Sakae Tanaka

The University of Tokyo, 白山, Tōkyō, Japan

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Publications (252)961.16 Total impact

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    ABSTRACT: Objective: The objective of the present study was to examine the associations between metabolic syndrome (MS) components, such as overweight (OW), hypertension (HT), dyslipidemia (DL), and impaired glucose tolerance (IGT), and intervertebral disc degeneration (DD). Design: The present study included 928 participants (308 men, 620 women) of the 1,011 participants in the Wakayama Spine Study. DD on magnetic resonance imaging was classified according to the Pfirrmann system. OW, HT, DL, and IGT were assessed using the criteria of the Examination Committee of Criteria for MS in Japan. Results: Multivariable logistic regression analysis revealed that OW was significantly associated with cervical, thoracic, and lumbar DD (cervical: odds ratio [OR], 1.28; 95% confidence interval [CI], 0.92-1.78; thoracic: OR, 1.75; 95% CI, 1.24-2.51; lumbar: OR, 1.87; 95% CI, 1.06-3.48). HT and IGT were significantly associated with thoracic DD (HT: OR, 1.54; 95% CI, 1.09-2.18; IGT: OR, 1.65; 95% CI, 1.12-2.48). Furthermore, subjects with 1 or more MS components had a higher OR for thoracic DD compared with those without MS components (vs. no component; 1 component: OR, 1.58; 95% CI, 1.03-2.42; 2 components: OR, 2.60; 95% CI, 1.62-4.20; ≥3 components: OR, 2.62; 95% CI, 1.42-5.00). Conclusion: MS components were significantly associated with thoracic DD. Furthermore, accumulation of MS components significantly increased the OR for thoracic DD. These findings support the need for further studies of the effects of metabolic abnormality on DD.
    Preview · Article · Feb 2016 · PLoS ONE
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    ABSTRACT: OBJECTIVE Although minimally invasive spinal surgery has recently gained popularity, few nationwide studies have compared the adverse events that occur during endoscopic versus open spinal surgery. The purpose of this study was to compare perioperative complications associated with microendoscopic discectomy (MED) and open discectomy for patients with lumbar disc herniation. METHODS The authors retrospectively extracted from the Diagnosis Procedure Combination database, a national inpatient database in Japan, data for patients admitted between July 2010 and March 2013. Patients who underwent lumbar discectomy without fusion surgery were included in the analysis, and those with an urgent admission were excluded. The authors examined patient age, sex, Charlson Comorbidity Index, body mass index, smoking status, blood transfusion, duration of anesthesia, type of hospital, and hospital volume (number of patients undergoing discectomy at each hospital). One-to-one propensity score matching between the MED and open discectomy groups was performed to compare the proportions of in-hospital deaths, surgical site infections (SSIs), and major complications, including stroke, acute coronary events, pulmonary embolism, respiratory complications, urinary tract infection, and sepsis. The authors also compared the hospital length of stay between the 2 groups. RESULTS A total of 26,612 patients were identified in the database. The mean age was 49.6 years (SD 17.7 years). Among all patients, 17,406 (65.4%) were male and 6422 (24.1%) underwent MED. A propensity score-matched analysis with 6040 pairs of patients showed significant decreases in the occurrence of major complications (0.8% vs 1.3%, p = 0.01) and SSI (0.1% vs 0.2%, p = 0.02) in patients treated with MED compared with those who underwent open discectomy. Overall, MED was associated with significantly lower risks of major complications (OR 0.62, 95% CI 0.43-0.89, p = 0.01) and SSI (OR 0.29, 95% CI 0.09-0.87, p = 0.03) than open discectomy. There was a significant difference in length of hospital stay (11 vs 15 days, p < 0.001) between the groups. There was no significant difference in in-hospital mortality between MED and open discectomy. CONCLUSIONS The microendoscopic technique was associated with lower risks for SSI and major complications following discectomy in patients with lumbar disc herniation.
    No preview · Article · Feb 2016 · Neurosurgical FOCUS
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    ABSTRACT: Background: The purpose of the present study was to investigate 30-day postoperative outcomes after lower extremity amputation in patients with diabetes mellitus (DM) alone, peripheral artery disease (PAD) alone, or both. Methods: Eight thousand five hundred sixty-five patients with DM alone (n = 2,700), PAD alone (n = 2,919), and both (n = 2,946) who had above-knee amputation or below-knee amputation during 2007 to 2012 from the Japanese Diagnosis Procedure Combination inpatient database were retrospectively analyzed. Results: Overall 30-day mortality was 6.4% (5.1%, 8.5%, and 5.6% in DM alone, PAD alone and both group, respectively). Multivariable regression analysis showed no significant differences in 30-day mortality or overall postoperative complication rates among the 3 groups. Patients with both PAD and DM had a significantly higher proportion of cardiac events than those with DM alone (6.9% vs 3.0%; odds ratio = 2.27; 95% confidence interval = 1.73 to 2.98). Conclusions: Patients with both DM and PAD were more likely to have postoperative cardiac events.
    No preview · Article · Jan 2016 · American journal of surgery
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    ABSTRACT: BACKGROUND CONTEXT: Although the negative aspects of blood transfusion are increasingly recognized, less is known about transfusion-related risks in spinal surgery. PURPOSE: This study was designed to determine whether perioperative allogeneic blood transfusion is associated with increased risk of infectious complications after elective spinal surgery. STUDY DESIGN: A retrospective cohort study with propensity score matched analysis was carried out. PATIENT SAMPLE: Data of patients with spinal canal stenosis and spondylolisthesis who underwent elective lumbar surgeries (decompression or fusion) were obtained from the Diagnosis Procedure Combination database, a nationwide administrative inpatient database in Japan. OUTCOME MEASURES: Clinical outcomes included in-hospital death and the occurrence of infectious complications (surgical site infection [SSI], respiratory tract infection, urinary tract infection, and sepsis). METHODS: Patients' clinical information, including sex, age, type of hospital, preoperative comorbidities, duration of anesthesia, cell saver use, and volume of allogeneic blood transfused, were investigated. Patients transfused with >840 mL (6 units) were excluded. Propensity scores for receiving transfusion were calculated, with one-to-one matching based on estimated propensity scores to adjust for patients' baseline characteristics. The proportions of complications were compared in patients with and without transfusions. This study was funded by grants from the Ministry of Health, Labour and Welfare, Japan. RESULTS: Of the 84,650 patients identified, 5,289 patients (6.1%) received transfusions, with 4,436 (5.2%) receiving up to 840 mL. One-to-one propensity score matching resulted in 4,275 pairs with and without transfusion. Patients transfused were at increased risk of SSI (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.4-2.5; p<.001) and urinary tract infection (OR, 2.5; 95% CI, 1.5-4.2; p<.001) than those not transfused. CONCLUSIONS: Allogeneic blood transfusion after elective lumbar surgery was associated with increased risks of SSI and urinary tract infection.
    No preview · Article · Jan 2016 · The Spine Journal
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    ABSTRACT: Study design: Retrospective cohort study. Objective: The objective of this study was to investigate the predictive validity of 2 comorbidity indices in a study of patient outcomes following cervical decompression surgery. The comorbidity indices evaluated were the Charlson comorbidity index (CCI) and the self-administered comorbidity questionnaire (SCQ). Summary of background data: Comorbidities have been shown to have independent prognostic factors for HRQOL outcome in patients with spinal disorders. However, no appropriate evaluation method of comorbidity has been established in spinal research. Methods: We retrospectively reviewed 86 cervical myelopathy cases treated by decompression surgery between 2004 and 2010. Health-related quality of life (HRQOL) outcomes were measured using the short form 36 physical component summary (PCS) and the neck disability index (NDI), administered both pre- and postoperatively. Patient comorbidity was evaluated by the CCI and SCQ. The CCI was calculated by the medical record review, whereas the SCQ was obtained from patients' self-reports. The correlations between HRQOL outcomes and comorbidity indices were investigated. Thereafter, multiple liner regression analyses were performed to assess the performance of these comorbidity indices for predicting postoperative HRQOL. Results: The SCQ significantly correlated with both pre- and postoperative PCS scores and both pre- and postoperative NDI scores. The CCI did not correlate significantly with any outcome measure. On regression analysis, the CCI was a poor predictor of postoperative HRQOL, demonstrating only 0.2% of variance in the PCS score (P = 0.25) and only 0.4% of variance in the NDI score (P = 0.59). In comparison, the SCQ was a significant predictor of postoperative HRQOL, demonstrating 4.0% of variance in PCS score (P = 0.011) and 10.2% of variance in NDI score (P = 0.0001). Conclusion: The SCQ, but not the CCI, was a robust predictor of postoperative HRQOL. Our study suggests that the SCQ score is a more appropriate adjustment for HRQOL outcomes following cervical decompression surgery. Level of evidence: 3.
    No preview · Article · Dec 2015 · Spine
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    ABSTRACT: Study Design. A retrospective cohort study. Objective. To clarify the influence of cervical spondylolisthesis on neurological outcomes in cervical spondylotic myelopathy (CSM) patients following cervical laminoplasty. Summary of Background Data. Studies focusing on the surgical outcomes in CSM patients with cervical spondylolisthesis are limited. Methods. We retrospectively reviewed 125 CSM patients following cervical laminoplasty. Neurological outcomes were evaluated by calculating the Japanese Orthopedic Association (JOA) recovery rate at 2 years after surgery. We defined anterolisthesis as a >3-mm anterior vertebral displacement in a flexion radiograph and retrolisthesis as a >3-mm posterior vertebral displacement in an extension radiograph. We further assessed potential risk factors for poor neurological outcomes following cervical laminoplasty, including cervical alignment, degree of spinal cord compression, duration of myelopathic symptoms, diabetes mellitus, and preoperative JOA score. Multivariate logistic regression analysis was performed to investigate the risk factors for poor outcomes (JOA recovery rate < 50%) following cervical laminoplasty. Results. Our study included 86 men and 39 women with mean age of 64 (range, 30-89) years. Average JOA scores were 9.9 points and 13.3 points before and at 2 years after surgery, respectively. Average recovery rate was 47.2% (range, -68% to 100%), with 62 patients having poor outcomes (JOA recovery rate < 50%) at 2 years after surgery. Anterolisthesis and retrolisthesis were observed in 13 and 24 patients, respectively. Multivariate logistic regression analysis revealed that the anterolisthesis was a significant risk factor for poor outcomes (JOA recovery rate < 50%) following cervical laminoplasty (p = 0.02), whereas retrolisthesis did not affect the neurological outcomes (p = 0.4). Conclusions. Anterolisthesis, but not retrolisthesis, is a significant risk factor for and predictor of poor neurological outcomes following cervical laminoplasty. Cervical laminoplasty should not be considered in CSM patients with anterolisthesis. Level of Evidence: 2 Copyright
    No preview · Article · Dec 2015 · Spine
  • Takumi Matsumoto · Sakae Tanaka
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    ABSTRACT: Significant advancement in pharmacological treatment including biological agents has gradually changed the role and content of surgical treatments for patients with rheumatoid arthritis. The number of joint replacements in the large joints of lower limbs has decreased, while the number of surgeries in the small joints of hand and feet has increased. Favorable disease control by pharmacological treatment has changed the needs of patients for surgeries and expanded the options of operative procedures for surgeons. The changing needs of patients demanding the higher level of quality of life may seek a change in the surgical treatments.
    No preview · Article · Nov 2015 · Clinical calcium
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    ABSTRACT: Objective This study aimed to evaluate the validity and reliability of the Japanese version of the Neuropathic Pain Symptom Inventory (NPSI-J). Design Cross-sectional study design. Subjects and Methods The original Neuropathic Pain Symptom Inventory (NPSI) was translated into Japanese according to published guidelines. Subsequently, an observational study of 60 Japanese patients suffering from neuropathic pain was performed to evaluate the validity and reliability of the NPSI-J. Results The NPSI-J exhibited a statistically significant correlation with pain intensity (Numerical Rating Scale). The Cronbach alpha value for Likert items was 0.86. Using the test–retest analysis method, the intraclass correlation coefficient between the two scores was 0.81. Factor analysis revealed that the main component of NPSI-J comprised three determinative factors. Conclusions The NPSI-J is a reliable and valid pain assessment tool.
    Full-text · Article · Nov 2015 · PLoS ONE
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    ABSTRACT: Incidences of cervical laminoplasty in the elderly are increasing; the influence of other age-related complications and neurological status must be considered for justifying surgery. This study identified the aforementioned influence on long-term outcomes of cervical laminoplasty in patients aged ≥75 years. Thirty-seven of 38 consecutive patients aged ≥75 years who underwent cervical laminoplasty were retrospectively evaluated. Minimum 5-year follow-up was acceptable if patients were complication-free. Follow-up was terminated when neurological evaluation was not possible, owing to death or other serious complications affecting activities of daily living (ADL). Postoperative neurological changes and newly developed severe complications were investigated. Postoperatively, one patient died of acute pneumonia, one remained nonambulatory owing to cerebral infarction, and 35 were ambulatory and were discharged. At a mean follow-up of 78 months, three patients died and nine developed serious complications severely affecting ADL. Of the 25 remaining patients, 23 remained ambulatory at mean follow-up of 105 months. Cox proportional hazard analysis revealed that postoperative motor upper and lower extremities JOA scores of ≤2 and ≤1, respectively, were risk factors for mortality or other severe complications. Postoperative neurological status can be maintained in the elderly if they remain complication-free. Poorer neurological status significantly affected their ADL and mortality.
    Full-text · Article · Nov 2015 · BioMed Research International
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    ABSTRACT: Objective: Prevalence of ankle osteoarthritis (OA) is lower than that of knee OA, however, the molecular mechanisms underlying the difference remain unrevealed. In the present study, we developed mouse ankle OA models for use as tools to investigate pathophysiology of ankle OA and molecular characteristics of ankle cartilage. Design: We anatomically and histologically examined ankle and knee joints of C57BL/6 mice, and compared them with human samples. We examined joints of 8-week-old and 25-month-old mice. For experimental models, we developed three different ankle OA models: a medial model, a lateral model, and a bilateral model, by resection of respective structures. OA severity was evaluated eight weeks after the surgery by safranin O staining, and cartilage degradation in the medial model was sequentially examined. Results: Anatomical and histological features of human and mouse ankle joints were comparable. Additionally, the mouse ankle joint was more resistant to cartilage degeneration with aging than the mouse knee joint. In the medial model, the tibiotalar joint was markedly affected while the subtalar joint was less degenerated. In the lateral model, the subtalar joint was mainly affected while the tibiotalar joint was less altered. In the bilateral model, both joints were markedly degenerated. In the time course of the medial model, TUNEL staining and Adamts5 expression were enhanced at early and middle stages, while Mmp13 expression was gradually increased during the OA development. Conclusion: Since human and mouse ankles are comparable, the present models will contribute to ankle OA pathophysiology and general cartilage research in future.
    No preview · Article · Nov 2015 · Osteoarthritis and Cartilage
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    ABSTRACT: Background: The objective of this study was to clarify the association of quadriceps muscle strength with knee pain using a large-scale, population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. Methods: From the 2566 subjects at the third visit of the ROAD study, the present study analyzed 2152 subjects who completed radiographic examinations and measurements of muscle strength and mass (690 men and 1462 women; mean age, 71.6 ± 12.2 years). Knee pain was assessed by an experienced orthopedist. Knee osteoarthritis (OA) was defined according to Kellgren-Lawrence (KL) grade. Quadriceps muscle strength and muscle mass at the lower limbs were measured by the Quadriceps Training Machine (QTM-05F, Alcare Co., Ltd. Tokyo, Japan) and the Body Composition Analyzer MC-190 (Tanita Corp., Tokyo, Japan), respectively. Results: Quadriceps muscle strength and weight bearing index (WBI: quadriceps muscle strength by weight) were significantly associated with knee pain after adjustment for age and body mass index, whereas grip strength and muscle mass at the lower limbs were not. The significant association of quadriceps muscle strength with knee pain was independent of radiographic knee OA. Conclusion: The present cross-sectional study showed an independent association of quadriceps muscle strength with knee pain.
    Full-text · Article · Oct 2015 · BMC Musculoskeletal Disorders
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    ABSTRACT: Background: Currently, there are few reports regarding predictors of postoperative complications and short-term mortality after surgery for pathological femur fracture related to bone metastasis. Methods: Using data from the Japanese Diagnosis Procedure Combination Database from 2007 to 2012, we retrospectively identified 1497 patients who underwent internal fixation (n = 1073) or proximal femur resection and endoprosthetic reconstruction of the proximal femur (n = 424) for pathological femur fracture related to bone metastasis. Multivariable logistic regression analysis was performed to examine the relationship of various factors with postoperative complications and 30-day mortality. Results: The overall 30-day mortality after surgery was 2.6 %, and the proportion of postoperative complications was 12.1 %. Multivariable logistic regression analysis showed that postoperative complications overall were significantly associated with older age [odds ratio (OR), 2.15; 95 % confidence interval (CI) 1.23-3.74 for age ≥80 vs. ≤59 years]; lung carcinoma (OR 2.05; 95 % CI 1.47-2.86); esophageal carcinoma (OR 4.41; 95 % CI 1.57-12.43); higher Charlson Comorbidity Index (OR 1.50; 95 % CI 1.03-2.18 for ≥9 vs. 8); and blood transfusion (OR 1.57; 95 % CI 1.14-2.15). Thirty-day mortality also was significantly higher in patients with rapid-growth tumors, visceral metastasis, internal fixation, and no postoperative chemotherapy in the univariate analysis. Conclusions: Older age, type of primary tumor, higher Charlson Comorbidity Index, and blood transfusion were associated with higher morbidity. These findings can provide important information to assess perioperative risk in patients with pathological femur fracture related to bone metastasis.
    No preview · Article · Oct 2015 · Annals of Surgical Oncology
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    ABSTRACT: Background: Although a few studies on perioperative stroke following spinal surgery have been reported, differences in the incidence of perioperative stroke among various surgical procedures have not been determined. The purpose of this retrospective analysis was to investigate the incidence of perioperative stroke during hospitalization in patients undergoing elective spinal surgery, and to examine whether the incidence varied according to the surgical procedure. Methods: A retrospective analysis of data from the Diagnosis Procedure Combination database, a nationwide administrative impatient database in Japan, identified 167,106 patients who underwent elective spinal surgery during 2007-2012. Patient information extracted included age, sex, preoperative comorbidity, administration of blood transfusion, length of hospitalization, and type of hospital. Clinical outcomes included perioperative stroke during hospitalization, and in-hospital death. Results: The overall incidence of perioperative stroke was 0.22 % (371/167,106) during hospitalization. A logistic regression model fitted with a generalized estimating equation showed perioperative stroke was associated with advanced age, a history of cardiac disease, an academic institution, and resection of a spinal tumor. Patients who underwent resection of a spinal cord tumor (reference) had a higher risk of stroke compared with those undergoing discectomy (odds ratio (OR), 0.29; 95 % confidence interval (CI), 0.14-0.58; p = 0.001), decompression surgery (OR, 0.44; 95 % CI, 0.26-0.73; p = 0.001), or arthrodesis surgery (OR, 0.55; 95 % CI, 0.34-0.90); p = 0.02). Advanced age (≥80 years; OR, 5.66; 95 % CI, 3.10-10.34; p ≤ 0.001), history of cardiac disease (OR, 1.58; 95 % CI, 1.10-2.26; p = 0.01), diabetes (OR, 1.73; 95 % CI, 1.36-2.20; p ≤ 0.001), hypertension (OR, 1.53; 95 % CI, 1.18-1.98; p = 0.001), cervical spine surgery (OR, 1.44; 95 % CI, 1.09-1.90; p = 0.01), a teaching hospital (OR, 1.36; 95 % CI, 1.01-1.82; p = 0.04), and length of stay (OR, 1.008; 95 % CI, 1.005-1.010; p ≤ 0.001) were also risk factors for perioperative stroke. Conclusions: Perioperative stroke occurred in 0.22 % of patients undergoing spinal surgery. Resection of a spinal cord tumor was associated with increased risk of perioperative stroke as well as advanced age, comorbidities at admission, cervical spine surgery, surgery in a teaching hospital, and length of stay.
    Full-text · Article · Oct 2015 · BMC Musculoskeletal Disorders
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    ABSTRACT: Background context: Although the negative aspects of blood transfusion are increasingly recognized, less is known about transfusion-related risks in spinal surgery. Purpose: This study was designed to determine whether perioperative allogeneic blood transfusion is associated with increased risk of infectious complications after elective spinal surgery. Study design: Retrospective cohort study with propensity score matched analysis. Patient sample: Data of patients with spinal canal stenosis and spondylolisthesis who underwent elective lumbar surgeries (decompression and/or fusion) were obtained from the Diagnosis Procedure Combination database, a nationwide administrative impatient database in Japan. Outcome measures: Clinical outcomes included in-hospital death and the occurrence of infectious complications (surgical site infection, respiratory tract infection, urinary tract infection and sepsis). Methods: Patients' clinical information, including sex, age, type of hospital, preoperative comorbidities, duration of anesthesia, cell saver use and volume of allogeneic blood transfused, were investigated. Patients transfused with > 840 mL (6 units) were excluded. Propensity scores for receiving transfusion were calculated, with one-to-one matching based on estimated propensity scores to adjust for patients' baseline characteristics. The proportions of complications were compared in patients with and without transfusions. This study was funded by grants from the Ministry of Health, Labour and Welfare, Japan. The authors declare that they have no conflicts of interest. Results: Of the 84,650 patients identified, 5,289 patients (6.1%) received transfusions, with 4,436 (5.2%) receiving up to 840 mL. One-to-one propensity score matching resulted in 4,275 pairs with and without transfusion. Patients transfused were at increased risk of surgical site infection (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.4-2.5; p < 0.001), and urinary tract infection (OR, 2.5; 95% CI, 1.5-4.2; p < 0.001) than those not transfused. Conclusions: Allogeneic blood transfusion after elective lumbar surgery was associated with increased risks of surgical site infection and urinary tract infection.
    No preview · Article · Oct 2015 · The spine journal: official journal of the North American Spine Society
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    ABSTRACT: Objectives: We investigated the effect of cartilage degeneration on ultrasound speed in human articular cartilage in vitro. Methods: Ultrasound speed was calculated by the time-of-flight method for twenty-two femoral condyle osteochondral blocks obtained from osteoarthritis patients. In parallel, histological evaluation of specimens was performed using the modified Mankin and OARSI scores. Results: The mean ultrasound speed was 1757 ± 109 m/s. Ultrasound speed showed significant negative correlation with OARSI score, and a decreasing tendency with high Mankin scores. Good correlation was found between the optically measured and the calculated cartilage thickness. Conclusion: Our results show that articular cartilage degeneration has relatively little influence on ultrasound speed. In addition, morphological evaluation of articular cartilage using a preset value of ultrasound speed seems to offer relatively accurate results.
    No preview · Article · Sep 2015 · Modern Rheumatology
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    ABSTRACT: Idiopathic osteonecrosis of the talus is a rare but severe condition that directly affects the ability to walk and is difficult to treat either conservatively or surgically. We report the case of a 72-year-old female with idiopathic necrosis of the talus treated with total talar replacement surgery. A custom-made aluminum-ceramic total talar prosthesis was prepared using the mirror image of the computed tomography and radiographic data from the contralateral ankle. The talus was exposed and removed using an anterior approach, and the total talar prosthesis was inserted. The prosthesis was placed in a stable position between the tibia, calcaneus, and navicular, with no signs of instability with ankle joint movement. The ankle was immobilized in a short-leg cast for 3 weeks. At the latest follow-up examination, 2 years after surgery, the patient was walking without pain. Examination of the left ankle showed 20° of dorsiflexion and 40° of plantar flexion. The American Orthopaedic Foot and Ankle Society ankle/hindfoot score was 90, which had improved from a preoperative score of 45. Radiographic examination showed that the prosthesis was in a stable position in the ankle mortise, and no degenerative or destructive changes were observed in the surrounding bones. This is the first reported case of total talar replacement with a prosthesis for idiopathic talar necrosis. Although the long-term outcome is still unknown, this procedure could provide a good treatment option for idiopathic necrosis of the talus.
    No preview · Article · Sep 2015 · The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons

  • No preview · Article · Sep 2015 · Global Spine Journal
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    ABSTRACT: Introduction Mortality following hip fracture surgery is higher in patients with dementia than those without; however, few large-scale studies have investigated postoperative in-hospital complications in such patients. The aim of this study was to elucidate the complications that occur after hip fracture surgery in patients with and without dementia using a large national database. Materials and methods We retrospectively identified patients aged ≥70 years who underwent hemiarthroplasty, osteosynthesis for femoral neck fracture or osteosynthesis for intertrochanteric fracture, and compared the occurrence of postoperative complications between patients with and without dementia. Multivariate logistic regression analysis was performed to adjust for patient characteristics and hospital factors. Results A total of 87,654 patients were included in this study, including 9419 with dementia. Compared with the non-dementia group, the dementia group showed a higher incidence of overall postoperative complications [odds ratio (OR) 1.45; p < 0.001), surgical site infection (OR 1.58; p = 0.004), urinary tract infection (OR 1.87; p < 0.001) and respiratory complications (OR 1.49; p < 0.001). The rate of postoperative complications was higher for all types of hip fracture surgery. The occurrence of a postoperative complication was significantly higher in patients aged ≥80 years (OR 1.37; p < 0.001) and those with dementia (OR 1.45; p < 0.001), any type of malignancy (OR 1.42; p < 0.001), a history of cardiovascular disease (OR 1.33; p < 0.001), a history of cerebrovascular disease (OR 1.15; p = 0.029), chronic renal failure (OR 1.36; p < 0.001), liver cirrhosis (OR 1.41; p < 0.001) or blood transfusion after surgery (OR 1.49; p < 0.001). Conclusions Our results highlight the need to pay particular attention to surgical site infection, urinary tract infection and respiratory complications in patients with preoperative dementia after hip fracture surgery. These results provide additional useful evidence to inform the management of these patients.
    No preview · Article · Sep 2015 · Archives of Orthopaedic and Trauma Surgery
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    ABSTRACT: Dumbbell-shaped tumors consisting of 2 different tumors are extremely rare. Herein, the authors present a case of concurrent spinal schwannoma and meningioma mimicking a single cervical dumbbell-shaped tumor. A 64-year-old man presented with a 5-year history of gradually exacerbating left occipital pain without clinical evidence of neurofibromatosis. Magnetic resonance imaging showed an extradural tumor along the left C-2 nerve root with a small intradural component. The tumor was approached via a C-1 hemilaminectomy. The intradural tumor was resected together with the extradural tumor after opening the dura mater. The intradural tumor was attached to the dura mater around the exit point of the C-2 nerve root. Intraoperative biopsy revealed that the extradural tumor was a schwannoma and that the intradural tumor was a meningioma. The dura mater adjacent to the tumor was then coagulated and resected. Postoperative pathological examination confirmed the same diagnoses with no evidence of continuity between the intra- and extradural components. The patient's postoperative clinical course was uneventful. Clinicians should be aware that cervical dumbbell-shaped tumors can consist of 2 different tumors.
    No preview · Article · Aug 2015 · Journal of neurosurgery. Spine
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    ABSTRACT: Rheumatoid arthritis (RA) is an autoimmune destructive arthritis associated with CD4(+) T cell-mediated immunity. Although expanded CD4(+) T cell clones (ECs) has already been confirmed, the detailed characteristics of ECs have not been elucidated in RA. Using combination of a single-cell analysis and next-generation sequencing (NGS) in TCR repertoire analysis, we here revealed the detailed nature of ECs by examining peripheral blood (PB) from 5 RA patients and synovium from 1 RA patient. When we intensively investigated the single-cell transcriptome of the most expanded clones in memory CD4(+) T cells (memory-mECs) in RA-PB, senescence-related transcripts were up-regulated, indicating circulating ECs were constantly stimulated. Tracking of the transcriptome shift within the same memory-mECs between PB and the synovium revealed the augmentations in senescence-related gene expression and the up-regulation of synovium-homing chemokine receptors in the synovium. Our in-depth characterization of ECs in RA successfully demonstrated the presence of the specific immunological selection pressure, which determines the phenotype of ECs. Moreover, transcriptome tracking added novel aspects to the underlying sequential immune processes. Our approach may provide new insights into the pathophysiology of RA.
    Preview · Article · Aug 2015 · Scientific Reports

Publication Stats

8k Citations
961.16 Total Impact Points

Institutions

  • 1997-2016
    • The University of Tokyo
      • • Department of Orthopaedic Surgery and Spinal Surgery
      • • Division of Sensory and Motor System Medicine
      • • School of Medicine
      白山, 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
  • 1992-2009
    • Showa University
      • • Department of Biochemistry
      • • School of Dentistry
      Shinagawa, Tōkyō, Japan
  • 2005
    • National Hospital Organization Sagamihara Hospital
      Sagamihara, Kanagawa, Japan