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Abstract Competition in sports, unlike cooperation in everyday life, does not involve a single solution because individuals aim to behave unpredictably, thereby preventing others from predicting their actions. This study determined how individuals in court-based sports attempted to control others’ unpredictable behaviors, addressing the gap in previous studies regarding the lack of clarity around strategies employed by individuals in competitive situations. We achieved this by applying a switching hybrid dynamics model, considering external inputs to analyze individual behaviors. Consequently, the study indicates that skilled individuals, in contrast to intermediate players, exhibit greater consistency in their behaviors. These skilled individuals lead others to anticipate their consistency and subsequently employ strategies to disrupt these expectations. This strategy exploits the principles of active human inference, implying that competition involves cooperation. This was revealed by an analysis of both human decision-making and behavior in actual matches as discrete and continuous dynamical systems. This interpersonal strategy could assist policymakers in the field of everyday life to enhance competitiveness. This strategy enables policymakers to adopt new policies that promote cooperation with competitors, ultimately increasing competitiveness in various aspects of our daily lives.

Disorders associated with the immune system burden multiple organs, although the shared biology exists across the diseases. Preceding family-based studies reveal that immune diseases are heritable to varying degrees, providing the basis for immunogenomics. The recent cost reduction in genetic analysis intensively promotes biobank-scale studies and the development of frameworks for statistical genetics. The accumulating multi-layer omics data, including genome-wide association studies (GWAS) and RNA-sequencing at single-cell resolution, enable us to dissect the genetic backgrounds of immune-related disorders. Although autoimmune and allergic diseases are generally categorized into different disease categories, epidemiological studies reveal the high incidence of autoimmune and allergic disease complications, suggesting the shared genetics and biology between the disease categories. Biobank resources and consortia cover multiple immune-related disorders to accumulate phenome-wide associations of genetic variants and enhance researchers to analyze the shared and heterogeneous genetic backgrounds. The emerging post-GWAS and integrative multi-omics analyses provide genetic and biological insights into the multicategorical disease associations.

Friction stir processing (FSP) effectively improves the fatigue strength of arc-welded joints; however, wear of tools is inevitable in case of high-strength materials. Notably, a new benefit has been discovered: compressive residual stress is applied on the FSPed steel surface, alloyed with the WC tool constituent elements, contrasting with the tensile residual stress typically applied via conventional FSP. To elucidate the mechanism of compressive residual stress application, FSP was performed on a low-carbon steel plate at various rotational speeds. The alloyed topmost layers in the stir zone comprised martensite structures with a small amount of retained austenite grains, resulting in a hardness increase owing to the tool constituent elements. The residual stresses on the stir zone surface were influenced by the alloying contents and the corresponding martensite start temperature (Ms). Compressive residual stresses were maximized at an Ms of approximately 150 °C owing to martensitic transformation expansion near room temperature. Lowering the Ms below approximately 150 °C led to tensile residual stresses and an increased volume fraction of the retained austenite, suggesting that martensitic transformation expansion is insufficient to apply compressive residual stress. Conversely, the retained austenite can resist plastic deformation and crack propagation through deformation-induced martensitic transformation, thereby enhancing fatigue properties.

Abstract Purpose This study aimed to investigate the intraoperative knee kinematics of cruciate‐retaining total knee arthroplasty with a medial stabilising technique (MST‐TKA) and compare the kinematics between mobile‐ and fixed‐bearing MST‐TKAs. We hypothesised that mobile‐bearing MST‐TKA would result in greater physiological kinematic motion than fixed‐bearing MST‐TKA. Methods Twenty‐one and 20 knees underwent mobile‐ and fixed‐bearing MST‐TKAs using a navigation system (Orthopilot® ver. 6.0; B. Braun Aesculap), respectively. In the preoperative and postoperative kinematic analysis, the knee was moved manually from 0° to 120°, and femoral anteroposterior translations of the medial femoral condyle (MFC) and lateral femoral condyle (LFC) were recorded every 0.1 s from 0° to 120°. Data were subsequently extracted from the software every 10° of flexion and compared between the two groups, and the correlation coefficients between preoperative and postoperative kinematics were calculated. Results In the postoperative analysis, the MFC in the mobile‐bearing group showed significant posterior translation at 100°, 110° and 120° compared to the fixed‐bearing group (p

Purpose: Iliofemoral ligament (ILFL) is a capsular ligament located in the anterosuperior part of the hip joint capsule and contributes to hip joint stability. The purpose of this study was to compare the surgical outcomes of resection versus preservation procedure of the medial arm of the ILFL in total hip arthroplasty (THA) using the anterolateral approach. Methods: Perioperative outcomes, complication, implant placement and patient-reported outcome measures (PROMs) were evaluated in 42 patients in the resection group and 38 patients in the preservation group. As a PROM, the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), was administered at 6 months, 1 year and 2 years postoperatively. Results: There was no significant difference in perioperative outcomes, complication and implant placement between the two groups. Satisfaction for the hip joint condition (80.6 ​± ​22.4 vs 89.2 ​± ​20.1), JHEQ pain score (21.5 ​± ​4.5 vs 24.1 ​± ​5.2) at 6 months, and JHEQ pain score (21.6 ​± ​5.1 vs 23.5 ​± ​5.5) at 1 year were significantly better in the preservation group than in the resection group. At 2 years postoperatively, no significant difference was found in PROMs between the two groups. Conclusion: Our results indicate that preservation of the medial arm of the ILFL in THA improves pain during the first postoperative year without increased complications or disadvantages of implant placement. Preserving the medial arm of the ILFL may be a safe and effective option to improve the early clinical outcomes after THA using the anterolateral approach.

IntroductionWhile informal communication is essential for employee performance and wellbeing, it is difficult to maintain in telework settings. This issue has recently been becoming more prominent worldwide, especially because of the coronavirus disease 2019 (COVID-19). Nevertheless, how employees managed their informal communication in the sudden shift to teleworking is still understudied. This study fills this research gap by clarifying how an organization's employees improvised informal communication during the urgent shift to teleworking.MethodsAn exploratory case study of a large construction firm in Japan was conducted, focusing on how employees improvised informal communication during teleworking in response to COVID-19. The authors conducted semi-structured interviews with 24 employees and applied a qualitative thematic analysis to the collected data.ResultsFour informal communication strategies (structured informality, casual tech, implicit communication, and face-to-face opportunity seeking) that were improvised amid the sudden shift to teleworking caused by COVID-19 were identified.DiscussionThe findings can inform concrete means for the effective and dynamic transition of informal communication to teleworking settings during emergencies, thus contributing to informal communication studies as well as the promotion of resilient business operations and employee wellbeing in response to future crises.

Objectives This study documents the time elapsed from the diagnosis of osteonecrosis of the femoral head (ONFH) to surgery, exploring the factors that influence ONFH severity.Design Retrospective observational study of a nationwide database.Setting The Kaplan-Meier method with log-rank tests was applied to examine the period from definitive diagnosis of ONFH to surgery using any surgery as the end point. For bilateral cases, the date of the first surgery was the endpoint.Participants This study included 2074 ONFH cases registered in 34 university hospitals and highly specialised hospitals of the multicentre sentinel monitoring system of the Japanese Investigation Committee between 1997 and 2018.Main outcome measure The primary outcome was the time from diagnosis to surgery. The secondary outcome was the proportion of subjects remaining without surgery at 3, 6 and 9 months, and at 1, 2 and 5 years after diagnosis.Results The median time to surgery was 9 months (IQR 4–22 months) after diagnosis of ONFH. The time to surgery was significantly shorter in the alcohol alone group and the combined corticosteroid and alcohol group than in the corticosteroid alone group (p=0.018 and p

Elevated plasma low‐density lipoprotein (LDL) cholesterol level is a risk factor for developing atherosclerosis. Increased LDL receptor (LDLR) expression is expected to reduce the risk of atherosclerotic disease since hepatic LDLR is essential for clearing plasma LDL cholesterol. Here, we screened human LDLR promoter effectors and observed that extracts from peduncles of sweet cherry (Prunus avium) ‘Sato‐Nishiki’ induce LDLR gene promoter activity. We used several analytical and chemical methods to show that chrysin 7‐O‐β‐d‐glucopyranoside (chrysin‐7G) is one of the compounds that stimulate LDLR gene promoter activity in cherry peduncle extracts. Furthermore, synthetic chrysin‐7G increased the expression and activity of LDLR. The chrysin‐7G–mediated increase in LDLR expression and activity was completely abolished by treatment with an AMP‐activated protein kinase (AMPK) inhibitor, compound C. These results indicate that chrysin‐7G increases LDLR expression through AMPK activation and may be a useful compound that can be recycled from waste parts of agricultural products.

Objectives: A low rate of the incidence of venous thromboembolism (VTE) after surgeries that are preoperatively classified as having high risk of VTE has been reported in recent years. We seek to identify the optimal cases to receive perioperative pharmacologic thromboprophylaxis. In this study, we evaluated the incidence rate of VTE among patients undergoing colorectal surgery who did not receive perioperative pharmacologic thromboprophylaxis, and the ability of coagulofibrinolytic markers to predict the postoperative development of VTE. Methods: We retrospectively analyzed the rate of postoperative development of VTE in 70 patients undergoing elective colorectal surgery without perioperative pharmacologic thromboprophylaxis and the ability of coagulofibrinolytic markers to predict the development of VTE. Results: The incidence of VTE was observed in 11 patients (15.7%); all cases were asymptomatic and distal-type deep vein thrombosis (DVT). Comparisons of time course changes in perioperative coagulofibrinolytic markers between patients with and without DVT revealed significant differences in soluble fibrin (SF), thrombin-antithrombin complex (TAT), fibrin/fibrinogen degradation product (FDP) and D-dimer. Dynamic postoperative physiological coagulofibrinolytic responses were shown, but all four markers at each postoperative point demonstrated moderate accuracy (median area under the curve [AUC]: 0.788, median sensitivity: 0.865, median specificity: 0.644) for predicting the development of DVT. Conclusions: The incidence of postoperative VTE was low in patients with colorectal surgery even in those who did not receive perioperative pharmacologic thromboprophylaxis. SF, TAT, FDP and D-dimer were useful for predicting the development of DVT when we set cut-off values taking the physiological perioperative coagulofibrinolytic responses into consideration.

Abstract This retrospective cross-sectional study investigated the association between bone marrow lesions (BMLs) and bone mineral density (BMD) in the proximal tibia of end-stage osteoarthritic knees from a large patient sample. Overall, 1308 end-stage osteoarthritic knees were enrolled before total knee arthroplasty. The preoperative range of motion was recorded. Bone mineral density in the medial tibial plateau (MTP), lateral tibial plateau (LTP), and metaphysis were measured using dual-energy X-ray absorptiometry. The MTP/LTP, MTP/metaphysis, and LTP/metaphysis ratios were calculated. BMLs were scored using a whole-organ magnetic resonance imaging scoring system. The relationship between BMD and BML scores was investigated using linear regression analysis. The highest BMD was 0.787 ± 0.176 g/cm2 at the MTP, followed by 0.676 ± 0.180 g/cm2 and 0.572 ± 0.145 g/cm2 at the metaphysis and LTP, respectively. The prevalence of BMLs was 90.4% and 24.2% in the MTP and LTP, respectively. In women, higher BML scores at the MTP were positively correlated with the BMD of the MTP (p

Abstract Background Knee osteoarthritis (OA) has enormous medical and socioeconomic burdens, which early diagnosis and intervention can reduce. We investigated the influence of knee effusion on the progression of knee OA in patients with early knee OA. Methods A total of 404 participants without radiographic knee OA were assessed from a 3-year longitudinal analysis. Participants were classified into non-OA and early knee OA groups. The effusion area (mm2) was quantified using ultrasonography. Receiver operating characteristic and logistic regression analyses were performed. Results At the 3-year follow-up, 114 of 349 knees (32%) had progressed from non-OA and 32 of 55 knees (58%) had progressed from early knee OA to radiographic knee OA. Logistic regression analysis showed that female sex (odds ratio [OR] 3.36, 95% confidence interval [CIs] 2.98–5.42), early knee OA (OR 2.02, 95% CI 1.08–3.75), body mass index (OR 1.11, 95% CI 1.02–1.19), and effusion area (OR 1.01, 95% CI 1.01–1.02) were significantly correlated with knee OA progression. Women who were overweight (body mass index ≥ 25 kg/m2) with more severe effusion had a higher risk of OA progression (area under the curve = 0.691, OR = 6.00) compared to those not overweight (area under the curve = 0.568, OR = 1.91). Conclusion Knee effusion may be an indicator of the progression of early-stage knee OA.

Abstract Background Ultraviolet (UV) light-mediated photofunctionalization improves the osseointegration of pure titanium and titanium alloy (Ti6Al4V). However, little is known about the effect of UV irradiation on Ti6Al4V, used frequently in orthopedic surgery, in diabetic patients. We examined the effect of UV irradiation on Ti6Al4V in rats with type 2 diabetes. Methods Cylinder Ti6Al4V implants were used. Half the animals were Sprague Dawley rats (the control group), and the other half were Spontaneously Diabetic Torii fatty rats (the diabetes mellitus model). For radiological analysis, bone density was observed and calculated using 3D microcomputed tomography. Histological analysis was performed to calculate the bone–implant contact (BIC) ratio. We used Pearson correlation to analyze the correlation between average blood glucose level and BIC ratio, and between average blood glucose level and bone volume (BV) ratio. Results In the UV light-treated group, the BIC ratios of the normal and diabetic rats increased significantly compared with those in the untreated group at 2 weeks; at 4 weeks, the BIC ratio of the diabetic rats increased significantly, but there was no significant increase in the control animals. In both the control and diabetic groups, there was no significant difference in the BV ratios between the UV-treated and untreated implants at 2 or 4 weeks. The average blood glucose level in the 4-week group negatively correlated with the BIC and BV ratios. The average blood glucose level in the UV-treated group negatively correlated with the BIC ratio. Conclusion Photofunctionalization of Ti6Al4V implants may promote osseointegration in the early stages in rats with type 2 diabetes.

Genetic mechanisms influencing COVID-19 susceptibility are not well understood. Here, the authors analyzed whole blood RNA-seq data of 465 Japanese individuals with COVID-19, highlighting thousands of fine-mapped variants affecting expression and splicing of genes, as well as the presence of COVID-19 severity-interaction eQTLs.

Background: This study aimed to compare the clinical outcomes and patient reported outcome measurement scales (PROMs) between hamstring tendon (HT) or bone-patellar tendon-bone (BTB) grafts in each primary and revision anterior cruciate ligament (ACL) reconstruction. Additionally, the clinical outcomes and PROMs between primary and revision surgeries were compared. Methods: A total of 150 patients (109 primary and 41 revision ACL reconstructions) were enrolled and followed up for an average of 3.9 years (2 years minimum). Knee injury and osteoarthritis outcome scores (KOOS) were examined as PROMs. Side-to-side differences of anterior knee laxity were assessed using KT-1000 and were recorded at the final follow-up. After categorizing patients into HT and BTB reconstruction groups, regression analysis was performed to determine the relationship between revision surgery and changes in KOOS. Results: In patients who underwent primary surgery, there was no significant difference in side-to-side differences of anterior laxity and KOOS between HT and BTB grafts. In those who underwent revision surgery, BTB grafts had a higher KOOS for activities of daily living (ADL) than HT grafts (p = 0.032). Comparing primary and revision surgeries, postoperative side-to-side differences of anterior laxity in the revision group were significantly larger than those in the primary group (p = 0.001). The KOOS for sports after overall revision reconstruction was significantly lower than that after primary reconstruction (p = 0.026). Comparing the KOOS after dividing all patients into HT and BTB reconstruction groups, in the HT reconstruction group, postoperative KOOS results were not different in any subscale from BTB grafts. In contrast, the KOOS for sports (p = 0.008) and QOL (p = 0.039) were significantly lower in revision surgery than in primary surgery. Furthermore, regression analysis including multiple confounders in the HT reconstruction group showed revision surgery using HT graft was correlated with worsened KOOS for symptoms (p = 0.012) and sports (p = 0.010). Revision surgery using BTB graft was not correlated with decreased KOOS. Conclusions: There were no differences between the clinical outcome and KOOS in primary and revision surgery, except for ADL scores following revision ACL reconstruction using BTB graft. Side-to-side difference of anterior laxity and KOOS for sports following revision ACL reconstruction were inferior to those following primary ACL reconstruction.Furthermore, revision ACL reconstruction using HT grafts were correlated with low scores in KOOS for symptoms and sports, while there was no difference of anterior laxity between BTB and HT grafts in revision surgery.

Abstract Background Osteoarthritis (OA) is one of the costliest and most disabling forms of arthritis, and it poses a major public health burden; however, its detailed etiology, pathophysiology, and metabolism remain unclear. Therefore, the purpose of this study was to investigate the key plasma metabolites and metabolic pathways, especially focusing on radiographic OA severity and synovitis, from a large sample cohort study. Methods We recruited 596 female volunteers who participated in the Iwaki Health Promotion Project in 2017. Standing anterior-posterior radiographs of the knee were classified by the Kellgren-Lawrence (KL) grade. Radiographic OA was defined as a KL grade of ≥ 2. Individual effusion-synovitis was scored according to the Whole-Organ Magnetic Resonance Imaging Scoring System. Blood samples were collected, and metabolites were extracted from the plasma. Metabolome analysis was performed using capillary electrophoresis time-of-flight mass spectrometry. To investigate the relationships among metabolites, the KL grade, and effusion-synovitis scores, partial least squares with rank order of groups (PLS-ROG) analyses were performed. Results Among the 82 metabolites examined in this assay, PLS-ROG analysis identified 42 metabolites that correlated with OA severity. A subsequent metabolite set enrichment analysis using the significant metabolites showed the urea cycle and tricarboxylic acid cycle as key metabolic pathways. Moreover, further PLS-ROG analysis identified cystine (p = 0.009), uric acid (p = 0.024), and tyrosine (p = 0.048) as common metabolites associated with both OA severity and effusion-synovitis. Receiver operating characteristic analyses showed that cystine levels were moderately associated with radiographic OA (p < 0.001, area under the curve 0.714, odds ratio 3.7). Conclusion Large sample metabolome analyses revealed that cystine, an amino acid associated with antioxidant activity and glutamate homeostasis, might be a potential metabolic biomarker for radiographic osteoarthritis and early phase synovitis.

Extreme and long-term social withdrawal, first described in Japan as Hikikomori, has now become a globally recognized mental health problem. Intervention studies severely lag behind epidemiological and phenomenological research. We present two descriptive case reports of Japanese university students with Hikikomori who participated in an early phase test of a structured intervention involving physical activities that was developed and facilitated by clinicians and physical education specialists—Human Movement Consultation (HMC). The two recipients (19- and 29-years old at the start of treatment) completed approximately 40 consultation sessions delivered over 3 years consisting of a combination of outdoor workouts (i.e., walking, running, and cycling) and interpersonal sports (e.g., table tennis, badminton, and tennis). Changes in social withdrawal behavior were independently rated from clinical health records using a structured scale (the Glasgow Hikikomori Scale; GHS). Behavioral observations and scale data for both cases indicated improvements from pre-treatment levels of social withdrawal. At the end of the intervention, both had returned to normative levels of functioning. Case A returned to university and Case B secured a new job upon the completion of HMC. To help advance our understanding of treatment options, these case descriptions analyze potential change mechanisms in order to understand how HMC can support recovery from extreme social withdrawal. One key observation is that both outdoor workouts and interpersonal sports offer a non-threatening method of enabling Hikikomori to engage in interpersonal interactions. Such connections via structured activities may allow the reinstatement of social skills in a graded manner. In addition, an initial focus on physical experiences may help promote psychological and social connectedness without triggering the social fears and challenges that underlie the Hikikomori state. The findings from these two cases offer a framework to guide further research and the development of exercise-based interventions for this hidden and often neglected group.

Abstract Sterol regulatory element-binding proteins (SREBPs) are transcription factors that regulate various genes involved in cholesterol and fatty acid synthesis. In this study, we describe that naturally occurring isothiocyanate sulforaphane (SFaN) impairs fatty acid synthase promoter activity and reduces SREBP target gene (e.g., fatty acid synthase and acetyl-CoA carboxylase 1) expression in human hepatoma Huh-7 cells. SFaN reduced SREBP proteins by promoting the degradation of the SREBP precursor. Amino acids 595–784 of SREBP-1a were essential for SFaN-mediated SREBP-1a degradation. We also found that such SREBP-1 degradation occurs independently of the SREBP cleavage-activating protein and the Keap1-Nrf2 pathway. This study identifies SFaN as an SREBP inhibitor and provides evidence that SFaN could have major potential as a pharmaceutical preparation against hepatic steatosis and obesity.

Abstract Background Methods that facilitate muscle quality measurement may improve the diagnosis of sarcopenia. Current research has focused on the phase angle (PhA) obtained through bioelectrical impedance analysis (BIA) as an indicator of cellular health, particularly cell membrane integrity and cell function. The current study therefore aimed to evaluate the relationship between the PhA and muscle quality and muscle‐related parameters and to determine factors associated with the PhA. Moreover, we attempted to determine the cut‐off value of PhA for predicting sarcopenia. Methods First‐year university students (830 male students, 18.5 ± 0.6 years old; 422 female students, 18.3 ± 0.5 years old) and community‐dwelling elderly individuals (70 male individuals, 74.4 ± 5.5 years old; 97 female individuals, 73.1 ± 6.4 years old) were included. PhA and other body composition data were measured using BIA, while muscle quality was calculated by dividing handgrip strength by upper limbs muscle mass. The relationship between PhA and the aforementioned parameters were then analysed, after which the cut‐off value of PhA for predicting sarcopenia was examined. Results Multiple linear regression analysis revealed that age, skeletal muscle mass index (SMI), and muscle quality were independently associated with PhA in both sexes [male (age: standardized regression coefficient (β) = −0.43, P

Abstract Background The purpose of this study was to determine the prevalence of Segond fractures and to compare knee stability between patients undergoing primary anterior cruciate ligament (ACL) reconstruction with and without Segond fractures pre- and postoperatively. Methods A total of 712 patients who underwent primary ACL reconstruction between 2014 and 2019. Exclusion criteria included patients with multi-ligament knee injuries, skeletally immature patients, osteoarthritis in the knee, combined surgery of high tibial osteotomy, lack of data, and loss to follow-up for at least 2 years. Segond fractures were confirmed using plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Patients with Segond fractures were classified into Group S and without Segond fractures into Group N. Pre- and postoperative Lachman grades, pivot-shift grades, and assessment of side-to-side differences in anterior stability were evaluated. Results Five hundred and forty patients included in this study. There were 22 patients with Segond fractures. Of these, all 22 cases (4.1%) were identified on CT, but only 20 cases (3.7%) were identified on MRI and 18 cases (3.3%) on plain radiographs. There was no significant difference in preoperative Lachman grade or pivot-shift grade between Groups S and N (p = 0.662, p = 0.677, respectively). There was no significant difference in postoperative Lachman grade or pivot-shift grade between Groups S and N (p = 0.685, p = 0.390, respectively). There were no significant differences in preoperative (p = 0.398) or postoperative (p = 0.546) side-to-side differences of anterior stability between Groups S and N. Conclusions Segond fractures were confirmed in 4.1% of the cases on CT scans among patients undergoing primary ACL reconstruction. Segond fractures did not affect preoperative or 2-year follow-up evaluations of knee stability. From these results, we concluded that Segond fractures did not affect the clinical outcomes of the primary ACL reconstruction and that it may not be necessary to treat Segond fractures.

We describe our experience with robotic posterior rectopexy for a patient with full-thickness rectal prolapse. To our knowledge, this is the first report of such a case in the literature. A 94-year-old woman presented with a history of gradually worsening rectal prolapse. On examination, we found that the rectum was completely prolapsed, and we observed a prolapsed intestinal tract. Surgery was indicated and robotic rectopexy was performed without intraoperative complications. The postoperative course was uneventful, and she was discharged 10 days after the operation. One year later, there were no signs of recurrence. Robotic surgery has become common in recent years. We used robotic surgery for rectopexy, including the suturing procedure. Suturing in robotic surgery is easier than that in laparoscopic surgery, and we demonstrated that robotic rectopexy could be safely and easily performed. The trial was registered in the UMIN clinical trial registry (number 000040378).

Purpose: To quantify the cartilage surface profile visualized during arthroscopic surgery and examine its clinical utility by comparing the results of quantitative measurements with a conventional grading system. Methods: Fifty consecutive patients diagnosed with knee osteoarthritis and who underwent arthroscopic surgery were included in this study. A 4 K camera system was used, and the cartilage surface profile was visualized using the augmented reality imaging program. The highlighted image was displayed in 2 colors: black (the worn cartilage area) and green (the part where the cartilage thickness was maintained). The percentage of the green area was calculated using ImageJ and used as an index of cartilage degeneration. The quantitative value was statistically compared with the International Cartilage Repair Society (ICRS) grade as a conventional macroscopic evaluation. Results: In the quantitative measurement, the median percentage of the green area was 60.7 at ICRS grades 0 and 1 (interquartile range [IQR], 67.3-51.0), 47.2 at grade 2 (IQR, 54.1-39.2), 36.5 at grade 3 (IQR, 43.2-30.4), and 34.0 at grade 4 (IQR, 38.5-29.3). There was a significant difference between the macroscopic grades, except for Grades 3 and 4. There was a significant negative correlation between macroscopic evaluation and quantitative measurement (r = −0.672, P < .001). Conclusions: The quantitative measurement of the cartilage surface profile using the spectroscopic absorption technique was significantly correlated with the conventional macroscopic grading system and demonstrated fair to good inter-rater and intra-rater reliabilities. Level of Evidence: Level II, diagnostic (prospective cohort study).

This study investigated the interpersonal coordination between the pitcher and the batter in bat-and-ball sports. Although the importance of interpersonal coordination is widely accepted in many sports, no studies have investigated it in bat-and-ball sports because the dominant task constraints surrounding the interaction between pitcher and batter make it difficult to apply conventional analytic techniques. To address the issue, this study proposes a new analytical framework to investigate interpersonal coordination in bat-and-ball sports under a real game situation with two main characteristics: asymmetric interaction and delayed coupling. First, the dynamic time warping technique was used to evaluate the stability of the head movement pattern of the pitcher and batter, and cross-correlation analysis was used to quantify the temporal relationship between them. We found that the head movement pattern of batters was significantly more unstable than that of pitchers, and approximately 60% of the variance of the change in the head movement pattern of batters could be explained by that of the pitchers. Moreover, expert batters followed a pitcher's movements with a specific time delay of approximately 250 ms. These findings highlight the characteristics of interpersonal coordination in bat-and-ball sports: the pitcher can make a pre-patterned stable motion, whereas the batter needs to follow and adjust their movement to it. Although the effects of prediction ability need to be investigated to understand its detailed mechanism, the contribution of this study is that it revealed the existence of the interpersonal coordination between the pitcher and batter of bat-and-ball sports under a real game situation.

Abstract This report described a rare case of subcutaneous anaerobic bacterial abscess due to Peptoniphilus olsenii and Gleimia europaea after COVID‐19. The patient received incision and drainage of the abscess and antibiotics, thereby achieving recovery. Immunodeficiency related to COVID‐19 and its treatment might contribute to secondary skin and subcutaneous bacterial infections.

Abstract Background Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examined the distinctions between ABPA with and without CEP-like shadows. Methods This retrospective cohort study from a single center included 25 outpatients (median age, 65 years) with ABPA diagnosed between April 2015 and March 2019, using criteria proposed by the International Society of Human and Animal Mycology (ISHAM), which focuses on positive specific IgE for Aspergillus fumigatus. Patients were assigned to either the eosinophilic pneumonia (EP) group or Non-EP group, defined according to findings on high-resolution computed tomography (HRCT). The EP group included patients with HRCT findings compatible with CEP; i.e., the presence of peripheral consolidation (p-consolidation) or ground-glass opacities (GGO), with no evidence of high-attenuation mucus. The Non-EP group comprised the remaining patients, who showed classical findings of ABPA such as mucoid impaction. Differences between the groups were analyzed. Results Baseline characteristics, frequency of a history of CEP (EP, 50% vs. Non-EP, 26%) and tentative diagnosis of CEP before diagnosis of ABPA (67% vs. 16%) did not differ significantly between groups. Although elevated absolute eosinophil count and Aspergillus-specific immunoglobulin E titers did not differ significantly between groups, the Non-EP group showed a strong positive correlation between these values (R = 0.7878, p = 0.0003). The Non-EP group displayed significantly higher levels of the fungal marker beta-D glucan (median, 11.7 pg/ml; interquartile range, 6.7–18.4 pg/ml) than the EP group (median, 6.6 pg/ml; interquartile range, 5.2–9.3 pg/ml). Both groups exhibited frequent recurrence of shadows on X-rays but no cases in the EP group had progressed to the Non-EP group at the time of relapse. Conclusions The ABPA subgroup with imaging findings resembling CEP experienced frequent recurrences, as in typical ABPA. In pulmonary eosinophilia, even if there are no shadows indicating apparent mucous change, the Aspergillus-specific immunoglobulin E level is important in obtaining an accurate diagnosis and in the selection of appropriate therapies for this type of ABPA.

Objective To assess the potential benefit of a behavioural change programme in working individuals with chronic pain or headache, in the form of increased physician consultation.Design Retrospective observational database study.Setting Members of employment-based healthcare insurance in Japan.Participants Individual-level data of working individuals aged

Messenger RNA (mRNA) vaccines that protect against COVID-19 are widely used in many countries owing to their high efficacy and safety profiles. Recently, few severe adverse events, such as anaphylaxis and myocarditis, were reported in healthy individuals. The safety of mRNA COVID-19 vaccines has not been adequately studied in patients with interstitial lung disease. We report 2 cases of acute exacerbation of preexisting interstitial pneumonia associated with mRNA COVID-19 vaccination. In both cases, lung disease was stable before the vaccination. Initial responses to steroid therapy were unfavorable, and intravenous cyclophosphamide was administered in both cases. Both patients were diagnosed with vaccine-related exacerbation of interstitial pneumonia based on laboratory results, radiologic features, and the observed clinical course, which lacked other causative events. We suggest that clinicians should note the possibility of acute exacerbation of pneumonia after mRNA COVID-19 vaccination and carefully monitor patients with interstitial lung disease.

Abstract We investigated the prevalence of magnetic resonance imaging (MRI) findings and their relationship with knee symptoms in women without radiographic evidence of knee osteoarthritis (KOA). This cross-sectional cohort study included 359 Japanese women without radiographic evidence of KOA (Kellgren‒Lawrence grade

Abstract Pulmonary pleomorphic carcinoma is a rare malignant tumor that grows rapidly and has a poor prognosis. Although no effective treatments have so far been established, immune checkpoint inhibitors (ICIs) have shown clinical improvement in some cases of pleomorphic carcinoma. However, pseudoprogression is a major concern for treatment of this carcinoma using ICIs. Here, we report the case of a 61‐year‐old man who was diagnosed with large cell carcinoma of the lung with brain metastases. Systemic chemotherapy comprising carboplatin and pemetrexed was administered as a first‐line therapy; however, disease progression was observed. A tonsillar lesion grew rapidly after the administration of nivolumab as a second‐line therapy. Tracheostomy was planned to avoid suffocation, but the patient naturally expectorated the tumor. Pathological examination revealed that it was a palatine tonsillar metastasis of pulmonary pleomorphic carcinoma with infiltration of CD8+/CD4‐ lymphocytes and necrosis. The primary lesion expanded after nivolumab administration and shrank with no additional nivolumab administration. We therefore concluded that pseudoprogression caused expectoration of the tonsillar metastasis. Hence, ICIs can cause serious adverse events due to pseudoprogression.

The design and construction of advanced semiconductor devices relies on the formation of nanostructures with spatially engineered compositions. Here, the authors use phase-field simulations combined with experimental data to understand how to control and utilise phase segregation in SiGe alloys by laser processing for fabrication of in-plane heterostructures.

Developing the competence to share intentions with others is an important role of elementary schools for the children’s future well-being. We analyzed and clarified the relationship between physical and cognitive tasks that require collaborative solving to cultivate the skill of sharing intentions with others through human movement. As a physical task, we designed a tag game in which two defenders prevented three attackers from passing through to reach the goal line. We focused on the defenders’ movement in the game and analyzed the efficiency of each defender’s movement as an individual behavior and the interpersonal distance between these two defenders as a pair behavior. As a cognitive task, we examined pair activities when understanding concepts in math classes. We observed talking and listening behaviors during the pair activities and analyzed the responsive behavior as an individual behavior, which comprised responsive utterances and active listening from the listener’s gaze direction. Role change during pair activities in math lessons was analyzed as a pair behavior. We then analyzed the relationship between behaviors in both tasks. The hypotheses were as follows: (1) task constraints lead to an interaction between individual and pair behaviors in both tasks and (2) individual and pair behaviors in the two tasks have similar characteristics. The results from both tasks support the first hypothesis that the efficiencies of individual movement and interpersonal distance in the tag game and the frequencies of responsive behavior and role changes in the pair activities in math classes are positively correlated. The results also support the second hypothesis that the individual and pair behaviors in the two tasks are significantly correlated. These results suggest that the competence to share intention with others is fundamental regardless of the task nature: physical or cognitive. The findings suggest that the task constraints of joint action in physical education lead to an understanding of the task goals and to exploring the solution for winning. These experiences might be generalized to all cognitive tasks for cultivating the competence to share intentions with others.

Abstract Background The objectives of this study were to assess radiolucent lines around a highly porous titanium cup (Tritanium) using digital tomosynthesis and to investigate the clinical and radiographic factors associated with radiolucent lines on tomosynthesis. Methods Fifty-five patients underwent total hip arthroplasty using a Tritanium cup, and digital tomosynthesis and plain radiography were performed at 1 week, 6 months, 1 year, and 2 years after surgery. The radiolucent lines around the cup were measured on both DTS and plain radiography at each postoperative period. Clinical evaluations were performed by the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ), and revision surgeries were examined. Based on the presence of radiolucent lines on digital tomosynthesis at 2 years postoperatively, patients were divided into RL (+) and RL (−) groups and investigated for related factors. Results There were 20 cases in the RL (+) group and 35 cases in the RL (−) group, and no revision surgeries were required. Statistically, there were more cases with radiolucent lines on digital tomosynthesis (45.4% at 1 week and 36.3% at 2 years) than on plain radiography (9.1% at 1 week and 9.1% at 2 years) at each postoperative point. Logistic analysis showed no significant associations between the presence of radiolucent lines at 2 years on digital tomosynthesis, and the JHEQ parameters of pain (p = 0.937), movement (p = 0.266), or mental status (p = 0.404). Conclusion In a short-term evaluation up to 2 years, digital tomosynthesis detected more radiolucent lines around the titanium cups than plain radiography. The occurrence of radiolucent lines was not related to the postoperative clinical evaluation.

Background: Repetitive mechanical stress on the elbow joint during throwing is a cause of ulnar collateral ligament dysfunction that may increase the compressive force on the humeral capitellum. This study aimed to examine the effects of ulnar collateral ligament material properties on the humeral capitellum under valgus stress using the finite element method. Methods: Computed tomography data of the dominant elbow of five healthy adults were used to create finite element models. The elbows were kept at 90° of flexion with the forearm in the neutral position, and the ulnar collateral ligament was reproduced using truss elements. The proximal humeral shaft was restrained, and valgus torque of 40 N·m was applied to the forearm. The ulnar collateral ligament condition was changed to simulate ulnar collateral ligament dysfunction. Ulnar collateral ligament stiffness values were changed to 72.3 N/mm, 63.3 N/mm, 54.2 N/mm, 45.2 N/mm, and 36.1 N/mm to simulate ulnar collateral ligament laxity. The ulnar collateral ligament toe region width was changed in increments of 0.5 mm from 0.0 to 2.5 mm to simulate ulnar collateral ligament loosening. We assessed the maximum equivalent stress and stress distribution on the humeral capitellum under these conditions. Results: As ulnar collateral ligament stiffness decreased, the maximum equivalent stress on the humeral capitellum gradually increased under elbow valgus stress (P < .001). Regarding the change in the ulnar collateral ligament toe region width, as the toe region elongated, the maximum equivalent stress of the humeral capitellum increased significantly under elbow valgus stress (P < .001). On the capitellum, the equivalent stress on the most lateral part was significantly higher than that on other parts (P < .01 for all). Conclusion: Under elbow valgus stress with elbow flexion of 90° and the forearm in the neutral position, ulnar collateral ligament dysfunction increased equivalent stress on the humeral capitellum during the finite element analysis. The highest equivalent stress was noted on the lateral part of the capitellum.

Abstract A recent epidemiological study revealed that the highest prevalence of early knee osteoarthritis (OA) was observed in females aged ≥ 50 years. The major causal factor of early knee OA was sex. Despite the relevance of estrogen in evaluating chondral and bone metabolism in OA, it is not easily clinically monitored because irregular menstrual cycles induce unstable female hormone patterns during menopausal transitions. Anti-Mullerian hormone (AMH) has been found to be a new stable biomarker to predict menopause. This study aimed to investigate the association between menopausal transition and early knee OA by using serum biomarkers, with special focus on AMH. A total of 518 female volunteers who participated in the Iwaki cohort study were enrolled and divided into pre-menopause and post-menopause groups. Weight-bearing anterior–posterior knee radiographs were classified by Kellgren–Lawrence (KL) grade, and grade ≥ 2 was defined as radiographic knee OA. In participants with KL grades 0 and 1, early knee OA was defined by Luyten’s criteria. AMH, luteinizing hormone, follicle-stimulating hormone, estradiol (pg/ml), prolactin, and testosterone were measured on the female hormones. Bone mineral density at a distal radius was measured. The predictive power of female hormones for early knee OA was estimated by ROC analysis (comparison of area under curve, AUC) and regression analysis. Fifty-two participants (10.0%) were diagnosed with early knee OA and 204 (39.4%) with radiographic knee OA. In 393 (75.9%) females, menopause began. From the ROC analysis in pre-menopausal females, cutoff value of AMH for detecting early knee OA was 0.08 ng/ml (area under curve (AUC), 0.712; 95% CI, 0.527–0.897; p value, 0.025; odds ratio, 8.28). AUCs of other female hormones did not reach the level of AMH (range, 0.513 of prolactine to 0.636 of estradiol). Logistic regression analysis focusing on AMH reduction at menopausal transition showed that the related AMH below 0.08 ng/ml was significantly related to the presence of early knee OA (p = 0.035; odds ratio, 5.55). Reduced serum levels of AMH in middle-aged females were correlated with the presence of early knee OA, which might be a useful serum biomarker.

We have demonstrated the high–density formation of super–atom–like Si quantum dots with Ge–core on ultrathin SiO2 with control of high–selective chemical–vapor deposition and applied them to an active layer of light–emitting diodes (LEDs). Through luminescence measurements, we have reported characteristics carrier confinement and recombination properties in the Ge–core, reflecting the type II energy band discontinuity between the Si–clad and Ge–core. Additionally, under forward bias conditions over a threshold bias for LEDs, electroluminescence becomes observable at room temperature in the near–infrared region and is attributed to radiative recombination between quantized states in the Ge–core with a deep potential well for holes caused by electron/hole simultaneous injection from the gate and substrate, respectively. The results will lead to the development of Si–based light–emitting devices that are highly compatible with Si–ultra–large–scale integration processing, which has been believed to have extreme difficulty in realizing silicon photonics.

Abstract There are no previous reports of hepatic granuloma secondary to intraoperative liver retraction. Using softer hepatic retraction instruments and keeping hepatic retraction time to a minimum are vital in preventing postoperative liver damage.

Abstract High-need, high-cost (HNHC) patients—usually defined as those who account for the top 5% of annual healthcare costs—use as much as half of the total healthcare costs. Accurately predicting future HNHC patients and designing targeted interventions for them has the potential to effectively control rapidly growing healthcare expenditures. To achieve this goal, we used a nationally representative random sample of the working-age population who underwent a screening program in Japan in 2013–2016, and developed five machine-learning-based prediction models for HNHC patients in the subsequent year. Predictors include demographics, blood pressure, laboratory tests (e.g., HbA1c, LDL-C, and AST), survey responses (e.g., smoking status, medications, and past medical history), and annual healthcare cost in the prior year. Our prediction models for HNHC patients combining clinical data from the national screening program with claims data showed a c-statistics of 0.84 (95%CI, 0.83–0.86), and overperformed traditional prediction models relying only on claims data.

Background Pirfenidone is an antifibrotic agent that is potentially effective for the treatment of idiopathic pulmonary fibrosis (IPF). However, no study has reported on its prophylactic value against chemotherapy‐associated acute IPF exacerbations when combined with chemotherapy for non‐small cell lung cancer (NSCLC). The present study assessed the safety and effectiveness of pirfenidone combined with carboplatin‐based chemotherapy or immune checkpoint inhibitors (ICIs) in patients with IPF and NSCLC. Methods A total of 14 patients with IPF and NSCLC who received treatment from 2013 to 2019 were included. Patients were treated with pirfenidone combined with carboplatin and nanoparticle albumin‐bound paclitaxel or S‐1 as first‐line chemotherapy. After confirming disease progression, patients received cytotoxic agents or ICIs, including nivolumab and pembrolizumab. Pirfenidone was continued regardless of chemotherapy changes. Overall survival (OS) and progression‐free survival (PFS) for lung cancer and IPF were calculated. Moreover, the cumulative incidence of acute exacerbation of IPF (AE‐IPF) within one year was evaluated. Results Median PFS for lung cancer was 110 days (95% confidence interval [CI]: 57–199 days), while the median OS was 362 days (95% CI: 220–526 days). Moreover, PFS for IPF was 447 days (95% CI: 286–indeterminate days), and the cumulative incidence of AE‐IPF within one year was 18%. Notably, none of the patients developed AE‐IPF associated with first‐line chemotherapy. Among the included patients, four received ICIs, none of whom developed ICI‐associated AE‐IPF. Conclusions The present study found that pirfenidone combined with carboplatin‐based regimens or ICIs might be safe first‐line chemotherapy for patients with IPF and NSCLC. Key points Significant findings of the study No patients with IPF and NSCLC who received pirfenidone in combination with first‐line carboplatin‐based chemotherapy or late‐line ICIs developed acute IPF exacerbations. What this study adds Pirfenidone might have a prophylactic effect against chemotherapy‐associated AE‐IPF.

Abstract Background The purpose of this study is to compare the outcomes of acute primary repair of extraarticular ligaments with staged surgery for acute knee dislocations (KDs) and multiligament knee injuries (MLKIs). Materials and methods Between January 2005 and May 2018, 61 consecutive patients diagnosed with MLKI or KD were referred to or visited our institution. Of these, 31 patients who underwent acute repair of extraarticular ligaments within 3 weeks of injury were included in this study. These patients were retrospectively classified into two groups: those who underwent only primary repair (repair group) and those who underwent staged reconstructive surgery (staged group). Follow-up examination included range of motion (ROM), knee joint stability (Lachman test, posterior drawer test, and varus and valgus stress test), Lysholm knee score, Tegner activity scale, and Knee Injury and Osteoarthritis and Outcome Score (KOOS). Results Twelve of the 31 patients did not need or desire further surgery and were included in the repair group. No significant difference was observed in demographic data between the repair and staged groups. Although staged surgery decreased positive posterior drawer test results, no significant difference was observed between the two groups regarding ROM, other knee joint stability tests, Lysholm scores, Tegner scale, or KOOS. Conclusions In this series, all patients returned to their activities of daily living and preinjury occupation levels. Acute primary repair of extraarticular ligaments provides essential knee stability without varus/valgus instability and may reduce the need for subsequent cruciate ligament reconstruction. Level of evidence Level IV, retrospective observational study.

Abstract Background Treating a titanium or titanium alloy implant with ultraviolet (UV) light is known to improve its associated cell growth and osseointegration. However, little is known about the effect of UV irradiation on hydroxyapatite (HA), which is also used frequently in orthopaedic and dental surgery. Here we examined the effect of UV irradiation on the hydrophilicity of HA, and on its osteoconduction ability in rats. Methods HA implants of low and high porosity were treated with UV light, and photofunctionalisation was assessed by the contact angle of a water drop on the surface. HA implants were also inserted into rat femurs, and the rats were killed 2 or 4 weeks later. The bone volume and bone area ratio were calculated from microcomputed tomography and histological data. Results The contact angle of a water drop on HA implants of both porosities was significantly reduced after UV irradiation. In the rat femurs, there was no significant difference in the bone volume between the UV light-treated and control implants at 2 or 4 weeks. The bone area ratio for the UV light-treated versus control implants was significantly increased at 2 weeks, but there was no significant difference at 4 weeks. Conclusions The surface of UV-irradiated HA disks was hydrophilic, in contrast to that of non-irradiated HA disks. Photofunctionalisation accelerated the increase in the bone area ratio in the early healing stage. This technology can be applied to surgical cases requiring the early fusion of bone and HA.

Abstract Background Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) has been reported to be associated with favorable outcomes. However, little is known regarding the risk and prognostic factors for refractory and recurrent cases. We aimed to evaluate the overall impact and benefit of adjuvant lung surgery by comparing NTM-PD patients who underwent adjuvant lung resection with those treated exclusively with antibiotics. We also investigated the efficacy of serum IgA antibody against glycopeptidolipid (GPL) core antigen (GPL core antibody) to monitor disease activity and predict the recurrence of disease after adjuvant lung resection. Methods We retrospectively evaluated the clinical characteristics and surgical outcomes of 35 patients surgically treated for NTM-PD. Furthermore, we compared surgically treated patients and control patients treated exclusively with antibiotics who were matched statistically 1:1 using a propensity score calculated from age, sex, body mass index, and radiologic features of disease. Results In the surgically treated patients, the median age was 58 (interquartile range, 47–65) years and 65.7% were female. Twenty-eight patients had Mycobacterium avium complex. Operations comprised four pneumonectomies, two bilobectomies, one bilobectomy plus segmentectomy, 17 lobectomies, two segmentectomies, and nine lobectomies plus segmentectomies. Postoperative complications occurred in seven patients (20%), there were no operative deaths, and 33 (94.3%) patients achieved negative sputum culture conversion. Refractory and recurrent cases were associated with remnant bronchiectasis, contralateral shadows, and positive acid-fast bacilli staining or culture. Of 28 statistically matched pairs, long-term sustained negative culture conversion was observed in 23 (82.2%) surgical group patients and in 14 (50.0%) non-surgical group patients (0.0438). The mortality rate was lower in the surgical group, but did not reach statistical significance (one in the surgical group and four in the non-surgical group, p = 0.3516). GPL core antibody was correlated with disease activity and recurrence. Conclusions NTM-PD patients who underwent adjuvant lung resection experienced overall favorable outcomes and achieved sputum culture conversion more frequently. Long-term mortality may have been reduced by this procedure, and the level of GPL core antibody was shown to be a good clinical indicator of disease activity after surgery.

In a table tennis rally, players perform interceptive actions on a moving ball continuously in a short time, such that the acquisition process of visual information is an important determinant of the performance of the action. However, because it is technically hard to measure gaze movement in a real game, little is known about how gaze behavior is conducted during the continuous visuomotor actions and contributes to the performance. To examine these points, we constructed a novel psychophysical experiment model enabling a continuous visuomotor task without spatial movement of any body parts, including the arm and head, and recorded the movement of the gaze and effector simultaneously at high spatiotemporal resolution. In the task, Gabor patches (target) moved one after another at a constant speed from right to left at random vertical positions on an LC display. Participants hit the target with a cursor moving vertically on the left side of the display by controlling their prehensile force on a force sensor. Participants hit the target with the cursor using a rapid-approaching movement (rapid cursor approach, RCA). Their gaze also showed rapid saccadic approaching movement (saccadic eye approach, SEA), reaching the predicted arrival point of the target earlier than the cursor. The RCA reached in or near the Hit zone in the successful (Hit) trial, but ended up away from it in the unsuccessful (Miss) trial, suggesting the spatial accuracy of the RCA determines the task's success. The SEA in the Hit trial ended nearer the target than the Miss trial. The spatial accuracy of the RCA diminished when the target disappeared 100 ms just after the end of the SEA, suggesting that visual information acquired after the saccade acted as feedback information to correct the cursor movement online for the cursor to reach the target. There was a target speed condition that the target disappearance did not compromise RCA's spatial accuracy, implying the possible RCA correction based on the post-saccadic gaze location information. These experiments clarified that gaze behavior conducted during fast continuous visuomotor actions enables online correction of the ongoing interceptive movement of an effector, improving visuomotor performance.

Pure red cell aplasia (PRCA), Good's syndrome (GS), and thymoma-associated multiorgan autoimmunity (TAMA) are associated with thymoma. Herein, we describe the case of a 56-year-old woman with PRCA, GS, and TAMA simultaneously. She was treated with cyclosporine, immunoglobulin supplementation, and prednisolone; however, she died of uncontrolled sepsis due to extreme immunosuppression. The combination of these three diseases is likely to lead to fatal infections, and to avoid such infections, it may be necessary to reduce or discontinue immunosuppressants and steroids as soon as possible if the diseases are controlled, as well as regular immunoglobulin supplementation.

Osteochondral lesions of the tarsal navicular bone are rare. The pathogenesis of osteochondral lesions of the tarsal navicular involves direct trauma to the tarsal navicular joint and repetitive trauma caused by excessive shear force, including a stress fracture. Osteochondral autograft transplantation (OAT) has emerged as a surgical treatment option for osteochondral lesions of the knee, ankle, and elbow joints. This report discusses the surgical treatment of an osteochondral lesion in the tarsal navicular bone of a 16-year-old track and field jumper. The patient was surgically treated with curettage of the osteochondral lesion at the center of the tarsal navicular and OAT. Computed tomography images 3 months postoperatively revealed adequate bone-to-bone healing of the graft and tarsal navicular joint surface. He returned to track and field competition without experiencing foot pain for 10 postoperative months. No symptom recurrence was observed during the 4-year follow-up. Based on the results of this case, we recommend OAT as a viable treatment option for patients with isolated cartilage lesion of the navicular bone (without fracture line) that does not respond to conservative treatment.

This study examined the descriptive parameters for separation and recombination processes in a cycling points race. The candidate descriptive parameters were the speed of the leading cyclist and the main group and the difference between their time and speed. We focused on the transition between the four states of peloton configuration (dense state, stretched state, divided state, and escape and dense state) defined by previous studies that occur during the points race. As a result, it was found that the distribution of the leader’s velocity and the speed difference significantly differed when the groups were separated and recombined compared to when the state did not change. It was also examined whether the separation and recombination processes had a phenomenon such as a hysteresis depending on the present state. Regarding the leader velocity and the speed difference between the leader and the main group, the state of the group was not uniquely determined by the speed difference, and the influence of the speed difference for separation or recombination depended on the state; that is, there was asymmetry in separation and recombination in a points race. These suggest that the cyclists need the ability to choose an appropriate speed and distance from other cyclists depending on the situation.

Purpose: To investigate the clinical outcomes following meniscus allograft transplantation (MAT) to replace removed discoid lateral meniscus using intact lateral meniscus obtained from patients undergoing total knee arthroplasty for medial compartment osteoarthritis. Methods: Pediatric patients who underwent MAT secondary to partial or total meniscectomy due to discoid lateral meniscus between August 2010 and November 2018 were identified. Lateral menisci with bone blocks were transplanted arthroscopically. The demographic data, range of motion, meniscal allograft failure, which was defined as removal of an implanted meniscus, and complications were recorded. The Lysholm score and the Kellgren-Lawrence (KL) grade on radiographs were evaluated preoperatively and at final follow-up. The Knee injury and Osteoarthritis Outcome Score was evaluated in the final follow-up. Results: Eight patients who were symptomatic after discoid lateral meniscectomy were included. Donated allografts were harvested from adult patients aged between 64 and 78 years (mean 70.5 years). The mean age at previous meniscectomy and MAT were 10.5 and 18.1 years, respectively. All patients were followed up for a mean time of 5.2 years, and there were no cases of meniscus failure and complication. The Lysholm score significantly improved from preoperative to the final follow-up. Preoperatively, 6 and 2 knees were of KL grades II and III, respectively. At final follow-up, no increased KL grade was observed in 5 patients; however, an increase by 1 grade was observed in 2 patients and an increase by 2 grades was observed in 1 patient. The Knee injury and Osteoarthritis Outcome Scores at the final follow-up were 87.2 for pain, 87.9 for symptoms, 95.4 for activities of daily living, 79.4 for sports, and 65.6 for quality of life. Conclusions: Older lateral meniscus allografts obtained from knees of adult patients undergoing total knee arthroplasty and transplanted into younger patients with defects from discoid lateral meniscectomy resulted in improved Lysholm scores but no improvement in Tegner scores or knee motion. KL grades were unchanged in 5 of the 8 patients at the final follow-up. Level of Evidence: IV, therapeutic case series.

Objectives There have been concerns that patients with chronic conditions may be avoiding in-person physician visits due to fear of COVID-19, leading to lower quality of care. We aimed to investigate changes in physician visits and medication prescriptions for chronic diseases before and during the COVID-19 pandemic at the population level.Design Retrospective cohort study.Setting Nationwide claims data in Japan, 2018–2020.Participants Working-age population (aged 18–74 years) who visited physicians and received any prescriptions for major chronic diseases (hypertension, diabetes and dyslipidaemia) before the pandemic.Outcome measures The outcomes were the monthly number of physician visits, the monthly proportion of physician visits and the monthly proportion of days covered by prescribed medication (PDC) during the pandemic (April–May 2020, as the first state of emergency over COVID-19 was declared on 7 April, and withdrawn nationally on 25 May).Results Among 10 346 patients who visited physicians for chronic diseases before the pandemic, we found a temporary decline in physician visits (mean number of visits was 1.9 in March vs 1.7 in April; p

Abstract Background The etiology of bone marrow lesions (BMLs) without knee osteoarthritis (KOA) and their association with bone fragility are unclear. We aimed to investigate the association between BMLs, bone mineral density (BMD), and bone markers in women without radiographic evidence of KOA. Methods This single-center cross-sectional study in a Japanese population included 266 women without radiographic evidence of KOA, which was defined as a Kellgren-Lawrence grade

The association between Mycobacterium avium complex pulmonary disease (MAC-PD) and pleuroparenchymal fibroelastosis (PPFE) has been reported previously, and interstitial pneumonia as a comorbidity is associated with a worse prognosis. However, no study has thoroughly reported on PPFE associated with MAC-PD. The present study investigated the prevalence, clinical characteristics, and prognostic impact of PPFE in patients with MAC-PD. A total of 224 patients, newly diagnosed with MAC-PD, were retrospectively reviewed. At the time of diagnosis, chest high-resolution computed tomography (HRCT), sputum examination, and clinical characteristics were collected. The extent of PPFE and MAC-PD was evaluated semi-quantitatively using HRCT scores. Risk factor analysis for clinical or radiological deterioration necessitating multidrug antimicrobial treatment within 3 years, and all-cause mortality within 5 years, from the initial diagnosis was performed based on the PPFE score. PPFE was observed in 59 out of 224 patients (26.3%). A higher PPFE score was a risk factor for dyspnoea, fatigue, and lower body mass index (BMI) (p

Abstract Purpose The purpose of this study was to examine the effect of simple core muscle training (CMT) program on trunk muscle strength and neuromuscular control among pediatric athletes. Methods Forty‐nine male soccer players (mean age, 10.8 years) participated. The CMT program had three components (bench, side bench, and Nordic hamstrings) and was performed at least three times weekly for a year. Trunk flexion/extension muscle strength and the K/H ratio (determined by dividing knee separation distance by hip separation distance during drop‐jump test and used as an index of lower limb valgus alignment) were measured, and the Y balance test (YBT) was performed before and after intervention. This study did not include the pure control group among the same team. To consider the effect of CMT on trunk muscle strength due to physical growth, we used the data of trunk muscle strength from the local cohort study previously conducted in our institution. One hundred participants who matched the age, height, body weight, and body mass index of the training group was designated as a control group. Results In the training group, the trunk flexion/extension strength significantly increased at 6 months (p