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Terashima K, Suefuji H, Matsunobu A, Toyama S, Fukunishi K, Ohta W, Shioyama Y. Carbon-Ion Radiotherapy for Postoperative Locoregional Recurrence of Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e344. [PMID: 37785198 DOI: 10.1016/j.ijrobp.2023.06.2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the efficacy and safety of carbon-ion radiotherapy (CIRT) for patients with locoregional recurrence after surgery for pancreatic cancer. MATERIALS/METHODS A total of 32 patients, who underwent CIRT for locoregional recurrence after surgery for pancreatic cancer between January 2015 and July 2022, were retrospectively analyzed. The total dose of CIRT was 55.2 Gy (RBE) in 12 fractions. Concurrent chemotherapy included gemcitabine for 17 patients and S-1 for 3 patients. The overall survival (OS), local control (LC), progression free survival (PFS), and toxicity were evaluated. RESULTS The median follow-up time from the initiation of CIRT was 21.4 months. The 1- and 2-year OS were 84.2 and 55.3%, respectively. The median survival were 24.2 months. The 1- and 2-year PFS were 40.7 and 14.8%, respectively, with a median PFS of 9.9 months. The 1- and 2-year LC were 100 and 50.2 %, respectively. 4 patients experienced grade 3 acute toxicities: hematologic toxicity in 2 patients, anorexia in 1 patient and gastric ulcer/bleeding in 1 patient. The patients with grade 3 gastric ulcer/bleeding underwent blood transfusion and recovered quickly. There was no grade 4 or 5 acute toxicity. In terms of late toxicity, no grade 3 or greater toxicity was observed. CONCLUSION CIRT for postoperative locoregional recurrence of pancreatic cancer resulted in relatively long survival with acceptable toxicity. CIRT may be one of the choices of treatment for patients with this disease.
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Affiliation(s)
- K Terashima
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan
| | - H Suefuji
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan
| | - A Matsunobu
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan
| | - S Toyama
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan
| | - K Fukunishi
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan
| | - W Ohta
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan
| | - Y Shioyama
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan
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Han S, Toyama S. Engorged cervical epidural venous plexus presenting as posterior cervical pain after accidental dural puncture. Anaesth Rep 2023; 11:e12250. [PMID: 37869173 PMCID: PMC10589824 DOI: 10.1002/anr3.12250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- S. Han
- Department of AnesthesiologyTokyo Medical and Dental University HospitalTokyoJapan
| | - S. Toyama
- Department of AnesthesiologyTokyo Medical and Dental University, Graduate School of Medical and Dental SciencesTokyoJapan
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Kamada Y, Arai Y, Toyama S, Inoue A, Nakagawa S, Fujii Y, Kaihara K, Cha R, Mazda O, Takahashi K. Hypoxia with or without Treadmill Exercises Affects Slow-Twitch Muscle Atrophy and Joint Destruction in a Rat Model of Rheumatoid Arthritis. Int J Mol Sci 2023; 24:ijms24119761. [PMID: 37298711 DOI: 10.3390/ijms24119761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023] Open
Abstract
The effects of treadmill running under hypoxic conditions on joints and muscles of collagen-induced arthritis (CIA) rats were investigated. CIA rats were divided into normoxia no-exercise, hypoxia no-exercise (Hypo-no), and hypoxia exercise (Hypo-ex) groups. Changes were examined on days 2 and 44 of hypoxia with or without treadmill exercises. In the early stage of hypoxia, the expression of hypoxia-inducible factor (HIF)-1α increased in the Hypo-no and Hypo-ex groups. The expression of the egl-9 family hypoxia-inducible factor 1 (EGLN1) and vascular endothelial growth factor (VEGF) in the Hypo-ex group also increased. Under sustained hypoxia, the Hypo-no and Hypo-ex groups did not show increased expression of HIF-1α or VEGF, but p70S6K levels were elevated. Histologically, joint destruction was alleviated in the Hypo-no group, the loss of muscle weight in slow-twitch muscles was prevented, and muscle fibrosis was suppressed. In the Hypo-ex group, the preventive effect of a reduction in the slow-twitch muscle cross-sectional area was enhanced. Thus, chronic hypoxia in an animal model of rheumatoid arthritis controlled arthritis and joint destruction and prevented slow-twitch muscle atrophy and fibrosis. The combination of hypoxia with treadmill running further enhanced the preventive effects on slow-twitch muscle atrophy.
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Affiliation(s)
- Yoichiro Kamada
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Atsuo Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yuta Fujii
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kenta Kaihara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Ryota Cha
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Osam Mazda
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Hishikawa N, Toyama S, Shimahara N, Taira K, Kawasaki T, Ohashi S, Sawada K, Mikami Y. A home-based low-intensity resistance exercise programme with supervision for secondary sarcopenia in a patient with established rheumatoid arthritis: A case report. Mod Rheumatol Case Rep 2023:7085674. [PMID: 36961737 DOI: 10.1093/mrcr/rxad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/28/2023] [Accepted: 03/23/2023] [Indexed: 03/25/2023]
Abstract
Patients with established rheumatoid arthritis are at risk of developing secondary sarcopenia. Both pharmacological and exercise interventions are essential for treatment. However, for such patients, exercise loads may lead to progression of joint destruction and worsening of pain. The purpose of this report was to assess the feasibility of a home-based, low-intensity resistance exercise programme. The case was a 70-year-old female patient with sarcopenia secondary to rheumatoid arthritis. She was diagnosed with rheumatoid arthritis at 57 years of age and began medication, maintaining remission of disease activity. However, she did not exercise habitually and was relatively inactive in her daily life. Furthermore, she had kinesiophobia associated with her rheumatoid arthritis-related symptoms. We suggested implementing a home-based low-intensity resistance exercise programme over 3 months, with the goal of exercising the lower extremities daily. The patient was asked to self-monitor using an exercise diary and attend monthly outpatient visits for repeat counselling and feedback. As a result, she was able to perform the exercise programme safely with high compliance, improving her kinesiophobia as well as physical inactivity, although her skeletal muscle mass did not change. Regular exercise and increased physical activity may help prevent the onset of sarcopenia. These results demonstrate the feasibility of implementing our exercise programme and support its potential for preventing progression of sarcopenia. While questions remain in terms of treating sarcopenia, we believe that our findings will lead to the establishment of an exercise programme for patients with sarcopenia secondary to established rheumatoid arthritis.
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Affiliation(s)
- Norikazu Hishikawa
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Noriyoshi Shimahara
- Department of Rehabilitation, Center of Rheumatic Diseases, Dogo Spa Hospital, Ehime, Japan
| | - Kazuaki Taira
- Department of Rehabilitation, Shirahama Hamayu Hospital, Wakayama, Japan
| | - Takashi Kawasaki
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koshiro Sawada
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Development of Multidisciplinary Promotion for Physical Activity, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Morisaki S, Tsuchida S, Oda R, Toyama S, Takahashi K. Fourth Dorsal Interosseous Muscle Transfer to Treat an Abducted Little Finger. J Hand Surg Am 2022; 47:95.e1-95.e4. [PMID: 34147318 DOI: 10.1016/j.jhsa.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/27/2020] [Accepted: 05/07/2021] [Indexed: 02/02/2023]
Abstract
A patient presented with an abducted little finger due to the avulsion of the third volar interosseous muscle. For treatment, we transferred the fourth dorsal interosseous muscle arising from the ulnar side of the fourth metacarpal bone to the lateral band of the little finger.
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Affiliation(s)
- Shinsuke Morisaki
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan.
| | - Shinji Tsuchida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Japan
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Hishikawa N, Toyama S, Sawada K, Kawasaki T, Ohashi S, Ikoma K, Tokunaga D, Mikami Y. Effect of Foot Orthosis Treatment on Quality of Life in Secondary Sarcopenia Patients with Rheumatoid Arthritis-Related Foot Impairment. Prog Rehabil Med 2022; 7:20220047. [PMID: 36160028 PMCID: PMC9470498 DOI: 10.2490/prm.20220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives: Patients with rheumatoid arthritis (RA)-related foot impairment have a high rate of sarcopenia. Treatment using a foot orthosis (FO) enables not only a reduction in pain while walking but also an increase in physical activity, helping to prevent further loss of muscle mass. However, the primary goal of treating RA is to maximize patients’ long-term quality of life (QOL). We investigated whether FO treatment both increases physical activity and improves QOL. Methods: Among 31 patients with RA-related foot impairment, 15 with sarcopenia were treated with an FO for 6 months. Foot-specific QOL (measuring using the Self-Administered Foot Evaluation Questionnaire), foot pain, activities of daily living, and physical activity (walking-intensity activity and moderate- to vigorous-intensity activity) were compared before treatment and after 6 months of treatment. Results: Ten patients who completed 6 months of follow-up were analyzed. Significant QOL improvements were found in the Pain and Pain-Related category and the Physical Functioning and Daily Living category (P = 0.02–0.04); however, no significant changes were found in the Social Functioning, General Health and Well-Being, or Shoe-Related categories (P = 0.09–0.21). Foot pain and activities of daily living significantly improved (P = 0.01–0.04). Physical activity significantly increased for walking-intensity activity (P = 0.04) but did not change for moderate- to vigorous-intensity activity (P = 1.00). Conclusions: FO treatment in patients with RA-related foot impairment and sarcopenia increased light-intensity physical activity such as walking and improved physical QOL.
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Affiliation(s)
- Norikazu Hishikawa
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koshiro Sawada
- Department of Development of Multidisciplinary Promotion for Physical Activity, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Kawasaki
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Kamada Y, Toyama S, Arai Y, Inoue H, Nakagawa S, Fujii Y, Kaihara K, Kishida T, Mazda O, Takahashi K. Treadmill running prevents atrophy differently in fast- versus slow-twitch muscles in a rat model of rheumatoid arthritis. J Muscle Res Cell Motil 2021; 42:429-441. [PMID: 34687403 DOI: 10.1007/s10974-021-09610-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
To investigate the effects of treadmill running on two different types of skeletal muscle, we established a rat model of collagen-induced arthritis (CIA). The skeletal muscles studied were the extensor digitorum longus (EDL), which is rich in fast-twitch muscle fibers, and the soleus, which is rich in slow-twitch muscle fibers. The histological and transcriptional changes in these muscles at 14 and 44 days after immunosensitization were compared between rats that were forced to exercise (CIA ex group) and free-reared CIA rats (CIA no group). Change in protein expression was examined on day 14 after a single bout of treadmill running. Treadmill running had different effects on the relative muscle weight and total and fiber cross-sectional areas in each muscle type. In the soleus, it prevented muscle atrophy. Transcriptional analysis revealed increased eukaryotic translation initiation factor 4E (Eif4e) expression on day 14 and increased Atrogin-1 and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) expression on day 44 in the soleus in the CIA ex group, suggesting an interaction between muscle type and exercise. A single bout of treadmill running increased the level of Eif4e and p70S6K and decreased that of Atrogin-1 in the soleus on day 14. Treadmill running prevented muscle atrophy in the soleus in a rat model of rheumatoid arthritis via activation of mitochondrial function, as evidenced by increased PGC-1α expression.
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Affiliation(s)
- Yoichiro Kamada
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan.
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Yuta Fujii
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Kenta Kaihara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Tsunao Kishida
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Osam Mazda
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
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Morisaki S, Tsuchida S, Oda R, Toyama S, Takahashi K. Use of the Extensor Carpi Ulnaris Half-Slip for Treating Chronic Neglected Volar Dislocation of the Distal Radioulnar Joint. J Hand Surg Asian Pac Vol 2021; 26:472-476. [PMID: 34380390 DOI: 10.1142/s242483552172019x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Volar dislocation of the distal radioulnar joint (DRUJ) is a rare injury. Furthermore, few reports exist regarding DRUJ dislocation with simultaneous elbow dislocation. Elbow dislocation is easily diagnosed and reduced, whereas a DRUJ dislocation is easily missed because of an inaccurate or missed examination of the wrist, which results in a chronic condition. We experienced a case of simultaneous elbow and volar DRUJ dislocation; the latter was found 2 months postinjury. To treat chronic volar dislocation of the DRUJ, surgical methods should include reconstruction of the triangle fibrocartilage complex because of scar tissue and severe instability. In this paper, we describe triangle fibrocartilage complex reconstruction by using the extensor carpi ulnaris half-slip. It is the first report of applying this technique for chronic volar DRUJ dislocation. This technique has a role in creating strong stabilization of the DRUJ and can be an effective treatment option.
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Affiliation(s)
- Shinsuke Morisaki
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinji Tsuchida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Abe M, Sato M, Toyama S, Ohara R, Yamashita Y, Suzuki Y. Labor analgesia for three parturients with Behçet's disease. Int J Obstet Anesth 2021; 46:102980. [PMID: 33893009 DOI: 10.1016/j.ijoa.2021.102980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 11/18/2022]
Affiliation(s)
- M Abe
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Department of Anesthesiology, Tokyo Teishin Hospital, Chiyoda-ku, Tokyo, Japan
| | - M Sato
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
| | - S Toyama
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, Bunkyo-Ku, Tokyo, Japan
| | - R Ohara
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Y Yamashita
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Y Suzuki
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
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Toyama S, Tokunaga D, Tsuchida S, Kushida R, Oda R, Kawahito Y, Takahashi K. Comprehensive assessment of alterations in hand deformities over 11 years in patients with rheumatoid arthritis using cluster analysis and analysis of covariance. Arthritis Res Ther 2021; 23:66. [PMID: 33640011 PMCID: PMC7913439 DOI: 10.1186/s13075-021-02448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although drug therapy for rheumatoid arthritis (RA) has recently improved, treating patients with established disease, whose hands have three major deformities (thumb deformity, finger deformities, and ulnar drift), remains a challenge. The underlying complex pathophysiology makes understanding these deformities difficult, and comprehensive assessment methods require accumulated skill with long learning curves. We aimed to establish a simpler composite method to understand the pathophysiology of and alterations in the hand deformities of patients with RA. Methods We established a rheumatoid hand cohort in 2004 and clinically evaluated 134 hands (67 patients). We repeated the evaluations in 2009 (100 hands of 52 patients) and 2015 (63 hands of 37 patients) after case exclusion. Thumb deformities, finger deformities (swan-neck and boutonnière deformity), and ulnar drift were semi-quantitated and entered as parameters into a two-step cross-sectional cluster analysis for the data in 2004. The parameters in each cluster were plotted at each evaluation point. Two-way analysis of covariance was used to examine whether differences existed between evaluation points and clusters of deformity parameters. Results Five clusters most appropriately described hand deformity: (i) cluster 1, minimal deformity; (ii) cluster 2, type 1 thumb deformity; (iii) cluster 3, thumb deformity and severe boutonnière deformity; (iv) cluster 4, type 2 or 3 thumb deformity and severe ulnar drift; and (v) cluster 5, thumb deformity and severe swan-neck deformity. Clusters 1 and 2 had higher function than cluster 5, and cluster 3 had moderate function. Clusters 1–4 had similar disease duration but showed different paths of deformity progression from disease onset. Clusters 1 and 2 represented conservative deformity parameters and clusters 3, 4, and 5 represented progressive deformity parameters. Over time, thumb deformity evolved into other types of deformities and swan-neck deformity worsened significantly. Conclusions Our comprehensive analysis identified five deformity patterns and a progressive course in the rheumatoid hand. Knowledge of the characteristics of progressive deformity parameters may allow rheumatologists to more easily implement practical interventions and determine functional prognosis.
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Affiliation(s)
- Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shinji Tsuchida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Rie Kushida
- Rehabilitation Unit, Marutamachi Rehabilitation Clinic, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yutaka Kawahito
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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Hishikawa N, Toyama S, Sawada K, Kawasaki T, Ohashi S, Ikoma K, Tokunaga D, Mikami Y. Foot orthosis treatment improves physical activity but not muscle quantity in patients with concurrent rheumatoid arthritis and sarcopenia. Mod Rheumatol 2020; 31:997-1003. [PMID: 33153343 DOI: 10.1080/14397595.2020.1847714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Foot impairment in rheumatoid arthritis (RA) may exacerbate sarcopenia from physical inactivity because of foot pain while walking. The present study aimed to investigate the prevalence of sarcopenia in patients with RA-associated foot impairment, and whether treatment with a foot orthosis improved physical activity and muscle quantity. METHODS Thirty-two patients with RA were diagnosed as sarcopenic or nonsarcopenic, and the prevalence of sarcopenia was determined. Eleven patients with sarcopenia were treated with a foot orthosis. The following parameters were compared between baseline and after 6 months of treatment: physical activity (walking, moderate-intensity activity, and vigorous-intensity activity), foot pain while walking, Health Assessment Questionnaire (HAQ) score, and body composition parameters, including muscle quantity. RESULTS Sarcopenia was present in 25/32 patients (78.1%). The use of a foot orthosis improved walking activity (p = .02), foot pain while walking (p = .02), and HAQ score (p = .02). However, there were no significant changes in moderate- or vigorous-intensity activities or body composition parameters, including muscle quantity. CONCLUSION Patients with RA-associated foot impairment had a high rate of sarcopenia. Treatment with a foot orthosis increases light-intensity physical activity such as walking, but does not enhance moderate-to-vigorous-intensity activities or increase muscle quantity.
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Affiliation(s)
- Norikazu Hishikawa
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shogo Toyama
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Multidisciplinary Promote for Physical Activity, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Orthopaedics, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koshiro Sawada
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Kawasaki
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisaku Tokunaga
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Toyama S, Shioyama Y, Suefuji H, Shinoto M, Hirata H, Ueda M, Fukunishi K, Matsumoto K, Terashima K, Matsunobu A, Nomoto S, Nakagawara A, Naito S. Hypofractionated Carbon Ion Radiotherapy for D’Amico High-risk Prostate Cancer; a Subset Analysis of a Phase II Clinical Trial. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Kamio S, Fujiwara Y, Ogawa K, Kobayashi MI, Sangaroon S, Isobe M, Seki R, Nuga H, Osakabe M, Matsuyama S, Miwa M, Toyama S. Neutron-induced signal on the single crystal chemical vapor deposition diamond-based neutral particle analyzer. Rev Sci Instrum 2020; 91:113304. [PMID: 33261440 DOI: 10.1063/5.0020460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/29/2020] [Indexed: 06/12/2023]
Abstract
A diamond-based neutral particle analyzer (DNPA) array composed of single-crystal chemical vapor deposition (sCVD) diamond detectors was installed on the Large Helical Device (LHD) for measuring the helically trapped energetic particles. In high neutron flux experiments, the unwanted neutron-induced pulse counting rate should be estimated using the neutron diagnostics because a diamond detector is sensitive to neutrons as well as energetic neutral particles. In order to evaluate the quantitative neutron-induced pulse counting rate on the DNPA, the response functions of the sCVD diamond detector for mono-energetic neutrons were obtained using accelerator-based D-D and D-7Li neutron sources in Fast Neutron Laboratory (FNL). As a result of the neutron flux estimation by the Monte Carlo N-Particle code at the NPA position in the LHD and the response function obtained in the FNL experiment, the counting rate of the neutron-induced signal was predicted to be 1.1 kcps for the source neutron emission rate of Sn = 1 × 1015 n/s. In the LHD experiment, the neutron-induced signals were observed by closing the gate valve during the plasma discharges. It is found that the counting rates of the neutron-induced signals proportional to Sn reached 1.1 kcps at Sn = 1 × 1015 n/s. As a result of the quantitative estimation of the neutron-induced signals on the DNPA using other neutron measurements, it has become possible to accurately measure energetic neutral particles in the high neutron flux experiment.
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Affiliation(s)
- S Kamio
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - Y Fujiwara
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - K Ogawa
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - M I Kobayashi
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - S Sangaroon
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - M Isobe
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - R Seki
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - H Nuga
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - M Osakabe
- National Institute for Fusion Science, 322-6 Oroshi-cho, Toki 509-5292, Japan
| | - S Matsuyama
- Tohoku University, 6-6 Aoba, Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - M Miwa
- Tohoku University, 6-6 Aoba, Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - S Toyama
- Tohoku University, 6-6 Aoba, Aramaki, Aoba-ku, Sendai 980-8579, Japan
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14
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Sawada K, Horii M, Imoto D, Ozaki K, Toyama S, Saitoh E, Mikami Y, Kubo T. Usefulness of Electromyography to Predict Future Muscle Weakness in Clinically Unaffected Muscles of Polio Survivors. PM R 2020; 12:692-698. [DOI: 10.1002/pmrj.12281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/24/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Koshiro Sawada
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Motoyuki Horii
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Daisuke Imoto
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Kenichi Ozaki
- Department of Rehabilitation Medicine 1School of Medicine, Fujita Health University Toyoake Japan
| | - Shogo Toyama
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine 1School of Medicine, Fujita Health University Toyoake Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Toshikazu Kubo
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
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15
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Toyama S, Oda R, Tokunaga D, Tsuchida S, Hishikawa N, Ohara M, Mikami Y. AB0228 COMPREHENSIVE RHEUMATOID HAND ASSESSMENT THROUGH PATTERN OF DEFORMITIES USING CLUSTER ANALYSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The treatment of rheumatoid hand, which is characterized by thumb deformity, finger deformities, and ulnar drift (UD), is challenging. Its pathophysiology is complex, and a comprehensive understanding of the optimal intervention for this condition requires high technical skill and extensive clinical experience. Moreover, the natural course of rheumatoid hand itself remains unclear.Objectives:This study was performed to comprehensively evaluate rheumatoid hand through the specific parameters of each deformity.Methods:A rheumatoid hand cohort was established in 2004. In total, 134 hands of 67 patients were registered and underwent clinical evaluations. All hands surgically treated during follow-up were excluded from the study, but the contralateral hands were assessed. Evaluations were repeated in 2009 (100 hands of 52 patients) and in 2015 (63 hands of 37 patients) among all available patients. Therefore, among the data obtained from the 3 study endpoints, 297 hands were available for the cross-sectional analysis and 43 hands were available for the longitudinal analysis.Thumb deformities and finger deformities (swan-neck and boutonnière) were semi-quantitated by the Nalebuff classification score, and UD was quantified using a metacarpophalangeal joint condition scoring method1). A two-step cluster analysis was performed with entered parameters, and the distribution of each parameter was considered to clarify the characteristics of each cluster. The hands with different clusters at each endpoint were recruited for the following longitudinal analysis. The natural course of rheumatoid hand was considered based on the cluster change.Results:Seven clusters were used in this study to emphasize the impact of thumb deformity on function. The characteristics of each cluster were as follows. Cluster 1: mild finger deformities and various severities of UD; Cluster 2: type 1 thumb deformity and various severities of UD; Cluster 3: type 2 thumb deformity and severe UD; Cluster 4: type 3 or 4 thumb deformity, low or moderate level of swan-neck deformity, and various severities of UD; Cluster 5: various types of thumb deformity, severe boutonnière deformity, and various severities of UD; Cluster 6: type 1 thumb deformity, severe swan-neck deformity, and various severities of UD; and Cluster 7: type 6 thumb deformity.The longitudinal analysis showed that Cluster 1 mainly changed to Cluster 2 or 4, indicating progression of thumb deformity. Cluster 2 changed to Cluster 3, indicating that thumb type 1 progressed to type 2 (Figure 1). When the affected period was shorter than 10 years, the incidence of severe hand deformity (including two or more affected joint areas and low hand function) was <10%. In contrast, when the affected period was longer than 10 years, the incidence of severe hand deformity was >30% (Figure 2).Figure 1.Figure 2.Conclusion:This study suggests the presence of seven patterns of deformity enabling a comprehensive understanding of rheumatoid hand. Furthermore, the results of the longitudinal analysis suggest a natural course of rheumatoid hand progression. Therefore, from the distribution of parameters of each deformity and its severity, rheumatologists can easily classify rheumatoid hand and determine its pathophysiology to choose the most effective intervention.References:[1]Toyama S, Oda R, Tokunaga D et al. A new assessment tool for ulnar drift in patients with rheumatoid arthritis using pathophysiological parameters of the metacarpophalangeal joint. Modern rheumatology 2019, 29: 113-8.Acknowledgments:This work was supported by JSPS KAKENHI Grant Numbers JP19K19914.Disclosure of Interests:None declared
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Hishikawa N, Toyama S, Ohashi S, Sawada K, Ikoma K, Tokunaga D, Mikami Y. THU0568 EFFECTIVENESS OF FOOT ORTHOSIS TO PROMOTE PHYSICAL ACTIVITY FOR PATIENTS WITH CONCURRENT RHEUMATOID ARTHRITIS AND SARCOPENIA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Sarcopenia is a progressive systemic skeletal muscle disorder associated with an increased likelihood of adverse outcomes including physical disability, falls, and mortality. The muscle mass of patients with rheumatoid arthritis (RA) is lower than that of age-matched healthy individuals, and a high prevalence rate of sarcopenia has been reported1). In particular, foot deformities may increase the prevalence rate of sarcopenia because of inactivity due to foot pain on walking. Treatment with a foot orthosis (FO) can reportedly reduce pain2); however, whether a FO can resolve inactivity and sarcopenia is unclear.Objectives:To elucidate the effectiveness of a FO on physical activity and sarcopenia in patients with RA.Methods:Thirty patients with RA with foot deformities were enrolled from April 2017 to December 2019. Sarcopenia was diagnosed using the algorithm of the European Working Group on Sarcopenia in Older People, and the cut-off values of the Asian Working Group for Sarcopenia were applied. We also collected the clinical variables of patients with concurrent RA and sarcopenia who continued to use a FO for 6 months. The primary outcome was physical activity determined by the International Physical Activity Questionnaire. The secondary outcomes were foot pain measured with a visual analog scale; activities of daily living (ADL) measured with the Health Assessment Questionnaire; and body mass index, body fat percentage, and the skeletal muscle mass index measured with a body composition device. The clinical variables were compared between baseline and 6 months after continuous treatment with a FO.Results:The prevalence rate of sarcopenia was 76.6% (23/30), and nine patients with RA continued to use the FO for 6 months. Table 1 shows outcomes at baseline and after 6 months of treatment with a FO. The only clinical variable that showed a significant difference was foot pain. Physical activities, ADL, and body compositions were maintained after 6 months.Table 1.Outcomes of 6-month treatment with FOBaseline6 monthsp valuePhysical activityIPAQWalking, MET-min/weekModerate, MET-min/weekVigorous, MET-min/week132 (66, 594)0 (0, 0)0 (0, 0)594 (396, 2376)0 (0, 0)0 (0, 0)0.071.000.32Foot painVAS score4.6 (3.1, 7.4)2.8 (1.1, 4.7)0.02ADLHAQ1.5 (1.1, 2.3)1.1 (0.9, 1.5)0.07Body compositionBMI, kg/m2BFP, %SMI, kg/m221.4 (20.7, 22.7)31.1 (24.2, 37.6)5.2 (4.8, 5.3)20.7 (19.3, 22.1)32.9 (26.3, 36.5)5.2 (5.0, 5.2)0.890.820.61IPAQ: International Physical Activity Questionnaire, VAS: visual analog scale, ADL: activities of daily living, HAQ: Health Assessment Questionnaire, BMI: body mass index, BFP: body fat percentage, SMI: skeletal muscle mass indexData are presented as median (lower quartile, upper quartile)Conclusion:The prevalence rate of sarcopenia in patients with RA with foot deformities was much higher than previous reported1). However, 6 months of treatment with a FO not only reduced foot pain but also maintained physical activity and muscle mass. Physical therapy has recently been recommended for patients with inflammatory arthritis. physical activity and muscle mass of patients with RA and concurrent foot deformities may be increased by combining physical therapy with orthotic treatment.References:[1]Tada M, et al. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis. 2018; 21 (11): 1962-9.[2]Hennessy K, et al. Custom foot orthoses for rheumatoid arthritis: A systematic review. Arthritis Care Res (Hoboken). 2012; 64 (3): 311-20.Acknowledgments:This work was supported by JSPS KAKENHI Grant Numbers JP19K11420.Disclosure of Interests:None declaredDOI: 10.1136/annrheumdis-2020-eular.3143
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Toyama S, Sato S, Asano Y. Localized scleroderma histologically characterized by liquefaction degeneration and upper dermis fibrosis: a possible association with chemotherapy. Clin Exp Dermatol 2020; 45:632-634. [PMID: 32170760 DOI: 10.1111/ced.14216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 01/14/2023]
Affiliation(s)
- S Toyama
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - S Sato
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Y Asano
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Toyama S, Oda R, Asada M, Nakamura S, Ohara M, Tokunaga D, Mikami Y. A modified Terrono classification for Type 1 thumb deformity in rheumatoid arthritis: a cross-sectional analysis. J Hand Surg Eur Vol 2020; 45:187-192. [PMID: 31722639 DOI: 10.1177/1753193419886719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The most common thumb deformity in rheumatoid arthritis is Nalebuff Type 1 deformity (boutonniere deformity). Type 1 deformity severely impairs hand function, and this impairment is evaluated by the Terrono classification. In some cases, the Terrono classification incorrectly categorizes advanced thumb deformity into earlier stages. We modified the Terrono classification by assessing the active range of motion of the interphalangeal joint prior to assessing the passive range of movement of the metacarpophalangeal joint. An active range of movement of the interphalangeal joint was strongly correlated with hand function. In 55 hands that we treated between 2004 and 2015, we compared the modified classification with the original Terrono classification. Our modified classification could detect advanced deformity earlier, and was more strongly correlated with hand function. Additionally, correlation analysis showed that advanced Type 1 deformity should be treated first, even in cases with severe ulnar drift. Our results suggest that the modified classification may benefit the treatment of Type 1 deformity, including joint-preserving surgery. Level of evidence: III.
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Affiliation(s)
- Shogo Toyama
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Development of Multidisciplinary Promotion for Physical Activity, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Rehabilitation Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Maki Asada
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoru Nakamura
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masato Ohara
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisaku Tokunaga
- Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Oda R, Toyama S, Fujiwara H. A New Approach for the Correction of Type I Thumb Deformity Owing to Rheumatoid Arthritis. Journal of Hand Surgery Global Online 2020; 2:55-60. [PMID: 35415477 PMCID: PMC8991876 DOI: 10.1016/j.jhsg.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/03/2019] [Indexed: 11/25/2022] Open
Abstract
A major transition in the surgical treatment of rheumatoid arthritis has been facilitated by a recent paradigm shift in its diagnosis and treatment. Improved outcomes in the treatment of the rheumatoid thumb are desirable; however, the results of conventional surgery are less than ideal. Even if the rheumatoid arthritis is well-controlled, the progression of thumb deformity may persist owing to an ineffective deformity correction and an insufficient understanding of the mechanism by which the deformity occurs. The mechanism of rheumatoid thumb deformity should be considered, using it to base the appropriate correction. We applied a new deformity correction procedure that accounts for the mechanism of type I rheumatoid thumb deformity and obtained positive results without recurrence. Although the primary cause of type I thumb deformity is believed to be an extensor mechanism failure resulting from synovitis of the metacarpophalangeal (MCP) joint, surgical outcomes are negatively affected as a result of flexion contracture caused by the adductor pollicis (ADP). Because the ADP attaches to the ulnar sesamoid on the palmar side of MCP joint, we release the ADP tendon to improve flexion contracture of the MCP joint. We consider release of ADP to be effective in preventing the recurrence of flexion contracture of the MCP joint and re-tensioning of the extensor pollicis brevis. Rheumatoid thumb deformity can be restored by applying this procedure, improving a patient’s outcome.
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Kida T, Umemura A, Kaneshita S, Sagawa R, Inoue T, Toyama S, Wada M, Kohno M, Oda R, Inaba T, Itoh Y, Kawahito Y. Effectiveness and safety of chronic hepatitis C treatment with direct-acting antivirals in patients with rheumatic diseases: A case-series. Mod Rheumatol 2019; 30:1009-1015. [PMID: 31625432 DOI: 10.1080/14397595.2019.1682787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: To assess the effectiveness and safety of interferon-free direct-acting antiviral (DAA) therapy for patients with concomitant hepatitis C virus (HCV) infection and rheumatic diseases (RDs), including rheumatoid arthritis (RA).Methods: This was a single-center observational case-series study conducted in Japan from 2014 to 2018. The primary endpoint was the sustained virological response (SVR) rate 24 weeks after the end of therapy (EoT24). We also evaluated hepatological and rheumatological outcomes and adverse events.Results: Of the 2314 patients with RDs, 18 received DAA therapy (RA = 11, other RDs = 7). The SVR rate for the initial DAA therapy was 89% (16/18). The remaining two achieved SVR with secondary DAA therapy. Along with HCV elimination, hepatological parameters improved significantly from baseline to EoT24. During the study period, no patients newly developed cirrhosis or HCC after HCV elimination. Several patients showed improvement in RDs activity. In RA patients, the simplified disease activity index decreased significantly from baseline to EoT24 (median [interquartile range]: 11.53 [5.14-14.89] vs. 4.06 [2.08-9.05], respectively). On-treatment adverse events were minimal, while two patients experienced tuberculosis reactivation after EoT.Conclusion: DAA therapy was effective and safe, providing hepatological and rheumatological benefits in HCV-infected patients with RDs. Immune reconstitution following HCV elimination should be noted.
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Affiliation(s)
- Takashi Kida
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Umemura
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shunya Kaneshita
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Risa Sagawa
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuya Inoue
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Wada
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masataka Kohno
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tohru Inaba
- Department of Infection Control and Laboratory Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Kawahito
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Fujii Y, Inoue H, Arai Y, Shimomura S, Nakagawa S, Kishida T, Tsuchida S, Kamada Y, Kaihara K, Shirai T, Terauchi R, Toyama S, Ikoma K, Mazda O, Mikami Y. Treadmill Running in Established Phase Arthritis Inhibits Joint Destruction in Rat Rheumatoid Arthritis Models. Int J Mol Sci 2019; 20:ijms20205100. [PMID: 31618828 PMCID: PMC6834114 DOI: 10.3390/ijms20205100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 12/14/2022] Open
Abstract
Exercise therapy inhibits joint destruction by suppressing pro-inflammatory cytokines. The efficacy of pharmacotherapy for rheumatoid arthritis differs depending on the phase of the disease, but that of exercise therapy for each phase is unknown. We assessed the differences in the efficacy of treadmill running on rheumatoid arthritis at various phases, using rat rheumatoid arthritis models. Rats with collagen-induced arthritis were used as rheumatoid arthritis models, and the phase after immunization was divided as pre-arthritis and established phases. Histologically, the groups with forced treadmill running in the established phase had significantly inhibited joint destruction compared with the other groups. The group with forced treadmill running in only the established phase had significantly better bone morphometry and reduced expression of connexin 43 and tumor necrosis factor α in the synovial membranes compared with the no treadmill group. Furthermore, few cells were positive for cathepsin K immunostaining in the groups with forced treadmill running in the established phase. Our results suggest that the efficacy of exercise therapy may differ depending on rheumatoid arthritis disease activity. Active exercise during phases of decreased disease activity may effectively inhibit arthritis and joint destruction.
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MESH Headings
- Animals
- Arthritis, Experimental
- Arthritis, Rheumatoid/diagnostic imaging
- Arthritis, Rheumatoid/etiology
- Arthritis, Rheumatoid/metabolism
- Arthritis, Rheumatoid/pathology
- Biomarkers
- Body Weight
- Bone Resorption/diagnostic imaging
- Bone Resorption/metabolism
- Cartilage, Articular/diagnostic imaging
- Cartilage, Articular/metabolism
- Cartilage, Articular/pathology
- Connexin 43/metabolism
- Cytokines/metabolism
- Disease Models, Animal
- Inflammation Mediators/metabolism
- Physical Conditioning, Animal
- Rats
- Synovial Membrane/metabolism
- Synovial Membrane/pathology
- Tumor Necrosis Factor-alpha/metabolism
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Affiliation(s)
- Yuta Fujii
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Seiji Shimomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Tsunao Kishida
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Shinji Tsuchida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Yoichiro Kamada
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Kenta Kaihara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Toshiharu Shirai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Ryu Terauchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Osam Mazda
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
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Fukui Y, Miyagawa T, Hirabayashi M, Nakamura K, Omatsu J, Toyama S, Yoshizaki A, Sato S, Asano Y. 624 Myeloid cell-specific Fli1 knockout mice exhibit systemic sclerosis-like vasculopathy and delayed wound healing due to impaired vasculogenesis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shioyama Y, Terashima K, Suefuji H, Shinoto M, Toyama S, Matsumoto K, Matsunobu A, Oshima K. Results of Hypofractionated Carbon-Ion Radiation Therapy for Peripherally Located Stage I Non-Small-Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Itoh N, Imoto D, Kubo S, Yamaguchi M, Shimizu N, Toyama S, Mikami Y, Kubo T. Kinematic, kinetic, and electromyographic characteristics during quiet standing on a balance exercise assist robot. J Phys Ther Sci 2018; 30:1262-1266. [PMID: 30349161 PMCID: PMC6181658 DOI: 10.1589/jpts.30.1262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/20/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The balance exercise assist robot is a training device based on a personal transport assistance robot ridden in the standing position. The personal transport assistance robot uses an inverted pendulum control system and moves in response to movements of the user's center of gravity. The purpose of this study was to describe the characteristics of postural control during the action of stopping the personal transport assistance robot. [Participants and Methods] Eleven healthy male participants were required to maintain a standing position for 30 s; each task was performed 10 times. The measurement conditions were as follows: (1) on the floor; (2) on the robot, touching the handlebars; and (3) on the robot, not touching the handlebars. [Results] During the robotic tasks, the total locus lengths of the center of gravity and total joint momentums of the hip, knee, and ankle joints were larger, and the amount of displacement of the center of pressure was smaller than that during the floor task. Posture control on the robot was performed actively by mechanical interaction of the ankle, knee, and hip joints within a small base of support. [Conclusion] The balance exercise assist robot can be useful for postural control exercises because maintaining a standing position on the personal transport assistance robot required active postural control.
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Affiliation(s)
- Norihide Itoh
- Department of Advanced Rehabilitation Medicine, Kyoto Prefectural University of Medicine: 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.,Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Daisuke Imoto
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Shuichi Kubo
- Department of Rehabilitation, University Hospital, Kyoto Prefectural University of Medicine, Japan
| | - Masaki Yamaguchi
- Department of Rehabilitation, University Hospital, Kyoto Prefectural University of Medicine, Japan
| | - Naoto Shimizu
- Department of Rehabilitation, University Hospital, Kyoto Prefectural University of Medicine, Japan
| | - Shogo Toyama
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.,Department of Rehabilitation, University Hospital, Kyoto Prefectural University of Medicine, Japan
| | - Toshikazu Kubo
- Department of Advanced Rehabilitation Medicine, Kyoto Prefectural University of Medicine: 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.,Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.,Department of Rehabilitation, University Hospital, Kyoto Prefectural University of Medicine, Japan
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Maeda H, Ikoma K, Toyama S, Taniguchi D, Kido M, Ohashi S, Kubo S, Hishikawa N, Sawada K, Mikami Y, Kubo T. A kinematic and kinetic analysis of the hip and knee joints in patients with posterior tibialis tendon dysfunction; comparison with healthy age-matched controls. Gait Posture 2018; 66:228-235. [PMID: 30212782 DOI: 10.1016/j.gaitpost.2018.08.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/10/2018] [Accepted: 08/31/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The biomechanical abnormalities in patients with posterior tibial tendon dysfunction (PTTD) have been described, but few studies have investigated biomechanical chains of adjacent joints. Therefore, we examined the gait pattern of the lower extremity in subjects with PTTD, focusing on the hip and knee joints. METHODS We compared 19 PTTD patients (average age: 67.1) with 30 age-matched control subjects (average age: 65.1). Gait analysis was performed with a nine-camera motion-capture system and four force plates, using the Vicon Plug-In-Gait and Vicon Nexus software. Temporal-spatial parameters were compared between PTTD and control subjects, and motion and ground reaction force data were compared between the affected limb, the contralateral limb, and the right limb in control subjects. RESULTS Subjects with PTTD had increased stance phase ratio and decreased stride length, cadence, and gait speed. The limbs of subjects with PTTD showed increased knee internal rotation at lording response, which was biased to abduction in the knee joint during the gait cycle, and irregular hip flexion and knee extension moment in the terminal stance, even under control of gait speed. SIGNIFICANCE We believe that the subjects with PTTD have an increased risk of knee osteoarthritis in both the affected and contralateral limbs.
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Affiliation(s)
- Hiroshi Maeda
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan.
| | - Shogo Toyama
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan; Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Daigo Taniguchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Masamitsu Kido
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - Shuichi Kubo
- Rehabilitation Unit, Kyoto Prefectural University Hospital 'Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Norikazu Hishikawa
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - Koshiro Sawada
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan
| | - Toshikazu Kubo
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566 Kyoto, Japan; Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan; Rehabilitation Unit, Kyoto Prefectural University Hospital 'Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
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Hishikawa N, Toyama S, Ikoma K, Taniguchi D, Kido M, Ohashi S, Kubo S, Maeda H, Sawada K, Mikami Y, Toshikazu K. ISPR8-0437/The abnormalities of the hip and knee joints in patients with posterior tibialis tendon dysfunction: Comparison with healthy age-matched controls. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ohara M, Oda R, Toyama S, Katsuyama Y, Fujiwara H, Kubo T. Five-decade-delayed closed flexor tendon rupture due to Galeazzi dislocation fracture associated with Behçet syndrome: A case report. Int J Surg Case Rep 2018; 48:87-91. [PMID: 29913431 PMCID: PMC6005791 DOI: 10.1016/j.ijscr.2018.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Closed flexor tendon rupture after a malunited distal radius fracture is rare and usually becomes apparent early after the fracture. Most cases are accompanied by a severe distal radio-ulnar joint capsule injury, wherein bone protrusion (as a spur) directly stresses the tendons. We experienced a nonspecific flexor tendon rupture associated with an old fracture and the presence of collagen disease. PRESENTATION OF CASE A 63-year-old woman presented with delayed complete rupture of the flexor digitorum profundus (FDP) of the fifth digit. Her history included closed fracture on the left wrist at age 13 years. At 27 years, she was diagnosed with Behçet syndrome and commenced oral prednisolone 10 mg/day. At the current admission, physical examination revealed that she was incapable of fifth finger flexion after minor passive extension. The fifth digit FDP rupture appeared to be due to damage at the wrist-level fracture site. A tiny capsule rupture was seen on the volar side of the distal radio-ulnar joint. We resected ulnar head osteophytes protruding from the capsule hole and transferred tendon from the fifth FDP to the fourth FDP. CONCLUSION Reportedly, metalloproteases weaken tendon structure by acting as a collagenase in patients with Behçet syndrome. Also, vasculitis next to a tendon and steroid intake are considered to impede the tendon repair process. Hence, even minor trauma may lead to complete tendon rupture. Although an injury seems slight, we should take into account the possible history of bone and joint trauma.
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Affiliation(s)
- Masato Ohara
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan.
| | - Yusei Katsuyama
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, 602-8566, Kyoto, Japan
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Toyama S, Oda R, Tokunaga D, Taniguchi D, Nakamura S, Asada M, Fujiwara H, Kubo T. A new assessment tool for ulnar drift in patients with rheumatoid arthritis using pathophysiological parameters of the metacarpophalangeal joint. Mod Rheumatol 2018; 29:113-118. [PMID: 29448870 DOI: 10.1080/14397595.2018.1442171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To establish a new assessment tool for ulnar drift (UD) in rheumatoid arthritis (RA). METHODS We established an observational cohort of 67 patients (134 rheumatoid hands) beginning in 2004. Fifty-two patients (100 hands) had follow-up in 2009 and 37 patients (63 hands) completed follow-up in 2015. UD was evaluated with the Fearnley classification and our scoring method, which assesses four parameters of the metacarpophalangeal joint. Cluster analysis using UD parameters divided hands into groups. Changes in UD over time, correlation of the Fearnley stage and cluster with a functional assessment, and reliability of the parameters were analyzed. RESULTS UD increased and worsened over time according to the trend test. A dendrogram indicated five clusters would be appropriate. Both the Fearnley classification and cluster were associated with function; however, our method related to function more linearly (R-squared: 0.42). We found one type of hand in which bone destruction precedes the joint dislocation and one type in which joint dislocation progresses with little deviation during UD progression. CONCLUSION Our UD evaluation appeared to be simple and related to function. Additionally, it enables dividing UD hands into five stages. Thus, our assessment should be beneficial compared to the Fearnley classification in considering treatments of UD.
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Affiliation(s)
- Shogo Toyama
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Ryo Oda
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Daisaku Tokunaga
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Daigo Taniguchi
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Satoru Nakamura
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Maki Asada
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Hiroyoshi Fujiwara
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Toshikazu Kubo
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
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Toyama S, Suefuji H, Shinoto M, Matsumoto K, Shioyama Y. PO-0690: An initial result of carbon-ion radiotherapy for metastatic liver tumors. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31127-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Taniguchi D, Oda R, Ikoma K, Toyama S, Takatori R, Imai K, Hara Y, Sawada K, Tokunaga D, Fujiwara H, Kubo T. Recurrence of deformity after silicone implant and resection arthroplasty of the metatarsophalangeal joint for rheumatoid arthritis: long-term results. Mod Rheumatol 2016; 27:266-270. [PMID: 27539207 DOI: 10.1080/14397595.2016.1207286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the recurrence of deformity after silicone implant arthroplasty combined with resection arthroplasty for severe forefoot deformity in patients with rheumatoid arthritis. METHODS We reviewed the long-term results of this procedure for 27 feet in 15 patients. Their average age and disease duration at the time of operation were 58.6 years and 17.5 years, respectively, and the average follow-up period was 10.3 years. RESULTS An improved hallux valgus angle (45.3° preoperatively, 23.6° 6 months after operation) was maintained. By contrast, deformity and dislocation of lesser toe had recurred at the final follow-up; the angle between the proximal phalanx and the metatarsal of the second toe improved 13.4° with recurrence of 22.5°, the angle between the proximal phalanx and ground surface improved 22.4° with recurrence of 34.5. Furthermore, claw toe deformity at the final follow-up was significantly worse in the group whose hallux valgus deformity was observed 6 months after operation. CONCLUSION This procedure could maintain the alignment of the first metatarsophalangeal joint, but the recurrence of claw toe deformity is a problem and the relation between the first toe and the lesser toe is an important consideration.
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Affiliation(s)
- Daigo Taniguchi
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
| | - Ryo Oda
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
| | - Kazuya Ikoma
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
| | - Shogo Toyama
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
| | - Ryota Takatori
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
| | - Kan Imai
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
| | - Yusuke Hara
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
| | - Koshiro Sawada
- b Department of Rehabilitation Medicine , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Daisaku Tokunaga
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
| | - Hiroyoshi Fujiwara
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
| | - Toshikazu Kubo
- a Department of Orthopaedics, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kamigyo-Ku , Kyoto , Japan and
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Nomiya T, Tsuji H, Kawamura H, Ohno T, Toyama S, Shioyama Y, Nakayama Y, Nemoto K, Tsujii H, Kamada T. A Multi-institutional Analysis of Prospective Studies of Carbon Ion Radiation Therapy for Prostate Cancer: An Analysis of 2157 Patients from the Japan Carbon Ion Radiation Oncology Study Group (J-CROS). Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shinoto M, Shioyama Y, Suefuji H, Matsunobu A, Toyama S, Kudo S. Dosimetric Analysis of Upper Gastrointestinal Ulcer After Carbon Ion Radiation Therapy for Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hosokawa T, Oda R, Toyama S, Taniguchi D, Tokunaga D, Fujiwara H, Kubo T. Spontaneous flexor tendon rupture due to an insufficiency fracture of the hamate hook in a patient with systemic lupus erythematosus: A case report. Int J Surg Case Rep 2016; 27:63-65. [PMID: 27552031 PMCID: PMC4995535 DOI: 10.1016/j.ijscr.2016.06.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Spontaneous flexor tendon rupture is usually caused by trauma, systemic diseases, or carpal bone and joint disorders. Here we report a case of spontaneous flexor tendon rupture occurring in a systemic lupus erythematosus (SLE) patient following nonunion of the hamate hook after an insufficiency fracture, and which was also associated with tendon degeneration caused by SLE. CASE PRESENTATION A 57-year-old woman was diagnosed with SLE 22 years ago and being treated with oral prednisolone. She became unable to flex her left little finger without any history of trauma or sporting activity. CT showed nonunion of the hamate hook. MRI showed rupture of the flexor digitorum profundus tendon of the little finger. We performed tendon transfer and excision of the hamate hook. She recovered active flexion of the little finger at 4 months postoperatively with full satisfaction. DISCUSSION There was no history of trauma that could have caused nonunion of the hamate hook. We considered that the insufficiency fracture of the hamate hook occurred as a result of osteoporosis caused by SLE and long-term steroid use. Nonunion of the hamate hook caused mechanical attrition of the tendons, and in combination with the tendon degeneration caused by SLE, further resulted in rupture of the flexor tendon. CONCLUSION When we encounter a case of spontaneous flexor tendon rupture in a patient with systemic disease such as SLE or long-term steroid use, attention should be paid to the state of the carpal bones and joints as they sometimes accompany unexpected causes.
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Affiliation(s)
- Toshihiro Hosokawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Daigo Taniguchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
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Akai T, Taniguchi D, Oda R, Asada M, Toyama S, Tokunaga D, Seno T, Kawahito Y, Fujii Y, Ito H, Fujiwara H, Kubo T. Prediction of radiographic progression in synovitis-positive joints on maximum intensity projection of magnetic resonance imaging in rheumatoid arthritis. Clin Rheumatol 2016; 35:873-8. [PMID: 26861034 DOI: 10.1007/s10067-016-3208-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/31/2016] [Indexed: 11/28/2022]
Abstract
Contrast-enhanced magnetic resonance imaging with maximum intensity projection (MRI-MIP) is an easy, useful imaging method to evaluate synovitis in rheumatoid hands. However, the prognosis of synovitis-positive joints on MRI-MIP has not been clarified. The aim of this study was to evaluate the relationship between synovitis visualized by MRI-MIP and joint destruction on X-rays in rheumatoid hands. The wrists, metacarpophalangeal (MP) joints, and proximal interphalangeal (PIP) joints of both hands (500 joints in total) were evaluated in 25 rheumatoid arthritis (RA) patients. Synovitis was scored from grade 0 to 2 on the MRI-MIP images. The Sharp/van der Heijde score and Larsen grade were used for radiographic evaluation. The relationships between the MIP score and the progression of radiographic scores and between the MIP score and bone marrow edema on MRI were analyzed using the trend test. As the MIP score increased, the Sharp/van der Heijde score and Larsen grade progressed severely. The rate of bone marrow edema-positive joints also increased with higher MIP scores. MRI-MIP imaging of RA hands is a clinically useful method that allows semi-quantitative evaluation of synovitis with ease and can be used to predict joint destruction.
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Affiliation(s)
- Takanori Akai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Daigo Taniguchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Maki Asada
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takahiro Seno
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Rheumatic Diseases and Joint Function, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yutaka Kawahito
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yosuke Fujii
- Statistical Genetics, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, 53 Shogoinkawaramachi, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hirotoshi Ito
- Department of Diagnostic Radiology, Kajiicho Medical Imaging Center, 457 Kajii-cho, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Rheumatic Diseases and Joint Function, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Yamasaki T, Oda R, Imai K, Taniguchi D, Toyama S, Seno T, Arai Y, Ikoma K, Fujiwara H, Tokunaga D, Kawahito Y, Kubo T. Efficacy of MRP8/14 as a Marker of Disease Activity in Rheumatoid Arthritis. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojra.2016.62006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Toyama S, Matsuoka K, Tagaito Y, Shimoyama M. Retrospective evaluation of the effect of carotid artery stenosis on cerebral oxygen saturation during off-pump coronary artery bypasses grafting in adult patients. BMC Anesthesiol 2015; 15:180. [PMID: 26667409 PMCID: PMC4678630 DOI: 10.1186/s12871-015-0164-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 12/05/2015] [Indexed: 01/18/2023] Open
Abstract
Background It is unknown whether cerebral oxygenation in patients with carotid artery stenosis (CAS) undergoing off-pump coronary artery bypass grafting (CABG) differs from that in patients without CAS. Thus, the effect of the presence of CAS ≥ 50 % on cerebral oxygenation during off-pump CABG in adult patients was evaluated retrospectively. Methods Eleven patients with CAS ≥ 50 % and 14 patients without CAS ≥ 50 % were enrolled. Regional cerebral tissue oxygen saturation (rSO2) was quantified using near-infrared spectroscopy. Mean arterial pressure, cardiac index, central venous pressure (CVP), and rSO2 at specific points were collected, and significant changes in each parameter were detected using repeated analysis of variance. Mean rSO2 and minimum rSO2 during anastomosis were analyzed by one-way analysis of variance. Multiple logistic regression analysis was used to estimate the odds ratio (OR) with 95 % confidence interval (CI) for cerebral desaturation (a decrease in rSO2 ≥ 10 % from preoperative value). Results Two patients with CAS ≥ 50 % who received complete carotid artery stenting preoperatively were excluded from the analyses. In both patients with and without CAS, a decrease in rSO2 and cardiac index and an increase in CVP were observed during anastomosis. Mean (SD) maximum decrease in rSO2 from preoperative value was 9.2 (12.7) % on the left side and 8.1 (11.7) % on the right side in patients with CAS ≥ 50 %, and 13.5 (11.3) % on the left side and 16.1 (9.8) % on the right side in patients without CAS ≥ 50 % (p = 0.316). Neurological complications were not identified in both patients with and without CAS ≥ 50 %. In multiple logistic regression analysis, CAS ≥ 50 % was not associated with an increased risk of cerebral desaturation (OR 0.160, 95 % CI 0.036–0.707, p = 0.016), and rSO2 decreased with decreasing cardiac index < 2.0 l/min/m2 (OR 3.287, 95 % CI 2.218–5.076, p < 0.001). Conclusions CAS ≥ 50 % was not an independent risk factor of cerebral desaturation during off-pump CABG. Our results suggest that maintaining cardiac output can prevent a decrease in cerebral oxygenation in both patients with and without CAS ≥ 50 %.
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Affiliation(s)
- S Toyama
- Department of Anesthesiology, Medical Hospital of Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - K Matsuoka
- Department of Anesthesiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-City, Chiba, 299-0111, Japan.
| | - Y Tagaito
- Department of Anesthesiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-City, Chiba, 299-0111, Japan.
| | - M Shimoyama
- Department of Anesthesiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-City, Chiba, 299-0111, Japan. .,Department of Palliative Medicine, Jikei University Graduate School of Medicine, 3-19-18 Nishi-shimbashi, Minato-Ku, Tokyo, 105-8471, Japan.
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Toyama S. Hypotension during spinal anaesthesia for caesarean section. Anaesthesia 2015; 70:1208-9. [PMID: 26372866 DOI: 10.1111/anae.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Toyama
- Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan.
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Toyama S, Tokunaga D, Fujiwara H, Oda R, Kobashi H, Okumura H, Nakamura S, Taniguchi D, Kubo T. Rheumatoid arthritis of the hand: a five-year longitudinal analysis of clinical and radiographic findings. Mod Rheumatol 2014; 24:69-77. [PMID: 24261761 DOI: 10.3109/14397595.2013.854054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Treatments for rheumatoid arthritis (RA) have improved since methotrexate and biological agents were approved; however, few longitudinal analyses have tracked joint destruction, deformity progression, or functional impairments that directly affect the activities of daily living. Due to the consequences of functional impairments, we conducted this study to glean more information regarding deformity progression over time. METHODS This study enrolled 134 hands in 67 RA patients with hand deformities in 2004. After 5 years, 100 hands in 52 patients were eligible for the final assessment. Analyses consisted of morphological and radiographical evaluations of deformities, functional evaluations by questionnaires and the modified Kapandji index, and activity evaluations. RESULTS In this period, the type I deformity (Nalebuff and Millender, Orthop Clin North Am 6(3):753-63, 1975) was the most common thumb deformity. Swan-neck and boutonnière finger deformities also progressed. At the 5-year follow-up, questionnaire score worsened, when disease activity was high. CONCLUSIONS Our study showed that there was a marked progression in hand deformities in RA patients over a 5-year period. In order to assist RA patients in performing the activities of daily living, medical and rehabilitative interventions should target the restoration of functional loss through joint destruction as well as the prevention of disease progression.
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Affiliation(s)
- Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kajii-cho 465, Kamigyo-ku, Kyoto, Kyoto , Japan . e-mail: ,
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Toyama S, Tamai K, Sakamoto A, Hirashima T. The short-term outcome of the modified Sauvé–Kapandji procedure regarding range of motion, carpal bone translation and bony shelf size. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0346-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Toyama S, Kakumoto M, Morioka M, Matsuoka K, Omatsu H, Tagaito Y, Numai T, Shimoyama M. Perfusion index derived from a pulse oximeter can predict the incidence of hypotension during spinal anaesthesia for Caesarean delivery. Br J Anaesth 2013; 111:235-41. [DOI: 10.1093/bja/aet058] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Toyama S, Oda R, Tokunaga D, Fujiwara H, Kobashi H, Yamazaki T, Okubo N, Kubo T. AB0335 The relationship between joint mobility and upper limb function in boutonniΈre deformities in the rheumatoid thumb. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Toyama S, Tsuji H, Mizoguchi N, Kamada T, Tsujii H, Tokumaru S, Onishi Y. Long-term Result of Carbon-ion Radiation Therapy for Locally Advanced or Unfavorably Located Choroidal Melanoma: CT Based 2-port Orthogonal Therapy Can Reduce the Incidence of Neovascular Glaucoma. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mizoguchi N, Tsuji H, Toyama S, Kamada T, Tsujii H, Nakayama Y, Ohnishi Y. Carbon-ion Radiation Therapy for Locally Advanced Primary or Postoperative Recurrent Epithelial Carcinoma of Lacrimal Gland: A Phase I/II Dose-escalation Study. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tokumaru S, Hirakawa K, Imaizumi T, Toyama S, Oishi M, Kamochi N, Sasaguri K, Irie H, Iwasaka T. Concurrent Chemoradiation Therapy for Uterine Cervical Cancer: Correlation of MRI Findings With Histopathologic Results. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fujiwara S, Tokunaga D, Oda R, Toyama S, Imai K, Doi A, Kubo T. Dynamic close-mouth view radiograph method for the diagnosis of lateral dynamic instability of the atlantoaxial joint. Clin Imaging 2011; 34:375-8. [PMID: 20813302 DOI: 10.1016/j.clinimag.2009.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 08/15/2009] [Indexed: 10/19/2022]
Abstract
The purpose of the current study is to establish the dynamic close-mouth view radiograph method. Seven healthy volunteers were enrolled. Dynamic open-mouth and close-mouth view radiographs were obtained. The odontoid lateral mass interval and the dynamic atlantodental lateral shift (ADLS) were measured. The ADLS was 9.4+/-5.3% by the close-mouth view, showing a significantly greater percentage than that of 5.3+/-4.0% by the open-mouth view. The dynamic close-mouth view can be useful for diagnosis of atlantoaxial lateral instability.
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Affiliation(s)
- Susumu Fujiwara
- Department of Radiological Technology, Kyoto Takeda Hospital, Shimogyo-ku, Kyoto, Japan
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Maekawa Y, Yoshimura Y, Nakashima K, Toyama S, Minagawa T, Sadahiro M, Suzuki H, Niki T, Sasa S. [Aortic root replacement for aortic dissection and aortic regurgitation due to aortitis syndrome]. Kyobu Geka 2009; 62:1128-1131. [PMID: 19999088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Aortic aneurysms and aortic regurgitation (AR) with aortitis syndrome are occasionally reported in young women. We report a case of aortic dissection with severe AR in an 8-year-old girl. The patient underwent aortic root replacement with a composite graft. Pathological report revealed aortitis syndrome and steroid therapy was continued to suppress further inflammatory vascular reaction.
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Affiliation(s)
- Y Maekawa
- Department of Cardiovascular, Thoracic and Pediatric Surgery, Yamagata University, Yamagata, Japan
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Toyama S, Nakashima K, Maekawa Y, Minagawa T, Kuroda Y, Yoshimura Y, Sadahiro M. [Aortic valve replacement through right thoracotomy; report of a case]. Kyobu Geka 2009; 62:827-829. [PMID: 19670788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 78-year-old female was admitted to our hospital with a diagnosis of severe aortic valve regurgitation. She had had dyspnea on effort and syncope twice in 5 months. She had also suffered from right pneumonia 8 years before, and her respiratory function was severely constrictive. Chest X-ray showed her mediastinum significantly shifted toward the right side. Chest computed tomography (CT) revealed the main pulmonary artery, right atrium (RA) and right pulmonary veins also shifted toward the right. We planned right thoracotomy at 4th intercostals space to obtain a good surgical field. A cardiopulmonary bypass was established by RA appendage drainage and femoral artery perfusion. Aortic valve replacement(AVR) was performed successfully after aortic clamp. Though defibrillator pads were placed on her back and the anterior wall of the left chest during operation, no ventricular fibrillation occurred. AVR via right thoracotomy is considered to be a good option for such a mediastinum shifted case.
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Affiliation(s)
- S Toyama
- Department of Cardiovascular, Thoracic and Pediatric Surgery, School of Medicine, Yamagata University, Yamagata, Japan
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Ishihara M, Tawata S, Toyama S. Disintegration of uncooked rice by carboxymethyl cellulase from Sporotrichum sp. HG-I. J Biosci Bioeng 2005; 87:249-51. [PMID: 16232461 DOI: 10.1016/s1389-1723(99)89023-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/1998] [Accepted: 11/09/1998] [Indexed: 11/26/2022]
Abstract
A thermostable carboxymethyl cellulase (CMCase) was purified to homogeneity from a wheat bran culture of the thermophilic fungus Sporotrichum sp. HG-1, an isolate from a compost heap. The enzyme had a molecular weight (M(r)) of 33,000 by SDS-PAGE. The optimum temperature and pH for enzyme activity were 70 degrees C and 4.5-5.0, and the enzyme was heat stable. Uncooked Thai rice was digested so as to cause its disintegration by the addition of purified CMCase, but not by the addition of xylanase purified from strain HG-1. Ferulic acid conjugated to oligosaccharide was released significantly by the combined action of CMCase and xylanase, but the free form of ferulic acid was not detectable.
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Affiliation(s)
- M Ishihara
- Department of Bioscience and Biotechnology, Faculty of Agriculture, University of the Ryukyus, 1 Senbaru, Nishihara-cho, Okinawa 903-0213, Japan
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Shimanuki T, Uchino H, Toyama S, Abiko M. [Surgical osteoplasty of the left main coronary artery using the right internal thoracic artery]. Kyobu Geka 2004; 57:481-4. [PMID: 15202269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 39-year-old female with a history of progressive refractory angina required medical treatment. A coronary angiography showed 75% left coronary ostial stenosis without any other atherosclerotic lesions. The isolated ostial stenosis of the left main coronary artery was reconstructed by patch angioplasty, using a proximal segment of the right internal thoracic artery. The transaortic patch angioplasty was performed using a superior approach, which allowed a good exposure of the left coronary artery to the aorta without difficulty. A postoperative coronary angiography showed satisfactory patency, and a small biopsy of the ostial tissue demonstrated findings compatible with fibromuscular dysplasia. Based on this outcome, a proximal segment of the internal thoracic artery appears to provide a suitable patch material for enlarging the left coronary ostium.
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Affiliation(s)
- T Shimanuki
- Department of Cardiovascular Surgery, Yamagata Prefectural Nihonkai Hospital, Sakata, Japan
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