Higher-continuity s-version of finite element method with B-spline functions

This paper proposes a strategy to solve the problems of the conventional s-version of finite element method (SFEM) fundamentally. Because SFEM can reasonably model an analytical domain by superimposing meshes with different spatial resolutions, it has intrinsic advantages of local high accuracy, low computation time, and simple meshing procedure. However, it has disadvantages such as accuracy of numerical integration and matrix singularity. Although several additional techniques have been proposed to mitigate these limitations, they are computationally expensive or ad-hoc, and detract from its strengths. To solve these issues, we propose a novel strategy called B-spline based SFEM. To improve the accuracy of numerical integration, we employed cubic B-spline basis functions with $C^2$-continuity across element boundaries as the global basis functions. To avoid matrix singularity, we applied different basis functions to different meshes. Specifically, we employed the Lagrange basis functions as local basis functions. The numerical results indicate that using the proposed method, numerical integration can be calculated with sufficient accuracy without any additional techniques used in conventional SFEM. Furthermore, the proposed method avoids matrix singularity and is superior to conventional methods in terms of convergence for solving linear equations. Therefore, the proposed method has the potential to reduce computation time while maintaining a comparable accuracy to conventional SFEM.Comment: 40 pages, 15 figures and 2 table

Graves\u27 Disease Associated with Goserelin Acetate

We describe a case of Graves\u27 disease associated with goserelin acetate. A 47-year-old woman experienced thyrotoxicosis during the administration of goserelin acetate, a gonadotropin-releasing hormone (GnRH) -agonist. Since the TSH receptor-antibody was positive, and a thyroid scintigram showed diffuse goiter and high uptake, she was diagnosed as having Graves\u27 disease. 26 months after treatment with thiamazole, she recovered. We speculate that the administration of goserelin acetate may be one of the triggers of Graves\u27 disease

人工距骨併用の人工足関節置換術

AIMS: Total ankle arthroplasty (TAA) has become the most reliable surgical solution for patients with end-stage arthritis of the ankle. Aseptic loosening of the talar component is the most common complication. A custom-made artificial talus can be used as the talar component in a combined TAA for patients with poor bone stock of the talus. The purpose of this study was to investigate the functional and clinical outcomes of combined TAA. PATIENTS AND METHODS: Ten patients (two men, eight women; ten ankles) treated using a combined TAA between 2009 and 2013 were matched for age, gender, and length of follow-up with 12 patients (one man, 11 women; 12 ankles) who underwent a standard TAA. All had end-stage arthritis of the ankle. The combined TAA features a tibial component of the TNK ankle (Kyocera, Kyoto, Japan) and an alumina ceramic artificial talus (Kyocera), designed using individualized CT data. The mean age at the time of surgery in the combined TAA and standard TAA groups was 71 years (61 to 82) and 75 years (62 to 82), respectively. The mean follow-up was 58 months (43 to 81) and 64 months (48 to 88), respectively. The outcome was assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, the Ankle Osteoarthritis Scale (AOS), and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). RESULTS: The mean preoperative JSSF score of the combined TAA and standard TAA groups was 44 (sd 11) and 49 (sd 10), respectively. The mean postoperative JSSF scores were 89 (sd 6.1) and 72 (sd 15), respectively. The mean postoperative JSSF score of the combined TAA group was significantly higher (p = 0.0034). The mean preoperative AOS scores for pain and function in the combined TAA and standard TAA groups were 5.8 (sd 3.3) and 5.5 (sd 3.1), and 8.6 (sd 1.3), and 7.1 (sd 2.9), respectively. The mean postoperative AOS scores of pain and function were 2.5 (sd 2.5) and 2.2 (sd 1.9), and 2.5 (sd 3.3) and 3.4 (sd 2.9), respectively. There were no significant differences between the two groups in terms of postoperative AOS scores. The mean postoperative SAFE-Q scores were: for pain, 76 (sd 23) and 70 (sd 23); for physical function, 66 (sd 25) and 55 (sd 27); for social function, 73 (sd 35) and 62 (sd 34); for shoe-related, 73 (sd 19) and 65 (sd 26); and for general health, 78 (sd 28) and 67 (sd 29), respectively. There were no significant differences between the two groups in terms of postoperative SAFE-Q scores. CONCLUSION: Combined TAA resulted in better clinical results than standard TAA. Cite this article: Bone Joint J 2019;101-B:443-446.博士（医学）・甲第717号・令和元年6月26日This is a non-final version of an article published in final form in "http://dx.doi.org/10.1302/0301-620X.101B4.BJJ-2018-0812.R2

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

距骨壊死に対するアルミナセラミック性人工距骨置換術のSAFE-Qを用いた臨床成績

Background: The purpose of this retrospective review was to evaluate the clinical outcomes of patients who underwent total talar replacement for talar necrosis using the SAFE-Q score, which was hypothesized to improve postoperatively. Methods: The study included 24 ankles of 22 patients who underwent total talar replacement from 2012 to 2018 and were evaluated using SAFE-Q preoperatively and postoperatively. Statistical analysis was performed using the mean values of the SAFE-Q and JSSF scale scores, and the range of ankle motion was compared before and 3 years after the surgery using the Wilcoxon signed-rank test. Results: The SAFE-Q scores improved postoperatively in the all the subcategories. “Pain and Pain-Related” changed from a mean value of 42.2±23.9 points preoperatively to a mean value of 84.6±12.6 points postoperatively (p<.01); “Physical Functioning and Daily Living” changed from 36.3±25.2 points to 73.4±20.5 points (p<.01); “Social Functioning” changed from 34.1±34.8 points to 81.0±25.3 points (p<.01); “Shoe-Related” changed from 41.3±28.9 points to 75.4±22.3 points (p<.01); “General Health and Well-Being” changed from 36.7±32.1 to 76.9±29.3 points (p<.01). Conclusion: Twenty-four osteonecrotic tali of 22 patients treated with alumina ceramic total talar replacement achieved good clinical results, as evaluated using the JSSF ankle/hindfoot score and SAFE-Q. Alumina ceramic total talar replacement is the mainstream treatment for talar osteonecrosis.博士（医学）・甲第856号・令和4年12月22

Generalized edema and heart failure caused from hypothyroidism and ferrous agent for hypochromic anemia

The patient was an 85-year-old female who has been treated for hypertension and atrial fibrillation (Af). She has visited outpatient clinic and has received regularly general blood tests for every six months. Hemoglobin (Hb) level was stable as 11.2-12.3 g/dL and MCV 88fL from 2017, but it decreased suddenly to 5.2 g/dL and 64 fL in Sept 2020. She did not feel any symptoms or signs. Further evaluations revealed that occult blood in stool and upper and endoscopic exams were negative. About 40 days after starting sodium ferrous citrate, she developed edema anasarca, bilateral pleural effusion and heart failure. Laboratory test showed hypothyroidism, and then the administration of thyroid hormone and diuretics brought her early improvement. As to this impressive case report, general clinical progress and some discussion of the relationship among anemia, edema anasarca, heart failure and hypothyroidism would be described