Search

Introduction: Milk basic protein (MBP) has been reported to be effective against osteoporosis; however, the underlying details are unknown. This study aimed to clarify the efficacy of MBP and investigate the synergistic effects between MBP and zoledronic acid, which is a bone resorption inhibitor, in a rat osteoporosis model. Methods: Ovariectomies were performed on 28 24-week-old female Sprague-Dawley rats. Eight weeks after the surgery, seven mice each were assigned to the following four arms: control (C arm), spontaneous oral MBP ingestion (MBP arm), zoledronic acid administration (ZA arm), and spontaneous oral MBP ingestion in addition to ZA administration (MBP + ZA arm). Furthermore, seven sham-operated mice (S arm) were included. After 10 weeks of intervention, the animals were sacrificed, both femurs were excised, and sera were collected. Soft X-ray imaging and micro-computed tomography (CT) were performed for bone morphometry of the excised femurs. Additionally, histopathological examinations, serum bone metabolism marker evaluations, and three-point bending bone strength tests on the femurs were performed. Results: Soft X-ray images revealed no obvious differences between the arms. On the contrary, micro-CT examinations revealed cancellous bone mass increase in the order of C < MBP < MBP + ZA < ZA < S arms. Similar results were confirmed by histopathology. The analysis of serum bone metabolism markers showed almost no differences in bone resorption markers between the MBP and MBP + ZA arms; however, bone formation marker levels showed the following trend: MBP + ZA < MBP arms. Moreover, in the bone strength test, Young's modulus was higher in the order of ZA < MBP < MBP + ZA < S arms. Conclusion: In terms of cancellous bone mass, the inhibitory effect of ZA on bone resorption was greater than that of MBP; hence, bone turnover decreased and no synergistic effect was observed. However, MBP was considered to enhance material properties (bone quality), and thus a synergistic effect was observed between MBP and ZA.As an osteoporosis treatment, MBP + ZA appears to be ineffective in terms of cancellous bone mass; however, it may be effective in terms of bone strength. [ABSTRACT FROM AUTHOR]

Objective:To evaluate measures for preventing multidrug resistant Pseudomonas aeruginosa (MDRP) in catheter-associated urinary tract infection (CAUTI) in spinal cord injury patients.Setting:Spinal Cord Injury Unit of Hyogo Prefectural Hyogo Prefectural Rehabilitation Center, Kobe, Japan.Methods:We defined MDRP as resistance to amikacin, imipenem and levofloxacin. We had eight cases of MDRP-causing CAUTI in hospitalized neurogenic bladder patients caused by spinal cord injury in 2 months. Pulse-field gel electrophoresis (PFGE) was performed for epidemiological studies. We assessed prevention measures against MDRP emergence from the 2nd month, such as surveillance of CAUTI and infection control, and evaluated the outcomes of these measures over a total of 8 months.Results:Our PFGE results showed that these eight MDRP isolates could be considered as closely related strains. We concluded that this was an MDRP outbreak that was causing CAUTI. The isolated ratio of MDRP began to decrease over 4 months of surveillance and significantly decreased in the 4th quarter (7th and 8th months) compared with the 1st quarter (1st and 2nd months) (P=0.021) even though urinary tract device usage significantly increased over the same period (P<0.001).Conclusion:We experienced an outbreak of emergent MDRP causing CAUTI in neurogenic bladder patients with spinal cord injury. Our preventive measures for isolating the outbreak, including surveillance, may have led to the decrease we observed in the ratio of MDRP isolated. [ABSTRACT FROM AUTHOR]

Introduction: In this study, we investigated the accelerate fracture-healing and bone mineral density-increasing effects of combination therapy with low-dose romosozumab and active vitamin D3 on fractures in ovariectomized rats. Methods: Ovariectomy was performed on forty 24-week-old female Sprague-Dawley rats. After eight weeks, the rats underwent removal of the periosteum and osteotomy of the femoral shaft followed by osteosynthesis with intramedullary nailing to create an open fracture model. One week postsurgery, 40 rats were divided into four groups {C group, R group [romosozumab 25 mg/kg, a subcutaneous (sc) injection/ month], VD group (active vitamin D3 0.2 µg/kg, two times sc injections/week), R + VD group}.In addition, 10 rats were categorized as the sham group. Ten weeks postintervention, both femurs were removed, and blood was collected. Soft X-ray imaging was used to evaluate bone union, and micro-computed tomography (micro-CT) was used for bone morphometric evaluation. Toluidine blue staining of undecalcified specimens was used for histo-pathological evaluation, and bone turnover marker levels were measured by enzyme-linked immunosorbent assay. Results: Bone morphometry analysis with micro-CT revealed an increased mineral density of the trabecular bone, demonstrating the effectiveness of combination therapy with low-dose romosozumab and active vitamin D3. However, no differences in callus increase and bone union evaluated by soft X-ray imaging were observed, demonstrating no acceleration of fracture-healing. Conclusion: Although combination therapy with low-dose romosozumab and active vitamin D3 increased the trabecular bone mineral density, it might not accelerate fracture-healing. This effect might not be observed regardless of romosozumab dose. [ABSTRACT FROM AUTHOR]

Introduction: Most of the studies on the effects of Romosozumab in animal models used high doses, such as 25 mg/kg twice weekly, which was not a practical dose. Furthermore, there was no report on the effect of the combination with active vitamin D3 (VitD) on bone mi-crostructure and strength. The purpose of this study was to investigate the effects of low-dose Romosozumab and VitD combination therapy on bone microstructure and strength in ovariectomized rats. Methods: A total of 40 female Sprague-Dawley rats aged 24-week-old were divided into 4 groups (n = 10 each) after 8 weeks of ovariectomy according to interventions: Control (C group, administered saline); Romosozumab administration (R group, 25 mg/kg monthly administration); VitD administration (VitD group, 0.2mg/kg, 2 times/week) and Romosozumab + VitD administration (R + VitD group). In addition, 10 rats without ovariectomy were included as the sham group (S group). After 10 weeks of treatment, we removed the femur and evaluated bone mineral density and bone morphometry by μT (SkyScan 1172, Kontich, Belgium). In addition, we measured bone metabolic markers by ELISA and bone strength by using a 3-point bending test. SPSS 22.0 was used for statistical analysis. Following a one-way analysis of variance, the Tukey test was performed as a post-hoc test between group comparisons. Results: The results of trabecular bone morphometry in the R and R+VitD groups, trabecular bone volume, trabecular thickness, and trabecular number were improved compared with the C group. In the cortical bone, the cortical bone thickness and cortical bone area were also improved. In addition, the R+VitD group improved compared with the R group. On the other hand, there was no difference in bone metabolic markers between the groups. In the bone strength measurement, the maximum load and Young's modulus were improved in the R and R+VitD groups compared with the C group. Conclusion: Romosozumab improving the bone structure that activates osteoblast activity and inhibits osteoclast activity by inhibiting sclerostin. On the other hand, VitD has also been reported to improve bone structure by promoting bone formation and increasing bone density. The results of this study indicate that low-dose Romosozumab is not only effective in the treatment of osteoporosis but also improve the bone microstructure and bone strength when combined with VitD. [ABSTRACT FROM AUTHOR]

The ability of microorganisms to decompose brown algae has attracted attention. This study aims to clarify the characteristics of marine microbial communities in which prokaryotic and eukaryotic microorganisms interact via the metabolism of brown algae carbohydrates. Amplicon-based microbiome analysis revealed the predominance of the genera Marinomonas and Vibrio in seawater and seaweed samples mixed with alginate and mannitol, which are the primary carbohydrates in brown algae. Three Vibrio species and Candida intermedia were isolated via alginate enrichment culture. Although C. intermedia did not utilize alginate as a nutrient source, the yeast grew in the spent alginate medium in which Vibrio algivorus had been cultured. Coculture with C. intermedia and the Vibrio isolates, especially V. algivorus , also enhanced the growth of the yeast on alginate. These results suggested that C. intermedia grew because of the supply of nutrients via alginate metabolism by Vibrio species. In the coculture medium, the amount of phosphatidylserine increased in the early phase but decreased with the growth of C. intermedia , indicating that phosphatidylserine secreted by Vibrio is involved in the putative mutualistic interaction. We examined whether such interaction is applicable to the production of useful substances and succeeded in lipid production by oleaginous marine yeast Yarrowia lipolytica through coculture with V. algivorus . Our study suggested the potential of mutualistic interaction via degradation of alginate by marine Vibrio for production of industrially useful substances in yeast cells.IMPORTANCEIn this study, we analyzed the microbiome of seawater and seaweed in the presence of brown algae carbohydrates and reconstructed the putative mutualistic relationship of marine Vibrio and Candida intermedia mediated by metabolism of brown algae in the ocean.

Brown algae are one of the most abundant biomasses on Earth. To recycle them as blue carbon sources, an effective decomposition system is necessary. This study focused on microorganisms present in seawater that decompose brown algae which contain laminarin and alginate. Where Undaria and Sargassum spp. were present, genera Psychromonas, Psychrobacter, and Pseudoalteromonas were predominant in seawater, while genera Arcobacter and Fusobacterium increased in abundance during the process of decomposition. The inoculation of Undaria samples into laminarin-minimal media led to a predominance of Pseudoalteromonas species. A Pseudoalteromonas isolate, identified as Pseudoalteromonas distincta, possesses genes encoding a putative laminarinase, polysaccharide lyase family 6 (PL6) alginate lyases, and a PL7 alginate lyase. The culture media of P. distincta contained no monosaccharides, suggesting the rapid conversion of polysaccharides to metabolites. These findings indicated that Pseudoalteromonas species play a major role in the decomposition of brown algae and affect the microbiota associated with them., (© The Author(s) 2024. Published by Oxford University Press on behalf of Japan Society for Bioscience, Biotechnology, and Agrochemistry.)

Purpose: We investigated the potential efficacy of abaloparatide (Abalo) and zoledronate (ZA) combination therapy for accelerating femoral union in a rat osteotomy model. Methods: Nine-week-old male Sprague-Dawley rats were randomly divided into four groups ( n = 14 per group): control, abaloparatide (Abalo, 30 μg/kg via subcutaneous injection [s.c.] 5 times per week for 6 weeks), zoledronate (ZA; 0.1 mg/kg via s.c., single dose), and Abalo + ZA. Rats were then subjected to unilateral osteotomy of the femoral shaft, followed by osteosynthesis with intramedullary nailing to establish bone healing models. At 2 and 4 weeks after osteotomy, both femurs were removed from seven rats per group for soft X-ray imaging to evaluate bone union and microcomputed tomography (micro-CT) for bone morphometric evaluation. Blood samples were collected from all rats every 2 week starting 6 weeks pre- to 4 weeks postosteotomy. Toluidine blue staining was used for histopathological evaluation of the undecalcified specimens. Results: Soft X-ray imaging revealed accelerated callus formation, callus maturation, and fracture line closure in Abalo and Abalo + ZA groups compared to ZA and control groups. Micro-CT demonstrated greater cortical bone and trabecular bone to total volume ratios in contralateral (left) femurs of the Abalo + ZA group compared to the Abalo group. Both trabecular and cortical bone mineral densities were also greater in contralateral femurs of the Abalo + ZA group compared to Abalo and ZA groups. Conclusion: These findings suggest substantial additive or synergistic efficacy of abaloparatide plus zoledronate combination therapy for accelerating bone healing following osteotomy and for maintaining normal bone health., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The optimal management of degenerative meniscal tears remains controversial. Extracorporeal shockwave therapy (ESWT) has been shown to promote tissue repair in both preclinical and clinical studies; however, its effect on degenerative meniscal tears remains unknown. This study aimed to examine whether ESWT improves meniscal degeneration., Methods: This randomized trial was conducted between 2020 and 2022 and involved patients with degenerative medial meniscal tears. Patients were allocated to receive either focused ESWT (0.25 mJ/mm 2 , 2000 impulses, 3 sessions with a 1-week interval) or sham treatment. Patients were evaluated using magnetic resonance imaging (MRI) before treatment and at 12 months after treatment. The primary endpoint was improvement in meniscal degeneration, as assessed by the change in T2 relaxation time from baseline on MRI T2 mapping. Knee pain and clinical outcomes were also examined at the same time., Results: Of 29 randomized patients, 27 patients (mean age 63.9 ± 8.7 years; females 37%; ESWT group 14 patients; control group 13 patients) were included in the final analysis. At 12 months postintervention, patients in the ESWT group showed a greater decrease in the T2 relaxation time (ESWT group -2.9 ± 1.7 ms vs. control group 1.0 ± 1.9 ms; p < 0.001) and had less knee pain (p = 0.04). The clinical outcomes at 12 months post-treatment were not statistically significant. No adverse events were reported., Conclusion: ESWT decreased the T2 relaxation time in the meniscus at 12 months post-treatment. ESWT also provided pain relief, but no differences were observed in clinical outcomes., Level of Evidence: Level II., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Orthostatic intolerance (OI) is a key symptom of long COVID; however, the pathophysiology remains unknown. Among 688 long COVID patients who visited our clinic during the period from February 2021 to April 2023, 86 patients who were suspected of having OI and who underwent an active standing test (ST) were investigated to elucidate the clinical characteristics of OI in patients with long COVID. Of the 86 patients, 33 patients (38%) were ST-positive. Nausea and tachycardia in daily life were frequent complaints in the ST-positive group. The increase in heart rate (HR) during the ST was significantly greater during a 10-min period after standing in the ST-positive group (+ 30 bpm) than in the ST-negative group (+ 16 bpm). The initial increase in diastolic blood pressure (DBP) just after standing was significantly greater in the ST-positive group (+ 14 mmHg) than in the ST-negative group (+ 9 mmHg). Serum cortisol levels in the ST-positive patients aged over 20 years were higher and growth hormone levels in the patients under 20 years of age were lower than those in the ST-negative group. Autonomous nervous symptoms, transient DBP rise with increasing HR after standing, and endocrine dysfunctions are helpful for detecting OI related to long COVID., (© 2024. The Author(s).)

Purpose: The present study aimed to clarify the effects of a hyperglycemic condition on the clinical consequences of long COVID. Methods: Among 643 patients who visited the outpatient clinic of our hospital from February 2021 to September 2023, long COVID patients were classified into a hyperglycemic (HG) group with casual blood glucose levels above 140 mg/dL and a normoglycemic (NG) group. The patients' backgrounds, clinical symptoms, health status including the QOL evaluation scale (EQ-5D-5L), self-rating depression scale (SDS), and F-scale questionnaire (FSSG), blood test data, and recovery periods were analyzed. Results: The NG group included 607 patients with long COVID and the HG group included 36 patients with long COVID. Patients in the HG group were older than those in the NG group (55 vs. 41 years; p < 0.001) and included a larger percentage of males (67% vs. 44%; p = 0.009). The HG group had a larger percentage of patients with moderate-to-severe conditions in the acute infection phase (28% vs. 12%; p = 0.008), a higher BMI (25 vs. 22 kg/m 2 ; p < 0.001), higher blood pressure (138/81 vs. 122/72 mmHg; p < 0.001), and a larger percentage of patients with an alcohol drinking habit (53% vs. 34%; p = 0.031). Long COVID symptoms and self-rated scales were not differed between the two groups; however, the laboratory data showed that liver and renal functions and metabolic data were significantly worse in the HG group. Although there was no apparent difference between the two groups in duration from the infection to the first visit, the HG group had a significantly longer period of recovery from long COVID (median period of 421 vs. 294 days; p = 0.019). Conclusion: A hyperglycemic state associated with other lifestyle-related diseases is associated with the prolongation of recovery from long COVID.

Introduction: This observation study aimed to differentiate between lobular endocervical glandular hyperplasia (LEGH) and gastric-type mucinous carcinoma (GAS) while evaluating the feasibility and efficacy of laparoscopic surgery in the preoperative diagnosis of cervical cystic lesions., Method and Material: A retrospective study was conducted to evaluate the diagnostic process and laparoscopic surgical management of cervical cystic lesions suspected to be LEGH or GAS. Preoperatively and postoperatively, MRI, cytology, histology, tumor marker analysis, and surgical outcomes (blood loss during surgery, operative time) were assessed. Six individuals were selected based on magnetic resonance imaging (MRI) results indicating a preoperative suspicion of LEGH or GAS. These patients underwent laparoscopic surgical treatment without indications of malignancy based on preoperative histology or cytology., Results: Initially, all individuals were suspected to have LEGH based on MRI findings. Postoperatively, two patients were diagnosed with LEGH, two with adenocarcinoma in situ (AIS) and minimal deviation adenocarcinoma (MDA), and two showed no notable findings on pathology (one diagnosed endometrioid carcinoma in endometrial tissue). Patients with malignancies exhibited longer surgical times and higher intraoperative blood loss. Preoperatively, no significant variation was observed in maximal lesion diameter between adenocarcinoma and LEGH. However, lesion diameter increased significantly over time in patients with GAS., Conclusion: Laparoscopic surgery demonstrated feasibility and provided crucial diagnostic and therapeutic outcomes, with no postoperative recurrence observed in cases of malignancy, despite the challenges associated with preoperative differentiation. These findings underscore the potential of laparoscopic surgery in enhancing both diagnostic accuracy and therapeutic efficacy for cervical cystic lesions, offering promise for improved patient outcomes and management strategies in clinical practice., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Horibe et al.)

Purpose : The present study aimed to uncover the impact of long COVID on the working situations of Japanese patients. Methods : Changes in the working situations of the patients who visited our long COVID clinic were evaluated from medical records for the aspects of physical status, quality of life (QOL), and mental conditions. Results : Of 846 long COVID patients who visited our clinic from February 2021 to December 2023, 545 employed patients aged between 18 and 65 years were included in this study. A total of 295 patients (54.1%) with long COVID (median age: 43 years, female: 55.6%) experienced changes in their working status. Those patients included 220 patients (40.4%) who took a leave of absence, 53 patients (9.7%) who retired, and 22 patients (4%) with reduced working hours. Most of the patients (93.2%) with changes in working conditions had mild disease severity in the acute phase of COVID-19. The majority of those patients with mild disease severity (58.8%) were infected in the Omicron-variant phase and included 65.3% of the female patients. The major symptoms in long COVID patients who had changes in their working situations were fatigue, insomnia, headache, and dyspnea. Scores indicating fatigue and QOL were worsened in long COVID patients who had changes in their working situations. In addition, 63.7% of the long COVID patients with changes in their working situations had decreases in their incomes. Conclusions: Changes in the working situation of long COVID patients who were employed had a negative impact on the maintenance of their QOL.

Introduction:  Posterior shiny corner lesions (PSCLs) have been reported to be useful for the early diagnosis of medial meniscus posterior root tears (MMPRTs) in surgical patients. However, the usefulness of PSCLs in outpatients, particularly regarding the optimal timing of magnetic resonance imaging (MRI) examinations after injury, remains unknown. We hypothesized that PSCLs would normally be observed in patients with MMPRTs within one month of injury., Materials and Methods:  This study included 144 patients with knee pain who visited our hospital between January 2021 and May 2023. MRI findings within and after one month were examined. Fisher's exact test was performed for PSCLs, cleft signs, ghost signs, radial tear signs, bone cysts, and medial meniscus extrusion (MME), which are findings used for the diagnosis of MMPRTs. Time-dependent receiver operating characteristic (ROC) curve analysis was performed for each MRI finding. A binomial logistic regression analysis was performed for age, sex, PSCL, ghost sign, and MME., Results: PSCLs were observed on 82.6% of the MRI scans within one month, but the positivity rate decreased after one month. After one month, a high percentage of patients had cleft signs and ghost signs. The results of a time-dependent ROC curve analysis showed that the PSCL had better diagnostic ability than the cleft sign, ghost sign, radial tear sign, and MME at a relatively early stage. Additionally, the area under the curve (AUC) of PSCL peaks around 35 days and then declines, reaching 0.8 or less around 40 days. On the other hand, the AUC of the cleft sign and ghost sign began to increase around 30 days after injury, and it exceeded 0.8 after approximately 100 days. The results of the binomial logistic regression analysis revealed significant PSCLs and ghost signs. Independent associations between the PSCL, or ghost sign, and the MMPRT were demonstrated., Conclusion:  This study suggests that PSCLs have a superior diagnostic capability for MMPRT during the early stages of injury compared with other MRI findings in outpatients. In particular, PSCLs have a high positivity rate within one month after injury and a high diagnostic capacity up to 40 days after injury., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kaneko et al.)

Although the molecular mechanisms underlying congenital heart disease (CHD) remain poorly understood, recent advances in genetic analysis have facilitated the exploration of causative genes for CHD. We reported that the pathogenic variant c.1617del of TMEM260, which encodes a transmembrane protein, is highly associated with CHD, specifically persistent truncus arteriosus (PTA), the most severe cardiac outflow tract (OFT) defect. Using whole-exome sequencing, the c.1617del variant was identified in two siblings with PTA in a Japanese family and in three of the 26 DNAs obtained from Japanese individuals with PTA. The c.1617del of TMEM260 has been found only in East Asians, especially Japanese and Korean populations, and the frequency of this variant in PTA is estimated to be next to that of the 22q11.2 deletion, the most well-known genetic cause of PTA. Phenotype of patients with c.1617del appears to be predominantly in the heart, although TMEM260 is responsible for structural heart defects and renal anomalies syndrome (SHDRA). The mouse TMEM260 variant (p.W535Cfs*56), synonymous with the human variant (p.W539Cfs*9), exhibited truncation and downregulation by western blotting, and aggregation by immunocytochemistry. In situ hybridization demonstrated that Tmem260 is expressed ubiquitously during embryogenesis, including in the development of cardiac OFT implicated in PTA. This expression may be regulated by a ~ 0.8 kb genomic region in intron 3 of Tmem260 that includes multiple highly conserved binding sites for essential cardiac transcription factors, thus revealing that the c.1617del variant of TMEM260 is the major single-gene variant responsible for PTA in the Japanese population., (© 2024. The Author(s).)

Serum levels of growth hormone (GH) and insulin-like growth factor (IGF)-I are crucial in the diagnosis and management of GH-related diseases. However, these levels are affected by nutritional and metabolic status. To elucidate the correlations between GH and IGF-I in various conditions, a retrospective analysis was performed for adult patients in which GH levels were examined by general practitioners during the period from January 2019 to December 2021. Of 642 patients, 33 patients were diagnosed with acromegaly, 21 were diagnosed with GH deficiency (GHD), and 588 were diagnosed with non-GH-related diseases (NGRD). In contrast to the positive correlations found between the levels of GH and IGF-I in patients with acromegaly ( R =0.50; P <0.001) and patients with GHD ( R =0.39; P =0.08), a negative correlation was found in the NGRD group ( R =-0.23; P <0.001). In that group, the results of multivariable analysis showed that GH levels were predominantly influenced by gender and body mass index (BMI), whereas IGF-I levels were modulated by albumin in addition to age and GH. Of note, in the NGRD group, there was an enhanced negative correlation between GH and IGF-I under conditions of BMI < 22 and albumin < 4.0 g/dL ( R =-0.45; P <0.001), and the negative correlation between GH and IGF-I was reinforced by excluding patients with other pituitary diseases and patients taking oral steroids ( R =-0.51; P <0.001 and R =-0.59; P <0.001, respectively). Collectively, the results indicate that attention should be given to the presence of a negative correlation between serum levels of GH and IGF-I, especially in lean and low-nutritious conditions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Oguni, Yamamoto, Nakano, Soejima, Suyama, Takase, Yasuda, Hasegawa and Otsuka.)

Background: Loss of meniscal function in association with degenerative changes affects the development and progression of knee osteoarthritis, for which there is currently no effective treatment. Extracorporeal shockwave therapy (ESWT) is an established treatment for musculoskeletal disorders. However, the therapeutic effect of ESWT on meniscal degeneration remains unclear., Purpose: To evaluate the therapeutic effect of ESWT on the degenerated meniscus in an anterior cruciate ligament transection (ACLT) model., Study Design: Controlled laboratory study., Methods: Twelve-week-old male Wistar rats were randomly assigned to 3 groups (normal, ESWT-, and ESWT+). Unilateral ACLT of the right knee was performed in the latter 2 groups. At 4 weeks after ACLT, the ESWT+ group received 800 shockwave impulses at an energy flux density of 0.22 mJ/mm 2 in a single session. Histological changes were examined in the posterior portion of the medial meniscus after ESWT (n = 15 per group). Real-time polymerase chain reaction (PCR) was performed after ESWT (n = 5 per group) to analyze the expression of connective tissue growth factor/CCN family member 2 (CTGF/CCN2), sex determining region Y-box 9, vascular endothelial growth factor α, aggrecan, collagen type 1 alpha 2, and collagen type 2 alpha 1 (Col2α1). Immunohistochemistry was used to analyze the expression of CTGF/CCN2 and Ki-67 (n = 5 per group) after ESWT., Results: The meniscal histopathological score at 4 weeks after ACLT was significantly higher than that in the normal group, and the score in the ESWT+ group was significantly lower than that in the ESWT- group at 4 and 12 weeks after ESWT. Real-time PCR revealed that the mRNA expression of CTGF/CCN2 and Col2α1 decreased 4 weeks after ACLT. In the ESWT+ group, real-time PCR revealed that the mRNA expression of CTGF/CCN2 increased 24 hours after ESWT, and the expression of Col2α1 increased 4 weeks after ESWT (all significant data were P < .05). The ratio of CTGF/CCN2-positive cells and Ki67-positive cells was significantly higher in the ESWT+ group after ESWT., Conclusion: The present study revealed that ESWT might suppress ACLT-induced meniscal degeneration by stimulating cartilage repair factors and inducing collagen type 2., Clinical Relevance: ESWT can be an effective treatment to protect the degenerated meniscus in a rat model of ACLT., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This work was supported by JSPS KAKENHI Grant No. JP 21K16676. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

A 62-year-old woman was diagnosed as a hemophilia A carrier (factor VIII activity 35%) on preoperative examination of an ovarian tumor. A total of 35,600 units of recombinant factor VIII products was administered perioperatively. On postoperative day 95, a subcutaneous hematoma formed and immunosuppressive therapy with prednisolone was started based on an APTT of 66 seconds, factor VIII (FVIII) activity of 3%, and FVIII inhibitor of 1 BU/ml. During this treatment, the patient was hospitalized due to ankle joint bleeds and required hemostatic treatment, but the inhibitor disappeared and FVIII activity recovered to 30% after postoperative day 438 with cyclophosphamide. F8 analysis revealed the patient carried a heterozygosity of p.Arg391Cys, which has previously been categorized as cross-reacting material (CRM)-positive severe hemophilia A. No high-risk mutations for inhibitor development were found. We also report the results of a desmopressin acetate hydrate test administered to the patient to prepare for future treatment in case of hemorrhage, since high-dose FVIII administration may have been a factor in inhibitor development.

Some probiotics including lactobacilli, colonize host animal cells by targeting glycosaminoglycans (GAGs), such as heparin, located in the extracellular matrix. Recent studies have shown that several lactic acid bacteria degrade GAGs. Here we show the structure/function relationship of Lacticaseibacillus rhamnosus 4-deoxy-L- threo -5-hexosulose-uronate ketol-isomerase (KduI) crucial for metabolism of unsaturated glucuronic acid produced through degradation of GAGs. Crystal structures of ligand-free and bound KduIs were determined by X-ray crystallography and the enzyme was found to consist of six identical subunits and adopt a β-helix as a basic scaffold. Ligands structurally similar to the substrate were bound to the cleft of each enzyme subunit. Several residues located in the cleft interacted with ligands through hydrogen bonds and/or C-C contacts. In addition to substrate analogs, a metal ion coordinated to four residues, His198, His200, Glu205, and His248, in the cleft, and the enzyme activity was significantly inhibited by a chelator, ethylenediaminetetraacetic acid. Site-directed mutants in Arg163, Ile165, Thr184, Thr194, His200, Arg203, Tyr207, Met262, and Tyr269 in the cleft exhibited little enzyme activity, indicating that these residues and the metal ion constituted an active site in the cleft. This is the first report on the active site structure of KduI based on the ligand-bound complex., Competing Interests: The authors declare no conflict of interests., (2023 by The Japanese Society of Applied Glycoscience.)

Purpose: The long-term changes in the dynamics of the medial meniscus after transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) are not completely understood. Thus, the aim of this study was to investigate the effects of transtibial pullout repair on MMPRTs and whether the effects would be sustained., Methods: Nineteen knees with MMPRTs that were treated by trans-tibial pullout repair were enrolled in this study. Medial meniscus extrusion (MME) was measured by ultrasonography during knee extension (no weight-bearing with the knee at 0° extension: NW0°) and 90° flexion (no weight-bearing with the knee at 90° flexion: NW90°) with the patient in the supine position and with full weight-bearing (FW0°) preoperatively and at 3 and 12 months postoperatively. The clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score, Lysholm score, and International Knee Documentation Committee score., Results: The difference in MME with NW0° was not statistically significant between the preoperative (3.4 ± 1.0 mm) and 12-month postoperative (3.7 ± 0.6 mm) time points. The MME with NW90° at 3 (2.1 ± 0.7 mm) and 12 months (2.9 ± 0.6 mm) postoperatively were significantly lower than the preoperative values (3.4 ± 0.8 mm) (P < 0.05). However, the value significantly increased from 3 to 12 months postoperatively (P < 0.05). The MME with FW0° at 12 months postoperatively (4.3 ± 0.6 mm) was significantly larger than that at pre-operatively (3.6 ± 0.9 mm) (P < 0.05). All the patients' clinical conditions were significantly improved at 12 months postoperatively when compared to their preoperative clinical conditions., Conclusion: Surgery did not reduce the extrusion in the no weight-bearing and weight-bearing positions at knee extension, and these values increased in the postoperative period. In addition, while the surgery reduced the extrusion in the knee flexion position, the restoration achieved by the surgery was not sustained in the long term., Level of Evidence: Level IV., (© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

Background: Reproducing the medial pivot pattern after total knee arthroplasty (TKA) is known to improve patient satisfaction. However, the factors affecting the postoperative medial pivot pattern in TKA are controversial. The purpose of this study was to examine the factors affecting the postoperative medial pivot pattern in posterior-stabilized TKA., Methods: This study involved 30 cases with knee osteoarthritis who underwent primary posterior-stabilized TKA. The preoperative and postoperative kinematics were measured using a computed tomography-free navigation system, and the patients were divided into the following 2 groups: the medial pivot pattern (MP) group and non-medial pivot pattern (non-MP) group. In addition, we measured each of the following angles on X-ray films (preoperative and postoperative femorotibial angle, hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle). We examine the factors affecting the postoperative medial pivot pattern., Results: There were 14 cases in the MP group and 16 cases in the non-MP group at the preoperative knee kinematic assessment and 17 cases in the MP group and 13 cases in the non-MP group at the postoperative knee kinematic assessment. The preoperative kinematic pattern was conserved after the surgery at a rate of 76.7%. The postoperative MP-group showed a significantly smaller preoperative femorotibial angle and hip-knee-ankle and a significantly smaller postoperative mechanical lateral distal femoral angle and medial proximal tibial angle in comparison to the postoperative non-MP group., Conclusions: Preoperative kinematics and postoperative mechanical lateral distal femoral angle and medial proximal tibial angle may be important factors that affect the postoperative medial pivot pattern., (© 2023 The Authors.)