Bilateral coronary ostial stenosis and aortic regurgitation in a patient with cardiovascular syphilis

AbstractCardiovascular syphilis is associated with the tertiary stage of syphilis infection; it involves the ascending aorta and can cause aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. We report a surgical case of bilateral coronary ostial lesion and aortic regurgitation due to syphilitic aortitis.<Learning objective: Syphilitic aortitis involves the ascending aorta, resulting in aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. Unlike atherosclerosis, coronary ostial stenosis is caused by aortic wall thickening, and coronary lesions distal to the ostia occur only rarely. After surgery, long-term follow up is mandatory as a result of aortic dilatation involving the sinuses of Valsalva, occurrence of prosthetic valve dehiscence, or graft failure caused by continuous infection of the aortic wall.

Acceptable range of forearm deformity derived from relation to three-dimensional analysis and clinical impairments

Shiode R., Miyamura S., Kazui A., et al. Acceptable range of forearm deformity derived from relation to three-dimensional analysis and clinical impairments. Journal of Orthopaedic Research , (2024); https://doi.org/10.1002/jor.25805.This study aimed to investigate deformity patterns that cause clinical impairments and determine the acceptable range of deformity in the treatment of forearm diaphyseal fractures. A three-dimensional (3D) deformity analysis based on computed bone models was performed on 39 patients with malunited diaphyseal both-bone forearm fractures to investigate the 3D deformity patterns of the radius and ulna at the fracture location and the relationship between 3D deformity and clinical impairments. Clinical impairments were evaluated using forearm motion deficit. Cutoff values of forearm deformities were calculated by performing receiver operating characteristic analysis using the deformity angle and the limited forearm rotation range of motion (less than 50° of pronation or supination) resulting in activities of daily living (ADL) impairment as variables. The extension, varus, and pronation deformities most commonly occurred in the radius, whereas the extension deformity was commonly observed in the ulna. A positive correlation was observed between pronation deficit and extension deformity of the radius (R = 0.41) and between supination deficit and pronation deformity of the ulna (R = 0.44). In contrast, a negative correlation was observed between pronation deficit and pronation deformity of the radius (R = −0.44) and between pronation deficit and pronation deformity of the ulna (R = −0.51). To minimize ADL impairment, radial extension deformity should be <18.4°, radial rotation deformity <12.8°, and ulnar rotation deformity <16.6°. The deformities in the sagittal and axial planes of the radius and in the axial plane of the ulna were responsible for the limited forearm rotation

Surgical repair for aortic dissection accompanying a right-sided aortic arch

Aortic anomaly in which a right-sided aortic arch associated with Kommerell's diverticulum and aberrant left subclavian artery is rare. The present report describes a patient with type-B aortic dissection accompanying aortic anomalies consisting of right-sided aortic arch and the left common carotid and left subclavian artery arising from Kommerell's diverticulum. As dissecting aortic aneurysm diameter increased rapidly, Single-stage surgical repair of extensive thoracic aorta was performed through median sternotomy and right posterolateral fifth intercostal thoracotomy, yielding favorable results. Our surgical procedures are discussed

Administration of oxygen ultra-fine bubbles improves nerve dysfunction in a rat sciatic nerve crush injury model

Ultra-fine bubbles (<200 nm in diameter) have several unique properties and have been tested in various medical fields. The purpose of this study was to investigate the effects of oxygen ultra-fine bubbles (OUBs) on a sciatic nerve crush injury (SNC) model rats. Rats were intraperitoneally injected with 1.5 mL saline, OUBs diluted in saline, or nitrogen ultra-fine bubbles (NUBs) diluted in saline three times per week for 4 weeks in four groups: (1) control, (sham operation + saline); (2) SNC, (crush + saline); (3) SNC+OUB, (crush + OUB-saline); (4) SNC+NUB, (crush + NUB-saline). The effects of the OUBs on dorsal root ganglion (DRG) neurons and Schwann cells (SCs) were examined by serial dilution of OUB medium in vitro. Sciatic functional index, paw withdrawal thresholds, nerve conduction velocity, and myelinated axons were significantly decreased in the SNC group compared to the control group; these parameters were significantly improved in the SNC+OUB group, although NUB treatment did not affect these parameters. In vitro, OUBs significantly promoted neurite outgrowth in DRG neurons by activating AKT signaling and SC proliferation by activating ERK1/2 and JNK/c-JUN signaling. OUBs may improve nerve dysfunction in SNC rats by promoting neurite outgrowth in DRG neurons and SC proliferation.Matsuoka H., Ebina K., Tanaka H., et al. Administration of oxygen ultra-fine bubbles improves nerve dysfunction in a rat sciatic nerve crush injury model. International Journal of Molecular Sciences 19, 1395 (2018); https://doi.org/10.3390/ijms19051395

Association of dorsal malunion in distal radius fractures with wrist osteoarthritis: Alterations of bone density and stress-distribution patterns in relation to deformation angles

Kazui A., Miyamura S., Shiode R., et al. Association of dorsal malunion in distal radius fractures with wrist osteoarthritis: Alterations of bone density and stress-distribution patterns in relation to deformation angles. Osteoarthritis and Cartilage, (2024); https://doi.org/10.1016/j.joca.2024.08.006.Objective: Distal radius fractures (DRFs) with dorsal malunion increase the risk of osteoarthritis (OA), although the cause of post-DRF OA is yet to be elucidated. To clarify the abnormal effects of a post-DRF dorsal radius deformity, we evaluated the bone density (BD) and stress-distribution patterns of the articular surface in dorsally malunited DRFs. Design: In 36 cases of dorsally malunited DRFs following extra-articular fractures, we generated three-dimensional computerized models of the malunited distal radius from computed tomography data and extracted the subchondral bones of the radiocarpal joint (RCJ) and distal radioulnar joint (DRUJ). Both BD and stress distribution in the subchondral bones were quantitatively evaluated by comparing the affected and normal sides. Correlations of alterations in high-BD distribution and deformation angles were analyzed. Results: The center of high-BD distribution from the center of the RCJ in the volar(-)-dorsal(+) direction was dorsal (0.56 ± 0.72 mm) on the affected side compared with the normal side (−0.15 ± 0.63 mm) [95% CI: 0.43, 1.00, P < 0.0001]. The maximum stress distribution was also dorsal on the affected side (2.34 ± 3.52 mm) compared with the normal side (−2.49 ± 1.62 mm) [95% CI: 0.89, 1.79, P < 0.0001]. The alterations in BD and stress distribution correlated with the dorsiflexion and radial deviation angles. In the DRUJ, there was no significant difference in BD between the affected and normal sides. Conclusions: In dorsally malunited DRFs, the alignment change of the RCJ resulted in high BD-concentration areas and stress distribution on the dorsal side of the radius, which may constitute a precursor for OA

Comparison of the effects of forefoot joint-preserving arthroplasty and resection-replacement arthroplasty on walking plantar pressure distribution and patient-based outcomes in patients with rheumatoid arthritis

Purpose: The purpose of this retrospective study is to clarify the difference in plantar pressure distribution during walking and related patient-based outcomes between forefoot joint-preserving arthroplasty and resection-replacement arthroplasty in patients with rheumatoid arthritis (RA). Methods: Four groups of patients were recruited. Group1 included 22 feet of 11 healthy controls (age 48.6 years), Group2 included 36 feet of 28 RA patients with deformed non-operated feet (age 64.8 years, Disease activity score assessing 28 joints with CRP [DAS28-CRP] 2.3), Group3 included 27 feet of 20 RA patients with metatarsal head resection-replacement arthroplasty (age 60.7 years, post-operative duration 5.6 years, DAS28-CRP 2.4), and Group4 included 34 feet of 29 RA patients with metatarsophalangeal (MTP) joint-preserving arthroplasty (age 64.6 years, post-operative duration 3.2 years, DAS28-CRP 2.3). Patients were cross-sectionally examined by F-SCAN II to evaluate walking plantar pressure, and the self-administered foot evaluation questionnaire (SAFE-Q). Twenty joint-preserving arthroplasty feet were longitudinally examined at both pre- and post-operation. Results: In the 1st MTP joint, Group4 showed higher pressure distribution (13.7%) than Group2 (8.0%) and Group3 (6.7%) (P<0.001). In the 2nd-3rd MTP joint, Group4 showed lower pressure distribution (9.0%) than Group2 (14.5%) (P<0.001) and Group3 (11.5%) (P<0.05). On longitudinal analysis, Group4 showed increased 1st MTP joint pressure (8.5% vs. 14.7%; P<0.001) and decreased 2nd-3rd MTP joint pressure (15.2% vs. 10.7%; P<0.01) distribution. In the SAFE-Q subscale scores, Group4 showed higher scores than Group3 in pain and pain-related scores (84.1 vs. 71.7; P<0.01) and in shoe-related scores (62.5 vs. 43.1; P<0.01). Conclusions: Joint-preserving arthroplasty resulted in higher 1st MTP joint and lower 2nd-3rd MTP joint pressures than resection-replacement arthroplasty, which were associated with better patient-based outcomes.Ebina K., Hirao M., Takagi K., et al. (2017) Comparison of the effects of forefoot joint-preserving arthroplasty and resection-replacement arthroplasty on walking plantar pressure distribution and patient-based outcomes in patients with rheumatoid arthritis. PLoS ONE 12(8): e0183805. doi: 10.1371/journal.pone.0183805

Comparison of the effects of denosumab between a native vitamin D combination and an active vitamin D combination in patients with postmenopausal osteoporosis

The aim of this 12-month, retrospective study was to compare the effects of denosumab (DMAb; 60 mg subcutaneously every 6 months) plus native vitamin D (VD) (cholecalciferol) combination therapy with DMAb plus active VD analog (alfacalcidol) combination therapy in patients with postmenopausal osteoporosis. Patients [N = 127; mean age 75.6 years (range 58–93 years); 28 treatment-naïve patients, 59 patients treated with oral bisphosphonate therapy, 40 patients treated with teriparatide daily] were allocated to either (1) the DMAb plus native VD group (n = 60; cholecalciferol, 10 μg, plus calcium, 610 mg/day; 13 treatment-naïve patients, 28 patients treated with oral bisphosphonate therapy, and 19 patients treated with teriparatide daily) or (2) the DMAb plus active VD group [n = 67; alfacalcidol, 0.8 ± 0.0 μg, plus calcium, 99.2 ± 8.5 mg/day; 15 treatment-naïve patients, 31 patients treated with oral bisphosphonate therapy, and 21 patients treated with teriparatide daily) on the basis of each physician’s decision. Changes in bone mineral density (BMD), serum bone turnover marker levels, and fracture incidence were monitored every 6 months. There were no significant differences in baseline age, BMD, bone turnover marker levels, and prior treatments between the two groups. After 12 months, compared with the DMAb plus native VD group, the DMAb plus active VD group showed similar increases in the BMD of the lumbar spine (6.4% vs 6.5%) and total hip (3.3% vs 3.4%), but significantly greater increases in the BMD of the femoral neck (1.0% vs 4.9%, P < 0.001) and the distal part of the forearm (third of radius) (−0.8% vs 3.9%, P < 0.01). These tendencies were similar regardless of the differences in the prior treatments. The rates of decrease of bone turnover marker levels were similar for tartrate-resistant acid phosphatase isoform 5b (−49.0% vs −49.0%), procollagen type I N-terminal propeptide (−45.9% vs −49.3%), and undercarboxylated osteocalcin (−56.0 vs −66.5%), whereas serum intact parathyroid hormone levels were significantly lower in the DMAb plus active VD group (47.6 pg/mL vs 30.4 pg/mL, P < 0.001). The rate of hypocalcemia was 1.7% in the DMAb plus native VD group and 1.5% in the DMAb plus active VD group, and the rate of clinical fracture incidence was 8.3% in the DMAb plus native VD group and 4.5% in the DMAb plus active VD group, with no significant difference between the groups. DMAb with active VD combination therapy may be a more effective treatment option than DMAb with native VD combination therapy in terms of increasing BMD of the femoral neck and distal part of the forearm and also maintaining serum intact parathyroid hormone at lower levels.This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s00774-016-0792-5Ebina K., Kashii M., Hirao M., et al. Comparison of the effects of denosumab between a native vitamin D combination and an active vitamin D combination in patients with postmenopausal osteoporosis. Journal of Bone and Mineral Metabolism 35, 571 (2017); https://doi.org/10.1007/s00774-016-0792-5

Cubitus varus deformity following paediatric supracondylar humeral fracture remodelling predominantly in the sagittal direction: A three-dimensional analysis of eighty-six cases

The version of record of this article, first published in International Orthopaedics, is available online at Publisher’s website: https://doi.org/10.1007/s00264-024-06197-2.Purpose: Three-dimensional (3D) capacity for remodelling in cubitus varus deformity (CVD) after paediatric supracondylar humeral fractures (PSHFs) remains unelucidated. This study investigated remodelling patterns after PSHFs by examining 3D deformity distribution over time after injury. Methods: Computed tomography (CT) data of 86 patients with CVD after PSHFs were analysed. The 3D deformity angles in the sagittal, coronal, and axial directions were assessed and correlated with the duration between the age at injury and CT evaluation. For the subgroup analysis, we performed the same correlation analysis in a younger (< 8 years old) and an older group (≥ 8 years old); we categorized the duration into early (< 2 years), middle (≥ 2 to < 5 years), and late periods (≥ 5 years) and compared the deformity angles of each direction among the three groups. Results: Sagittal deformity showed a moderate correlation with the duration of deformity (r = -0.54; P < 0.001), while coronal and axial deformities showed a negligible correlation. Sagittal deformity showed moderate correlations with the duration in the younger group (r = -0.62; P < 0.001) and weak correlations in the older group (r = -0.37; P = 0.091). In the sagittal direction, the deformity angle in the early period was significantly larger than those in the mid and late periods (P < 0.001). However, there were no significant differences among the three groups in the coronal and axial directions. Conclusion: Sagittal deformities in CVDs are capable of remodelling, especially in the early period and at a younger age, whereas coronal and axial deformities are less likely to undergo remodelling

Validation of decay heat calculation results of ORIGEN2.2 and CASMO5 for light water reactor fuel

<p>Comparing with the fission product nuclide (FP) decay heat summation calculation result in MeV/sec/fission based on the JENDL FP decay and yield data files 2011 for the burst fission, FP decay heat calculated by ORIGEN2.2 coupled with JENDL-4.0 base library ORLIBJ40 was verified at the cooling time from 1 sec to 10⁸ sec for ²³⁵U (thermal), ²³⁸U (fast), ²³⁹Pu (thermal) and ²⁴¹Pu (thermal). For these fission nuclides, FP decay heat calculated by CASMO5 at the same cooling time after a short irradiation (10⁴ sec) was also compared with that of ORIGEN2.2. In the analysis of decay heat measurements at the cooling time from 2.3 years to 27 years consisting of four data sets on the fuel assemblies discharged from the US PWRs and BWRs, and the Swedish PWRs and BWRs, the average values of the ratios of the calculated to measured results (C/E's) were from 0.972 to 1.031 for ORIGEN2.2, and from 0.977 to 1.016 for CASMO5. The standard deviations of C/E's for the four data sets were from 0.02 to 0.03 for the both codes except for those of the US BWR fuel assemblies which were from 0.11 to 0.12. The obtained C/E's were similar to those in the precedent study.</p

北松地域およびその周辺にみられる八ノ久保砂礫層（新称） について : ''佐世保炭田''の研究（その2)

The Hachinokubo Gravel Bed occurs in the Sasebo coal fieid and extends over the northern part of the Nishisonogi and Higashimatsuura Peninsulas. It unconformably overlies on the basement rocks which consist of Paleozoic metamorphic complex, coalbearing and non-coal-bearing Tertiary groups, and older basalts. They are overlain unconformably by the Matsuura Basalts. In several coal pits, the Tertiary shale and sandstone over the coal, and the coal seam itself, gradually become thinner where the Gravel Bed lies directly above them. Consequently, the coal seam becomes thinner and thinner until it disappears completely due to erosion. In the western part of the area, gravels of the Gravel Bed are predominantly round to subangular in shape but are somewhat flattish in directions along the bedding planes. They are of pebble to cobble size and the matrix contists of relatively well sorted loose coarse sand. The Gravel Bed is presumed to be of fluvial origin. In the eastern part, however, the Gravel Bed is formed of fine-grained materials, such as sand and clay, in which a few plant remains are found. Gravels are not as well developed here as in other areas. They may be of lacustrine origin in the eastern region. Gravels of the Gravel Bed are composed of white quartzite, quartz schists, brownish purple to dark greenish gray chert, hard black siltstone, gray sandstone, gray conglomerate, granites, granodiorite, aplite, granophyre, rhyolites, basalts, and andesites. Among these various rock types, fossil radiolaria are frequently found in the gravels of chert, black siltstone, and the same kind of chert fragments contained in the conglomerate. Sandstone and conglomerates are fairly hard and indurated. They might have been derived from the Mesozoic or Paleozoic formations far removed from this area. The maximum thickness of the Gravel Bed is about 30 meters, but it is not uniform in thickness. In some places it vanishes completely. With the maximum dip of less than 4°, the Gravel Bed is inclined northward at an angle of about 1°. Several faults that extend in the directions northwest by west to southeast by east and east to west intersect both the Gravel Bed and the Matsuura Basalts. These conditions lead to the conclusion that the faults might have been active before the Gravel Bed was deposited. They show different amounts of vertical separation between the Gravel Bed and the underlying Tertiary formations