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OBJECTIVES The pain of hip osteoarthritis is generally recognized as nociceptive in origin because of the local pathology. However, some patients with osteoarthritis experience a neuropathic pain component as an essential part of some nociplastic pain subtype. Here, we sought to examine the mechanism of chronic pain of symptomatic hip osteoarthritis by association of its distribution, complex pain mechanism screening, and the prevalence of lumbar spinal stenosis (LSS). METHODS We conducted a prospective cross-sectional study of 100 hips in 100 patients with symptomatic hip osteoarthritis in a chronic state. We examined all baseline clinical characteristics including clinical and functional score, location of pain and numbness, and pain score (PainDETECT questionnaire (PDQ) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)), and magnetic resonance imaging of the hip and lumbar spine. RESULTS The PDQ and LANSS revealed that 23% of the patients had a neuropathic pain component. There were 24 variations of the pain pattern. By contrast, the pain localized around the hip joint was only 15%. Pain distal to the thigh and any numbness was significantly more frequent in the group with neuropathic pain (P

Background One of the major complications of gastric endoscopic submucosal dissection (ESD) is delayed bleeding. The treatment of exposed vessels after completed dissection should be effective to avoid delayed bleeding. However, it’s sometimes difficult to detect the detection of exposed blood vessels on ulcers induced by ESD. A recent study reported that red dichromatic imaging (RDI) was useful for detecting exposed vessels. In this study, we aimed to measure the visibility of exposed vessels and the quantitative color difference between the exposed vessels and surrounding tissue on ulcers, as observed using RDI after completed dissection. Methods Sixty-four vessels (14 patients) in gastric ESD-induced ulcers were evaluated using both white light imaging (WLI) and RDI. The Commission Internationale de l’Eclairage 1976 (L*a*b*) color space was used to measure the color difference. The color difference was evaluated by comparing the color values of regions of interest for the point of an exposed vessel and three points surrounding an exposed vessel. The visibility of exposed vessels was evaluated using a visibility scoring system. The primary endpoint was color differences (ΔE) between the exposed vessels and surrounding tissue in each modality. Results The average ΔE values (± SEM) for WLI and RDI were 24.85 (± 1.19) and 31.83(± 1.31), respectively. The ΔE value for RDI was significantly higher than that for WLI (p < 0.01). The visibility score was improved in 54.7% (35/64) of cases. Conclusions The color differences between the exposed vessels and surrounding tissue on gastric ESD-induced ulcers were higher with RDI than with WLI, and RDI improved the visibility of exposed vessels.

Background and Aim The mechanism underlying carcinogenesis and the genomic features of superficial non‐ampullary duodenal epithelial tumors (SNADETs) have not been elucidated in detail. In this study, we examined the genomic features of incipient SNADETs, such as small lesions resected via endoscopic treatment, using next‐generation sequencing (NGS). Methods Twenty consecutive patients who underwent endoscopic treatment for SNADETs of less than 20 mm between January and December 2017 were enrolled. Targeted genomic sequencing was performed through NGS using a panel of 160 cancer‐related genes. Furthermore, the alteration/mutation frequencies in SNADETs were examined. Results The maximum size of the SNADETs examined in this study was 12 mm in diameter. Five SNADETs were classified as low‐grade dysplasia (LGD) tumors, while 14 SNADETs were classified as high‐grade dysplasia tumors. Only one carcinoma in situ was detected. NGS data for 16 samples were obtained. APC alterations were detected in 81% of samples (13/16). KRAS, BRAF, and TP53 alterations were detected in 25% (4/16), 18.8% (3/16), and 6.3% (1/16) of cases, respectively. Conclusion We detected APC alterations in most small SNADETs resected via endoscopic treatment, from LGD to carcinoma samples. Even in SNADETs classified as small LGD exhibited KRAS and BRAF alterations., APC alterations were detected in most small superficial non‐ampullary duodenal epithelial tumors (SNADETs) resected via endoscopic treatment. Even in SNADETs classified as small low‐grade dysplasia, KRAS and BRAF alterations were present in a few samples.

Hepatocellular carcinoma (HCC) hemorrhaging/rupture is a rare adverse effect of lenvatinib, and only limited pathological examinations have been reported. This report presents the case of a 69-year-old man who suffered from cardiac arrest and died 7 days after starting lenvatinib treatment for HCC, with an autopsy subsequently performed. Crack and coagulated blood were observed in the largest tumor. Pathologically, the hemorrhaging area was scattered in nearly all of the HCC lesions, regardless of tumor differentiation. This pathological feature is unusual in normal HCC. Thus, it is believed to have been the effect of lenvatinib.

AimsThe main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA.MethodsA retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis.ResultsRLLs were detected in 27.2% of patients one year postoperatively. In multivariate regression analysis controlling for confounders, atrophic osteoarthritis (odds ratio (OR) 2.17 (95% confidence interval (CI), 1.04 to 4.49); p = 0.038) and 26 mm (OR 3.23 (95% CI 1.85 to 5.66); p < 0.001) or 28 mm head diameter (OR 3.64 (95% CI 2.07 to 6.41); p < 0.001) had a significantly greater risk for any RLLs one year after surgery. Structural bone graft (OR 0.19 (95% CI 0.13 to 0.29) p < 0.001) and location of the hip centre within the true acetabular region (OR 0.15 (95% CI 0.09 to 0.24); p < 0.001) were significantly less prognostic. Improvement of the cement-bone interface including complete disappearance and poorly defined RLLs was identified in 15.1% of patients. Kaplan-Meier survival analysis for the acetabular component at ten years with revision of the acetabular component for aseptic loosening as the end point was 100.0% with a RLL and 99.1% without a RLL (95% CI 97.9 to 100). With revision of the acetabular component for any reason as the end point, the survival rate was 99.2% with a RLL (95% CI 97.6 to 100) and 96.5% without a RLL (95% CI 93.4 to 99.7).ConclusionThis study demonstrates that acetabular bone quality, head diameter, structural bone graft, and hip centre position may influence the presence of the any RLL. Cite this article: Bone Joint Open 2021;2(5):278–292.

A well-fixed cement–bone interface is a crucial factor for acetabular and femoral components in cemented total hip arthroplasty (THA). The aim of the present study was to evaluate the middle-term clinical and radiological results of fixing the acetabular component with an interface bioactive bone cement (IBBC) technique in primary cemented THA. We undertook a retrospective review was undertaken of 193 primary cemented THAs in 174 patients using acetabular components cemented with an IBBC technique and followed for a minimum of 5 years (mean 8.3 years; range 5–17 years). Baseline data, clinical and radiological outcomes were evaluated. Japanese Orthopedic Association hip score and modified Harris hip scores demonstrated significant clinical improvement in all patients (p

The human parainfluenza viruses are common causes of upper and lower respiratory tract infection; however, nonrespiratory infections with human parainfluenza viruses are rare, and there are no reports of pediatric cases of liver enzyme elevation. We present 2 pediatric patients who developed liver enzyme elevation related to human parainfluenza virus type 3 infection.

The Trilliance stem (B. Braun-Aesculap, Tuttlingen, Germany), a novel collarless triple-tapered polished stem, was introduced in 2009. The aim of this study is to evaluate the long-term clinical and radiological results of the Trilliance stem with line-to-line implantation in primary total hip arthroplasty using a direct anterior approach.A consecutive retrospective series of 130 patients (151 hips) who underwent total hip arthroplasty between February 2009 and August 2011 were evaluated for a minimum of 10 years. Of these, 87.4% had a diagnosis of secondary osteoarthritis based on developmental hip dysplasia. Clinical and radiological results, complications were evaluated and survival analysis was performed.The mean follow-up was 10.7 years (range, 10.0-12.1). Thirteen hips (13 patients, 6.8%) were lost to follow-up. Adequate cementation (Barrack grade A) was achieved in 136 hips (93.8%) 1 week post-operatively. Nearly all (144 hips, 99.3%) had been inserted within the range of 3°. No significant differences were identified between high- (≥30 procedures/year) and low- (30 procedures/year) volume surgeons. The Kaplan-Meier survival analysis with revision of the femoral component for aseptic loosening, revision of the femoral component for any reason and revision of either component for any reason as the end points, cumulative survivorship was 100.0%, 97.6% (95% confidence interval (CI) 95.4-100.0) and 96.5% (95% CI 93.8-99.3) at 10 years, respectively.The Trilliance stem with line-to-line implantation using a direct anterior approach has an excellent clinical and radiological outcome at a minimum of 10 years' follow-up.Level IV, Retrospective cohort study.

A 23-year-old man had epilepsy, mental retardation, and a stereotyped movement (figure 1 and video1), which was exacerbated by emotion. No abnormality was detected in the EEG during this movement. Array comparative genomic hybridization showed a Xq28 duplication: arr[GRCh37]Xq28(153032004_153406233)x2 (figure 2).

Little is known about the association between well-fixed polished tapered cemented stems (PTCS) implanted by the line-to-line technique and changes of stem migration, or the change of functional anteversion of the femur after total hip arthroplasty (THA). This retrospective study included 422 two-stage bilateral primary THAs performed using PTCS implanted by the line-to-line technique. CT scans were made on both the target side (first postoperative CT) and on the contralateral side (second postoperative CT) 1 week postoperatively. The mean follow-up was 7.8 months. CT data for each scan were transferred to 3D template software (Zed hip, Lexi, Japan). The postoperative changes of anatomical stem anteversion (ASA), functional femoral anteversion (FFA), and stem subsidence were evaluated. A total of 20 THAs with CT scans were available on 3D template software. The ASA and the FFA had migrated − 0.68° ± 0.62° and − 5.5° ± 9.7°, respectively, over the follow-up period. A significant positive correlation was observed between the change of subsidence and ASA (r2 = 0.34, p = 0.007), between the FFA on the second postoperative CT and ASA on the first postoperative CT (r2 = 0.26, p = 0.02) and between the FFA on the second postoperative CT and FFA on the first postoperative CT (r2 = 0.52, p = 0.0003). This study indicates that the change in axial rotation of a PTCS implanted by the line-to-line technique was less than that reported by other studies and the preoperative external rotation contracture was substantially improved after THA.

We investigated the efficacy of duloxetine on hyperalgesia, histopathological and radiographic findings, pain-related sensory innervation of dorsal-root ganglia (DRG), and spinal changes in a rat model of induced hip osteoarthritis (OA). The right hip joints of male Sprague-Dawley rats (n = 6 rats/group) in the Sham group were injected with 25 μl of sterile saline and 25 μl of sterile saline with 2 mg of monosodium iodoacetate (MIA) were injected to the MIA + Vehicle and MIA + Duloxetine groups. We injected duloxetine 20 mg/kg intraperitoneally in the MIA + Duloxetine group 28 days after injection, whereas rats in the MIA + Vehicle group were injected with 0.5 ml of 20% dimethyl sulfoxide. We assessed hyperalgesia, histopathological changes, immunoreactive (-ir) neurons for calcitonin gene-related peptide and activating transcription factor 3 in DRG, and immunoreactive neurons for ionized-calcium-binding adaptor molecule 1 (Iba1) in the dorsal horn of the spinal cord. MIA administration into the hip joint let to mechanical hyperalgesia of the ipsilateral hind paw (p < 0.05). A single injection of duloxetine significantly attenuated it in induced hip OA (p < 0.05) and suppressed the number of Iba1-ir microglia of the ipsilateral dorsal horn (p < 0.05). These results suggest that a single injection of duloxetine suppressed mechanical hyperalgesia and may influence the expression of Iba1 in the microglia of the ipsilateral dorsal horn in the MIA-induced hip OA. This finding implies the inhibitory effects of duloxetine against neuropathic pain, which may lead to a change of microglial activities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:422-430, 2020.

Background Monoiodoacetate (MIA)-induced arthritis models are used widely in osteoarthritis (OA) research to develop effective conservative treatments for hip OA, as an alternative to joint replacement surgery. In joint OA models, such as the MIA-induced knee OA model, various doses of MIA are utilized, depending on the purpose of the research. So far, only 2 mg of MIA has been used for MIA-induced hip OA research. We hypothesized that the amount of MIA should be adjusted according to the osteoarthritis model under investigation. We performed radiographic and histological evaluations in rats for hip OA models induced by different doses of MIA. Methods One hundred and eighty right hips of six-week-old, male Sprague–Dawley rats (n = 30 rats per group) were treated with either a single intra-articular injection of various doses of MIA (0.25, 0.5, 1.0, 2.0, and 4.0 mg) dissolved in 25 μl of sterile saline (MIA group), or with 25 μl of sterile saline alone (Sham group). Radiographic and histological evaluations of the hip joint were performed at one, two, four, eight, and 12 weeks after administration (n = 6 rats per group per time point). Results OA changes progressed from 1 week after administration in the 1.0-mg, 2.0-mg, and 4.0-mg MIA groups. The degree of OA changes increased as the dose of MIA increased. The 0.25-mg and 0.5-mg MIA groups presented fewer OA changes than the 2.0-mg and 4.0-mg MIA groups during the entire study period (up to 12 weeks). The administration of 0.25 mg and 0.5 mg of MIA-induced both radiographic and histological OA changes in a time-dependent manner, whereas more than 2 mg of MIA provoked end-stage OA at 8 weeks after injection. Absolute, dose-dependent histopathological OA changes were observed 4 weeks after MIA administration. Conclusions Intra-articular MIA injection to the hip joints of rats induced diverse OA changes dose-dependently. Research for developing novel conservative treatments for hip OA and intractable pain should consider the pathological condition when determining the dose of MIA to be employed.

Background: Helicobacter pylori (H. pylori) gastritis could cause dyspepsia, and eradication is recommended as the first-line treatment. Patients who continuously have their symptoms under control > 6 months after eradication are defined as having H. pylori-associated dyspepsia (HPD), whereas patients who do not benefit from successful eradication are defined as having functional dyspepsia. Objectives: We assessed changes in dyspeptic symptoms after successful eradication of H. pylori by using a questionnaire. Methods: We studied H. pylori-infected dyspeptic participants with abdominal symptom scores > 4 points on the Global Overall Symptom (GOS) scoring items and received eradication therapy. We evaluated their symptoms using the GOS questionnaire before their eradications, at 1-month and at 1-year check-ups after eradication therapy. Results: Thirty dyspeptic participants (mean age 59.6 ± 15.3 years) answered every questionnaire. Fourteen participants (46.7%) had HPD, whereas 16 participants (53.3%) were non-HPD patients. The questionnaire at 1 month showed sensitivity of 64.3% (9/14) and specificity of 56.3% (9/16) for HPD. Approximately 60% of H. pylori-infected dyspepsia participants were identified as having HPD or non-HPD within 1 month after their eradications. Conclusions: Approximately 60% of HPD participants improved at 1 month after eradication. The questionnaire at 1 month helped diagnose HPD in advance and guided next treatment choice.

Highlights • Stress fractures of the midshaft of the clavicle caused by sternocostoclavicular hyperostosis are very rare. • The differential diagnosis of sternocostoclavicular hyperostosis might be difficult. • Sternocostoclavicular hyperostosis in the patient was suspected of having either SAPHO syndrome or ankylosing spondylitis. • The patient was treated conservatively and the shoulder function was satisfactory at the final follow-up., Introduction Stress fracture is generally a result of cumulative and repetitive stress in athletes, which accelerates the normal remodeling process of bones, and the most frequently involved areas are the tibia and metatarsal bones. Therefore, stress fractures of the midshaft of the clavicle are very rare. Presentation of case A 58-year-old female was admitted to our hospital because of pain in the middle of the right clavicle. Based on laboratory and radiographic inspection, it was concluded that the stress fracture of the midshaft of the clavicle in this case was caused by sternocostoclavicular hyperostosis (SCCH). Because the clavicular fracture had no displacement or callus formation, conservative treatment with a clavicle band was undertaken. Shoulder function at the final follow-up visit was satisfactory. Discussion SCCH is a rare chronic inflammatory disorder of the axial skeleton and ossifying diathesis associated with a predominantly osteogenic response. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and ankylosing spondylitis (AS) should be considered in the differential diagnosis of SCCH. If a patient with this type of fracture has no history of traumatic injury or sports activity, the differential diagnosis might be very difficult. Conclusion We report the case of a female who had a stress fracture of the midshaft of the clavicle associated with SCCH in SAPHO or AS. Although the patient was treated conservatively, and the shoulder function was satisfactory at the final follow-up visit, re-fracture may occur in the future.

Although pediatric lower limb shaft fractures are common, little is known about associated injuries. The purpose of this study was to examine associated injuries complicated by pediatric lower limb shaft fractures and the efficacy of surgical treatment using a flexible stainless-steel intramedullary Ender nail in children less than 15 years old. This is a retrospective review of 29 children younger than 15 years old who were diagnosed with femoral or tibial shaft fractures and treated using Ender nails from 2005 to 2016. Baseline data, etiology, associated injuries, fracture site and patterns, operative and post-operative assessment were evaluated. The average age of the patients was 9.0 years, and mean follow-up was 18.2 months. Eleven patients (79%) had associated injury. At the final follow up, six patients (43%) sustained complications associated with the insertion area of the nail. There was no evidence of deep infection or nonunion at either fracture site. The clinical results were excellent in 10 (67%) fractures, and good in 5 (33%) fractures, based on the modified Flynn criteria. Almost all patients with a femoral fracture had an associated injury including abdominal visceral injury, cerebral contusion or other fractures. This study indicated good clinical and functional outcomes. On the other hand, the minor complications rate was high. Nevertheless, elastic stable intramedullary nailing recently has become available in Japan, and a prospective and comparative study is needed.

Lymphoepithelioma-like carcinoma is a poorly differentiated carcinoma with prominent lymphoid infiltration occurring in various organs but is exceedingly rare in the colorectal region. This malignancy is frequently associated with Epstein-Barr virus (EBV). Here we report a case of EBV-associated lymphoepithelioma-like carcinoma of the cecum in an 84-year-old male who presented with occult blood. In situ hybridization for EBV-encoded small RNAs (EBER) in an endoscopic submucosal dissection specimen showed that the tumor consisted of EBER-negative well-differentiated tubular adenocarcinoma and EBER-positive lymphoepithelioma-like carcinoma. Real-time PCR detected 7.16 copies of the EBV genome per cell in a sample microdissected from the latter component. Genotyping analysis demonstrated EBV genotype 1, and viral protein/transcript expression in the tumor showed EBV latency I. Expression of Ephrin receptor A2, a recently reported receptor for EBV, was demonstrated in the tumor cells by immunohistochemistry. To our knowledge, this is the first report of lymphoepithelioma-like carcinoma in the colorectal region showing a definite association with EBV infection.

Introduction The mechanism underlying carcinogenesis and the genomic features of superficial non-ampullary duodenal epithelial tumors (SNADETs) have not been elucidated in detail. In this study, we examined the genomic features of incipient SNADETs, such as small lesions resected via endoscopic treatment, using next-generation sequencing (NGS). Methods Twenty consecutive patients who underwent endoscopic treatment for SNADETs of less than 20 mm between January 2017 and December 2017 were enrolled. Targeted genomic sequencing was performed through NGS using a 160 cancer-related gene panel. We examined the alteration/mutation frequencies in SNADETs. Results The maximum size of the SNADETs examined in this study was 12 mm in diameter. Five SNADETs were classified as low grade dysplasia (LGD) tumors, while 14 SNADETs were classified as high grade dysplasia tumors. Only one carcinoma-in-situ tumor was detected. We obtained NGS data for 16 samples. APC alterations were detected in 81% of samples (13/16). KRAS, BRAF, and TP53 alterations were detected in 25% (4/16), 18.8% (3/16), and 6.3% (1/16) of cases, respectively. Conclusions We detected APC alterations in most small SNADETs resected via endoscopic treatment, from LGD to carcinoma samples. Even in SNADETs classified as small LGD, KRAS and BRAF alterations were present in a few samples.

Diffusion is a spontaneous process and one of the physicochemical phenomena responsible for molecular transport, the rate of which is governed mainly by the diffusion coefficient, however, few coefficients are available because the measurement of diffusion rates is not straightforward. The translational diffusion coefficient is related by the Stokes&ndash, Einstein equation to the approximate radius of the diffusing molecule. Therefore, the stable conformations of small molecules were first calculated by molecular modeling. A simple radius rs and an effective radius re were then proposed and estimated using the stable conformers with the van der Waals radii of atoms. The diffusion coefficients were finally calculated with the Stokes&ndash, Einstein equation. The results showed that, for the molecules with strong hydration ability, the diffusion coefficients are best given by re and for other compounds, rs provided the best coefficients, with a reasonably small deviation of ~0.3 &times, 10&minus, 6 cm2/s from the experimental data. This demonstrates the effectiveness of the theoretical estimation approach, suggesting that diffusion coefficients have potential use as an additional molecular property in drug screening.

Introduction Ceramic-on-ceramic (COC) total hip arthroplasty (THA) was developed to reduce wear debris, and consequently the occurrence of osteolysis and aseptic loosening. The purpose of the present study was to determine the incidence and natural history of noise including squeaking after COC THA, and to clarify whether clinical outcomes and any demographic and implant-related factors are associated with noise from these ceramic bearings. Methods This was a retrospective observational study of 137 primary COC THAs between 2004 and 2009 at our institute. The Mean follow-up was for 10.5 years. All patients were followed up with an office visit to obtain information regarding noise, pain, and function. The correlations between the noise, and patient demographic, radiographic, and implant-related factors were evaluated. Results Noise developed in 30 hips (21.9%), specifically squeaking in 2 (1.5%) of the 137 hips during the follow-up period. Noise including squeaking was not associated with pain or functional outcomes. There was significant correlation between noise and cup anteversion, in that cup anteversion of patients with noise was smaller than that in those without noise. No significant correlation was found between noise and any other patient demographic including age, sex, height, body weight, or body mass index. Kaplan–Meier survivorship analysis with revision for any reason and an aseptic loosening of either component as the end point, revealed a cumulative survival rate at 10 years of 98.4% and 99.1% respectively. Conclusion The long-term clinical and radiographic outcome of cementless COC THA is excellent, but we should be vigilant for noise from COC bearings.

Background Little is known about how bone cement and American Society of Anesthesiologists (ASA) classification influence the cardiovascular system in elderly patients with femoral-neck fractures treated with cemented hemiarthroplasty. Therefore, we performed a case-control study to investigate these questions and compared the following: ≥ ASA III with ≤ ASA II patients who underwent cemented hemiarthroplasty; and cemented with cementless hemiarthroplasty in ≥ ASA III patients. Hypothesis ASA classification influences the cardiovascular system during cemented hemiarthroplasty and bone cement influences intraoperative blood pressure [IBP] in patients rated ≥ ASA III. Materials and methods This multicenter, prospective study included patients with acute displaced femoral-neck fractures. Baseline data, medical history, anesthesia, FiO2, vasopressor use, femoral component, IBP, SpO2, and complications were evaluated. Of 200 patients, 100 were cemented (mean age, 77 ± 10 years), and 100 were cementless (mean age, 78 ± 9 years). Cemented hemiarthroplasty employed a third-generation technique (plugging, irrigating, drying and filling the canal with cement under pressurization). Results Systolic blood pressure (SBP) decreased significantly during cementing, versus pre-rasping in ≤ ASA II patients (from 117.9 ± 24.5 [range, 65–199] to 106.9 ± 20.3 [range, 59–172]; p = 0.007), in ≥ ASA III patients (from 129.5 ± 21.0 [range, 90–169] to 110.4 ± 17.9 [range, 79–157]; p = 0.006), and post-stem-insertion, versus pre-rasping in ≤ ASA II patients (from 117.9 ± 24.5 [range, 65–199] to 103.9 ± 20.7 [range, 53–178]; p = 0.0004), and in ≥ ASA III patients (from 129.5 ± 21.0 [range, 90–169] to 111.2 ± 24.6 [range, 70–156]; p = 0.009). In ≥ ASA III patients, SBP decreased significantly during cementing or rasping, versus pre-rasping in cemented patients (from 129.5 ± 21.0 [range, 90–169] to 110.4 ± 17.9 [range, 79–157]; p = 0.006), in cementless patients (from 115.0 ± 17.7 [range, 85–150] to 100.7 ± 15.7 [range, 75–142]; p = 0.004), and post-stem-insertion, versus pre-rasping in cemented patients (from 129.5 ± 21.0 [range, 90–169] to 111.2 ± SD [range]; p = 0.009), and in cementless patients (from 115.0 ± 17.7 [range, 85–150] to 89.4 ± 17.5 [range, 58–140]; p Conclusions This study indicate a similar hemodynamic change intraoperatively between ≤ ASA II patients and ≥ ASA III patients in the cemented group, and between patients with cemented and cementless hemiarthroplasty in the ≥ ASA III patients. With modern hemiarthroplasty techniques, bone cement might be as safe as cementless techniques in elderly, ≥ ASA III patients. Level of evidence III, multicenter case-control cohort study.

OBJECTIVE To elucidate the long-term outcomes of permanent endoscopic biliary stenting (EBS) and risk factors for recurrent biliary obstruction (RBO) in high-risk or elderly patients with common bile duct (CBD) stones. METHODS The electronic database of Hakodate Municipal Hospital was searched to identify elderly or high-risk patients with CBD stones who had undergone permanent EBS using a plastic stent without stone removal and were followed up between April 2011 and May 2019, with no further intervention until symptoms occurred. RESULTS We analyzed a total of 47 patients, of whom 19 (40.4%) were men, with a median age of 86 years (interquartile range 80-90 years). RBO and death without biliary disease occurred in 14 (29.8%) and 19 (40.4%) patients, respectively. The cumulative RBO rates at 20, 40, and 60 months were 22.1%, 31.8%, and 35.5%, respectively. The median time to RBO was 13.0 and 38.0 months in the group with CBD stone ≥15 mm and 11-14 mm in diameter, respectively. The cumulative RBO incidence rate in the group with CBD stone ≤10 mm in diameter did not reach 50%. The cumulative RBO incidence rates were significantly different among the three groups based on the CBD stone diameter (competing risk analysis, P

The aim of this study was to investigate the local production of proinflammatory cytokines, pain-related sensory innervation of dorsal-root ganglia (DRG), and spinal changes in a rat model of induced hip osteoarthritis (OA). Seventy-five Sprague-Dawley rats were used, including 25 controls and 50 injected into the right hip joints (sham group, injected with 25 µl of sterile saline: N = 25; and monosodium iodoacetate (MIA) group, injected with 25 µl of sterile saline with 2 mg of MIA: N = 25). We measured the local production of TNF-α, immunoreactive (-ir) neurons for calcitonin gene-related peptide (CGRP), and growth associated protein-43 (GAP-43) in DRG, and immunoreactive neurons for ionized-calcium-binding adaptor molecule-1 (Iba-1) in the dorsal horn of spinal cord, on post-induction days 7, 14, 28, 42, and 56 (N = 5 rats/group/time point). For post-induction days 7-42, the MIA group presented significantly elevated concentrations of TNF-α than the other groups (p < 0.01), and a higher expression of CGRP-ir in FG-labeled DRG neurons than the sham group (p < 0.01). MIA rats also presented significantly more FG-labeled GAP-43-ir DRG neurons than the sham group on post-induction days 28, 42, and 56 (p < 0.05), and a significantly higher number of Iba-1-ir microglia in the ipsilateral dorsal horn than the other groups, on post-induction days 28, 42, and 56. The results suggest that in rat models, pain-related pathologies due to MIA-induced hip OA, originate from inflammation caused by cytokines, which leads to progressive, chronic neuronal damage that may cause neuropathic pain. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2978-2986, 2018.

The isolation of useful microbes is one of the traditional approaches for the lead generation in drug discovery. As an effective technique for microbe isolation, we recently developed a multidimensional diffusion-based gradient culture system of microbes. In order to enhance the utility of the system, it is favorable to have diffusion coefficients of nutrients such as sugars in the culture medium beforehand. We have, therefore, built a simple and convenient experimental system that uses agar-gel to observe diffusion. Next, we performed computer simulations-based on random-walk concepts-of the experimental diffusion system and derived correlation formulas that relate observable diffusion data to diffusion coefficients. Finally, we applied these correlation formulas to our experimentally-determined diffusion data to estimate the diffusion coefficients of sugars. Our values for these coefficients agree reasonably well with values published in the literature. The effectiveness of our simple technique, which has elucidated the diffusion coefficients of some molecules which are rarely reported (e.g., galactose, trehalose, and glycerol) is demonstrated by the strong correspondence between the literature values and those obtained in our experiments.

Background: Metachronous multiple squamous cell carcinoma (SCC) of the esophagus and the head and neck is commonly observed in patients who have previously undergone endoscopic resection (ER) for SCC of the esophagus (ESCC). We evaluated the risk for developing metachronous SCC following ER for ESCC based on the genetic polymorphisms for alcohol dehydrogenase-1B (ADH1B) and aldehyde dehydrogenase-2 (ALDH2) as well as the alcohol consumption and smoking habits. Methods: We studied 158 patients who underwent ER for ESCC (median follow-up 80 months). Genotyping of ADH1B/ALDH2 was performed using saliva sampling. The alcohol consumption and smoking histories of the patients before and after the ER were documented. Results: Multivariate analyses revealed that inactive heterozygous ALDH2 [hazard ratio (HR) 2.25] and alcohol consumption after ER (HR 1.94) were independently associated with the risk of developing secondary SCC. Moreover, inactive heterozygous ALDH2 (HR 4.39) and alcohol consumption after the ER (HR 2.82) were independently associated with the risk of a third SCC. We analyzed 110 patients who had a history of moderate or heavy alcohol consumption before the ER. The 3-year cumulative incidence rates of secondary SCC in the temperance (n = 65) and non-temperance groups (n = 45) were 14.0 and 42.1% (p = 0.0002). Further, the 5-year cumulative incidence rates of a third SCC in the temperance and non-temperance groups were 0 and 15.6% (p = 0.0011), respectively. In addition, the 7-year cumulative incidence rates of a fourth SCC in the temperance and non-temperance groups were 0 and 15.3% (p = 0.0015), respectively. Conclusions: Continued alcohol consumption is an important risk factor for the onset of metachronous SCC and is a risk factor for the third and subsequent SCCs. Strict advice in favor of temperance is crucial.

The Rome III diagnostic criteria had been used to diagnose functional gastrointestinal disorders (FGIDs) world wide, and functional bowel disorders (FBDs) including irritable bowel syndrome (IBS) have recently attracted the attention of Japanese physicians. However, there have been few reports on the prevalence of FBDs diagnosed by the Rome III diagnostic criteria. The aim of this study was to determine the prevalence of FBDs diagnosed according to the diagnostic criteria of Rome III in Japan. All patients who were booked for colonoscopy were enrolled from eight institutions in Japan. This study was a prospective observational study in the period from April 2013 to December 2013. Patients filled out FGID questionnaires of Rome III when they were waiting for colonoscopy. Data for 1200 patients who underwent colonoscopy were analyzed. A total of 547 patients (45.6%) were diagnosed with FBDs. Out of those patients, 9.1% had IBS. According to the Rome III diagnostic criteria, 134 patients (11.2%) had functional bloating (FB), 73 (6.1%) had functional constipation (FC), 40 (3.3%) had functional diarrhea (FD), and 191 (15.9%) had unspecified functional bowel disorder (UFBD). Patients with FBDs had significantly higher rates of almost all symptoms (abdominal pain, hard or lumpy stools, loose or watery stools, and bloating) than those in the controls. In Japan, the prevalence of FBDs and IBS is high, similar to that in the US. Many patients with FBDs have multiple symptoms.