Arthroscopic findings in chronic lateral ankle instability: do focal chondral lesions influence the results of ligament reconstruction?

BACKGROUND: There are few studies that have assessed the influence of focal chondral lesions on the results of ligament reconstruction for chronic lateral ankle instability. HYPOTHESIS: Focal chondral lesions do not influence the results of ligament reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Arthroscopic examination of the ankle was performed on 30 consecutive patients immediately before ligament reconstruction using the palmaris longus tendon. Clinical assessment was performed using the Karlsson scoring scale. A radiologic assessment was performed on stress radiographs of the ankle. Preoperative anteroposterior and lateral weightbearing radiographs of the ankle did not show any joint space narrowing in any ankle. The mean duration of follow-up was 38 months. RESULTS: On arthroscopy, focal chondral lesions were found in 19 ankles (63%). Chondral lesions were located on the medial side of the tibial plafond in 13 ankles (43%), on the lateral side in 2 ankles (7%), on the lateral side of the talar dome in 3 ankles (10%), and on the medial side in 9 ankles (30%). Postoperative mean Karlsson scores in patients without chondral lesions and in those with chondral lesions were 99.1 and 98.4 points, respectively. Postoperative mean talar tilt angles in patients without chondral lesions and in those with chondral lesions were 5.9 degrees and 4.7 degrees , respectively. There were no significant differences in the clinical and radiologic results between patients with chondral lesions and those without chondral lesions. CONCLUSIONS: Reconstruction of the lateral ligament can be successful regardless of the presence of focal chondral lesions in patients with chronic lateral ankle instability when preoperative weightbearing radiographs of the ankle do not show any joint space narrowing.     

Arrhythmias observed during high-G training: proposed training safety criterion

INTRODUCTION: Most arrhythmias during centrifuge training are physiological responses to high +Gz stress. However, potentially dangerous arrhythmias occasionally occur during centrifuge training. We reviewed all arrhythmias recorded during the Japan Air Self-Defense Force (JASDF) centrifuge training from April 2001 to March 2003, and developed a criterion for suspending G-training based on observed arrhythmias. METHOD: There were 195 male fighter pilots who received high-G centrifuge training monitored with electrocardiographs (ECGs). We evaluated types and occurrences of all arrhythmias during high-G training over a 24-mo period. RESULTS: Sinus arrhythmia (48.7%), single premature atrial contraction (32.3%), and single (58.5%) or paired (9.7%) premature ventricular contraction were commonly occurring arrhythmias during high-G training. We considered these arrhythmias as variant physiological responses to high-G training (category 1). In addition, we observed ventricular tachycardia (2.6%), paroxysmal supraventricular tachycardia (1.5%), and paroxysmal atrial fibrillation (0.5%). Further investigation of these trainees revealed a significant proportion with cardiac anomalies. As a result, the JASDF currently categorizes these arrhythmias as indicators to suspend G-training and initiate cardiac workup (category 3). Other arrhythmias, such as non-sustained ventricular tachycardia (VT) or Morbitz type I atrioventricular (AV) block, were considered borderline anomalies; whether training was allowed to continue depended on the decision of the physicians monitoring the training (category 2). CONCLUSION: Routine ECG monitoring during centrifuge training is recommended to catch the pathology underlying dangerous arrhythmias for flight safety. Our proposed criterion for stopping the centrifuge is intended to differentiate between serious arrhythmias and arrhythmias of physiologic response.     

Efficacy of docetaxel as a second-line chemotherapy for thymic carcinoma

Thymic carcinoma is a rare and aggressive tumor, and the efficacy of second-line chemotherapy is still unclear. Here, we reported a case of thymic carcinoma that responded well to the administration of docetaxel alone as a second-line chemotherapy. A 64-year-old woman was diagnosed with thymic carcinoma (squamous cell type) with bone metastasis, and she, therefore, received nedaplatin combined with etoposide and ifosfamide. She responded partially, after which she received irradiation for bone metastasis. Two months after chemotherapy, the thymic carcinoma exhibited gradual regrowth and she experienced shoulder pain. We treated this with docetaxel alone (60 mg/m2 every 4 weeks). After three courses of docetaxel, we observed a partial response and her shoulder pain disappeared. This case demonstrated that docetaxel is effective as a second-line chemotherapy for thymic carcinoma.     

Phenylarsine oxide (PAO) more intensely induces apoptosis in acute promyelocytic leukemia and As2O3-resistant APL cell lines than As2O3 by activating the mitochondrial pathway

We studied the cytotoxic effect of an organic arsenical compound, phenylarsine oxide (PAO) on an acute promyelocytic leukemia (APL) cell line (NB4) and an As₂O₃-resistant NB4 subline (NB4/As). Cell growth was inhibited by 50% (IC₅₀) upon 2-day treatment with As₂O₃ or PAO at 0.54 and 0.06 μM, respectively in NB4 cells (P = 0.025), and 2.80 and 0.08 μM, respectively in NB4/As (P = 0.030). 0.1 μM PAO increased the proportion of hypodiploid cells (50.3%) by a greater degree than the same dose of As₂O₃ (3.8%) in NB4 cells. In NB4 cells, 0.1 μM PAO reduced the mitochondrial transmembrane potential (20.5% in a PI^negative-Rhodamine123^low fraction) by a greater degree than 1 μM As₂O₃ (7.1%). Western blotting showed that 0.1 μM PAO downregulated the expression of both Bcl-2 and Bcl-X_L proteins, whereas I μM As₂O₃ downregulated only Bcl-2 expression. These results suggest that the cytotoxic effect of PAO on an APL cell line and As₂O₃-resistant subline is significantly higher than that of As₂O₃. PAO-induced apoptosis seems to be related to the activation of the mitochondrial pathway and downregulation of both Bcl-2 and Bcl-X_L. PAO is a considerable agent for relapsed/refractory APL and for purging APL cells following stem cell transplantation.     

Influence of hepatitis B virus genotypes on the development of preS deletions and advanced liver disease

Hepatitis B virus (HBV) mutants with deletions in the preS region have not been evaluated for association with viral genotypes. In a case-control study, HBV DNA samples collected from 80 each of carriers infected with HBV genotype B or C were examined for preS deletions. PreS deletion mutants were found in a total of 37 of 160 (23%) HBV carriers. Carriers with preS deletion mutants were older (56.0 +/- 12.7 vs 49.3 +/- 16.9 years, P < 0.05), were infected more frequently with HBV genotype C (84% vs 40%, P < 0.05), and had more advanced disease, such as liver cirrhosis and hepatocellular carcinoma (54% vs 31%; P < 0.05), than did those without such mutants. In a multivariate analysis, genotype C (odds ratio [OR] = 9.3, P < 0.001) and advanced liver disease (OR = 3.1, P < 0.01) were the most significant variables in association with preS deletions. A direct repeat sequence (TCAGG) was found at the start or at the end of preS1 deletions in 6 of the 20 (30%) cases examined, and preS2 deletions in these cases were clustered over the 5'-terminal half of this region. These results indicate that the development of preS deletion mutants depends on HBV genotypes and that it may be associated with progressive liver disease.     

Potential limitations in using minor histocompatibility antigen-specific cytotoxic T cells for targeting solid tumor cells

We have shown previously that KIAA0223, a gene encoding a minor histocompatibility antigen, HA-1, whose expression was believed to be restricted to the hematopoietic cells, is aberrantly expressed in some solid tumor cell lines. However, its significance in tumor immunity needs to be determined. Cytotoxic activity of HA-1(H)-specific cytotoxic T lymphocytes (CTLs) was assessed against solid tumor cell lines expressing KIAA0223 using (51)Cr release assays. Five of seven cell lines were lysed when HLA-A*0201 was adequately expressed. One of the two CTL-resistant cell lines became susceptible after treatment with IFN-gamma and TNF-alpha, while the other was lysed only after pulsing with HA-1(H) peptide. In most cell lines tested, HA-1(H) peptide was properly generated and presented for recognition by the CTL. However, impaired antigen processing and presentation observed in this study may result in escape from CTL recognition in vivo, as well as in vitro, as observed in this study.     

Chaos attractors of ventricular elastance to evaluate cardiac performance

Quantitative evaluation of cardiac function is very important in the clinical application of a ventricular assist device. This article reports a new evaluating method of E max, which is the most reliable parameter to evaluate cardiac function. Fluctuation in the E max time series data was evaluated by the nonlinear mathematical analyzing method including chaos and fractal theory. Experimental goats were anesthetized with halothane inhalation, and left ventricular volume and pressure were measured with other hemodynamic parameters to evaluate E max during various drug administrations. E max was evaluated by two methods. One was the conventional pressure volume loop evaluation and the other was the parameter optimization method without left ventricular volume data. As a result, E max evaluated by the parameter optimization method correlated well with the E max with conventional PV curve. Furthermore, interesting results were obtained. There were rhythmical fluctuations in the E max time series data. By the methodology of Takens, E max time series data was embedded into the phase space and a strange attractor was observed. These results may be important when considering E max evaluation during left ventricular assistance.     

Serial measurement of serum S-100B protein as a marker of cerebral damage after cardiac surgery

BACKGROUND: We used serial measurements of serum S-100B protein to evaluate the time course of serum S-100B protein concentration after cardiovascular surgery and to determine the clinical relevance of its concentration and cerebral damage. METHODS: We assessed neurologic function in 149 patients undergoing cardiovascular surgery with cardiopulmonary bypass. The patients were classified into three groups according to their early postoperative outcome: those without complications (group A), those having unconsciousness or convulsion or both but no hemiplegia (group B), and those having unconsciousness and hemiplegia either with or without convulsion (group C). Serum S-100B protein concentrations were measured with a commercially available immunoluminometric assay, Sangtec 100 LIA, at seven time-points: before cardiopulmonary bypass, at the end of cardiopulmonary bypass, and at 5, 12, 24, 48, and 72 hours after cardiopulmonary bypass. RESULTS: At 5 hours after cardiopulmonary bypass, the S-100B values in groups B and C were significantly higher than the value in group A. Although the S-100B level decreased in group C during the first 5 hours after cardiopulmonary bypass, it increased thereafter (12 through 24 hours) and continued at a high level until the final measurement at 72 hours. At 12 hours after cardiopulmonary bypass, S-100B was significantly higher in group C than in group B. This late increase in S-100B was associated with radiologically detected abnormalities and cerebral damage. CONCLUSIONS: Serial measurement of serum S-100B protein in the initial 12 hours after cardiopulmonary bypass can be used to predict early postoperative brain injury.     

Vitamin intake in Japanese women college students

The Standard Food Tables of Japanese Foods was newly revised in 2000, and contains information on all of the vitamins except biotin. Thus, we carried out a survey of vitamin intake in Japanese women who were university seniors majoring a dietitian course. The subjects (n = 33) consumed self-selected foods, and food intake was recorded by the weight method. We calculated the vitamin intake except for biotin from the food records using the Standard Food Tables of Japanese Foods. In terms of daily intake, vitamin A was 705+/-435 microg (mean+/-SD), vitamin D 6+/-8 microg, vitamin E 7.7+/-3.0 mg, vitamin K 191+/-156 microg, vitamin B1 0.7+/-0.3 mg (0.43+/-0.15 mg/1,000 kcal), vitamin B2 1.1+/-0.4 mg (0.65+/-0.18 mg/1,000 kcal), vitamin B6 0.9+/-0.4 mg (0.017+/-0.005 mg/g protein), vitamin B12 4.4+/-4.1 microg, niacin equivalent 23+/-7 mg (14.4+/-4.9 mg/1,000 kcal), pantothenic acid 4.6+/-1.4 mg, folic acid 267+/-115 microg, and vitamin C 73+/-38 mg. All of these averages were around the Japanese Recommended Dietary Allowance (RDA) for level "III (preferable)" of physical activity. Major vitamin A resources were vegetables; vitamin D resources, fish; vitamin E resources, fats and oils and vegetables; vitamin K resources, vegetables; vitamin B1 resources, cereals and animal meats; vitamin B2 resources, various foods; vitamin B6 resources, cereals, vegetables, fish, and animal meats; vitamin B12 resources, fish; niacin equivalent resources, fish, animal meats, and cereals; pantothenic acid resources, various foods; folic acid resources, vegetables; and vitamin C resources, vegetables and potatoes. From this survey, it was found that Japanese women college students consumed many kinds of food, and therefore, their vitamin nutrition was good as compared to the RDA values for level III of physical activity; however, their energy intake (1,622+/-377 kcal) was lower than the RDA for level III (2,050 kcal/d). Their strength of physical activity would be level I. Therefore, in consideration of their lifestyle, their energy intakes is considered adequate. In conclusion, a problem for student lifestyle is a shortage of food intake due to lack of exercise.