PubMed | Osaka University, Japan Community Health Care Organization Hoshigaoka Medical Center and Japan Community Health Care Organization Osaka Hospital
Type: Journal Article | Journal: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association | Year: 2016
The purposes of this study were to quantitatively analyze osteophyte formation of the distal radius following scaphoid nonunion and to investigate how fracture locations relate to osteophyte formation patterns.Three-dimensional surface models of the scaphoid and distal radius were constructed from computed tomographic images of both the wrists of 17 patients with scaphoid nonunion. The scaphoid nonunions were classified into 3 types according to the location of the fracture line: distal extra-articular (n=6); distal intra-articular (n=5); and proximal (n=6). The osteophyte models of the radius were created by subtracting the mirror image of the contralateral radius model from the affected radius model using a Boolean operation. The osteophyte locations on the radius were divided into 5 areas: styloid process, dorsal scaphoid fossa, volar scaphoid fossa, dorsal lunate fossa, and volar lunate fossa. Osteophyte volumes were compared among the areas and types of nonunion. The presence or absence of dorsal intercalated segment instability (DISI) deformity was also determined.The distal intra-articular type exhibited significantly larger osteophytes in the styloid process than the distal extra-articular type. Furthermore, the proximal type exhibited significantly larger osteophytes in the dorsal scaphoid fossa than the distal extra-articular type. Finally, the distal intra- and extra-articular types were more associated with DISI deformity and tended to have larger osteophytes in the lunate fossa than the proximal type.The pattern of osteophyte formation in the distal radius determined using three-dimensional computed tomography imaging varied among the different types of scaphoid nonunion (distal extra-articular, distal intra-articular, and proximal). The results of this study are clinically useful in determining whether additional resection of osteophytes or radial styloid is necessary or not during the treatment of the scaphoid nonunion.
PubMed | Toyonaka Municipal Hospital, Osaka Rosai Hospital, National Hospital Organization, Nippon Telegraph and Telephone and 8 more.
Type: Journal Article | Journal: Journal of medical virology | Year: 2016
The factors associated with sustained virologic response (SVR) in chronic hepatitis C (CH-C) genotype 1 patients treated with simeprevir (SMV), pegylated interferon (Peg-IFN) plus ribavirin (RBV) triple therapy have not been fully investigated. Two hundred and twenty-nine treatment-nave CH-C patients treated with SMV triple therapy were enrolled in this study. The overall SVR rate was 87% in per-protocol analysis. In multivariate analysis, the interleukin (IL) 28B genotype (rs8099917, TT vs. non-TT, odds ratio [OR]: 0.044, P=0.001) and RBV dose (<10/10-12/12mg/kg/day, OR: 4.513, P=0.041) were significant factors associated with SVR. In patients with the IL28B non-TT genotype, RBV dose affected SVR dose-dependently in stratified analysis of RBV dose (P=0.015); it was 44% (8/18) for patients administered <10mg/kg/day of RBV, 78% (14/18) for those administered 10-12mg/kg/day of RBV, and 100% (3/3) for those administered 12mg/kg/day of RBV, whereas in patients with the IL28B TT genotype, a significant correlation between SVR and RBV dose was not observed (P=0.229). Regarding RBV dose reduction of less than 10mg/kg/day, the inosine triphosphate pyrophosphatase (ITPA) genotype (rs1127354, CC vs. non-CC, OR: 0.239, P=0.003) and age (by 1 y.o., OR: 1.084, P=0.002) were significant independent factors. RBV dosage affected SVR dose-dependently in patients with the IL28B non-TT genotype treated with SMV triple therapy. Special attention to anemia progression and RBV dosage should be paid to aged patients with the ITPA CC genotype. J. Med. Virol. 88:1776-1784, 2016. 2016 Wiley Periodicals, Inc.
PubMed | National Hospital Organization Osaka National Hospital, Osaka General Medical Center, Osaka University, Kaizuka City Hospital and 9 more.
Type: Clinical Trial | Journal: Journal of gastroenterology | Year: 2016
Hyperbilirubinemia, mild or moderate, is a commonly observed laboratory abnormality in chronic hepatitis C patients treated with simeprevir with pegylated interferon (Peg-IFN) plus ribavirin. In this prospective, multicenter study, we aimed to investigate the clinical features and factors associated with bilirubin increases during the therapy.A total of 192 patients with chronic hepatitis C who were treated with simeprevir with Peg-IFN plus ribavirin were analyzed.The mean serum bilirubin level increased significantly during the initial 12 weeks of simeprevir administration and peaked at 2 weeks after the administration. Hyperbilirubinemia of more than 2 mg/dl developed in 18% of the patients; in 85% of those patients, the bilirubin levels peaked within 6 weeks and gradually decreased thereafter. A univariable analysis revealed that an increase in serum total bilirubin of 1.0 mg/dl or more from baseline was significantly associated with the sex, red blood cell count, serum hemoglobin level, serum alanine aminotransferase level, serum creatinine level and inosine triphosphate pyrophosphatase (ITPA) genotype. In the multivariable analysis, the ITPA genotype (CC odds ratio 4.990, p = 0.011) was found to be the only independent factor. Consistent with this result, there was a significant correlation between hyperbilirubinemia and the degree of hemolytic anemia.Hyperbilirubinemia develops at early time points after simeprevir administration in most cases and is dependent on the ITPA genotype. Careful attention should be paid to hyperbilirubinemia, which occurs at later time points or in patients with an ITPA non-CC genotype so that a diagnosis of liver damage with hyperbilirubinemia is not missed.
PubMed | National Hospital Organization Osaka National Hospital, Osaka Rosai Hospital, Osaka University, Toyonaka Municipal Hospital and 3 more.
Type: Journal Article | Journal: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association | Year: 2016
Surgical site infection is one of the commonest complications of gastrointestinal surgery. The nature of surgical procedures and wound closure methods may influence the incidence of superficial incisional surgical site infection. Patients enrolled in a prospective randomized controlled trial comparing skin closure methods are the best subjects for analyzing surgical site infection risk.From a cohort of 1080 patients who had been enrolled in our previous randomized controlled trial, data for 685 patients who had undergone elective open total gastrectomy or distal gastrectomy for gastric cancer were extracted. The incidences of superficial incisional surgical site infection after total gastrectomy and distal gastrectomy were compared and risk factors for superficial incisional surgical site infection were investigated by univariate analyses using logistic regression models.In all, 42 patients (6.1 %) developed superficial incisional surgical site infections after gastrectomy; 15 of 288 patients (5.2 %) developed these infections after total gastrectomy, and 27 of 397 patients (6.8 %) developed these infections after distal gastrectomy-these differences are not significant. According to univariate analysis, age (75 years or older or younger than 75 years) was the only risk factor for superficial incisional surgical site infections (P = 0.049). There was a tendency for the incidence of superficial incisional surgical site infection to increase in parallel with age.The incidence of superficial incisional surgical site infection did not differ between total gastrectomy and distal gastrectomy. Advanced age was the only identified risk factor for superficial incisional surgical site infections after gastrectomy.
Fuji T.,Japan Community Health care Organization Osaka Hospital |
Wang C.-J.,Chang Gung University |
Fujita S.,Takarazuka Daiichi Hospital |
Kawai Y.,International University of Health and Welfare |
And 2 more authors.
Journal of Arthroplasty | Year: 2014
Edoxaban, an oral direct factor Xa inhibitor, has proven antithrombotic efficacy. In a multicenter, phase II study, 264 total hip arthroplasty (THA) patients randomly received edoxaban 15 or 30 mg once daily or enoxaparin 2000. IU (20-mg) twice daily for 11-14 days. Thromboembolic event incidences were 3.8% (3/78), 2.8% (2/72), and 4.1% (3/74) for edoxaban 15-mg, 30-mg, and enoxaparin, respectively (P= 1.00). Edoxaban-induced prolongation of prothrombin time, international normalized ratio, and activated partial thromboplastin time were proportional to plasma edoxaban concentration. Major or clinically relevant non-major bleeding incidences were 2.2% (2/89), 1.2% (1/85), and 2.3% (2/87) for edoxaban 15-mg, 30-mg, and enoxaparin, respectively (P= 1.00). Once-daily edoxaban showed similar efficacy and safety to enoxaparin for prevention of thromboembolic events in patients undergoing THA. © 2014 The Authors.
PubMed | aMs New Otani Clinic, Osaka University, Ogaki Municipal Hospital, Japan Community Health Care Organization Osaka Hospital and 2 more.
Type: Journal Article | Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] | Year: 2016
Pancreatic ductal adenocarcinoma (PDAC) has the worst prognosis of all malignancies, and its diagnosis in early stages is the most important prognostic factor. Chronic pancreatitis (CP), a common background of PDAC occurrence, is morphologically defined as progressive pancreatic fibrosis and inflammation accompanied by pancreatic exocrine cell atrophy. We recently found that inflammation and fibrosis are independent characteristic histological changes in noncancerous lesions in PDAC patients despite the absence of a past history of clinical CP. Subclinical CP is an important background for PDAC occurrence. Therefore, there is an urgent need to develop a noninvasive and reliable biomarker for CP diagnosis.Fifty-nine healthy volunteers (HV), 159 patients with CP, and 83 patients with PDAC were enrolled in this study. We measured serum total fucosylated haptoglobin (Fuc-Hpt) and core-Fuc-Hpt levels using lectin-antibody enzyme-linked immunosorbent assay kits that we developed. In these kits, total Fuc-Hpt and core-Fuc-Hpt were measured using Aleuria aurantia lectin and Pholiota squarrosa lectin, respectively.Serum Fuc-Hpt levels were significantly increased in CP patients compared to HV (P<0.0001) and were further increased in PDAC patients (P<0.0001). Interestingly, serum core-Fuc-Hpt levels were significantly higher in CP patients compared to HV (P<0.0001) and PDAC patients (P<0.0001). Multivariate analyses demonstrated that total serum core-Fuc-Hpt was an independent determinant for CP diagnosis, but Fuc-Hpt was not.A dramatic change in oligosaccharides was observed in serum haptoglobin between CP and PDAC. Serum core-Fuc-Hpt may be a novel and useful biomarker for CP diagnosis.
PubMed | Osaka General Medical Center, Japan Community Health Care Organization Osaka Hospital and Osaka University
Type: | Journal: Clinical and experimental nephrology | Year: 2016
It is not known whether asymptomatic cardiac troponin T (cTnT) elevation is associated with all-cause or cardiovascular mortality in non-diabetic and advanced chronic kidney disease (CKD) patients.We measured cTnT in 248 consecutive patients at 1-2weeks before dialysis initiation between March 2005 and August 2010 and followed them prospectively. A Cox proportional hazard model was used to investigate the relationship between cTnT and all-cause and cardiovascular mortality on dialysis.The median age of the patients was 67years (male 59.3%), and the prevalence of diabetic nephropathy (DN) was 38.3%. Asymptomatic cTnT elevation (>0.01ng/mL) was observed in 196 (79%) and 111 (73%) patients among the overall patients and among patients without DN, respectively. A total of 51 patients died during a median follow-up period of 31.6months. The cTnT level was associated with all-cause [hazard ratio (HR) 1.453; 95% confidence interval (CI) 1.093-1.931; P=0.010] and cardiovascular mortality [HR 1.973; 95% CI 1.127-3.454; P=0.017] on dialysis after extensive adjustment in the overall patient population. Patients without DN showed similar associations as those for the overall patient population (all-cause mortality: HR 1.566; 95% CI 1.048-2.339; P=0.029 and cardiovascular mortality: HR 2.657; 95% CI 1.115-6.328; P=0.027).Asymptomatic cTnT elevation might be strongly associated with all-cause and cardiovascular mortality in patients without DN, as well as in the overall advanced CKD patients. We suggest that cardiovascular risk in patients with pre-dialysis CKD should be stratified according to cTnT levels.
PubMed | Osaka University and Japan Community Health Care Organization Osaka Hospital
Type: Journal Article | Journal: Archives of orthopaedic and trauma surgery | Year: 2016
Intra-articular malunion after fractures of the distal humerus can cause pain, stiffness and, consequently, osteoarthritis in the long run. Although corrective osteotomy for intra-articular malunion has been reported, it is still technically challenging and needs careful preoperative evaluation and planning. Here, we present two cases of corrective osteotomy assisted by preoperative three-dimensional (3-D) computer simulation.Wepresenttwocases of malunited intra-articular fracture of the distal humerus, which was treated by corrective osteotomy with the aid of 3-D computer simulation. One case was initially treated with closed reduction and pinning, and the other was initially treated with open reduction and internal fixation. Both of them had pain and severely limited range of motion in the elbow due to intra-articular malunion. 3-D models of the bilateral humeri were created on a computer using computed tomography (CT) data. The deformity was analyzed by superimposing the model of the affected humerus on the mirrored model of the contralateral normal humerus. Osteotomy, reduction and fixation were simulated preoperatively on the computer. The actual surgery was performed exactly according to the preoperative 3-D computer simulation.The operative procedures were performed successfully according to the computer simulation. Range-of-motion exercises started 3days and immediately after the surgery in cases 1 and 2, respectively. Two years after surgery, there were no complaints of pain or instability. The range of elbow motion was 5-140 and 15-125 in cases 1 and 2, respectively. Plain radiographs and CT scans showed good reconstruction of the articular surface.3-D computer simulations can be useful in preoperative planning for intra-articular corrective osteotomy for complex malunion of the distal humerus.
PubMed | Osaka University and Japan Community Health Care Organization Osaka Hospital
Type: Journal Article | Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie | Year: 2016
Primary vitreoretinal lymphoma (PVRL), a subset of primary central nervous system lymphoma (PCNSL), is a high-grade malignant tumor that shows various chorioretinal findings. Optical coherence tomography (OCT) is useful for detecting these lesions, and various abnormalities on OCT images have been reported. The purpose of this report was to investigate retrospectively the OCT manifestations of various disease stages and compare the manifestations of pretreatment, recurrent, and chronic cases.We reviewed the medical charts and OCT images of 38 consecutive cases with PVRL. When abnormalities were detected on OCT images, the patients were classified based on the treatment of the primary disease: pretreatment if not treated, recurrent if treated previously, and chronic when chronic changes.Twenty-six eyes (20 cases) had abnormalities in the post-pole OCT images, i.e., 16 eyes (12 cases) were in the pretreatment group, seven eyes (five cases) were in the recurrent group, and five eyes (five cases) were in the chronic group. Two eyes (two cases) had abnormalities on OCT in the pretreatment and recurrent or chronic stages. The pretreatment and recurrent groups had subretinal or retinal pigment epithelium (RPE) level abnormalities more often than intraretinal changes. Twelve of 16 pretreated eyes and all seven eyes with recurrent disease had subretinal or RPE level abnormalities. One pretreatment case and three recurrent cases had atypical OCT manifestations of intraretinal (round lesions) or epiretinal changes (villous-shaped lesions).Although pretreatment cases and recurrent cases showed similar OCT abnormalities and the specific changes in the various disease stages were unclarified, collecting OCT data from various disease stages will facilitate detection of typical OCT changes of PVRL and lead to early diagnosis and treatment.