Association between Relative Thrombocytosis and Microalbuminuria in Adults with Mild Fasting Hyperglycemia.

An elevated platelet count may contribute to significant thrombotic events and pose a risk for diabetic microvascular complications. Albuminuria, one of the hallmarks of diabetes, is thought to be a risk factor for endothelial dysfunction. In this study, we investigated the association between relative thrombocytosis and an increased urine albumin-to-creatinine ratio in healthy adult participants. Using multivariate analyses on data from the Korea National Health and Nutrition Examination Survey V-VI, 12,525 eligible native Koreans aged ≥ 20 were categorized into platelet count quintiles by sex. The highest platelet count quintile included younger, more obese participants with elevated white blood cell counts, poor lipid profiles, and a better estimated glomerular filtration rate. Restricted cubic spline regression analysis revealed significant associations between platelet count and fasting blood glucose, glycated hemoglobin, and urine albumin-to-creatinine ratio. Adjusted logistic regression models indicated that heightened fasting blood glucose and platelet count were linked to risk of microalbuminuria (fasting blood glucose, odds ratio = 1.026, 95%CI = 1.011-1.042; platelet count, odds ratio = 1.004, 95%CI = 1.002-1.006). Particularly, an increased platelet count was notably associated with microalbuminuria progression in subjects with impaired fasting glucose. These findings suggest that an elevated platelet count, even below diagnostic thrombocytosis levels, independently correlates with an increased risk of vascular endothelial dysfunction in patients with impaired fasting glucose.

Evaluating the Safety and effectivenesS in adult KorEaN patients treated with Tolvaptan for management of autosomal domInAnt poLycystic kidney disease (ESSENTIAL): short-term outcomes during the titration period.

BACKGROUND: Tolvaptan reduces height-adjusted total kidney volume (htTKV) and renal function decline in autosomal dominant polycystic kidney disease (ADPKD). This study was aimed at investigating the efficacy and safety of tolvaptan in Korean patients with ADPKD during the titration period. METHODS: This study is a multicenter, single-arm, open-label phase 4 study. We enrolled 108 patients with ADPKD (age, 19-50 years) with an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2 and factors defined as indicative of rapid disease progression. After tolvaptan titration, we evaluated efficacy and side effects and assessed factors associated with the effects. RESULTS: After titration for 4 weeks, eGFR and htTKV decreased by 6.4 ± 7.9 mL/min/1.73 m2 and 16 ± 45 mL/m, respectively. No serious adverse drug reactions were observed during the titration period. The greatest eGFR decline was observed in the first week, with a starting tolvaptan dose of 45 mg. Multivariate linear regression for htTKV decline showed that the greater the change in urine osmolality (Uosm), the greater the decrease in htTKV (ß, 0.436; p = 0.009) in the 1D group stratified by the Mayo Clinic image classification. Higher baseline eGFR was related to a higher htTKV reduction rate in the 1E group (ß, -0.642; p = 0.009). CONCLUSION: We observed short-term effects and safety during the tolvaptan titration period. The decline of htTKV can be predicted as a short-term effect of tolvaptan by observing Uosm changes from baseline to end of titration in 1D and baseline eGFR in 1E groups.

A phase II, multicenter, open-label trial to evaluate the safety and efficacy of ISU303 (Agalsidase beta) in patients with Fabry disease.

BACKGROUND: Fabry disease (FD) is caused by a deficiency in the activity of the lysosomal enzyme, α-galactosidase A (α-Gal A), which leads to globotriaosylceramide (Gb3) deposition in multiple tissues. The current management of FD is enzyme replacement therapy (ERT). We report on the efficacy and safety of a new agalsidase beta, ISU303, in FD. METHODS: Ten patients (7 males, 3 females) were enrolled and administered a 1 mg/kg dose of ISU303, every other week for 6 months. The primary endpoint was the normalization of plasma Gb3 level. The secondary endpoints were the changes from baseline in urine Gb3 and the plasma and urine lyso-globotriaosylsphingosine (lyso-Gb3) level. Echocardiography, renal function test, and pain-related quality of life were also assessed before and after administration. Safety evaluation was performed including vital signs, laboratory tests, electrocardiograms, antibody screening tests, and adverse events at each visit. RESULTS: At 22 weeks of treatment, plasma and urine Gb3 level decreased by a mean of 4.01 ±â€…1.29 µg/mL (range 2.50-5.70) (P = .005) and 1.12 ±â€…1.98 µg/mg Cr. (range 0.04-5.65) (P = .017), respectively. However, no significant difference was observed in plasma and urine lyso-Gb3 levels. Echocardiography also was not changed. Renal function and pain-related quality of life showed improvements, but there was no clinical significance. No severe adverse events were observed. Only 1 patient developed an anti-drug antibody without neutralizing activity during the trial. CONCLUSION: This study showed the efficacy and safety of ISU303. Treatment with ISU303 significantly resulted in plasma and urine Gb3 decrease in patients with FD. These results suggest that ISU303 is safe and effective and can alternative ERT for FD.

The association between dietary sodium intake and osteoporosis.

The association of inadequate dietary sodium intake with bone mineral density (BMD) and the risk of osteoporosis is controversial. To find the association between low sodium diet and the risk of incipient osteoporosis, we performed a population-based cross-sectional analysis using Tanaka method for estimation 24-h urinary sodium excretion (e24hUNaETanaka) as a candidate indicator of sodium intake. We identified 3869 participants without osteoporosis and classified them into quartiles according to their value of e24hUNaETanaka. BMD was measured to find participants at risk of osteoporosis. Lower e24hUNaETanaka was related to decreasing BMD of the distal radius. Multiple Cox-proportional hazard models demonstrated that e24hUNaETanaka had an inverse association with the risk of osteoporosis (adjusted HR = 0.859, 95% CI = 0.751-0.982) and survival analysis revealed that the lowest quartile group had poor osteoporosis-free survival (PLog-rank < 0.0001). Furthermore, our restricted cubic spline analysis revealed that the relationship between e24hUNaETanaka and HR of osteoporosis was negative curvilinear in males and postmenopausal females and positive linear in premenopausal females. Our findings suggest that lower sodium intake was a significant predictor of incipient osteoporosis and there was wide variation in this relationship according to sex and female hormone status.

Immunogenicity of COVID-19 Vaccination in Patients With End-Stage Renal Disease Undergoing Maintenance Hemodialysis: The Efficacy of a Mix-and-Match Strategy.

BACKGROUND: The objective of this study was to evaluate the immunogenicity of coronavirus disease 2019 (COVID-19) vaccination in patients with end-stage renal disease (ESRD) on hemodialysis. METHODS: ESRD patients at the hemodialysis center of a tertiary-care university-affiliated hospital and healthy employees at the clinical laboratory center were prospectively recruited between March and June 2021. For severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody analysis, blood samples were collected serially on days 0, 14, 28, and 56 after the first vaccine dose, and on days 7 and 50 after the second dose. Antibodies against the SARS-CoV-2 spike protein were quantified, and SARS-CoV-2 neutralizing antibodies were measured in the serum and plasma. RESULTS: Thirty-one ESRD patients and 55 healthy employees were regularly monitored. Twenty-five (80.6%) ESRD patients on hemodialysis received a mix-and-match strategy with ChAdOx1-BNT162b2 (AZ-Pf group) and six (19.4%) received two doses of ChAdOx1 (AZ-AZ group). ESRD patients on hemodialysis showed lower binding antibody titers and neutralizing antibody activities compared to healthy participants following the first vaccination with ChAdOx1. After the second dose, AZ-Pf group had higher immunogenicity than healthy people on days 7 and 50. The binding antibody titer and neutralizing antibody activities on days 7 and 50 were significantly higher in the AZ-Pf group than in the AZ-AZ group. CONCLUSION: ESRD patients on hemodialysis receiving the mix-and-match strategy (ChAdOx1-BNT162b2) have COVID-19 vaccine immunogenicity comparable to healthy individuals receiving two doses of ChAdOx1. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04871945.

The roles of sodium and volume overload on hypertension in chronic kidney disease.

Chronic kidney disease (CKD) is associated with increased risk of cardiovascular (CV) events, and the disease burden is rising rapidly. An important contributor to CV events and CKD progression is high blood pressure (BP). The main mechanisms of hypertension in early and advanced CKD are renin-angiotensin system activation and volume overload, respectively. Sodium retention is well known as a factor for high BP in CKD. However, a BP increase in response to total body sodium or volume overload can be limited by neurohormonal modulation. Recent clinical trial data favoring intensive BP lowering in CKD imply that the balance between volume and neurohormonal control could be revisited with respect to the safety and efficacy of strict volume control when using antihypertensive medications. In hemodialysis patients, the role of more liberal use of antihypertensive medications with the concept of functional dry weight for intensive BP control must be studied.

Genetically determined hypoalbuminemia as a risk factor for hypertension: instrumental variable analysis.

Hypoalbuminemia is associated with vascular endothelial dysfunction and the development of chronic cardiovascular diseases. However, the relationship between serum albumin concentration and blood pressure changes remains controversial. Community-based longitudinal cohort data collected from Korean Genome and Epidemiology Study were used in this study. Hypoalbuminemia was defined as a serum albumin concentration of ≤ 4.0 g/dL. A total of 4325 participants were categorized into control (n = 3157) and hypoalbuminemia (n = 1168) groups. Serum albumin had a non-linear relationship with the risk of hypertension development. A genome-wide association study revealed 71 susceptibility loci associated with hypoalbuminemia. Among susceptibility loci, genetic variations at rs2894536 in LOC107986598 and rs10972486 in ATP8B5P were related to elevated blood pressure. Serum albumin (HR = 0.654, 95% CI 0.521-0.820) and polymorphisms of rs2894536 (HR = 1.176, 95% CI 1.015-1.361) and rs10972486 (HR = 1.152, 95% CI 1.009-1.316) were significant predictors of hypertension development. Increased albumin concentration instrumented by 2 hypoalbuminemia-associated SNPs (rs2894536 and rs10972486) was associated with decreased HRs for hypertension development (HR = 0.762, 95% CI 0.659-0.882 and HR = 0.759, 95% CI 0.656-0.878). Our study demonstrated that genetically determined hypoalbuminemia is a significant predictor of incipient hypertension.

Urinary Concentration Defect and Renal Glycosuria in Cyclosporine-treated Rats.

BACKGROUND: Urinary concentration impairment is a major feature of cyclosporine nephrotoxicity. METHODS: We explored two possible mechanisms that may underlie cyclosporine-induced polyuria; water, and/or osmotic diuresis. Cyclosporine was subcutaneously injected to normal salt-fed Sprague-Dawley rats at a daily dose of 25mg/kg for 2 weeks (Experiment I) and 7.5mg/kg for 6 weeks (Experiment II). RESULTS: In Experiment I, cyclosporine treatment caused an increase in urine volume (2.7±0.5 vs. 10.3±1.13mL/d/100 g BW, p<0.001) and a decrease in urine osmolality (2,831±554 vs. 1,379±478mOsm/kg H2O, p<0.05). Aquaporin-2 (AQP2) protein expression decreased in cyclosporine-treated rat kidneys (cortex, 78±8%, p<0.05; medulla, 80±1%, p<0.05). Experiment II also showed that urine volume was increased by cyclosporine treatment (4.97±0.66 vs. 9.65±1.76mL/d/100 g BW, p<0.05). Whereas urine osmolality was not affected, urinary excretion of osmoles was increased (7.5±0.4 vs. 14.9±1.4mosmoles/d/100 g BW, p<0.005). Notably, urinary excretion of glucose increased in cyclosporine-treated rats (7±1 vs. 10,932±2,462 mg/d/100 g BW, p<0.005) without a significant elevation in plasma glucose. In both Experiment I and II, GLUT2 protein expression in the renal cortex was decreased by cyclosporine treatment (Experiment I, 55±6%, p<0.005; Experiment II, 88±3%, p<0.05). CONCLUSION: Both water diuresis and osmotic diuresis are induced by cyclosporine nephrotoxicity. AQP2 and GLUT2 downregulation may underlie water and osmotic diuresis, respectively.

Interactive effect of high sodium intake with increased serum triglycerides on hypertension.

BACKGROUND: A high salt diet is associated with the development of hypertension, one of the most important cardiovascular risk factors. A reduction in sodium intake seems to have an effect on increasing serum triglycerides (TGs). Elevated TGs are independently linked to cardiovascular risk. However, there is limited evidence of a possible interactive effect of sodium intake and serum TGs on high blood pressure (BP). METHODS: We conducted a nationwide, population-based interaction analysis using the Kawasaki method for estimating 24-h urinary sodium excretion (e24hUNaEKawasaki) as a candidate indicator of dietary sodium intake. All native Koreans aged 20 years or older without significant medical illness were eligible for inclusion. RESULTS: A total of 16936 participants were divided into quintiles according to their e24hUNaEKawasaki results. Participants in the highest quintile were more obese and hypertensive and had higher white blood cell count, lower hemoglobin, greater glycemic exposure, and poor lipid profiles compared to the same parameters of individuals in other quintiles. Linear regression revealed that e24UNaEKawasaki was related to systolic BP, diastolic BP, and TGs. Multiple logistic regression, adjusted for dietary sodium intake and various conventional risk factors for chronic vascular diseases, showed that both e24UNaEKawasaki and TGs were significant predictors of hypertension. Our interaction analysis demonstrated that increased sodium intake was associated with higher risk of hypertension in participants with elevated TGs than in those without (adjusted RERI = 0.022, 95% CI = 0.017-0.027; adjusted AP = 0.017, 95% CI = 0.006-0.028; adjusted SI = 1.010, 95% CI = 1.007-1.014). CONCLUSION: Our findings suggest that the interaction between a high salt diet and elevated TGs may exert synergistic biological effects on the risk of hypertension.

Surgical Outcomes of Subtotal Parathyroidectomy for Renal Hyperparathyroidism.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of subtotal parathyroidectomy for patients with renal hyperparathyroidism. METHODS: We studied 25 patients with renal hyperparathyroidism who underwent subtotal parathyroidectomy from October 2002 to October 2017. We analyzed serum intact parathyroid hormone (iPTH), calcium, and inorganic phosphorus levels before and at multiple time points following surgery, and evaluated the surgical outcomes and complications. RESULTS: Of the 25 patients, 13 (52%) were male and 12 (48%) were female, and the mean age was 53.4±9.3 years. The mean duration of dialysis before parathyroidectomy was 156.8±79.5 months. Mean preoperative serum iPTH and calcium levels were 1,199.0±571.3 pg/mL and 10.5±1.0 mg/dL, respectively. At 6 months postoperatively, the mean iPTH and calcium levels decreased to 49.2±47.6 pg/mL (P<0.01) and 8.0±1.0 mg/dL (P<0.01), respectively. Recurrent hyperparathyroidism occurred in two patients: one subsequently underwent kidney transplantation and the other continued hemodialysis and maintained normal calcium levels. One patient developed postoperative permanent hypoparathyroidism. CONCLUSION: Subtotal parathyroidectomy is a safe and effective surgical treatment for renal hyperparathyroidism.

Characteristics of Different Size Phytoplankton for Primary Production and Biochemical Compositions in the Western East/Japan Sea.

The current phytoplankton community structure is expected to change, with small phytoplankton becoming dominant under ongoing warming conditions. To understand and evaluate the ecological roles of small phytoplankton in terms of food quantity and quality, the carbon uptake rates and intracellular biochemical compositions (i.e., carbohydrates, CHO; proteins, PRT; and lipids, LIP) of phytoplankton of different sizes were analyzed and compared in two different regions of the western East/Japan Sea (EJS): the Ulleung Basin (UB) and northwestern East/Japan Sea (NES). The average carbon uptake rate by the whole phytoplankton community in the UB (79.0 ± 12.2 mg C m-2 h-1) was approximately two times higher than that in the NES (40.7 ± 2.2 mg C m-2 h-1), although the average chlorophyll a (chl a) concentration was similar between the UB (31.0 ± 8.4 mg chl a m-2) and NES (28.4 ± 7.9 mg chl a m-2). The main reasons for the large difference in the carbon uptake rates are believed to be water temperature, which affects metabolic activity and growth rate, and the difference in euphotic depths. The contributions of small phytoplankton to the total carbon uptake rate were not significantly different between the regions studied. However, the rate of decrease in the total carbon uptake with increasing contributions from small phytoplankton was substantially higher in the UB than in the NES. This result suggests that compared to other regions in the EJS, the primary production in the UB could decrease rapidly under ongoing climate change. The calorific contents calculated based on biochemical compositions were similar between the small (1.01 ± 0.33 Kcal m-3) and large (1.14 ± 0.36 Kcal m-3) phytoplankton in the UB, whereas the biochemical contents were higher in the large phytoplankton (1.88 ± 0.54 Kcal m-3) than in the small phytoplankton (1.06 ± 0.18 Kcal m-3) in the NES. The calorific values per unit of chl a were higher for the large phytoplankton than for the small phytoplankton in both regions, which suggests that large phytoplankton could provide a more energy efficient food source to organisms in higher trophic levels in the western EJS.

Variability of trophic magnification factors as an effect of estimated trophic position: Application of compound-specific nitrogen isotope analysis of amino acids.

The trophic magnification of persistent organic pollutants (POPs), which is the relationship between POP concentration and the trophic position (TPs) of an organism, is considered an important factor for prioritizing chemicals of concern in the environment. Organismal TPs are typically based on nitrogen isotope ratios of bulk tissue (δ15Nbulk). In this study, nitrogen isotope ratios of amino acids (δ15NAAs), a more precise approach for TP estimation (TPAAs), was applied and compared with estimations of TP based on δ15Nbulk (TPbulk) in marine organisms living in Masan Bay, South Korea. Compound-specific isotope analysis of the amino acids (CSIA-AAs) in fish samples allows us to calculate robust TPs by correcting the variation in baseline isotope values with use of the δ15Nbulk technique. In a benthic food chain, this approach reveals more significant magnification trends for POPs [polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and organochlorine pesticides (OCPs)] than those revealed by analysis of the relationship between TPbulk and POPs. The trophic magnification factors (TMF) associated with TPAAs were significant for some POPs, especially pp'-DDD and chlordane. The results presented in this study suggest that TP calculations based on δ15NAAs are an effective tool for characterizing trophic magnification trends related to the fates of various pollutants.

Efficacy and Safety of CKD-11101 (Proposed Biosimilar of Darbepoetin-Alfa) Compared with Darbepoetin-Alfa in Patients on Hemodialysis: A Randomized, Double-Blinded, Parallel-Group Phase III Study.

BACKGROUND: Darbepoetin-alfa is an erythropoiesis-stimulating agent (ESA) with a long elimination half-life that achieves better hemoglobin (Hb) stability than short-acting ESAs. OBJECTIVE: We aimed to evaluate the efficacy and safety of intravenous CKD-11101 (a biosimilar of darbepoetin-alfa) compared with those of darbepoetin-alfa in hemodialysis patients. METHODS: The study was performed in 24 centers in Korea between June 2015 and June 2017. The study subjects were randomized in a double-blind manner. The follow-up duration was 24 weeks, which consisted of 20 weeks of maintenance and 4 weeks of evaluation period. All patients underwent a stabilization period to achieve a target baseline Hb of 10-12 g/dL before randomization. Following randomization, patients received darbepoetin-alfa or CKD-11101 weekly or biweekly. RESULTS: A total of 403 patients were randomized into two groups, and a total of 325 patients (80.6%) completed the investigation. The differences between the two groups in terms of change in the average Hb level from baseline to evaluation were not significant. The average administered dose of ESA was similar between the groups. There was no difference in the proportion of patients who maintained the target Hb during the evaluation period [60.4% vs. 66.2% in the CKD-11101 and darbepoetin-alfa groups, respectively (p = 0.3038)]. In addition, the safety analysis, consisting of adverse events and adverse drug reactions, showed comparable results between the two groups. CONCLUSION: The changes in the level of Hb, dose of erythropoietin, and achievement rate of the target Hb during the study period were comparable between the groups. CKD-11101 has an equivalent efficacy and safety compared with darbepoetin-alfa in patients undergoing hemodialysis.

Comparison of laboratory indices of non-alcoholic fatty liver disease for the detection of incipient kidney dysfunction.

Non-alcoholic fatty liver disease (NAFLD) is closely linked to insulin resistance and related adverse health outcomes. We investigated the non-invasive index of NAFLD that has the best performance in estimating the renal manifestations of metabolic disturbances. This nation-wide, cross-sectional study included 11,836 subjects, using various non-invasive assessments comprising routinely measured clinical and laboratory variables. The subjects were native Koreans aged 20 years or older and had no diabetes, history of liver or kidney disease. All participants were divided into quintiles according to their fibrosis-4 (FIB-4) results. Participants in the highest quintile were more hypertensive and obese with greater glycemic exposure, poor lipid profiles, and impaired kidney function, than those in the other quintiles. Multiple logistic regression, adjusted for age, sex, smoking, systolic blood pressure, white blood cell, platelet, fasting plasma glucose, and triglyceride, demonstrated that FIB-4, the hepatic steatosis index, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, Gholam's model for non-alcoholic steatohepatitis, and the BARD score were independently associated with kidney dysfunction. ROC curve analysis revealed that FIB-4 (AUC = 0.6227, 95% CI [0.5929-0.6526], p = 0.0258) was the most precise in predicting kidney dysfunction. Our findings suggest that FIB-4 may be a favorable screening tool for the renal manifestation of hepatic metabolic disturbances.

Patient-specific Guides Using 3-dimensional Reconstruction Provide Accuracy and Reproducibility in Reverse Total Shoulder Arthroplasty.

BACKGROUND: We aimed to evaluate whether the use of our novel patient-specific guide (PSG) with 3-dimensional reconstruction in reverse total shoulder arthroplasty (RTSA) would allow accurate and reliable implantation of the glenoid and humeral components. METHODS: 20 fresh-frozen cadaveric shoulders were used. The PSG group (n=10) and conventional group (n=10) was evaluated the accuracy and reproducibility of implant positioning between before and after surgery on the computed tomography image. RESULTS: The superoinferior and anteroposterior offset in the glenoid component were 0.42 ± 0.07, 0.50 ± 0.08 in the conventional group and 0.45 ± 0.03, 0.46 ± 0.02 in the PSG group. The inclination and version angles were -1.93° ± 4.31°, 2.27° ± 5.91° and 0.46° ± 0.02°, 3.38° ± 2.79°. The standard deviation showed a smaller difference in the PSG group. The anteroposterior and lateromedial humeral canal center offset in the humeral component were 0.45 ± 0.12, 0.48 ± 0.15 in the conventional group and 0.46 ± 0.59 (p=0.794), 0.46 ± 0.06 (p=0.702) in the PSG group. The PSG showed significantly better humeral stem alignment. CONCLUSIONS: The use of PSGs with 3-dimensional reconstruction reduces variabilities in glenoid and humerus component positions and prevents extreme positioning errors in RTSA.

Sustained Delivery of Transforming Growth Factor ß1 by Use of Absorbable Alginate Scaffold Enhances Rotator Cuff Healing in a Rabbit Model.

BACKGROUND: The failure rate for healing after rotator cuff repair is relatively high. PURPOSE: To establish a system for sustained release of transforming growth factor ß1 (TGF-ß1) using an alginate scaffold and evaluate the effects of the sustained release of TGF-ß1 on rotator cuff healing in a rabbit model. STUDY DESIGN: Controlled laboratory study. METHODS: Before the in vivo animal study, a standard MTS assay was performed to evaluate cell proliferation and metabolic activity on the alginate scaffold. Additionally, an enzyme-linked immunosorbent assay was performed to confirm the capacity of the sustained release of TGF-ß1-containing alginate scaffold. Once the in vitro studies were completed, bilateral supraspinatus tendon repairs were performed in 48 rabbits that were allocated to 3 groups (n = 16 each) (group 1, supraspinatus repair only; group 2, supraspinatus repair with TGF-ß1 single injection; group 3, supraspinatus repair with TGF-ß1 sustained release via an alginate-based delivery system). Biomechanical and histological analyses were performed to evaluate the quality of tendon-to-bone healing at 12 weeks after rotator cuff repair. RESULTS: The cell proliferation rate of the alginate scaffold was 122.30% compared with the control (fresh medium) group, which confirmed that the alginate sheet had no cytotoxicity and enhanced cell proliferation. Additionally, the level of TGF-ß1 was found to increase with time on the alginate scaffold. Biomechanically, group 3 exhibited a significantly heightened ultimate failure load compared with groups 1 and 2 (group 1, 74.89 ± 29.82 N; group 2, 80.02 ± 34.42 N; group 3, 108.32 ± 32.48 N; P = .011) and more prevalent midsubstance tear compared with group 1 ( P = .028). However, no statistical differences were found in the cross-sectional area of the supraspinatus tendon (group 1, 32.74 ± 9.38; group 2, 33.76 ± 8.89; group 3, 34.80 ± 14.52; P = .882) and ultimate stress (group 1, 2.62 ± 1.13 MPa; group 2, 2.99 ± 1.81 MPa; group 3, 3.62 ± 2.24 MPa; P = .317). Histologically, group 3 exhibited a significantly heightened modified total Bonar score (group 1, 5.00 ± 1.54; group 2, 6.12 ± 1.85; group 3, 7.50 ± 1.31; P = .001). In addition, the tendon-to-bone interface for group 3 demonstrated better collagen orientation, continuity, and organization, and the area of new fibrocartilage formation was more evident in group 3. CONCLUSION: At 12 weeks after rotator cuff repair, the authors found improved biomechanical and histological outcomes for sustained release of TGF-ß1 using alginate scaffold in a rabbit model. CLINICAL RELEVANCE: The alginate-bound growth factor delivery system might improve healing after rotator cuff repair in humans.

Is there a J-shaped relationship between the fatty liver index and risk of microalbuminuria in the general population?

BACKGROUND: We investigated whether the fatty liver index (FLI), as a clinical indicator of hepatic fat accumulation based on body mass index, gamma-glutamyl-transferase, triglycerides, and waist circumference, has an association with microalbuminuria. METHODS: We analyzed anthropometric and biochemical data from a nation-wide, population-based, cross-sectional study. A total of 1605 participants included were healthy native Korean 40years or older and divided into quintiles according to their log-FLI and sex. Microalbuminuria was defined as urine albumin/creatinine ratio (UACR) between 30 and 300mg/g. RESULTS: Participants in higher quintiles of log-FLI were more obese and hypertensive and had greater glycemic exposure, poorer lipid profiles, and greater increases in log-UACR compared with lower quintiles. Linear regression analysis demonstrated that log-FLI was associated with systolic and diastolic blood pressure, body mass index, waist circumference, fasting plasma glucose, glycated hemoglobin, and log-UACR. In logistic regression adjusted for age, sex, body mass index, waist circumference, and fasting plasma glucose, the OR of microalbuminuria was elevated in quintile 1 (adjusted OR=2.161, 95% CI=0.453-10.31) and quintile 5 (adjusted OR=6.387, 95% CI=1.317-51.58), when compared to quintile 2. CONCLUSIONS: There appears to be a J-shaped association between FLI and UACR in healthy general population.

Fatty Degeneration of the Rotator Cuff Reflects Shoulder Strength Deficits in Patients With Rotator Cuff Tears.

Fatty degeneration is an important clinical factor in patients with rotator cuff tears. Goutallier grade, occupation ratio, and tangent sign help identify fatty degeneration; however, little is known about how closely these measurement techniques correlate with actual muscle strength deficits. The authors evaluated each method's ability to determine the correlation between fatty degeneration and muscle strength deficits. The authors included 203 patients who underwent full-thickness rotator cuff repair (mean age, 61.29±7.92 years). All patients were evaluated with preoperative magnetic resonance imaging to identify fatty degeneration and with an isokinetic test to determine actual shoulder strength. Fatty degeneration was evaluated using Goutallier grade, occupation ratio, and tangent sign. The actual shoulder strength deficit was evaluated by abduction, whereas external and internal rotation were tested using the isokinetic test. More severe fatty degeneration was correlated with lower degrees of abduction, external rotation, and internal rotation. The occupation ratio was more closely correlated with actual muscle strength deficits. However, in patients with massive tears, the correlation between fatty degeneration and muscle strength was less pronounced. Tangent sign (+) findings had a significantly lower strength of external rotation and abduction. The fatty degeneration of the rotator cuff muscle measured by each method was correlated with actual shoulder strength deficits in patients with rotator cuff tears. However, the correlations were less clear in patients with massive rotator cuff tears. Therefore, in cases of massive rotator cuff tears, fatty degeneration was correlated with muscle strength deficits but was not directly proportional to their extent. [Orthopedics. 2018; 41(1):e15-e21.].

Features of Golf-Related Shoulder Pain in Korean Amateur Golfers.

OBJECTIVE: To investigate the causes and characteristics of golf-related shoulder injuries in Korean amateur golfers. METHODS: Golf-related surveys were administered to, and ultrasonography were conducted on, 77 Korean amateur golfers with golf-related shoulder pain. The correlation between the golf-related surveys and ultrasonographic findings were investigated. RESULTS: The non-dominant shoulder is more likely to have golf-related pain and abnormal findings on ultrasonography than is the dominant shoulder. Supraspinatus muscle tear was the most frequent type of injury on ultrasonography, followed by subscapularis muscle tear. Investigation of the participants' golf-related habits revealed that only the amount of time spent practicing golf was correlated with supraspinatus muscle tear. No correlation was observed between the most painful swing phases and abnormal ultrasonographic findings. Participants who had not previously visited clinics were more likely to present with abnormal ultrasonographic findings, and many of the participants complained of additional upper limb pain. CONCLUSION: Golf-related shoulder injuries and pain are most likely to be observed in the non-dominant shoulder. The supraspinatus muscle was the most susceptible muscle to damage. A correlation was observed between time spent practicing golf and supraspinatus muscle tear.

Effect of synergistic interaction between abnormal adiposity-related metabolism and prediabetes on microalbuminuria in the general population.

Central obesity and related metabolic components are important risks for microalbuminuria. To describe the effects of interactions between central obesity and related metabolic components on microalbuminuria, we conducted a nation-wide, population-based interaction analysis using cardio-metabolic index (CMI) as a candidate indicator of central obesity and related abnormal lipid metabolism. We recruited native Koreans aged 20 years or older with no medical illness. A total of 5398 participants were divided into quintiles according to CMI with sex as a covariate factor. Participants in the highest CMI quintile had elevated blood pressure (BP), increased glycemic exposure, poor lipid profile, and increased urine albumin-to-creatinine ratio compared to other lower quintiles. Multiple logistic regression models adjusted for age, sex, systolic BP, and diastolic BP showed that CMI had an independent association with increased glycemic exposure and increased urine albumin-to-creatinine ratio. Our interaction analysis revealed a significant interaction between the highest CMI quintile and prediabetes with an increased risk of microalbuminuria (adjusted RERI = 0.473, 95% CI = 0.464-0.482; adjusted AP = 0.276, 95% CI = 0.156-0.395; adjusted SI = 2.952, 95% CI = 1.234-4.670). Our findings suggest a significant association between central obesity-related abnormal lipid metabolism and prediabetes, and their interaction may exert a synergistic effect on renal vascular endothelial dysfunction even before the appearance of full-blown diabetes mellitus. To confirm these findings, large population-based prospective studies are needed.