Shape of the joint gap for 90° and 120° knee flexion after total knee arthroplasty

BACKGROUND: The joint gap is set rectangular at 90 degrees flexion during total knee arthroplasty (TKA). However, the condition of the joint gap in deep knee flexion is obscure. METHODS: The method for obtaining a posteroanterior view radiograph of the knee at 90 degrees flexion (the epicondylar view) was modified, and a method to obtain an anteroposterior view radiograph at 120 degrees flexion (deep flexion view) was established. With this method, subjects lie on the radiography table with their thighs placed on a device so their lower legs hang down in neutral rotation with a 1.5-kg weight attached to the ankle. The joint gap angle and medial and lateral joint space widths were measured on epicondylar view and deep flexion view radiographs in 20 normal male subjects, 20 normal female subjects, and 20 subjects after TKA. RESULTS: The joint gap was almost rectangular at two flexion angles in normal subjects. In the implanted knees, the gap angle was 1.4 degrees varus +/- 3.3 degrees (mean +/- standard deviation), and no significant difference was found between medial and lateral joint space widths at 90 degrees flexion. In contrast, the gap angle was 2.5 degrees varus +/- 2.5 degrees and the lateral joint space width was significantly wider than the medial joint space width at 120 degrees flexion (P < 0.001). The gap angle was more varus with a significant difference in the implanted knees than that in the normal subjects at 120 degrees flexion (P < 0.001). CONCLUSIONS: The joint gap was trapezoidal with a wider lateral side at 120 degrees flexion even though it was almost rectangular at 90 degrees flexion after TKA.     

Isolation of azaspiracid-2 from a marine sponge Echinoclathria sp. as a potent cytotoxin

Azaspiracid-2 was isolated from a marine sponge Echinoclathria sp. collected off Amami-Oshima as the predominant cytotoxic constituent. A combination of HPLC using ODS, GS320, and Phenylhexyl stationary phases permitted the purification without using acid or inorganic additives in the mobile phase. Azaspiracid-2 exhibited potent cytotoxicity against P388 cells with an IC₅₀ value of 0.72 ng/mL and caused S phase arrest on the cell cycle.     

Development of Gastroesophageal Varices and Risk of Variceal Bleeding in Patients With Cirrhosis

Abstract: We studied the relationships between portal pressure measured using the portal venous pressure gradient, the development of gastroesophageal varices, and the risk of variceal bleeding in 56 patients with cirrhosis. Portal pressure was higher in patients with varices than in those without (P>0.01), and 11 mmHg was the lowest portal pressure measured in the patients with varices. The size of the varices was not associated with the portal pressure. There was no difference in the value of portal pressure measurements for the patients with variceal bleeding and those without and there was no linear-relationship between the degree of portal hypertension and the rate of variceal bleeding. 12 mmHg was the lowest portal pressure measured in the patients with variceal bleeding. The size of the varices was related to the rate of variceal bleeding (P>0.05). We conclude that (a) a portal pressure of 11 mmHg is necessary for the formation of varices, (b) 12 mmHg of portal pressure is necessary for variceal bleeding to occur but the degree of portal hypertension has no predictive value for the risk of variceal bleeding, and (c) the size of the varices does not depend on the degree of portal hypertension but is associated with the risk of variceal bleeding.     

Simple genotype analysis of the Asp299Gly polymorphism of the Toll-like receptor-4 gene that is associated with lipopolysaccharide hyporesponsiveness

A nonsynonymous single nucleotide polymorphism (Asp299Gly) in the Toll-like receptor-4 (TLR-4) gene affects the responsiveness to lipopolysaccharide in humans. To analyze this important polymorphism more efficiently, we developed a simple polymerase chain reaction (PCR) restriction length fragment polymorphism (RFLP) assay and examined the Asp299Gly allele frequency in a Japanese population. The PCR primer was designed with 1- or 2-bp mismatches, creating the recognition sequence for restriction enzyme BsaBI or BstXI, allowing RFLP analysis of the digested products. Genotyping was carried out with this assay for 275 DNA specimens from 107 healthy volunteers and 168 patients with various diseases, including ulcerative colitis (n = 86). The Asp299Gly allele of the TLR-4 gene was not detected in any of the specimens, suggesting that it is very rare in Japanese.     

Endovascular management of endotension by graft reinforcement followed by direct sac embolization

Purpose: To assess the efficacy of graft reinforcement followed by percutaneous direct sac embolization (PDSE) for the treatment of endotension after endovascular abdominal aortic aneurysm repair (EVAR).

Materials and methods: A total of 290 patients underwent elective EVAR. All patients regularly underwent scheduled surveillance with contrast-enhanced computed tomography (CT). Two hundred thirty-five patients were followed for ≥24?months after EVAR. Aneurysmal sac expansion of ≥10?mm was observed in 20 patients. The patients with sac expansion of ≥10?mm with no evidence of endoleak were treated with graft reinforcement. Graft reinforcement consisted of graft extension and graft relining. The patients with sac expansion at 6?months after graft reinforcement received PDSE using metallic coils and n-butyl cyanoacrylate–Lipiodol mixture. The aneurysm diameter was measured by CT performed 6?months and every year after the final intervention.

Results: Seven patients (7 men, 0 women; mean age, 69.1?±?4.2?years, Zenith^®:5/Excluder^®:1/Powerlink^®:1) underwent graft reinforcement. Two patients underwent graft reinforcement alone, and five patients underwent PDSE after graft reinforcement. Mean follow-up time after the final intervention was 21.1?months. The sac diameter stabilized after the final intervention in all patients.

Conclusion: Graft reinforcement followed by complementary PDSE could be a useful treatment strategy for endotension.     

Oscillations in the embryonic chick olfactory bulb: initial expression and development revealed by optical imaging with a voltage‐sensitive dye

In a previous study, we applied a multiple‐site optical recording technique with a voltage‐sensitive dye to the embryonic chick olfactory system and showed that functional synaptic transmission in the olfactory bulb was expressed at embryonic 6–7‐day stages. It is known that oscillations, i.e. stereotyped sinusoidal neural activity, appear in the olfactory system of various species. The focus of the present study is to determine whether the oscillation is also generated in the embryonic chick olfactory bulb and, if this is the case, when the oscillation appears and how its profiles change during embryogenesis. At the early stages of development (embryonic 6‐ to 8‐day stages), postsynaptic response‐related optical signals evoked by olfactory nerve stimulation exhibited a simple monophasic waveform that lasted for a few seconds. At embryonic 9‐day stage, the optical signal became multi‐phasic, and the oscillatory event was detected in some preparations. The oscillation was restricted to the distal half of the olfactory bulb. As development proceeded, the incidence and duration of the oscillation gradually increased, and the waveform became complicated. In some cases at embryonic 12‐day stage, the oscillation lasted for nearly a minute. The frequency of the oscillation increased slightly with development, but it remained in the range of theta oscillation during the 9‐ to 12‐day stages. We discuss the ontogenetic dynamics of the oscillation and the significance of this activity in the developing olfactory bulb.     

Multidimensional anatomy of ‘modern type depression’ in Japan: A proposal for a different diagnostic approach to depression beyond the DSM‐5

Japan's prototype of depression was traditionally a melancholic depression based on the premorbid personality known as shūchaku‐kishitsu proposed by Mitsuzo Shimoda in the 1930s. However, since around 2000, a novel form of depression has emerged among Japanese youth. Called ‘modern type depression (MTD)’ by the mass media, the term has quickly gained popularity among the general public, though it has not been regarded as an official medical term. Likewise, lack of consensus guidelines for its diagnosis and treatment, and a dearth of scientific literature on MTD has led to confusion when dealing with it in clinical practice in Japan. In this review article, we summarize and discuss the present situation and issues regarding MTD by focusing on historical, diagnostic, psychosocial, and cultural perspectives. We also draw on international perspectives that begin to suggest that MTD is a phenomenon that may exist not only in Japan but also in many other countries with different sociocultural and historical backgrounds. It is therefore of interest to establish whether MTD is a culture‐specific phenomenon in Japan or a syndrome that can be classified using international diagnostic criteria as contained in the ICD or the DSM. We propose a novel diagnostic approach for depression that addresses MTD in order to combat the current confusion about depression under the present diagnostic systems.