城戸 顕

BACKGROUND: In haemophilia, recurrent joint bleeding often results in joint destruction, which in turn leads to reduced physical activity (PA) and decreased quality of life (QOL). While maintaining high PA levels is important in the care of people with haemophilia (PwH), it remains unclear whether PwH without joint disease can maintain adequate activity levels. AIM: This descriptive cross-sectional study sought to compare moderate-to-vigorous physical activity (MVPA) levels among 19 PwH with haemophilic arthropathy (HA), 12 PwH without HA, and 15 non-PwH. METHODS: A total of 46 males wore a triaxial accelerometer (wGT3X-BT, ActiGraph) during daily activities for seven consecutive days. A bout of MVPA was defined as at least 10 consecutive minutes of moderate-intensity or higher activity. MVPA was expressed as the percentage of the total wear time spent in MVPA, and the total number of MVPA bouts was also recorded. RESULTS: Both PwH groups demonstrated significantly lower MVPA percentages and fewer MVPA bouts than the controls (p < 0.01). No MVPA bouts were recorded among 52.6% of PwH with HA versus 25% of PwH without HA. No significant differences were observed in sedentary or light activity between the PwH groups. CONCLUSIONS: PA levels were significantly reduced in PwH, regardless of joint status, suggesting that factors beyond joint damage, such as fear of bleeding or behavioural avoidance, may play a role. These findings highlight the need for individualized, evidence-based interventions to safely promote physical activity and improve long-term health outcomes in PwH.

BACKGROUND: Recent advancements in haemophilia treatment have dramatically reduced the frequency of symptomatic bleeding. However, minor, asymptomatic bleeding may contribute to the progression of joint damage and decrease quality of life. Detecting small amounts of blood with minimal flow is difficult using existing testing methods, necessitating the development of new diagnostic approaches. AIM: To determine whether tiny amounts of blood injected subcutaneously, intramuscularly, and intra-articularly can be detected in a pig to assess the feasibility of detecting microbleeds in people with haemophilia. METHODS: Pig whole blood was injected subcutaneously, intramuscularly, and intra-articularly into the isolated hind limbs of pigs. Photoacoustic imaging (PAI) was performed using an Acoustic X device (CYBERDYNE INC, Tsukuba, Japan) to detect blood signals. RESULTS: Following the injection of 200 µL of blood, conventional ultrasound imaging revealed no discernible changes, such as echo-free spaces. Conversely, on PAI, a signal indicating the presence of blood was detected. CONCLUSIONS: We have demonstrated that even very small amounts of nonflowing blood injected into the subcutaneous tissue, muscle, and joint of the hind limbs of pigs can be detected using PAI. We believe that the results of this study show the potential of this technique for detecting microbleeds in people with haemophilia. TRIAL REGISTRATION: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12959-026-00852-x.

Background Previous studies have reported the characteristics of rehabilitation therapy and physical restraint use in patients with neurocognitive disorders during the acute phase, based on three years of clinical records from dementia care team rounds at our hospital. The incidence of neurocognitive disorders varies by disease group, and the degree of physical restraint is significantly associated with the intensity of the rehabilitation therapy. Among the disease groups addressed in this study, we were particularly interested in cardiovascular diseases. In patients with cardiovascular disease, which is associated with high clinical acuity and disease severity, the presence of neurocognitive disorders may affect the prognosis. This study aimed to clarify the incidence of neurocognitive impairment (including delirium) in patients with cardiovascular disease and its characteristics with respect to rehabilitation therapy and physical restraint. Methods We examined data from dementia care team rounds conducted between July 1, 2021, and October 7, 2024, to identify relationships between clinicopathological characteristics, rehabilitation therapy, and physical restraint status. Cardiovascular diseases were classified into nine subgroups: ischemic diseases; arrhythmia; heart failure; valvular heart disease; acute pericarditis; aortic diseases; peripheral vascular diseases; and renal, carotid, and subclavian artery diseases. The treatment modalities were categorized as conservative management, pacemaker implantation (PM), percutaneous coronary intervention (PCI), minimally invasive surgery (MIS; including endovascular aneurysm repair and endovascular thoracic aortic repair), thoracotomy, and laparotomy. Cognitive function was assessed weekly, and patients whose neurocognitive disorders improved sufficiently were excluded from the dementia care team. Chi-square (χ²) tests were used to assess the associations between the variables. Results A total of 101 patients with cardiovascular disease underwent 379 rounds. Significant differences in treatment selection were observed between the disease groups (p < 0.0001). Significant differences in the number of dementia rounds were also observed between treatment groups, with more rounds occurring in patients who received invasive treatment (p = 0.019). No significant differences in the number of neurocognitive disorder episodes, training intensity, or physical restraint intensity were identified between the treatment groups. Patients who received stronger physical restraints generally underwent high-intensity training (p = 0.015). Conclusions Patients with cardiovascular diseases who received more invasive treatments generally received more dementia care team rounds, suggesting a possible association with prolonged neurocognitive disorders. Most patients who were subjected to stronger physical restraints could undergo intensive rehabilitation, suggesting that increased staffing levels could reduce the need for physical restraints.

Rehabilitation after radical gastrectomy or esophagectomy for upper gastrointestinal cancer can improve physical function and quality of life; however, objective day-to-day measures of psychological change are lacking. We aimed to test whether facial emotion analysis can quantitatively evaluate patients' emotional responses before and after each rehabilitation session and whether these changes relate to conventional subjective/physiological stress markers and discharge physical outcomes. We conducted a single-center prospective observational study of 32 patients who underwent radical gastrectomy or esophagectomy between August 2024 and February 2025. Immediately before and after each rehabilitation session, 30 s iPad video interviews (median, six per patient) were recorded and analyzed using MAL Face Emotion software to obtain normalized scores (0%-100%) for Neutral, Happy, Sad, Angry, and Surprised emotions. Subjective stress (0-100 mm visual analog scale) and salivary α-amylase activity were collected concurrently; discharge physical function was assessed using the 6 min walk distance and Five Times Sit-to-Stand tests. Pre- and post-session values were compared using Wilcoxon signed-rank tests, and associations were examined with age-adjusted regression and Spearman correlation. Thirty-one patients completed the study without adverse events. After rehabilitation, the Happy score increased (median +3.5%, p = 0.013) and stress decreased (-1.5 mm, p = 0.025), whereas salivary α-amylase and other emotions were unchanged. Changes in the Happy score (p = 0.21) and stress (p = 0.19) did not predict discharge physical function, whereas changes in the Sad score correlated moderately with changes in salivary α-amylase (ρ = 0.45). The findings of this single-center study provide preliminary evidence supporting the feasibility of facial emotion analysis as a non-invasive, quantitative tool for real-time psychological monitoring during postoperative rehabilitation. Furthermore, our results demonstrate its potential to support a more personalized delivery of cancer rehabilitation.

BACKGROUND: Haemophilia, caused by deficiencies in factor VIII or IX, leads to deep tissue bleeding and haemophilic arthropathy. Bleeding, arthropathy, and the perioperative period of surgery for arthropathy are associated with severe pain. To avoid this pain, patients may compensate by overloading other parts of the body, potentially resulting in pain or secondary damage in areas distant from the primary site. This study investigates the use of infrared thermography (IRT) to monitor whole-body surface temperatures in people with haemophilia and to explore the potential of infrared thermography for early detection of compensatory overload. METHODS: A cross-sectional study involved 24 people with haemophilia aged 6-76 years old, experiencing pain after bleeding, post-orthopaedic surgery, or haemophilic arthropathy. Thermal images were captured with IRT and analyzed using software that utilises deep learning for whole-body temperature mapping. RESULTS: Increases in temperature indicative of overload were observed in areas distant from the affected site, either on the same side (vertical pattern) or on the opposite side (diagonal pattern) relative to the site of pain. These patterns were observed in 13 of 14 participants with haemophilic arthropathy, all post-orthopaedic surgery participants, and 5 of 6 after bleeding. CONCLUSIONS: Temperature increases occurred in areas beyond the painful area, suggesting strain even in asymptomatic regions. People with haemophilia experiencing pain may require careful monitoring and treatment of surrounding areas. Our findings could aid in diagnosing haemorrhage and local inflammation while informing treatment decisions. CLINICAL TRIAL REGISTRATION: Not applicable.

PURPOSE: Patients with metastatic chondrosarcoma at presentation have a poor prognosis. Owing to the lack of sensitivity to chemotherapy and radiotherapy, surgical resection is the mainstay of treatment of localized chondrosarcoma. The aim of this study was to investigate whether surgical resection of the primary site was associated with improved survival in patients with metastatic chondrosarcoma at presentation. METHODS: Sixty-two patients with distant metastases at initial diagnosis who were pathologically diagnosed with grade 2 or 3 conventional chondrosarcoma, dedifferentiated chondrosarcoma, or mesenchymal chondrosarcoma between 2001 and 2022 and registered in the Japanese National Bone and Soft Tissue Tumour Registry database were analysed retrospectively. Propensity score matching was performed to correct for differences in background characteristics, including the number of organs affected by metastases, performance of metastasectomy, and performance of chemotherapy, between patients who underwent surgical resection of the primary site (N = 31) and those who did not (N = 31). RESULTS: The median disease-specific survival was six months for the whole cohort, 12 months for the patients who underwent surgical resection of the primary site, and two months for the patients who did not. Overall, 37 patients (59.7%) died of the disease. Univariate analysis showed a better disease-specific survival for patients who underwent surgical resection of the primary site compared with patients who did not (2-year disease-specific survival 51.0% [95% CI: 32.3-69.4] vs. 19.3% [95% CI: 6.9-43.7]; P = 0.005). CONCLUSION: Surgical resection of the primary site may increase the survival of patients with metastatic chondrosarcoma at presentation.

The risk of falls increases with age, particularly in patients with osteoarthritis (OA). We aimed to investigate the relationships of fall history and spatiotemporal parameters in patients with hip and knee OA. This cross-sectional study included 51 patients with hip or knee OA. Fall history over the past year was recorded, and the centre of pressure (COP) parameters of gait and standing were assessed using the FDM-T treadmill. Comparisons were made between the fall and non-fall groups. Compared with the non-fall group, the fall group exhibited significant posterior displacement of the COP intersection during gait (p = 0.001). In hip OA patients, significant age, anterior‒posterior symmetry, and variability differences were observed. In knee OA patients, anterior‒posterior symmetry and lateral variability showed significant between-group differences. This study revealed a significant association between posterior COP displacement during gait and fall history. This parameter may serve as a novel fall indicator. Further prospective studies are needed to determine its predictive value for fall prevention.

BACKGROUND: Advances in hemophilia treatment have reduced bleeding episodes in patients with hemophilia (PWH) and improved their musculoskeletal prognosis; however, complete prevention of musculoskeletal disorders has not been achieved. Recently, the usefulness of ultrasound (US) examinations in the musculoskeletal assessment of PWH has been reported, but the actual use of US has been suggested to be limited. The aim of this study was to clarify the extent to which US is being performed on young male PWH at medical institutions in Japan. METHODS: This was an observational study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. We identified almost all male PWH aged under 30 years who were prescribed hemostatic agents between 2015 and 2021 in Japan. For each year, we calculated the proportion of PWH who underwent US and, as a sensitivity analysis, the proportion of PWH who underwent US examinations for musculoskeletal disease. The Cochran‒Armitage trend test was used to examine changes in the number of PWH who underwent US examinations over the observation period. The Lorenz curves and Gini coefficients were calculated from the proportion of US examinations performed at each medical institution annually. RESULTS: A total of 2137-2483 male PWH younger than 30 years were identified annually. The annual proportion of PWH who underwent US ranged from 6.1 to 12.9%. By age group, the annual proportions of US were 6.7-14.4%, 8.1-16.6%, and 2.0-8.7% for 0-9, 10-19, and 20-29 years, respectively. The annual proportions of musculoskeletal US were 2.9-7.7%. The proportion of PWH who underwent US increased significantly over the seven-year period; however, it varied by medical institution (Gini coefficients 0.85-0.92). CONCLUSIONS: The use of US for young PWH is becoming more widespread in Japan. However, US is performed at different rates among medical institutions.

Background In 2016, the Japanese health insurance system introduced a new dementia care incentive requiring clinical rounds by a dementia care team to promote dementia care in acute hospitals. Due to the nature of acute care, this round is conducted for all patients with neurocognitive disorders, including those with delirium and dementia. Both physical and psychological interventions are important, but the status of physical interventions for these patients is still unclear. This study investigated the current status by focusing on the intensity of rehabilitation training and the level of physical restraint as indicators of physical interventions. Methods Data from dementia care team rounds conducted between July 1, 2021, and October 7, 2024, were reviewed for relationships between clinicopathological characteristics, training programs for rehabilitation treatment, and physical restraint status. Results A total of 596 patients with neurocognitive disorders underwent 1,987 consultations. Patients with dementia, delirium, and a combination of the two were included. By disease groups, the frequency of consultations was higher than average for disuse, cardiovascular, and respiratory diseases, but lower for cerebrovascular, cancer, and musculoskeletal diseases. The training intensity was primarily level 1 (in-bed exercise) or level 5 (gait training) across all groups. A statistically significant relationship was observed between the disease group and the training intensity (p < 0.0001). The physical restraint (PR) level was significantly associated with the intensity of training in rehabilitation therapy (p < 0.0001). Conclusions The incidence of neurocognitive disorders varied according to the disease group. This intensity correlated with the number of patients subjected to physical restraint. To establish a care system, we should consider the characteristics of disease groups.

Background The principle of edema treatment is conservative, and compression therapy is the mainstay of conservative treatment. In this study, we developed a compression garment with a novel and effective shape and examined its pressure maintenance. Methods We focused on the shape of the gap between the pullers, which affects pressure stability. First, we designed models with a smaller gap area by increasing the number of pullers and then selected an optimal number for the new product. Next, we investigated the effects of posture and movement on the interface pressure using the new product in seven healthy participants and statistically analyzed the results. Results Based on comparisons between models with reduced gap areas, we determined the number of pullers to be four and developed a new product. Compared with current products, the new product maintained a significantly higher interface pressure and was less affected by posture and movement.  Conclusions Shape, especially the number of pullers and shape of the gaps, is an important factor determining the therapeutic effect of compression garments for edema treatment, which can maintain a higher interface pressure and reduce fluctuations due to posture and movement. The newly developed compression garment with a novel shape is expected to produce a high and stable therapeutic effect.

INTRODUCTION: Dedifferentiated chondrosarcoma (DDCS) is a high-grade subtype of chondrosarcoma with a poor prognosis. Treatment for localized DDCS generally involves wide resection; the effectiveness of adjuvant radiotherapy and chemotherapy is questionable. This research was designed to find prognostic factors for DDCS and evaluate the impact of adjuvant therapies on localized cases. METHODS: One hundred thirty-two patients with DDCS diagnosed by pathology in the period 2006 to 2022 were identified in the Japanese National Bone and Soft Tissue Tumor Registry database and were retrospectively analyzed. RESULTS: Patients with distant metastases at diagnosis (n = 34) had significantly poorer survival than those without metastases (n = 98), with a 5-year disease-specific survival (DSS) of 9.7% vs. 37.1% (P < 0.0001). For patients without distant metastasis at diagnosis, uni- and multivariate analysis showed that R1 or R2 surgical margin was an independent risk factor linked with unfavorable local recurrence (hazard ratio [HR] 3.39 [95% CI: 1.35-8.52]; P = 0.010). Adjuvant radiotherapy was not associated with local recurrence (HR 2.41 [95% CI: 0.87-6.64]; P = 0.090). Larger size (HR 1.13 [95% CI: 1.06-1.19]; P < 0.001) and no surgery (HR 3.87 [95% CI: 1.61-9.28]; P = 0.002) were independent risk factors for unfavorable DSS. Previous surgery (HR 0.19 [95% CI: 0.04-0.84]; P = 0.028) and adjuvant chemotherapy (HR 0.36 [95% CI: 0.16-0.77]; P = 0.009) were independent risk factors for favorable DSS. DISCUSSION: Survival may have been improved by chemotherapy, but the effect of adjuvant radiotherapy in controlling the local spread of the tumor appears to have been limited in DDCS cases that were localized.

Reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) is an essential tool for gene expression analysis; choosing appropriate reference genes for normalization is crucial to ensure data reliability. However, most studies on osteogenic differentiation have had limited success in identifying optimal reference genes. To the best of our knowledge, no optimal reference genes in three-dimensional (3D) osteogenic differentiation culture experiments using human induced pluripotent stem cells (hiPSCs) have been identified. In this study, we aimed to identify stable reference genes that could be used for normalization in gene expression analyses during the 3D osteogenic differentiation of hiPSCs using an atelocollagen sponge as a scaffold. Four algorithms-ΔCt, BestKeeper, NormFinder, and geNorm-were used to evaluate the stability of 14 candidate reference genes. Genes encoding TATA box-binding protein, hypoxanthine phosphoribosyltransferase 1, and 14-3-3 protein zeta polypeptide were identified as the most stable reference genes. In comparison, conventionally used reference genes (beta-2 microglobulin and beta-actin genes) ranked among those with low stability. We also demonstrated the successful 3D osteogenic differentiation of hiPSCs on atelocollagen sponge. Our findings provide valuable insights for reference gene selection and bone tissue regeneration from hiPSCs, which could improve the treatment prospects for bone defects and other similar conditions in regenerative medicine.

Allogeneic bone grafts are used to treat bone defects in orthopedic surgery, but the osteogenic potential of artificial bones remains a challenge. In this study, we developed a β-tricalcium phosphate (β-TCP) formulation containing MgO, ZnO, SrO, and SiO2 and compared its bone-forming ability with that of β-TCP without biological elements. We prepared β-TCP discs with 60% porosity containing 1.0 wt% of these biological elements. β-TCP scaffolds were loaded with bone marrow-derived mesenchymal stem cells (BMSC) from 7-week-old male rats and cultured for 2 weeks. ALP activity and mRNA expression of osteogenic markers were evaluated. In addition, scaffolds were implanted subcutaneously in rats and analyzed after 7 weeks. In vitro, the MgO group showed lower Ca concentrations and higher osteogenic marker expression compared to controls. In vivo, the MgO group showed higher ALP activity compared to controls, and RT-qPCR analysis showed significant expression of BMP2 and VEGF. Histopathology, fluorescent immunostaining, and micro-CT also showed relatively better bone formation in the MgO group. β-TCP with MgO may enhance bone morphology in vitro and in vivo and improve the prognosis of patients with substantial and refractory bone defects.

En bloc resection is required for treatment of intermediate-grade talar tumors with extraosseous extension (Enneking stage 3) and malignant talar tumors without intra-articular invasion (Enneking stages IA and IIA). After resection, reconstruction options include tibiocalcaneal fusion, frozen autograft, and talar prosthesis; however, a talar prosthesis is preferable because it preserves ankle range of motion, does not cause leg length discrepancy, and is associated with good long-term outcomes. To the best of our knowledge, en bloc resection and reconstruction of a malignant talar tumor has not been previously reported in detail. We report a detailed surgical technique for en bloc resection of a malignant talar bone tumor using combined anterior and lateral approaches followed by reconstruction using a talar prosthesis.

Background Glioblastoma (GBM) is the most frequent invasive brain tumor and a rapidly progressive disease with a poor prognosis that predominantly affects middle-aged and older adults. The relationship between daily functioning and prognosis in patients with GBM will become more important as advances in multimodality treatment are expected to increase the number of long-term survivors. Methods Sixty-seven patients were initially diagnosed with GBM at our hospital between December 2013 and December 2022. All patients were divided into two groups: those who survived for one year or longer from the date of discharge (Group A) and those who died within one year from the date of discharge (Group B). Muscle strength, nutritional status, and Karnofsky Performance Status (KPS) were examined upon admission (p1), post-surgery (p2), and discharge (p3), and their relationships with prognosis were investigated. Results Group A was significantly younger than Group B, with a significant difference in the total radiation dose. There were no significant differences in the anatomical tumor location, whether the tumor occurred on the left or right side, or tumor size. KPS at discharge (p3) and the degree of improvement in the KPS between p1 and p3 were associated with a good prognosis. Conclusions The KPS varies throughout the treatment. When considering the KPS as a prognostic indicator, the KPS at discharge is the most important, given the structure of the disability and the course of treatment for GBM.

PURPOSE: Immune checkpoint inhibitors (ICIs) have improved the prognosis of patients with cancer, such as melanoma, renal cell carcinoma, head and neck cancer, non-small cell lung cancer (NSCLC), and urothelial carcinoma. The extension of life expectancy has led to an increased incidence of bone metastases (BM) among patients with cancer. BM result in skeletal-related events, including severe pain, pathological fractures, and nerve palsy. Surgery is typically required for the treatment of BM in patients with an impending fracture; however, it may be avoided in those who respond to ICIs. We systematically reviewed studies analyzing BM responses to treatment with ICIs. METHODS: This study was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 statement and registered in the UMIN Clinical Trials Registry (ID: UMIN000053707). Studies reporting response rates based on the Response Evaluation Criteria in Solid Tumors (RECIST) or the MD Anderson Cancer Center (MDA) criteria specific for BM in patients treated with ICIs were included; reports of fewer than five cases and review articles were excluded. Studies involving humans, published in English and Japanese, were searched. The PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched. Ultimately, nine studies were analyzed. The Risk of Bias Assessment tool for Non-randomized Studies was used to assess the quality of studies. RESULTS: Based on the MDA criteria, complete response (CR) or partial response (PR) was observed in 44-78% and 62% patients treated with ICIs plus denosumab for NSCLC and melanoma, respectively. According to the RECIST, CR or PR was recorded in 5% and 7-28% of patients treated with ICIs for renal cell carcinoma and urothelial carcinoma, respectively. CONCLUSION: Although response rates to ICIs for BM are poor, patients treated with ICI plus denosumab for bone metastases with impending fractures from NSCLC and melanoma are likely to avoid surgery to prevent fractures.

BACKGROUND: Hip fractures are most likely to occur in older people, and after hip surgery muscle mass and the ability to perform activities of daily living often decline. In this study, we conducted inpatient rehabilitation after surgery for hip fracture and measured changes in muscle mass and physical performance. METHODS: We retrospectively analyzed patients aged 65 years or older who underwent surgery (prosthetic replacement or internal fixation) and inpatient rehabilitation for hip fracture at our hospital between August and December 2020. The training included a joint range of motion exercise, muscle-strengthening exercise, gait training, early mobilization training, and neuromuscular electrical stimulation. We measured the following factors after one and six weeks postoperatively: muscle mass, body weight, fat mass, grip strength, bilateral knee extension strength, ability to walk, and ability to perform activities of daily living. RESULTS: Seventeen patients were included. Median age was 84 years (interquartile range, 72-90). Lower limbs skeletal muscle mass increased (median 4.8 kg to 4.9 kg, p = 0.045), while upper limbs skeletal muscle mass and body weight decreased (median 1.2 kg to 1.1 kg, p = 0.0027), (median 46.8 kg to 45.5 kg, p = 0.0039), respectively. Total skeletal muscle mass and fat mass remained unchanged. Grip strength was maintained, and knee extension muscle strength on the healthy and affected sides increased (healthy side median 10.7 kgf to 13.7 kgf, p = 0.019; affected side median 5.5 kgf to 9.5 kgf, p < 0.001). All patients exhibited improved ability to perform activities of daily living; however, 52.9% of patients regained their pre-injury walking ability. CONCLUSIONS: Our rehabilitation program increased lower limb skeletal muscle mass in patients with hip fractures.

BACKGROUND: Factors associated with falls after total knee arthroplasty (TKA) have been rarely reported. The aim of this study was to identify factors that influence the incidence of falls after TKA, focusing on toe grip strength (TGS) in particular, which has been associated with falls in older adults. METHODS: 217 patients who underwent TKA were included and followed up for 1 year. Main study outcome measures were the presence or absence of falls within 1 year after TKA. Multiple logistic regression analysis was used with postoperative falls as the dependent variable and preoperative falls and postoperative TGS on the affected sides as independent variables. RESULTS: 170 (43 and 127 in the fall and non-fall groups) patients were included in the analysis. The presence of a preoperative falls history before TKA and a weak postoperative affected TGS indicated an increased susceptibility of the patient to fall postoperatively. CONCLUSIONS: Results of the current study revealed the association between postoperative TGS and postoperative falls. We highlight the importance of preoperative fall monitoring and postoperative TGS evaluation to prevent falls after TKA.

Curettage is recommended for the treatment of Campanacci stages 1-2 giant cell tumor of bone (GCTB) in the extremities, pelvis, sacrum, and spine, without preoperative denosumab treatment. In the distal femur, bone chips and plate fixation are utilized to reduce damage to the subchondral bone and prevent pathological fracture, respectively. For local recurrence, re-curettage may be utilized when feasible. En bloc resection is an option for very aggressive Campanacci stage 3 GCTB in the extremities, pelvis, sacrum, and spine, combined with 1-3 doses of preoperative denosumab treatment. Denosumab monotherapy once every 3 months is currently the standard strategy for inoperable patients and those with metastatic GCTB. However, in case of tumor growth, a possible malignant transformation should be considered. Zoledronic acid appears to be as effective as denosumab; nevertheless, it is a more cost-effective option. Therefore, zoledronic acid may be an alternative treatment option, particularly in developing countries. Surgery is the mainstay treatment for malignant GCTB.

BACKGROUND: Joint damage in patients with haemophilia (PwH) is commonly assessed by imaging, but few reports have described how structural changes in joints, for example, haemophilic arthropathy (HA)-affect gait ability. OBJECTIVES: We evaluated gait function among PwH with HA, PwH without HA, and people without haemophilia (non-PwH) using a Zebris FDM-T treadmill (FDM-T), an easy-to-use gait assessment instrument with a force sensor matrix. METHODS: The following gait parameters were collected: centre of pressure trajectory intersection (COPi) anterior/posterior variability, COPi lateral variability, COPi anterior/posterior symmetry, COPi lateral symmetry, single-limb support line (SLSL) length, and SLSL variability. Participants walked at their typical gait speed. The physical function of the PwH was assessed by the Hemophilia Joint Health Score (HJHS). Parameters were compared among the three groups. RESULTS: Twelve PwH with HA, 28 PwH without HA, and 12 non-PwH were enrolled. Gait speed significantly differed between groups (non-PwH, 3.1 ± 0.7; PwH without HA, 2.0 ± 0.7; PwH with HA; 1.5 ± 0.4). The COPi anterior/posterior variability, COPi lateral variability, SLSL length, and SLSL variability were greater in the PwH groups than in the non-PwH group. The COPi lateral symmetry differed between PwH with HA and the other groups. The HJHS was not correlated with gait parameters among PwH with HA. CONCLUSIONS: Gait parameters and speed were abnormal in both PwH with HA and PwH without HA. The FDM-T can be used to identify early stages of physical dysfunction that cannot be detected by conventional functional assessments such as the HJHS.

Dedifferentiated chondrosarcoma (DDCS) is a high-grade subtype of chondrosarcoma with the bimorphic histological appearance of a conventional chondrosarcoma component with abrupt transition to a high-grade, non-cartilaginous sarcoma. DDCS can be radiographically divided into central and peripheral types. Wide resection is currently the main therapeutic option for localized DDCS. Moreover, the effectiveness of adjuvant chemotherapy remains controversial. Therefore, we performed a systematic review of available evidence to evaluate the effect of adjuvant chemotherapy on localized DDCS. The purpose was to compare the 5-year survival rate among patients treated with surgery plus adjuvant chemotherapy or surgery alone for localized DDCS. The search was conducted in PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Of the 217 studies shortlisted, 11 retrospective non-randomized studies (comprising 556 patients with localized DDCS) were selected. The 5-year survival rates were similar between the two treatment groups (28.2% (51/181) vs. 24.0% (90/375), respectively). The overall pooled odds ratio was 1.25 (95% confidence interval: 0.80-1.94; p = 0.324), and heterogeneity I2 was 2%. However, when limited to peripheral DDCS, adjuvant chemotherapy was associated with prolonged survival (p = 0.03). Due to the paucity of included studies and the absence of prospective comparative studies, no conclusions can be drawn regarding the effectiveness or ineffectiveness of adjuvant chemotherapy for localized DDCS.

Abstract Falls after total knee arthroplasty (TKA) are common in knee osteoarthritis patients due to advanced age and implant-induced sensory function changes. We reported the influence of toe grip strength (TGS) on falls in knee osteoarthritis patients. This study aimed to determine whether TGS training after TKA is related to the screening assessment and incidence of falls. Elderly patients undergoing unilateral TKA were divided into TGS training (T-group) and control groups (C-group). Six types of training were conducted on bilateral toes. The primary outcomes were changes (Δ) in TGS and Timed up and go test (TUG) time from preintervention to 12 weeks post-intervention. Secondary outcomes involved several factors, including the occurrence of falls. T-group had a shorter TUG and stronger bilateral TGS than C-group. ΔTUG time was significantly correlated with ΔTGS on the affected side. There were significantly fewer falls in T-group than in C-group between 3 and 12 months after TKA. TGS training was useful in improving walking ability and preventing falls in postoperative TKA patients. The advantage of TGS training is that it is an unoperated muscle function, so the intervention can be conducted safely without specialist supervision unless the toes are impaired.

INTRODUCTION: To prevent infection after limb-sparing surgery for primary malignant bone tumors, it is important to cover the megaprosthesis with muscle tissue that has sufficient blood flow. Coverage with a lateral gastrocnemius flap has been reported in cases of distal femoral replacement in which the vastus lateralis and vastus intermedius muscles have been resected; however, the risk of peroneal nerve palsy is reportedly high because the muscle flap passes near the peroneal head. This study was performed to examine the postoperative outcomes of patients with primary malignant bone tumors of the distal femur who underwent wide resection (including the vastus lateralis and vastus intermedius muscles) followed by reconstruction with a megaprosthesis and coverage of the lateral side of the prosthesis with a sartorius muscle flap. METHODS: We retrospectively analyzed three patients who underwent reconstruction with a megaprosthesis after wide resection of a primary malignant bone tumor of the distal femur involving the vastus lateralis and vastus intermedius muscles and reconstruction of the soft tissue defect on the lateral side of the prosthesis with a sartorius muscle flap. RESULTS: The average defect size was 6 × 13 cm, the average time required for a sartorius muscle flap was 100 min, and the average implant coverage was 93%. The average postoperative follow-up period was 35 months, during which no postoperative complications such as infection, skin necrosis, or nerve palsy occurred. DISCUSSION: The distally based sartorius muscle flap is easy to elevate in the supine position, has minimal functional loss after harvesting, and has minimal risk of nerve palsy. It can be advocated as the first option for coverage of soft tissue defects lateral to distal femoral replacement.

INTRODUCTION: Mesenchymal chondrosarcoma (MCS) is a malignant, biphasic, high-grade, primitive mesenchymal tumor that has a well-differentiated, organized hyaline component. MCS has a poor prognosis, and treatment recommended for localized MCS is based on wide resection while controversy remains regarding the efficacy of adjuvant chemotherapy and radiotherapy. In this study, we aimed to investigate the prognostic factors of MCS, especially the efficacy of adjuvant chemotherapy and radiotherapy for localized MCS. METHODS: Eighty patients with MCS pathologically diagnosed between 2006 and 2022 from the Japanese National Bone and Soft Tissue Tumor Registry database were analyzed retrospectively. RESULTS: Patients with distant metastases at presentation (n = 23) had significantly shorter survival than those without (n = 57) (5-year disease-specific survival 19.9% [95% confidence interval (CI): 5.6-50.7] vs. 79.8% [95% CI: 62.4-90.4]; p < 0.0001). In the group without distant metastasis at presentation (n = 57), R1 or R2 surgical margin was a risk factor for unfavorable local recurrence (hazard ratio (HR): 17.44 [95% CI: 2.17-139.98]; p = 0.007). There was no correlation between adjuvant radiotherapy and local recurrence rate (HR 5.18 [95% CI: 0.99-27.12]; p = 0.051). R1 or R2 surgical margin was a risk factor for unfavorable disease-specific survival (HR 17.42 [95% CI: 2.18-138.90]; p = 0.007). There was no correlation between adjuvant chemotherapy and disease-specific survival (HR 0.99 [95% CI: 0.28-3.47]; p = 0.990). DISCUSSION: Patients with MCS and distant metastases at presentation have a poor prognosis, and wide resection is important for the treatment of localized MCS. The efficacy of adjuvant radiotherapy and chemotherapy could not be determined because of the small number of patients.

BACKGROUND: Myxoid liposarcoma is more radiosensitive than other soft tissue sarcomas, and radiotherapy has been reported to reduce tumour size. This study was performed to compare the rates of local recurrence, survival and wound complications between pre- and post-operative radiotherapy for localized myxoid liposarcoma. METHODS: From the Japanese Nationwide Bone and Soft Tissue Tumor Registry database, 200 patients with localized myxoid liposarcoma who received pre- (range, 30-56 Gy) or post-operative (range, 45-70 Gy) radiotherapy and surgery were included in this retrospective study. Propensity score matching was used to adjust for background differences between patients who received pre- and post-operative radiotherapy. RESULTS: Local recurrence occurred in five (5.0%) and nine (9.0%) patients in the pre- and post-operative radiotherapy groups, respectively (both n = 100). The median follow-up time from diagnosis was 40.5 months (IQR, 26.3-74). Univariate analysis showed a similar risk of local recurrence between the pre- and post-operative radiotherapy groups (5-year local recurrence-free survival 94.9% [95% CI 87.0-98.1] vs. 89.0% [95% CI 79.6-94.3]; P = 0.167). Disease-specific survival was similar between the pre- and post-operative radiotherapy groups (5-year disease-specific survival 88.1% [95% CI 75.5-94.6] vs. 88.4% [95% CI 77.3-94.5]; P = 0.900). The incidence of wound complications was similar between the pre- and post-operative radiotherapy groups (7.0% vs. 12.0%; P = 0.228). CONCLUSIONS: There was no difference in local recurrence, survival or incidence of wound complications between pre- and post-operative radiotherapy for localized myxoid liposarcoma. Therefore, pre-operative radiotherapy for myxoid liposarcoma provides clinical results equivalent to post-operative radiotherapy.

当院で人工膝関節全置換術(TKA)を施行した変形性膝関節症28膝を対象に、術前のロコモ25合計点数が24点以上のロコモ度3群17膝と24点未満のコントロール群11膝に分け、比較検討した。その結果、ロコモ度3群はコントロール群と比べ、術前の高CSIの割合が有意に高く、術後6時間・12時間・48時間のNRSが有意に高値を示した。今回の結果から、ロコモ度の悪化は中枢性感作の発現を引き起こし、TKA術後疼痛に影響する可能性が示唆された。

INTRODUCTION: Haemophilic arthropathy, a serious complication of haemophilia, results from recurrent joint bleeding, causing progressive joint damage and severely impacting patient quality of life. Rehabilitation therapy (RT) effectively addresses declining physical function due to joint degradation, but pain during RT can hinder its success. Therefore, an effective pain-alleviating treatment method is required. The single-joint hybrid assistive limb (HAL-SJ), a powered exoskeleton, measures bioelectric potential during muscle contraction and provides motorised support, potentially alleviating pain. OBJECTIVE: This study outlines our protocol for a randomised, prospective, single-blind (evaluator) trial aimed to investigate the effects of HAL-SJ on pain reduction during RT, kinesiophobia and other physical functions in patients with haemophilia. METHODS AND ANALYSIS: This two-group comparison intervention study will include 24 male patients aged 12-85 years diagnosed with a bleeding disorder necessitating RT for pain and physical function improvement. The primary outcome measures pain changes during the first and second RT session in patients receiving HAL-SJ-assisted RT compared with traditional RT without HAL-SJ. The secondary outcomes include kinesiophobia (Japanese version of the Tampa Scale for Kinesiophobia), standing position gait (zebris FDM-T treadmill), range of motion (manual goniometer) and body surface temperature (infrared thermography camera) during the study period of up to 3 months or until the end of 10 RTs. RT intensity remains below that required to move the affected joint against gravity, given HAL-SJ's muscular support. The follow-up period extends to 1 month after the last RT. Intergroup study variables are compared by an unpaired t-test or Mann-Whitney test. Intragroup comparisons of secondary outcomes are analysed by a paired t-test or Wilcoxon signed-rank test. ETHICS AND DISSEMINATION: This study was approved by the accreditation committee of Nara Medical University Hospital. The study results will disseminate through publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: jRCTs052220076.

BACKGROUND AND OBJECTIVE: The prognosis of metastatic renal cell carcinoma (RCC) has markedly improved with the advent of molecular targeted therapies and immune checkpoint inhibitors. However, the therapeutic response in patients with bone metastasis remains low; therefore, surgery still plays a significant role in treatment of bone metastasis. It is important to maintain quality of life for patients with bone metastasis from RCC and avoid reoperation after surgery for bone metastasis. Therefore, we investigated the risk factors for reoperation after surgery in patients with bone metastasis from RCC. METHODS: We retrospectively studied 103 bones of 97 patients who underwent surgery for bone metastasis of RCC from 2001 to 2023 at our institutions. RESULTS: Reoperation was performed in 10 (9.7%) of 103 bones. There was no correlation between reoperation-free survival and any of the following variables: preoperative and postoperative radiotherapy, site of bone metastasis, indication for surgery (solitary bone metastasis or impending or pathologic fractures), surgical method (intramedullary nailing fixation, curettage, or en bloc resection), preoperative embolization, or survival. CONCLUSION: The risk of reoperation for bone metastasis of RCC does not appear to be based on the surgical method.

BACKGROUND: Older patients are more likely to have comorbidities than younger patients, and multiple comorbidities are associated with mortality in patients with cancer. Therefore, we hypothesized that a functional comorbidity index could predict the therapeutic effects of rehabilitation. OBJECTIVES: In this study, we investigate whether the comorbidities influenced the execution and therapeutic effects of rehabilitation. METHODS: A consecutive cohort of 48 patients with gastrointestinal cancer who underwent surgery between January 1 and November 30, 2020, was analyzed. Charlson Comorbidity Index (CCI) scores were calculated based on data derived from medical records. The primary outcomes were ambulation status, duration (days) from the start of postoperative rehabilitation, and length of hospital stay. We investigated the relationship between CCI scores and primary outcomes. RESULTS: The CCI did not correlate with the duration of rehabilitation or the length of hospital stay. Subsequently, patients with functional recovery problems were evaluated, and we identified the conditions that were not included in the list using CCI scores. Most conditions are associated with surgical complications. Furthermore, using the Clavien-Dindo classification (CDC), we assessed the clinical features of the severity of complications. We found that the length of stay and the duration to start rehabilitation were significantly longer in the patients with higher severity of surgical complications (CDC≧III) than in those with lower severity (CDC≦II). CONCLUSIONS: Treatment-related conditions may significantly impact the perioperative period more than the original comorbidities. In addition to original comorbidities, events related to surgical complications should be assessed to determine the therapeutic effects of rehabilitation in patients with gastrointestinal cancer.

Abstract Summary We investigated the risk factors for mortality of hip fracture in the elderly using the National Database of Health Insurance Claims in Japan, and survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. Purpose Hip fracture is the most common fracture in the elderly and is known to have a high mortality rate. In Japan, to the best of our knowledge, no studies have reported on mortality risk factors for hip fracture using nationwide registry databases. This study aimed to determine the number of occurrences of hip fracture and factors that increase mortality using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Methods This study included extracted data from patients who were hospitalized and underwent surgical treatment for hip fracture between 2013 and 2021, using a nationwide health insurance claims database in Japan. Patient characteristics, such as sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism, were tabulated to obtain 1-year and in-hospital mortality rates. Results Both 1-year and in-patient survival were significantly lower in men, older patients, patients who underwent surgery after 3 days of admission, and patients with trochanteric and subtrochanteric fractures, internal fixation, more preoperative comorbidities, blood transfusions, and pulmonary embolism. Conclusions Survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. As the number of male patients with hip fracture will increase with the aging of society, medical staff must provide sufficient information before surgery to avoid postoperative mortality.