The Effectiveness of Rehabilitation after Open Surgical Release for Trigger Finger: A Prospective, Randomized, Controlled Study

Background: It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. Methods: This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercises. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. Results: Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. At final follow-up, the DASH score, grip strength, and ROM were significantly improved in the rehabilitation group compared to that preoperatively. At final follow-up, pain was significantly improved in both groups from that preoperatively. There were no significant differences in the results, including the DASH score, grip strength, ROM and pain-VAS between the control and rehabilitation groups at the final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms >12 months between the control and rehabilitation groups at the final follow-up

Characteristic Scales of Baryon Acoustic Oscillations from Perturbation Theory: Non-linearity and Redshift-Space Distortion Effects

An acoustic oscillation of the primeval photon-baryon fluid around the decoupling time imprints a characteristic scale in the galaxy distribution today, known as the baryon acoustic oscillation (BAO) scale. Several on-going and/or future galaxy surveys aim at detecting and precisely determining the BAO scale so as to trace the expansion history of the universe. We consider nonlinear and redshift-space distortion effects on the shifts of the BAO scale in $k$-space using perturbation theory. The resulting shifts are indeed sensitive to different choices of the definition of the BAO scale, which needs to be kept in mind in the data analysis. We present a toy model to explain the physical behavior of the shifts. We find that the BAO scale defined as in Percival et al. (2007) indeed shows very small shifts ($\lesssim$ 1%) relative to the prediction in {\it linear theory} in real space. The shifts can be predicted accurately for scales where the perturbation theory is reliable.Comment: 21 pages, 9 figures, references and supplementary sections added, accepted for publication in PAS

Tooth Loss and Carotid Intima-Media Thickness in Relation to Functional Atherosclerosis: A Cross-Sectional Study

Structural arterial stiffness can be evaluated with carotid intima-media thickness (CIMT). Functional arterial stiffness can be evaluated with cardio-ankle vascular index (CAVI). A positive association between CIMT and tooth loss has been reported, but no studies have evaluated the association between CIMT and tooth loss in relation to functional arterial stiffness (functional atherosclerosis). A cross-sectional study of 1235 Japanese individuals aged 40–89 years was conducted. Tooth loss was defined as being in the lowest tertile for the number of remaining teeth (≤20 in men and ≤19 in women). Functional atherosclerosis was defined as CAVI ≥ 9.0. Independent of known confounding factors, CIMT was positively associated with tooth loss only in participants without functional atherosclerosis. Adjusted odds ratios for tooth loss and a 1 standard deviation increment in CIMT were 1.27 (1.04–1.55) for participants without functional atherosclerosis and 0.99 (0.77–1.26) for participants with functional atherosclerosis. CIMT and functional atherosclerosis had a significant effect on tooth loss; the fully adjusted p-value for the interaction on tooth loss was 0.019. Independent of known confounding factors, CIMT is positively associated with tooth loss only in participants without functional atherosclerosis. This finding helps clarify the influence of the progression of arterial stiffness on tooth loss because the progression of structural atherosclerosis might have a beneficial influence on the maintenance of the microcirculation

Deletion of CDKAL1 Affects Mitochondrial ATP Generation and First-Phase Insulin Exocytosis

A variant of the CDKAL1 gene was reported to be associated with type 2 diabetes and reduced insulin release in humans; however, the role of CDKAL1 in β cells is largely unknown. Therefore, to determine the role of CDKAL1 in insulin release from β cells, we studied insulin release profiles in CDKAL1 gene knockout (CDKAL1 KO) mice.Total internal reflection fluorescence imaging of CDKAL1 KO β cells showed that the number of fusion events during first-phase insulin release was reduced. However, there was no significant difference in the number of fusion events during second-phase release or high K(+)-induced release between WT and KO cells. CDKAL1 deletion resulted in a delayed and slow increase in cytosolic free Ca(2+) concentration during high glucose stimulation. Patch-clamp experiments revealed that the responsiveness of ATP-sensitive K(+) (K(ATP)) channels to glucose was blunted in KO cells. In addition, glucose-induced ATP generation was impaired. Although CDKAL1 is homologous to cyclin-dependent kinase 5 (CDK5) regulatory subunit-associated protein 1, there was no difference in the kinase activity of CDK5 between WT and CDKAL1 KO islets.We provide the first report describing the function of CDKAL1 in β cells. Our results indicate that CDKAL1 controls first-phase insulin exocytosis in β cells by facilitating ATP generation, K(ATP) channel responsiveness and the subsequent activity of Ca(2+) channels through pathways other than CDK5-mediated regulation

出生前診断の現状と今後の展望

この総説は2013年3月16日, 西南学院大学コミュニティーセンターホールで開催された公開シンポジウム「新型出生前診断の導入を考える」で, シンポジストの一人として「新型出生前検査について」と題して講演した時の原稿に少々加筆したものである. 昨年8月読売新聞のスクープ記事には「妊婦血液」で「ダウン症診断」, 「精度99%」の文字が踊った. この検査の導入を検討していた無侵襲出生前検査共同研究施設Non-Invasive Prenatal Test (NIPT) consortiumには検査を望む妊婦の問い合わせが殺到したという. 研究対象が限られたため, 侵襲的な羊水検査までもが例年になく増加した. 高年妊婦にダウン症など染色体トリソミー児の出産リスクが高まることを広く社会に周知したマスメディアの役割も見逃せない. ｢障害児を避けたい」というごく自然な感情が, 倫理とは別次元の実用主義（プラグマティズム）へと妊婦を駆り立てた, ともいえる現象であった. そこには今までの倫理を超えたパラダイム・シフトが起ろうとしているかのようであった

遣伝力ウンセリングの現状と今後の展望

わが国の医学・医療の中で,遺伝カウンセリングの必要性が,今日ほど強調されたことがかつてあったであろうか.その背景には21世紀に向けてわが国が立ち上げたミレニアム・プロジェクトがある.それは平成11年12月,新しいミレニアム(千年紀)の始まりを目前に控え,人類の直面する課題に応え,新しい産業を生み出す大胆な技術革新に取り組むこととして始まった.そして今後のわが国経済社会にとって重要性や緊要性の高い情報化,高齢化,環境対応の三分野について技術革新を中心とした産学官共同プロジェクトを構築し,明るい未来を切り開く核を作り上げる,という.このプロジェクトを推進するために3省合同で示した「ヒトゲノム・遺伝子解析研究に関する倫理指針」1)が2001年に発表された.この指針には,遺伝・遺伝子情報を取り扱う際のインフォームドコンセントのあり方などが示されており,研究の現場では改めて検体資料の扱いや同意のあり方が問われた.そしてこの指針で重要な事は,遺伝や遺伝子情報を取り扱う際には遺伝カウンセリングが必須であると明記された事である.このような時代の要請を受けてわが国でも遺伝医療システムの構築と運用に関する具体的な取り組みがようやく始まった.九州大学医学部においても平成16年4月に附属病院に臨床遺伝医療部が開設された.そしてこれを機会に遺伝カウンセリングが話題として取り上げられ,同年9月に九大小児科クリニカルカンファレンスにおいて首題のような講演を依頼されたのである.この総説はこのときの原稿に多少加筆してまとめたものである

The Effectiveness of Rehabilitation after Open Surgical Release for Trigger Finger: A Prospective, Randomized, Controlled Study

Background: It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. Methods: This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercises. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. Results: Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. At final follow-up, the DASH score, grip strength, and ROM were significantly improved in the rehabilitation group compared to that preoperatively. At final follow-up, pain was significantly improved in both groups from that preoperatively. There were no significant differences in the results, including the DASH score, grip strength, ROM and pain-VAS between the control and rehabilitation groups at the final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms >12 months between the control and rehabilitation groups at the final follow-up