Faculty Profiles - NAKAHARA Ryuuichi

Papers - NAKAHARA Ryuuichi

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The trend of treatment and conveyance system for upper extremity replantation in Japan: A nationwide population-based study from the Japan trauma data bank. Reviewed International journal

Taichi Saito, Satoshi Nezu, Minami Matsuhashi, Ryuichi Nakahara, Yasunori Shimamura, Tomoyuki Noda, Tetsuya Yumoto, Atsunori Nakao, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 26 ( 2 ) 271 - 275 2021.3

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

BACKGROUND: In Japan, microsurgical skill development and a system to transfer patients to an appropriate hospital for upper extremity amputation have been promoted; however, information about trends of replantation is limited. Therefore, the aim of this study was to clarify the trends in the treatment for upper extremity amputation using the Japan Trauma Data Bank (JTDB). METHODS: Data derived from JTDB (2004-2015) were used to quantify trends in the volume of replantation for upper extremity amputation including finger amputation. Trauma was diagnosed based on the Abbreviated Injury Scale code; a subgroup of patients who underwent replantation was delineated. We investigated patient demographics, infection rate, and characteristics of treating facilities. RESULTS: A total of 1240 patients underwent upper extremity amputation. Among these, 510 (41.1%) underwent replantation, and the rate of replantation did not change over the study period. The average age of patients who underwent or did not undergo replantation was 45.5 and 47.2 years, respectively. The proportion of the patients who were transferred to another hospital for treatment significantly decreased between 2004 (28.5%) and 2015 (16.3%) (P < 0.01). Time taken for transfer from the accident site to hospitals increased. The rate of patients who underwent replantation differed among different hospitals; however, higher-volume hospitals were more likely to perform replantation. CONCLUSION: The rate of patients transferred to another hospital decreased between 2004 and 2015; however, the rate of patients who underwent replantation remained unchanged. This suggests that the number of patients who were transported directly from the accident site to an appropriate hospital has increased, whereas the indication for care in each hospital remains unchanged. Common criteria for amputations are needed to address the differing rates of replantation among hospitals.

DOI： 10.1016/j.jos.2020.03.006

PubMed

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骨粗鬆症と骨代謝ロモソズマブ治療における関節リウマチの影響

原田遼三, 西田圭一郎, 那須義久, 中原龍一, 高杉幸司, 江澤和彦, 井上貴絵, 藤田慎一朗, 與座未来, 金谷麻未, 新名早希子, 山本渉

日本リウマチ学会総会・学術集会プログラム・抄録集 65回 365 - 365 2021.3

ロモソズマブ治療において骨粗鬆症の前治療が与える影響、投与1年時の効果予測因子について

原田遼三, 西田圭一郎, 那須義久, 中原龍一, 高杉幸司, 江澤和彦, 井上貴絵, 藤田慎一朗, 與座未来, 金谷麻未, 新名早希子, 山本渉

日本リウマチ学会総会・学術集会プログラム・抄録集 65回 610 - 610 2021.3

生物学的製剤と手術当科におけるリウマチ外科手術1569例の患者背景

那須義久, 堀田佳史, 渡辺雅仁, 松橋美波, 中原龍一, 西田圭一郎, 尾崎敏文

日本リウマチ学会総会・学術集会プログラム・抄録集 65回 343 - 343 2021.3

関節リウマチ超音波検査におけるデジタルカメラ画像とAIを用いたボディーマーク付与

中原龍一, 西田圭一郎, 那須義久, 渡辺雅仁, 松橋美波, 堀田佳史, 尾崎敏文

日本リウマチ学会総会・学術集会プログラム・抄録集 65回 555 - 555 2021.3

【整形外科におけるAIを用いた研究】AI技術の過去と現状 Reviewed

中原龍一

関節外科 39 ( 12 ) 1280 - 1286 2020.12

Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：(株)メジカルビュー社

＜文献概要＞人工知能(artificial intelligence;AI)技術の発展は技術だけの問題ではなく経済も含めた複合的な現象である。AIを中心としたデータ処理が得意なGAFA企業は世界の株式時価総額のトップを占めるようになった。AIの中心技術である深層学習は画像処理能力を飛躍的に伸ばしただけでなく,言語や音声などの解析能力も伸ばした。またGPUの進歩,大規模データセットの進化などの要因がAIの発展を支えている。本稿ではこれらのAI技術の進歩にまつわる歴史を概説する。

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What Are the Results of Resection of Localized Dedifferentiated Liposarcomas in the Extremities? Reviewed International journal

Eiji Nakata, Toshiyuki Kunisada, Joe Hasei, Ryuichi Nakahara, Hiroyuki Yanai, Tomohiro Toji, Hirofumi Inoue Ct, Toshifumi Ozaki

Clinical orthopaedics and related research 478 ( 11 ) 2550 - 2561 2020.11

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

BACKGROUND: Dedifferentiated liposarcoma (DDLPS) is a rare malignancy that transitions from an atypical lipomatous tumor to a sarcoma with a variable morphologic appearance. The behavior of this tumor in the retroperitoneum is aggressive, but the behavior of DDLPS in the extremities is less well-defined because it is rare. Few reports have assessed the imaging features and clinical outcomes of primary DDLPS in the extremities. QUESTIONS/PURPOSES: In patients with primary DDLPS of the extremity, we asked the following questions: (1) How frequently do additional primary malignancies occur in patients with DDLPS? (2) What is the rate of overall survival, metastases, and local recurrence in DDLPS? (3) What factors are associated with metastasis-free survival and local recurrence in DDLPS? METHODS: We defined DDLPS as a biphasic neoplasm that transitions from an atypical lipomatous tumor (ALT) to a sarcoma of variable morphologic appearance and histologic grades. We retrospectively evaluated the medical records of patients with DDLPS of the extremities who underwent surgery in our institution between 2003 and 2017. During that time, 16 patients were treated for this diagnosis; one was excluded from this study because the patient did not have an MRI, leaving 15 patients (nine men, six women; their median [range] age was 67 years [42 to 87]) for evaluation. All had a minimum of 2 years follow-up (median [range] 54 months [25 to 136]); 14 of 15 have been seen in the last 5 years (one patient, who was doing well at the time, was lost after 9 years of follow-up). In 11 patients, MRI demonstrated two components: an ALT component with high intensity on both T1-weighed and T2-weighted sequences and a dedifferentiated component low-to-intermediate intensity on T1-weighed and heterogeneous hyperintensity on T2-weighted sequence. Nine patients were evaluated using 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography (FDG-PET) combined with CT (PET/CT). PET/CT showed a biphasic pattern with a close relationship to MRI findings. The dedifferentiated component presented with high FDG uptake (median [range] maximum standardized uptake value 5.1 [1.9 to 22.6]), while the atypical lipomatous tumor component showed almost no FDG uptake. In all patients, immunohistochemical studies of p16 and cyclin-dependent kinase-4 (CDK4) were investigated. Positive staining for both p16 and CDK4 were seen in 13 of 15 patients.We retrospectively evaluated the electronic medical records of all patients in our institution for the presence of additional primary malignancies, local recurrence-free survival, metastasis-free survival, and overall survival. The survival rate was estimated using the Kaplan-Meier method. The Wilcoxon exact test was used to determine the prognostic importance of the following survival variables: age, sex, maximum tumor size, radiotherapy, and surgical margin. RESULTS: Seven additional primary malignancies developed in five of 15 patients (two lung cancers, two sarcomas, one renal cell cancer, one uterine cancer, and one non-Hodgkin lymphoma). The 3- and 5-year metastasis-free survival rates were 86% (95% CI 0.67 to 1.00) and 75% (95% CI 0.49 to 1.00), respectively. With the numbers available, we found no factors associated with metastasis-free survival. The 3- and 5-year overall survival rates were 100% (95% CI 1.00 to 1.00) and 88% (95% CI 0.65 to 1.00), respectively. Three of 15 patients had local recurrence. The 3- and 5-year local recurrence-free survival rates were 86% (95% CI 0.67 to 1.00) and 75% (95% CI 0.49 to 1.00), respectively. Large (> 15 cm) tumors were more likely to have a local recurrence (p = 0.04). CONCLUSIONS: In this small series, we found that the extremities are a favorable site for DDLPS compared with the retroperitoneum, although we did not directly compare the two sites. This rare tumor has a relatively high likelihood of being associated with other malignancies. We believe patients should be assessed and monitored carefully for this possibility. In the future, larger studies are needed to better define predictors of local recurrence, although the tumor's size may be associated with a greater propensity for local recurrence. LEVEL OF EVIDENCE: Level II, prognostic study.

DOI： 10.1097/CORR.0000000000001338

PubMed

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Early response of bone metastases can predict tumor response in patients with non-small-cell lung cancer with bone metastases in the treatment with nivolumab. Reviewed International journal

Eiji Nakata, Shinsuke Sugihara, Yoshifumi Sugawara, Toshiyuki Kozuki, Daijiro Harada, Naoyuki Nogami, Ryuichi Nakahara, Takayuki Furumatsu, Tomonori Tetsunaga, Toshiyuki Kunisada, Toshifumi Ozaki

Oncology letters 20 ( 3 ) 2977 - 2986 2020.9

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

The effect of nivolumab and the relation between bone response and tumor control in patients with non-small-cell lung cancer (NSCLC) with bone metastases are not clear. The outcome of nivolumab monotherapy was investigated, and whether the response of bone metastases is useful as an early predictor of tumor control in patients with NSCLC with bone metastases was examined. The participants included 15 patients who received nivolumab monotherapy for NSCLC with bone metastases in our institution between 2015 and 2017. Tumor control was defined using Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST1.1). Response of bone metastases was assessed by the MD Anderson response criteria (MDA criteria). Responses according to RECIST1.1 and the MDA criteria were classified as responder (complete response or partial response) and non-responder [progressive disease (PD) or stable disease]. Progression-free survival (PFS) was investigated using the Kaplan-Meier method. With RECIST1.1, the overall response rate was 20%. Multivariate analysis showed that the MDA criteria were the only risk factor for patients with PD (RECIST1.1). Median PFS was 1.9 months, with PFS of 20% at 6 months. Univariate analysis showed that being a non-responder according to the MDA criteria was the only risk factor for PFS. In patients who were responders (MDA criteria) within 3 months, PFS was 83 and 50% at 3 and 6 months, respectively, though all non-responder (MDA criteria) patients converted to PD (RECIST1.1) within 3 months. Response according to RECIST1.1 was significantly correlated with response according to the MDA criteria (P<0.05). In patients who were both responders according to RECIST1.1 and the MDA criteria, time to response with the MDA criteria (1.4-2.0 months) was earlier than with RECIST1.1 (2.8-3.0 months) in all patients. In conclusion, application of the MDA criteria within 2 months of nivolumab monotherapy is useful for early prediction of response and prognosis in patients with NSCLC with bone metastases.

DOI： 10.3892/ol.2020.11856

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【整形外科×人工知能】整形外科の画像診断領域における深層学習 Reviewed

中原龍一

臨床整形外科 55 ( 8 ) 919 - 924 2020.8

Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：(株)医学書院

＜文献概要＞深層学習(deep learning)と呼ばれる人工知能(artificial intelligence)AI技術の発達により,AI画像診断研究が劇的に発展している.それを支えているのがAIプログラムの無料公開文化だ.AI学者が再利用可能な形でAIプログラムを公開してくれるため,公開されたAI技術を組み合わせることで医療AIの開発が可能となった.整形外科領域におけるAI開発もその例外ではなく,骨折診断領域を中心に様々なAI技術を組み合わせて開発を行われている.本稿ではAI技術の発展にフォーカスしてAI画像診断研究について概説する.

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バリシチニブを休薬せず行った整形外科手術の小経験

原田遼三, 西田圭一郎, 那須義久, 中原龍一, 高杉幸司, 浅野澄恵, 藤田慎一朗, 井上貴絵, 山本渉, 與座未来, 金谷麻未, 新名早希子, 江澤和彦

日本リウマチ学会総会・学術集会プログラム・抄録集 64回 574 - 574 2020.8

生物学的製剤治療を行った関節リウマチ患者における関節破壊の解析

浅野澄恵, 高杉幸司, 江澤和彦, 原田遼三, 藤田慎一朗, 山本渉, 中原龍一, 那須義久, 西田圭一郎

日本リウマチ学会総会・学術集会プログラム・抄録集 64回 561 - 561 2020.8

地域包括ケア病棟における期限内退院可能な患者の特徴、予測モデルについて

原田遼三, 中原龍一, 那須義久, 西田圭一郎

The Japanese Journal of Rehabilitation Medicine 57 ( 特別号 ) 3 - 4 2020.7

【整形外科臨床研究の手引き-適切に行い,正しく読み解くために】最新研究紹介 AIを用いた整形外科研究 Reviewed

中原龍一

整形外科 71 ( 6 ) 725 - 730 2020.5

Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：(株)南江堂

＜文献概要＞はじめに近年,画像認識や自動翻訳などで人工知能(artificial intelligence:AI)が急速に発展している.その中心にあるのは深層学習(deep learning)と呼ばれるAI技術である.医療界でも爆発的な勢いでAI研究が増えており,PubMedで"deep learning"で検索される論文は2012年には12件にすぎなかったが,2019年には3,919件にまで増えている(図1).医療AI研究は放射線科の画像分野ではじまり,さまざまな領域に医療AI研究は拡大している.整形外科領域でも骨折のAI画像診断を中心にAI研究が広がりをみせている.本項ではそのようなAI論文の読み解き方とAI研究のはじめ方について概説する.

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Multidisciplinary treatment system for bone metastases for early diagnosis, treatment and prevention of malignant spinal cord compression. Reviewed International journal

Eiji Nakata, Shinsuke Sugihara, Yoshifumi Sugawara, Ryuichi Nakahara, Takayuki Furumatsu, Tomonori Tetsunaga, Toshiyuki Kunisada, Kazuo Nakanishi, Yoshiteru Akezaki, Toshifumi Ozaki

Oncology letters 19 ( 4 ) 3137 - 3144 2020.4

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

Malignant spinal cord compression (MSCC) is a serious complication of cancers. The present study aimed to establish a multidisciplinary treatment system for urgent magnetic resonance imaging (MRI) and referral to orthopedists in order to prevent neurological deficits caused by MSCC. In the present study, the extent to which this system achieved early diagnosis and treatment and prevented MSCC-caused neurological deficits was examined. The records from patients with neurological deficits caused by MSCC before (between April 2007 and March 2012; group A) and after (between April 2012 and March 2017; group B) the establishment of the multidisciplinary system at the Shikoku Cancer Center (Ehime, Japan) were retrospectively evaluated. The numbers of patients with neurological deficits were 38 and 7 in groups A and B, respectively. All patients received radiotherapy. The incidence of neurological deficits was 13.2 and 3.4% in groups A and B, respectively (P<0.001). The proportion of patients with improvement in the severity of neurological deficits was 5.3 and 28.6% in groups A and B, respectively (P<0.001). The interval between physicians' recognition of a neurological deficit and MRI and the start of treatment, the number of cases, and the severity of neurological deficits were evaluated in groups A and B. The median interval between recognition of a neurological deficit by physicians and MRI was 3 and 0 days in groups A and B, respectively (P<0.001). The median interval between physicians' recognition of a neurological deficit and the start of treatment was 3 and 0 days in groups A and B, respectively (P<0.001). By using a multidisciplinary treatment system, the incidence and severity of neurological deficits following treatment were significantly improved. Therefore, the multidisciplinary treatment system used in the present study may be useful for early diagnosis, treatment and prevention of MSCC in patients with bone metastases.

DOI： 10.3892/ol.2020.11415

PubMed

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【整形外科の外傷治療-現状と課題-】その他のトピックにおける現状と課題整形外科における人工知能 Reviewed

中原龍一

関節外科 39 ( 4月増刊 ) 151 - 158 2020.4

Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：(株)メジカルビュー社

＜文献概要＞・医療AIの研究が急速に発展している。さまざまな医療AI企業が生まれ,米国を中心に医療AIの臨床利用が開始された。・無料のAI開発環境が公開され誰でもAI研究が可能となったため,外傷領域でもAI研究は進んでいる。・AIはAI特有の誤認識を犯すことも分かってきたため,AIの臨床利用のためにはAIの利点だけではなく,問題点の研究も重要である。

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尺骨末端切除術(Darrach法)後に手指伸筋腱再断裂を生じた1例 Reviewed

那須義久, 大橋基秀, 木曽洋平, 沖田駿治, 渡辺雅仁, 松橋美波, 中原龍一, 西田圭一郎, 尾崎敏文

岡山医学会雑誌 132 ( 1 ) 48 - 48 2020.4

超音波ガイド下関節穿刺が診断治療に有用であった股関節偽痛風の2例 Reviewed

渡辺雅仁, 西田圭一郎, 那須義久, 中原龍一, 尾崎敏文, 原田遼三

中国・四国整形外科学会雑誌 32 ( 1 ) 1 - 7 2020.4

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：中国・四国整形外科学会

症例1は93歳女性で、右膝痛による体動困難を主訴とした。CT、超音波で右股関節包内前方に水腫と石灰化像を認め、超音波ガイド下に股関節穿刺吸引を施行した。関節液の検査結果は比重1.015、尿酸結晶(-)、CPPD結晶(+)、細胞数46325/μL(分画:Stab1%、Seg85%、Mono13%、Lymph1%)、糖77mg/dL、塗抹菌体(-)であり、股関節偽痛風と診断した。穿刺の際にキシロカインを投与し、症状が速やかに改善した。症例2は81歳女性で、誘因のない右股関節痛を主訴とした。CT、超音波で右股関節包内前方に水腫と石灰化像を認め、超音波ガイド下に股関節穿刺吸引を施行した。関節液の検査結果は比重1.020、尿酸結晶(-)、CPPD結晶(+)、細胞数20800/μL(分画:Stab0%、Seg82%、Mono13%、Lymph8%)、糖155mg/dL、塗抹菌体(-)であり、股関節偽痛風と診断した。穿刺の際にキシロカインを投与し、症状が速やかに改善した。以後、2例とも疼痛の再燃を認めなかった。

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【リウマチと整形外科】関節エコーの使用ポイント Reviewed

中原龍一

関節外科 39 ( 3 ) 256 - 262 2020.3

Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：(株)メジカルビュー社

関節エコーは単純X線画像では検出困難な滑膜炎や微小な骨びらんの検出が可能である。早期診断・薬効判定・寛解基準に有用であるだけでなく,関節穿刺にも用いることができ,安価で低侵襲であるため関節リウマチ診療においてなくてはならない検査となった。(著者抄録)

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Bone microarchitectural analysis using ultra-high-resolution CT in tiger vertebra and human tibia. Reviewed International journal

Ryota Inai, Ryuichi Nakahara, Yusuke Morimitsu, Noriaki Akagi, Youhei Marukawa, Toshi Matsushita, Takashi Tanaka, Akihiro Tada, Takao Hiraki, Yoshihisa Nasu, Keiichiro Nishida, Toshifumi Ozaki, Susumu Kanazawa

European radiology experimental 4 ( 1 ) 4 - 4 2020.1

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: To reveal trends in bone microarchitectural parameters with increasing spatial resolution on ultra-high-resolution computed tomography (UHRCT) in vivo and to compare its performance with that of conventional-resolution CT (CRCT) and micro-CT ex vivo. METHODS: We retrospectively assessed 5 tiger vertebrae ex vivo and 16 human tibiae in vivo. Seven-pattern and four-pattern resolution imaging were performed on tiger vertebra using CRCT, UHRCT, and micro-CT, and on human tibiae using UHRCT. We measured six microarchitectural parameters: volumetric bone mineral density (vBMD), trabecular bone volume fraction (bone volume/total volume, BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and connectivity density (ConnD). Comparisons between different imaging resolutions were performed using Tukey or Dunnett T3 test. RESULTS: The vBMD, BV/TV, Tb.N, and ConnD parameters showed an increasing trend, while Tb.Sp showed a decreasing trend both ex vivo and in vivo. Ex vivo, UHRCT at the two highest resolutions (1024- and 2048-matrix imaging with 0.25-mm slice thickness) and CRCT showed significant differences (p ≤ 0.047) in vBMD (51.4 mg/cm3 and 63.5 mg/cm3 versus 20.8 mg/cm3), BV/TV (26.5% and 29.5% versus 13.8 %), Tb.N (1.3 l/mm and 1.48 l/mm versus 0.47 l/mm), and ConnD (0.52 l/mm3 and 0.74 l/mm3 versus 0.02 l/mm3, respectively). In vivo, the 512- and 1024-matrix imaging with 0.25-mm slice thickness showed significant differences in Tb.N (0.38 l/mm versus 0.67 l/mm, respectively) and ConnD (0.06 l/mm3 versus 0.22 l/mm3, respectively). CONCLUSIONS: We observed characteristic trends in microarchitectural parameters and demonstrated the potential utility of applying UHRCT for microarchitectural analysis.

DOI： 10.1186/s41747-019-0135-0

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【手外科リハビリテーション診療】RA手指変形 MCP人工関節置換術後のリハビリテーションについて Reviewed

松山宜之, 中原龍一, 那須義久, 岡佳純, 千田益生, 西田圭一郎

MEDICAL REHABILITATION ( 244 ) 1 - 7 2020.1

Language：Japanese Publisher：(株)全日本病院出版会

関節リウマチ(RA)手の障害は、スワンネック変形・ボタン穴変形・尺側偏位など多彩であり、一つの手に複数の変形が混在している。その中でも、中手指節(MCP)関節は早期から罹患率が高く関節変形が生じやすく、進行例ではシリコン製インプラントによるMCP人工関節置換術での良好な成績が報告されている。当院では、MCP人工関節置換術に対しては、スタンダードパスを用いて術後療法を行っている。しかし、RA手指においては隣接関節の障害や伸筋腱皮下断裂を伴っていることも多く、進行例の変形では必要に応じて追加手術が同時に実施される。本稿では、通常のMCP人工関節置換術からスワンネック変形・ボタン穴変形・若年者の関節変形の術後リハビリテーションについて概説する。(著者抄録)

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