Molecular Property, Manipulation, and Potential Use of Opn5 and Its Homologs.

Animal opsin is a G-protein coupled receptor (GPCR) and binds retinal as a chromophore to form a photopigment. The Opsin 5 (Opn5) group within the animal opsin family comprises a diverse array of related proteins, such as Opn5m, a protein conserved across all vertebrate lineages including mammals, and other members like Opn5L1 and Opn5L2 found in non-mammalian vertebrate genomes, and Opn6 found in non-therian vertebrate genomes, along with Opn5 homologs present in invertebrates. Although these proteins collectively constitute a single clade within the molecular phylogenetic tree of animal opsins, they exhibit markedly distinct molecular characteristics in areas such as retinal binding properties, photoreaction, and G-protein coupling specificity. Based on their molecular features, they are believed to play a significant role in physiological functions. However, our understanding of their precise physiological functions and molecular characteristics is still developing and only partially realized. Furthermore, their unique molecular characteristics of Opn5-related proteins suggest a high potential for their use as optogenetic tools through more specialized manipulations. This review intends to encapsulate our current understanding of Opn5, discuss potential manipulations of its molecular attributes, and delve into its prospective utility in the burgeoning field of animal opsin optogenetics.

REV7 is involved in outcomes of platinum-based chemotherapy in pancreatic cancer by controlling the DNA damage response.

REV7 is a multifunctional protein implicated in various biological processes, including DNA damage response. REV7 expression in human cancer cells affects their sensitivity to DNA-damaging agents. In the present study, we investigated the significance of REV7 in pancreatic ductal adenocarcinoma (PDAC). REV7 expression was immunohistochemically examined in 92 resected PDAC specimens and 60 endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) specimens of unresectable PDAC treated with platinum-based chemotherapy, and its association with clinicopathologic features was analyzed. Although REV7 expression was not significantly associated with the progression of primary tumors (T-factor and Stage) in either resected or unresectable PDAC, decreased levels of REV7 expression in EUS-FNAB specimens of unresectable PDAC were significantly associated with better outcomes of platinum-based chemotherapy and a favorable prognosis. REV7-deficient PDAC cell lines showed suppressed cell growth and enhanced sensitivity to cisplatin in vitro. Tumor-bearing mice generated using REV7-deficient PDAC cell lines also showed enhanced sensitivity to cisplatin in vivo. RNA sequencing analysis using WT and REV7-deficient PDAC cell lines revealed that REV7 inactivation promoted the downregulation of genes involved in the DNA repair and the upregulation of genes involved in apoptosis. Our results indicate that decreased expression of REV7 is associated with better outcomes of platinum-based chemotherapy in PDAC by suppressing the DNA damage response. It is also suggested that REV7 is a useful biomarker for predicting the outcome of platinum-based chemotherapy and the prognosis of unresectable PDAC and is a potential target for PDAC treatment.

Influence of changes in pelvic anteversion during gait on walking ability and physical function in patients with adult spinal deformity: A cross-sectional study.

BACKGROUNDS: Evaluation of gait posture using a three-dimensional motion analysis system (3DMAS) revealed that elderly patients with adult spinal deformity (ASD) experience pelvic anteversion while walking. The purpose of this study was to investigate the influence of changes in pelvic anteversion during gait on walking ability and physical function in patients with ASD. METHODS: Fifty-four patients with ASD aged 50 years or older who were admitted to our hospital between March 2016 and December 2021 were included in the study. The 6-min walking distance (6MWD) was used to evaluate walking ability, and trunk and hip extensor strength were measured to evaluate physical function in the subjects. The 3DMAS was used to measure the subject's changes in pelvic anteversion during gait. After measuring the changes in pelvic anteversion, the median value of the study subjects was calculated, according to which the subjects were divided into two groups (small anteversion [S] group, large anteversion [L] group). Walking ability and physical function were compared between the two groups. RESULTS: The number of subjects in each group was 27. Comparisons of walking ability and physical function between the groups revealed significant differences in 6MWD (S group, 333.6 ± 111.2 m; L group, 238.0 ± 106.3 m) and hip extensor strength (S group, 15.8 ± 3.8 kgf; L group, 13.4 ± 4.4 kgf). No significant differences regarding trunk extensor strength were observed between the groups (S group, 15.2 ± 4.0 kgf; L group, 12.9 ± 4.8 kgf). CONCLUSION: The results of the present study revealed that ASD patients with greater pelvic anteversion associated with walking have lower walking ability and physical function. These results suggest the importance of evaluating the posture of ASD patients not only by using radiographic findings but also by assessing movement, such as gait posture.

A case of lymphatic flow evaluation using indocyanine green fluorescence imaging for recurrence of anastomotic site after laparoscopic right hemicolectomy.

BACKGROUND: Anastomotic recurrence of colorectal cancer is rare, but reoperation improves prognosis. However, there is no clear evidence regarding the extent of dissection, and there are few reports on the details of surgery. We used intraoperative lymphatic flow imaging with indocyanine green (ICG) fluorescence as a reference to determine the range of additional resection. CASE PRESENTATION: The patient was a 75-year-old man who underwent laparoscopic right hemicolectomy and extracorporeal functional terminal anastomosis for ascending colon cancer 4 years ago. Histopathological examination revealed a well-differentiated tubular adenocarcinoma, T4aN0M0, pathological stageIIB. During follow-up, anemia was observed, and colonoscopy indicated anastomotic recurrence, so additional laparoscopic resection was performed. Intraoperatively, ICG was injected into the anastomotic site, and the operation proceeded under near-infrared light observation. Lymphatic vessels along the middle colonic artery were visualized down to the root of the vessel. Using this as an indicator, the vessel was ligated from the root. Using the fact that the lymphatic vessels were also depicted in the small intestinal mesentery on the oral side of the anastomosis as an indicator, the small intestine and mesentery were resected about 7 cm from the anastomosis. CONCLUSIONS: The optimal surgical approach for anastomotic recurrence of colorectal cancer has not been defined. Intraoperative ICG fluorescence imaging can provide images of lymphatic flow from the site of recurrence and may be an indicator of lymph node dissection in the case of anastomotic recurrence.

Mammalian type opsin 5 preferentially activates G14 in Gq-type G proteins triggering intracellular calcium response.

Mammalian type opsin 5 (Opn5m), a UV-sensitive G protein-coupled receptor opsin highly conserved in vertebrates, would provide a common basis for UV sensing from lamprey to humans. However, G protein coupled with Opn5m remains controversial due to variations in assay conditions and the origin of Opn5m across different reports. Here, we examined Opn5m from diverse species using an aequorin luminescence assay and Gα-KO cell line. Beyond the commonly studied major Gα classes, Gαq, Gα11, Gα14, and Gα15 in the Gq class were individually investigated in this study, as they can drive distinct signaling pathways in addition to a canonical calcium response. UV light triggered a calcium response via all the tested Opn5m proteins in 293T cells, which was abolished by Gq-type Gα deletion and rescued by cotransfection with mouse and medaka Gq-type Gα proteins. Opn5m preferentially activated Gα14 and close relatives. Mutational analysis implicated specific regions, including α3-ß5 and αG-α4 loops, αG and α4 helices, and the extreme C terminus, in the preferential activation of Gα14 by Opn5m. FISH revealed co-expression of genes encoding Opn5m and Gα14 in the scleral cartilage of medaka and chicken eyes, supporting their physiological coupling. This suggests that the preferential activation of Gα14 by Opn5m is relevant for UV sensing in specific cell types.

Diversification processes of teleost intron-less opsin genes.

Opsins are universal photosensitive proteins in animals. Vertebrates have a variety of opsin genes for visual and non-visual photoreceptions. Analysis of the gene structures shows that most opsin genes have introns in their coding regions. However, teleosts exceptionally have several intron-less opsin genes that are presumed to have been duplicated by an RNA-based gene duplication mechanism, retroduplication. Among these retrogenes, we focused on the Opn4 (melanopsin) gene responsible for non-image-forming photoreception. Many teleosts have five Opn4 genes including one intron-less gene, which is speculated to have been formed from a parental intron-containing gene in the Actinopterygii. In this study, to reveal the evolutionary history of Opn4 genes, we analyzed them in teleost (zebrafish and medaka) and non-teleost (bichir, sturgeon, and gar) fishes. Our synteny analysis suggests that the intron-less Opn4 gene emerged by retroduplication after the branching of the bichir lineage. In addition, our biochemical and histochemical analyses showed that, in the teleost lineage, the newly acquired intron-less Opn4 gene became abundantly used without substantial changes in the molecular properties of the Opn4 protein. This stepwise evolutionary model of Opn4 genes is quite similar to that of rhodopsin genes in the Actinopterygii. The unique acquisition of rhodopsin and Opn4 retrogenes would have contributed to the diversification of the opsin gene repertoires in the Actinopterygii and the adaptation of teleosts to various aquatic environments.

Is dynamic spino-pelvic alignment during gait associated with lumbar function in patients with degenerative lumbar spinal stenosis?

INTRODUCTION: Static spine and pelvic posture has been reported to be associated with symptoms in patients with lumbar spinal stenosis (LSS), but it is unknown whether dynamic alignment of the spine and pelvis is associated with lumbar function in daily life. This study aims to investigate the relationship between dynamic alignment of the spine and pelvis during gait and lumbar function in daily life in patients with LSS. METHODS: We evaluated lumbar function in daily life using the Oswestry Disability Index (ODI), trunk and hip muscle strength as physical function, static spinal alignment, and dynamic spinal/pelvic alignment during gait. The relationship between the ODI score and physical function or static and dynamic alignment was examined. RESULTS: A total of 35 preoperative patients with LSS participated in this study. ODI score significantly correlated with trunk extension strength (r = -0.578, p = 0.000), hip extension strength (r = -0.472, p = 0.004), maximum spinal flexion angle during gait (r = -0.473, p = 0.004) and maximum pelvic anterior tilt angle (r = 0.510, p = 0.002). Multiple regression analysis showed that trunk extension strength (standardized ß; - 0.309), hip extension strength (standardized ß; -0.287), maximum spinal flexion angle (standardized ß; - 0.306) and maximum pelvic anterior tilt angle (standardized ß; 0.271) significantly affected the ODI score, with adjusted coefficient of determination of 0.529. CONCLUSION: The results of this study showed that the patients with LSS with weak hip or trunk extensor muscles, a greater angle of pelvic tilt or a less spinal flexion during gait had a lower lumbar function in daily life.

Simultaneously operation for combined head and abdominal blunt trauma: A case report.

An 82-year-old woman fell down the stairs and was brought to our hospital. When she came to our hospital, she had a left acute epidural hematoma, brain contusion, and splenic injury. During plain computed tomography (CT) imaging, hypotension and deteriorated level of consciousness was observed, and simultaneous head and abdominal surgery was performed to control intracranial hematoma growth and hemorrhagic shock. The head was positioned in right rotation and the trunk in supine position, and craniotomy and splenectomy were performed simultaneously. Simultaneous head and abdominal surgery is a very effective treatment strategy for multiple trauma because it does not require repositioning of the patient.

Lesser omental hernia through a defect in the posterior layer of the lesser omentum.

BACKGROUND: In previously reported cases of lesser omental hernia, a rare clinical presentation, the herniated intestinal tract was passing through both peritoneal layers of the lesser omentum to herniate into the peritoneal cavity or bursa omentalis. Here we present a very rare case of lesser omentum hernia, where the transverse colon entered through only the posterior layer of the lesser omentum to form a hernia between the anterior and posterior layers. CASE PRESENTATION: A 43-year-old man was admitted to the emergency department with acute abdominal pain. Plain abdominal computed tomography (CT) revealed a change in the caliber of the transverse colon between the stomach and pancreas, forming a closed loop on the cephaloventral side of the stomach. On contrast-enhanced CT images, vessels were observed in the contrast-enhanced lesser omentum surrounding the herniated intestine. The patient was diagnosed with a lesser omental hernia and underwent laparoscopic surgery. Intraoperatively, the transverse colon was covered by the anterior layer of the lesser omentum, and a defect was found in the posterior layer of the lesser omentum on the dorsal side of the stomach. A 2-cm incision was made in the posterior layer of the lesser omentum to widen the small defect. The herniated intestinal section was removed from the hernia sac, and the transverse colon was retained unresected. The postoperative course was uneventful. CONCLUSIONS: As illustrated in this first case of a lesser omental hernia forming between the anterior and posterior layers, characteristic CT findings may play an active role in the diagnosis of this rare presentation.

Novel assessment of physiotherapy outcomes in adults with structural spinal disorders.

PURPOSE: The aim is to investigate whether a simple prone posture assessment test (P-test) at baseline can be predict the effectiveness of at least 3 months of physiotherapy for adults with structural spinal disorders. METHODS: Seventy-six adults (age 71.0 ± 7.1 years) with structural spinal disorders who visited our outpatient clinic and underwent physiotherapy, which included muscle strength and range of motion training was provided once a week for a minimum of 3 months, and where the load was adjusted individually by the physiotherapist. The P-test is performed with the subject lying on the bed in a prone position and is positive if no low back pain is seen and the abdomen touches the bed. The Oswestry Disability Index (ODI) was used to assess disability. The minimum clinically important difference (MCID) was set at 10% improvement of the ODI score. Logistic regression analysis was performed to investigate the association between baseline P-test and achievement of ODI-MCID. RESULTS: The study population characteristics were: Sagittal vertical axis 138.1 ± 73.2 mm; Pelvic tilt, 36.9 ± 9.8 degrees; Pelvic incidence minus lumbar lordosis, 45.3 ± 22.1 degrees; and maximum coronal Cobb angle, 21.3 ± 19.7 degrees. Logistic regression analysis showed that being positive on the P-test was associated with the achievement of ODI-MCID (Odds ratio, 8.381; 95% confidence interval, 2.487-35.257). CONCLUSIONS: This study found that our developed P-test was a useful predictor of achieving the ODI-MCID in a cohort of adults with structural spinal disorders receiving at least 3 months of physiotherapy.

Cumulated ambulation score in hospitalized patients with osteoporotic vertebral fractures is an important predictor of returning home: a retrospective cohort study.

Osteoporotic vertebral fractures are recognized as a serious problem in the aging society. In this study, we found that the cumulated ambulation score predicts returning home in patients with osteoporotic vertebral fractures. The cumulated ambulation score is an important piece of information in determining the destination of patients with osteoporotic vertebral fractures. PURPOSE: Osteoporotic vertebral fractures are a serious problem affecting the health status of the elderly, and if they require inpatient treatment, they may have difficulty deciding where to discharge. The study's purpose is to investigate whether the cumulated ambulation scores predict returning home for hospitalized osteoporotic vertebral fractures patients. METHODS: The subjects were 120 osteoporotic vertebral fractures patients aged 65 years or older who were admitted to our hospital between April 2015 and March 2022. The cumulated ambulation scores for all subjects were measured in the 3-days right after admission. A multivariable analysis was performed with the dependent variable as whether the patient returned home and the independent variable as the cumulated ambulation score. Three models were created from the measured cumulated ambulation score, and each model was analyzed as an independent variable (model 1; score on the 1st day, model 2; total score on the 2-days, model 3; total score on the 3-days). RESULTS: The length of hospitalization for the osteoporotic vertebral fracture's patients were 11.8 ± 5.3 days, and 80 (66.7%) returned home. Multivariable analysis showed that cumulated ambulation score was a predictor of returning home (model 1, odds ratio: 3.151, 95% confidence interval: 2.074-5.203; model 2, odds ratio: 2.234, 95% confidence interval: 1.685-3.187; model 3, odds ratio: 1.929, 95% confidence interval: 1.535-2.599). CONCLUSION: The cumulated ambulation score of patients with osteoporotic vertebral fractures right after admission is a factor that affected returning home and is useful in determining where patients are discharged.

Chromophore Structure in an Inactive State of a Novel Photosensor Protein Opn5L1: Resonance Raman Evidence for the Formation of a Deprotonated Adduct at the 11th Carbon Atom.

Opsins are photosensitive G protein-coupled receptor proteins and are classified into visual and nonvisual receptors. Opn5L1 is a nonvisual opsin that binds all-trans retinal as a chromophore. A unique feature of Opn5L1 is that the protein exhibits a photocyclic reaction upon photoexcitation. Determining the chromophore structures of intermediates in the photocycle is essential for understanding the functional mechanism of Opn5L1. A previous study revealed that a long-lived intermediate in the photocycle cannot activate the G protein and forms a covalent bond between the retinal chromophore and a nearby cysteine residue. However, the position of this covalent bond in the chromophore remains undetermined. Here, we report a resonance Raman study on isotopically labeled samples in combination with density functional theory calculations and reveal that the 11th carbon atom of the chromophore of the intermediate forms a covalent linkage to the cysteine residue. Furthermore, vibrational assignments based on the isotopic substitutions and density functional theory calculations suggested that the Schiff base of the intermediate is deprotonated. The chromophore structure determined in the present study well explains the mechanism of the photocyclic reaction, which is crucial to the photobiological function of Opn5L1.

Delayed rupture of adrenal grand after trauma: A case report.

Background: Because adrenal glands are enveloped by Gerota's fascia, spontaneous hemostasis is achieved in most cases of traumatic adrenal injury. For this reason, adrenal injuries are often treated conservatively and rarely present a clinical problem. Case presentation: An 85-year-old man. He presented with right adrenal injury due to blunt trauma, fracture of the right transverse process of the 1st-4th lumbar vertebra, and fracture of the right 12th rib. A small amount of hematoma was observed around the adrenal gland, but his vital signs were stable and he was treated conservatively. However, on the 20th day of hospitalization, he developed sudden onset right-sided abdominal pain, hypotension, and restlessness. Contrast-enhanced CT scan revealed hemorrhagic shock due to delayed adrenal rupture, and emergency transcatheter arterial embolization was performed. A pseudoaneurysm formed at the time of injury was considered to have ruptured late. Conclusion: Delayed rupture after adrenal injury has never been reported in the past, and is a very rare occurrence. Prompt diagnosis and hemostatic treatment are necessary.

The association of dynamic spinal alignment on gait endurance of patients with adult spinal deformity: a cross-sectional study.

PURPOSE: The purpose of this study was to evaluate the gait posture of patients with adult spinal deformity (ASD) using a 3-dimensional motion analysis system (3DMAS) and to investigate whether it affects gait endurance. METHODS: Fifty-one patients with ASD aged 50 years or older who were admitted to our hospital between March 2016 and March 2018 were included in the study. The subjects completed the 6-min walking test, which is an indicator of gait endurance. Static standing posture was assessed by whole-spine x-ray examination (coronal cobb angle, CCA; sagittal vertical axis, SVA; pelvic tilt, PT; and pelvic incidence minus lumbar lordosis, PI-LL). In addition, the gait posture was evaluated by a 3DMAS (dynamic trunk tilt angle, DTA; and dynamic pelvic tilt angle, DPA). The relationship between standing and gait postures and gait endurance was investigated by multivariable analysis. RESULTS: In univariable analysis, SVA, PI-LL, and DTA were associated with gait endurance. Furthermore, in the multivariable analysis, DTA showed the strongest association among the static and dynamic parameters (R2 = 0.61, ß = - 0.35, P < 0.05). CONCLUSIONS: An association was found between gait posture and gait endurance in patients with ASD. These findings can be useful to health care providers treating patients with ASD. It is advisable to assess the gait posture of patients with ASD because they present postural abnormalities during gait.

The medaka mutant deficient in eyes shut homolog exhibits opsin transport defects and enhanced autophagy in retinal photoreceptors.

Eyes shut homolog (EYS) encodes a proteoglycan and the human mutation causes retinitis pigmentosa type 25 (RP25) with progressive retinal degeneration. RP25 most frequently affects autosomal recessive RP patients with many ethnic backgrounds. Although studies using RP models have facilitated the development of therapeutic medications, Eys has been lost in rodent model animals. Here we examined the roles for Eys in the maintenance of photoreceptor structure and function by generating eys-null medaka fish using the CRISPR-Cas9 system. Medaka EYS protein was present near the connecting cilium of wild-type photoreceptors, while it was absent from the eys-/- retina. The mutant larvae exhibited a reduced visual motor response compared with wild-type. In contrast to reported eys-deficient zebrafish at the similar stage, no retinal cell death was detected in the 8-month post-hatching (8-mph) medaka eys mutant. Immunohistochemistry showed a significant reduction in the length of cone outer segments (OSs), retention of OS proteins in the inner segments of photoreceptors, and abnormal filamentous actin network at the base of cone OSs in the mutant retina by 8 mph. Electron microscopy revealed aberrant structure of calyceal processes, numerous vesiculation and lamellar interruptions, and autophagosomes in the eys-mutant cone photoreceptors. In situ hybridization showed an autophagy component gene, gabarap, was ectopically expressed in the eys-null retina. These results suggest eys is required for regeneration of OS, especially of cone photoreceptors, and transport of OS proteins by regulating actin filaments. Enhanced autophagy may delay the progression of retinal degeneration when lacking EYS in the medaka retina.

Open abdominal management after ruptured abdominal aortic aneurysm repair: from a single-center study in Japan.

PURPOSE: We investigated the utility of the open abdominal management (OA) technique for ruptured abdominal aortic aneurysm (rAAA). METHODS: Between January 2016 and August 2021, 33 patients underwent open surgery for rAAA at our institution. The patients were divided into OA (n = 12) and non-OA (n = 21) groups. We compared preoperative characteristics, operative data, and postoperative outcomes between the two groups. The intensive care unit management and abdominal wall closure statuses of the OA group were evaluated. RESULTS: The OA group included significantly more cases of a preoperative shock than the non-OA group. The operation time was also significantly longer in the OA group than in the non-OA group. The need for intraoperative fluids, amount of bleeding, and need for blood transfusion were significantly higher in the OA group than in the non-OA group. Negative pressure therapy (NPT) systems are useful in OA. In five of the six survivors in the OA group, abdominal closure was able to be achieved using components separation (CS) technique. CONCLUSIONS: NPT and the CS technique may increase the abdominal wall closure rate in rAAA surgery using OA and are expected to improve outcomes.

Involvement of a Basic Helix-Loop-Helix Gene BHLHE40 in Specification of Chicken Retinal Pigment Epithelium.

The first event of differentiation and morphogenesis in the optic vesicle (OV) is specification of the neural retina (NR) and retinal pigment epithelium (RPE), separating the inner and outer layers of the optic cup, respectively. Here, we focus on a basic helix-loop-helix gene, BHLHE40, which has been shown to be expressed by the developing RPE in mice and zebrafish. Firstly, we examined the expression pattern of BHLHE40 in the developing chicken eye primordia by in situ hybridization. Secondly, BHLHE40 overexpression was performed with in ovo electroporation and its effects on optic cup morphology and expression of NR and RPE marker genes were examined. Thirdly, we examined the expression pattern of BHLHE40 in LHX1-overexpressed optic cup. BHLHE40 expression emerged in a subset of cells of the OV at Hamburger and Hamilton stage 14 and became confined to the outer layer of the OV and the ciliary marginal zone of the retina by stage 17. BHLHE40 overexpression in the prospective NR resulted in ectopic induction of OTX2 and repression of VSX2. Conversely, BHLHE40 was repressed in the second NR after LHX1 overexpression. These results suggest that emergence of BHLHE40 expression in the OV is involved in initial RPE specification and that BHLHE40 plays a role in separation of the early OV domains by maintaining OTX2 expression and antagonizing an NR developmental program.

Protrusion of KCNJ13 Gene Knockout Retinal Pigment Epithelium Due to Oxidative Stress-Induced Cell Death.

Purpose: This study was performed to elucidate the mechanisms of morphological abnormalities in a Leber congenital amaurosis 16 (LCA16) cell model using KCNJ13 knockout (KO) retinal pigment epithelial cells derived from human iPS cells (hiPSC-RPE). Methods: In KCNJ13 KO and wild-type hiPSC-RPE cells, ZO-1 immunofluorescence was performed, and confocal images were captured. The area and perimeter of each cell were measured. To detect cell death, ethidium homodimer III (EthD-III) staining and LDH assay were used. Scanning electron microscopy (SEM) was used to observe the cell surface. The expression levels of oxidative stress-related genes were examined by quantitative PCR. To explore the effects of oxidative stress, tert-butyl hydroperoxide (t-BHP) was administered to the hiPSC-RPE cells. Cell viability was tested by MTS assay, whereas oxidative damage was monitored by oxidized (GSSG) and reduced glutathione levels. Results: The area and perimeter of KCNJ13-KO hiPSC-RPE cells were enlarged. EthD-III-positive cells were increased with more dead cells in the protruded region. The KO RPE had significantly higher LDH levels in the medium. SEM observations revealed aggregated cells having broken cell surfaces on the KO RPE sheet. The KCNJ13-deficient RPE showed increased expression levels of oxidative stress-related genes and total glutathione levels. Furthermore, t-BHP induced a significant increase in cell death and GSSG levels in the KO RPE. Conclusions: We suggest that in the absence of the Kir.7.1 potassium channel, human RPE cells are vulnerable to oxidative stress and ultimately die. The dying/dead cells form aggregates and protrude from the surviving KCNJ13-deficient RPE sheet.

A Case of Hypermucoviscosity Phenotype of Klebsiella pneumoniae Liver Abscess Saved by Damage Control Strategy.

Liver abscess caused by the Hypermucoviscosity phenotype of Klebsiella pneumoniae (HKp) is characterized by high tissue invasiveness and multiple systemic infections. This leads to sepsis, multiple organ failure, and coagulopathy. An 80 year old man came to our hospital with a complaint of malaise and went into hemorrhagic shock after percutaneous transhepatic drainage of a liver abscess caused by HKp. An emergency laparotomy was performed, but the patient suffered from severe coagulopathy and underwent damage control surgery. HKp liver abscesses must be operated on in the presence of multiple organ failure and disseminated intravascular coagulation (DIC) complications when medical treatment is refractory. In these situations, a two-stage damage control strategy should be considered: hemostasis and infection control at the initial surgery and hepatic resection.

Relationship between Lower Limb Pain Intensity and Dynamic Lumbopelvic-Hip Alignment in Patients with Degenerative Lumbar Spinal Canal Stenosis: A Cross-Sectional Study.

STUDY DESIGN: This cross-sectional study was conducted in a single hospital. PURPOSE: To clarify the relationship between lower limb pain intensity and dynamic lumbopelvic-hip alignment in patients with lumbar spinal canal stenosis (LSS), using a three-dimensional (3D) motion analysis system. OVERVIEW OF LITERATURE: Although it is well known that leg symptoms have a close relationship with posture in patients with LSS, the relationship under dynamic conditions, such as gait, remain unclear. METHODS: Thirty patients with LSS scheduled for spine surgery participated in this study. Lower limb pain was assessed using the Visual Analog Scale (VAS), and the patients were divided into two groups based on the mean scores (patients with scores above and below the mean were classified as the high-VAS and low-VAS groups, respectively). The kinematics of the spine, pelvis, and hip joints during gait were then measured using a 3D motion analysis system. Student paired t -tests were used to compare the angles of the spine, pelvis, and hip during gait between the two groups. RESULTS: Compared to those in the low-VAS group, the spine was significantly extended and bent toward the more painful lower limb side, and the pelvis was significantly anteriorly tilted among individuals in the high-VAS group. CONCLUSIONS: Patients with LSS experiencing severe pain in their lower limb tend to keep the spine in a more extended position, bend laterally toward the painful side, and have an anteriorly tilted pelvic posture. The dynamic spinal and pelvic alignment was closely related to the intensity of the lower limb pain.