Research Achievements - Original paper -
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Kinoshita H.
Modern Rheumatology ( Modern Rheumatology ) 27 ( 4 ) 582 - 586 2017.07
Research paper (journal)
Objectives: This study aimed to investigate the efficacy of denosumab (compared with that of bisphosphonates) for preventing secondary osteoporosis and inflammation caused by excessive bone resorption in Japanese rheumatoid arthritis (RA) patients never previously treated for osteoporosis.
Methods: Ninety-eight patients with coexisting RA and osteoporosis were enrolled. The patients were subdivided by whether they were treated with denosumab (n=49) or traditional bisphosphonates (n=49). RA disease activity, bone turnover markers, and bone mineral density (BMD) were compared between the two groups before treatment, and after 6 and 12 months of treatment.
Results: There was no significant difference between the groups in any of the disease activity indices and BMD at any of the measured time points. With regard to bone metabolism, denosumab significantly reduced bone-specific alkaline phosphatase at 6 and 12 months compared with pretreatment, but had no effect on tartrate-resistant acid phosphatase 5b levels, suggesting an effect on the bone formation rate, but not on the bone resorption rate.
Conclusions: Neither denosumab nor bisphosphonates could suppress inflammation or RA disease activity, but denosumab significantly suppressed a marker of bone metabolism in Japanese RA patients never previously treated for osteoporosis. -
Distant metastasis in patients with myxofibrosarcoma
Tsuchie H.
Upsala Journal of Medical Sciences ( Upsala Journal of Medical Sciences ) 122 ( 3 ) 190 - 193 2017.07
Research paper (journal)
Purpose: A clinical feature of myxofibrosarcoma is local recurrence, but knowledge about distant metastasis is sparse. We evaluated the tendency of clinical and histological features of metastasis in myxofibrosarcoma patients.
Methods: Fifty-eight patients with myxofibrosarcoma were treated in our hospitals, and a total of 16 consecutive patients with distant metastases were included in this retrospective study (9 males and 7 females, with a mean age of 77 years). Because there was no patient complicated by both lung and lymph node metastases, we compared the age, sex, tumor size and location, French Federation of Cancer Centers Sarcoma Group (FNCLCC) grade, American Joint Committee on Cancer (AJCC) stage, and times of the first metastasis from the initial examination between the lung and lymph node groups. In addition, we examined factors affecting the prognosis.
Results: The median follow-up period was 42.9 months (range 8-142). Eleven of 16 patients developed pulmonary metastases. The sites of extra pulmonary metastases were the lymph nodes in 5 patients, bone in 1, subcutaneous in 1, intramuscular in 1, and peritoneum in 1. The median time for patients to develop distant metastases was 17.4 months (range 0-59). The time until the onset of the first metastasis in the lung metastasis group was significantly shorter than in the lymph node group (p < 0.05). Also, the survival rate in the lymph node metastasis group was better than in the lung metastasis group (p < 0.05).
Conclusions: Not only lung metastasis but also lymph node metastasis occurs frequently in myxofibrosarcoma patients. Myxofibrosarcoma with lung metastasis is more aggressive than the type with lymph node metastasis. -
Enhanced bone healing and decreased pain in sacral insufficiency fractures after teriparatide treatment: retrospective clinical-based observational study.
Kasukawa Y, Miyakoshi N, Ebina T, Hongo M, Ishikawa Y, Kudo D, Nozaka K, Shimada Y
Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases 14 ( 2 ) 140 - 145 2017.05
Research paper (journal)
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Back Strengthening Exercise for Elderly Patients with Spinal Deformity
30 ( 4 ) 339 - 344 2017.04
Research paper (journal)
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Ishikawa Y.
Gait and Posture ( Gait and Posture ) 53 98 - 103 2017.03
Research paper (journal)
Spinal deformities can affect quality of life (QOL) and risk of falling, but no studies have explored the relationships of spinal mobility and sagittal alignment of spine and the lower extremities simultaneously. Purpose of this study is to clarify the relationship of those postural parameters to QOL and risk of falling. The study evaluated 110 subjects (41 men, 69 women; mean age, 73 years). Upright and flexion and extension angles for thoracic kyphosis, lumbar lordosis, and spinal inclination were evaluated with SpinalMouse. Total-body inclination and hip and knee flexion angles in upright position were measured from lateral photographs. Subjects were divided into Fallers (n= 23, 21%) and Non-fallers (n= 87, 79%) based on past history of falls. QOL was assessed using the Short Form 36 Health Survey (SF-36). Age, total-body inclination, spinal inclination upright and in extension, thoracic kyphosis in flexion, lumbar lordosis upright and in extension, and knee flexion correlated significantly with the SF-36. Multiple regression analysis revealed total-body inclination and knee flexion to have the most significant relationships with the SF-36. SF-36, total-body inclination, spinal inclination in extension, thoracic kyphosis in flexion, lumbar lordosis upright and in extension, and hip and knee flexion angles differed significantly between Fallers and Non-fallers (P<0.05 for all). Multivariate logistic regression analyses revealed lumbar lordosis in extension to be a significant predictor of falling (P= 0.038). Forward-stooped posture and knee-flexion deformity could be important indicator of lower QOL. Moreover, limited extension in the lumbar spine could be a useful screening examination for fall prevention in the elderly. (C) 2017 Elsevier B.V. All rights reserved.
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Age-related changes in muscle strength and spinal kyphosis angles in an elderly Japanese population
Kasukawa Y.
Clinical Interventions in Aging ( Clinical Interventions in Aging ) 12 413 - 420 2017.02
Research paper (journal)
Lumbar kyphosis and the decreased mobility of the lumbar spine increase the risk of falls and impair both the quality of life and the ability to perform activities of daily living. However, in the elderly Japanese population, little is known about the age-related changes and sex-related differences in muscle strength, including of the upper and lower extremities and back extensors. An adequate kyphotic or lordotic angle has also not been determined. In this study, we evaluated the age-related changes in muscle strength and spinal kyphosis in 252 males and 320 females $50 years of age. Grip, back extensor, hip flexor, and knee extensor strength
thoracic and lumbar kyphosis
and spinal inclination in the neutral standing position were assessed, together with the range of motion of the thoracic and lumbar spine and spinal inclination. Grip strength, back extensor strength, and the strength of the hip flexors and knee extensors decreased significantly with aging, both in males (P,0.0001) and in females (P=0.0015 to P,0.0001). The lumbar but not the thoracic kyphosis angle decreased significantly with aging, only in females (P,0.0001). Spinal inclination increased significantly with aging in both males (P=0.002) and females (P,0.0001). Back extensor strength and the thoracic kyphosis angle were significant variables influencing the lumbar kyphosis angle in both sexes. Spinal inclination correlated significantly with both the lumbar kyphosis angle and hip flexor strength in males, as well as with the lumbar kyphosis angle in females. -
Imajo Y.
Journal of Orthopaedic Science ( Journal of Orthopaedic Science ) 22 ( 1 ) 10 - 15 2017.01
Research paper (journal)
Background: The Japanese Society for Spine Surgery and Related Research USSR) performed a third study on complications in spinal surgery in 2011. The purpose was to present information about surgery and complications in a large amount of elderly patients aged 65 years with lumbar spinal stenosis (LSS) without coexisting spondylolisthesis, spondylolysis, or scoliosis, and to compare patients aged >= 80 years to those aged 65-79 years.
Methods: A recordable optical disc for data storage was sent by JSSR in January 2012 to 1105 surgeons certified by the JSSR in order to collect surgical data. Data were returned by the end of May 2012.
Results: Data were accumulated for 8033 patients aged 65 years. The incidence of surgical complications was 10.8%, and did not differ significantly between age groups. The incidence of general complications was 2.7%, and differed significantly between age groups (p < 0.005). The highest incidence of surgical complications was for dural tear (DT) (3.6%), followed by deep wound infection (DWI) (1.4%), neurological complications (1.3%), and epidural hematoma (1.3%). Spinal instrumentation was applied in 30.3%. Incidences of surgical complications in instrumented and noninstrumented surgery were 17.3% and 8.8%. In instrumented surgery, incidences of surgical and general complications were higher in the >= 80 year age group than in the 65-79 year age group. Logistic regression analyses showed patients with microendoscopic surgery at increased risk of DT. Patients with diabetes mellitus and instrumented surgery showed increased risks of DWI.
Conclusions: Incidences of surgical complications did not differ significantly between age groups. Attention should be paid to both surgical and general complications, particularly for postoperative mental disease in instrumented surgery for patients >= 80 years old. (C) 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved. -
Effects of exercise and sports on bone health in pre- and postmenopausal women
Miyakoshi N.
Clinical calcium ( Clinical calcium ) 27 ( 1 ) 107 - 115 2017.01
Research paper (journal)
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Kobayashi T.
Journal of Medical Case Reports ( Journal of Medical Case Reports ) 11 ( 1 ) 1 - 7 2017.01
Research paper (journal)
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[Aging and homeostasis. Prevention and treatment of locomotive syndrome.]
Miyakoshi N
Clinical calcium 27 ( 7 ) 1013 - 1020 2017
Research paper (journal)
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[Effects of exercise and sports on bone health in pre- and postmenopausal women.]
Miyakoshi N
Clinical calcium 27 ( 1 ) 107 - 115 2017
Research paper (journal)
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A Case of Fracture-Redislocation of the Hip Caused by a Depressed Fracture of the Femoral Head Similar to a Hill-Sachs Lesion.
Okudera Y, Kijima H, Yamada S, Konishi N, Kubota H, Tazawa H, Tani T, Suzuki N, Kamo K, Sasaki K, Kawano T, Iwamoto Y, Miyakoshi N, Shimada Y
Case reports in orthopedics 2017 7409153 2017
Research paper (journal)
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Okuyama K.
Spine Surgery and Related Research ( Spine Surgery and Related Research ) 1 ( 3 ) 129 - 134 2017
Research paper (journal)
<p>Study Design: A prospective cohort study was conducted on patients with anterior cervical decompression and fusion (ACDF) with a polyetheretherketone cage (PEEKc).</p><p>Background: Advantages of a PEEKc have been proposed in the study. However, benefits of using a PEEKc in ACDF are still controversial.</p><p>Objective: To investigate the advantages of a PEEKc in ACDF.</p><p>Materials and Methods: A total of 27 patients was enrolled in the study. The mean age of patients was 55±10 years (mean±standard deviation). The mean duration of symptoms was 17±21 months. Surgery was conducted at C3/4 in 1, C4/5 in 3, C5/6 in 11, C6/7 in 9, C7/T1 in 2, and C5/6/7 in 1 patient. The mean follow-up period was 2.1±1.3 years. Clinical outcomes were analyzed by the Japanese Orthopedic Association Scores (JOA scores) and its recovery rate. Perioperative complications were also investigated. Radiologically, studies were conducted on interbody lordotic angle (IBLA), interbody height (IBH), and bone fusion rates.</p><p>Results: The JOA score was 14.7±1.4 preoperatively and 16.3±1.3 at the final follow-up. A significant improvement was observed (p<0.05). The mean recovery rate of JOA scores was 74.0±25.0%. The preoperative IBLA was 0.5±6.1°. The mean IBLA at the final follow-up was 1.9±5.6°. The preoperative IBH was 34.2±3.5 mm. The mean IBH at the final follow-up was 34.3±3.5 mm. No significant improvement in IBLA and IBH was observed. A complete union rate at 1 year and 2.3 years (range, 2.0-6.0) after surgery was 29% (8/28 segments) and 61% (11/18 segments). No major complications were observed.</p><p>Conclusions: Despite an unsatisfactory bone union rate and no significant improvement in IBLA and IBH at the final follow-up, ACDF with a PEEKc clinically provided a stable outcome with less surgical invasion and minor donor-site morbidity.</p>
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Cut-off value of medial meniscal extrusion for knee pain
Kijima H.
Advances in Orthopedics ( Advances in Orthopedics ) 2017 6793026 2017
Research paper (journal)
Purpose. Medial meniscal extrusion (MME) has attracted attention as an index of knee pain in conjunction with clinical symptoms that could be more useful than the diagnosis of knee osteoarthritis on X-ray. However, the size of MME that would cause knee pain has not been clarified. The aim of the present study was to investigate the cut-off value of MME for knee pain. Methods. A total of 318 knees were evaluated. The presence of current or past knee pain was confirmed by interview. Next, MME was measured using vertical sonographic images of the medial joint spaces during weightbearing. Results. Overall, 71 knees were painful (P-group), and 247 knees were not (N-group). MME was 5.9 ± 1.8 mm in the P-group and 2.9 ± 1.5 mm in the N-group (P<
0.0001). Analysis of the receiver operating characteristic curve showed that the cut-off value of MME for knee pain was 4.3 mm, with sensitivity of 0.8451 and specificity of 0.8502. In addition, 64% of knees without pain cases at the time of examination whose MME exceeded this cut-off value had past knee pain. Conclusions. The sensitivity and specificity of MME for knee pain were very high with a cut-off value of 4.3 mm. -
Unoki E.
Spine Surgery and Related Research ( Spine Surgery and Related Research ) 1 ( 2 ) 90 - 95 2017
Research paper (journal)
<p>Introduction: Sacroiliac joint pain (SIJP) after lumbar fusion surgery has recently gained attention as a source of low back pain after lumbar fusion. There are two risk factors for postoperative SIJP, i.e., fusion involving the sacrum and multiple-segment fusion. In this study, we examined whether SIJP could occur more frequently in patients with two risk factors (multiple-segment fusion to sacrum). Further, we examined SIJP after multiple-segment (≥3) lumbar fusion, focusing on the difference between floating fusion (non-fused sacrum) and fixed fusion (fused sacrum).</p><p>Methods: Ninety-one patients who underwent multiple-segment lumbar fusion were included. Patients without preoperative clinical SIJP were considered. Of these, 17 developed new-onset SIJP. We investigated postoperative SIJP development, duration from surgery to SIJP onset, and postoperative treatment outcomes of SIJP patients using Japanese Orthopaedic Association (JOA) scores. We compared the findings between floating fusion group and fixed fusion group.</p><p>Results: The incidence of SIJP was significantly higher with fixed fusion (32.1%) than with floating fusion (12.7%). The mean time of onset of sacroiliac joint pain was at 8.63 (2-13) months after surgery in the floating fusion group and 3.78 (1-10) months after surgery in the fixed fusion group, indicating that incidence occurred significantly earlier in the fixed fusion group. Our treatment outcome indicated that the mean JOA score significantly improved in the floating fusion group from 5.13 at the time of onset to 9.50 at the time of final follow-up; however, in the fixed fusion group, it improved from 5.78 at the time of onset to 7.33 at the time of final follow-up, indicating no significant improvement.</p><p>Conclusions: In multiple-segment lumbar fusion, fixed fusion (fused sacrum) has a very high risk of SIJP. In addition, the onset of SIJP in such cases may occur earlier. This aspect deserves consideration, given the difficulty of pain treatment.</p>
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Imajo Y.
Spine Surgery and Related Research ( Spine Surgery and Related Research ) 1 ( 1 ) 7 - 13 2017
Research paper (journal)
<p>Introduction: Details of surgical and general complications for patients with cervical spondylotic myelopathy (CSM) are still uncertain. The purpose of this study was to describe surgeries and their complications among Japanese patients with CSM. Methods: The Japanese Society for Spine Surgery and Related Research performed a nationwide survey on spine surgery and complications in 2011. Data of patients with 2,961 CSM >40 years old were included. The clinicopathological variables were basic demographic and clinical information, surgical information, and surgical and general complications. To examine the influence of age, variables were compared among three age groups: patients 40-64 (n=1,123), 65-74 (n=966), and ≥75 (n=872) years of age. Results: The study included 1,970 males and 991 females and the mean age was 64.3 years old. There were 168 anterior (5.7%) and 2,770 posterior (94.2%) approach surgeries. The vast majority of patients with CSM were treated using the posterior approach, 89.4% of whom had decompression surgery only. Anterior surgeries were more common in the younger age group, but posterior surgeries were equally distributed. The incidence of total complications including surgical/general complications was similar for the anterior (16/168; 9.5%) and posterior (295/2,770; 10.6%) approaches. No patient died on the operating table, but four patients (0.1%) died within one month after surgery. No association was detected between complications and age, comorbidity, and other surgical factors. The incidence of complications was similar for the different age groups. However general complications were predominantly observed in the older group and those who had instrumented surgery. Conclusions: The results indicate that the indication and surgical performance for patients with CSM is favorable in Japan, despite the super-aging population. Few serious complications were reported in this study. However, more detailed informed consent about surgical and, in particular, general complications is necessary for the older patients with CSM.</p>
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Evaluation of Trunk Stability in the Sitting Position Using a New Device
Saito Kimio, Takahashi Yasuhiro, Chida Satoaki, Hatakeyama Kazutoshi, Watanabe Motoyuki, Ishikawa Junki, Takahashi Yusuke, Suzuki Masamichi, Murata Shu, Shimada Yoichi, Miyakoshi Naohisa, Matsunaga Toshiki, Iwami Takehiro, Hongo Michio, Kasukawa Yuji, Saito Hidetomo, Masutani Norimitsu
The Japanese Journal of Rehabilitation Medicine ( The Japanese Association of Rehabilitation Medicine ) 54 ( 1 ) 31 - 35 2017
Research paper (journal)
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Systemic administration of insulin-like growth factor(IGF)-binding protein-4(IGFBP-4)increases bone formation parameters in mice by increasing IGF bioavailability via an IGFBP-4 protease-dependent mechanism.
Miyakoshi N, et al.
Endocrinology 142 ( 6 ) 2641 - 2648 2001.01 [Refereed]
Research paper (journal)