In vitro algaecid effect of itraconazole and ravuconazole on Prototheca species.

Protothecosis is a rare infection in humans, dogs, and cats, and its causative agent is Prototheca species, which consists of achlorophyllic algae that are ubiquitous in natural environments and hosts intestinal flora. Ravuconazole (RVZ) is a new available human azole drug in Japan since 2018 and broad-spectrum antifungal agent. In the present study, the in vitro susceptibility of clinical and environmental isolates of P. wickerhamii, P. zopfii, and P. blaschkeae to itraconazole (ITZ) voriconazole (VRZ), posaconazole (PCZ), and RVZ. RVZ was more potent than the other azoles against Protheca species and has considerable potential for use as a therapeutic agent for human and animal protothecosis.

Next-generation sequencing analysis of bacterial flora in bovine protothecal mastitic milk and feces.

The aim of the present study was to evaluate the bacterial flora in the udder and intestinal environments in cows with and without protothecal mastitis. We used next-generation sequencing (NGS) analysis to identify 16S rRNA genes from bacterial flora present in 13 milk and 13 fecal samples from protothecal mastitic and healthy dairy cows in the Aichi region of Japan. Sequences associated with 5 species (Calothrix desertica, Corynebacterium simulans, Corynebacterium striatum, Empedobacter falsenii, and Rothia endophytica) showed the highest prevalence in samples of milk and feces from animals with protothecal mastitis. This range of species differed from those detected in the milk and feces from healthy cows.

Partial transmalleolar approach for lateral impingement after total ankle arthroplasty: a case report.

Advances in implant technology have made total ankle arthroplasty an increasingly popular alternative to arthrodesis for the management of ankle arthritis. However, a frequent complication of the procedure is nerve impingement related to either to heterotrophic bone growth or the prosthesis itself. Successful resolution of this complication presents a challenge to clinicians. We present a case of lateral impingement following total ankle arthroplasty that was successfully treated using a partial transmalleolar approach to effect a partial osteotomy of the lateral malleolus and create a fragment attached to the anterior talofibular and calcaneofibular ligaments. This approach provides a good operative field in the lateral gutter with minimal soft tissue impairment. It also facilitates curettage, and resolution of tissue impingement. The osteotomy site healed fully by 3 months postoperative, and the pain around the lateral malleolus resolved. Furthermore, the patient's score on the Japanese Society for Surgery of the Foot Ankle/Hindfoot Scale improved from 33 preoperatively to 82 at 6 months postoperative.

Radiologic patterning of joint damage to the foot in rheumatoid arthritis.

OBJECTIVE: Foot and ankle deformities greatly affect the quality of life of rheumatoid arthritis (RA) patients. The aim of this study was to elucidate the pattern of destruction of the RA foot and its impact on patients. METHODS: We cross-sectionally investigated RA patients (274 patients and 542 feet) using radiographs. The grade of joint destruction was assigned using Larsen's grading system for 12 joints in the foot and ankle. Cluster analysis was performed using the K-means method to classify the pattern of joint destruction. Of the 274 patients evaluated radiographically, 212 were assessed for functional disability using questionnaires. RESULTS: Cluster analysis revealed that 542 feet were divided into 5 clusters, named according to the characteristic distribution of joint destruction: cluster I (normal type), cluster II (forefoot type), cluster III (midfoot type), cluster IV (mid-hindfoot type), and cluster V (combined type). Radiographic measurements revealed the characteristic deformities of each cluster: splay foot for cluster II, flat foot for cluster III, hindfoot malalignment for cluster IV, and mixtures of these characteristics for cluster V. A distribution map of each cluster based on disease duration revealed that cluster III peaked in cases of 5-10-year disease duration and subsequently decreased, followed by a gradual increase of cluster IV and cluster V. Cluster IV and cluster V showed significant changes in functional disability compared to cluster III. CONCLUSION: This report is the first to reveal the pattern of RA foot deformities and their impact on patients using statistical measures in a large series.

Distal interphalangeal joint arthrodesis with the reverse fix nail.

PURPOSE: Arthrodesis of distal interphalangeal (DIP) and thumb interphalangeal (IP) joints is a well-established procedure for the treatment of pain, deformity, and instability associated with arthritis and traumatic conditions. Fixation with various headless compression screws has become increasingly common and with favorable outcomes. However, there are still characteristic complications, such as hardware prominence with the distal end of the screw incompletely buried in the distal phalanx. The purpose of this study was to review the outcomes and complications associated with the arthrodesis of DIP and thumb IP joints using the Reverse Fix Nail (Tact Medical, Inc., Tokyo, Japan), a headless compression screw designed for DIP and thumb IP joint arthrodesis. METHODS: We retrospectively reviewed 89 cases involving 60 patients, in which arthrodesis with the Reverse Fix Nail was performed for DIP and thumb IP joints. We referenced medical charts, radiographs, and operative records to investigate the complications and postoperative periods to bone union. RESULTS: Of the 89 consecutive cases, 86 (97%) achieved bone union. Complications included 1 case of prominent hardware and 3 cases of nonunion (1 was asymptomatic and the other 2 were symptomatic, requiring secondary surgery). CONCLUSIONS: The Reverse Fix Nail is a favorable implant for DIP joint or thumb IP joint arthrodesis with a comparable bone union rate and lower risk of hardware prominence than other implants.

New-onset multiple sclerosis associated with adalimumab treatment in rheumatoid arthritis: a case report and literature review.

Tumor necrosis factor (TNF) antagonists have brought about a significant advancement in treatment for autoimmune diseases such as rheumatoid arthritis (RA) and Crohn's disease; however, they are accompanied with a risk of severe adverse effects. We report the case of a 68-year-old female with a 33-year history of RA that developed multiple sclerosis (MS) during adalimumab (ADM) treatment at 22 months after the initial administration. Her first neurological symptom was mild dizziness, which progressed to severe dizziness with gait disturbance within 2 weeks. Fortunately, when she had this neurological disorder, ADM treatment was being transiently stopped because she was in the perioperative period. Repeated magnetic resonance imaging examinations revealed multiple demyelinating lesions in her brain, leading to the diagnosis of MS. The patient completely recovered spontaneously from the symptoms in several days. A review of the literature revealed another 15 cases of MS associated with anti-TNF-α treatment, emphasizing the importance of detecting neurological symptoms and discontinuing the anti-TNF-α therapy.