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橈骨舟状骨月状骨固定に追加する舟状骨遠位切除及び三角骨切除が手関節ダーツスロー運動とぶんまわし運動に与える生体力学的効果
Get PDFPurpose: Distal scaphoid and triquetrum excisions can improve the range of wrist motion after radioscapholunate (RSL) fusion, but little is known about the kinematics of dart-throwing and global circumduction motions. We hypothesized that these excisions could increase the range of motion without causing midcarpal instability. Methods: Seven fresh-frozen cadaver upper extremities were mounted on a testing apparatus after isolation and preloading of the tendons of the flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis, and extensor carpi ulnaris. Sequential loadings of the flexor carpi ulnaris and extensor carpi radialis simulated active dart-throwing motion. Passive circumferential loading produced the wrist circumduction motion. We measured the range of wrist motions with an electromagnetic tracking system in 4 experiments: intact, simulated RSL fusion, RSL fusion with distal scaphoid excision, and RSL fusion with distal scaphoid and total triquetrum excisions. To evaluate midcarpal stability, we conducted passive mobility testing of the distal carpal row in the radial, volar, ulnar, and dorsal directions. Results: Radioscapholunate fusion decreased the dart-throwing motion to a mean of 46% of the baseline value; distal scaphoid and triquetrum excisions increased the mean arc to 50% and 62%, respectively. Radioscapholunate fusion diminished the wrist circumduction to a mean of 43% of the baseline value, which increased to a mean of 58% and 74% after distal scaphoid and triquetrum excision, respectively. A significant increase in radial deviation was noted after distal scaphoid excision, and subsequent triquetrum excision significantly increased motion in the ulnar-palmar direction. Regarding midcarpal stability, dorsal translation significantly increased after distal scaphoid and triquetrum excisions. Conclusions: Distal scaphoid and triquetrum excision after RSL fusion improved both dart-throwing and circumduction motions, but dorsal midcarpal instability occurred. Clinical relevance: Subsequent carpal excisions may improve short-term outcome by increasing motions in a RSL-fused wrist; however, a potential risk of midcarpal instability should be considered.博士（医学）・甲第757号・令和2年12月24日Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved
アルツハイマー病における不快表情認知と鉤状束との関連：横断的拡散テンソル画像研究
Get PDFBackground: Recognising facial emotions involves visual and emotional information processing. Patients with dementia, including dementia of Alzheimer's type (DAT), are known to poorly recognise facial emotions, especially negative facial emotions. In this study, we aimed to assess if DAT patients exhibit poor facial emotional recognition, and to identify a neural basis for how poor facial emotional recognition might occur. Methods: Magnetic resonance imaging and diffusion tensor imaging (DTI) analysis were conducted in 20 DAT patients and 15 cognitive normal (CN) subjects. The uncinate fasciculus (UF), inferior longitudinal fasciculus, and inferior fronto-occipital fasciculus were delineated by deterministic tractography. DTI parameters were calculated for each fibre. Facial emotion recognition was evaluated with the Facial Emotion Selection Test (FEST). The relationships between FEST scores and DTI parameters in each fibre were measured by partial correlation analyses with age, gender, and the Mini-Mental State Examination as covariates. Group-wise comparisons between DAT and CN subjects were performed for each DTI parameter in each fibre. Results: DAT patients showed lower FEST negative emotion scores than CN subjects (P < 0.05). The score of negative emotion subscale was negatively correlated (r = -0.770, P < 0.001) to mean diffusivity of the left UF in DAT patients. There were no relationships between negative emotion subscale and the other fibre tracts. DAT patients showed no differences in the DTI parameters for each fibre compared to CN subjects. Conclusions: DAT-related prefrontal-limbic network dysfunction is associated with poor recognition of unpleasant emotions; consequently, worse facial recognition of negative emotion is observed in DAT patients.博士（医学）・甲第763号・令和2年12月24日© 2020 Japanese Psychogeriatric SocietyThis is the peer reviewed version of the following article: https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12498, which has been published in final form at https://doi.org/10.1111/psyg.12498
. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
The Statistical Association Between Blood Alcohol Concentration and Soft Blood Clot Formation Following Asphyxial Death.
Get PDFThe fluidity of cadaveric blood is a major finding of asphyxial deaths. Although soft blood clots are present in asphyxial cadaveric blood containing alcohol, only a few reports have statistically compared blood alcohol concentration (BAC) and soft blood clot formation. Using cadavers, German forensic pathologists found a positive correlation between BAC and the incidence of soft blood clots. Others found racial differences in sensitivity to ethanol due to polymorphisms in alcohol dehydrogenase and aldehyde dehydrogenase. We therefore set a low cutoff value (BAC>0.1mg/ml) and reexamined cases of asphyxial death-with or without ethanolin cadaveric blood obtained from Japanese cadavers. We divided 150 autopsy cases into two groups based on the cause of death: asphyxial deaths (n=74) and others (n=76).There were no significant between group differences in BAC; however, patients with asphyxial death exhibited significantly increased soft blood clot formation. When we divided the asphyxial group by BAC, there were 17 cases with BAC>0.1 and 57 cases with BAC=0mg/l. Soft blood clot formation was significantly increased in the BAC>0.1 group. Even a very low BAC is correlated with soft blood clot formation. Alcohol consumption should be considered if a soft blood clot is seen during autopsy
Factors associated with return to work among participants in the rework program at Nara Medical University.
No full textSince the 1990s, many psychiatric clinics and hospitals in Japan have started rehabilitation programs for patients who have had long-term absence from work because of mental disorders. At Nara Medical University Hospital, we started a program for returning to work from 2015. In this study we investigated factors associated with return to work among participants in Nara Medical University Hospital's rework program from July 1, 2015, to September 30, 2019, who were examined through a retrospective study. In our program, sessions were held twice a week over 12 weeks. Most participants had been diagnosed with depression or bipolar disorder, but patients with other diseases were also accepted. A total of 49 patients participated in the study, 25 of whom could return to work and 24 who could not within 6 months after the rogram. The average age was 37.33, with 38 (77.6%) men and 11 (22.4%) women. Of the participants, 63.3% had a diagnosis of depression, 16.3% bipolar disorder, and 6.1% adjustment disorder. The baseline survey found no differences in demographic characteristics, occupational characteristics, or clinical features between those able to return to work and those who were unable. Due to significant differences in scores on the HAM-D (Hamilton Rating Scale for Depression) and PRRS (Psychiatric Rework Readiness Scale) at the beginning of the program, gender, age, and HAM-D and PRRS scores were assumed to be confounding factors. Propensity score matching was used to analyze the data. However, there was no difference between the HAM-D scores of the two groups at the end of the program. On the PRRS, the scores for "grooming," "feeling a trauma against their workplace," and "interest in work" were higher in
the group that could return to work. In the Standardized Assessment Sheet of the Rework Program, the two items of "conversation" and "objective comprehension of the disease" showed differences between the two groups. The possibility that improvement of these items will lead to early return to work has been suggested. Limitations of our study are that the sample size was small and we could not evaluate the effect of the program because there was no control group. Since we set as the outcome only success or failure in returning to work, we could not investigate repeated sick leave or relapse. Further long-term study in larger samples is necessary to verify the factors associated with another sick leave or relapse and we expect it will help patients to keep working.博士（医学）・乙第1489号・令和2年12月24日発行元である科学評論社の許諾を得て登録（2020年12月25日付）ジャーナル公式サイト（科学評論社HP内）：https://www.kahyo.com/product/detail/SE20200
子宮内膜症性嚢胞の悪性転化におけるHO-1発現マクロファージの特徴
Get PDFMalignant transformation of endometriosis is a rare and still poorly understood event, but is associated with the distortion of the pro-oxidant and anti-oxidant balance. The aim of the present study was to quantify the numbers of macrophages polarized as M1 or M2 phenotypes and the expression of heme oxygenase (HO)-1 in tissue sections from patients with benign ovarian endometrioma (OE) and its malignant transformation (endometriosis-associated ovarian cancer, EAOC). We performed a retrospective study at the Department of Gynecology, Nara Medical University hospital from December 2012 to March 2015. This study included 53 patients with OE (n = 33) and EAOC (n = 20), and we evaluated polarized functional status of macrophages by immunohistochemical staining of CD68, CD11c, CD163 and HO-1. The number of the M1 phenotype (CD11c+, p = 0.001) and the M2 phenotype (CD163+, p = 0.009) was significantly lower in EAOC patients than in OE patients. Analyzing the correlations between the studied markers, the expression of CD68, CD11c, and CD163 proteins significantly correlated with each other (p < 0.001). The number of M2 phenotypes expressing HO-1 was significantly decreased in the EAOC group, compared with the OE group (P < 0.001), demonstrating sustained downregulation of an antioxidant marker, HO-1, in EAOC. In conclusion, reduced number of M2 macrophages expressing HO-1 may have an important role in promoting malignant transformation of OE.博士（医学）・乙第1434号・令和元年9月27日Copyright © 2018. Published by Elsevier GmbH
人工靭帯へのケイ酸ストロンチウムアパタイトナノコートは骨形成を促進する
Get PDFBackground: Treatment of anterior cruciate ligament injuries commonly involves the use of polyethylene terephthalate (PET) artificial ligaments for reconstruction. However, the currently available methods require long fixation periods, thereby necessitating the development of alternative methods to accelerate the healing process between tendons and bones. Thus, we developed and evaluated a novel technique that utilizes silicate-substituted strontium (SrSiP). Methods: PET films, nano-coated with SrSiP, were prepared. Bone marrow mesenchymal cells (BMSCs) from femurs of male rats were cultured and seeded at a density of 1.0 × 104/cm2 onto the SrSiP-coated and non-coated PET film, and subsequently placed in an osteogenic medium. The osteocalcin concentration secreted into the medium was compared in each case. Next, PET artificial ligament, nano-coated with SrSiP, were prepared. BMSCs were seeded at a density of 4.5 × 105/cm2 onto the SrSiP-coated, and non-coated artificial ligament, and then placed in osteogenic medium. The osteocalcin and calcium concentrations in the culture medium were measured on the 8th, 10th, 12th, and 14th day of culture. Furthermore, mRNA expression of osteocalcin, alkaline phosphatase (ALP), bone morphogenetic protein-2 (BMP2), and runt-related transcription factor 2 (Runx2) was evaluated by qPCR. We transplanted the SrSiP-coated and non-coated artificial ligament to the tibiae of mature New Zealand white rabbits. Two months later, we sacrificed them and histologically evaluated them. Results: The secretory osteocalcin concentration in the medium on the film was significantly higher for the SrSiP group than for the non-coated group. Secretory osteocalcin concentration in the medium on the artificial ligament was also significantly higher in the SrSiP group than in the non-coated group on the 14th day. Calcium concentration on the artificial ligament was significantly lower in the SrSiP group than in the non-coated group on the 8th, 10th, 12th, and 14th day. In qPCR as well, OC, ALP, BMP2, and Runx2 mRNA expression were significantly higher in the SrSiP group than in the non-coated group. Newly formed bone was histologically found around the artificial ligament in the SrSiP group. Conclusions: Our findings demonstrate that artificial ligaments using SrSiP display high osteogenic potential and thus may be efficiently used in future clinical applications.博士（医学）・甲第724号・令和元年12月5日© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
包括的凝固機能検査による急性期川崎病における止血動態の評価
Get PDFIntroduction: Kawasaki disease (KD) is a systemic vasculitis involving coronary arteries, sometimes resulting in aneurysms and myocardial infarction. Hyper-coagulability in the acute-phase of KD is indicated in some circumstances based on changes of individual clotting factors. Comprehensive coagulation assays, clot waveform analysis (CWA) and thrombin/plasmin generation assay (T/P-GA), have been developed to assess physiological hemostasis, but these techniques have not been applied in KD. Methods: We utilized both assays to analyze coagulation function in KD children (n = 42) prior to intravenous-immunoglobulin (IVIG) treatment (Pre), 1-week (1W) and 1-month (1M) post-IVIG. Results: In CWA, the clot time (CT) pre-treatment was prolonged, and was significantly shortened at 1W and 1M. However, the maximum coagulation velocity (|min1|) and acceleration (|min2|) were ~2-fold greater relative to controls, indicating an overall hypercoagulable tendency. These parameters were related to fibrinogen concentration, and were decreased at 1W and declined to normal at 1M. In T/P-GA, the endogenous potentials of thrombin and plasmin were greater relative to control at each of three time-points, and measurements at 1W were greater than those Pre-treatment. The ratios of TG and PG relative to control were similar, however, suggesting well-balanced dynamic coagulation and fibrinolysis. In non-responders to IVIG, the |min1| and |min2| measurements were greater than those in responders at 1W and 1M, suggesting that non-responders remained hypercoagulable after primary treatment. Conclusion: The coagulation data observed in KD were consistent with hypercoagulability, although fibrinolytic function appeared to be well-balanced. Comprehensive assays of this nature could provide valuable information on coagulation potential in KD.博士（医学）・乙第1441号・令和元年12月5日Copyright © 2018 Elsevier Ltd. All rights reserved