Zinc balance in premature infants given the minimal dietary zinc requirement

A zinc balance study was conducted on low birth weight infants (670 to 2420 g) fed unsupplemented human milk (the mother's or pooled) (group 1, n = 17) or human milk with zinc supplementation (group 2, n = 17). The mean zinc concentrations of the diets in groups 1 and 2 were 2.2 +/- 1.1 mg/L and 8.4 +/- 0.8 mg/L, respectively, and the mean copper concentration of the diets in both groups was 0.45 +/- 0.12 mg/L. The studies were performed 7 to 128 days after birth, which corresponded to 29 to 43 weeks postconceptional age. The turning point of zinc balance from negative to positive appeared to be greatly influenced by the postconceptional age, being approximately 36 weeks in both group 1 and group 2, rather than other factors such as the zinc intake and the postnatal age. The calculated minimal requirement of dietary zinc during the period from 36 to 40 weeks postconceptional age, for an adequate amount of zinc retention in infants (250 micrograms/kg/d), was 0.8 mg/kg/d. Zinc supplementation did not appear to interfere with copper retention.     

Changes in physical function and ambulatory state after Achilles tendon lengthening for diabetic foot ulcers

[Purpose] The recurrence rate of diabetic foot ulcers is high and is related to kinematic factors. Achilles tendon lengthening has been shown to reduce the recurrence rate of foot ulcers by increasing the range of motion in the ankle joint and decreasing the plantar load. However, there are few reports on the effects of Achilles tendon lengthening in Japanese patients, but the results are yet to be clarified. This study aims to investigate the effects of Achilles tendon lengthening on physical function and ambulatory state in patients with diabetic foot ulcers. [Participants and Methods] This study initially included 10 patients with diabetic ulcers who had undergone Achilles tendon lengthening between April 2013 and March 2020. We retrospectively evaluated the factors available from the medical records. [Results] The dorsiflexion range of motion in the ankle joint increased by 10.5 degrees on average after surgery, while the plantar load decreased by 19.1 percent, while gait speed and stride length remained unchanged. [Conclusion] Achilles tendon lengthening for diabetic foot ulcers increased the range of motion in the ankle joint and decreased the plantar load without changing the ambulatory state.     

Dental management of unilateral multiple impacted primary teeth

Impacted primary teeth can be caused by odontogenic tumors such as odontomas, cystic diseases such as dentigerous and eruption cysts, and fibrous hyperplasia of the gingiva, while elimination of those causes reportedly results in normal eruption of primary teeth. We describe the course of a child from the age of 1 year until 4 years 10 months who had primary tooth eruption failure and was treated with dental methods. Although primary teeth expected to spontaneously erupt were followed, there were several on the left side that remained unerupted. We performed a left maxillary and mandibular gingivectomy to closely examine the cause of eruption delay and tooth germ dislocation, as well as attempt to induce eruption of the primary teeth. Based on histopathological results, the diagnosis was fibroma. Surgical procedures did not result in clear improvement of eruption failure. In order to improve masticatory function and aesthetics, the child was fixed with an artificial denture for all primary teeth not expected to erupt.     

Lifestyle intervention might easily improve blood pressure in hypertensive men with the C genotype of angiotensin II type 2 receptor gene

BACKGROUND/OBJECTIVESRecent studies have reported an association of the angiotensin II type 2 receptor (AT2R) 3123Cytosine/Adenine (3123C/A) polymorphism with essential hypertension and cardiovascular diseases. The purpose of the study was to investigate whether the AT2R 3123C/A polymorphism affects blood pressure for free-living hypertensive men during a 5-month intervention period.SUBJECTS/METHODSThe subjects were free-living hypertensive Japanese men aged 40 to 75 years who agreed to intervention in the period from 2004 to 2011. Detection of the AT2R 3123C/A polymorphism was determined by polymerase chain reaction. The dietary intervention was designed to decrease salt level and to increase potassium level through cooking instructions and self-monitoring of the diet. The exercise session consisted of activities such as stretching, resistance training, and walking. Blood pressure, urinary sodium and potassium excretion, dietary and lifestyle data, and non-fasting venous blood sample were collected at baseline and after the intervention period.RESULTSThirty nine subjects were eligible for participation and the follow-up rate was 97.4%. The C allele proportion was 57.9%. AT2R 3123C/A polymorphism was X-chromosome-linked, therefore we analyzed the C and A genotypes. At baseline, no significant differences were observed between the genotype groups. After the intervention, there were no significant differences in lifestyle habit between the groups. Nevertheless, the estimated salt excretion (g/day) was significantly decreased only in the C genotype (13.0-10.3, P = 0.031). No significant change was observed in systolic blood pressure (SBP) (mmHg) in the A genotype, but a significant decrease was observed in the C genotype (150.0-141.5, P = 0.024).CONCLUSTIONSIn the C genotype, it might be easy to improve SBP through lifestyle intervention in free-living hypertensive Japanese men, however generalization could not be achieved by the small sample size.     

Oxidative stress and endothelial dysfunction: Clinical evidence and therapeutic implications

An imbalance of nitric oxide (NO) and reactive oxygen species (ROS), so-called “oxidative stress,” may promote endothelial dysfunction, leading to cardiovascular complications. Activation of nicotinamide–adenine dinucleotide phosphate oxidase, xanthine oxidase, cyclooxygenase, and mitochondrial electron transport, inactivation of the antioxidant system, and uncoupling of endothelial NO synthase lead to oxidative stress along with an increase in ROS production and decrease in ROS degradation. Although experimental studies, both in vitro and in vivo, have shown a critical role of oxidative stress in endothelial dysfunction under the condition of excessive oxidative stress, there is little information on whether oxidative stress is really involved in endothelial function in humans. In a clinical setting, we showed an association between oxidative stress and endothelial function, especially in patients with renovascular hypertension as a model of increased oxidative stress and in patients with Gilbert syndrome as a model of decreased oxidative stress, through an increase in the antioxidant property of unconjugated bilirubin.     

Granulomatous/sarcoid-like reactions in the setting of programmed cell death-1 inhibition: a potential mimic of disease recurrence

Nivolumab and pembrolizumab are humanized IgG4 monoclonal antibodies against programmed cell death 1 (PD-1). Although these agents are effective in treating advanced melanoma, non-small-cell lung carcinoma, and other types of cancers, various adverse events have been reported. Cutaneous adverse events are particularly prevalent and, while granulomatous/sarcoid-like reactions are uncommon, they are increasingly recognized as immune-related adverse events associated with immune checkpoint inhibitors. Herein, we report two cases of granulomatous/sarcoid-like reaction with foreign material, mimicking metastatic malignancy after PD-1 inhibitor treatment. Clinicians should be aware of the existence of cutaneous lesions and perform biopsy if needed to prevent misdiagnosis and unnecessary adjustments to immunotherapy.     

Spread of lymph node metastasis and adjuvant therapy for distal cholangiocarcinoma

International Journal of Clinical Oncology - Lymphatic metastasis is a major route of metastasis in distal cholangiocarcinoma (DCC). The present study aimed to elucidate the pattern of lymph node...