Sakae Tanaka

The University of Tokyo, Tōkyō, Japan

Are you Sakae Tanaka?

Claim your profile

Publications (213)848.67 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We examined the individual and combined effects of teriparatide and anti-RANKL (receptor activator of nuclear factor κB ligand) monoclonal antibody in ovariectomized mice. Three-month-old female C57BL/6 mice were ovariectomized (OVX) or sham operated. Four weeks after OVX, they were assigned to 3 different groups to receive anti-RANKL monoclonal antibody (Ab) alone (5 mg/kg single injection at 4 weeks after OVX, Ab group), teriparatide alone (80 μg/kg daily injection for 4 weeks from 4 weeks after OVX, PTH group), or mAb plus teriparatide (Ab + PTH group). Mice were sacrificed 8 weeks after OVX. Bone mineral density (BMD) was measured at the femur and lumbar spine. Hind limbs were subjected to histological and histomorphometric analysis. Serum osteocalcin and CTX-I levels were measured to investigate the bone turnover. Compared with Ab group, Ab + PTH group showed a significant increase in BMD at distal femur and femoral shaft. Cortical bone volume was significantly increased in PTH and Ab + PTH groups compared with Ab group. Bone turnover in Ab + PTH group was suppressed to the same degree as in Ab group. The number of TRAP-positive multinucleated cells was markedly reduced in Ab and Ab + PTH groups. These results suggest that combined treatment of teriparatide with anti-RANKL antibody has additive effects on BMD in OVX mice compared with individual treatment.
    06/2015; 2. DOI:10.1016/j.bonr.2014.12.002
  • [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to clarify the association between new indices in a locomotive syndrome risk test and decline in mobility. In the third survey of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study, data on the indices were obtained from 1575 subjects (513 men, 1062 women) of the 1721 participants in mountainous and coastal areas. As outcome measures for decline in mobility, we used the five-times-sit-to-stand test (FTSST) and walking speed with cutoff values of 12 s and 0.8 m/s, respectively. We first estimated the prevalence of the indices in locomotive syndrome risk test stage 1, including two-step test score <1.3, difficulty with one-leg standing from a 40-cm-high seat in the stand-up test, and 25-question GLFS score ≥7, which were found to be 57.4, 40.6, and 22.6 %, respectively. Next, we investigated the prevalence of the indices in locomotive syndrome risk test stage 2, including two-step test score <1.1, difficulty with standing from a 20-cm-high seat using both legs in the stand-up test, and 25-question GLFS score ≥16, which were found to be 21.1, 7.9, and 10.6 %, respectively. Logistic regression analysis using slow FTSST time or slow walking speed as the objective factor, and presence or absence of indices as the independent factor, after adjusting for confounders, showed all three indices in both stages 1 and 2 were significantly and independently associated with immobility. Finally, we clarified the risk of immobility according to an increasing number of indices in both stages 1 and 2 and found that the odds ratio for both slow FTSST time and slow walking speed increased exponentially. We found that the three indices independently predicted immobility and that accumulation of indices increased the risk of immobility exponentially.
    Journal of Orthopaedic Science 06/2015; DOI:10.1007/s00776-015-0741-5 · 1.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Total en bloc spondylectomy (TES) is a surgical procedure performed to achieve complete resection of an aggressive benign spinal tumor or a malignant spinal tumor. When reconstructing the spine after resection, we have been using liquid nitrogen-frozen resected spine bearing tumor as a bone graft, expecting an immunological response to tumor-specific antigen(s). The purpose of this article is to report a successful treatment case of lung adenocarcinoma metastasis with TES and this cryotherapy. A 59-year-old male presented with rapid progression of neurological deterioration of the lower limbs due to a spinal metastasis from T8 to T10. The primary lung adenocarcinoma had already been excised under thoracoscopy. The patient underwent TES with reconstruction using frozen tumor-bearing vertebra for the bone graft. One month after surgery, a new nodule appeared at the right middle lobe of the lung. However, we carried out no biopsy of the newly emerged nodule and the patient received no adjuvant chemotherapy or radiotherapy. Six months after surgery, the tumor vanished. No local recurrence or metastasis of the tumor has been observed until now. TES with a liquid nitrogen-frozen tumor specimen could be a promising therapeutic option for cancer patients with spine metastasis.
    European Spine Journal 06/2015; DOI:10.1007/s00586-015-4077-9 · 2.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the construction of artificial hip joint replacements, the surface and substrate of a cross-linked polyethylene (CLPE) liner are designed to achieve high wear resistance and prevent infection by bacteria. In this study, we fabricated a highly hydrophilic and antibiofouling poly(2-methacryloyloxyethyl phosphorylcholine [MPC]) (PMPC)-graft layer on the vitamin E-blended CLPE (HD-CLPE(VE)) surface. The 100-nm-thick, smooth, and electrically neutral PMPC layer was successfully fabricated on the HD-CLPE(VE) surface using photoinduced graft polymerization. The PMPC-grafted HD-CLPE(VE) was found to prevent bacterial adherence and biofilm formation on the surface because of the formation of a highly hydrophilic polyzwitterionic layer on the surface of HD-CLPE(VE), which can serve as an extremely efficient antibiofouling layer. The number of bacterial adhered on the PMPC-grafted HD-CLPE(VE) surface was reduced by 100-fold or more by PMPC grafting, regardless of the biofilm-production characteristics of the strains. In contrast, vitamin E blending did not affect bacterial adhesion. Moreover, the number of planktonic bacteria did not differ significantly, regardless of PMPC grafting and vitamin E blending. In conclusion, the PMPC-grafted HD-CLPE(VE) provided bacteriostatic effects associated with smooth, highly hydrophilic surfaces with a neutral electrostatic charge owing to the zwitterionic structure of the MPC unit. Thus, this modification may prove useful for the production of artificial hip joint replacement materials. Copyright © 2015. Published by Elsevier Ltd.
    Acta biomaterialia 06/2015; DOI:10.1016/j.actbio.2015.05.034 · 5.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Surface modification by grafting of biocompatible phospholipid polymer onto the surface of artificial joint material has been proposed to reduce the risk of aseptic loosening and improve the durability. Poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted cross-linked polyethylene (CLPE) has shown promising results for reducing wear of CLPE. The main lubrication mechanism for the PMPC layer is considered to be the hydration lubrication. In this study, the lubrication properties of PMPC-grafted CLPE were evaluated in reciprocating friction test with rehydration process by unloading in various lubricants. The start-up friction of PMPC-grafted CLPE was reduced, and the damage of PMPC layer was suppressed by rehydration in water or hyaluronic acid solutions. In contrast, the start-up friction of PMPC-grafted CLPE increased in fetal bovine serum solution, and the damage for PMPC layer was quite noticeable. Interestingly, the start-up friction of PMPC-grafted CLPE was reduced in fetal bovine serum solution containing hyaluronic acid, and the damage of the PMPC layer was suppressed. These results indicate that the rehydration by unloading and hyaluronic acid are elemental in maximizing the lubrication effect of hydrated PMPC layer. © IMechE 2015.
    06/2015; DOI:10.1177/0954411915588969
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To determine whether 8-iso-prostaglandin F2α (8-iso-PGF2α) is a reliable biomarker of the accumulation of metabolic risks [e.g., overweight, hypertension, impaired glucose tolerance (IGT), and dyslipidemia].Methods This was a cross-sectional study of the baseline characteristics of a Japanese general population cohort study: Research on Osteoarthritis/Osteoporosis Against Disability (ROAD). Of 1,690 participants, 1,527 fulfilled all questionnaires and examinations. Free and conjugated urinary 8-iso-PGF2α levels and metabolic syndrome (MetS) components including blood pressure, HbA1c, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and non-HDL-C were analyzed. The data were analyzed by ANCOVA, multiple regression analysis, and multinomial logistic analysis.Results8-iso-PGF2α was significantly associated with HbA1c and significantly inversely associated with total cholesterol and non-HDL-C. Notably, IGT with an HbA1c cut-off of 5.5% was significantly associated with 8-iso-PGF2α level in participants aged ≤50 years. Multinomial logistic regression analysis revealed 8-iso-PGF2α level was significantly associated with a greater number of MetS risks present; this association was stronger in younger participants. In participants aged ≥71 years, 8-iso-PGF2α was significantly associated with a greater number of MetS risks with higher IGT cut-offs.Conclusions Urinary 8-iso-PGF2α can be a reliable marker of IGT and the accumulation of MetS risks, especially in younger people.
    Obesity 06/2015; DOI:10.1002/oby.21130 · 4.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to clarify the prevalence and the predictive factors for undergoing total knee arthroplasty (TKA) among patients with rheumatoid arthritis (RA). The data of 1,134 patients with RA who were enrolled in the Japanese nationwide cohort database NinJa in 2003 and consecutively followed up until 2009 were analyzed. Seventy-six patients underwent TKA during the observation period. The yearly progression of the Modified Health Assessment Questionnaire (mHAQ) score from 2003 to 2004, but not the yearly progression of the Disease Activity Score in 28 Joints (DAS28) or patient visual analog scale (VAS) score, was significantly higher in the patients who underwent TKA than those who did not. Multivariate analysis showed that knee involvement in the disease, high Steinbrocker stage (III or IV), and high patient VAS score at the time of enrollment were powerful predictive factors, with hazard ratios of 4.01, 3.71, and 1.20, respectively. According to survival analysis with TKA as an endpoint, patients with knee involvement in the disease at the time of enrollment had a significantly worse 5-year survival rate than did those without knee involvement (83.5% vs 97.0%, respectively). Several factors were elucidated as predictive factors for undergoing TKA among patients with RA.
    Modern Rheumatology 05/2015; DOI:10.3109/14397595.2015.1045258 · 2.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to investigate the factors that affect the predicted bone strength of proximal femur in Japanese population. Participants (552 men and 273 women) in a health checkup program with computed tomography (CT) at the University of Tokyo Hospital were enrolled in this study. Three dimensional finite element models of the proximal femur were constructed from CT data of the participants with simultaneous scans of a calibration phantom containing hydroxyapatite rods. Multiple regression analysis was performed to analyze the relationship between predicted bone strength and clinical factors. Average predicted strength of proximal femur was lower in women than in men in all age ranges. Predicted bone strength in women under both stance and fall configurations significantly decreased with age, and that in men had the tendency to decrease with age. Body weight positively affected predicted bone strength in both men and women. This is the first cross-sectional analysis of predicted bone strength of the proximal femur in Japanese population of wide age range. Age and body weight critically affected Quantitative computed tomography-based finite element method-determined bone strength of proximal femur, in particular in women, under both stance and fall configurations.
    Modern Rheumatology 04/2015; DOI:10.3109/14397595.2015.1046220 · 2.21 Impact Factor
  • PLoS ONE 04/2015; 10(4):e0123022. DOI:10.1371/journal.pone.0123022 · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The phosphorylated neurofilament heavy subunit (pNfH) is an axon fiber structural protein that is released into the cerebrospinal fluid (CSF) after nerve damage. Although previous studies have reported elevated CSF levels of pNfH in various neurological diseases, including amyotrophic lateral sclerosis, these levels have not been examined in patients with spinal stenosis. To investigate the CSF levels of pNfH in patients with lumbar spinal stenosis (LSS), and to examine the relationship between CSF levels of pNfH and the severity of LSS. A prospective observational study. We included consecutive patients with LSS who were undergoing myelography for preoperative evaluation. CSF samples from patients with idiopathic scoliosis were used as the controls. Physiological measures: CSF levels of pNfH were measured using an enzyme-linked immunosorbent assay. The Zurich Claudication Questionnaire (ZCQ) and the numerical rating scale (NRS) for sciatic pain were used to assess the clinical severity of LSS, and patients were grouped into tertiles according to their symptom severity and pain grading. Axial magnetic resonance imaging was used to evaluate the morphological severity of LSS, and patients were classified into 3 groups based on their morphological grading (using the CSF/rootlet ratio). Analysis of variance was used to examine the relationship between the CSF levels of pNfH and the severity of LSS. This work was supported by a grant from the Japanese Ministry of Health, Labour and Welfare, although there are no potential conflicts of interest to disclose. Thirty-three patients with LSS were included (13 men and 20 women; mean age, 73.2 years; range, 58-88 years). Most patients (n = 32) were positive for pNfH in their CSF (mean, 1,344 pg/mL; range, 149-9,250 pg/mL), while all control subjects were negative for pNfH in their CSF. Regarding the association with clinical severity, patients in the third tertiles of ZCQ and NRS tended to have higher levels of pNfH compared to the other groups. There was no association between the CSF level of pNfH and the morphological severity of LSS. This study detected elevated pNfH levels in the CSF of patients with LSS. Patients with severe clinical symptoms were more likely to exhibit high levels of pNfH. Our results indicate the potential usefulness of pNfH as a biomarker for compressive spinal disorders. Copyright © 2015 Elsevier Inc. All rights reserved.
    The spine journal: official journal of the North American Spine Society 03/2015; DOI:10.1016/j.spinee.2015.03.013 · 2.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The use of larger femoral heads to prevent the dislocation of artificial hip joints has recently become more common. However, concerns about the subsequent use of thinner polyethylene liners and their effects on wear rate have arisen. Previously, we prepared and evaluated the biological and mechanical effects of a novel highly crosslinked polyethylene (CLPE) liner with a nanometer-scaled graft layer of poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC). Our findings showed that the PMPC-grafted particles were biologically inert and caused no subsequent bone resorptive responses and that the PMPC-grafting markedly decreased wear in a hip joint simulator. However, the metal or ceramic femoral heads used in this previous study had a diameter of 26 mm. Here, we investigated the wear-resistance of the PMPC-grafted CLPE liner with a 40-mm femoral head during 10 × 10(6) cycles of loading in the hip joint simulator. The results provide preliminary evidence the grafting markedly decreased gravimetric wear rate and the volume of wear particles, even when coupled with larger femoral heads. Thus, we believe the PMPC-grafting will prolong artificial hip joint longevity both by preventing aseptic loosening and by improving the stability of articular surface. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Orthopaedic Research 03/2015; 33(7). DOI:10.1002/jor.22868 · 2.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Notch signaling modulates skeletal formation and pathogenesis of osteoarthritis (OA) through induction of catabolic factors. Here we examined roles of Hes1, a transcription factor and important target of Notch signaling, in these processes. SRY-box containing gene 9 (Sox9)-Cre mice were mated with Hes1(fl/fl) mice to generate tissue-specific deletion of Hes1 from chondroprogenitor cells; this deletion caused no obvious abnormality in the perinatal period. Notably, OA development was suppressed when Hes1 was deleted from articular cartilage after skeletal growth in type II collagen (Col2a1)-Cre(ERT);Hes1(fl/fl) mice. In cultured chondrocytes, Hes1 induced metallopeptidase with thrombospondin type 1 motif, 5 (Adamts5) and matrix metalloproteinase-13 (Mmp13), which are catabolic enzymes that break down cartilage matrix. ChIP-seq and luciferase assays identified Hes1-responsive regions in intronic sites of both genes; the region in the ADAMTS5 gene contained a typical consensus sequence for Hes1 binding, whereas that in the MMP13 gene did not. Additionally, microarray analysis, together with the ChIP-seq, revealed novel Hes1 target genes, including Il6 and Il1rl1, coding a receptor for IL-33. We further identified calcium/calmodulin-dependent protein kinase 2δ (CaMK2δ) as a cofactor of Hes1; CaMK2δ was activated during OA development, formed a protein complex with Hes1, and switched it from a transcriptional repressor to a transcriptional activator to induce cartilage catabolic factors. Therefore, Hes1 cooperated with CaMK2δ to modulate OA pathogenesis through induction of catabolic factors, including Adamts5, Mmp13, Il6, and Il1rl1. Our findings have contributed to further understanding of the molecular pathophysiology of OA, and may provide the basis for development of novel treatments for joint disorders.
    Proceedings of the National Academy of Sciences 03/2015; 112(10). DOI:10.1073/pnas.1419699112 · 9.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: CCAAT/enhancer-binding protein (C/EBP) β regulates chondrocyte differentiaion and proliferation during endochondral ossification. However, expression and function of other C/EBP family members in chondrocytes have not been fully understood. To understand the comprehensive regulation of chondrocyte differentiation by C/EBPs, we initially examined their expression levels. Among four members (C/EBPα, C/EBPβ, C/EBPδ and C/EBPε) with transactivation domain, expression of Cebpb and Cebpd was abundant compared to Cebpa, while Cebpe was hardly expressed in mouse isolated chondrocytes. Doxycycline (DOX)-inducible overexpression of each of the three C/EBPs (C/EBPα, C/EBPβ and C/EBPδ) in ATDC5 cells suppressed expressions of early differentiation markers including Col2a1, aggrecan and Sox9, enhanced those of late differentiation markers including Mmp13, Vegfa and Col10a1, and decelerated cell proliferation, indicating their overlapped functions in chondrocytes. In contrast, DOX-inducible overexpression of A-CEBP, which exerts a dominant-negative effect against all C/EBPs, increased expressions of early differentiation markers and decreased those of late differentiation markers. Finally, microarray and gene ontology analyses showed that A-CEBP altered many genes related with various events or tissues such as skeletal development, cartilage, cell cycle, inflammation and apoptosis. In conclusion, C/EBPα, C/EBPβ and C/EBPδ regulate proliferation and differentiation of chondrocytes and possibly is involved with apoptosis and inflammation. C/EBPs may play a variety of roles in the homeostasis of joint cartilage under physiological and pathological conditions.
    Biomedical research (Tokyo, Japan) 02/2015; 36(1):21-9. DOI:10.2220/biomedres.36.21 · 1.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the present study was to clarify the association of joint space narrowing with knee pain in Japanese men and women using a large-scale population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. This study examined the association between minimum joint space width (mJSW) in the medial compartment and pain at the knee. mJSW was measured in the medial and lateral compartments of the knee using a knee OA computer-aided diagnosis system. From the 3,040 participants in the ROAD study, the present study analyzed 2,733 participants who completed the radiographic examinations and questionnaires regarding knee pain (975 men and 1,758 women; mean age, 69.9±11.2 years). Subjects with lateral knee OA were excluded. After adjustment for age and BMI, medial mJSW, as well as medial mJSW/lateral mJSW, was significantly associated with knee pain. Sex and BMI affected the association of medial mJSW with knee pain. The threshold of medial mJSW was approximately 3 mm in men and 2 mm in women, while that of medial mJSW/lateral mJSW was approximately 60% in both men and women. Body mass index was found to have a distinct effect on the association of mJSW with pain. The present cross-sectional study using a large-scale population from the ROAD study showed that joint space narrowing had a significant association with knee pain. The thresholds of joint space narrowing for knee pain were also established. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
    Osteoarthritis and Cartilage 01/2015; 23(6). DOI:10.1016/j.joca.2015.01.011 · 4.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Induced pluripotent stem cells (iPSCs) are a promising cell source for cartilage regenerative medicine. Meanwhile, the risk of tumorigenesis should be considered in the clinical application of human iPSCs (hiPSCs). Here, we report in vitro chondrogenic differentiation of hiPSCs and maturation of the differentiated hiPSCs through transplantation into mouse knee joints. Three hiPSC clones showed efficient chondrogenic differentiation using an established protocol for human embryonic stem cells. The differentiated hiPSCs formed hyaline cartilage tissues at 8 weeks after transplantation into the articular cartilage of NOD/SCID mouse knee joints. Although tumors were not observed during the 8 weeks after transplantation, an immature teratoma had developed in one mouse at 16 weeks. In conclusion, hiPSCs are a potent cell source for regeneration of hyaline articular cartilage. However, the risk of tumorigenesis should be managed for clinical application in the future.
    Biomedical Research 01/2015; 36(3):179-86. DOI:10.2220/biomedres.36.179 · 1.10 Impact Factor
  • IEEE/ASME Transactions on Mechatronics 01/2015; DOI:10.1109/TMECH.2015.2410287 · 3.65 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Transcription factors SOX9, SOX5 and SOX6 are indispensable for generation and differentiation of chondrocytes. However, molecular mechanisms to induce the SOX genes are poorly understood. To address this issue, we previously determined the human embryonic enhancer of SOX6 by 5'RACE analysis, and identified the 46-bp core enhancer region (CES6). We initially performed yeast one-hybrid assay for screening other chondrogenic factors using CES6 as bait, and identified a zinc finger protein ZNF449. ZNF449 and Zfp449, a counterpart in mouse, transactivated enhancers or promoters of SOX6, SOX9 and COL2A1. Zfp449 was expressed in mesenchyme-derived tissues including cartilage, calvaria, muscle and tendon, as well as in other tissues including brain, lung and kidney. In limb cartilage of mouse embryo, Zfp449 protein was abundantly located in periarticular chondrocytes, and decreased in accordance with the differentiation. Zfp449 protein was also detected in articular cartilage of an adult mouse. During chondrogenic differentiation of human mesenchymal stem cells, ZNF449 was increased at an early stage, and its overexpression enhanced SOX9 and SOX6 only at the initial stage of the differentiation. We further generated Zfp449 knockout mice to examine the in vivo roles; however, no obvious abnormality was observed in skeletal development or articular cartilage homeostasis. ZNF449 may regulate chondrogenic differentiation from mesenchymal progenitor cells, although the underlying mechanisms are still unknown.
    PLoS ONE 12/2014; 9(12):e115169. DOI:10.1371/journal.pone.0115169 · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Schwann cells are an important cell source for regenerative therapy for neural disorders. We investigated the role of the transcription factor sex determining region Y (SRY)-box 10 (SOX10) in the proliferation and myelination of Schwann cells. SOX10 is predominantly expressed in rat sciatic nerve-derived Schwann cells and is induced shortly after birth. Among transcription factors known to be important for the differentiation of Schwann cells, SOX10 potently transactivates the S100B promoter. In cultures of Schwann cells, overexpressing SOX10 dramatically induces S100B expression, while knocking down SOX10 with shRNA suppresses S100B expression. Here, we identify three core response elements of SOX10 in the S100B promoter and intron 1 with a putative SOX motif. Knockdown of either SOX10 or S100B enhances the proliferation of Schwann cells. In addition, using dissociated cultures of dorsal root ganglia, we demonstrate that suppressing S100B with shRNA impairs myelination of Schwann cells. These results suggest that the SOX10-S100B signaling axis critically regulates Schwann cell proliferation and myelination, and therefore is a putative therapeutic target for neuronal disorders.
    PLoS ONE 12/2014; 9(12):e115400. DOI:10.1371/journal.pone.0115400 · 3.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objectives The aim of this study was to estimate the effect of fondaparinux and enoxaparin combined with mechanical prophylaxis (MP) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). We also investigated the occurrence of pulmonary embolism (PE) and associated risk factors. Methods Data were retrospectively collected on patients who underwent THA or TKA between 2008 and 2010 from the Japanese Diagnosis Procedure Combination database (n=49,678). We extracted information on sex, age, main diagnosis, types of anesthesia, duration of anesthesia, comorbidities, hospital volume, the use of MP, and the use of anticoagulant drugs. Results The overall occurrence of PE was 0.41%. Multivariate logistic regression analysis showed that the occurrence of PE was significantly higher in females (odds ratio, 2.17; p<0.001, compared with males), TKA (1.47; p=0.039, compared with THA), and longer-duration anesthesia (2.63; p=0.008 in the ≥240-min. group compared with the ≤119-min. group). Compared with the MP-alone group, the occurrence of PE was significantly reduced in the fondaparinux group (0.58; p=0.025) and the enoxaparin group (0.59; p=0.046). Conclusions Fondaparinux or enoxaparin combined with MP decreased the occurrence of PE. The risk factors for PE were female patients, TKA, and longer-duration anesthesia (≥240 min.).
    Modern Rheumatology 12/2014; DOI:10.3109/14397595.2014.997424 · 2.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objectives of this study are to examine in-hospital mortality and postoperative major complications in patients undergoing fusion surgery for atlantoaxial subluxation (AAS) and to examine whether the risk of perioperative complications varies between rheumatoid arthritis (RA) patients and non-RA patients. A retrospective analysis of data from the Diagnosis Procedure Combination database, a nationwide administrative impatient database in Japan, identified 1,090 patients who underwent spinal fusion surgery for AAS during 2007-2012. Patients' clinical characteristics were extracted, including age, sex, use of homologous blood transfusion, length of stay, and type of hospital. Clinical outcomes included in-hospital death and major complications including surgical site infection, sepsis, cardiac events, respiratory disorders, acute renal failure, pulmonary embolism, perioperative stroke, and vertebral injury. Massive blood transfusion was defined as at least 6 units of red blood cells. Four hundred and sixty-five patients (42.7%) were classified as the RA group. In-hospital mortality following fusion surgery for AAS was 0.5% (5/1090), and major complications occurred in 5% (55/1090). Multivariate analyses showed that RA patients were more likely to have major complications after surgery than non-RA patients (odds ratio: 1.69; 95% confidence interval: 0.96-2.97; p=0.07) and the rate of massive blood transfusion was significantly higher in RA patients than in non-RA patients (odds ratio: 2.29; 95% confidence interval: 1.12-4.68; p=0.02). The in-hospital mortality following fusion surgery for AAS was relatively low. However, RA patients had an increased risk of postoperative complications and massive blood transfusion compared with non-RA patients. Copyright © 2014 Elsevier Inc. All rights reserved.
    World Neurosurgery 12/2014; 83(4). DOI:10.1016/j.wneu.2014.12.019 · 2.42 Impact Factor

Publication Stats

7k Citations
848.67 Total Impact Points

Institutions

  • 1997–2015
    • The University of Tokyo
      • • Department of Orthopaedic Surgery and Spinal Surgery
      • • Division of Sensory and Motor System Medicine
      • • School of Medicine
      Tōkyō, Japan
    • Tokyo Metropolitan Institute of Medical Science
      Edo, Tōkyō, Japan
  • 2009–2014
    • Tokyo Medical University
      • Department of Orthopedic Surgery
      Edo, Tōkyō, Japan
  • 2004–2014
    • Sagamihara National Hospital
      Йокосука, Kanagawa, Japan
  • 2012
    • Tokyo Metropolitan Institute of Gerontology
      Edo, Tōkyō, Japan
  • 1992–2009
    • Showa University
      • Department of Biochemistry
      Shinagawa, Tōkyō, Japan
  • 2005
    • National Hospital Organization Sagamihara Hospital
      Sagamihara, Kanagawa, Japan
  • 1996–2004
    • Yale University
      • Department of Cell Biology
      New Haven, Connecticut, United States
  • 2003
    • Matsumoto Dental University
      • Institute for Oral Science
      Matsumoto, Nagano-ken, Japan