Pins and Rubber Band Traction System Combined with Internal Fixation for Intra-articular Fractures of the Proximal Interphalangeal Joints.

Background: Intra-articular fractures of the proximal interphalangeal joint (PIPJ) can result in poor outcomes if inadequately treated. Dynamic external fixation and internal fixation with plates and/or screws are two treatment options. The role of combining these two methods is unclear. The aim of this study is to determine the outcomes of patients with intra-articular fractures of the PIPJ treated with a combination of dynamic external fixation with a plate and/or screws. Methods: A retrospective review was conducted on 18 consecutive cases of intra-articular fractures of the PIPJ treated with pins and rubber band traction system (PRTS) combined with dorsal internal fixation with plates and/or screws. The patients' average age was 51 years (range: 20-81 years). The fracture patterns were volar-type (n = 2), dorsal-type (n = 4) and pilon-type (n = 12). Data with regard to time to surgery, interphalangeal joint range of motion, grip strength, VAS for pain, Quick DASH score, complications, duration of follow-up and return to work were collected. Results: The levels of articular involvement were stable (n = 1), tenuous (n = 5) and unstable (n = 12). The average time to surgery was 9 days, and the average follow-up period was 15 months. The fracture was fixed with a dorsal plate and screws in 10 patients and with only screws in eight patients. All patients had PRTS. All patients returned to their original occupation and the fractures united in good alignment. The average grip strength was 86% of that of the unaffected side. The average active PIPJ motion was 85° (range: 50°-106°), and the average active distal interphalangeal joint (DIPJ) motion was 48° (range: 10°-90°). Conclusions: Our results show that a combination of PRTS and open reduction and fixation with plate and/or screws achieved a good range of motion and articular reduction. Level of Evidence: Level IV (Therapeutic).

Deciding Who Is Worthy of Help: Effect of the Probability of Reciprocity on Individuals' Willingness to Help Others.

In order to explain helping strangers in need in terms of reciprocal altruism, it is necessary to ensure that the help is reciprocated and that the costs of helping are thus compensated. Competence and willingness to make sacrifices for the benefactor of the person being helped are important cues for ensuring a return on help because reciprocity would not be possible if the person being helped had neither the competence nor the inclination to give back in the future. In this study, we used vignettes and manipulated the cause of suffering strangers' difficulties and prosociality to investigate participants' compassion for and willingness to help the stranger. In Study 1, we measured willingness to help by using hypothetical helping behaviors that were designed to vary in cost. In Study 2, we measured willingness to help by using the checkbox method in which participants were asked to sequentially check 10 × 10 checkboxes on a webpage, which asked the participants to pay a small but real cost. In both studies, the controllability of the cause and the prosociality were found to independently affect compassion. These two factors also independently affected willingness to help, as measured by both the hypothetical questions and the checkbox method. We consequently discussed the reasons for the independent processing of the competence and behavioral tendency cues.

The role of preoperative glycemic control in decreasing surgical site infections in lower extremity fractures.

BACKGROUND: Postoperative surgical site infections (SSIs) are an important complication to prevent in surgical treatment. Patients with diabetes mellitus (DM) have a higher risk of SSIs. Preoperative glycemic control is required. For patients with orthopedic trauma, the duration of preoperative glycemic control is limited because delaying operative treatment is difficult. However, whether preoperative glycemic control would decrease the risk of SSIs in diabetic patients with lower extremity fractures is unclear. The first aim of this study was to investigate the rate of SSIs among patients with DM who had undergone preoperative glycemic control, compared with that of patients without DM. As the secondary aim, we sought to demonstrate among patients with DM whether preoperative glycemic control would affect the development of SSIs between patients with controlled DM and patients with poorly controlled DM. METHODS: In this retrospective cohort study, 1510 patients treated surgically for lower extremity fractures were enrolled. Data collected were patient age, sex, body mass index, history of DM, development of SSIs, tobacco use, the presence of an open fracture, the period between the day of injury and the operation, the length of surgery, and blood glucose levels on admission and on the day before surgery. RESULTS: The rate of total SSIs was 6.0% among patients with DM and 4.4% among patients without DM (p = 0.31). Multivariate logistic regression revealed a significant association between the development of SSIs and the presence of DM (odds ratio, 1.79; 95% confidence interval 1.01-3.19; p = 0.047). The results of the secondary study revealed that the rate of early SSIs was significantly higher in the poorly controlled DM group than in the controlled DM group (5.9% vs. 1.5%; p = 0.032). However, multivariate logistic regression revealed that control levels of DM were not significantly associated with the development of SSIs. CONCLUSIONS: Even though patients with DM had undergone preoperative glycemic control, SSIs were significantly associated with DM, especially when the patients had poorly controlled DM. This finding suggested that continuous glycemic control is important preoperatively and postoperatively to prevent SSIs.

Factors associated with maintaining walking ability postoperation for hip fractures and the predictive value of the CGA7 score for postoperative walking ability.

AIM: Patients with hip fractures have a high rate of mortality or decreased mobility, despite early operative treatment and rehabilitation. The first aim of this study was to investigate the factors of decreased walking ability after hip fracture based on whether walking ability was or was not maintained postoperatively. The second aim was to examine the usefulness of the Comprehensive Geriatric Assessment 7 (CGA7), modified from the conventional Comprehensive Geriatric Assessment, for predicting postoperative walking ability. METHODS: This study included patients who were treated surgically for hip fractures. We divided patients by whether they did or did not maintain their walking ability postoperatively. We registered the following demographic data: walking ability preadmission and at discharge, CGA7 score, cognitive impairment, the patient's prefracture status, fracture type, surgical waiting time, hospital stay duration, limitation of weight-bearing, postoperative complications, transfer to rehabilitation hospital, final living place, and follow-up period. The characteristics of the two groups were compared using Wilcoxon's rank-sum test, the chi-squared test, or Fisher's exact test. RESULTS: Among 855 patients, 616 (73.0%) patients maintained walking ability and 239 (27.0%) patients did not. Multivariate logistic regression revealed that the factors of age, sex, preoperative walking ability, and postoperative complications were significantly associated with maintaining postoperative walking ability. Furthermore, the higher the CGA7 score, the more likely were patients to maintain their walking ability (odds ratio, 0.72; 95% confidence interval, 0.61-0.85; P < 0.001). CONCLUSIONS: Patients who had a low CGA7 score had the potential risk of decreased walking ability. Geriatr Gerontol Int 2023; 23: 830-835.

Micronized Cellular Adipose Matrix Promotes the Therapeutic Effect of an Artificial Nerve Conduit in Peripheral Nerve Gap Injury.

BACKGROUND: Stromal vascular fraction (SVF) isolated from adipose tissue has been shown to be beneficial for treating peripheral nerve injuries. Micronized cellular adipose matrix (MCAM) is an SVF-rich micronized fat tissue obtained by a series of simple mechanical processes. This study assessed the therapeutic effect of MCAM for peripheral nerve injury. METHODS: Microscopic evaluation of the cell phenotype and functions was performed to determine the adipose-derived stem cell content of the MCAM. An artificial nerve conduit (ANC) filled with MCAM was implanted into a sciatic nerve defect in immunodeficient mice. Comparisons of this treatment with an autograft, an ANC filled with SVF cells, and an ANC alone were made based on electrophysiologic characteristics, Sciatic Functional Index, and histologic analyses of regenerated nerve fiber and myelination using electron microscopy, and the preventive effect on innervated muscle atrophy. RESULTS: MCAM contained many cells with a phenotype and differentiation potency similar to those of ADSCs. The implantation experiment indicated that MCAM enhanced the efficiency of functional and structural recovery and prevented atrophy of the innervated muscle. These effects were significantly improved compared with the control group (ANC only) and comparable to those in the SVF group, whereas the improvement did not reach the same level of the autograft group. CONCLUSION: Injection of MCAM into an ANC accelerated nerve regeneration compared with use of an ANC alone, which indicates that MCAM is a promising transplant material for treatment of peripheral nerve injury and an alternative to use of SVF cells. CLINICAL RELEVANCE STATEMENT: Micronized cellular adipose matrix, which can be harvested and isolated from adipose tissue with a simple device, has been shown for the first time to be highly useful as an implantable material for new peripheral nerve regeneration.

Quantitative Analysis of Ultrasonography for de Quervain's Disease: Comparison of the Affected Side With the Asymptomatic Side.

OBJECTIVES: The pathology of de Quervain's disease affects the tenosynovium and rarely the tendons. The ultrasonographic features of de Quervain's disease unresponsive to conservative treatment are unknown. The purpose of this study was to describe and compare the morphological differences between patients with de Quervain's disease that is refractory to conservative treatment and patients who respond to conservative treatment. METHODS: de Quervain's disease unresponsive to conservative treatment was evaluated in 51 patients. The bilateral wrists underwent preoperative ultrasonographic assessments. The asymptomatic side was presumed to be the patient's anatomical baseline and was used for comparison. We measured the diameter and cross-sectional area of the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB), and the thickness of the tendon sheath and the intercompartmental septum, if present. The affected side and asymptomatic side were compared. RESULTS: The APL and EPB cross-sectional area was significantly larger on the affected side than on the asymptomatic side (APL: 13 mm2 versus 8.3 mm2 ; P < .0001; EPB: 5.4 mm2 versus 3.9 mm2 ; P = .031). The tendon sheath was significantly thicker on the affected side (1.5 mm) than on the asymptomatic side (0.95 mm) (P < .0001). The intercompartmental septum was significantly thicker on the affected side (1.1 mm) than on the asymptomatic side (0.72 mm) (P = .0004). Operative findings revealed 41 (80%) patients had an intercompartmental septum. CONCLUSIONS: The ultrasonographic features of de Quervain's disease requiring surgical treatment were a significantly thickened tendon sheath, an intercompartmental septum, and increased cross-sectional area of the APL and EPB.

Conservative treatment of ulnar styloid fractures following volar-plate fixation of distal radius fractures: incidence of nonunion evaluated by computed tomography.

PURPOSE: The first aim of this study was to investigate the incidence of ulnar styloid fractures (USFs) accompanied by distal radius fractures (DRFs), treated with volar locking plates. The fracture type of DRFs was evaluated by the classifications, based on computed tomography (CT) scan findings. The second aim was to investigate the bone union rate of USFs, depending on the fracture type of DRFs, by comparing union and nonunion groups in the USFs groups. METHODS: Between May 2012 and December 2019, 239 consecutive patients with DRFs were treated. Of these patients, 177 DRFs met inclusion criteria. The fracture patterns of the DRFs, based on the classification, using CT scans, which included the AO classification, sagittal angulation, and axial fracture patterns of the articular surface of the distal radius in two-part intra-articular fractures were evaluated. The size of USFs, classified as a tip or base fracture was also investigated. RESULTS: The incidence of USFs was significantly higher for AO types A and C than for type B. Analysis of the sagittal angulation of DRFs showed that the incidence of USFs was higher for the extension type than for the flexion type. Axial CT classification of two-part fractures revealed that DRFs with a dorsal fracture line was more frequent than the volar type of DRFs. These results suggested that dorsal displacement of DRFs was associated with a higher incidence of USFs. Finally, the analysis of the bone union rate of USFs revealed that AO classification and sagittal angulation were not correlated with bone union in USFs. However, it was found that a fracture line on the radial side of the radius had a significantly low rate of bone union, compared to a fracture line on the dorsal side. The size of USFs was also not correlated with the bone union rate. CONCLUSIONS: The incidence and the bone union rate of USFs have different patterns. The incidence of USFs was higher in the dorsal displacement type of DRFs. However, the bone union rate of USFs was lower for a fracture line on the radial side. Therefore, USFs with DRFs that have a fracture line on the radial side is a candidate for fixation to prevent nonunion.

Fourth Dorsal Interosseous Muscle Transfer to Treat an Abducted Little Finger.

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.

Use of an iliac bone graft with the tensor fasciae latae for the reconstruction of capitellum and radial collateral ligament in wind swept elbow.

Traumatic elbow injuries often result in wounds and exposure of the nerves, tendons, and bone with defects in the soft tissue. A severe type of wind swept injury causes loss of the capitellum and radial collateral ligament (RCL), which leads to severe instability of the elbow. For reconstructing a defect of the capitellum and RCL, we applied an autogenous iliac bone graft with the fascia of the tensor fasciae latae muscle, which has never been reported with successful results. This bone-tendon unit may be a strong candidate for the reconstruction of defects of the radiocapitellar joint in a wind swept injury.

ALK5 i II Accelerates Induction of Adipose-Derived Stem Cells toward Schwann Cells through a Non-Smad Signaling Pathway.

Schwann cells (SCs) are likely to be a vital component of cell-based therapies for nerve regeneration. There are various methods for inducing SC-like cells (SCLCs) from adipose-derived stem cells (ADSCs), but their phenotypic and functional characteristics remain unsatisfactory. Here, we report a novel efficient procedure to induce SCLCs by culturing ADSCs with ALK5 inhibitor (ALK5 i) II, a specific inhibitor of activin-like kinase 5 (ALK5) (transforming growth factor-ß receptor 1 (TGFßR1)) that is also known as Repsox. The resultant cells that we named "modified SCLCs (mSCLCs)" expressed SC-specific genes more strongly than conventional SCLCs (cSCLCs) and displayed a neurosupportive capacity in vitro, similarly to genuine SCs. Regarding the mechanism of the mSCLC induction by ALK5 i II, knockdown of Smad2 and Smad3, key proteins in the TGFß/Smad signaling pathway, did not induce SC markers. Meanwhile, expression of multipotent stem cell markers such as Sex-determining region Y- (SRY-) box 2 (Sox2) was upregulated during induction. These findings imply that ALK5 i II exerts its effect via the non-Smad pathway and following upregulation of undifferentiated cell-related genes such as Sox2. The procedure described here results in highly efficient induction of ADSCs into transgene-free and highly functional SCLCs. This approach might be applicable to regeneration therapy for peripheral nerve injury.

Use of the Extensor Carpi Ulnaris Half-Slip for Treating Chronic Neglected Volar Dislocation of the Distal Radioulnar Joint.

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.

Healing Effect of Subcutaneous Administration of Granulocyte Colony-Stimulating Factor on Acute Rotator Cuff Injury in a Rat Model.

Granulocyte colony-stimulating factor (G-CSF) is a cytokine that mobilizes bone marrow-derived cells (BMDCs) to peripheral blood and has been clinically used to treat neutropenia. Previously, we reported that BMDCs migrated into the rotator cuff repair site via peripheral blood in the healing process. However, techniques to accelerate the healing process using the peripheral blood pathway have not been established. We evaluated whether G-CSF has a noteworthy effect on improving rotator cuff healing by enhancing the influx of BMDCs into the peripheral blood. We used Sprague-Dawley rats and chimeric rats, selectively expressing green fluorescent protein (GFP) in BMDCs. Their bilateral supraspinatus tendons were resected and sutured to the greater tuberosity of the humerus using the Masson-Allen technique, and G-CSF was subcutaneously injected for 5 days after surgery. Several GFP-positive cells were observed around the enthesis in the G-CSF-treated group compared with that in the Control group. Histological analysis revealed that the tendon-to-bone maturing scores and the Safranin O-stained cartilaginous areas were significantly higher in G-CSF-injected rats than in the control rats at weeks 4 and 8 after surgery. Consistently, the ultimate force to failure in the G-CSF-treated group significantly increased compared with the Control group at weeks 4 and 8 after surgery. These results suggest that BMDCs mobilized into the peripheral blood after G-CSF administration migrated to the rotator cuff repair area and effectively enhanced rotator cuff healing by promoting tenocyte and cartilage matrix production. In conclusion, the BMDC mobilization technique by G-CSF treatment via peripheral blood will provide a potential therapeutic approach for rotator cuff healing with clinically relevant applications. Impact statement As the retear rate following rotator cuff repair is high, new methods to aid its healing are required. Granulocyte colony-stimulating factor (G-CSF) has been used clinically and may represent a novel approach to treating rotator cuff tear. Herein, using a rat model, we elucidate the kinetics of bone marrow-derived mesenchymal stem cells at the repair site following G-CSF administration and describe the underlying mechanism by which G-CSF can help promote the repair of the rotator cuff.

Do Social Relationships With Those Who Witness Moral Transgression Affect the Sense of Guilt?

Moral emotion is thought to have evolved to guide our behavior and control our impulse to achieve immediate rewards, thus serving to enforce pro-social behavior. Guilt, one of the moral emotions, is a social, other-oriented emotion that is experienced primarily in interpersonal situations, although it may also be experienced in non-interpersonal situations. We predicted that the intensity of the sense of guilt would differ depending on the relationship between a witness and the person who performed the antisocial behavior because building a good reputation plays an important role in the evolution of reciprocal altruism through indirect reciprocity. Participants were asked to imagine that they had been observed by a third party while committing five kinds of moral transgression based on moral foundation theory, and to describe the intensity of their sense of guilt when witnessed by parents, a cordial friend, a neighbor, or a stranger. The intensity of guilt was significantly lower when the act was witnessed by a stranger regardless of the moral foundation involved. The effects of the kind of witness, however, differed for each moral foundation. The results support the hypothesis that guilt functions to guide our behavior, to achieve cooperation.

Comprehensive assessment of alterations in hand deformities over 11 years in patients with rheumatoid arthritis using cluster analysis and analysis of covariance.

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.

Carpal tunnel syndrome caused by a vascular malformation in a 48-year-old woman.

INTRODUCTION: Vascular malformation can present as nerve compression syndrome in middle age due to slow lesion growth, after first appearing in childhood. In a case of vascular malformation involving the peripheral nerve, surgical resection may cause uncontrollable hemorrhage and further nerve compression. Therefore, a more conservative approach is needed in such cases. CASE PRESENTATION: A 48-year-old woman complained of pain and paresthesia of the fingers, and was diagnosed with a large vascular malformation expanding from the proximal forearm to the palm on MRI. Because of the size of the lesion and involvement of soft tissue, resection had a risk of major hemorrhage and incomplete removal. Thus, carpal tunnel release was performed as a less invasive procedure, and was effective for reducing pain while avoiding the risks associated with resection. DISCUSSION: Our case indicates that a vascular lesion is a possible cause of nerve compression in the carpal tunnel. Finger numbness and pain were caused by this nerve compression, but the lesion itself was not painful. The median nerve was separate from the venous structure, and the case was diagnosed as an extraneural type. CONCLUSION: Symptoms that develop in middle age due to an extraneural vascular malformation in the carpal tunnel can be treated successfully using carpal tunnel release, instead of more invasive resection of the lesion.

A New Approach for the Correction of Type I Thumb Deformity Owing to Rheumatoid Arthritis.

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.

A modified Terrono classification for Type 1 thumb deformity in rheumatoid arthritis: a cross-sectional analysis.

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.

Effectiveness and safety of chronic hepatitis C treatment with direct-acting antivirals in patients with rheumatic diseases: A case-series.

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.

Efficacy of electrical polarization on a rat femoral bone defect model with a custom-made external fixator.

BACKGROUND: We have developed a technology to electrically polarize living bone. OBJECTIVE: The effects of stored electrical charge in electrical polarized bone on the facilitation of new bone formation were assayed. METHODS: Stimulated depolarized current measurement was performed in electrically polarized and nonpolarized femora of SD rats. These bone specimens were implanted into bone defects of the rat femora and fixed with a custom-made external fixator. X-ray imaging of the implant was performed every week. After 3 weeks, micro-CT scanning was performed to evaluate the displacement rate. Histological observation was performed, and the occupancy ratio of the newly formed bone was calculated from tissue specimens stained with Villanueva's Goldner method. RESULTS: There was a tendency for the displacement rate of the implant to be smaller and the occupancy ratio of the newly formed bone to be larger, especially at the distal end, in the polarized group compared with the nonpolarized group. The time of callus appearance was significantly earlier in the polarized group than in the nonpolarized group, and bridging callus grew from the distal to the proximal end. CONCLUSIONS: Bone specimens can be electrically polarized, and the stored electrical charge can work effectively to facilitate new bone formation.

Degeneration of the Sacroiliac Joint in Hip Osteoarthritis Patients: A Three-Dimensional Image Analysis.

OBJECTIVE: The sacroiliac joint is an important source of low back pain and may be influenced by pathologies in adjoining structures such as the hip or the spine. This study aimed to investigate the influence of hip osteoarthritis on sacroiliac joint degeneration by examining the sacroiliac joints of hip osteoarthritis patients, focusing on the localization and quantity of vacuum phenomena. MATERIALS AND METHODS: The preoperative computed tomography (CT) of 31 female hip replacement candidates (mean age 69.1) and pelvic CT of 34 age-matched controls (mean age 67.9) were used to reconstruct the sacroiliac joints three-dimensionally. The degeneration score of the sacroiliac joints on axial view, as well as the location and volume of vacuum phenomena in the three-dimensionally reconstructed sacroiliac joints, were analyzed. RESULTS: The total sacroiliac joint degeneration scores were similar in hip osteoarthritis patients and controls but the breakdown of the score revealed that joint space narrowing and vacuum phenomena in the sacroiliac joint increase in hip osteoarthritis, while osteophytes decrease. Three-dimensional reconstruction revealed that the volume of vacuum phenomena in the sacroiliac joint was significantly larger in the hip osteoarthritis group and the vacuum areas were localized in the antero-superior region of the sacroiliac joint. CONCLUSION: Our results suggest that hip osteoarthritis and sacroiliac joint degeneration are related, and that with further investigation, the sacroiliac joint may become a new treatment target in hip osteoarthritis.