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Abstract Background We evaluated the relationship between the weight-bearing line (WBL) ratio and anatomical femorotibial angle (FTA) by simulated open wedge high tibial osteotomy (OWHTO). This study evaluated the correlation between the ‘‘Fujisawa point’’ and FTA, and identified factors which caused deviations between the two measurement methods. We hypothesized that the Fujisawa point corresponded with 170° of the FTA. Methods Preoperative antero-posterior full-length lower limb radiographs of 82 patients were obtained for the OWHTO to place the WBL ratio at a target of 62.5% of the width of the tibial plateau (Fujisawa point). The coronal alignment was measured pre- and post-planning. The patients were divided into two groups by the post-planning FTA: a correspondence group (168.5°≦FTA≦171.5°) and a non-correspondence group (FTA

In this study, best-fit fatigue curves are constructed considering material properties and loading modes. Three common fatigue test methods (rotating bending, axial load-controlled and strain-controlled) are compared, and their scopes of applications are clarified. The best-fit fatigue curves are given as a function of tensile strength and have been constructed based on the strain-controlled fatigue test data. The comparison of the best-fit fatigue curves with the axial load-controlled test data reveals that both deviated from each other for the carbon and low-alloy steels and the austenitic stainless steel. Therefore, the best-fit fatigue curves are reconstructed considering the data by the rotating bending fatigue test and the axial load-controlled fatigue test. In the case of the carbon and low-alloy steels, the best-fit fatigue curves are classified by two kinds of microstructures. In the case of the austenitic stainless steel, the best-fit fatigue curves are classified by two kinds of loading modes. Finally, design factors based on the reliability of best-fit fatigue curves are specifically presented.

We previously reported that sodium–glucose cotransporter 2 (SGLT2) inhibitors exert sustained fluid homeostatic actions through compensatory increases in osmotic diuresis-induced vasopressin secretion and fluid intake. However, SGLT2 inhibitors alone do not produce durable amelioration of fluid retention. In this study, we examined the comparative effects of the SGLT2 inhibitor dapagliflozin (SGLT2i group, n = 53) and the combined use of dapagliflozin and conventional diuretics, including loop diuretics and/or thiazides (SGLT2i + diuretic group, n = 23), on serum copeptin, a stable, sensitive, and simple surrogate marker of vasopressin release and body fluid status. After six months of treatment, the change in copeptin was significantly lower in the SGLT2i + diuretic group than in the SGLT2i group (−1.4 ± 31.5% vs. 31.5 ± 56.3%, p = 0.0153). The change in the estimated plasma volume calculated using the Strauss formula was not significantly different between the two groups. Contrastingly, changes in interstitial fluid, extracellular water, intracellular water, and total body water were significantly lower in the SGLT2i + diuretic group than in the SGLT2i group. Changes in renin, aldosterone, and absolute epinephrine levels were not significantly different between the two groups. In conclusion, the combined use of the SGLT2 inhibitor dapagliflozin and conventional diuretics inhibited the increase in copeptin levels and remarkably ameliorated fluid retention without excessively reducing plasma volume and activating the renin–angiotensin–aldosterone and sympathetic nervous systems. [ABSTRACT FROM AUTHOR]

Single‐nucleotide polymorphisms (SNP) of ATP2B1 gene are associated with essential hypertension but their association with resistant hypertension (RHT) remains unexplored. The authors examined the relationship between ATP2B1 SNPs and RHT by genotyping 12 SNPs in ATP2B1 gene of 1124 Japanese individuals with lifestyle‐related diseases. Patients with RHT had inadequate blood pressure (BP) control using three antihypertensive drugs or used ≥4 antihypertensive drugs. Patients with controlled hypertension had BP controlled using ≤3 antihypertensive drugs. The association between each SNP and RHT was analyzed by logistic regression. The final cohort had 888 (79.0%) and 43 (3.8%) patients with controlled hypertension and RHT, respectively. Compared with patients homozygous for the minor allele of each SNP in ATP2B1, a significantly higher number of patients carrying the major allele at 10 SNPs exhibited RHT (most significant at rs1401982: 5.8% vs. 0.8%, p =.014; least significant at rs11105378: 5.7% vs. 0.9%, p =.035; most nonsignificant at rs12817819: 5.1% vs. 10%, p =.413). After multivariate adjustment for age, sex, systolic BP, and other confounders, the association remained significant for rs2681472 and rs1401982 (OR: 7.60, p <.05 and OR: 7.62, p =.049, respectively). Additionally, rs2681472 and rs1401982 were in linkage disequilibrium with rs11105378. This study identified two ATP2B1 SNPs associated with RHT in the Japanese population. rs1401982 was most closely associated with RHT, and major allele carriers of rs1401982 required significantly more antihypertensive medications. Analysis of ATP2B1 SNPs in patients with hypertension can help in early prediction of RHT and identification of high‐risk patients who are more likely to require more antihypertensive medications. [ABSTRACT FROM AUTHOR]

The direct anterior approach (DAA) has its origins in the first and oldest approach for hip replacement in the literature, but at the same time it would not be fanciful to suggest its increasing popularity as the latest approach for hip replacement procedures, especially among younger surgeons. However, in a geographical context, the DAA is not considered the major approach in most countries. Moreover, the term DAA encompasses numerous variations in terms of technique. In this narrative review, we describe our recent experience of advances in the DAA in terms of improved techniques and devices, along with some of its disadvantages. Also, we express our perspective on its future application. The DAA is established as one of exemplary approaches to THA. The use of fluoroscopy, the traction table, and appropriate soft tissue management has become essential in the DAA for a safe and trouble-free procedure with adequate patient comfort. With the combination of recent technologies such as robotics, three-dimensional preoperative planning, and artificial intelligence (AI)-based surgeon assist systems, we can look forward to the DAA being performed more efficiently in the future. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate bone mineral density (BMD) and radiographic and clinical outcomes of patients with varus knee osteoarthritis treated with open wedge high tibial osteotomy (OWHTO). We hypothesised that medial condyle BMD would decrease and lateral condyle BMD would increase after OWHTO. Methods: Overall, 51 patients (mean age: 65.3 years; female: 40, male: 11) treated with OWHTO were prospectively enrolled. Several angles using whole single-leg radiographs were measured preoperatively and up to 24 months postoperatively. Five square tibial regions of interest (ROI) located below the proximal tibia as T1–T5 from medial to lateral regions and two square femoral ROI as F1 and F2 from medial and lateral regions, respectively, were defined. M/L BMD ratio was used to define the medial-to-lateral condyle BMD ratio. Femoral condyle BMD (F1 and F2) around the knee, as well as lumbar spine, and ipsilateral and contralateral femoral neck BMD, were measured before OWHTO and 3, 6, 12 and 24 months after OWHTO using dual-energy X-ray absorptiometry. Furthermore, tibial condyle BMD (T1–T5) around the knee was measured before and 24 months after OWHTO. Clinical outcomes were evaluated using the Knee Society knee and function scores, the Knee Injury and Osteoarthritis Outcome Score, and the Lysholm score preoperatively and 24 months postoperatively. A power analysis was performed. Results: F1 BMD decreased by 19.2% from before to 3 months postoperatively. F2 BMD did not change up to 24 months after OWHTO. Femoral M/L BMD ratio decreased by 22.2% 3 months after OWHTO. T1 BMD and tibial M/L BMD ratio decreased, whilst T3, T4 and T5 BMD increased 24 months after OWHTO. Mean hip–knee–ankle angle (HKA) and weight-bearing line ratio were corrected from − 6.8° to 4.5° and 14.7 to 60.7%, respectively, postoperatively. Lumbar spine BMD did not change up to 12 months postoperatively. Ipsilateral femoral neck BMD decreased up to 6 months after OWHTO. Conclusion: Medial femoral condyle BMD decreased rapidly within 3 months and continued to decrease up to 12 months, but lateral femoral condyle BMD did not change after OWHTO. BMD measurements around the knee condyle enabled the evaluation of the changes in stress distribution before and after OWHTO with accelerated rehabilitation. Level of evidence: II. [ABSTRACT FROM AUTHOR]

This study explored the association of disagreement in the perception of patient disability between patients and family caregivers with physical and psychological quality of life (QOL) in both parties. A cross-sectional analysis of data collected from male stroke patients and family caregivers was conducted. Physical and psychological QOL in patients and caregivers were measured using the WHOQOL BREF. Perceptions of patient disability were measured using the 12-item WHO Disability Assessment Schedule 2.0 (DAS). Using DAS scores reported independently by patients and caregivers, dyads were categorized into one of four groups representing agreement or disagreement about patient disability. Generalized estimating equations were used to examine the associations between WHOQOL scores in patients and caregivers and these four groups. Among 56 dyads enrolled, approximately 52% were categorized into 'agreement' groups and 48% were categorized into 'disagreement' groups. The disagreement in perception about patient disability were significantly associated with poor patient physical QOL. However, the disagreement in perception were not significantly associated with caregiver QOL. Findings suggest the association of disagreement with QOL differs between patients and caregivers. Further research is needed to carefully appraise the relationship and interaction between patient and caregiver. [ABSTRACT FROM AUTHOR]

Syndiotactic polystyrene (sPS) incorporates low‐mass guest molecules to form a co‐crystalline structure, the δ‐phase, in which the guest molecules are confined within a nanosized space. Under such spatial constraints, what factors determine the dynamics of the guest molecules? This is an interesting question and needs to be clarified toward the functionalization of sPS/functional guest systems. In this study, the size effect of the guest molecules and use monosubstituted halobenzenes (fluorobenzene, chlorobenzene, bromobenzene, and iodobenzene) to systematically change the molecular size is focussed. Since halobenzene has a large electric dipole moment, dielectric relaxation measurements can effectively detect its molecular motion. This study aims to identify the guest dynamics in the δ‐phase by dielectric relaxation measurement and examines the molecular length dependence of the rotational relaxation times and their activation energies. [ABSTRACT FROM AUTHOR]

Purpose: To compare radiographic, clinical, and arthroscopic findings in patellofemoral (PF) osteoarthritis (OA) between open wedge high tibial osteotomy (OWHTO) and double-level osteotomy (DLO) with the same operative indication. Methods: After adjustment for patient age, and coronal alignment, 36 knees with OWHTO alone and 36 knees with DLO were compared. Radiographic, clinical, and arthroscopic findings were documented before osteotomy. Arthroscopic findings were observed 1 year after osteotomy, and clinical and radiographic findings were observed 2 years after osteotomy. Patellar height was evaluated using the Insall-Salvati (IS) ratio, Carton-Deschamps (CD) index, and Blackburne-Peel (BP) index. Lateral patellar tilt and patellar shift were measured. A power analysis was performed. Results: The postoperative CD and BP indices in the OWHTO group were lower than those in the DLO group (p < 0.001 and p = 0.001, respectively). The CD and BP indices in both groups significantly decreased postoperatively (all p < 0.001). Tilting angles in the OWHTO and DLO groups significantly decreased postoperatively (p < 0.001 and p = 0.002, respectively). There were no significant differences in American Knee Society scores, Kujala score, and the Knee Injury and Osteoarthritis Outcome Scores between both groups. The PF OA progression of the trochlear in the OWHTO group was higher than that in the DLO group (p = 0.002), and the PF OA progression of the patellar facet in the DLO group and anterior femoral condyle in both groups on the lateral side were higher than those on the medial side (p = 0.006, 0.032, and 0.041, respectively). Conclusions: DLO decreased the rate of low patellar height compared with OWHTO. DLO decreased the rate of PF OA progression in the trochlea compared with OWHTO. There were no significant differences in clinical outcomes in both groups. Level of evidence: Level III, case–control study. [ABSTRACT FROM AUTHOR]

Cancer, the uncontrolled growth of cells, is not a single but a multifaceted disorder with malignant behavior, metastasis, and invasion, medically known as malignant neoplasm. The number of cases and morbidity due to cancer is rising alarmingly worldwide, causing around 21 % annually. Imidazoquinoxaline is a privileged scaffold with a wide range of pharmacological activities that is well explored for its anticancer potential. As a synthon, imidazoquinoxaline presents a large number of possibilities for structural modifications, which have attained the attention of many researchers for the development of new anticancer molecules with diverse improved target specificity and efficiency. Development of imiquimod followed by EAPB203 and EAPB503 derivatives further enhanced the popularity of this structural pharmacophore. In this report, we have focused on the anticancer potential of newly reported imidazoquinoxaline derivatives, along with their SAR studies and therapeutic potential. We have also enlisted the synthetic schemes reported for the synthesis of imidazoquinoxaline derivatives. The lead structural features described in this review will assist the researchers in designing and developing the novel imidazoquinoxaline pharmacophore containing anticancer compounds possessing the potential to interfere with various factors or mediators which are responsible for the progression of cancer. This report will also help in identifying the potent compounds which can be further evaluated in clinical trials for the development of new anticancer drugs with minimal to no side effects. [ABSTRACT FROM AUTHOR]

Background: We evaluated the relationship between the weight-bearing line (WBL) ratio and anatomical femorotibial angle (FTA) by simulated open wedge high tibial osteotomy (OWHTO). This study evaluated the correlation between the ''Fujisawa point'' and FTA, and identified factors which caused deviations between the two measurement methods. We hypothesized that the Fujisawa point corresponded with 170° of the FTA.Methods: Preoperative antero-posterior full-length lower limb radiographs of 82 patients were obtained for the OWHTO to place the WBL ratio at a target of 62.5% of the width of the tibial plateau (Fujisawa point). The coronal alignment was measured pre- and post-planning. The patients were divided into two groups by the post-planning FTA: a correspondence group (168.5°≦FTA≦171.5°) and a non-correspondence group (FTA < 168.5°, 171.5° < FTA). The relationship between the Fujisawa point and the FTA was analyzed with multivariate regression analysis.Results: The post-planning FTA was 169.8 ± 1.1° and within 170 ± 1.5° in 69 cases (84.1%) when the WBL ratio was 62.5%. The neck shaft angle was 128.1 ± 5.2° in the correspondence group, and 122.3 ± 6.3° in the non-correspondence group. The multivariate linear regression analysis revealed that the neck shaft angle was the only factor that predicted the correspondence of the Fujisawa point with the FTA at 170° (p = 0.006, odd 1.28).Conclusions: The post-planning FTA converged at 170° when the WBL ratio passed through the Fujisawa point and the neck shaft angle was the only predictor. [ABSTRACT FROM AUTHOR]

Purpose: To compare the radiographic, clinical, and arthroscopic outcomes of varus osteoarthritic knees treated with an open-wedge high tibial osteotomy (OWHTO) alone or with a double-level osteotomy (DLO). It was hypothesized that treatment with DLO would maintain the joint line obliquity (JLO) and acquire better arthroscopic and clinical outcomes after surgery than OWHTO alone. Methods: Knees with predicted medial proximal tibial angle (MPTA) > 95° were treated with OWHTO alone or with DLO. Preoperatively, age, body mass index, and hip-knee-ankle angle (HKA) differed between the two groups. Therefore, after adjustment for those factors, 34 knees with OWHTO alone and 34 knees with DLO were compared. On whole-leg radiographs for a single leg, HKA, weightbearing line (WBL) ratio, lateral distal femoral angle (LDFA), MPTA, and JLO were measured before and 2 years after surgery. Clinical outcomes were evaluated by the Knee Society Score (KSS) knee, KSS function, Lysholm, and Knee injury and Osteoarthritis Outcome Score (KOOS) scores before and 2 years after surgery. Arthroscopic findings were obtained before and 1 year after surgery. Various factors were compared between the two groups. Results: JLO increased significantly from 1.4° to 6.3° in the OWHTO group (p < 0.001) and changed from 1.0° to 1.3° in the DLO group (n.s.). Postoperative MPTA and JLO in the OWHTO group were significantly higher than those in the DLO group (both p < 0.001). There were no significant differences in the KSS knee, KSS function, and KOOS scores between the two groups. Postoperative Lysholm score in the DLO group was higher than that in the OWHTO group (p < 0.025). Femoral and tibial cartilage regeneration in the medial condyles and deterioration in the lateral condyles did not differ between the two groups on second-look arthroscopy. Conclusions: JLO was not significantly changed after surgery in the DLO group. DLO enabled the acquisition of physiological JLO compared with OWHTO alone. Level of evidence: Retrospective comparative study, Level III. [ABSTRACT FROM AUTHOR]

This article explored how severe prolonged grief disorder (PGD) is associated with psychological and social variables using an interpretative phenomenological analysis. From a sample of 225 Japanese hospitalized adults with depression, seven participants were identified as having PGD based on their medical records and semi-structured interviews. Risk factors appeared to be psychological factors associated with the deceased (dependence on the deceased, feeling sorry for the deceased, intense self-blame, and infrequent expression of anger) and environmental factors (loneliness and isolation, lack of opportunity to determine separation, and release from practical burdens). These findings are discussed in relation to Japanese culture. [ABSTRACT FROM AUTHOR]