Human fetal anatomy of the coccygeal attachments of the levator ani muscle

Niikura, Hitoshi,Jin, Zhe Wu,Hwan Cho, Baik,Murakami, Gen,Yaegashi, Nobuo,Lee, Jong Kyun,Lee, Nae Ho,Li, Chun Ai Wiley Subscription Services, Inc., A Wiley Company 2010 Clinical Anatomy Vol.23 No.5

<P>In contrast to the attachments to the pubis and rectum, there is little information on fetal development of the coccygeal attachment of the levator ani muscles. We find that at 9 weeks, the coccygeus muscle is a large muscle facing the piriformis or gluteus maximus and inserting onto the ischial spine, whereas the levator ani is restricted to the area near the pubis. By 12 weeks, the levator ani also obtains attachment to the ischial spine immediately ventral to the coccygeus muscle. The most superior part of the coccygeus muscle occupies a space at an angle between the pelvic splanchnic and pudendal nerves. Notably, medial to the coccygeus muscle, a third parasagittal muscle (previously termed the sacrococcygeus anterior) appears by 12 weeks, increases in mass by 18 weeks, and connects and mixes with the dorsal end of the levator ani by 18–20 weeks. Thus, the coccygeal attachment of the levator ani appears not to depend on the dorsal extension of the muscle itself but on fusion with the sacrococcygeus anterior. Therefore, the final levator sheet is formed medial (internal) to the coccygeus muscle and originates from two distinct anlage. Clin. Anat. 23:566–574, 2010. © 2010 Wiley-Liss, Inc.</P>

Treatment Results of a Periprosthetic Femoral Fracture Case Series: Treatment Method for Vancouver Type B2 Fractures Can Be Customized

Takahiro Niikura,Sang Yang Lee,Yoshitada Sakai,Kotaro Nishida,Ryosuke Kuroda,Masahiro Kurosaka 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.2

Background: Currently, an algorithmic approach for deciding treatment options according to the Vancouver classification is widely used for treatment of periprosthetic femoral fractures after hip arthroplasty. However, this treatment algorithm based on the Vancouver classification lacks consideration of patient physiology and surgeon’s experience (judgment), which are also important for deciding treatment options. The purpose of this study was to assess the treatment results and discuss the treatment options using a case series. Methods: Eighteen consecutive cases with periprosthetic femoral fractures after total hip arthroplasty and hemiarthroplasty were retrospectively reviewed. A locking compression plate system was used for osteosynthesis during the study period. The fracture type was determined by the Vancouver classification. The treatment algorithm based on the Vancouver classification was generally applied, but was modified in some cases according to the surgeon’s judgment. The reasons for modification of the treatment algorithm were investigated. Mobility status, ambulatory status, and social status were assessed before the fracture and at the latest follow-up. Radiological results including bony union and stem stability were also evaluated. Results: Thirteen cases were treated by osteosynthesis, two by revision arthroplasty and three by conservative treatment. Four cases of type B2 fractures with a loose stem, in which revision arthroplasty is recommended according to the Vancouver classification, were treated by other options. Of these, three were treated by osteosynthesis and one was treated conservatively. The reasons why the three cases were treated by osteosynthesis were technical difficulty associated with performance of revision arthroplasty owing to severe central migration of an Austin-Moore implant in one case and subsequent severe hip contracture and low activity in two cases. The reasons for the conservative treatment in the remaining case were low activity, low-grade pain, previous wiring around the fracture and light weight. All patients obtained primary bony union and almost fully regained their prior activities. Conclusions: We suggest reaching a decision regarding treatment methods of periprosthetic femoral fractures by following the algorithmic approach of the Vancouver classification in addition to the assessment of each patient’s hip joint pathology, physical status and activity, especially for type B2 fractures. The customized treatments demonstrated favorable overall results.

일본의 독일어 능력시험

마야코니이쿠라 ( Niikura Mayako ) 한국독일어교육학회 2014 외국어로서의 독일어 Vol.34 No.-

일본의 디플롬 도이취 (약자 DDJ)는 일본인을 위한 외국어로서의 독일어 능력 시험이다. 이는 사단법인 일본 독문학 진흥협회에 의해 개발되고 관리되는 시험으로서 1992년부터 일본 교육분야에서 독일어 능력에 대한 인증시험의 역할을 하고 있다. 이 시험은 입학시험의 입학조건이 되거나 독일어 강좌의 성적증명 또는 독일어 수업의 목표가 되어왔다. 디플롬도이취의 가장 높은 등급은 일본 번역 국가고시에서도 어학능력으로서 인정되고, 일반 회사에 지원할 때도 어학증명서로써 필요하며, 다양한 연령층에서 온 지원자들이 이 시험에 대거 참여함으로써 일본 전역에서 인정받고 있다. 디플롬 도이취 시험은 6단계로 이루어져 있고, 듣기와 쓰기를 포함하는 필기시험이 주를 이루고 있으나 제일 상위 등급의 두 단계에서는 구두시험도 포함하고 있다. 모든 수준별 단계에서 합격하는 데에 필요한 능력과 숙련도 및 지식은 시험설명에 정해놓았고, 이 수준에 도달하기 위한 수업 시수도 명시되어 있다. 이 시험의 자격내용은 주로 일본의 전통적인 독일어 수업의 교과과정에 그 근거를 두어 낮은 수준에서는 주로 문법과 어휘에 관련된 과제를 내고 있다. 하지만 최상위 등급의 두 단계에서는 학술적인 분야에서 요구되는 주제를 다룰 줄 알아야 한다. 앞으로 디플롬 도이취 시험은 일본 교육시스템을 크게 바꾸지 않는 선에서 자격시험으로서의 계속적인 개발을 추구하여 국제적인 인정을 받을 수 있는 독자적인 길을 개척하고자 한다. The Diplom Deutsch in Japan (abbreviated DDJ) is a formal certificate test for “German as a Foreign Language” for Japanese people. It is conducted, maintained and issued by the Japan Society for the Promotion of German Studies. The DDJ, established in 1992, verifies knowledge of the German language, especially for the field of higher education. In some universities the DDJ-certificate serves as specialqualification for admission, as German-course credits or in the goal description of German courses. The DDJ serves not only educational purposes, but also professional: job-applicants arepresumably evaluated according to the test and the participants of “Japan National Tourism Organization” with Grade 1 are exempted from the German test. With a total of about 310,000 examinees of different age groups up to 2013,the DDJ exhibits general acceptance all over Japan. The DDJ-examination hassix Grades. It is a pencil-and-paper testof listening and writing skills. The two higher levels have also tests for oral competence. All 6 Grades have detailed descriptions of appropriate competence, skills, knowledge and presupposed lesson times for success. The DDJ qualification is oriented to grammar-lexical questions at lower levels and to stipulated academic theme areas at the two higher levels. DDJ aims at qualitative development for international acceptance while stayingin tune with the Japanese educational system.

Observation of Carbon Nanotube/Elastomer Composites by Atomic Force Microscopy

Ayako Niikura,Ken Nakajima,So FUJINAMI,Michio ONO,Toshio NISHI 한국고분자학회 2006 한국고분자학회 학술대회 연구논문 초록집 Vol.2006 No.10

Change of the Nursing/Support Care Levels among In-Home Care Service Users Covered by Long-term Care Insurance

Hiroyuki Hirata,Mariko Niikura,Yuko Shimoda,Keiko Teranishi,Yuchi Naruse 한국간호과학회 2015 한국간호과학회 학술대회 Vol.2015 No.10

Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures

Nobuaki Chinzei,Takafumi Hiranaka,Takahiro Niikura,Mitsuo Tsuji,Ryosuke Kuroda,Minoru Doita,Masahiro Kurosaka 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.3

Background: Recently, various femoral head fixation devices (HFDs) for trochanteric fractures have become available. However, there are some cases in which femoral head rotation with excessive sliding of the HFD is observed and it is often followed by cutout. The purpose of this study is to compare the ability of the three types of HFDs to prevent femoral head rotation. Methods: Between July 2005 and December 2009, 206 patients aged over 60 years with trochanteric fractures who had undergone surgical treatment using a short femoral nail in our institution were enrolled into the study. We used the gamma 3 nail (GMN) as the screw-type HFD in 66 cases, the gliding nail (GLN) as a non-cylindrical blade in 76 cases, and the proximal femoral nail antirotation (PFNA) as a cylindrical blade in 64 cases. The sliding length of HFDs and the occurrence of femoral head rotation were evaluated by assessing radiographs as the main outcome, and the results were compared among these devices. Results: A comparison of the degree of sliding in the GMN group showed that femoral head rotation was observed significantly more frequently in cases with rotation. Further, it appeared that femoral head rotation occurred more frequently in comminuted fractures. However, no significant differences between the sliding lengths of the different HFDs were observed among three groups. Femoral head rotation was observed in 15 cases of GMN (22.7%), 0 case of GLN, and 5 case of PFNA (7.8%). Significant differences with regard to the occurrence of femoral head rotation were observed among the three groups. Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation. Conclusions: The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials. Furthermore, we believe that a non-cylindrical blade is preferable to a cylindrical blade for the surgical treatment of comminuted, unstable trochanteric fractures in order to prevent femoral head rotation and cut-out.

Accurate and Easy Measurement of Sliding Distance of Intramedullary Nail in Trochanteric Fracture

Nobuaki Chinzei,Takafumi Hiranaka,Takahiro Niikura,Takaaki Fujishiro,Shinya Hayashi,Noriyuki Kanzaki,Shingo Hashimoto,Yoshitada Sakai,Ryosuke Kuroda,Masahiro Kurosaka 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.2

In daily clinical practice, it is essential to properly evaluate the postoperative sliding distance of various femoral head fixation devices (HFD) for trochanteric fractures. Although it is necessary to develop an accurate and reproducible method that is unaffected by inconsistent postoperative limb position on radiography, few studies have examined which method is optimal. Therefore, the purpose of this study is to prospectively compare the accuracy and reproducibility of our four original methods in the measurement of sliding distance of the HFD. Methods: Radiographs of plastic simulated bone implanted with Japanese proximal femoral nail antirotation were taken in five limb postures: neutral, flexion, minute internal rotation, greater external rotation, and flexion with external rotation. Orthopedic surgeons performed five measurements of the sliding distance of the HFD in each of the flowing four methods: nail axis reference (NAR), modified NAR, inner edge reference, and nail tip reference. We also assessed two clinical cases by using these methods and evaluated the intraclass correlation coefficients. Results: The measured values were consistent in the NAR method regardless of limb posture, with an even smaller error when using the modified NAR method. The standard deviation (SD) was high in the nail tip reference method and extremely low in the modified NAR method. In the two clinical cases, the SD was the lowest in the modified NAR method, similar to the results using plastic simulated bone. The intraclass correlation coefficients showed the highest value in the modified NAR method. Conclusions: We conclude that the modified NAR method should be the most recommended based on its accuracy, reproducibility, and usefulness.

Cooperative interaction of Angiopoietin-like proteins 1 and 2 in zebrafish vascular development.

Kubota, Yoshiaki,Oike, Yuichi,Satoh, Shinya,Tabata, Yoko,Niikura, Yuichi,Morisada, Tohru,Akao, Masaki,Urano, Takashi,Ito, Yasuhiro,Miyamoto, Takeshi,Nagai, Norihiro,Koh, Gou Young,Watanabe, Sumiko,Sud National Academy of Sciences 2005 PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF Vol.102 No.38

<P>Angiopoietin-like protein (Angptl) 1 and Angptl2, which are considered orphan ligands, are highly homologous, particularly in the fibrinogen-like domain containing the putative receptor binding site. This similarity suggests potentially cooperative functions between the two proteins. In this report, the function of Angptl1 and Angptl2 is analyzed by using morpholino antisense technology in zebrafish. Knockdown of both Angptl1 and Angptl2 produced severe vascular defects due to increased apoptosis of endothelial cells at the sprouting stage. In vitro studies showed that Angptl1 and Angptl2 have antiapoptotic activities through the phosphatidylinositol 3-kinase/Akt pathway, and coinjection of constitutively active Akt/protein kinase B mRNA rescued impaired vascular development seen in double knockdown embryos. These results provide a physiological demonstration of the cooperative interaction of Angptl1 and Angptl2 in endothelial cells through phosphatidylinositol 3-kinase/Akt mediated antiapoptotic activities.</P>

Development of Wide Band Gap P-a-SiOxCy:H Using Additional Trimethylboron as Carbon Source Gas

강동원,Porponth Sichanugrist,Bancha Janthong,Muhammad Ajmal Khan,Chisato Niikura,Makoto Konagai 대한금속·재료학회 2016 ELECTRONIC MATERIALS LETTERS Vol.12 No.4

We report p-type a-SiOxCy:H thin films which were fabricated byintroducing additional Trimethylboron (TMB, B(CH3)3) dopinggas into conventional standard p-type a-SiOx:H films. The TMBaddition into the condition of p-a-SiOx:H improved opticalbandgap from 2.14 to 2.20 eV without deterioration of electricalconductivity, which is promising for p-type window layer of thinfilm solar cells. The suggested p-a-SiOxCy:H films were appliedin amorphous silicon solar cells and we found an increase ofquantum efficiency at short wavelength regions due to widebandgap of the new p-layer, and thus efficiency improvementfrom 10.4 to 10.7% was demonstrated in a-Si:H solar cell byemploying the p-a-SiOxCy:H film. In case of a-SiOx:H cell, highopen circuit voltage of 1.01 V was confirmed by using thesuggested the p-a-SiOxCy:H film as a window layer. This new playercan be highly promising as a wide bandgap window layer toimprove the performance of thin film silicon solar cells.

Quality indicators for cervical cancer care in Japan

Tomone Watanabe,Mikio Mikami,Hidetaka Katabuchi,Shingo Kato,Masanori Kaneuchi,Masahiro Takahashi,Hidekatsu Nakai,Satoru Nagase,Hitoshi Niikura,Masaki Mandai,Yasuyuki Hirashima,Hiroyuki Yanai,Wataru Ya 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.6

Objective: Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors. Methods: The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival. Results: Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including blood loss (p<0.001), recurrent urinary tract infections (p=0.013), and leg lymphedema (p=0.038). Age over 50-year (HR=9.2; 95% confidence interval [CI], 1.2–70.9) and grade 3 histology (HR=7.28; 95% CI, 1.45–36.6) were independent predictors of OS. Grade 3 histology was an independent predictor of RFS (HR=5.13; 95% CI, 1.38–19.1) and DSS (HR=5.97; 95% CI, 1.06–58.7). Patients receiving adjuvant RT had lower locoregional recurrence (p=0.046), but no impact on survival. Conclusion: Different treatment modalities yield similar survival outcomes. Patients receiving SH with RT had lower locoregional recurrent with acceptable morbidity. Age and tumor grading remained significant predictors for survival among patients with FIGO 2009 stage II EEC. Objective: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. Methods: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. Results: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for ‘cystoscope or proctoscope for stage IVA’ to 98.8% for ‘chemotherapy using platinum for stage IVB’. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. Conclusion: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.