Abnormalities of the pericruciate fat pad: Correlations with the location and severity of chondral lesions of the knee

PURPOSE

The aim of this study was to evaluate the relationship between the grade of signal change of the pericruciate fat pad (PCFP) and the location and severity of cartilage alterations in the knee on magnetic resonance imaging (MRI).

MATERIALS AND METHODS

This retrospective study included 234 patients (M:F = 96:138, mean: 51 years) who underwent knee MRI. Two experienced musculoskeletal radiologists assessed any PCFP alterations (as grades 0-3) and chondral lesions using the modified Outerbridge grade (as grades 0-4). Bone marrow lesions (BMLs), meniscal status, anterior cruciate ligament alterations, and effusion-synovitis were also evaluated on the MRI. The relationships between PCFP alteration and MR findings (including the grade of chondral lesion) were evaluated.

RESULTS

Signal changes in the PCFP were detected in 150 cases by Reader 1 (grade 0, 67 cases; grade 1, 53 cases; grade 2, 21 cases; grade 3, 9 cases) and in 154 cases by Reader 2 (grade 0, 59 cases; grade 1, 61 cases; grade 2, 24 cases; grade 3, 10 cases). The grade of PCFP signal change was statistically significantly correlated with the grade of the chondral lesion of the medial femoral condyle (MFC) (p = 0.029 and p = 0.003, respectively) and the medial tibial plateau (MTP) (p = 0.045, p = 0.002, Readers 1 and 2, respectively). The grade of PCFP signal change was significantly correlated with the grade of the BMLs of the MFC, MTP, and lateral femoral condyle (p < 0.05) for both readers. PCFP alteration was related to effusion-synovitis and tears of the medial meniscus.

CONCLUSIONS

The grade of PCFP signal change was correlated with the severity of the cartilage alteration in the medial compartment of the knee joint and was also correlated with BMLs in the medial compartment, medial meniscal tears, and synovitis. Therefore, signal change in the PFCP seen on MRI can be an additional clue of the presence of osteoarthritis in the knee, particularly in the medial compartment.

Protruding anterior medial meniscus and posterior tibial translation as secondary signs of complete and partial posterior cruciate ligament tear

OBJECTIVE

To evaluate whether measurement of protruding anterior meniscus in the medial compartment (PAMM) and posterior tibial translation (PTT) can be used as a secondary sign of posterior cruciate ligament (PCL) tear for differential diagnosis of partial or complete tear.

METHODS

21 cases with complete PCL tear, 35 cases with partial PCL tear, and 55 normal cases were reviewed in this retrospective study. PTT and PAMM were measured from the MR images associated with each case. Non-parametric data were evaluated using the Kruskal-Wallis test and the Mann-Whitney U-test with Bonferroni correction to compare differences among the three groups: complete tear, partial tear, and controls.

RESULTS

There were significant differences in the median values of PAMM among the three groups, and with PAMM increasing as the grade of PCL injury increased. However, there were no significant differences in median PTT among the three groups. Median PAMM in the partial and complete tear groups was significantly higher than in subjects without PCL rupture (adjusted p-value <0.05). Although median PAMM in subjects in the complete tear group tended to be higher than in those with a partial tear, this difference was not statistically significant (adjusted p-values ≥0.418).

CONCLUSION

PAMM is more useful finding than PTT and can predict PCL tear with or without posterior instability. However, PAMM cannot differentiate partial tear and complete tear of the PCL.

ADVANCES IN KNOWLEDGE

PAMM is more useful finding than PTT and can predict PCL tear with or without posterior instability. However, PAMM cannot differentiate partial tear and complete tear of the PCL.

Recurrent umbilical varix rupture with hemoperitoneum: a case report and review of literature

Background

Non-traumatic hemoperitoneum was a rare event with the risk of sudden death. Spontaneous rupture of hepatocellular carcinoma is the most intuitive diagnosis when hemoperitoneum occurs in cirrhotic patients who are not regularly followed up. However, other etiologies of hemoperitoneum, such as intra-abdominal varix rupture, should be kept in mind.

Case presentation

A 44-year-old man with alcoholic liver cirrhosis, Child–Pugh B was sent to our emergency department (ED) because of recurrent abdominal pain and hypovolemic shock. He had similar symptoms one month ago and was diagnosed as hepatocellular carcinoma (HCC) rupture with hemoperitoneum, therefore he underwent trans-arterial embolization (TAE). However, the follow-up magnetic resonance imaging (MRI) showed less possibility of hepatocellular carcinoma. Contrast enhanced abdominal computed tomography (CT) showed possible umbilical vein contrast agent extravasation. Exploratory laparotomy confirmed the diagnosis of rupture umbilical varix with hemoperitoneum.

Conclusion

Although umbilical varix rupture is a rare cause of hemoperitoneum, it should be kept in mind in cirrhotic patients with unexplained hemoperitoneum.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-022-02167-3.

Surgical treatment of pelvic organ prolapse in women aged ≥75 years in Hong Kong: a multicentre retrospective study

INTRODUCTION

Pelvic organ prolapse (POP) is common among older women. With the increasing lifespan and emphasis on quality of life worldwide, older women increasingly prefer surgical treatment for POP. We reviewed the surgical treatment of POP in older women to characterise its safety, effectiveness, and the type most often selected.

METHODS

This multicentre, retrospective study was conducted at four hospitals between 2013 and 2018. Included patients were aged ≥75 years and had undergone POP surgery. We compared patient demographic characteristics, POP severity, and surgical outcomes between reconstructive and obliterative surgeries; these comparisons were also made among vaginal hysterectomy plus pelvic floor repair (VHPFR), transvaginal mesh surgery (TVM), vaginal hysterectomy (VH) plus colpocleisis, and colpocleisis alone.

RESULTS

In total, 343 patients were included; 84.3% and 15.7% underwent reconstructive and obliterative surgeries, respectively. Overall, 246 (71.7%), 43 (12.5%), 20 (5.8%), and 34 (9.9%) patients underwent VHPFR, TVM, VH plus colpocleisis, and colpocleisis alone, respectively. Patients who were older (81.9 vs 79.6 y; P=0.001), had vault prolapse (38.9% vs 3.5%; P<0.001), and had medical co-morbidities (37% vs 4.8%; P<0.001) chose obliterative surgery more frequently than reconstructive surgery. Obliterative surgeries had shorter operative time (73.5 min vs 107 min; P<0.001) and fewer surgical complications (9.3% vs 28.0%; P=0.003). Vaginal hysterectomy plus pelvic floor repair had the highest rate of surgical complications (most were minor), while colpocleisis alone had the lowest rate (30.1% vs 8.8%; P=0.01).

CONCLUSIONS

Pelvic organ prolapse surgeries were safe and effective for older women. Colpocleisis may be appropriate as primary surgery for fragile older women.

Postsurgical status of articular cartilage after arthroscopic posterior cruciate ligament reconstruction in patients with or without concomitant meniscal pathology

PURPOSE

Several factors present at the time of posterior cruciate ligament reconstruction (PCLR) may cause the subsequent progression of articular cartilage lesions. This study aimed to evaluate postsurgical articular cartilage lesions which can be seen on MRI in patients who underwent arthroscopic PCLR with or without concomitant meniscal pathology.

MATERIAL AND METHODS

A total of sixty-five patients (mean age 35.8 ± 12.3 years) who underwent arthroscopic PCLR were included in this retrospective study. Patients were divided into two groups: ten patients with concomitant meniscal injuries at the time of PCLR who underwent meniscal surgery and fifty-five patients with intact menisci. The cartilage status of all knees was evaluated by MRI and modified Noyes classification.

RESULTS

Cartilage lesions were observed in 18 patients (27.7%) on the last follow-up MRI. The cartilage lesions were more common in the medial (15.4%) and patellofemoral (12.3%) compartments than in the lateral compartment (7.7%). Progression of cartilage lesions was present in 11 patients (16.9%) during follow-up MRI. The majority of cartilage lesions with progression were located in the medial compartment. The meniscal pathology group showed a higher prevalence of articular cartilage lesions on the last follow-up MRI (21.8% versus 60%, p = 0.022). In multivariate Cox regression, concomitant meniscal pathology was significantly associated with progression of articular cartilage lesions (p = 0.044).

CONCLUSION

PCLR patients with associated meniscal pathology showed worse cartilage condition and more progression of cartilage lesions than isolated PCLR patients. Attention to this risk factor might provide more applicable treatment options for potential osteoarthritis prevention strategies.

Can ultrasound distinguish between dermatofibroma and subcutaneous epidermal tumors? - Imaging features and reproducibility

BACKGROUND

We evaluated ultrasound (US) features of dermatofibroma and epidermal tumor (ET). We also evaluated the reproducibility of each US findings.

MATERIALS AND METHODS

We retrospectively assessed US findings of 30 surgically confirmed dermatofibromas and 44 ETs, measuring the lesion (i.e., the depth and the length of the lesion) and calculating the depth to length ratio (DLR). We then determined the sharpness and the shape of the lesion. Finally, we assessed whether the lesion appeared with a "more-than-half sign" (involving more than 50% of the dermal layer) or a "submarine sign" (focal projection to skin). We used Pearson's chi-squared test to analyze the US findings (i.e., presence of more-than-half sign or submarine sign and margin sharpness) between dermatofibroma and ET. Inter-observer agreement of the image findings was assessed using kappa statistics.

RESULTS

The submarine sign and margin sharpness of ET lesions and the more-than-half sign and submarine sign in dermatofibroma, respectively, showed almost perfect agreement. Also, the more-than-half sign and shape of the lesion in ET and the margin sharpness and shape of the lesion in dermatofibroma showed substantial agreement. The measurements of DLRs showed excellent reproducibility. There were no significant differences of DLRs between two groups (p values = 0.512, 0.671, respectively). The more-than-half sign was observed more frequently in the context of dermatofibroma to a statistically significant degree (p < 0.001), while the submarine sign was statistically more common in relation to ET together with greater margin sharpness (p = 0.021 and <0.001, respectively).

CONCLUSIONS

More-than-half signs are common in dermatofibroma while submarine sign and sharp margin are common in ET. Each finding showed high reproducibility and can be useful as a sonographic marker for differentiation between ET and dermatofibroma.

Inter-observer reliability and clinical validity of the MRI grading system for cervical central stenosis based on sagittal T2-weighted image

PURPOSE

The aim was to evaluate the inter-observer reliability of the Kang system among radiologists, residents, and clinicians and examine the correlation between radiologic and clinical findings.

METHODS

A total of 133 patients (M:F = 44:89, mean age 56 years) who underwent MRI of the cervical spine at our hospital were included. Two radiologists, two trainees, and two clinicians measured Central cervical spinal stenosis (CCSS) grade at the narrowest point according to the grading system suggested by Kang et al. A different clinician (a neurosurgeon) assessed the associated neurologic manifestations. Kappa statistics were used to analyze the inter-reader agreement among the radiologists, trainees, and clinicians. The clinical correlation (R) between grade and positive clinical manifestations (PCMs) was assessed using nonparametric correlation analysis (Spearman's correlation).

RESULTS

We found almost perfect agreement between trainees (k value = 0.890) and between radiologists (k value = 0.912) and substantial agreement between clinicians (k value = 0.691). Clinical correlations for all six readers suggested moderate correlation with R values ranging from 0.380 to 0.566. There was moderate correlation between grade and clinical manifestation within each group (R = 0.562-0.669).

CONCLUSION

The Kang MRI grading system of CCSS based on mid-sagittal MRI provides objective, reliable, and reproducible assessment regardless of field proficiency of the reader although the reproducibility of the clinician is slightly lower than radiologist and trainee of the radiology department. There was moderate correlation between image interpretation and clinical findings irrespective of the reader's main field of research.

A Data Processing Pipeline for Prediction of Milling Machine Tool Condition from Raw Sensor Data

With recent advances in sensor and computing technology, it is now possible to use real-time machine learning techniques to monitor the state of manufacturing machines. However, making accurate predictions from raw sensor data is still a difficult challenge. In this work, a data processing pipeline is developed to predict the condition of a milling machine tool using raw sensor data. Acceleration and audio time series sensor data is aggregated into blocks that correspond to the individual cutting operations of the Computer Numerical Control (CNC) milling machine. Each block of data is preprocessed using well-known and computationally efficient signal processing techniques. A novel kernel function is proposed to approximate the covariance between preprocessed blocks of time series data. Several Gaussian process regression models are trained to predict tool condition, each with a different covariance kernel function. The model with the novel covariance function outperforms the models that use more common covariance functions. The trained models are expressed using the Predictive Model Markup Language (PMML), where possible, to demonstrate how the predictive model component of the pipeline can be represented in a standardized form. The tool condition model is shown to be accurate, especially when predicting the condition of lightly worn tools.

Untangling the Complexity of Liver Fluke Infection and Cholangiocarcinoma in NE Thailand Through Transdisciplinary Learning

This study demonstrates how a transdisciplinary learning approach provided new insights for explaining persistent Opisthorchis viverrini infection in northern Thailand, as well as elucidating problems of focusing solely on the parasite as a means of addressing high prevalence of cholangiocarcinoma. Researchers from diverse backgrounds collaborated to design an investigative homestay program for 72 Singaporean and Thai university students in five northeast Thai villages. The students explored how liver fluke infection and potential cholangiocarcinoma development are influenced by local landscape dynamics, aquatic ecology, livelihoods, food culture and health education. Qualitative fieldwork was guided daily by the researchers in a collaborative, co-learning process that led to viewing this health issue as a complex system, influenced by interlinked multidimensional factors. Our transdisciplinary experience has led us to believe that an incomplete understanding of these linkages may reduce the efficacy of interventions. Further, viewing liver fluke infection and cholangiocarcinoma as the same issue is inadvisable. Although O. viverrini infection is an established risk factor for the development of cholangiocarcinoma, multiple factors are known to influence the likelihood of acquiring either. Understanding the importance of the current livelihood transition, landscape modification and the resulting mismatch between local cultures and new socio-ecological settings on cholangiocarcinoma initiation and liver fluke transmission is of critical importance as it may help readjust our view of the respective role of O. viverrini and other socioeconomic risk factors in cholangiocarcinoma etiology and refine intervention strategies. As demonstrated in this study, transdisciplinary approaches have the potential to yield more nuanced perspectives to complex diseases than research that focuses on specific aspects of their epidemiology. They may therefore be valuable when designing effective solutions to context-sensitive diseases such as liver fluke infection and cholangiocarcinoma.

The effect of a core exercise program on Cobb angle and back muscle activity in male students with functional scoliosis: a prospective, randomized, parallel-group, comparative study

Objective

To assess the effect of core strengthening exercises on Cobb angle and muscle activity in male college students with functional scoliosis.

Methods

Static and dynamic back muscle activity were evaluated via surface electromyography (sEMG). A core exercise protocol comprising 18 exercises was performed three times/week for 10 weeks. Patients were randomly allocated to either a home- or community-based exercise programme. Cervical thoracolumbar scans and sEMG were performed after 10 weeks.

Results

A total of 87 students underwent cervical thoracolumbar scans. Of these, 53 were abnormal and were randomised between the home-based (n = 25) or community-based (n = 28) groups. After the 10-week exercise programme, Cobb angles were significantly lower and back muscle strength was significantly improved than baseline in both groups, but there were no statistically significant between group differences.

Conclusions

A 10-week core strengthening exercise programme decreases Cobb angle and improves back muscle strength in patients with functional scoliosis.

Effects of sheng hua tang on uterine involution and ovarian activity in postpartum dairy cows

The effects of Sheng Hua Tang (SHT) on uterine involution and ovarian activity were investigated in postpartum dairy cows. SHT (70 g) was given to dairy cows (n = 10) to evaluate its effects for five days from the first postpartum day. Postpartum cows fed with a basal diet without SHT were used as the control group (n = 10). Ultrasounds and blood tests were recorded for four weeks from postpartum day seven with a 3-d interval. The results showed that the areas and diameters of endometria were significantly (p<0.01) reduced in the group that received SHT compared to the control group on the seventh postpartum day. The group that received SHT had an intrauterine fluid volume mean of 1.2±0.6 cm(3), which was significantly lower than that of the control group, 2.3±0.8 cm(3) (p<0.01) on the 13th postpartum day. In addition, the uterine tension score was a mean of 1.0±0.0 in the group that received SHT, which was also significantly lower than that of the control group, 1.5±0.5 (p<0.01) on the 19th postpartum day. Taken together, the Chinese herbal medicine remedy, SHT, promoted uterine involution and ovarian activity in postpartum dairy cows.

Cardiac transplantation and concomitant coronary artery bypass grafting: our experiences in 11 cases

INTRODUCTION

The shortage of donor hearts for transplantation could be alleviated by including the hearts of older donors. Previous literature revealed similar early and medium-term survival outcomes compared with those of younger donors. This study presents our experience with patients who underwent orthotopic heart transplantation and concomitant coronary artery bypass grafting at our institution.

METHODS

We present our experience with 11 patients with end-stage cardiomyopathy (8 men and 3 women) undergoing orthotopic heart transplantation and concomitant coronary artery bypass grafting from September 2002 to November 2011 at our institute.

RESULTS

All 11 donor organs would otherwise have been rejected, depriving potential recipients of organ transplantation. Two patients received concurrent 2-coronary-artery bypass, and the other 9 patients received concurrent single-coronary-artery bypass during orthotopic heart transplantation. All patients had an uneventful postoperative course, with follow-up completed 3 to 128 months after cardiac transplantation and concomitant coronary artery bypass grafting surgery.

CONCLUSIONS

Our experiences suggest that donor hearts requiring coronary artery bypass grafting, which form a small but significant donor subgroup, can be used effectively and safely when matched to the recipients' age and medical condition.

Combined heart transplantation and total replacement of thoracic aorta in Marfan's syndrome with recurrent aortic dissection: a case report

It is extremely rare for a patient to need simultaneous heart transplantation (HTx) and replacement of the thoracic aorta. A 23-year-old woman with Marfan's syndrome underwent Bentall's operation and replacement of the ascending aorta (AsA) due to a type A aortic dissection (AD) in August 2001. In March 2005, she began to experience dyspnea on exertion and was found to have a huge pseudoaneurysm at the aortic root, which had caused dehiscence of the aortic conduit. In July 2009, she suffered acute chest pain followed by hypotension and cold sweating. The computed tomography (CT) scan showed a recurrent dissection with a long intimal tear extending from the arch to the mid-portion of the descending thoracic aorta (DTA). Due to technical difficulties in the repair of the aortic root, she was placed on the HTx waiting list. The next day, she received a donor heart and underwent combined HTx and total replacement of the thoracic aorta. Explantation of the heart improved the exposure of the DTA. With the use of a vascular ring connector (Vasoring), the operation was successfully performed without need for a blood transfusion. The patient was still well at 2 years after the operation. Simultaneous replacement of the heart and the whole segment of the thoracic aorta is technically possible in Marfan patients who are complicated with aortic dissection.

Effect of temperature on optical and electronic properties of InGaP/InGaAIP multiple quantum wells

The optical and electronic properties in an InGaP/InGaAIP multiple quantum well (MQW) grown by using molecular-beam epitaxy utilizing the digital alloy technique were investigated through temperature-dependent photoluminescence (PL) measurements and numerical calculations. The high-resolution transmission electron microscopy images showed that the sample clearly displayed the InGaP wells and the InGaAIP barriers and separate confinement heterostructure layers. The PL measurements at various temperatures were performed to investigate the interband transitions of the InGaP/InGaAIP MQW. The electronic subband energies and the wavefunctions in the InGaP/InGaAIP MQW at several temperatures were determined by using a finite element method employing the standard 8-band k x p Lagrangian. The numerical results for optical interband transition energies from the ground state electron subband to the ground state heavy-hole subband of the InGaP/InGaAIP MQW at various temperatures were in reasonable agreement with the excitonic transition energies observed in the PL measurements.

Tendinosis-like histologic and molecular changes of the Achilles tendon to repetitive stress: a pilot study in rats

BACKGROUND

Tendinopathy (pain and tendon degeneration) is associated with repetitive use and mechanical overload. However, the etiology of tendinopathy remains unclear. Clarification of histologic and molecular changes of tendon to repetitive stress could provide better understanding of Achilles tendon disorders related to repetitive stress.

QUESTIONS/PURPOSES

We asked whether repetitive stress simulating overuse of the Achilles tendon induced (1) histologic changes in rats similar to tendinosis (increased cellularity of fibrocytes, increased disorganization of collagen fiber, and increased roundness of the nucleus of the fibrocyte), (2) increased collagen Type III occurrence, and (3) increased inducible nitric oxide synthase (iNOS) expression.

METHODS

We used an exercise protocol simulating repetitive, jerky, eccentric contraction of the triceps surae in 15 rats. We conducted the exercise for 2 hours per day, three times per week using the right rear legs only and the left legs as internal controls. We harvested Achilles tendons after either 2, 4, or 6 weeks of exercise, and evaluated changes in tendon thickness, fibrocyte count, collagen fiber arrangement, collagen fiber type, and occurrence of iNOS.

RESULTS

Exercised Achilles tendons showed increased cellularity of fibrocytes at 4 and 6 weeks of exercise, and disorganized collagen fiber arrangement at 6 weeks of exercise. There was a trend for Type III collagen occurrence being greater in experimental groups. Expression of iNOS increased after 2 and 4 weeks of exercise when compared with that of the controls, but decreased after 6 weeks.

CONCLUSIONS

These observations suggest repetitive, synchronized, passive, and jerky exercise induced by electrical stimulation can lead to the tendinosis-like changes in the Achilles tendons in rats with imbalance between synthesis and degeneration after 4 weeks of exercise.

CLINICAL RELEVANCE

This newly designed exercise protocol may be used to design an animal model of Achilles tendon overuse. With this model, therapeutic interventions of tendinopathy could be analyzed by investigation of tendon biology and response in terms of histologic and molecular changes.

Catechin stimulates osteogenesis by enhancing PP2A activity in human mesenchymal stem cells

SUMMARY

Using human mesenchymal stem cells, we identified catechin from a panel of herbal ingredients and Chinese traditional compounds with the strongest osteogenic effects. Catechin increased alkaline phosphatase activity, calcium deposition, and mRNA expression of Runx2 and osteocalcin. We further clarified the signaling pathway that catechin mediated to stimulate osteogenesis.

INTRODUCTION

Human mesenchymal stem cells (hMSCs), useful as a species specific cell culture system for studying cell lineage differentiation, were examined as a tool to identify novel herbal ingredients and Chinese traditional compounds for enhancing osteogenesis.

METHODS

Immortalized and primary hMSCs were induced in osteogenic induction medium in the presence of a variety of herbal ingredients and Chinese traditional compounds and osteogenic differentiation was evaluated by histochemical assays and quantitative RT-PCR.

RESULTS

Using immortalized hMSCs, we first identified catechin, 18β-glycyrrhetinic acid, baishao, and danggui with osteogenic properties, which enhanced calcium deposition at the dose without significant cytotoxic effects. Primary hMSCs were then applied for confirming the osteogenic effects of catechin, which increased alkaline phosphatase activity, calcium deposition, and mRNA expression of Runx2 and osteocalcin. We further found the extracellular signal-regulated kinase (ERK) pathway was downregulated upon stimulation with catechin. Catechin increased the level and activity of protein phosphatases 2A (PP2A) that dephosphorylates ERK kinase (MEK) and ERK. Further, PP2A inhibitor, okadaic acid, abolished the effect of catechin-mediated inactivation of ERK and stimulation of osteogenesis. The blocking effect of okadaic acid on osteogenesis was further reversed by PD98059, a specific inhibitor of MEK. Co-immunoprecipitation revealed the association of PP2A to both MEK and ERK.

CONCLUSIONS

These studies propose catechin enhanced osteogenesis by increasing the PP2A level that inhibits the MEK and ERK signaling in hMSCs. These results prove the concept of using hMSCs as a convenient tool for rapid and consistent screening of the osteogenic herbal ingredients and traditional Chinese compounds.

Leukoaraiosis predicts poor outcome after spontaneous supratentorial intracerebral hemorrhage

BACKGROUND AND AIMS

Leukoaraiosis (LA) is associated with aging and vascular risk factors, and is a risk factor of intracerebral hemorrhage (ICH) after treatment with warfarin or thrombolytic treatment for ischemic stroke. In this study, we sought to examine whether LA is a predictor of outcome after spontaneous ICH.

METHODS

We retrospectively analyzed 238 consecutive patients with spontaneous supratentorial ICH identified by a database search. Patients were divided into two groups according to neurological outcome at 90 days: patients with good outcomes (Glasgow Outcome Scale ≥4) and patients with poor outcomes. Demographic features, ICH characteristics, and LA severity as assessed by van Swieten score on brain CT were compared between the two groups.

RESULTS

Overall, 105 (44.1%) of the patients analyzed had poor outcomes. In univariate analysis, LA severity, ICH volume on initial brain CT, initial Glasgow Coma Scale (GCS), presence of intraventricular hemorrhage (IVH), old age, surgical treatment, and higher admission serum glucose level were associated with poor outcome. Multiple logistic regression analysis showed that severity of LA, initial GCS score, hematoma volume, presence of IVH, and surgical treatment were independent predictors of poor outcome.

CONCLUSION

LA is an independent predictor of poor neurological outcome in patients with spontaneous supratentorial ICH.

A transcriptome-based examination of blood group expression

Over the last two decades, red cell biologists witnessed a vast expansion of genetic-based information pertaining to blood group antigens and their carrier molecules. Genetic progress has led to a better comprehension of the associated antigens. To assist with studies concerning the integrated regulation and function of blood groups, transcript levels for each of the 36 associated genes were studied. Profiles using mRNA from directly sampled reticulocytes and cultured primary erythroblasts are summarized in this report. Transcriptome profiles suggest a highly regulated pattern of blood group gene expression during erythroid differentiation and ontogeny. Approximately one-third of the blood group carrier genes are transcribed in an erythroid-specific fashion. Low-level and indistinct expression was noted for most of the carbohydrate-associated genes. Methods are now being developed to further explore and manipulate expression of the blood group genes at all stages of human erythropoiesis.

Living-donor liver transplantation in patients with concurrent active tuberculosis at transplantation

SETTING

Although active tuberculosis (TB) is a contraindication for liver transplantation (LT), LT may be the only possible treatment option in patients with irreversible liver failure and concurrent TB.

OBJECTIVES

To assess the outcome of LT in patients with concurrent TB and liver failure.

METHODS

We retrospectively evaluated the clinical outcomes of nine LT recipients with concurrent TB in Korea, an intermediate TB burden country.

RESULTS

The primary causes of living-donor LT (LDLT) in nine patients were anti-tuberculosis drug-induced fulminant hepatic failure (n = 4) and end-stage liver disease (n = 5). The sites of active TB were the lungs (n = 5), lymph nodes (n = 3) and pleura (n = 1). After LDLT, most patients were treated with less hepatotoxic drugs, including fluoroquinolones, ethambutol and cycloserine; none was treated with pyrazinamide. One patient experienced acute rejection, probably attributable to an interaction between rifampicin and cyclosporine. All nine patients, including one taking rifabutin, successfully completed anti-tuberculosis treatment and have been followed up for a median of 926 days after LDLT, without relapse of TB.

CONCLUSION

When properly managed, the prognosis of LDLT recipients with concurrently active TB at transplantation is very favourable. The current protocol, which considers active TB an absolute contraindication for LT, should be modified or relaxed, particularly for patients with LDLT.

Topographic patterns and stroke subtypes according to progressive motor deficits in lacunar syndrome

Although progressive hemiparesis occurs frequently in acute ischemic stroke, the topography and mechanisms associated with progressive motor deficit (PMD) remain unclear. The aim of this study was to identify the differences in PMD according to lesion location and the presumed underlying pathogenesis in patients with lacunar motor syndrome. Consecutive patients experiencing acute lacunar motor syndrome within 24 hours of stroke onset were included. Topographic patterns, risk factors, and presumed stroke mechanisms were compared between patients with PMD and those without PMD. Of the 168 patients in the study group, 47 (28.0%) had PMD. Baseline National Institutes of Health Stroke Scale score (P = .034) and female sex (P = .005) were associated with PMD on univariate analysis. Deep perforating artery infarct was more frequently associated with PMD (35.8%) compared with large artery disease (27.3%) and cardioembolism (5.3%). Multiple logistic analysis found that deep perforating artery infarct was independently associated with PMD (odds ratio, 2.87; 95% confidence interval, 1.26-6.5; P = .012). Deep perforating artery infarct is the major cause of PMD. In patients with lacunar syndrome, the pattern of PMD varies according to the location and etiology of stroke.

Endoscopic ultrasonography-guided fine-needle aspiration in the management of mediastinal diseases: local experience of a novel investigation

OBJECTIVE

To study the efficacy and safety of endoscopic ultrasonography-guided fine-needle aspiration in the management of mediastinal diseases in Hong Kong.

DESIGN

Retrospective review of prospectively collected data.

SETTING

University teaching hospital, Hong Kong.

PATIENTS

A total of 125 consecutive patients with various mediastinal and pulmonary lesions that underwent trans-oesophageal endoscopic ultrasonography-guided fine-needle aspiration from July 1998 to June 2007.

MAIN OUTCOME MEASURES

The diagnostic accuracy and safety of the procedure and its influence in patient management.

RESULTS

Malignancy was confirmed in 62 (50%) of the patients and excluded in 42 (34%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of endoscopic ultrasonography-guided fine-needle aspiration in diagnosing mediastinal malignancies were 75% (95% confidence interval, 64-83%), 100% (90-100%), 100% (93-100%), 67% (54-78%), and 83%, respectively. Eighty-six (69%) of the patients had their initial plan of invasive investigations changed. Only one (0.8%) patient developed a septic complication in a mediastinal cyst after puncturing, and was treated surgically.

CONCLUSIONS

Trans-oesophageal endoscopic ultrasonography-guided fine-needle aspiration is a minimally invasive, effective, and safe method of diagnosing malignant mediastinal disease. It may reduce the need for other invasive investigations.

Favorable influence of subclinical hypothyroidism on the functional outcomes in stroke patients

Subclinical hypothyroidism (SCH) is thought to have an influence on stroke outcomes. However, few reports demonstrate a favorable relationship between the two. We evaluated this association in acute ischemic stroke. From Jan 2005 to June 2008, 756 acute ischemic stroke patients were recruited within seven days of onset. The patients with overt hypothyroidism/hyperthyroidism or other medical conditions that may affect thyroid function were excluded. Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were measured within two days. Patients were divided into two groups: the SCH group (TSH > 5.0 microU/mL and normal FT4 levels) and the control group. Stroke outcomes were assessed using two different criteria. In the first outcome model, favorable outcomes [I] were simply defined by modified Rankin Scale (mRS) scores (<or= 1), while the favorable outcomes [II] were defined as follows: a) a mRS score of 0, if the baseline National Institute of Health Stroke Scale (NIHSS) scores were < 8, b) a mRS score of 0 or 1, if the NIHSS scores were 8-14, c) a mRS score 0-2, if the NIHSS scores were >14. The changes in mRS scores and the proportion of patients with favorable outcomes [I] or [II] at the 30(th) and 90(th) day were compared between the two patient groups. Of the 756 patients, 31 (4.1%) were patients with SCH. More patients from the SCH group showed improvement in NIHSS scores on the 30(th) day compared to the control group (48.4% vs. 25.3%, p=.006). In addition, the proportion of patients who exhibited favorable outcomes [I] was significantly higher in the SCH group on the 90(th) day (74.2% vs. 55.3%, p=.027) and that trend was seen as early as the 30(th) day (p=.102). Similarly, the proportion of the patients with favorable outcomes [II] was significantly greater in the SCH group both on the 30(th) (29.0% vs. 14.6%, p=.039) and 90(th) day (58.0% vs. 31.0%, p=.003). We found that acute ischemic stroke patients with SCH at admission were more likely to show favorable functional outcomes than those without SCH. We can suggest preconditioning before the stroke combined with a reduced response to stress as a possible protective mechanism.

Light-extraction enhancement of red AlGaInP light-emitting diodes with antireflective subwavelength structures

We demonstrate the enhancement of light extraction in 633 nm AlGaInP light-emitting diodes (LEDs) with antireflective subwavelength structures (SWS). From the contour plots by the rigorous coupled wave analysis method, it is found that the reduction of the internal reflection strongly depends on the period of SWS. The Ag nanoparticles formed by thermal dewetting were used as an etch mask for dry etch process to fabricate antireflective SWS on the LED surface. The tapered pillars on the GaP were fabricated, on average, with distances below 200 nm, satisfying the required antireflection condition at the emission wavelength. The improvement in light output power by approximately 26.4% was achieved for the fabricated AlGaInP LEDs with SWS compared to the conventional LEDs due to a strongly reduced Fresnel internal reflection at the GaP/air interface. The improved directionality in the far-field pattern was also obtained due to the directional light extraction enhancement.

High-speed characteristics of vertical cavity surface emitting lasers and resonant-cavity-enhanced photodetectors based on intracavity-contacted structure

We fabricated vertical cavity surface emitting lasers (VCSELs) and resonant-cavity-enhanced photodetectors (RCE-PDs) with GaAs/AlGaAs distributed Bragg reflectors (DBRs), operating at lambda approximately 980 nm, based on an intracavity-contacted structure. The top-DBR mesa diameter of the VCSELs was optimized to 18 microm in terms of slope efficiency, differential series resistance, and 3 dB bandwidth. For VCSELs with an oxide aperture of 4.5 microm and a top-DBR mesa diameter of 18 microm, the threshold current was about 1.2 mA, exhibiting maximum output power of approximately 3.49 mW (at 20 degrees C) with good uniformity. The effect of the overetching in the outermost layer of RCE-PDs on the device performance was also investigated. For RCE-PDs based on the VCSEL structure, a peak responsivity of 0.44 A/W (at lambda approximately 979.7 nm) with a spectral width of approximately 3 nm and a dark current of 68 pA under a bias voltage of -5 V at 20 degrees C was obtained. The maximum 3 dB bandwidths of approximately 11.5 GHz with a modulation current efficiency factor of 5.6 GHz/mA(1/2) at -7 mA and 9 GHz at -7 V were achieved for VCSELs and RCE-PDs, respectively.

A CMOS neuroelectronic interface based on two-dimensional transistor arrays with monolithically-integrated circuitry

The ability to monitor and to elicit neural activity with a high spatiotemporal resolution has grown essential for studying the functionality of neuronal networks. Although a variety of microelectrode arrays (MEAs) has been proposed, very few MEAs are integrated with signal-processing circuitry. As a result, the maximum number of electrodes is limited by routing complexity, and the signal-to-noise ratio is degraded by parasitics and noise interference. This paper presents a single-chip neuroelectronic interface integrating oxide-semiconductor field-effect transistors (OSFETs) with signal-processing circuitry. After the chip was fabricated with the standard complementary-metal-oxide-semiconductor (CMOS) process, polygates of specific transistors were etched at die-level to form OSFETs, while metal layers were retained to connect the OSFETs into two-dimensional arrays. The complete removal of polygates was confirmed by high-resolution image scanners, and the reliability of OSFETs was examined by measuring their electrical characteristics. Through a gate oxide of only 7nm thick, each OSFET can record and stimulate neural activity extracellularly by capacitive coupling. The capability of the full chip in neural recording and stimulation was further experimented using the well-characterised escape circuit of the crayfish. Experimental results indicate that the OSFET-based neuroelectronic interface can be used to study neuronal networks as faithfully as conventional electrophysiological tools. Moreover, the proposed simple, die-level fabrication process of the OSFETs underpins the development of various field-effect biosensors on a large scale with on-chip circuitry.

Cardiac troponin T elevation after stroke: relationships between elevated serum troponin T, stroke location, and prognosis

Background and Purpose

Elevation of serum cardiac troponin T (cTnT) is regarded as a specific marker of acute coronary syndrome. Serum cTnT can be increased in patients with acute ischemic stroke, but its clinical implications remain unclear. The aim of this study was to identify the relationships between elevated cTnT and stroke severity, location, and prognosis.

Methods

From January 2005 to December 2006, this study recruited 455 consecutive patients who were admitted to Kangbuk Samsung Hospital due to acute ischemic stroke within 3 days of onset, which was confirmed by diffusion magnetic resonance imaging. A total of 416 patients was finally included and divided into 2 groups: an elevated cTnT group (n=45) and a normal cTnT group (n=371). The short-term prognosis was assessed by 30-day modified Rankin Scale responder analysis was compared between the two groups.

Results

Serum cTnT was elevated in 10.8% of cases, with elevated cTnT associated with greater stroke severity, as assessed by the National Institutes of Health Stroke Scale score, Insular-lobe involvement was more common in patients with elevated cTnT than in the normal cTnT group. Short-term prognosis was more unfavorable in the elevated cTnT group than in the normal cTnT group. Multivariate regression analysis indicated that elevated cTnT was independently related to insular involvement, cardioembolism, and unfavorable outcome.

Conclusions

Elevated cTnT in acute ischemic stroke was associated with severe neurological deficits at stroke onset and damages to the insular lobe. The outcome of acute ischemic stroke was worse for patients with elevated cTnT than for those with normal cTnT. The pathomechanism underlying acute ischemic stroke and subclinical myocardial damage warrants further study.

Endoscopic submucosal dissection used for treating early neoplasia of the foregut using a combination of knives

BACKGROUND

Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for early esophageal or gastric carcinoma limited to the mucosa. The authors report their experience with a combination of various devices to treat early neoplasia of the foregut using the ESD technique.

METHODS

In this prospective case series, ESD was performed for early esophageal or gastric carcinoma limited to the mucosa. These lesions were staged by endoscopic ultrasonography before resection. Magnifying endoscopy and chromoendoscopy were used to locate the tumor and define the margin. The resection was accomplished with submucosal dissection using the insulated tip knife, the hook knife, and the triangular tip knife. The resected specimen was examined systematically for the lateral and deep margins.

RESULTS

From January 2004 to March 2006, ESD was performed to manage 30 cases of early gastric or esophageal carcinoma. For 29 of these patients, R0 resection was successfully achieved. The mean operating time was 84.6 min. One patient experienced reactionary hemorrhage 12 h after resection, which was controlled endoscopically. There was no perforation. Most of the circumferential mucosal incisions were performed using the insulated tip knife (76.6%), whereas submucosal dissection was accomplished with a combination of various knives. One of the specimens showed involvement of the lateral margin, whereas another patient had two areas of new early gastric cancer 6 months after the initial procedure. These patients received salvage laparoscopically assisted gastrectomy.

CONCLUSIONS

Endoscopic submucosal dissection to manage early neoplasia of the foregut can be achieved safely and effectively with a combination of knives.

Effect of quilting sutures on hematoma formation after liposuction with dermal curettage for treatment of axillary hyperhidrosis: a randomized clinical trial

BACKGROUND

Liposuction provides further reduction of axillary sweating and malodor when combined with dermal curettage with sharp rasping cannulas. This aggressive approach is associated with relatively higher rate of hematoma formation when compared to the conventional simple liposuction.

OBJECTIVE

The aim of this prospective, randomized, controlled trial was to evaluate the effect of quilting sutures on the incidence of hematoma formation after liposuction-curettage for treatment of axillary hyperhidrosis (AH).

MATERIALS AND METHODS

The trial randomized 59 male patients (118 axillae) undergoing liposuction-curettage for AH to quilting procedures (61 axillae) or control group (57 axillae) for intention-to-treat analysis. Outcome measures included the incidence of hematoma formation, operative time, degree of postoperative pain, and amount of analgesics consumption.

RESULTS

Quilting sutures significantly reduced the incidence of axillary hematoma from 28.1% to 4.9%. Quilting was associated with the lengthening of operative time but did not affect the postoperative pain.

CONCLUSION

Considering its efficacy in reducing postoperative hematoma, quilting is recommended in combination with aggressive liposuction-curettage procedure for treating AH and osmidrosis.