Search

The effect of prostaglandins (PGA1 and PGB2) on the replication of Mayaro virus was studied in Vero cells. PGA1 and PGB2 antiviral activity was found to be dose-dependent. However, while 10 µg/ml PGB2 inhibited virus yield by 60%, at the same dose PGA1 suppressed virus replication by more than 90%. SDS-PAGE analysis of [35S]-methionine-labelled proteins showed that PGA1 did not alter cellular protein synthesis. In infected cells, PGA1 slightly inhibited the synthesis of protein C, while drastically inhibiting the synthesis of glycoproteins E1 and E2.

Morcellized bone grafting was performed to significant acetabular deficiency in 35 hips of 29 patients in cementless total hip arthroplasty (THA). Bridging trabeculation across the graft-host interface, remodeling of the graft, and trabecular reorientation were observed at 4 weeks, 3.7 months, and 10.7 months postoperatively, respectively. These remodeling processes were observed in all cases. Morcellized bone grafting for acetabular deficiency in cementless THA stock, which is necessary to make the cup stable, revealed encouraging early trabecular reorientation and recovery of acetabular bone even in cases in which structural bone grafting is needed. [ABSTRACT FROM AUTHOR]

Objective: Disturbances in rest-activity rhythms (RAR) are commonly observed in patients with dementia; however, the influence thereof on behavioral and psychological symptoms of dementia (BPSD) remains unexplored. This study aimed to determine whether there is an association between RAR and BPSD among patients with moderate and severe dementia., Methods: RAR analyses of 64 participants were performed using actigraphy. BPSD was assessed using the Neuropsychiatric Inventory-Nursing Home (NPI-NH) scale, and other clinical variables were assessed by the Mini-Mental State Examination, Cognitive Test for Severe Dementia, and Hyogo Activities of Daily Living Scale. Correlations among RAR, sleep time, and BPSD were analyzed. A stepwise multiple linear regression analysis was conducted to examine the association of RAR and sleep time with BPSD. The demographic variables were also adjusted. Variables were compared between two groups with aberrant and nonaberrant activity peak timing., Results: Correlation analysis showed that longer maximum durations of activity and shorter daytime sleep were associated with higher NPI-NH scores. Stepwise multiple linear regression analysis showed that maximum activity duration predicted the NPI-NH score after adjustment for the demographic variables. There was no significant difference in any variables between the groups with aberrant and nonaberrant activity peak timing., Conclusion: RAR is associated with BPSD in moderate-to-severe dementia, which should be considered with regard to treatment., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Developing approaches for early detection of possible risk clusters for mental health problems among undergraduate university students is warranted to reduce the duration of untreated illness (DUI). However, little is known about indicators of need for care by others. Herein, we aimed to clarify the specific value of study engagement and lifestyle habit variables in predicting potentially high-risk cluster of mental health problems among undergraduate university students., Methods: This cross-sectional study used a web-based demographic questionnaire [the Utrecht Work Engagement Scale for Students (UWES-S-J)] as study engagement scale. Moreover, information regarding life habits such as sleep duration and meal frequency, along with mental health problems such as depression and fatigue were also collected. Students with both mental health problems were classified as high risk. Characteristics of students in the two groups were compared. Univariate logistic regression was performed to identify predictors of membership. Receiver Operating Characteristic (ROC) curve was used to clarify the specific values that differentiated the groups in terms of significant predictors in univariate logistic analysis. Cut-off point was calculated using Youden index. Statistical significance was set at p  < 0.05., Results: A total of 1,644 students were assessed, and 30.1% were classified as high-risk for mental health problems. Significant differences were found between the two groups in terms of sex, age, study engagement, weekday sleep duration, and meal frequency. In the ROC curve, students who had lower study engagement with UWES-S-J score < 37.5 points (sensitivity, 81.5%; specificity, 38.0%), <6 h sleep duration on weekdays (sensitivity, 82.0%; specificity, 24.0%), and < 2.5 times of meals per day (sensitivity, 73.3%; specificity, 35.8%), were more likely to be classified into the high-risk group for mental health problems., Conclusion: Academic staff should detect students who meet these criteria at the earliest and provide mental health support to reduce DUI among undergraduate university students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ishimaru, Adachi, Mizumoto, Erdelyi, Nagahara, Shirai, Takemura, Takemura, Alizadeh, Higashino, Yagi and Ikeda.)

This retrospective cohort study investigates the association between the incidence of sleep problems and changes in digital media use among university students during the COVID-19 pandemic. It used data from annual health check-ups performed at a Japanese university in 2019 and 2020. Students undergoing these check-ups were identified to respond to questions about sleep problems, digital media use, breakfast and exercise habits, and stress. In total, 3,869 students were included in the analysis. The association between the incidence of sleep problems in 2020 and the changes in digital media use between 2019 and 2020 was assessed using logistic regression models. The rate of long digital media use (≥ 2 hours) in 2019 was 42.6%, while in 2020 it was 53.6%. Incidence of sleep problems was observed in 244 students (6.3%) in 2020. There were 786 students (20.3%) who used digital media for ≤ 2 h in 2019 and ≥ 2 h in 2020. From the sample, 66 students (8.4%) reported incidence of sleep problems in 2020. Additionally, those respondents who specifically reported increased digital media use between 2019 and 2020 (increased use) where at greater risk (OR: 1.76; 95% CI: 1.21, 2.55) of reporting sleep problems in 2020, even after controlling for other study variables. Thus, this study provides evidence that the incidence of sleep problems has had a significant association with an increase in digital media use among university students throughout the COVID-19 pandemic. These findings highlight the importance of ensuring appropriate digital media use among students for improved quality of sleep., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Watanabe, Adachi, Yamamoto, Fujino, Ishimaru, Kanayama, Sakagami, Akamine, Marutani, Mamiya, Mashita, Nakano, Kudo and Ikeda.)

Background: We developed the assessment scale for engagement in activities (ASEA), an assessment tool used to quantify engagement in therapeutic activities for patients with moderate-to-severe dementia. In this study, we report additional analyses to confirm the viability of ASEA as a reliable measurement scale., Methods: This study included 195 patients with moderate-to-severe dementia in a psychiatric acute-phase hospital. Additional analyses based on the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist were as follows: (i) exploratory and confirmatory factor analysis; (ii) standard error of measurement (SEM), minimal detectable change (MDC) and limit of agreement (LOA); (iii) short change score from baseline to 2 weeks; and (iv) correlation to the facial expression analysis system., Results: Exploratory factor analysis yielded two factors. This two-factor model of ASEA exhibited an acceptable and validated model fit (comparative fit index = 0.954, Tucker Lewis index = 0.936, goodness-of-fit index = 0.927, adjusted goodness-of-fit index = 0.873, root mean square error of approximation = 0.091, standardised root mean square residual = 0.045) by confirmatory factor analysis. SEM and MDC were 1.29 and 3.80, respectively. The Bland-Altman plot for examining LOA showed no apparent fixed bias. From baseline to 2 weeks later, 129 participants were retested. The mean ASEA total score improved significantly (Wilcoxon signed-rank test; P < 0.01, effect size = 0.25) from baseline (14.30 ± 2.63) to 2 weeks later (15.00 ± 2.73). The correlation between each emotion value was calculated using Kokoro sensor, which is an affect analysis based on human facial expression data using deep learning. For the 36 video data samples, the total score and domains of arousal, interaction, and affect in ASEA were statistically significantly correlated with the emotion value of joy, engagement, and valence (Spearman rank correlation; P < 0.05)., Conclusions: Among the few evaluation methods specific to severe dementia, ASEA is a useful scale for quantifying and evaluating the state of engagement in therapeutic activities., (© 2022 Japanese Psychogeriatric Society.)

Background: A comprehensive understanding of the relevant factors involved in improving quality of life (QoL) is essential in patients with severe dementia; however, rating scales used in previous studies may not adequately reflect the factors that affect these patients. The purpose of this study was to identify factors that contribute to QoL using an evaluation scale suitable for patients with severe dementia., Methods: The current cross-sectional study was conducted at a hospital for recuperation in Hyogo prefecture in Japan. The measurement scales included the QoL in Late-Stage Dementia Japanese version (QUALID-J), Cognitive Test for Severe Dementia, Neuropsychiatric Inventory-Nursing Home (NPI-NH), Physical Self-Maintenance Scale (PSMS), Pain Assessment in Advanced Dementia (PAINAD), and Special Care Unit Environment Quality Scale (SCUEQS). Multiple regression analyses were performed., Results: We assessed a total of 105 patients with severe dementia (80 women; aged 87.3 ± 6.3 years). Multiple regression demonstrated that the QUALID-J total score was significantly affected by the NPI-NH and PAINAD scores. Factors 1 (expression of comfort) and 2 (expression of discomfort) of the QUALID-J were significantly affected by the PSMS and PAINAD, and the NPI-NH and PAINAD scores, respectively., Conclusion: Our results indicate that behavioural and psychological symptoms of dementia and pain are important factors in influencing the QoL of patients with severe dementia., (© 2021 Japanese Psychogeriatric Society.)

Abstract: Insight into illness is a multidimensional phenomenon, and various assessments are available. We focused on Markova's Insight Scale (IS) and investigated the relationship between insight, psychological defenses, and neurocognition in 38 patients with schizophrenia. Results showed that insight was significantly correlated with an immature defense style. Moreover, IS was significantly predicted by immature defense style after adjusting for clinical variables. Although insight is often assumed to be multidetermined with potential contributions from factors such as cognitive function and psychological defensive mechanisms, our results indicated that better insight assessed with the IS is more likely to reflect immature defenses. This may also be reflected in our result that a higher insight score correlated with earlier onset of illness. The insight score may reflect the immature psychological defensive attitudes of schizophrenia and may lead such patients to wish to comply with the views of clinicians., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This study aimed to clarify the adaptation features of University students exposed to fully online education during the novel coronavirus disease 2019 (COVID-19) pandemic and to identify accompanying mental health problems and predictors of school adaptation. The pandemic has forced many universities to transition rapidly to delivering online education. However, little is known about the impact of this drastic change on students' school adaptation. This cross-sectional study used an online questionnaire, including assessments of impressions of online education, study engagement, mental health, and lifestyle habits. In total, 1,259 students were assessed. The characteristics of school adaptation were analyzed by a two-step cluster analysis. The proportion of mental health problems was compared among different groups based on a cluster analysis. A logistic regression analysis was used to identify predictors of cluster membership. P -values < 0.05 were considered statistically significant. The two-step cluster analysis determined three clusters: school adaptation group, school maladaptation group, and school over-adaptation group. The last group significantly exhibited the most mental health problems. Membership of this group was significantly associated with being female (OR = 1.42; 95% CI 1.06-1.91), being older (OR = 1.21; 95% CI 1.01-1.44), those who considered online education to be less beneficial (OR = 2.17; 95% CI 1.64-2.88), shorter sleep time on weekdays (OR = 0.826; 95% CI 0.683-.998), longer sleep time on holidays (OR = 1.21; 95% CI 1.03-1.43), and worse restorative sleep (OR = 2.27; 95% CI 1.81-2.86). The results suggest that academic staff should understand distinctive features of school adaptation owing to the rapid transition of the educational system and should develop support systems to improve students' mental health. They should consider ways to incorporate online classes with their lectures to improve students' perceived benefits of online education. Additionally, educational guidance on lifestyle, such as sleep hygiene, may be necessary., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ishimaru, Adachi, Nagahara, Shirai, Takemura, Takemura, Mehrasa, Higashino, Yagi and Ikeda.)

Background: Various types of therapy, including occupational therapy, are utilised for the treatment of moderate to severe dementia. In order to determine the optimal rehabilitation strategy for such patients and examine the treatment efficacy, an assessment scale for engagement in various group activities that can be easily applied in clinical situations is required. We herein report the development of the Assessment Scale for Engagement in Activities (ASEA) and its clinical utility., Methods: The ASEA was developed by nine occupational therapists and a psychiatrist with experience in developing measures for dementia, in accordance with the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. This assessment comprises 10 items covering four domains: Engagement in the Activity, Interaction, Arousal, and Affect. Participants with moderate to severe dementia who resided in a psychiatric acute phase hospital in Japan were assessed in terms of engagement in activities using the ASEA and Todai-shiki Observational Rating Scale (TORS), and in terms of cognitive function using the Mini-Mental State Examination (MMSE). We examined the internal consistency, inter- and intra-rater reliability, content validity, and concurrent validity of the ASEA., Results: Cronbach's alpha of the ASEA was 0.889. The overall inter-rater reliability was 0.937 (Spearman rank correlation, P < 0.001), and the intraclass correlation (ICC) for each item was 0.490-0.965 (P < 0.018-0.001). The overall test-retest reliability was 0.778 (Spearman's rank correlation, P < 0.001), and the ICC for each item was 0.498-0.863 (P < 0.023-0.001). The test-retest correlations were significant for almost all items, aside from 'Interaction with others' (P = 0.051). The concurrent validity, examined using the TORS and MMSE, was 0.920 and 0.304 (Spearman's rank correlation, P < 0.001-0.006)., Conclusions: The ASEA has confirmed reliability and validity, aside from 'Interaction with others' regarding test-retest reliability. Generally, this assessment tool has clinical utility and allows the evaluation of activity engagement among patients with moderate to severe dementia., (© 2021 Japanese Psychogeriatric Society.)

Backgrounds: Exostosin-1 (EXT1) and exostosin-2 (EXT2) cause multiple osteochondromas (MO). In this study, we investigated the correlation between forearm deformity and mutant EXTs in Japanese families with MO., Methods: We evaluated 112 patients in 71 families with MO. Genomic DNA was isolated from peripheral blood leucocytes. Of these, 28 patients were selected and underwent radiography for their forearms since they had gross forearm deformities. We measured the radial articular angle (RAA), ulna variance (UV), carpal slip (CS), and percentage of radial bowing (%RB) to compare between patients with mutant EXT1 or EXT2 and those with missense or other mutations using Student's t-test., Results: Twenty-two (78.6%) and 6 (11.4%) out of 28 patients had mutations in EXT1 and EXT2, respectively. Nine (32.1%) and 19 (67.9%) of the 28 patients had missense and other mutations, respectively. The mean age of patients with EXT1 and EXT2 were 25.9 ± 20.3 and 33.5 ± 25.4 years, respectively and those with missense mutation and other mutations were 28.7 ± 27.0 and 24.6 ± 17.0 years, respectively. There were no significant differences in RAA, UV, and RB between patients harbouring mutant EXT1 or EXT2 (RAA, 40.1 ± 8.7 and 31.5 ± 13.9°; UV, -2.7 ± 5.7 and -3.1 ± 3.7 mm; %RB, 8.6 ± 1.5 and 8.3 ± 2.0%). CS was significantly greater in patients with mutant EXT1 than that in those with mutant EXT2 (EXT1, 44.1 ± 16.8%; EXT2, 18.6 ± 14.0%). There were no significant differences in RAA, UV, CS and %RB between patients with missense and other mutations., Conclusions: Patients with mutant EXT1 displayed greater CS than patients with mutant EXT2, indicating that patients with MO harbouring EXT1 mutations sustain more severe ulnar drift deformities than those with EXT2 mutations., Competing Interests: Declaration of Competing Interest The authors describe that there are no conflicts of interest to declare., (Copyright © 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Purpose: People with dementia exhibit disturbed rest-activity rhythms and extended sleep duration issues throughout their disease. Little is known about the effects of these issues on clinical problems for those with moderate and severe dementia. This cross-sectional study aimed to examine the associations of disturbed rest-activity rhythms and extended sleep duration with activities of daily living (ADL)., Methods: Sleep parameters were measured using an actigraphy device. Cognitive function was assessed using the Mini-Mental State Examination and Cognitive Test for Severe Dementia, the Hyogo Activities of Daily Living Scale was used to assess ADL, and behavioral and psychological symptoms of dementia were assessed using the Neuropsychiatric Inventory-Nursing Home scale. Associations among rest-activity rhythms, sleep duration, and other clinical variables were analyzed with multiple linear regression. Clinical variables were compared between 2 groups categorized by onset timing of rest peak., Patients: Sixty-four participants with moderate and severe dementia were assessed., Results: In the correlation analysis, unstable daily rest-activity rhythm was associated with lower ADL. In the multiple linear regression analysis, low intradaily variability, and long daytime sleep duration were associated with low ADL. Aberrant rest peak timing showed lower ADL compared with nonaberrant timing., Conclusions: Abnormal rest-activity rhythm and sleep duration in persons with moderate and severe dementia may affect ADL., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: To identify the clinical factors affecting activities of daily living (ADL) at baseline and after 6 months., Methods: We conducted a single-centre observational study at two time points across 6 months (baseline and after 6 months) from April 2015 to March 2017. in a 270-bed rural recuperation hospital at Hyogo prefecture in Japan. The total number of participants was 131 (male 33, female 98; mean age: 87.0 ± 7.0; mild and moderate dementia, 38; severe dementia, 93). Measurement scales used were Personal Self-Maintenance Scale (PSMS) for assessing ADL, Mini-Mental State Examination and Cognitive Test in Severe Dementia (CTSD) for cognitive function, Neuropsychiatric Inventory-Nursing Home version and Cornell Scale for Depression in Dementia (CSDD) for behavioural/psychological symptoms of dementia, Mini Nutritional Assessment Short form (MNA-SF) for nutritional status, Pain Assessment in Advanced Dementia for pain, and Charlson comorbidity index (CCI) and the number of illness categories based on Cumulative Illness Rating Scale Geriatrics for comorbidities. Multiple regression analyses identified the association between PSMS score as the dependent variable and other variables as independent variables., Results: In participants with severe dementia, the PSMS scores at baseline were significantly associated with CTSD, CCI, MNA-SF, and CSDD scores. In the longitudinal analysis, only CTSD score was significantly associated with PSMS score after 6 months. It is noteworthy that for participants with severe dementia, the only factor associated with ADL after 6 months was cognitive function, as assessed by CTSD score., Conclusions: The most important factor predicting functional decline is cognitive function, even at the severe and profound stage., (© 2019 Japanese Psychogeriatric Society.)

Background: The authors examined associations between physical activity, cognitive function, activities of daily living, and behavioral and psychological dementia symptoms (BPSD) in severe and moderate dementia., Methods: A cross-sectional study was conducted to assess severe and moderate dementia groups according to the Clinical Dementia Rating. An actigraphy measured physical activity. Other measures included Mini-Mental State Examination, Cognitive Test for Severe Dementia, Hyogo Activities of Daily Living Scale, and Neuropsychiatric Inventory-Nursing Home., Results: Sixty-three participants were assessed (mean age = 89.3 ± 6.4). Physical activity was not associated with cognitive function among participants with severe dementia, although there was a trend-level association with cognitive function among those with moderate dementia. Physical activity was significantly associated with BPSD, specifically agitation/aggression symptoms, for participants with severe dementia, and there was a trend-level association with anxiety for participants with moderate dementia., Conclusions: Physical activity appears to be associated with BPSD among individuals in the advanced stages of dementia.

In this histologically controlled in vitro study, we evaluated the validity of plain radiography for the assessment of lateral knee joint cartilage degeneration (25 specimens). We examined the correlation between histological grade and radiography findings along with patient demographics. Our study indicated that the Mankin score had a significant inverse correlation with middle joint space width (JSW ; r=-0.19,P=0.02), but not with inner and outer JSW (inner : r=-0.11,P=0.10, outer : r=-0.14,P=0.06) under a non-weight bearing condition. The Mankin score had a significant inverse correlation with middle and outer JSW (middle : r=-0.17,P=0.04, outer : r=-0.14,P=0.04), but not with inner JSW (inner : r=-0.15,P=0.06) under valgus stress. There was no significant correlation between the Mankin score and osteophyte thickness (r=0.004,P=0.76). We also examined the correlation with patient demographics. We found that only the preoperative femorotibial angle had a significant inverse correlation with the Mankin score. These results indicate that JSW, but not osteophyte thickness, is reliable for evaluating lateral femoral cartilage degeneration.

Although the psychological denial model argues that poor insight is a result of defense mechanisms, the direct relationship between the two remains unclear. This study aimed to examine the relationship between insight into illness and defense mechanisms while considering cognitive dysfunction in schizophrenia. A total of 38 patients with schizophrenia were evaluated for level of insight (Schedule for the Assessment of Insight), defense mechanisms (Defense Style Questionnaire), neurocognitive function (Brief Assessment of Cognition in Schizophrenia), and psychotic symptoms (Brief Psychiatric Rating Scale). Regarding level of insight, partial correlation analysis controlling neurocognitive and psychotic variables showed that "recognition of illness" was positively correlated with immature defense styles and negatively correlated with mature defense styles. Stepwise regression analyses revealed that "recognition of illness" was significantly predicted by immature defense styles. Our findings suggest that patients who tend to use immature defense styles are more likely to accept their own mental illness.

Bony mallet injury of the hallux is uncommon. In the few reports of this injury, authors have described surgical treatments such as closed reduction with percutaneous pinning and open surgical fixation with Kirschner wires or a suture anchor. However, the appropriate surgical management for this injury remains controversial. In this article, we describe a case of bony mallet injury of the hallux repaired with the modified extension block techniqueusing 3 Kirschner wires. This method is an effective and simple treatment to allow anatomic reduction of the displaced articular fracture fragment without incision, residual hardware, or the complications associated with open surgical treatment., (Copyright © 2018 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Aims: This study sought to conduct additional analyses of the Cognitive Test for Severe Dementia (CTSD) using the COSMIN checklist to ensure the development of adequate outcome measures., Methods: The following analyses were conducted: (1) factor analyses were used to evaluate construct validity; (2) the standard error of measurement (SEM) and minimal detectable change (MDC) were assessed to evaluate reliability and interpretability; and (3) longitudinal change was assessed to evaluate responsiveness., Results: The CTSD factor analysis yielded 2 factors, each of which was dichotomized by the passage rate of each item. We calculated a SEM and MDC of 1.6 and 3.6 points, respectively. Finally, the mean CTSD score showed a significant reduction ( p < 0.001) over time, and the change in score exceeded the SEM and MDC., Conclusion: Our results indicate that the CTSD could provide a reliable outcome measure in severe dementia.

Aim: Until now, there has been no instrument to measure the quality of life (QoL) of patients with severe dementia in Japan. The purpose of this study was to translate the Quality of Life in Late-stage Dementia Scale and to evaluate the reliability and validity of the Japanese version (QUALID-J)., Methods: We translated the Quality of Life in Late-stage Dementia into Japanese with permission from the original authors. We assessed a total of 70 dementia patients (14 men, 56 women; mean age: 87.4 ± 7.9 years) with the QUALID-J., Results: The test-retest and inter-rater reliability of the QUALID-J was significant. With regard to the criterion-related validity, the correlation coefficient for the total score between the QUALID-J and Quality of Life for Alzheimer's Disease was -0.287 (P < 0.05). With regard to the construct validity, the QUALID-J total score was significantly correlated with the Mini-Mental State Examination (ρ = -0.346, P < 0.01), the Cognitive Test for Severe Dementia (ρ = -0.323, P < 0.01), the Neuropsychiatry Inventory-Nursing Home version (ρ = 0.386, P < 0.01), the Cornell Scale for Depression in Dementia (ρ = 0.262, P < 0.05), the Physical Self-Maintenance Scale (ρ = -0.283, P < 0.05), and the Pain Assessment in Advanced Dementia (ρ = 0.530, P < 0.01)., Conclusion: The results of this study showed that the QUALID-J is a reliable and valid quality of life scale for severe dementia. This scale finally enables an adequate assessment of the quality of life of patients with severe dementia in Japan, which has not been possible until now., (© 2018 Japanese Psychogeriatric Society.)

Background: Optimal treatments of patients aged >40 years with osteosarcoma and Ewing sarcoma and of patients with other types of bone sarcoma have not yet been established., Methods: The clinical characteristics of 746 patients with primary bone sarcomas aged >40 years listed in the nationwide tumor registry (Bone and Soft Tissue Tumor Registry of Japan) were investigated. Patients with Ewing sarcoma, conventional chondrosarcoma, multiple myeloma, and malignant lymphoma were excluded. The effects of adjuvant chemotherapy were determined by comparing outcomes in patients aged 40-70 years with non-metastatic high grade bone tumors who received surgery plus chemotherapy with those who underwent surgery alone., Results: Axial site tumors (38.6%) and distant metastasis at presentation (21.4%) were frequent in patients aged >40 years with primary bone sarcomas. Chemotherapy was administered to 407 (54.6%) patients. Their 5-year overall survival (OS) and progression free survival (PFS) rates were 47.6% and 39.8%, respectively. Multivariate analysis showed that distant metastases at presentation, histological high grade, and radiation therapy were significantly correlated with both OS and PFS. Age and tumor size were also significantly correlated with OS. Patients aged 40-70 years who underwent surgery plus chemotherapy and those who underwent surgery alone had 5-year OS rates of 69.3% and 63.2%, respectively (p = 0.092), and 5-year PFS rates of 55.4% and 50.7%, respectively (p = 0.63)., Conclusions: Bone sarcoma patients aged >40 years had distinct clinical features and a poor prognosis. Chemotherapy did not improve OS or PFS in patients aged 40-70 years., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Objective: The purpose of this study was to elucidate the characteristics of spinal fractures during recreational snowboarding and to determine the risk factors for these fractures., Design: Case series study., Setting: The Oku-mino ski area during the 7-year period between the 2005 to 2006 and 2011 to 2012 skiing seasons., Participants: Eight thousand seven hundred twenty-three snowboarders with injures., Interventions: Cases involved snowboarders with spinal fractures; controls were snowboarders without spinal fractures., Main Outcome Measures: The characteristics of spinal fractures were assessed using a standard form and patient records, including radiographs. Multivariate regression analysis was performed to investigate risk factors for spinal fractures, including age, type of slope, snow condition, accident cause, self-reported skill level, experience level, and the use of protective equipment., Results: Of 8723 snowboarders with injuries, 431 snowboarders presented with spinal fractures (4.9%). The most common spinal fracture was isolated transverse process fracture in the lumbar spine (33.2%, n = 143), followed by compression type fracture in the lumbar spine (25.1%, n = 108). Age (20-39 years), terrain slopes (half-pipe/box/kicker/rail), and jump-landing failure were associated with a significantly high risk of spinal fracture., Conclusions: Among the recreational snowboarders, isolated transverse process fracture in the lumbar spine was the most frequent spinal fracture. Age (20-39 year old), terrain slopes, and jump-landing failure were found to be risk factors for spinal fracture., Clinical Relevance: Identification of characteristics and risk factors for spinal fractures during snowboarding is useful information to create a preventive strategy for the fractures and make snowboarding a safer sport.

Background: Multiple osteochondroma (MO) is an autosomal dominant skeletal disorder characterized by the formation of multiple osteochondromas, and exostosin-1 (EXT1) and exostosin-2 (EXT2) are major causative genes in MO. In this study, we evaluated the genetic backgrounds and mutational patterns in Japanese families with MO., Results: We evaluated 112 patients in 71 families with MO. Genomic DNA was isolated from peripheral blood leucocytes. The exons and exon/intron junctions of EXT1 and EXT2 were directly sequenced after PCR amplification. Fifty-two mutations in 47 families with MO in either EXT1 or EXT2, and 42.3% (22/52) of mutations were novel mutations. Twenty-nine families (40.8%) had mutations in EXT1, and 15 families (21.1%) had mutations in EXT2. Interestingly, three families (4.2%) had mutations in both EXT1 and EXT2. Twenty-four families (33.8%) did not exhibit mutations in either EXT1 or EXT2. With regard to the types of mutations identified, 59.6% of mutations were inactivating mutations, and 38.5% of mutations were missense mutations., Conclusions: We found that the prevalence of EXT1 mutations was greater than that of EXT2 mutations in Japanese MO families. Additionally, we identified 22 novel EXT1 and EXT2 mutations in this Japanese MO cohort. This study represents the variety of genotype in MO.

Soft tissue metastases of prostate cancer to other sites are extremely rare, and, to our best knowledge, there have been no reports of metastasis to soft tissue of the hand. A 63-year-old man was diagnosed with prostatic cancer. During treatment, bone and soft tissue metastases to the right hand, appearing in the first web space, were observed. The tumor was resected, along with both the first and second metacarpal bones. The thumb was reconstructed by pollicization of the remaining index finger, enabling the patient to use the pollicized thumb for activities of daily living. This is the first case report of prostate cancer metastasizing to the soft tissue in hand. After wide resection, pollicization was able to reconstruct a functional hand and thumb.

Mild discolouration of the articular cartilage is known to gradually occur during aging. However, pathological tissue pigmentation is occasionally induced under several specific conditions. In the present case, we performed total knee replacement in a patient with recurrent haemarthrosis. However, during the operation, we observed severe black colouration of the knee articular cartilage, due to the deposition of hemosiderin and lipofuscin. To our knowledge, this is the first report of severe cartilage pigmentation, due to hemosiderin and lipofuscin deposition in articular cartilage.

Objective: To examine whether child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures., Design: Descriptive epidemiological study., Setting: Prospectively analyzed the epidemiologic factors, injury types, and injury mechanisms at Sumi Memorial Hospital., Patients: This study analyzed information obtained from 276 patients with tibial fractures sustained during skiing between 2004 and 2012., Main Outcome Measures: We focused on 174 ski-related tibial shaft fractures with respect to the following factors: age, gender, laterality of fracture, skill level, mechanism of fracture (fall vs collision), scene of injury (steepness of slope), snow condition, and weather. Fracture pattern was graded according to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and mechanical direction [external (ER) or internal rotation (IR)]., Results: Tibial shaft fractures were the most common in both children (89.3%) and adults (47.4%). There were no significant differences in gender, side of fracture, mechanism of fracture, snow condition, or weather between children and adults. Skill levels were significantly lower in children than in adults (P < 0.0001). Type A fractures were more dominant in children (73 cases, 72.3%) than in adults (39 cases, 53.4%). There was significantly more ER in children than in adults (P < 0.0001). Among children, female patients had significantly more IR than ER; in contrast, among adults, women were injured by ER., Conclusions: We found significant differences in some of these parameters, suggesting that child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures.

MicroRNA (miRNA) biogenesis follows a conserved succession of processing steps, beginning with the recognition and liberation of an miRNA-containing precursor miRNA hairpin from a large primary miRNA transcript (pri-miRNA) by the Microprocessor, which consists of the nuclear RNase III Drosha and the double-stranded RNA-binding domain protein DGCR8 (DiGeorge syndrome critical region protein 8). Current models suggest that specific recognition is driven by DGCR8 detection of single-stranded elements of the pri-miRNA stem-loop followed by Drosha recruitment and pri-miRNA cleavage. Because countless RNA transcripts feature single-stranded-dsRNA junctions and DGCR8 can bind hundreds of mRNAs, we explored correlations between RNA binding properties of DGCR8 and specific pri-miRNA substrate processing. We found that DGCR8 bound single-stranded, double-stranded, and random hairpin transcripts with similar affinity. Further investigation of DGCR8/pri-mir-16 interactions by NMR detected intermediate exchange regimes over a wide range of stoichiometric ratios. Diffusion analysis of DGCR8/pri-mir-16 interactions by pulsed field gradient NMR lent further support to dynamic complex formation involving free components in exchange with complexes of varying stoichiometry, although in vitro processing assays showed exclusive cleavage of pri-mir-16 variants bearing single-stranded flanking regions. Our results indicate that DGCR8 binds RNA nonspecifically. Therefore, a sequential model of DGCR8 recognition followed by Drosha recruitment is unlikely. Known RNA substrate requirements are broad and include 70-nucleotide hairpins with unpaired flanking regions. Thus, specific RNA processing is likely facilitated by preformed DGCR8-Drosha heterodimers that can discriminate between authentic substrates and other hairpins.

Messenger RNA encoded signals that are involved in programmed -1 ribosomal frameshifting (-1 PRF) are typically two-stemmed hairpin (H)-type pseudoknots (pks). We previously described an unusual three-stemmed pseudoknot from the severe acute respiratory syndrome (SARS) coronavirus (CoV) that stimulated -1 PRF. The conserved existence of a third stem-loop suggested an important hitherto unknown function. Here we present new information describing structure and function of the third stem of the SARS pseudoknot. We uncovered RNA dimerization through a palindromic sequence embedded in the SARS-CoV Stem 3. Further in vitro analysis revealed that SARS-CoV RNA dimers assemble through 'kissing' loop-loop interactions. We also show that loop-loop kissing complex formation becomes more efficient at physiological temperature and in the presence of magnesium. When the palindromic sequence was mutated, in vitro RNA dimerization was abolished, and frameshifting was reduced from 15 to 5.7%. Furthermore, the inability to dimerize caused by the silent codon change in Stem 3 of SARS-CoV changed the viral growth kinetics and affected the levels of genomic and subgenomic RNA in infected cells. These results suggest that the homodimeric RNA complex formed by the SARS pseudoknot occurs in the cellular environment and that loop-loop kissing interactions involving Stem 3 modulate -1 PRF and play a role in subgenomic and full-length RNA synthesis.

Objective: The purpose is to determine common injuries in recreational snowboarding as targets of preventive strategy and protective gear that reduces the overall risk of these injuries., Methods: The subjects comprised 5561 injured recreational snowboarders. On the basis of patients' self-reporting form, 'the common snowboarding injuries' (cut-off point >2.0% in prevalence) were decided, and all injured snowboarders were categorised into two groups: common injuries and the other injuries (control). Several factors such as age, gender, self-reported skill level, experienced seasons, experienced days, previous snowboarding school attendance and the use of protective gears (helmet, elbow pads, wrist guards, backbone guard, hip pads and knee pads) were recorded. Multiple logistic regression analysis was conducted to investigate which type of protective gear reduced the overall risk of the common injuries., Results: The common snowboarding injuries consisted of eight types, in which distal radial fracture was the most common (17.7%), followed by head injury (9.4%) and clavicle fracture (6.5%). In univariate regression analysis, skill level, experienced seasons, experienced days and the use of hip pads and knee pads were manifested potential risk factors on the common injuries. In subsequent multivariate regression analysis, the use of hip pads was related with a lower overall risk of these common injuries (OR, 0.84; 95% CI, 0.75 to 0.95), specifically that of distal radial fracture and glenohumeral dislocation., Conclusions: The use of hip pads is recommended for snowboarders as it reduces the overall risk of common snowboarding injuries.