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Electron microscopy is crucial for detecting ultrastructural changes that are undetectable by conventional histology. A key application is the identification of organized electron-dense deposits with distinct morphologies, such as fibrillar, microtubular, lamellar, or crystalline forms. These structures, occasionally observed in renal biopsy specimens, provide important diagnostic clues and are often associated with monoclonal immunoglobulin-related or matrix-derived materials. Renal diseases with organized deposits encompass a broad and heterogeneous spectrum of conditions, including amyloidosis, fibrillary glomerulonephritis, immunotactoid glomerulopathy, cryoglobulinemic glomerulonephritis, crystalline nephropathies, and hereditary matrix-associated conditions. The clinical importance of detecting these deposits is highlighted by the emergence of monoclonal gammopathy of renal significance, even in patients with a low clonal burden. Careful differentiation from mimickers, such as non-specific matrix changes, fibrin tactoids, spheroids, and artifacts, is essential to avoid misdiagnosis. Diagnostic precision requires a multidisciplinary approach incorporating light microscopy, immunofluorescence, special stains such as Congo red, and advanced molecular tools, including mass spectrometry. The discovery of disease-specific markers, such as the DnaJ Heat Shock Protein Family Member B9, has greatly improved the diagnostic accuracy of fibrillary glomerulonephritis. Identifying organized deposits can prompt additional clinical evaluations, including hematologic workups, and help guide management. In conclusion, organized deposits provide key diagnostic insights and reflect a diverse spectrum of underlying pathologies. Owing to their structural complexity, careful ultrastructural assessments are essential for accurate diagnosis. Advances in proteomic and genomic methods will refine disease classification and support the development of targeted therapies. Continued interdisciplinary collaboration is crucial for optimizing care for complex renal disorders.
Cardiogenic shock has a high mortality rate. Even with the use of the Impella device, there are certain number of cases require further escalation therapy, although the predictive factors have not been fully elucidated. In this study, we aimed to estimate the acute mortality rate and the rate of requiring escalation therapy, as well as evaluate the predictors of the need for escalation therapy, including electrocardiographic parameters. In this retrospective study, we analyzed the patients with cardiogenic shock on Impella support between April 2018 and June 2021. Electrocardiogram, serum lactate levels, and pulmonary artery catheterization parameters were assessed 12 h after Impella implantation. Patients who died or required escalation therapy within 30 days of Impella implantation were defined as the deteriorated group and the remaining as the recovered group. A total of 67 patients with cardiogenic shock (66 ± 16 years; 46 men) with Impella were evaluated. The 30-day mortality rate and rate of requiring escalation therapy were 24
An anti-interleukin (IL)‑13 antibody, lebrikizumab, has shown efficacy in the treatment of atopic dermatitis (AD). However, real‑world data on 1‑year transition of clinical and laboratory indices are limited. To evaluate the 48‑week transition of clinical and laboratory indices during lebrikizumab treatment in Japanese patients with moderate‑to‑severe AD, stratified by the presence or absence of prior systemic therapy. We conducted a two‑center prospective study of 187 Japanese patients with AD treated with lebrikizumab. Clinical and laboratory indices were assessed until week 48 in systemic therapy-naive and -experienced patients. Lebrikizumab reduced total and anatomical site-specific eczema area and severity index (EASI) and the peak pruritus numerical rating scale (PP‑NRS) throughout the 48 weeks. The magnitude of decreasing head and neck EASI was slightly lower in systemic therapy-experienced patients. Week 48 achievement rates of EASI 75, EASI 90, and PP‑NRS 4 were 84
Abstract Background Valgus knee deformity, which is less common, is not a mirror image of varus knee deformity and poses unique technical challenges in total knee arthroplasty (TKA). Although the lateral parapatellar approach may be advantageous for severe valgus knee, the medial approach is often preferred due to surgeons’ limited familiarity with valgus TKA and the lateral approach. Recently, robotic technology has demonstrated superior accuracy in bone resection and soft-tissue balancing during TKA. Hence, we introduce the application of robotic technology for valgus knees via the lateral approach in TKA. As the standard patella drill template of the onlay oval patellar implant was designed for the medial approach, we created a reversed-asymmetric patella drill template for the lateral approach. In the recent cases, patellar tracking following prosthesis implantation was also evaluated using robotic technology. Methods We included cases of primary TKA performed for Ranawat classification types II and III with uncorrectable valgus knee alignment, as well as for valgus deformity > 20°. In TKA, arthrotomy was performed via the lateral approach, and the patella was retracted medially. After soft-tissue balancing was adjusted, bone resection was performed using the Mako robotic system. The patella was replaced with an onlay oval patellar implant using our novel patella drill template in the lateral approach. Patellar tracking on the femoral trochlear groove after implantation was visualized and assessed using robotic technology. Results The surgical procedures were performed smoothly in 10 knees of 9 patients. The pre-operative limitations of knee extension, Visual Analog Scale scores, and radiographic knee alignment significantly improved following TKA. Pre-operatively, the tibiofemoral joint gaps were tighter laterally in both extension and flexion; post-operative medial laxity was effectively corrected. The accuracy and precision of prostheses positioning were confirmed radiographically. Patellar tracking was found to be appropriate after replacement with the oval patellar implant. Conclusions The combination of robotic assistance, the lateral approach, and onlay oval patellar implants using our originally developed patella drill template showed feasibility for precise bone resection, optimal soft-tissue balancing, and proper patellar tracking for TKA in cases of valgus knee deformity.
This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
