Changes in the WOMAC, EuroQol and Japanese lifestyle measurements among patients undergoing total hip arthroplasty.

OBJECTIVE: To assess changes in the health outcomes of Japanese patients before and after total hip arthroplasty (THA), and to assess the impact of THA on commonly performed postures or body positions requiring deep flexion of the hip joint such as the use of Japanese squat toilets. METHODS: Consecutive patients undergoing primary THA between July 2003 and July 2004 were eligible for the study. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the EuroQol 5D (EQ-5D) were administered at the preoperative period and two postoperative periods of 6 weeks and 6 months. The patients were also asked to rate three items regarding common activities of daily living in Japan such as squatting. Changes in scores were examined using effect size and proportion at the floor and ceiling. RESULTS: Four-hundred and fifty-one patients completed both pre- and post-THA surveys. Significant improvements in pain and physical function as measured by WOMAC and EQ-5D were evident within 6 weeks. Changes in WOMAC and EQ-5D subscale scores and scores for each item from the three time periods were highly significant (P=0.000). The effect size was 1.56 for WOMAC pain and 1.38 for physical function at 6 months. In contrast, two items (Japanese toilet and seiza) became significantly worse at the 6-week postoperative period (P=0.000) and returned to preoperative levels by the 6-month postoperative period. CONCLUSION: These results highlight the importance of evaluating culturally sensitive physical functions in addition to conventional measurements for the health outcomes of THA patients.

Cloning and structural analysis of the full-length cytolethal distending toxin (cdt) gene operon from Campylobacter lari.

Polymerase chain reaction (PCR) amplicons (approximately 2.5 kbp) encoding a cdt gene operon and two partial and putative open reading frames (ORFs) were identified in six urease-negative (UN) Campylobacter lari isolates using a new PCR primer pair constructed in silico. Three closely spaced and putative ORFs for cdtA, cdtB and cdtC, two putative promoters and a hypothetically intrinsic p-independent transcription terminator were found in the operon. Each ORF commenced with an ATG start codon and terminated with a TGA stop codon for cdtA and cdtB and a TAA for cdtC. Interestingly, an overlap of four nucleotides was detected between cdtA and cdtB and the non-coding region of six base pairs occurring between cdtB and cdtC. The start codons for the three cdt genes were preceded by Shine-Dalgarno sequences. Although nucleotide sequence differences were identified at seven loci in the cdtA gene, six in cdtB and two in cdtC among the seven isolates (including C. lari RM2100), no polymorphic sites occurred in the putative promoters, hypothetically intrinsic transcription terminator and the three ribosome binding sites among the seven isolates. All nine amino acid residues specific for both Escherichia coli cdtB and mammalian DNase I were completely conserved in the cdtB gene locus in the 26 C. lari isolates, as well as in C. jejuni and C. coli. No PCR amplicons were generated with urease-positive thermophilic campylobacters (UPTC; n=10) using the primer pair.

An orthognathic simulation system integrating teeth, jaw and face data using 3D cephalometry.

A method for simulating the movement of teeth, jaw and face caused by orthognathic surgery is proposed, characterized by the use of 3D cephalometric data for 3D simulation. Computed tomography data are not required. The teeth and facial data are obtained by a laser scanner and the data for the patient's mandible are reconstructed and integrated according to 3D cephalometry using a projection-matching technique. The mandibular form is simulated by transforming a generic model to match the patient's cephalometric data. This system permits analysis of bone movement at each individual part, while also helping in the choice of optimal osteotomy design considering the influences on facial soft-tissue form.

Masticatory function and neurosensory disturbance after mandibular correction by bilateral sagittal split ramus osteotomy: a comparison between miniplate and bicortical screw rigid internal fixation.

Bilateral sagittal split osteotomy is commonly used to treat mandibular prognathism. Several fixation methods for bony segments have been described. The present study compared masticatory function and neurosensory recovery patterns after mandibular correction between two methods of rigid fixation, bicortical screw (n = 38) and monocortical miniplate (n = 32). Patients who had undergone bilateral sagittal split osteotomy for Class III malocclusion were reviewed, and masticatory function and neurosensory recovery were studied with the appropriate indicators at 1, 3, 6 and 12 months postoperatively. Minimal differences were seen between groups at 1-year postoperatively, and although patients treated with miniplate fixation tended to recover faster, with regard to masticatory function and neurosensory disturbance, than those treated with screw fixation, no significant differences were identified. As the two methods seem to provide equal comfort and reliability, the choice should be made by the individual surgeon.

A new navigation system based on cephalograms and dental casts for oral and maxillofacial surgery.

Intraoperative navigation systems help surgeons to accurately carry out preoperative plans without injuring anatomically important structures. A system is evaluated that uses cephalograms instead of computed tomographic (CT) scans to create images. Three-dimensional (3D) dental casts provide registration between imaging data and the patient. Cephalograms are widely employed in orthognathic and oral and maxillofacial surgery and expose patients to lower doses of radiation than CT. The system uses a dental cast to register the operation field to a pair of frontal and lateral cephalograms. The cast is transformed to 3D data with a laser scanner and a programme that runs on a personal computer. 3D data describing the dental cast, cephalograms and the oral and maxillofacial region of the patient are integrated with specialized software. The optical tracking system for navigation uses charged-coupled-device (CCD) video cameras and light-emitting diodes (LEDs). Two CCD video cameras follow the 3D coordinates of LED assemblies attached to the head, lower jaw and a handpiece. Errors occurring when a dental cast was transformed to 3D data ranged from 0.08 to 0.21 mm. Mean errors were 0.71 mm (0.21-1.09 mm) for the right maxillary central incisor, 0.62 mm (0.04-1.69 mm) for the right maxillary 2nd molar and 1.02 mm (0.23-1.47 mm) for the left maxillary 2nd molar. This surgical navigation system is sufficiently accurate for use in oral and maxillofacial surgery.

Effectiveness of autologous fibrin tissue adhesive in reducing postoperative blood loss during total hip arthroplasty: a prospective randomised study of 100 cases.

PURPOSE: To evaluate the effectiveness of autologous fibrin tissue adhesive (auto-FTA) in reducing blood loss during cementless total hip arthroplasty (THA). METHODS: From September 2000 to August 2001, 100 patients who predonated 400 ml of autologous blood were randomised to undergo either standard treatment with auto-FTA (auto-FTA group) or standard treatment alone (control group). The volume of postoperative blood loss and the decrease in haemoglobin level were measured. All patients were followed up for 3 years to evaluate the rate of bone ingrowth and heterotopic ossification. RESULTS: The mean postoperative blood loss was 580 ml (standard deviation [SD], 240 ml) in the auto-FTA group and 810 ml (SD, 341 ml) in the control group; the difference was significant (230 ml, p<0.001). The decrease in haemoglobin concentration was 17 g/l (SD, 11 g/l) in the auto-FTA group and 22 g/l (SD, 12 g/l) in the control group. The difference was significant (5 g/l, p=0.03). The percentage of total blood loss of >1200 ml in any single patient was significantly lower in the auto-FTA group (4%) than in the control group (20%) [p=0.01]. CONCLUSION: Auto-FTA is a safe and effective means of reducing perioperative blood loss in THA.

Spirochaete-like swimming mode of Campylobacter jejuni in a viscous environment.

The swimming patterns of Campylobacter jejuni in environments of low and high viscosity were examined by a video tracking method. In media of low viscosity, C. jejuni swam with an average velocity of 39.3 microm/s with frequent changes in direction. The velocity of C. jejuni increased in a medium at a little higher viscosity than that of a low viscosity buffer. In addition to this, C. jejuni showed a second increase of velocity in media of a high viscosity of about 40 centipoise. The swimming patterns at these two velocity peaks were compared. In the second peak the wild-type C. jejuni exhibited repeated back and forth swimming patterns which were more like the swimming pattern of spirochaetes than that of monotrichous bacteria. Thus C. jejuni may presumably use a different swimming mode in media of high viscosity than the original swimming mode mediated by the propelling force of the flagella. The spiral shape of this bacterium like that of spirochaetes may strongly influence its swimming ability in media of high viscosity such as the mucous layer of the intestinal tract.

Significance of increase in lipocortin-1 gene transcripts in the blood monocytes of patients with pulmonary sarcoidosis.

BACKGROUND AND AIM OF THE WORK: Lipocortin-1 (also known as annexin-1) is upregulated by corticosteroids and plays a prominent part in many of their anti-inflammatory actions. In our previou investigation, lipocortin-1 gene expression in blood monocytes was higher in sarcoidosis patients tha in healthy subjects or IPF patients. In this study, we examined the amounts of lipocortin-1 gene tran scripts [at baseline and after stimulation by synthetic adrenocorticotrophic hormone (ACTH)] in the blood monocytes of sarcoidosis patients, and then we analyzed the relationships between these amount and several clinical indexes. METHODS: Serum and blood monocyte samples were prepared from 21 sar coidosis patients before and after ACTH stimulation. The amounts of lipocortin-1 and beta-actin gene tran scripts obtained from monocytes were quantified by RT-PCR. The patients were prospectively followe for at least 2.5 years. RESULTS: 1. Serum cortisol was increased in all patients after synthetic ACTH in jection. 2. Lipocortin-1 gene transcripts tended to increase in parallel with increases in serum cortisol but the relationship was not significant. 3. The amounts of lipocortin-1 gene transcripts induced by syn thetic ACTH were related to two indexes of disease activity/extension: the presence of parenchymal lesions (p = 0.018), and the presence of extrathoracic lesions (p = 0.043). 4. After 3 years of follow-up the patients with higher basal amounts of lipocortin-1 gene transcripts in monocytes showed improve ment of sACE activity and FEV1/FVC%. CONCLUSION: The amounts of lipocortin-1 gene transcripts induced by synthetic ACTH were related to the presence of parenchymal lesions, while their basa amounts correlated with either improvement of sACE activity or stabilization of FEV1/FVC%.

Summer-type hypersensitivity pneumonitis. T-cell receptor V gene usage in BALF T-cells from 3 cases in one family.

BACKGROUND AND AIM OF THE WORK: Hypersensitivity pneumonitis (HP) is a granulomatous lung disease characterized by a T lymphocyte bronchiolalveolitis and in several recent studies the preferential use of V beta regions of T-cell receptor (TCR) has been demonstrated. In Japan, summer-type HP, caused by Trichosporon cutaneum, is the most prevalent type of HP, and it is known by the familial occurrence. To clarify whether TCR expression could be restricted on lung T-cell and associate with the HLA type in an organic antigen-driven hyperimmune status, we examined three cases of summer-type HP in one Japanese family. METHODS: TCR expression on bronchoalveolar lavage (BAL) fluid T-cells was analyzed with 13 TCR V gene specific monoclonal antibodies. In addition, HLA types were analyzed using the microlymphocyte toxicity method. RESULTS: The changes in TCR expression were most frequently found in the BAL fluid CD8+ subset, but we found no preferential TCR V gene usage common to the three cases or correlation between the HLA type and the V gene usage. In two of the three cases who underwent a second lavage three months after the first one, some of the TCR expansions were preserved. CONCLUSION: Preferential usage of several TCR V genes was observed in three cases with summer-type HP in one family, but we could find neither a common T cell expansion nor any correlation between the HLA type and the TCR V gene usage.

ECG-abnormalities in Japanese and Swedish patients with sarcoidosis. A comparison.

BACKGROUND AND AIM OF THE WORK: ECG abnormalities are more common in patients with sarcoidosis than in controls. The incidence of cardiac sarcoid granulomas in the Japanese population has been found to be higher than that seen in Caucasians. We compared the prevalence of ECG abnormalities in Japanese and Swedish patients with sarcoidosis. METHODS: Twelve-lead routine ECG's were compared between consecutive patients (134 Japanese and 149 Swedish) of similar age with histologically verified sarcoidosis or a high clinical probability of the disease and a history of no more than 12 months before the ECG. RESULTS: There was no statistically significant difference in the prevalence of first degree AV block, ST-T-segment abnormalities, right bundle branch block (RBBB) and left anterior block (LAH) in Japanese and Swedish patients. Among the Swedes, the results were compared with those of a smaller group (n = 29) of older patients with a longer disease course. In these few patients LAH and RBBB occurred more frequently than in patients with a recent diagnosis. CONCLUSIONS: ECG abnormalities in patients with sarcoidosis seem to be of similar frequency in Japan and Sweden. ST-T changes and first degree AV block would appear early in the course of the disease, whereas more pronounced conduction defects may appear later.

Liver metastasis rare in colorectal cancer patients with fatty liver.

BACKGROUND/AIMS: As no reports in terms of the relationship between fatty liver and liver metastasis of colorectal cancer clinicopathological analysis of colorectal cancer patients with fatty were found a liver was carried out. PATIENTS AND METHODS: Among 839 patients with single colorectal carcinoma who underwent operations at our department between 1985 and 1994, 121 patients were designated as fatty liver using ultrasonography (FL group). The remaining 718 non-fatty liver patients with colorectal cancer (NFL group) were compared to the FL group regarding clinicopathological aspects. RESULTS: (1) There were only two patients who had liver metastasis in the FL group (1.7%), while the NFL group included 115 patients with liver metastasis (16.0%) (p < 0.01). (2) The five-year survival rate of the FL group was 95.7%, which was significantly higher than that in the NFL group (9.8%) (p < 0.001). (3) In the multivariate analysis, the fatty liver was identified as an independent prognostic factor. CONCLUSIONS: The FL group had a much better prognosis compared to the NFL group. Especially, liver metastasis was extremely rare in the FL group. We believe that these results will lead to the clarification of the liver metastasis mechanism.

Sarcoidosis with granulomatous interstitial nephritis: report of three cases.

Three cases of sarcoidosis with granulomatous interstitial nephritis are reported. Patients were all male and over 50 years of age. They simultaneously had evidence of multiorgan involvement of sarcoidosis including lung and skin and/or eye. In addition, distinct features were found in each case: a granulomatous infiltration mimicking unilateral renal tumor (case 1); renal insufficiency solely due to granulomatous interstitial nephritis (case 2); and renal insufficiency with calcemic nephropathy and granulomatous interstitial nephritis (case 3). Prednisolone therapy resulted in disappearance of the pseudotumor in case 1 and partial improvement of renal function in cases 2 and 3. In cases 2 and 3, however, plasma creatinine did not return to normal values and a second renal biopsy in case 2 demonstrated residual interstitial fibrosis and few granulomas, suggesting that steroid therapy did not achieve complete reversal of changes.

Relatively high F-18 fluorodeoxyglucose uptake in paranasal sinus aspergillosis: a PET study.

We report a case of maxillary sinus (MS) aspergillosis studied by positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) and by 67Ga-citrate (Ga) single photon emission computed tomography (SPECT). The FDG uptake existed in the lesion and along the inflammatory edematous mucous membrane of the MS. Ga uptake occurred not only in the lesion and in the mucous membrane but also in the MS. Relative quantification, the standardized uptake value (SUV) of the lesion showed relatively high FDG uptake (3.7). But in other reports, many malignant head and neck tumors had a SUV below 3.7. It was thought to be difficult to differentiate between aspergillosis and malignant head and neck tumors by FDG-PET.

Coronary artery disease in dermatomyositis. A case report.

A sixty-two-year-old woman with chronic dermatomyositis (DM) receiving steroid monotherapy developed coronary artery stenosis. She had lung fibrosis and complained of dyspnea, but no ischemia was suggested by electrocardiogram. Ateriographic findings and clinical symptoms of coronary artery disease in DM have not been previously reported.

Effects of football training on ventilatory and gas exchange kinetics to sinusoidal work load.

The purpose of this study was to evaluate the effects of football training on maximal oxygen uptake (VO2max), ventilatory threshold (VT) and kinetics of ventilation and gas exchange variables to sinusoidal work load. The sinusoidal work load during cycling exercise was varied from 30 watts to 60% of VO2max (60% VO2max) with a period of 2 min. O2 uptake (VO2), CO2 output (VCO2), minute ventilation (VE) and heart rate (HR) were measured on a breath-by-breath basis using a computer system. Training periods were continued for 9 months. Six males who had no football experience were performed in which VO2max, VT, and the kinetics of each variable were measured for 3-month intervals (PRE, TR.3, TR.6, and TR.9). They usually underwent football training, such as sprint and strength training for 2-3 hours day-1, 6 days week-1. Mean VO2max was significantly increased at TR.3 and TR.6. VT was also significantly increased during the training period. The amplitude of VO2, VCO2, VE, and HR responses during sinusoidal exercise unchanged during the training period. Phase shifts to work load in VO2 and HR responses did not significantly change during the 9 months, but the phase shift in VCO2 and VE responses significantly continued increasing as the training intervals progressed. These results suggest that football training does not significantly affect the development of the kinetics of VO2 and HR during submaximal exercise, but that it dramatically increases VO2max and VT values.

Studies on the psychosomatic functioning of ill-health according to Eastern and Western medicine 5. Psychosomatic characteristics of anxiety and anxiety-affinitive constitution.

In successive studies of the psychosomatic functioning of ill-health according to Oriental and Western medicine in medical students, we established the existence of the psychosomatic characteristics we have provisionally termed the anxiety-affinitve constitution at the core of ill-health. Therefore, we conducted this research because our previous investigation showed this constitution included a high complexity of respiratory movement and eye movement with a significant correlation to the State Trait Anxiety Inventory (STAI). We examined the correlation between the STAI and somatic function of 88 medical students to identify the psychosomatic characteristics of anxiety and the anxiety-affinitive constitution. These tests included STAI, fractal (EEG, EOG, plethysmogram, respiratory curves, and EMG) and non-fractal (accelerated plethysmogram) dimension analyses, and malocclusion (based on Angle's classification). In particular, EOG, plethysmogram, and respiratory curves are known to have close association with trait anxiety. We were able to discover the correlation between (1) trait anxiety and thoracic and abdominal respiratory movements, and malocclusion (Class III), and (2) the correlation of state anxiety with thoracic respiratory movement, horizontal eye movement, a plethysmogram and an EEG-Pz (in males only). In subsequent study the relation between thoracic dominance and state-trait anxiety and between abdominal dominance and state-trait anxiety should be assessed to develop this research regarding the psychosomatic characteristics of anxiety and the anxiety-affinitive constitution. Further, it is essential to create an anxiety-affinitve constitution index based on multi-regression analysis.

[A comparative study of imaging of myocardial perfusion with 201Tl-SPECT and 13NH3-PET: visual and quantitative evaluation].

UNLABELLED: We compared the results of visual and quantitative evaluation of imaging of myocardial perfusion with 201Tl-SPECT and 13NH3-PET in the 7 non-myocardial infarction (non-MI) and 42 myocardial infarction (MI) patients. On the 201Tl-SPECT and 13NH3-PET imaging, the degree of accumulation of each radioisotope (RI) was visually classified into four grades of defect score. The percentage of uptake was also quantitatively evaluated. RESULTS: In the 7 non-MI patients, NH3% uptake in the lateral wall was significantly lower than in the septum, and in the lateral wall NH3% uptake was significantly lower than Tl% uptake. For the 42 MI patients, segmental defect scores (DS) on 201Tl-SPECT were compared with those on 13NH3-PET, and a high degree of concordance in DS was found for all territories of the left ventricle, antero-septum MI and inferior MI territories. Average Tl% uptake/NH3% uptake was near 1, a highly positive correlation was found between Tl% uptake and NH3% uptake in all territories of the left ventricle and antero-septum MI territories, and Tl% uptake/NH3% uptake was larger than 1, but, a significant positive correlation existed between Tl% uptake and NH3% uptake in the territory with inferior MI. CONCLUSION: These findings indicate that results of 201Tl-SPECT imaging were similar to those of 13NH3-PET in evaluation of myocardial perfusion in the antero-septum and inferior. However, a difference in distribution was observed between 201TlCl and 13NH3 in the lateral wall, indicating that particular attention should be paid to the results of imaging of myocardial perfusion in the lateral wall.

[Analysis of the swimming pattern and the velocity of bacteria using video tracking method].

The swimming patterns and the velocities of several flagellated bacteria were measured by a computer assisted video tracking method. The moving path of the individual bacterium revealed that the bacterium frequently changed its swimming direction and velocity. The velocity among bacterial strains varies widely. In low viscous environment. Campylobacter jejuni has characteristic swimming pattern with frequent changes in their swimming direction. As the viscosity increase, C. jejuni increases its velocity at a little higher viscosity of 3 centipoise (cP) and secondly increases at about 40 cP. Different from other flagellated bacteria, the swimming pattern of C. jejuni in these two velocity peaks were changed. C. jejuni exhibited continuously forward moving path in the first peak, but in the second it repeated back and forth swimming pattern. We thus assumed that C. jejuni may use a different swimming mode in high viscous media from the original mode mediated by the propelling force of the flagella. This method is useful for a detail analysis of bacterial movement and moving patterns in different environmental conditions.