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Akazawa T.,Seirei Sakura Citizen Hospital | Kotani T.,Seirei Sakura Citizen Hospital | Sakuma T.,Seirei Sakura Citizen Hospital | Nemoto T.,Seirei Sakura Citizen Hospital | Minami S.,Seirei Sakura Citizen Hospital
Journal of Orthopaedic Science | Year: 2013

Background: No reports have been published on detailed risk factors for rod fracture after spinal deformity correction and fusion. The purpose of this study was to analyze clinical and radiographic risk factors of rod fracture after long construct fusion for spinal deformity. Methods: The survey subjects were 155 cases who were diagnosed with spinal deformity and underwent correction and fusion surgery with long construct instrumentation (>3 levels, average 10.3 levels) between July 2004 and June 2010. The subjects comprised 32 males and 123 females with a mean age of 19.0 (range 8-78) years. The mean Cobb angle was 61.0 ± 16.1 preoperatively and 25.7 ± 16.9 postoperatively. Univariate analysis and logistic regression analysis were performed. Results: Rod fracture occurred in 8 of 155 cases (5.2 %). The mean period from surgery to rod fracture was 18.1 months (range 2-37). The level of fracture ranged from the thoracolumbar junction to the lumbosacral vertebrae. Six patients had fracture near the fused lower end and two patients had fracture at the thoracolumbar junction. Univariate analysis revealed that non-ambulatory status, preoperative kyphosis, small-diameter rods, multiple surgery, and use of iliac screws were significant risk factors for rod fracture. Sex, obesity, severity of preoperative scoliosis, and rod material were not significant risk factors. Logistic regression analysis revealed that use of iliac screws (odds ratio: 81.9, 95 % confidence interval: 7.2-935.0, p < 0.001) and small-diameter (<6 mm) rods (odds ratio: 16.3, 95 % confidence interval: 1.7-152.6, p = 0.015) were risk factors for rod fracture. Conclusions: The incidence of rod fracture after long construct fusion for spinal deformity was 5.2 %. Iliac screw fixation and small-diameter rods were risk factors for rod fracture. © 2013 The Japanese Orthopaedic Association.

Takebe T.,Yokohama City University | Takebe T.,Japan Science and Technology Agency | Zhang R.-R.,Yokohama City University | Koike H.,Yokohama City University | And 7 more authors.
Nature Protocols | Year: 2014

Generation of functional and vascularized organs from human induced pluripotent stem cells (iPSCs) will facilitate our understanding of human developmental biology and disease modeling, hopefully offering a drug-screening platform and providing novel therapies against end-stage organ failure. Here we describe a protocol for the in vitro generation of a 3D liver bud from human iPSC cultures and the monitoring of further hepatic maturation after transplantation at various ectopic sites. iPSC-derived specified hepatic cells are dissociated and suspended with endothelial cells and mesenchymal stem cells. These mixed cells are then plated onto a presolidified matrix, and they form a 3D spherical tissue mass termed a liver bud (iPSC-LB) in 1-2 d. To facilitate additional maturation, 4-d-old iPSC-LBs are transplanted in the immunodeficient mouse. Live imaging has identified functional blood perfusion into the preformed human vascular networks. Functional analyses show the appearance of multiple hepatic functions in a chronological manner in vivo. © 2014 Nature America, Inc. All rights reserved.

Matsumoto M.,Keio University | Watanabe K.,Keio University | Hosogane N.,Keio University | Kawakami N.,Meijo Hospital | And 8 more authors.
Spine | Year: 2013

Study Design: A retrospective, multicenter study. Objective: To investigate the occurrence of and factors related to postoperative adding-on in Lenke type 1A curve. Summary of Background Data: Although several studies have investigated factors associated with adding-on in Lenke type 1A curve, these factors have not been elucidated in a large study population. Methods: This study included 112 patients who were followed more than 2 years after undergoing selective posterior thoracic fusion surgery for Lenke Type 1A curve (8 males, 104 females; mean age at surgery, 16.1 yr; mean follow-up, 3.6 yr). The lower instrumented vertebra (LIV) was T12 in 22 patients, L1 in 55, L2 in 32, and L3 in 3. Distal to the main thoracic curve, the end vertebra, neutral vertebra, stable vertebra (SV), and the last vertebra touching the central sacral vertical line (last touching vertebra, LTV) were determined. The occurrence and factors associated with distal adding-on were investigated. Results: The mean Cobb angle and apical translation of the main thoracic curve were 54.6 ° ± 9.6 ° and 53.1 ± 20.4 mm before surgery, and 14.2 ± 7.4 and 16.2 ± 12.7 at follow-up, respectively. Distal adding-on was observed in 21 patients (18.8%) at follow-up. Univariate analyses identifi ed several factors signifi cantly associated with adding-on, including the preoperative proximal thoracic curve, the apical translation of the main thoracic curve, Miyanji's subclassifi cation, the postsurgical proximal and main thoracic curves, the postsurgical apical translation of the main thoracic curve, the correction rate of the main thoracic curve and the clavicle angle immediately after surgery and at follow-up, and the difference in levels between the LIV and the end vertebra, neutral vertebra, LTV, and stable vertebra. Logistic regression analysis showed that the apical translation of the main thoracic curve immediately after surgery (apical translation > 25 mm, odds ratio: 10.7, 95% confi dence interval: 3.1-37.0, P = 0.001) and the difference in levels between LIV and LTV (LIV-LTV) (LIV-LTV < 0, odds ratio: 6.7, 95% confi dence interval: 1.9-23.9, P = 0.003) were signifi cantly associated with adding-on. Conclusion: Since the residual apical translation of the main thoracic curve and the lowest instrumented vertebra more cranial to the last touching vertebra were signifi cantly associated with addingon, surgeons may need to obtain the maximum reduction of the apical translation of the main thoracic curve and to extend the LIV at least to the LTV to avoid postoperative adding-on. Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Akazawa T.,Seirei Sakura Citizen Hospital | Minami S.,Seirei Sakura Citizen Hospital | Kotani T.,Seirei Sakura Citizen Hospital | Nemoto T.,Seirei Sakura Citizen Hospital | And 2 more authors.
Spine | Year: 2012

Study Design: A case control study. Objective: To determine the clinical outcome of middle-aged patients surgically treated for adolescent idiopathic scoliosis and to compare their outcomes with assessments of age- and sex-matched healthy controls. Summary of Background Data: Several long-term follow-up studies have been published on the clinical outcomes of surgical treatment for adolescent idiopathic scoliosis in patients who have reached their 20s or 30s. However, clinical outcomes in patients who have reached middle age remain unknown. Methods: This study included 256 patients surgically treated for adolescent idiopathic scoliosis (AIS) between 1968 and 1988. The Scoliosis Research Society Patient Questionnaire (SRS-22) and Roland-Morris Disability Questionnaire (RDQ) were used for evaluating long-term clinical outcomes. Sixty-six (25.8%; 62 females, 4 males; mean age, 46.0 years [range 34-56]) of the 256 patients responded to the questionnaires. The mean follow-up period was 31.5 (range 21-41) years. Seventy-six healthy age- and sex-matched individuals with neither a history of spinal surgery nor scoliosis were selected as a control (CTR) group. Results: On the basis of the SRS-22 responses, AIS patients had significantly decreased function (AIS: 4.3 ± 0.6, CTR: 4.7 ± 0.5, P < 0.01) and decreased self-image (AIS: 3.0 ± 0.8, CTR: 3.7 ± 0.5, P < 0.01) in comparison with the controls, but the 2 groups were similar with respect to pain (AIS: 4.3 ± 0.6, CTR: 4.2 ± 0.5, P = 0.14) and mental health (AIS: 3.9 ± 0.9, CTR: 3.7 ± 0.7, P = 0.14). The RDQ responses indicated that low back pain was not significantly increased in the AIS group compared with the CTR group (AIS: 1.8 ± 3.5, CTR: 1.4 ± 3.1, P = 0.36). Conclusion: Surgery had no demonstrable adverse effects on pain or mental health in these middle-aged AIS patients 21-41 years after surgery, although the AIS patients did have significantly lower function and lower self-image than the controls. Copyright © 2012 Lippincott Williams & Wilkins.

Takahashi Y.,RIKEN | Takahashi Y.,Keio University | Kou I.,RIKEN | Takahashi A.,RIKEN | And 21 more authors.
Nature Genetics | Year: 2011

Adolescent idiopathic scoliosis is a pediatric spinal deformity affecting 2-3% of school-age children worldwide. Genetic factors have been implicated in its etiology. Through a genome-wide association study (GWAS) and replication study involving a total of 1,376 Japanese females with adolescent idiopathic scoliosis and 11,297 female controls, we identified a locus at chromosome 10q24.31 associated with adolescent idiopathic scoliosis susceptibility. The most significant SNP (rs11190870; combined P = 1.24 × 10 -19; odds ratio (OR) = 1.56) is located near LBX1 (encoding ladybird homeobox 1). The identification of this susceptibility locus provides new insights into the pathogenesis of adolescent idiopathic scoliosis. © 2011 Nature America, Inc. All rights reserved.

Moriyama M.,Osaka Institute of Technology | Kubota S.,Industrial Technology Center Of Okayama Prefecture | Tashiro H.,Seirei Sakura Citizen Hospital | Tonami H.,Osaka Institute of Technology
Journal of Artificial Organs | Year: 2011

Chronic venous insufficiency (CVI) remains a major health problem worldwide. Direct venous valve surgical repair and venous segment transplantation are clinical options; however, they are highly invasive procedures. The objectives of this study were to fabricate prosthetic venous valves (PVVs) by electrospinning, for percutaneous treatment of CVI, and evaluate their hydrodynamic characteristics in vitro at the same locations and under the same flow conditions. The PVVs consisted of polyurethane fiber scaffolds attached to a cobalt-chromium stent. PVVs with two different valve-leaflet configurations were compared: biomimetic PVV (bPVV) and open PVV (oPVV). A balloon catheter was used to implant the devices in a poly(vinyl chloride) tube and the column outlet was set at a height of 100 cm above the test valve to simulate the elevation of the heart above a distal vein valve while standing; 50 wt% glycerin solution was used as the test fluid. The devices were evaluated for antegrade flow, effect of ankle flexion, and stagnation zones around the valve leaflets. During sudden hydrostatic backpressure, little leakage and constant peripheral pressure were observed for the devices; under forward pulsatile pressure of 0-4 mmHg, to simulate the effect of breathing, the oPVV had a higher flow rate than the bPVV. With regard to the effect of ankle flexion, the oPVV was functionless. Moreover, the stagnation zone around the oPVV valve leaflets was larger than that around the bPVV valve leaflets. These results suggest that the bPVV would be clinically suitable for percutaneous treatment of CVI. © 2011 The Japanese Society for Artificial Organs.

Mori K.,Seirei Sakura Citizen Hospital
Clinical Nephrology | Year: 2010

Orally-administered steroids often induce osteonecrosis of the femoral head. In cases of Perthes disease, osteonecrosis of the femoral head occurs in children due to an unknown cause. Our subject was a 4-year-old boy who had to be given large amounts of steroids because of frequently relapsing nephrotic syndrome (FRNS) developed after the onset of Perthes disease. One month earlier, he would limp with his right leg, but his radiographs were normal. Later, facial edema appeared and he was brought to our hospital with heavy proteinuria. He was diagnosed with NS and prescribed prednisolone for 2 months. As he would limp occasionally during the treatment, he had an orthopedic examination at our hospital, and shrinkage of the right femoral head was disclosed. Perthes disease was diagnosed on the basis of his MRI and clinical history. Meanwhile, NS relapsed twice over a half year, and he was diagnosed as having FRNS. Cyclophosphamide was administered for 12 weeks. Four years later, MRI indicated that the femoral head slowly improved and he was able to walk without prosthetic support. These results suggest that in the course of healing from Perthes disease, the conventional method of using prednisolone has little impact on the femoral head. ©2010 Dustri-Verlag Dr. K. Feistle.

Akazawa T.,Seirei Sakura Citizen Hospital | Minami S.,Seirei Sakura Citizen Hospital | Kotani T.,Seirei Sakura Citizen Hospital | Nemoto T.,Seirei Sakura Citizen Hospital | And 2 more authors.
Spine | Year: 2012

Study Design: A case-control study. Objective: To compare health-related quality of life and low back pain of healthy subjects with those of patients with nonidiopathic scoliosis (non-IS) and idiopathic scoliosis (IS) 21 years or more after surgery. SUMMARY OF BACKGROUND DATA.: There have been a very small number of reports on long-term results of surgery for non-IS. There have not been any reports that compare non-IS, IS, and healthy subjects. Methods: The subjects with scoliosis were 602 patients who had undergone surgery between 1968 and 1988. The Scoliosis Research Society Patient Questionnaire (SRS-22), Roland-Morris Disability Questionnaire (RDQ), and our institution's original questionnaire were used for evaluating long-term clinical outcomes. The 136 respondents consisted of 56 patients with non-IS (non-IS group) and 80 patients with IS (IS group). The control group (CTR group) consisted of 80 healthy volunteers who were age- and body mass index-matched to the scoliosis groups. Results: In the SRS-22, the 3 groups had no significant differences in pain and mental health. For function and self-image, the non-IS group and the IS group had a significantly lower score than the CTR group. In the RDQ, the non-IS group had significantly more severe low back pain than the CTR group. There was no significant difference in low back pain between the non-IS group and IS group or between the IS group and CTR group. The non-IS group had a significantly lower marriage rate than the IS and CTR groups. Conclusion: The patients with non-IS and IS had similar health-related quality of life and low back pain. The patients with non-IS were found to have lower function and self-image in the SRS-22 questionnaire and more severe low back pain in the RDQ than healthy subjects. The patients with non-IS had a significantly lower marriage rate than the other 2 groups. Copyright © 2012 Lippincott Williams & Wilkins.

Kotani T.,Seirei Sakura Citizen Hospital
BMJ case reports | Year: 2014

Migration of neurogenic spinal tumours is uncommon. However, such possible mobility should be kept in mind during surgery for neurogenic tumours whenever the lesion is not found at the anticipated level. Conventional static imaging techniques, such as myelography and MRI, have not documented dynamic motion of tumours. A 12-year-old boy was diagnosed with a neurogenic spinal tumour in the thoracolumbar region. To assess the migratory tendency of the tumour, cine MRI was performed to acquire dynamic images under postural change. Cine MRI showed that the tumour migrated up to the lower part of the T12 vertebra from the upper part of the L1 vertebra during a change in spinal posture from cervical flexion to extension. The tumour was completely removed and histological examination revealed the tumour to be an ependymoma. Cine MRI is useful for dynamically and non-invasively assessing the migratory tendency of spinal tumours.

PubMed | Keio University, RIKEN, Japan National Institute of Health Sciences, Hokkaido University and 3 more.
Type: | Journal: Human mutation | Year: 2017

Congenital scoliosis (CS) occurs as a result of vertebral malformations and has an incidence of 0.5-1/1,000 births. Recently, TBX6 on chromosome 16p11.2 was reported as a disease gene for CS; about 10% of Chinese CS patients were compound heterozygotes for rare null mutations and a common haplotype defined by three SNPs in TBX6. All patients had hemivertebrae. We recruited 94 Japanese CS patients, investigated the TBX6 locus for both mutations and the risk haplotype, examined transcriptional activities of mutant TBX6 in vitro, and evaluated clinical and radiographic features. We identified TBX6 null mutations in nine patients, including a missense mutation that had a loss of function in vitro. All had the risk haplotype in the opposite allele. One of the mutations showed dominant negative effect. Although all Chinese patients had one or more hemivertebrae, two Japanese patients did not have hemivertebra. The compound heterozygosity of null mutations and the common risk haplotype in TBX6 also causes CS in Japanese patients with similar incidence. Hemivertebra was not a specific type of spinal malformation in TBX6-associated CS (TACS). A heterozygous TBX6 loss-of-function mutation has been reported in a family with autosomal-dominant spondylocostal dysostosis, but it may represent a spectrum of the same disease with TACS.

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