Psychological Characteristics and Quality of Life of Patients With Functional Dyspepsia.

OBJECTIVE: The objective of this study is to compare the psychosocial characteristics of functional dyspepsia (FD) with its subgroups, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), against a healthy control group, and to investigate the quality of life (QoL). METHODS: All of the subjects were 210 adults, 131 patients with FD were diagnosed by gastroenterologist and 79 adults with no observable symptoms of FD were selected as the normal control group. Demographic factors were investigated. The Korean-Beck Depression Inventory-II, Korean-Beck Anxiety Inventory, Korean-Childhood Trauma Questionnaire, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale, and WHO Quality of Life Assessment Instrument Brief Form were used to assess psychological factors. A one-way analysis of variance was used to compare differences among the groups. Further, a stepwise regression analysis was conducted to determine factors affecting the QoL of the FD group. RESULTS: Between-group differences in demographic characteristics were not significant. Depression (F=37.166, p<0.001), anxiety (F=30.261, p<0.001), and childhood trauma (F=6.591, p<0.01) were all significantly higher in FD group compared to the normal control. Among FD subgroups, EPS exhibited higher levels of both depression and anxiety than PDS. Social support (F=17.673, p<0.001) and resilience (F=8.425, p<0.001) were significantly lower in FD group than in other groups, and the values were higher in PDS than in EPS. Resilience (ß=0.328, p<0.001) was the most important explanatory variable. The explained variance was 46.6%. CONCLUSION: Significantly more symptoms of depression, anxiety, childhood trauma was observed for both FD sub-group. These groups also had less social support, resilience, and QoL than the control groups.

Clinical outcomes of extensor indicis proprius tendon transfer for extensor pollicis longus tendon rupture.

LEVEL OF EVIDENCE: IV.

Perceptions of and Practices for the Management of Constipation: Results of a Korean National Survey.

Background/Aims: Although guidelines exist regarding the evaluation and management of patients with chronic constipation (CC), little is known about real-world clinical practice patterns. This study aimed to evaluate the various practices used to manage CC patients in various clinical settings in South Korea. Methods: A nationwide web-based survey was conducted, randomly selecting gastroenterologists and non-gastroenterologists. The 25-item questionnaire included physicians' perceptions and practices regarding the available options for diagnosing and managing CC patients in Korea. Results: The study participants comprised 193 physicians (86 gastroenterologists, 44.6%) involved in the clinical management of CC patients. The mean clinical experience was 12 years. Only 21 of 193 respondents (10.9%) used the Rome criteria when diagnosing CC. The Bristol Stool Form Scale was used by 29% of the respondents (56/193), while the digital rectal examination was performed by 11.9% of the respondents (23/193). Laboratory testing and colonoscopies were performed more frequently by gastroenterologists than by non-gastroenterologists (both p=0.001). Physiologic testing was used more frequently by gastroenterologists (p=0.046), physicians at teaching hospitals, and physicians with clinical experience ≤10 years (both p<0.05). There were also significant differences in the preference for laxatives depending on the type of hospital. Conclusions: There were discrepancies in the diagnosis and management of CC patients depending on the clinical setting. The utilization rates of the Bristol Stool Form Scale and digital rectal examination by physicians are low in real-world clinical practice. These results imply the need for better and more practical training of physicians in the assessment and management of CC.

Spontaneous Acute Epidural Hematoma Associated With Metastatic Hepatocellular Carcinoma: A Case Report.

Spontaneous acute epidural hematoma (AEDH) co-occurring with metastatic hepatocellular carcinoma (HCC) of the skull is rare, with only 7 documented cases in existing literature. This report describes the case of a 42-year-old man who presented with decreased consciousness following intermittent headaches following minor head trauma. Computed tomography imaging revealed an AEDH, prompting surgical intervention. Despite preliminary assumptions linking the causes of the trauma, surgical exploration revealed no evidence of traumatic injury. Instead, an infiltrative soft-tissue mass within the skull was identified. Histopathological examination confirmed that the mass was a metastatic HCC. Despite the successful hematoma evacuation, the patient's neurological status did not improve. This case underscores the importance of considering metastatic disease in the differential diagnosis of AEDH, particularly in patients with a history of malignant tumors, irrespective of prior indications of bone metastasis. Furthermore, it emphasizes the need to enhance diagnostic and therapeutic strategies for such complex cases.

Differences in gross appearance and histopathology of the outer membrane of the subdural hematoma envelope over time: A respective case series and literature review.

RATIONALE: Chronic subdural hematoma (CSDH) is a common disorder among elderly males. The most common theory of its cause is a minor brain injury resulting in the rupture of a bridging vein. The outer membrane of subdural hematoma (SDH) evolves like cutaneous wound healing with different phases. This report aims to use a surgical microscope and an electron microscope to show the pathophysiological differences in the temporal flow of the outer membrane of SDH. PATIENT CONCERNS: This study retrospectively reviewed the cases of 6 patients who underwent craniotomy from 2016 to 2021 at the single center of Chonnam National University Hospital. DIAGNOSES: These patients had a history of intracranial hematoma (ICH) at the surgical site on brain computed tomography (CT) before craniotomy. This study aimed to observe the morphological changes over time in the outer membrane of SDH and analyzed them through macroscopic and pathological findings. INTERVENTIONS AND OUTCOMES: The outer membrane of SDH was confirmed in all six patients who underwent surgery, and macroscopic analysis was performed using an operating microscope. Three patients underwent pathological analysis through histological examination, and through this, the difference according to ICH occurrence and detection time was analyzed. LESSONS: This study suggests that the outer membrane of SDH contains inflammatory and collagen cells in the early stages and thickens over time. This healing response is similar to cutaneous wound healing.

[Brain-Gut-Microbiota Axis].

Patients frequently report that stress causes or exacerbates gastrointestinal (GI) symptoms, indicating a functional relationship between the brain and the GI tract. The brain and GI tract are closely related embryologically and functionally, interacting in various ways. The concept of the brain-gut axis was originally established in the 19th and early 20th centuries based on physiological observations and experiments conducted in animals and humans. In recent years, with the growing recognition that gut microbiota plays a vital role in human health and disease, this concept has been expanded to the brain-gut-microbiota axis. The brain influences the motility, secretion, and immunity of the GI tract, with consequent effects on the composition and function of the gut microbiota. On the other hand, gut microbiota plays an essential role in the development and function of the brain and enteric nervous system. Although knowledge of the mechanisms through which the gut microbiota influences distant brain function is incomplete, studies have demonstrated communication between these organs through the neuronal, immune, and endocrine systems. The brain-gut-microbiota axis is an essential aspect of the pathophysiology of functional GI disorders such as irritable bowel syndrome, and is also involved in other GI diseases, including inflammatory bowel disease. This review summarizes the evolving concept of the brain-gut-microbiota axis and its implications for GI diseases, providing clinicians with new knowledge to apply in clinical practice.

Occipital artery bypass importance in unsuitable superficial temporal artery: Two case reports.

BACKGROUND: Superficial temporal artery-middle cerebral artery (STA-MCA) bypass helps treat cerebral ischemia. However, the STA is not available for bypass in some conditions. Therefore, with some technical tips, the authors introduced a bypass technique using the occipital artery (OA). CASE SUMMARY: Two female patients complained of hemiparesis. Brain magnetic resonance imaging (MRI) indicated contralateral infarction from the MCA steno-occlusion. On Diamox single photon emission computed tomography or perfusion MRI, the contralateral front parietotemporal reserve was diminished. On transfemoral cerebral angiography, the STA was thin with a weak flow; however, the OA was prominent. Direct OA-MCA end-to-side extracranial-intracranial bypass surgery was implemented instead of STA because the caliber was too narrow. The postoperative course was uneventful in both cases, with well-maintained bypass patency and neurological stability during follow-up. CONCLUSION: OA might be an acceptable alternative for MCA cerebral ischemic cases with an unsuitable STA.

Minimally invasive fibrinolytic treatment and drainage in patients with acute subdural hemorrhage and underlying comorbidities.

The incidence of acute subdural hemorrhage (ASDH), which is often caused by head trauma, is steadily increasing due to an increase in the elderly population and the use of anticoagulants. Urgent surgical treatment is recommended if the patient has impaired consciousness, worsening neurological symptoms, or brain midline shift (MLS) due to large hematomas on brain computed tomography (CT). Although large craniotomy is traditionally recommended for ASDH removal, old age, comorbidities, and antiplatelet drugs are considered risk factors for surgical complications, many neurosurgeons hesitate to perform aggressive surgical procedures in these patients. In this study, we introduced a method that can quickly and effectively remove ASDH without general anesthesia. We retrospectively reviewed 11 cases of patients with ASDH who underwent hematoma drainage between June 2019 and December 2020. We measured the maximum subdural hematoma thickness and MLS on brain CT of patients and recorded the Glasgow Coma Scale scores before and after the surgical procedure. All patients had multiple comorbidities, and seven patients received anticoagulant or antiplatelet therapy. On initial brain CT, the median subdural hemorrhage thickness was 21.36 mm, median MLS was 10.09 mm, and mean volume of the subdural hematoma was 163.64 mL. The mean evacuation rate of the subdural hematoma after drainage was 83.57%. There was no rebleeding or operation-related infection during the aspiration procedure, and the median MLS correction after the procedure was 7.0 mm. Our treatment strategies can be a reliable, less invasive, and alternative treatment option for patients at high risk of complications due to general anesthesia or patients who are reluctant to undergo a large craniotomy due to a high bleeding tendency.

Influence of subsidence after stand-alone anterior cervical discectomy and fusion in patients with degenerative cervical disease: A long-term follow-up study.

This study aimed to evaluate the influence of subsidence in patients who performed stand-alone anterior cervical discectomy and fusion (ACDF) by analyzing the long-term clinical and radiological outcomes. This retrospective study enrolled 53 patients with 79 segments with degenerative cervical disease treated with stand-alone ACDF with ≥5 years of follow-up. Segmental angle (SA), cervical sagittal alignment (CSA), subsidence, and fusion were analyzed. Visual analog scale (VAS) scores and neck disability index (NDI) were also evaluated. Subsidence occurred in 24 (45.2%) patients and 38 segments (48.1%) at the last follow-up. The mean VAS score and NDI had improved in both the subsidence and non- subsidence groups. The mean SA at the last follow-up had increased to 1.3°â€…±â€…8.5° in the subsidence group and to 1.5°â€…±â€…5.2° in the non-subsidence group compared with the post-operative SA (P < .001). The overall mean CSA at the last follow-up increased over time in both the groups compared with the post-operative CSA (P = .003). The fusion rate at 1 year after surgery was 86.8% and 82.9% in the subsidence and non-subsidence groups, respectively. However, the differences in the SA, CSA, and fusion rates between the groups were not statistically significant (P = .117, .98, and .682, respectively). Subsidence after stand-alone ACDF occurs to a certain capacity; however, it does not appear to significantly influence the radiological and clinical outcomes if foramen decompression is adequately and sufficiently provided in a long-term follow-up study. In contrast, subsidence appears to positively affect the fusion rate in the short-term follow-up.

Factors affecting contralateral wrist surgery after one carpal tunnel release in bilateral carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) can be bilateral, with varying incidence. Carpal tunnel release (CTR) in one wrist may relieve the symptoms of the contralateral wrist, avoiding the need for second surgery; conversely, the symptoms may persist or worsen, requiring contralateral surgery in some cases. The present study investigated whether surgical treatment was finally required for the non-operated CTS wrist, and in what cases non-operative treatment was possible. We compared baseline characteristics, risk factors and electrodiagnostic data between CTS patients who underwent only unilateral CTR and those who subsequently underwent bilateral surgery at various time intervals. This single-center retrospective study included 188 patients with bilateral CTS managed between 2010 and 2020; 137 patients (group 1, 73%) underwent only unilateral CTR, and 51 (group 2, 27%) subsequently underwent contralateral CTR. In group 1, contralateral CTS symptoms were assessed in 4 categories and compared to the presenting symptoms in the index wrist. There were no significant differences in age, gender, preoperative symptom duration, body status, addictive behavior, electrodiagnostic study or comorbidities, other than a higher rate of dialysis in group 2. The contralateral wrist showed partial or complete symptom relief in 57% of patients undergoing unilateral CTR. High BMI and history of diabetes were risk factors for persistent severe CTS or subsequent contralateral CTR.

Self-reported Non-celiac Gluten Sensitivity in the Korean Population: Demographic and Clinical Characteristics.

Background/Aims: Non-celiac gluten sensitivity is characterized by intestinal and extra intestinal symptoms associated with the consumption of gluten-containing food. Since biomarkers for non-celiac gluten sensitivity are lacking, its prevalence is estimated based on self-reported symptoms. However, no data exist on self-reported non-celiac gluten sensitivity in the Korean population. Thus, we aim to investigate the prevalence of self-reported non-celiac gluten sensitivity in the Korean population and to determine its demographic and clinical characteristics. Methods: This study surveyed Korean participants aged 18-80 years who visited gastroenterology outpatient clinics at 9 tertiary hospitals in South Korea from January 2016 to February 2017. They were questioned regarding symptoms related to gluten ingestion: degree of discomfort (visual analog scale score), frequency, time of symptom onset, and duration. Abdominal discomfort caused by 11 different kinds of gluten-containing Korean food items was investigated. Results: More non-celiac gluten sensitivity self-reporters were identified among those with irritable bowel syndrome (33.6%) than among controls (5.8%). Major gastrointestinal symptoms included bloating (75.0%), abdominal discomfort (71.3%), and belching (45.0%). Common extra-intestinal symptoms included fatigue (20.0%) and headache (13.7%). More than half of those who self-reported non-celiac gluten sensitivity (66.3%) developed symptoms within 1 hour of food ingestion, and symptoms were localized in the upper abdomen (37.5%) and entire abdomen (30.0%). Conclusion: Our findings suggest that if there are gluten-related symptoms in irritable bowel syndrome, the possibility of accompanying non-celiac gluten sensitivity should be considered.

Direct Removal of Fourth Ventricle Hematoma in Massive Intraventricular Hemorrhage.

Various grading systems and surgical techniques have been developed for the treatment of intraventricular hemorrhage (IVH); however, little attention has been paid to the fourth ventricle hematoma. Nonetheless, hemorrhagic dilation of the fourth ventricle may lead to catastrophic consequences for patients with massive IVH. We present two cases of massive IVH accompanied by massive fourth ventricle hematoma which was successfully removed with combination of suboccipital craniotomy for fourth ventricle hematoma and intraventricular fibrinolysis for supratentorial hematoma.

Psychological Characteristics and Quality of Life of Patients with Upper and Lower Functional Gastrointestinal Disorders.

Background: This study aimed to identify the differences in the psychological characteristics of the anatomical location of functional gastrointestinal disorders (FGIDs) and the factors that influence the quality of life (QOL). Methods: Altogether, 233 patients with FGIDs were classified into the upper gastrointestinal disorder (UGID; n = 175) group and the lower gastrointestinal disorder group (LGID; n = 58). Psychological characteristics and QOL were evaluated using the validated questionnaires. Results: The LGID group demonstrated higher scores in 'emotional depression' than the UGID group in depressive symptoms (t = −3.031, p < 0.01). A significant difference was observed between groups in 'significant others' in social supports (t = 2.254, p < 0.05). Significant differences were observed between the groups in hardiness (t = 2.259, p < 0.05) and persistence (t = 2.526, p < 0.05) in resilience, while the LGID group demonstrated significantly lower scores than the UGID group in 'negative affectivity' in type-D personality (t = −1.997, p < 0.05). Additionally, the LGID group demonstrated lower QOL than the UGID group (t = 2.615, p < 0.05). The stepwise regression analysis on QOL involved depression, resilience, social support, and childhood trauma, which accounted for 48.4% of the total QOL explanatory variance. Conclusions: Psychological characteristics and QOL significantly differed when FGIDs were classified according to anatomical location. Thus, psychological interventions customized for each type of FGIDs may be necessary for effective treatment.

Incidence and Factors Affecting the Occurrence of Lateral Hinge Fracture After Medial Opening-Wedge High Tibial Osteotomy.

BACKGROUND: Few clinical studies have reported the predictors of lateral hinge fracture (LHF) after medial opening-wedge high tibial osteotomy (MOWHTO). PURPOSE/HYPOTHESIS: The purpose was to compare the incidence of LHF on plain radiographs versus computed tomography (CT) scans and to investigate the factors related to the development of LHF after MOWHTO. We hypothesized that (1) a higher LHF detection rate would be seen on CT scans versus plain radiographs and (2) LHF incidence would be related to opening gap width and hinge position. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: A total of 97 MOWHTO cases were included. The presence and types of LHF were determined from plain radiographs and CT scans. Radiographic parameters were measured on plain radiographs taken 6 weeks postoperatively. Anterior and posterior opening gap widths, coronal and sagittal osteotomy slopes, and fibular height were calculated from CT scans. The wedge-hinge relationship and the zone of hinge position were assessed, and the patient and radiographic factors related to LHF occurrence were evaluated. RESULTS: Seventeen LHF cases (20.5%) were detected on plain radiographs, while significantly more (37 cases; 44.6%) were found on CT scans (P = .001). Based on Takeuchi classification, 28 LHF cases were considered type 1, 7 were type 2, and 2 were type 3. Logistic regression analysis revealed that opening gap width (odds ratio, 1.615; 95% confidence interval, 1.232-2.118; P = .001) and posterior opening gap width (odds ratio, 3.731; 95% confidence interval, 1.642-4.351; P = .008,) differed significantly between patients with versus without LHF. Other patient and radiographic factors were not significantly related to LHF occurrence. Receiver operating characteristic curve analysis identified the opening gap width cutoff values for LHF as 11.0 mm (area under the curve, 0.81; sensitivity, 78.4%; specificity, 73.9%). CONCLUSION: The incidence of LHF after MOWHTO can be underestimated on plain radiographs compared with CT scans. Only large opening gap width, especially posterior gap width, was found to have a statistically significant relationship with occurrence of LHF. Therefore, special caution for possible LHF may be needed if a large correction is planned.

Medical Management of Constipation in Elderly Patients: Systematic Review.

BACKGROUND/AIMS: Constipation is a common gastrointestinal problem in the elderly. Because of the limitations of life style modifications and the comorbidity, laxative use is also very common. Therefore, this study reviews the latest literature on the effect and safety of laxative in the elderly. METHODS: A systematic review of randomized controlled trials investigating the effectiveness and safety of laxatives for constipation in elderly patients over 65 years old were performed using the following databases: PubMed, EMBASE, and the Cochrane Library. RESULTS: Twenty-three randomized controlled trials were included in this review. Among the selected studies, 9 studies compared laxative with placebo and 5 studies compared laxatives of the same type. Four studies compared different types of laxatives or compared combination agents. Five studies compared novel medications such as prucalopride, lubiprostone, and elobixibat with placebo. Psyllium, calcium polycarbophil, lactulose syrup, lactitol, polyethylene glycol, magnesium hydroxide, stimulant laxative with or without fiber, and other medications were more effective than placebo in elderly constipation patients in short-term. Generally, the frequency and severity of adverse effects of laxative were similar between the arms of studies. CONCLUSIONS: Bulk laxative, osmotic laxative, stimulant laxative with or without fiber, and other medications can be used in elderly patients in short-term within 3 months with reasonable safety. However, the quality of included studies was not high and most of studies was conducted in a small number of patients. Among these laxatives, polyethylene glycol seems to be safe and effective in long-term use of about 6 months in elderly patients.

Systemic macrophage depletion attenuates infarct size in an experimental mouse model of stroke.

OBJECTIVE: Macrophages have been shown to play important roles in various pathophysiological processes of the central nervous system via neuroinflammation, leading to an increased interest in macrophage biology. Circulating blood monocytes are among the first cells to infiltrate the brain after ischemic stroke; however, the role of innate immune cells such as monocytes and macrophages remains to be elucidated. Here, we investigated the association between blood monocytes and infarct size following ischemic stroke. METHODS: We induced stroke using a focal ischemia mouse model through middle cerebral artery suture occlusion. To deplete circulating blood monocytes, clodronate was injected intraperitoneally 24 h before the surgery. Animals were sacrificed at specified time points, and the infarct size and mRNA expression were then measured. RESULTS: The clodronate-injected mice showed significantly smaller infarct size than the control mice. Immunohistochemical staining revealed that monocyte depletion significantly blocked the infiltration of macrophages and microglia. The mRNA expression levels of macrophage and microglia markers were higher in the left infarcted brain than in the right non-infarcted brain. CONCLUSIONS: In summary, monocyte depletion reduced the infarct size and mitigated neurological deficits in mice following ischemic stroke, likely by blocking the infiltration of inflammatory cells such as macrophages and microglia.

Carpal Tunnel Release Despite Normal Nerve Conduction Studies in Carpal Tunnel Syndrome Patients.

PURPOSE: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy, often requiring carpal tunnel release (CTR) surgery. Often, a nerve conduction study (NCS) is performed before CTR; however, there are various reports questioning the sensitivity of NCS, and some patients do undergo CTR despite normal NCS results. We had the following purposes: (1) to report clinical outcome of CTS patients who undergo CTR despite normal NCS, (2) to identify the characteristics and compare those with abnormal NCS patients in terms of basic features and risk factors, and (3) to analyze and compare normal and abnormal NCS results. MATERIALS AND METHODS: Medical records of 546 CTS (30 normal NCS and 516 abnormal NCS) patients were retrospectively reviewed. Of 30 normal NCS patients, 7 were excluded, leaving 23 patients in the experimental group. We investigated the influence of age, sex, operative arm, and body mass index, as well as medical conditions known to be risk factors for CTS. In normal NCS patients, as a functional score, we investigated Boston carpal tunnel scores before and after CTR. The NCS results were compared in terms of median motor and median sensory testing. In normal NCS patients, NCS data were compared with that of the contralateral nonoperated wrists. RESULTS: There were 18 women and 5 men in the normal NCS group (mean age 43.7 years). On physical examination, 22 (94.7%) patients showed a positive Tinel test, 19 (82.6%) showed a positive Phalen test, 8 (34.8%) complained of nocturnal paresthesia, and only 1 (4.3%) presented with thenar atrophy. In 19 of 23 patients, the Boston CTS scores showed significant improvement after CTR. Normal NCS patients were significantly younger and significantly heavier and more likely to be a current smoker. In NCS analysis of normal NCS patients, the operated wrists were closer to the reference values than nonoperated wrists. CONCLUSIONS: Surgeons should evaluate the possibility of other combined lesions before CTR in normal NCS patients. Normal NCS can be present with a CTS diagnosis, especially in younger patients. Nevertheless, CTR after failed conservative management, despite normal NCS, could relieve subjective symptoms and function.

A Study of Psychological Factors Associated with Functional Gastrointestinal Disorders and Use of Health Care.

OBJECTIVE: : The purpose of this study was to analyze the symptoms of depression, anxiety, and childhood trauma in functional gastrointestinal disorder (FGID) patients who visited the brain-gut axis clinic. METHODS: The study participants included 99 individuals who were diagnosed with FGID by gastroenterologists, 88 individuals who had no FGID but showed symptoms of FGID based on the Rome criteria, and 79 individuals who did not show any symptoms or were diagnosed with FGID. Symptoms of depression, anxiety, and childhood trauma were evaluated by the Korean version of Beck-depression inventory-II (K-BDI-II), Korean version of Beck anxiety inventory (K-BAI), and Korean version of childhood trauma questionnaire (K-CTQ), respectively. RESULTS: The BDI score, BAI score, and CTQ score were significantly different between the groups. The group also had higher odds for developing anxiety as compared to the control group (odds ratio [OR] = 10.215, 95% confidence intervals [CI]: 2.49-41.76). Additionally, the FGID group had higher odds for developing symptoms of depression (OR = 5.554, 95% CI: 2.06-14.97) and experiencing physical violence (OR = 3.128, 95% CI: 1.53-6.38) than the non-FGID group. CONCLUSION: This study showed that FGID patients were more likely to have symptoms of depression, severe anxiety, and childhood trauma, which were the risk factors of FGID.

Potential Role of PDGFRß-Associated THBS4 in Colorectal Cancer Development.

Colorectal cancer is a significant cause of death since it frequently metastasizes to several organs such as the lung or liver. Tumor development is affected by various factors, including a tumor microenvironment, which may be an essential factor that leads to tumor growth, proliferation, invasion, and metastasis. In the tumor microenvironment, abnormal changes in various growth factors, enzymes, and cytokines can wield a strong influence on cancer. Thrombospondin-4 (THBS4), which is an extracellular matrix protein, also plays essential roles in the tumor microenvironment and mediates angiogenesis by transforming growth factor-ß (TGFß) signaling. Platelet-derived growth factor receptor ß (PDGFRß), which is a receptor tyrosine kinase and is also a downstream signal of TGFß, is associated with invasion and metastasis in colorectal cancer. We identified that PDGFRß and THBS4 are overexpressed in tumor tissues of colorectal cancer patients, and that PDGF-D expression increased after TGFß treatment in the colon cancer cell line DLD-1. TGFß and PDGF-D increased cellular THBS4 protein levels and secretion but did not increase THBS4 mRNA levels. This response was further confirmed by the inositol 1,4,5-triphosphate receptor (IP3R) and stromal interaction molecule 1 (STIM1) blockade as well as the PDGFRß blockade. We propose that the PDGFRß signal leads to a modification of the incomplete form of THBS4 to its complete form through IP3R, STIM1, and Ca2+-signal proteins, which further induces THBS4 secretion. Additionally, we identified that DLD-1 cell-conditioned medium stimulated with PDGF-D promotes adhesion, migration, and proliferation of colon myofibroblast CCD-18co cells, and this effect was intensified in the presence of thrombin. These findings suggest that excessive PDGFRß signaling due to increased TGFß and PDGF-D in colorectal tumors leads to over-secretion of THBS4 and proliferative tumor development.

Vertical Interfragmentary Doubled Suture for Displaced Patella Fractures: Sequential Compressive Tightening with Nice Knot.

In the treatment of displaced patella fractures, open reduction and internal fixation is essential for patellofemoral congruency and restoration of the knee extension mechanism. Various surgical techniques and materials can be used, and their clinical outcomes are favorable. However, soft-tissue and skin irritation, pain, and limited range of motion due to metallic hardware can occur, and removal of hardware such as screws and K-wire may be required after bony union. We present a vertical interfragmentary suture technique for patella fractures using sequential compressive tightening with the Nice knot. This knot-tying technique is low profile, provides stable fixation enough to hold displaced fractures, and does not require a secondary procedure for hardware removal.