Clinical features and radiological findings of 67 patients with SAPHO syndrome.

OBJECTIVES: The purpose of this study was to facilitate the understanding of the SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis) syndrome by analyzing the clinical and radiological features of 67 Japanese patients with SAPHO syndrome. METHODS: Sixty-seven Japanese patients (female/male: 44/23, mean age at onset: 48.5 years) were diagnosed with SAPHO syndrome from 2002 to 2013 at our hospital. Medical records and radiological imaging of these patients were retrospectively reviewed. RESULTS: Among the 67 patients, 41 had dermatological manifestations, such as palmoplantar pustulosis, acne, and psoriasis. Initial symptom was local pain in all patients, and the most common initial site of the symptom was the anterior chest. Bacterial and fungal cultures from 20 bone biopsies were all negative. Histopathological diagnosis of the specimens was non-specific inflammation in all cases. Bone lesions were observed in 65 patients (97.0%). On the other hand, articular lesions including enthesitis were found in 31 patients (46.2%). CONCLUSION: SAPHO syndrome had different clinical and radiological aspects. The clinical features were not remarkable, except the dermatological manifestations and the involvement of the anterior chest. Bone lesions including hyperostosis and osteitis were found radiographically in the majority of patients with SAPHO syndrome. These are the characteristics of the SAPHO syndrome, with the exclusion of other bone diseases.

Differences in humeral retroversion in dominant and nondominant sides of young baseball players.

BACKGROUND: The relationship between the disabled throwing shoulder and humeral retroversion has recently attracted a great deal of attention. However, none of the previous studies clarified when the side-to-side difference of humeral retroversion in young baseball players would start. This study aimed to clarify when the difference of humeral retroversion in the dominant and nondominant sides appeared in baseball players. METHODS: The bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball players was measured by ultrasound. The bicipital-forearm angle was defined as an angle between the perpendicular line to the bicipital groove and the ulnar long axis with the elbow flexed at 90°. The correlation between the bicipital-forearm angle and the grade and the difference of the bicipital-forearm angle between the dominant and nondominant sides were analyzed. RESULTS: In the nondominant shoulders, the bicipital-forearm angle increased with the grade in school (r = 0.32, P < .0001), but this was not observed in the dominant shoulders. In the fourth to sixth graders, the bicipital-forearm angles were significantly smaller in the dominant shoulders than in the nondominant shoulders. CONCLUSION: Our findings indicated that humeral retroversion decreased with age in the nonthrowing side but not in the throwing side and that the side-to-side difference of humeral retroversion in the baseball players became obvious from the fourth grade. We assume that the repetitive throwing motion restricts the physiologic humeral derotation process and the difference became apparent from the fourth grade when the growth spurt begins in boys.

Whole-body counter surveys of Miharu-town school children for four consecutive years after the Fukushima NPP accident.

Comprehensive whole-body counter surveys of Miharu-town school children have been conducted for four consecutive years, in 2011-2014. This represents the only long-term sampling-bias-free study of its type conducted after the Fukushima Dai-ichi accident. For the first time in 2014, a new device called the Babyscan, which has a low (134/137)Cs MDA of <50 Bq/body, was used to screen the children shorter than 130 cm. No child in this group was found to have detectable level of radiocesium. Using the MDAs, upper limits of daily intake of radiocesium were estimated for each child. For those screened with the Babyscan, the upper intake limits were found to be ≲1 Bq/day for (137)Cs. Analysis of a questionnaire filled out by the children's parents regarding their food and water consumption shows that the majority of Miharu children regularly consume local and/or home-grown rice and vegetables. This however does not increase the body burden.

Comprehensive whole-body counter surveys of Miharu-town school children for three consecutive years after the Fukushima NPP accident.

Comprehensive whole-body counter surveys covering over 93% of the school children between the ages of 6 and 15 in Miharu town, Fukushima Prefecture, have been conducted for three consecutive years, in 2011, 2012 and 2013. Although the results of a questionnaire indicate that approximately 60% of the children have been regularly eating local or home-grown rice, in 2012 and 2013 no child was found to exceed the (137)Cs detection limit of 300 Bq/body.

Internal radiocesium contamination of adults and children in Fukushima 7 to 20 months after the Fukushima NPP accident as measured by extensive whole-body-counter surveys.

The Fukushima Dai-ichi NPP accident contaminated the soil of densely-populated regions in Fukushima Prefecture with radioactive cesium, which poses significant risks of internal and external exposure to the residents. If we apply the knowledge of post-Chernobyl accident studies, internal exposures in excess of a few mSv/y would be expected to be frequent in Fukushima.Extensive whole-body-counter surveys (n = 32,811) carried out at the Hirata Central Hospital between October, 2011 and November, 2012, however show that the internal exposure levels of residents are much lower than estimated. In particular, the first sampling-bias-free assessment of the internal exposure of children in the town of Miharu, Fukushima, shows that the (137)Cs body burdens of all children (n = 1,383, ages 6-15, covering 95% of children enrolled in town-operated schools) were below the detection limit of 300 Bq/body in the fall of 2012. These results are not conclusive for the prefecture as a whole, but are consistent with results obtained from other municipalities in the prefecture, and with prefectural data.

Synovial cyst of the hip in a patient with rheumatoid arthritis.

A 67-year-old woman with rheumatoid arthritis (RA; Steinblocker stage IV, class 4) who had RA onset at 34 years of age had anterior thigh pain, femoral neuropathy and lower abdominal pain. Physical examination showed multidirectional limit of motion, and radiographic examination showed destruction of the hip joint. MRI and arthrography indicated a cystic lesion that communicated with the hip joint. The rheumatoid synovial cyst was removed during total hip arthroplasty. The symptoms were relieved, and the mass was reduced in size.

2-[Bis(carboxymethyl)amino] propanoic acid-Chelated Copper Chelate Enhances Bacterial Elimination by Sodium Percarbonate.

Sodium percarbonate (SP) is a relatively low-cost and stable solid oxidizer with a small environmental burden. It is often included in cleansers for sanitizing circulating water pipes and as bleaching reagents in laundry, although the bactericidal effect of SP is lower than that of chlorine-based agents. 2-[Bis(carboxymethyl)amino] propanoic acid-chelated copper (MGDA-Cu) was added to increase the effect of SP. The addition of 12 µM MGDA-Cu increased the bactericidal effect of 0.5 wt% SP against Staphylococcus aureus even in the presence of 0.3 wt% BSA, which is an experimental model of organic stain to protect bacteria from SP. MGDA-Cu was effective against Escherichia coli only in the absence of BSA and showed little effect against Bacillus subtilis. It enhanced the effect of SP to decrease the viscosity of sodium alginate, which is one of the major components of biofilms. The effect of MGDA-Cu on sanitization was also evaluated by 16S rRNA amplicon sequencing of the bacterial flora of the biofilm on an experimental model of a circulating water pipe. The structure of the bacterial flora was more influenced by a cleanser containing both MGDA-Cu and SP than a cleanser with only SP, suggesting that MGDA-Cu increases the sanitization effect.

Ultra-high-purity iron is a novel and very compatible biomaterial.

Metals and alloys are used widely in bone prosthetic materials, stents and dental tissue reconstructions. The most common materials are stainless steels and cobalt-chromium-nickel and titanium alloys. These alloys can be easily deformed but are hard to break. However, their affinity for cells and tissues is very low. In addition, they can sometimes provoke unexpected metal allergies. Iron is an abundant trace element essential for humans. However, excess amounts in particular of Fe2+ ions are toxic. We previously succeeded in obtaining 99.9996% ultra-high-purity iron (ABIKO iron). The chemical properties of ABIKO iron are completely different from that of conventional pure iron. For example, the reaction rate in hydrochloric acid is very slow and there is barely any corrosion. Here, we found that, in the absence of any type of coating, mammalian cells could easily attach to, and normally proliferate and differentiate on, ABIKO iron. On the other hand, cell densities and proliferation rate of the surfaces of plates made from Co-Cr-Mo or Ti-6Al-4V were significantly reduced. In addition, several stress and iron response genes, HSP70, SOD1, ATM and IRP2 did not change in the cells on ABIKO iron, while these genes were induced with exogenous application of FeSO4. Cells also secreted and fastened some organics on ABIKO iron. In vitro collagen binding assay showed that ABIKO iron binds higher amount of collagens. These findings highlight ABIKO iron as a novel biocompatible prosthetic material.

Computer Graphics Animation for Objective Self-Evaluation.

The increased number of students enrolling in dance classes in Japan has resulted in a shortage of qualified instructors, leaving classes to be taught by instructors who are not trained in dance. The authors developed a system specifically designed to help nonqualified dance instructors teach dance using motion capture and animation. The goal is to allow dancers to easily self-evaluate their own performances by comparing it to a standard example.

Experimental investigation on feasible bioreactor using mechanism of hydrogen oxidation of natural soil for detritiation system.

A passive reactor for tritium oxidation at room temperature has been widely studied in nuclear engineering especially for a detritiation system (DS) of a tritium process facility taking possible extraordinary situation severely into consideration. We have focused on bacterial oxidation of tritium by hydrogen-oxidizing bacteria in natural soil to realize the passive oxidation reactor. The purpose of this study was to examine the feasibility of a bioreactor with hydrogen-oxidizing bacteria in soil from a point of view of engineering. The efficiency of the bioreactor was evaluated by kinetics. The bioreactor packed with natural soil shows a relative high conversion rate of tritium under the saturated moisture condition at room temperature, which is obviously superior to that of a Pt/Al2O3 catalyst generally used for tritium oxidation in the existing tritium handling facilities. The order of reaction for tritium oxidation with soil was the pseudo-first order as assessed with Michaelis-Menten kinetics model. Our engineering suggestion to increase the reaction rate is the intentional addition of hydrogen at a small concentration in the feed gas on condition that the oxidation of tritium with soil is expressed by the Michaelis-Menten kinetics model.

Measurement of internal radiation exposure among decontamination workers in villages near the crippled Fukushima Daiichi Nuclear Power Plant.

Decontamination workers may face a high risk of exposure to internal irradiation through inhalation during decontamination activities; there is, however, little previous research on the levels of internal contamination during decontamination procedures. The authors reviewed the medical records, including whole body counter measurements, of decontamination workers in villages near the crippled Fukushima Daiichi Nuclear Power Plant to assess their levels of internal radiation exposure. In total, 83 decontamination workers were enrolled in this study. They were regularly engaged in decontamination activities in highly contaminated areas where surface 137Cs deposition density was over 100 kBq m-2. The present study showed low levels of internal exposure among the decontamination workers near the Fukushima Daiichi nuclear plant. The cesium burdens of all the decontamination workers were below detection limits. They had reported no acute health problems. The resuspension of radioactive materials may cause minimal internal contamination during decontamination activities.

A local application of recombinant human fibroblast growth factor 2 for tibial shaft fractures: A randomized, placebo-controlled trial.

Fibroblast growth factor 2 (FGF-2) is a potent mitogen for mesenchymal cells, and a local application of recombinant human FGF-2 (rhFGF-2) in a gelatin hydrogel has been reported to accelerate bone union in our animal studies and preparatory dose-escalation trial on patients with surgical osteotomy. We have performed a randomized, double-blind, placebo-controlled trial in which patients with fresh tibial shaft fractures of transverse or short oblique type were randomly assigned to three groups receiving a single injection of the gelatin hydrogel containing either placebo or 0.8 mg (low-dosage group) or 2.4 mg (high-dosage group) of rhFGF-2 into the fracture gap at the end of an intramedullary nailing surgery. Of 194 consecutive patients over 2 years, 85 met the eligibility criteria, and 70 (24 in the placebo group and 23 each in low- and high-dosage groups) completed the 24-week study. The cumulative percentages of patients with radiographic bone union were higher in the rhFGF-2-treated groups (p = .031 and .009 in low- and high-dosage group, respectively) compared with the placebo group, although there was no significant difference between low- and high-dosage groups (p = .776). At 24 weeks, 4, 1, and 0 patients in the placebo, low-dosage, and high-dosage groups, respectively, continued to show delayed union. No patient underwent a secondary intervention, and the time to full weight bearing without pain was not significantly different among the three groups (p = .567). There also was no significant difference in the profiles of adverse events among the groups. In conclusion, a local application of the rhFGF-2 hydrogel accelerated healing of tibial shaft fractures with a safety profile.

Factors related to successful outcome of conservative treatment for rotator cuff tears.

BACKGROUND: Much controversy exists as to the management of full-thickness tears of the rotator cuff. Not all patients with rotator cuff tears require surgical treatment. We have little information whether there are factors that are related to successful outcome of conservative treatment. AIM. The purpose of this study was to determine the factors related to the successful outcome following conservative treatment. METHODS: This study included 123 shoulders in 118 patients with full-thickness tears of the rotator cuff diagnosed by high-resolution magnetic resonance imaging with a microscopy coil. All patients were treated conservatively for at least 3 months. Clinical symptoms improved in 65 shoulders in 62 patients by conservative treatment (conservative group), but remained unchanged or aggravated in 58 shoulders in 56 patients, who eventually underwent surgical repair (surgical group). RESULTS: The following parameters showed significant differences: 1) integrity of the intramuscular tendon of the supraspinatus (24.1% in the surgical group and 58.4% in the conservative group showed an intact intramuscular tendon); 2) supraspinatus muscle atrophy (occupancy ratio was 69.8% in the surgical group and 78.0% in the conservative group); 3) impingement sign (positive in 79.3% in the surgical group and 30.7% in the conservative group); and 4) external rotation angle (35.0 degrees in the surgical group and 52.2 degrees in the conservative group). The success rate of conservative treatment was 87% in the cases with at least three of these four factors. CONCLUSION: These four factors are useful in selecting patients who will respond well to conservative treatment before initiating the treatment.

Effects of tendon transfer to restore index finger abduction for severe cubital tunnel syndrome.

BACKGROUND: Severe cases of cubital tunnel syndrome do not always result in functional recovery after surgical decompression of the ulnar nerve. A combined operation of tendon transfer to restore index finger abduction and decompression of the ulnar nerve was performed for patients with severe cubital tunnel syndrome who required powerful pinch strength and whose preoperative compound muscle action potential of the abductor digiti minimi muscle was not recordable or almost non-recordable. The purpose of this study was to assess the efficacy of tendon transfer to restore index finger abduction for severe cubital tunnel syndrome. METHODS: Sixteen hands in 15 patients with severe cubital tunnel syndrome were operated on with extensor pollicis brevis tendon transfer to the first dorsal interosseous muscle to restore index finger abduction and ulnar nerve decompression. They were reviewed after a mean follow-up of 16 months. All 16 hands had preoperatively severe lesions with paralysis of ulnar intrinsics, marked anaesthesia, or hypaesthesia. RESULTS: Postoperative results were excellent in 2 hands, good in 10, fair in 4, and no cases with poor results according to Akahori's criteria. Four hands with fair results had a residual Froment sign or annoying hypaesthesia in the ring and little fingers. All patients were relieved of preoperative discomfort and showed recovery of motor and sensory function. The mean pre- and postoperative pinch strength was 3.3 kg and 5.6 kg, respectively, which showed a significant difference (P<0.01). Mean time of showing a negative Froment sign after surgery was 5 months in 13 cases. CONCLUSIONS: The extensor pollicis brevis tendon transfer is simple and useful to restore index finger abduction and pinch strength for severe cubital tunnel syndrome.

Internal fixation of proximal humeral fractures with a Polarus humeral nail.

BACKGROUND: Proximal humeral fractures occur frequently. Displaced or unstable fractures require open reduction and internal fixation. Our objective was to investigate the clinical and radiographic results of the internal fixation using Polarus humeral nails for fractures of the proximal humerus. MATERIALS AND METHODS: From January 2001 to April 2006, 54 shoulders of 54 patients (44 females, 10 males) underwent the intramedullary fixation using Polarus humeral nail. Mean age of the patients was 66-year-old (39-89) at the time of the surgery. Fracture-type by Neer classification was 2-part (29 shoulders), 3-part (22 shoulders) and 4-part (3 shoulders). The clinical and radiological outcomes were evaluated. RESULTS: All the shoulders after osteosynthesis obtained bone-union. There was no osteonecrosis of the humeral head. Functional outcome measured by JOA score averaged 81 points. Totally 43 patients (79%) had satisfactory to excellent results. Varus deformity was seen in 4 shoulders (8%) and the deformity of the greater tuberosity in 4 (8%). CONCLUSION: The Polarus intramedullary humeral nail is effective for the treatment of proximal humeral fractures.

Open elbow arthrolysis for post-traumatic elbow contracture.

BACKGROUND: Post-traumatic contracture is a common complication after elbow trauma. If conservative therapy fails to restore adequate elbow motion, arthrolysis is indicated. The purposes of this study were to evaluate the clinical outcome of open arthrolysis for post-traumatic elbow contracture and to determine factors influencing the outcome. METHODS: Twenty-seven patients with post-traumatic elbow contracture were followed-up after open arthrolysis for at least 12 months. Before surgery, the mean limitation in extension was 30 and the mean maximum flexion was 83 degrees. A posterior surgical approach was used in 18 patients, and a lateral approach was employed in nine patients. Using the posterior approach, the fibrotic posterior capsule was excised and the ulnar collateral ligament was split. Both the anterior and posterior capsules were released with a lateral approach. RESULTS: The mean flexion increased from 83 degrees to 121 degrees, but the mean extension improved little from -30 degrees to -26 degrees. The mean flexion-extension arc increased from 53 degrees to 95 degrees. According to the elbow evaluation score by the Japanese Orthopaedic Association, both pain and function scales improved significantly. By Hertel's subjective evaluation, the results were good in 13 patients, fair in ten patients, and poor in four patients. Twenty-three patients (85 percent) were satisfied with the results, but four were not satisfied because of residual contracture. These poor results were related to severe soft tissue trauma, residual displacement of intra-articular fragments, and recurrence of heterotopic bone formation. CONCLUSIONS: Tendon lengthening of stiff triceps, accurate reduction of intra-articular fragments, and sharp epiperiosteal resection around the heterotopic bones are essential procedures of open arthrolysis to restore adequate motion in post-traumatic elbow contracture.

Effects of wrist splinting for Carpal Tunnel syndrome and motor nerve conduction measurements.

BACKGROUND: Carpal tunnel syndrome (CTS) is one of the most common disease among the entrapment neuropathies. Wrist splinting has been conventionally used for the CTS treatment. The purposes of this study were to assess the efficacy of wrist splinting for CTS, and to evaluate the value of the motor nerve conduction measurement as a prognostic indicator for CTS. METHODS: Two hundred and fourteen hands with CTS were treated by wrist splinting, and reviewed after a mean follow up of seven months. Severity of symptoms were minimal lesions in 177 hands, intermediate lesions in 33 hands, and severe lesions in four hands. Motor nerve conduction measurement was performed in all cases before and after treatment, and distal latency (DL) and amplitude on compound muscle action potential (CMAP) from the abductor pollicis brevis (APB) muscle were analyzed. RESULTS: According to Kelly's grading of outcome, results were excellent in 41 hands, good in 110 hands, fair in 45 hands, and poor in 18 hands. Excellent or good results were obtained in 131 hands (74 percent) with minimal lesions, 20 hands (61 percent) with intermediate lesions, and in no cases with severe lesions. The ratio of excellent or good results was 79 percent in patients in whom DL of pre-treatment APB-CMAP was less than 8 milliseconds (ms), and 62 percent in patients whose DL was 8 ms or more, which showed a significant difference. In nine hands whose pre-treatment APB-CMAP was unrecordable, the results were good in one hand, fair in five, and poor in three. CONCLUSIONS: Wrist splinting is most effective in cases of minimal or intermediate lesions with DL of APB-CMAP less than 8 ms. If relief of symptoms is not obtained after five months of treatment by splinting, that would be the limit of splinting. Surgical release is recommended for cases with severe lesions and with unrecordable APB-CMAP.

Clinical outcome of fragment fixation for osteochondritis dissecans of the elbow.

BACKGROUND: The choice of surgical or non-surgical treatments for osteochondritis dissecans (OCD) of the humeral capitellum is still controversial. The purpose of this study was to assess the efficacy of fragment fixation for OCD of the humeral capitellum. METHODS: We reviewed 28 patients with OCD of the humeral capitellum after a mean follow up of 17 months. All patients were men and mean age was 14 years. Twenty-seven patients had a history of repetitive overuse of the elbow with baseball pitching, one with tennis. Mean duration of overuse of the elbow was four years. All patients had elbow pain and difficulty in throwing, with a mean duration of symptoms for 17 months. The mean arc of flexion before surgery ranged from 11 degrees to 126 degrees. Radiographs of the elbow showed a radiolucent cystic area of the humeral capitellum in one patient, a non-displaced split type fragment in 12 patients, and a slightly displaced split type fragment in 15 patients. Fragment fixation surgery was performed in all patients by lateral arthrotomy including drilling and fixation of the fragment with a double wiring technique using flexible wire or thread under direct vision. Sport activities using upper extremities were restricted for four to six months until the lesion healed in radiograph. RESULTS: Post-operatively, 25 patients had no pain and three decreased pain. Average arc of flexion was one to 132 degrees, an improvement of 16 degrees compared with the pre-operative arc. Radiographic findings showed complete healing of the lesion in 11 patients, partial healing in 12, unchanged in three, and loose body formation in two. By Tivnon's evaluation of the elbow function, results were excellent in 19 patients, good in five, fair in two, and poor in two. The ratio of complete or partial healing of the lesion was 100 percent in 16 patients in whom the thickness of the lesion was less than 9 mm on pre-operative radiograph, and 58 percent in 12 patients in whom the lesion thickness was 9 mm or more, which showed a significant difference (p<0.01). CONCLUSIONS: Fragment fixation for OCD of the humeral capitellum was effective in patients whose lesion thickness was less than 9 mm. Fixation by flexible wire or thread and revascularization by drilling for the fragment were considered to be insufficient for large lesions with a thickness of 9 mm or more.

Clinical results in severe carpal tunnel syndrome and motor nerve conduction studies.

The purposes of this study were to assess the value of motor nerve conduction studies as a prognostic indicator for severe carpal tunnel syndrome (CTS) and to investigate residual nerve disorder after surgery. Fifty hands in 46 patients with severe CTS were followed for at least 6 months after surgery for open carpal tunnel release. Compound muscle action potential (CMAP) from the abductor pollicis brevis (APB) muscle and the second lumbrical (SL) muscle were recorded before and after surgery, and distal latency (DL) and amplitude were analyzed. APB-CMAP was not recordable in 43 hands while SL-CMAP was recordable in all 50 hands before surgery. Results were excellent in 28 hands, good in 16 hands, fair in 6 hands, with no poor results after surgery. The ratio of excellent result was 65% in patients in whom DL of preoperative SL-CMAP was less than 10 ms, and 20% in patients whose DL was 10 ms or more. Delayed DL was seen in postoperative APB-CMAP and SL-CMAP, especially in the patients with good or fair results. We consider that SL-CMAP was valuable as a prognostic indicator for severe CTS, and if DL was 10 ms or more, myelinization of fibers would not be sufficient after surgery.