Arata Nakajima

Background: Pyothorax‐associated lymphoma (PAL) is an Epstein–Barr virus (EBV)–positive diffuse large B‐cell lymphoma developing in the setting of long‐standing chronic pyothorax. Neurological involvement due to spinal invasion is extremely rare. Case Presentation: An 87‐year‐old woman with a remote history of pulmonary tuberculosis presented with rapidly progressive paraplegia. Imaging demonstrated chronic right pyothorax with a dorsal epidural mass compressing the spinal cord, continuous with a pleural lesion. A biopsy confirmed EBV‐positive diffuse large B‐cell lymphoma, consistent with PAL. Surgery was considered but declined by the patient and the family. Therefore, the patient was treated with corticosteroids followed by two cycles of R‐CHOP chemotherapy; however, no neurological improvement was observed. Conclusion: This case highlights a rare neurological manifestation of PAL. Clinicians should consider lymphoma infiltration in elderly patients with chronic pyothorax who develop new neurological deficits. Early MRI and biopsy are crucial for accurate diagnosis and management.

Orthostatic hypotension is frequently observed in patients with neurodegenerative diseases such as multiple system atrophy (MSA) and Parkinson’s disease (PD). This study aimed to investigate the immediate effects of ankle plantar-dorsal flexion (APDF) exercises on hemodynamics and autonomic nerve function in patients with orthostatic hypotension. Thirteen consecutively admitted patients diagnosed with MSA or PD and orthostatic hypotension were included in this study. This crossover study included two consecutive, randomly assigned intervention sessions: one exercise session and one control session. In both sessions, patients sat relaxed in a chair for 6 min before standing up for 5 min. During the exercise session, they performed APDF exercises at 60 cycles/min during the final minute of sitting. Blood pressure and autonomic nerve function were monitored continuously. Correlations between patient characteristics and changes in SBP after standing (ΔSBP) were also analyzed. After 1 min of standing, SBP was reduced by a median value of 17.5 mmHg during the control session, while it lowered to only 1.0 mmHg during the exercise session. There were no significant changes in heart rate frequencies during both sessions. These results suggest that APDF exercises mitigate the drop in SBP through improved venous return, without affecting autonomic nerve function. We conclude that a short bout of ankle exercises may be an effective and safe intervention to prevent orthostatic hypotension in patients with neurodegenerative diseases.

SAPHO syndrome is a rare inflammatory osteoarticular disorder, which includes autoimmune diseases such as pustulotic arthro-osteitis, inflammatory bowel disease-associated spondyloarthritis, and psoriatic arthritis. There are few reports on the treatment of SAPHO syndrome that presents with bone destruction in the spine. We present a case in which adalimumab (ADA) was administered to treat destruction of the lumbar vertebral endplates caused by SAPHO syndrome. The patient was a woman in her 20s who was referred to Toho University Sakura Medical Center with complaints of low back pain; acne on the face, anterior chest, and back; and sternoclavicular joint pain. Blood tests showed a mild increase in C-reactive protein but negative results for rheumatoid factor and anti-cyclic citrullinated peptide antibody. Radiographs and computed tomography images demonstrated destruction with surrounding bone sclerosis in the cranial endplates of the L4 and L5 vertebrae and the left sternoclavicular joint. The Ankylosing Spondylitis Disease Activity Score was 2.05, and the Bath Ankylosing Spondylitis Functional Index was 3.00. Despite the use of the maximum dose of nonsteroidal anti-inflammatory drugs, her symptoms did not improve, and ADA was administered at a dose of 40 mg every 2 weeks. After ADA administration, both the Ankylosing Spondylitis Disease Activity Score and the Bath Ankylosing Spondylitis Functional Index were immediately reduced and low disease activity or remission was maintained thereafter. After 3 years, the computed tomography images showed no progression of bone destruction in the lumbar vertebrae and sternoclavicular joint, and the patient was completely free from low back pain and was able to run normally.

Objectives: Predicting postoperative clinical outcomes from preoperative physical factors of patients undergoing total knee arthroplasty (TKA) would be useful. This study aimed to investigate the association between preoperative physical factors and postoperative outcomes.Methods: This study included 119 patients. The preoperative physical factors and 1-year postoperative clinical outcomes were collected and assessed. Physical factors included age, sex, body mass index, skeletal mass index, knee range of motion, 5-m walk time, and Timed Up-and-Go (TUG) test result. Postoperative outcomes were evaluated using a sum of symptoms, pain, activities of daily living, and quality of life subscales of the Knee injury Osteoarthritis Outcome Score (KOOS-4), and the Oxford Knee Score (OKS). Correlation between physical factors and postoperative outcomes was analyzed by Spearman’s rank correlation coefficient, and the association between physical factors and KOOS-4 or OKS was analyzed using multiple regression analysis. Receiver operating characteristic analysis was performed to calculate the cut-off value for the TUG test time associated with minimum postoperative OKS of 40.Results: Among the preoperative physical factors, TUG test time showed significant correlation with OKS (ρ=−0.267), but none correlated with KOOS-4. Multiple regression analysis showed a significant association between TUG test time and OKS (95% confidence interval: −0.590 to −0.163) but not with KOOS-4. The cut-off value of preoperative TUG test time associated with minimum postoperative OKS of 40 was 12.96 s.Conclusions: Among the preoperative physical factors of patients undergoing TKA, the TUG test time was associated with clinical outcomes at 1 year after surgery.

Regeneration of articular cartilage remains a challenge for patients who have undergone cartilage injury, osteochondritis dissecans and osteoarthritis. Here, we describe a new recombinant silk fibroin with basic fibroblast growth factor (bFGF) binding peptide, which has a genetically introduced sequence PLLQATLGGGS, named P7. In this study, we cultured a human mesenchymal cell line derived from bone marrow, UE6E7-16, in wild-type fibroin sponge (FS) and recombinant silk fibroin sponge with P7 peptide (P7 FS). We compared cell proliferation, chondrogenic differentiation and cartilaginous tissue formation between the two types of sponge. After stimulation with bFGF at 3 ng/mL, P7 FS showed significantly higher cell growth (1.2-fold) and higher cellular DNA content (5.6-fold) than did wild-type FS. To promote chondrogenic differentiation, cells were cultured in the presence of TGF-β at 10 ng/mL for 28 days. Immunostaining of P7 FS showed SOX9-positive cells comparable to wild-type FS. Alcian-Blue staining of P7 FS also showed cartilaginous tissue formation equivalent to wild-type FS. A significant increase in cell proliferation in P7 FS implies future clinical application of this transgenic fibroin for regeneration of articular cartilage. To produce cartilaginous tissue efficiently, transgenic fibroin sponges and culture conditions must be improved. Such changes should include the selection of growth factors involved in chondrogenic differentiation and cartilage formation.

The relationship between arterial stiffness and oxygen uptake (VO₂) in patients with acute myocardial infarction (AMI) remains unclear. We aimed to investigate this relationship and factors contributing to VO₂ in patients with AMI. The role of arterial stiffness in cardio–skeletal muscle coupling during exercise was then elucidated. Upon discharge, we measured exercise capacity using cardiopulmonary exercise testing (CPX), assessed arterial stiffness with the cardio–ankle vascular index (CAVI), and determined body composition to assess the skeletal muscle mass of 101 patients with AMI. Patients were categorized based on their CAVI scores into three groups: (i) normal (CAVI: ≤7.9), (ii) borderline (CAVI: 8.0–8.9), and (iii) abnormal (CAVI: ≥9.0). Subsequently, VO₂ was compared among these groups. The relationship between the CAVI and VO_{2 Peak} during CPX and factors contributing to VO_{2 Peak} were investigated. The abnormal CAVI group had a significantly lower VO_{2 Peak} than the normal and borderline groups. The CAVI was associated with VO_{2 Peak}. Furthermore, the CAVI was found to be a factor contributing to VO_{2 Peak}. These findings suggest that arterial stiffness in tissue blood distribution and blood supply causes systemic exercise limits in patients with AMI. This suggests that arterial stiffness plays a significant role in cardio–vascular–skeletal muscle coupling.

The relationship between arterial stiffness and oxygen uptake (VO2) in patients with acute myocardial infarction (AMI) remains unclear. We aimed to investigate this relationship and factors contributing to VO2 in patients with AMI. The role of arterial stiffness in cardiac-skeletal muscle coupling during exercise was then elucidated. The exercise capacity via cardiopulmonary exercise testing (CPX), cardio-ankle vascular index (CAVI), and body composition of 101 patients with AMI were measured at discharge. Patients were categorized based on their CAVI into three groups: (i) normal (CAVI: ≤7.9), (ii) borderline (CAVI: 8.0–8.9), and (iii) abnormal (CAVI: ≥9.0). Subsequently, VO2 was compared among these groups. The relationship between the CAVI and peak VO2 (VO2 Peak) during CPX and factors contributing to VO2 Peak were investigated. The abnormal CAVI group had a significantly lower VO2 Peak than the normal and borderline groups. The CAVI was associated with VO2 Peak in patients with AMI. Furthermore, the CAVI was found to be a factor contributing to VO2 Peak. These findings suggest that arterial stiffness in tissue blood distribution and blood supply defines systemic exercise limits in patients with AMI. This suggested that arterial stiffness plays a significant role in cardio-vascular-skeletal muscle coupling.

Introduction: We investigated a comparison of clinical outcomes between cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty. However, it is still controversial which design leads to better clinical results. In clinical settings, choosing either CR or PS is likely based on the surgeon’s preferences. In this study, short-term clinical outcomes between CR and PS in patients who received a single knee prosthesis were compared using propensity score matching. Methods: Two hundred and twelve CR and 43 PS of a single knee prosthesis were enrolled in this study. After propensity score matching, 34 knees each in the CR and PS groups were chosen and were without significant differences in age at operation, gender, BMI, preoperative range of motion (ROM), preoperative femorotibial angle (FTA), and presence or absence of patellar replacement. Clinical scores, including ROM, Knee Society score (KSS), knee injury and osteoarthritis outcome score (KOOS), except for the sports subscale, were compared between the CR and PS groups preoperatively and two years postoperatively. Results: Postoperatively, there were no significant differences in FTA, ROM, or KSS. Preoperative scores for the KOOS except for the pain subscale were comparable between the groups. Postoperatively, however, the PS group had a significantly higher score in the ADL subscale compared to the CR group (PS: 89.5 vs. CR: 80.8, p = 0.017). The KOOS subscales other than activities of daily living (ADL) were comparable between the groups. Conclusions: In this propensity score-matched cohort study, PS showed a better outcome for the ADL than the CR design. These findings suggest that choosing either CR or PS should not depend on the surgeon’s preferences. A PS design may be preferable to CR for elderly patients.