Combinational therapy with antibiotics and antibiotics-loaded adipose-derived stem cells reduce abscess formation in implant-related infection in rats

13301甲第5228号博士（医学）金沢大学博士論文要旨Abstract 以下に掲載：Scientific Reports 2020. Nature. 共著者：Junya Yoshitani, Tamon Kabata, Hiroshi Arakawa, Yukio Kato, Takayuki Nojima, Katsuhiro Hayashi, Masaharu Tokoro, Naotoshi Sugimoto, Yoshitomo Kajino, Daisuke Inoue, Ken Ueoka, Yuki Yamamuro, Hiroyuki Tsuchiy

Combinational therapy with antibiotics and antibiotics-loaded adipose-derived stem cells reduce abscess formation in implant-related infection in rats

13301甲第5228号博士（医学）金沢大学博士論文本文Full 以下に掲載：Scientific Reports 2020. Nature. 共著者：Junya Yoshitani, Tamon Kabata, Hiroshi Arakawa, Yukio Kato, Takayuki Nojima, Katsuhiro Hayashi, Masaharu Tokoro, Naotoshi Sugimoto, Yoshitomo Kajino, Daisuke Inoue, Ken Ueoka, Yuki Yamamuro, Hiroyuki Tsuchiy

脂肪由来幹細胞を用いたインプラント周囲感染症の新たな治療法の開発

金沢大学医薬保健研究域医学系This study aimed to evaluate the antimicrobial activity and therapeutic effect of local treatment with antibiotic-loaded adipose-derived stem cells (ADSCs) plus an antibiotic in a rat implant-associated infection model. Liquid chromatography/tandem mass spectrometry revealed that ADSCs cultured in the presence of ciprofloxacin for 24 h showed time-dependent antibiotic loading. The therapeutic effects of ADSCs plus antibiotics, antibiotics, and ADSCs were compared with no treatment as a control. Rats treated with ADSCs plus ciprofloxacin had the lowest modified osteomyelitis scores, abscess formation, and bacterial burden on the implant among all groups (P < 0.05). Thus, local treatment with ADSCs plus an antibiotic has an antimicrobial effect in implant-related infection and decrease abscess formation. Thus, our findings indicate that local administration of ADSCs with antibiotics represents a novel treatment strategy for implant-associated osteomyelitis.抗生剤と脂肪由来幹細胞(ADSCs)のcombined therapyのインプラント周囲感染に対する治療効果を検討した。ラット大腿骨インプラント周囲感染モデルを作成し、治療効果を検討した。ADSCsの局所投与は抗菌作用を示した。またADSCsを抗生剤と併用することによりその効果はさらに強まり、抗生剤単独投与よりインプラント付着細菌数を減少させ、骨溶解を抑制し、膿瘍形成を抑制強いた。ADSCsと抗生剤のloading and combined therapyはインプラント周囲感染の新たな治療法となり得る。研究課題/領域番号:20K18057, 研究期間(年度):2020-04-01 – 2022-03-31出典：研究課題「脂肪由来幹細胞を用いたインプラント周囲感染症の新たな治療法の開発」課題番号20K18057（KAKEN：科学研究費助成事業データベース（国立情報学研究所）） （https://kaken.nii.ac.jp/ja/report/KAKENHI-PROJECT-20K18057/20K18057seika/）を加工して作

Current concepts in the diagnosis and management of Os Acetabuli.

PURPOSE: The aim of this review is to appraise the current evidence on the epidemiology, pathophysiology, diagnosis and management of os acetabuli. METHODS: A scoping review was conducted according to the Joanna Briggs Institute guidelines. A systematic search was performed on Medline (PubMed), Embase and Cochrane Library. Inclusion criteria comprised observational and interventional studies and review articles published in the English language that focused on patients with os acetabuli according to the PRISMA extension of scoping reviews checklist using the terms 'Os Acetabuli' or 'os acetabula' or 'acetabular ossicles'. A narrative synthesis of results was undertaken, and the included articles were divided into (i) definition, (ii) aetiology, (iii) diagnosis and imaging and (iv) management of os acetabuli. RESULTS: 107 articles were screened, with 22 meeting the eligibility criteria. A total of 8836 patients were considered, of which 604 had os acetabuli. The mean age was 32.8 years. The prevalence of os acetabuli ranged from 3.4 to 7.7%, with a higher prevalence in males compared to females. True os acetabuli was defined as an unfused secondary ossification centre along the acetabular rim. The aetiology of os acetabuli is thought to be secondary to acetabular dysplasia and/or femoroacetabular impingement. Standard of care for management of symptomatic os acetabuli is considered to be arthroscopic excision unless the excision results in acetabular undercoverage and/or instability, in which case, fixation is recommended. CONCLUSIONS: Successful management of os acetabuli depends on understanding the pathology and treating the underlying cause rather than treating the os acetabuli in isolation. Future work needs to focus on establishing clear diagnostic criteria, consensus on definition and an evidence-based treatment algorithm

A proposed new rotating reference axis for the tibial component after proximal tibial resection in total knee arthroplasty.

PURPOSE:During total knee arthroplasty, few rotating reference axes can be reliably used after tibial resection. We speculated that a line that passes through the lateral edge of the posterior cruciate ligament (PCL) at its tibial attachment after resection and the most prominent point of the tibial tubercle [after-tibial resection (ATR) line] will provide a good reference axis. In this study, we aimed to evaluate the association between ATR and Akagi's lines. MATERIALS AND METHODS:In this case-control simulation study, we retrospectively evaluated 38 patients with varus knee and 28 patients with valgus knee. We defined the reference cutting plane as 10 mm distal from the lateral articular surface of the tibia in varus group and as 7 mm distal from the medial articular surface in the valgus group. We measured angles between Akagi's line and the ATR line (ATR line angle) as well as between Akagi's line and 1/3 Akagi's line (1/3 Akagi's line angle), which passes through the midpoint of PCL and the medial third of the patellar tendon. We used paired t-tests to determine the significance of differences between these angles, with p < 0.05 indicating statistical significance. Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi's line angle and ATR line angle were analyzed by two surgeons. RESULTS:We found that 1/3 Akagi's line angle was 10.2° ± 1.3° in the varus group and 10.9° ± 1.3° in the valgus group (p = 0.017). The ATR line was positioned externally compared with Akagi's line in all patients. Mean ATR line angles at 0°, 3° and 7° posterior slopes were 6.1° ± 1.9°, 5.8° ± 2.0° and 6.0° ± 1.7° in the varus group and 6.3° ± 2.3°, 6.2° ± 2.3° and 5.4° ± 2.1° in the valgus group, respectively. There were no significant differences in the ATR line angle between the varus and valgus groups. (p = 0.34-0.67) Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi's line angle were 0.936 and 0.986 and those for the reproducibility of ATR line angle were 0.811 and 0.839. CONCLUSIONS:The ATR line was positioned between Akagi's line and 1/3 Akagi's line in all patients and was a valid option for evaluating rotational tibial alignment after tibial resection

Reduction status and screw direction in the BFN and PFNA groups.

Reduction status and screw direction in the BFN and PFNA groups.</p

Data of BFN group and PFNA group.

(XLSX)</p

Appearance of the Best Fit Nail.

The Best Fit Nail (BFN) has a lag screw hole with a selectable anterior offset to the nail axis. The anterior offset of the BFNs used in the present study was 4 mm. (A) Nail central axis. (B) Lag screw hole central axis.</p