Safety and feasibility of in-hospital autonomous transportation using a driverless mobility for patients with musculoskeletal disorders: preliminary clinical study to achieve mobility as a service in medical care.

BACKGROUND: Recent advancements in and the proliferation of autonomous mobility technology, such as intelligent wheelchairs, have made it possible to provide mobility services for patients with reduced mobility due to musculoskeletal disorders. In the present study, we conducted a preliminary clinical study to assess the safety and feasibility of in-hospital autonomous transportation using a driverless mobility (wheelchair) for patients with musculoskeletal disorders. METHODS: From January to February 2022, 51 patients with musculoskeletal disorders exhibiting gait disturbance who presented to our institution were included in the present study. Driverless mobility rides were conducted over a straight-line distance of 100 m from the orthopaedic outpatient reception to the payment counter after the outpatient consultation. We assessed the quality of life using an EQ-5D-5 L index and pain using a VAS score before riding the mobility to investigate the patient's condition. After the ride, a questionnaire survey was conducted to assess patient satisfaction on a 5-point scale. In addition, adverse events during the mobility ride were investigated. RESULTS: Overall satisfaction levels showed that 44 out of 51 (86%) patients rated the level as 3 or higher. There were no significant differences in the level of satisfaction based on the cause of disorders or EQ-5D-5 L Index. Among 19 patients who rated the level of satisfaction as 2-3, the ratio of postoperative patients and those with pain tended to be higher (p < 0.05). While 26 of 51 (51%) patients reported moments of feeling unsafe during the mobility ride, no actual adverse events, such as collisions, were observed. CONCLUSIONS: An in-hospital autonomous transportation service using a driverless mobility for patients with musculoskeletal disorders demonstrated high satisfaction levels and was safe with no severe adverse events observed. The expansion of autonomous mobility deployment is expected to achieve mobility as a service in medical care.

Comparison of outcomes of different osteotomy sites for hallux valgus: A systematic review and meta-analysis.

BACKGROUND: Hallux valgus (HV) is a common foot deformity for which several corrective surgical procedures, with different osteotomy sites, have been reported. The purpose of the present study was to systematically review randomized (RCTs) or controlled (CCTs) clinical trials and perform meta-analysis on outcomes of different osteotomy sites of the first metatarsal. METHODS: An extensive literature search was conducted in PubMed and the Cochrane Library from January 1983 to July 2020. Studies were identified using the terms "hallux valgus" and "osteotomy". We included RCTs or CCTs comparing different locations of osteotomy for the first metatarsal bone (distal vs. mid-shaft, distal vs. proximal, and mid-shaft vs. proximal). The surgical outcomes included postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale (VAS) score, perioperative complications and recurrence of deformity. We enrolled 10 studies with a total of 793 feet in the qualitative synthesis following full-text screening. RESULTS: A majority of patients included in the enrolled trials showed mild to moderate deformity, with mean HVA <40°. Out of the 10 enrolled studies; six compared distal osteotomies with mid-shaft osteotomies and showed no significant differences in the surgical outcomes between the scarf and chevron groups; three RCTs compared distal osteotomies with proximal osteotomies with conflicting results, one RCT showed the superiority of proximal osteotomy while the other two RCTs showed equivalent outcomes; one study that compared between mid-shaft and proximal osteotomies showed equivalent outcomes between the groups. CONCLUSION: For the management of mild to moderate HV deformity, we found no significant clinical and radiological differences between patients treated with scarf and chevron osteotomies. Further controlled trials comparing different sites of osteotomies for moderate to severe HV deformity are needed.

Treatment of Periprosthetic Humeral Shaft Fracture after Total Elbow Arthroplasty in an Osteoporotic Patient, using the Ilizarov External Ring Fixator: A Case Report.

INTRODUCTION: Periprosthetic humeral shaft fracture after total elbow arthroplasty (TEA) and open reduction and internal fixation at the same side humeral neck fracture in patients with osteoporosis poses a treatment challenge. Herein, we describe our experience with its treatment using the Ilizarov external ring fixator. CASE REPORT: A 74-year-old Japanese woman with rheumatoid arthritis and osteoporosis sustained a periprosthetic humeral shaft fracture. The fracture was externally fixated with the Ilizarov external ring fixator, and five wires (Orthofix, Lewisville, Texas) were inserted just beside the components of the TEA (three wires were beside the humeral component and two wires the ulnar component). 4 months postoperatively, the fracture showed bone union and the fixator was removed. There were minor pin tract infections treated with oral antibiotics and transient ulnar nerve palsy with resolution after 6 months of the fixator removal. During the period of wearing the fixator, the left elbow joint was immobilized, and mainly isometric muscle exercises were performed. At 6 months of follow-up after the fixator removal, the patient was pain free, with good functional results (patient-rated elbow evaluation Japanese version 8.6 and quick- disability of the arm, shoulder, and hand Japanese version 20.5), elbow range of motion 10-°, 80° pronation, and 80° supination. The patient returned successfully to her pre-injury occupational activities. CONCLUSION: We believe that the use of the Ilizarov external fixator is a useful option for managing periprosthetic humeral shaft fractures after TEA in patients with osteoporosis.

Location of fractures and the characteristics of patients with atypical femoral fractures: analyses of 38 Japanese cases.

The purpose of this study was to determine fracture location and the characteristics of patients with atypical femoral fractures (AFFs). We studied 38 AFFs in 34 patients admitted to our institution between November 2007 and July 2013. The diagnostic criteria for the AFFs were based on 2014 American Society of Bone and Mineral Research guidelines. We classified the fracture location as proximal, middle, or distal to trisect the femoral diaphysis from just distal to the lesser trochanter to just proximal to the supracondylar flare. Bowing was defined as a line through the inside of the tip of the great trochanter and a condylar center that was outside the medullary cavity. We investigated the fracture's location, existence of coronal bowing, and bisphosphonates (BPs), glucocorticoids (GCs), and proton pump inhibitors therapy. We analyzed associations between fracture location and demographic and clinical factors. Twelve fractures were proximal, 25 were middle, and one was distal. Nineteen limbs showed femoral bowing. Thirty-one patients received BP treatment-20 patients received alendronic acid, eight risedronic acid, and three minodronic acid. Fourteen patients received a GC, and 16 received a proton pump inhibitor. There was a significant association between coronal bowing and middle fracture locations, GC therapy and proximal fracture locations, and older age and middle fracture locations. Tall height and heavy weight had an association with proximal fracture location, and short height and light weight had an association with middle fracture location. In conclusion, we provide evidence supporting a causal relationship between BP-related severely suppressed bone turnover and AFFs. We also provide evidence supporting additional influences from altered distribution of mechanical stress with femoral bowing and various factors, such as GC therapy, age, body weight, and height, which might negatively affect bone intensity and quality and result in fracture.

Hypoxia responsive mesenchymal stem cells derived from human umbilical cord blood are effective for bone repair.

Mesenchymal stem cells (MSCs) are highly useful in a variety of cell therapies owing to their multipotential differentiation capability. MSCs derived from umbilical cord blood are generally isolated by their plastic adherence without using specific cell surface markers and examined for their osteogenic, adipogenic, and chondrogenic differentiation properties retrospectively. Here, we report 2 subpopulations of MSCs, separated based on aldehyde dehydrogenase (ALDH) activity. MSCs with a high ALDH activity (Alde-High) proliferated more than those with a low ALDH activity (Alde-Low). Alde-High MSCs had a greater ability to differentiate than Alde-Low MSCs in in vitro culture. Transplantation of Alde-High MSCs into fractured mouse femurs enabled early repair of tissues and rapid bone substitution. Alde-High MSCs were also more responsive to hypoxia than Alde-Low MSCs, with the upregulation of Flt-1, CXCR4, and Angiopoietin-2. Thus, MSCs with a high ALDH activity might serve as an effective therapeutic tool for healing fractures within a short period of time.

GATA2-dependent and region-specific regulation of Gata2 transcription in the mouse midbrain.

Transcription factor GATA2 is expressed in numerous mammalian tissues, including neural, hematopoietic, cardiovascular and urogenital systems, and yet it plays important roles in the regulation of tissue-restricted gene expression. The Gata2 gene itself is also under stringent tissue-specific control and multiple cis-regulatory domains have been identified in the Gata2 locus. In this study we sought out and then examined in detail the domains that regulate Gata2 in the midbrain. We identified two discrete domains in the Gata2 promoter that direct midbrain expression; these distal 5H and proximal 2H regulatory domains are located 3.0 and 1.9 kbp, respectively, upstream of the transcriptional initiation site. Importantly, both domains contain GATA factor binding sites. Our analyses further revealed that GATA2 is essential for Gata2 gene expression in the midbrain, whereas GATA3 is not. Both the 2H and 5H domains have the independent ability to activate Gata2 gene expression in the midbrain superior colliculus, whereas the distal-5H domain is additionally capable of activating Gata2 transcription in the inferior colliculus. These results demonstrate that two distinct regulatory domains contribute to the Gata2 gene expression in the mouse midbrain and that Gata2 midbrain transcription is under positive autoregulation.