Novel insight into the genetic diversity of strongylid nematodes infecting South-East and East Asian primates.

With many non-human primates (NHPs) showing continued population decline, there is an ongoing need to better understand their ecology and conservation threats. One such threat is the risk of disease, with various bacterial, viral and parasitic infections previously reported to have damaging consequences for NHP hosts. Strongylid nematodes are one of the most commonly reported parasitic infections in NHPs. Current knowledge of NHP strongylid infections is restricted by their typical occurrence as mixed infections of multiple genera, which are indistinguishable through traditional microscopic approaches. Here, modern metagenomics approaches were applied for insight into the genetic diversity of strongylid infections in South-East and East Asian NHPs. We hypothesized that strongylid nematodes occur in mixed communities of multiple taxa, dominated by Oesophagostomum, matching previous findings using single-specimen genetics. Utilizing the Illumina MiSeq platform, ITS-2 strongylid metabarcoding was applied to 90 samples from various wild NHPs occurring in Malaysian Borneo and Japan. A clear dominance of Oesophagostomum aculeatum was found, with almost all sequences assigned to this species. This study suggests that strongylid communities of Asian NHPs may be less species-rich than those in African NHPs, where multi-genera communities are reported. Such knowledge contributes baseline data, assisting with ongoing monitoring of health threats to NHPs.

Tapeworm Infection Diagnosed after Campylobacter jejuni-induced Enteritis.

A 35-year-old man with fever and diarrhea visited our hospital because of white string-like fecal excretion. Based on a morphological examination of the excreted object, a Diphyllobothrium infection was suspected. Additionally, Gram staining of a fecal sample revealed Campylobacter infection. After the intraduodenal administration of meglumine/diatrizoate sodium, the tapeworm was excreted. A polymerase chain reaction-based DNA sequence analysis demonstrated that the tapeworm excreted in this case was Diphyllobothrium nihonkaiensis. This report presents a rare case of coinfection with Diphyllobothrium nihonkaiensis and Campylobacter jejuni. Therefore, it is important to consider the coexistence of other intestinal infections when diagnosing parasitic infections in patients with fever.

Anatomical Relations of the Perforators from the Descending Lateral Femoral Circumflex Artery and Vastus Lateralis Motor Nerve Branches.

Background: The anterolateral thigh (ALT) flap, which is nourished by perforators from the descending branch of the lateral femoral circumflex artery (P), is one of the most commonly used flaps in soft tissue reconstruction. With the growing use of ALT flaps, attention toward donor-site morbidity has increased in recent years. Damage to the motor nerve branches of the vastus lateralis muscle (N) is one of the causes of donor-site morbidity, particularly muscle weakness. This study investigated the anatomical locations of the P and N in fresh-frozen cadaveric specimens. Methods: This study included 43 cadaver limbs. A silicone rubber compound (30 mL) was injected into the femoral artery to visualize the vessel. The locations of the P and motor points of N were measured to assess the risk of N injury during ALT flap harvesting. Results: There were one to six (mean, 2.7) P and two to seven (mean, 4) N. When the two most proximal perforators were used for flap harvesting, an average of 1.5 motor nerve branches (42%) was damaged because transection of the motor nerve branches was required for flap harvesting. In 33% of the limbs, only one motor nerve branch remained after the flap harvest. However, there were no cases where all motor nerve branches were severed. Conclusion: When an ALT flap with two perforators is harvested, weakness of the vastus lateralis muscle may occur in cases with a small number of motor nerve branches.

Clinical outcomes of reposition flap transfer for fingertip amputation.

PURPOSE: This study aimed to describe the reposition flap for reconstructing fingertip amputation when replantation is not possible. METHODS: This study retrospectively reviewed the records of patients with reposition flap transfers and investigated postoperative clinical outcomes and patient satisfaction. Sixteen patients with fingertip amputations treated with a reposition flap from 2016 to 2020. The mean age at injury was 46 years (range, 26-70 years). Ten cases were treated with oblique triangular advancement flaps, 3 with retrograde-flow digital artery flaps, and 3 with thumb palmar advancement flaps. Postoperative outcomes, including wound healing period and the IP/PIP extension angle, and the presence of grafted bone absorption and patient satisfaction were evaluated as of 3 years after surgery. RESULTS: The average reduction in passive extension angle of the IP/PIP joint was 19°. The average time for complete wound healing was 28 days (range, 18-41 days). The reduction in passive extension angle of the IP/PIP joint was significantly correlated with the wound healing period (r = 0.66, p = 0.01). The absorption of the grafted bone was observed in 3 cases. In these cases, the distal tip of the flap became thin due to flap retraction and an insufficient flap volume. All patients were highly or fairly satisfied with the results of surgery. CONCLUSION: Our findings show that IP/PIP flexion contracture can occur due to delayed wound healing after reposition flap transfer, but the patient satisfaction level was generally high. Therefore, reconstruction using a reposition flap gives acceptable clinical outcomes and high patient satisfaction as a result of medium to long-term.

Arthroscopy-Assisted Surgery for Trapeziometacarpal Osteoarthritis.

Background: Functional outcomes of patients who underwent arthroscopy-assisted surgery for trapeziometacarpal osteoarthritis were reported. Methods: We included 24 consecutive patients (6 males and 18 females) who underwent surgery and postoperative hand therapy at our hospital between April 2012 and March 2018. For functional evaluation, we used the Purdue Pegboard Test (PPT), grip and pinch strength, range of motion of the thumb, visual analogue scale (VAS) for thumb pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Japanese version of the Patient-Rated Wrist Evaluation (PRWE-J) preoperatively and 3 months postoperatively. Results: The mean PPT rating improved from 12.3 to 13.3, the VAS score from 51 to 16, the QuickDASH score from 48 to 30 and the PRWE-J score from 55 to 29. All the improvements were statistically significant. There was a moderate positive correlation between the magnitude of improvement in PPT and QuickDASH scores. Conclusions: Arthroscopic intervention and associated hand therapy were effective in achieving early postoperative relief of thumb pain and in improving hand dexterity and activities of daily living. Level of Evidence: Level IV (Therapeutic).

Anatomical quantitative evaluation of popliteal artery visualization during medial approach in supine position.

PURPOSE: The medial approach to the popliteal artery has been less commonly used than the posterior approach in surgical repair of traumatic popliteal injury. This study was performed to quantitatively evaluate the visual field of the popliteal artery obtained by staged myotendotomy in the medial approach to the popliteal artery. METHODS: Twenty legs of fresh-frozen adult cadavers were dissected using the medial approach to the popliteal artery. In stage 1, the popliteal artery was exposed between the vastus medialis and sartorius muscles without myotendotomy. In stage 2, the medial head of the gastrocnemius muscle was dissected. In stage 3, the tendons of the sartorius and semimembranosus muscles were dissected. In stage 4, the tendons of the gracilis and semitendinosus muscles were dissected to fully expose the popliteal artery. The length of the popliteal artery that could be visualized in each stage was measured. RESULTS: The anatomical length of the popliteal artery from the hiatus of the adductor magnus to the tendinous arch of soleus muscle ranged from 15 to 20 cm (mean, 16.3 cm). On average, 45%, 59%, 72%, and 100% of the popliteal artery were visualized in stage 1, 2, 3, and 4, respectively. CONCLUSIONS: The medial approach to the popliteal artery has the advantage of being performed in the supine position, but it requires multiple myotendotomies around the knee. The results of this study may serve as a reference for myotendotomy depending on the site of injury to the popliteal artery.

A surgical case of inflammatory pseudotumor by hepatic anisakiasis.

Anisakiasis is a parasitic infection caused by the ingestion of raw or undercooked seafood infected with Anisakis larvae. It generally affects the gastrointestinal tract, particularly the stomach, but very rare cases have been reported in which infection of the liver leads to the formation of inflammatory pseudotumors. We herein report an extremely rare case of an inflammatory pseudotumor induced by hepatic anisakiasis that was laparoscopically resected for the purpose of both diagnosis and treatment. A 51-year-old woman underwent a routine medical checkup by ultrasound examination, which incidentally detected a 15-mm mass on the surface of S6 of the liver. Because a malignant tumor could not be ruled out on several preoperative imaging studies, laparoscopic partial resection of the liver was performed. Histopathological examination revealed Anisakis larva in the inflammatory pseudotumor, suggesting hepatic anisakiasis. This report describes an extremely rare case of an inflammatory pseudotumor induced by hepatic anisakiasis. Because the preoperative diagnosis could not be obtained by several imaging modalities, laparoscopic liver resection with a sufficient margin might be suitable for diagnosis and treatment of this disease.

Reliability and Validity Analysis of the Distal Radioulnar Joint Ballottement Test.

PURPOSE: Triangular fibrocartilage complex injuries can cause distal radioulnar joint (DRUJ) instability, which can be evaluated clinically with the DRUJ ballottement test. However, the reliability and validity of the test are unclear. This study aimed to analyze the reliability and validity of the test using a tracking device on healthy participants and patients with triangular fibrocartilage complex injuries. METHODS: In this cross-sectional study, three orthopedic hand surgeons performed the DRUJ ballottement test using a technique of holding the carpal bones to the radius on 25 healthy participants (50 hands; 10 men and 15 women; mean age, 33 years; range, 20-51 years) and eight patients with triangular fibrocartilage complex injuries (16 hands; six men and two women; mean age, 43 years; range, 27-59 years). We used a three-dimensional electromagnetic tracking device to quantify the movement of the DRUJ and verify the reliability and validity of the test. RESULTS: The intrarater and interrater intraclass correlation coefficients for DRUJ movement were 0.77 and 0.61, respectively, and the kappa coefficient for grading of DRUJ instability was 0.79. The correlation coefficient between DRUJ movement measured using the tracking device and instability judged clinically was 0.77. A comparison of healthy participants and the patients showed significantly greater DRUJ movement in the patients. CONCLUSIONS: The test showed substantial intrarater and interrater reliability for assessing DRUJ movement and instability. The significant positive correlation between DRUJ movement and instability indicates the concurrent validity of the test. Moreover, the test showed discriminative validity in identifying mild or moderate DRUJ instability. CLINICAL RELEVANCE: The DRUJ ballottement test using the holding technique has a relatively high diagnostic accuracy and can be used to assess DRUJ instability.

Ankle Skin Defects with Vascular Ehlers-Danlos Syndromes Treated by Posterior Tibial Artery Perforator Flap: A Case Report.

CASE: A 46-year-old man with vascular Ehlers-Danlos syndrome (EDS) had an open ankle fracture with a 10 × 5-cm skin defect on the medial side of the ankle. The patient underwent open reduction and internal fixation, as well as coverage of the skin defect with a posterior tibial artery perforator flap, which led to successful outcomes. CONCLUSION: We present the successful implementation of a posterior tibial artery perforator flap for the reconstruction of skin defects in a patient with vascular EDS. Despite the fragility of soft tissues, favorable surgical outcomes were observed.

Arthrostoma supriatnai sp. nov. (Nematoda: Ancylostomatidae) parasitic in Mydaus javanensis (Carnivora: Mephitidae) from Mount Ciremai, Java, Indonesia.

Arthrostoma supriatnai sp. nov. was described from Mydaus javanensis obtained from Mount Ciremai, Java, Indonesia. It is characterized by having a buccal capsule with ten articulated plates including a pair of additional lateral plates. To date, the genus Arthrostoma consists of eleven species that are native to Asia. Of them, only A. miyazankiense and A. tunkanati have ten articulated plates including the lateral plates. However, the present species has a much stouter body, being readily distinguishable from these two species. Moreover, its male has much shorter spicules than A. miyazakiense, and an arrow-shaped gubernaculum, differing from A. tunkanati, in which gubernaculum is distally bifid. In the female, the present species is readily distinguished from these two species in the shape and number of vulval swellings.

A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity.

BACKGROUND: Cubital tunnel syndrome can be caused by overtraction and dynamic compression in elbow deformities. The extent to which elbow deformities contribute to ulnar nerve strain is unknown. Here, we investigated ulnar nerve strain caused by cubitus valgus/varus deformity using fresh-frozen cadavers. METHODS: We used six fresh-frozen cadaver upper extremities. A strain gauge was placed on the ulnar nerve 2 cm proximal to the medial epicondyle of the humerus. For the elbow deformity model, osteotomy was performed at the distal humerus, and plate fixation was performed to create cubitus valgus/varus deformities (10°, 20°, and 30°). Ulnar nerve strain caused by elbow flexion (0-125°) was measured in both the normal and deformity models. The strains at different elbow flexion angles within each model were compared, and the strains at elbow extension and at maximum elbow flexion were compared between the normal model and each elbow deformity model. However, in the cubitus varus model, the ulnar nerve deflected more than the measurable range of the strain gauge; elbow flexion of 60° or more were considered effective values. Statistical analysis of the strain values was performed with Friedman test, followed by the Williams' test (the Shirley‒Williams' test for non-parametric analysis). RESULTS: In all models, ulnar nerve strain increased significantly from elbow extension to maximal flexion (control: 13.2%; cubitus valgus 10°: 13.6%; cubitus valgus 20°: 13.5%; cubitus valgus 30°: 12.2%; cubitus varus 10°: 8.3%; cubitus varus 20°: 8.2%; cubitus varus 30°: 6.3%, P < 0.001). The control and cubitus valgus models had similar values, but the cubitus varus models revealed that this deformity caused ulnar nerve relaxation. CONCLUSIONS: Ulnar nerve strain significantly increased during elbow flexion. No significant increase in strain 2 cm proximal to the medial epicondyle was observed in the cubitus valgus model. Major changes may have been observed in the measurement behind the medial epicondyle. In the cubitus varus model, the ulnar nerve was relaxed during elbow extension, but this effect was reduced by elbow flexion.

Arthroscopic Scaphocapitate Fusion: Surgical Technique.

Scapholunate fusion appears to be an interesting surgical solution for carpal pathologies, which are sometimes difficult to manage as Kienbock's disease or chronic scapholunate instability. Open intracarpal fusion is notorious for decreasing joint range of motion due to the fusion of several carpal bones and because of the capsulotomy sectioning important ligamentous elements in carpal biomechanics. Wrist arthroscopy has already demonstrated its effectiveness in preserving joint mobility compared with open procedures. In this work, we present a detailed procedure for performing a scaphocapitate fusion under arthroscopy by specifying the key points of this procedure in our experience.

Zoonotic infection caused by Onchocerca japonica (Nematoda: Filarioidea) in a 69-year-old woman in Kanto Region, Eastern Honshu, Japan.

Reports of zoonotic infections caused by the filarial nematode Onchocerca japonica have recently increased in Japan. A 69-year-old woman living in Sosa City, Chiba Prefecture, Kanto Region, Honshu, developed a painful nodule at the metacarpophalangeal joint of the index finger of her right hand. The causative agent was identified as a female O. japonica based on the histopathological characteristics (i.e., cuticle with transverse triangular ridges but without inner striae) of the biopsy specimens of the nodule. The species identification was corroborated by cox1 gene sequencing of the worm tissues isolated from paraffin-embedded sections of the specimens. Subsequent to the excision of the nodule, followed by anthelmintic treatment, the patient remained asymptomatic. Human infection with O. japonica has not previously been reported in Kanto Region, Eastern Honshu. The present case is likely linked to the recent expansion of the geographic range of the Japanese wild boar into this area.

DEVELOPMENTAL STAGES OF GRASSENEMA PROCAVIAE PETTER, 1959 (COSMOCERCOIDEA: ATRACTIDAE) FOUND IN THE STOMACH OF CAPE HYRAX (PROCAVIA CAPENSIS).

Morphological examination was made of the larval forms of Grassenema procaviae (Cosmocercoidea: Atractidae), an autoinfective and viviparous nematode parasite in the stomach of Cape hyrax (Procavia capensis). Three different larval stages (second-, third- and fourth-stages), and the adult stage were found among the worms collected at necropsy of 3 hosts, which were reared in a zoo in Japan. Molting phases between the larval stages and the final molt to the adult stage were also observed. It was considered that the gravid female delivers the second-stage larva, which develops to the adult stage through 3 molts. The cephalic structure was identical throughout the second to adult stages; all with transparent filaments extending from the mouth. Because starch grains were frequently found attached to the filaments and the worm intestinal lumen also contained starch grains ingested, the filaments were surmised to act as nutrient catchers.

Dynamic analysis of the ulnar nerve and cubital tunnel morphology using ultrasonography: a cadaveric study.

BACKGROUND: The causes of ulnar neuropathy at the elbow are unclear. The authors hypothesized that the humeral trochlea protrudes into the cubital tunnel during elbow flexion and causes a dynamic morphologic change of the ulnar nerve in the cubital tunnel. METHODS: An ultrasonic probe was fixed to the ulnar shafts of 10 fresh cadavers with an external fixator, and dynamic morphology of the cubital tunnel and ulnar nerve was observed. The distance from the Osborne band to the trochlea (OTD), distance from ulnar nerve center to the trochlea (UTD), and the short- and long-axis diameters of the nerve at 30°, 60°, 90°, and 120° of elbow flexion were recorded. We compared the OTD, UTD, and the flattening of the ulnar nerve at the different angles of flexion using single-factor analysis of variance. Correlation between the ulnar nerve flattering, OTD, and UTD was examined using Spearman correlation coefficient. A P value less than .05 was used to denote statistical significance. RESULTS: Flattening of the ulnar nerve progressed with increasing elbow flexion and was significantly different between 0° and 60°, 90°, and 120° (P = .03 at 60°, P < .01 at 90° and 120°). OTD decreased with elbow flexion, and there was a significant difference at all elbow flexion angles (all P < .01). UTD decreased significantly from 0° flexion to 90° flexion (P = .03). Flattening of the nerve was significantly correlated with the OTD (r = 0.66, P < .01). CONCLUSIONS: A positive correlation was found between the protrusion of the humeral trochlea into the cubital tunnel during elbow flexion and ulnar nerve flattening using cadaveric elbow and ultrasonography.

Arthroscopic Radioscapholunate Fusion: Surgical Technique.

The development of radioscapholunar osteoarthritis after a distal radius joint fracture is a challenge, especially when it is addressed to young patients who want to maintain some wrist mobility. Classically, radioscapholunar arthrodesis is performed by an open longitudinal approach of more than 10 cm on the dorsal surface, largely exposing the midcarpal level. Wrist arthroscopy has already shown its effectiveness in preserving joint mobility compared to open procedures. Performing this arthroscopic procedure minimizes the "aggression" of the joint and hypothetically provides better mobility. This article details the surgical technique for performing radioscapholunar arthrodesis arthroscopically.

Simultaneous Bilateral Chronic Volar Lunate Dislocation: A Case Report.

CASE: A 24-year-old professional judo competitor suffered injuries to both the wrists when he fell on his back while lifting a 90-kg barbell in the bilateral dorsiflexed wrist position. Simultaneous bilateral volar lunate dislocation had been missed for a year. The degenerated lunates were simultaneously removed using a palmar approach. At 12 months postoperatively, the patient returned to judo competitions without pain. Radiography showed no progression of the intercarpal alignment abnormality. CONCLUSION: Simultaneous bilateral chronic volar lunate dislocation is extremely rare. Long-term follow-up is necessary to check for carpal alignment.

Soft-tissue reconstruction after soft-tissue sarcoma resection: the clinical outcomes of 24 patients.

PURPOSE: Pedicle or free-flap reconstruction is important in surgical sarcoma management. Free flaps are indicated only when pedicle flaps are considered inadequate; however, they are associated with a higher risk of flap failure, longer surgical times, and technical difficulty. To determine the skin defect size that can be covered by a pedicle flap, we investigated the clinical outcomes and complications of reconstruction using pedicle flaps vs. free flaps after sarcoma resection. METHODS: We retrospectively studied the medical records of 24 patients with soft-tissue sarcomas who underwent reconstruction using a pedicle (n = 20) or free flap (n = 4) following wide tumour resection. RESULTS: All skin defects of the knee, lower leg, and ankle were reconstructed using a pedicle flap. Skin defects of the knee, lower leg, and ankle were covered by up to 525 cm2, 325 cm2, and 234 cm2, respectively. The amount of blood loss was significantly greater in the free-flap group than in the pedicle flap group (p = 0.011). Surgical time was significantly shorter in the pedicle flap group than in the free-flap group (p = 0.006). Total necrosis was observed in one (25%) patient in the free-flap group; no case of total necrosis was observed in the pedicle flap group. CONCLUSION: Less blood loss, shorter surgical time, and lower risk of total flap necrosis are notable advantages of pedicle flaps over free flaps. Most skin defects, even large ones, of the lower extremities following sarcoma resection can be covered using a single pedicle flap or multiple pedicle flaps.

Treatment of painful median nerve neuroma using pedicled vascularized lateral antebrachial cutaneous nerve with adipofascial flap: a cadaveric study and exploration of clinical application.

The most common procedure for the treatment of painful median nerve neuroma is coverage with vascularized soft tissue following external neurolysis. However, the ideal treatment should include reconnecting the proximal and distal stumps of the damaged nerve to allow the growth of regenerating axons to their proper targets for a functional recovery. We developed a useful technique employing radial artery perforator adipofascial flap including the lateral antebrachial cutaneous nerve (LABCN) to repair the median nerve by vascularized nerve grafting and to achieve coverage of the nerve with vascularized soft tissue. In an anatomical study of 10 fresh-frozen cadaver upper extremities, LABCN was constantly bifurcated into two branches at the proximal forearm (mean: 8.2 cm distal to the elbow) and two branches that run in a parallel manner toward the wrist. The mean length of the LABCN branches between the bifurcating point and the wrist was 18.2 cm, which enabled inclusion of adequate length of the LABCN branches into the radial artery perforator adipofascial flap. The diameters of the LABCN branches (mean: 1.7 mm) were considered suitable to bridge the funiculus of the median nerve defect after microsurgical internal neurolysis. In all cadaver upper extremities, the 3-cm median nerve defect at the wrist level could be repaired using the LABCN branches and covered with the radial artery perforator adipofascial flap. On the basis of this anatomical study, the median nerve neuroma was successfully treated with radial artery perforator adipofascial flap including vascularized LABCN branches.