Kikkoman (Japan)

Background: Cerclage wiring (CW) is a surgical option in distal clavicular fractures with small bone fragments; however, complications associated with pin backout are occasionally observed. Therefore, we introduced a locked CW system integrating the pin and sleeve and evaluated its clinical outcomes.Methods: This case series included 11 patients who underwent locked CW fixation (age, 57.5 ± 20.0 years; eight men, three women). Postoperatively, shoulder range of motion exercises were commenced at two weeks based on pain tolerance. The primary outcomes were the range of forward elevation, the Constant and American Shoulder and Elbow Surgeons (ASES) scores at six months, bone union rates, pin backout distances, and postoperative complications.Results: The range of forward elevation was 176.7 ± 22.2° at six weeks and 180 ± 0° at six months postoperatively. The Constant and ASES scores were 100 (95-100) and 95 (95-100), respectively. Bone union was achieved in all cases. Compared with immediately after surgery, the pin backout distance was 0.9 mm (-0.2 to 1.2 mm). One patient developed a surgical site infection. Two patients had subcutaneous pin prominence that required implant removal.Discussion: Locked CW showed excellent early recovery of shoulder motion after surgery. This outcome may be attributed to stable fixation even in small distal fragments, minimal pin backout, and the ability to initiate range-of-motion exercises at an early stage.Conclusion: Locked CW appears to be a useful and reliable option for distal clavicular fractures. Further comparative and multicenter studies are needed to validate these results.

Rheumatoid nodules are typically benign and asymptomatic, requiring no specific treatment. However, we encountered a diagnostically challenging case involving a painful elbow mass that rapidly enlarged. The lesion eventually caused posterior interosseous nerve (PIN) palsy. Surgical excision revealed histological features of a rheumatoid nodule with marked neutrophilic infiltration, raising suspicion of superimposed infection. Despite initial negative cultures, the lesion recurred aggressively, and infection was later confirmed by pathogen isolation. After adjusting immunosuppressive therapy and administering antibiotics, the patient achieved long-term remission with functional recovery. This case underscores the importance of distinguishing infection from rheumatoid activity in atypical nodular presentations.

BackgroundBone marrow transplantation has been employed as a regenerative treatment for osteonecrosis of the femoral head (ONFH). However, in clinical practice, obtaining a sufficient volume of bone marrow aspirate under general anesthesia can sometimes be challenging. Currently, there is no established method to predict the quantity and quality of bone marrow that can be harvested preoperatively. We hypothesized that these parameters could be inferred from preoperative bone scintigraphy uptake. Therefore, this study aims to investigate the relationship between bone marrow quantity and quality and the uptake observed on preoperative bone scintigraphy.MethodsThis retrospective study included 145 consecutive patients with ONFH who underwent bone marrow transplantation between 2009 and 2014. The edges of the ilium were manually delineated on the images obtained by combining bone scintigraphy and computed tomography. The average pixel value within this delineated area was calculated. We analyzed correlations between the average pixel value on bone scintigraphy for both ilium and the quantity of bone marrow collected from the ilium, as well as the CFU-Fs obtained from 600μl of concentrated bone marrow.ResultsSixty-two patients were excluded due to insufficient data on bone scintigraphy and colony-forming unit of fibroblasts (CFU-Fs), leaving 83 patients for final analysis. The mean bone marrow quantity, CFU-Fs per 600μl, and the pixel value of bone scintigraphy were 227 ml (range, 6–400), 42 (range, 4–200), and 109 (range, 28–730), respectively. A significant correlation was found between the pixel value and bone marrow quantity (Pearson’s correlation coefficient, r = 0.24, p < 0.05), while no significant relationship was observed with CFU-Fs.ConclusionsPatients with low bone scintigraphy uptake require careful consideration as an adequate amount of bone marrow may not be obtainable.

Background/Objective: Recently, there has been an increasing need to implement the diagnosis of the presence of covert hepatic encephalopathy (CHE) in patients with cirrhosis. The aim of this study was to identify novel factors associated with CHE in clinical practice. Methods: This retrospective study enrolled a total of 402 patients with cirrhosis at 17 institutions. The Stroop test was performed to diagnose CHE at each center. Results: The patients comprised 233 males and 169 females, with a median age of 69 (IQR, 61-75) years. The median albumin and 25(OH)D3 levels were 3.9 (3.5-4.3) g/dL and 15.4 (11.0-21.0) ng/mL, respectively. This cohort included 181 patients with esophageal varices (EV). Multivariate analysis revealed that low 25(OH)D3 (p < 0.05) and EV (p < 0.05) were independent risk factors for CHE. When limited to only laboratory factors, low albumin (p < 0.01) and low 25(OH)D3 (p < 0.05) were independent factors for CHE. The optimal cut-off values of albumin and 25(OH)D3 for predicting CHE were 3.7 g/dL and 16.5 ng/mL, respectively. The prevalence of CHE was 59.2% for 25(OH)D3 < 16.5 ng/mL and EV, 53.8% for albumin < 3.7 g/dL and 25(OH)D3 < 16.5 ng/mL, and 66.7% for albumin < 3.7 g/dL, EV, and 25(OH)D3 < 16.5 ng/mL. Conclusions: Low 25(OH)D3 and albumin levels, and the EV were positively associated with CHE in patients with cirrhosis. Specifically, the prevalence of CHE increased with a decrease in 25(OH)D3 levels. Patients with such risk factors should be actively and carefully examined for the presence of CHE.

We report a rare case of a patient who developed age-related macular degeneration (AMD) in one eye during treatment of diabetic macular edema (DME) in both eyes. A 70-year-old man was followed for diabetic retinopathy for 23 years. At his initial visit in 200X, his decimal visual acuity was 1.0 in both eyes. He underwent panretinal photocoagulation for pre-proliferative diabetic retinopathy (PPDR) in both eyes. Optical coherence tomography (OCT), which was done nine years after the initial visit, revealed a small retinal pigment epithelial detachment (PED) in the left eye. Sixteen years after the initial visit, he developed DME in his right eye and an epiretinal membrane (ERM) in his left eye. Seventeen years after the initial visit, he developed DME in his left eye, and he was treated with sub-tenon triamcinolone acetonide (STTA) injections in the right eye. The STTA was not effective, and we switched to anti-vascular endothelial growth factor (anti-VEGF) injections for both eyes. The anti-VEGF injections were performed 22 times (aflibercept, IVA 12 times; faricimab, IVF 10 times) in the right eye for the DME. His decimal visual acuity fluctuated between 0.2 and 0.9 during this period. The left eye underwent pars plana vitrectomy (PPV) for the DME and ERM 17 years after the initial visit. Although the macular edema was resolved, subretinal fluid and macular neovascularization (MNV) appeared 22 years after the initial visit. Since then, IVF has been performed 10 times, and the decimal visual acuity has improved from 0.4 to 0.8. He underwent bilateral cataract surgery 17 years after the initial visit. Twenty-two years after the initial visit, the left eye developed MNV, located near the PED that had been seen on the OCT image taken 13 years earlier. The relationships of the ERM, DME, and PPV with MNV were not determined. At present, both eyes are responding well to the IVF treatments. This case will remind clinicians of the possibility of the two diseases coexisting and will lead to a better understanding of the pathogenic mechanisms of both diseases.

Corrective osteotomy for upper limb deformities caused by fractures, trauma, or degeneration necessitates detailed preoperative planning to ensure accurate anatomical alignment, restore limb length, and correct angular deformities. This review evaluates the effectiveness of a three-dimensional (3D) preoperative planning program and an image fusion system designed for intraoperative guidance during corrective osteotomy procedures. The application processes and clinical outcomes observed with these technologies in various surgical scenarios involving the upper extremities were summarized. The systems proved beneficial in allowing surgeons to visualize surgical steps and optimize implant placement. However, despite these technological advancements, we found no significant impact on clinical outcomes compared to conventional methods. This indicates a need for further enhancements in system efficiency and user-friendliness to significantly improve patient results. Future developments should focus on addressing these limitations to enhance the practical utility of such advanced systems.

Abstract Background Distal radius fractures are among the most common fractures, traditionally evaluated using two-dimensional (2D) parameters. These methods are unreliable in significantly displaced fractures, with discrepancies among evaluators. Recent advancements in imaging have introduced three-dimensional (3D) models, but standard parameters for 3D reduction morphology are not well established. This study aimed to develop a novel method for evaluating 3D reduction morphology based on the normal vector of a plane defined by anatomical reference points, comparing the reduction shape to the mirror image of the unaffected contralateral side. Methods This retrospective case-control study included 27 patients (mean age 67.6 years) who underwent osteosynthesis with a volar locking plate for distal radius fractures. Preoperative and postoperative computed tomography (CT) scans of the affected and unaffected wrists were analyzed using 3D image analysis software. The 3D coordinates of three reference points; (1) radial styloid process, (2) sigmoid notch volar edge, and (3) sigmoid notch dorsal edge, were used to evaluate the reduction shape and compare it to the unaffected side mirror image. Correlations between vector angles in the coronal, sagittal, and axial planes and clinical outcomes, such as % total active motion (%TAM) and Mayo wrist scores, were analyzed. Results The distances between the unaffected mirror image and postoperative image for the three reference points were 2.1 mm, 2.1 mm, and 2.7 mm, with barycenter differences of 1.7 mm. The postoperative plane areas consisted from three reference points were significantly larger in the postoperative image compared to the unaffected mirror image (203.4 mm² vs. 192.4 mm², P &lt; 0.01). Correlation coefficients for vector angles in the yz-plane between unaffected mirror image and postoperative image were moderate (0.53, P &lt; 0.05). Mild correlations were found between postoperative vector angles in the xy and xz planes and %TAM. Conclusions This novel 3D evaluation method provides a more comprehensive assessment of fracture reduction, particularly in the axial plane. While it demonstrates good reproducibility in coronal alignment, further refinement is needed for sagittal and axial alignments. This method could enhance surgical precision and improve clinical outcomes in distal radius fracture management. Clinical trial number: not applicable.

Abstract Background The forearm muscles coordinately control wrist motion, and their activity is affected by forearm rotation. Although forearm rotation has been implicated in the development of lateral and medial epicondylitis, its biomechanical background remains unknown. Therefore, the present study investigated the activity of wrist muscles in various forearm positions. Methods Surface electromyography of the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris was performed on 40 healthy upper limbs. We initially measured muscle strength and electromyographic activity (integrated electromyographic value per second) at maximum voluntary output towards wrist extension and flexion in a neutral position. We then assessed electromyographic activity under constant wrist torque (75% of maximum strength in the neutral position) in pronation, the neutral position, and supination. The percentage of maximum electromyographic activity was evaluated for each position. Results In wrist extension, the extensor carpi radialis brevis was activated during forearm pronation, while extensor carpi ulnaris activity did not change in any forearm position. In wrist flexion, the flexor carpi radialis was activated during forearm supination, while flexor carpi ulnaris activity was significantly lower with forearm pronation than in the neutral position. Conclusions Since muscle activation increases traction force at the tendon origin, forearm positions that increase muscle activity may be a biomechanical risk factor for the development of tendinopathy. The present results are consistent with epidemiological and pathological findings on lateral and medial epicondylitis. These results provide insights into wrist biomechanics and the pathophysiology of lateral and medial epicondylitis.

BackgroundRecent advancements in and the proliferation of autonomous mobility technology, such as intelligent wheelchairs, have made it possible to provide mobility services for patients with reduced mobility due to musculoskeletal disorders. In the present study, we conducted a preliminary clinical study to assess the safety and feasibility of in-hospital autonomous transportation using a driverless mobility (wheelchair) for patients with musculoskeletal disorders.MethodsFrom January to February 2022, 51 patients with musculoskeletal disorders exhibiting gait disturbance who presented to our institution were included in the present study. Driverless mobility rides were conducted over a straight-line distance of 100 m from the orthopaedic outpatient reception to the payment counter after the outpatient consultation. We assessed the quality of life using an EQ-5D-5 L index and pain using a VAS score before riding the mobility to investigate the patient’s condition. After the ride, a questionnaire survey was conducted to assess patient satisfaction on a 5-point scale. In addition, adverse events during the mobility ride were investigated.ResultsOverall satisfaction levels showed that 44 out of 51 (86%) patients rated the level as 3 or higher. There were no significant differences in the level of satisfaction based on the cause of disorders or EQ-5D-5 L Index. Among 19 patients who rated the level of satisfaction as 2–3, the ratio of postoperative patients and those with pain tended to be higher (p < 0.05). While 26 of 51 (51%) patients reported moments of feeling unsafe during the mobility ride, no actual adverse events, such as collisions, were observed.ConclusionsAn in-hospital autonomous transportation service using a driverless mobility for patients with musculoskeletal disorders demonstrated high satisfaction levels and was safe with no severe adverse events observed. The expansion of autonomous mobility deployment is expected to achieve mobility as a service in medical care.

The intestinal microbiota is involved in many diseases, such as constipation, obesity, and inflammatory bowel disease. To determine the associations between the gut microbiome and the frequency of bowel movements, we performed cross-sectional correlation analysis at the baseline and longitudinal correlation analysis after the intervention. Forty-three women were enrolled in this study. All participants ingested soymilk-okara powder (15g) daily for 12weeks. They recorded the ingested okara powder amounts and their frequency of bowel movements during the entire 12weeks of the intervention. The fecal microbiota percentages were measured at baseline and after 12weeks of intervention. Two women who did not completely record the frequency of bowel movements were excluded. In the cross-sectional correlation analysis at the baseline, there was a significant positive correlation between the relative abundance of the Bacteroides genus in the feces and the frequency of bowel movements per week (R = 0.429, p = 0.005) and a significant negative correlation between the relative abundance of Clostridium cluster XI in the feces and the frequency of bowel movements per week (R = -0.315, p = 0.045). Moreover, in the longitudinal correlation analysis, the difference in the relative abundance of Bacteroides genus in feces between the baseline and after the intervention significantly correlated with the changes in the frequency of bowel movements per week (R = 0.492, p = 0.001). Therefore, it was suggested that there was a relationship between the gut relative abundance of the Bacteroides genus and the frequency of bowel movements.