Publications by authors named "Takashi Sakai"

284 Publications

The reference intervals of intraoperative posterior tibial nerve somatosensory evoked potentials.

J Orthop Sci 2021 Jul 27. Epub 2021 Jul 27.

Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Japan.

Background: A reference interval exists for posterior tibial nerve somatosensory evoked potentials (PTN-SEPs) in awake. However, the reference interval for intraoperative- PTN-SEPs (I-PTN-SEPs) remains unclear. As a substitute for PTN-SEPs in awake, we considered I-PTN-SEPs can provide functional information about the dorsal somatosensory system. No report evaluated the physiologic and analytical issues in the measurement of I-PTN-SEPs. We investigated the sources of variation and reference intervals for I-PTN-SEPs.

Methods: We studied 143 patients with unilateral radiculopathy and without neurologic deficit who underwent surgery. Stimulation was delivered to the PTN at the ankle. The scalp recording electrode was placed at the Cz with a reference electrode located on the forehead at the Fz. SEPs were recorded from patients during electrical stimulation of the I-PTN.

Results: P1 and N1 latencies showed significant positive linear correlations with age (P1 latency = 36.52 + 0.0814 × age, P = 0.00003; N1 latency = 46.21 + 0.081 × age, P = 0.00022), and body height (P1 latency = 16.94 + 14.91 × body height, P = 0.00000; N1 latency = 25.42 + 15.64 × body height, P = 0.00002). In contrast, I-PTN-SEPs amplitude showed no correlation with age or body height. The 95% confidence interval for I-PTN-SEPs amplitude, or the reference interval, was determined as 0.31-5.91 μV.

Conclusions: The lower normal limit value was 0.31 μV, and this reference interval may be useful to evaluate function of the posterior funiculus, such that as during surgery for patients with intramedullary tumor.
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http://dx.doi.org/10.1016/j.jos.2021.05.004DOI Listing
July 2021

Current Concepts of Stem Cell Therapy for Chronic Spinal Cord Injury.

Int J Mol Sci 2021 Jul 11;22(14). Epub 2021 Jul 11.

Department of Orthopedics Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan.

Chronic spinal cord injury (SCI) is a catastrophic condition associated with significant neurological deficit and social and financial burdens. It is currently being managed symptomatically with no real therapeutic strategies available. In recent years, a number of innovative regenerative strategies have emerged and have been continuously investigated in clinical trials. In addition, several more are coming down the translational pipeline. Among ongoing and completed trials are those reporting the use of mesenchymal stem cells, neural stem/progenitor cells, induced pluripotent stem cells, olfactory ensheathing cells, and Schwann cells. The advancements in stem cell technology, combined with the powerful neuroimaging modalities, can now accelerate the pathway of promising novel therapeutic strategies from bench to bedside. Various combinations of different molecular therapies have been combined with supportive scaffolds to facilitate favorable cell-material interactions. In this review, we summarized some of the most recent insights into the preclinical and clinical studies using stem cells and other supportive drugs to unlock the microenvironment in chronic SCI to treat patients with this condition. Successful future therapies will require these stem cells and other synergistic approaches to address the persistent barriers to regeneration, including glial scarring, loss of structural framework, and immunorejection.
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http://dx.doi.org/10.3390/ijms22147435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308009PMC
July 2021

Impact of various MRI signal intensity changes on radiological parameters, the neurological status, and surgical outcomes in degenerative cervical myelopathy.

Clin Neurol Neurosurg 2021 Jul 8;207:106802. Epub 2021 Jul 8.

Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.

Study Design: A retrospective study of prospectively collected date.

Purpose: The present study aimed to identify patient characteristics, radiological factors, the neurological status, and postoperative outcomes associated with MRI signal intensity changes in degenerative cervical myelopathy (DCM).

Material And Method: One hundred and fourteen DCM patients who underwent posterior decompression surgeries were enrolled. Pre- and postoperative (12 months) Japanese Orthopedic Association (JOA) scores, cervical alignment and balance on X rays, the cross-sectional area of the spinal cord (CSA) in kinematic CT myelography (CTM). The recovery rate (RR) of the total JOA score and those specific for the upper and lower limb items were evaluated. MRI included T1-weighted imaging (WI) and T2WI. Patients were classified into two groups for a univariate analysis according to the presence or absence of a high signal intensity (HIS) in the sagittal view on T2WI, a low signal intensity (LSI) in the sagittal view on T1WI, the distribution of HSI at a single or multiple levels, and the presence or absence of the snake eye appearance. A multiple logistic regression analysis (MLRA) was performed to identify factors associated with signal intensity changes on MRI.

Results: Ninety-six patients (84.3%) were classified into HIS changes in the sagittal view on T2WI. The group with multilevel HSI showed significantly lower RR specific for the lower extremity JOA score (30.8% vs 47.7%; P = 0.016). The snake eye-positive group showed a significantly inferior RR specific for the upper extremity JOA score (40.1% vs 53.2%; P = 0.04). In MLRA, LSI changes on T1WI revealed small CSAF (P = 0.02, Odds ratio; 0.77, 95%CI:0.61-0.97), while HSI changes on T2WI revealed a small CSAF (P = 0.008, Odds ratio;1.36, 95%CI:1.08-1.72) and large C2-7 angle during extension (P = 0.009, Odds ratio;0.73, 95%CI:0.58-0.92). CSAF correlated with multilevel HSI changes (P = 0.006, Odds ratio;0.78, 95%CI:0.66-0.93). The snake eye appearance correlated with CSAF (P = 0.006, Odds ratio;0.78, 95%CI:0.66-0.93) and the duration of disease (P = 0.05, Odds ratio;1.01, 95%CI:1.0-1.03).

Conclusion: Severe and poorly compensated spinal cord compression during neck flexion may cause signal intensity changes. The snake eye appearance may be useful as a sign of the inferior postoperative recovery of upper limb function, and multilevel HSI as a sign of the inferior postoperative recovery of lower limb function.
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http://dx.doi.org/10.1016/j.clineuro.2021.106802DOI Listing
July 2021

The associations between radiological and neurological findings of degenerative cervical myelopathy: radiological analysis based on kinematic CT myelography and evoked potentials of the spinal cord.

J Neurosurg Spine 2021 Jul 9:1-12. Epub 2021 Jul 9.

Objective: Neurological and imaging findings play significant roles in the diagnosis of degenerative cervical myelopathy (DCM). Consistency between neurological and imaging findings is important for diagnosing DCM. The reasons why neurological findings exhibit varying sensitivity for DCM and their associations with radiological findings are unclear. This study aimed to identify associations between radiological parameters and neurological findings in DCM and elucidate the utility of concordance between imaging and neurological findings for diagnosing DCM.

Methods: One hundred twenty-one patients with DCM were enrolled. The Japanese Orthopaedic Association (JOA) score, radiological parameters, MRI and kinematic CT myelography (CTM) parameters, and the affected spinal level (according to multimodal spinal cord evoked potential examinations) were assessed. Kinematic CTM was conducted with neutral positioning or at maximal extension or flexion of the cervical spine. The cross-sectional area (CSA) of the spinal cord, dynamic change in the CSA, C2-7 range of motion, and C2-7 angle were measured. The associations between radiological parameters and hyperreflexia, the Hoffmann reflex, the Babinski sign, and positional sense were analyzed via multiple logistic regression analysis.

Results: In univariate analyses, the upper- and lower-limb JOA scores were found to be significantly associated with a positive Hoffmann reflex and a positive Babinski sign, respectively. In the multivariate analysis, a positive Hoffmann reflex was associated with a higher MRI grade (p = 0.026, OR 2.23) and a responsible level other than C6-7 (p = 0.0017, OR 0.061). A small CSA during flexion was found to be significantly associated with a positive Babinski sign (p = 0.021, OR 0.90). The presence of ossification of the posterior longitudinal ligament (p = 0.0045, OR 0.31) and a larger C2-7 angle during flexion (p = 0.01, OR 0.89) were significantly associated with abnormal great toe proprioception (GTP).

Conclusions: This study found that the Hoffmann reflex is associated with chronic and severe spinal cord compression but not the dynamic factors. The Babinski sign is associated with severe spinal cord compression during neck flexion. The GTP is associated with large cervical lordosis. These imaging features can help us understand the characteristics of the neurological findings.
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http://dx.doi.org/10.3171/2020.11.SPINE201626DOI Listing
July 2021

Analysis of individual differences in pelvic and spine alignment in seated posture and impact on the seatbelt kinematics using human body model.

PLoS One 2021 9;16(7):e0254120. Epub 2021 Jul 9.

Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi Prefecture, Japan.

Analysis using human body models has been performed to reduce the impact of accidents; however, no analysis has shown a relationship between lumbar and pelvic/spine angle and seat belts in reducing human damage from accidents. Lumbar and pelvic/spine angles were measured in 75 individuals and the measurements were used to create three different angles for the Total Human Model for Safety model. In the present study, we focused on lumber lordosis (LL) and pelvic angle (PA). A normal distribution and histogram were used for analysis of PA (01, 10, and 50). The Total Human Model for Safety, including LL and PA, was corrected using finite element software. Simulations were conducted under the conditions of the Japan New Car Assessment Programme (JNCAP) 56 kph full lap frontal impact. Using the results of the FEM, the amount of lap-belt cranial sliding-up, anterior movement of the pelvis, posterior tilt of the pelvis, head injury criterion (HIC), second cervical vertebrae (C2) compressive load, C2 moment, chest deflectiou (upper, middle, and lower), left and right femur load, and shoulder belt force were measured. The lap-belt cranial sliding-up was 1.91 and 2.37 for PA10 and PA01, respectively, compared to PA50; the anterior movement of the pelvis was 1.08 and 1.12 for PA10 and PA01, respectively; and the posterior tilt of the pelvis was 1.1 and 1.18 for PA10 and PA01, respectively. HIC was 1.13 for PA10 and 1.58 for PA01; there was no difference in C2 compressive load by PA, but C2 moment increased to 1.59 for PA10 and 2.72 for PA01. It was found that as LL increases and the PA decreases, the seat belt becomes likely to catch the iliac bone, making it harder to cause injury. This study could help to reconsider the safe seat and seatbelt position in the future.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254120PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270461PMC
July 2021

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment.

J Korean Med Sci 2021 Jun 21;36(24):e177. Epub 2021 Jun 21.

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip. It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.
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http://dx.doi.org/10.3346/jkms.2021.36.e177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216992PMC
June 2021

Environmental impacts of a rice-beef-biogas integrated system in the Mekong Delta, Vietnam evaluated by life cycle assessment.

J Environ Manage 2021 Sep 7;294:112900. Epub 2021 Jun 7.

Faculty of Agriculture, University of Miyazaki, Miyazaki, 889-2192, Japan.

It is essential to increase the production of foods to meet the increasing future food demand, but this should be done in an environmentally sustainable manner. Integrated crop-livestock systems have been suggested to balance the reduction of environmental impacts and the increase in food production. Here we assessed and compared the environmental impacts of specialized (SPC) and integrated (ITG) rice and beef production systems in the Mekong Delta, Vietnam, using a life-cycle assessment (LCA). The productions of rice and beef are separated in the SPC, whereas they are integrated in the ITG: cattle manure is treated by a biodigester for biogas production, its digestate is applied to rice paddy fields as fertilizer, and part of the rice straw is used as cattle feed. We developed an LCA model based on data collected by site investigations of rice and beef farms and the relevant literature and LCA databases. Our evaluation of the ITG and SPC rice-beef production systems using the LCA revealed that among the four environmental impact categories investigated herein, the ITG had less environmental impacts on climate change (22%), energy consumption (22%), and eutrophication (14%) compared to the SPC. With the ITG, the reduction of methane emissions from paddy fields, the avoided energy consumption by the biogas produced, and the lower ammonia, nitrate, and phosphorous emissions from cattle manure and no eutrophying pollutant emissions from grassland were the main contributors to the lower greenhouse gas emissions, energy consumption, and eutrophication potential of this system, respectively. A sensitivity analysis showed that the use of cover for digestate storage resulted in lower environmental impacts of the ITG system compared to SPC system in all of the impact categories investigated here. These results provide helpful information to develop a circular and resource-efficient rice and beef production system that balances increasing productivity with environmental sustainability in rice-producing countries, particularly in Asia.
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http://dx.doi.org/10.1016/j.jenvman.2021.112900DOI Listing
September 2021

Necessity of Thin Section CT in the Detection of Pulmonary Metastases: Comparison between 5 mm and 1 mm Sections of CT.

Ann Thorac Cardiovasc Surg 2021 Jun 7. Epub 2021 Jun 7.

Division of Chest Surgery, Department of Surgery, Toho University, School of Medicine, Tokyo, Japan.

Background: The aim of this study was to evaluate the difference in the ability of 1-mm and 5-mm section Computed Tomography(CT) to detect pulmonary metastases in patients with pulmonary metastases.

Methods: We retrospectively analyzed the CT findings of 106 patients with pulmonary metastases due to malignancies treated at Toho University Omori Medical Center between 2013 and 2020.

Results: Cases with only one nodule evaluated by 5-mm section CT had significantly lower discordance with 1-mm section CT than cases with two or more nodules detected by a 5 mm section (p = 0.0161). After reference to a 1 mm section, cases with only one nodule reevaluated by 5-mm section CT had significantly lower discordance than cases with two or more nodules reevaluated using 5-mm section CT. In cases with only one nodule, reevaluation using a 5 mm section was consistent with evaluation using a 1 mm section. However, this was not observed in cases with two or more nodules, with a significant difference between one nodule and two or more nodules.

Conclusions: If there are two or more nodules observed in 5-mm section CT it may be necessary to reevaluate using 1-mm section CT to determine the exact number of pulmonary metastases.
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http://dx.doi.org/10.5761/atcs.oa.21-00037DOI Listing
June 2021

Three-dimensional analysis of the characteristics of joint motion and gait pattern in a rodent model following spinal nerve ligation.

Biomed Eng Online 2021 Jun 5;20(1):55. Epub 2021 Jun 5.

Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.

Background: The spinal nerve ligation (SNL) rat is well known as the most common rodent model of neuropathic pain without motor deficit. Researchers have performed analyses using only the von Frey and thermal withdrawal tests to evaluate pain intensity in the rat experimental model. However, these test are completely different from the neurological examinations performed clinically. We think that several behavioral reactions must be observed following SNL because the patients with neuropathic pain usually have impaired coordination of the motions of the right-left limbs and right-left joint motion differences. In this study, we attempted to clarify the pain behavioral reactions in SNL rat model as in patients. We used the Kinema-Tracer system for 3D kinematics gait analysis to identify new characteristic parameters of each joint movement and gait pattern.

Results: The effect of SNL on mechanical allodynia was a 47 ± 6.1% decrease in the withdrawal threshold during 1-8 weeks post-operation. Sagittal trajectories of the hip, knee and ankle markers in SNL rats showed a large sagittal fluctuation of each joint while walking. Top minus bottom height of the left hip and knee that represents instability during walking was significantly larger in the SNL than sham rats. Both-foot contact time, which is one of the gait characteristics, was significantly longer in the SNL versus sham rats: 1.9 ± 0.15 s vs. 1.03 ± 0.15 s at 4 weeks post-operation (p = 0.003). We also examined the circular phase time to evaluate coordination of the right and left hind-limbs. The ratio of the right/left circular time was 1.0 ± 0.08 in the sham rats and 0.62 ± 0.15 in the SNL rats at 4 weeks post-operation.

Conclusions: We revealed new quantitative parameters in an SNL rat model that are directly relevant to the neurological symptoms in patients with neuropathic pain, in whom the von Frey and thermal withdrawal tests are not used at all clinically. This new 3D analysis system can contribute to the analysis of pain intensity of SNL rats in detail similar to human patients' reactions following neuropathic pain.
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http://dx.doi.org/10.1186/s12938-021-00892-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180104PMC
June 2021

Low frequency of local findings in periprosthetic hip infection caused by low-virulent bacteria compared to periprosthetic knee infection.

Sci Rep 2021 Jun 3;11(1):11714. Epub 2021 Jun 3.

Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, 7558505, Japan.

Periprosthetic joint infection (PJI) is suspected when local findings such as pain, swelling, hyperthermia, and sinus tract are present. However, the frequency of these findings and the difference between hip and knee are unclear. This study compared the positive rates of local findings in periprosthetic hip infection (PHI) with periprosthetic knee infection (PKI), and aimed to identify potential risk factors associated with the frequency. One hundred one PJI (46 hips and 55 knees) fulfilled the 2018 Musculoskeletal infection society criteria were analysed retrospectively to assess the positive rates of each local finding. Patients were categorized into two groups based on the presence or absence of each local finding, and the influence of two potential risk factors [body mass index (BMI) and C-reactive protein (CRP)] was investigated. Causative bacterial species were divided into high and low-virulent groups, and then culture negative cases were included in low-virulent group. PHI had significantly lower rates of pain, swelling and hyperthermia compared to PKI. Overall, up to one-third of PHI had pain as only symptom. High BMI and low-virulent bacteria were associated with lower frequency of swelling and hyperthermia in PHI. CRP had no impact on positive rates of local findings. PHI was oligosymptomatic in a significant percentage of cases. This is particularly important in obese patients and infection by low-virulent bacteria.
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http://dx.doi.org/10.1038/s41598-021-91139-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175376PMC
June 2021

Serum receptor activator of nuclear factor kappa-Β ligand/osteoprotegerin ratio correlates with severity and suggests fracture's risk in older women with atopic dermatitis.

Allergy 2021 Jun 3. Epub 2021 Jun 3.

Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education (CK-CARE), University Hospital Bonn, Bonn, Germany.

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http://dx.doi.org/10.1111/all.14971DOI Listing
June 2021

Diagnosis and Treatment of Femoral Head Osteonecrosis: A Protocol for Development of Evidence-Based Clinical Practice Guidelines.

Surg Technol Int 2021 05 27;38. Epub 2021 May 27.

Zhongshan Hospital of Dalian University, Dalian, China.

Introduction: There are many treatment options for patients who have osteonecrosis of the femoral head (ONFH) and management strategies vary widely both among and within individual countries. Although many researchers have attempted to elucidate the optimal strategies for managing this disease, the lack of large-scale randomized control trials and the lack of agreement on disease staging have curtailed the development of clear-cut guidelines.

Materials And Methods: The Association Research Circulation Osseous (ARCO) group sought to address three questions for the management of patients who have ONFH: 1) What imaging studies are most sensitive and specific for the diagnostic evaluation of patients who have ONFH?; 2) What is the best treatment strategy for preventing disease progression in patients who have pre-collapse lesions?; and 3) What is the best treatment strategy for patients who have post-collapse disease? The Patient, Intervention, Comparison, and Outcome (PICO) format was used to formulate the search strategy for each research question. A systematic review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ARCO participants have been allocated to three groups, each representing one of the PICO questions. After qualitative and quantitative analysis of the data extracted from studies pertaining to each of the three research questions, a set of evidence-based clinical practice guidelines will be proposed for the management of patients who have ONFH.

Discussion: It is not always clear which treatment method is optimal for the management of ONFH. Thus, many surgeons have developed and performed various procedures based on patient-specific factors. As there is no consensus on the optimal treatment for various stages of disease, it was clear that developing evidence-based clinical practice guidelines would provide more structure and uniformity to management of these patients. Therefore, the results of this systematic review will lead to the development guidelines that may improve patient-care strategies and result in better outcomes for patients who have ONFH.
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May 2021

A rare case of epidural chordoma without bone involvement within the thoracic spinal canal: A case report with a review of literature.

J Orthop Sci 2021 May 22. Epub 2021 May 22.

Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.

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http://dx.doi.org/10.1016/j.jos.2021.03.016DOI Listing
May 2021

Prognostic and functional impact of perioperative LAMA/LABA inhaled therapy in patients with lung cancer and chronic obstructive pulmonary disease.

BMC Pulm Med 2021 May 21;21(1):174. Epub 2021 May 21.

Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.

Background: Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients.

Methods: Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical record to evaluate that LAMA/LABA might be an optimal regimen for patients with COPD undergoing surgery for lung cancer. All patients were received perioperative rehabilitation and divided into 3 groups according to the type of perioperative inhaled therapy and management: LAMA/LABA (n = 64), LAMA (n = 23) and rehabilitation only (no bronchodilator) (n = 43). We conducted a retrospective review of their medical records.

Results: Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p < 0.001 for both forced expiratory volume in 1 s (FEV) and percentage of predicted forced expiratory volume in 1 s (FEV%pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV, LAMA/LABA 223.1 mL vs. LAMA 130.0 mL, ΔFEV%pred, LAMA/LABA 10.8% vs. LAMA 6.8%; both p < 0.05). Postoperative complications were lower frequent in the LAMA/LABA group than in the LAMA group (p = 0.007). In patients with moderate to severe air flow limitation (n = 61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with the LAMA (p = 0.049, p = 0.026) and rehabilitation-only groups (p = 0.001, p < 0.001). Perioperative LAMA/LABA therapy was also associated with lower recurrence rates (vs. LAMA p = 0.006, vs. rehabilitation-only p = 0.008).

Conclusions: We believe this treatment combination is optimal for patients with lung cancer and COPD.
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http://dx.doi.org/10.1186/s12890-021-01537-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139148PMC
May 2021

Bisphosphonate-related atypical insufficiency fracture of the tibial plateau : A case report.

J Med Invest 2021 ;68(1.2):186-188

Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan.

Objective : Only a few cases of insufficiency fractures of the tibial plateau following bisphosphonate use have been reported. The authors report a case with bisphosphonate (BP) -related atypical insufficiency fracture of tibial plateau, which developed delayed union. Patient : A 65-year-old Japanese woman presented with left knee pain without any trauma. She had a 5-year history of risedronate use for primary osteoporosis. Initial X-rays were unremarkable, but magnetic resonance imaging (MRI) confirmed an insufficiency fracture at the left tibial plateau at 3 weeks after the initial visit. Risedronate treatment was stopped because we diagnosed her with a BP-related atypical insufficiency fracture of the tibial plateau. She was treated with rest, a lateral wedge insole and protective weight-bearing with a T-cane for 3 months. Result : At 3-month follow-up, the patient still had a pain and a delayed healing on radiographs. Six months later, X-rays showed that the fracture site had a sclerotic change, but MRI revealed delayed union. At 8-month follow-up, the fracture was healed without any symptoms. Conclusion : All clinicians need to be aware of the delayed healing of atypical insufficiency fracture related with prolonged BP use. J. Med. Invest. 68 : 186-188, February, 2021.
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http://dx.doi.org/10.2152/jmi.68.186DOI Listing
January 2021

Streak Metal Artifact Reduction Technique in Cone Beam Computed Tomography Images after Endovascular Neurosurgery.

Neurol Med Chir (Tokyo) 2021 May 14. Epub 2021 May 14.

Department of Neurosurgery, Nagoya University Graduate School of Medicine.

Cone beam computed tomography (CBCT) images are degraded by artifacts due to endovascular implants. We evaluated the use of streak metal artifact reduction technique (SMART) in non-contrast CBCT images after endovascular neurosurgery obtained from 148 patients (125 with aneurysm and 23 with dural arteriovenous fistula [dAVF]). Three neurosurgeons evaluated the cistern and brain surface visibility in CBCT images with and without SMART correction based on a 4-point scale (1, excellent; 2, good; 3, limited; and 4, insufficient). Significant improvement in visibility was achieved when the median scores improved from 4 or 3 to 2 or 1 or from 2 to 1. Metal artifact reduction in adjacent slices without metal and new artifacts after SMART correction was also examined. A significant improvement was achieved regarding the visibility of the cistern in 90 (60.8%) images and of the brain surface in 108 (73.0%) images. Metal size (cistern: odds ratio [OR], 0.91 per 1 mm increase; 95% confidence interval [CI], 0.83-0.99), irregular metal shape (cistern: OR, 0.18; 95% CI, 0.05-0.60 and brain surface: OR, 0.15; 95% CI, 0.05-0.45), and infratentorial lesions (cistern: OR, 0.37; 95% CI, 0.14-0.96 and brain surface: OR, 0.30; 95% CI, 0.11-0.80) were negatively correlated with improved visibility. Metal artifact reduction in adjacent slices without metal was obtained in 25.6% and 34.8% of images with aneurysm and dAVF, respectively. New artifacts after SMART correction were found in 4.8% and 13.0% of images with aneurysm and dAVF, respectively. SMART is especially effective for supratentorial small aneurysms.
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http://dx.doi.org/10.2176/nmc.oa.2021-0014DOI Listing
May 2021

Tensile mechanical analysis of anisotropy and velocity dependence of the spinal cord white matter: a biomechanical study.

Neural Regen Res 2021 Dec;16(12):2557-2562

Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Minami-Kogushi, Ube, Yamaguchi, Japan.

In spinal cord injuries, external forces from various directions occur at various velocities. Therefore, it is important to physically evaluate whether the spinal cord is susceptible to damage and an increase in internal stress for external forces. We hypothesized that the spinal cord has mechanical features that vary under stress depending on the direction and velocity of injury. However, it is difficult to perform experiment because the spinal cord is very soft. There are no reports on the effects of multiple external forces. In this study, we used bovine spinal cord white matter to test and analyze the anisotropy and velocity dependence of the spinal cord. Tensile-vertical, tensile-parallel, shear-vertical, and shear-parallel tests were performed on the white matter in the fibrous direction (cranial to caudal). Strain rate in the experiment was 0.1, 1, 10, and 100/s. We calculated the Young's modulus of the spinal cord. Results of the tensile and shear tests revealed that stress tended to increase when external forces were applied parallel to the direction of axon fibers, such as in tensile-vertical and shear-vertical tests. However, external forces those tear against the fibrous direction and vertically, such as in tensile-parallel and shear-parallel tests, were less likely to increase stress even with increased velocity. We found that the spinal cord was prone to external forces, especially in the direction of the fibers, and to be under increased stress levels when the velocity of external forces increased. From these results, we confirmed that the spinal cord has velocity dependence and anisotropy. The Institutional Animal Care and Use Committee of Yamaguchi University waived the requirement for ethical approval.
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http://dx.doi.org/10.4103/1673-5374.313059DOI Listing
December 2021

Evaluation of femoral anteversion, hip rotation, and lateral patellar tilt after total hip arthroplasty using a changeable neck system.

J Artif Organs 2021 Apr 26. Epub 2021 Apr 26.

Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan.

In patients with secondary osteoarthritis due to acetabular dysplasia, femoral anteversion has many variations. A changeable neck system is one useful option to adjust the femoral anteversion. Retroverted necks can effectively adjust anatomical anteversion (AA), femoral rotational angle (FRA), and functional anteversion (FA); however, effectiveness of anteverted necks for these adjustments has not been investigated. Moreover, although the lateral patellar tilt after total hip arthroplasty (THA) has been reported to externally rotate, the influence on lateral patellar tilt using a changeable neck system remains unknown. To clarify the effectiveness of anteverted necks in THA, 96 consecutive patients (111 hips) who underwent THA using anatomical short stem with a changeable neck system were retrospectively investigated using pre- and post-operative computed tomography. Patients were divided into the straight (ST) group using straight and 4-mm-high-offset neck (N = 34) and the anteverted (AV) group using 15°-anteverted and 15°-anteverted/3-mm-high-offset neck (N = 34) after age, body mass index, and surgical approach were matched using propensity scores. AA did not change in the ST group, while it increased by 14.0° in the AV group. FRA decreased after surgery in both groups. FA decreased after surgery in the ST group, while it did not change in the AV group. Lateral patella tilt did not significantly change in both groups between pre- and post-operative position. In conclusion, with a changeable neck system, straight and anteverted necks can adjust AA to achieve pre-operative planning while not influencing lateral patellar tilt.
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http://dx.doi.org/10.1007/s10047-021-01269-1DOI Listing
April 2021

Long-term survival of airway silicone stents in patients with central airway stenosis or obstruction due to thoracic malignancy.

Gen Thorac Cardiovasc Surg 2021 Apr 12. Epub 2021 Apr 12.

Nishiyokohama International Hospital, Kanagawa, Japan.

Objectives: Silicone airway stents are used to manage central airway stenosis or obstruction, although their impact on long-term survival remains unknown in patients with central airway stenosis or obstruction due to thoracic malignancy. In this study, we retrospectively analyzed the impact of silicone stents on survival.

Methods: We retrospectively analyzed clinical data of 106 patients with central airway stenosis or obstruction due to thoracic malignancy treated by stenting at Toho University Omori Medical Center between 1998 and 2018.

Results: Patients treated with silicone stents had significantly higher survival rates than patients treated with metallic stents (p = 0.0173). Silicone stents patients also had significantly more additional treatments for thoracic malignancy after stenting than metallic stents patients (p = 0.0007). Notably, significantly more silicone stents patients underwent chemoradiotherapy or radiotherapy (p = 0.0268, p = 0.0300). During multivariate analyses, the additional treatment, including chemoradiotherapy or radiotherapy, was an independent optimal prognostic factor.

Conclusions: Silicone stents patients had significantly higher survival rates than metallic stents patients. Although stenting for airway stenosis or obstruction due to thoracic malignancy may be mainly palliative, additional treatments after stenting should be considered to improve the prognoses of patients with airway stenosis or obstruction due to thoracic malignancy.
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http://dx.doi.org/10.1007/s11748-021-01634-0DOI Listing
April 2021

Identification of CXCL12-abundant reticular cells in human adult bone marrow.

Br J Haematol 2021 May 10;193(3):659-668. Epub 2021 Apr 10.

Laboratory of Stem Cell Biology and Developmental Immunology, Immunology Frontier Research Center, World Premier International Research Center (WPI), Graduate School of Frontier Biosciences, Graduate School of Medicine, Osaka University, Suita, Japan.

A population of mesenchymal stem cells, termed CXC chemokine ligand (CXCL)12-abundant reticular (CAR) cells or leptin receptor-expressing cells, are the major cellular component of niches for haematopoietic stem cells (HSCs) in murine bone marrow. CAR cells are characterized by several salient features, including much higher expression of CXCL12, stem cell factor (SCF), forkhead box C1 (FOXC1) and early B-cell factor 3 (EBF3), which are essential for HSC maintenance, than other cells. However, the human counterpart of CAR cells has not been fully described. Here, we show the presence of cells expressing much higher CXCL12 than other cells in human adult bone marrow using a flow cytometry-based in situ technique that enables high-throughput detection of mRNA at single-cell resolution. Most CXCL12 cells expressed high levels of SCF, FOXC1 and EBF3 and had the potential to differentiate into adipocytes and osteoblasts. Histologically, the nuclei of CXCL12 cells were identified and quantified by EBF3 expression in fixed marrow sections. CXCL12 cells sorted from residual bone marrow aspirates of chronic myeloid leukaemia patients expressed reduced levels of CXCL12, SCF, FOXC1 and EBF3 in correlation with increased leukaemic burden. Together, we identified the human counterpart of CAR cells, enabling the evaluation of their alterations in various haematological disorders by flow cytometric and histological analyses.
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http://dx.doi.org/10.1111/bjh.17396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252541PMC
May 2021

Elective lung resection after treatment for COVID-19 pneumonia.

Gen Thorac Cardiovasc Surg 2021 Jul 3;69(7):1159-1162. Epub 2021 Apr 3.

Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.

A 65-year-old man with coronavirus disease 2019 (COVID-19) was admitted to our hospital. Computed tomography detected bilateral pneumonia with a lung nodule suspicious for lung cancer. Lobectomy was performed 3 months after the treatment for COVID-19 without any complications. The surgical specimen revealed fibrosis below the pleura with a small collection of lymphocytes and intravascular hemorrhagic thrombosis, and no residual RNA was detected. This is the first report describing a surgical specimen after recovery from COVID-19 pneumonia, and suggests that elective thoracic surgery can be performed safely, depending on the patient's respiratory function, without infectious risk.
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http://dx.doi.org/10.1007/s11748-021-01630-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019292PMC
July 2021

Diaphragm reconstruction by GORE DUALMESH in patients undergoing resection for thoracic malignancies.

J Cardiothorac Surg 2021 Mar 31;16(1):65. Epub 2021 Mar 31.

Division of Chest Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.

Background: We used GORE DUALMESH for the reconstruction of diaphragms in patients with thoracic malignancies. Here, we report the results.

Methods: Between July 2015 and August 2017, diaphragm reconstruction using 2-mm GORE DUALMESH was performed in 7 patients undergoing surgical resection for thoracic malignancies. After resection of the diaphragm, the mesh was trimmed to the size of defect and placed with the smooth surface facing the chest cavity and the rough surface facing the abdomen. It was fixed with interrupted sutures consisting of synthetic monofilament nonabsorbable 1-0 to 2 threads.

Results: Indications for resection were malignant pleural mesothelioma and primary lung cancer in 5 and 2 patients, respectively. Patients with malignant pleural mesothelioma underwent pleurectomy with decortication; patients with primary lung cancer underwent lung lobectomy. Right and left diaphragm reconstruction was performed for 4 and 3 patients, respectively. Neither complications related to diaphragm reconstruction nor displacement of mesh occurred during a follow-up period ranging from 11 days to 37 months.

Conclusions: GORE DUALMESH is a good synthetic material for diaphragm reconstruction, because its smooth surface prevents adhesions to the lung and its rough surface allows adherence to abdominal tissue.
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http://dx.doi.org/10.1186/s13019-021-01449-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011125PMC
March 2021

Serum sphingosine-1-phosphate is elevated in atopic dermatitis and associated with severity.

Allergy 2021 Aug 7;76(8):2592-2595. Epub 2021 Apr 7.

Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education (CK-CARE), University Hospital Bonn, Bonn, Germany.

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http://dx.doi.org/10.1111/all.14826DOI Listing
August 2021

Randomized trial of granulocyte colony-stimulating factor for spinal cord injury.

Brain 2021 Apr;144(3):789-799

G-SPIRIT Study Group, Chiba, Japan.

Attenuation of the secondary injury of spinal cord injury (SCI) can suppress the spread of spinal cord tissue damage, possibly resulting in spinal cord sparing that can improve functional prognoses. Granulocyte colony-stimulating factor (G-CSF) is a haematological cytokine commonly used to treat neutropenia. Previous reports have shown that G-CSF promotes functional recovery in rodent models of SCI. Based on preclinical results, we conducted early phase clinical trials, showing safety/feasibility and suggestive efficacy. These lines of evidence demonstrate that G-CSF might have therapeutic benefits for acute SCI in humans. To confirm this efficacy and to obtain strong evidence for pharmaceutical approval of G-CSF therapy for SCI, we conducted a phase 3 clinical trial designed as a prospective, randomized, double-blinded and placebo-controlled comparative trial. The current trial included cervical SCI [severity of American Spinal Injury Association (ASIA) Impairment Scale (AIS) B or C] within 48 h after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group was administered 400 μg/m2/day × 5 days of G-CSF in normal saline via intravenous infusion for five consecutive days. The placebo group was similarly administered a placebo. Allocation was concealed between blinded evaluators of efficacy/safety and those for laboratory data, as G-CSF markedly increases white blood cell counts that can reveal patient treatment. Efficacy and safety were evaluated by blinded observer. Our primary end point was changes in ASIA motor scores from baseline to 3 months after drug administration. Each group includes 44 patients (88 total patients). Our protocol was approved by the Pharmaceuticals and Medical Device Agency in Japan and this trial is funded by the Center for Clinical Trials, Japan Medical Association. There was no significant difference in the primary end point between the G-CSF and the placebo control groups. In contrast, one of the secondary end points showed that the ASIA motor score 6 months (P = 0.062) and 1 year (P = 0.073) after drug administration tend to be higher in the G-CSF group compared with the placebo control group. Moreover, in patients aged over 65 years old, motor recovery 6 months after drug administration showed a strong trend towards a better recovery in the G-CSF treated group (P = 0.056) compared with the control group. The present trial failed to show a significant effect of G-CSF in primary end point although the subanalyses of the present trial suggested potential G-CSF benefits for specific population.
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http://dx.doi.org/10.1093/brain/awaa466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041047PMC
April 2021

Partial trapeziectomy for Eaton stage III thumb carpometacarpal arthritis: ligament reconstruction with tendon interposition using the entire flexor carpi radialis and interference screw fixation.

Eur J Orthop Surg Traumatol 2021 Mar 25. Epub 2021 Mar 25.

Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.

Background: Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is currently the most popular technique for treating primary osteoarthritis of the thumb carpometacarpal joint. However, reduced trapezial height has sometimes been reported after LRTI. Longer immobilization and delayed rehabilitation times are also problematic. In this study, we evaluated the clinical and radiological outcomes of patients who underwent our modified LRTI procedure.

Methods: Retrospective study included 26 thumbs in 24 cases with advanced stages. Our modified Burton's procedure was as follows: (1) trapeziectomy was limited to distal-half, (2) the entire flexor carpi radialis (FCR) was harvested from the forearm, and (3) half-slip of the FCR tendon was stabilized by interference screw in the first metacarpal bone tunnel.

Results: Pain on the visual analogue scale (VAS), the quick Disabilities of the Arm Shoulder and Hand score, tip pinch strength significantly improved postoperatively. The preoperative height of the trapezial space was well-maintained at final follow-up. Magnetic resonance imaging at the one-year follow-up showed the existence of FCR tendon ball in 15 cases. Eighteen housewives resumed their daily activities after a mean period of 10 days postoperative, while another 6 patients returned to their original jobs after 3 weeks.

Conclusions: Our modified LRTI method involves distal-half trapeziectomy and entire FCR interposition. A sewn FCR tendon ball always provide enough volume to fill the trapeziectomy space, which helps to prevent sinking of the metacarpal bone. Our technique produced sufficient ligamentoplasty and allowed early mobilization after surgery.
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http://dx.doi.org/10.1007/s00590-020-02863-4DOI Listing
March 2021

Streptococcus anginosus group infection as a predictor for the progression of descending necrotizing mediastinitis.

Ann Palliat Med 2021 Apr 22;10(4):4008-4016. Epub 2021 Mar 22.

Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan.

Background: The prognosis of descending necrotizing mediastinitis (DNM), especially that extending inferiorly to the carina, remains poor. The identification of additional prognostic factors may improve the prognosis.

Methods: We retrospectively analyzed six patients who underwent thoracic surgery for DNM extending to the anterior and posterior mediastinum inferior to the carina (Endo classification type IIB) from 2014 to 2020. We reviewed their characteristics, clinical course, causative bacteria, and treatment to investigate their prognostic factors.

Results: The median patient age was 62 years. Five patients were men and one patient was a woman. The causative disease in three of the patients was pharyngolaryngeal, and for the others, it was an odontogenic infection. Five patients had sepsis and four had disseminated intravascular coagulation (DIC) at surgery. Four patients had polymicrobial infections of aerobic and anaerobic bacteria, all of whom showed gas bubbles on a chest computed tomography scan and detection of Streptococcus anginosus group (SAG). All patients underwent cervicotomy, tracheostomy, and mediastinal drainage and debridement via a transthoracic approach. Three patients underwent additional surgery or drainage because an additional abscess appeared postoperatively. The median duration of hospitalization was 58 days and the mixed infections, including SAG, were all detected in the three cases of long-term hospitalization. No disease-associated death was observed during the follow-up period of 18 months.

Conclusions: Mixed infection, including SAG, may be a predictor for DNM aggravation and spread. Gas bubbles on a chest computed tomography scan suggest polymicrobial aerobic and anaerobic infections including SAG, which require broad-spectrum antibiotic therapy and aggressive drainage and surgery.
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http://dx.doi.org/10.21037/apm-20-2120DOI Listing
April 2021

Geographic distribution of the incidence of osteonecrosis of the femoral head in Japan and its relation to smoking prevalence.

Mod Rheumatol 2021 Mar 30:1-7. Epub 2021 Mar 30.

Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.

Objectives: Alcohol intake and smoking are modifiable lifestyle-related risk factors for osteonecrosis of the femoral head (ONFH). We investigated geographic differences in ONFH incidence in Japan and the correlation with alcohol intake and smoking to develop prevention strategies for ONFH in Japan.

Methods: This ecological study was conducted in Japan primarily using the following data sources: nationwide epidemiological survey and national survey. We estimated the annual ONFH incidence and the prevalence of alcohol drinking and smoking in each prefecture. Prefectural incidence and prevalence were calculated by sex and age-standardization.

Results: The mean annual ONFH incidence per 100,000 population was 3.08 in men and 1.63 in women, respectively. There was no significant correlation between ONFH incidence and the prevalence of any levels of alcohol intake, while smoking ≥20 cigarettes/day showed a significant and moderate correlation in men (r = 0.47,  = .01). This correlation remained significant after adjustment for the prevalence of any levels of alcohol intake (standardized partial regression coefficient = 0.47-0.49,  = .009-.01).

Conclusion: ONFH incidence is geographically variable in Japan, and this may be partly explained by the distribution of smoking prevalence. Smoking cessation may contribute to an effective decline in the overall ONFH incidence in Japan.
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http://dx.doi.org/10.1080/14397595.2021.1899452DOI Listing
March 2021

Complete remission of DnaJ homolog subfamily B member 9-positive fibrillary glomerulonephritis following steroid monotherapy in an elderly Japanese woman.

CEN Case Rep 2021 08 3;10(3):442-447. Epub 2021 Mar 3.

Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan.

A 74-year-old Japanese woman was referred to our department because of anasarca and massive proteinuria. She was clinically diagnosed with nephrotic syndrome, and renal biopsy showed membranoproliferative glomerulonephritis accompanied by marked glomerular infiltration with macrophages and full-house immunofluorescence glomerular deposition. Furthermore, randomly arranged nonbranching fibrils, approximately 12 nm in diameter, were found by electron microscopy, and immunostaining for DnaJ homolog subfamily B member 9 (DNAJB9), a recently identified diagnostic biomarker of fibrillary glomerulonephritis (FGN), showed positive result, thereby confirming the diagnosis of FGN. Steroid treatment was initiated, and she obtained complete remission of nephrotic syndrome and has maintained it. FGN is an uncommon form of glomerular disease, and reported cases of DNAJB9-positive FGN among Asians, particularly among Japanese population, are rare. There have been no established therapeutic regimens and its renal prognosis is generally unfavorable. The present case suggests that some patients with FGN can achieve favorable clinical outcomes through steroid monotherapy.
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http://dx.doi.org/10.1007/s13730-021-00585-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8271071PMC
August 2021

The Effects of Rasp Oversize on the Clinical and Radiographic Outcomes of Total Hip Arthroplasty With a Collared Satin-Finished Composite Beam Cemented Stem.

J Arthroplasty 2021 06 22;36(6):2055-2061. Epub 2021 Jan 22.

Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.

Background: This study aimed to compare the clinical and radiographic outcomes of using two different oversized rasps in total hip arthroplasty (THA) with a composite beam cemented stem (DCM-J).

Methods: A consecutive series of 105 hips underwent hybrid THA using the DCM-J stem between 2006 and 2010. Among the patients with a minimum 10-year follow-up, a 1.5-mm oversized rasp was used in 38 hips (group S), whereas a 0.5-mm oversized rasp was used in 36 hips (group M). The Japanese Orthopedic Association hip score and radiographic findings were evaluated, including cement mantle thickness, stress shielding, and cortical hypertrophy.

Results: The Japanese Orthopedic Association hip score was significantly improved postoperatively with 100% of the implant survival rate in both groups when septic loosening was excluded. Radiographic assessment performed immediately postoperatively revealed that the cement mantle thickness was significantly larger in group M than group S in Gruen zone 1 but did not differ between groups in zones 2-7. Stress shielding was significantly more frequent in group M than group S at 2 years (P = .011), 5 years (P = .012), and ≥10 years postoperatively (P = .038). Cortical hypertrophy appeared in a time-dependent manner; however, the prevalence did not significantly differ between groups at final follow-up at a mean of 11.7 years (range 10-14 years) postoperatively.

Conclusions: The DCM-J stem achieved good clinical results in both groups. Stress shielding was significantly more frequent in THA using the 0.5-mm rasp than the 1.5-mm rasp, indicating that sufficient cement mantle room should be prepared for the cemented stem.
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http://dx.doi.org/10.1016/j.arth.2021.01.044DOI Listing
June 2021

Contributions of Airway Stent for Long-term Outcome in Patients With Malignant Central Airway Stenosis or Obstruction.

J Bronchology Interv Pulmonol 2021 Jul;28(3):228-234

Nishiyokohama International Hospital, Kanagawa, Japan.

Background: Although an airway stent is used for malignant central airway stenosis or obstruction, long-term outcomes are unknown. In this study, we retrospectively analyzed the clinical features of patients who required stenting for malignant central airway stenosis or obstruction.

Patients And Methods: We retrospectively analyzed clinical data from 116 patients with stenting for central airway stenosis or obstruction who underwent treatment at Toho University Hospital from 1998 to 2018. We evaluated the clinical features, prognoses, and complications for stenting in these patients.

Results: The distribution of the 116 patients was as follows: lung cancer, 53; esophageal cancer, 40; thyroid cancer, 8; and others, 15. Patients with thyroid cancer had a significantly higher rate of complications after stenting than patients with lung cancer (P=0.0062), esophageal cancer (P=0.0029), and others (P=0.0062). Patients with esophageal cancer had a significantly worse prognosis than patients with lung and thyroid cancer. In patients with lung cancer the prognosis was significantly different between patients who underwent additional treatment for lung cancer after stenting and patients with no treatment (P=0.0398), and patients who received chemoradiotherapy for lung cancer after stenting had a significantly better prognosis than patients with no treatment (P=0.0306).

Conclusion: Stenting for airway stenosis/obstruction may improve prognosis in patients with lung or thyroid cancer, especially if patients with lung cancer undergo additional treatments after stenting, although airway stenting for patients with esophageal cancer was palliative. New treatment strategies may be necessary for patients with esophageal cancer after stenting to improve prognosis.
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http://dx.doi.org/10.1097/LBR.0000000000000749DOI Listing
July 2021
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