A variety of substitutes and numerous operative procedures have been described to stabilize the anterior cruciate ligament(ACL) deficient knee. OBJECTIVES: The purpose of this study has been to evaluated the remodelling process of bone-patef- lar tendon-bone(B-PTB) allograft(Tutoplast(r)) for ACL reconstruction by means of light microscopic(LM) and electron microscopic(EM) examinations from the biopsy specimens obtained at the time of second-look arthroscopy. The authors also have been grossly observed the width, vascularity, elasticity and stability of B-PTB allograft. MATERIALS AND METHODS: ACL reconstruction using B-PTB allograft was performed on 22 consecutive patients. Among them, 12 patients were reviewed and the average age at time of operation was 22.5 years ranging from 21 to 40 years. The second look arthroscopy was performed at 6 months, 12 months, 24 months in each of the 4 cases. The gross findings of allograft were observed, and biopsy was done by the method of Millonig. Results; The arthroscopic findings of the reconstructed ACL were partially covered with synovium and narrowed in diameter at 6 months follow up. At 12 months follow up after reconstruction, that grafted ligaments were covered with more synovial membrane, and observed the more thickness with normal strength similar to normal anterior cruciate ligament configuration. At 24 months, grafted ligaments were grossly similar to normal ACL. The LM findings demonstrated many fibroblasts with spindle shape nuclei and and hypercellularity at 6 months. At the 12 months, crimp pattern of collagen bundles and decreased hypercellularity observed. At 24 months, grafted ligament were similar to nomal ACL. The EM findings that fibroblasts were showed abundant cytoplasm which contained marked dilated rough endoplasmic reticulum(r-ER) and aggregates of microfilaments at 6 months. At 12 months, fibroblasts with folded nuclei and abundant cytoplasm were observed. At 24 months, demonstrated the fibroblasts with abundant cytoplasm and densely packed collagen fibrils. Collagen fibrils displayed parallel arrangement and characteristic cross striation with a periodicity. Scanning EM findings showed uniformly small diameter of collagen in the transeverse section. CONCLUSIONS: Gross & LM findings of B-PTB allograft were similar to that of normal ACL at 6 months, and at 12 months, postoperatively. But EM findings of B-PTB allograft were compared with the biopsy samples of normal ACLs, the allograft was still undergoing maturation 24 months postoperati vely.
Actin Cytoskeleton ; Allografts* ; Anterior Cruciate Ligament* ; Arthroscopy ; Biopsy ; Collagen ; Cytoplasm ; Elasticity ; Fibroblasts ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Patella* ; Patellar Ligament* ; Periodicity ; Prospective Studies* ; Surgical Procedures, Operative ; Synovial Membrane ; Transplants

E-cadherin (ECD) is a Ca++ -dependent adhesion molecule which plays a major role in the maintenance of intercellular adhesion in epithelial tissues. The expression pattern of ECD in 77 surgically resected gastric adenocarcinomas was examined by immunohistochemistry, using a rat monoclonal antibody raised against murine E-cadherin (DECAM-1). ECD was strongly expressed uniformly at cell to cell borders in normal gastric epithelium without exception. But, various staining patterns were observed in the cancer tissues. The frequency of tumors with preserved ECD expression (Pre-type) and reduced ECD expression (Rd-type) was 44% and 56%, respectively. Using Lauren's classification, the high frequency of the Pre-type expression in adenocarcinoma of the intestinal type was significantly higher than that in adenocarcinoma of the diffuse type (p<0.05). But, no significant correlation between the ECD expression and the gross type, invasion depth, growth pattern or metastasis was observed. These results suggest that ECD might play a key role in the morphogenesis of gastric adenocarcinoma.
Adenocarcinoma* ; Animals ; Cadherins* ; Classification ; Epithelium ; Immunohistochemistry ; Morphogenesis ; Neoplasm Metastasis ; Rats

Although there have been many reports about the importance of the spleen's role in hepatic fibrogenesis, the exact mechanism is still uncertain. The author designed this study to evaluate splenic function on hepatic fibrogenesis. The degree of hepatic fibrosis and the population of splenocyte subsets were studied in the experimental animal model with fibrosis produced by injecting normal swine serum intra-peritoneally into Sprague-Dawley rats. The animals were divided into three groups; group A was subjected to injection of swine serum only, group B swine serum and complete Freund's adjuvant and group C swine serum and cyclosporin A. The experimental hepatic fibrogenesis by swine serum was augumented by coinjection with the adjuvant and inhibited by cyclosporin A. The study of the splenocyte subset revealed increased percentages of spienic B cell and CD4+ cell and a decreased percentage of CD8+ cell, and these changes of splenocyte subset were also augumented by the adjuvant and inhibited by cyclosporin A. The percent of monocytes was not significantly altered, although a tendancy of early decrease by the adjuvant was noted.
Rats ; Animals

Poland's syndrome is congenital anomaly which was described first by Alfred Poland in 1841. The clinical features are variable but always include congenital aplasia of fingers and syndactyly. We have experienced a case of Poland's syndrome. This case was male children and revealed thoracic anomaly of right side (absence of pectoral muscles and anterior axillary fold), atrophy of forearm muscles, ipsilateral syndactyly with aplasia of thumb and middle phalanges of 2, 3, 4, 5,th fingers, and ipsilateral congenital radio-ulnar synostosis.
Atrophy ; Child ; Fingers ; Forearm ; Humans ; Male ; Muscles ; Poland ; Syndactyly ; Synostosis ; Thumb

The Ehlers-Danlos syndrome is a familial disorder of connective tissue, and seven distinct clinical forms are reported. Author experienced two cases of the type 3 Ehlers-Danlos syndrome which present hypermobility of the joints, asymmetry of the thorax, anomalies of the thoracic spine, and flatfoot. So, we report these patients with references.
Connective Tissue ; Ehlers-Danlos Syndrome ; Flatfoot ; Humans ; Joints ; Spine ; Thorax

Purpose: This study aimed to identify the most delirium assessment tool with high predictive validity for elderly patients with stroke. Methods: This was a prospective observational study. The subjects were 219 stroke patients aged 60 years or older admitted to the neurology ward of a general hospital and data collection was conducted from August 2022 to February 2023. The collected data were analyzed using descriptive statistics, x 2 -test, independent t-test, and Fisher's exact test. The predictive validity of the Delirium Observation Screening Scale (DOS), the Nursing Delirium Screening Scale(Nu-DESC), and the 4'A's test (4AT) were assessed based on the sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC). Results: Of the 38 patients screened for delirium using delirium assessment tools, 32 (14.6%) were diagnosed with delirium by a neurologist. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.4%, 91.1%, 71.1%, and 97.2% for DOS; 93.8%, 96.8%, 83.3%, and 98.9% for Nu-DESC; and 100.0%, 96.8%, 84.2%, and 100.0% for 4AT, respectively. The AUC was shown to be 0.89 for the DOS, 0.95 for the Nu-DESC, and 0.98 for the 4AT. Conclusion The results indicate that the 4AT was the most valid delirium assessment tool for elderly patients with stroke. Therefore, the active use of 4AT by nurses to screen for delirium of elderly stroke patients in clinical settings can contribute to the prevention and early management of delirium.

Purpose: This study aimed to identify the most delirium assessment tool with high predictive validity for elderly patients with stroke. Methods: This was a prospective observational study. The subjects were 219 stroke patients aged 60 years or older admitted to the neurology ward of a general hospital and data collection was conducted from August 2022 to February 2023. The collected data were analyzed using descriptive statistics, x 2 -test, independent t-test, and Fisher's exact test. The predictive validity of the Delirium Observation Screening Scale (DOS), the Nursing Delirium Screening Scale(Nu-DESC), and the 4'A's test (4AT) were assessed based on the sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC). Results: Of the 38 patients screened for delirium using delirium assessment tools, 32 (14.6%) were diagnosed with delirium by a neurologist. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.4%, 91.1%, 71.1%, and 97.2% for DOS; 93.8%, 96.8%, 83.3%, and 98.9% for Nu-DESC; and 100.0%, 96.8%, 84.2%, and 100.0% for 4AT, respectively. The AUC was shown to be 0.89 for the DOS, 0.95 for the Nu-DESC, and 0.98 for the 4AT. Conclusion The results indicate that the 4AT was the most valid delirium assessment tool for elderly patients with stroke. Therefore, the active use of 4AT by nurses to screen for delirium of elderly stroke patients in clinical settings can contribute to the prevention and early management of delirium.

Purpose: This study aimed to identify the most delirium assessment tool with high predictive validity for elderly patients with stroke. Methods: This was a prospective observational study. The subjects were 219 stroke patients aged 60 years or older admitted to the neurology ward of a general hospital and data collection was conducted from August 2022 to February 2023. The collected data were analyzed using descriptive statistics, x 2 -test, independent t-test, and Fisher's exact test. The predictive validity of the Delirium Observation Screening Scale (DOS), the Nursing Delirium Screening Scale(Nu-DESC), and the 4'A's test (4AT) were assessed based on the sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC). Results: Of the 38 patients screened for delirium using delirium assessment tools, 32 (14.6%) were diagnosed with delirium by a neurologist. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.4%, 91.1%, 71.1%, and 97.2% for DOS; 93.8%, 96.8%, 83.3%, and 98.9% for Nu-DESC; and 100.0%, 96.8%, 84.2%, and 100.0% for 4AT, respectively. The AUC was shown to be 0.89 for the DOS, 0.95 for the Nu-DESC, and 0.98 for the 4AT. Conclusion The results indicate that the 4AT was the most valid delirium assessment tool for elderly patients with stroke. Therefore, the active use of 4AT by nurses to screen for delirium of elderly stroke patients in clinical settings can contribute to the prevention and early management of delirium.

Purpose: This study aimed to identify the most delirium assessment tool with high predictive validity for elderly patients with stroke. Methods: This was a prospective observational study. The subjects were 219 stroke patients aged 60 years or older admitted to the neurology ward of a general hospital and data collection was conducted from August 2022 to February 2023. The collected data were analyzed using descriptive statistics, x 2 -test, independent t-test, and Fisher's exact test. The predictive validity of the Delirium Observation Screening Scale (DOS), the Nursing Delirium Screening Scale(Nu-DESC), and the 4'A's test (4AT) were assessed based on the sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC). Results: Of the 38 patients screened for delirium using delirium assessment tools, 32 (14.6%) were diagnosed with delirium by a neurologist. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.4%, 91.1%, 71.1%, and 97.2% for DOS; 93.8%, 96.8%, 83.3%, and 98.9% for Nu-DESC; and 100.0%, 96.8%, 84.2%, and 100.0% for 4AT, respectively. The AUC was shown to be 0.89 for the DOS, 0.95 for the Nu-DESC, and 0.98 for the 4AT. Conclusion The results indicate that the 4AT was the most valid delirium assessment tool for elderly patients with stroke. Therefore, the active use of 4AT by nurses to screen for delirium of elderly stroke patients in clinical settings can contribute to the prevention and early management of delirium.

Local or distant flap surgery has been applied in the soft tissue defect area where bone and tendon are exposed, but there are many pitfalls in these surgeries including limitation of donor site selection, as well as functional and aesthetic dissatisfaction of the donor and recipient site. So these problems have facilitated the development and study of skin substitute (artificial dermis). The history of artificial skin began in the 1980s with the invention of Stage I membrane by Yannas and Burke. Since then it has been developed and applied to chinical cases of extensive burn injury and soft tissue defect. In 1989, and artificial dermis (Terudermis) composed of fibrillar collagen and heat denaturated atelocollagen was developed by Konish. It has the advantage of allowing early-incorporation of cellular and vascular components into its collagen sponge, as well as dehydrothermal cross-linking, which is very weak. This study included 18 consecutive cases which underwent application of artificial dermis on bone and tendon from January 1997 to November 1998. The exposed areas were the result of trauma in 10 cases, postoperative complications in 2 cases, and other causes in 6 cases. The follow-up period ranged from 3 months to 18 months, averaging 11 months. A week after wound debridement and Terudermis application, neovascularization had begun and granulation tissue appeared aften 2-3 weeks. Then the split or full -thickness skin graft was secondarily applied resulting in the production of sufficient skin. In conclusion, Terudermis application to an area of exposed bone and tendon is a very useful method, especially when primary local or distant flap surgery cannot be used. This method is very simple, convenient and reliable.
Burns ; Collagen ; Debridement ; Dermis ; Fibrillar Collagens ; Follow-Up Studies ; Granulation Tissue ; Hot Temperature ; Humans ; Inventions ; Membranes ; Porifera ; Postoperative Complications ; Skin ; Skin, Artificial ; Tendons* ; Tissue Donors ; Transplants ; Wounds and Injuries