Formulate Adaptive Biphasic Scaffold via Sequential Protein-Instructed Peptide Co-Assembly

To ensure compositional consistency while mitigating potential immunogenicity for stem cell therapy, synthetic scaffolds have emerged as compelling alternatives to native extracellular matrix (ECM). Substantial progress has been made in emulating specific natural traits featuring consistent chemical compositions and physical structures. However, recapitulating the dynamic responsiveness of the native ECM involving chemical transitions and physical remodeling during differentiation, remains a challenging endeavor. Here, the creation of adaptive scaffolds is demonstrated through sequential protein-instructed molecular assembly, utilizing stage-specific proteins, and incorporating in situ assembly technique. The procedure is commenced by introducing a dual-targeting peptide at the onset of stem cell differentiation. In response to highly expressed integrins and heparan sulfate proteoglycans (HSPGs) on human mesenchymal stem cell (hMSC), the peptides assembled in situ, creating customized extracellular scaffolds that adhered to hMSCs promoting osteoblast differentiation. As the expression of alkaline phosphatase (ALP) and collagen (COL-1) increased in osteoblasts, an additional peptide is introduced that interacts with ALP, initiating peptide assembly and facilitating calcium phosphate (CaP) deposition. The growth and entanglement of peptide assemblies with collagen fibers efficiently incorporated CaP into the network resulting in an adaptive biphasic scaffold that enhanced healing of bone injuries.

Construction of the single-diamond-structured titania scaffold-Recreation of the holy grail photonic structure

As one of the most stunning biological nanostructures, the single-diamond (SD) surface discovered in beetles and weevils exoskeletons possesses the widest complete photonic bandgap known to date and is renowned as the "holy grail" of photonic materials. However, the synthesis of SD is difficult due to its thermodynamical instability compared to the energetically favoured bicontinuous double diamond and other easily formed lattices; thus, the artificial fabrication of SD has long been a formidable challenge. Herein, we report a bottom-up approach to fabricate SD titania networks via a one-pot cooperative assembly scenario employing the diblock copolymer poly(ethylene oxide)-block-polystyrene as a soft template and titanium diisopropoxide bis(acetylacetonate) as an inorganic precursor in a mixed solvent, in which the SD scaffold was obtained by kinetically controlled nucleation and growth in the skeletal channels of the diamond minimal surface formed by the polymer matrix. Electron crystallography investigations revealed the formation of tetrahedrally connected SD frameworks with the space group Fd [Formula: see text] m in a polycrystalline anatase form. A photonic bandgap calculation showed that the resulting SD structure has a wide and complete bandgap. This work solves the complex synthetic enigmas and offers a frontier in hyperbolic surfaces, biorelevant materials, next-generation optical devices, etc.

NOAEL cancer therapy: a tumor targetable docetaxel-inorganic polymer nanohybrid prevents drug-induced neutropenia

To date, cancer therapies largely consist of five pillars: surgery, radiation, chemotherapy, targeted therapy, and immunotherapy. Still, researchers are trying to innovate the current cancer therapies to pursue an ideal one without side effects. For developing such a therapy, we designed a chemically well-defined route to a PEG- and docetaxel (DTX)-conjugated inorganic polymer, polyphosphazene, named "polytaxel (PTX)" with a prolonged blood circulation time and tumor localization. Here, we conducted the proof-of-concept study of the ideal therapy in orthotopic and xenograft pancreatic cancer models. We found that the average tumor inhibition rates of PTX were similar to those of DTX without any DTX toxicity-related side effects, such as neutropenia and weight loss. In conclusion, PTX met the requirements of an ideal anticancer drug with high anticancer efficacy and 100% survival rate. PTX is expected to replace any existing anticancer therapies in clinical practice.

Control cell migration by engineering integrin ligand assembly

Advances in mechanistic understanding of integrin-mediated adhesion highlight the importance of precise control of ligand presentation in directing cell migration. Top-down nanopatterning limited the spatial presentation to sub-micron placing restrictions on both fundamental study and biomedical applications. To break the constraint, here we propose a bottom-up nanofabrication strategy to enhance the spatial resolution to the molecular level using simple formulation that is applicable as treatment agent. Via self-assembly and co-assembly, precise control of ligand presentation is succeeded by varying the proportions of assembling ligand and nonfunctional peptide. Assembled nanofilaments fulfill multi-functions exerting enhancement to suppression effect on cell migration with tunable amplitudes. Self-assembled nanofilaments possessing by far the highest ligand density prevent integrin/actin disassembly at cell rear, which expands the perspective of ligand-density-dependent-modulation, revealing valuable inputs to therapeutic innovations in tumor metastasis.

Engineering peptide assembly that controls integrin ligand presentation on the molecular level possesses by far the highest ligand density, expanding the perspective of ligand-density-dependent modulation.

Towards a comprehensive understanding of mesoporosity in zeolite Y at the single particle level

A full understanding of zeolite mesoporosity is not trivial yet is necessary to understand and optimize the catalytic performance of zeolites. The present work reports an integrated approach for the...

Advanced scanning electron microscopy techniques for structural characterization of zeolites

Chemical etching after Ar ion beam cross sectioning enables the formation of zeolite internal nano structures to be observed directly using a newly developed highly sensitive scanning electron microscope.

Lipid-Raft-Targeted Molecular Self-Assembly Inactivates YAP to Treat Ovarian Cancer

The Yes-associated protein (YAP) is a major oncoprotein responsible for cell proliferation control. YAP's oncogenic activity is regulated by both the Hippo kinase cascade and uniquely by a mechanical-force-induced actin remodeling process. Inspired by reports that ovarian cancer cells specifically accumulate the phosphatase protein ALPP on lipid rafts that physically link to actin cytoskeleton, we developed a molecular self-assembly (MSA) technology that selectively halts cancer cell proliferation by inactivating YAP. We designed a ruthenium-complex-peptide precursor molecule that, upon cleavage of phosphate groups, undergoes self-assembly to form nanostructures specifically on lipid rafts of ovarian cancer cells. The MSAs exert potent, cancer-cell-specific antiproliferative effects in multiple cancer cell lines and in mouse xenograft tumor models. Our work illustrates how basic biochemical insights can be exploited as the basis for a nanobiointerface fabrication technology which links nanoscale protein activities at specific subcellular locations to molecular biological activities to suppress cancer cell proliferation.

Investigation of the Image Contrast in an Ultra-Low Voltage Scanning Electron Microscope Using an Auger Electron Spectrometer

Surface-sensitive information on a bulk sample can be obtained by using a low incident electron energy (low accelerating voltage/landing voltage) in a scanning electron microscope (SEM). However, topography and composition contrast obtained at low incident electron energies may not be intuitive and should be analyzed carefully. By combining an Auger electron spectrometer (AES) with a low incident electron energy SEM (LE-SEM), we investigated the SEM contrast carefully by separating the secondary electron (SE) and back-scattered electron (BSE) components with high accuracy. For this, we modified an AES to measure the electron energy in the range of 0–0.6 keV with a sample bias voltage of 0 to −0.3 keV. We could clearly observe reversed brightness of gold and carbon (graphite) in BSE images when the energy of the incident electrons was reduced to 0.2–0.3 keV. In addition, reflected electron energy spectroscopy (REELS) is known to be a tool for chemical state analysis of the sample. We demonstrated that it is possible to study the electron states of graphite, diamond, and graphene by acquiring low incident energy REELS spectra from their surfaces with the newly modified AES. This will be a new method for analyzing the electron states of local areas of a surface.

Mechanoresponsive Alignment of Molecular Self-Assembled Negatively Charged Nanofibrils

Inspired by the mechanoresponsive orientation of actin filaments in cell, we introduce a design paradigm of synthetic molecular self-assembling fibrils that respond to external mechanical force by transforming from a macroscopically disorder state to a highly ordered uniaxial aligned state. The incorporation of aromatic-containing amino acids and negatively charged amino acids lead to self-assembly motifs that transform into uniform nanofibrils in acidic solution. Adjusting the pH level of aqueous solution introduces optimal negative charge to the surface of self-assembling nanofibrils inducing long-range electrostatic repulsion forming a nematic phase. Upon external mechanical force, nanofibrils align in the force direction. Via evaporation casting in capillary confinement, the solvated synthetic self-assembling nanofibrils transform into scalable lamellar domains. Adjusting capillary geometry and drying procedure offers further parameters for tuning the mesoscale alignment of nanofibrils generating a variety of interference colors. The design paradigm of mechanoresponsive alignment of self-assembled nanofibrils as an addition of nanofabrication techniques is potentially employable for realizing biomimetic optical structures.

Formation dynamics of mesocrystals composed of organically modified CeO2 nanoparticles: analogy to a particle formation model

Mesocrystals, non-classical crystalline nanostructured materials composed of aligned nanoparticles, present analogous behavior to ordinary particle formation.

A novel geopolymer route to porous carbon: high CO2 adsorption capacity

We report the synthesis of porous carbon through a novel geopolymer route, starting from natural clay kaolin.

Structural investigations on green culms and charcoal of Bambusa multiplex

Green culms of Bambusa multiplex and the bamboo charcoal carbonized from the green culms at 700°C have been studied by means of X-ray diffraction, X-ray fluorescent element analysis, analytical scanning electron microscopy, and analytical scanning transmission electron microscopy (STEM), aiming at industrial applications as raw materials for functional devices and substances. It is revealed that the green culms and the charcoal contain a significant amount of Si, in particular, ∼18 wt % in the skin. The green culms comprise amorphous and crystalline celluloses. The charcoal has a so-called amorphous structure which is composed of randomly distributed carbon nanotubes and fibers. The growth of Ag-doped activated charcoal powders that were produced by two different methods using this charcoal powder has also been studied.

Scanning Electron Microscopy (SEM) Energy Dispersive X-ray Spectroscopy (EDS) Mapping and In-situ Observation of Carbonization of Culms of Bambusa Multiplex

Green culms of bamboo and charcoal of Bambusa multiplex were investigated by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) mapping. A dynamic observation of the initial stage of carbonization was also performed in-situ by heating a radial longitudinal section of the bamboo culm at a rate of 20°C/min up to 500°C. EDS mapping of the green bamboo culms detected Si signals in the harder cells such as the epidermis (Ep), cortex (Cor) and vascular bundle sheath (Bs) and between these cells as silicon oxide particles. Appreciable morphological change of the cells occurred in a temperature range of about 300-400°C due to the decomposition of cellulose that is the main component of the bamboo cells. The charcoal of the bamboo culm has a skin layer which originates from the Ep and Cor and the main central cylinder with many openings that originate from the expanded xylem and phloem holes. During carbonization, the Si atoms in the Ep and Cor were segregated as thin silicon oxide layers onto both the sides of the skin layer and the Si included in the Bs fibers and parenchyma cells accumulated near the walls of the openings.

Direct Observation of the Outermost Surfaces of Mesoporous Silica Thin Films by High Resolution Ultralow Voltage Scanning Electron Microscopy

The properties of the outermost surfaces of mesoporous silica thin films are critical in determining their functions. Obtaining information on the presence or absence of silica layers on the film surfaces and on the degree of mesopore opening is essential for applications of surface mesopores. In this study, the outermost surfaces of mesoporous silica thin films with 3-dimensional orthorhombic and 2-dimensional hexagonal structures were observed using ultralow voltage high resolution scanning electron microscopy (HR-SEM) with decelerating optics. SEM images of the surfaces before and after etching with NH₄F were taken at various landing voltages. Comparing the images taken under different conditions indicated that the outermost surfaces of the nonetched mesoporous silica thin films are coated with a thin layer of silica. The images taken at an ultralow landing voltage (i.e., 80 V) showed that the presence or absence of surface silica layers depends on whether the film was etched with an aqueous solution of NH₄F. The mesostructures of both the etched and nonetched films were visible in images taken at a conventional landing voltage (2 kV); hence, the ultralow landing voltage was more suitable for analyzing the outermost surfaces. The SEM observations provided detailed information about the surfaces of mesoporous silica thin films, such as the degree of pore opening and their homogeneities. AFM images of nonetched 2-dimensional hexagonal mesoporous silica thin films show that the shape of the silica layer on the surface of the films reflects the curvature of the top surface of the cylindrical mesochannels. SEM images taken at various landing voltages are discussed, with respect to the electron penetration range at each voltage. This study increases our understanding of the surfaces of mesoporous silica thin films, which may lead to potential applications utilizing the periodically arranged mesopores on these surfaces.

A Co₃O₄-embedded porous ZnO rhombic dodecahedron prepared using zeolitic imidazolate frameworks as precursors for CO₂ photoreduction

Metal-organic frameworks (MOFs) are attracting considerable attention for their use as both the precursor and the template to prepare metal oxides or carbon-based materials. For the first time in this paper, the core-shell ZIF-8@ZIF-67 crystals are thermally converted into porous ZnO@Co3O4 composites by combining a seed-mediated growth process with a two-step calcination. The designed porous ZnO@Co3O4 composites exhibited the highest photocatalytic activity with an excellent stability for the reduction of CO2 among the commonly reported composite photocatalysts. Their superior photocatalytic performance is demonstrated to be resulting from the unique porous structure of ZnO@Co3O4 and the co-catalytic function of Co3O4 which can effectively suppress the photocorrosion of ZnO.

Metamorphic GaAs/GaAsBi Heterostructured Nanowires

GaAs/GaAsBi coaxial multishell nanowires were grown by molecular beam epitaxy. Introducing Bi results in a characteristic nanowire surface morphology with strong roughening. Elemental mappings clearly show the formation of the GaAsBi shell with inhomogeneous Bi distributions within the layer surrounded by the outermost GaAs, having a strong structural disorder at the wire surface. The nanowire exhibits a predominantly ZB structure from the bottom to the middle part. The polytipic WZ structure creates denser twin defects in the upper part than in the bottom and middle parts of the nanowire. We observe room temperature cathodoluminescence from the GaAsBi nanowires with a broad spectral line shape between 1.1 and 1.5 eV, accompanied by multiple peaks. A distinct energy peak at 1.24 eV agrees well with the energy of the reduced GaAsBi alloy band gap by the introduction of 2% Bi. The existence of localized states energetically and spatially dispersed throughout the NW are indicated from the low temperature cathodoluminescence spectra and images, resulting in the observed luminescence spectra characterized by large line widths at low temperatures as well as by the appearance of multiple peaks at high temperatures and for high excitation powers.

Optically active chiral CuO "nanoflowers"

Helical symmetry can be found in most flowers with a rotation of contort petal aestivation. For micro- and nanoscale analogies, flower mimicking structures have been reproduced; however, the conceptual chirality of "nanoflowers" has not yet been defined. Here, the chirality of the "flower" was defined by its nanosized chiral structure and consequent optical activity (OA), opening new horizons for the physical theory and chiral materials. We report the surfactant-mediated hydrothermal synthesis of chiral CuO nanoflowers using sodium dodecyl sulfate (SDS) as a structure-directing agent, an amino alcohol as a symmetry-breaking agent, and cupric salt as the inorganic source. Two levels of hierarchical chirality exist for a CuO nanoflower including primary helically arranged "nanoflakes" and secondary helical "subnanopetals" that form "nanopetals". The nanoflowers exhibited a prominent optical response to circularly polarized light (CPL) at the absorption bands characteristic of CuO.

Synthesis of chiral TiO₂ nanofibre with electron transition-based optical activity

The optical chirality induced at the absorption bands due to electronic exciton coupling of the transition dipole moments between chromophores in close proximity is ubiquitous in helical organic materials. However, inorganic materials with optical activity resulting from electronic transitions have not been explored. Here we report the synthesis of chiral TiO₂ fibres via transcription of the helical structure of amino acid-derived amphiphile fibres through coordination bonding interactions between the organics and the TiO₂ source. Upon calcination, the as-prepared amorphous TiO₂ double-helical fibres with a pitch length of ~100 nm were converted to double-helical crystalline fibres with stacks of anatase nanocrystals in an epitaxial helical relationship. Both the amorphous and anatase crystalline helical TiO₂ fibres exhibited optical response to circularly polarized light at the absorption edge around ~350 nm. This was attributed to the semiconductor TiO₂-based electronic transitions from the valence band to the conduction band under an asymmetric electric field.

Optical activity resulting from electronic transitions in chiral inorganic materials is rare. Liu et al. report the synthesis of amino acid-derived amphiphile templated chiral TiO₂ fibres, which exhibit an optical response to polarized light resulting from valence to conduction band electronic transitions.

Synthesis of self-pillared zeolite nanosheets by repetitive branching

Hierarchical zeolites are a class of microporous catalysts and adsorbents that also contain mesopores, which allow for fast transport of bulky molecules and thereby enable improved performance in petrochemical and biomass processing. We used repetitive branching during one-step hydrothermal crystal growth to synthesize a new hierarchical zeolite made of orthogonally connected microporous nanosheets. The nanosheets are 2 nanometers thick and contain a network of 0.5-nanometer micropores. The house-of-cards arrangement of the nanosheets creates a permanent network of 2- to 7-nanometer mesopores, which, along with the high external surface area and reduced micropore diffusion length, account for higher reaction rates for bulky molecules relative to those of other mesoporous and conventional MFI zeolites.

Decline in glutathione peroxidase activity is a reason for brain senescence: consumption of green tea catechin prevents the decline in its activity and protein oxidative damage in ageing mouse brain

The accumulation of oxidative damage is believed to contribute to senescence. We have previously found that the consumption of green tea catechins (GT-catechin), which are potent antioxidants, decreases oxidative damage to DNA and improves brain function in aged mice with accelerated senescence (SAMP10 mice). To investigate the mechanisms underlying the beneficial effects of GT-catechin, we measured the activities of antioxidative enzymes in the brains of aged SAMP10 mice. The activity of glutathione peroxidase (GPx), an essential enzyme for reduction of hydrogen and lipid peroxides, was significantly lower in aged mice than in younger ones. However, the decline in activity was prevented in aged mice that had consumed GT-catechin. The increased level of carbonyl proteins, a marker of oxidative damage in proteins, was also significantly reduced in aged mice that had consumed GT-catechin. The activities of superoxide dismutase and catalase were not decreased in aged mice. These results suggest that decreased activity of GPx importantly contributes to brain dysfunction in ageing SAMP10 mice. Furthermore, the intake of GT-catechin protected the decline in GPx activity and age-related oxidative damage in the brain.

Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction

Eighty patients receiving hematological stem cell transplantation (HCT) with a preparative regimen consisting of total body irradiation (12.5 Gy), cyclophosphamide (4000 or 4500 mg/m2), and thiotepa (400 mg/m2) were evaluated for the development of cardiac toxicity. Patients in whom the pretransplant cumulative dose of anthracycline was more than or equal to 300 mg/m2 showed a lower left ventricular ejection fraction (EF) before HCT compared to patients with less than 300 mg/m2 (0.61 +/- 0.09 vs 0.67 +/- 0.06, P = 0.0010). Patients who had undergone more than or equal to six courses of chemotherapy showed a decreased EF before HCT compared to those after less than six courses (0.67 +/- 0.05 vs 0.63 +/- 0.09, P = 0.03). Three of seven patients (43%) whose pretransplant EF had been less than or equal to 0.55 developed severe cardiac toxicity, characterized by congestive heart failure (CHF) compared with none of 83 patients (0%) whose pretransplant EF had been more than 0.55 (P = 0.00026). Of the three patients who developed severe cardiac toxicity, two were given more than 300 mg/m2 of cumulative anthracycline and underwent 23 courses and six courses of chemotherapy, while the other patient received only two courses of chemotherapy with a total dose of 139 mg/m2 of anthracycline. These results indicate that an increased cumulative dose of anthracycline and number of chemotherapy treatments are correlated with a decrease of the EF and that the EF before HCT is useful for predicting the risk of cardiac complications for recipients who have received chemotherapy.

Homozygosity mapping of the locus responsible for renal tubular dysplasia of cattle on bovine chromosome 1

Renal tubular dysplasia is a hereditary disease of Japanese black cattle showing renal failure and growth retardation with an autosomal recessive trait. In the present study, we mapped the locus responsible for the disease (RTD) by linkage analysis with an inbred paternal half-sib pedigree obtained from commercial herds. By analyzing segregation of microsatellite markers in the half-sibs, significant linkage was observed between the RTD locus and markers on bovine Chromosome (Chr) 1 with the highest lod score of 11.4. Homozygosity mapping with the inbred pedigree further defined the localization of the RTD locus in a 4-cM region between microsatellite markers BMS4003 and INRA119. Mapping of the RTD locus on bovine Chr 1 will facilitate cloning and characterization of the gene responsible for this disease.

Notchplasty in anterior cruciate ligament reconstruction: an experimental animal study

The purpose of this study was to evaluate the effects of a notchplasty on the biomechanical and histological properties of the anterior cruciate ligament (ACL) and changes in patellar articular cartilage. We used an in situ freeze-thaw model for the ACL reconstruction performed with or without notchplasty in 36 Japanese white rabbits. The cross-sectional area of the regenerated ACLs without a notchplasty (6.4 +/- 0.4 mm(2)) was statistically smaller than that of the ACLs with a notchplasty (7.0 +/- 0.3 mm(2)), and the cross-sectional area of the normal ACLs (5.4 +/- 0.5 mm(2)) was statistically smaller than that of both other types. However, the mechanical strength of the ACL with the notchplasty was identical to that of the ACL without a notchplasty. Although the notchplasty areas were covered with fibrous scar tissue, caliper measurement and histological examination showed no obvious osteochondral reconstitution in the notchplasty sites of any of the specimens. Regarding the deleterious effect of notchplasty on patellar articular cartilage, the extent of the slight degenerative changes was about the same in the group with a 1-mm notchplasty and in the control group.

The long-term effects of tibial drill hole position on the outcome of anterior cruciate ligament reconstruction

Fifty-three cases of anterior cruciate ligament reconstruction were classified into two groups depending on the tibial drill hole position: in the anterior group, the center of tibial drill hole was positioned anteriorly to the dome of the intercondylar notch (Blumensaat's line), and in the posterior group, it was positioned posteriorly to the Blumensaat's line. Knee extension loss in the anterior group was significantly greater at 1 and 2 years postoperatively than that of the posterior group. However, there were no differences between the anterior and posterior groups 3 to 5 years postoperatively. No significant differences in anterior laxity were seen from 1 to 4 years postoperatively. After more than 5 years, anteroposterior translation of the anterior group was significantly greater than that of the posterior group. In the anterior group, extension was restricted in the early postoperative period. At latest follow-up more than 5 years postoperatively, anterior laxity in the posterior group was significantly less than that in the anterior group.

[Assessment of ischemic heart disease by dipyridamole stress electrocardiographic gated myocardial single photon emission computed tomography with technetium-99m tetrofosmin]

Simultaneous assessment of stress perfusion and rest function is possible with gated single photon emission computed tomography (SPECT) using stress injected technetium-99m (99mTc) tetrofosmin (TF). The feasibility of dipyridamole stress electrocardiographic gated myocardial SPECT (GSPECT) with TF was examined as an alternative to conventional stress/rest imaging. Fifty-one patients underwent stress GSPECT. 740 MBq of TF was administered 3 min after dipyridamole infusion. GSPECT acquisition was performed one hour after the injection. Additional rest SPECT was performed on another day only in patients with abnormal perfusion on stress images. Perfusion and thickening were analyzed visually on 17 segments of the left ventricle. Percentage of wall thickening (%WT) was also calculated in 17 segments of the polar map. Thirty-two of 51 patients (63%) had normal stress perfusion and normal rest thickening. Nineteen of 51 patients (37%) had abnormal perfusion on stress images. Among 157 abnormal perfusion segments of the 19 patients, 139 segments (89%) had thickening and the rest (11%) had no thickening. %WT was higher in the reversible segments with or without thickening. There was better agreement for the identification of normal segments and the presence of reversibility between stress GSPECT and the conventional stress/rest study in patients without previous myocardial infarction than in those with previous myocardial infarction (89% vs 79%). These results suggest that stress GSPECT may substitute for conventional stress/rest perfusion study in patients without previous myocardial infarction, allowing shorter examination time and lower cost. However, stress GSPECT does not replace the need for rest perfusion study in patients with previous myocardial infarction, because of underestimation of viability, but %WT may eliminate this underestimation.

Intermediate-term results of meniscal repair in anterior cruciate ligament-reconstructed knees

We investigated the incidence of and risk factors for recurrent tears of repaired menisci in anterior cruciate ligament-reconstructed knees. We observed 63 patients whose menisci had been evaluated at second-look arthroscopy as healed (N = 50) or incompletely healed (N = 13) for an average of 4 years (range, 2 to 9.5). Of the 13 patients with incompletely healed menisci, 6 (46%) required additional meniscal surgery and 2 (15%) had recurrence of meniscal symptoms such as catching or locking. Among the 50 patients with healed menisci, 5 (10%) required additional meniscal surgery and 9 (18%) had recurrence of meniscal symptoms after second-look arthroscopy. The timing of the recurrence of these symptoms was from 12 to 28 months after surgical repair. Of the 11 patients who had undergone additional surgery, 6 had sustained second injuries during sports activities and the other 5 had no identifiable cause of injury. When comparing age, tear sites, rim width, side-to-side differences with KT-1000 arthrometer testing, and the pivot shift test, there were no differences between the group requiring additional surgery, the symptomatic group, and the asymptomatic group. However, the postoperative Tegner activity score of the group requiring additional surgery was statistically significantly higher than the others.

Malignant insulinoma with extensive liver metastases presenting as disturbance of consciousness

A 56-year-old man was referred to our hospital for evaluation of episodic disturbance of consciousness. Hypoglycemic symptoms were noted and Whipple's triad was satisfied. The 75 g OGTT and the glucagon test revealed a high baseline insulin level and hyperreactivity to glucagon. A pancreatic tumor and liver metastases were found by abdominal computed tomography (CT). Based on the finding of liver biopsy, the final diagnosis was malignant insulinoma with liver metastasis. He selected conservative treatment and no hypoglycemic crisis has occurred for one year since discharge. Early diagnosis and long-term follow-up is necessary since this tumor is slow growing.

Arthroscopic meniscal repair in conjunction with anterior cruciate ligament reconstruction: factors affecting the healing rate

Ninety-eight of 121 consecutive patients who underwent arthroscopy-assisted meniscal repair in combination with anterior cruciate ligament reconstruction were evaluated by second-look arthroscopy with an average interval of 16 months (range, 6 to 63 months). Of the 98 meniscal repairs, 73 had completely healed, 13 had incompletely healed, and 12 had not healed. Six possible factors that may have affected the healing of the repaired menisci were statistically analyzed. There were no statistically significant differences between the three groups with respect to sex, age, tear site on the medial or lateral meniscus, or residual anterior laxity as measured using the KT-1000. The factors that had a statistically significant impact on healing rate were the rim width and meniscal locking. Negative correlations with the healing rate were observed in menisci that were repaired in the central third zone and that had been locked or could be locked by probing at the time of surgery.

Forefoot pressures during walking in feet afficted with hallux valgus

Forefoot pressures during walking in feet with hallux valgus were recorded using pressure-sensitive film, and the relationships between deformities and foot pressures were analyzed. There were 32 female subjects comprising 50 feet with hallux valgus, of which 20 feet underwent surgery. As in normal feet, the pressure patterns of feet with hallux valgus were varied: peak pressures were under the first metatarsal head, under the second and/or third metatarsal heads, and first, second, and/or third metatarsal heads. Peak pressures of hallux valgus feet were larger in each type than those of the normal foot. In feet with hallux valgus showing peak pressures under the first metatarsal heads, the hallux valgus angle and the intermetatarsal angle were larger than those in feet showing peak pressures on the second and/or third metatarsal heads. After surgery, peak pressures were under the second and/or third metatarsal heads and they decreased.