An understanding of normal joint kinematics is essential to develop treatments that restore normal joint mechanics; however, reports of kinematics during dynamic motion are rare. This study thus investigated glenohumeral (GH) translation in vivo during loaded and unloaded shoulder abduction. Nine healthy shoulders were studied from our patient cohort (average age, 31 years). We created 3D models of the scapula and humerus using computed tomography (CT) images and recorded fluoroscopic images during active abduction in neutral rotation in the plane of the scapula using a hand-held 3kg weight or no additional load. 3D motions were determined using model-based 3D-to-2D registration. Glenohumeral translation was determined by finding the location on the humeral head with the smallest separation from the plane of the glenoid. The humerus moved an average of 2 mm during arm abduction, from inferior to the center of the glenoid. There were no statistically significant differences between the unloaded and loaded conditions. Variability in humeral translation decreased with abduction using both 3-kg and 0-kg conditions, with significantly lower variability showing above a 70° GH abduction. We showed that humeral translation to the center of the glenoid maximizes joint congruency for optimal shoulder function and joint longevity. This data should lead to better strategies for shoulder injury prevention, enhanced rehabilitation, and improved surgical treatments.

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Controlling Nutritional Status (CONUT) is an efficient tool for early detection of malnutrition, measured using two biochemical parameters (serum albumin and total cholesterol) and one immune indicator (total lymphocyte count). The aim of this study was to define the efficacy of CONUT for predicting postoperative complications in very elderly patients with colorectal cancer. This study enrolled 52 patients aged 85 years or older with colorectal cancer for whom we were able to measure CONUT before surgery, conducted at the Department of Gastroenterological and General Surgery of Showa University Hospital in Japan between January 2010 and December 2014. The patients were subdivided into those with complications (Group C, n=9) and those with no complications (Group NC, n=43), and then were retrospectively compared for clinical characteristics, CONUT, and surgical outcomes. Multivariate analysis was finally performed to identify the risk factors of complications. The percentage of patients with a CONUT score of 5 or more in Group C was significantly greater than that in Group NC (7 vs. 12 patients, 77.8% vs. 27.9%, P=0.0079). No other significant difference was observed in the clinical characteristics between Group C and Group NC. Multivariate analysis identified CONUT score as the only significant predictor of complications in this patient cohort (odds ratio=1.374; 95% confidence interval, 1.019-1.949; P=0.0366). Our study suggests that CONUT score is predictive of postoperative complications in very elderly patients with colorectal cancer.

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Benzene and its metabolite phenol are extractable from human whole blood and urine using headspace solid-phase microextraction (SPME. with a Carboxen/polydimethylsiloxane fiber. Both compounds were assayed using ethylbenzene and 2,4-dimethylphenol as internal standards (IS. and capillary gas chromatography (GC. with flame ionization detection. The headspace SPME-GC gave sharp peaks for benzene, phenol, and IS-1, 2; with the whole blood and urine samples showing low background noise. The extraction efficiencies of benzene and phenol were 51.8–99.4% and 10.6–14.3%, respectively, for both whole blood and urine. Regression equations also showed excellent linearity in the range of 5–400ng/0.5ml for benzene and 10–500ng/0.5ml for phenol extracted from whole blood and urine. The detection limits (signal-to-noise ratio=3. for the benzene and phenol were 5–10ng/0.5ml for whole blood and 2–5ng/0.5ml for urine. The coefficients of within-day variation in terms of extraction efficiency for both compounds in whole blood and urine samples were not greater than 13.8%. These data indicate that benzene and phenol can be successfully separated and determined from human samples using the established headspace SPME method.

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The aim of the present study was to assess the non-inferiority of low-dose benralizumab relative to high-dose benralizumab as a treatment option for uncontrolled eosinophilic asthma through a meta-analysis of efficacy and safety in randomized controlled trials (RCTs). PubMed, the Cochrane Library Database, and Scopus were searched to identify relevant articles. Outcome measures were a change in the Asthma Control Questionnaire-6 (ACQ-6) score and the exacerbation rate. In addition, the meta-analysis assessed the incidence of adverse events, injection site reactions, and pyrexia or influenza-like illness. Two RCTs with two doses of benralizumab (20 and 100mg) and a placebo for the treatment of uncontrolled eosinophilic asthma met the criteria and were included in the present study. Non-inferiority of low-dose (20mg) versus high-dose (100mg) benralizumab was shown for the change in ACQ-6 score, exacerbation rate, and the incidence of adverse events, injection site reactions, and pyrexia or influenza-like illness. Although not significant, the incidence of pyrexia or influenza-like illness was lower in patients treated with low-dose benralizumab. These results suggest that low-dose (20mg) benralizumab is effective for symptom control and reduction of exacerbation rate in uncontrolled eosinophilic asthma, with lower treatment costs.

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High serum triglyceride (TG) levels may lower bone fracture risk, but the association between serum TG and bone resorption activity is unclear. The aim of the present study was to analyze this association using casual serum TG levels in patients with and without accelerated bone resorption. A case-control study was performed in 39 patients with accelerated bone resorption and in 69 controls, treated between April 2011 and March 2016 at the Internal Medicine Clinic. Bone resorption activity was assessed by urinary N-telopeptide of type I collagen (uNTx; a marker of bone resorption), which is routinely measured at the Internal Medicine Clinic. Cases were female outpatients aged ≥40 years in whom uNTx levels were ≥54.3nmol bone collagen equivalent (BCE)/mmol creatinine. Subjects with casual serum TG levels ＞150mg/dl were diagnosed with potential hypertriglyceridemia (PHTG). Propensity score-adjusted multinomial logistic regression was performed to estimate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for PHTG in cases compared with controls. Correlations between uNTX and casual serum TG levels in all patients were evaluated using multivariate regression. The prevalence of PHTG was significantly lower in cases than in controls (OR 0.20; 95% CI 0.05-0.65; P=0.006). uNTx levels were negatively associated with casual serum TG levels in all patients (r=-0.07, P=0.046). These results suggest that serum TG levels are negatively associated with bone resorption activity. Reduced bone resorption activity may explain, in part, the reduced fracture risk in Japanese middle-aged and elderly female patients with hypertriglyceridemia.

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The aim of this study was to assess the non-inferiority of on-demand (OD) inhaled corticosteroid (ICS) and fast-acting beta-2 agonist (FABA) combination therapy. Although regular inhalation of low-dose ICS and OD short-acting beta-2 agonist (REG-ICS+OD-SABA) is said to be effective therapy for mild asthma, we investigated whether OD-ICS/FABA is as effective as REG-ICS+OD-SABA. A network meta-analysis of randomized controlled trials was conducted to examine non-inferiority by comparing the efficacy of NON-REG+OD-ICS/FABA with REG-ICS+OD-SABA for mild asthma. We also assessed the superiority of NON-REG+OD-ICS/FABA to OD-SABA without any regular treatment (NON-REG+OD-SABA). PubMed, the Cochrane library database, and Scopus were searched to identify relevant articles with an outcome measure of the incidence of asthma control. A network meta-analysis was performed and the summary effect size was expressed as the mean difference (MD) with 95% confidence intervals (CIs). The probability of being the best treatment for the outcome and the surface under the cumulative ranking curves were also calculated. Three randomized controlled trials of treatment for mild asthma met the criteria and were included in the study. Non-inferiority of NON-REG+OD-ICS/FABA to REG-ICS+OD-SABA (MD, -0.17; 95% CI, -0.41 to 0.07) and superiority of NON-REG+OD-ICS/FABA to NON-REG+OD-SABA (MD, -0.29; 95% CI, -0.49 to -0.08) were shown in patients with mild asthma. The respective probabilities of being the best treatment for asthma control were 91.2%, 8.8% and 0.2% for NON-REG+OD-ICS/FABA, REG-ICS+OD-SABA, and NON-REG+OD-SABA, respectively, and the surface under the cumulative ranking curves were 1.0, 0.5, and 0.1, respectively. These results suggest that NON-REG+OD-ICS/FABA is an effective alternative to REG-ICS+OD-SABA for asthma control in patients with mild asthma.

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A 60-year-old female presented to our clinic with flushing and paresthesia of the face. Deep red facial color was noted, and facial skin paresthesia was confirmed. Multiple subcutaneous calcifications of 1-3mm in diameter were observed by computed tomography (CT), extending from the forehead bilaterally to both cheeks. The patient had received dozens of subcutaneous injections over the last 〜10 years as a regimen of cosmetic surgery to her face, and we concluded that a subcutaneously injected agent had caused the present calcifications.

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Mycobacterium shinjukuense is a species of non-tuberculous mycobacteria newly reported in 2010. Herein, we report on an 85-year-old woman with M. shinjukuense lung disease. Radiographic examinations showed consolidation with bronchiectasis, which responded transiently to clarithromycin monotherapy. After 1 year of monotherapy, the diagnosis was established and drug susceptibility testing revealed elevated minimum inhibitory concentration for clarithromycin. The patient was then treated successfully with a combination of antituberculosis drugs. The transient response to clarithromycin suggested that the M. shinjukuense had acquired resistance to clarithromycin. Appropriate treatment for M. shinjukuense lung disease has not yet been established; therefore, it is important to accumulate information from case reports.

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