Opioid-Induced Adrenal Insufficiency.

This case report describes a woman in her 40s with opioid use disorder receiving methadone who was admitted for extended antibiotic treatment for methicillin-resistant Staphylococcus aureus bacteremia and was subesequently diagnosed with opioid-induced adrenal insufficiency.

Effect of protruding stickers enhancing plantar sensory feedback on control of the center of force trajectory during gait: A preliminary study.

BACKGROUND: Abnormal kinematics and kinetics in the lower extremity during gait may be improved by modulating the center of force trajectory of the foot. This study aimed to confirm whether short-interval training using plastic hemispherical protruding stickers (diameter: 5 mm; height: 2 mm) attached to the plantar surface of the foot to enhance plantar sensory feedback can help actively control the center of force trajectory during gait. METHODS: Twenty healthy female subjects underwent three-dimensional barefoot gait analysis under control conditions and two post-training conditions. Before the measurements under post-training conditions, the subjects underwent a 5-minute training to control the center of force trajectory with two protruding stickers attached to the plantar surface of the right foot. During training, the subjects were asked to put their weight on the stickers. The attachment positions of the stickers were the heel and either the first or fifth metatarsal head, which was randomly determined although both were tested. RESULTS: The center of pressure trajectory during the right stance phase of the gait shifted in the direction of the protruding stickers attached in the last training, although the stickers had already been removed. CONCLUSIONS: The study results confirmed that a 5-minute training with protruding stickers attached to the plantar surface of the foot can help actively control the center of pressure trajectory during gait.

Acute Carpal Tunnel Syndrome Due to Pyogenic Flexor Tenosynovitis without Any Antecedent Injury.

We herein report a case of acute carpal tunnel syndrome due to pyogenic flexor tenosynovitis in the absence of any antecedent injury whose rapid progression and course was similar to that seen with necrotizing fasciitis. This potentially disastrous clinical condition must be promptly recognized, since it needs early surgical management to prevent morbidity.

Tenosynovitis due to pseudogout.

A 93-year-old woman acutely developed fever associated with pain and swelling around her left wrist. Physical examination revealed fusiform symmetric swelling of the entire digits, digits held in partial flexion, tenderness along the flexor tendon sheath and pain along the tendon with passive digits extension. Gram stain of collected fluid showed the presence of calcium pyrophosphate dihydrate crystals.

Direct action of capsaicin in brown adipogenesis and activation of brown adipocytes.

The ingestion of capsaicin, the principle pungent component of red and chili peppers, induces thermogenesis, in part, through the activation of brown adipocytes expressing genes related to mitochondrial biogenesis and uncoupling such as peroxisome proliferator-activated receptor (Ppar) γ coactivator-1α (Pgc-1α) and uncoupling protein 1 (Ucp1). Capsaicin has been suggested to induce the activation of brown adipocytes, which is mediated by the stimulation of sympathetic nerves. However, capsaicin may directly affect the differentiation of brown preadipocytes, brown adipocyte function, or both, through its significant absorption. We herein demonstrated that Trpv1, a capsaicin receptor, is expressed in brown adipose tissue, and that its expression level is increased during the differentiation of HB2 brown preadipocytes. Furthermore, capsaicin induced calcium influx in brown preadipocytes. A treatment with capsaicin in the early stage of brown adipogenesis did not affect lipid accumulation or the expression levels of Fabp4 (a gene expressed in mature adipocytes), Pparγ2 (a master regulator of adipogenesis) or brown adipocyte-selective genes. In contrast, a treatment with capsaicin in the late stage of brown adipogenesis slightly increased the expression levels of Fabp4, Pparγ2 and Pgc-1α. Although capsaicin did not affect the basal expression level of Ucp1, Ucp1 induction by forskolin was partially inhibited by capsaicin, irrespective of the dose of capsaicin. The results of the present study suggest the direct effects of capsaicin on brown adipocytes or in the late stage of brown adipogenesis.

Bmp4 expressed in preadipocytes is required for the onset of adipocyte differentiation.

We previously revealed that endogenous bone morphogenetic protein (Bmp) activity is required for lipid accumulation in 3T3-L1 adipocytes. The present study characterized the role of endogenous Bmp activity in preadipocytes. Endogenous Bmp activity was monitored by analyzing the level of phosphorylation of Smad1/5/8, downstream molecules in the Bmp pathway. Higher levels of phosphorylated Smad1/5/8 were detected in adipogenic cells but not in non-adipogenic cells prior to differentiation induction. The inhibition of the Bmp pathway during this period decreased the expression of Pparγ2 and C/ebpα, which are transcription factors responsible for adipocyte differentiation. The expression of these transcription factors were also down-regulated by Bmp4 knockdown. In addition, endogenous Bmp4 was required for the repression of Intrleukin-11 expression. Endogenous Bmp4 in preadipocytes is indispensable for the onset of the adipogenic program, and may help to maintain the preadipocytic state during adipocyte differentiation.

Regulation of brown adipogenesis by the Tgf-ß family: involvement of Srebp1c in Tgf-ß- and Activin-induced inhibition of adipogenesis.

BACKGROUND: Brown adipocytes generate heat through the expression of mitochondrial Ucp1. Compared with the information on the regulatory differentiation of white preadipocytes, the factors affecting brown adipogenesis are not as well understood. The present study examined the roles of the Tgf-ß family members Bmp, Tgf-ß and Activin during differentiation of HB2 brown preadipocytes. METHODS: Endogenous Bmp activity and effects of exogenous Tgf-ß family members were examined. Role of Srebp1c in brown adipogenesis was further explored. RESULTS: Although Bmp7 has been suggested to be a potent stimulator of brown adipogenesis, it affected neither the expression of brown adipocyte-selective genes nor Ucp1 induction in response to a ß adrenergic receptor agonist. Unlike in 3T3-L1 white preadipocytes, endogenous Bmp activity was not required for brown adipogenesis; treatment with inhibitors of the Bmp pathway did not affect differentiation of preadipocytes. Administration of Tgf-ß1 or Activin A efficiently decreased the insulin-induced expression of brown adipocyte-selective genes. Tgf-ß1 and Activin A decreased the expression of Pparγ2 and C/ebpα, suggesting the inhibition of adipogenesis. The Tgf-ß- and Activin-induced inhibition of brown adipogenesis was mediated by the repression of Srebp1c expression; Tgf-ß1 and Activin A blocked Srebp1c gene induction in response to the differentiation induction, and knock-down of Srebp1 expression inhibited brown adipogenesis. CONCLUSION: Endogenous Bmp is dispensable for brown adipogenesis, and Srebp1c is indispensable, which is negatively regulated by Tgf-ß and Activin. GENERAL SIGNIFICANCE: Control of activity of the Tgf-ß family is potentially useful for maintenance of energy homeostasis through manipulation of brown adipogenesis.

Measuring retinal nerve fiber layer birefringence, retardation, and thickness using wide-field, high-speed polarization sensitive spectral domain OCT.

PURPOSE: We presented a novel polarization sensitive optical coherence tomography (PS-OCT) system for measuring retinal nerve fiber layer (RNFL) birefringence, retardation, and thickness, and report on the repeatability of acquiring these quantities. METHODS: A new PS-OCT system, measuring at 840 nm, was developed that supports scan angles of up to 40° × 40° with an A-scan rate of 70 kHz. To test the performance and reproducibility, we measured 10 eyes of 5 healthy human volunteers five times each. All volunteers were imaged further with scanning laser polarimetry (SLP). The obtained RNFL birefringence, retardation, and thickness maps were averaged, and standard deviation maps were calculated. For quantitative comparison between the new PS-OCT and SLP, a circumpapillary evaluation within 2 annular segments (superior and inferior to the optic disc) was performed. RESULTS: High quality RNFL birefringence, retardation, and thickness maps were obtained. Within the superior and inferior segments, the mean retardation for individual eyes ranged from 20° to 28.9° and 17.2° to 28.2°, respectively. The quadrant precision over the 5 consecutive measurements for each subject, calculated for the average retardation obtained within the superior and inferior quadrants ranged from 0.16° to 0.69°. The mean birefringence ranged from 0.106°/µm to 0.141°/µm superior and 0.101°/µm to 0.135°/µm inferior, with a quadrant precision of 0.001°/µm to 0.007°/µm. The mean RNFL thickness varied from 114 to 150 µm superior, and 111 to 140.9 µm inferior (quadrant precision ranged from 3.6 to 11.9 µm). CONCLUSIONS: The new PS-OCT system showed high image quality and reproducibility, and, therefore, might be a valuable tool for glaucoma diagnosis.

Large-field high-speed polarization sensitive spectral domain OCT and its applications in ophthalmology.

We present a novel spectral domain polarization sensitive OCT system (PS-OCT) that operates at an A-scan rate of 70 kHz and supports scan angles of up to 40° × 40°. The high-speed imaging allows the acquisition of up to 1024 × 250 A-scans per 3D scan, which, together with the large field of view, considerably increases the informative value of the images. To demonstrate the excellent performance of the new PS-OCT system, we imaged several healthy volunteers and patients with various diseases such as glaucoma, AMD, Stargardt's disease, and albinism. The results are compared with clinically established methods such as scanning laser polarimetry and autofluorescence.

Pressure-induced buckling of spin ladder in SrCu2O3.

Pressure-induced structural phase transition of spin ladder compound SrCu2O3 was investigated by synchrotron X-ray powder diffraction with a diamond anvil cell (DAC). The change was characterized by a buckling of the Cu2O3 plane in the rung direction of the ladder. The structure of the high-pressure phase was found to be essentially the same as that of CaCu2O3. Application of an external pressure of 3.4 GPa therefore affected the structure in the same manner that the chemical (internal) pressure does.