Robotic Renal Autotransplantation: First Case Outside of North America

A 38-year-old woman with a 2.7-cm left ureteral stenosis requiring chronic ureteral stent exchange elected to undergo robotic renal autotransplantation. Left ureteropelvic junction obstruction (UPJO) was also suspected. Robotic donor nephrectomy contributed to the fine dissection for desmoplastic changes. The kidney was removed through a Gelport and examined on ice. UPJO was not seen. An end-to-side robotic anastomosis was created between the renal and external iliac vessels. The console time was 507 min, and the warm ischemia time was 4 min 5 sec. She became stent-free. Robotic renal autotransplantation is a new, minimally invasive approach to renal preservation

エイセイ ハッシンキ ニ ヨリ スイテイ シタ ホッカイドウ レブントウ ニ セイソク スル ゴマフアザラシ（Phoca largha） ノ ハンショクキ オヨビ ハンショクジョウ

礼文島を上陸場として利用するゴマフアザラシの繁殖期および繁殖場の推定を目的に，2009年～2014年に当島で本種の成獣（メス3個体およびオス1個体）と亜成獣（メス・オス各2個体）に衛星発信器を装着・放獣し，行動を追跡した。その結果，成獣はメス・オス共にタタール（間宮）海峡の海氷域に3月を中心に滞在し，その分布域も重複する傾向が見られた。また，上陸割合を算出できた成獣メス1個体においては，その3月に海氷上での上陸割合も高い値（日中：56.7%，夜間：23.9%）を示した。それ以外の成獣メス2個体の海氷上利用時期は2月～4月であった。成獣オス1個体の上陸割合も3月に最高値（日中：47.2%，夜間：15.1%）を示しており，その時期が当個体の交尾期であったと推定された。以上の結果と，本種の繁殖は一般的に海氷上で行われるとの既往知見から，礼文島を利用するゴマフアザラシの繁殖場は当海域であり，繁殖期は2月～4月と推定された。さらに，成獣に装着した発信器は4月以降にタタール海峡で脱落したことから，成獣は換毛期までタタール海峡を利用していたと推測された。一方，亜成獣は4月に礼文海域で発信器が脱落したことに加え，上陸割合も最大となったことから，換毛期は4月と推定された。To determine the breeding period and area of spotted seals hauling out at Rebun Island, a total of 8 seals (4 adults and 4 sub adults) were equipped with satellite transmitters and were tracked. All of the adults stayed in the Tatar Strait during the sea-ice period for up to 4 months, and did not enter into the Okhotsk Sea. Of these, 3 adult females were distributed in the sea-ice area between January and April, and they often co-occurred within a relatively narrow distance (ca. 28 km). The distribution of an adult male overlapped well with the adult females during March, suggesting that mating of this male occurred during this month in the Tatar Strait. Daytime and night haul-out ratios obtained from an adult female were both highest during March. From the result of haul-out ratio, it was considered that the adult female gave birth and nursed in March. Thus, it has been concluded that the spotted seals occurring on Rebun Island breed during February through April in the Tatar Strait. In addition, the fact that the transmission of the satellite tags disconnected after April indicated that the molting of the seals occurs after April

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Efficacy and Safety of Endoscopic Mucosal Resection with the Two-Person Method

Objectives Endoscopic mucosal resection (EMR) is useful for removing colon polyps and is generally carried out by one doctor. It is occasionally difficult for colorectal polyps to be removed by EMR. In such cases, EMR is performed by the main doctor and an assistant doctor (the two-person method). However, the efficacy and safety of EMR in the two-person method remain unclear. This study aimed to compare the procedure time and incomplete resection rate (IRR) by the two- and single-person methods of EMR for polyp removal. Materials and Methods Data from colorectal polyps resected by EMR were reviewed retrospectively and divided into two groups: general procedure/single- (n = 215) or two-person method (n = 56). The IRR, the procedure time, and the incidence of adverse events were compared between these methods. Results A total of 152 patients and 271 lesions were included in this study. The mean procedure time for polypectomy was significantly shorter in the two-person method group than in the general procedure group (median time: 3.38 minutes vs. 6.56 minutes; p < 0.001). Additionally, the IRR for polyps was significantly lower in the two-person methods group than in the single-person methods group (2/56, 3.6% vs. 47/215, 21.9%; p = 0.001). None of the patients in the two-person method group presented with delayed bleeding. Conclusions The two-person method for EMR was more effective than the single-person method. Therefore, this method may replace the conventional one-operator method in the future

Biomechanical Evaluation of Ti-Nb-Sn Alloy Implants with a Low Young’s Modulus

Dental implants are widely used and are a predictable treatment in various edentulous cases. Occlusal overload may be causally related to implant bone loss and a loss of integration. Stress concentrations may be diminished using a mechanobiologically integrated implant with bone tissue. The purpose of this study was to investigate the biomechanical behavior, biocompatibility and bioactivity of a Ti-Nb-Sn alloy as a dental implant material. It was compared with cpTi. Cell proliferation and alkaline phosphatase (ALP) activity were quantified. To assess the degree of osseointegration, a push-in test was carried out. Cell proliferation and ALP activity in the cells grown on prepared surfaces were similar for the Ti-Nb-Sn alloy and for cpTi in all the experiments. A comparison between the Ti-Nb-Sn alloy implant and the cpTi implant revealed that no significant difference was apparent for the push-in test values. These results suggest that implants fabricated using Ti-Nb-Sn have a similar biological potential as cpTi and are capable of excellent osseointegration

Effects of Continuous Intake of Rosemary Extracts on Mental Health in Working Generation Healthy Japanese Men: Post-Hoc Testing of a Randomized Controlled Trial

We previously performed a 4 week interventional trial that suggested that continuous intake of rosemary extract improves the mood states, fatigue, and cognitive function of working generation healthy adult Japanese men. However, the severity of depression in participants in our previous study was relatively mild. Therefore, in the present study, a post-hoc analysis of our previous study was conducted, limited to participants whose total mood disturbance (TMD) scores, which indicate greater mood disturbance, were above the median at baseline, to evaluate whether rosemary extract was effective for individuals with poor mental health. Following the intervention, the scores of TMD and &ldquo;Confusion-Bewilderment&rdquo; were significantly decreased (both p &lt; 0.05), and scores of &ldquo;Vigor-Activity&rdquo; were significantly increased in the rosemary group (n = 8) compared with those in the control group (n = 13; p &lt; 0.01). When comparing the scores from pre- and post-intervention, significant improvements in &ldquo;Tension-Anxiety&rdquo;, &ldquo;Vigor-Activity&rdquo;, &ldquo;Fatigue on awakening&rdquo;, &ldquo;Daytime sleepiness&rdquo;, and &ldquo;Psychomotor speed&rdquo; were observed in the rosemary group only (all p &lt; 0.05). Based on these results, it was expected that rosemary extracts were effective for improving the mental energy and sleep quality of work-age men with poor mental health