Medial Tibial Osteophyte Width Strongly Reflects Medial Meniscus Extrusion Distance and Medial Joint Space Width Moderately Reflects Cartilage Thickness in Knee Radiographs.

BACKGROUND: The presence of medial tibial osteophytes on knee radiographs suggests cartilage wear, but may be associated with medial meniscus extrusion (MME). The joint space width of the medial compartment consists anatomically of cartilage and the medial meniscus, but which is most responsible for joint space narrowing remains unclear. Magnetic resonance imaging (MRI) reveals MME and cartilage thickness. PURPOSES: To determine which radiographic medial tibial osteophyte width correlates better with cartilage thickness or MME distance and which radiographic medial joint space width correlates better with cartilage thickness or MME distance. STUDY TYPE: Cross-sectional. POPULATION: Total of 527 subjects, 253 females and 274 males, aged 30-79 years, included in the Kanagawa Knee Study. FIELD STRENGTH/SEQUENCE: 3 T/fat-suppressed spoiled gradient echo and proton density weighted. ASSESSMENT: The medial tibial osteophyte width and "the minimum joint space width at the medial compartment" (mJSW) were measured from plain radiographs. The cartilage region was automatically extracted from MRI data using software. The medial femoral and tibial cartilage regions were each divided into nine subregions, and the average thickness of the cartilage was determined in each region and subregion. MME was manually measured by two orthopedic surgeons using MRI coronal section images. STATISTICAL TESTS: Pearson's correlation coefficient and their comparison, with P < 0.05 considered statistically significant. RESULTS: The absolute values of the correlation coefficients were 0.33 at maximum between osteophyte width and cartilage thickness and 0.76 between osteophyte width and MME; the value was significantly higher with MME than with cartilage thickness (P < 0.001). The absolute values of the correlation coefficients were 0.50 at maximum between mJSW and cartilage thickness and 0.16 between mJSW and MME; the value was significantly higher with cartilage thickness than with MME (P < 0.001). DATA CONCLUSION: The medial tibial osteophyte width strongly reflected MME and the medial joint space width moderately reflected cartilage thickness. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 3.

Difference in the joint space of the medial knee compartment between full extension and Rosenberg weight-bearing radiographs.

OBJECTIVES: Radiographs are the most widespread imaging tool for diagnosing osteoarthritis (OA) of the knee. Our purpose was to determine which of the two factors, medial meniscus extrusion (MME) or cartilage thickness, had a greater effect on the difference in the minimum joint space width (mJSW) at the medial compartment between the extension anteroposterior view (extension view) and the 45° flexion posteroanterior view (Rosenberg view). METHODS: The subjects were 546 participants (more than 50 females and 50 males in their 30 s, 40 s, 50 s, 60 s, and 70 s) in the Kanagawa Knee Study. The mJSW at the medial compartment was measured from both the extension and the Rosenberg views, and the "mJSW difference" was defined as the mJSW in the Rosenberg view subtracted from the mJSW in the extension view. The cartilage region was automatically extracted from MRI data and constructed in three dimensions. The medial region of the femorotibial joint cartilage was divided into 18 subregions, and the cartilage thickness in each subregion was determined. The MME was also measured from MRI data. RESULTS: The mJSW difference and cartilage thickness were significantly correlated at 4 subregions, with 0.248 as the highest absolute value of the correlation coefficient. The mJSW difference and MME were also significantly correlated, with a significantly higher correlation coefficient (0.547) than for the mJSW difference and cartilage thickness. CONCLUSIONS: The MME had a greater effect than cartilage thickness on the difference between the mJSW at the medial compartment in the extension view and in the Rosenberg view. KEY POINTS: • The difference in the width at the medial compartment of the knee between the extension and the flexion radiographic views was more affected by medial meniscus extrusion than by cartilage thickness.

Relationship between medial meniscus extrusion and cartilage measurements in the knee by fully automatic three-dimensional MRI analysis.

BACKGROUND: We developed a fully automatic three-dimensional knee MRI analysis software that can quantify meniscus extrusion and cartilage measurements, including the projected cartilage area ratio (PCAR), which represents the ratio of the subject's actual cartilage area to their ideal cartilage area. We also collected 3D MRI knee data from 561 volunteers (aged 30-79 years) from the "Kanagawa Knee Study." Our purposes were to verify the accuracy of the software for automatic cartilage and meniscus segmentation using knee MRI and to examine the relationship between medial meniscus extrusion measurements and cartilage measurements from Kanagawa Knee Study data. METHODS: We constructed a neural network for the software by randomly choosing 10 healthy volunteers and 103 patients with knee pain. We validated the algorithm by randomly selecting 108 of these 113 subjects for training, and determined Dice similarity coefficients from five other subjects. We constructed a neural network using all data (113 subjects) for training. Cartilage thickness, cartilage volume, and PCAR in the medial femoral, lateral femoral, medial tibial, and lateral tibial regions were quantified by using the trained software on Kanagawa Knee Study data and their relationship with subject height was investigated. We also quantified the medial meniscus coverage ratio (MMCR), defined as the ratio of the overlapping area between the medial meniscus area and the medial tibial cartilage area to the medial tibial cartilage area. Finally, we examined the relationship between MMCR and PCAR at middle central medial tibial (mcMT) subregion located in the center of nine subregions in the medial tibial cartilage. RESULTS: Dice similarity coefficients for cartilage and meniscus were both approximately 0.9. The femoral and tibial cartilage thickness and volume at each region correlated with height, but PCAR did not correlate with height in most settings. PCAR at the mcMT was significantly correlated with MMCR. CONCLUSIONS: Our software showed high segmentation accuracy for the knee cartilage and meniscus. PCAR was more useful than cartilage thickness or volume since it was less affected by height. Relations ips were observed between the medial tibial cartilage measurements and the medial meniscus extrusion measurements in our cross-sectional study. TRIAL REGISTRATION: UMIN, UMIN000032826 ; 1 September 2018.

Comprehensive analysis of a dipeptide library to identify ghrelin release-modulating peptides.

We performed a comprehensive analysis of ghrelin release-modulating activity of a dipeptide library using MGN3-1, a ghrelin-producing cell line. We found that most dipeptides suppress ghrelin secretion, whereas the N-terminal Ser-containing dipeptides and a few others stimulate it. N-terminal amino acid residues, but not C-terminal residues, play a dominant role in the effects of dipeptides. Among dipeptides, Leu-Ile (LI) and Ser-Val (SV) most strongly suppress and stimulate ghrelin secretion, respectively. LI activates Gi signaling and SV acts via the MAPK pathway. Orally administered LI and SV reduce and increase plasma ghrelin levels and food intake in mice, respectively. In conclusion, LI and SV, found based on the comprehensive screening of a dipeptide library, modulate ghrelin secretion in vitro and in vivo.

Lacto-ghrestatin, a novel bovine milk-derived peptide, suppresses ghrelin secretion.

Ghrelin, an endogenous peptide isolated from the stomach, is known to stimulate food intake after peripheral administration. We found that the enzymatic digest of ß-lactoglobulin decreases ghrelin secretion from the ghrelin-producing cell line MGN3-1. The peptides present in the digest were comprehensively analyzed using the nanoLC-OrbitrapMS. Among them, we identified that the nonapeptide LIVTQTMKG, corresponding to ß-lactoglobulin(1-9), suppresses ghrelin secretion from MGN3-1 cells. We named LIVTQTMKG 'lacto-ghrestatin'. We found that lacto-ghrestatin decreases intracellular cAMP levels and mRNA expression levels of ghrelin production-related genes in MGN3-1 cells. Orally administered lacto-ghrestatin decreases plasma ghrelin levels and food intake in fasted mice. Lacto-ghrestatin is the first food-derived peptide to suppress ghrelin secretion in vitro and in vivo.

Soy-ghretropin, a novel ghrelin-releasing peptide derived from soy protein.

We investigated exogenous secretagogues of ghrelin, which is an orexigenic hormone isolated from the stomach. We found that the tryptic digest of soy ß-conglycinin stimulated ghrelin secretion by the ghrelin-producing cell line, MGN3-1. We then identified a 22-amino acid peptide corresponding to the ß-conglycinin α-subunit(192-213) [ßCGα(192-213)] from an active fraction separated by HPLC. The N-terminal undecapeptide of ßCGα(192-213), NKNPFLFGSNR, exhibited ghrelin-releasing activity at a lower dose than that of ßCGα(192-213). We named NKNPFLFGSNR 'soy-ghretropin', which corresponds to ßCGα(192-202). Neither [des-N(1) K(2) ]-soy-ghretropin nor [des-R(11) ]-soy-ghretropin stimulated ghrelin secretion; hence, both the N- and C-terminal structures of soy-ghretropin were indispensable. Orally administered soy-ghretropin increased plasma ghrelin levels and food intake in vivo. Soy-ghretropin is the first exogenous ghrelin-releasing peptide derived from food protein.

Preoperative endoscopic ultrasonography-guided tattooing of the pancreas with a minuscule amount of marking solution using a newly designed injector.

BACKGROUND AND AIM: Recent studies have reported the usefulness of preoperative endoscopic ultrasonography-guided fiducial tattooing (EUS-tattooing) of the pancreas. However, problems of proper procedure, including markers and amounts, have not been resolved. The aim of the present study was to evaluate the feasibility of EUS-tattooing with a minuscule amount of marking solution using a new injector. METHODS: Six consecutive patients who underwent EUS-tattooing between June 2013 and April 2015 at our center were retrospectively analyzed (mean age, 60.7 years; males, 4). A 25-gauge needle was inserted into the surface of the pancreas near the tumor with EUS guidance. Then, 0.02 mL marking solution was injected three to five times (maximal total amount was defined as 0.1 mL). The marking solution used in this study was a compound of aqueous solution of sodium hyaluronate and India ink with proportions of 4 to 1. The newly developed injector for precise injection of minuscule amount of solution was used. RESULTS: All six patients were successfully injected with the intended amount of marking solution. The tattoo mark was easily detected during surgery and localized in a small area in five patients. In one patient, however, the tattoo mark was not detected during surgery. There were no adverse events, including bleeding, perforation, and acute pancreatitis, by EUS-tattooing. CONCLUSIONS: EUS-tattooing with a minuscule amount of marking solution using the newly developed injector was feasible and seemed useful and relatively safe. Further studies are warranted to confirm the safety and efficacy of EUS-tattooing.