Publications by authors named "Yusuke Ueda"

73 Publications

Three-dimensional kinematics of reverse shoulder arthroplasty: a comparison between shoulders with good or poor elevation.

JSES Int 2021 May 31;5(3):353-359. Epub 2021 Mar 31.

Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, USA.

Background: Various factors may be related to outcomes of reverse shoulder arthroplasty (RSA) including patient and surgical factors. Differences in shoulder kinematics might be associated with poor function after RSA; however, kinematic differences between shoulders with good or poor elevation have not been elucidated. The purpose of this study was to compare RSA kinematics between shoulders with good or poor elevation.

Methods: The study included 28 shoulders with a minimum 6-month follow-up after RSA using Grammont-type prostheses. Subjects comprised 17 men and 11 women with the mean age of 75 years (range, 63-91). Subjects underwent fluoroscopy during active scapular plane abduction. Computed tomography of their shoulders was performed to create 3-dimensional scapular implant models. Using model-image registration techniques, poses of 3-dimensional implant models were iteratively adjusted to match their silhouettes with the silhouettes in the fluoroscopic images, and 3-dimensional kinematics of implants were computed. Kinematics and glenosphere orientation were compared between shoulders with good (>90 degree) or poor (<90 degree) scapular plane abduction.

Results: Nineteen and 9 shoulders were assigned to the good- and poor-elevation groups, respectively. There were no significant differences between the groups in age, sex, height, weight, preoperative range of motion, or Constant score, but body mass index in the poor elevation shoulders was significantly larger than that in the good elevation shoulders. There were no significant differences in glenosphere (upward/downward rotation, anterior/posterior tilt, internal/external rotation) or glenohumeral (internal/external rotation, abduction/adduction) kinematics between the good and poor elevation shoulders. Scapulohumeral rhythm was significantly higher in the good elevation shoulders than the poor elevation shoulders ( = .04). Glenosphere superior tilt was 2.3° ± 4.2° in the good-elevation group and 8.1° ± 8.9° in the poor-elevation group, and the difference was statistically significant ( = .03).

Discussion: Shoulders with good elevation after RSA demonstrated better scapulohumeral rhythm than those with poor elevation, though there were no significant differences in glenosphere and glenohumeral kinematics. It may be important for better elevation to achieve good glenohumeral motion in shoulders with RSA. Glenosphere orientations may affect postoperative shoulder function.
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http://dx.doi.org/10.1016/j.jseint.2021.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178639PMC
May 2021

(4-Hydroxyphenyl) retinamide suppresses SARS-CoV-2 spike protein-mediated cell-cell fusion by a dihydroceramide Δ4-desaturase 1-independent mechanism.

J Virol 2021 Jun 9:JVI0080721. Epub 2021 Jun 9.

Faculty of Pharma-Science, Teikyo University, Tokyo, Japan.

The membrane fusion between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and host cells is essential for the initial step of infection; therefore, the host cell membrane components, including sphingolipids, influence the viral infection. We assessed several inhibitors of the enzymes pertaining to sphingolipid metabolism, against SARS-CoV-2 spike protein (S)-mediated cell-cell fusion and viral infection. -(4-hydroxyphenyl) retinamide (4-HPR), an inhibitor of dihydroceramide Δ4-desaturase 1 (DES1), suppressed cell-cell fusion, and viral infection. The analysis of sphingolipid levels revealed that the inhibition efficiencies of cell-cell fusion and viral infection in 4-HPR-treated cells were consistent with an increased ratio of saturated sphinganine-based lipids to total sphingolipids. We investigated the relationship of DES1 with the inhibition efficiencies of cell-cell fusion. The changes in the sphingolipid profile induced by 4-HPR were mitigated by the supplementation with exogenous cell-permeable ceramide; however, the reduced cell-cell fusion could not be reversed. The efficiency of cell-cell fusion in DES1 knockout (KO) cells was at a level comparable to that in wild-type (WT) cells; however, the ratio of saturated sphinganine-based lipids to the total sphingolipids was higher in DES1 KO cells, compared to that in WT cells. 4-HPR reduced cell membrane fluidity without any significant effects on the expression or localization of angiotensin-converting enzyme 2, the SARS-CoV-2 receptor. Therefore, 4-HPR suppresses SARS-CoV-2 S-mediated membrane fusion through a DES1-independent mechanism, and this decrease in membrane fluidity induced by 4-HPR could be the major cause for the inhibition of SARS-CoV-2 infection. Sphingolipids could play an important role in SARS-CoV-2 S-meditated membrane fusion with host cells. We studied the cell-cell fusion using SARS-CoV-2 S expressing cells and sphingolipid-manipulated target cells, with an inhibitor of the sphingolipid metabolism. 4-HPR (also known as fenretinide) is an inhibitor of DES1 and it exhibits antitumor activity and suppresses cell-cell fusion and viral infection. 4-HPR suppresses membrane fusion through a decrease in membrane fluidity, which could possibly be the cause for the inhibition of SARS-CoV-2 infection. There is accumulating clinical data on the safety of 4-HPR. Therefore, it could be a potential candidate drug against COVID-19.
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http://dx.doi.org/10.1128/JVI.00807-21DOI Listing
June 2021

A 63-Year-Old Woman With an Acute Exacerbation of Interstitial Pneumonia.

Chest 2021 Jun;159(6):e389-e394

Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan. Electronic address:

Case Presentation: A 63-year-old, non-smoking Asian woman presented to our hospital due to abnormal findings on chest radiography. She had no history of dust exposure. Chest radiography and CT imaging showed patchy ground-glass attenuation (GGA) in the bilateral lower lung lobes, a ground-glass nodule in the right lower lung lobe (diameter, 9.8 mm), and some thin-walled cysts in both lungs (Fig 1). Thickening of the interlobular septa, mediastinal lymphadenopathy, and pleural effusion were not evident. Video-assisted thoracic surgery was performed for the examination of the nodule and the background lung disease, and the nodule was histologically diagnosed as lung adenocarcinoma. Simultaneously, the lung background showed diffuse lymphocytic infiltration in the alveolar septum and peribronchovascular interstitium (Fig 2). There were no symptoms suggestive of autoimmune diseases such as dryness, arthralgia, skin rash, or fever. The patient was followed up without treatment for the interstitial lung disease.
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http://dx.doi.org/10.1016/j.chest.2021.01.018DOI Listing
June 2021

Determinants of Exercise-Induced Mitral Regurgitation Using Three-Dimensional Transesophageal Echocardiography Combined With Isometric Handgrip Exercise.

Am J Cardiol 2021 May 25. Epub 2021 May 25.

Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.

Using three-dimensional (3D) transesophageal echocardiography (TEE) and isometric handgrip exercise (IHE), we investigated the determinants of exercise-induced mitral regurgitation (MR) according to MR etiologies. Seventy-six patients with more than moderate MR, 40 patients with functional MR (FMR) and 36 patients with degenerative MR (DMR), underwent 3D TEE combined with IHE. Mitral valve (MV) geometry and 3D vena contracta area (3D VCA) were simultaneously evaluated at baseline and during IHE. With regard to exercise-induced MR, Δ3D VCA was calculated as the difference between 3D VCA at baseline and 3D VCA during IHE. IHE caused different changes in MV geometry between etiologies and led to exacerbation of 3D VCA at baseline. Larger Δ3D VCA was observed in the FMR group compared with the DMR group (15.9 ± 10.3 mm versus 7.3 ± 4.2 mm; p < 0.0001). In multivariate analyses, tenting height and 3D VCA were selected as independent factors associated with Δ3D VCA in the FMR group (p = 0.0135 and p = 0.0201, respectively), while flail width was selected as an independent factor associated with Δ3D VCA in the DMR group (p = 0.0066). In conclusion, IHE alters mitral valve geometry and causes exacerbation of MR regardless of MR etiology and the determinants of exercise-induced MR differed between MR etiologies.
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http://dx.doi.org/10.1016/j.amjcard.2021.04.018DOI Listing
May 2021

Prevalence, distribution, and determinants of pulmonary venous systolic flow reversal in severe mitral regurgitation.

Eur Heart J Cardiovasc Imaging 2021 May 26. Epub 2021 May 26.

Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.

Aims: This study aimed to evaluate the prevalence and distribution of pulmonary venous systolic flow reversal (PVSFR) in patients with severe mitral regurgitation (MR), and to examine the relationship between PVSFR profile and cardiac parameters.

Methods And Results: A total of 125 patients with severe MR who had transoesophageal echocardiography (TOE) performed were reviewed. Of these, 121 (96.8%) patients showed all four pulmonary venous (PV) flows by TOE. They were categorized into three groups by the MR aetiology: degenerative MR (DMR) (n = 72), ventricular functional MR (V-FMR) (n = 20), and atrial functional MR (A-FMR) (n = 16). Eighteen (16.7%) patients had PVSFR in all four PVs. Twenty-nine (26.9%) had PVSFR in three PVs, 23 (21.3%) in two PVs, and 23 (21.3%) in one PV. PVSFR appeared at right PVs more frequently compared with left PVs. A high number of PVSFR was significantly correlated with higher pulmonary capillary wedge pressure (PCWP) and 3D vena contracta area (3D-VCA). With regard to MR aetiology, the number of PVSFRs was correlated with high 3D-VCA in patients with DMR and A-FMR, while it was correlated with high PCWP in patients with V-FMR. Laminar-type PVSFR appeared more frequently in FMR compared with DMR, and it had a relationship with higher PCWP and lower right ventricular fractional area change (RVFAC).

Conclusion: All four PV were detected in 96.8%, and 16.8% patients had PVSFR in all four PVs. PCWP and 3D-VCA were correlated with the number of PVSFRs in severe MR patients. Laminar-type PVSFR was related to higher PCWP and lower RVFAC.
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http://dx.doi.org/10.1093/ehjci/jeab098DOI Listing
May 2021

Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes.

Am J Sports Med 2021 05 12;49(6):1604-1611. Epub 2021 Apr 12.

Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan.

Background: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes.

Purpose: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability.

Study Design: Case series; Level of evidence, 4.

Methods: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated.

Results: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; = .002).

Conclusion: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.
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http://dx.doi.org/10.1177/03635465211003091DOI Listing
May 2021

Severe and progressive platythorax disproportionate to lung fibrosis: A rare variant of idiopathic pleuroparenchymal fibroelastosis.

Respir Med Case Rep 2021 19;33:101395. Epub 2021 Mar 19.

Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan.

A 57-year-old man was referred to our department because of progressive shortness of breath and emaciation. He had experienced pneumothorax three times in the past five years. The patient radiologically showed mild upper-lobe predominant airspace consolidation and severe platythorax and was clinically diagnosed with idiopathic pleuroparenchymal fibroelastosis (PPFE). Although the wedge-shaped shadows in the bilateral lung apexes did not significantly progress, his platythorax gradually worsened during the clinical course. He ultimately died of chronic respiratory failure 1.2 years after the diagnosis. This case demonstrates a rare variant of idiopathic PPFE with progressive platythorax disproportionate to the extent of upper-lobe fibroelastosis.
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http://dx.doi.org/10.1016/j.rmcr.2021.101395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008244PMC
March 2021

In vivo measurement of distance between scapular neck and polyethylene insert during active external rotation in shoulders with Grammont type reverse prosthesis.

Clin Biomech (Bristol, Avon) 2021 Apr 26;84:105341. Epub 2021 Mar 26.

Department of Mechanical & Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA.

Background: Scapular notching is a frequently observed complication after reverse shoulder arthroplasty. Impingement of the humeral plastic insert against the scapular neck is believed to be the cause of notching. There have been no in vivo studies that analyzed the positional relationship between the scapular neck and humeral insert. The purpose of this study was to measure the distance between the scapular neck and insert in shoulders with Grammont-type prostheses during active external rotation at the side.

Methods: Eighteen shoulders with Grammont-type prostheses were enrolled in this study. There were 13 males and 5 females, and the mean age at surgery was 74 years (range, 63-91). Fluoroscopic images were recorded during active external rotation at the side from maximum internal to external rotation at an average of 14 months (range, 7-24) after surgery. Implant kinematics were determined with three-dimensional models of the implants and fluoroscopic images using model-image registration techniques. Based on the implant kinematics, the closest distance between the scapular neck and insert was computed at each 5° increment of glenohumeral internal/external rotation.

Results: Mean glenohumeral abduction during rotation was 17°-22°. The mean distance between the neck and insert was approximately 1 mm throughout the activity. The separation distance tended to narrow with arm external rotation, but the change was not significant.

Interpretation: The small distance between the scapular neck and insert in early post-operative reverse shoulder arthroplasty patients may be associated with the high incidence of scapular notching in Grammont-type prostheses.
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http://dx.doi.org/10.1016/j.clinbiomech.2021.105341DOI Listing
April 2021

Arthroscopic Iliac Bone Grafting for Traumatic Anterior Shoulder Instability with Significant Glenoid Bone Loss Yields Low Recurrence and Good Outcome at a Minimum of Five-year Follow-Up.

Arthroscopy 2021 Mar 24. Epub 2021 Mar 24.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba.

Purpose: The purpose of this study was to investigate the clinical and radiographic outcomes of arthroscopic iliac bone grafting with capsulolabral reconstruction for severe glenoid bone loss with a minimum of 5 years' follow-up.

Methods: The inclusion criterion was shoulders that underwent arthroscopic iliac bone grafting for >20%-25% glenoid defect between January 2007 and April 2014, and the exclusion criterion was <5 years' follow-up. Iliac crest bone grafts of approximately 2.0 cm length and 0.8 cm height were arthroscopically fixed to the anterior glenoid using 2 cannulated screws followed by capsulolabral repair. Rowe score, Western Ontario Shoulder Instability Index (WOSI), and passive range of motion were evaluated. Radiographic findings including the Kellgren and Lawrence osteoarthritis grade and graft integration on 3-dimensional computed tomography at the final follow-up were also evaluated.

Results: Forty-eight shoulders met the inclusion criteria, and 24 shoulders with ≥5 years' follow-up were included (1 died; 23 were lost follow-up): 22 males, 2 females; a mean age at surgery, 30 years (range, 18-52 years); a mean follow-up of 8 years (range, 5-11 years). The mean preoperative glenoid bone defect was 22% (range, 20%-28%). All shoulders had a Hill-Sachs lesion including 4 on-track lesions. One shoulder experienced traumatic redislocation at 5 years after surgery. The scores significantly improved: Rowe score, 19 ± 8 to 94 ± 8 (P < .001); WOSI, 1547 ± 241 to 439 ± 318 (P < .001). Postoperative flexion showed significant improvement from 158 ± 18 to 169 ± 11 (P = .008), whereas internal rotation deteriorated from T8 ± 3 to T10 ± 3 (P = .005). Graft integration showed remodeling in 54% and excessive absorption in 13%. Osteoarthritis grades progressed significantly (P < .001), but only grade 1 osteoarthritic changes were seen, except for 4 shoulders with grade 2 osteoarthritis.

Conclusions: Arthroscopic iliac bone grafting for traumatic anterior shoulder instability with severe glenoid bone loss yielded satisfactory outcomes with mid-term follow-up. Arthritic changes progressed in half of the shoulders; however, most shoulders only demonstrated grade 1 osteoarthritis.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.arthro.2021.03.028DOI Listing
March 2021

Comparison Between Osteochondral Autograft Transplantation and Arthroscopic Fragment Resection for Large Capitellar Osteochondritis Dissecans in Adolescent Athletes: A Minimum 5 Years' Follow-up.

Am J Sports Med 2021 04 11;49(5):1145-1151. Epub 2021 Mar 11.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan.

Background: The choice of surgical option for unstable large capitellar osteochondritis dissecans (OCD) lesions in skeletally immature athletes remains controversial.

Purpose/hypothesis: The purpose was to investigate functional and radiographic outcomes after arthroscopic fragment resection and osteochondral autograft transplantation (OAT) for unstable large capitellar OCD lesions in skeletally immature athletes with a minimum 5 years' follow-up. We hypothesized that the outcomes after OAT for large capitellar OCD lesions would be superior to those after arthroscopic fragment resection.

Study Design: Cohort study; Level of evidence, 3.

Methods: A total of 19 elbows in 19 patients (17 male and 2 females) who underwent arthroscopic resection were assigned to group 1 (mean age, 14 years [range, 13-15 years]), whereas 29 elbows in 29 patients (29 male) who underwent OAT were assigned to group 2 (mean age, 14 years [range, 13-15 years]), with the mean follow-up of 8 (range, 5-11 years) and 7 (range, 5-13 years) years, respectively. All OCD lesions were larger than one-half of the radial head diameter. Functional scores, patient satisfaction, and range of motion were compared between the groups. Radiographic changes, including superior migration, radial head enlargement, and osteoarthritis (OA) grade, were examined.

Results: All patients returned to sports activity. Functional scores, patient satisfaction, and flexion at the final follow-up were significantly improved in both groups compared with preoperative values, and differences were not significant between groups at the final follow-up. Extension showed a significant improvement in both groups (group 1: -17° to 0°; group 2: -18° to -6°; < .001). Extension in group 1 was significantly better than that in group 2 at the final follow-up ( = .045). No elbows developed postoperative severe OA in group 1, whereas 3 elbows in group 2 had grade 3 OA; these 3 elbows had preoperative superior migration and radial head enlargement.

Conclusion: No differences were observed in clinical and radiographic outcomes between patients undergoing arthroscopic fragment resection and OAT, except for elbow extension, at a minimum 5 years' follow-up. We believe that for adolescents with large capitellar OCD lesion, OAT is a good option for skeletally immature elbows and that arthroscopic fragment resection is a reliable and less invasive surgical option for relatively mature elbows.
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http://dx.doi.org/10.1177/0363546521994558DOI Listing
April 2021

Morphology of the Undersurface of the Anterolateral Acromion and Its Relationship to Surrounding Structures.

Orthop J Sports Med 2021 Jan 27;9(1):2325967120977485. Epub 2021 Jan 27.

Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.

Background: A better understanding of the morphology underneath the acromion is needed to prevent complications after arthroscopic subacromial decompression. The precise correlations between the morphologic features underneath the acromion and the surrounding structures including the attachment of the coracoacromial ligament (CAL) and the origin of the deltoid middle head have not yet been determined in the absence of artifacts on the bony surface caused by dissection techniques. Moreover, anatomic findings in previous studies using only older-aged cadavers or dried bones may not reflect the morphologic features of younger and healthy specimens.

Purpose: To characterize the anterolateral structures morphologically in the inferior aspect of the acromion, assess the relationships of these structures with surrounding structures without dissection artifacts on the bony surface, and verify the cadaveric data in the asymptomatic shoulders of living middle-aged patients.

Study Design: Descriptive laboratory study.

Methods: We initially analyzed the relationship between the morphology of the anterolateral structures and surrounding structures in 18 cadaveric shoulders (mean age, 81.8 years), 15 of which were subjected to macroscopic investigation of the CAL attachment and 3-dimensional micro-computed tomography investigation with radiopaque markers and 3 of which were subjected to histologic examination. We also analyzed the morphology underneath the anterolateral acromion in 24 asymptomatic shoulders of middle-aged patients (mean age, 54.8 years) to verify the cadaveric data. In both the cadaveric shoulders and the asymptomatic shoulders of live patients, the long axis, width, and height of the anterolateral prominence were measured by use of 3-dimensional CT imaging.

Results: In cadavers, the anterolateral prominence underneath the acromion corresponded to the attachment of the CAL. Histologic evaluation revealed that the CAL was continuous to the deep layer of the deltoid middle head in the lateral acromion. The study in asymptomatic shoulders of middle-aged patients revealed bony prominences similar to those observed in cadavers.

Conclusion: The anterolateral prominence, which corresponds to the attachment of the CAL below the acromion, may be a native structure below the acromion. Moreover, the CAL is continuous to the deep layer of the deltoid middle head in the lateral acromion.
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http://dx.doi.org/10.1177/2325967120977485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844461PMC
January 2021

Physiological Criteria Are Useful for the Diagnosis of Idiopathic Pleuroparenchymal Fibroelastosis.

J Clin Med 2020 Nov 22;9(11). Epub 2020 Nov 22.

Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan.

Background: Diagnostic criteria of idiopathic pleuroparenchymal fibroelastosis (IPPFE) were recently proposed, including physiological criteria of the body mass index (BMI) and percentage of the predicted values of residual volume (RV)/total lung capacity (TLC) (RV/TLC %pred.). The aim of this study was to evaluate (i) whether the physiologic criteria are useful for the diagnosis and (ii) whether the flat chest index, defined as the ratio of the anteroposterior diameter to the transverse diameter of the thoracic cage, could be an alternative parameter to RV/TLC %pred.

Methods: We selected consecutive IPPFE patients and idiopathic pulmonary fibrosis (IPF) patients. We examined the diagnostic sensitivity and specificity of the physiological criteria and flat chest index for differentiating IPPFE patients from IPF patients.

Results: This study included 37 IPPFE patients and 89 IPF patients. The physiological criteria distinguished IPPFE patients from IPF patients with a sensitivity of 78.6% and specificity of 88.0%. The combination of the flat chest index and BMI was also effective for differentiation (sensitivity of 82.1% and specificity of 89.3%).

Conclusion: We verified the good performance of the physiologic criteria in a different cohort. When the RV/TLC is not measured, using the flat chest index instead of RV/TLC %pred. may be reasonable.
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http://dx.doi.org/10.3390/jcm9113761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700592PMC
November 2020

Three-dimensional measurement of proximal radioulnar space during active forearm pronation.

J Biomech 2020 12 9;113:110120. Epub 2020 Nov 9.

Department of Mechanical & Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA.

Distal biceps tendon ruptures have been reported to be associated with narrowing of the proximal radioulnar space. There have been no studies that three-dimensionally measured the distance between the bicipital tuberosity and the proximal ulna during active motion. The purpose of this study was to three-dimensionally measure the proximal radioulnar space during active forearm pronation in healthy subjects. Five healthy volunteers (10 forearms) were recruited for this study. They consisted of all males with a mean age of 37 years (range, 34-46 years). Lateral fluoroscopy of forearm rotation from maximum supination to maximum pronation was recorded for both forearms. Three-dimensional forearm kinematics were determined using model-image registration techniques with fluoroscopic images and CT-derived bone models, and the closest distance between the bicipital tuberosity and the proximal ulna was computed at each 30° increment of radial axial rotation relative to the distal humerus. The distance between the bicipital tuberosity and the proximal ulna decreased with pronation, reaching a minimum value at 90° of radial rotation (average 4.6 ± 1.3 mm), then increased with further rotation to maximum pronation (P = 0.004). The clearance between the proximal radioulnar space and the distal biceps tendon is very small (<1mm). Hypertrophy of the bicipital tuberosity or tendon can induce impingement and lead to tendon rupture.
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http://dx.doi.org/10.1016/j.jbiomech.2020.110120DOI Listing
December 2020

Tricuspid valve geometry and right heart remodelling: insights into the mechanism of atrial functional tricuspid regurgitation.

Eur Heart J Cardiovasc Imaging 2020 10;21(10):1068-1078

Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.

Aims: We sought to investigate tricuspid valve (TV) geometry and right heart remodelling in atrial functional tricuspid regurgitation (AF-TR) as compared with ventricular functional TR with sinus rhythm (VF-TR).

Methods And Results: Transoesophageal 3D echocardiography datasets of the TV and right ventricle were acquired in 51 symptomatic patients with severe TR (AF-TR, n = 23; VF-TR, n = 28). Three-dimensional right ventricular (RV) endocardial surfaces were reconstructed throughout the cardiac cycle and then postprocessed using semiautomated integration and segmentation software to calculate position of papillary muscle (PM) tips. Compared with VF-TR, AF-TR had more dilated and posteriorly displaced annulus and less leaflet tethering angles with more prominent right atrium and smaller RV end-systolic volume. On the XY (annular) plane, the centre of annulus was getting closer towards the anterior and posterior PM tips and was going away from the medial PM tip caused by prominent annular dilatation in AF-TR. On the Z-axis, the position of each PM tip in AF-TR was not so much displaced apically as that in VF-TR. Multiple linear regression analyses revealed that right atrial volume and right atrial/RV end-systolic volume ratio were determinants of annular area and orientation in AF-TR, respectively (both P < 0.001). Additionally, the posteromedial-directed component of posterior PM tip position and the apically directed component of the position of all three PM tips were independently associated with TV tethering angles of each leaflet in AF-TR (all P < 0.02).

Conclusion: Right heart remodelling and its association with 3D TV geometry differ entirely between AF-TR and VF-TR, which may offer distinctive therapeutic implication.
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http://dx.doi.org/10.1093/ehjci/jeaa194DOI Listing
October 2020

Superior Labral Injuries in Elite Gymnasts: Symptoms, Pathology, and Outcomes After Surgical Repair.

Orthop J Sports Med 2020 Jul 14;8(7):2325967120935001. Epub 2020 Jul 14.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan.

Background: Superior labral anterior-posterior (SLAP) lesions are common among elite gymnasts and throwing athletes. Although SLAP lesions in throwers are well-described in the literature, no study has described the characteristics of SLAP lesions in gymnasts. We aimed to reveal the characteristics of SLAP lesions in gymnasts by comparing the location and extension of these lesions between gymnasts and throwers.

Hypothesis: The location and arc of SLAP lesions in gymnasts will be different from those in throwing athletes.

Study Design: Case series; Level of evidence, 4.

Methods: This study included 27 shoulders in 20 males and 3 females with a mean ± SD age of 20 ± 2.5 years (range, 16-25 years). We performed debridement alone for shoulders with a stable lesion. Anterior and/or posterior labral repair was added for unstable SLAP lesions depending on the extension and stability of the lesions. We investigated symptoms, onset, return to sport (based on patient records), and subjective shoulder values. SLAP lesions were evaluated through use of the Snyder classification. The location and arc of SLAP lesions were determined from surgical records and videos and described by use of the right shoulder clockface method. During the same period, 65 baseball players (65 shoulders; all males; mean age, 23 ± 7.0 years; range, 16-44 years) underwent arthroscopic SLAP surgery. We compared the location and arc of SLAP lesions between gymnasts and baseball players.

Results: Symptoms during gymnastics included pain (100%), apprehension (48%), or catching (11%). We found that 20 shoulders had symptom onset during gymnastics, most commonly during rings events. Type II SLAP lesions were found in 17 shoulders, type III in 2 shoulders, and type IV in 8 shoulders. The mean center of SLAP lesions was at the 11:40 clockface position in 27 gymnasts and 10:40 clockface position in 65 baseball players, and the difference was statistically significant ( < .001). The mean arc of SLAP lesions was 125° in gymnasts and 140° in baseball players, and the difference was not significant. We performed debridement in 2 shoulders (7%) and labral repair in 25 shoulders (93%). After surgery, all patients returned to gymnastics. The mean subjective shoulder value was 35 (range, 10-90) preoperatively and 76 (range, 40-100) postoperatively.

Conclusion: SLAP lesions in gymnasts were significantly located anteriorly compared with those in baseball players. All patients returned to gymnastics after arthroscopic surgery. Secure repair of SLAP lesions may be important for good surgical outcomes, because 50% of patients experienced preoperative shoulder apprehension.
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http://dx.doi.org/10.1177/2325967120935001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361489PMC
July 2020

Repair Integrity and Retear Pattern After Arthroscopic Medial Knot-Tying After Suture-Bridge Lateral Row Rotator Cuff Repair.

Am J Sports Med 2020 08 14;48(10):2510-2517. Epub 2020 Jul 14.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan.

Background: Type 2 failure is a big issue after suture-bridge rotator cuff repair, which may be because of stress concentration at the medial row stitches. We have been performing medial knot-tying after suture-bridge lateral row repair to avoid the stress concentration. This study aimed to evaluate clinical and radiological outcomes after arthroscopic rotator cuff repair using this technique.

Hypothesis: This technique would yield better radiological outcomes with a reduced type 2 failure rate compared with reported outcomes after conventional suture-bridge repair.

Study Design: Case series; Level of evidence, 4.

Methods: The inclusion criteria of this study were (1) full-thickness tears, (2) primary surgery, and (3) minimum 2-year follow-up with pre- and postoperative magnetic resonance imaging (MRI). We investigated active ranges of motion (forward elevation and external rotation), as well as the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA), scores preoperatively and at the final follow-up.

Results: This study included 384 shoulders in 373 patients (205 men and 168 women) with a mean age of 65 years (range, 24-89 years) at the time of surgery. The mean follow-up was 29 months (range, 24-60 months). There were 91 small, 137 medium, 121 large, and 35 massive tears. Postoperative MRI scans demonstrated successful repair in 324 shoulders (84.4%, group S) and retear in 60 shoulders (15.6%). Among 60 retears, 40 shoulders (67%) had type 1 failure (group F1) and 20 shoulders (33%) had type 2 failure (group F2). Forward elevation and external rotation significantly improved after surgery ( < .001 for both). Postoperative JOA and UCLA scores in group F2 were significantly lower than those in the other groups.

Conclusion: The medial knot-tying after suture-bridge lateral row repair demonstrated excellent functional and radiological outcomes after surgery, with a retear rate of 15.6%. The type 2 failure showed significantly inferior functional outcomes; however, the rate of type 2 failure was less relative to previous studies using conventional suture-bridge techniques. Our technique could be a good alternative to conventional suture-bridging rotator cuff repair because it may reduce the rate of postoperative type 2 failure.
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http://dx.doi.org/10.1177/0363546520934786DOI Listing
August 2020

Return to Sport After Arthroscopic Rotator Cuff Repair in Middle-Aged and Elderly Swimmers.

Orthop J Sports Med 2020 Jun 17;8(6):2325967120922203. Epub 2020 Jun 17.

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

Background: No reports have been published on the clinical outcomes, including return to sport, after rotator cuff repair in middle-aged and elderly swimmers with rotator cuff tears.

Purpose: To retrospectively investigate clinical outcomes and return to sport after arthroscopic rotator cuff repair in middle-aged and elderly swimmers.

Study Design: Case series; Level of evidence, 4.

Methods: Patients who underwent arthroscopic rotator cuff repair and met the following criteria were included: (1) age older than 45 years, (2) rotator cuff tears confirmed during surgery, (3) arthroscopic suture bridge rotator cuff repair, (4) primary surgery, and (5) swam more than once a week before surgery. The exclusion criteria were as follows: (1) irreparable large and massive tears, (2) shoulder instability, (3) arthritis or rheumatic disorders, or (4) less than 2-year follow-up. We investigated functional outcomes including range of motion; the University of California, Los Angeles (UCLA) score; the American Shoulder and Elbow Surgeons (ASES) score; return to swimming; and the return rates for each style of swimming. In addition, the functional outcomes and findings of magnetic resonance imaging were compared between the group with complete return and the group with incomplete or failed return.

Results: A total of 32 shoulders in 31 middle-aged and elderly swimmers (5 males, 26 females) were included. The mean age was 65 years (range, 47-78 years), and the mean follow-up was 47 months (range, 24-86 months). Return to swimming was achieved in 31 (97%) shoulders at a mean of 8 months (range, 3-24 months), and complete return was achieved in 18 (56%) shoulders at a mean of 12 months (range, 3-24 months). The return rate was 97% for freestyle, 83% for breaststroke, 74% for backstroke, and 44% for butterfly stroke. Postoperative UCLA and ASES scores were significantly higher in the group with complete return than in the group with incomplete or failed return ( = .001 and .01, respectively). Postoperative forward elevation was significantly better in the complete return group ( = .01).

Conclusion: This study demonstrated that 97% of elderly swimmers who underwent arthroscopic rotator cuff repair could return to swimming. The complete return rate was 56%; however, the group with incomplete or failed return showed poorer active forward elevation. Freestyle had the highest complete return rate, whereas the butterfly stroke had the lowest return rate. It may be important to achieve good active forward elevation postoperatively to return to swimming.
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http://dx.doi.org/10.1177/2325967120922203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301663PMC
June 2020

Incidence of Axillary Nerve Injury After Arthroscopic Shoulder Stabilization.

Arthroscopy 2020 06 26;36(6):1555-1564. Epub 2020 Feb 26.

Nagareyama Central Hospital, Nagareyama, Japan.

Purpose: To investigate the incidence of axillary nerve palsy after arthroscopic shoulder stabilization and to measure the distance between the nerve and capsule in shoulders with a capsular lesion.

Methods: This retrospective study included 2,027 shoulders (1,909 patients; 1,433 male and 476 female patients; mean age, 32 years [age range, 13-81 years]) subjected to arthroscopic soft-tissue stabilization for recurrent shoulder instability from 2005 to 2017. The exclusion criteria were bone grafting or transfer and preoperative axillary nerve symptoms. We retrospectively reviewed patient records and investigated the incidence and clinical features of axillary nerve palsy. We measured the closest distance between the axillary nerve and capsule on preoperative magnetic resonance images.

Results: Postoperative axillary nerve palsy occurred in 4 shoulders (0.2% of all arthroscopic stabilizations). Capsular repair was performed in 2 shoulders (1.2% of 160 capsular repairs); humeral avulsion of the glenohumeral ligament (HAGL) repair, 1 shoulder (2% of 47 HAGL repairs); and isolated Bankart repair, 1 shoulder (0.05% of 1,941 Bankart repairs). The closest distance between the nerve and capsule was 3.4 ± 3.2 mm in shoulders with capsular or HAGL lesions and less than 1 mm in the 3 shoulders with palsy. The common symptoms in axillary nerve palsy cases were shoulder discomfort, delayed recovery of range of motion, and deltoid weakness and atrophy. A definitive diagnosis was made with electromyography in all cases. Nerve injury by a suture was confirmed during revision surgery in 3 shoulders subjected to capsular or HAGL repair during the initial operation. The palsy was transient and fully recovered in 1 shoulder with isolated Bankart repair.

Conclusions: The incidence of axillary nerve palsy after arthroscopic soft-tissue shoulder stabilization was low but higher in shoulders subjected to capsular or HAGL repair. We should always consider the possibility of axillary nerve palsy in shoulders that require capsular or HAGL repair.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.arthro.2020.02.016DOI Listing
June 2020

A fast and convenient solid phase preparation method for releasing N-glycans from glycoproteins using trypsin- and peptide-N-glycosidase F (PNGase F)-impregnated polyacrylamide gels fabricated in a pipette tip.

J Pharm Biomed Anal 2020 Feb 17;179:112995. Epub 2019 Nov 17.

Faculty of Pharmaceutical Sciences, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Japan; Antiaging Center, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Japan.

An efficient deglycosylation process is a key requirement for the identification and characterization of glycosylation during the production and purification of therapeutic antibodies. PNGase F is widely used for the deglycosylation of N-linked glycans. The commonly-used in-solution deglycosylation method is relatively time-consuming and requires several hours up to overnight for complete removal of all N-linked glycans. In order to develop a simple and efficient method for the rapid release of N-linked glycans from glycoproteins, we fabricated trypsin- and PNGase F-impregnated polyacrylamide gels in a commercial 200 μL volume pipette tip. Our enzyme reactor is based on simple photochemical copolymerization of monomers using the following procedure: (1) a pipette tip was filled with a gel solution comprising acrylamide, N,N'-methylene-bis-acrylamide containing PNGase F or trypsin with 2,2-azobis(2-methyl-N-(2-hydroxyethyl) propionamide) as a photocatalytic initiator; and (2) in situ polymerization of gel solution approximately 30 mm from the tip was performed by irradiation with a 365 nm blue LED beam from a distance 10 mm. The fixed enzymes maintained their activities in the polyacrylamide gel and the reaction was completed by 40 iterations of suction and discharge with a pipette (hereafter referred to as manual pipetting times) for 8 min with each enzyme digestion. Capillary electrophoresis (CE) of released glycans labeled with 8-aminopyrene-1,3,6-trisulfonate (APTS) demonstrated quantitative recovery of glycans from selected glycoproteins.
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http://dx.doi.org/10.1016/j.jpba.2019.112995DOI Listing
February 2020

HFPEF Score for the Prediction of Exercise Intolerance and Abnormal Hemodynamics in Japanese - Evaluation by Exercise Stress Echocardiography Combined With Cardiopulmonary Exercise Testing.

Circ J 2019 11 8;83(12):2487-2493. Epub 2019 Nov 8.

Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences.

Background: Both the HFPEF-score and nomogram-score, which consist of simple clinical parameters, can assist in diagnosing "early" heart failure with preserved ejection fraction (HFpEF) and only exertional dyspnea, but their these usefulness in Japanese remains unclear. We sought to investigate the correlation between these scores and exercise response, including the peak oxygen uptake (V̇O), the pulmonary artery systolic pressure (PASP), the ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e') and stroke volume (SV) using exercise stress echocardiography (ESE) combined with cardiopulmonary exercise testing (CPET).Methods and Results:In this single-center, retrospective cross-sectional study the HFPEF-score and nomogram-score were calculated in a total of 139 patients who underwent ESE combined with CPET. The scores correlated with peak V̇O(r=-0.48, r=-0.44), PASP (r=0.23, r=0.29) and SV (r=-0.32, r=-0.19) at peak exercise. The nomogram-score correlated with E/e' (r=0.24). The prevalence of exercise intolerance (percent predicted peak V̇O<75% and <50%) increased as the HFPEF-score increased and reached 88.9% and 22.2% among the patients with high HFPEF-score (6-9 points).

Conclusions: The HFPEF-score may be useful as the initial step to diagnosing 'early' HFpEF. The nomogram-score may be more useful in Japanese because of its more universal association with exercise response than the HFPEF-score.
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http://dx.doi.org/10.1253/circj.CJ-19-0699DOI Listing
November 2019

The Effect of Mesenchymal Stem Cell Sheets on Early Healing of the Achilles Tendon in Rats.

Tissue Eng Part A 2020 02 12;26(3-4):206-213. Epub 2019 Nov 12.

Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California.

Bone marrow-derived mesenchymal stem cells (BMSCs) have potential to accelerate flexor tendon healing and allow for earlier rehabilitation. The ideal BMSC construct and delivery method to the repair site remains unknown. We investigated the efficacy of interposed scaffold-free BMSC sheets on early Achilles tendon healing in rats. BMSCs were isolated from the femora and tibias of male Sprague-Dawley rats aged 8-12 weeks and BMSC sheets were produced on temperature-responsive culture dishes. Ninety-five male Sprague-Dawley rats aged 8-12 weeks were utilized. A bilateral Achilles tendon repair model was created. One side was randomly selected, and the tendon was repaired with the interposed BMSC sheet (BMSC group). The other side was repaired without BMSCs (control group). The bilateral tendons were harvested at 5, 6, 7, 10, and 14 days postoperatively for biomechanical analysis, measurement of the gene expression level of tendon markers and by real-time polymerase chain reaction, and histological evaluation. The BMSC group had significantly higher maximum load to failure and stiffness at 5 and 6 days compared with the control group. Moreover, the BMSC group showed significantly increased gene expression of and/or at all timepoints. The cross sectional areas in the BMSC group were significantly larger at 5, 6, and 14 days. However, hematoxylin and eosin staining of the central part of the repair site revealed no significant differences at all timepoints. These results suggest that the increased biomechanical strength afforded by BMSC sheet implantation into tendon repair sites may allow for the earlier onset of rehabilitation and improved clinical outcomes in flexor tendon surgery. Impact Statement We investigated the efficacy of interposed bone marrow-derived mesenchymal stem cell (BMSC) sheets on early Achilles tendon healing in rats. The tendons repaired with BMSC sheets revealed significantly increased mechanical strength compared with the control repairs (without the BMSC sheet) at 5 and 6 days. These data reveal that BMSC sheet implantation into tendon repair sites may allow for earlier onset of rehabilitation and improved clinical outcomes in flexor tendon surgery.
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http://dx.doi.org/10.1089/ten.TEA.2019.0163DOI Listing
February 2020

Comprehensive Evaluation of Tricuspid Regurgitation Location and Severity Using Vena Contracta Analysis: A Color Doppler Three-Dimensional Transesophageal Echocardiographic Study.

J Am Soc Echocardiogr 2019 12 25;32(12):1526-1537.e2. Epub 2019 Sep 25.

Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.

Background: The clinical significance of three-dimensional (3D) vena contracta area (VCA) in tricuspid regurgitation (TR) is not fully elucidated. The aim of this study was to investigate the diagnostic accuracy of 3D VCA using 3D echocardiography-derived regurgitation volume as a reference standard.

Methods: One hundred sixteen patients with at least moderate TR underwent two-dimensional transthoracic and color Doppler 3D transesophageal echocardiography. The 3D vena contracta, which was located at the narrowest neck of the TR jet just above and toward the right atrial side of the flow convergence zone, was assessed for TR location and severity.

Results: As for TR location, patients with severe functional TR had the highest prevalence of central jet location among TR subgroups, whereas patients with severe primary TR showed a greater spatial extent of TR jet location involved compared with the moderate TR group (P < .05 for both). As for TR severity, a 3D VCA cutoff value of 0.61 cm discriminated severe TR with sensitivity of 78% and specificity of 97% in the total patient population (area under the curve = 0.93, P < .001). Multivariate analysis revealed that 3D VCA, a dilated right ventricle, and hepatic vein systolic reversal were independently associated with regurgitant volume (P < .001 for all). The χ value for the model that incorporated clinical and two-dimensional integrative parameters and 3D VCA > 0.61 cm to evaluate severe TR was significantly higher than that for the model that incorporated only clinical and two-dimensional integrative parameters (P = .001).

Conclusions: Three-dimensional VCA has independent and incremental diagnostic value for evaluating severe TR. Comprehensive evaluation of TR location and severity using 3D vena contracta analysis may help in treatment selection for TR.
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http://dx.doi.org/10.1016/j.echo.2019.07.022DOI Listing
December 2019

A case of drug-induced hypersensitivity syndrome induced by salazosulfapyridine combined with SIADH caused by interstitial pneumonia.

Drug Discov Ther 2019 ;13(4):232-238

Department of Neurosurgery, Fukuoka University Chikushi Hospital.

We present a case of a patient with drug-induced hypersensitivity syndrome (DIHS) caused by salazosulfapyridine combined with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) caused by interstitial pneumonia (IP). A 67-year-old man with a past history of rheumatism (RA) presented with right hemiparalysis and aphasia as the chief complaints. A diagnosis of left embolic cerebral infarction following trial therapy for RA based on computed tomography findings was made, and external decompression was performed. Salazosulfapyridine was newly started on day 7. Dabigatran was started on day 37. On day 41, the patient developed fever. On day 42, edema and erythema appeared on his face, and erythema and rash appeared on his trunk and extremities, with gradual transition to erythroderma. The drug eruption was initially attributed to the dabigatran. Various symptoms of organ dysfunction (enteritis, myocarditis, interstitial pneumonia, hepatic disorder, stomatitis, and others) then appeared and persisted; hence, a diagnosis of DIHS associated with human herpes virus 6 and cytomegalovirus infection induced by salazosulfapyridine was suggested, and the oral administration of salazosulfapyridine was discontinued on day 53. Hyponatremia was observed in association with exacerbation of IP. Due to low serum osmotic pressure and prompt improvement of the serum sodium level by fluid restriction, the SIADH was attributed to IP. In this case, steroid pulse therapy followed by gradual decrease therapy prevented worsening of the condition.
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http://dx.doi.org/10.5582/ddt.2019.01045DOI Listing
February 2020

Relationship between postoperative retear and preoperative fatty degeneration in large and massive rotator cuff tears: quantitative analysis using T2 mapping.

J Shoulder Elbow Surg 2019 Aug;28(8):1562-1567

Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan.

Background: Fatty degeneration of the rotator cuff muscles is reported to be associated with retear after rotator cuff repair. The purpose of this study was to assess the relationship between retear and preoperative fatty degeneration, as quantified by T2 mapping.

Methods: This prospective cohort study included 83 large and 24 massive rotator cuff tears (average age, 67 years; range, 46-82 years). All patients preoperatively underwent T2 mapping magnetic resonance imaging, and T2 values of the supraspinatus and infraspinatus muscles were quantified. Cuff integrity was evaluated with magnetic resonance imaging 1 year postoperatively. Preoperative T2 values were compared between the retear and intact groups. The preoperative Goutallier stage, Constant score, and the shoulder score of the University of California at Los Angeles were also compared between the 2 groups.

Results: Retear was found in 32 shoulders (30%). Postoperative Constant and University of California at Los Angeles scores were significantly higher in intact shoulders than in retear shoulders (P < .001 for both). Mean preoperative T2 values of supraspinatus and infraspinatus were 77.4 ± 13.2 ms and 73.2 ± 15.3 ms in retear shoulders and 66.5 ± 11.1 ms and 58.6 ± 11.7 ms in intact shoulders, respectively; the differences were significant in both muscles (P < .001). Cutoff values for prediction of retear were 71.8 ms in supraspinatus and 63.1 ms in infraspinatus. There were no significant differences in the preoperative Goutallier stages of supraspinatus and infraspinatus between the 2 groups.

Conclusions: Retear shoulders demonstrated significantly higher preoperative T2 values than intact shoulders. T2 mapping can be a useful tool for predicting postoperative retears.
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http://dx.doi.org/10.1016/j.jse.2019.04.036DOI Listing
August 2019

Prevalence and Site of Rotator Cuff Lesions in Shoulders With Recurrent Anterior Instability in a Young Population.

Orthop J Sports Med 2019 Jun 4;7(6):2325967119849876. Epub 2019 Jun 4.

Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan.

Background: Partial articular supraspinatus tendon avulsion (PASTA) lesions are often seen in shoulders of throwing athletes. PASTA lesions in anterior instability are also found in recurrent anterior glenohumeral instability.

Purpose: To investigate the prevalence and location of rotator cuff tears (RCTs), including PASTA lesions, in shoulders with recurrent anterior instability.

Study Design: Case series; Level of evidence, 4.

Methods: A total of 842 shoulders in 801 patients with recurrent anterior instability (647 men, 154 women; mean age, 24 years; age range, 13-40 years) who underwent arthroscopic surgery at the age of 40 years or younger were enrolled. During surgery, the thickness and the sites of RCTs as well as patient factors associated with RCTs were examined.

Results: RCTs were found in 57 shoulders (7%) in 56 patients. There were 4 shoulders with full-thickness RCTs and 54 shoulders with PASTA lesions. All lesions but 1 involved the anterior border of the supraspinatus (SSP). Participation in high-level athletics and older age at injury were associated with RCTs.

Conclusion: The incidence of RCTs was 7% in shoulders with recurrent anterior instability at age 40 years or younger. Most RCTs were PASTA lesions that involved the anterior border of the SSP.
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http://dx.doi.org/10.1177/2325967119849876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552367PMC
June 2019

Procalcitonin-Guided Antibiotic Discontinuation Might Shorten the Duration of Antibiotic Treatment Without Increasing Pneumonia Recurrence.

Am J Med Sci 2019 07 16;358(1):33-44. Epub 2019 Apr 16.

Department of Respiratory Medicine, Fukuoka University, Jonan-ku, Fukuoka, Fukuoka, Japan.

Background: The optimal duration of antibiotic treatment has not been established for pneumonia patients. Some investigators reported procalcitonin (PCT)-guided antimicrobial stewardship reduces the duration of antibiotic use without increasing mortality in pneumonia patients.

Material And Methods: We prospectively enrolled hospitalized community-acquired pneumonia or healthcare-associated pneumonia patients with PCT levels >0.20 ng/mL on admission, who were admitted between 2014 and 2017. PCT levels were measured on days 5, 8 and 11 and every 3 days thereafter if needed. Physicians were encouraged and strongly encouraged to discontinue antibiotics when PCT levels decreased below 0.20 ng/mL and 0.10 ng/mL, respectively. Those admitted between 2010 and 2014 were included in the study as historical controls. Primary endpoints were duration of antibiotic treatment and recurrence of pneumonia within 30 days after antibiotic discontinuation.

Results: The PCT-guided and control groups consisted of 116 patients each. Background factors including pneumonia severity and PCT levels did not differ between the 2 groups. Median duration of antibiotic treatment was 8.0 and 11 days in the PCT-guided and control groups, respectively (P < 0.001). Multivariable regression analysis revealed that PCT-guided antibiotic discontinuation (partial regression coefficient [PRC] -1.9319, P < 0.001), PCT (PRC 0.1501, P = 0.0059) and albumin (PRC -1.4398, P = 0.0096) were significantly related to duration of antibiotic treatment. Pneumonia recurrence within 30 days after antibiotic discontinuation was not statistically different between the 2 groups (4.3% vs. 6.0%, P = 0.5541).

Conclusions: PCT-guided antibiotic discontinuation might be useful for shortening the duration of antibiotic treatment without increasing pneumonia recurrence.
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http://dx.doi.org/10.1016/j.amjms.2019.04.005DOI Listing
July 2019

Nickel-Copper-Catalyzed Hydroacylation of Vinylarenes with Acyl Fluorides and Hydrosilanes.

Chemistry 2019 Jul 20;25(40):9410-9414. Epub 2019 May 20.

Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Kita 21, Nishi 10, Kita-ku, 001-0021, Sapporo, Japan.

The hydroacylation of vinylarenes with acyl fluorides and hydrosilanes was enabled by a synergistic bimetallic Ni/Cu-catalytic system, giving access to the corresponding branched ketone products. The reaction takes place under mild conditions at 25-80 °C and tolerates base-sensitive functional groups such as methoxycarbonyl and acetoxy groups.
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http://dx.doi.org/10.1002/chem.201900822DOI Listing
July 2019

Maternal Glucocorticoids Make the Fetal Membrane Thinner: Involvement of Amniotic Macrophages.

Endocrinology 2019 04;160(4):925-937

Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Glucocorticoid use during pregnancy is known to increase the risk of preterm birth and preterm premature rupture of membranes (pPROM). Here, we investigated the mechanism of how glucocorticoids weaken the fetal membranes. The amnion mesenchymal layer was significantly thinner in pregnant women treated with prednisolone and in corticosterone-injected mice than in control groups. Matrix metalloproteinase (MMP)-9 mRNA and its activity, COX2 mRNA levels, and prostaglandin E2 synthesis were increased, whereas type 1 collagen (COL1A1) mRNA levels were decreased in the fetal membranes of corticosterone-injected mice. Unexpectedly, the proliferation and migration of macrophages were observed around the corticosterone-injected amnion, and IL-1β was released from these macrophages. In human amnion mesenchymal cells, cortisol did not change MMP mRNA expression, whereas IL-1β treatment robustly increased MMP and COX2 mRNA expression. COL1A1 mRNA level was decreased by both cortisol and IL-1β. These data suggest that the recruitment of amniotic macrophages by glucocorticoids plays a pivotal role in weakening of the fetal membranes, leading to the pathogenesis of pPROM.
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http://dx.doi.org/10.1210/en.2018-01039DOI Listing
April 2019

Enoxaparin administration within 24 hours of caesarean section: a 6-year single-centre experience and patient outcomes.

J Obstet Gynaecol 2019 May 22;39(4):451-454. Epub 2018 Dec 22.

a Department of Gynaecology and Obstetrics , Kyoto University , Kyoto , Japan.

A caesarean section (CS) is a major risk factor for a venous thromboembolism, and enoxaparin, a low-molecular-weight heparin, has been widely used for thromboprophylaxis. However, it remains unclear whether an enoxaparin thromboprophylaxis has an acceptable safety profile when given early after CS compared to delayed administration, especially in the presence of an epidural catheter. This study aimed to survey cases in which enoxaparin administration was performed within 24 hours of CS and to evaluate patient outcomes with or without epidural anaesthesia. The number of eligible cases were 578: 328 patients received an epidural anaesthesia (epidural group), and 250 did not (non-epidural group). In both groups, no patient developed a spinal epidural haematoma. A wound or a subcutaneous bleeding occurred in 22 (6.7%) and 20 (8.0%) cases in the epidural and non-epidural groups, respectively. One patient developed a mild pulmonary embolism, and one case of asymptomatic deep vein thrombosis was detected. An enoxaparin administration within 24 hours of CS appears to be reasonable, regardless of an epidural anaesthesia. Impact statement What is already known on this subject? A venous thromboembolism (VTE) after a caesarean section (CS) remains a significant cause of maternal morbidity and mortality. Therefore, a thromboprophylaxis using enoxaparin, a low-molecular-weight heparin, has been widely recommended and accepted. However, there is no consensus regarding the optimal timing to initiate an enoxaparin administration after CS in the presence of an epidural catheter. What do the results of this study add? This is the largest study that has collected cases receiving enoxaparin within 24 hours of a CS. Irrespective of the presence of an epidural catheter, no patient developed a spinal epidural haematoma after an early administration of enoxaparin. Furthermore, the incidence of haemorrhagic complications did not increase. What are the implications of these findings for clinical practice and/or further research? Given the significant incidence of VTE after CS and the extremely low frequency of spinal epidural haematomas, it can be justified to initiate thromboprophylaxis with enoxaparin soon after CS. However, appropriately designed, large clinical trials are necessary to examine the safety and efficacy of an early enoxaparin administration after CS. Based on such studies, the starting time of thromboprophylaxis after a CS should be decided.
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http://dx.doi.org/10.1080/01443615.2018.1527300DOI Listing
May 2019

Three-dimensional measurement of glenoid dimensions and orientations.

J Orthop Sci 2019 Jul 20;24(4):624-630. Epub 2018 Dec 20.

Department of Mechanical and Aerospace Engineering, University of Florida, 330 MAE-A P.O. Box 116250, Gainesville, FL 32611-6250, USA.

Background: Asians generally have smaller stature than Europeans and Americans, and currently available implants used in reverse shoulder arthroplasty might not fit smaller bony anatomies. However, few articles have reported glenoid geometry in the Asian population. The purpose of this study was to measure the dimensions and orientations of the glenoid from three-dimensional computed tomography reconstructions of elderly Japanese subjects.

Methods: This study included 100 shoulders (50 males and 50 females with >50 years of age). The mean age was 67 ± 7 years for both sexes, and the mean height was 167 ± 7 cm for males and 154 ± 6 cm for females. Three-dimensional scapular models were created from computed tomographic images, and the glenoid height, glenoid width, glenoid version, glenoid inclination, vault depth, and vault width were measured.

Results: The mean glenoid height and width were 38.6 and 29.4 mm for males and 33.1 and 24.4 mm for females, respectively. Both retroversion and superior inclination were approximately 3° in both sexes. The glenoid vault was deeper in the posterior region with the maximum depth of 26.1 and 23.6 mm in males and females. The vault width was narrower in the anterior region with the anterior width of 2.5 mm at 15 mm medial from the glenoid face in females.

Conclusion: Glenoids of Japanese females are small compared to currently available baseplates for reverse shoulder arthroplasty. These results may be helpful to aid design in smaller baseplates that better fit the anatomic geometry of the Asian glenoid.
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http://dx.doi.org/10.1016/j.jos.2018.11.019DOI Listing
July 2019