Morphological differences between the dorsal and palmar septa of the first extensor compartment in relation to the brachioradialis and pronator quadratus.

BACKGROUND: The first extensor compartment of the wrist is known as a frequent site of stenosing tenosynovitis, referred to as de Quervain's disease. De Quervain's disease occurs more frequently in the dorsal part of the first extensor compartment than in the palmar part; however, the anatomical reason why the dorsal part is worse remains poorly elucidated. This study clarified the morphological differences between the dorsal and palmar parts by examining their relationship with the surrounding structures. METHODS: In this study, a total of 35 wrists from 23 Japanese cadavers were used. Twenty-five wrists were randomly assigned for macroscopic analysis, and the remaining 10 wrists were used for histological analysis. RESULTS: The palmar septum of the first extensor compartment was connected to the brachioradialis tendon and superficial head of the pronator quadratus and was histologically stout compared to the dorsal septum. Despite several anatomical variations, such as the septum between the abductor pollicis longus/extensor pollicis brevis and the multiple tendons of these muscles, the aforementioned characteristics of the fibrous sheath in the first extensor compartment were identical in all specimens. CONCLUSION: In contrast to the fragile structure of the dorsal septum, the stout structure of the palmar septum could be related to the low occurrence of symptoms of de Quervain's disease. The present results could play a role in revealing the pathogeny and establish the precise treatment for de Quervain's disease and provide an anatomical basis for kinesiological/biomechanical studies.

Validation of an automated sample preparation module directly connected to LC-MS/MS (CLAM-LC-MS/MS system) and comparison with conventional immunoassays for quantitation of tacrolimus and cyclosporin A in a clinical setting.

BACKGROUND: Therapeutic drug monitoring (TDM) systems generally use either liquid chromatography/tandem mass spectrometry (LC-MS/MS) or immunoassay, though both methodologies have disadvantages. In this study, we aimed to evaluate whether a CLAM-LC-MS/MS system, which consists of a sample preparation module directly connected to LC-MS/MS, could be used for clinical TDM work for immunosuppressive drugs in whole blood, which requires a hemolytic process. For this purpose, we prospectively validated this system for clinical measurement of tacrolimus and cyclosporin A in patients' whole blood. The results were also compared with those of commercial immunoassays. METHODS: Whole blood from patients treated with tacrolimus or cyclosporin A at the Department of Nephrology and Departments of Rheumatology, Kanazawa University Hospital, from May 2018 to July 2019 was collected with informed consent, and drug concentrations were measured by CLAM-LC-MS/MS and by chemiluminescence immunoassay (CLIA) for tacrolimus and affinity column-mediated immunoassay (ACMIA) for cyclosporin A. Correlations between the CLAM-LC-MS/MS and immunoassay results were analyzed. RESULTS: Two hundred and twenty-four blood samples from 80 patients were used for tacrolimus measurement, and 76 samples from 21 patients were used for cyclosporin A. Intra- and inter-assay precision values of quality controls were less than 7%. There were significant correlations between CLAM-LC-MS/MS and the immunoassays for tacrolimus and cyclosporin A (Spearman rank correlation coefficients: 0.861, 0.941, P < 0.00001 in each case). The drug concentrations measured by CLAM-LC-MS/MS were about 20% lower than those obtained using the immunoassays. CLAM-LC-MS/MS maintenance requirements did not interfere with clinical operations. Compared to manual pretreatment, automated pretreatment by CLAM showed lower inter-assay precision values and greatly reduced the pretreatment time. CONCLUSIONS: The results obtained by CLAM-LC-MS/MS were highly correlated with those of commercial immunoassay methods. CLAM-LC-MS/MS offers advantages in clinical TDM practice, including simple, automatic pretreatment, low maintenance requirement, and avoidance of interference.

The ability to appropriately distinguish throws for different target positions.

Repeated and accurate throwing of an object to a target position is a special human motor skill. It is particularly important to understand accuracy, which has received less attention than speed due to difficulties in measurement. Accuracy has been studied in terms of reducing errors against a single target, but also in terms of distinguishing appropriate throws for targets in different positions. In this study, this ability was investigated by evaluating the two-dimensional distributions of the pitch locations of 15 pitches to three target positions in university students with and without baseball experience. The center, major and minor axis length, major and minor axis ratio, slope, area, and percentage of overlapping area of the 95% confidence ellipse were compared between target positions and participants using a two-way repeated-measures analysis of variance (ANOVA). The center and area of the ellipse indicate the mean and variability of the error, respectively. The lengths of the major axes correspond to the variability of the release timing, and the minor axes correspond to the variability of the release point in space. Therefore, the ratio of the major and minor axes indicates how the variability of the pitching motion is controlled. The slope of the ellipse corresponds to the throwing arm's trajectory, and the percentage of overlap area means the ability to distinguish throws at different target positions. The result showed a main effect of participants on all indices except the center of the ellipse. This indicates that participants can generally distinguish throws by target positions regardless of their baseball experience, although participants with baseball experience may naturally reduce variability. Furthermore, participants with baseball experience demonstrated a decrease variability in release timing, which is a primary contributor to the pitch location variability, relative to the spatial variability of the pitching movements. This reduction in timing variability may be attributed to advanced motor control mechanisms.

Conversion from cilostazol to OPC-13015 linked to mitigation of cognitive impairment.

INTRODUCTION: Cilostazol may be a novel therapeutic agent for Alzheimer's disease. Its metabolite, OPC-13015, has a stronger inhibitory effect on type 3 phosphodiesterase than cilostazol. METHODS: We prospectively enrolled patients with mild cognitive impairment to whom cilostazol was newly prescribed. Patients underwent the Montreal Cognitive Assessment (MoCA) twice, at a 6-month interval. Plasma cilostazol, OPC-13015, OPC-13213, and OPC-13217 concentrations were determined using liquid chromatography-tandem mass spectrometry. RESULTS: MoCA score changes from baseline to the 6-month visit were positively correlated with ratios of OPC-13015 to cilostazol and total metabolites (n = 19, P = .005). Patients with higher ratios of OPC-13015 (≥0.18, median value; n = 10) had significantly higher MoCA scores (P = .036) than patients with lower ratios (the ratio <0.18, n = 9). The absolute value of OPC-13015 concentration in blood was also higher in patients with preserved cognitive function (P = .033). DISCUSSION: Blood OPC-13015 levels may be a predictive biomarker of cilostazol treatment for Alzheimer's disease.

The ulnar nerve is surrounded by the tendon expansion of the flexor carpi ulnaris muscle at the wrist: an anatomical study of Guyon's canal.

The ulnar tunnel (Guyon's canal) is an osseofibrous tunnel for the ulnar nerve and artery. With regard to the proximal palmar wall (palmar carpal ligament) of the ulnar tunnel, detailed anatomical data such as attachment sites, fibrous continuity to surroundings, and variations have not been clearly described. In this study, topology of Guyon's canal was examined, especially to the palmar side of the ulnar nerve, focusing on the continuity of tendinous structures to reveal a more detailed constitution of Guyon's canal. The palmar wall of Guyon's canal was investigated in 113 forearms of 57 cadavers. The dorsal wall of the canal was also investigated in 25 subjects. The ulnar nerve passed lateral to the pisiform and the flexor carpi ulnaris tendon. At the level of the pisiform, except for one, the ulnar nerve passed dorsal to the aponeurosis expanding from the flexor carpi ulnaris tendon and the periosteum of the pisiform, and this aponeurosis laterally merged with the palmar aspect of the flexor retinaculum. Moreover, the ulnar nerve ran palmar to the pisohamate ligament and the flexor retinaculum extended from the same tendon. The present study suggests that the aponeurosis of palmar side to the ulnar nerve connected with the flexor carpi ulnaris tendon, the periosteum of the pisiform, and the palmar surface of the flexor retinaculum. These findings indicate that the ulnar nerve is surrounded by the aponeurotic portion expanding from the flexor carpi ulnaris tendon at the wrist, which is a new insight of Guyon's canal.

Long-Term Outcome of Ischemic Cardiomyopathy After Autologous Myoblast Cell-Sheet Implantation.

Heart failure is a refractory condition despite remarkable medical progress in therapeutic concepts. Recently, tissue-engineered cell-sheet implantation for end-stage heart failure has been explored experimentally and clinically. We present the case of a 22-year-old woman with ischemic cardiomyopathy who underwent mitral valve replacement and coronary artery bypass graft for infective endocarditis. Ventricular assist device therapy was recommended. After cell-sheet therapy, cardiac function and clinical symptoms significantly improved, and the improvement persisted for more than 36 months without ventricular assist device therapy or heart transplantation. This regenerative treatment might be feasible and effective for severe heart failure of ischemic etiology.

Silent Native-valve Endocarditis Caused by Propionibacterium acnes.

We describe a rare case of Propionibacterium acnes native-valve endocarditis that silently progressed in a 67-year-old man with hybrid dialysis. The patient was scheduled for kidney transplantation, and pre-operative investigation incidentally detected a vegetative structure at his native mitral valve that had increased in size. He underwent cardiac surgery and P. acnes was detected in cultures of a resected cardiac valve specimen and blood. This case highlights that P. acnes can silently cause infective endocarditis in a native-valve, and that physicians should consider the possibility of infection when P. acnes is isolated in blood cultures.

Large-scale microfabricated channel plates for high-throughput, fully automated DNA sequencing.

We have described a new DNA sequencing platform based on the Sanger chemistry, in which the large-scale microfabricated channel plates and electrophoretic system result in higher-throughput DNA sequencing. Three hundred and eighty-four channels are arranged in a fan-like shape on a 25x47 cm glass plate, on which 384 oval sample holes are connected to each channel coupled to the opposite anode access holes. Two microfabricated plates are set on the sequencing apparatus, in which sequencing electrophoresis is conducted on one plate and the preparation process is on another plate. Each sample hole is loaded with 2.3 microL volume of sample and injected into separation channels electrokinetically. High-quality sequencing data were acquired using the pUC18 template, achieving an average read-length of 1001 bases with 99% accuracy and a throughput of 5 Mbases per day per instrument. To assess the performance in actual sequencing field, the bacterial artificial chromosome shotgun library of the Pseudorca crassidens genome was sequenced, using 1/80 of the quantity of Sanger reagent (0.1 microL). We believe that this is the first demonstration of the useful performance of DNA sequencing using monolithic microfabricated devices with walk-away operation.