Publications by authors named "Eiji Itoi"

440 Publications

Surgical treatment for persistent second carpometacarpal joint pain.

Orthop Rev (Pavia) 2021 Mar 31;13(1):9085. Epub 2021 Mar 31.

Department of Orthopaedic Surgery, Tohoku University School of Medicine.

The purposes of this study were to demonstrate the clinical characteristics of patients with persistent second carpometacarpal (CMC) joint pain without bony abnormalities known as the carpal boss, and to assess the clinical efficacy of surgical stabilization of the second CMC joint. Eleven patients had persistent wrist pain with characteristic symptoms, including tenderness over the second CMC joint, increased symptoms when the involved hand was placed on the ground or gripped strongly with the involved hand, a positive metacarpal stress test and temporary pain relief with the intra-articular injection of the lidocaine. The patients underwent arthrodesis of the second CMC joint. All cases showed radiologically confirmed fusion of the second CMC joint. At the final followup examination, 10 of 11 patients resulted in satisfactory clinical outcomes, excepting one patient with remnant pain and restricted range of wrist motions. This report highlights the importance of conducting a careful assessment of patients who present with persistent second CMC joint pain without the bony abnormalities, such as carpal bossing. Surgery to stabilize the second CMC joint may be an option to improve their symptoms when conservative treatment fails.
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http://dx.doi.org/10.4081/or.2021.9085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077286PMC
March 2021

Effect of interleukin-17A inhibitor in Japanese patients with psoriatic arthritis compared with tumor necrosis factor-alpha inhibitor.

J Orthop Surg (Hong Kong) 2021 May-Aug;29(2):23094990211012286

Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

Objectives: The patient of severe psoriatic arthritis (PsA) is mainly treated with oral methotrexate, ciclosporin, and anti-tumor necrosis factor-alpha inhibitors (TNFi). Recently, anti-interleukin-17A inhibitors (IL-17Ai) have been used in the treatment of PsA. This study aimed to evaluate the efficacy and safety of IL-17Ai in Japanese patients with PsA compared with those of TNFi.

Methods: This was a longitudinal and retrospective study. The study population included 31 Japanese patients with PsA. All enrolled patients fulfilled the Classification Criteria for Psoriatic Arthritis. All patients were treated with TNFi or IL-17Ai. The assessed clinical manifestations were C-reactive protein (CRP)-based Disease Activity Score in 28 Joints (DAS28-CRP), disease activity in psoriatic arthritis (DAPSA), 20% achievement of American College of Rheumatology core set, swollen joint count (SJC), tender joint count (TJC), and visual analog scale (VAS). Functional ability of patients with PsA was analyzed using the modified health assessment questionnaire (mHAQ) score. We evaluated the parameters at baseline and weeks 12, 24, and 52.

Results: The change in SJC, TJC, VAS, mHAQ, and DAPSA had no significant difference at weeks 12, 24, and 52. The improvements of CRP and DAS28-CRP were significantly higher in TNFi group only at week 12. The biologics retention rate was significantly higher in TNFi group by the log-rank test. No critical adverse events occurred.

Conclusions: Our study presented that IL-17Ai had treatment effects comparable to TNFi. IL-17Ai might have the potential to become an alternative to the previous drug, but more large-scale studies are expected.
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http://dx.doi.org/10.1177/23094990211012286DOI Listing
May 2021

Changes in the shoulder muscle activities and glenohumeral motion after rotator cuff repair: an assessment using ultrasound real-time tissue elastography.

J Shoulder Elbow Surg 2021 Apr 22. Epub 2021 Apr 22.

Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan.

Background: Although rotator cuff repair is performed to restore the function of the rotator cuff muscles and glenohumeral (GH) joint motion, little has been known regarding the recovery process. The purpose of this study was (1) to investigate changes over time in activities of the supraspinatus and deltoid muscles assessed by ultrasound real-time tissue elastography (RTE) after rotator cuff repair and (2) to determine contributions of the activities of these muscles to the GH joint motion.

Methods: Twenty patients after rotator cuff repair and 13 control participants were enrolled in this study. Elasticity of the supraspinatus and middle deltoid muscles were measured at rest and 30° of humerothoracic elevation in the scapular plane (scaption) by using RTE. The elasticity at 30° of scaption was normalized to that at rest in each muscle to quantify their muscle activities. In addition, the supraspinatus-to-middle deltoid (SSP/MD) ratio for the normalized elasticity was calculated. The GH elevation angle was measured with a digital inclinometer, which was calculated by subtracting the scapular upward rotation angle from 30° of scaption. For patients after rotator cuff repair, all measurements were performed at 6 weeks, 8 weeks, 3 months, and 6 months after surgery. Rotator cuff integrity was examined with magnetic resonance imaging at 6 months after surgery.

Results: Fifteen of 20 patients who remained intact at 6 months after surgery completed this study. The supraspinatus activity at 6 weeks was significantly smaller than that at 3 months (P = .006) and 6 months (P = .010). There was no significant difference in the supraspinatus activity between the patients at 3 months and the control participants (P = .586). The middle deltoid activity at 6 weeks was significantly greater than that at 6 months (P = .003). There was positive correlation between GH elevation angle and the activity of the supraspinatus relative to the deltoid at 6 weeks (r = 0.75, P = .001) and 8 weeks (r = 0.53, P = .041).

Conclusion: The supraspinatus activity increased from 6 weeks to 3 months after surgery. The supraspinatus activity at 3 months after surgery was the same level as that in healthy individuals. On the other hand, the deltoid activity decreased from 6 weeks to 6 months after surgery. The increase in activity of the supraspinatus relative to the deltoid was likely to be related to the increase in GH elevation during postoperative 8 weeks.

Level Of Evidence: Level IV; Case Series; Treatment Study.
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http://dx.doi.org/10.1016/j.jse.2021.04.013DOI Listing
April 2021

Skeletal muscle-specific Keap1 disruption modulates fatty acid utilization and enhances exercise capacity in female mice.

Redox Biol 2021 Apr 5;43:101966. Epub 2021 Apr 5.

Department of Gene Expression Regulation, IDAC, Tohoku University, Sendai, 980-8575, Japan. Electronic address:

Skeletal muscle health is important for the prevention of various age-related diseases. The loss of skeletal muscle mass, which is known as sarcopenia, underlies physical disability, poor quality of life and chronic diseases in elderly people. The transcription factor NRF2 plays important roles in the regulation of the cellular defense against oxidative stress, as well as the metabolism and mitochondrial activity. To determine the contribution of skeletal muscle NRF2 to exercise capacity, we conducted skeletal muscle-specific inhibition of KEAP1, which is a negative regulator of NRF2, and examined the cell-autonomous and non-cell-autonomous effects of NRF2 pathway activation in skeletal muscles. We found that NRF2 activation in skeletal muscles increased slow oxidative muscle fiber type and improved exercise endurance capacity in female mice. We also observed that female mice with NRF2 pathway activation in their skeletal muscles exhibited enhanced exercise-induced mobilization and β-oxidation of fatty acids. These results indicate that NRF2 activation in skeletal muscles promotes communication with adipose tissues via humoral and/or neuronal signaling and facilitates the utilization of fatty acids as an energy source, resulting in increased mitochondrial activity and efficient energy production during exercise, which leads to improved exercise endurance.
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http://dx.doi.org/10.1016/j.redox.2021.101966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050939PMC
April 2021

Morphological and Morphometrical Analyses of Fracture-Healing Sites of an Atypical Femoral Fracture in Patients with and without Long-Term Bisphosphonate Treatment for Osteoporosis: A Report of Two Cases.

Tohoku J Exp Med 2021 04;253(4):261-267

Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine.

Bisphosphonates have been the first drug of choice for osteoporosis in the recent years because of their known ability to suppress osteoclast activity. The adverse effect of long-term bisphosphonate administration in the fracture-healing process is controversial. The aim of our study was to observe not only morphology but also morphometry of the fracture site of atypical femoral fracture with and without long-term bisphosphonate administration, in a case study of two difficult-to-obtain human samples. The patients with insufficient healing of atypical femoral fracture were treated with valgus wedge osteotomy. Histomorphometrical analysis was performed in bone samples of fracture sites harvested during osteotomy. The thickness of the femoral cortex was measured in the fracture site and the adjacent, non-fracture site. A comparative analysis of the content of hypertrophic osteoclasts in fracture sites, shape and size of osteons, mass, and ratio of the woven bone to the total bone mass was performed, comparing bisphosphonate-treated and untreated samples. In bisphosphonate-treated samples, we observed femoral cortex thickening at the fracture site; the appearance of hypertrophic osteoclasts; decreased bone resorption surface, decreased osteoclast numbers on the bone resorption surface, and increased ratio of multinuclear osteoclasts; osteons were misshapen and thin; and the mass and ratio of the woven bone to the total bone mass were higher. This study demonstrated that long-term bisphosphonate administration can alter the morphological features of the fracture site compared to its physiological state.
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http://dx.doi.org/10.1620/tjem.253.261DOI Listing
April 2021

Treatment of irreparable rotator cuff tears with superior capsular reconstruction.

J Exp Orthop 2021 Mar 27;8(1):23. Epub 2021 Mar 27.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.

The treatment of irreparable rotator cuff tears with severe muscle atrophy and fatty infiltration remains a challenge, especially in young patients. Many surgical procedures for these tears have been reported. No one surgical treatment has proven to be an optimal solution. Recently, reconstruction of the superior capsule with an allograft or autograft has gained popularity. In this manuscript, we reviewed the biomechanical and clinical reports that have assessed superior capsular reconstruction and clarified the issues about the surgical techniques and indication which have been discussed recently. Reconstruction of the superior capsule has shown promising early results with good clinical outcomes. Biomechanical studies have suggested various mechanisms of this procedure. Although good clinical results and biomechanical data are available, more research is necessary to further define the surgical indications and improve the surgical outcomes of this procedure. LEVEL OF EVIDENCE: Level V.
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http://dx.doi.org/10.1186/s40634-021-00342-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997932PMC
March 2021

Characteristics of Parents Who Feel a Lack of Communication with Coaches of Youth Sports.

Tohoku J Exp Med 2021 03;253(3):191-198

Department of Medicine and Science in Sports and Exercise, Tohoku University School of Medicine.

Communication between parents and their children's coaches is important for children's sports activities, but the relationship between parents and coaches is not well understood. It is possible that parents feel a lack of communication with coaches, which could be due to parents' experience with sports activities or the social environment of the team. This study aimed to elucidate the characteristics of parents who feel a lack of communication with their children's coaches of youth sports. A cross-sectional study was conducted on parents of young athletes (n = 6,641) and multivariate logistic regression analyses were performed to assess factors related to parents' feeling of a lack of communication with their children's coaches. Among the respondents, 29.4% of parents felt a lack of communication with their children's coaches. The factors related to the parents' feeling were a shorter duration of their children playing the present sport, an absence of experience playing the same sport as their children or playing in a team with high competition level, dissatisfaction with their children's attitude towards sports activities, and an awareness of verbal and/or physical abuse by the coaches and bullying by the teammates in their children's team. Parents' previous sports experience and awareness of interpersonal violence in their children's team were associated with their feeling of a lack of communication with coaches. Educating parents on the sport and their roles in youth sport is necessary to make appropriate mutual communication between parents and coaches, which could lead to better circumstances for young athletes.
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http://dx.doi.org/10.1620/tjem.253.191DOI Listing
March 2021

Validation and reliability of a Japanese version of the Simple Shoulder Test: a cross-sectional study.

JSES Int 2021 Mar 15;5(2):334-337. Epub 2020 Dec 15.

Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan.

Background: The Simple Shoulder Test (SST) is a widely used patient-reported outcome assessment. The purpose of this study was to develop and validate a Japanese version of the SST (SST-Jp).

Methods: A two-stage observational study was conducted to validate the cross-cultural adaptation of the SST. A total of 100 patients with shoulder disorders completed the SST-Jp; the Disability of Arm, Shoulder, and Hand assessment; and the Medical Outcomes Short-Form 36 (SF-36) at an initial visit. Thirty-four of the patients repeated the SST-Jp one week after the first examination. The test-retest reliability was quantified using the interclass correlation coefficient, and Cronbach's alpha (α) was calculated to assess internal consistency. Construct validity was assessed using Spearman's rank correlation coefficient.

Results: The internal consistency of the SST-Jp was very high (α = 0.826). The interclass correlation coefficient of the SST-Jp was also high (0.859). There was a strong, positive correlation between the Disability of Arm, Shoulder, and Hand and the SST-Jp (r = 0.717, < .001). The SST-Jp was significantly correlated with most of the SF-36 subscales. The correlations of the SST-Jp with physical subscales of the SF-36 were stronger than those with the other subscales.

Conclusions: The SST-Jp was found to be a valid and reliable measurement for shoulder joint pain and function assessment among the Japanese population.
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http://dx.doi.org/10.1016/j.jseint.2020.10.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910716PMC
March 2021

Differences in scapular motion and parascapular muscle activities among patients with symptomatic and asymptomatic rotator cuff tears, and healthy individuals.

JSES Int 2021 Mar 15;5(2):238-246. Epub 2020 Dec 15.

Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan.

Background: Altered scapular motion is thought to be one of the factors associated with the development of symptomatic rotator cuff tears. However, the differences in kinematics and muscle activities of scapular upward/downward rotation between patients with symptomatic and asymptomatic tears are unclear. The purpose of this study was to compare the differences in kinematics and muscle activities of scapular rotation among patients with symptomatic and asymptomatic tears, and healthy individuals.

Methods: Twenty-three patients with rotator cuff tears and 9 healthy individuals (healthy group) participated in this study. Based on a visual analog scale (VAS, 0-100 mm), the patients were divided into symptomatic (13 patients; VAS ≥20 mm) and asymptomatic (10 patients; VAS <20 mm) groups. Scapular upward rotation was measured with a digital inclinometer. Elasticities of the upper trapezius, levator scapulae, and rhomboid major were assessed by using ultrasound real-time tissue elastography to quantify their muscle activities. All measurements were performed at 0°, 60°, 90°, and 120° of active arm elevation in the scapular plane.

Results: Scapular upward rotation was significantly less in the symptomatic group (9.4° ± 5.6°) compared with the asymptomatic group (15.7° ± 6.0°;  = .022) at 90° of arm elevation. The activity of the levator scapulae was significantly higher in the symptomatic group compared with the asymptomatic and healthy groups ( = .013 and  = .005, respectively) at 90° of arm elevation. The activity of the upper trapezius was significantly higher in the symptomatic group compared with the healthy group ( = .015) at 120° of arm elevation.

Conclusion: Patients with symptomatic rotator cuff tears showed less scapular upward rotation and higher activity of the levator scapulae at 90° of arm elevation compared to patients with asymptomatic rotator cuff tears.
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http://dx.doi.org/10.1016/j.jseint.2020.10.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910733PMC
March 2021

Clinical Features of Ulnar Tunnel Syndrome and the Diagnostic Value of Nerve Conduction Measurements.

Prog Rehabil Med 2021 13;6:20210010. Epub 2021 Feb 13.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.

Objectives: The purposes of this study were to assess the clinical features of ulnar tunnel syndrome (UTS) and to investigate the diagnostic value of nerve conduction measurements for UTS.

Methods: Eighteen patients with UTS were reviewed retrospectively. Fifteen patients had intrinsic muscle atrophy and motor weakness, and 15 had numbness with hypesthesia. The compound muscle action potentials (CMAPs) from the first dorsal interosseous (FDI) muscle and the abductor digiti minimi (ADM) muscle and the sensory nerve action potential (SNAP) from the little finger were recorded and analyzed. All patients underwent ulnar tunnel release surgery and neurolysis. Static two-point discrimination test results and pinch strengths were assessed before and after surgery.

Results: Before surgery, FDI-CMAP was recorded in 17 patients, and ADM-CMAP in 16, and all showed delayed latency and/or low amplitude. SNAP was recorded in eight patients and two showed delayed latency. The causes of ulnar nerve lesions were ganglion in five patients, traumatic adhesion in four, ulnar artery aberrancy in four, pisohamate arch in three, anomalous muscle in one, and ulnar vein varix in one. The sites of the lesions were in zone 1 of the ulnar tunnel anatomy in 12 patients, in zone 2 in 2, and in zones 1 and 2 in 4. After surgery, all patients obtained recovery of motor function and sensation; however, postoperative FDI-CMAP and ADM-CMAP did not improve to the normal range.

Conclusions: The causes of UTS were ganglion, traumatic adhesion, ulnar artery aberrancy, and pisohamate arch. Both FDI-CMAP and ADM-CMAP were valuable for electrophysiological diagnosis of UTS.
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http://dx.doi.org/10.2490/prm.20210010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882426PMC
February 2021

Association of musculoskeletal pain in other body parts with new-onset shoulder pain: a longitudinal study among survivors of the Great East Japan Earthquake.

BMJ Open 2021 02 15;11(2):e041804. Epub 2021 Feb 15.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.

Objective: Shoulder pain is a common health problem coexisting with other musculoskeletal pain. However, the effects of pre-existing musculoskeletal pain on the development of shoulder pain are not clear. The present study aimed to elucidate the association between coexisting musculoskeletal pain at other body sites and new-onset shoulder pain among survivors of the Great East Japan Earthquake (GEJE).

Design: This is a longitudinal study.

Setting: The study was conducted at the severely damaged coastal areas in Ishinomaki and Sendai cities.

Participants: The survivors who did not have shoulder pain at 3 years after the GEJE were followed up 1 year later (n=2131).

Interventions: Musculoskeletal pain (low back, hand and/or foot, knee, shoulder and neck pain) was assessed using self-reported questionnaires.

Main Outcome Measures: The outcome of interest was new-onset shoulder pain, which was defined as shoulder pain absent at 3 years but present at 4 years after the disaster. The main predictive factor for new-onset shoulder pain was musculoskeletal pain in other body parts at 3 years after the GEJE; this was categorised according to the number of pain sites (0, 1, ≥2). Multiple regression analyses were conducted to calculate the odds ratio (OR) and 95% confidence interval (CI) for new-onset shoulder pain due to musculoskeletal pain in other body parts.

Results: The incidence of new-onset shoulder pain was 6.7% (143/2131). Musculoskeletal pain in other body parts was significantly associated with new-onset shoulder pain. Using the survivors without other musculoskeletal pain as reference, the adjusted OR and 95% CI for new-onset shoulder pain were 1.86 (1.18 to 2.94) for those with one body part and 3.22 (2.08 to 4.98) for those with ≥2 body parts presenting with musculoskeletal pain (p<0.001).

Conclusions: Pre-existing musculoskeletal pain in other body parts was significantly associated with new-onset shoulder pain among survivors; this provides useful information for clinical and public health policies.
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http://dx.doi.org/10.1136/bmjopen-2020-041804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887348PMC
February 2021

Retrospective comparison of the surgical results for patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament: Posterior decompression with instrumented spinal fusion versus modified anterior decompression through a posterior approach.

J Orthop Sci 2021 Feb 7. Epub 2021 Feb 7.

Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University School of Medicine, 1-12-1, Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan.

Background: In Japan, approximately 75% of patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) are treated by posterior decompression with instrumented spinal fusion (PDF) because of its efficacy and safety. To achieve more effective decompression of the spinal cord using a posterior approach, anterior decompression through a posterior approach was developed. However, this technique has a high risk of postoperative paralysis. We have added a couple of ingenuities to this procedure (modified Ohtsuka procedure). This study was performed to report the surgical results of our modified Ohtsuka procedure and to compare them with the results of PDF.

Methods: This was a retrospective case series. From 2008 to 2018, we surgically treated 32 patients: 20 patients treated by PDF (PDF group) and 12 patients by our modified Ohtsuka procedure (modified Ohtsuka group) as the initial surgery. All patients were followed up for at least 12 months. The degree of surgical invasion and patients' neurological condition were assessed.

Results: The operative duration and intraoperative blood loss indicated no significant differences (PDF vs. Ohtuska: 507 ± 103 vs. 534 ± 99 min, 1022 ± 675 vs. 1160 ± 685 ml, respectively). The preoperative Japanese Orthopaedic Association (JOA) score was 4.5 ± 2.0 in the PDF group and 3.3 ± 1.4 in the modified Ohtsuka group (p < 0.05). However, the latest JOA score and recovery rate were significantly better in the modified Ohtsuka group than in the PDF group (8.9 ± 1.2 vs. 7.4 ± 2.5 and 70.8 ± 17.6% vs. 44.5 ± 40.2%, respectively). Postoperative paralysis did not occur in the modified Ohtsuka group while four patients had it in the PDF group.

Conclusions: The present study clearly indicated the modified Ohtsuka group showed significantly better surgical outcomes than the PDF group with the recovery rate ≥70%.
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http://dx.doi.org/10.1016/j.jos.2021.01.001DOI Listing
February 2021

Impact of simultaneous hydrolysis of OCP and PLGA on bone induction of a PLGA-OCP composite scaffold in a rat femoral defect.

Acta Biomater 2021 04 5;124:358-373. Epub 2021 Feb 5.

Division of Craniofacial Function Engineering, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan. Electronic address:

Effect of the simultaneous hydrolysis of octacalcium phosphate (OCP) and poly (lactic-co-glycolic acid) (PLGA) was investigated on its osteoconductivity. PLGA soaked in phosphate buffered saline with 0%, 20%, and 40% OCP at 37°C for eight weeks indicated that when the OCP dose was increased, 1) the weight loss of PLGA increased, 2) the glass transition temperature of the PLGAs decreased, 3) the saturation degree in the saline moved to nearly saturated condition with respect to hydroxyapatite (HA) but was undersaturated with respect to OCP, and 4) OCP tended to convert to HA by X-ray diffraction and Fourier transform infrared spectroscopy. OCP/PLGA composites of 20% and 40% with more than 92% porosity were produced by combining OCP granules with 1,4-dioxane-solubilizing PLGA followed by lyophilization and then subjected to four- and eight-week in vivo implantation tests in 3 mm diameter rat femora defects. Microfocus X-ray computed tomography, histochemical and histomorphometric analyses showed that while bone formation was very limited with PLGA implantation, the extent of repair tended to increase with increasing OCP content in the PLGA, coupled with PLGA degradation, and bridge the defects with trabecular bone. Tartrate-resistant acid phosphatase-positive osteoclast-like cells were accumulated four weeks after implantation, while osteocalcin-positive osteoblastic cells appeared later at eight weeks, especially in 40% OCP/PLGA. These results suggest that OCP hydrolysis, with phosphate ion release, enhances PLGA hydrolysis, probably through the acid catalysis function of the protons supplied during the hydrolysis of OCP, thereby inducing PLGA biodegradation and new bone formation in the femoral defects. STATEMENT OF SIGNIFICANCE: Octacalcium phosphate (OCP) enhances osteoblasts and osteocytes differentiations during its hydrolysis accompanying inorganic ions exchange in this material. The present study found that the advancement of OCP hydrolysis under physiological conditions had an effect on poly (lactic-co-glycolic acid) (PLGA) degradation through its chemical environmental change around OCP, which was ascertained by the decreases in weight loss and glass transition temperature of PLGA with increasing the dose of OCP co-present. Rat femur-penetrated standardized severe defects were found to repair through bridging the cortical region defect margin. PLGA degradation could be enhanced through an acid catalyst function by protons derived from inorganic phosphate (Pi) ions through OCP hydrolysis under bone forming condition, resulting in showing a prominent bone regenerative capacity in OCP/PLGA composite materials.
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http://dx.doi.org/10.1016/j.actbio.2021.01.048DOI Listing
April 2021

Effect of denosumab switched from bisphosphonates in preventing joint destruction in postmenopausal rheumatoid arthritis patients with anti-cyclic citrullinated peptide antibodies.

J Orthop Surg Res 2021 Feb 4;16(1):107. Epub 2021 Feb 4.

Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo machi, Aobaku, Sendai, Miyagi, 980-8574, Japan.

Introduction: This study aimed to determine the effects of denosumab treatment on the joint destruction of Japanese females with rheumatoid arthritis (RA) and anti-cyclic citrullinated peptide (CCP) antibodies.

Materials And Methods: This retrospective longitudinal study included 56 patients treated with denosumab and 50 patients treated with bisphosphonate. All participants were positive for anti-CCP antibodies. All patients also had a history of osteoporosis treatment with bisphosphonate, which was either continued or switched to 60 mg of subcutaneous denosumab injection every 6 months. To assess the progression of joint destruction, hand and foot radiographs were taken, and changes in modified total Sharp score (mTSS), erosion score (ERO), and joint space narrowing score (JSN) were evaluated at 12 months and 24 months. The changes in BMD of the lumbar spine and hip were also assessed at 12 months.

Results: At 12 months, there were significant differences in the change of ERO (p = 0.015) and mTSS (p = 0.01). Similarly, there were significant differences in the change of ERO (p = 0.013) and mTSS (p = 0.003) at 24 months. In contrast, no significant difference was observed in the changes of JSN and clinical parameters. There were significant differences in the changes in BMD in the femoral neck (p = 0.011) and total hip (p = 0.012).

Conclusion: Denosumab treatment might be effective for the inhibition of bone erosion progression in the patients with RA, and it potentially contributes to the treatment of osteoporosis and prevention of destructive arthritis in patients with switching treatment from bisphosphonate.
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http://dx.doi.org/10.1186/s13018-021-02271-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7860620PMC
February 2021

Reply to the Park and Lee regarding: "Effects of joint capsular release on range of motion in patients with frozen shoulder".

J Shoulder Elbow Surg 2021 Apr 10;30(4):e177. Epub 2021 Jan 10.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.

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http://dx.doi.org/10.1016/j.jse.2020.11.020DOI Listing
April 2021

Impact of bone mineral density in reducing fracture risk in patients receiving alendronate plus alfacalcidol therapy.

J Orthop Sci 2020 Dec 22. Epub 2020 Dec 22.

Department of Internal Medicine, Research Institute and Practice for Involutional Diseases, Nagano, Japan.

Backgroud: Changes in bone mineral density (BMD) are a potential surrogate marker for fracture endpoints in clinical trials. However little is known whether the increase in BMD in response to combination treatment with alendronate plus alfacalcidol is associated with fracture risk reduction. We aimed to evaluate the impact of BMD on fracture risk in osteoporosis patients, using the data from the randomized clinical trial comparing alendronate plus alfacalcidol with alendronate alone.

Methods: We selected 412 patients with two or more prevalent vertebral fractures and who had BMD measurements at baseline and after 6, 12, and/or 24 months out of 2022 patients from the database of the Japanese Osteoporosis Intervention Trial. Patients in this subset who received combination treatment with alendronate plus alfacalcidol had shown a lower risk of fracture than patients treated with alendronate alone. We used Poisson regression model analysis to calculate the proportion of treatment effect (PTE) that was attributable to BMD increases in patients receiving combination treatment.

Results: The highest PTE attributable to changes in BMD was 1.2% in patients with a BMD increase of 3% or more in the lumbar spine. For BMD measurements of the radius, the highest PTE was 2.8% with a BMD increase of 0% or more. For BMD measurements of the metacarpal bone, the highest PTE was 1.2% with a BMD increase of 3% or more. In patients with a BMD greater than or equal to 70% of the young adult mean in the lumbar spine, the PTE attributable to BMD was 0.2%. In patients with a BMD greater than or equal to 70% of the young adult mean in the radius, the PTE attributable to BMD was 0.3%.

Conclusions: The additional effects of alfacalcidol in reducing fracture risk do not likely result from increased BMD; other mechanisms remain a possibility.
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http://dx.doi.org/10.1016/j.jos.2020.10.017DOI Listing
December 2020

Does glenoid remodeling occur with an erosion-type bone loss after arthroscopic Bankart repair?

JSES Int 2020 Dec 15;4(4):814-817. Epub 2020 Jul 15.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.

Introduction: Fragment-type glenoid bone loss is known to remodel after arthroscopic Bankart repair. To our knowledge, no studies have been reported about the morphologic changes of the erosion-type bone loss.

Aim: To determine the morphologic changes of erosion-type glenoid bone loss after arthroscopic Bankart repair.

Methods: Twenty-eight patients (mean age: 31 years) with traumatic anterior glenohumeral instability with an erosion-type glenoid bone loss <25% underwent arthroscopic Bankart repair. The minimum follow-up was 2 years. Pre- and postoperative bilateral computed tomography scans were performed in all patients. The width and surface area of the glenoid were measured by a software program and compared pre- and postoperatively.

Results: The recurrence rate was 7.1% (2 of 28 shoulders). The size of the bone loss was 7.2% ± 5.3% (mean ± standard deviation). The preoperative glenoid width and area were 24.9 ± 2.2 mm and 7.0 ± 0.8 cm, respectively, and the postoperative ones (2 years after surgery) were 24.7 ± 2.2 mm and 6.8 ± 0.8 cm, respectively. There were no significant differences between the pre- and postoperative glenoid width and area.

Discussion And Conclusion: Unlike the fragment-type bone loss, the erosion-type bone loss <25% did not show any morphologic changes of the glenoid at least 2 years after arthroscopic Bankart repair.
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http://dx.doi.org/10.1016/j.jseint.2020.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738447PMC
December 2020

Surgical results of nonambulatory patients caused by ossification of the posterior longitudinal ligaments in the thoracic spine: retrospective comparative study between posterior decompression and instrumented spinal fusion versus anterior decompression through a posterior approach.

J Neurosurg Spine 2020 Dec 11:1-6. Epub 2020 Dec 11.

2Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan.

Objective: Thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) remains one of the most difficult-to-treat disorders for spine surgeons. In Japan, approximately 75% of patients with this condition are treated using posterior decompression with instrumented spinal fusion (PDF). In contrast, anterior decompression is the most effective method for relieving spinal cord compression. The authors treated nonambulatory patients with thoracic OPLL by either PDF or by their technique using anterior decompression through a posterior approach. In this study the surgical results of these procedures are compared.

Methods: This was a retrospective case series. From 2008 to 2018, 9 patients with thoracic OPLL who could not walk preoperatively were treated surgically. Three patients were treated by PDF (the PDF group) and 6 patients were treated by anterior decompression through a posterior approach (the modified Ohtsuka group). The degree of surgical invasion and the neurological conditions of the patients were assessed.

Results: The PDF group had a shorter operative duration (mean 477 ± 122 vs 569 ± 92 minutes) and less intraoperative blood loss (mean 613 ± 380 vs 1180 ± 614 ml), although the differences were not statistically significant. The preoperative Japanese Orthopaedic Association (JOA) score was almost identical between the two groups; however, the latest JOA score and the recovery rate were significantly better in the modified Ohtsuka group than in the PDF group (8.8 ± 1.5 vs 5.0 ± 1.7 and 71.3% ± 23.7% vs 28.3% ± 5.7%, respectively). The walking ability was evaluated using the modified Frankel scale. According to this scale, 3 patients showed three grade improvements, 2 patients showed two grade improvements, and 1 patient showed one grade improvement in the modified Ohtsuka group. Three patients in the modified Ohtsuka group could walk without any support at the final follow-up.

Conclusions: The present study clearly indicated that the surgical outcomes of the authors' modified Ohtsuka procedure were significantly better than those of PDF for patients who could not walk preoperatively.
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http://dx.doi.org/10.3171/2020.7.SPINE20411DOI Listing
December 2020

A 5-year Longitudinal Study of Low Back Pain in Survivors of the Great East Japan Earthquake.

Spine (Phila Pa 1976) 2021 May;46(10):695-701

Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan.

Study Design: A longitudinal panel study.

Objective: The aim of this study was to examine the occurrence of low back pain (LBP), especially the association of previous LBP with further episodes of LBP, in survivors of the Great East Japan Earthquake (GEJE) during the course of 5 years.

Summary Of Background Data: LBP is common among survivors of natural disasters, but its long-term course is not clear.

Methods: A 5-year longitudinal study was conducted among survivors of the GEJE (n = 1821). The presence of LBP was assessed using a self-reported questionnaire at 2, 4, and 7 years after the disaster (termed the first, second, and third time points, respectively). Multiple logistic regression analysis was performed to assess a potential association between LBP at the first and second time points with LBP at the third time point, and the odds ratios (ORs) and 95% confidence intervals (CI) were calculated.

Results: The prevalence of LBP was 25.3%, 27.3%, and 27.2% at the first, second, and third time points, respectively. The occurrence of LBP at the first time point was significantly associated with LBP at the third time point, and the adjusted odds ratio (OR) (95% confidence interval [CI]) was 5.47 (4.28-6.98). Furthermore, LBP at the first and second time points was significantly associated with LBP at the third time point. Compared to no LBP at the first and second time points, the adjusted OR (95% CIs) for LBP at the third time point was 4.12 (3.14-5.41) in the case of LBP at either of the first or second time points and 10.73 (7.80-14.76) for LBP at both time points (P for trend < 0.001).

Conclusion: Previous LBP was associated with LBP 5 years later among survivors of the GEJE. Furthermore, the effect on subsequent LBP was stronger with a higher frequency of previous LBP episodes.Level of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000003860DOI Listing
May 2021

Mitochondrial dysfunction underlying sporadic inclusion body myositis is ameliorated by the mitochondrial homing drug MA-5.

PLoS One 2020 2;15(12):e0231064. Epub 2020 Dec 2.

Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.

Sporadic inclusion body myositis (sIBM) is the most common idiopathic inflammatory myopathy, and several reports have suggested that mitochondrial abnormalities are involved in its etiology. We recruited 9 sIBM patients and found significant histological changes and an elevation of growth differential factor 15 (GDF15), a marker of mitochondrial disease, strongly suggesting the involvement of mitochondrial dysfunction. Bioenergetic analysis of sIBM patient myoblasts revealed impaired mitochondrial function. Decreased ATP production, reduced mitochondrial size and reduced mitochondrial dynamics were also observed in sIBM myoblasts. Cell vulnerability to oxidative stress also suggested the existence of mitochondrial dysfunction. Mitochonic acid-5 (MA-5) increased the cellular ATP level, reduced mitochondrial ROS, and provided protection against sIBM myoblast death. MA-5 also improved the survival of sIBM skin fibroblasts as well as mitochondrial morphology and dynamics in these cells. The reduction in the gene expression levels of Opa1 and Drp1 was also reversed by MA-5, suggesting the modification of the fusion/fission process. These data suggest that MA-5 may provide an alternative therapeutic strategy for treating not only mitochondrial diseases but also sIBM.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231064PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710105PMC
January 2021

Joint hemorrhage accelerates cartilage degeneration in a rat immobilized knee model.

BMC Musculoskelet Disord 2020 Nov 19;21(1):761. Epub 2020 Nov 19.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.

Background: Joint hemorrhage is caused by trauma, ligament reconstruction surgery, and bleeding disorders such as hemophilia. Recurrence of hemorrhage in the joint space induces hemosiderotic synovitis and oxidative stress, resulting in both articular cartilage degeneration and arthropathy. Joint immobilization is a common treatment option for articular fractures accompanied by joint hemorrhage. Although joint hemorrhage has negative effects on the articular cartilage, there is no consensus on whether a reduction in joint hemorrhage would effectively prevent articular cartilage degeneration. The purpose of this study was to investigate the effect of joint hemorrhage combined with joint immobilization on articular cartilage degeneration in a rat immobilized knee model.

Methods: The knee joints of adult male rats were immobilized at the flexion using an internal fixator from 3 days to 8 weeks. The rats were randomly divided into the following groups: immobilized blood injection (Im-B) and immobilized-normal saline injection (Im-NS) groups. The cartilage was evaluated in two areas (contact and non-contact areas). The cartilage was used to assess chondrocyte count, Modified Mankin score, and cartilage thickness. The total RNA was extracted from the cartilage in both areas, and the expression of metalloproteinase (MMP)-8, MMP-13, interleukin (IL)-1β, and tumor necrosis factor (TNF)-α was measured by quantitative real-time polymerase chain reaction.

Results: The number of chondrocytes in the Im-B group significantly decreased in both areas, compared with that in the Im-NS group. Modified Mankin score from 4 to 8 weeks of the Im-B group was significantly higher than that of the Im-NS group only in the contact area. The expression of MMP-8 and MMP-13 from 2 to 4 weeks and TNF-α from 2 to 8 weeks significantly increased in the Im-B group compared with those in the Im-NS group, but there was no significant difference in IL-1β expression.

Conclusions: The results showed that joint hemorrhage exacerbated immobilization-induced articular cartilage degeneration. Drainage of a joint hemorrhage or avoidance of loading may help prevent cartilage degeneration during joint immobilization with a hemorrhage.
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http://dx.doi.org/10.1186/s12891-020-03795-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678279PMC
November 2020

Bladder perforation by orthopedic implants 26 years after limb-sparing surgery for left proximal femoral chondrosarcoma: A case report.

Int J Surg Case Rep 2020 16;76:441-445. Epub 2020 Oct 16.

Department of Orthopedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Japan.

Introduction: The need for implant use during orthopedic surgeries has been increasing. Accordingly, increased implant failures have been reported. However, bladder perforation remains a rare complication after orthopedic surgery. Although a few reports have described bladder perforation after total hip arthroplasty, no previous studies have reported the migration of staples into the bladder after limb-sparing surgery.

Presentation Of Case: A 65-year-old patient underwent limb-sparing surgery to remove a chondrosarcoma in the left proximal thigh. Twenty-six years after surgery, a staple that had been used to fix artificial ligaments to the pubis migrated to perforate the bladder, resulting in painful urination. The staple was removed, and her symptoms improved.

Discussion: In this case, bladder perforation by the staple resulted in painful urination. The bladder perforation was not detected until 26 years after the initial surgery.

Conclusion: Our observations emphasize that implant complications may occur even after a long postoperative period, and the possibility of delayed bladder perforation from previous pelvic surgeries should be considered in patients presenting with urinary tract symptoms.
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http://dx.doi.org/10.1016/j.ijscr.2020.09.175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586051PMC
October 2020

Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide.

Spine Surg Relat Res 2020 26;4(4):358-364. Epub 2020 Feb 26.

Department of Orthopaedic Surgery, Tohoku University Graduated School of Medicine, Sendai, Japan.

Introduction: Cervical pedicle screw (CPS) fixation provides the strongest mechanical stability. It needs, however, wide soft tissue detachment to expose the entry point and carries the potential risk of iatrogenic damage to neurovascular structures. Malposition of the CPS cannot be completely avoided even using the navigation system.

Technical Note: Using the bone biopsy needle as drill guide, we developed a novel accurate CPS insertion technique. (1) The entry point of CPS was exposed using Southwick's technique for anterior fixation or Tokioka's technique for posterior fixation. (2) A 13G bone biopsy needle was inserted from the entry point established by the fluoroscopy-assisted pedicle axis view technique described by Yukawa et al. to within a few millimeters of the pedicle. (3) The external sleeve of the bone biopsy needle was left in place as a drill guide, and the 1.25 mm guidewire for a 4.0 mm cannulated screw was then inserted into the pedicle cavity. (4) The external sleeve of the bone biopsy needle was removed, and the screw trajectory was created by a 2.7 mm cannulated drill bit over the guidewire. (5) Tapping was conducted prior to CPS insertion. Using this method, 29 CPSs in nine patients were inserted. Postoperative computed tomography scans revealed that all the CPSs were placed accurately.

Conclusions: Utilizing the bone biopsy needle as drill guide, our procedure enables accurate positioning of CPS without expensive instruments.
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http://dx.doi.org/10.22603/ssrr.2019-0114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661024PMC
February 2020

Obesity is a risk factor for osteoarthritis progression and spontaneous osteoporosis is a risk for the development of spontaneous osteonecrosis in patients with medial meniscus posterior root tear.

J Orthop Sci 2020 Oct 5. Epub 2020 Oct 5.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi Prefecture, 980-8574, Japan.

Background: Obesity is a representative risk factor for osteoarthritis (OA). The relationship between osteoporosis and executed osteonecrosis has been reported. The primary aim of this study was to determine the influence of obesity and osteoporosis on disease progression in patients with medial meniscus posterior root tear (MMPRT).

Methods: We included 41 knees with MMPRT in this study. MMPRT was diagnosed based on the presence of both a meniscus ghost sign and a vertical linear defect on MRI. OA progression and development of osteonecrosis were evaluated using plain radiographs obtained at the initial visit and the final follow-up. The follow-up period for all knees was 30 ± 8 (mean ± standard deviation) months. Patients' physical attributes were assessed at initial visits; these attributes included body mass index (BMI) and the clinical risk for osteoporotic fracture, as determined by the World Health Organization fracture risk assessment tool (FRAX). Patients with a BMI ≥25 kg/m were classified in the obesity group and those with a BMI <25 kg/m in the control group. Patients with a FRAX score of ≥10% were classified in the high FRAX group and those with a FRAX score of <10% in the low FRAX group.

Results: OA progression evaluated by Kellgren-Lawrence grading scale was observed in 75% patients in the obesity group (1 grade in 38%, 2 grades in 31%, and 3 grades in 6%) and 58% in the control group (1 grade in 58%). Patients in the obesity group showed significantly greater OA progression. Spontaneous osteonecrosis was observed in no knees at the initial visit and six knees at the final follow-up. All six lesions were observed in the high FRAX group, which was statistically significant.

Conclusions: OA progression and development of osteonecrosis were the two representative deterioration patterns in patients with MMPRT. High BMI was related with OA progression, and FRAX score of ≥10% with the development of osteonecrosis.
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http://dx.doi.org/10.1016/j.jos.2020.09.001DOI Listing
October 2020

Effects of arthroscopic pancapsular release for proximal humeral fractures treated with intramedullary nailing: a retrospective study.

JSES Int 2020 Sep 29;4(3):546-550. Epub 2020 May 29.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.

Background: Proximal humeral fractures are one of the most common fractures in adults. Some patients treated operatively have restriction in range of motion (ROM) after surgery. This study aimed to evaluate arthroscopic pancapsular release in patients with severe stiffness after treatment with intramedullary nailing for proximal humeral fractures.

Methods: This study included 12 patients (7 women and 5 men) who underwent arthroscopic pancapsular release in the beach-chair position between May 2015 and February 2018. Intraoperative findings were recorded, and ordinary (with scapulothoracic motion) and true (without scapulothoracic motion) glenohumeral ROMs were measured with a goniometer. The American Shoulder and Elbow Surgeons shoulder score, Shoulder Rating Scale score of the University of California, Los Angeles scoring system, and Constant score were compared before and after the release. The Wilcoxon signed rank and Mann-Whitney tests were used to analyze data.

Results: The average age of the patients was 65.1 years (standard deviation, 9.5 years), and the mean follow-up period after the release was 30.6 months (standard deviation, 11.7 months). All ROMs on the affected side after surgery were significantly greater than those before surgery in all directions. However, ROMs in forward flexion, lateral elevation, and external rotation with the arm at the side and at 90° of forward flexion on the affected side postoperatively were significantly lower than those on the unaffected side. All scores were significantly greater after surgery than before surgery.

Conclusion: Arthroscopic pancapsular release is effective for patients with proximal humeral fractures treated with intramedullary nailing.
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http://dx.doi.org/10.1016/j.jseint.2020.03.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479035PMC
September 2020

Tocilizumab Was Effective in Repairing the Large Geode in a Patient with Rheumatoid Arthritis.

Case Rep Rheumatol 2020 24;2020:8899391. Epub 2020 Aug 24.

Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

Rheumatoid arthritis is characterized by multiple chronic arthritis subsequently inducing joint destruction. Although subchondral geode is a well-known feature of high-disease activity, a large geode is rare. Moreover, the treatment effect of biologic agents in the repair of large geode has not been reported. The present report shows the significant effect of interleukin-6 receptor blocker, tocilizumab, in repairing the large geode in the left humeral lateral epicondyle. This case implies that tocilizumab might be an effective treatment in patients with rheumatoid arthritis even with large geode.
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http://dx.doi.org/10.1155/2020/8899391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468654PMC
August 2020

Validation and reliability of a Japanese version of the Shoulder Pain and Disability Index: A cross-sectional study.

J Orthop Sci 2020 Aug 20. Epub 2020 Aug 20.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.

Background: The Shoulder Pain and Disability Index (SPADI) is a simple disease specific questionnaire that is used to evaluate the impact of shoulder disorders. The purpose of this study was to translate the SPADI into Japanese (SPADI-Jp) and evaluate its reliability and validity in Japanese patients with shoulder disorders.

Methods: Cross-cultural adaptation of the SPADI was performed according to international guidelines. A total of 100 patients with shoulder disorders participated in this study. Each participant was asked to finish the SPADI-Jp, Disability of Arm, Shoulder and Hand (DASH), and the Short-Form 36 (SF-36) at the initial visit. Thirty-four patients repeated the SPADI-Jp to assess the test-retest reliability. The test-retest reliability was quantified using the interclass correlation coefficient (ICC), while Cronbach's alpha was calculated to assess the internal consistency. The construct validity was assessed using Spearman's rank correlation coefficients.

Results: Internal consistency in the SPADI-Jp was very high (0.969), as measured by the Cronbach's alpha. The ICC of the SPADI-Jp was 0.930. There was a strong, positive correlation between the DASH and the SPADI-Jp (r = 0.837, p < 0.001). The SPADI-Jp was significantly correlated with most of the SF-36 subscales. The correlations of the SPADI-Jp with physical subscales of the SF-36 were stronger than those with the other subscales.

Conclusions: We demonstrated that the SPADI-Jp is a reliable and valid self-assessment tool. Because cross-cultural adaptation, validation, and reliability of the disease-specific questionnaire for shoulder pain and disability have not been evaluated in Japan, the SPADI-Jp can be useful for evaluating such patients in the Japanese population.
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http://dx.doi.org/10.1016/j.jos.2020.06.007DOI Listing
August 2020

Bach1 promotes muscle regeneration through repressing Smad-mediated inhibition of myoblast differentiation.

PLoS One 2020 10;15(8):e0236781. Epub 2020 Aug 10.

Department of Biochemistry, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

It has been reported that Bach1-deficient mice show reduced tissue injuries in diverse disease models due to increased expression of heme oxygenase-1 (HO-1)that possesses an antioxidant function. In contrast, we found that Bach1 deficiency in mice exacerbated skeletal muscle injury induced by cardiotoxin. Inhibition of Bach1 expression in C2C12 myoblast cells using RNA interference resulted in reduced proliferation, myotube formation, and myogenin expression compared with control cells. While the expression of HO-1 was increased by Bach1 silencing in C2C12 cells, the reduced myotube formation was not rescued by HO-1 inhibition. Up-regulations of Smad2, Smad3 and FoxO1, known inhibitors of muscle cell differentiation, were observed in Bach1-deficient mice and Bach1-silenced C2C12 cells. Therefore, Bach1 may promote regeneration of muscle by increasing proliferation and differentiation of myoblasts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236781PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416950PMC
October 2020

Low Back Pain in School-Aged Martial Arts Athletes in Japan: A Comparison among Judo, Kendo, and Karate.

Tohoku J Exp Med 2020 08;251(4):295-301

Department of Medicine and Science in Sports and Exercise, Tohoku University School of Medicine.

Martial arts, such as judo, kendo, and karate, are popular worldwide, not only among adults but also among children and adolescents. Although low back pain (LBP) is considered to be a common problem in these sports, it has been scarcely studied, especially in young athletes. The purpose of this study was to elucidate the point prevalence of and factors related to LBP among school-aged athletes in judo, kendo, and karate. A cross-sectional study was conducted in school-aged athletes (age, 6-15 years; n = 896) using a self-reported questionnaire. Multiple logistic regression models were used to assess the factors related to LBP along with the odds ratio (OR) and 95% confidence interval (95% CI). Variables included in the analysis were sex, age, body mass index, team level, number of days and hours of training, frequency of participation in games, practice intensity, and lower extremity pain. The prevalence of LBP was 6.9% in judo, 4.7% in kendo, and 2.9% in karate. Older age was significantly associated with LBP in judo (adjusted OR, 2.12 [95% CI, 1.24-3.61]), kendo (1.77 [1.27-2.47]), and karate (2.22 [1.14-4.33]). Lower extremity pain was significantly associated with LBP in judo (6.56 [1.57-27.34]) and kendo (21.66 [6.96-67.41]). Coaches should understand the characteristics of LBP in each martial art to develop strategies to prevent LBP among school-aged martial arts athletes.
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http://dx.doi.org/10.1620/tjem.251.295DOI Listing
August 2020

Downsizing effect of a modular radial head prosthesis on the lateral collateral ligament of the elbow: A cadaveric study.

Clin Biomech (Bristol, Avon) 2020 12 30;80:105140. Epub 2020 Jul 30.

Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.

Background: It remains unclear how the head and stem diameters for the radial head prosthesis could affect mechanical properties of the lateral collateral ligament measured by strain changes during elbow and forearm motions.

Methods: Eight cadaveric specimens were secured to the device, which allows elbow flexion-extension and forearm pro-supination. Using six different implant combinations comprising 2 sizes for the head (long- and short-axis of the native head) and 3 sizes for the stem (press-fit, -1 mm, and -2 mm downsizing), prostheses were attached via the posterior approach. A differential variable reluctance transducer placed on the central portion of the radial collateral ligament were used for strain measurement with elbow flexion at 0°, 30°, 60°, and 90°. At each position, the strain patterns with the forearm in the neutral and 45° pro-supination positions were also assessed.

Findings: Specimens implanted with long-axis head component showed greater increases in the ligament strain during elbow flexion than intact specimens or those implanted with short-axis head. Compared to press-fit stem, implants with downsizing to -1 mm approximated strain patterns during pro-supination with elbow extension to intact condition.

Interpretation: Morphologic variation of the head and stem components in radial head prostheses led to altered strain patterns in the lateral collateral ligament during elbow and forearm motions. A short-axis head component can be used to prevent excessive strain changes after the prosthesis application. Downsizing of the stem component might be an option for approximating the biomechanics at the radiocapitellar joint during forearm rotation to the intact elbow.
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http://dx.doi.org/10.1016/j.clinbiomech.2020.105140DOI Listing
December 2020