The first intermediate host of Paragonimus westermani in Sri Lanka

Freshwater snails (family Paludomidae, genus Paludomus) were collected from streams in Hedeniya and Peradeniya (the campus of Peradeniya University), Kandy district, Central Province, Sri Lanka, and found to harbor rediae and cercariae of a Paragonimus sp. These larvae were identified as Paragonimus westermani by using ITS2 DNA sequences. The infection rates of P. westermani in Paludomus sp. in Hedeniya and Peradeniya were 0.1% (one of 1014) and 0.2% (two of 1006), respectively. The snail has not been identified to species in the present study. This is the first report of the snail host of Paragonimus in Sri Lanka.     

Plasmodium vivax PCR genotyping of the first malaria case imported from South Korea into Japan

Although indigenous malaria was successfully eradicated in Japan in 1959, malaria remains one of the most important health concerns in the control of imported infectious diseases. However, in South Korea, the re-emergence of indigenous vivax malaria was reported in 1993 in the Demilitarized Zone (the border region with North Korea), from where a vivax malaria case was imported into Japan in 2002. In this study, we conducted genotyping of the circumsporozoite protein gene, the apical membrane antigen-1 gene, and the merozoite surface protein-1 gene of Plasmodium vivax in one patient, and estimated the geographical origin of the parasites. This estimate was based on the findings of previous studies, which showed the coexistence of at least two distinct genotypes of antigenic molecules of endemic P. vivax in South Korea. One genotype is similar to that of a Chinese strain CH-5, and the other is similar to that of a North Korean isolate. The results of this study showed that the DNA sequences of the patient’s P. vivax parasites were similar to those of the North Korean isolate. It may even be possible in the near future for seasonally synchronized North Korean P. vivax parasites to be imported into parts of Japan and to establish breeding populations.     

Regenerative medicine for the joints

Each joint must have a certain range of motion, the stability and mobility. The joints sustain the great force caused by musculoskeletal motion. Once the articular cartilage is damaged, regeneration of the complete articular cartilage does not occur. Numerous treatments to repair full-thickness defects in articular cartilage have been undertaken, however, osteochondral defects present practical problems. According to the progress of regenerative medicine, effective treatments have been developed. This review examines the current techniques used in managing osteochondral defect.     

Evaluation of functional outcome of the floating knee injury using multivariate analysis

INTRODUCTION: The objective of this study is to evaluate significant contributing factors affecting the functional prognosis of floating knee injuries using multivariate analysis. PATIENTS AND METHODS: A total of 68 floating knee injuries (67 patients) were treated at Kitasato University Hospital from 1986 to 1999. Both the femoral fractures and the tibial fractures were managed surgically by various methods. The functional results of these injuries were evaluated using the grading system of Karlstr?m and Olerud. Follow-up periods ranged from 2 to 19 years (mean 50.2 months) after the original injury. We defined satisfactory (S) outcomes as those cases with excellent or good results and unsatisfactory (US) outcomes as those cases with acceptable or poor results. Logistic regression analysis was used as a multivariate analysis, and the dependent variables were defined as a satisfactory outcome or as an unsatisfactory outcome. The explanatory variables were predicting factors influencing the functional outcome such as age at trauma, gender, severity of soft-tissue injury in the femur and the tibia, AO fracture grade in the femur and the tibia, Fraser type (type I or type II), Injury Severity Score (ISS), and fixation time after injury (less than 1 week or more than 1 week) in the femur and the tibia. RESULTS: The final functional results were as follows: 25 cases had excellent results, 15 cases good results, 16 cases acceptable results, and 12 cases poor results. The predictive logistic regression equation was as follows: Log 1-p/p = 3.12-1.52 x Fraser type - 1.65 x severity of soft-tissue injury in the tibia - 1.31 x fixation time after injury in the tibia - 0.821 x AO fracture grade in the tibia + 1.025 x fixation time after injury in the femur - 0.687 x AO fracture grade in the femur ( p=0.01). Among the variables, Fraser type and the severity of soft-tissue injury in the tibia were significantly related to the final result. CONCLUSION: The multivariate analysis showed that both the involvement of the knee joint and the severity grade of soft-tissue injury in the tibia represented significant risk factors of poor outcome in floating knee injuries in this study.     

Current trends in bone grafting and the issue of banked bone allografts based on the fourth nationwide survey of bone grafting status from 2000 to 2004

Background The Japanese Orthopaedic Association Committee on Tissue Transplantation and Regenerative Medicine has conducted a nationwide survey of the status of bone grafting in Japan every 5 years from 1985. We report here the status of bone grafting from 2000 to 2004, show the trends in bone grafting from 1985 to 2004, and draw attention to the issues affecting banked bone allografts. Methods Questionnaires devised by the Committee were sent to all educational and training hospitals (2239 institutions) approved by the Japanese Orthopaedic Association. Results Survey responses were obtained from 1263 institutions (56%). Of these, 875 institutions performed tissue transplantation during this period. A total of 163 564 tissue transplantations were performed, and 134 782 (82.4%) of them were bone grafts. Of the bone grafts, 76 015 (56.4%) were autografts, 53 735 (40%) used a synthetic bone substitute, and 4886 (3.6%) were banked bone allografts. The proportion of synthetic bone substitutes increased, and the proportion of autografts decreased year by year. Synthetic bone substitutes were most frequently used for replacement arthroplasty (31%). Fifty percent of banked bone allografts were performed for joint disorders requiring replacement arthroplasty. During this period, 271 institutions performed banked bone allografts, with 210 preserving allografts in their own institutions. Donor selection criteria, processing and preservation methods, and management of the bone bank were not the same in all banks. Conclusions Most bone grafts performed in Japan during the four surveys were still autografts. However, the proportion of autografts decreased, and the proportion of synthetic bone substitutes increased. The number of synthetic bone substitutes and banked bone allografts used for replacement arthroplasty increased significantly. However, the total number of banked bone allografts reported in the fourth survey was still low. Quality control of banked bone allografts and management of bone banks were not satisfactory, although they were improved.     

A new plain radiography method using the optimal angle of knee flexion for assessing early degeneration of the knee joint

During total knee arthroplasty for primary osteoarthritis, we measured the area of worn cartilage on the medial femoral condyle in 44 knees. By reference to a lateral femoral radiograph of each knee, the optimal knee flexion angle-reflecting the worn area of the femoral condyle-was determined and found to be 19.8 degrees +/- 7.6 degrees. Using this result, a new method for posteroanterior radiography of the weight-bearing knee (20/10 radiography) was devised. We compared the use of our method with Rosenberg's method in 56 varus knees and found that the width of the cartilage space determined by our method was narrower than that determined by Rosenberg's method (t test, <0.001). These results confirmed that 20/10 radiography well reflects the region of worn cartilage in knees with early-stage primary osteoarthritis.     

Effects of reamed or unreamed intramedullary nailing under non-damaged conditions on pulmonary function in sheep

BACKGROUND: Pulmonary damage after reamed or unreamed femoral nailing has been controversial in clinical and experimental studies. We investigated changes in pulmonary function and coagulatory response in normal lungs of sheep after reamed or unreamed intramedullary nailing of an unfractured femur. METHODS: We used three groups of sheep (each group, n = 6): reamed femoral nailing (RFN); unreamed femoral nailing (UFN); and sham control group. Femoral osteotomies and lung contusions were not made. Hemodynamic monitoring data and blood gas data (BGD) were recorded, and blood samples for biochemistry (antithrombin III, lipid peroxidase and fibrinogen) were collected 0 to 6 hours after nailing. Bronchoalveolar lavage fluid (BALF) and myeloperoxidase (MPO) activity in pulmonary tissue were analyzed 6 hours after nailing. RESULTS: There were no significant differences in time course of hemodynamic monitoring data, BGD, or biochemical data among the three groups. In BALF analysis, the lipid-laden cell count in the RFN group was higher than those of the other groups, and MPO activity was highest in the RFN group. CONCLUSION: RFN did not affect pulmonary function at the physiologic level or affect the coagulatory system at the acute stage, but RFN under non-damaged conditions could lead to leukocyte activation in lung tissue without worse alteration of alveolar permeability in the acute post-operative course.     

Performance of Rapid Diagnostic Tests for Plasmodium ovale Malaria in Japanese Travellers

Background: Rapid diagnostic tests (RDTs) are used widely in the diagnosis of malaria. Although the effectiveness of RDTs for malaria has been described in many previous studies, the low performance of RDT particularly for Plasmodium ovale malaria in traveller has rarely been reported. Methods: This was a retrospective cohort study conducted on Japanese travellers diagnosed with malaria at the National Center for Global Health and Medicine between January 2004 and June 2013. The diagnosis of malaria was confirmed by microscopic examination, RDT, and polymerase chain reaction in all patients. The RDTs used in our study were Binax NOW Malaria (Binax Inc., Scarborough, Maine, USA) (BN) and SD Malaria Antigen Pf/Pan (Standard Diagnostics Inc., Korea) (SDMA). We compared the sensitivity of the RDTs to P. ovale malaria and Plasmodium vivax malaria. Results: A total of 153 cases of malaria were observed, 113 of which were found among Japanese travellers. Nine patients with P. ovale malaria and 17 patients with P. vivax malaria undergoing RDTs were evaluated. The overall sensitivity of RDTs for P. ovale malaria and P. vivax malaria was 22.2% and 94.1%, respectively (P < 0.001). The sensitivity of SDMA for P. ovale malaria and P. vivax malaria was 50% and 100%, respectively. The sensitivity of BN for P. vivax malaria was 90.0%, but it was ineffective in detecting the cases of P. ovale malaria. Conclusions: The sensitivity of RDTs was not high enough to diagnose P. ovale malaria in our study. In order not to overlook P. ovale malaria, therefore, microscopic examination is indispensable.