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A total of 120 Japanese melanoma cases in the adjuvant setting were retrospectively analysed as an observational study. Non-acral cutaneous type melanoma (low-CSD and high-CSD types) had significantly better RFS than acral type melanoma. On multivariate analyses, the acral subtype and agents used in adjuvant therapy were identified as important prognostic factors.

Motoki Sonohata,1,2,* Atsushi Doi,3,* Kazuyoshi Uchihashi,4 Akira Hashimoto,2 Sakumo Kii,1 Takao Inoue,5 Masaaki Mawatari1 1Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan; 2Department of Orthopaedic Surgery, Saga Central Hospital, Saga, Japan; 3Department of Rehabilitation, Kumamoto Health Science University, Kumamoto, Japan; 4Department of Surgical Pathology, National Hospital Organization Saga Hospital, Saga, Japan; 5Organization of Research Initiatives, Yamaguchi University, Yamaguchi, Japan*These authors contributed equally to this workCorrespondence: Atsushi Doi, Department of Rehabilitation, Kumamoto Health Science University, 324, Izumi, Kumamoto-kitaku, Kumamoto, 861-5598, Japan, Tel +81-96-275-2111, Email atsushidoi01@gmail.comPurpose: This study used a sciatic nerve injury rat model to investigate the short-term effects of a polyglycolic acid (PGA)-collagen tube for nerve injury in continuity.Materials and Methods: Sixteen female Wistar rats (6– 8 weeks) were used, and the left sciatic nerve was crushed with a Sugita aneurysm clip. Sciatic nerve model rats were randomly categorized into two groups (n = 8; control group, n = 8; nerve wrapping group). Then, we measured four sensory thresholds, magnetically stimulated the lumbar region to induce motor-evoked potentials (MEPs), and evaluated the sciatic nerve histopathologically.Results: In the sensory thresholds, there were significant differences for the main effect in 250 and 2000 Hz stimulation (p = 0.048 and 0.006, respectively). Further, a significant difference was observed with 2000 Hz stimulation at 1 week (p = 0.003). In the heat stimulation, there were significant differences for the main effect in both weeks and groups (p = 0.0002 and 0.0185, respectively). The post-hoc test showed a significant difference between groups only in 2W (p = 0.0283). Three weeks after the surgery, both 2nd and 3rd MEPs waves-related latencies in the nerve wrapping group were significantly shorter than those in the control group (p = 0.0207 and 0.0271, respectively). Histological evaluation of the sciatic nerve revealed considerable differences in the number of axons between the two groups (p = 0.0352).Conclusion: The short-term PGA-collagen tube nerve wrapping facilitated motor and sensory recovery from nerve degeneration in the sciatic nerve injury rat model.Keywords: polyglycolic acid-collagen tube, nerve wrapping, sciatic nerve injury, sensory threshold, motor and sensory recovery

There are several reports of D-amino acids being the causative molecules of serious diseases, resulting in the formation of, for example, prion protein and amyloid β. D-Amino acids in peptides and proteins are typically identified by sequencing each residue by Edman degradation or by hydrolysis with hydrochloric acid for amino acid analysis. However, these approaches can result in racemization of the L-form to the D-form by hydrolysis and long pre-treatment for hydrolysis. To address these problems, we aimed to identify the DL-forms of amino acids in peptides without hydrolysis. Here, we showed that the DL-forms in peptides which are difficult to separate on a chiral column can be precisely separated by labeling with 1-fluoro-2,4-dinitrophenyl-5-D-leucine-N,N-dimethylethylenediamine-amide (D-FDLDA). Additionally, the peptides could be quantitatively analyzed using the same labeling method as for amino acids. Furthermore, the detection sensitivity of a sample labeled with D-FDLDA was higher than that of the conventional reagents Nα-(5-fluoro-2,4-dinitrophenyl)-L-alaninamide (L-FDAA) and Nα-(5-fluoro-2,4-dinitrophenyl)-L-leucinamide (L-FDLA) used in Marfey's method. The proposed method for identifying DL-forms of amino acids in peptides is a powerful tool for use in organic chemistry, biochemistry, and medical science.

Background While periprosthetic fractures following total hip arthroplasty (THA) are a well-known phenomenon for orthopedic surgeons, fragility fractures following THA are also a significant, though less studied, concern. Furthermore, patients who have undergone THA have several additional risk factors for fragility fractures, including motor weakness, bone atrophy, and limping. The aims of this study were to evaluate the incidence of fragility fractures following THA and to clarify the characteristics of these fractures. Methods This study included 5678 primary THA procedures in 4589 female patients. This study evaluated body morphology data, disease type leading to THA, Japanese Orthopaedic Association hip score, range of motion of the hip joint, and medical history. Distal radius and patella fractures were defined as fragility fractures. Risk factors for fragility fractures after THA were calculated by comparing the fragility fracture group with the non-fracture group. Results Fifty-three fragility fractures were confirmed in 53 patients (distal radius fracture: 32 fractures in 32 patients, patella fracture: 21 fractures in 21 patients). In the univariate analysis, the following eight risk factors for fragility fractures were significantly different between the groups: height, weight, follow-up period, developmental dysplasia of the hip, primary osteoarthritis, abduction before THA, internal rotation before THA, and external rotation before THA. Medical histories were not significantly different between the groups. There was no difference in any study factor and in the time of occurrence between the radius fractures and patella fractures analyzed as fragility fractures. Conclusions This study revealed that there are significant preoperative factors of fragility fractures following THA. These factors will serve as useful data for THA treatment strategies, preoperative explanations, and future studies.

Antherospora vaillantii is an anther smut fungus that was originally considered occurring on Muscari spp. around the world; however, cryptic species were revealed during recent taxonomic investigations, thus emphasizing the importance of host specificity. In Japan, A. vaillantii was identified on Barnardia japonica in 1936. Although the recent revelations indicate that it may be part of a complex based on the host plant genus, the phylogenetic placement of this Japanese species is currently unresolved. In this investigation, seven specimens of the A. vaillantii complex were collected from the Kanto area of Japan, and six new single teliospore isolates were established. Molecular phylogenetic analyses based on the internal transcribed spacer sequences and large subunit nuclear ribosomal DNA (28S) region indicated that the new samples formed a monophyletic clade with other Antherospora spp. among Floromycetaceae lineage. Our samples were separated from other known species of Antherospora and formed a robust monophyletic clade in any analysis. Detailed morphological observations revealed that the new samples could be distinguished from other known Antherospora species. As a result, it is proposed that A. barnardiae can accommodate B. japonica parasites. The evolutionary processes of Floromycetaceae in relation to their Asparagaceous host plants have also been carefully discussed. Based on the morphological observations of the basidiospore ontogenic patterns, the familial concept of Floromycetaceae was redefined.

Objectives Few studies have compared the clinical outcomes and complications of total knee arthroplasty (TKA) in patients with and without osseous ankylosed knees. Thus, we investigated the clinical outcomes and complications of TKA in patients with osseous ankylosed knees using a propensity-score matching method. Methods Thirteen knees in the osseous ankylosed-knees group and 13 knees in the non-ankylosed-knees group were included after excluding those with less than 2 years of follow-up or a lack of data and after propensity-score matching. The American Knee Society Score-knee (AKSS-knee), AKSS-function, knee-flexion angle, knee-extension angle, knee range of motion (ROM) before and after TKA, and the number of knees with postoperative complications were evaluated as primary outcomes. Results The AKSS-knee, AKSS-function, knee-flexion angle, and knee ROM in the osseous ankylosed-knees group after TKA were significantly lower than those in the non-ankylosed-knees group. The knee-extension angle after TKA and number of knees with postoperative complications within 2 years were not significantly different between the two groups. Conclusions The clinical results of TKA in patients with osseous ankylosed knees were inferior to those in patients with non-ankylosed knees.

Since the efficacy of mogamulizumab has been confirmed by a phase III, randomized study, mogamulizumab is one of the promising first-line therapies for advanced cutaneous T cell lymphoma (CTCL), though its efficacy is not completely satisfactory. Therefore, several anti-lymphoma drugs such as etoposide were recently used to enhance the anti-tumor effects of mogamulizumab for the treatment of mycosis fungoides (MF). In this report, the anti-tumor effects of mogamulizumab and post mogamulizumab therapy were retrospectively evaluated in 11 cases of CTCL in real-world clinical practice. The best response rate (RR) was 45.5% (95% confidence interval [CI], 21.3%-72.0%) for the total cohort, 50.0% (95%CI, 21.5%-78.5%) for the MF cohort, and 33.3% (95%CI, 5.6%-79.8%) for the primary cutaneous peripheral T cell lymphoma not otherwise specified (PCPTCL-NOS) cohort. The objective response rate (ORR) at 1 month (ORR1) for the total cohort was 45.5% (95%CI, 21.3%-72.0%), and ORR at 4 months (ORR4) was 27.3% (95%CI, 9.2%-57.1%). The mean time to next treatment (TTNT) was 16.0 weeks (3-100 weeks) for all patients, 16.5 months (3-100 weeks) for the MF cohort, and 9.0 (7-16) weeks for the PCPTCL-NOS cohort. The efficacy rate of etoposide-based therapy was 71.4% (95%CI, 35.9%-98.0%) for all patients, 80% (95%CI, 35.9%-98.0%) in the MF cohort, and 50% (95%CI, 9.5%-90.5%) in the PCPTCL-NOS cohort. The median duration of response was 182 (45-323) weeks. The safety profile of mogamulizumab monotherapy in the present cohort was comparable to the previous phase III, randomized trial. The present study suggests that the efficacy and safety profiles of mogamulizumab monotherapy as second-line therapy and beyond in a real-world Japanese cohort were comparable to those in the previous phase III, randomized trial.

Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor characterized by a high risk of local recurrence but a low risk of metastasis. A small subpopulation of DFSP undergoes fibrosarcomatous (FS) change, and approximately 15%-57% of cases of DFSP with FS change metastasizes, leading to a poor prognosis. In this report, a case of metastatic FS-DFSP that was successfully treated with imatinib mesylate in which the IHC staining pattern of recurrent DFSP was quantitatively analyzed in primary and metastatic DFSP areas, is described. Importantly, the recurrent area was composed of two IHC staining patterns (CD34

A limitation of finger extension resulting from scarring of the juncturae tendinum (JT) is a rare condition. We report a patient with limitation in active extension of the metacarpophalangeal joint (MCPJ) of the ring finger due to a scarred JT in a 37-year-old man. Surgical exploration showed a hard, fixed and scarred JT in the third intermetacarpal space. After resection of the scarred JT, the patient achieved full range of active extension of the ring finger MCPJ. Scarring of the JT may decrease excursion of the extensor digitorum communis and must be considered as one of the differentials in patients with limitation in MCPJ extension. Level of Evidence: Level V (Therapeutic)

Background Of late, periarticular analgesic injection (PAI) has become a common alternative treatment for pain following total hip arthroplasty (THA). However, the systemic effects of PAI containing corticosteroids in patients subjected to THA have not been investigated. This study evaluated the analgesic efficacy and systemic effects of PAI containing a corticosteroid in patients subjected to THA. Methods This single-center, retrospective cohort study enrolled patients undergoing unilateral, primary THA. A total of 197 patients (200 hips) were included in the final analyses, with 87 hips in the PAI group and 113 hips in the control group. Numeric Rating Scale (NRS) and laboratory data were assessed preoperatively and on postoperative days (POD) 1 and 7. Pearson’s correlation coefficients were obtained to assess the correlations between the D-dimer level on POD 7 and each outcome measure on POD 1. Results The postoperative white blood cell count (WBC) was significantly higher in the PAI group than in the control group. Postoperative NRS, creatine phosphokinase (CK), and C-reactive protein (CRP) levels were significantly lower in the PAI group. D-dimer levels were significantly lower in the PAI group on POD 7. Postoperative aspartate transaminase (AST), alanine aminotransferase, blood urea nitrogen, and creatinine levels were within reference ranges. D-dimer levels on POD 7 showed a significant negative correlation with WBC on POD 1 (r=-0.4652) and a significant positive correlation with the NRS score and AST, CK, CRP, and D-dimer levels on POD 1 (r = 0.1558, 0.2353, 0.2718, 0.3545, and 0.3359, respectively). Conclusions PAI containing a corticosteroid may be an effective treatment for pain and inflammation after THA, and it does not seem to cause drug-induced liver or kidney injury. Moreover, corticosteroid PAI can may accelerate early ambulation, which prevents the elevation of postoperative D-dimer levels, and may reduce the risk of deep venous thrombosis.

The efficacy of encorafenib plus binimetinib (E + B) combination therapy for BRAF-mutated advanced melanoma as second-line therapy and beyond is still unknown. In this report, we investigated 22 cases of BRAF-mutated advanced melanoma treated with E + B combination therapy. The objective response rate (ORR) for the total cohort was 68.4%. Notably, the ORR for the second-line and beyond cohort was 73.3%, suggesting that the therapeutic effect of E + B combination therapy is comparable with that of first-line targeted therapy. In contrast, overall survival and progress-free survival in our present cohort was worse than that in a previous clinical trial. Notably, although the incidence rate of severe adverse events was higher than that in a previous report, our present study suggested that E + B combination therapy is a well-tolerated antimelanoma regimen. Our present study suggested that the efficacy and safety profile of E + B combination therapy as a second-line therapy and beyond is comparable with that of first-line targeted therapy.

Since the cost of molecular biological methods for Spitzoid neoplasms is expensive, the number of institutes that employ these methods might be limited. Preferentially expressed antigen in melanoma (PRAME) is a tumor-associated antigen that is useful to distinguish melanoma from other melanocytic disorders, including pediatric Spitzoid tumors that are difficult to diagnose by conventional methods alone. In this report, we report a case of PRAME-expressing juvenile Spitzoid melanoma with lymph node metastasis. Unexpectedly, there were few PRAME-expressing cells in the primary tumor, whereas most metastatic tumors expressed PRAME in the metastatic lymph node. These observations might suggest that, in Spitzoid melanomas, a limited number of melanoma cells possess metastatic potential and that metastatic lesions possess clonality.

The classification system and evolutionary history of Erysiphaceae have been studied based on the results of molecular phylogenetic analyses. However, the sequence data used for these phylogenetic estimations have been limited to the nrDNA of ca., 50 taxa, and the relationships among higher taxonomic groups are not well understood. To provide a phylogenetic overview of Erysiphaceae, we performed phylogenetic estimations based on nrDNA and MCM7 sequences obtained from ca., 270 taxa. The phylogenetic tree showed a similar topology to the trees obtained in previous studies, although the branching order between Golovinomyceteae and Phyllactinieae was different and Phyllactinieae was not monophyletic. Phyllactinieae and Erysipheae were estimated to diversify after the divergence of Golovinomyceteae, suggesting an evolutionary trend in which non-catenate conidia + endoparasitic or non-catenate conidia + ectoparasitic lineages were derived from catenate conidia + ectoparasitic lineages. Phyllactinieae was divided into a clade of Phyllactinia + Leveillula and other clade(s) consisting of Pleochaeta and Queirozia. The phylogenetic hypothesis of Erysiphaceae was updated based on the largest dataset to date, but the higher-level phylogenetic relationships remain unclear. For a more robust phylogenetic hypothesis of Erysiphaceae, further sequence data, including protein coding regions, should be added to the dataset of nrDNA sequences.

The Japanese Dermatological Association prepared the clinical guidelines for the "Wound, pressure ulcer and burn guidelines", second edition, focusing on treatments. Among them, "Guidelines for wounds in general" is intended to provide the knowledge necessary to heal wounds, without focusing on particular disorders. It informs the basic principles of wound treatment, before explanations are provided in individual chapters of the guidelines. We updated all sections by collecting references published since the publication of the first edition. In particular, we included new wound dressings and topical medications. Additionally, we added "Question 6: How should wound-related pain be considered, and what should be done to control it?" as a new section addressing wound pain, which was not included in the first edition.

Aims Biofilm formation is intrinsic to prosthetic joint infection (PJI). In the current study, we evaluated the effects of silver-containing hydroxyapatite (Ag-HA) coating and vancomycin (VCM) on methicillin-resistant Staphylococcus aureus (MRSA) biofilm formation. Methods Pure titanium discs (Ti discs), Ti discs coated with HA (HA discs), and 3% Ag-HA discs developed using a thermal spraying were inoculated with MRSA suspensions containing a mean in vitro 4.3 (SD 0.8) x 106 or 43.0 (SD 8.4) x 105 colony-forming units (CFUs). Immediately after MRSA inoculation, sterile phosphate-buffered saline or VCM (20 µg/ml) was added, and the discs were incubated for 24 hours at 37°C. Viable cell counting, 3D confocal laser scanning microscopy with Airyscan, and scanning electron microscopy were then performed. HA discs and Ag HA discs were implanted subcutaneously in vivo in the dorsum of rats, and MRSA suspensions containing a mean in vivo 7.2 (SD 0.4) x 106 or 72.0 (SD 4.2) x 105 CFUs were inoculated on the discs. VCM was injected subcutaneously daily every 12 hours followed by viable cell counting. Results Biofilms that formed on HA discs were thicker and larger than those on Ti discs, whereas those on Ag-HA discs were thinner and smaller than those on Ti discs. Viable bacterial counts in vivo revealed that Ag-HA combined with VCM was the most effective treatment. Conclusion Ag-HA with VCM has a potential synergistic effect in reducing MRSA biofilm formation and can thus be useful for preventing and treating PJI. Cite this article: Bone Joint Res. 2020;9(5):211–218.

Since the incidence of mucosal melanoma is higher in the Japanese population compared to Caucasians, and since mucosal melanoma possesses a lower mutation burden compared to cutaneous melanoma, the efficacy of anti-PD1 antibody (Ab) monotherapy for mucosal melanoma is limited. Therefore, other targeting molecules that enhance the anti-tumor effects of immune checkpoint inhibitors are needed. In this report, we present a case with anti-PD1 Ab-resistant recurrent malignant melanoma of the nasal cavity successfully treated with nivolu­mab, ipilimumab plus denosumab combination therapy.

The Japanese Dermatological Association prepared guidelines focused on the treatment of skin ulcers associated with connective tissue disease/vasculitis practical in clinical settings of dermatological care. Skin ulcers associated with connective tissue diseases or vasculitis occur on the background of a wide variety of diseases including, typically, systemic sclerosis but also systemic lupus erythematosus (SLE), dermatomyositis, rheumatoid arthritis (RA), various vasculitides and antiphospholipid antibody syndrome (APS). Therefore, in preparing the present guidelines, we considered diagnostic/therapeutic approaches appropriate for each of these disorders to be necessary and developed algorithms and clinical questions for systemic sclerosis, SLE, dermatomyositis, RA, vasculitis and APS.

Highlights • Septic arthritis of the hip joint is relatively uncommon in adults. • Ag-HA implants have not been used in two-stage total hip arthroplasty. • Ag-HA implants may be used in two-staged total hip arthroplasty., Introduction Septic arthritis of the hip joint in adults is a rare and potentially devasting disease. To the best of our knowledge, there have been no reports of two-stage total hip arthroplasty (THA) for the treatment of septic arthritis of the hip joint with a cementless hip implant that has antibacterial properties. Presentation of case We present a case of two-stage THA with a thermal-sprayed silver oxide-containing hydroxyapatite coating (Ag-HA) implant to treat septic arthritis of the hip joint with hip osteoarthritis in an 80-year-old woman. There was no complication or recurrence at 28 months follow-up after 2nd-stage operation. Discussion Ag-HA implants were found to have antibacterial activity within the subcutaneous tissues and bone, osteoconductive properties, and no adverse reactions in vivo. Moreover, no adverse events due to silver were reported in a clinical or radiographic study. Conclusion To further reduce infection after two-staged THA for septic arthritis of the hip joint, antibacterial implants, such as an Ag-HA implant, may be used.

MicroRNAs (miRNAs) are a group of small non-coding RNAs that suppress the expression of target mRNAs. The seed sequence of miRNA plays a crucial role in recognizing the 3'-untranslated region of the target mRNA. Cells infected with a simian foamy virus (SFV) isolated from an African green monkey (Chlorocebus aethiops) (SFVcae) showed high expression levels of viral miRNAs encoded in the long terminal repeat of SFVcae. In the present study, we investigated the roles and expression of miRNAs derived from an SFV isolated from a Japanese macaque (Macaca fuscata) (SFVmfu) using next-generation sequencing technologies. The results obtained showed that SFVmfu also expressed viral miRNAs; however, the seed sequences of most miRNAs derived from SFVmfu differed from those reported previously from SFVcae. Cells persistently infected with SFVmfu strongly expressed an miRNA with the same seed sequence as the miR-1 microRNA precursor family. Luciferase reporter assays indicated that this miRNA down-regulates the expression of adenylyl cyclase-associated protein 1, which is up-regulated in several solid tumors. The present results suggest that SFVmfu utilizes viral miRNAs to establish long-term co-existence with the Japanese macaque.

A Japanese woman in her 40s came to our emergency room with vomiting and upper abdominal pain after drinking a bottle of milk tea at home. She had a history of bipolar disorder. Blood tests revealed hypercalcemia (calcium level of 18.6mg/dl). Abdominal computed tomography depicted thickening of the gastric wall and hyperabsorbed material in the stomach. Upper gastroduodenal endoscopy showed extreme mucosal redness from the gastric body to the pylorus. The hypercalcemia improved with intravenous infusion of zoledronic acid. The patient had not been taking any medication that could have caused hypercalcemia. Later, her father drank the same bottle of milk tea at home and developed upper abdominal pain. He was admitted to the hospital because of vomiting, and computed tomography showed hyperabsorbed material in the stomach, as in his daughter's case. Computed tomography of the bottle of milk tea revealed a highly absorbent substance. The bottle was sent to the forensics laboratory for testing, and it was found to contain calcium chloride. Thus both patients had consumed a beverage containing calcium chloride, and corrosive gastritis was diagnosed. Despite fasting and intravenous drip therapy, the first patient underwent a total gastrectomy because of severe stenosis and perforation of the gastric lumen.

Background Numerous patients who receive hemodialysis (HD) undergo total knee arthroplasty (TKA) due to advanced knee joint arthritis. However, there are few studies that describe the clinical outcomes and complications of TKA in HD patients. This study investigated the mid-term results of TKA in patients undergoing HD. Methods This single-center retrospective study compared clinical and surgical outcomes following TKA in patients who were receiving HD with those who were not. We used propensity scores to match 21 knees of 18 patients who received HD to 706 knees of 569 patients who had not received HD, from a total of 727 knees (587 patients) that underwent primary unilateral TKA. The clinical outcomes were evaluated using the American Knee Society Score-knee (AKSS-knee) and AKSS-function scores. The primary surgical outcome measure was the number of knees with postoperative complications. Results In both the HD and non-HD groups, postoperative AKSS-knee and function scores significantly improved when compared to preoperative values. Postoperative AKSS-knee and function scores were not significantly different between the groups. The number of knees with postoperative complications was larger in the HD group than the non-HD group within the first postoperative month, 0–12 months, 12–24 months, 0–24 months, and two years after surgery. Additionally, in the HD group, more complications occurred in the first month than any subsequent month in the two years after surgery. Conclusions TKA improves AKSS-knee and function scores equivalently for HD patients and non-HD patients. However, HD patients develop more complications after TKA, especially within the first month. Therefore, surgeons who perform TKA for HD patients should obtain informed consent after explaining the possible complications, and HD patients should be carefully observed following TKA.

The diversity of sporocarp-inhabiting fungi (SCIF) was examined using six samples of xylarialean fungi from two different forests in Ibaraki Prefecture, Japan: a moist forest in the Sakuragawa area and an urban dry forest in the Tsukuba area. These fungi were enumerated using direct observation and dilution plate methods. We obtained 44 isolates, and careful morphological and molecular phylogenetic studies of these isolates revealed that approximately 30% of the operating taxonomic units were undescribed or cryptic species related to known fungi. Although typical mycoparasitic fungi, such as helotialean fungi and Trichoderma spp., were not isolated, the genera Acremonium, Acrodontium, and Simplicillium were detected. Comparisons of SCIF communities between the two forests suggested that the number of isolated species in the Sakuragawa area was lower than that in the Tsukuba area. Soil-borne fungi, such as Aspergillus, Beauveria, Penicillium, and Talaromyces, or polypores/corticioid mushrooms, are frequently detected in the Tsukuba area. Factors affecting SCIF communities in the two forests are discussed. Some noteworthy fungi are briefly described with notes on taxonomy, ecology, and molecular phylogeny.

BackgroundThe number of total hip arthroplasties (THAs) performed for patients undergoing dialysis is increasing. However, there are few reports of cementless THA for patients undergoing dialysis. This study investigated the mid-term to long-term results of hydroxyapatite (HA)-coated cementless THA for dialysis patients.MethodsThis single-center, retrospective study enrolled dialysis patients undergoing primary HA-coated cementless THA. A total of 24 patients (30 hips) were included in the final analyses. The Harris hip score and radiographic results were assessed preoperatively and during the final follow-up examination. Postoperative complications and mortality rates were recorded. The mean follow-up period was 109 months (range, 60–216 months).ResultsThe total Harris hip score significantly improved from 40 to 84 points. The overall cumulative survival rates with revision as the endpoint were 100% at 5 years and 90.4% at both 10 and 15 years. Stress shielding was observed in 24 hips (80%). No deaths were related to the primary THA. Complications included periprosthetic fracture for one patient (3.3%), blood transfusion for nine patients (30%), shunt blockage for two patients (6.7%), deep infection for one patient (3.3%), and dislocation for two patients (6.7%).ConclusionsHA-coated cementless THA resulted in good mid-term outcomes for patients undergoing dialysis with no mortality risk. However, the procedure involved a relatively high perioperative risk of blood transfusion.

The phylogenetic affinities of four representative Endocalyx taxa, including three species and two varieties, are studied based on materials collected on different palm hosts in Japan and the states of Hawaii and Texas, USA. They include specimens and their isolates belonging to E. cinctus, E. indumentum, E. melanoxanthus var. grossus and E. melanoxanthus var. melanoxanthus. Phylogenetic analyses of nuclear ribosomal DNA sequence data (ITS-LSU nrDNA) confirmed that Endocalyx belongs to the order Xylariales (Sordariomycetes) where all species and varieties treated form a strongly supported monophyletic lineage within the family Cainiaceae. They were also phylogenetically well resolved and consistent with their morphological and ecological circumscription. Species status is proposed for E. melanoxanthus var. grossus under the name E. grossus comb. et stat. nov. on the basis of its distinct morphological, molecular, cultural and ecological characteristics. The putative placement of Endocalyx within the family Apiosporaceae (Amphisphaeriales) based on the presence of basauxic conidiophores is rejected considering that all species treated clustered within the distant Cainiaceae (Xylariales). This characteristic mode of conidiophore elongation is determined to have evolved independently within unrelated or distant ascomycetous lineages. Novel morphological and cultural features of Endocalyx taxa based on new isolates are commented. The recently described E. metroxyli is reduced to synonym with E. melanoxanthus.

Highlights • A case of boutonniere deformity of the second toe caused by sumo wrestling. • Forced passive flexion exerted on an actively extended PIP joint is the likely cause. • Surgical repair of the extensor mechanism and temporary pinning were effective., Introduction Traumatic boutonniere deformities of the fingers are well documented unlike those of the lesser toes. With few existing reports on boutonniere deformities of the lesser toes, the related pathology and treatment guidelines remain unclear. Presentation of case We present a case of traumatic boutonniere deformity of the second toe caused by sumo wrestling in a 23-year-old man. A flexion deformity of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint of the right second toe were observed, including a torn central slip and plantarly displaced lateral bands during surgery. Surgical repair of the extensor mechanism and temporary pinning led to good clinical results. Discussion Acute traumatic boutonniere deformity of the interphalangeal joint of the lesser toe is very rare. The mechanism of boutonniere deformity in this case is thought to be due to forced passive flexion exerted on an actively extended PIP joint, which is similar to that seen in fingers. Conclusion We describe the pathophysiology of a case of boutonniere deformity of the lesser toe and suggest the effectiveness of surgical treatment.

Die Kombination aus Nivolumab und Ipilimumab ist einer der vielversprechenden Therapieansätze zur Steigerung der antitumoralen Immunreaktion bei Patienten mit fortgeschrittenem Melanom. Ein Hauptaugenmerk der Dermatologen liegt auf der Optimierung des Ansprechens. Aktuelle Berichte deuten darauf hin, dass – vor dem Hintergrund, dass CD8+-T-Zellen nach Anwendung von Immuncheckpoint-Inhibitoren beim Melanom die RANKL-Expression steigern und so ein immunsuppressives Tumormikromilieu schaffen – Denosumab die antitumorale Wirkung dieser Immuncheckpoint-Inhibitoren, z.B. Nivolumab und Ipilimumab, zusätzlich steigern könnte. Wir stellen hier den Fall eines Patienten mit multipel metastasierendem Melanom vor, der mit einer Kombinationstherapie aus Nivolumab, Ipilimumab und Denosumab behandelt wurde.

Nivolumab plus ipilimumab combined therapy is one of the promising drugs that enhance the anti- immune response in patients with advanced melanoma. Therefore, to increase its response rate is of great interest to dermatologists. Recent reports suggested that, since CD8+ T cells after the administration of ICIs increase the RANKL expression to induce an immunosuppressive tumor microenvironment in melanoma, denosumab might enhance the anti-tumor effects of immune checkpoint inhibitors, such as nivolumab and ipilimumab. In this report, we present a case of multiple metastatic melanoma with nivolumab, ipilimumab plus denosumab combined therapy.

Several antibacterial materials have been developed to prevent periprosthetic joint infection and thus prevent serious complications for patients and surgeons. However, no study has addressed the activity of antibacterial materials against hematogenous infection. The present study evaluated the antibacterial activity of a silver-containing hydroxyapatite-coated implant against methicillin-resistant Staphylococcus aureus (MRSA) hematogenous infection. Implants coated with hydroxyapatite and silver-hydroxyapatite were inserted into rats' right and left femurs, respectively, after which the animals were infected with S. aureus via a tail vessel. About 107 colony-forming units was the optimal bacterial number for the establishment of S. aureus hematogenous infection. Bacterial loads and C-reactive protein in the blood were measured to confirm bacteremia and inflammation. Fourteen days after the infection, bacterial loads were statistically lower in the femurs containing silver-hydroxyapatite-coated implants than in those with hydroxyapatite-coated implants (p = 0.022). Thus, silver-hydroxyapatite-coated implants might provide antibacterial activity against MRSA hematogenous infection in the postoperative period. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2655-2660, 2019.