[in Japanese]

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Apelin binds to APJ (a putative receptor protein related to AT1) and has an antihypertensive function in an NO-dependent manner. Endothelial cell dysfunction is one of the mechanisms of hypertensive disorders of pregnancy (HDPs). To investigate the pathophysiology of HDP, the apelin concentration in blood was measured in patients with normal pregnancy, in their umbilical cord, and in patients with HDP using ELISA. The localization of apelin in the placenta was analyzed using immunohistochemistry. The concentration of apelin decreased throughout pregnancy and returned to nonpregnant levels 1 month after delivery. The apelin levels in patients with HDPs that developed after 32 weeks of gestation were significantly increased compared with those in patients with normal pregnancies in the third trimester. Apelin expression was found in the cytotrophoblasts of normal pregnancy placentas. No significant difference was found between placenta with normal pregnancy and HDP. The increased apelin levels in patients with HDPs may have antihypertensive effects by vasodilator mechanisms.

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Treatment for limb fractures is well established, but severe trauma and extensive bone loss may result in inadequate bone union, even with appropriate treatment and surgery. Recently, regenerative medicine using stem cells has been applied in the field of orthopedics. Dedifferentiated fat (DFAT) cells are mature adipocyte-derived multipotent cells that have characteristics similar to mesenchymal stem cells. In this study, we examined whether DFAT cell transplantation into the fracture site promotes bone formation in a mouse femoral fracture model. As a result, we found that DFAT cell transplantation promoted callus formation and increased bone volume around the fracture site. These results suggest that DFAT cells are an attractive cell source for the treatment of refractory fracture.

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Dedifferentiated fat cells (DFATs) are multipotent cells, similar to mesenchymal stem cells obtained with the ceiling culture method for mature adipocytes. In this study, we tried to generate induced pluripotent stem (iPS) cells by transducing Yamanaka factors into human DFATs and compared the induction efficiency with that in human dermal fibroblasts (HDFs). Using the Sendai virus vector, Yamanaka factors were transfected into DFATs to induce iPS cell colonies. HDFs and human neonatal foreskin-derived fibroblasts (BJs) were used as controls, and iPS cells were similarly induced. After embryoid bodies had developed from the induced iPS cell colonies, the ability to differentiate into three germ layers in vitro was evaluated immunohistologically. In addition, the induced iPS cell colonies were stained with alkaline phosphatase (ALP), and the number of positive colonies was measured over time to analyze the iPS cell induction efficiency. In the DFAT-derived iPS cell colonies, 25 embryonic stem cell markers examined by reverse transcription polymerase chain reaction were expressed. Immunostaining showed strongly positive findings for Nanog, Oct3/4, SSEA-3, and TRA1-60. The induced embryoid body tissue was positive for the three germ layer markers. The induction efficiency of iPS cell colonies was significantly higher in DFATs than in BJs and HDFs. DFATs were found to be more efficient for inducing iPS cell colonies than dermal fibroblasts, a standard source of iPS cells.

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Purpose: The aim of this study was to clarify the actual condition of sarcopenia and factors influencing the activities of daily living (ADL) of patients with hip fractures. Methods: The study included 42 patients with hip fractures. ADL were assessed using the Barthel index. The following information was registered retrospectively: (a) at admission: age, sex, body mass index, Charlson comorbidity index, Geriatric Nutritional Risk Index (GNRI), medications, and Barthel index (BI) at admission; and (b) at discharge: BI, BI gain and length of stay. Results: Twenty-four patients (57.1%) had sarcopenia. According to the multiple linear regression analysis, age and inappropriate drugs were significant factors affecting ADL. Conclusions: The sarcopenia group had significantly lower ADL at discharge, and age and inappropriate drugs were independent factors related to ADL at discharge.

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A 93-year-old man receiving follow-up care for hypertension and a thoracic aorta aneurysm experienced sudden precordial and back pain. He requested an ambulance and was taken to our hospital. We checked his thoracic aorta with computed tomography and diagnosed him with an 84 mm maximum minor-axis diameter arch thoracic aortic aneurysm (TAA) with imminent rupture and pleural effusion. After undergoing 2-debranch TEVAR emergency surgery, the patient made an uneventful recovery without postoperative complications and left the hospital on his own on POD 35. This case is being reported because it describes the successful treatment of TAA with an emergency stent graft for a patient of advanced age.

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We present multicentric glioblastomas radiologically mimicking metastatic tumors. A 57-year-old female presented with multiple brain masses accompanied by generalized seizures. Since there was no primary lesion considered to be the origin, the patient underwent craniotomy to remove the mass. The mass was pathologically diagnosed as glioblastoma, IDH-wildtype. When we found a multicentric tumor mass in the brain, a metastatic tumor was first suspected, and radiotherapy without surgical resection was believed to be acceptable. However, glioblastoma, which requires intensive chemoradiotherapy, rarely demonstrates multiple lesions as in the presented case. Therefore, surgical resection should be considered to make a diagnosis and treat multiple brain tumors, especially in cases with no certain primary lesion.

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Gallbladder torsion is common in elderly women and is a rare condition that occurs due to inadequate attachment of the gallbladder to the liver bed. A 95-year-old woman was admitted to our hospital with a chief complaint of abdominal pain. The upper abdomen showed bloating, tenderness, and muscular defense, and imaging examination revealed an enlarged gallbladder and rupture of the gallbladder wall structure. We performed an emergency operation after diagnosing gangrenous cholecystitis. The gallbladder was not attached to the liver bed but was rotated 270° clockwise around the cystic duct. Based on the above findings, we diagnosed gallbladder torsion and removed the gallbladder. We reported a case of gallbladder torsion that was successfully treated by laparoscopic surgery.

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