Possible involvement of DExD/H box helicase 60 in synovial inflammation of rheumatoid arthritis: role of toll-like receptor 3 signaling.

BACKGROUND: Innate immunity is known to be implicated in the etiology of synovitis in rheumatoid arthritis (RA). However, details of the molecular mechanisms have not been fully clarified. DExD/H-box helicase 60 (DDX60), a putative RNA helicase, is of consequence in anti-viral innate immune reactions followed by inflammation. Although DDX60 is involved in the pathogenesis of autoimmune diseases such as systemic lupus nephritis, the role of DDX60 in RA has not been elucidated. The objective of this study was to examine the expression and the role of DDX60 in RA synovial inflammation. METHODS AND RESULTS: DDX60 protein expression was investigated by immunohistochemistry in synovial tissues resected from 4 RA and 4 osteoarthritis (OA) patients. We found that synovial DDX60 expression was more intense in RA than in OA. Treatment of human rheumatoid fibroblast-like synoviocytes in culture with polyinosinic-polycytidylic acid, a Toll-like receptor 3 (TLR3) ligand, increased DDX60 protein and mRNA expression. A knockdown experiment of DDX60 using RNA interference revealed a decrease in the expression of poly IC-induced C-X-C motif chemokine ligand 10 (CXCL10) which induces lymphocyte chemotaxis. CONCLUSIONS: The synovial DDX60 was more expressed in RA patients than in OA. In human RFLS, DDX60 stimulated by TLR3 signaling affected CXCL10 expression. DDX60 may contribute to synovial inflammation in RA.

Cartilage regeneration is related to superior mid-term patient-reported outcomes after open-wedge high tibial osteotomy.

PURPOSE: Medial open-wedge high tibial osteotomy (OWHTO) is related to cartilage improvement in the medial compartment. This study aimed to evaluate factors associated with cartilage improvement and patient-reported outcomes (PRO) after OWHTO. It was hypothesised that cartilage improvement is associated with favourable PRO. METHODS: This retrospective study included 94 patients who underwent OWHTO. The mean follow-up period was 5 years. The weight-bearing line ratio (WBLR) was defined as the ratio of the distance from the medial tibial edge to the tibial insertion of the weight-bearing line and the tibial width. The International Cartilage Research Society grade evaluated the medial femoral condyle (MFC) and medial tibial plateau (MTP) at initial and second-look arthroscopy, and cartilage improvement after OWHTO was assessed. Postoperative knee injury and osteoarthritis outcome scores (KOOS) were compared between the groups with improved and non-improved cartilage. Additionally, factors related to cartilage improvement and postoperative KOOS scores were analysed. RESULTS: Regarding the MFC, KOOS pain, symptoms, activities of daily living (ADL) and quality of life (QOL) were significantly higher in the cartilage-improved group than in the non-improved group (p = 0.012, 0.003, 0.001, 0.006), and cartilage improvement was significantly related to KOOS pain, ADL and QOL (p = 0.021, 0.039, 0.013). In addition, the postoperative WBLR was associated with cartilage improvement, with a cutoff value of 54.0% (p = 0.046). Regarding the MTP, KOOS ADL and QOL (p = 0.026, 0.022) were significantly higher in the cartilage-improved group than in the nonimproved group. Body mass index (BMI) was significantly related to the postoperative QOL (p = 0.018) and associated with cartilage improvement, with a cutoff value of 25.9 kg/m2 (p = 0.002). CONCLUSION: A postoperative WBLR greater than 54.0% and a preoperative BMI below 25.9 kg/m2 were associated with cartilage improvement, positively impacting PRO after OWHTO. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

A new neural network model that detects graft ruptures and contralateral anterior cruciate ligament injuries.

PURPOSE: The purpose of this study was to develop a neural network model for predicting second anterior cruciate ligament (ACL) injury risk following ACL reconstruction using patient features from medical records. METHODS: Of 486 consecutive patients who underwent primary unilateral ACL reconstruction, 386 patients (198 women, 188 men) with a mean age of 25.1 ± 11.6 years were included in this study. Fifty-eight features, including demographic data, surgical, preoperative and postoperative data, were retrospectively collected from medical records, and features with an incidence of less than 5% were excluded. Finally, 14 features were used for the analysis. The multilayer perceptron was composed of four hidden layers with a rectified linear unit as activation and was trained to maximise the area under the receiver-operating characteristic curve (auROC). Subsequently, validation was carried out through a rigorous threefold cross-validation process. To ascertain the most efficacious combination of features with the highest auROC, a single feature with the least impact on auROC maximisation was systematically eliminated from the comprehensive variable set, ultimately resulting in the retention of a mere two variables. RESULTS: The median follow-up period was 50.5 (24-142) months. Fifty-seven knees had a second ACL injury, with a graft rupture rate of 7.7% and a contralateral injury rate of 6.9%. The maximum auROC for predicting graft rupture was 0.81 with two features: young age and hamstring graft. Meanwhile, the maximum auROC for predicting contralateral ACL injury was 0.74 with seven features, including young age, presence of medial meniscus tear, small body mass index, hamstring graft, female sex and medial meniscus repair or treatment. CONCLUSION: A neural network model with patient features from medical records detected graft ruptures and contralateral ACL injuries with acceptable accuracy. This model can serve as a new, useful tool in clinical practice to inform decisions about ACL reconstruction and retuning to sports postoperatively. LEVEL OF EVIDENCE: Level IV.

Importance of Bowel Habits in Predicting Inadequate Bowel Preparation: A Prospective Observational Study.

OBJECTIVES: Inadequate bowel preparation (BP) negatively affects the efficacy and quality of colonoscopy. Although constipation has already been reported as one of the most important predictors of inadequate BP, there is limited information on the relation between inadequate BP and bowel habits including constipation-related symptoms, medications, and severity of constipation. METHODS: This single-center, prospective observational study was conducted between August 2019 and May 2020. All participants answered questionnaires regarding personal bowel habits and received low-volume polyethylene glycol plus ascorbic acid for outpatient colonoscopy. Severity of constipation was evaluated by constipation scoring system. Bowel preparation cleansing was evaluated using Boston Bowel Preparation Scale (BBPS). Potential predictors of inadequate BP were analyzed using multivariate logistic regression models. RESULTS: Overall, 1054 patients were enrolled, of which, 105 (10%) had inadequate BP (total BBPS ≤ 6 or any segmental BBPS < 2). The risk of inadequate BP increased with constipation severity (P = 0.01). Multivariate analysis showed that frequent straining (> 25% of defecations) (OR 2.09, 95% CI: 1.33-3.28) and chronic use of stimulant laxatives (OR 2.57, 95% CI: 1.59-4.17) were significant predictors of inadequate BP, among personal bowel habits. CONCLUSION: Frequent straining and chronic use of stimulant laxatives were predictors of inadequate BP. An intensified preparation regimen should be considered for severely constipated patients with straining and chronic use of stimulant laxatives.

Menstrual Status and Pregnancy in Former Elite Long-Distance Runners With Menstrual Disorders.

OBJECTIVE: To estimate the ratio of menstrual abnormalities, infertility, and other problems related to pregnancy and childbirth in former long-distance runners. We hypothesized that the female athlete triad during an athletic career affects future fertility and childbearing in former athletes. DESIGN: Cross-sectional study. SETTING: Participants of the All Japan University Women's Ekiden. PARTICIPANTS: Female former athletes who competed at national level were asked to complete the questionnaire; 137 valid responses were obtained. INDEPENDENT VARIABLES: Age at menarche and at the onset of pregnancy, history of amenorrhea and gynecological disorders, and lowest body mass index (BMI) during their athletic career. MAIN OUTCOME MEASURES: Menstrual status, history of pregnancy and childbirth, any related infertility treatment and problems, and history of stress fractures. RESULTS: The mean age at menarche was 13.3 ± 2.2 (range, 10-25) years. Five athletes (3.6%) had primary amenorrhea. Eleven of the 137 participants (8.0%) required treatment for infertility. Sixty participants had 121 pregnancies, of which 5 were yet to deliver during the survey. Fifteen of 116 pregnancies (12.9%) ended in miscarriage, induced abortion, or stillbirth. Logistic regression analysis showed that the factors related to "infertility treatment" were age at the onset of pregnancy ( P = 0.047) and higher BMI during their athletic career ( P = 0.032; odds ratio, 2.19). CONCLUSIONS: The main factor influencing infertility was an older age at the time of pregnancy, similar to that observed in the general population. Amenorrhea or being underweight during their athletic career was not associated with problems related to conception and childbirth.

Efficacy and tolerability of 1 L polyethylene glycol plus ascorbic acid with senna versus 2 L polyethylene glycol plus ascorbic acid for colonoscopic bowel preparation: Prospective, randomized, investigator-blinded trial.

OBJECTIVES: Low-volume polyethylene glycol plus ascorbic acid (PEG-Asc) reduces the dosage of colonoscopic bowel preparation (BP) solution, but is still poorly tolerated. Adding laxatives to the BP solution reduces the volume of fluid required, without affecting quality. This study aimed to compare 1 L PEG-Asc plus 24 mg senna (1L-PEG/AS) and conventional 2 L PEG-Asc (2L-PEG/A) regimens on BP quality and patient tolerability. METHODS: A single-center, randomized, investigator-blinded, noninferiority trial was performed between June and August 2022. Outpatients scheduled for colonoscopy were randomized (1:1) to the 1L-PEG/AS or 2L-PEG/A group. The Boston Bowel Preparation Scale (BBPS) was used to evaluate BP quality. Adverse events and tolerability were surveyed using questionnaires. RESULTS: Overall, 344 patients received 1L-PEG/AS or 2L-PEG/A regimens. The baseline characteristics and adverse events of the two groups were comparable. The 1L-PEG/AS group showed noninferior adequate BP rates compared with the 2L-PEG/A group (88% vs. 89%, P = 1.00); overall BBPS was 7.1 ± 1.5 and 7.2 ± 1.5, respectively (P = 0.39). Higher willingness to repeat the BP was observed in the 1L-PEG/AS group (85% vs. 62%, P < 0.01). CONCLUSIONS: The 1L-PEG/AS regimen was comparable to the 2L-PEG/A regimen in terms of BP adequacy, requiring lower BP solution volumes, with better patient tolerance. Thus, it may be a suitable alternative to the conventional BP solution for colonoscopy. The Japan Registry of Clinical Trials (jRCT1051220043).

Lower bone mineral density can be a risk for an enlarging bone marrow lesion: A longitudinal cohort study of Japanese women without radiographic knee osteoarthritis.

OBJECTIVES: The aim is to elucidate the relationship between bone mineral density (BMD) at baseline and the change of bone marrow lesion (BML) during a 2-year follow-up (2YFU) period. METHODS: Seventy-eight female participants (mean age: 54.9 ± 9.6 years) without radiographic knee osteoarthritis were eligible. Based on right-knee magnetic resonance imaging, maximum BML area (BMLa) was calculated by tracing the BML border. The change in BMLa was defined using the following formula: [2YFU] - [Baseline] = ΔBMLa. Positive ΔBMLa was defined as enlarged; negative ΔBMLa was defined as regressed. Dual-energy X-ray absorptiometry was performed to measure the BMD of distal radius. Young adult mean [YAM (%)] of the BMD was used for statistical analysis. Linear regression analysis was conducted with ΔBMLa as the dependent variable and YAM as the independent variable. Receiver operating characteristic curve and logistic regression analyses were conducted for YAM to predict the prevalence of BML enlargement or regression. RESULTS: Twenty-six (33.3%) patients had enlarged BMLa, 12 (15.4%) participants showed regressing BMLa, and 40 (51.3%) patients remained stable. YAM was negatively associated with ΔBMLa (ß: - 0.375, P = 0.046). The best predictor of BML enlargement risk was 85% (odds ratio: 8.383, P = 0.025). CONCLUSIONS: Lower BMD could predict BML enlargement during a 2YFU period.

Greater medial proximal tibial slope is associated with bone marrow lesions in middle-aged women with early knee osteoarthritis.

BACKGROUND: Bone marrow lesion (BML) is an important magnetic resonance finding (MRI) finding that predicts knee osteoarthritis. The purpose of this study was to investigate the influence of proximal tibial morphology on BML, including the spreading root sign (SRS), in women without radiographic knee osteoarthritis (OA). It was hypothesized that varus alignment and a greater posterior tibial slopes (PTS) are associated with BML. MATERIALS AND METHODS: A total of 359 female volunteers without knee OA who were participants in the Iwaki Health Promotion Project in 2017 or 2019 were enrolled. Participants were divided into the non-OA and early knee OA (EKOA) groups based on the Luyten's classification criteria. The presence of pathological cartilage lesions, BMLs, attritions, meniscal lesions and effusions was scored on T2-weighted fat-suppressed magnetic resonance imaging (MRI) according to the Whole-Organ MRI Scoring system. The medial proximal tibial angle (MPTA) and medial and lateral PTS (MPTS and LPTS, respectively) were measured. Regression and receiver operating characteristic (ROC) analyses were performed to reveal the relationship between BMLs and proximal tibial morphological parameters. RESULTS: Of the 359 participants, 54 (15%) were classified as having EKOA. The prevalence of cartilage lesions, BMLs, attritions, meniscal lesions and effusions was higher in the EKOA group than in the non-OA group. The two groups had no significant difference in the proximal tibial parameters. Regression analysis revealed that age and a smaller MPTA were associated with BML in both groups. Attrition (p = 0.029) and the MPTS (p = 0.025) were positively associated with BML in the EKOA group. CONCLUSION: The prevalence of BMLs was higher in women with EKOA and correlated with the varus and greater posterior slopes in those without radiographic knee OA. LEVEL OF EVIDENCE: Level III, retrospective case-control study.

Usefulness of digital tomosynthesis in diagnosing cervical ossification of the posterior longitudinal ligament: a comparative study with other imaging modalities.

PURPOSE: The diagnosis and classification of ossification of the posterior longitudinal ligament (OPLL) can be difficult with radiography alone; therefore, computed tomography (CT) is also usually performed. There are many reports on the usefulness of digital tomosynthesis (DTS) for image analysis in orthopedics. This study aimed to compare the accuracy of DTS with radiography and CT for the diagnosis and classification of cervical OPLL (C-OPLL). MATERIALS AND METHODS: We included 31 patients with OPLL and 30 with cervical spondylotic myelopathy. The patients' cervical spine radiography, DTS, and CT images were each evaluated twice by three specialists and three residents. RESULTS: In the intra-observer reliability study, there was one observer with a fair level of kappa values for radiography and DTS among three residents. The kappa values for CT were the best for all observers. In the inter-observer reliability study, the interclass correlation coefficient (ICC) values were high for both diagnosis and classification by specialists at the almost perfect level for all three imaging modalities. On the other hand, the ICC values for both diagnosis and classification for radiography by the residents were lower than those for DTS and CT. CONCLUSIONS: This study revealed that DTS may be an alternative to CT for the diagnosis and classification of C-OPLL by specialists. Caution should be exercised in diagnosing and classifying C-OPLL using radiography and DTS by residents, and the use of CT is recommended.

Prevalence of Segond fractures associated with anterior cruciate ligament injuries and their influence on knee joint stability; A case-control study.

BACKGROUND: The purpose of this study was to determine the prevalence of Segond fractures and to compare knee stability between patients undergoing primary anterior cruciate ligament (ACL) reconstruction with and without Segond fractures pre- and postoperatively. METHODS: A total of 712 patients who underwent primary ACL reconstruction between 2014 and 2019. Exclusion criteria included patients with multi-ligament knee injuries, skeletally immature patients, osteoarthritis in the knee, combined surgery of high tibial osteotomy, lack of data, and loss to follow-up for at least 2 years. Segond fractures were confirmed using plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Patients with Segond fractures were classified into Group S and without Segond fractures into Group N. Pre- and postoperative Lachman grades, pivot-shift grades, and assessment of side-to-side differences in anterior stability were evaluated. RESULTS: Five hundred and forty patients included in this study. There were 22 patients with Segond fractures. Of these, all 22 cases (4.1%) were identified on CT, but only 20 cases (3.7%) were identified on MRI and 18 cases (3.3%) on plain radiographs. There was no significant difference in preoperative Lachman grade or pivot-shift grade between Groups S and N (p = 0.662, p = 0.677, respectively). There was no significant difference in postoperative Lachman grade or pivot-shift grade between Groups S and N (p = 0.685, p = 0.390, respectively). There were no significant differences in preoperative (p = 0.398) or postoperative (p = 0.546) side-to-side differences of anterior stability between Groups S and N. CONCLUSIONS: Segond fractures were confirmed in 4.1% of the cases on CT scans among patients undergoing primary ACL reconstruction. Segond fractures did not affect preoperative or 2-year follow-up evaluations of knee stability. From these results, we concluded that Segond fractures did not affect the clinical outcomes of the primary ACL reconstruction and that it may not be necessary to treat Segond fractures.

Effusion detected by ultrasonography and overweight may predict the risk of knee osteoarthritis in females with early knee osteoarthritis: a retrospective analysis of Iwaki cohort data.

BACKGROUND: Knee osteoarthritis (OA) has enormous medical and socioeconomic burdens, which early diagnosis and intervention can reduce. We investigated the influence of knee effusion on the progression of knee OA in patients with early knee OA. METHODS: A total of 404 participants without radiographic knee OA were assessed from a 3-year longitudinal analysis. Participants were classified into non-OA and early knee OA groups. The effusion area (mm2) was quantified using ultrasonography. Receiver operating characteristic and logistic regression analyses were performed. RESULTS: At the 3-year follow-up, 114 of 349 knees (32%) had progressed from non-OA and 32 of 55 knees (58%) had progressed from early knee OA to radiographic knee OA. Logistic regression analysis showed that female sex (odds ratio [OR] 3.36, 95% confidence interval [CIs] 2.98-5.42), early knee OA (OR 2.02, 95% CI 1.08-3.75), body mass index (OR 1.11, 95% CI 1.02-1.19), and effusion area (OR 1.01, 95% CI 1.01-1.02) were significantly correlated with knee OA progression. Women who were overweight (body mass index ≥ 25 kg/m2) with more severe effusion had a higher risk of OA progression (area under the curve = 0.691, OR = 6.00) compared to those not overweight (area under the curve = 0.568, OR = 1.91). CONCLUSION: Knee effusion may be an indicator of the progression of early-stage knee OA.

Tranexamic Acid Use in Anterior Cruciate Ligament Reconstruction Decreases Bleeding Complications: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PURPOSE: To systematically review all available randomized controlled trials (RCTs) in the literature that examine outcomes following tranexamic acid (TXA) use in anterior cruciate ligament reconstruction (ACLR) to determine its effectiveness. METHODS: PubMed/MEDLINE, Embase, Science Direct, Web of Science, CINAHL, and The Cochrane Library databases were systematically searched for RCTs comparing TXA versus no TXA in ACLR with a 4-week minimum follow-up. Quality was assessed using Risk of Bias 2. Pooled analyses were conducted using inverse variance for continuous variables and Mantel-Haenszel for dichotomous variables. The Grading of Recommendations, Assessment, Development and Evaluation guidelines were used to evaluate primary outcomes. RESULTS: A total of 807 patients (632 male, 175 female) from 7 RCTs were included. Mean age was 28.4 years. Bias was graded "low" in 4 RCTs, "some concerns" in 2 RCTs, and "high" in 1 RCT. Visual analog scale was found to be not significantly different with TXA use at day 1-3 (mean difference [MD] -0.92, I2 = 96%, P = .14) and 12 weeks (MD -0.03, I2 = 0%, P = .73). Visual analog scale was significantly decreased at week 2 (MD -1.18, I2 = 56%, P < .00001) and weeks 3-6 (MD -0.38, I2 = 73%, P < .010). Lysholm scores were greater with TXA use at week 2 (MD 9.04, I2 = 74%, P = .002) and weeks 4-6 (MD 6.17, I2 = 73%, P = .0004) but not significantly different at 12 weeks (MD 6.13, I2 = 98%, P = .28). Need for aspiration was less with TXA use (odds ratio 0.40, I2 = 49%, P = 0.0009). Considerable heterogeneity was seen in many results. Certainty was low for 2 primary outcomes, moderate for 2, and high for 5. CONCLUSIONS: Pooled data suggest that the use of TXA in ACLR reduces the need for aspiration, hemarthrosis, drain output, and knee swelling in the postoperative period. While early improvements in pain and function were observed, the clinical relevance is questionable. The risk of complications does not increase with TXA use, and the use of intravenous TXA over intra-articular TXA may improve and prolong hemarthrosis reduction, although the evidence is weak. LEVEL OF EVIDENCE: Level II, systematic review of therapeutic Level I-II studies.

Laterally shifted tibial tunnel can be the risk of residual knee laxity for double-bundle anterior cruciate ligament reconstruction.

PURPOSE: To elucidate the relationship between graft tunnel position and knee laxity in the cases of double-bundle ACL reconstruction. METHODS: Total of 132 cases were included. Femoral and tibial tunnels were evaluated by quadrant method on 3D-CT. As additional reference of tibia, the distances from medial tibial spine to the tunnel center (DMS) and from Parsons' knob to the tunnel center (DPK) were evaluated; %DMS/ML and %DPK/AP were calculated (ML and AP: mediolateral and anteroposterior width of tibial plateau). Preoperative and postoperative (1 year from surgery) stabilities were evaluated by Lachman and pivot-shift procedures. If there was ≥ 2 mm side-to-side difference, the subject was defined as having anterior knee laxity (AKL); if the pivot-shift phenomenon was observed with IKDC grade ≥ 1, there was rotatory knee laxity (RKL). Multiple logistic regression analysis was conducted with the prevalence of AKL or RKL as the dependent variable and with tunnel positions as the independent variables. RESULTS: Overall, 21 subjects (15.9%) showed AKL, and 15 subjects (11.4%) showed RKL. Those with postoperative laxity showed higher %DMS/ML and higher femoral position than those without laxity. Regarding posterolateral bundle, logistic regression model estimated that %DMS/ML was associated with the prevalence of AKL (B = 0.608; p < 0.001) and RKL (B = 0.789; p < 0.001); %high-low femoral tunnel position (B = - 0.127; p = 0.023) was associated with that of RKL. CONCLUSION: There was the risk of residual knee laxity in ACL-reconstructed knee when tibial tunnel shifted more laterally or higher femoral tunnel was created with regard to posterolateral bundle. LEVEL OF EVIDENCE: III.

Bone marrow lesion severity was associated with proximal tibial inclination in early knee osteoarthritis.

PURPOSE: This study aimed to investigate the effect of tibial plateau (TP) inclination and serum bone metabolic markers on bone marrow lesion (BML) in the general Japanese population with early knee osteoarthritis (EKOA). METHODS: A total of 441 female volunteers who participated in the Iwaki Health Promotion Project in 2017 were enrolled. Participants without radiographic abnormalities were divided into normal and EKOA groups according to the Luyten's classification criteria for EKOA. The medial proximal tibial angle (MPTA), growth plate-TP angle, and growth plate-medial tibial plateau (MTP) angle were measured on standing anteroposterior radiographs of the knees. BML severity on T2-weighted fat-suppressed magnetic resonance imaging (MRI) was scored using the Whole-Organ MRI Score method. Serum levels of N-telopeptide of type I collagen, tartrate-resistant acid phosphatase-5b (TRACP-5b), bone-specific alkaline phosphatase, procollagen type I N-terminal propeptide, pentosidine, and homocysteine were assessed. Linear regression analysis was conducted to investigate the relationship between proximal tibial inclination, BML, and serum bone metabolic markers. RESULTS: The growth plate was observed in 309 (70%) participants, and 48 (16%) participants had EKOA. The mean MPTA, growth plate-TP angle, and growth plate-MTP angle were 86.1 ± 5.9°, 3.6 ± 1.1°, and 9.9 ± 2.6°, respectively. The MPTA was negatively correlated with the growth plate-TP and growth plate-MTP angles (p = 0.006, p < 0.001). Participants with EKOA who had BML exhibited greater growth plate-MTP angle than those who did not (p = 0.018). Regression analysis revealed that BML severity was positively associated with MPTA (p = 0.036) and a bone formation marker (p = 0.045). CONCLUSION: BML severity was positively associated with proximal tibial inclination and serum TRACP-5b level in participants with EKOA and normal knees, respectively. Assessment of proximal tibial inclination may provide insight into potential BML risk. Residual medial tibial inclination may potentially result in knee pain and symptoms in EKOA. LEVEL OF EVIDENCE: III.

Biomechanical analysis of bioabsorbable suture anchors for rotator cuff repair using osteoporotic and normal bone models.

BACKGROUND: This study aimed to compare the failure load of suture anchors used in rotator cuff repair between normal and osteoporotic bone models. METHODS: A total of 16 anchors made from metal (TwinFix Ti 5.0 or 6.5 mm, Corkscrew FT 4.5, 5.5, or 6.5 mm), polyether ether ketone (HEALICOIL PK [HC-PK] 4.5 or 5.5 mm, SwiveLock PK 4.75 or 5.5 mm), or bioabsorbable material (HEALICOIL RG [HC-RG] 4.75 or 5.5 mm, Corkscrew Bio 4.75, 5.5, or 6.5 mm, SwiveLock BC 4.75 or 5.5 mm) were included. Moreover, 10- and 5-pounds per cubic foot (pcf) Sawbone® models were set as normal and osteoporotic cancellous bone models, respectively. Pullout testing was performed in parallel to the insertion axis at a displacement rate of 12.5 mm/s using a universal testing machine. To evaluate the change in failure load between the two Sawbone® models with different densities, the remaining failure load ratio (RFLR) was defined as the ratio of the failure load in 10 pcf to that in 5 pcf. RESULTS: In the 10-pcf Sawbone®, TwinFix Ti 6.5 mm showed the highest mean failure load (304.0 ± 15.2 N). In the 5-pcf Sawbone® model, HC-PK 5.5 mm showed the highest failure load (146.3 ± 5.8 N). Among anchors with the same diameter, HC-PK and HC-RG showed a significantly higher failure load than other anchors in the 10- and 5-pcf Sawbone® models. HC-PK 5.5 mm (62.1%) and HC-PK 4.5 mm (51.1%) have the highest RFLR among anchors with the same diameter. CONCLUSIONS: HC-PK and HC-RG showed higher failure load than the other anchors in both normal and osteoporotic bone models, except for TwinFix Ti 6.5 mm in the 10-pcf Sawbone® model. Based on our results, bioabsorbable anchors had sufficient failure load for rotator cuff repair in addition to bioabsorbability.

Occupational ionizing radiation-induced skin injury among orthopedic surgeons: A clinical survey.

BACKGROUND: This study aimed to assess orthopedic surgeons' attitudes and behaviors toward occupational radiation exposure and investigate the prevalence of occupational radiation-induced skin injury among orthopedic surgeons. Similarly, risk factors for the presence of radiation-induced skin injury were investigated. METHODS: Overall, 108 orthopedic surgeons were administered self-reported questionnaires about occupational radiation exposure, and their hands were then photographed. Their fields of expertise were classified into spine, arthroplasty, sports medicine, hand, oncology, rheumatoid arthritis, pediatric orthopedic, and resident. Dermatologists evaluated the surgeons' skin conditions and classified into 3 grades of injury: grade 0, no clinical symptoms; grade 1, careful observation required; and grade 2, detailed examination required. Logistic regression analysis was performed to investigate the factors related to the presence of radiation-induced skin injury. Crude and adjusted logistic regression analysis using the backward stepwise selection method was similarly conducted. Receiver operating characteristic curve (ROC) analysis was performed to estimate the predictive power of exposure time, occupational period, and accumulated annual exposure time for radiation-induced skin injury. RESULTS: In total, 93.5% of the surgeons were careful about occupational radiation exposure, of which 76.8% used a dosimeter. Skin changes in the hands were self-reported by 42.5% of the surgeons, and radiation-induced skin injury was diagnosed in 31.4%. The accuracy of the self-reported skin changes was 100% for grade 2 and 61.5% for grade 1. Adjusted regression analysis showed that dermatologists' diagnosis-related factors were self-reported skin changes (odds ratio [OR] 3.1) and spine surgeons (OR 3.2). ROC analysis demonstrated that an occupational period >21 years and an accumulated exposure time >6696 min were considered risk factors, with ORs of 4.07 and 5.99, respectively. CONCLUSIONS: Orthopedic surgeons, particularly spine surgeons, should be regularly examined by dermatologists early in their careers for early detection of radiation-induced skin injury on the hands.

A Novel Quantitative Evaluation of Bone Formation After Opening Wedge High Tibial Osteotomy Using Tomosynthesis.

This study aimed to establish and validate a novel evaluation method using digital tomosynthesis to quantify bone formation in the gap after opening wedge high tibial osteotomy (OW-HTO). We retrospectively analyzed bone formation in the gap in 22 patients who underwent OW-HTO using digital tomosynthesis at 1, 2, 3, 6, 9, and 12 months postoperatively. Bone formation was semi-quantitatively assessed using the modified van Hemert's score and density measurements on digital tomosynthesis images. The gap filling value (GFV) was calculated as the ratio of the intensities of the opening gap and the tibial shaft. In addition, the relationship between the modified van Hemert's score and GFV was evaluated. The reproducibility of GFV had an interclass correlation coefficient (ICC [1,2]) of 0.958 for intraobserver reliability and an ICC (2,1) of 0.975 for interobserver reliability. The GFV increased in a time-dependent manner and was moderately correlated with the modified van Hemert's score (r = 0.630, p < 0.001). The GFV plateaued at 6 months postoperatively. In addition, the GFV was higher in patients with a modified van Hemert's score of 2 than in patients with a modified van Hemert's score of 3 (p = 0.008). The GFVs obtained using digital tomosynthesis can be used to assess postoperative bone formation in the opening gap after OW-HTO with high accuracy and reproducibility.

Retraction: Differences between the Craig's test and computed tomography in measuring femoral anteversion in patients with anterior cruciate ligament injuries.

[This retracts the article on p. 365 in vol. 32 PMCPMC7276780.].

Chronic constipation is negatively associated with colonic diverticula.

OBJECTIVES: Constipation has been considered the key risk factor for diverticulosis occurrence, but the underlying mechanism is unclear. We investigated the factors associated with diverticulosis, focusing on the association of constipation severity with the localization and number of diverticula. MATERIALS AND METHODS: We analyzed consecutive patients who underwent colonoscopy between March and December 2019. Chronic constipation was diagnosed as constipation meeting Rome IV criteria or as that requiring laxative therapy for more than 6 months. The degree of constipation was scored using the Constipation Scoring System (CSS). RESULTS: We assessed 1014 patients. Multivariate analysis revealed that age, alcohol consumption, and hypertension were positively associated with diverticulosis, whereas chronic constipation was negatively associated with diverticulosis (odds ratio [OR] = 0.74; 95% confidence interval [CI], 0.55-0.99). When assessed according to the location of diverticula, right-sided diverticula were significantly associated with a lower incidence of constipation (OR = 0.94; 95% CI, 0.89-0.98), whereas neither left-sided nor bilateral diverticula was associated with constipation. This negative association of diverticula with constipation was stronger in patients with a high CSS score. In stratified analysis, the number of diverticula decreased with increasing degree of constipation (p for trend <.01), and a high CSS score was associated with a decreased prevalence of ≥3 diverticula (OR = 0.64; 95% CI, 0.44-0.99). CONCLUSIONS: Chronic constipation was negatively associated with colonic diverticulosis. The association increased with the degree of constipation and was strong only in cases with right-sided diverticula and those with ≥3 diverticula.

Effect of teriparatide on ligamentum flavum mesenchymal stem cells isolated from patients with ossification of the posterior longitudinal ligament.

Ossification of the posterior longitudinal ligament (OPLL) within the spinal canal sometimes leads to severe myelopathy. Teriparatide (TPD) is a recombinant human parathyroid hormone (PTH) (1-34), which promotes osteogenesis of mesenchymal stem cells (MSCs) via PTH 1 receptor (PTH1R). Although ligamentum flavum (LF)-MSCs from patients with OPLL have a high osteogenic potency, the effect of TPD on them remains unknown. In this study, we determined PTH1R expression in LF-MSCs from patients with OPLL and investigated whether TPD promotes osteogenic differentiation in them. First, LF-MSCs were isolated from patients with OPLL and cervical spondylotic myelopathy (CSM) (controls). Cultured LF-MSCs were treated with different concentrations of TPD on days 0, 7, and 14. On day 21, osteogenic gene expression was quantified. Mineralization was measured based on optical density after Alizarin Red S staining. LF-MSCs from both groups expressed PTH1R at the same level. TPD did not enhance osteogenic gene expression and mineralization in LF-MSCs from both groups. TPD did not promote the osteogenic differentiation of LF-MSCs from patients with OPLL. Thus, it may be safe for patients with OPLL. However, further confirmation of our results with in vivo studies is necessary.