Publications by authors named "Motoyuki Horii"

29 Publications

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Hip fractures among the elderly in Kyoto, Japan: a 10-year study.

Arch Osteoporos 2021 02 12;16(1):30. Epub 2021 Feb 12.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013-2017 compared to 2008-2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85.

Purpose: The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017.

Methods: Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015.

Results: The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65-74, and a decrease in trochanteric fractures in the age group 75-84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85.

Conclusion: In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013-2017) compared to the first half (2008-2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.
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http://dx.doi.org/10.1007/s11657-021-00888-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880939PMC
February 2021

Evaluation of myostatin as a possible regulator and marker of skeletal muscle-cortical bone interaction in adults.

J Bone Miner Metab 2020 Oct 12. Epub 2020 Oct 12.

Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.

Introduction: Bone mass was recently reported to be related to skeletal muscle mass in humans, and a decrease in cortical bone is a risk factor for osteoporosis. Because circulating myostatin is a factor that primarily controls muscle metabolism, this study examined the role of myostatin in bone mass-skeletal muscle mass interactions.

Methods: The subjects were 375 middle-aged community residents with no history of osteoporosis or sarcopenia who participated in a health check-up. Cortical bone thickness and cancellous bone density were measured by ultrasonic bone densitometry in a health check-up survey. The subjects were divided into those with low cortical bone thickness (LCT) or low cancellous bone density (LBD) and those with normal values (NCT/NBD). Bone metabolism markers (TRACP-5b, etc.), skeletal muscle mass, serum myostatin levels, and lifestyle were then compared between the groups.

Results: The percentage of diabetic participants, TRACP-5b, and myostatin levels were significantly higher, and the frequency of physical activity, skeletal muscle mass, grip strength, and leg strength were significantly lower in the LCT group than in the NCT group. The odds ratio (OR) of high myostatin levels in the LCT group compared with the NCT group was significant (OR 2.17) even after adjusting for related factors. Between the low cancellous bone density (LBD) and normal cancellous bone density (NBD) groups, significant differences were observed in the same items as between the LCT and NCT groups, but no significant differences were observed in skeletal muscle mass and blood myostatin levels. The myostatin level was significantly negatively correlated with cortical bone thickness and skeletal muscle mass.

Conclusions: A decrease in cortical bone thickness was associated with a decrease in skeletal muscle mass accompanied by an increase in the blood myostatin level. Blood myostatin may regulate the bone-skeletal muscle relationship and serve as a surrogate marker of bone metabolism, potentially linking muscle mass to bone structure.
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http://dx.doi.org/10.1007/s00774-020-01160-8DOI Listing
October 2020

Usefulness of Electromyography to Predict Future Muscle Weakness in Clinically Unaffected Muscles of Polio Survivors.

PM R 2020 07 16;12(7):692-698. Epub 2020 Jan 16.

Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: Post-polio syndrome-induced muscle weakness may develop in limbs that have had normal muscle strength and have been considered unaffected by polio.

Objective: To investigate the utility of electromyography (EMG) for predicting future muscle weakness in clinically unaffected limb muscles of polio survivors.

Design: Retrospective study.

Setting: Academic polio clinic.

Participants: Polio survivors (N = 77) who underwent EMG between April 2008 and March 2010 and were followed for at least 2 years.

Materials And Methods: Chart reviews were conducted to extract baseline EMG and manual muscle strength test (MMT) results to investigate the relationship between baseline EMG abnormalities and change in muscle strength over 2 years for various upper and lower limb muscles that control movement in the limb joints.

Main Outcome Measurements: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EMG findings for prediction of subsequent muscle weakness.

Results: EMG data were available for 44 deltoid, 59 biceps brachii, 60 triceps brachii, 59 vastus lateralis, 59 tibialis anterior, and 55 gastrocnemius (medial head) muscles. The percentage of muscles with an initial MMT of grade 5 that developed weakness over 2 years of follow-up was approximately 15% for most muscle types. Sensitivity of EMG to predict subsequent weakness was higher in the lower limbs (0.67-1.00). Specificity was higher in the biceps brachii (0.83). PPV was higher in the biceps brachii (0.50). NPV was higher in the lower limbs (0.89-1.00) but lower in the deltoid (0.75).

Conclusion: EMG abnormalities were detected in some clinically normal muscles of polio survivors. EMG abnormalities predicted muscle weakness 2 years later, although the strength of this relationship varied depending on the muscle.
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http://dx.doi.org/10.1002/pmrj.12281DOI Listing
July 2020

Factors associated with falls in Japanese polio survivors.

Disabil Rehabil 2020 06 7;42(13):1814-1818. Epub 2019 Jan 7.

Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

To identify factors associated with falls in Japanese polio survivors and assess the extent of their impact. Subjects were 128 polio survivors. Fall history and fear of falling, lower limb muscle strength, gait ability (determined by walking speed and number of steps per day), post-polio syndrome incidence, and orthosis or walking aid use were assessed, and factors associated with falls were identified using logistic regression analysis. The fall rate was 64%. Fallers (subjects with one or more falls in the preceding 12 months) had low lower limb muscle strength, slow walking speed, high total scores on the Fall Efficacy Scale-International, which assesses fear of falling, and a high orthosis use rate. Knee extension muscle strength on the weaker side was identified as a main factor influencing risk of falls (odds ratio: 0.72, 95% confidence interval: 0.56-0.96). Receiver operating characteristic curve analysis gave a cutoff value for knee extension muscle strength on the weaker side of 0.42 N/kg or lower. Low knee extension muscle strength on the weaker side was associated with falls, but predictive ability using a single internal factor might be poor. It appears that a comprehensive examination, including other factors, is required.Implications for rehabilitationAs polio survivors age, their risk of falling increases.To identify polio survivors who are at risk of falls, it is important to determine the factors associated with falls and their influence on fall risk.The results of this study showed that reduced knee extension muscle strength on the weaker side was a risk factor for falls in polio survivors.To precisely predict the risk of falls in polio survivors, a comprehensive evaluation of both internal and external factors is required.
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http://dx.doi.org/10.1080/09638288.2018.1537381DOI Listing
June 2020

Usefulness of Sweep Imaging With Fourier Transform for Evaluation of Cortical Bone in Diabetic Rats.

J Magn Reson Imaging 2018 08 23;48(2):389-397. Epub 2018 Jan 23.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: Diabetes decreases bone strength, possibly because of cortical bone changes. Sweep imaging with Fourier transform (SWIFT) has been reported to be useful for cortical bone evaluation.

Purpose: To evaluate cortical bone changes in diabetic rats using SWIFT, assess the usefulness of this technique through comparisons with microcomputed tomography (μCT) and conventional MRI, and clarify the mechanism underlying cortical bone changes using histomorphometry STUDY TYPE: Animal cohort.

Animal Model: 8-week-old male Wistar/ST rats (N = 36) were divided into diabetes (induced by streptozotocin injection) and control groups.

Field Strength/sequence: 7.04T MRI, SWIFT.

Assessment: Six animals from each group were sacrificed at 2, 4, and 8 weeks after injection. Tibial bones were extracted and evaluated using μCT and MRI. The cortical bone mineral density (BMD) was measured using μCT. Proton density-weighted imaging (PDWI) and SWIFT were also performed. The signal-to-noise ratio (SNR) was calculated for each acquisition. The bone formation rate was evaluated using histomorphometry.

Statistical Tests: Findings at each timepoint were compared using Mann-Whitney U-tests.

Results: Cortical BMD was significantly lower in the diabetes group than in the control group only at 8 weeks (P < 0.05). At all timepoints, PDWI-SNR showed no significant differences between groups (P = 0.59, 0.70, and 0.82 at 2, 4, and 8 weeks, respectively). SWIFT-SNR was significantly lower in the diabetes group than in the control group (P < 0.05 at 2 and 4 weeks and P < 0.01 at 8 weeks), and the bone formation rate was significantly lower in the diabetes group than in the control group (P < 0.01 for all).

Data Conclusion: SWIFT can detect cortical bone changes even before a decline in the cortical BMD in a diabetic model.

Level Of Evidence: 1 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2018;48:389-397.
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http://dx.doi.org/10.1002/jmri.25955DOI Listing
August 2018

Cytotoxic effects of zoledronic acid-loaded hydroxyapatite and bone cement in malignant tumors.

Oncol Lett 2017 Aug 8;14(2):1648-1656. Epub 2017 Jun 8.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602-8566, Japan.

Metastatic and primary bone tumors are malignant tumors affecting the skeleton. Although the prognosis of patients with these tumors has improved with the development of effective chemotherapy, the challenges of local recurrence, subsequent osteolysis, degradation of bone strength and unresectable tumors persist. Local control of these tumors is therefore a key strategy to address these limitations. The third-generation bisphosphonate (BP), zoledronic acid (ZOL), has been demonstrated to reduce osteoclasts and exhibited potent antitumor effects in a number of malignancies. Hydroxyapatite (HA) and polymethyl methacrylate (PMMA) bone cement are used in orthopedic surgery as bone graft substitutes, for implant arthroplasty and bone strengthening, and as a sustained-release system for drugs such as antibiotics. At present, the antitumor effects of ZOL-loaded HA or or of ZOL-loaded bone cement have not been described. Therefore, the present study assessed the effects of ZOL-loaded HA and bone cement in malignant tumor cells. The two materials exerted strong antitumor effects against osteosarcoma, fibrosarcoma, synovial sarcoma, renal cancer, prostate cancer and lung cancer cells upon releasing ZOL. The antitumor effects of ZOL-loaded HA were less potent compared with those of ZOL-loaded bone cement, possibly as BPs exhibit higher affinity to HA. ZOL-loaded bone cement also exerted antitumor effects against pulmonary metastases and primary lesions, without exhibiting systemic toxicity . These results demonstrate that these materials may be beneficial for the treatment of malignant bone tumors, including metastatic bone tumors. In addition, as these materials are already in clinical use, such applications may be easily implemented.
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http://dx.doi.org/10.3892/ol.2017.6355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529883PMC
August 2017

New quantitative ultrasound techniques for bone analysis at the distal radius in hip fracture cases: differences between femoral neck and trochanteric fractures.

Clin Cases Miner Bone Metab 2017 Jan-Apr;14(1):23-27. Epub 2017 May 30.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur.

Methods: Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan). The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age.

Results: There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P < 0.005). The regression lines for femoral neck fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively.

Conclusions: The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius. There might be systemic differences between them, in addition to localized factors at the proximal femur.
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http://dx.doi.org/10.11138/ccmbm/2017.14.1.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505710PMC
May 2017

Association between loss of bone mass due to short sleep and leptin-sympathetic nervous system activity.

Arch Gerontol Geriatr 2017 May - Jun;70:201-208. Epub 2017 Feb 10.

Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: Sleep has been reported to be an important factor in bone metabolism, and sympathetic nervous system activity has been reported to regulate bone metabolism. In this study, we evaluated the association between sleep, sympathetic nervous system activity, and bone mass.

Methods: The study subjects were 221 individuals (108 males; 113 females; mean age: 55.1±7.0years) divided into two groups: those who slept for less than 6h a day (short sleep [SS] group), and those who slept 6h or longer (normal sleep [NS] group). The groups were compared with regard to lifestyle, cortical bone thickness, cancellous bone density, bone metabolism markers, blood leptin levels, and sympathetic nervous system activity as evaluated by heart rate variability analysis.

Results: Significant differences were observed between the two groups in cortical bone thickness, blood TRACP-5b, and leptin levels. The L/H ratio (an index of sympathetic nervous system activity) was higher in the SS group than in the NS group. Significant negative correlations were observed between cortical bone thickness and both the L/H ratio and leptin levels, and a significant positive correlation was observed between the L/H ratio and leptin levels.

Conclusions: Short sleep was associated with a decline in cortical bone thickness due to the promotion of bone resorption and sympathetic nervous system hyperactivity in the middle-aged group. Leptin levels and cortical bone thickness were found to be closely related, suggesting that cortical bone mass may be regulated via interaction with the leptin-sympathetic nervous system.
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http://dx.doi.org/10.1016/j.archger.2017.02.005DOI Listing
July 2017

Investigation of the Longitudinal Relaxation Time of Rat Tibial Cortical Bone Using SWIFT.

Magn Reson Med Sci 2017 Oct 12;16(4):351-356. Epub 2016 Dec 12.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine.

Sweep imaging with Fourier transform (SWIFT) method has been developed to image tissues with very short T values, such as cortical bone. The purpose of this study was to measure the T value of the rat cortical bone. It was approximately 120 ms on 7.04T. This result could thus be useful for studying bony tissue according to the SWIFT method in the future.
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http://dx.doi.org/10.2463/mrms.tn.2016-0050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743527PMC
October 2017

Effects of electrical stimulation therapy on the blood flow in chronic critical limb ischemia patients following regenerative therapy.

SAGE Open Med 2016 22;4:2050312116660723. Epub 2016 Jul 22.

Rehabilitation Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Objectives: We investigated the effects of electrical stimulation therapy on cutaneous and muscle blood flow in critical limb ischemia patients following regenerative therapy.

Methods: Three groups were studied: 10 healthy young subjects, 10 elderly subjects, and 7 critical limb ischemia patients after regenerative therapy. After 5 min rest, electrical stimulation was applied at 5 Hz on the tibialis anterior muscle for 10 min. We estimated the relative changes in oxyhemoglobin and total hemoglobin compared to the basal values at rest (Δ[HbO2], Δ[Hbtot]), which reflected the blood flow in the skin and muscle layer, and we simultaneously measured the tissue O2 saturation (StO2) throughout the electrical stimulation and recovery phase by near-infrared spectroscopy.

Results: The Δ[HbO2] and Δ[Hbtot] values of the muscle layer in critical limb ischemia patients increased gradually and remained significantly higher at the 5-min and 10-min recovery periods after the electrical stimulation without reducing the StO2, but there is no significant change in the other two groups. Skin blood flow was not influenced by electrical stimulation in three groups.

Conclusion: This improvement of the peripheral circulation by electrical stimulation would be beneficial as the adjunctive therapy after regenerative cell therapy.
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http://dx.doi.org/10.1177/2050312116660723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962517PMC
August 2016

Differences in monthly variation, cause, and place of injury between femoral neck and trochanteric fractures: 6-year survey (2008-2013) in Kyoto prefecture, Japan.

Clin Cases Miner Bone Metab 2016 Jan-Apr;13(1):19-24. Epub 2016 May 11.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period.

Methods: Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain.

Results: There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had "uncertain" as the cause of injury than trochanteric fracture in all age groups.

Conclusions: Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures.
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http://dx.doi.org/10.11138/ccmbm/2016.13.1.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869947PMC
June 2016

Cortical bone water changes in ovariectomized rats during the early postoperative period: Objective evaluation using sweep imaging with Fourier transform.

J Magn Reson Imaging 2015 Jul 24;42(1):128-35. Epub 2014 Sep 24.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Purpose: To evaluate the cortical bone signal-to-noise ratio (SNR) in ovariectomized (OVX) rats during the early postoperative period as a method to measure bone quality using the sweep imaging with Fourier transform (SWIFT) technique.

Materials And Methods: Twelve-week-old female Sprague-Dawley rats (n = 64) were divided into sham and OVX groups. Preoperative tetracycline was immediately administered subcutaneously to distinguish new cortical bone area, and tibial samples were collected at 2, 4, 8, and 12 weeks postoperatively. Magnetic resonance imaging (MRI) was performed using proton density-weighted imaging (PDWI) and SWIFT to obtain cross-sectional images of the tibial diaphysis. The cortical bone SNR was calculated. Bone histomorphometry was performed.

Results: Histomorphometry findings showed that the new bone area was significantly greater at 8 and 12 weeks postoperatively in the OVX group (P < 0.05) while the porosity area decreased gradually in both groups (P < 0.001). The difference of SNR receiving PDWI did not reach statistical significance (P = 0.057). The SWIFT technique showed that the SNR was significantly higher at 8 and 12 weeks postoperatively in the OVX group (P < 0.05) and was correlated with the new bone area (R(2) = 0.430).

Conclusion: The SWIFT findings suggest that the SWIFT technique may depict early changes in cortical bone quality.
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http://dx.doi.org/10.1002/jmri.24765DOI Listing
July 2015

Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears using radial-slice magnetic resonance images.

J Shoulder Elbow Surg 2014 Nov 11;23(11):e283-90. Epub 2014 Jun 11.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: Magnetic resonance imaging has low diagnostic accuracy for subscapularis tendon tears. This study investigated the utility of radial-slice magnetic resonance images for diagnosing subscapularis tendon tears.

Materials And Methods: We investigated 55 shoulders in 54 patients with rotator cuff tears evident during arthroscopic shoulder surgery. The intraoperative finding of a subscapularis tendon tear was compared with the identification of a subscapularis tendon tear on preoperative radial, transverse, and oblique sagittal images using a 3.0-T system. The sensitivity and specificity of diagnostic images generated using different imaging methods for subscapularis tendon tears were investigated.

Results: A subscapularis tendon tear was present in 38 shoulders (69.1%). When the diagnostic accuracy of the magnetic resonance images was compared with the arthroscopic findings, the radial images had 94.7% sensitivity and 82.4% specificity, the transverse images had 57.9% sensitivity and 100% specificity, and the oblique sagittal images had 60.5% sensitivity and 100% specificity.

Conclusion: Radial-slice magnetic resonance images have high sensitivity for subscapularis tendon tears and are useful for diagnosing these lesions. In particular, the sensitivity for tears in the superior part of the subscapularis tendon is higher than that of conventional methods.
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http://dx.doi.org/10.1016/j.jse.2014.03.011DOI Listing
November 2014

Urban versus rural differences in the occurrence of hip fractures in Japan's Kyoto prefecture during 2008-2010: a comparison of femoral neck and trochanteric fractures.

BMC Musculoskelet Disord 2013 Oct 25;14:304. Epub 2013 Oct 25.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: To investigate the differences in the characteristics of femoral neck and trochanteric fractures between urban and rural areas of Kyoto Prefecture in Japan.

Methods: Fracture type (neck vs. trochanteric), age, sex, place where fracture occurred (indoors vs. outdoors), and cause of injury were surveyed among patients aged ≥65 years who sustained hip fractures between 2008 and 2010 and who were treated at 1 of 13 participating hospitals (5 urban, 8 rural). The ratio of sick beds to total number of beds at the participating hospitals was 19.6% (2,188/11,158) in the urban area and 34.9% (1,963/5,623) in the rural area. We also investigated the incidence of hip fracture in Tango medical district as a representative rural area.

Results: There were 1,346 neck (mean age, 82.4 years) and 1,606 trochanteric fractures (mean age, 85.0 years). The ratio of neck to trochanteric fractures was higher in the urban area than in the rural area in all age groups (65-74, 75-84, and ≥ 85 years). There were no apparent differences in place or cause of injury. The incidence of hip fracture in the women of Tango medical district was lower than the national average.

Conclusions: There was a difference in the ratio of neck to trochanteric fractures between urban and rural areas. This difference is estimated to be caused by the high and low incidence of neck fracture in urban and rural areas, respectively.
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http://dx.doi.org/10.1186/1471-2474-14-304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016527PMC
October 2013

Effectiveness of sulforaphane as a radiosensitizer for murine osteosarcoma cells.

Oncol Rep 2013 Mar 18;29(3):941-5. Epub 2012 Dec 18.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.

Sulforaphane (SFN), a naturally occurring member of the isothiocyanate family, is effective against various types of malignant tumor cells. We studied whether the combination of SFN and radiation would be more effective against osteosarcoma cells when compared to these treatments alone. LM8 murine osteosarcoma cells were cultured with various concentrations of SFN for 24 h and/or 2 Gy X-irradiation. The effects of individual and combination treatments on the number of cells, the cell cycle, cell proliferation-related factors and apoptosis were analyzed. The combination of SFN plus radiation had significantly greater antitumor effects than either treatment alone. Exposure to SFN increased the population of cells in the G2/M phase. Combination treatment resulted in a higher percentage of cells being in sub-G1 than did SFN alone. In addition, the combination of SFN and radiation effectively induced nuclear fragmentation and apoptotic bodies, as shown by DAPI staining. The combination of SFN and 2 Gy radiation increased the cleavage and activation of caspase-3 compared with SFN or radiation alone, as shown by western blotting. Although radiation alone increased the phosphorylation of ERK and Akt proteins, the combination of SFN and radiation induced suppression of ERK and Akt phosphorylation when compared with radiation alone. We found that SFN enhanced the radiosensitivity of LM8 murine osteosarcoma cells by inducing apoptosis through G2/M-phase arrest and by inhibiting ERK and Akt activation. These findings suggest that SFN can be used as a radiosensitizer for osteosarcomas.
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http://dx.doi.org/10.3892/or.2012.2195DOI Listing
March 2013

Anchor hole enlargement after arthroscopic Bankart repair using absorbable suture anchors: a report of three cases.

J Shoulder Elbow Surg 2008 Nov-Dec;17(6):e16-8. Epub 2008 Jun 30.

Department of Orthopaedic Surgery, Otsu Municipal Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.

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http://dx.doi.org/10.1016/j.jse.2008.02.014DOI Listing
March 2009

Initial change in transient osteoporosis of the hip on magnetic resonance images: a case report.

Mod Rheumatol 2004 ;14(3):264-6

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan.

We report the case of a 29-year-old Japanese man with transient osteoporosis of the left hip (TOH) following contralateral TOH, paying special attention to the initial changes on MRI. MR images showed no abnormal findings 6 weeks before the clinical manifestation, but the images just after the onset depicted a linear abnormality equivalent to a subchondral insufficiency fracture. Both radiological findings and clinical symptoms disappeared completely without any surgical intervention within 10 months.
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http://dx.doi.org/10.1007/s10165-004-0305-6DOI Listing
July 2007

Relationship between acetabular labrum evaluation by using radial magnetic resonance imaging and progressive joint space narrowing in mild hip dysplasia.

Magn Reson Imaging 2006 Jun 20;24(5):645-50. Epub 2006 Feb 20.

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.

Objective: The aim of this study was to investigate the relationship between abnormal acetabular labrum depicted by radial magnetic resonance and progressive joint space narrowing (JSN) of hip dysplasia.

Methods: Subjects were 23 joints [21 patients; mean age: 35.1 years (16-53 years)] that had acetabular dysplasia with lateral center-edge angle of Wiberg (CE angle) greater than 5 degrees and smaller than 25 degrees (mean, 16.4 degrees ), which did not show any arthrotic changes on plain radiograms and were followed up for 3 years or longer. Radial images of acetabular labrum were classified into three stages.

Results: Progression of JSN was not significantly related to CE angle but to progression of MRI stage (P=.006). In multivariate analysis, one rank progression of MRI stage was significantly associated with progression of JSN (adjusted OR=11.41, 95% CI: 1.51-86.24, P=.018).

Conclusion: Our findings showed that in patients whose acetabular dysplasia has 5-25 degrees CE angle, MRI staging based on radial MRI is a better factor for prediction of progression of JSN than CE angle.
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http://dx.doi.org/10.1016/j.mri.2005.12.009DOI Listing
June 2006

Incidence of physeal injuries in Japanese children.

J Pediatr Orthop B 2006 Mar;15(2):126-30

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Although epidemiological studies on epiphyseal injury have been reported, such studies have not been made systematically in Japan. In this study, we examined the incidence of epiphyseal injury in paediatric patients treated at five general hospitals and three private clinics. We treated the patients with limb injuries between January 1992 and December 1997, and reviewed them at least 18 months after the original injuries. The original radiograms and the completed case records were classified according to age and sex of the injured children, site of the fracture, type of treatment, and its complications. Epiphyseal injuries accounted for 17.9% of all paediatric fractures. The most frequently injured epiphysis was the phalanges of hands, 21.9% of all physeal injuries. Salter-Harris type I accounted for 28.6% of physeal injuries; type II (60.9%) revealed the largest number of cases in this study, compared with type III (6.7%) and type IV (3.7%). Type V was not recognized. Most physeal injuries were treated conservatively. Either weight-bearing joints or elbow joints were treated surgically. Complications of physeal injuries were seen in seven cases. Five cases involved the upper limb, and the other two cases involve the lower limb. Although deformity or malfunction caused by physeal injuries was remained, only one case needed a corrective osteotomy. Other six cases revealed a fair prognosis.
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http://dx.doi.org/10.1097/01.bpb.0000191874.69258.0bDOI Listing
March 2006

Magnetic resonance imaging evaluation of the inferior glenohumeral ligament: non-arthrographic imaging in abduction and external rotation.

J Shoulder Elbow Surg 2005 Sep-Oct;14(5):511-5

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

The anterior band of the inferior glenohumeral ligament is the most important restraint for preventing traumatic anterior glenohumeral instability. The condition of this ligament markedly affects the results of arthroscopic Bankart repair. We compared non-arthrographic magnetic resonance imaging (MRI) in abduction and external rotation and arthroscopic findings of the ligament in 51 shoulders with traumatic anterior glenohumeral instability. The condition of the ligament was evaluated based on the presence of a thick low-signal band between the anterior labrum and the head of the humerus in all magnetic resonance images obtained from the 3- to 5-o'clock position of the glenoid rim (right shoulder). The sensitivity and specificity of the MRI evaluation were 94% and 82%, respectively. MRI in abduction and external rotation is fairly useful for predicting the condition of the ligament in advance of invasive measures (ie, arthroscopy).
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http://dx.doi.org/10.1016/j.jse.2005.02.015DOI Listing
February 2006

Effects of alternating current electrical stimulation on lengthening callus.

J Pediatr Orthop B 2005 Jul;14(4):299-302

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto, Japan.

Limb lengthening by the callotasis method has been clinically applied to patients who suffered from limb length inequality, micromelia, angular deformation and partial bone defect on long bones. However, this technique was time consuming and led to various complications, such as infection at the pin insertion sites, limitation of the range of motion in adjacent joints, muscular weakness and peripheral neuroparalysis. This study was undertaken to investigate whether alternating current electric (AC) stimulation could shorten the maturation period during callotasis. The tibiae of 20 immature male Japanese white rabbits were osteotomized and fixed with external lengthener (Orthofix M100; Orthofix Srl, Bussolengo, Italy). The experimental schedule lasted 5 weeks consisting of 1 week for the latency period, 2 weeks for distraction and 2 weeks for maturation. Twenty rabbits were equally divided into two groups: the control group and the electrical stimulation (ES) group. The control group was not stimulated with an AC stimulator. The ES group was stimulated for 5 weeks just after osteotomy. The obtained results revealed radiologically, electrophysiologically and histologically that AC stimulation accelerated the maturation of lengthened callus and that it could shorten the time course of callus lengthening.
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http://dx.doi.org/10.1097/01202412-200507000-00013DOI Listing
July 2005

Arthroscopic treatment for septic arthritis of the shoulder in an infant.

J Orthop Sci 2005 ;10(1):95-8

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.

We report a case of septic arthritis in the shoulder of an infant treated with a combination of arthroscopic irrigation, debridement, and synovectomy. The results were encouraging. The patient was a boy who was 2 years 6 months of age. His first symptoms were a body temperature of 40 degrees C and right upper arm pain. Five days after the onset, he was brought to our institution. His shoulder was swollen and erythematous. Yellowish fluid (7 ml) was aspirated from his shoulder joint; the causative organism was group A Streptococcus. On admission, arthroscopic surgery was performed. His temperature gradually decreased, and inflammatory markers including the white blood cell count and C-reactive protein level improved. At his 1-year follow-up there was no sign of infection, and a full range of motion in the shoulder was maintained. The interval between the onset and the start of treatment is an important factor affecting the prognosis. The patient was brought to our institution 5 days after onset and underwent arthroscopic surgery on the same day. This early treatment was one of the factors that contributed to a successful result. Arthroscopic surgery, including irrigation and debridement, may be one of the options for treating septic arthritis of an infant's shoulder.
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http://dx.doi.org/10.1007/s00776-004-0861-9DOI Listing
May 2005

Usefulness of epiphyseal quotient measurement on magnetic resonance images for outcome prediction in patients with early-stage Legg-Calve-Perthes disease.

J Pediatr Orthop B 2005 Jan;14(1):16-23

Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.

To investigate the usefulness of epiphyseal quotient (EQ) measurement for outcome prediction in patients with Legg-Calve-Perthes disease (LCPD), magnetic resonance (MR) imaging was performed in 26 patients with unilateral LCPD within 6 months of the disease onset and subsequently once every 3 months. All the patients were treated conservatively in our institute between 1990 and 1999. The mean follow-up period was 80 months. Clinical outcome was evaluated based on the plain radiograms of the femoral head at the final examination according to Stulberg's classification: the patients whose outcome was class I were regarded as 'excellent' (excellent group), class II as 'good' (good group), and classes III, IV and V as 'poor' (poor group). The excellent group consisted of 10 patients, the good group of 12, and the poor group of four. The EQ measured on MR images (MR-EQ) decreased remarkably in the poor group chronologically, whereas there was no decrease in the excellent group and a slow decrease in the good group. The mean MR-EQ at or before the sixth month (range, 2-6 months; mean, 4.9 months) was 86.2 (range, 76.8-94.8) in the excellent group, 78.3 (57.0-93.4) in the good group, and 67.4 (57.8-74.5) in the poor group (P<0.05 among the three groups). According to our results, because all patients having an MR-EQ at or before the sixth month of 75 or higher were classified in the excellent or good groups, it is thought that the ongoing method of treatment can be continued. On the other hand, since half of the patients having an MR-EQ at or before the sixth month of lower than 75 were classified in the poor group and had a high potential for a poor outcome, it is thought that these patients require strict containment therapy, and altering the surgical procedure could be considered depending on the particular patient. It was thought that the MR-EQ is a useful predictive factor of LCPD prognosis.
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http://dx.doi.org/10.1097/01202412-200501000-00003DOI Listing
January 2005

Risk factors for nontraumatic osteonecrosis of the femoral head after renal transplantation.

J Orthop Sci 2003 ;8(6):751-6

Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan.

We investigated risk factors for osteonecrosis of the femoral head (ONF) in renal transplant recipients, who are susceptible to the disease. Among 287 renal transplant recipients, 18 ONF patients with enough data were included, and 18 age- and sex-matched recipients without ONF were nominated as reference cases. Risk factors were analyzed using a conditional logistic regression method. There were no differences between the ONF patients and the reference cases regarding the types of immunosuppressant or the donor (living or cadaveric, father or mother, matching blood type and human leukocyte antigens). The daily oral steroid dosage (prednisolone 25.0 mg/day or more) and blood urea nitrogen level 2 months after transplantation were the only factors with relevance to the occurrence of ONF. We propose that oral steroid dosages should be low or reduced after renal transplantation, and acute rejection should be controlled with pulsed therapy.
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http://dx.doi.org/10.1007/s00776-003-0716-9DOI Listing
February 2004

A case of locking shoulder caused by longitudinal rotator cuff tear.

J Shoulder Elbow Surg 2003 Sep-Oct;12(5):514-6

Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

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http://dx.doi.org/10.1016/s1058-2746(03)00028-4DOI Listing
February 2004

Minimum 10-year radiographic follow-up of a cementless acetabular component for primary total hip arthroplasty with a bulk autograft.

J Orthop Sci 2003 ;8(5):664-8

Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

We radiographically investigated 36 hips in 34 patients with osteoarthritis of the hip who had undergone total hip arthroplasty. Their mean age was 59.2 years (range 36-79 years), and the mean follow-up period was 11.2 years (range 10-14 years). The long-term outcome and the chronological changes in the bulk autograft were examined. The acetabular component of the prosthesis was a Lord-type threaded cup with a smooth surface. At follow-up, bone absorption was minor in 17 joints, moderate in 11, and major in 8. The hips with graft coverage of >==20% (group A) had a significantly higher loosening rate than hips with coverage of <20% (group B) ( P < 0.05). The cup position changed markedly in group A. Our findings indicate that graft coverage should be less than 20% when a bulk graft is used together with a smooth-surfaced cementless cup.
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http://dx.doi.org/10.1007/s00776-003-0699-6DOI Listing
November 2003

Coverage of the femoral head by the acetabular labrum in dysplastic hips: quantitative analysis with radial MR imaging.

Acta Orthop Scand 2003 Jun;74(3):287-92

Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.

Hip dysplasia is an important cause of osteoarthrosis of the hip, especially in Japanese. Recently, the role of the acetabular labrum in hip diseases has attracted the attention of researchers, but the condition of the labrum in the dysplastic hips has not been described. We used radial MRI to measure the degree of coverage of the femoral head by the acetabulum and the labrum, corresponding to 7 positions on the acetabular rim at every 15 degrees from anterosuperior 45 degrees via midsuperior to posterosuperior 45 degrees. 38 Japanese patients (51 hips) with dysplasia, and 11 healthy controls 122 hips) were studied. In the dysplastic hips, the labrum was larger than in the controls. We found no correlation between the coverage of the acetabulum in the anterosuperior positions and the size of the labrum among the dysplastic hips.
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http://dx.doi.org/10.1080/00016470310014201DOI Listing
June 2003

Predictive value of magnetic resonance imaging in avascular necrosis following talar fractures.

J Orthop Surg (Hong Kong) 2000 Jun;8(1):73-78

Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Ischemic bone necrosis following talar fractures is a problematic complication and its early diagnosis is important. Patients with Hawkins Type II and III talar fractures received internal fixation using titanium alloy screws, and chronological bone changes were observed with Magnetic Resonance Imaging (MRI). With the Type II patient, Hawkins' sign was radiographically confirmed 2 months after the surgery. Furthermore, there were no changes of MR images for 2 years and a good clinical outcome was obtained. However, in the Type III patient, Hawkins' sign was negative and MRI revealed a low signal-intensity band on the talus 2 months after the surgery and then necrosis was radiographically confirmed; pain appeared 10 months later. These 2 cases suggest that MRI is a useful means for detecting bone necrosis with talar fractures in the early post-operative period.
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http://dx.doi.org/10.1177/230949900000800113DOI Listing
June 2000

Development of the acetabulum and the acetabular labrum in the normal child: analysis with radial-sequence magnetic resonance imaging.

J Pediatr Orthop 2002 Mar-Apr;22(2):222-7

Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

The degree of acetabular and labral coverage was clarified in children at different positions using radial-sequence magnetic resonance imaging. Scans were performed on 40 hips in 20 normal children (group A, 6-8 years old; group B, 9-11 years old; group C, 12-13 years old) and on 19 hips of 10 healthy adults as controls. The degrees of coverage of the femoral head by acetabulum, acetabular labrum, and both were measured at seven positions at every 15 degrees from anterosuperior 45 degrees via midsuperior to posterosuperior 45 degrees. Coverage of the femoral head by the acetabulum in young children was less than in adults at all positions, but the total coverage including the labrum was greater than in adults. Development of the acetabulum and the acetabular labrum showed differences by position.
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May 2002