Medial meniscus posterior root tears (MMPRTs) with focal cartilage defects present a therapeutic challenge, even in neutral-to-mild varus knees. Although transtibial pullout repair is standard for MMPRTs without advanced osteoarthritis, coexisting cartilage lesions may compromise outcomes and prompt unicompartmental knee arthroplasty (UKA). Combining pullout repair with osteochondral autograft transplantation (OAT) may offer a joint-preserving alternative by restoring meniscal hoop stress and reconstructing focal osteochondral defects. However, supporting evidence is limited. We retrospectively analyzed 150 patients treated surgically for MMPRT between 2015 and 2019, divided into three groups: pullout repair with OAT (Group O, n = 6), pullout repair alone (Group P, n = 120), and UKA (Group U, n = 24), with OAT being applied only in carefully selected patients based on strict clinical and radiographic indications. Clinical outcomes were assessed preoperatively, at 1 year, and at final follow-up (mean, 4.2-5.8 years). The primary outcome was the final clinical score, and secondary outcomes were changes from baseline. All groups improved postoperatively. Group O showed marked improvement in Knee Injury and Osteoarthritis Outcome Score-Symptom and Visual Analogue Scale-Pain score, achieving outcomes comparable to Group U at final follow-up. Group P showed consistent improvement from baseline. Radiographically, mild osteoarthritis progression was observed in Group O. Given the small sample size in Group O and the retrospective design, the findings are exploratory and warrant confirmation in larger prospective studies.
Since cefixime and tellurite are known to inhibit most bacteria belonging to Enterobacterales, we found that addition of tellurite inhibited E. albertii growth in Luria Bertani broth but not in tryptic soy broth (TSB), and addition of phosphate and soy peptone enhanced E. albertii growth in TSB in presence of tellurite. Subsequently, to find the positive factor present in TSB, E. albertii growth was examined in tryptone, soy peptone, glucose, or phosphate deficient tryptic soy agar plates. Phosphate, soy peptone, and/or glucose deficiency indeed decreased E. albertii growth. However, none of the substances are specifically present in xylose-rhamnose-melibiose (XRM)-MacConkey agar and thus, not affecting E. albertii growth. Altogether, a novel E. albertii selective differential medium, XRM-MacConkey medium containing cefixime (C), tellurite (T), phosphate (P), and soy peptone (S) (named CT-PS-XR-MacConkey medium), which differentiate E. albertii (colorless) from E. coli (red) by colony color, has been developed. The CT-PS-XR-MacConkey agar was evaluated with 156 bacterial strains including 65 E. albertii. While all E. albertii strains grew as colorless colonies, 54 strains of 9 different genera belonging to 19 different species were unable to grow on this medium. However, rest of these bacterial strains grew either as colorless or as red colonies. Furthermore, spiking experiments using chicken meat as food samples showed that the CT-PS-XR-MacConkey medium is highly selective for E. albertii than XRM-MacConkey agar. Altogether, the results suggest that the CT-PS-XR-MacConkey agar is indeed a useful selective medium for isolation of E. albertii from food samples.
Background A medial meniscal posterior root tear (MMPRT) has a significant impact on knee joint stability, often leading to meniscal extrusion and progressive osteoarthritis (OA). Arthroscopic transtibial pullout repair, the preferred surgical approach for MMPRTs, may be associated with postoperative progression of medial meniscal extrusion (MME), but the results are conflicting. Therefore, the aim of this study was to evaluate the efficacy of a circumferential fiber augmentation (CFA) technique combined with a transtibial pullout repair (TPCFA) in reducing medial meniscal extrusion (MME) compared with that of conventional two simple stitches transtibial pullout repair (TSS). Methods Forty patients with MMPRTs who underwent either TSS (n = 20) or TPCFA (n = 20) were retrospectively analyzed. MME in the TPCFA group was measured intraoperatively using ultrasound imaging at different tension levels of 20 N, 30 N, and 40 N. Because of concerns about suture cutout of the meniscus in the TSS, MME evaluation of the TPCFA group and TSS group was compared under 20 N tension. Results A significant decrease in MME was observed with increasing tension in the TPCFA group, with TPCFA also showing superior reduction in MME compared to TSS under 20 N tension (2.9 ± 0.8 mm vs. 3.4 ± 0.6 mm; P < 0.05). Conclusions This study highlights the potential of the TPCFA technique to reduce meniscal extrusion in MMPRT repair. This is clinically significant as reducing MME can help prevent the progression of OA and improve knee joint stability and function.
Escherichia albertii is an emerging zoonotic foodborne pathogen . The clinical significance of this bacterium has increasingly been recognized worldwide. However, diagnostic method has not yet been established and its clinical manifestations are not fully understood. Here, we show that an Eacdt gene-based quantitative real-time PCR (qRT-PCR) developed in this study is 100% specific and sensitive when tested with 39 E. albertii and 36 non- E. albertii strains, respectively. Detection limit of the real-time PCR was 10 colony forming unit (CFU) and 1 pg of genomic DNA per PCR tube. When E. albertii was spiked with 4 x 10 0 - 10 6 CFU per mL to stool of healthy person, detection limit was 4.0 x 10 3 and 4.0 CFU per mL before and after enrichment culture, respectively. Moreover, the qRT-PCR was able to detect E. albertii in five children out of 246 (2%) but none from 142 adults suffering from gastroenteritis. All five E. albertii strains isolated carried eae and paa genes, however, only one strain harbored stx2f genes. Long -term shedding of stx2f genepositive E. albertii in a child stool could be detected because of the qRT-PCR developed in this study which might have been missed if only conventional PCR and culture methods were employed. Furthermore, E. albertii isolated from siblings with diarrhea showed clonality by PFGE analysis. Taken together, these data suggest that the Eacdt gene-based qRT-PCR developed for the detection of E. albertii is useful and will assist in determining the real burden and clinical manifestation of E. albertii infections.
ABSTRACT We have recently described a clinical isolate of Providencia rustigianii strain JH-1 carrying the genes for cytolethal distending toxin (CDT) in a conjugative plasmid. A cdtB mutant of strain JH-1, which lost CDT activity, was still found to retain invasiveness and diarrheagenicity. The strain was subjected to phenotypic and genetic analyses including whole genome sequencing (WGS) to explore the genetic determinants of the observed invasiveness and diarrheagenic properties. Analysis and annotation of WGS data revealed the presence of two distinct type III secretion systems (T3SS) in strain JH-1, one of which was located on the chromosome designated as cT3SS (3,992,833 bp) and the other on a mega-plasmid designated as pT3SS (168,819 bp). Comparative genomic analysis revealed that cT3SS is generally conserved in Providencia spp. but pT3SS was limited to a subset of Providencia spp., carrying cdt genes. Strain JH-1 was found to invade HeLa cells and induce fluid accumulation with characteristic pathological lesions in rabbit ileal loops. Remarkably, these phenomena were associated with the pT3SS but not cT3SS. The plasmid could be transferred by conjugation from strain JH-1 to other strains of P. rustigianii , Providencia rettgeri , and Escherichia coli with concomitant transfer of these virulence properties. This is the first report of a functional and mobile T3SS in P. rustigianii and its association with invasiveness and diarrheagenicity of this bacterium. These data suggest that P. rustigianii and other CDT-producing Providencia strains might carry T3SS and exert their diarrheagenic effect by exploiting the T3SS nano-machinery. IMPORTANCE The precise mechanism of virulence of Providencia rustigianii is unclear, although some strains produce cytolethal distending toxin as a putative virulence factor. We have detected the presence of a type III secretion system (T3SS) for the first time on a plasmid in a P. rustigianii strain. Plasmid-mediated T3SS seems to be directly involved in virulence of P. rustigianii and may serve as a means of horizontal transfer of T3SS genes. Our results may have implication in understanding the mechanism of emergence of new pathogenic strains of P. rustigianii .
