Clinical predictors of the estimated glomerular filtration rate 1 year after radical nephrectomy in Japanese patients

Shuichi Shimada,Hideo Saito,Yoshihide Kawasaki,Shinichi Yamashita,Hisanobu Adachi,Narihiko Kakoi,Takashige Namima,Masahiko Sato,Atsushi Kyan,Koji Mitsuzuka,Akihiro Ito,Takuhiro Yamaguchi,Yoichi Arai 대한비뇨의학회 2017 Investigative and Clinical Urology Vol.58 No.4

Purpose: To evaluate renal function 1 year after radical nephrectomy (RN) for renal cell carcinoma, the preoperative predictors of postnephrectomy renal function were investigated by sex, and equations to predict the estimated glomerular filtration rate (eGFR) 1 year after RN were developed. Materials and Methods: A total of 525 patients who underwent RN between May 2007 and August 2011 at Tohoku University Hospital and its affiliated hospitals were prospectively evaluated. Overall, 422 patients were analyzed in this study. Results: Independent preoperative factors associated with postnephrectomy renal function were different in males and females. Preoperative eGFR, age, tumor size, and body mass index (BMI) were independent factors in males, while tumor size and BMI were not independent factors in females. The equations developed to predict eGFR 1 year after RN were: Predicted eGFR in males (mL/min/1.73 m2)=27.99−(0.196×age)+(0.497×eGFR)+(0.744×tumor size)−(0.339×BMI); and predicted eGFR in females=44.57−(0.275×age)+(0.298×eGFR). The equations were validated in the validation dataset (R2=0.63, p<0.0001 and R2=0.31, p<0.0001, respectively). Conclusions: The developed equations by sex enable better prediction of eGFR 1 year after RN. The equations will be useful for preoperative patient counseling and selection of the type of surgical procedure in elective partial or RN cases.

Long-term changes in lean mass in postmenopausal women and the effects of osteoporosis pharmacotherapy: A 10-year longitudinal study

Naohisa Miyakoshi,Michio Hongo,Yoichi Shimada 대한골다공증학회 2021 Osteoporosis and Sarcopenia Vol.7 No.1

Objectives: Although sarcopenia is diagnosed using appendicular lean mass (ALM), only a few long-term studies on changes in both ALM and bone mineral density (BMD) have been reported. The purposes of this study are to evaluate the changes in the parameters of lean mass and bone mass over a 10-year interval and to estimate the effects of osteoporosis pharmacotherapy on muscle. Methods: A total of 175 postmenopausal women were evaluated at baseline and after 10 years for BMD, ALM, fat mass, height, and weight. Subjects were further divided into an osteoporosis treatment group (n ¼ 60) and a control group (n ¼ 67) according to whether they had received pharmacotherapy for > 5 years. This was followed by propensity score matching for age, height, weight, and body mass index (BMI), and estimated parameters were compared between groups. Results: Height, weight, ALM, and fat mass decreased significantly over 10 years (P < 0.05). However, lean mass index (LMI), derived as the ALM divided by the height squared, increased significantly (P < 0.001). BMD increased significantly with osteoporosis treatment (P < 0.05), while no significant differences were observed between the osteoporosis treatment and control groups in the changes to ALM or fat mass. Conclusions: ALM was decreased, while LMI was significantly increased. This contradictory result seems to be affected by age-related height loss. Thus, the effect of height loss needs to be considered when sarcopenia is evaluated longitudinally using LMI.

Short-Term Results of Hybrid Closed-Wedge High Tibial Osteotomy: A Case Series with a Minimum 3-Year Follow-up

Hidetomo Saito,Kimio Saito,Yoichi Shimada,Toshiaki Yamamura,Shin Yamada,Takahiro Sato,Koji Nozaka,Hiroaki Kijima,Naohisa Miyakoshi 대한슬관절학회 2018 대한슬관절학회지 Vol.30 No.4

Purpose: High tibial valgus osteotomy (HTO) is a well­established surgical procedure for patients with medial compartment osteoarthritis (OA) of the knee. The hybrid closed­wedge HTO (CWHTO) procedure permits extensive correction in patients with severe deformities or patellofemoral joint OA. The aim of this study was to report the short­term results in a consecutive series of patients treated with hybrid CWHTO.Materials and Methods: We retrospectively evaluated the clinical outcomes and radiographic parameters in 29 consecutive knees that underwent hybrid CWTHO to correct medial compartment OA at an average follow­up of 52.6 months. Clinical outcomes were assessed using the Lysholm score and knee scoring system of the Japanese Orthopedic Association (JOA). The Kellgren­Lawrence grading system and pre­ and postoperative mechanical axis (MA), femorotibial angle (FTA), posterior tibial slope, and patella height were assessed.Results: The FTA and MA significantly changed from 180.7° to 170.4° and from 22.0° to 60.2°, respectively. No significant differences were observed between the mean pre­ and postoperative posterior tibial slope, Insall­Salvati ratio, or Caton­Deschamps index. The postoperative JOA and Lysholm scores significantly improved from 76.7 to 95.8 and from 58.8 to 90.2, respectively. Conclusions: Satisfactory outcomes can be achieved with hybrid CWHTO in patients with medial OA.

Phase II study of niraparib in recurrent or persistent rare fraction of gynecologic malignancies with homologous recombination deficiency (JGOG2052)

Hiroshi Asano,Katsutoshi Oda,Kosuke Yoshihara,Yoichi M Ito,Noriomi Matsumura,Muneaki Shimada,Hidemichi Watari,Takayuki Enomoto 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.4

Background: Poly (adenosine diphosphate)-ribose polymerase (PARP) inhibitors for tumors with homologous recombination deficiency (HRD), including pathogenic mutationsin , have been developed. Genomic analysis revealed that about 20% of uterine leiomyosarcoma (uLMS) have HRD, including 7.5%–10% of alterations and 4%–6% of carcinomas of the uterine corpus, and 2.5%–4% of the uterine cervix have alterations of. Preclinical and clinical case reports suggest that PARP inhibitors may be effective against those targets. The Japanese Gynecologic Oncology Group (JGOG) is now planning to conduct a new investigator-initiated clinical trial, JGOG2052. Methods: JGOG2052 is a single-arm, open-label, multi-center, phase 2 clinical trial to evaluate the efficacy and safety of niraparib monotherapy for a recurrent or persistent rare fraction of gynecologic malignancies with mutations except for ovarian cancers. We will independently consider the effect of niraparib for uLMS or other gynecologic malignancies with mutations (cohort A, C) and HRD positive uLMS without mutations (cohort B). Participants must have 1–3 lines of previous chemotherapy and at least one measurable lesion according to RECIST (v.1.1). Niraparib will be orally administered once a day until lesion exacerbation or unacceptable adverse events occur. Efficacy will be evaluated by imaging through an additional computed tomography scan every 8 weeks. Safety will be measured weekly in cycle 1 and every 4 weeks after cycle 2 by blood tests and physical examinations. The sample size is 16–20 in each of cohort A and B, and 31 in cohort C. Primary endpoint is the objective response rate.

Short-Term Results of Transforaminal Lumbar Interbody Fusion Using Pedicle Screw with Cortical Bone Trajectory Compared with Conventional Trajectory

Yuji Kasukawa,Naohisa Miyakoshi,Michio Hongo,Yoshinori Ishikawa,Daisuke Kudo,Yoichi Shimada 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.3

Study Design: Case-control study. Purpose: To evaluate clinical and radiological results of transforaminal lumbar interbody fusion (TLIF) performed with cortical bone trajectory (CBT) pedicle screw insertion with those of TLIF using ‘conventional’ or percutaneous pedicle screw insertion. Overview of Literature: CBT is a new trajectory for pedicle screw insertion in the lumbar spine; clinical and radiological results of TLIF using pedicle screws inserted with CBT are unclear. Methods: In total, 26 patients (11 males, 15 females) were enrolled in this retrospective study and divided into three groups: TLIF with pedicle screw insertion by conventional minimally invasive methods via the Wiltse approach (M-TLIF, n=10), TLIF with percutaneous pedicle screw insertion (P-TLIF, n=6), and TLIF with pedicle screw insertion with CBT (CBT-TLIF, n=10). Surgical results and preand postoperative radiological findings were evaluated and compared. Results: Intraoperative blood loss was significantly less with CBT-TLIF (p =0.03) than with M-TLIF. Postoperative lordotic angles did not differ significantly among the three groups. Complete fusions were obtained in 10 of 12 levels (83%) with M-TLIF, in seven levels (100%) with P-TLIF, and in 10 of 11 levels (91%) with CBT-TLIF. On postoperative computed tomography, correct positioning was seen in 84.1% of M-TLIF screws, 88.5% of P-TLIF screws, and 90% of CBT-TLIF screws. Conclusions: CBT-TLIF resulted in less blood loss and a shorter operative duration than M-TLIF or P-TLIF. Postoperative rates of bone union, maintenance of lordotic angles, and accuracy of pedicle screw positions were similar among the three groups.

Age-Related Prevalence of Periodontoid Calcification and Its Associations with Acute Cervical Pain

Takashi Kobayashi,Naohisa Miyakoshi,Norikazu Konno,Yoshinori Ishikawa,Hideaki Noguchi,Yoichi Shimada 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.6

Study Design: Prospective study. Purpose: To assess the prevalence of periodontoid calcification and its associations with acute cervical pain. Overview of Literature: Calcium pyrophosphate dihydrate (CPPD) deposition disease is a common rheumatological disorder that occurs especially in elderly patients. Although CPPD crystals induce acute arthritis, these crystals are not usually symptomatic. Calcification surrounding the odontoid process (periodontoid calcification) has been reported to induce inflammation, resulting in acute neck pain. This disease is called crowned dens syndrome. Whether calcification induces inflammation or whether the crystals are symptomatic remains unclear. Methods: The prevalence of periodontoid calcification at the atlas transverse ligament was examined by computed tomography of the upper cervical spine in patients suspected of brain disease but no cervical pain (control group, n=296), patients with pseudogout of the peripheral joints but no cervical pain (arthritis group, n=41), and patients with acute neck pain (neck pain group, n=22). Next, the correlation between the prevalence of periodontoid calcification and symptoms was analyzed. Results: In the control group, 40 patients (13.5%) showed periodontoid calcification with no significant difference in the prevalence with gender. The prevalence of calcification increased significantly with age (p =0.002). In the arthritis group, 26 patients (63.4%) reported periodontoid calcification. In the neck pain group, 14 patients (63.6%) reported periodontoid calcification. Multiple logistic regression analysis by age and group revealed that higher age, inclusion in the arthritis group, and inclusion in the neck pain group significantly affected the prevalence of calcification. Conclusions: Our results cumulatively suggest that periodontoid calcification is an aging-related reaction and that calcification per se does not always cause neck pain. Periodontoid calcification was observed more frequently in patients with pseudogout of the peripheral joints and in those with acute neck pain than in asymptomatic control patients.

Evaluation of bone mineral density and bone strength in autochthonous transgenic model mice for diabetes mellitus (Akita mice)

Kentaro Ohuchi,Naohisa Miyakoshi,Yuji Kasukawa,Toyohito Segawa,Hayato Kinoshita,Yoichi Shimada 대한골다공증학회 2015 Osteoporosis and Sarcopenia Vol.1 No.2

Objectives: Diabetes mellitus (DM) causes secondary osteoporosis, which reduces bone mineral density (BMD) and bone strength. Akita mice (AM) are DM model mice used to evaluate glucose metabolism. However, bone metabolism in AM remains unclear. The purpose of this study was to evaluate BMD, bone strength, and serum sclerostin levels in AM. Methods: Female AM and control mice (C57/BL/6NCrSlc; CM) were divided into four groups: (1) a CM group sacrificed at 14 (CM-14w; n ¼ 8) or (2) 18 weeks of age (CM-18w; n ¼ 6); and (3) an AM group sacrificed at 14 (AM-14w; n ¼ 9) or (4) 18 weeks of age (AM-18w; n ¼ 6). Blood glucose level, serum sclerostin level, total tibial BMD, and femoral shaft bone strength were evaluated at each time point. Results: Blood glucose levels were significantly higher in AM than in CM (p < 0.001). Serum sclerostin levels were significantly lower in AM- 18w than in CM-18w (p < 0.001). BMD was significantly lower in AM-14w than in CM-14w (p ¼ 0.004). Stiffness of the femoral shaft was significantly lower in AM-18w than in CM-14w (p ¼ 0.04). Body weight (r ¼ 0.608, p < 0.01) and maximum load (r ¼ 0.438, p < 0.05) were significantly positively correlated with serum sclerostin levels, while blood glucose levels showed a significant negative correlation (r¼?0.708, p < 0.01). Conclusions: AM showed decreased BMD and bone strength with lower levels of serum sclerostin than CM. © 2015 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Comparison between Bilateral C2 Pedicle Screwing and Unilateral C2 Pedicle Screwing, Combined with Contralateral C2 Laminar Screwing, for Atlantoaxial Posterior Fixation

Naohisa Miyakoshi,Michio Hongo,Takashi Kobayashi,Tetsuya Suzuki,Eiji Abe,Yoichi Shimada 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.6

Study Design: A retrospective study. Purpose: To compare clinical and radiological outcomes between bilateral C2 pedicle screwing (C2PS) and unilateral C2PS, combined with contralateral C2 laminar screwing (LS), for posterior atlantoaxial fixation. Overview of Literature: Posterior fixation with C1 lateral mass screwing (C1LMS) and C2PS (C1LMS–C2PS method) is an accepted procedure for rigid atlantoaxial stabilization. However, conventional bilateral C2PS is not always allowed in this method due to anatomical variations of C2 pedicles and/or asymmetry of the vertebral artery. Although unilateral C2PS plus contralateral LS (C2PS+LS) is an alternative in such cases, the efficacy of this procedure has not been evaluated in controlled studies (i.e., with bilateral C2PS as a control). Methods: Clinical and radiological records of patients who underwent the C1LMS–C2PS method, using unilateral C2PS+LS (n=9), and those treated using conventional bilateral C2PS (n=10) were compared, with a minimum two years follow-up. Results: Postoperative complications related to the unilateral C2PS+LS technique included one case of spontaneous spinous process fracture of C2. A C1 anterior arch fracture occurred after a fall in one patient, who underwent bilateral C2PS and C1 laminectomy. No significant differences were seen between the groups in reduction of neck pain after surgery or improvement of neurological status, as evaluated using the Japanese Orthopaedic Association score. A delayed union occurred in one patient each of the groups, with the final fusion rate being 100% in both groups. Conclusions: Clinical and radiological outcomes of unilateral C2PS+LS were comparable with those of the bilateral C2PS fixation technique for the C1LMS-C2PS method.

Combined treatment with minodronate and vitamin C increases bone mineral density and strength in vitamin C-deficient rats

Toyohito Segawa,Naohisa Miyakoshi,Yuji Kasukawa,Hiroshi Aonuma,Hiroyuki Tsuchie,Yoichi Shimada 대한골다공증학회 2016 Osteoporosis and Sarcopenia Vol.2 No.1

Objectives: Reduced bone quality caused by vitamin C deficiency in older persons may lead to incidental fragility fractures during bisphosphonate treatment, although bisphosphonate increases bone mineral density (BMD). This study aimed to evaluate the effects of minodronate and ascorbic acid (Aa) on BMD, bone quality, and bone strength in Aa-deficient osteogenic disorder Shionogi (ODS) rats. Methods: Six-month-old ODS rats were divided into four groups (n ¼ 20 per group): (1) Aa supplementation (Aa þ ); (2) Aa-deficient (Aa ? ); (3) Aa supplementation and minodronate administration (Aaþ þ Mino); and (4) Aa-deficient and minodronate administration (Aa? þ Mino). BMD, bone strength, bone histomorphometry, and bone quality determined using Fourier transform infrared spectroscopy imaging (FTIRI) were evaluated after 4 and 8 weeks. Results: BMD was significantly higher in the Aaþ þ Mino group than in the Aa? group ( p < 0.05). Bone strength was significantly higher in the Aaþ and Aaþ þ Mino groups than in the Aa? group ( p < 0.05). Furthermore, bone strength was significantly higher in the Aaþ þ Mino group than in the Aa? þ Mino group ( p < 0.05). Minodronate treatment irrespective of Aa supplementation significantly decreased bone resorption compared with the Aaþ and Aa? groups ( p < 0.05). No significant differences in the parameters evaluated by FTIRI were observed between the groups. Conclusions: Aa supplementation improved bone strength in ODS rats. Combined treatment with minodronate and Aa, but not minodronate alone, improved bone strength and increased BMD. Aa is required for bone health because it is essential for osteoblast differentiation. © 2016 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Occurrence of vertebral fracture more closely associated with decreased anteroposterior than lateral lumbar bone mineral density

Hiroyuki Tsuchie,Naohisa Miyakoshi,Yuji Kasukawa,Tomio Nishi,Hidekazu Abe,Toyohito Segawa,Yoichi Shimada 대한골다공증학회 2016 Osteoporosis and Sarcopenia Vol.2 No.1

Objectives: While it has been pointed out that an anteroposterior (AP) view of the lumbar spine may lead to overestimation of the bone mineral density (BMD), a lateral view is expected lead to the early detection of BMD loss on scanning cancellous bone. Vertebral fracture is often seen in aged osteoporotic patients, and it is important to prevent this fracture. Therefore, we aimed to identify the optimal site for BMD measurement to assess the risk of vertebral fracture. Methods: Forty-seven female patients with fresh osteoporotic vertebral fracture and BMD measurements were included in this study (Fracture group). As a non-fractured control group, 218 female patients with BMD measurements were enrolled (Control group). We compared BMD values based on AP and lateral views of the lumbar spine from L2 to L4 and the femoral neck. With a lateral view of the lumbar spine, we measured both the total vertebral body and vertebral body center, mainly composed of cancellous bone. Results: BMD of the AP lumbar spine in the Fracture group was significantly lower than in the Control group (P < 0.05). In the subanalyses for comparisons between age-matched fracture and control groups, BMD of only the AP lumbar spine in the Fracture group was significantly lower than in the Control group (P < 0.01). Conclusions: AP lumbar spine BMD is optimal for assessing vertebral fracture occurrence. © 2016 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).