Publications by authors named "Koichi Nakagawa"

104 Publications

Diltiazem-associated photodistributed hyperpigmentation with abundant immature melanosome leakage into the dermis.

J Dermatol 2021 May 24. Epub 2021 May 24.

Department of Dermatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.

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http://dx.doi.org/10.1111/1346-8138.15960DOI Listing
May 2021

Skip decompression surgeries in the treatment of holospinal epidural abscess: a case report.

Spinal Cord Ser Cases 2021 May 13;7(1):38. Epub 2021 May 13.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan.

Introduction: Holospinal epidural abscess (HEA) extending from the cervical to the lumbosacral spine is an extremely rare condition. Surgical treatment of HEA, which involves extensive decompression of the spinal lesion is difficult in emergency settings. However, the authors successfully treated a case of HEA in critical condition with severe neurological deficits through a combination of skip decompression surgeries and catheter irrigation.

Case Presentation: A 73-year-old man complained of neck and back pain and developed muscle weakness in the upper and lower extremities (C5 AIS D tetraplegia). When he was transferred to our hospital, a marked increase in leukocytes (13330/μL) and C-reactive protein levels (32.11 mg/dL) was observed. Magnetic resonance imaging (MRI) revealed a HEA extending from C1 to S2 levels. Therefore, an emergency posterior decompression on C4-5 and T4-7 was performed, followed by catheter irrigation using a venous catheter. Blood and intraoperative isolated microorganisms were identified as Streptococcus intermedius, which is a rare cause of spinal infection. He experienced marked improvement in pain after surgery. Two months after surgery, the epidural abscess completely disappeared. Motor weakness gradually improved, and he was able to walk without support and showed no pain recurrence during the final follow-up (20 months after surgery).

Discussion: Early diagnosis is important for the treatment of HEAs. Therefore, a whole spine MRI is recommended when an extensive spinal epidural abscess is suspected. Decompression surgery at limited spine levels followed by catheter irrigation should be considered in patients with HEA.
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http://dx.doi.org/10.1038/s41394-021-00401-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119455PMC
May 2021

Dietary C-3102 Supplementation Enhances the Exclusion of from Chickens.

J Poult Sci 2021 Apr;58(2):138-145

School of Life Science and Technology, Tokyo Institute of Technology, Yokohama, Kanagawa, Japan.

Among the reported probiotic strains, C-3102 has the unique potential to improve feed uptake under stress conditions in the broilers, piglets, and cows. In this study, we sought to evaluate the protective effect of feed additive probiotic C-3102 against infection of specific pathogen-free (SPF) chicks in floor pens in two experiments. In the experiment-1, the chicks in the control group (=32) were fed a basal diet and those in the C-3102 group (=32) were fed a basal diet supplemented with 1×10 CFU/g of feed for 28 days. On day 7 post-challenge with , there was no significant change in the body weight between both the groups throughout the test period, whereas detection rates of in the C-3102 group were significantly lower in the cecum and liver on days 21 and 14 post-challenge, respectively. In the experiment-2, minimum dosage of C-3102 cells required to protect infection was evaluated using 3 dosages. Chicks were divided into four groups, fed with different dosages of C-3102 (1×10, 5×10, 3×10, and 0 CFU/g of feed), and challenged with (2.8×10 CFU/chicken). infection was completed within 7 days post- challenge and was almost excluded from the liver and spleen on day 21 post- challenge in the control group. Average values showed a trend for higher infection rates in the control group >3×10>5×10>1×10 CFU/g on days 14 and 21 post-challenge. These results suggest that C-3102 supplementation has the potential to reduce infection rates and/or to accelerate the exclusion of from the chicks.
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http://dx.doi.org/10.2141/jpsa.0200036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076624PMC
April 2021

Rapidly destructive coxopathy due to dialysis amyloidosis: a case report.

Mod Rheumatol Case Rep 2021 Apr 15:1-5. Epub 2021 Apr 15.

Department of Orthopaedic Surgery and Rheumatology, Toho University Sakura Medical Center, Chiba, Japan.

Rapidly destructive coxopathy (RDC) is a disease that is sometimes seen in geriatric patients. A total hip arthroplasty (THA) is mostly chosen to treat the RDC, but few cases are known that received THAs due to RDC associated with dialysis amyloidosis. We report a case of RDC due to dialysis amyloidosis with special references to its pathophysiology. The case involved a 61-year-old male who had been on dialysis for seven years due to diabetic nephropathy. At his first visit, the radiographs showed collapse and flattening of the femoral head, which progressed within a month. Magnetic resonance imaging for the hip disclosed bone marrow edoema of the acetabulum and sclerosis of the subchondral bone of the femoral head. Biochemical analyses for the blood revealed high inflammatory reactions with elevated C-reactive protein and white blood cell count, but the joint fluid cultures were negative for general bacteria, tubercle bacillus, and nontuberculous mycobacteria. As he did not have gastrointestinal disorders or inflammatory arthritis other than the left hip and no disease that caused elevated inflammatory reactions was observed, we diagnosed the patient with RDC due to dialysis amyloidosis, and a THA was performed. Pathological findings for the synovium collected during surgery showed infiltration of the inflammatory mononuclear cells and vascular hyperplasia. The synovial tissues were extensively stained with an antibody to β2-microglobulin. Many tartrate-resistant acid phosphatase-positive multinucleated cells were also observed in the synovium. One year after surgery, his left hip pain disappeared and he returned to work.
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http://dx.doi.org/10.1080/24725625.2021.1912888DOI Listing
April 2021

Three-year clinical and radiological results of a cruciate-retaining type of the knee prosthesis with anatomical geometry developed in Japan.

BMC Musculoskelet Disord 2021 Mar 3;22(1):241. Epub 2021 Mar 3.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan.

Background: The FINE total knee was developed in Japan and clinical use began in 2001. It has unique design features, including an oblique 3 femorotibial joint line that reproduces anatomical geometry. Although 20 years have passed since the FINE knee was clinically used for the first time in Japan, a formal clinical evaluation including patient-reported and radiographic outcomes has not been undertaken.

Methods: A total of 175 consecutive primary cruciate-retaining (CR)-FINE total knee arthroplasties (TKAs) at our hospital between February 2015 and March 2017 were included in this study. Three years postoperatively, range of motion (ROM), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score (FJS) were recorded and compared with preoperative scores. Radiographic analyses including mechanical alignment, component alignment, and incidence of radiolucent lines also were undertaken based on the radiographs 3 years postoperatively.

Results: One-hundred twenty-two knees (70%) were available for 3-year follow-up data using KOOS, except for the sports subscale. Postoperative KOOS-symptom, -pain and -ADL were > 85 points, but KOOS-sports, -QOL and FJS were less satisfactory. ROM, KSS and all the subscales of KOOS were significantly improved compared with preoperative scores. Postoperative mean FJS was 66 and was significantly correlated with all the subscales of KOOS, but not with postoperative ROM. Radiolucent lines ≧1 mm wide were detected in five knees (4.1%). There were no major complications needing revision surgeries.

Conclusions: Patient-reported outcomes (PROs) for symptoms, pain and ADL after the CR-FINE TKA were generally improved, but those for sports, QOL and FJS were improved less. The incidence of radiolucent lines was rare but detected around the femoral components. With the mid- to long-term follow-up, improvements of surgical technique will be necessary to achieve better PROs from patients receiving the FINE knee.
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http://dx.doi.org/10.1186/s12891-021-04114-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927405PMC
March 2021

Characteristics of relief and residual low back pain after discectomy in patients with lumbar disc herniation: analysis using a detailed visual analog scale.

BMC Musculoskelet Disord 2021 Feb 11;22(1):167. Epub 2021 Feb 11.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan.

Background: Several authors have reported favorable results in low back pain (LBP) for patients with lumbar disc herniation (LDH) treated with discectomy. However, detailed changes over time in the characteristics and location of LBP before and after discectomy for LDH remain unclear. To clarify these points, we conducted an observational study to determine the detailed characteristics and location of LBP before and after discectomy for LDH, using a detailed visual analog scale (VAS) bilaterally.

Methods: We included 65 patients with LDH treated by discectomy in this study. A detailed VAS for LBP was administered with the patient under 3 different conditions: in motion, standing, and sitting. Bilateral VAS was also administered (affected versus opposite side) for LBP, lower extremity pain (LEP), and lower extremity numbness (LEN). The Oswestry Disability Index (ODI) was used to quantify clinical status. Changes over time in these VAS and ODI were investigated. Pfirrmann grading and Modic change as seen by magnetic resonance imaging (MRI) were reviewed before and 1 year after discectomy to determine disc and endplate condition.

Results: Before surgery, LBP on the affected side while the patients were in motion was significantly higher than LBP while they were sitting (p = 0.025). This increased LBP on the affected side in motion was improved significantly after discectomy (p < 0.001). By contrast, the residual LBP while sitting at 1 year after surgery was significantly higher than the LBP while they were in motion or standing (p = 0.015). At 1 year following discectomy, residual LBP while sitting was significantly greater in cases showing changes in Pfirrmann grade (p = 0.002) or Modic type (p = 0.025).

Conclusions: Improvement of LBP on the affected side while the patient is in motion suggests that radicular LBP is improved following discectomy by nerve root decompression. Furthermore, residual LBP may reflect increased load and pressure on the disc and endplate in the sitting position.
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http://dx.doi.org/10.1186/s12891-021-04015-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879619PMC
February 2021

Influence of Spondylolysis on Clinical Presentations in Patients With Lumbar Degenerative Disease.

Cureus 2021 Jan 8;13(1):e12570. Epub 2021 Jan 8.

Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN.

Background: There is insufficient current information regarding the prognosis of patients with lumbar spondylolysis when bone union is not achieved. To examine the number, age, and surgically treated levels of patients with lumbar degenerative disease who underwent lumbar spine surgery, and to compare the results between patients with spondylolysis and without spondylolysis, a cross-sectional study was performed.

Methods: Patients with degenerative lumbar disease who underwent lumbar spine surgery were retrospectively reviewed (n=354). The prevalence of spondylolysis was determined using CT images. Patients were divided into a spondylolysis group and a non-spondylolysis group, and the patients' age, sex, and surgically treated levels were compared between the two groups.

Results: The prevalence of lumbar spondylolysis in the 354 patients was 6.50% (23/354). The patients' age was significantly lower in the spondylolysis group (54.2 ± 13.5 years) than in the non-spondylolysis group (63.8 ± 14.2). The number of surgically treated levels was significantly lower in the spondylolysis group (1.33 ± 0.56 levels) than in the non-spondylolysis group (1.70 ± 0.87). The percentage of patients who underwent surgery at L5-S1 was significantly higher in the spondylolysis group; whereas the percentage of patients who underwent surgery at L3-L4 or L4-L5 was significantly higher in the non-spondylolysis group.

Conclusions: Our results suggest that the presence of spondylolysis may not increase the incidence of degenerative lumbar spinal disorders requiring spinal surgery. However, spondylolysis patients frequently have severe degenerative disease at one level caudal to the spondylolysis, and infrequently have multilevel lumbar degenerative disease requiring spinal surgery.
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http://dx.doi.org/10.7759/cureus.12570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863028PMC
January 2021

Good response to methotrexate is associated with a decrease in the gene expression of ABCG2, a drug transporter, in patients with rheumatoid arthritis.

Mod Rheumatol 2021 Feb 9:1-12. Epub 2021 Feb 9.

Division of Rheumatology, Department of Internal Medicine, Toho University (Ohashi Medical Center), Tokyo, Japan.

Objectives: Methotrexate (MTX) is used as an anchor drug in the treatment of rheumatoid arthritis (RA), although more than a half of the patients with RA require additional treatments. We designed a prospective study involving two medical centers in Japan to examine the association between the expression of MTX-related genes including a drug transporter ATP-binding cassette sub-family G member 2 (ABCG2) gene and the clinical response to MTX in MTX-naive patients with RA.

Methods: The primary endpoint of this study was good response based on the European League Against Rheumatism (EULAR) response criteria by Disease Activity Score using 28-joint count (DAS28). We evaluated the association between the baseline expression of six genes involved in the intracellular pharmacokinetics of MTX, including ABCG2, as well as their temporal changes, and the clinical response at week 12 from the initiation of MTX.

Results: Based on the clinical response at 12 weeks after the initiation of MTX, 24 patients were classified into good responders ( = 9) and non-good responders ( = 15; 10 moderate responders and 5 non-responders) groups. A univariate logistic regression analysis of the baseline gene expression levels to predict the EULAR good response at week 12 showed a significant association with expression alone. Furthermore, the rate of baseline expression of mRNA above the cut-off value determined using a receiver operating characteristic curve was higher in good responders than in non-good responders ( = .012). Moreover, expression decreased in almost all good responders, but not in non-good responders, after MTX treatment for 12 weeks (median -76% vs. +41% from baseline, respectively;  = .011). The expression level did not correlate with DAS28 at baseline or week 12.

Conclusions: Our study revealed that good response to MTX is associated with a decrease in the expression of in patients with RA.
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http://dx.doi.org/10.1080/14397595.2021.1879429DOI Listing
February 2021

Influence of Preoperative Difference in Lumbar Lordosis Between the Standing and Supine Positions on Clinical Outcomes After Single-Level Transforaminal Lumbar Interbody Fusion: Minimum 2-Year Follow-Up.

Spine (Phila Pa 1976) 2021 Jan 22. Epub 2021 Jan 22.

Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan Department of Orthopaedic Surgery, Sawara Prefectural Hospital, Katori, Chiba, Japan Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.

Study Design: Retrospective cohort study.

Objective: To investigate whether a preoperative difference in lumbar lordosis (D-LL) between the standing and supine positions is associated with clinical outcomes after transforaminal lumbar interbody fusion (TLIF).

Summary Of Background Data: Several factors have been reported to be associated with surgical outcomes after TLIF. However, the association between preoperative D-LL and clinical outcomes after TLIF is unknown.

Methods: We enrolled 45 lumbar degenerative disease patients (mean age: 65.7 ± 11.3 years old; 24 male) treated with single-level TLIF. Surgical outcomes were assessed using Oswestry disability index, visual analog scale (VAS; low back pain (LBP), lower-extremity pain, numbness, LBP in motion, in standing, and in sitting), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Japanese Orthopaedic Association score for intermittent claudication (JOA score), and Nakai's scoring system. The preoperative D-LL between the standing radiograph and computed tomography (CT) in the supine position was defined as LL in supine CT-standing radiograph. Patients were divided into two groups according to D-LL value (D-LL > -4°, and D-LL ≤ -4°). Clinical outcomes were compared between the groups, and correlations between preoperative D-LL and clinical outcomes were analyzed.

Results: There were no significant differences in preoperative clinical parameters between the two groups. Postoperative VASs for lower extremity pain, numbness, LBP in standing, and JOA score in D-LL > -4° group were significantly worse than in the D-LL ≤ -4° group (P < 0.05). Preoperative D-LL showed a weak correlation with postoperative lower extremity pain and numbness (P < 0.05).

Conclusions: This study revealed that lumbar degenerative disease patients, who have greater preoperative kyphotic lumbar alignment in the standing versus supine position, tend to have postoperative residual symptoms after TLIF. A preoperative comparison of lateral radiographs between the standing and supine positions is useful to predict patients' postoperative residual symptoms.Level of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000003955DOI Listing
January 2021

Time Course of Changes in Serum Oxidative Stress Markers to Predict Outcomes for Surgical Treatment of Lumbar Degenerative Disorders.

Oxid Med Cell Longev 2020 24;2020:5649767. Epub 2020 Dec 24.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura City, Chiba 285-8741, Japan.

Recent reports indicate that oxidative stress is involved in the pathobiology of acute spinal cord injury or compression myelopathy. We conducted an observational study to determine levels of oxidative stress markers in serum from 80 patients who underwent spinal surgery to treat neurological symptoms related to lumbar degenerative disorders. Serum samples were collected before surgery and at 3 months, 6 months, and 1 year after surgery. Derivatives of reactive oxygen metabolites (ROM) in the serum samples were measured to gauge the level of oxidative stress. For preoperative neurological evaluation, patients were assessed for motor weakness in the lower extremities. We divided the patient samples into two groups: ROM decreasing at 1 year after surgery (G group) and ROM increasing at 1 year after surgery (W group). Then, we evaluated clinical outcomes using the visual analog scale and Oswestry disability index (ODI). Among the samples from the 80 enrolled patients, mean ROM levels before surgery increased to 388.5 ± 92.0, indicating the presence of moderate oxidative stress. The level of ROM gradually decreased after surgery and 1 year after surgery: the levels had significantly decreased to 367.6 ± 83.3 ( < 0.05). In patients who exhibited motor weakness, ROM values were significantly increased compared to those patients who had no motor weakness ( < 0.05). In analyses of clinical outcomes, ODI values for the W group 1 year after surgery were significantly higher than those for the G group ( < 0.05). Moderate oxidative stress was present in patients who had lumbar degenerative disorders and the degree of oxidative stress gradually improved within 1 year after surgery. The clinical results suggest that neurogenic oxidative stress can be mitigated by surgery for patients with lumbar degenerative disorders, and residual oxidative stress reflects poor surgical outcomes.
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http://dx.doi.org/10.1155/2020/5649767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775168PMC
December 2020

Age-Specific Characteristics of Lumbopelvic Alignment in Patients with Spondylolysis: How Bilateral L5 Spondylolysis Influences Lumbopelvic Alignment During the Aging Process.

World Neurosurg 2021 Mar 29;147:e524-e532. Epub 2020 Dec 29.

Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Japan.

Background: To elucidate the influence of spondylolysis on age-related lumbar degenerative changes, age-specific lumbopelvic alignment in patients with or without spondylolysis was examined.

Methods: Sagittal reconstructed computed tomography images of the lumbar spine in consecutive patients (n = 581) undergoing computed tomography scans of abdominal or lumbar regions for reasons other than low back disorders were obtained. Lumbar lordosis (LL), L5-S1 angle, and sacral slope (SS) were measured. Lumbopelvic parameters in patients with or without spondylolysis were evaluated in 3 age groups (<50, 50-69, and ≥70). The influence of bilateral L5 spondylolysis (L5-lysis) and L5 vertebral slip on each lumbopelvic parameter, as well as correlation between cross-sectional area (CSA) of paraspinal muscles and the degree of vertebral slip, were examined by multiple regression analysis.

Results: Patients with bilateral spondylolysis showed greater LL and SS than patients without spondylolysis. When analyzing the influence of L5-lysis, only elderly patients (≥70) with L5-lysis showed significantly greater LL and SS than nonspondylolysis (nonlysis) patients. L5-lysis patients more frequently showed L5 vertebral slip than nonlysis patients, and a smaller L5-S1 angle was observed when L5 vertebral slip accompanied L5-lysis. The degree of vertebral slip was significantly correlated with CSA of psoas muscles, but not with CSA of paraspinal extensor muscles.

Conclusions: When patients have L5-lysis, lumbar lordosis and pelvic anteversion occurred age dependently. In elderly patients with L5-lysis, L5 vertebral slip with decrease of the L5-S1 angle occurs frequently. The progression of vertebral slip was correlated with atrophy of psoas muscles, but not that of paraspinal extensor muscles.
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http://dx.doi.org/10.1016/j.wneu.2020.12.097DOI Listing
March 2021

Referencing the substitute anteroposterior line of the tibia improves rotational alignment of the tibial component in medial unicompartmental knee arthroplasty.

Knee 2020 Oct 22;27(5):1458-1466. Epub 2020 Aug 22.

Department of Orthopaedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan; Department of Orthopaedic Surgery, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma City, Nara Prefecture 630-0293, Japan.

Background: There is no consensus regarding how best to determine the tibial rotational alignment in unicompartmental knee arthroplasty (UKA). The purpose of this study was to clarify whether using the substitute anteroposterior (sAP) line of the tibia, as has recently been proposed, can improve tibial rotation.

Methods: The study included 57 consecutive medial UKAs. From May 2015 to September 2016, 28 knees in 28 patients underwent UKA using the medial intercondylar ridge (MIR) line as the tibial anteroposterior (AP) reference (MIR group). From October 2016 to March 2018, 29 knees in 29 patients underwent UKA using the sAP line (sAP group). In both groups, the external rotation angle of the tibial component relative to a line perpendicular to the surgical epicondylar axis was measured using computed tomography-based three-dimensional preoperative planning software for TKA and UKA.

Results: The mean external rotation angles of the tibial component in the MIR and sAP groups were 5.2° ± 8.5° (range, -12.4° to 20.8°) and 0.7° ± 3.2° (range, -6.0° to 7.4°), respectively (unpaired t test, P = 0.014). The variation in the external rotation angle of the tibial component was significantly smaller in the sAP group than in the MIR group (F test, P < 0.0001), as was the number of the outliers with more than ±5° error (Fisher's exact test, P < 0.0001).

Conclusions: The use of the sAP line as the AP reference could improve and stabilize the rotational orientation of the tibial component in UKA procedures.
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http://dx.doi.org/10.1016/j.knee.2020.07.086DOI Listing
October 2020

Surgical Treatment for Spinal Tuberculosis without Elevation of Inflammatory Biomarkers at the Initial Visit Mimicking Spinal Metastasis.

Case Rep Orthop 2020 25;2020:8873170. Epub 2020 Aug 25.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, Japan.

Here, we report a case of spinal tuberculosis without elevation of C-reactive protein (CRP) at the initial visit mimicking spinal metastasis. A 70-year-old woman developed progressive paraplegia without a history of injury and came to our hospital for evaluation. Severe compression to the spinal cord with osteolytic destruction of the spinal vertebrae at T6-7 was observed without elevation of CRP. A T4-9 posterior decompression and fusion were performed. Although the pathology revealed no malignant tumor cells, a positron emission tomography-computed tomography (PET-CT) showed upregulation of the thyroid gland and aspiration cytology revealed a thyroid carcinoma. Thus, we diagnosed her with spinal metastases from thyroid carcinoma. Conservative treatment was chosen with the hope of a significant neurologic recovery; however, 9 months after the primary surgery, she returned to our hospital with reprogressive paraplegia. In addition to progression of osteolytic changes to the T5-7 vertebrae, a coin lesion on the right side of the lung and elevation of CRP were observed. Finally, we diagnosed her with spinal tuberculosis based on the results of a CT-guided needle culture. Two-stage surgeries (posterior and anterior) were performed in addition to administering antituberculosis medications. At the 1-year postoperative follow-up evaluation, both neurologic function and laboratory data were improved with T5-9 complete fusion. It is difficult to determine based on imaging findings alone whether osteolytic vertebrae represent spinal metastases or tuberculosis. Even though inflammatory biomarkers, such as CRP, were not elevated, we should consider the possibility of not only spinal metastases but also tuberculosis when planning surgery involving osteolytic vertebrae. In addition, the combination of neurological, imaging, and pathological findings is important for the diagnosis of spinal tuberculosis.
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http://dx.doi.org/10.1155/2020/8873170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471824PMC
August 2020

Delayed surgical site infection after posterior cervical instrumented surgery in a patient with atopic dermatitis: a case report.

J Rural Med 2020 Jul 17;15(3):124-129. Epub 2020 Jul 17.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Japan.

Atopic dermatitis (AD) is one of the known risk factors for infection. The authors report the case of a patient with cervical spondylosis and AD who developed delayed surgical site infection after posterior cervical instrumented surgery. A 39-year-old male presented to our hospital with paralysis of the left upper extremity without any cause or prior injury. He had a history of severe AD. We performed C3-C7 posterior decompression and instrumented fusion based on the diagnosis of cervical spondylotic amyotrophy. One year after surgery, his deltoid and bicep muscle strength were fully recovered. Nevertheless, his neck pain worsened 2 years after surgery following worsening of AD. One month after that, he developed severe myelopathy and was admitted to our hospital. Radiographic findings showed that all the screws had loosened and the retropharyngeal space had expanded. Magnetic resonance imaging and computed tomography showed severe abscess formation and destruction of the C7/T1 vertebrae. We diagnosed him with delayed surgical site infection. Methicillin-resistant was identified on abscess culture. The patient responded adequately to treatment with antibiotic therapy and two debridements and the infection subsided. We should consider the possibility of delayed surgical site infection when conducting instrumented spinal surgery in patients with severe AD.
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http://dx.doi.org/10.2185/jrm.2020-006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369410PMC
July 2020

Surgical Treatment for Central Sleep Apnea due to Occipitocervical Compression Myelopathy in a Patient with Klippel-Feil Syndrome.

World Neurosurg 2020 09 15;141:232-235. Epub 2020 Jun 15.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Chiba, Japan.

Background: Central sleep apnea (CSA) due to occipitocervical compression myelopathy is an extremely rare condition. Here we report a case of surgical treatment for CSA due to occipitocervical compression myelopathy in a patient with Klippel-Feil syndrome.

Case Description: A 60-year-old man had become aware of a gradually progressive clumsiness and gait disturbance without any cause of injury 5 years before. He had complicated respiratory discomfort during sleep for the previous month and visited our hospital. Neurologic examination revealed severe myelopathy. Polysomnography showed CSA and Cheyne-Stokes respiration. Imaging findings showed C2-3 vertebral fusion and severe spinal cord compression caused by hypoplasia of the C1 posterior arch complicated by an anomaly of the vertebral artery. We diagnosed the patient with CSA due to occipitocervical compression myelopathy complicated by Klippel-Feil syndrome. After a simulation using a full-scale 3-dimensional model, resection of the C1 posterior arch and C4-5 laminoplasty was performed. After surgery, both clumsiness and gait disturbance gradually improved. Polysomnography 1 month after surgery showed that the CSA and the Cheyne-Stokes respiration disappeared.

Conclusions: Although a recent report has indicated the cause of sleep apnea in patients with rheumatoid arthritis and occipitocervical disorders as obstructive sleep apnea, a significant improvement of CSA was observed with decompression surgery in this case. Appropriate surgical planning resulted in a favorable outcome.
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http://dx.doi.org/10.1016/j.wneu.2020.06.059DOI Listing
September 2020

Prevalence of lumbar spondylolysis and spondylolisthesis in patients with degenerative spinal disease.

Sci Rep 2020 04 21;10(1):6739. Epub 2020 Apr 21.

Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.

Lumbar spondylolysis generally occurs in adolescent athletes. Bony union can be expected with conservative treatment, however, the fracture does not heal in some cases. When the fracture becomes a pseudoarthrosis, spondylolysis patients have the potential to develop isthmic spondylolisthesis. A cross-sectional study was performed to determine the incidence of spondylolysis and spondylolisthesis, and to elucidate when and how often spondylolisthesis occurs in patients with or without spondylolysis. Patients undergoing computed tomography (CT) scans of abdominal or lumbar regions for reasons other than low back pain were included (n = 580). Reconstruction CT images were obtained, and the prevalence of spondylolysis and spondylolisthesis were evaluated. Of the 580 patients, 37 patients (6.4%) had spondylolysis. Of these 37 patients, 19 patients (51.4%) showed spondylolisthesis, whereas only 7.4% of non-spondylolysis patients showed spondylolisthesis (p < 0.05). When excluding unilateral spondylolysis, 90% (18/20) of spondylolysis patients aged ≥60 years-old showed spondylolisthesis. None of the patients with isthmic spondylolisthesis had received fusion surgery, suggesting that most of these patients didn't have a severe disability requiring surgical treatment. Our results showed that the majority of bilateral spondylolysis patients aged ≥60 years-old show spondylolisthesis, and suggest that spondylolisthesis occurs very frequently and may develop at a younger age when spondylolysis exists.
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http://dx.doi.org/10.1038/s41598-020-63784-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174286PMC
April 2020

Extra-articular synovial osteochondroma of the Hoffa's fat pad involving the patellar tendon: A case report and literature review.

Mol Clin Oncol 2020 Apr 18;12(4):355-357. Epub 2020 Feb 18.

Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan.

Synovial osteochondroma (SO) is a relatively uncommon tumor affecting the synovial joints that is characterized by the development of hyaline cartilage from the synovial membrane. The basic pathophysiology of SO is thought to be the metaplastic change of the synovium to hyaline cartilage. Large extra- or para-articular lesions in the Hoffa's fat pad are relatively uncommon. A 56-year-old woman complained of knee pain associated with a large lesion on the anterior of the right knee. She also had restricted range of motion in the knee. Examination revealed an elastic hard 8x9-cm lesion involving the patellar tendon. Computed tomography and magnetic resonance imaging demonstrated a mosaic-intensity mass lesion in the inferior side of the Hoffa's fat pad as well as the patellar tendon. The patient underwent needle biopsy. Histological analysis revealed a solitary SO. There were no atypical features suggestive of malignancy and the mass was resected marginally. The patient had no recurrence or knee functional disorder 3 years postoperatively. There are no reports of SO involving the patellar tendon with restriction of range of motion. Removal of the mass lesion for management for SO, as in the present case, is unusual. To the best of our knowledge, this is the first case of extra-articular SO in the Hoffa's fat pad involving the patellar tendon causing a restriction of range of motion of the knee. Marginal surgical resection improved knee function.
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http://dx.doi.org/10.3892/mco.2020.1998DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057915PMC
April 2020

Surgical treatment for atlantoaxial rotatory fixation in an adult with spastic torticollis: A case report.

J Clin Neurosci 2020 May 13;75:225-228. Epub 2020 Mar 13.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba 285-8741, Japan. Electronic address:

Atlantoaxial rotatory fixation (AARF) in an adult without any trauma is an extremely rare condition. Here we report a case of surgical treatment for existing atlantoaxial rotatory fixation in an adult with spastic torticollis. A 50-year-old man had become aware of torticollis without any cause of injury 6 weeks before he visited our hospital, where he presented with a one-week history of severe neck pain. Based on the local and imaging findings, we diagnosed him as having existing AARF of Fielding classification type I. The AARF was not reduced by 3 weeks of Glisson traction. Thus, we performed C1-C2 posterior fusion surgery 3 months after his initial visit. Although CT findings just after surgery showed that the C1-2 facet subluxation was reduced, the complaint of torticollis was not improved, with scoliosis at the middle to lower cervical level because of left sternocleidomastoid hypertonia. Administration of diazepam was initiated 2 weeks after surgery and botulinum toxin injections to the left sternocleidomastoid were added 2 months after surgery under the neurological diagnosis of spastic torticollis. As a result, the complaint of his torticollis was significantly improved 3 months after surgery. There were no relapses of the torticollis and complete fusion of the C1-C2 laminae was observed at the 2-year final follow-up. Surgical treatment for AARF in an adult should be considered if the diagnosis of AARF is delayed. In addition, appropriate treatment for spastic torticollis applied after surgery resulted in a favorable outcome of this case.
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http://dx.doi.org/10.1016/j.jocn.2020.03.017DOI Listing
May 2020

Predicting clinical outcomes after total knee arthroplasty from preoperative radiographic factors of the knee osteoarthritis.

BMC Musculoskelet Disord 2020 Jan 6;21(1). Epub 2020 Jan 6.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-city, Chiba, 285-8741, Japan.

Background: Total knee arthroplasty (TKA) is the major surgical treatment for end-stage osteoarthritis (OA). Despite its effectiveness, there are about 20% of patients who are dissatisfied with the outcome. Predicting the surgical outcome preoperatively could be beneficial in order to guide clinical decisions.

Methods: One-hundred and ten knees of 110 consecutive patients who underwent TKAs for varus knees resulting from OA were included in this study. Preoperative varus deformities were evaluated by femorotibial angle (FTA), medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA), and classified as a severe varus (SV) or a mild varus (MV) group. The osteophyte score (OS), which we developed originally, was also calculated based on the size of the osteophytes and classified as groups with more or less osteophytes. We compared preoperative and 1-year postoperative range of motion, the Knee Society Score, and Japanese Knee injury Osteoarthritis Outcome Score (KOOS) between SV and MV groups (varus defined by FTA, MPTA, or LDFA), in each group with more or less osteophytes.

Results: When varus deformities were defined by FTA, regardless of OS, postoperative KOOS subscales and/or the improvement rates were significantly higher in the SV group than in the MV group. When varus defined by MPTA, regardless of OS, there were no significant differences in postoperative KOOS subscales between groups. However, when varus defined by LDFA, scores for pain, activities of daily living (ADL), and quality of life (QOL) on postoperative KOOS and/or the improvement rates were significantly higher in the SV group than in the MV group only in patients with less osteophytes. No significant differences were found between groups in patients with more osteophytes.

Conclusions: We classified OA types by radiographic measurements of femur and tibia in combination with OS. Postoperative patient-reported outcomes were better in patients with SV knees but were poor in patients with knees with MV deformity and less osteophytes.
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http://dx.doi.org/10.1186/s12891-019-3029-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945497PMC
January 2020

Serum levels of reactive oxygen metabolites at 12 weeks during tocilizumab therapy are predictive of 52 weeks-disease activity score-remission in patients with rheumatoid arthritis.

BMC Rheumatol 2019 16;3:48. Epub 2019 Dec 16.

1Department of Orthopaedics, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741 Japan.

Background: To verify whether serum levels of reactive oxygen metabolites (ROM) are predictive of future clinical remission in patients with rheumatoid arthritis (RA) receiving tocilizumab (TCZ) therapy.

Methods: A total of 46 patients with RA receiving TCZ therapy were enrolled in this study. Patients were divided into remission and non-remission groups based on disease activity score 28 (DAS28)-erythrocyte sedimentation rate (ESR) or clinical disease activity index (CDAI) at 52 weeks. Associations between serum levels of ROM, C-reactive protein (CRP), and matrix metalloproteinase-3 (MMP-3) at 4 and 12 weeks and the remission by DAS28-ESR and CDAI at 52 weeks were investigated.

Results: There were no significant differences in CRP and MMP-3 between DAS- or CDAI-remission and non-remission groups at 12 weeks. However, ROM in DAS-remission group were significantly lower than those in the non-remission group. For ROM, the area under the curve of the receiver operating characteristic curve was 0.735 and the cut-off value that distinguished DAS-remission group from non-remission group was 305.5 U. Carr (sensitivity: 70.0%, specificity: 72.2%). A multivariate logistic regression analysis revealed that ROM at 12 weeks was associated with DAS-remission at 52 weeks (odds ratio: 6.067, 95% confidence interval: 1.305-28.203).

Conclusion: Serum levels of ROM at 12 weeks during TCZ therapy may be predictive of DAS-remission at 52 weeks in patients with RA.
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http://dx.doi.org/10.1186/s41927-019-0096-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912997PMC
December 2019

Serum oxidative stress influences neurological recovery after surgery to treat acutely worsening symptoms of compression myelopathy: a cross-sectional human study.

BMC Musculoskelet Disord 2019 Dec 7;20(1):589. Epub 2019 Dec 7.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Center 564-1, Shimoshizu, Sakura, Chiba, 285-8741, Japan.

Background: Recent reports indicate that oxidative stress induced by reactive oxygen species is associated with the pathobiology of neurodegenerative disorders that involve neuronal cell apoptosis. Here we conducted a cross-sectional study to evaluate serum levels of oxidative stress in cervical compression myelopathy.

Methods: Thirty-six serum samples were collected preoperatively from patients treated for acutely worsening compression myelopathy (AM) and chronic compression myelopathy (CM). Serum levels of oxidative stress markers were evaluated by measuring derivatives of reactive oxygen metabolites (ROM), which reflect concentrations of hydroperoxides. ROM in healthy individuals range from 250 to 300 (U. CARR), whereas ROM >340-400 and > 400 define moderate and severe levels of oxidative stress, respectively. Difference of ROM by the cause of disorders whether cervical spondylotic myelopathy (CSM) or cervical ossification of longitudinal ligament (OPLL), correlations between ROM and patient age, body mass index (BMI), history of smoking, existence of diabetes were examined. Neurological evaluations according to Japanese Orthopaedic Association (JOA) scores were performed and correlated with ROM.

Results: ROM increased to 349.5 ± 54.8, representing a moderate oxidative stress, in CM samples. ROM increased to 409.2 ± 77.9 in AM samples, reflecting severe oxidative stress which were significantly higher than for CM samples (p < 0.05). There was no significant difference by the cause of disorders (CSM or OPLL). ROM were significantly increased in AM serum samples from female patients versus AM male and CM patients (p < 0.05). There were no correlations between ROM and age, BMI, history of smoking, and existence of diabetes. A negative correlation between ROM and recovery rate of JOA score (R = 0.454, p = 0.047) was observed in the AM group.

Conclusions: Although moderate oxidative stress was present in patients with CM, levels of oxidative stress increased in severity in patients with AM. These results suggest that postsurgical neurological recovery is influenced by severe oxidative stress in AM.
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http://dx.doi.org/10.1186/s12891-019-2966-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898939PMC
December 2019

Intradural metastasis to the cauda equina found as the initial presentation of breast cancer: a case report.

J Med Case Rep 2019 Jul 20;13(1):220. Epub 2019 Jul 20.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba, 285-8741, Japan.

Background: Intradural extramedullary spinal metastasis is a relatively rare condition. Furthermore, there are few reports with the initial presentation being a neurological symptom from an intradural metastasis. We report a case of a patient with metastasis to the cauda equina from breast cancer found due to neurological symptoms as the initial presentation.

Case Presentation: A 76-year-old Japanese woman who was previously healthy presented to our hospital with bilateral severe buttock and lower extremity pain without any history of injury. A solitary intradural cauda equina mass was found by magnetic resonance imaging at the L2/3 level, and we suspected a schwannoma initially. The patient hoped to undergo surgery due to the severe pain. However, the chest computed tomographic scan obtained to assess the patient's general status showed the suspected breast cancer of the left side and a lung metastasis. Hence, we considered the possibility of cauda equina tumor metastatic from the breast cancer. We performed an L1-3 laminectomy and tumor extirpation. The pathology revealed adenocarcinoma. After surgery, she had relief from pain, and her status remained satisfactory until she died 9 months after surgery.

Conclusions: It is difficult to clarify whether the cauda equina tumor is benign or malignant based only on Magnetic resonance imaging findings. Clinicians should consider the possibility of metastasis when planning the surgery for intradural cauda equina tumor extirpation.
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http://dx.doi.org/10.1186/s13256-019-2155-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642473PMC
July 2019

Case of low-grade neuroendocrine carcinoma of the skin presenting metastases to lymph nodes and peritoneum.

J Dermatol 2019 Aug 17;46(8):720-723. Epub 2019 Jun 17.

Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.

A 61-year-old Japanese man had a gradually growing, red-colored nodule in his umbilicus from 3 years ago. He had no symptoms such as hot flush, diarrhea or wheezing. Computed tomography detected a 3.0 cm × 3.0 cm enhanced nodule on the umbilical portion, inguinal and axillary lymph node swelling, and peritoneal nodules. Upper and lower gastrointestinal endoscopy and cystoscopy did not show any other tumor. We resected the umbilical nodule and subjected the inguinal lymph node and peritoneal nodule to biopsy. Histopathological findings indicated that the cutaneous lesion was composed of variously sized nests that included small, monomorphic, round to polygonal cells, mainly in the dermis to the peritoneum. Mitotic figures were scant. The inguinal lymph node and peritoneal nodule were positive for metastasis. Immunohistochemistry was diffusely positive for cytokeratin (CK)-7, CD56, chromogranin A, synaptophysin, estrogen receptor-α, progesterone receptor, GATA3 and carcinoembryonic antigen, and focally positive for mammaglobin and gross cystic disease fluid protein 15. The Ki-67 labeling index was 1.5%. The patient was diagnosed with a case of low-grade neuroendocrine carcinoma of the skin (LGNECS) occurring on the umbilicus. This case exhibited distant peritoneal metastasis, as well as inguinal and axillary lymph node metastases; however, the patient is alive without chemotherapy at 23 months after the first visit. LGNECS is a newly proposed, extremely rare entity that has been reported under various names, including primary cutaneous carcinoid tumor. In the present case, this tumor shows a slow-growing nature and favorable prognosis, even though it harbors metastatic potential.
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http://dx.doi.org/10.1111/1346-8138.14985DOI Listing
August 2019

Unilateral laminectomy for bilateral decompression improves low back pain while standing equally on both sides in patients with lumbar canal stenosis: analysis using a detailed visual analogue scale.

BMC Musculoskelet Disord 2019 Mar 4;20(1):100. Epub 2019 Mar 4.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba, 285-8741, Japan.

Background: Unilateral laminectomy for bilateral decompression (ULBD) for lumbar spinal stenosis (LSS) is a less invasive technique compared to conventional laminectomy. Recently, several authors have reported favorable results of low back pain (LBP) in patients of LSS treated with ULBD. However, the detailed changes and localization of LBP before and after ULBD for LSS remain unclear. Furthermore, unsymmetrical invasion to para-spinal muscle and facet joint may result in the residual unsymmetrical symptoms. To clarify these points, we conducted an observational study and used detailed visual analog scale (VAS) scores to evaluate the characteristics and bilateral changes of LBP and lower extremity symptoms.

Methods: We included 50 patients with LSS treated with ULBD. A detailed visual analogue scale (VAS; 100 mm) score of LBP in three different postural positions: motion, standing, and sitting, and bilateral VAS score (approached side versus opposite side) of LBP, lower extremity pain (LEP), and lower extremity numbness (LEN) were measured. Oswestry Disability Index (ODI) was used to quantify the clinical improvement.

Results: Detailed LBP VAS score before surgery was 51.5 ± 32.5 in motion, 63.0 ± 30.1 while standing, and 37.8 ± 31.8 while sitting; and showed LBP while standing was significantly greater than LBP while sitting (p < 0.01). After surgery, LBP while standing was significantly improved relative to that while sitting (p < 0.05), and levels of LBP in the three postures became almost the same with ODI improvement. Bilateral VAS scores showed significant improvement equally on both sides (p < 0.01).

Conclusions: ULBD improves LBP while standing equally on both sides in patients with LCS. The improvement of LBP by the ULBD surgery suggests radicular LBP improved because of decompression surgery. Furthermore, the symmetric improvement of LBP by the ULBD surgery suggests unsymmetrical invasion of the paraspinal muscles and facet joints is unrelated to residual LBP.
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http://dx.doi.org/10.1186/s12891-019-2475-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399850PMC
March 2019

Association between limb alignment and patient-reported outcomes after total knee arthroplasty using an implant that reproduces anatomical geometry.

J Orthop Surg Res 2018 Dec 17;13(1):320. Epub 2018 Dec 17.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan.

Background: A kinematically aligned (KA) total knee arthroplasty (TKA) is expected to improve patient satisfaction, but its effect remains controversial. We investigated differences in patient-reported outcomes (PROs) between KA and non-KA TKAs using an implant that reproduces anatomical geometry.

Methods: TKAs for varus deformity were performed in consecutive 129 patients (149 knees) via a measured resection technique with conventional instruments. The femorotibial angle (FTA), hip-knee-ankle angle (HKAA), and the angle between the joint line and the line perpendicular to the mechanical axis (AJLMA) were measured postoperatively (mean 13.6 months), and an AJLMA of ≥ 2° was defined as kinematic alignment. Patients were assigned to two or three alignment categories in each measurement method, and the Knee Society Scores (KSS) and Japanese Knee Injury and Osteoarthritis Outcome Scores (J-KOOS) was compared among the groups.

Results: For patients assessed by FTA, an ADL-related J-KOOS subscale (J-KOOS-A) showed a significant difference between valgus and varus outliers (p < 0.05). When assessed by HKAA, neither the KSS nor J-KOOS subscales were significantly different among groups. When assessed by AJLMA, J-KOOS-A was significantly different between groups, and a group for AJLMA of ≥ 2° had higher scores than a group for AJLMA of < 2° (95% CI 0.323-7.763; p < 0.05).

Conclusions: Patients with an AJLMA of ≥ 2° reported significantly higher patient's satisfaction regarding ADL. This suggests the importance of restoration of the physiological joint line which can be achieved via KA TKAs.
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http://dx.doi.org/10.1186/s13018-018-1030-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296124PMC
December 2018

Superior graft maturation after anatomical double-bundle anterior cruciate ligament reconstruction using the transtibial drilling technique compared to the transportal technique.

Knee Surg Sports Traumatol Arthrosc 2019 Aug 29;27(8):2468-2477. Epub 2018 Oct 29.

Department of Radiology, Toho University Sakura Medical Center (Chiba), Chiba, Japan.

Purpose: To evaluate and compare the femoral tunnel aperture position, graft bending angle and the magnetic resonance imaging (MRI) graft signal intensity after anatomical double-bundle anterior cruciate ligament (ACL) reconstruction between transtibial and transportal drilling techniques of the femoral tunnel.

Methods: Eighty-seven patients who underwent anatomic double-bundle ACL reconstruction with hamstring tendon autograft between January 2012 and December 2014 were included in this retrospective study. Forty-one patients underwent reconstruction using a transportal technique (TP group) and 46 patients underwent reconstruction using a transtibial technique (TT group). The anteromedial (AM) femoral aperture position and the graft bending angle were assessed using transparent three-dimensional CT 2 weeks postoperatively. MRI assessment was performed with proton density-weighted images in an oblique coronal plane 6 and 12 months postoperatively. Signal/noise quotient was calculated for two specific graft sites (femoral tunnel site and mid-substance site). Femoral aperture position, the graft bending angle and signal/noise quotient were compared between the TP and TT groups.

Results: There was no significant difference in the aperture position between the two groups. The graft bending angle of the AM tunnel in the axial plane was significantly greater in the TP group (p < 0.001). On the other hand, the TP group had a significantly more acute angle in the coronal plane (p < 0.001). There was no significant difference at either site in the signal/noise quotient of the graft between the two groups at 6 months. However, the TT group had a lower signal/noise quotient at 12 months at both sites (femoral aperture: p = 0.04, mid-substance: p = 0.004).

Conclusion: There was a significant difference in signal/noise quotient between the two drilling techniques 12 months postoperatively. There was no significant difference in femoral tunnel aperture position between the two groups. However, graft bending angle at the femoral tunnel aperture was significantly different between the two groups, indicating the possibility that graft bending angle is a factor that influences graft maturation. This indicates that the TT technique has an advantage over the TP technique in terms of graft maturation.
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http://dx.doi.org/10.1007/s00167-018-5240-8DOI Listing
August 2019

Predictive factors for radiographic progression of large joint damage in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs (bDMARDs): Results of 3 to 4 years of follow-up.

Mod Rheumatol 2019 Nov 3;29(6):903-909. Epub 2019 Jan 3.

Departments of Orthopaedics, Toho University Sakura Medical Center, Chiba, Japan.

Little information is available regarding long-term follow-up of radiographic progression of damage (RPD) to large joints during treatment of rheumatoid arthritis (RA) with biological disease-modifying antirheumatic drugs (bDMARDs). We evaluated 3- to 4-year follow-up results and the associations between RPD and patient background and Larsen grade (LG) of joints. Seventy-one RA patients receiving bDMARDs for 3 to 4 years or who achieved bDMARD-free status were included. The mean age and disease duration at the start of bDMARDs were 62.4 years and 10.8 years, respectively. A total of 314 joints, including shoulders, elbows, hips, knees, and ankles, were evaluated to determine whether RPD was present by comparing radiographs before and after treatment. RPD was observed in 24 patients (33.8%) and 34 joints (10.8%). Joints with an LG of III or higher had significantly higher rates of RPD than those with LGs I and II. Multivariate logistic regression analysis revealed that stage and health assessment questionnaire (HAQ) score at 18-months were independent risk factors for RPD (cut-off value: 2.5, odds ratio: 7.222 for stage; cut-off value: 0.9375, odds ratio: 6.278 for HAQ at 18-months). Stage, HAQ at 18-months, and LG at the start of bDMARDs were predictive of RPD after 3 to 4 years. bDMARDs should be started before both stage and LG exceed III and the therapeutic strategy should be determined so that HAQ does not exceed 1.0 during treatment.
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http://dx.doi.org/10.1080/14397595.2018.1532544DOI Listing
November 2019

Surgical treatment for dropped head syndrome with cervical spondylotic amyotrophy: a case report.

BMC Res Notes 2018 Jul 24;11(1):500. Epub 2018 Jul 24.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba, 285-8741, Japan.

Background: Dropped head syndrome (DHS) is a flexion deformity of the neck that is caused by severe weakness of the neck extensor muscles. DHS occurs in combination with not only neuromuscular disorders, but also cervical spondylosis. However, there are few reports of DHS complicated by cervical spondylotic amyotrophy (CSA). Here we report a case of DHS with CSA in a patient who underwent surgical treatment.

Case Presentation: A 79-year-old man became aware of dropped head and gait disturbance in addition to the paralysis of his right upper extremity. At his initial visit, he had a severe chin-on-chest posture. Neurological examination revealed severe paralysis of deltoid, biceps, wrist extensor, finger flexor, extensor, and abductors, in addition to lower extremity spasticity. Nevertheless, sensory dysfunction was not observed. X-ray images showed severe kyphosis at the upper thoracic level. MRI and CT myelography findings revealed spinal canal stenosis at the level of C5-6 and C6 root compression of the right side. Motor neuron disease was excluded because of findings from electromyography. Therefore, we diagnosed this patient as having DHS with cervical spondylotic amyotrophy. A C2-Th5 posterior fusion with C3-C6 laminoplasty and C5-6 foraminotomy on the right side were performed. After surgery, the complaint of dropped head was improved significantly and bilaterally finger motion was improved slightly. His neck position was maintained at the final follow-up at about 1 year after surgery.

Conclusions: Despite the limitation of short-term follow-up, favorable results for the DHS were maintained in the present case. Surgical treatment for similar cases may be a feasible option, but surgery does have some complications.
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http://dx.doi.org/10.1186/s13104-018-3612-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057102PMC
July 2018

Case of infective endocarditis caused by implanted artificial hair pyoderma.

J Dermatol 2019 Jan 20;46(1):e35-e36. Epub 2018 Jun 20.

Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan.

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http://dx.doi.org/10.1111/1346-8138.14499DOI Listing
January 2019

Notch Signaling Enhances Stemness by Regulating Metabolic Pathways Through Modifying p53, NF-κB, and HIF-1α.

Stem Cells Dev 2018 07 30;27(13):935-947. Epub 2018 May 30.

1 Pharmaceutical Research and Technology Institute, Kindai University , Osaka, Japan .

Human adipose-derived mesenchymal stromal cells (hASCs) are attractive for regenerative medicine, but their limited in vitro life span limits their therapeutic applicability. Recent data demonstrate that hypoxia may benefit the ex vivo culture of stem cells. Such cells exhibit a high level of glycolytic metabolism under hypoxic conditions. However, the physiological role of glycolytic activation and its underlying regulatory mechanism are incompletely understood. We have shown that when activated under conditions of 5% O, Notch signaling dramatically increases the rate of glycolysis, improves proliferation efficiency, prevents senescence, and maintains the multipotency of hASCs. In the present study, we found that activated Notch1 enhanced nuclear p65 levels, resulting in an increase in glucose metabolism through the upregulation of glycolytic factors, including GLUT3. Notch signaling was also involved in glucose metabolism through p53 inactivation. We also found that NF-κB signaling was regulated by p53. These data suggest that Notch-HES1 signaling enhances the glycolytic pathway through p53 and NF-κB. Our data also revealed that activated Notch1 markedly increased the transcriptional activity of hypoxia-inducible factor 1 (HIF-1). Knockdown of HIF-1α significantly attenuated glycolysis induced by activated Notch1, indicating that the glycolysis pathway is regulated by the coordination of Notch signaling and HIF. Overall, our observations provide new regulatory mechanisms for the glycolysis by Notch signaling to maintain the stemness of hASCs.
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http://dx.doi.org/10.1089/scd.2017.0260DOI Listing
July 2018