Induced pluripotent stem cells derived renal tubular cells from a patient with pseudohypoparathyroidism and its response to parathyroid hormone stimulation.

INTRODUCTION: Creating induced pluripotent stem cells (iPSCs) from somatic cells of patients with genetic diseases offers a pathway to generate disease-specific iPSCs carrying genetic markers. Differentiating these iPSCs into renal tubular cells can aid in understanding the pathophysiology of rare inherited renal tubular diseases through cellular experiments. MATERIALS AND METHODS: Two Japanese patients with Pseudohypoparathyroidism (PHP), a 49-year-old woman and a 71-year-old man, were studied. iPSC-derived tubular cells were established from their peripheral blood mononuclear cells (PBMCs). We examined changes in intracellular and extracellular cyclic adenosine monophosphate (cAMP) levels in these cells in response to parathyroid hormone (PTH) stimulation. RESULTS: Renal tubular cells, differentiated from iPSCs of a healthy control (648A1), showed a PTH-dependent increase in both intracellular and extracellular cAMP levels. However, the renal tubular cells derived from the PHP patients' iPSCs showed inconsistent changes in cAMP levels upon PTH exposure. CONCLUSION: We successfully created disease-specific iPSCs from PHP patients' PBMCs, differentiated them into tubular cells, and replicated the distinctive response of the disease to PTH in vitro. This approach could enhance our understanding of the pathophysiology of inherited renal tubular diseases and contribute to developing effective treatments.

Pre-milling technique improves the accuracy of posterior femoral condyle cut and reduces the tibial recut in Oxford unicompartmental knee arthroplasty.

BACKGROUND: Recuts are sometimes needed in UKA because of inadequate posterior tibial cut thickness. We investigated the efficacy of a pre-milling technique (the first milling is done prior to the posterior condylar cut) in Oxford unicompartmental knee arthroplasty to enhance bone cut thickness and to minimize tibial recuts. PATIENTS AND METHODS: Between January 2021 and January 2023, a posterior condyle cut was made before milling in 213 knees in 152 patients (conventional group), while the pre-milling technique was used in 198 knees in 140 patients (pre-milling group). The thickness of the posterior condyle and the rate of tibial recuts were compared between the groups. RESULTS: The bone cut thickness was thinner in the conventional group than in the pre-milling group in small-size (4.7 mm ± 0.6 mm and 5.0 mm ± 0.6 mm, P = 0.0001) and in medium-size (5.1 mm ± 0.5 mm and 5.4 mm ± 0.5 mm, 0.0001) femoral components, whereas there was no difference in large-size femoral components. However, the thickness was still less than the component thickness (5.17 mm for small, 5.57 mm for medium and 6.17 mm for large) in both groups. Tibial recuts were more prevalent in the conventional group than in the pre-milling group (14 knees, 7%, 3 knees 2%, P = 0.002). CONCLUSIONS: The pre-milling technique was found to increase the bone cut thickness in small and medium femoral components, reducing the need for tibial recuts. Further research is warranted to optimize the pre-milling technique and to investigate its long-term impact on patient outcomes.

High reproductive potential of the commercially exploited shark Squalus suckleyi in the major fishing grounds of the western North Pacific.

The present study examined body length (precaudal length, PCL) and age at sexual maturity, as well as fecundity and maternal investment in the Pacific spiny dogfish Squalus suckleyi, a long-term commercially exploited shark in the western North Pacific, using samples caught in several fisheries and across seasons. The PCL and age at 50% sexual maturity of males were 60.6 cm and 9.4 years, respectively, and those of females were 73.1 cm and 17.8 years, respectively. The PCL and age at 50% maternity were 77.4 cm and 19.7 years, respectively. General or generalized linear models revealed that capture by different fishing method did not significantly correlate with sexual maturity and maternity rates or litter size. Other general linear models revealed an increase in offspring size with maternal size, but litter size was not affected by embryonic development. These findings indicate that the reproductive potential of Pacific spiny dogfish is relatively high throughout the whole North Pacific region because of a smaller size and earlier age at sexual maturation in both sexes. In addition, pregnant females displayed no resting phase and produced 0.45 more embryos per centimetre of PCL in their lifetime after the onset of maturity, which is higher than in the eastern North Pacific. We suggest that these qualities are not a consequence of stock decline associated with the long-term exploitation of the species, but that its high reproductive potential has likely contributed to the long-term stability of the landings in Japan. SIGNIFICANCE STATEMENT: While reproductive potential has been determined for many fish species, such information is scarce for Pacific spiny dogfish. We evaluated the reproductive characteristics of this species in the major fishing grounds of the western North Pacific. The productivity and rebound potential of sharks is extremely low compared with those of bony fishes. However, our results indicate that even if the reproductive potential has a small effect on the population dynamics, it should not be ignored for sustainable stock utilisation.

Association between plasma aldosterone and markers of tubular and glomerular damage in primary aldosteronism.

OBJECTIVE: Although renal impairments are observed in patients with primary aldosteronism (PA), the association between plasma aldosterone concentration (PAC) and specific structural kidney damage remains unknown. Thus, we analysed the association between PAC, and markers of glomerular and tubular damage. DESIGN: This was a retrospective cross-sectional study of 96 PA patients, in which we analysed the association between PAC and markers of kidney damage, including urinary albumin-creatinine ratio (ACR) for glomerular damage, and urinary liver fatty acid-binding protein (L-FABP), N-acetyl-ß-D-glucosaminidase (NAG) and ß2-microglobulin (ß2-MG) for tubular damage. In addition, we evaluated the association between PAC and N-terminal pro-brain natriuretic peptide (NT-proBNP) as a marker for body fluid volume. RESULTS: Urinary ACR, L-FABP, NAG, ß2-MG and NT-proBNP significantly correlated with PAC. PAC (<415 pmol/L, 415-550, 550-740, 740 <)-based quartile analysis revealed that both elevated markers of kidney damage and NT-proBNP could be observed in PA patients with a PAC over 550 pmol/L. Logistic regression analysis showed that PAC was significantly associated with a risk of both microalbuminuria and lowered eGFR (<60 mL/min/1.73 m2 ), with its optimal cut-offs for predicting each, 558 and 594 pmol/L, respectively. CONCLUSIONS: Increased PAC, especially over 550 pmol/L, is associated with excessive damage to the tubule and glomerulus.

Ultrashort echo time time-spatial labeling inversion pulse magnetic resonance angiography with denoising deep learning reconstruction for the assessment of abdominal visceral arteries.

Current contrast-enhanced magnetic resonance angiography (MRA) and non-contrast-enhanced balanced steady-state free precession (bSSFP) MRA cause susceptibility artifacts from metallic devices in assessing endovascular visceral-artery interventions. The aims of this study are to investigate and compare image quality (IQ) and susceptibility artifacts of three-dimensional (3D) ultrashort echo time (UTE) time-spatial labeling inversion pulse (Time-SLIP) with those of 3D bSSFP Time-SLIP and to assess denoising deep learning reconstruction (dDLR) for the improvement of the signal-to-noise ratio (SNR) in 3D UTE with sparse sampling in phantoms and human subjects. This is a prospective type of study. Pulsatile glycerin-water flow phantom with platinum-tungsten-alloy coil, stainless-steel, nitinol, and cobalt-alloy stents were used. Ten healthy volunteers (seven males) and three patients (two males) were included in this study. 3D UTE Time-SLIP and 3D bSSFP Time-SLIP at 3T were used. The phantom-based study compared the signal-intensity ratio of the device levels (SRdevice ) and distal segments (SRdistal ) to the proximal segments. The volunteer-based study measured SNR, contrast ratio (CR), and IQ. The patient study evaluated local artifacts from metallic devices. Statistical tests included paired t-tests, Wilcoxon-signed rank tests, and Kruskal-Wallis tests. In the phantom-based study, SRdevice was small with UTE Time-SLIP, except the stainless-steel stent. SRdistal was greater (49.1%-90.4%) on bSSFP images than UTE images (-11.1% to 9.6%). Among volunteers, dDLR in UTE images improved SNR (p < 0.05) and IQ (p < 0.05), but CR was unaffected. UTE Time-SLIP showed inferior SNR and IQ than bSSFP Time-SLIP in images with and without dDLR (p < 0.05 for each). However, among patients, UTE Time-SLIP showed reduced metal artifacts compared to bSSFP Time-SLIP. Irrespective of the lower SNR and IQ of 3D UTE Time-SLIP than those of 3D bSSFP Time-SLIP, the former appeared to better depict flow after stenting or coiling. This indicates the potential of 3D UTE Time-SLIP to provide suitable diagnostic images of target vessels. dDLR improved SNR with reducing artifacts related to radial sampling, while maintaining the contrast. LEVEL OF EVIDENCE: 2. TECHNICAL EFFICACY STAGE: 2.

Role of complement 3 in renin generation during the differentiation of mesenchymal stem cells to smooth muscle cells.

We showed that increased expression of complement 3 (C3) induces dedifferentiation of mesenchymal cells and epithelial mesenchymal transition, which activate the local renin-angiotensin system (RAS) that contributes to cardiovascular and renal remodeling in spontaneously hypertensive rats (SHRs). In the present study, to investigate contributions of C3 to the development of the pathogenesis of hypertension, we evaluated the formation of renin-producing cells and roles of C3 in renin generation during differentiation of primary bone marrow-mesenchymal stem cells (MSCs) from C57BL/6 mice, Wistar-Kyoto (WKY) rats, and SHRs to smooth muscle cells (SMCs) with transforming growth factor-ß1. The expression of renin transiently increased with increases in transcription factor liver X receptor α (LXRα), and expression of C3 and Krüppel-like factor 5 (KLF5) increased during differentiation of MSCs from C57BL/6 mice, WKY rats, and SHRs to SMCs. Exogenous C3a stimulated renin and LXRα expression accompanied by nuclear translocation of LXRα. C3a receptor antagonist SB290157 suppressed renin and LXRα expression, with inhibition of nuclear translocation of LXRα during the differentiation of mouse MSCs to SMCs. The expression of C3 and KLF5 was significantly higher in the differentiated cells from SHRs compared with the cells from WKY rats during differentiation. Renin-producing cells were formed during differentiation of MSCs to SMCs, and renin generation was observed in undifferentiated SMCs, in which transient expression of renin in the differentiated cells with lower differentiation stage was stronger from SHRs than that from WKY rats. Expression and nuclear localization of LXRα in the differentiated cells from SHRs were stronger than that from WKY rats. C3 was important in forming and maintaining this undifferentiated state of SMCs from MSCs to generate renin with increases in transcription factor LXRα and KLF5. Increases in C3 expression maintain the undifferentiated state of SMCs from MSCs to generate renin that activates RAS and contributes to the pathogenesis of hypertension in SHRs.

Growth trajectories of prenatal embryos of the deep-sea shark Chlamydoselachus anguineus (Chondrichthyes).

Chlamydoselachus anguineus, Garman 1884, commonly called the frilled shark, is a deep-sea shark species occurring up to depths of 1300 m. It is assumed to represent an ancient morphotype of sharks (e.g., terminal mouth opening, more than five gill slits) and thus is often considered to represent plesiomorphic traits for sharks. Therefore, its early ontogenetic developmental traits are important for understanding the evolution of its particular phenotype. Here, we established six stages for prenatal embryos and used linear measurements and geometric morphometrics to analyse changes in shape and size as well as their timing during different embryonic stages. Our results show a change in head shape and a relocation of the mouth opening at a late stage of development. We also detected a negative allometric growth of the head and especially the eye compared to the rest of the body and a sexual dimorphism in total body length, which differs from the known data for adults. A multivariate analysis of covariance shows a significant interaction of shape related to the logarithm of centroid size and developmental stage. Geometric morphometrics results indicate that the head shape changes as a covariate of body size while not accounting for differences between sexes. The growth pattern of stages 32 and 33 indicates a shift in head shape, thus highlighting the moment in development when the jaws start to elongate anteriorly to finally achieve the adult condition of terminal mouth opening rather than retaining the early embryonic subterminal position as is typical for sharks. Thus, the antero-terminal mouth opening of the frilled shark has to be considered a derived feature.

New records and range extension of the Portuguese dogfish Centroscymnus coelolepis in the south-western Atlantic Ocean, with comments on its morphology.

The Portuguese dogfish Centroscymnus coelolepis is a wide-ranging deep-water shark and a common by-catch component of the catches of several mid- to deep-water fisheries. In the present study, two new records from the south-western Atlantic Ocean are reported based on specimens caught by bottom-longline fishing vessels operating in the Argentinean-Uruguayan Common Fishing Zone. Species identification based on morphology and detailed morphometrics, as well as molecular data are presented for one of the specimens. The distribution of the species over the south-western Atlantic is discussed on the basis of the available bibliography and a thorough revision of museum collections. The records presented here expand the species' previously acknowledged distribution southwards, from around 21° S to at least 38° S, suggesting it occurs continuously along the shelf break of eastern South America. However, given the limited access to specimens of deep-water sharks in the region, the abundance and real extent of C. coelolepis distribution in the south-western Atlantic as well as its interaction with deep-water fisheries remain to be fully assessed.

Involvement of complement 3 in the salt-sensitive hypertension by activation of renal renin-angiotensin system in spontaneously hypertensive rats.

We previously showed that complement 3 (C3) is highly expressed in mesenchymal tissues in spontaneously hypertensive rats (SHR). We targeted C3 gene by zinc-finger nuclease (ZFN) gene-editing technology and investigated blood pressure and phenotype in SHR. Blood pressure was measured by tail-cuff and telemetry methods. Histology and expression of liver X receptor α (LXRα), renin, Krüppel-like factor 5 (KLF5), and E-cadherin were evaluated in kidneys. Mesangial cells (MCs) were removed from glomeruli from three strains, and we evaluated the phenotype in vitro. SHR showed the salt-sensitive hypertension that was abolished in C3 knockout (KO) SHR. Proliferation of MCs from SHR was higher than that from Wistar-Kyoto (WKY) rats and showed a synthetic phenotype. Renal injury scores were higher in SHR than in WKY rats and C3 KO SHR. Expression of E-cadherin was lower, and expression of renin was higher in the nephrotubulus from SHR than WKY rats and C3 KO SHR. Expression of C3 α-chain protein and α-smooth muscle actin protein was significantly higher in renal medulla from SHR than from WKY rats. Expression of angiotensinogen, LXRα, renin, and KLF5 mRNA was increased in kidney from SHR compared with C3 KO SHR. Intrarenal angiotensin II levels were significantly higher in kidney from SHR than WKY rats and C3 KO SHR. Urinary epinephrine and norepinephrine excretions were significantly higher in SHR than in WKY rats and C3 KO SHR. These findings showed that increased C3 induces salt-sensitive hypertension with increases in urinary catecholamine excretion and intrarenal activation of the renin-angiotensin system by the dedifferentiation of mesenchymal tissues in kidney from SHR.

Phylogenetic analyses of the hepatic architecture in vertebrates.

The mammalian liver has a structural and functional unit called the liver lobule, in the periphery of which the portal triad consisting of the portal vein, bile duct and hepatic artery is developed. This type of hepatic architecture is detectable in many other vertebrates, including amphibians and birds, whereas intrahepatic bile ducts run independently of portal vein distribution in actinopterygians such as the salmon and tilapia. It remains to be clarified how the hepatic architectures are phylogenetically developed among vertebrates. The present study morphologically and immunohistochemically analyzed the hepatic structures of various vertebrates, including as many classes and subclasses as possible, with reference to intrahepatic bile duct distribution. The livers of vertebrates belonging to the Agnatha, Chondrichthyes, Amphibia, Aves, Mammalia, and Actinopterygii before Elopomorpha, had the portal triad-type architecture. The Anguilliformes livers developed both periportal bile ducts and non-periportal bile ducts. The Otocephala and Euteleostei livers had independent configuration of bile ducts and portal veins. Pancreatic tissues penetrated the liver parenchyma along portal veins in the Euteleostei. The liver of the lungfish, which shares the same origin with amphibians, did not have the portal triad-type architecture. Teleostei and lungfish livers had ductular development in the liver parenchyma similar to oval cell proliferation in injured mammalian livers. Euteleostei livers had penetration of significant numbers of independent portal veins from their intestines, suggesting that each liver lobe might receive a different blood supply. The hepatic architectures of the portal triad-type changed to non-portal triad-type architecture along the evolution of the Actinopterygii. The hepatic architecture of the lungfish resembles that of the Actinopterygii after Elopomorpha in intrahepatic biliary configuration, which may be an example of convergent evolution.

7-Ketocholesterol induces ROS-mediated mRNA expression of 12-lipoxygenase, cyclooxygenase-2 and pro-inflammatory cytokines in human mesangial cells: Potential role in diabetic nephropathy.

7-Ketocholesterol (7-KCHO) is a highly proinflammatory oxysterol and plays an important role in the pathophysiology of diabetic nephropathy (DN). Lipoxygenases (LOXs) and cyclooxygenases (COXs) are also involved in the development of DN. The aim of this study was to clarify the effects of 7-KCHO on mRNA expression of LOXs and COXs as well as pro-inflammatory cytokines in human mesangial cells (HMC). We evaluated cell viability by WST-8 assay and measured mRNA expression by reverse transcription-polymerase chain reaction. Intracellular reactive oxygen species (ROS) production was evaluated by flow cytometry. Although 7-KCHO did not affect cell viability of HMC, 7-KCHO stimulated significant increases in mRNA expression of 12-LOX, COX-2 and pro-inflammatory cytokines. 7-KCHO also induced an increase in ROS production, while N-acetylcysteine partially suppressed the increase. The 12-LOX and COX-2 inhibitors also suppressed mRNA expression of cytokines. These findings may contribute to the elucidation of the molecular mechanism of the pathophysiology of DN.

Scoring system for the diagnosis of bilateral primary aldosteronism in the outpatient setting before adrenal venous sampling.

OBJECTIVE: The only reliable method for subtyping primary aldosteronism (PA) is adrenal venous sampling (AVS), which is costly and time-consuming. Considering the limited availability of AVS, it would be helpful to obtain information on the diagnosis of bilateral hyperaldosteronism (BHA) from routine tests. We aimed to establish new, simple criteria for outpatients to diagnose BHA from PA before AVS. DESIGN: We retrospectively analysed 82 patients who were diagnosed with PA and underwent AVS. Thirty-seven patients were diagnosed with unilateral hyperaldosteronism (UHA), and 36 with BHA and nine were undetermined. Among the variables that were significantly different between UHA and BHA in the univariate analysis, we chose three variables to be included in multivariate logistic regression models and constructed a subtype prediction score. RESULTS: The subtype prediction score was calculated as follows: 3 points for no adrenal nodules on computed tomography imaging, 2 for serum potassium of ≥3·5 mmol/l and 2 for aldosterone-to-renin ratio of <490 after a captopril challenge test. Receiver operating characteristic curve analysis for the ability to discriminate BHA from UHA showed that a score of 7 points had 50% sensitivity and 100% specificity and a score of 5 points had 67% sensitivity and 94% specificity (area under the curve: 0·922; 95% CI: 0·863-0·980). CONCLUSIONS: Our new, simple criteria specifically distinguished BHA from UHA in the outpatient setting before AVS. Furthermore, not only endocrinologists but also general internists can use this convenient, safe scoring system.

Subtype prediction in primary aldosteronism: measurement of circadian variation of adrenocortical hormones and 24-h urinary aldosterone.

OBJECTIVE: Currently, adrenal venous sampling (AVS) is the only reliable method to distinguish unilateral from bilateral hyperaldosteronism in primary aldosteronism (PA). However, AVS is costly and time-consuming compared with simple blood tests. In this study, we conducted a retrospective study to determine whether circadian variation in plasma adrenocortical hormone levels (i.e. aldosterone, cortisol and ACTH) and a 24-h urinary aldosterone could contribute to the clinical differentiation between unilateral hyperaldosteronism (UHA) and bilateral hyperaldosteronism (BHA). DESIGN: In 64 patients who were diagnosed with PA and underwent AVS, 32 and 22 patients were diagnosed with UHA and BHA, respectively. Plasma adrenocortical hormone levels at 0:00, 6:00, 12:00 and 18:00 and 24-h urinary aldosterone under a condition of 6 g daily dietary sodium chloride intake were measured. RESULTS: Baseline plasma aldosterone concentration (PAC) and 24-h urinary aldosterone level in patients with UHA were significantly higher than in patients with BHA, particularly at 6:00. The area under the ROC curve for PAC at 0:00, 6:00, 12:00 and 18:00 and 24-h urinary aldosterone to discriminate UHA and BHA was 0·839 [95% confidence interval (CI); 0·73-0·95], 0·922 (95% CI; 0·85-1·00), 0·875 (95% CI; 0·78-0·97), 0·811 (95% CI; 0·69-0·93), 0·898 (95% CI; 0·81-0·99), respectively. CONCLUSIONS: PAC at different blood sampling times and 24-h urinary aldosterone level may be diagnostically helpful in discriminating between UHA and BHA. We believe that these tests could reduce the number of unnecessary AVS procedures.

Caliper-Based Restricted Kinematic Alignment Total Knee Arthroplasty.

Restricted kinematic alignment total knee arthroplasty (rKA-TKA) is a reasonable selection for avoiding an extreme alignment that has been conceded to induce implant failure. However, computer-aided devices (CAS), such as navigation, robotics, and patient-specific instrumentation, are necessary to perform rKA-TKA. This paper reports on the surgical technique of kinematic alignment total knee arthroplasty (KA-TKA) using mechanical instruments. The lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) are measured from preoperative long radiographs or CT of the lower limb, and the arithmetic hip-knee-ankle angle (aHKA) is calculated from the MPTA - LDFA. The predefined restriction boundaries are used to determine the osteotomy angle. In our practice, the LDFA is 85° to 93°, the MPTA is 85° to 90°, and the aHKA is 5° varus to 3° valgus. If correction of the femoral osteotomy is required, this can be achieved by changing the thickness of the paddle set on the distal articular surface or by adjusting the angle of the variable angle femoral cutting guide. For the tibia, the distal end of the extramedullary rod, with the proximal part placed in the center of the knee joint, should be adjusted so that it does not exceed the lateral malleolus. This limits the medial tilt of the osteotomy plane to within 5.5°. These techniques allow restricted KA to be performed with existing mechanical instruments without using CAS.

Preoperative Arithmetic Hip-Knee-Ankle Angle as a Predictor of Postoperative Leg Alignment in Medial Oxford Unicompartmental Knee Arthroplasty.

Introduction This study aimed to evaluate whether the arithmetic hip-knee-ankle angle (aHKA) can be used to predict the postoperative HKA. Methods This study included 248 knees in 166 patients who underwent Oxford unicompartmental knee arthroplasty (UKA) between February 2021 and November 2022. Through preoperative and postoperative long-leg radiography, the medial proximal tibial angle (MPTA) and the lateral distal femoral angle (LDFA) were expressed as the deviation from the perpendicular line to the mechanical axes, and the mechanical HKA (mHKA) was defined as the angle between the femoral and tibial mechanical axes. Using the MPTA and LDFA, the arithmetic HKA (aHKA; MPTA + LDFA) and the joint line obliquity (JLO; MPTA - LDFA) were calculated, and the preoperative and postoperative values were compared. Results The preoperative aHKA and the postoperative mHKA values were similar (-0.38° ± 2.96°) and significantly smaller than the difference between the preoperative and postoperative mHKAs (4.58° ± 3.60°, P < 0.05). Meanwhile, the MPTA tended to be varus, and the LDFA tended to be valgus. Eventually, the JLO inclined more medially from -6.33° ± 3.42° preoperatively to -8.97° ± 3.92° postoperatively, representing a significant difference (P < 0.05). Conclusion The preoperative aHKA was similar to the postoperative mHKA. Therefore, it can be regarded as a predictor of postoperative leg alignment after Oxford UKA. Meanwhile, there was a medial incline of the joint line. Further investigation is required to evaluate the effect of such a joint line alteration.

Bone loss on the femoral side in knees with medial osteoarthritis: Implications for kinematically-aligned total knee arthroplasty - A comparative study of lateral distal femoral angle in knees with and without osteoarthritis in the same patients.

BACKGROUND: This study aimed to investigate the difference in lateral distal femoral angle (LDFA) between knees with medial osteoarthritis (mOA) and knees without osteoarthritis, and to explore the validity of the assumption that there is no bone wear on the femoral articular surface in kinematic alignment total knee arthroplasty (KA-TKA). METHODS: The study included 69 patients with mOA on one side of the knee and but no OA on the other side. LDFA, medial proximal tibial angle (MPTA), mechanical hip-knee-ankle angle (mHKA), and arithmetic hip-knee-ankle angle (aHKA) were measured and compared between the knees. Pearson's correlation coefficient and paired t-tests were used for statistical analysis. RESULTS: The LDFA and MPTA were significantly more varus in mOA knees than in knees non-OA knees, with differences of 1.0° ± 2.3° and 0.9° ± 2.0°, respectively. The difference between mHKA of the non-OA side and aHKA of the mOA side was not significant, indicating that it is appropriate to use aHKA as an estimation of postoperative alignment after kinematically-aligned total knee arthroplasty without anatomical correction. However, there was a significant difference in MPTA and aHKA between male and female patients in both mOA and non-OA knees. CONCLUSIONS: The assumption that there is no bone wear on the femoral articular surface is rejectable, and the constant compensation thickness of 2 mm for cartilage wear may not be sufficient. Further research is needed to estimate the amount of bone wear in both femur and tibia side to develop more individualized surgical planning strategies in KA-TKA.

Relationship between Lipoprotein Lipase Derived from Subcutaneous Adipose Tissue and Cardio-Ankle Vascular Index in Japanese Patients with Severe Obesity.

INTRODUCTION: Cardio-ankle vascular index (CAVI) is an arterial stiffness index that correlates inversely with body mass index (BMI) and subcutaneous fat area. Lipoprotein lipase (LPL) that catalyzes the hydrolysis of serum triglycerides is produced mainly in adipocytes. Serum LPL mass reflects LPL expression in adipose tissue, and its changes correlate inversely with changes in CAVI. We hypothesized that LPL derived from subcutaneous adipose tissue (SAT) suppresses the progression of arteriosclerosis and examined the relationship of LPL gene expression in different adipose tissues and serum LPL mass with CAVI in Japanese patients with severe obesity undergoing laparoscopic sleeve gastrectomy (LSG). METHODS: This study was a single-center retrospective database analysis. Fifty Japanese patients who underwent LSG and had 1-year postoperative follow-up data were enrolled (mean age 47.5 years, baseline BMI 46.6 kg/m2, baseline HbA1c 6.7%). SAT and visceral adipose tissue (VAT) samples were obtained during LSG surgery. LPL gene expression was analyzed by real-time PCR. Serum LPL mass was measured by ELISA using a specific monoclonal antibody against LPL. RESULTS: At baseline, LPL mRNA expression in SAT correlated positively with serum LPL mass, but LPL mRNA expression in VAT did not. LPL mRNA expression in SAT was correlated, and serum LPL mass tended to correlate inversely with the number of metabolic syndrome symptoms, but LPL mRNA expression in VAT did not. LPL mRNA expression in SAT and CAVI tended to correlate inversely in the group with visceral-to-subcutaneous fat ratio of 0.4 or higher, which is considered metabolically severe. Serum LPL mass increased 1 year after LSG. Change in serum LPL mass at 1 year after LSG tended to be an independent factor inversely associated with change in CAVI. CONCLUSIONS: Serum LPL mass reflected LPL mRNA expression in SAT in Japanese patients with severe obesity, and LPL mRNA expression in SAT was associated with CAVI in patients with visceral obesity. The change in serum LPL mass after LSG tended to independently contribute inversely to the change in CAVI. This study suggests that LPL derived from SAT may suppress the progression of arteriosclerosis.

A Muscle-Preserving Short Transverse Incision for Unicompartmental Knee Arthroplasty: A Technical Note.

We describe the use of a short transverse incision technique with muscle retention for unicompartmental knee arthroplasty (UKA). The incision is made transversely just above the joint line, followed by a detachment of subcutaneous soft tissue from the underlying capsule and fascia to create a mobile window. The fascia is incised along the medial border of the vastus medialis and the capsule of the suprapatellar pouch is incised laterally, preserving vastus medialis muscle. All procedures are performed within the mobile window while controlling the knee flexion angle. Following implantation, the capsule and fascia are anatomically repaired. This approach was used in 30 consecutive patients who underwent Oxford UKA, including one bi-unicompartmental knee arthroplasty without complications. Importantly, no patients had any disturbances of the infrapatellar branch of the saphenous nerve disturbances such as numbness, hyperesthesia, hypoesthesia, or neuroma pain. The transverse approach is thought to be a safe and feasible method for UKA.

Infection with male and female Trichuris trichiura diagnosed in a non-endemic area.

Trichuris trichiura parasitizes only humans through fecal-oral transmission. In non-endemic areas, the frequency of endoscopic identification has been increasing due to the increasing number of immigrants from endemic countries. To prevent infection, it is important to pay attention to sanitary conditions such as soil and water sources.