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This study aimed to determine whether the Fracture Risk Assessment Tool (FRAXWe enrolled 614 patients aged ≥ 40 years (average, 77.0 years) who were eligible for primary osteoporosis evaluation. Bone mineral density measurements of the lumbar spine, total hip, and femoral neck using ALPHYS LF (FUJIFILM, Tokyo, Japan) and imaging studies involving the lumbar spine were obtained and the FRAXThe FRAXThe FRAX

現在の災害は多様な形態を有している。そのような災害への対応は、地震、水害等の災害類型に応じたものではなく、いかなる災害への対応できるように、ダメージを受ける社会的機能に着目し、そのダメージの最少化、復旧の最短化を図ることが重要である。それには、情報技術を活用し、被害の状態と支援能力とのマッチングを図ることが必要である。そのためには、マイナンバー制度の有効活用を図るべきである。, 新川達郎教授退職記念号, 退職記念論文(Article in commemoration of the retirement of Professor Tatsuro Niikawa)

Synovial fluid is important for the preoperative etiological diagnosis of suspected periprosthetic joint infection (PJI) or septic arthritis (SA). GENECUBE, an automated real-time polymerase chain reaction (PCR) assay, was used to detect bacterial mecA (methicillin resistance) and was compared with microbiological cultures for preoperatively diagnosing PJI and SA in 74 patients suspected of these infections and thus earmarked for surgery. PJI and SA were diagnosed in 21 and 6 cases, respectively, using modified ICM 2018 diagnostic criteria. Microbiological cultures determined methicillin-resistant staphylococcus (MRS) as the causative organism in six samples, which were all positive in the GENECUBE assay. Significantly also, the GENECUBE assay detected six MRS infections in culture-negative but infection-diagnosed patients, and in one inconclusive case, suggesting a higher sensitivity of this assay. Compared with microbiological culture, the sensitivity and specificity of the GENECUBE assay for mecAwas 100% and 92.2%, respectively. However, GENECUBE also produced invalid results in three cases, suggesting possible PCR inhibitors in the synovial fluid samples. We additionally validated the accuracy of pan-bacterial real-time PCR targeting 16S rRNA and other tests. Pan-bacterial real-time PCR was as effective as preoperative bacterial culture testing, although the α-defensin assay had the highest sensitivity at 100%. Hence, fully automated real-time PCR targeting of the bacterial mecA gene improves the etiological diagnosis of PJI and SA by reducing the testing time and lowering the false-positive detection rates. A screening approach for α-defensin followed by bacterial mecA gene testing in synovial fluids is therefore a more efficient method of preoperatively diagnosing PJI and SA.

The severity of bone mineral density (BMD) loss after total hip arthroplasty (THA) depends on both implant- and patient-related factors. While implant fixation type is an important factor, but few studies have considered the effect of material composition on the same implant fixation type. In particular, differences in mechanical stiffness due to material composition are of great interest. Here, we compared changes in periprosthetic BMD after THA using proximal fixation concept stems comprising different titanium alloys, i.e., β titanium alloys stem and α + β titanium alloys stem.This retrospective cohort included 122 patients (β titanium alloys stem, 61 cases; α + β titanium alloys stem, 61 cases) who underwent primary THA between January 2009 and December 2019. The primary outcome was the change in periprosthetic BMD from base line. Age, body mass index, diagnosis, stem size, canal flare index, surgical approach, pre-operative lumbar BMD, and pre-operative activity scores were reviewed and changes in periprosthetic BMD between the two groups were compared using analysis of covariance. The secondary outcome was radiographic response after THA.There was significant difference in periprosthetic BMD in zone 6 and 7 at 2 years (p 0.05) between the two groups. There was no significant difference in other zones. A significant difference in radiographic response was noted only for the Engh classification.α + β titanium alloys stem resulted in a significantly higher rate of BMD loss in zones 6 and 7 compared with the β titanium alloys stem. These results may be due to differences in mechanical stiffness due to the different titanium alloy composition of the prosthetics.

Background and ObjectivesMinimally invasive methods are expected to avoid the risk of overtreatment and overtreatment of radical therapy to manage the increased number of patients with low-volume, low-grade localized prostate cancer. Based on our experience of radical transurethral resection of prostate cancer (TURPCa) as a radical treatment, we studied the efficacy and safety of focal TURPCa as a focal therapy for patients with localized prostate cancer. Materials and MethodsWe performed focal TURPCa in 49 patients during the period from July 2007 to August 2016 and followed them with prostate-specific antigen (PSA) testing for the mean period of 68.0 months. We selected the patient as a candidate for the study if the biopsy revealed that cancer foci were limited in one lobe, or the foci were several or less even found in both lobes. Standard TURP was followed by further resection and fulguration of the peripheral zone where cancer was considered to exist. We selected one of our three methods of focal TURPCa as follows: one lobe radical TURPCa, radical resection of the affected lobe with unaffected lobe being resected less vigorously; nerve-sparing radical TURPCa, radical resection of both lobes except for the posterolateral part of the prostate; target radical TURPCa, radical resection of the cancer focus and the surrounding prostate when the target is suggested single. ResultsTwelve patients were in the low-risk group (D’Amico), 29 in the intermediate-risk group, and 8 in the high-risk group. Pathological stages were as follows: pT0, three cases; pT2a-b, 17 cases; pT2c, 29 cases. The preoperative PSA of 6.15±2.73 ng/mL (mean±SD) dropped to 0.172±0.283 ng/mL postoperatively. PSA failure occurred in only two patients (4.1%). Incontinence did not develop and erectile function was preserved in eight (44.4%) of the 18 potent patients. The most frequent complication was bladder neck contracture (20.4%). Other complications included acute epididymitis (8.1%), bladder tamponade (2.0%). No patients died of prostate cancer. ConclusionsThough the final assessment of efficacy will require long-term follow-up results with more cases, we may think focal TURPCa can be another treatment option as a focal therapy for localized prostate cancer.

BackgroundStress shielding after total hip arthroplasty (THA) can induce bone mineral density (BMD) loss around the femoral implant. Several studies using drug have described methods to prevent BMD loss around implants following THA. Switching from teriparatide to alendronate was reported to increase lumbar BMD; on the other hands, it is unclear whether switching from teriparatide to alendronate is effective around the implant. The aim of this study is that changes in BMD is compared in patients switched from teriparatide to alendronate, in patients treated with alendronate alone, and in control patients without medication after total hip arthroplasty.Patients and methodsPatients were randomized into three groups, those switched to alendronate after teriparatide (switch:n= 17), those receiving continuous alendronate (ALD:n= 15), and control untreated patients (control:n= 16) and followed up for 2 years after THA. Baseline periprosthetic BMD was measured by dual-energy X-ray absorptiometry (DEXA) 1 week after THA, followed by subsequent measurements at 1 and 2 years postoperatively. Lumbar BMD was also evaluated at preoperatively, 1 and 2 years postoperatively.ResultsTwo years after surgery, BMD (%) at zone 1 was significantly higher in the switch group than in the control group (P= 0.02). BMD (%) at zone 7 was significantly higher in the switch and ALD groups than in the control group (P= 0.01,P= 0.03). Lumbar BMD (%) anterior-posterior (AP) side was significantly higher in the switch group than in the ALD and control groups 2 years after surgery. On the other hand, lumbar BMD (%) lateral side was significantly higher in the switch and ALD groups than control group 2 years after surgery.ConclusionsSwitching therapy had a significant effect on BMD of the lumbar spine and zones 1 and 7 at 2 years postoperatively. At zone 1 in particular, it was found to be more effective than ALD alone.Trial registrationUMIN, registry numberUMIN000016158. Registered 8 January 2015

AimIn tongue diagnosis, a dark purple tongue and enlarged sublingual vein are important findings of Oketsu (blood stasis). However, the association between the tongue color and the sublingual vein has not been reported. This study investigated the association between the tongue color values and the sublingual vein width using tongue image analyzing system (TIAS) for the objective assessment of blood stasis.MethodsA total of 38 patients (age 68.7 ± 11.3 years, 14 men and 24 women) who visited the Department of Kampo Medicine at Chiba University Hospital were included. Physical findings, blood test results, blood stasis score from medical records, and tongue images obtained with TIAS were analyzed. The patients were classified into two groups: patients with a sublingual vein width of ≤2.5 mm (20 patients) and those with a width of >2.5 mm (18 patients). The physical findings and the blood test results of the two groups were analyzed by Wilcoxon's rank-sum test or χ2-test, whereas logistic regression analysis was used to determine the association between the tongue color values and sublingual vein width. Receiver operating characteristic (ROC) analysis was used to differentiate blood stasis.ResultsThe color values significantly related to the sublingual vein width (mm) were the P1-L* and P4-L* (darkness of the tongue edge and tongue apex) and the P1-b* and P2-b* (blueness of the tongue edge and tongue posterior). The area under the curve was greater for the combination of the tongue color values and the sublingual vein width than that for either of them.ConclusionThis study demonstrated an objective evaluation of blood stasis in the tongue of patients with dark-blue discoloration and an enlarged sublingual vein. In addition, the combination of the tongue color and the sublingual vein is expected to facilitate a more reliable diagnosis of blood stasis.

The tongue is one of the most sensitive organs of the human body. The changes in the tongue indicate the changes of the human state. One of the features of the tongue, which can be used to inspect the blood circulation of human, is the shape information of the sublingual vein. Therefore, this paper aims to segment the sublingual vein from the RGB images of the tongue. In traditional segmentation network training based on deep learning, the resolution of the input image is generally resized to save training costs. However, the size of the sublingual vein is much smaller than the size of the tongue relative to the entire image. The resized inputs are likely to cause the network to fail to capture target information for the smaller segmentation and produce an “all black” output. This study first pointed out that the training of the segmentation of the sublingual vein compared to the tongue segmentation is much more difficult through a small dataset. At the same time, we also compared the effects of different input sizes on small sublingual segmentation. In response to the problems that arise, we propose a synergistic attention network. By dismembering the entire encoder–decoder framework and updating the parameters synergistically, the proposed network can not only improve the convergence speed of training process, but also avoid the problem of falling into the optimal local solution and maintains the stability of training without increasing the training cost and additional regional auxiliary labels.

Background Stress shielding after total hip arthroplasty (THA) leads to loss of bone mineral density (BMD) around the femoral implants, particularly in the proximal area. Loss of BMD around the implant is likely to occur within 1 year after THA; however, its severity depends on patient characteristics. This study evaluated preoperative factors correlated with the severity of zone 7 BMD loss after THA. Methods This retrospective cohort study included 48 patients who underwent primary THA from October 2011 to December 2015. All patients underwent implantation of a Zweymüller-type femoral component without any postoperative osteoporosis medications. The objective variable was a change in zone 7 BMD after 1 year. Factors evaluated included age, body mass index, Japanese Orthopaedic Association score, Harris Hip Score, Canal Flare Index (CFI), and lumbar BMD on the frontal and lateral sides. Univariate and multivariate regression analyses identified factors correlated with loss of zone 7 BMD. Results Univariate regression analysis identified CFI (P = 0.003) and preoperative lumbar BMD on the anterior-posterior (P = 0.003) and lateral (P P = 0.014) and lumbar BMD on the lateral side (P Conclusion Lower preoperative lumbar BMD on the lateral side and lower CFI were correlated with zone 7 BMD loss after THA. Patients with these characteristics should be monitored carefully for severe BMD loss after THA.

Case We report a 4-year-old girl with congenital muscular torticollis (CMT) who was treated with sternocleidomastoid muscle (SCM) tenotomy using ultrasonography (US). Prior to the surgery, US was utilized to identify the clavicle and sternum branches of the SCM, sternohyoid muscles, internal jugular vein, and common carotid artery. Then, local anesthesia was injected into the layer between the fascial sheath of the SCM and carotid sheath to reduce bleeding and avoid vascular injury. During surgery, the SCM dissection was carefully conducted under US guidance to avoid vascular injury. No residual of SCM dissection and improvement of neck motion were confirmed before the skin closure. Postoperative course was good with no obvious complications in this patient. Conclusion The intraoperative US investigation during SCM tenotomy is a useful procedure that provides vital information about dissection area of SCM and orientation of internal jugular vein that reduces the risk of insufficient tenotomy and vascular injury.

In Kampo medicine, blood stasis (BS) syndrome is strongly associated with microangiopathy and can lead to atherosclerosis. Vascular endothelial dysfunction (VED), evaluated through flow-mediated dilation (FMD), plays an important role in the early stages of atherosclerosis. However, the association of BS syndrome with VED, as determined using FMD, has not been reported. This study investigated the association between BS syndrome and VED using FMD. Forty-one patients with normal glucose tolerance or impaired glucose tolerance (IGT) and without macrovascular complications were evaluated using FMD from May 2017 to August 2017. Based on the BS score, the patients were divided into the non-BS (n = 19) and BS syndrome (n = 22) groups. Physical and background characteristics, physiological function test results, and laboratory data were compared. Univariate analysis revealed that FMD and a history of dyslipidemia/IGT were significantly different between the two groups ( p < 0.05 ). Multiple logistic regression analysis showed that BS syndrome was significantly associated with FMD (odds ratio: 6.26; p = 0.03 ) after adjusting for the history of dyslipidemia/IGT. The receiver operating characteristic curve showed that the area under the curve for BS syndrome (0.74; p < 0.001 ) and history of IGT ( p < 0.007 ) provided good diagnostic accuracy for FMD. The area under the curve for “BS syndrome + IGT” showed very good accuracy (0.80; p < 0.0001 ) and was higher than that for BS syndrome or IGT alone. In conclusion, the results of this study suggest that the BS score in Kampo medicine could be a useful tool for detecting the early pathogenic stages of atherosclerosis.

Osteoblastoma is a relatively rare benign bone-forming tumor accounting for less than 1% of all bone tumors. This report describes a patient with an osteoblastoma in the femoral head complicated by coexistence of femoroacetabular impingement. A 25-year-old male rugby football player complained of severe right hip pain after an injury during rugby practice. The pain became progressively worse despite resting from sports activity and rehabilitation for 4 months. The image inspection revealed bone tumor complicated by cam-type femoroacetabular impingement and a labral injury. Hip arthroscopic surgery was planned using a navigation system and a three-dimensional model for both complete debridement and cam resection. The tumor was resected by open surgery using a posterior approach. The bone tumor was diagnosed histopathologically as an osteoblastoma. The patient’s symptoms improved markedly after surgery, with no evidence of local tumor recurrence or hip arthritis 1 year later.

Background Hydroxyapatite- (HA-) coated implants tend to achieve good osteoinductivity and stable clinical results; however, the influence of the coating on the prevention of bone mineral density (BMD) loss around the implant is unclear. The purpose of this randomized controlled trial was to evaluate the effectiveness of HA-coated implants for preventing BMD loss and to determine the status of bone remodeling after total hip arthroplasty (THA), making comparisons with non-HA-coated implants. Methods A total of 52 patients who underwent primary THA were randomly allocated to HA and non-HA groups. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at 1 week postoperation to form a baseline measurement, and then 24 weeks and 48 weeks after surgery. The relative change in BMD was evaluated for regions of interest (ROIs) based on the Gruen zone classifications. 18F-fluoride positron emission tomography (PET) was performed at 24 weeks postsurgery, and the maximum standardized uptake values (SUVmax) were evaluated in the proximal (HA-coated) and distal (non-HA-coated) areas in both groups. Results There were significant differences in BMD loss in ROIs 3 and 6 (p = 0.03), while no significant difference was observed in ROI 7 at either 24 or 48 weeks postsurgery. There was no significant correlation between PET uptake and BMD (24 or 48 weeks) in either group. Conclusion The influence of a HA coating in terms of BMD preservation is limited. No significant correlation was found between BMD and SUVmax measured by PET, either with or without the use of a HA coating.

佐藤嘉彦教授 森本滋教授 古稀記念論集, Dedicated to Professor Yoshihiko Sato Professor Shigeru Morimoto on their 70th birthday, Article

日本のコーポレートガバナンスの特徴は、公共性の重視である。グローバル化にともない戦略的経営が求められるが、取締役会の権限を拡大させ、営業の自由の内在化が必要となる。, JAPANESE Corporate Governance and Business Judgement Rule., 早川勝教授古稀記念論集, Dedicated to Professor Masaru Hayakawa on his 70th birthday, 論説(Article)

Background:The alpha angle used to evaluate cam morphology can be determined on different imaging views; however, 2-dimensional (2D) imaging can present limitations in terms of the reproducibility of the radial alpha angle. Recent developments in 3-dimensional (3D) high-resolution magnetic resonance imaging (MRI) have allowed detailed evaluations of the radial alpha angle.Purpose:To determine whether there are any correlations or discrepancies between the 2D alpha angle on plain radiography and the maximum radial alpha angle on 3D MRI.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A total of 42 hips from 39 patients (19 males, 20 females) were analyzed, including 22 hips with femoroacetabular impingement (FAI; mean age, 41 years) and 20 hips with borderline developmental dysplasia of the hip (BDDH; mean age, 43 years). Radial images were reconstructed from 3D multiple echo recombined gradient echo (MERGE) MRI. Differences in the maximum radial alpha angle on MRI between hips with FAI and BDDH were evaluated. Correlations and discrepancies between the maximum radial alpha angle on MRI and alpha angles on the anteroposterior, cross-table lateral, and 45° Dunn views of radiography were also evaluated.Results:The maximum radial alpha angle was significantly higher for hips with FAI than for hips with BDDH. On average, the greatest alpha angle on radial MRI was higher than the alpha angle on each of the 3 radiographic views for both FAI and BDDH. The 45° Dunn view revealed the smallest discrepancy for both FAI ( P = .005) and BDDH ( P = .002). The cross-table lateral view had the highest correlation with the maximum radial alpha angle for BDDH ( P < .001).Conclusion:We reconfirmed the utility of the 45° Dunn view, with it presenting the best reproducibility for the maximum radial alpha angle in the evaluation of cam morphology, while the cross-table lateral view revealed the best correlation with the maximum radial alpha angle, particularly for hips with BDDH.

This paper reports the experimental study for the quantitative analysis of fat bloom formation of chocolate using 3D-laser scanning confocal microscopy (3D-LSCM). We focused on observation of very early stages of fat bloom formation (pre-bloom), which do not exhibit any whitish haze patterns that can be identified by the naked eye or whiteness index instruments. The final stage of the pre-bloom→bloom formation was confirmed using cryo-SEM measurements. The following results were obtained. (1) The initial occurrence of pre-bloom was monitored as concave and convex patterns whose depth and height were of the order of 0.2 μm. (2) The evolution of fat bloom was quantitatively measured as increases in depth, surface, and volume of concave/convex patterns in a separate manner. (3) The total volumes of the convex patterns were larger than those of the concave patterns, indicating that the cocoa butter (CB) molecules forming the convex patterns were supplied not only from the surface but also from the interior of the chocolate.

MALT (Micro Analysis Laboratory, Tandem accelerator, The University of Tokyo) was designed for a ‘highly sensitive and precise elemental and isotopic microanalysis system’ using an ion-beam generated by a Pelletron™ 5UD tandem accelerator. Currently, a multi-nuclide AMS (10Be, 14C, 26Al, 36Cl, 129I) system is available and shows good performance in both precision and sensitivity, and the accelerator serves for PIXE, NRA, ERDA/RBS measurements as well. The total operation time of the accelerator has been over 95,000 hours since the start of MALT, 20 years ago. After the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, many projects related to 129I have been conducted. The retrospective reconstruction of the 131I distribution at the accident from 129I is one of the most important missions for dose evaluation of the residents. The accident-derived 129I is also quite useful as a tracer for the general iodine dynamics in the environment. As a new tool for environmental assessment related to nuclear activity, including the global fallout from past atmospheric nuclear bomb testing, effects from the spent fuel reprocessing plant, and nuclear accidents such as Chernobyl and FDNPP, a 236U-AMS system is now under development.

Flip chip configurations have changed in terms of both their package design and packaging process. These emerging flip chips have become more popular now. Compared to traditional ones, the new flip chips need different dispensing approaches to improve unit-per-hour production, and require more accurate fluid dispensing. Newly developed motion control and stiffer platforms for automatic fluid dispensers have addressed the challenges. This paper shows how the new system achieved significant improvements for both: 27% UPH improvement in packaging a certain flip chip configuration and +/-40um line dispensing accuracy for a few hundred micron tighter clearance from die edge.

Wafer size transition from 300mm to 450mm has been started to address the higher manufacturing cost issue. Major challenges for front end of line (FEOL) clean are listed. From preliminary results, cleanness and etching uniformity are very positive with comparable or even better particle adder performance. Pattern collapse and damage become more and more critical to advanced technology node, but currently they couldn’t be tested due to the lack of 450mm pattern wafer. For 450mm wafer recycling, it will be done in single wafer processing tool instead of batch tool, good results in terms of short process time and low surface roughness were obtained on SiO2 and Si3N4 recycling wafers. Same as 300mm, single wafer processing tool for Si3N4 wet etching is requested.