河野 友祐

INTRODUCTION/AIMS: 3D magnetic resonance imaging (MRI) is a tool for visualizing and quantifying the volume of the median nerve; however, the diagnostic value of the volume of the median nerve for assessing CTS severity is unclear. This study aimed to evaluate the utility of 3T MRI combined with three-dimensional (3D) imaging to assess the cross-sectional volume (CSV) of the median nerve for diagnosing carpal tunnel syndrome (CTS) and determining its severity. METHODS: We used MRI to measure the CSV of the median nerve in 95 patients with CTS and 26 healthy controls. CTS severity was graded according to the Padua classification, and differences in CSV according to severity were analyzed. RESULTS: The mean CSVs for the severity groups were as follows: control, 22.4 mm3; minimal, 28.8 mm3; moderate, 34.4 mm3; severe, 53.6 mm3; and extreme, 48.3 mm3. CSV increased with CTS severity, with significantly higher values in the severe and extreme groups compared with the moderate, minimal, and control groups. DISCUSSION: This study showed that the CSV of the median nerve increased with disease severity, both visually and in three dimensions. This helps to visually understand the severity of CTS, and the association between morphology and disease severity may contribute to a better understanding of the pathophysiology of CTS.

BACKGROUND: Fractures are a significant health concern for older adults, affecting their activities of daily living (ADL), physical function, and mental well-being, and contributing to the need for long-term care. However, the factors associated with fractures among independent older adults remain unclear. This study aimed to examine the association between fractures and the health status of independent older adults in a representative suburban city in Japan using data from a survey of community-dwelling residents and to identify factors associated with fractures. METHODS: A total of 15,853 survey questionnaires were mailed, and 11,346 valid responses were received, resulting in a response rate of 71.6%. The survey included questions on ADL, physical function, mental health, memory, medical conditions, and subjective complaints. For fractures, participants were asked the following question: "How many times have you experienced fractures since the age of 65?". Data were analyzed using Poisson regression models adjusted for age, sex, body mass index, family structure, and smoking history. RESULTS: Among the respondents, 15% reported fractures after age of 65 years. A decline in ADL, physical function, mental health, and memory were significantly associated with increased fracture frequency. Under medical conditions, the prevalence of depression (p for trend = 0.042), respiratory diseases (p for trend = 0.001), and ophthalmologic conditions (p for trend = 0.002) increased significantly with fracture number. Most subjective complaints were significantly associated with fracture number, with dysphagia demonstrating the strongest association. CONCLUSIONS: This study utilized a relatively large and highly representative sample of community-dwelling residents to identify factors associated with fractures in independent older adults. Even in independent older adults who were not certified as requiring long-term care, fractures were significantly associated with a decline in multiple health domains. These findings provide valuable insights that can inform efforts to promote healthy aging and reduce care dependency. CLINICAL TRIAL: Not applicable.

OBJECTIVES: Symptomatic hand osteoarthritis (HOA) significantly affects daily activities and quality of life, but its associations with osteoarthritis (OA) in other joints and systemic factors remain unclear. This study aimed to comprehensively assess patients with symptomatic HOA by examining their laboratory findings and radiographic features across multiple joints. METHODS: This cross-sectional study enrolled 53 patients with symptomatic HOA who initially presented to the outpatient clinic with hand pain and were subsequently diagnosed. Radiographic assessments of the hands, knees, hips, and spine were performed using the grading system of Kellgren-Lawrence (KL). The sum of the KL scores for all joints in both hands was calculated as the hand KL score. RESULTS: In total, 79.2% of patients had coexistent knee OA. Elevated triglyceride levels and erythrocyte sedimentation rates were observed in >50% of the cohort. Hand KL scores displayed weak positive correlations with C-reactive protein levels (r=0.34) and knee KL scores (r=0.35). CONCLUSIONS: This study highlights the frequent coexistence of knee OA in patients with symptomatic HOA and suggests potential links between HOA, systemic inflammation, and lipid metabolism. These findings provide insights into the multifactorial nature of HOA and underscore the importance of comprehensive evaluation in clinical practice.

CASE: A 17-year-old adolescent boy sustained right lateral clavicle physeal separation with the epiphysis displaced superiorly in the acromioclavicular joint (ACJ). The ossified epiphysis formed a painful nonunion with the clavicular metaphysis. Resection of the epiphysis has achieved an excellent outcome. CONCLUSION: Children and adolescents with lateral clavicle injuries often develop pseudodislocation of the ACJ in which the metaphysis is displaced due to physeal separation. By contrast, displacement of the unossified epiphysis is extremely difficult to diagnose both radiographically and clinically at the time of injury.

An absorbable adhesion barrier is a medical device that prevents postoperative adhesion and matches its biodegradation time with the regeneration period of its target tissues, which is important for antiadhesion effects. Physical hydrogels of Bombyx mori silk fibroin (SF) proteins are degradable in vivo. However, their biodegradation time is too long to exert antiadhesion effects. To shorten the biodegradation time of the SF hydrogels, we decreased the molecular weight (MW) of the SF proteins by alkaline treatment and prepared low-MW (LMW) SF hydrogels. The hydrogels contained less β-sheet crystalline and more amorphous structures than conventional, high-MW (HMW) SF hydrogels. Because of the potential loosened SF molecular structures in the hydrogel networks, the LMW SF hydrogels showed enhanced biodegradation (i.e., shorter in vitro enzymatic biodegradation time and faster in vivo biodegradation rate) as well as a lower affinity for plasma proteins and fibroblasts, which are involved in postoperative adhesion formation. An antiadhesion test using a rat abdominal adhesion model demonstrated that the LMW SF hydrogel applied to the abraded cecum was almost completely degraded within two weeks postimplantation, with a significantly lower adhesion severity score than that in the untreated model rat group. Conversely, the HMW SF hydrogel remained between the cecum and abdominal wall, with the same adhesion severity as that of the untreated model rat group. Therefore, we concluded that the antiadhesion effects of SF hydrogels were induced by enhanced biodegradation. The results of this study indicate the potential of LMW SF hydrogels as absorbable adhesion barriers.