研究者詳細 - 中原　龍一

論文 - 中原　龍一

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小川健一, 土井武, 中原龍一, 宗友和生, 佐藤徹

骨折 29 ( 1 ) 80 - 84 2007年2月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：(一社)日本骨折治療学会

Sacroiliac Plate(SI plate)を用いた仙腸関節脱臼骨折の治療成績を検討した。患者は男性5例、女性1例、平均年齢53.3歳で、骨折型はAO分類61-C1.2のa1(仙腸関節脱臼+腸骨翼骨折):4例、a3(仙腸関節脱臼+仙骨骨折):2例であった。経過観察期間は平均17.6ヵ月であった。創外固定装着までの時間は搬入1時間以内5例、搬入3時間後1例で、平均11.8日にConversionとしてSI plateによる内固定を行った。整復位とプレート設置位置に関連性を認め、回旋位設置例では骨折部のギャップが8.4mm、上方設置例では垂直方向の転位が7.8mmであった。残る4例の転位は5mm以下でプレート設置位置も良好であった。最終観察時のADLは元職復帰4例、家庭内自立1例、車椅子使用1例であった。SI plateは本症例に対して有用な治療法であるが、手術時5mm以上の転位があるとプレート設置位置が不良になりやすいと考えられた。

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軽微な症状しか示さなかったO157感染性腸炎の1例査読

中原龍一, 犬飼道雄, 内藤稔, 村上正和, 伊野英男, 宗淳一, 梶谷伸顕, 氏家良人

日本腹部救急医学会雑誌 26 ( 7 ) 893 - 896 2006年11月

担当区分：筆頭著者記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：(一社)日本腹部救急医学会

ベロ毒素を産生するO157感染性腸炎は極めて重篤な転帰をとることがある。われわれは頻回の下痢や血便がなく,腹部超音波検査でtarget sign様の像をきたしていたため,診断に苦慮したO157感染性腸炎の1例を経験した。症例は20歳男性。腹痛と軟便を主訴に来院した。FOMと整腸剤を処方されたが症状が改善しないため翌日に再来院した。右下腹部に腫瘤を触知し同部位に限局性の筋性防御があり,腹部超音波検査でtarget sign様の像があり,腹部CT検査で上行結腸の腸管壁が著明に肥厚していた。便検査からO157表面抗原陽性,便培養でベロ毒素(VT1,VT2)産生大腸菌を検出したため,O157感染性腸炎と診断した。頻回の下痢や血便などの激しい消化器症状がない場合でも,画像検査で限局性の著明な腸管壁の肥厚像があった場合には,O157感染性腸炎を考慮した検査や治療を行う必要がある。(著者抄録)

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高エネルギー外傷に伴う大腿骨転子下骨折に対する髄内釘固定査読

土井武, 小川健一, 中原龍一, 宗友和生

中部日本整形外科災害外科学会雑誌 49 ( 5 ) 871 - 872 2006年9月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：(一社)中部日本整形外科災害外科学会

当科で標題の髄内釘固定を行った5例の成績を報告した。男性4例、女性1例、年齢は31?56歳、受傷機転は交通事故4例、墜落事故1例、骨折型(Seinsheimer分類)はIII A型2例、III B型1例、VI型1例、V型1例であった。手術方法は全例、骨折部を最低限展開し骨性構築を得て、cerclage wireなどで仮固定してから髄内釘を挿入した。仮固定に使用したワイヤーは術後骨片が転位しないようなら抜去し、転位する場合には体内に残した。術後観察期間6?12ヵ月(平均8.4ヵ月)で股関節可動域は屈曲120?135°(平均130°)、外転25?30°(平均29°)となった。2cm以上の脚長差を認めた症例やX線上インプラントの折損、整復位の喪失を認めた症例はなかった。全体重負荷を許可するまでの期間は10?16週(平均10.4週)、最終観察時のJOAスコアは66?95点(平均84点)であった。

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RANKL expression in chondrocytes and its promotion by lymphotoxin-α in the course of cartilage destruction during rheumatoid arthritis. 査読国際誌

Ayumu Takeshita, Keiichiro Nishida, Aki Yoshida, Yoshihisa Nasu, Ryuichi Nakahara, Daisuke Kaneda, Hideki Ohashi, Toshifumi Ozaki

PloS one 16 ( 7 ) e0254268 1905年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

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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Risk factors for surgical site infection and delayed wound healing after orthopedic surgery in rheumatoid arthritis patients. 査読国際誌

Yasutaka Kadota, Keiichiro Nishida, Kenzo Hashizume, Yoshihisa Nasu, Ryuichi Nakahara, Tomoko Kanazawa, Masatsugu Ozawa, Ryozo Harada, Takahiro Machida, Toshifumi Ozaki

Modern rheumatology 26 ( 1 ) 68 - 74 1905年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

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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Clinical and radiographic study of partial arthrodesis for rheumatoid wrists. 査読国際誌

Taichi Saito, Keiichiro Nishida, Kenzo Hashizume, Ryuichi Nakahara, Ryozo Harada, Takahiro Machida, Masahiro Horita, Toshifumi Ozaki

Modern rheumatology 26 ( 1 ) 57 - 61 1905年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: To retrospectively investigate the clinical and radiographic results of partial arthrodesis for the wrists with rheumatoid arthritis (RA). METHODS: Forty-one wrists with RA were treated by radiolunate (RL) or radiolunotriquetral (RLT) arthrodesis with ulnar head resection. The average follow-up period after surgery was 7.1 years. Preoperative radiographs of all wrists were classified according to Schulthess classification. We performed RL arthrodesis for all Type II (n = 26) and Type III wrists (n = 7), and RLT arthrodesis for Type III wrists (n = 8). Pre- and postoperative pain score (visual analog scale), grip strength, range of motion, and radiographic parameters were statistically compared. RESULTS: Pain scores in all groups were significantly improved at final follow-up (P < 0.05). Grip strength increased from 5.9 to 12.4 (kg) significantly in Type II wrists (P < 0.01), from 7.2 to 9.1 in Type III wrists after RLT arthrodesis, but decreased from 6.9 to 6.0 in Type III wrists after RL arthrodesis. In all groups, the arc of pronation and supination improved significantly (P < 0.05), and all radiographic parameters improved. CONCLUSIONS: RL arthrodesis for Type II wrists showed satisfactory clinical results. RLT arthrodesis would be a reliable method in case of unstable wrist joint.

DOI： 10.3109/14397595.2015.1072293

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Consensus-based identification of factors related to false-positives in ultrasound scanning of synovitis and tenosynovitis. 査読国際誌

Kei Ikeda, Akihiro Narita, Michihiro Ogasawara, Shigeru Ohno, Yutaka Kawahito, Atsushi Kawakami, Hiromu Ito, Isao Matsushita, Takeshi Suzuki, Kenta Misaki, Takehisa Ogura, Tamotsu Kamishima, Yohei Seto, Ryuichi Nakahara, Atsushi Kaneko, Takayuki Nakamura, Mihoko Henmi, Jun Fukae, Keiichiro Nishida, Takayuki Sumida, Takao Koike

Modern rheumatology 26 ( 1 ) 9 - 14 1905年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: We aimed to identify causes of false-positives in ultrasound scanning of synovial/tenosynovial/bursal inflammation and provide corresponding imaging examples. METHODS: We first performed systematic literature review to identify previously reported causes of false-positives. We next determined causes of false-positives and corresponding example images for educational material through Delphi exercises and discussion by 15 experts who were an instructor and/or a lecturer in the 2013 advanced course for musculoskeletal ultrasound organized by Japan College of Rheumatology Committee for the Standardization of Musculoskeletal Ultrasonography. RESULTS: Systematic literature review identified 11 articles relevant to sonographic false-positives of synovial/tenosynovial inflammation. Based on these studies, 21 candidate causes of false-positives were identified in the consensus meeting. Of these items, 11 achieved a predefined consensus (??80%) in Delphi exercise and were classified as follows: (I) Gray-scale assessment [(A) non-specific synovial findings and (B) normal anatomical structures which can mimic synovial lesions due to either their low echogenicity or anisotropy]; (II) Doppler assessment [(A) Intra-articular normal vessels and (B) reverberation)]. Twenty-four corresponding examples with 49 still and 23 video images also achieved consensus. CONCLUSIONS: Our study provides a set of representative images that can help sonographers to understand false-positives in ultrasound scanning of synovitis and tenosynovitis.

DOI： 10.3109/14397595.2015.1091123

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MRI of rheumatoid arthritis:comparing the outcome measures in rheumatology clinical trials (OMERACT) scoring and volume of synovitis for the assessment of biologic therapy. 査読国際誌

Ryuichi Nakahara, Keiichiro Nishida, Kenzo Hashizume, Ryouzou Harada, Takahiro Machida, Masahiro Horita, Aiji Ohtsuka, Toshifumi Ozaki

Acta medica Okayama 69 ( 1 ) 29 - 35 1905年7月

担当区分：筆頭著者記述言語：英語掲載種別：研究論文（学術雑誌）

The outcome measures in rheumatology clinical trials (OMERACT) scores are the most mature quantitation system for rheumatoid arthritis (RA) on magnetic resonance imaging (MRI). Direct measuring techniques of synovial volume have been reported with good reproducibility, although few reports have demonstrated the changes of these measures in response to treatment. To assess these clinical responses, we evaluated the correlation of the changes of clinical activity score 28-joints disease activity score (DAS28-CRP) with the changes of OMERACT scores and with synovial volume measurements. Eight RA patients who were treated by biologic agents were examined with MRI of the dominant affected wrist and finger joints before and one year after the treatment. The total OMERACT score was reduced from 48.0 to 41.3, and synovial volume was reduced from 15.4 to 8.8 milliliters. Positive correlations were seen between the changes of DAS28-CRP and the changes of OMERACT synovitis score (r＝0.27), OMERACT total score (r＝0.43) and synovial volume (r＝0.30). Limited to synovium assessment, synovial volume showed a better correlation with DAS28-CRP than the OMERACT synovitis score. On the other hand, the OMERACT total score showed a higher correlation with DAS28-CRP than synovial volume, probably because the OMERACT total score includes scores for bone erosion and bone edema as well.

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Surgical treatment for congenital kyphosis correction using both spinal navigation and a 3-dimensional model. 査読国際誌

Yoshihisa Sugimoto, Masato Tanaka, Ryuichi Nakahara, Haruo Misawa, Toshiyuki Kunisada, Toshifumi Ozaki

Acta medica Okayama 66 ( 6 ) 499 - 502 1905年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

An 11 year-old girl had 66 degrees of kyphosis in the thoracolumbar junction. For the purpose of planning for kyphosis correction, we created a 3-D, full-scale model of the spine and consulted spinal navigation. Three-dimensional models are generally used as tactile guides to verify the surgical approach and portray the anatomic relations specific to a given patient. We performed posterior fusion from Th10 to L3, and vertebral column resection of Th12 and L1. Screw entry points, directions, lengths and diameters were determined by reference to navigation. Both tools were useful in the bone resection. We could easily detect the posterior element to be resected using the 3D model. During the anterior bony resection, navigation helped us to check the disc level and anterior wall of the vertebrae, which were otherwise difficult to detect due to their depth in the surgical field. Thus, the combination of navigation and 3D models helped us to safely perform surgery for a patient with complex spinal deformity.

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