Predeposited Autologous Blood Transfusion in Single-Anesthetic Bilateral Total Knee Arthroplasty with Modern Blood Conservation Strategy.

This study was performed to examine the hypothesis that the rate of allogeneic blood transfusion in patients who did not predeposit an autologous blood transfusion before single-anesthetic bilateral total knee arthroplasty (TKA) would be noninferior to that in patients who did predeposit blood. Methods: We assessed the number of allogeneic transfusions required in 338 patients undergoing single-anesthetic bilateral TKA with a preoperative hemoglobin level of ≥11.0 g/dL. All TKAs were performed by a single surgeon according to the same operative and postoperative protocol. All patients received a combination of intravenous and intra-articular tranexamic acid. Neither a pneumonic tourniquet nor a drain was used. The difference in the risk of allogeneic transfusion between patients without and with autologous blood predeposit was compared with a noninferiority margin of 10 percentage points. Results: Allogeneic transfusion was required in 1 (0.5%) of 194 patients who predeposited autologous blood and 3 (2.1%) of 144 patients who did not predeposit blood. The difference in risk was -1.6 percentage points (95% confidence interval, -4.1 to 1.0 percentage points); the confidence interval did not include the noninferiority margin and included zero. Conclusions: In single-anesthetic bilateral TKA, allogeneic transfusion requirements in patients who did not predeposit autologous blood were noninferior to those in patients who predeposited blood. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Detection of Characteristic Phosphatidylcholine Containing Very Long Chain Fatty Acids in Cerebrospinal Fluid from Patients with X-Linked Adrenoleukodystrophy.

X-linked Adrenoleukodystrophy (X-ALD) is a rare genetic neurological disorder caused by a mutation of the ABCD1 gene that encodes a peroxisomal ABC protein ABCD1. ABCD1 has a role in transporting very long chain fatty acid (VLCFA)-CoA into the peroxisome for ß-oxidation. ABCD1 dysfunction leads to reduced VLCFA ß-oxidation and in turn increased VLCFA levels in the plasma and the cells of all tissues; these increased plasma levels have been used to diagnose X-ALD. It has been reported that plasma VLCFA is not correlated with the severity and disease phenotype of X-ALD. Therefore, we cannot predict the disease progression by the plasma VLCFA level. Cerebrospinal fluid (CSF) is constantly produced by brain, and thus levels of lipids containing VLCFA in CSF might be informative in terms of assessing X-ALD pathology. LC-MS/MS-based analysis showed that phosphatidylcholine (PC) containing VLCFA signals, such as PC 40 : 0(24 : 0/16 : 0), PC 42 : 0(26 : 0/16 : 0), PC 44 : 4(24 : 0/20 : 4) and PC 46 : 4(26 : 0/20 : 4) were characteristically detected only in the CSF from patients with X- ALD. In the present study, we analyzed limited number of patient's CSF samples (2 patients with X-ALD) due to the limitations of the availability for CSF samples from this rare disease. However, our finding would offer helpful information for studying the disease progression biomarkers in X-ALD. To our knowledge, this is the first report of analyzing lipids containing VLCFA in CSF from patients with X-ALD.

Medicinal Mushroom, Grifola gargal (Agaricomycetes), Lowers Triglyceride in Animal Models of Obesity and Diabetes and in Adults with Prediabetes.

Grifola gargal is a medicinal mushroom with biological effects, such as antiatherogenic activity, and is used as a treatment for various chronic inflammatory diseases. The aim of this study is to investigate the antidiabetic and antiobesity effects of a low-molecular weight hot water extract from G. gargal (GGL) against diabetes type 2. In a human clinical trial, 10 subjects with prediabetes consumed 9.2 g of GGL daily for 4 weeks. The significant beneficial health effects observed were decreases in triglyceride levels. This is the first report of these results in humans. Moreover, in animal experiments, we investigated the influence of administered feed with 2% (w/w) GGL for 42 days by using KK-Ay and ob/ob mice as animal models of obesity and diabetes. Results showed that GGL reduces blood glucose and triglyceride levels and adipose tissue. GGL (2.0 mg/mL) significantly suppressed the expression of the cytokine interleukin-6 in 3T3-L1 cells compared with control cells. Thus, the results indicate that G. gargal may be used as a safe and healthy medicinal food to prevent and improve diabetes- and obesity-related metabolic syndrome.

Blood Glucose-Reducing and Fat-Reducing Effects of a Novel Medicinal Mushroom, Grifola gargal (Agaricomycetes).

Grifola gargal Singer is a medicinal mushroom with biological effects such as antiatherogenic and antiosteoporotic activities. The objective of this study was to examine a blood glucose-reducing effect and a fatreducing effect of G. gargal supplementation in vivo. The effects of G. gargal powder (GGP) in a high-molecular weight hot water extract (GGH) and a low-molecular weight hot water extract (GGL) on blood glucose were investigated in streptozotocin (STZ)-induced diabetic ICR mice (STZ diabetic mice). A significant decrease in blood glucose was observed after 5 weeks of GGL supplementation (fraction with a molecular weight ≤ 6000 Da) in STZ diabetic mice. In the next test, we examined the antihyperglycemic and fat-reducing effects of GGL in diet-induced obesity (DIO) mice fed a high-fat diet. GGL facilitated reductions in blood glucose and body fat. This study confirms, to our knowledge for the first time, that administration of G. gargal extract has antihyperglycemic and body fat-reducing effects in STZ diabetic mice and DIO mice. Therefore, G. gargal is a promising functional food to prevent and treat diabetes and lifestyle-related diseases.

Efficient ethanol production from separated parenchyma and vascular bundle of oil palm trunk.

For efficient utilization of both starchy and cellulosic materials, oil palm trunk was separated into parenchyma (PA) and vascular bundle (VB). High solid-state simultaneous saccharification and fermentation (HSS-SSF) using 30% (w/v) PA, containing 46.7% (w/w) starch, supplemented with amylases and Saccharomyces cerevisiae K3, produced 6.1% (w/v) ethanol. Subsequent alkali-pretreatment using sodium hydroxide was carried out with starch-free PA (sfPA) and VB. Enzymatic digestibility of 5% (w/v) pretreated sfPA and VB was 92% and 97%, respectively, using 18 FPU of commercial cellulase supplemented with 10 U of Novozyme-188 per gram of substrate. Likewise, HSS-SSF using 30% (w/v) alkali-pretreated sfPA and VB, with cellulases and yeast, resulted in high ethanol production (8.2% and 8.5% (w/v), respectively). These results show that HSS-SSF using separated PA and VB is a useful fermentation strategy, without loss of starchy and cellulosic materials, for oil palm trunk.

Anti-tumor effects of water-soluble propolis on a mouse sarcoma cell line in vivo and in vitro.

The honeybee product propolis and its extracts are known to have biological effects such as antibiotic, anti-viral, anti-inflammatory and anti-tumor activities. This study was designed to investigate whether water-soluble propolis (WSP) inhibits tumor growth. The tumor cell line used was mouse sarcoma 180 (S-180), and its growth was determined in vitro and in vivo with exposure to different concentrations of WSP. The effects of WSP on tumor cells in vitro were evaluated by measuring the intracellular uptake of 3H-thymidine. 3H-thymidine uptake was inhibited in accordance with the concentration of WSP. The minimum concentration of WSP necessary for 3H-thymidine uptake inhibition was 1.0 microg/ml and uptake was suppressed to 88% of the level in non-treated cells at this concentration. In an experiment using tumor-bearing mice, oral administration of WSP was begun 24 hours after transplantation of S-180 cells. WSP was administered to the mice 5 times, every other day for 10 days. The doses were 320 mg/kg (10 mg/mouse) or 960 mg/kg (30 mg/mouse) of body weight. All mice were sacrificed 10 days after transplantation, and tumor growth was evaluated. The orally administered WSP significantly inhibited the growth of transplanted tumors (p < 0.05). Furthermore, histological findings revealed a significant reduction in mitotic cells and tumor invasion of the muscular tissue at both dose-levels of WSP.