Language：English   Publishing type：Research paper (scientific journal)  

AIMS: There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA). METHODS: We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening, complications, and revision surgery with or without implant removal. RESULTS: The mean MEPS significantly improved from 47 (15 to 70) points preoperatively to 95 (70 to 100) points at final follow-up (p < 0.001). Complications were noted in six elbows (23%) in six patients, and of these, four with an ulnar neuropathy and one elbow with postoperative traumatic fracture required additional surgeries. There was no revision with implant removal, and there was no radiological evidence of loosening around the components. With any revision surgery as the endpoint, the survival rates up to 25 years were 78.1% (95% confidence interval 52.8 to 90.6) as determined by Kaplan-Meier analysis. CONCLUSION: The clinical outcome of primary unlinked TEA for young patients with RA was satisfactory and comparable with that for elderly patients. A favourable survival rate without implant removal might support the use of unlinked devices for young patients with this disease entity, with a caution of a relatively high complication rate regarding ulnar neuropathy.Level of Evidence: Therapeutic Level IVCite this article: Bone Jt Open 2023;4(1):19-26.

DOI： 10.1302/2633-1462.41.BJO-2022-0151.R1

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OBJECTIVE: It has been reported that levels of soluble CD30 in serum and joint fluid are significantly elevated in patients with rheumatoid arthritis (RA). This study aimed to investigate whether CD30 could be a therapeutic target for RA. METHODS: The expression and localization of CD30 were examined by immunohistochemical and double immunofluorescence staining on synovial tissue samples obtained from patients with RA or osteoarthritis (OA) during surgery. Changes in CD30 expression of fibroblast-like synoviocytes (FLS) from RA patients with or without TNFα and IL-1β stimulation were examined by the polymerase chain reaction (PCR) and flow cytometry. Collagen antibody-induced arthritis (CAIA) was created in DBA/1 mice, and the therapeutic effect of brentuximab vedotin (BV) was examined by clinical score, histological findings and measurement of serum levels of SAA, IL-6, and TNFα. RESULTS: CD30 expression was significantly higher in samples from patients with RA than from those with OA. Double immunofluorescence showed a low rate of co-localization of CD30 with CD20 or CD90, but a high rate of co-localization of CD30 and CD138. CD30 mRNA expression was upregulated 11.7-fold in FLS following stimulation by inflammatory cytokines. The clinical scores of CAIA mice were significantly lower following both BV treatments, however, the histological scores of CAIA mice were significantly lower only following treatment with high dose BV (70 mg/kg). CONCLUSIONS: CD30 was expressed on immunocompetent cells in synovial tissue from RA patients and in cytokine-stimulated FLS in vitro. High dose BV (70 mg/kg) showed significant therapeutic effects in ameliorating inflammation and joint destruction in CAIA mice, but low dose BV (30 mg/kg) was insufficient.

DOI： 10.1007/s00011-021-01537-z

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Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

Purpose

We investigated objective and patient-reported outcomes after resection arthroplasty or shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal (MTP) joint for severe rheumatoid forefoot deformities.

Methods

17 feet from 14 women (mean age, 67.8 years) underwent resection arthroplasty of the lesser metatarsal heads (MTH resection group), while 13 feet from nine women and two men (mean age, 68.7 years) underwent SOO of the lesser metatarsals (MTH preservation group). Arthrodesis of the first MTP joint was performed in all cases. Mean follow-up in the MTH resection and preservation groups was 25.0 and 21.3 months, respectively. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q) scores.

Results

Mean total JSSF scale significantly improved from 53.4 to 76.4 in the MTH resection group ( p &lt; .001) and from 50.1 to 74.2 in the MTH preservation group ( p = .002). Pain and pain-related and shoe-related SAFE-Q subscale scores significantly improved after surgery in both groups. In the MTH resection group, recurrence of painful callosities and claw toe deformity was observed in four and three feet, respectively. In the MTH preservation group, one patient experienced recurrence of painful callosities and one underwent revision surgery for IP joint dislocation.

Conclusion

Resection arthroplasty or SOO of the lesser metatarsals combined with arthrodesis of the first MTP joint achieved significant improvement with respect to pain relief, deformity correction, and footwear comfort.

DOI： 10.1177/10225536221117903

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Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/10225536221117903

Language：Japanese   Publisher：(一社)日本小児整形外科学会  

股関節痛を契機に診断に至った、強直性脊椎炎:ankylosing spondylitis(以下、AS)の1例を経験したので報告する。症例は16歳男子で、右股関節痛のため近医を受診した。大腿骨寛骨臼インピンジメントの診断で当科に紹介された。当科初診時、右股関節痛は安静時と夜間に強く、運動時には感じなかった。右股関節の可動域制限を認め疼痛誘発テストは陽性であった。詳細に問診したところ、過去に腰臀部痛と両股関節痛を繰り返していた。単純X線では左仙腸関節に硬化像を認め、MRIでは右股関節水腫と両仙腸関節周囲の骨髄浮腫像を認めた。血液検査では炎症反応が上昇し、HLA-B27は陽性であった。ASと診断し、疾患活動性が高かったため、Infliximabの適応とした。治療は奏効し、現在も継続している。詳細な病歴聴取により早期の診断と治療が行えたため、短期の成績ではあるが経過良好であった。(著者抄録)

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OBJECTIVE: We examined the relationship between The Japanese version of Patient-Related Elbow Evaluation (PREE-J) and other established subjective and objective outcome measures in Japanese patients with rheumatoid arthritis (RA) who underwent total elbow arthroplasty (TEA). PATIENTS AND METHODS: This study involved 46 elbows of 40 RA patients. We collected clinical data one year after surgery, including the PREE-J, the Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder, and Hand (DASH), and Hand20. The correlation and responsiveness to PREE-J were evaluated compared with other outcome measures pre-and postoperatively. RESULTS: Almost all outcome measures were improved significantly after surgery. Preoperative PREE-J was significantly correlated with preoperative DASH, Hand20, and MEPS. Interestingly, postoperative PREE-J did not correlate with postoperative MEPS. Multiple regression analyses revealed that preoperative grip strength (B = -0.09; 95% CI -0.17 to -0.01, p = 0.03) and preoperative Hand20 (B = 0.31, 95% CI 0.03 - 0.58, p = 0.03) were significant factors those might influenced the postoperative PREE-J. CONCLUSIONS: The PREE-J was shown to correlate well with other preoperative outcome measures among the RA patients included in the current study. The postoperative PREE-J after TEA was influenced by the preoperative grip strength and function of the hand.

DOI： 10.1093/mr/roab100

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We investigated the effects of adipose-derived extract (AE) on cultured chondrocytes and in vivo cartilage destruction. AE was prepared from human adipose tissues using a nonenzymatic approach. Cultured human chondrocytes were stimulated with interleukin-1 beta (IL-1β) with or without different concentrations of AE. The effects of co-treatment with AE on intracellular signaling pathways and their downstream gene and protein expressions were examined using real-time PCR, Western blotting, and immunofluorescence staining. Rat AE prepared from inguinal adipose tissues was intra-articularly delivered to the knee joints of rats with experimental osteoarthritis (OA), and the effect of AE on cartilage destruction was evaluated histologically. In vitro, co-treatment with IL-1β combined with AE reduced activation of the p38 and ERK mitogen-activated protein kinase (MAPK) pathway and nuclear translocation of the p65 subunit of nuclear factor-kappa B (NF-κB), and subsequently downregulated the expressions of matrix metalloproteinase (MMP)-1, MMP-3, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4, IL-6, and IL-8, whereas it markedly upregulated the expression of IL-1 receptor type 2 (IL-1R2) in chondrocytes. Intra-articular injection of homologous AE significantly ameliorated cartilage destruction six weeks postoperatively in the rat OA model. These results suggested that AE may exert a chondroprotective effect, at least in part, through modulation of the IL-1β-induced inflammatory signaling pathway by upregulation of IL-1R2 expression.

DOI： 10.3390/ijms22189781

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Language：Japanese   Publisher：(一社)日本臨床リウマチ学会  

【目的】関節リウマチ(RA)患者におけるボディイメージ・アセスメントツール(BIAT)の信頼性と有効性を検証すること。【方法】本研究は横断的観察研究である。外来通院中(非手術群)および入院中(手術群)のRA患者265例および健常人62名を対象にBIAT質問用紙への回答を依頼した。信頼性の評価として、内部一貫法にはRA患者265例のbaselineのデータを、再テスト法には健常群62名のbaseline・3週後、および非手術群76例のbaseline・半年・1年後のデータを用いた。既存の評価法としてBDI-II(Beck Depression Inventory-II、ベック抑うつ質問票)を用いてBIATの臨床評価としての妥当性を検討した。RA患者265例をDAS28-CRPに基づき、寛解、低疾患活動性、中疾患活動性、高疾患活動性に群別し、BIATとの関連を検討した。さらに非手術群と手術群でBIATに差があるかどうかを検討した。【結果】BIATは全体の評価でも各構成概念の評価でもα係数は0.8以上を示しており、高い一貫性を有していた。再テスト法ではBIAT全体平均において、健常群のbaselineと3週後で相関係数0.75、非手術群のbaselineと半年後および1年後で相関係数0.79および0.78であり、比較的高い信頼性が確認できた。BIAT全体スコアはBDI-IIと有意な負の相関(r=-0.64、P<0.001)を示した。BIATは疾患活動性が高いほど低値となる傾向があることが示された。手術群でのbaselineの平均BIATの値はいずれの構成概念においても非手術群よりも有意に低値であった。【結論】RA患者に対するBIATは、高い一貫性、安定性を有する評価ツールであることが確認された。(著者抄録)

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Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (-0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.

DOI： 10.3390/ijerph18147520

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We investigated the clinical outcomes of surgical procedures for the treatment of forefoot deformities in patients with rheumatoid arthritis. Twenty feet in 16 women (mean age 62.1 years) underwent corrective osteotomy of the first metatarsal bone with shortening oblique osteotomy of the lesser metatarsophalangeal joints (joint-preservation group), while 13 feet in 12 women (mean age 67.4 years) underwent arthrodesis of the first metatarsophalangeal joint with resection arthroplasty of the lesser metatarsophalangeal joints (joint-sacrifice group); mean follow-up for each group was 25.8 and 23.8 months, respectively. The mean total Japanese Society for Surgery of the Foot (JSSF) scale improved significantly from 64.2 to 89.2 in the joint-preservation group (p < .001), and from 54.2 to 74.2 in the joint-sacrifice group (p = .003). In the joint-preservation group, the postoperative range of motion (ROM) of the joint, walking ability, and activities of daily living scores of the JSSF scale were significantly higher than those in the joint-sacrifice group (p = .001, p = .001, and p = .019, respectively). There were no differences in the subscale scores of the self-administered foot evaluation questionnaire between 2 groups either pre- or postoperatively. No differences in the postoperative complications were found between 2 groups. Although the joint-sacrificing procedure resulted in lower objective outcomes than the joint-preserving procedure regarding the ROM of the joint, the walking ability, and the level of activities of daily living, both procedures resulted in similar treatment outcomes when evaluated by the subjective measures.

DOI： 10.1053/j.jfas.2021.06.008

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BACKGROUND: Many histological, mechanical, and clinical studies have been performed on the medial meniscus posterior root attachment, as it often tears in patients with osteoarthritic knee. Medial meniscal root repair is recommended in clinical situations; however, to date, no studies have examined the differences between meniscal root and horn cells. The aim of this study was, therefore, to investigate the morphology, reaction to cyclic tensile strain, and gene expression levels of medial meniscal root and horn cells. METHODS: Meniscal samples were obtained from the medial knee compartments of 10 patients with osteoarthritis who underwent total knee arthroplasty. Root and horn cells were cultured in Dulbecco's modified Eagle's medium without enzymes. The morphology, distribution, and proliferation of medial meniscal root and horn cells, as well as the gene and protein expression levels of Sry-type HMG box 9 and type II collagen, were determined after cyclic tensile strain treatment. RESULTS: Horn cells had a triangular morphology, whereas root cells were fibroblast-like. The number of horn cells positive for Sry-type HMG box 9 and type II collagen was considerably higher than that of root cells. Although root and horn cells showed similar levels of proliferation after 48, 72, or 96 h of culture, more horn cells than root cells were lost following a 2-h treatment with 5% and 10% cyclic tensile. Sry-type HMG box 9 and α1(II) collagen mRNA expression levels were significantly enhanced in both cells after 2- and 4-h cyclic tensile strain (5%) treatment. CONCLUSIONS: Medial meniscal root and horn cells have distinct morphologies, reactions to mechanical stress, and cellular phenotypes. Our results suggest that physiological tensile strain is important to activate extracellular matrix production in horn cells.

DOI： 10.1016/j.jos.2020.02.015

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We investigated the expression and localization of the receptor activator nuclear factor κB ligand (RANKL) in cartilage from patients with rheumatoid arthritis (RA) of relevance to cartilage degeneration. We also examined the role of exogenous lymphotoxin (LT)-α on RANKL expression in human chondrocytes and its effect on in vitro osteoclast differentiation. Cartilage and synovial fluid samples were obtained from 45 patients undergoing total joint replacement surgery or joint puncture, including 24 patients with osteoarthritis (OA) and 21 patients with RA. RANKL expression in articular cartilage was examined by immunohistochemistry. LT-α concentrations in synovial fluid were measured using an enzyme-linked immunosorbent assay (ELISA). Normal human chondrocytes were stimulated with LT-α, and the relative mRNA levels of RANKL, osteoprotegerin (OPG), matrix metalloproteinase-9, and vascular endothelial growth factor were examined by real-time polymerase chain reaction. Soluble RANKL protein in culture media was measured using ELISA, and membrane-bound RANKL protein in cells was examined by western blotting. Co-cultures of human chondrocytes with peripheral blood mononuclear cells (PBMCs) were stimulated with macrophage-colony stimulating factor and LT-α, and osteoclast differentiation was evaluated by staining for tartrate-resistant acid phosphatase. LT-α concentrations were higher in RA synovial fluid than in OA samples. The population of RANKL-positive chondrocytes of RA cartilage was higher than that of OA cartilage, and correlated with cartilage degeneration. Stimulation of cultured human chondrocytes by LT-α increased RANKL expression, the RANKL/OPG ratio, and angiogenic factors. Membrane-bound RANKL in chondrocytes was up-regulated after stimulation of LT-α, whereas soluble RANKL in culture medium did not increase. Co-cultures of human chondrocytes and PBMCs demonstrated that LT-α stimulated human chondrocytes to produce RANKL and induced osteoclastic differentiation of PBMCs. RANKL produced by chondrocytes may contribute to cartilage destruction during RA and LT-α could promote the expression of RANKL in human chondrocytes.

DOI： 10.1371/journal.pone.0254268

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Language：Japanese   Publisher：(一社)日本手外科学会  

関節リウマチの人工指関節置換術において小指は十分な可動域が得られにくいという問題点がある.著者らは,シリコンインプラント(SBi Silicone人工指関節:旧AVANTA人工指関節)による人工指関節置換術を行っており,2014年以降小指に対してはプレフレックスタイプを使用している.ストレートタイプ(S群)27例とプレフレックスタイプ(P群)21例に対し,術後1年時の握力,可動域,HAND20,DASHを調査し,比較検討した.術後1年時のMP関節の屈曲角度はS群50.1度,及びP群67.4度であり,可動域もS群33.5度,及びP群60.7度(P<0.01)であり有意に大きかった.他の検討項目では有意差を認めなかった.屈曲角度に影響する因子は様々であるが,プレフレックスタイプの選択により小指の屈曲は有意に増加し,可動域が増加した.(著者抄録)

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Language：Japanese   Publisher：日本リウマチリハビリテーション研究会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

人工指関節置換術は,股関節や膝関節などと比べて経験することの少ない手術であり,関節リウマチ(RA)の手指変形に対して行われる症例が大きな割合を占める.強力な抗リウマチ薬の普及によりRA症例の人工関節手術が世界的に減少傾向にある中,本邦では手指の小手術がむしろ増加傾向にあり,より高い機能・整容的目標の達成が求められるようになっている.人工関節の特性や,軟部組織の破綻のメカニズムと再建方法について熟知することが人工関節置換術を正確に行うためには必須であり,リハビリテーションを担当するスタッフとの情報を共有する必要がある.本稿では最も多く行われているRAの中手指節関節(MCP関節)変形に対する人工関節置換術を例に,手術とリハビリテーションの実際について概説する.(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J04897&link_issn=&doc_id=20170330060006&doc_link_id=%2Fch7remed%2F2017%2F005403%2F006%2F0191-0194%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch7remed%2F2017%2F005403%2F006%2F0191-0194%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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The metatarsophalangeal (MTP) joints are often and predominantly affected in rheumatoid arthritis. The aim of the current study was to describe surgical techniques of shortening oblique osteotomy for lesser metatarsal bone with screw fixation at the osteotomy site, and to investigate the short-term clinical outcomes of our procedure. Twenty-seven feet (78 toes) of 24 RA patients underwent the shortening oblique osteotomy for the correction of deformity at the lesser MTP joints. The average Japanese Society of Surgery of the Foot (JSSF) standard rating system for the RA foot and ankle scale improved significantly from 59.6 points preoperatively to 88.3 points postoperatively (p＜0.001). Twenty-four feet (89% ) were free from metatarsalgia and symptomatic callosities at the lesser MTP joint after surgery. Our present findings showed satisfactory early clinical outcomes of the shortening oblique osteotomy of the metatarsal bone with screw fixation for RA forefoot.

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OBJECTIVE: To investigate the prevalence and the risk factors of surgical-site infection (SSI) and delayed wound healing (DWH) in patients with rheumatoid arthritis (RA) underwent orthopedic surgery. METHODS: We reviewed the records of 1036 elective orthopedic procedures undertaken in RA patients. Risk factors for SSI and DWH were assessed by logistic regression analysis using age, body mass index, disease duration, pre-operative laboratory data, surgical procedure, corticosteroid use, co-morbidity, and use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs) as variables. RESULTS: SSI and DWH were identified in 19 cases and 15 cases, respectively. One case of SSI and three cases of DWH were recorded among 196 procedures in patients using bDMARDs. Foot and ankle surgery was associated with an increased risk of SSI (odds ratio (OR), 3.167; 95% confidence interval (CI), 1.256-7.986; p = 0.015). Total knee arthroplasty (TKA; OR, 4.044; 95% CI, 1.436-11.389; p = 0.008) and disease duration (OR, 1.004; 95% CI, 1.000-1.007; p = 0.029) were associated with an increased risk of DWH. CONCLUSIONS: Our results indicated foot and ankle surgery, and TKA and disease duration as risk factors for SSI and DWH, respectively. bDMARDs was not associated with an increased risk of SSI and DWH.

DOI： 10.3109/14397595.2015.1073133

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BACKGROUND: We aimed to evaluate the early clinical results of the reconstruction of problematic elbow joints due to rheumatoid arthritis (RA) using a PROSNAP linked elbow prosthesis (Kyocera Medical, Osaka, Japan) for total elbow arthroplasty. METHODS: Seventeen elbows in 14 RA patients were replaced with a PROSNAP elbow with cement fixation. The patients comprised 1 man and 13 women, with a mean age of 63.9 years (range, 52-83 years) at the time of surgery. The preoperative conditions of the elbows were arthritis mutilans (n = 10), an ankylosed or stiff elbow with a preoperative range of motion of 45° or less (n = 4), and loosening of a primary total elbow arthroplasty (n = 3). The mean follow-up period was 47.7 months (range, 32-69 months), with a 100% follow-up rate. The clinical outcome of the elbows was evaluated by the Mayo Elbow Performance Index (maximum, 100 points). RESULTS: The mean postoperative Mayo Elbow Performance Index score improved from 57.6 points to 97.1 points. Preoperatively, 3 of the 17 elbows were judged as good, 7 as fair, and 7 as poor; at final follow-up, 16 elbows were judged as excellent and 1 as good. Complications were noted in 1 elbow (6%), which had undergone a postoperative fracture. CONCLUSIONS: The PROSNAP elbow prosthesis can be safely implanted through a relatively easy procedure and provides satisfactory short-term clinical outcomes for the reconstruction of severely damaged RA elbows. LEVEL OF EVIDENCE: Level IV, case series, treatment study.

DOI： 10.1016/j.jse.2013.12.031

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DOI： 10.3109/14397595.2013.874758

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BACKGROUND: We determined mid to long-term results of total elbow arthroplasty (TEA) by use of unlinked elbow prostheses with solid alumina ceramic trochleae, and ceramic ulnar stems (stemmed Kyocera type I; SKC-I) for patients with rheumatoid arthritis. PATIENTS AND METHODS: Fifty-four elbows of 39 patients were available for detailed clinical and radiographic review after a follow-up period of at least 5 years. The mean follow-up period was 12.6 years (range 5-22 years). Clinical condition before and after surgery was assessed by use of a modified version of the Mayo Elbow Performance Score (MEPS; 0-100 points) and a Japan Orthopaedic Association Elbow score (JOA score; 0-100 points). The radiographs were reviewed and loosening was defined as a progressive radiolucent line >1 mm wide that was completely circumferential around the prosthesis. Clinical records of post-operative events affecting the elbows were used for survival analysis of the prostheses using the Kaplan-Meier method. RESULTS: The average modified MEPS and JOA scores improved significantly from 39.7 ± 14.3 to 44.7 ± 9.4, respectively, pre-operatively, to 89.7 ± 15.4 and 83.1 ± 12.8, respectively, post-operatively (P < 0.0001). The functional assessment score also improved from 4.9 ± 2.8 to 8.5 ± 3.3 points (P < 0.0001). With loosening or implant revision defined as end points, the likelihood of survival of the prosthesis for up to 20 years was 92.6% (95% confidence interval (CI), 85.6-100.0) or 86.3 % (95 % CI 75.0-97.6), respectively. CONCLUSION: Satisfactory clinical results were obtained after TEA using SKC-I prostheses, which provided excellent pain relief and functional range of motion. The results of our study reveal the high reliability over a long period of the cemented SKC-I prosthesis with an alumina ceramic component.

DOI： 10.1007/s00776-013-0492-0

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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We investigated the expression and localization of high-mobility group box chromosomal protein-1 (HMGB-1) in human osteoarthritic (OA) cartilage in relation to the histopathological grade of cartilage destruction, and examined the role of HMGB-1 in the regulation of proinflammatory cytokine expression in chondrocytes. An immunohistochemical study demonstrated that total HMGB-1-positive cell ratios increase as the Osteoarthritis Research Society International (OARSI) histological grade increased. The population of cytoplasmic HMGB-1-positive chondrocytes was especially increased in the deep layers of higher-grade cartilage. The ratios and localization of receptors for advanced glycation end products (RAGE) expression by chondrocytes in Grade 2, 3, and 4 were significantly higher than those in Grade 1. In vitro stimulation with IL-1β, but not TNFα, significantly upregulated the expression of HMGB-1 mRNA by human OA chondrocytes. Both IL-1β and TNFα promoted the translocation of HMGB-1 from nuclei to cytoplasm. IL-1β and TNFα secretions were stimulated at higher levels of HMGB-1. The results of our study suggest the involvement of HMGB-1 in the pathogenesis of cartilage destruction in OA.

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Language：Japanese   Publisher：ライフサイエンス出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J00822&link_issn=&doc_id=20101025150013&doc_link_id=issn%3D0386-8109%26volume%3D44%26issue%3D10%26spage%3D1127&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0386-8109%26volume%3D44%26issue%3D10%26spage%3D1127&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Objective: To investigate the in vitro and in vivo effects of interleukin (IL)-4 on mechanical stress-induced nitric oxide (NO) expression by chondrocytes, and destruction of cartilage and NO production in an instability-induced osteoarthritis (OA) model in rat knee joints, respectively.
Materials and methods: Cyclic tensile stress (CTS; 0.5 Hz and 7% elongation) was applied to cultured normal rat chondrocytes with or without pre-incubation with recombinant rat IL-4 (rrIL-4). Inducible NO synthase (iNOS) mRNA expression and NO production were examined with real-time polymerase chain reaction and the Griess reaction, respectively. OA was induced in rat knee joints by transection of the anterior cruciate and medial collateral ligaments and resection of the medial meniscus. rrIL-4 (10, 50, and 100 ng/joint/day) was injected intra-articularly, and knee joint samples were collected 2, 4, and 6 weeks after surgery. Cartilage destruction was evaluated by the modified Mankin score and Osteoarthritis Research Society International scoring system on paraffin-embedded sections stained with safranin O. Cleavage of aggrecan and NO production were examined by immunohistochemistry for aggrecan neoepitope (NITEGE) and of nitrotyrosine (NT), respectively.
Results: rrIL-4 down-regulated CTS-induced iNOS mRNA expression and NO production by chondrocytes. The intra-articular injection of rrIL-4 gave rise to a limited, but significant amelioration of cartilage destruction, prevention of loss of aggrecan, and decrease in the number of NT-positive chondrocytes, an effect that was not dose-dependent.
Conclusion: The present study suggests that IL-4 may exert chondroprotective properties against mechanical stress-induced cartilage destruction, at least in part, by inhibiting NO production by chondrocytes. (C) 2007 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.joca.2007.11.006

Web of Science

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To investigate the effect of the histone deacetylase (HDAC) inhibitor, trichostatin A (TSA), on joint inflammation and cartilage degeneration in a collagen antibody-induced arthritis (CAIA) mouse model. METHODS: CAIA mice were given daily subcutaneous injections of various concentrations of TSA (0, 0.5, 1.0, and 2.0 mg/kg) and various parameters were monitored for 14 days. On Day 15, the hind paws were examined histologically. To investigate the effects of TSA on the expressions of matrix metalloproteinase (MMP)-3, MMP-13, tissue inhibitor of MMP-1 (TIMP-1), and acetyl-H4 by chondrocytes, another group of mice was sacrificed on Day 6. In vitro direct effect of TSA was examined by real-time PCR for mRNA of type II collagen, aggrecan, MMP-3, and MMP-13 in murine chondrogenic ATDC5 cells after pro-inflammatory cytokine stimulation. RESULTS: In the TSA-treated group, clinical arthritis was significantly ameliorated in a dose-dependent manner. The severity of synovial inflammation and the cartilage destruction score were significantly lower in the TSA 2.0 mg/kg group compared to the other TSA-treated groups. On immunohistochemistry, the number of MMP-3 and MMP-13-positive chondrocytes was significantly lower in the TSA 2.0 mg/kg group than in the control group. In contrast, the number of TIMP-1-positive cells and acetyl-histone H4-positive cells was significantly higher in the TSA 2.0mg/kg group than in the control group. TSA suppressed interleukin 1-beta and tumor necrosis factor-alpha-stimulated up-regulation of MMP-3, but not MMP-13 mRNA expression by ATDC5. CONCLUSION: The systemic administration of TSA ameliorated synovial inflammation in CAIA mice. Subsequently cartilage destruction was also suppressed by TSA, at least in part, by modulating chondrocyte gene expression.

DOI： 10.1016/j.joca.2007.10.014

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIRKHAUSER VERLAG AG  

Objective: To investigate the effect of FK228 on the in vitro expression of hypoxia-inducible factor-1 alpha (HIF-1 alpha) and vascular endothelial growth factor (VEGF) by rheumatoid arthritis synovial fibroblasts (RASFs), and on the in vivo expression of VEGF and angiogenesis in the synovial tissue of mice with collagen-antibody-induced arthritis (CAIA).
Methods: RASFs were stimulated with IL-1 beta and TNF alpha and then incubated under hypoxia (1 % O-2) with various concentrations of FK228. The effects of FK228 on the expression of HIF-1 alpha and VEGF mRNA were examined by quantitative real-time PCR. Changes in HIF-1 alpha protein expression and the secretion of VEGF protein into the culture medium were examined by Western blot analysis and ELISA, respectively. Immunohistochemical analysis was carried out to investigate the expression and distribution of VEGF in synovial tissues of CAIA mice.
Results: The cytokine-stimulated expression of HIF-1 alpha and VEGF mRNA was inhibited by FK228 in a dose-dependent manner. FK228 also reduced the expression of HIF-1 alpha and VEGF protein. Intravenous administration of FK228 (2.5 mg/kg) suppressed VEGF expression, and also blocked angiogenesis in the synovial tissue of CAIA.
Conclusion: FK228 may exhibit a therapeutic effect on RA by inhibition of angiogenesis through down-regulation of angiogenesis related factors, HIF-1 alpha and VEGF.

DOI： 10.1007/s00011-007-7036-z

Web of Science

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Ossification disturbance in femoral head reportedly is seen in the Spontaneously Hypertensive rats (SHR) between ages of 10 and 20 weeks. We investigated serum and tissue levels of insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF) in SHR relevant to the ossification disturbance and osteonecrosis of the femoral head. Serum levels of IGF-1 and VEGF were significantly lower in SHR than in Wistar Kyoto rats (WKY) at weeks 5, 10, 15 and 20 (p<0.005). The incidence of histological ossification disturbance of the femoral head was higher in SHR (59%) than in WKY (40%) at week 20. Lower serum and local levels of VEGF in SHR appeared to be related to the incomplete ossification of the femoral heads. Immunohistochemical study showed significantly lower numbers of IGF-1 and VEGF positive chondrocytes in the femoral epiphyseal cartilage of SHR than in those of WKY at weeks 10, 15 and 20. Our results suggest that local and/or systemic levels of IGF-1 and VEGF between ages of 5 and 20 weeks might play roles in the pathogenesis of ossifi cation disturbance of the femoral head in SHR.

PubMed

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DOI： 10.11359/chubu.2006.655

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RA診療における外科的治療として、2006年以降より肩・肘・股・膝関節の人工関節の手術件数は減少傾向にあるなか、手・足の手術件数は増加傾向にあった。術後リハビリテーション医療を行う際には、術前・術後に執刀医と綿密な連携をとることや、病棟看護師との連携の必要性が報告されている。本稿では、当院での作業療法士の立場からみた他職種連携について紹介する。当院での外科的治療におけるリハビリテーション医療は入院から外来と長期間に渡って行われ、計画的に入院中の術前評価から外来での術後3ヵ月・6ヵ月・1年と定期的に評価を行い患者の状況把握に努めている。入院期間中は主治医と手術に対して共通認識がもてるように、整形外科手術カンファレンス・回診、症例報告、超音波検査によって連携をとっている。また、上肢・手の手術でも移動能力に問題があれば、リハ医・理学療法士と、入院中のADLに関しては、病棟看護師と連携している。また、退院後も各術式による時期別の機能回復を意識しながら、術後評価を行い主治医と連携しながらフォローアップしている。多職種間で意思疎通しやすい環境構築を意識しながら診療を行うこが重要である。(著者抄録)

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Event date： 2016.12.2 - 2016.12.3

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.12.2 - 2016.12.3

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.11.19

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.11.11 - 2016.11.12

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.11.11 - 2016.11.12

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.11.11 - 2016.11.12

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.11.11 - 2016.11.12

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.11.11 - 2016.11.12

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.29 - 2016.10.30

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.29 - 2016.10.30

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2016.10.29 - 2016.10.30

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.22 - 2016.10.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.22 - 2016.10.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.22 - 2016.10.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.22 - 2016.10.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.13 - 2016.10.14

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.13 - 2016.10.14

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.13 - 2016.10.14

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.10.13 - 2016.10.14

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.9.30 - 2016.10.1

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.9.30 - 2016.10.1

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2016.8.26 - 2016.8.27

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.7.8 - 2016.7.9

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.6.8 - 2016.6.11

Language：English   Presentation type：Oral presentation (general)  

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Event date： 2016.6.8 - 2016.6.11

Language：English   Presentation type：Oral presentation (general)  

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Event date： 2016.6.8 - 2016.6.11

Language：English   Presentation type：Oral presentation (general)  

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Event date： 2016.6.8 - 2016.6.11

Language：English   Presentation type：Oral presentation (general)  

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Event date： 2016.5.26 - 2016.5.27

Language：English   Presentation type：Oral presentation (general)  

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Event date： 2016.5.12 - 2016.5.15

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.5.12 - 2016.5.15

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.5.12 - 2016.5.15

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.5.12 - 2016.5.15

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.5.12 - 2016.5.15

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.5.12 - 2016.5.15

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.4.21 - 2016.4.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.4.21 - 2016.4.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.4.21 - 2016.4.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.4.21 - 2016.4.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.4.21 - 2016.4.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.4.21 - 2016.4.23

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2016.4.21 - 2016.4.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.4.21 - 2016.4.23

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.4.8 - 2016.4.9

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2016.4

Language：Japanese  

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Event date： 2016.3.14

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.3.14

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2016.3.5 - 2016.3.8

Language：English   Presentation type：Oral presentation (general)  

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Event date： 2015.9

Language：Japanese  

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Event date： 2014.4

Language：Japanese  

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Event date： 2013.8

Language：Japanese  

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Event date： 2013.3

Language：Japanese  

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Event date： 2013.3

Language：Japanese  

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Event date： 2013.3

Language：Japanese  

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Event date： 2012.10

Language：Japanese  

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Event date： 2012.4

Language：Japanese  

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Event date： 2012.3

Language：Japanese  

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Event date： 2012.3

Language：Japanese  

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Event date： 2012.1

Language：Japanese  

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Event date： 2011.10

Language：Japanese  

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Event date： 2011.8

Language：Japanese  

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Event date： 2011.8

Language：Japanese  

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Event date： 2011.6

Language：Japanese  

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Event date： 2011.6

Language：Japanese  

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Event date： 2010.3

Language：Japanese  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Symposium, workshop panel (nominated)  

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Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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