A case of late iliac arterial thrombosis due to component migration after revision total hip arthroplasty

AbstractAlthough vascular injuries associated with primary and revision total hip arthroplasty are infrequent, these complications can have devastating effects that can lead to morbidity and even mortality. A few previous reports have described embolic distal limb ischemia secondary to a failed and migrated acetabular implant in discontinuity with the pelvis. We present a rare case in which a support ring from a failed and migrated acetabular cage construct led to injury of the common femoral artery. The patient developed acute thrombotic occlusion leading to distal extremity ischemia even after oral anticoagulant therapy. The patient was treated with embolectomy with a Fogarty catheter, replacement of the injured common femoral artery with an InteRing 8mm, and removal of the offending hardware. Recognition of the risks associated with failed and migrated components is important to prevent this complication for cardiologists as well as orthopedic surgeons.<Learning objective: Although vascular injuries associated with primary and revision total hip arthroplasty are infrequent, these complications can have devastating effects that can lead to morbidity and even mortality. Recognition of the risks associated with failed and migrated components is important to prevent this complication for cardiologists as well as orthopedic surgeons.

Hypertension resistant to antihypertensive agents commonly occurs with the progression of diabetic nephropathy in Japanese patients with type 2 diabetes mellitus: a prospective observational study

BACKGROUND: We investigated 1) the frequency of hypertension in patients with type 2 diabetes graded by the new classification of chronic kidney disease (CKD) reported by the Kidney Disease: Improving Global Outcomes (KDIGO) and 2) the number of antihypertensive agents needed to achieve treatment goals using a prospective observational study. METHODS: A population of 2018 patients with type 2 diabetes mellitus was recruited for the study. The CKD stage was classified according to the eGFR and the urinary albumin excretion levels. RESULTS: Hypertension was found in 1420 (70%) of the patients, and the proportion of subjects showing a blood pressure < 130/80 mmHg was 31% at the baseline. Although the mean blood pressure was approximately 130/75 mmHg, the rate of patients with a blood pressure of < 130/80 mmHg became limited to 41-50% during the observation period. The number of antihypertensive agents required for treatment was significantly higher at the endpoint (2.0 ± 1.3) than at the baseline (1.6 ± 1.2). Furthermore, it increased with the progression of the CKD stage at both the baseline and the endpoint of the observation. However, the frequency of subjects who did not achieve the blood pressure target was found to increase in the group demonstrating the later stage of CKD. CONCLUSIONS: Hypertension resistant to antihypertensive agents was common in the patients with type 2 diabetes mellitus and increased with the progression of CKD. Although powerful combination therapy using antihypertensive agents is considered necessary for the strict control of blood pressure, this became difficult in individuals who were in advanced stages as graded based on the eGFR and the urinary albumin excretion levels

Double chambered right ventricle with severe calcification of the tricuspid valve in an elderly woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Double chambered right ventricle is a rare congenital cardiac anomaly in which the right ventricle is divided into two chambers by an anomalous muscle bundle. The diagnosis of this disorder is difficult in adults. Calcification of the tricuspid valve is extremely rare, and very few cases have been reported. Most cases of tricuspid valve calcification had a congenital disorder with high pressure in the right ventricle.</p> <p>Case presentation</p> <p>We report a rare case of a 71-year-old Japanese woman who presented with chest discomfort, and was found to have a double chambered right ventricle with severe calcification of the tricuspid valve. This abnormality was found by echocardiography, and the diagnosis was confirmed by multislice cardiac computerized tomography, cardiac magnetic resonance imaging, and cardiac catheterization. Our patient rejected surgical repair, and medical therapy with carvedilol was effective to reduce her symptoms.</p> <p>Conclusion</p> <p>Calcification of the tricuspid valve is extremely rare, and considered to be due to high pressure in the right ventricle. To the best of our knowledge, there are no other reported cases of this combination of double chambered right ventricle and calcification of the tricuspid valve.</p

A Study on Project-Based Learning from the Viewpoint of Organizational Knowledge Creation Theory

アクティブラーニングの1 つとしてPBL（problem/project-based learning）がある。PBL には問題解決学習（problem based learning）とプロジェクト学習（project based learning）の2 つがある。これまでPBL を対象とする研究は着実に蓄積されてきたが，PBL の理論的枠組みは未だ脆弱であることが指摘されている。そこで，本研究ではこの問題を克服するために，大学教育でのプロジェクト学習について，組織的知識創造理論から考察する。本研究の第1 の目的は，組織的知識創造理論がプロジェクト学習においても適用できることを確認することである。第2 の目的は，プロジェクト学習における教員の役割について，組織的知識創造理論から示唆を得ることである。本研究では，以下の3 ステップを踏む。まず，本研究の鍵概念である組織的知識創造理論を紹介する。次に，3 つのプロジェクト学習の事例を紹介し，組織的知識創造理論から分析する。最後に，組織的知識創造理論がプロジェクト学習においても適用できることについて，また，示唆されたプロジェクト学習における教員の役割について議論する。One form of active learning is PBL. There are two types of PBL: “problem-based learning” and “project-based learning.” Although a large number of studies have been on PBL, few studies have been conducted using surveys based on academic theories. Therefore, this paper discusses “project-based learning” from the viewpoint of organizational knowledge creation theory. The primary objective of this study is to apply organizational knowledge creation theory in the field of “project-based learning.” The secondary objective is to recommend teachers’ roles in “project-based learning” from the standpoint of organizational knowledge creation theory. The analysis includes three steps: first, a review of organizational knowledge creation theory; second, an examination of three case studies; and finally, a discussion on applying the theory to “project-based learning”, and suggesting teachers’ roles from this viewpoint

Electronic structures and magnetic moments of Co3FeN thin films grown by molecular beam epitaxy

We evaluated electronic structures and magnetic moments in Co3FeN epitaxial films on SrTiO3(001). The experimentally obtained hard x-ray photoemission spectra of the Co3FeN film have a good agreement with those calculated. Site averaged spin magnetic moments deduced by x-ray magnetic circular dichroism were 1.52 μ B per Co atom and 2.08 μ B per Fe atom at 100 K. They are close to those of Co4N and Fe4N, respectively, implying that the Co and Fe atoms randomly occupy the corner and face-centered sites in the Co3FeN unit cell

Guanine- 5-carboxylcytosine base pairs mimic mismatches during DNA replication

The genetic information encoded in genomes must be faithfully replicated and transmitted to daughter cells. The recent discovery of consecutive DNA conversions by TET family proteins of 5-methylcytosine into 5-hydroxymethylcytosine, 5-formylcytosine, and 5-carboxylcytosine (5caC) suggests these modified cytosines act as DNA lesions, which could threaten genome integrity. Here, we have shown that although 5caC pairs with guanine during DNA replication in vitro, G·5caC pairs stimulated DNA polymerase exonuclease activity and were recognized by the mismatch repair (MMR) proteins. Knockdown of thymine DNA glycosylase increased 5caC in genome, affected cell proliferation via MMR, indicating MMR is a novel reader for 5caC. These results suggest the epigenetic modification products of 5caC behave as DNA lesions

A Functional SNP in BNC2 Is Associated with Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity. We previously conducted a genome-wide association study (GWAS) and detected two loci associated with AIS. To identify additional loci, we extended our GWAS by increasing the number of cohorts (2,109 affected subjects and 11,140 control subjects in total) and conducting a whole-genome imputation. Through the extended GWAS and replication studies using independent Japanese and Chinese populations, we identified a susceptibility locus on chromosome 9p22.2 (p = 2.46 × 10−13; odds ratio = 1.21). The most significantly associated SNPs were in intron 3 of BNC2, which encodes a zinc finger transcription factor, basonuclin-2. Expression quantitative trait loci data suggested that the associated SNPs have the potential to regulate the BNC2 transcriptional activity and that the susceptibility alleles increase BNC2 expression. We identified a functional SNP, rs10738445 in BNC2, whose susceptibility allele showed both higher binding to a transcription factor, YY1 (yin and yang 1), and higher BNC2 enhancer activity than the non-susceptibility allele. BNC2 overexpression produced body curvature in developing zebrafish in a gene-dosage-dependent manner. Our results suggest that increased BNC2 expression is implicated in the etiology of AIS

Phospholipase Cbeta4 and protein kinase Calpha and/or protein kinase CbetaI are involved in the induction of long term depression in cerebellar Purkinje cells.

Activation of the type-1 metabotropic glutamate receptor (mGluR1) signaling pathway in the cerebellum involves activation of phospholipase C (PLC) and protein kinase C (PKC) for the induction of cerebellar long term depression (LTD). The PLC and PKC isoforms that are involved in LTD remain unclear, however. One previous study found no change in LTD in PKCgamma-deficient mice, thus, in the present study, we examined cerebellar LTD in PLCbeta4-deficient mice. Immunohistochemical and Western blot analyses of cerebellum from wild-type mice revealed that PLCbeta1 was expressed weakly and uniformly, PLCbeta2 was not detected, PLCbeta3 was expressed predominantly in caudal cerebellum (lobes 7-10), and PLCbeta4 was expressed uniformly throughout. In PLCbeta4-deficient mice, expression of total PLCbeta, the mGluR1-mediated Ca(2+) response, and LTD induction were greatly reduced in rostral cerebellum (lobes 1-6). Furthermore, we used immunohistochemistry to localize PKCalpha, -betaI, -betaII, and -gamma in mouse cerebellar Purkinje cells during LTD induction. Both PKCalpha and PKCbetaI were found to be translocated to the plasmamembrane under these conditions. Taken together, these results suggest that mGluR1-mediated activation of PLCbeta4 in rostral cerebellar Purkinje cells induced LTD via PKCalpha and/or PKCbetaI