of 11, 18%) exhibited nonsense mutations. In contrast to the frequent occurrence of missense mutations in the p53 gene reported in the literature, the majority (82%) of the mutations in lung cancer patients in Taiwan were nonmissense mutations, ie., deletions and nonsense mutations. Immunohistochemical staining indicated that p53 mutations including non-in-frame deletions and nonsense mutations all resulted in no expression of p53 protein. Notably, mutations occurred more frequently in patients suffering from squamous cell carcinoma (SQ). Nine of 31 SQ patients (29%) exhibited deletions or nonsense mutations, suggesting that deletions and nonsense mutations in the p53 gene are involved in the formation of SQ in Taiwan. In addition, mutations occurred more frequently in patients with stage III or IV lung cancer. However, mutations were not correlated with patients' smoking habits. Our data suggest that p53 gene mutation involved in the formation of SQ and distinct environmental factor(s) and/or genetic factor(s) that induced specific short deletions in repeat sequences may be involved in lung tumorigenesis in Taiwan.

Subtalar arthrodesis for subtalar arthritis

Primary subtalar arthritis is not common except in cases of generalized arthritis such as rheumatoid arthritis. The majority of subtalar arthritis results from intraarticular calcaneal fractures. Arthrodesis seems to be the only way to solve this problem. Thirteen patients (15 feet) were treated with subtalar arthrodesis at KMCH. Preoperative diagnosis included 13 feet with traumatic arthritis secondary to a calcaneal fracture, one foot with rheumatoid arthritis and one foot with primary osteoarthritis. The mean follow up period was 24.9 months. Lateral approach without fibular osteotomy was done with decompression if there was entrapment syndrome and the arthrodesis were accomplished with use of staples for internal fixation. Eleven (85%) of the patients were satisfied with the results. Objectively, the results were excellent after 11 arthrodesis (73%), good or fair after three (20%), and poor after one (7%). There was no nonunion. Complications occurred in 1 patient who developed superficial wound infection, and in 1 patient with staple loosening. Though there was no case of nonunion, the fusion time was rather long. This might have been due to the fixation method because staples can not provide compression force which accelerates union. We believe subtalar arthrodesis is appropriate for isolated subtalar arthritis unless there are associated talonavicular or calcaneocuboid arthritis in which case triple arthrodesis will be more appropriate.

Salvage operation for neglected ankle fractures

From 1986 to 1993, 49 cases of untreated or poorly treated ankle fractures who received salvage surgery were followed up for an average of 36.4 months. The patients included 31 males & 18 females with an average age of 41.6y/o and the time interval from initial injury to reconstructive surgery average due 17.6 months. They were classified and treated according to their grade of reduction and degree of arthrosis. The surgical methods included arthrotomy & joint debridement, revised open reduction, lower tibial osteotomy and ankle arthrodesis, depending on different individual conditions. After surgery, all cases had symptomatic relief and functional improvement with an average score increased from 26.3 preoperatively to 86.8 at follow up. The goals of ankle fractures is as articular fractures, they are treated by surgical anatomic reduction with rigid fixation as early as possible in order to provide good functional results. Nevertheless they are varied in neglected ankle fractures according to their individual conditions: open reductions were performed on cases with no or little arthritic change even though arthrosis might occur later because, if necessary, future conversion to osteotomy or arthrodesis would be easier. As for late cases with advanced arthritis, ankle arthrodesis were done by compressive arthrodesis with necessary bone graft to secure fusion in an optimal position.

Digitizing of radiographs with a roller-type CCD scanner

OBJECTIVES

Roller-type scanners can be used to digitize radiographs. This study evaluated the physical performance of a roller-type scanner with regard to dynamic range, scan reproducibility, and homogeneity.

METHODS

A VXR-12 (Vidar System Corp., Herndon, Va.) roller-type scanner with imaging editing software Paint Shop Pro (JASC Inc., Minnetonka, Minn.) was used to digitize a step tablet image on Kodak T-MAT G films (Kodak, Rochester, N.Y.). The step tablet image was scanned at various locations and with different scanning settings. The pixel values of the resulting image were analyzed. The step tablet image was also scanned by a Wellhofer WD 102 Filmdensitometer (Wellhofer Dosimetrie, Schwarzenbruck, Germany) to measure the optical densities of the steps on the film for comparison.

RESULTS

With the use of the default scanning settings the digitized images had pixel values distributed in a similar dynamic range to that of the film densitometer. This scanner produced consistent images with different scanning positions, different orientation of the images, and different power states of the scanner.

CONCLUSIONS

This roller-type scanner has a similar dynamic range to that of the film densitometer. The operating condition of the scanner is stable, and the resulting image is not significantly affected by the scanning positions. This type of scanner should be suitable for digitizing dental x-ray films, although the limiting scanning resolution might not be sufficient for some diagnostic purposes.

Surgical treatment of complete acromioclavicular separations

A retrospective study of fifty-two patients (48 cases followed up), with Allman-Tossy grade III acromioclavicular separations, who were treated with coracoclavicular reconstruction by Mersilene prosthetic substitute (Mersilene tape with polyester suture, 5 mm wide, 30 cm, Ethicon), was carried out. The average follow up was 38 months, with the longest being 10 years, and the shortest being 8 months. The average age of the patients was 32 years, with a range from 20 to 62 years. Two groups were divided by age. Although the younger age group showed better results than the elder one in pain, range of motion and return to previous occupation or sports, the overall outcome was satisfactory in 41 of 48 (86%) followed patients. For the grade III acromioclavicular separation patients, surgical reconstruction with Mersilene looping provides a reliable result including use of the arm for sports or repetitive work.