長母趾屈筋と長趾屈筋の分枝形態は超音波画像診断装置にて評価できる

Purpose: Flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons are frequently used in surgery. Therefore, it is necessary to evaluate the chiasma plantare formation preoperatively. The development of ultrasonography (US) may help the chiasma plantare formation evaluation. The purpose of this study is to prove the usefulness of the US method using cadavers. Methods: Eleven cases (twenty-two ankles) were obtained from Asian adult cadavers. At first, we evaluated and compared the chiasma plantare formation using US. Later, we evaluated that using the findings after dissection as type A (connection from FHL to FDL of the second toe), type B (connection from FHL to the second and third toes), type C (connection from FHL to the second through fourth toes), or type D (connection from FHL to all lesser toes). Results: Chiasma plantare formation was classified as types A and B in fifteen and seven ankles, respectively. After dissection, chiasma plantare formation was classified as types A, B, and C in fourteen, six, and two ankles, respectively. Therefore, there was an 86% similarity between the two methods. Conclusions: Chiasma plantare formation can be reliably and noninvasively evaluated using US. This may be useful for preoperative rehabilitation or surgical procedure planning.博士（医学）・甲第782号・令和3年3月15日© 2021. Springer-Verlag France SAS, part of Springer Nature.This is a post-peer-review, pre-copyedit version of an article published in Surgical and radiologic anatomy. The final authenticated version is available online at: http://dx.doi.org/10.1007/s00276-020-02630-4

アキレス腱付着部症に対しアキレス腱モーメントアーム長が及ぼす影響

Insertional Achilles tendinopathy (IAT) is caused by traction force of the tendon. The effectiveness of the suture bridge technique in correcting it is unknown. We examined the moment arm in patients with IAT before and after surgery using the suture bridge technique, in comparison to that of healthy individuals. We hypothesized that the suture bridge method influences the moment arm length. An IAT group comprising 10 feet belonging to 8 patients requiring surgical treatment for IAT were followed up postoperatively and compared with a control group comprising 15 feet of 15 healthy individuals with no ankle complaints or history of trauma or surgery. The ratio of the moment arm (MA) length/foot length was found to be statistically significant between the control group, the IAT group preoperatively and the IAT group postoperatively (p < 0.01). Despite no significant difference in the force between the control and preoperative IAT groups, a significantly higher force to the Achilles tendon was observed in the IAT group postoperatively compared to the other groups (p < 0.05). This study demonstrates that a long moment arm may be one of the causes of IAT, and the suture bridge technique may reduce the Achilles tendon moment arm.博士（医学）・甲第845号・令和4年9月28日© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)

Microaxial Support After Orthotopic Heart Transplantation

Introduction and Objective Impella is a temporary ventricular support device intended for short term use (CP, and ≤ 6 days for Impella 5.0 and LD). There has yet to be a study investigating the outcomes of microaxial support for patients who previously underwent heart transplantation. We aimed to assess utilization patterns of microaxial mechanical circulatory support after heart transplantation in adults and adolescents.https://jdc.jefferson.edu/surgeryposters/1012/thumbnail.jp

Prognosis factors in the treatment of bisphosphonate-related osteonecrosis of the jaw - Prognostic factors in the treatment of BRONJ -

Objectives: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a relatively rare but serious side effect of bisphosphonate (BP)-based treatments. This retrospective study aimed to investigate the risk factors and predictive markers in cases where patients were refractory to a recommended conservative treatment offered in our hospital. Patients and Methods: This single-center study collated the medical records of all patients treated for BRONJ between 2004 and 2011. A complete medical history, including detailed questionnaires, was collected for all patients, focusing on identifying underlying risk factors, clinical features, location and bone marker levels of BRONJ. Results: The mean BRONJ remission rate was 57.6%, and the median duration of remission was seven months. Eighteen patients (34.6%) had persistent or progressive disease with a recommended conservative treatment for BRONJ. Notably, urinary cross-linked N-terminal telopeptide of type 1 collagen (NTX) levels in those resistant to conservative treatment tended to be lower than in patients that healed well. Conclusions: We confirm that a significant proportion of BRONJ sufferers are refractory to a recommended conservative treatment and find that anticancer drugs, periodontal disease, the level of bone exposure and the dosage of intravenous BPs (e.g. zoledronate) represent specific risk factors in BRONJ that may determine the success of a recommended conservative treatment. Additionally, the NTX levels might be able to be a prognostic factor for the conservative treatment of BRONJ; additional research is necessary

An Accidental Ingestion Of A Hearing Aid Including A Litium-Ion Rechargeable Battery Which Resulted In Spontaneous Excretion

　認知機能障害がある高齢者は，異物誤飲を生じるリスクとなりうる．これは認知症の併存によって誤飲の事実を患者本人が認知していないことや異物誤飲による症状が非特異的，もしくは無症候性であることが多いことと関係している．このため認知機能障害のある高齢者において異物誤飲は発見が遅れる可能性がある．リチウムイオン充電式電池を内蔵した補聴器の誤飲が MRI の撮像を契機に発覚し，その後合併症なく自然排泄が得られた症例を経験したので報告する．症例は 82歳女性，尿路感染の診断で入院となった．入院時から不穏行動があり，感染症によるせん妄が疑われた．入院２日目に補聴器を紛失したと訴え捜索を行ったが発見できなかった．入院４日目に腰椎圧迫骨折の精査目的で行った MRI 検査において腹腔内に強いアーチファクトを認め，補聴器の誤飲が疑われた．腹部 CT 検査を行い，補聴器であることを確認した．補聴器が充電式であることやトライツ靭帯を超え横行結腸に存在していることから外科的摘出を行わず自然排泄を待つこととした．その後，異物・電池誤飲に伴う腸管症状をきたすことなく経過し，入院５日目に補聴器が自然排泄された．精神疾患患者や高齢患者など，誤飲を生じうる患者が嚥下可能なサイズの装着物を紛失した際には，Ｘ線検査を行うことで発見できる可能性がある．異物誤飲に伴う腸閉塞や腸管損傷に加え，補聴器に使用されている電池がボタン型電池であるのか内蔵型の充電式電池であるのかによって，誤飲に伴う合併症の有無を評価し，対応する必要がある .　Delirium during hospitalization in elderly patients is a risk factor for accidental foreign body ingestion. The patient may not be aware of the fact that he or she has ingested foreign bodies due to coexisting dementia, and the symptoms of foreign body ingestion are often nonspecific or asymptomatic, which may delay the detection of the accidental ingestion. We report a case in which an accidental ingestion of a hearing aid containing a rechargeable battery was detected with the opportunity of MRI imaging, and the patient underwent spontaneous elimination without complications. An 82-year-old woman was admitted to the hospital with a diagnosis of urinary tract infection and was suspected to have delirium due to the infection because of her disturbing behavior from the time of her arrival. On day 2 of admission, she reported that she had lost her hearing aid, and a search was conducted but failed to find it. On day 4, an MRI scan performed to investigate complications revealed strong artifacts in the abdominal cavity, which led us to suspect that the patient had swallowed a hearing aid by mistake. An abdominal CT scan was performed and confirmed to be a hearing aid. The patient did not have any intestinal symptoms associated with ingestion of a foreign body or battery, and spontaneous excretion of the battery was obtained on day 5. When patients with psychiatric disorders or elderly patients who is at risk of accidental ingestion lose a swallowable size equipment, radiographic examination may help detect in such cases. In addition to intestinal obstruction and damage to the intestinal tract associated with ingestion of foreign objects, the presence or absence of complications associated with ingestion of batteries due to button batteries or rechargeable batteries in hearing aids should be evaluated and discussed with each department regarding the appropriate response

Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study

<p>Abstract</p> <p>Background</p> <p>Spontaneous rupture is rare complication of hepatocellular carcinoma (HCC) with high mortality rate in cirrhotic cases. The aim of this study was to determine the factors influencing prognosis in cases of spontaneously ruptured HCC and to investigate the outcomes of the treatments employed, especially transcatheter arterial embolization (TAE).</p> <p>Methods</p> <p>A retrospective multicenter study was conducted in 48 cirrhotic patients with spontaneous rupture of HCC. Conservative treatment was employed in 32 patients (ConT group) and TAE was performed in 16 patients (TAE group).</p> <p>Results</p> <p>The median survival time (MST) in the ConT group was only 13.1 days and the survival rate was extremely poor: 59.4% at 7 days, 37.5% at 14 days, and 6.3% at 30 days. On the other hand, the MST in the TAE group was 244.8 days and the survival rate was 87.5% at 1 month, 56.3% at 3 months, 23.4% at 12 months, and 15.6% at 24 months. According to the results of univariate analyses, factors associated with poor hepatic function and poor suitability for TAE was important determinants of short-term death (less than 3 weeks) among the patients (<it>p </it>< 0.05). On the other hand, among the patients in whom initial TAE was successfully performed (<it>n </it>= 15), a multivariate analysis showed that a maximum tumor size not exceeding 7 cm was the only independent factor determining long-term survival (<it>p </it>= 0.0130).</p> <p>Conclusion</p> <p>Despite the inherent limitations of this retrospective study, TAE appears to be a useful treatment strategy for cirrhotic patients with spontaneous HCC rupture, as it yielded a longer survival period compared with conservative treatment in patients with ruptured HCC. Among the patients with ruptured HCC in whom initial TAE was successfully performed, the maximum tumor size was an important factor influencing survival.</p

The development of \u27simultaneous posture\u27in acquiring daily actions by a person with cervical spinal cord injury : Longot : dinal observation of putting on socks action

We studied about development of putting on socks action performed by a patient with paralytic symptom in rehabilitation of ADL. Our purpose is to reveal what information are available to relearn and improve the action. Especially, it is important how he organized many movement into whole process of action and what patterns of action were used and selected, because we can find in these developmental aspects what information were explored and used to coordinate segments of body. We analyzed 5 videotaped actions over 6 months in these ways : time, number of sub-actions, organization of action process, variation of action patterns. Time decreased gradually, but number of sub-actions didn\u27t correspond to it. Organization of action process and variation of patterns showed that the patient explored posture supporting trunk and manipulation simultaneously and change of such posture varied some kinds of manipulation. These results suggest that putting on socks is based on this basic posture (\u27simultaneous posture\u27) and it is source of generating new patterns of actions

Integrins are not involved in the process of human sperm-oolemmal fusion

This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Human Reproduction following peer review. The definitive publisher-authenticated version Oxford University Press, Human Reproduction, 19(3), 2004, 639-644 is available online at: http://humrep.oxfordjournals.org/cgi/content/abstract/19/3/639. authorBACKGROUND: We investigated whether integrins are required for the human sperm–oocyte binding and fusion processes. METHODS: The expression of several integrin subunits at the human oocyte plasma membrane was investigated using immunofluorescence microscopy, and the functional role of integrins expressed at the human oocyte surface in sperm–oocyte interaction was studied using a zona-free human oocyte binding and fusion assay. A total of 144 unfertilized oocytes were stained with anti-integrin antibodies and 147 zona-free unfertilized oocytes were inseminated in the presence of various anti-integrin antibodies that were expressed in oocyte plasma membrane. RESULTS: The antibodies of six integrin subunits (2, 3, 5, 6, V, M) and six integrin subunits (1, 2, 3, 4, 5, 6) were bound to the surface of fixed unfertilized oocytes. In contrast, the presence of 1 and 4 subunits could not be verified. The human sperm–oocyte binding was only partially inhibited by blocking antibodies of 2, 3, 5, 6, V, M, 1, 2 and 3 with a maximum of 55% inhibition, but antibodies of 4, 5 and 6 showed no effect on sperm–oolemmal binding. A similar reduction of the number of fused sperm was observed. However, the ratio of fused sperm to total sperm (bound and fused) was not impaired by all integrin antibodies, suggesting that integrins had no role in the sperm–oolemmal fusion process. CONCLUSIONS: These results suggest that one of the binding mechanisms can be inhibited by integrin antibodies but that this mechanism does not play an essential role in the human sperm–oolemmal binding and fusion processes. The other mechanisms, insensitive to integrins, may involve both binding and fusion processes in human oocytes

人工足関節再置換術におけるカスタムメイド全置換型人工距骨の応用

Background: The rate of revision surgery for total ankle arthroplasty (TAA) is higher than for hip and knee arthroplasties. Tibiotalocalcaneal arthrodesis is widely used; however, it requires a large allograft. Thus, the use of a customized total talar prosthesis in combination with the tibial component of TAA (combined TAA) may be an effective strategy for talar component subsidence. This study aimed to evaluate the clinical and radiographic effectiveness of the combined TAA in such revision cases. Methods: Between 2000 and 2015, 10 patients (10 women; 10 ankles) were treated using the combined TAA for revision after standard TAA or combined procedures that included the use of a talar body prosthesis. In 6 patients, the tibial component was concurrently replaced. The median follow-up period was 49 months (interquartile range [IQR], 24.5 to 90 months). The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score, a numerical rating scale (NRS) pain score, passive range of motion of the ankle, and the presence of osteophytes and degenerative changes in the adjacent joints were assessed preoperatively and at final postoperative follow-up. Results: The median NRS pain score improved significantly, from 7 (IQR, 6.25 to 8.75) to 2 (IQR, 1 to 3). The median JSSF ankle-hindfoot scale total score improved significantly, from 64 (IQR, 56.25 to 71.5) to 88.5 (IQR, 79.75 to 96). In the subcategories of this scale, the median pain score improved from 20 (IQR, 20 to 27.5) to 35 (IQR, 30 to 40), and the median function score improved from 34 (IQR, 26.5 to 37) to 43.5 (IQR, 39.75 to 46). The median range of motion improved from 29° (IQR, 25.5° to 35°) to 35° (IQR, 31.25° to 43.75°). No significant difference in osteophyte formation was found. Degenerative changes in the adjacent joint were found only in the talonavicular joint. Conclusions: The combined TAA, used in revision for postoperative complications after standard TAA or combined procedures including the use of a talar body prosthesis, was associated with improved objective JSSF ankle-hindfoot scale scores, subjective pain assessment, and range of motion in the ankle. Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.博士（医学）・甲第758号・令和2年12月24日Copyright © 2020 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND https://creativecommons.org/licenses/by-nc-nd/4.0/), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal