de novo構造予測の改善とそのab initio位相決定への応用

学位の種別: 課程博士審査委員会委員 : (主査)東京大学教授 鈴木 穣, 東京大学教授 津田 宏治, 東京大学講師 笠原 雅弘, 北海道大学教授 姚 閔, 東京大学客員准教授 KamY.J. ZhangUniversity of Tokyo(東京大学

External rotation method for reduction of acute anterior dislocation of shoulder

Introductions: Many different techniques of reduction of acute anterior shoulder dislocation have been described. The aim of this study was to evaluate the effectiveness of external rotation method for reduction of acute anterior shoulder dislocation. Methods: Fifty-one patients with acute anterior shoulder dislocations with or without greater tuberosity fracture were reduced during a period from January 2013 to January 2015. The external rotation method was used as an initial reduction method performed by orthopaedic surgeon on call or residents. Data sheets completed by the orthopaedic surgeon on call or residents were evaluated with regard to the type of dislocation, the effectiveness of the procedure in achieving reduction, the need for premedication, the ease of performing the reduction, and complications, if any. Results: There were 42 male and nine female patients between 18 to 78 years. Among 51 patients, 49 had successful reduction. No premedication was required in 33 patients who had a successful reduction, and the average time required for reduction in 23 patients was within two minutes whereas 20 patients reduced within five minutes. Only four patients reported severe pain during the process of reduction. The method was not successful in two patients with subcoracoid dislocation associated with displaced fracture of the greater tuberosity. Conclusions: External rotation method is reliable, safe, simple and relatively painless method for reduction of acute anterior shoulder dislocation. Keywords: acute anterior shoulder dislocation, external rotation method, painless reductionÂ

Minimally Invasive-Closed Reduction and Percutaneous Pinning for Supracondylar Fractures of the Humerus in Children

Introductions: Although Closed Reduction and Percutaneous Pinning is the goldstandard of treatment for Supracondylar fractures (SC) in children, reductionis not always easy. Minimally Invasive, Closed Reduction and PercutaneousPinning (MI-CRPP) reduces the soft tissue trauma and provides easy reduction.We have reviewed the success rate of minimally invasive reduction techniqueand its outcome.Methods: We reviewed the charts of 155 children (97 male, 58 female) ageranging from 2 to 14 years with SC fractures of the humerus who were operatedwith minimally invasive closed reduction and precutaneous pinning fromNovember 2008 to June 2014 at Patan Hospital and Om Hospital. They werefollowed up for a mean of eight (4 to 24) weeks. The K-wires were removed at4 to 6 (average 4.28) weeks.Results: Male children were affected more than female with the ratio being 97to 58. Right side was affected more than left (ratio 89 to 66). Post-operatively,there were six (3.87%) ulnar nerve injury and eight (5.16%) patients came withsuperficial pin tract infection. One hundred and thirteen (72.9%) had excellent,35 (22.58%) good, five (3.23%) fair and two (1.3%) poor results at the eightweek follow-up which was improved to 144 (92.9%) excellent, seven (4.5%)good, three (1.9%) fair and one (0.65%) poor results at the 14 week follow-up.Conclusions: Closed reduction of supracondylar fractures of the humerus inchildren with minimally invasive technique prior to K-wire fixation is a relativelysimple, safe and effective method of achieving satisfactory reduction and goodfunctional outcome.Keywords: cubitus varus deformity, K wire fixation,minimally invasive closedreduction and precutaneous pinning, supracondylar fracture

Three lateral divergent pinning for displaced supracondylar humerus fractures in children

Introductions: Cross or two lateral pinnings are the most commonly doneprocedures for displaced supracondylar humerus fractures in children. Acrossed pin is biomechanically stable than lateral pins, but associated withrisk of iatrogenic ulnar nerve injury. Recent studies have shown stable fixationwith three lateral pin construct. The purpose of this study was to evaluate theefficacy of three lateral divergent pinning for displaced supracondylar humerusfractures.Methods: Thirty five children with Gartland types III were treated betweenNovember 2012 and November 2013. Closed reduction and three lateraldivergent pinning was done with image intensifier guidance. Patients werefollowed up for minimum 6 months. Radiological assessment was done to seeunion, proper pin placement and loss of reduction. Clinically, patients wereassessed by using Flynn criteria.Results: There were 24 (68.6%) male and 11 (31.4%) female children between2 to 13 years of age with displaced supracondylar fractures, left side 26 (74.3%) and right nine (25.7%) cases. All were successfully managed with closed reduction and three lateral divergent pins within 2-6 days of injury. One radial and one median nerve palsies sustained at injury recovered spontaneously. No iatrogenic nerve injuries occurred. A comparison of perioperative and final radiographs revealed no loss of reduction. Twenty-seven excellent, five good, two fair and one poor results on Flynn’s grading. One patient had a superficial pin-tract infection.Conclusions: Closed reduction with three lateral divergent pins is safe for stablefixation of displaced supracondylar humeral fractures in children.Keywords: children, humerus, percutaneous pinning, supracondylar fractur

Outcome of anterior cruciate ligament reconstruction using bone-patellar tendon-bone auto graft

Introductions: A rupture of the Anterior Cruciate Ligament (ACL) is the most common ligament injury resulting in instability of the knee which can cause secondary articular injury and early osteoarthritis (OA). Aim of this study was to evaluate the short term outcomes of ACL reconstruction using Bone Patellar Tendon Bone Auto Graft (BPTB) auto graft and factors that might contribute to poor results. Methods: Patients with Anterior Cruciate Ligament injury during the period of July 2013 to May 2014 were enrolled to observe the outcome of the ACL reconstruction using BPTB without arthroscopy. Lysholm Knee Scoring Scale was used to determine the clinical outcome. Outcome parameters were evaluated using Statistical Package for Social Science Version 20 (SPSS). Results: Total 30 normal or near normal function outcome of knee was reported in 29 (97%) patients after ACL reconstruction using BPTB without arthroscopy. There was no failure of grafts. Good static knee stability achieved with increased patient’s satisfaction. Lysholm Score was excellent in 27 (90%) and good in 3 (10 %) cases. Anterior knee pain persisted in 6 cases (20%). Conclusions: Excellent functional outcome with BPTB auto graft in Anterior Cruciate Ligament injury was achieved. Keywords: ACL reconstruction, bone-patellar tendon-bone auto graft, clinical outcom

Assessment of chemical-crosslink-assisted protein structure modeling in CASP13

International audienceWith the advance of experimental procedures obtaining chemical crosslinking information is becoming a fast and routine practice. Information on crosslinks can greatly enhance the accuracy of protein structure modeling. Here, we review the current state of the art in modeling protein structures with the assistance of experimentally determined chemical crosslinks within the framework of the 13th meeting of Critical Assessment of Structure Prediction approaches. This largest‐to‐date blind assessment reveals benefits of using data assistance in difficult to model protein structure prediction cases. However, in a broader context, it also suggests that with the unprecedented advance in accuracy to predict contacts in recent years, experimental crosslinks will be useful only if their specificity and accuracy further improved and they are better integrated into computational workflows

A probabilistic fragment-based protein structure prediction algorithm.

Conformational sampling is one of the bottlenecks in fragment-based protein structure prediction approaches. They generally start with a coarse-grained optimization where mainchain atoms and centroids of side chains are considered, followed by a fine-grained optimization with an all-atom representation of proteins. It is during this coarse-grained phase that fragment-based methods sample intensely the conformational space. If the native-like region is sampled more, the accuracy of the final all-atom predictions may be improved accordingly. In this work we present EdaFold, a new method for fragment-based protein structure prediction based on an Estimation of Distribution Algorithm. Fragment-based approaches build protein models by assembling short fragments from known protein structures. Whereas the probability mass functions over the fragment libraries are uniform in the usual case, we propose an algorithm that learns from previously generated decoys and steers the search toward native-like regions. A comparison with Rosetta AbInitio protocol shows that EdaFold is able to generate models with lower energies and to enhance the percentage of near-native coarse-grained decoys on a benchmark of [Formula: see text] proteins. The best coarse-grained models produced by both methods were refined into all-atom models and used in molecular replacement. All atom decoys produced out of EdaFold's decoy set reach high enough accuracy to solve the crystallographic phase problem by molecular replacement for some test proteins. EdaFold showed a higher success rate in molecular replacement when compared to Rosetta. Our study suggests that improving low resolution coarse-grained decoys allows computational methods to avoid subsequent sampling issues during all-atom refinement and to produce better all-atom models. EdaFold can be downloaded from http://www.riken.jp/zhangiru/software.html [corrected]