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骨肉腫X線画像の読影を目指した人工知能の開発

長谷井嬢, 中田英二, 国定俊之, 尾崎敏文

日本CAOS研究会・日本最小侵襲整形外科学会プログラム・抄録集 14回・26回 135 - 135 2020年3月

Bone and Soft-Tissue Sarcoma: A New Target for Telomerase-Specific Oncolytic Virotherapy. 査読国際誌

Hiroshi Tazawa, Joe Hasei, Shuya Yano, Shunsuke Kagawa, Toshifumi Ozaki, Toshiyoshi Fujiwara

Cancers 12 ( 2 ) 2020年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

Adenovirus serotype 5 (Ad5) is widely and frequently used as a virus vector in cancer gene therapy and oncolytic virotherapy. Oncolytic virotherapy is a novel antitumor treatment for inducing lytic cell death in tumor cells without affecting normal cells. Based on the Ad5 genome, we have generated three types of telomerase-specific replication-competent oncolytic adenoviruses: OBP-301 (Telomelysin), green fluorescent protein (GFP)-expressing OBP-401 (TelomeScan), and tumor suppressor p53-armed OBP-702. These viruses drive the expression of the adenoviral E1A and E1B genes under the control of the hTERT (human telomerase reverse transcriptase-encoding gene) promoter, providing tumor-specific virus replication. This review focuses on the therapeutic potential of three hTERT promoter-driven oncolytic adenoviruses against bone and soft-tissue sarcoma cells with telomerase activity. OBP-301 induces the antitumor effect in monotherapy or combination therapy with chemotherapeutic drugs via induction of autophagy and apoptosis. OBP-401 enables visualization of sarcoma cells within normal tissues by serving as a tumor-specific labeling reagent for fluorescence-guided surgery via induction of GFP expression. OBP-702 exhibits a profound antitumor effect in OBP-301-resistant sarcoma cells via activation of the p53 signaling pathway. Taken together, telomerase-specific oncolytic adenoviruses are promising antitumor reagents that are expected to provide novel therapeutic options for the treatment of bone and soft-tissue sarcomas.

DOI： 10.3390/cancers12020478

Comparison of the accuracy of CT- and accelerometer-based navigation systems for cup orientation in total hip arthroplasty. 国際誌

Tomonori Tetsunaga, Kazuki Yamada, Tomoko Tetsunaga, Takayuki Furumatsu, Tomoaki Sanki, Yoshi Kawamura, Toshifumi Ozaki

Hip international : the journal of clinical and experimental research on hip pathology and therapy 31 ( 5 ) 1120700020904940 - 1120700020904940 2020年2月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The accuracies of various navigation systems in total hip arthroplasty (THA) have been described; however, the accuracy of cup orientation with an accelerometer-based navigation system has not been reported. The purpose of this study was to compare the accuracies of computed tomography (CT)- and accelerometer-based navigation systems for cup orientation in THA. METHODS: In this prospective study, 30 patients who underwent cementless THA via anterolateral approach in the lateral decubitus position were analysed. A CT-based navigation system (30 hips) and an accelerometer-based navigation system (30 hips) were used simultaneously. The accuracy of cup orientation (absolute difference between intraoperative vs. postoperative measurements) was compared between the navigation systems using postoperative CT. RESULTS: The accuracy of cup inclination was 3.2 ± 2.4° in the CT-based navigation group and 4.1 ± 3.7° in the accelerometer-based navigation group (p = 0.3035). The accuracy of cup anteversion was 3.0° ± 2.5° in the CT-based navigation group and 6.8° ± 4.8° in the accelerometer-based navigation group. Cup anteversion was significantly more accurate with the CT-based navigation system than with accelerometer-based navigation (p = 0.0009). Multiple regression analysis demonstrated that the malposition in cup anteversion was positively correlated with the change in pelvic tilt and loosening of the reference antenna. CONCLUSIONS: Although, these results are only true for this specific accelerometer system, cup positioning was significantly more accurate with the CT-based navigation system than an accelerometer-based navigation in the lateral decubitus position. This is because of considerable discrepancies in the sagittal pelvic tilt, resulting in variability in cup anteversion angle with the use of an accelerometer-based navigation system.

DOI： 10.1177/1120700020904940

Idiopathic Chondrolysis of the Hip Treated by Immunosuppressive Therapy and Arthroscopic Intervention.

Hirosuke Endo, Hirofumi Akazawa, Masato Yashiro, Kazuki Yamada, Tomoaki Sanki, Tomonori Tetsunaga, Keiichiro Nishida, Takayuki Furumatsu, Toshifumi Ozaki

Acta medica Okayama 74 ( 1 ) 77 - 81 2020年2月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Idiopathic chondrolysis of the hip (ICH), a very rare disorder of unknown etiology, occurs mainly in female adolescents. Characterized by pain, limp, stiffness and radiological narrowing joint space from the rapid destruction of the articular cartilage, ICH sometimes results in ankyloses. We present the case of a 10-year-old girl diagnosed with ICH based on arthroscopic inspection and synovium biopsy. The femoral deformity appeared gradually, like a cam-type femoroacetabular impingement. She was treated with intensive rehabilitation and immunosuppressive drug. We later performed an arthroscopic bumpectomy for residual symptoms. She achieved a favorable outcome as a 15-year-old at the latest follow-up.

DOI： 10.18926/AMO/57957

Ten-Year Outcomes of Total Hip Arthroplasty Using Fit-and-Fill Type Cementless Collared Straight Stem Implants: Relationship between the Initial Contact Status and Stress Shielding.

Tomoaki Sanki, Hirosuke Endo, Tomonori Tetsunaga, Takayuki Furumatsu, Kazuki Yamada, Toshifumi Ozaki

Acta medica Okayama 74 ( 1 ) 7 - 15 2020年2月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

We investigated the relationship between the initial contact status and stress shielding in total hip arthroplasty (THA) using fit-and-fill type straight-stem implants. In addition we evaluated the clinical and radiographic outcomes. Subjects were 100 hips of 94 patients who underwent THA and were followed-up for ≥10 years. Contact areas with the femoral cortical bone were investigated according to the zonal distribution of Gruen using postoperative CT images. Depending on the number of contact areas, the patients were classified into high contact [HC], medium contact [MC], and low contact [LC] groups. Radiographic and clinical outcomes were evaluated. In the HC group (20 hips), severe stress shielding was observed in 12 hips, which was statistically significant (p=0.008). In the LC group (29 hips), mild stress shielding was observed in 27 hips which was statistically significant (p<0.001). No significant differences were observed among the 3 groups in clinical outcomes, Harris hip score (p=0.719) or Japanese Orthopedic Association (JOA) score (p=0.301). In insertion of cementless collared fit-and-fill type straight-stem implants, severe late stress shielding of the femoral bone may occur if high contact of the femoral component is achieved. However, the degree of stress shielding does not result in adverse clinical outcomes.

DOI： 10.18926/AMO/57947

The Masquelet technique for septic arthritis of the small joint in the hands: Case reports. 国際誌

Taichi Saito, Tomoyuki Noda, Hiroya Kondo, Koji Demiya, Satoshi Nezu, Suguru Yokoo, Minami Matsuhashi, Takenori Uehara, Yasunori Shimamura, Masayuki Kodama, Toshifumi Ozaki

Trauma case reports 25 100268 - 100268 2020年2月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Septic arthritis in distal interphalangeal (DIP) joints sometimes occurs in association with mucous cysts or after the surgical treatment of mallet fingers. Recently, several studies have demonstrated the effectiveness of the Masquelet technique in the treatment of bone defects caused by trauma or infection. However, only few studies have reported the use of this technique for septic arthritis in small joints of the hand, and its effectiveness in treating septic arthritis in DIP joints remains unclear. We report the clinical and radiological outcomes of three patients who were treated with the Masquelet technique for septic arthritis in DIP joints. One patient had uncontrolled diabetes and another had rheumatoid arthritis treated with methotrexate and prednisolone. The first surgical stage involved thorough debridement of the infection site, including the middle and distal phalanx. We placed an external fixator from the middle to the distal phalanx and then packed the cavity of the DIP joint with antibiotic cement bead of polymethylmethacrylate (40 g) including 2 g of vancomycin and 200 mg of minocycline. At 4-6 weeks after the first surgical stage, the infection had cleared, and the second surgical stage was performed. The external fixator and cement bead were carefully removed while carefully preserving the surrounding osteo-induced membrane. The membrane was smooth and nonadherent to the cement block. In the second surgical stage, an autogenous bone graft was harvested from the iliac bone and inserted into the joint space, within the membrane. The bone graft, distal phalanx, and middle phalanx were fixed with Kirschner wires and/or a soft wire. Despite the high risk of infection, bone union was achieved in all patients without recurrence of infection. Although the Masquelet technique requires two surgeries, it can lead to favorable clinical and radiological outcomes for infected small joints of the hand.

DOI： 10.1016/j.tcr.2019.100268

肘頭疲労骨折における骨折線のマッピング

根津智史, 島村安則, 内野崇彦, 斉藤太一, 島村好信, 野田知之, 尾崎敏文

日本肘関節学会雑誌 27 ( 1 ) S26 - S26 2020年2月

Bone microarchitectural analysis using ultra-high-resolution CT in tiger vertebra and human tibia. 国際誌

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年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

Combining pullout suture and retrograde screw fixation for anterior cruciate ligament tibial eminence avulsion fractures: A case report

Takaaki Hiranaka, Takayuki Furumatsu, Takaaki Tanaka, Yuki Okazaki, Yuya Kodama, Yusuke Kamatsuki, Kenji Masuda, Noritaka Seno, Toshifumi Ozaki

Journal of Orthopaedic Surgery 28 ( 2 ) 2020年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：SAGE Publications Ltd

This report describes a novel arthroscopic technique for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures. A 16-year-old boy who was diagnosed with a left ACL tibial eminence avulsion fracture was treated by arthroscopic fixation. Two bone tunnels were created from the anterior tibial cortex into the fracture bed, and a strong suture passed through the ACL just above its insertion was pulled out through them for reduction and fixation. A retrograde cannulated screw fixation was added for stronger fixation. Weight-bearing and range of motion exercises were started immediately after surgery. Radiographically, bone union was obtained 6 months postoperatively. During second-look arthroscopy (24 months postoperatively), there was no loss of reduction and no subsequent meniscal or cartilage injuries. At that point, the Lysholm score was 95, and the International Knee Documentation Committee score was 96.

DOI： 10.1177/2309499020918681

Medial meniscus posterior root repair decreases posteromedial extrusion of the medial meniscus during knee flexion. 国際誌

Yuki Okazaki, Takayuki Furumatsu, Yoshiki Okazaki, Shin Masuda, Takaaki Hiranaka, Yuya Kodama, Yusuke Kamatsuki, Shinichi Miyazawa, Tomonori Tetsunaga, Toshifumi Ozaki

The Knee 27 ( 1 ) 132 - 139 2020年1月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Medial meniscus (MM) medial extrusion in the coronal plane does not always improve, even after repair. This study aimed to determine the extent of posteromedial extrusion of the MM during knee flexion before and after MM pullout repair using three-dimensional magnetic resonance imaging (MRI). METHODS: Data from 14 patients (mean age, 63.4 years; 86% female) who had undergone MM pullout repair at the current institution between August 2017 and October 2018 were retrospectively reviewed. The MRIs were performed pre-operatively and ≥3 months postoperatively. Three-dimensional MRIs of the tibial surface and MM were evaluated using Tsukada's measurement method before and after pullout repair. The expected center of MM posterior root attachment (point A), the point on the extruded edge of the MM farthest away from point A (point E), and the point of intersection of a line through the posteromedial corner of the medial tibial plateau and a line connecting points A and E (point I) were identified. Subsequently, the pre-operative and postoperative AE and IE distances were calculated and compared. RESULTS: Point E was laterally shifted by the pullout repair, whereas point I showed no significant change. The postoperative IE distance (6.7 mm) was significantly shorter than the pre-operative one (9.1 mm, P < 0.01). The postoperative AE distance (29.3 mm) was significantly shorter than the pre-operative one (31.5 mm, P < 0.01). CONCLUSIONS: The AE and IE distances significantly decreased after MM posterior root repair, suggesting that transtibial pullout repair may be useful in reducing posteromedial extrusion of the MM.

DOI： 10.1016/j.knee.2019.09.005

The role of chemotherapy and radiotherapy in localized extraskeletal osteosarcoma 査読

Marilyn Heng, Abha Gupta, Peter W. Chung, John H. Healey, Max Vaynrub, Peter S. Rose, Matthew T. Houdek, Patrick P. Lin, Andrew J. Bishop, Francis J. Hornicek, Yen Lin Chen, Santiago Lozano-Calderon, Ginger E. Holt, Ilkyu Han, David Biau, Xiaohui Niu, Nicholas M. Bernthal, Peter C. Ferguson, Jay S. Wunder, Takafumi Ueda, Shigeki Kakunaga, Akira Kawai, Hideshi Sugiura, Teruki Kidani, Toshiyuki Kunisasa, Toshifumi Ozaki, Keisuke Ae, Akihito Nagano, Takatoshi Ohno, Koji Hiraoka, Norio Yamamoto, Hiroyuki Tsuchiya, Yoshihiro Matsumoto, Takashi Yanagawa, Robart Nakayama, Hideo Morioka, Tadahiko Kubo, Shoji Simose, Yoshiki Yamagami, Tetsuji Yamamoto, Motohiro Kawasaki, Tomoaki Torigoe, Yasuo Yazawa, Toru Akiyama, Tabu Gokita, Jun Manabe, Mitsunori Kaya, Makoto Emori, Tomoki Nakamura, Akihiko Matsumine, Shinsuke Sugihara, Masahiro Yokouchi, Setsuro Komiya, Yoshiyuki Suehara, Tatsuya Takagi, Teruya Kawamoto, Junji Wasa, Tsukasa Yonemoto, Takeshi Ishii, Ichiro Baba, Manabu Hoshi, Kenichiro Hamada, Norifumi Naka, Tsukasa Sotobori, Nobuhito Araki, Tomotake Okuma, Takahiro Goto, Hiroshi Kobayashi, Hirotaka Kawano, Masami Hosaka, Hiroyuki Futani, Hiroaski Hiraga, Yoshihiro Nishida, Anthony Griffin, Albiruni R.Abdul Razak, David Benjamin Shultz, Charles Catton, Steven Robinson, Shreyaskumar R. Patel, Valerae O. Lewis, B. Ashleigh Guadagnolo, Thomas DeLaney, Haotong Wang, Kevin Raskin, Alexandra K. Callan, Robert Henshaw, Marc Isler, Sophie Mottard, Wei Ming Chen, Frank Traub, Tom Wei Wu Chen, Robert E. Turcotte, Darin Davidson, Per Ulf Tunn, Herbert Loong, Michelle Ghert, Joel Werier, Paul Clarkson, John A. Abraham

European Journal of Cancer 125 130 - 141 2020年1月

掲載種別：研究論文（学術雑誌）

© 2019 Elsevier Ltd Purpose: The role of chemotherapy (CT) and radiotherapy (RT) for management of extraskeletal osteosarcoma (ESOS) remains controversial. We examined disease outcomes for ESOS patients and investigated the association between CT/RT with recurrence and survival. Patients and methods: Retrospective review at 25 international sarcoma centers identified patients ≥18 years old treated for ESOS from 1971 to 2016. Patient/tumour characteristics, treatment, local/systemic recurrence, and survival data were collected. Kaplan–Meier survival and Cox proportional-hazards regression and cumulative incidence competing risks analysis were performed. Results: 370 patients with localized ESOS treated definitively with surgery presented with mainly deep tumours (n = 294, 80%). 122 patients underwent surgical resection alone, 96 (26%) also received CT, 70 (19%) RT and 82 (22%) both adjuvants. Five-year survival for patients with localized ESOS was 56% (95% CI 51%–62%). Almost half of patients (n = 173, 47%) developed recurrence: local 9% (35/370), distant 28% (102/370) or both 10% (36/370). Considering death as a competing event, there was no significant difference in cumulative incidence of local or systemic recurrence between patients who received CT, RT, both or neither (local p = 0.50, systemic p = 0.69). Multiple regression Cox analysis showed a significant association between RT and decreased local recurrence (HR 0.46 [95% CI 0.26–0.80], p = 0.01). Conclusion: Although the use of RT significantly decreased local recurrences, CT did not decrease the risk of systemic recurrence, and neither CT, nor RT nor both were associated with improved survival in patients with localized ESOS. Our results do not support the use of CT; however, adjuvant RT demonstrates benefit in patients with locally resectable ESOS.

DOI： 10.1016/j.ejca.2019.07.029

Molecular radiosensitization of soft tissue sarcoma by oncolytic virus-mediated MCL1 ablation

Omori T, Tazawa H, Yamakawa Y, Osaki S, Hasei J, Sugiu K, Komatsubara T, Fujiwara T, Yoshida A, Kunisada T, Urata Y, Kagawa S, Ozaki T, Fujiwara T

2020年1月

Relationship between oral condition and risk factors for jaw osteonecrosis in patients with hip fractures.

Norio Yamamoto, Shintaro Sukegawa, Yuka Sukegawa-Takahashi, Toru Honda, Yoshihiko Furuki, Keisuke Kawasaki, Toshifumi Ozaki

The journal of medical investigation : JMI 67 ( 3.4 ) 328 - 331 2020年

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Purpose : Antiresorptive agents, such as bisphosphonates, are useful for the prevention of the recurrence of hip fractures. However, their administration has a risk of antiresorptive agent-related osteonecrosis of the jaw (ARONJ), and risk factors include poor oral hygiene. It is difficult for an orthopedic surgeon to examine a patient's oral condition thoroughly. This study evaluated the relationship between risk factors for ARONJ and intraoral findings in hip fracture patients. Materials and Methods : We evaluated 79 patients (average age of 82.2 years) with hip fracture surgery who underwent an oral assessment by dentists. The risk assessments of the intraoral findings were classified into four levels (levels 0-3), with levels 2 and 3 requiring dental treatment intervention. Data that could be extracted as risk factors of ARONJ were also examined. Results : Level 1 was found most frequently (54.4%), followed by level 0 (35.4%), level 2 (8.9%), level 3 (1.3%). The area under the receiver operating characteristic curve for the number of risk factors for the two groups (dental treatment intervention required and unnecessary) and oral findings were 0.732. When the cut-off value was set to two risk factors, the specificity and sensitivity was 53.5% and 87.5%. Conclusions : For hip fracture patients with a more than 2 risk factors, dental visits are recommended to prevent ARONJ. This is a useful evaluation method that can be used to screen for ONJ from data obtained from other risk factors, even if it is difficult to evaluate the oral condition in hospitals where dentists are absent. J. Med. Invest. 67 : 328-331, August, 2020.

DOI： 10.2152/jmi.67.328

Medial and Lateral Meniscus Posterior Root Tears with an Intact Anterior Cruciate Ligament. 国際誌

Yuki Okazaki, Takayuki Furumatsu, Yuya Kodama, Yoshinori Matsumoto, Motoki Takahashi, Toshifumi Ozaki

Case reports in orthopedics 2020 8842167 - 8842167 2020年

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Background: Medial meniscus (MM) posterior root tear (PRT) is often caused by meniscal degeneration, whereas lateral meniscus (LM) PRT is mainly caused by trauma, especially trauma associated with anterior cruciate ligament (ACL) injuries. Although there are a few reports on PRTs of both menisci with an ACL injury, to our knowledge, there is no report on those with an intact ACL. Thus, the purpose of this study was to describe a rare case of both meniscal PRTs with an intact ACL. Case Presentation. A 67-year-old woman complained of right knee pain during weeding in a deep knee flexion position. At presentation, three days after the injury, physical examination revealed signs of meniscal injury without ACL rupture. Magnetic resonance imaging showed PRTs of both menisci and damaged cartilage, especially on the medial femoral condyle and lateral tibial plateau. MM was sutured using the FasT-Fix dependent modified Mason-Allen suture technique, and LM by a single simple stitch using the Knee Scorpion suture passer. Referring to previous cadaveric studies, transtibial pullout repair using a single tibial tunnel for MM fixation was performed. The stability of the repaired menisci was checked by probing during second-look arthroscopy at one year after the primary surgery, and no meniscal signs and symptoms were present at the last follow-up one year after the surgery. Conclusions: This rare case showed PRTs of both menisci with an intact ACL. We speculated that, in this case, both roots tore because of the degenerative menisci. A good clinical outcome was achieved after single-transtibial pullout repair. This technique may be an effective surgical approach for PRTs of both menisci.

DOI： 10.1155/2020/8842167

The factors driving self-efficacy in intractable chronic pain patients: a retrospective study. 国際誌

Hironori Tsuji, Tomoko Tetsunaga, Tomonori Tetsunaga, Keiichiro Nishida, Haruo Misawa, Toshifumi Ozaki

Journal of orthopaedic surgery and research 14 ( 1 ) 473 - 473 2019年12月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The fear-avoidance model is a theoretical paradigm for explaining acute and chronic pain. In this model, pain catastrophizing plays an important role. On the other hand, self-efficacy influences whether patients view their pain optimistically, ultimately preventing the conversion of pain into intractable pain. The aim of the present study was to evaluate the factors that influence self-efficacy in patients with chronic pain. METHODS: Study participants included 147 outpatients (35 men, 112 women) with intractable chronic pain who visited our hospital between September 2014 and July 2015. Their mean age was 71.0 (range 32-92) years. Pain sites were as follows: low back, 97 patients; knee, 71 patients; shoulder, 34 patients; and hip, 15 patients. All patients were assessed using the following measures: Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and Pain Self-Efficacy Questionnaire (PSEQ). All participants were further divided into two groups based on median PSEQ scores (group L: PSEQ of 35 points or less, n = 74; group H: PSEQ greater than 35 points, n = 73). The factors that influenced self-efficacy in these patients were analyzed using univariate and multiple linear regression analyses. RESULTS: Significant differences were observed in gender; pain duration; and NRS, PDAS, HADS, and PCS scores between group L and group H. Multiple linear regression analysis revealed that self-efficacy was correlated with PDAS score, HADS depression score, and pain duration. CONCLUSIONS: Patients with longer pain duration indicated greater self-efficacy and patients with higher pain disability and depression exhibited lower self-efficacy.

DOI： 10.1186/s13018-019-1535-9

Multipotent Neurotrophic Effects of Hepatocyte Growth Factor in Spinal Cord Injury. 国際誌

Kentaro Yamane, Haruo Misawa, Tomoyuki Takigawa, Yoshihiro Ito, Toshifumi Ozaki, Akihiro Matsukawa

International journal of molecular sciences 20 ( 23 ) 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Spinal cord injury (SCI) results in neural tissue loss and so far untreatable functional impairment. In addition, at the initial injury site, inflammation induces secondary damage, and glial scar formation occurs to limit inflammation-mediated tissue damage. Consequently, it obstructs neural regeneration. Many studies have been conducted in the field of SCI; however, no satisfactory treatment has been established to date. Hepatocyte growth factor (HGF) is one of the neurotrophic growth factors and has been listed as a candidate medicine for SCI treatment. The highlighted effects of HGF on neural regeneration are associated with its anti-inflammatory and anti-fibrotic activities. Moreover, HGF exerts positive effects on transplanted stem cell differentiation into neurons. This paper reviews the mechanisms underlying the therapeutic effects of HGF in SCI recovery, and introduces recent advances in the clinical applications of HGF therapy.

DOI： 10.3390/ijms20236078

Transtibial Pullout Repair Reduces Posterior Extrusion of the Medial Meniscus.

Shin Masuda, Takayuki Furumatsu, Yoshiki Okazaki, Yusuke Kamatsuki, Yuki Okazaki, Yuya Kodama, Takaaki Hiranaka, Eiji Nakata, Toshifumi Ozaki

Acta medica Okayama 73 ( 6 ) 495 - 501 2019年12月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

Medial meniscus posterior root tear causes rapid knee cartilage degradation by inducing posteromedial displacement of the medial meniscus. We evaluated medial meniscus posterior extrusion before and after pullout repair for medial meniscus posterior root tear using magnetic resonance images. Twenty-eight patients with symptomatic medial meniscus posterior root tear were included. The inclusion criteria were: acute (< 3 months) or chronic (≥3 months) medial meniscus posterior root tear after painful popping events. The exclusion criteria were: other meniscus and anterior cruciate ligament injuries. We measured medial meniscus posterior extrusion and medial meniscus anteroposterior interval at knee flexion angles of 10° and 90° preoperatively and at 3 months postoperatively. The posterior extrusion at 90° knee flexion decreased from 4.42±1.38 mm preoperatively to 3.09±1.06 mm (p<0.001) postoperatively, while at 10° knee flexion it was -4.17±1.63 mm preoperatively and -3.77±1.72mm postoperatively, showing no significant change. The anteroposterior interval at 10° knee flexion increased from 19.74±4.27 mm preoperatively to 22.15±5.10 mm postoperatively (p<0.001); at 90° knee flexion, it increased from 16.81±4.51 mm preoperatively to 19.20±4.30 mm postoperatively (p<0.001). Medial meniscus posterior extrusion and movement decreased after pullout repair. Pullout repair for medial meniscus posterior root tear improves medial meniscus posterior extrusion, especially at 90° knee flexion.

DOI： 10.18926/AMO/57713

Intra-articular 1 g tranexamic acid administration during total knee arthroplasty is safe and effective for the reduction of blood loss and blood transfusion. 国際誌

Yusuke Kamatsuki, Shinichi Miyazawa, Takayuki Furumatsu, Yuya Kodama, Tomohito Hino, Yoshiki Okazaki, Shin Masuda, Yuki Okazaki, Toshifumi Ozaki

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 29 ( 8 ) 1737 - 1741 2019年12月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: The effect of tranexamic acid (TXA) on the incidence of venous thromboembolic events (VTEs) in total knee arthroplasty (TKA) as assessed by contrast-enhanced computed tomography (CT) is unclear. Thus, we investigated the efficacy and safety profiles of TXA administration during TKA. We hypothesised that intra-articular 1 g TXA administration would have a sufficient effect on the reduction of blood loss and transfusion rates without increasing VTE risk. MATERIALS AND METHODS: We retrospectively analysed 86 patients who underwent primary TKA from January 2014 to September 2017. The study comprised control (n = 45) and TXA (n = 41) groups. All patients underwent navigation-assisted TKA via the medial parapatellar approach. In those who received TXA, 1 g of intra-articular TXA was injected via a drain immediately following wound closure. The drain was clamped for 2 h and then reopened. Contrast-enhanced CT was performed 5-6 days after surgery to detect deep venous thrombosis (DVT) and pulmonary embolism (PE). Blood loss was calculated using the haemoglobin balance method. RESULTS: The mean postoperative volume of blood loss was 900 ± 296 mL vs 1216 ± 445 mL in the TXA vs control group (p < 0.01). Allogeneic blood transfusion was required for 0 (0%) vs 6 (13.3%) patients in the TXA vs control group (p = 0.013). There were no significant inter-group differences regarding DVT and PE incidence (p > 0.05). No case of symptomatic PE occurred. CONCLUSIONS: This study demonstrated that intra-articular 1 g TXA administration during TKA is safe and effective for reducing blood loss and blood transfusion without increasing VTE risk.

DOI： 10.1007/s00590-019-02520-5

A novel suture technique to reduce the meniscus extrusion in the pullout repair for medial meniscus posterior root tears. 国際誌

Yoshiki Okazaki, Takayuki Furumatsu, Shinichi Miyazawa, Shin Masuda, Yuki Okazaki, Takaaki Hiranaka, Toshifumi Ozaki

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 29 ( 8 ) 1805 - 1809 2019年12月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

The medial meniscus (MM) posterior root has important functions in preventing an excessive loading stress during knee motion and degeneration of the articular cartilage. Although the transtibial pullout repair has become the gold standard for MM posterior root tears (MMPRTs), MM extrusion remains. In addition, during knee extension to deep flexion, the MM posterior segment in the MMPRT knee has been shown to translate toward the posteromedial direction, causing a notable MM posterior extrusion. Thus, the reduction in the MM posteromedial extrusion is one of the important postoperative outcomes to restore the meniscal function and eventually prevent the progression of knee osteoarthritis. The present technical note describes an arthroscopic technique addition to the pullout repair, in which an all-inside suture is inserted into the posteromedial part of the MM to reduce the MM posteromedial extrusion.

DOI： 10.1007/s00590-019-02513-4

Calcaneal insufficiency fractures following total knee arthroplasty: Classification and clinical findings. 国際誌

Norio Yamamoto, Sachiyuki Tsukada, Jun Kawai, Daisuke Ueda, Tomoyuki Noda, Toshifumi Ozaki

Injury 50 ( 12 ) 2339 - 2345 2019年12月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Calcaneal insufficiency fracture (IF) following total knee arthroplasty (TKA) is a rare disorder. This study aimed to examine the prevalence and clinical findings of calcaneal IF following TKA. METHODS: We retrospectively reviewed 3,585 consecutive patients undergoing primary TKA between 2012 and 2017 in four hospitals. Calcaneal IF following TKA was diagnosed by plain radiography or magnetic resonance imaging. First, we investigated the prevalence and clinical findings of calcaneal IF following TKA. Second, we classified calcaneal IF into three types based on its location: type 1, fracture by traction force around the Achilles tendon insertion; type 2, compression fracture around the posterior subtalar joint; and type 3, fracture by ground reaction force at the bottom of the calcaneus. Finally, we compared the clinical findings between calcaneal IF with and without TKA. RESULTS: Calcaneal IF following TKA was seen in 17 (0.5%) of the 3,585 patients undergoing primary TKA. All patients were female, with a mean age of 76.5 ± 5.9 years, relatively high body mass index (BMI), and osteoporosis. All fractures achieved bone union with conservative treatment. Type 1 fractures were the most common. Calcaneal IFs following TKA were significantly shorter in height and the patients had higher BMI than those without TKA. The locations of calcaneal IF following TKA varied, while only type 1 calcaneal IFs were seen in cases without TKA. However, there were no significant differences with regard to the bone union period or malunion between the two groups. CONCLUSIONS: Calcaneal IF should be suspected in patients presenting with ipsilateral foot pain following TKA, particularly in female patients with a relatively high BMI and osteoporosis. Calcaneal IF can be classified into three types based on the fracture location. These variations in calcaneal IF may be due to differences in conditions and changes in mechanical loading of the lower extremity and bone quality following TKA.

DOI： 10.1016/j.injury.2019.10.017

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