Maximizing tibial coverage is an important consideration in total knee replacement arthroplasty to provide stability and even load transfer and to improve long term survival rate of the implants. We evaluated the coverage, underhang and overhang ratio for the proximal tibial resection surface during total knee replacement arthroplasty in Koreans. After cutting the proximal tibia, the outline of tibial resection surface was traced manually. We compared 5 tibial tray designs, AGC(Biomet, Warsaw, U.S.A.), Advantim(Wright medical technology, Arlington, U.S.A.), AMK(DePuy, Warsaw, U.S.A), MG II(Zimmer, Indiana, U.S.A.), Series 7000(Osteonics, New Jersey, U.S.A.), which have been commercially used in Korea for total knee replacement arthroplasty. The average percentage of coverage area were 83.3% in AGC, 81.6% in AMK, 80.3% in MG II, 80.2% in Advantim and 76.9% in Series 7000. The average percentage of underhang were 16.7% in AGC, 18.4% in AMK, 19.6% in MG II, 19.8% in Advantim and 23,1% in Series 7000. The average percentage of overhang were measured 7.97% in AGC, 7.86% in AMK, 8.01% in MG II, 8.77% in Advantim and 10.14% in Series 7000. So average coverage percentage of tibial cutting surface was 80.5% in Koreans. The factors which affect the optimal coverage, were the shape, dimensional interval of tibial trays and the number of practically useful tibial trays for Koreans.
Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Indiana ; Korea ; New Jersey ; Survival Rate ; Tibia

PURPOSE: To evaluate the effect of the decrease in posterior slope of the tibia on the patellar height after TKA. MATERIALS AND METHODS: One hundred and fifty three cases of TKA (CR type: 43, PS type: 110) were evaluated to measure the posterior slope of the tibia and the patellarheight on lateral radiographs of the knee before and after surgery. Then, we analyzed a correlation between two measurements. RESULTS: The decrease in tibial posterior slope and patellar height was average 6.6 degrees and 1.4mm, there was a weak correlation (r= -0.293, p=0.000), as more decrease in tibial slope, less decrease in patellar height. Comparing CR group with PS group, the decrease of posterior slope of tibia and patella height was average 3.5 vs 7.8 degrees (p=0.000) and 2.2 and 1.2 mm (p=0.146) respectively. There were also correlations (r=-0.438, p=0.003 vs r=-0.228, p=0.017) between two decreases. CONCLUSION: It is considered that the decrease in tibial posterior slope is one of elements influencing in patellar height, and through preoperative radiological examination, estimation of expected decrease in tibial posterior slope is helpful in preserving patellar height in TKA.
Arthroplasty ; Knee ; Patella ; Tibia

PURPOSE: To evaluate the effect of decreasing tibial slope on extension gap during posterior stabilized total knee arthroplasty. MATERIALS AND METHODS: One hundred and ten cases of total knee arthroplasty which were done with posterior stabilized implant were included and we divided those into Group I; having flexion contracture (n=35) and Group II; no flexion contracture (n=75), and from each group, we evaluated the relationship between degree of decreased angle of tibial slope and frequency of additional resection of distal femur which was done for compensating insufficient extension gap during total knee arthroplasty and compared frequencies of additional distal femoral resections between 2 parts having more and less degree of decreased angle of tibial slope. RESULTS: In Group I and II, tibial slope decrease were 8.7degrees, 7.4degrees (p=0.145) and frequencies of additional resection were 51.4%, 24% (p=0.005) in average. Comparing 2 parts having more and less degree of decreased angle of tibial slope in each Group, frequencies of additional resection were 44.4%, 58.8% (p=0.505) and 13.2%, 35.1% (p=0.032). CONCLUSION: During posterior stabilized total knee arthroplasty, especially having no preoperative flexion contracture, decreasing tibial slope can be considered as a factor influencing on extension gap by removing greater anterior bone and the estimation of predictable tibial slope decrease through preoperative radiologic findings can be helpful in creating equal flexion and extension gaps.
Arthroplasty ; Contracture ; Femur ; Knee

Histone deacetylase (HDAC) has been highlighted as one of key players in tumorigenesis and angiogenesis. Recently, several derivatives of psammaplin (Psams) from a marine sponge have been known to inhibit the HDAC activity, but the molecular mechanism for the inhibition has not fully understood. Here, we explored the mode of action of Psams for the inhibition of HDAC activity in the molecular and cellular level. Among the derivatives, psammaplin A (Psam A) showed the potent inhibitory activity in enzyme assay and anti-proliferation assay with IC50 value of 0.003 and 1 microM, respectively. Psam A selectively induced hyperacetylation of histones in the cells, resulting in the upregulation of gelsolin, a well-known HDAC target gene, in a transcriptional level. In addition, reduced Psam A showed a stronger inhibitory activity than that of non-reduced one. Notably, glutathione-depleted cells were not sensitive to Psam A, implying that cellular reduction of the compound is responsible for the HDAC inhibition of Psam A after uptake into the cells. Together, these data demonstrate that Psam A could exhibit its activity under the reduced condition in the cells and be a new natural prodrug targeting HDAC.
Tyrosine/*analogs & derivatives/chemistry/pharmacology ; Prodrugs/chemistry/*pharmacology ; Oxidation-Reduction ; Molecular Structure ; Humans ; Histones/metabolism ; Histone Deacetylases/*antagonists & inhibitors/*classification/genetics/metabolism ; Hela Cells ; Enzyme Inhibitors/chemistry/*pharmacology ; Disulfides/chemistry/*pharmacology ; Cell Proliferation ; Biological Products/chemistry/*pharmacology ; Acetylation

Inflammation is a part of the complex biological responses of a tissue to injury that protect the organ by removing injurious stimuli and initiating the healing process, and is considered as a mechanism of innate immunity. To identify biologically active compounds against pathogenic inflammatory and immune responses, we fractionated water, aqueous methanol and n-hexane layers from nine kinds of leguminosae and examined anti-inflammatory activity of the fractions in human keratinocytes and mouse skin. Among the fractions, rf3 and rf4, isolated from the aqueous methanol layer of Astragalus sinicus L., exhibited the strongest reactive oxygen species (ROS)-scavenging and anti-inflammatory activities as measured by inhibition of the intracellular ROS production, nuclear factor-kappaB (NF-kappaB), janus kinase (JAK)/signal transducer and activator of transcription (STAT), and phosphatidylinositol 3-kinase/Akt signaling in cytokine-stimulated human keratinocytes, as well as by effects on T-cell differentiation in mouse CD4+ T cells. In addition, topical application of rf3 and rf4 suppressed the progression of psoriasis-like dermatitis and expression of pro-inflammatory mediators in interleukin (IL)-23-injected mouse ears. Our results suggest that Astragalus sinicus L. may ameliorate chronic inflammatory skin diseases due to its antioxidant and anti-inflammatory activities via regulation of the intracellular ROS production, NF-kappaB, JAK/STAT and PI3/Akt signaling cascades as well as immune responses, and these results are the first report that Astragalus sinicus L. exhibits pharmacological activity.
Animals ; Anti-Inflammatory Agents/isolation & purification/*pharmacology/therapeutic use ; Astragalus Plant/*chemistry ; Cell Line ; Dermatitis/drug therapy ; Humans ; Interleukin-23/pharmacology ; Janus Kinases/metabolism ; Keratinocytes/*drug effects/metabolism ; Mice ; Mice, Inbred C57BL ; NF-kappa B/metabolism ; Phosphatidylinositol 3-Kinases/metabolism ; Plant Extracts/isolation & purification/*pharmacology/therapeutic use ; Proto-Oncogene Proteins c-akt/metabolism ; Reactive Oxygen Species/metabolism ; STAT Transcription Factors/metabolism ; Skin/*drug effects/metabolism

Purpose: Immune checkpoint inhibitors (ICI) and targeted small-molecule drugs are mainstay elements of lung cancer chemotherapy. However, they are associated with development of pneumonitis, a rare, but potentially life-threatening event. We analyzed lung cancer patients treated with ICI to evaluate the effect of sequential therapeutic administration on the incidence of pneumonitis. Materials and Methods: In this retrospective study, 242 patients were included. Serial radiologic findings taken during and immediately after ICI treatment were reviewed. Factors that increased pneumonitis and the relationship between peri-ICI chemotherapy and the development of pneumonitis were evaluated. Results: Pneumonitis developed in 23 patients (9.5%); severe pneumonitis (grade ≥ 3) occurred in 13 of 23 patients (56%); pneumonitis-related death occurred in six. High-dose thoracic radiation (≥ 6,000 cGy) revealed a tendency toward high risk of pneumonitis (odds ratio, 2.642; 95% confidence interval, 0.932 to 7.490; p=0.068). Among 149 patients followed for ≥ 8 weeks after the final ICI dose, more patients who received targeted agents within 8-weeks post-ICI experienced pneumonitis (3/16, 18.8%) compared with patients who received cytotoxic agents (4/54, 7.4%) or no chemotherapy (4/79, 5.1%) (p=0.162). Targeted therapy was associated with earlier-onset pneumonitis than treatment with cytotoxic agents (35 vs. 62 days post-ICI, p=0.007); the resulting pneumonitis was more severe (grade ≥ 3, 100% vs. 0%, p=0.031). Conclusion Sequential administration of small-molecule targeted agents immediately after ICI may increase the risk of severe pneumonitis. The sequence of chemotherapy regimens that include ICI and targeted agents should be carefully planned to reduce the risk of pneumonitis in lung cancer patients.

Anemia is the most common hematologic finding in patients with advanced infections caused by human immunodeficiency virus (HIV) or advanced acquired immunodeficiency syndrome (AIDS). Among many etiologies of HIV-associated anemia, vitamin B12 deficiency plays an important role, mostly due to malabsorption or HIV enteropathy. We experienced a case of megaloblastic anemia caused by vitamin B12 deficiency in a male patient with an AIDS who had no structural gastrointestinal problem. He showed severe anemia, leukopenia, thrombocytopenia and suspicious neurologic manifestations such as aggravation of dementia and gait disturbance. With vitamin B12 and folate treatment, the patient's general condition and hematologic features were improved successfully.
Acquired Immunodeficiency Syndrome ; Anemia ; Anemia, Megaloblastic ; Dementia ; Folic Acid ; Gait ; HIV ; HIV Enteropathy ; Humans ; Leukopenia ; Male ; Neurologic Manifestations ; Thrombocytopenia ; Vitamin B 12 ; Vitamin B 12 Deficiency ; Vitamins

Comprehensive chemical analysis of extracts and fractions of marine actinomycete strains led to the discovery of a new minor secondary metabolite, salternamide E (1), from a saltern-derived halophilic Streptomyces strain. The planar structure of salternamide E (1) was elucidated by a combinational analysis of spectroscopic data including NMR, MS, UV, and IR. The absolute configuration of salternamide E (1) was determined by circular dichroism spectroscopic analysis. Salternamide E displayed weak cytotoxicity against various human carcinoma cell lines.
Cell Line ; Circular Dichroism ; Humans ; Streptomyces*

Sarcotragin C (1), a new sesterterpene metabolite was isolated from a Sarcotragus sp. sponge collected from Chuja Island, Korea. On the basis of the combined spectroscopic analyses, the structure of this compound was determined to be a linear norsesterterpene containing a leucine-derived gamma-lactam moiety. This compound exhibited moderate cytotoxicity against K562 and A549 cell-lines.
Korea ; Porifera*

Many active compounds present in Rhododendron brachycarpum have been used in traditional Oriental medicine for the treatment of various skin diseases. However, the precise mechanism of action of the compounds isolated from R. brachycarpum and their relevance as therapeutics for the treatment of psoriasis remain elusive. In this study, we report that rhododendrin isolated from R. brachycarpum strongly inhibits imiquimod (IMQ)-induced psoriasis-like skin inflammation in mice. We showed that topical treatment with rhododendrin reduces IMQ-induced skin hyperplasia, inflammatory mononuclear cell infiltration and the expression of pro-inflammatory mediators in mouse skin. In addition, we found that rhododendrin inhibits the activation of the TLR-7/NF-κB and mitogen-activated protein kinase pathways in both IMQ-induced psoriasis-like skin inflammation in mice and in normal human epidermal keratinocytes treated with IMQ. These results suggest that rhododendrin has an anti-inflammatory effect and can be used as a therapeutic to fight against psoriasis and other inflammatory skin diseases.
Animals ; Humans ; Hyperplasia ; Inflammation* ; Keratinocytes ; Medicine, East Asian Traditional ; Mice* ; Protein Kinases ; Psoriasis ; Rhododendron ; Skin Diseases ; Skin*