No abstract available.
Bone Marrow*

The purpose of this study was to examine the effects of anthropometric measures, including body height, body weight, body mass index (BMI), fat mass (FM), and lean body mass (LBM), on quantitative ultrasound (QUS) parameters of calcaneus in 358 Japanese university women. Ultrasonic bone densitometer (Achilles, Lunar corp.) was utilized to measure broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI) of the right calcaneus. The average of SI in this study showed a slight lower value (84, 3±12.1, mean±SD) compared with that in age-matched university women as previously reported. The contradictive finding may suggest the need for a large-scale further investigation on SI in young women. Correlation analysis revealed that both BUA and SI are significantly correlated with all anthropometric measures. However SOS had only weak correlation with LBM. In consideration of the high colinearities of body weight and BMI with FM and LBM, the multiple liner regression analysis was conducted with BUA, SOS, and SI as dependent variables. Body height, FM, and LBM were then entered to a forward stepwise regression model. The analysis proved that the significant predictor of BUA, SOS, and SI is LBM. It also suggested BUA to be stronger correlated with LBM than the other QUS parameters, SOS and SI. In conclusion, our re sults support the view that QUS parameters appear to be influenced by anthropometric measures, especially by LBM in Japanese university women. It is conceivable that an increase in skeletal mus cle mass chiefly induced by physical exercise contributes to the improvement of bone mass as measured by QUS in young women.

The college years are an opportune timepoint of intervention in the primary prevention of osteoporosis. However, the effects of anthropometrical measures and lifestyle-related factors on the changes in bone mass during college years are unclear. The purpose of this study was thus to identify the determinants of the changes in calcaneal quantitative ultrasound (QUS) bone parameters (stiffness index: SI, speed of sound: SOS, broadband ultrasound attenuation: BUA) over 2 years in healthy Japanese college women (n=128). Correlation analysis revealed several significant relationships between the change rates in QUS parameters and anthropometry. Particularly, the changes in SI and BUA are highly correlated with the 2-year change in lean body mass (LBM). The subsequent multiple liner regression analysis also supported that the change in LBM was the significant predictor for the incremental rate of SI and BUA. All subjects then categorized into some grades, concerning about following lifestyle-related and physical variables during the last 2 years, living condition, sleeping time, alcohol consumption, smoking, meal skipping, dairy foods intake, instant foods intake, regular physical activity, regularity of menstruation, history of fracture, and history of dieting to reduce body weight. The incremental rates of all QUS parameters (i. e., SI, SOS, BUA) were positively associated with participation in regular physical activity. In addition, women who have continuously participated in regular physical activity from high school to college showed significant increases in SI and SOS compared with those who are not physically active or whose level of physical activity decline during college years. In conclusion, our study indicates that changes in QUS parameters in college-aged women were influenced by changes in anthropometric measures, especially LBM. It might suggest the importance of participation in regular physical activity to increase skeletal muscle mass. Our results also support the view that college women should maintain or increase regular physical activity before and after entering the college to maximize peak bone mass or lessen the age-related loss in bone mass in adulthood.

PURPOSE: Medial meniscus posterior root tears (MMPRT) induce medial meniscus extrusion (MME). However, the time-dependent extent of MME in patients suffering from the MMPRT remains unclear. This study evaluated the extent of MME after painful popping events that occurred at the onset of the MMPRT. MATERIALS AND METHODS: Thirty-five patients who had an episode of posteromedial painful popping were investigated. All the patients were diagnosed as having an MMPRT by magnetic resonance imaging (MRI) within 12 months after painful popping. Medial meniscus body width (MMBW), absolute MME, and relative MME (100×absolute MME/MMBW) were assessed among three groups divided according to the time after painful popping events: early period ( < 1 month), subacute period (1–3 months), and chronic period (4–12 months). RESULTS: In the early period, absolute and relative MMEs were 3.0 mm and 32.7%, respectively. Absolute MME increased up to 4.2 mm and 5.8 mm during the subacute and chronic periods, respectively. Relative MME also progressed to 49.2% and 60.3% in the subacute and chronic periods, respectively. CONCLUSIONS: This study demonstrated that absolute and relative MMEs increased progressively within the short period after the onset of symptomatic MMPRT. Our results suggest that early diagnosis of an MMPRT may be important to prevent progression of MME following the MMPRT.
Early Diagnosis ; Humans ; Magnetic Resonance Imaging ; Menisci, Tibial ; Tears

PURPOSE: To evaluate the clinical effects of using anatomical bony landmarks (Parsons' knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction. MATERIALS AND METHODS: We performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes. RESULTS: Use of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes. CONCLUSIONS: Use of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Arthroscopy ; Humans ; Knee ; Knee Joint ; Retrospective Studies ; Transplants

PURPOSE: Posterior root repair of the medial meniscus (MM) can prevent rapid progression of knee osteoarthritis in patients with a MM posterior root tear (MMPRT). The anatomic reattachment of the MM posterior root is considered to be critical in a transtibial pullout repair. However, tibial tunnel creation at the anatomic attachment is technically difficult. We hypothesized that a newly developed point-contact aiming guide [Unicorn Meniscal Root (UMR) guide] can create the tibial tunnel at a better position rather than a previously designed MMPRT guide. The aim of this study was to compare the position of the created tibial tunnel between the two meniscal root repair guides. MATERIALS AND METHODS: Thirty-eight patients underwent transtibial pullout repairs. Tibial tunnel creation was performed using the UMR guide (19 cases) or MMPRT guide (19 cases). Three-dimensional computed tomography images of the tibial surface were evaluated using the Tsukada's measurement method postoperatively. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines referring to three anatomic bony landmarks (anterior border of the posterior cruciate ligament, lateral margin of the medial tibial plateau, and retro-eminence ridge). The expected anatomic center and tibial tunnel center were evaluated using the percentage-based posterolateral location on the tibial surface. The distance between the anatomic center and tunnel center was calculated. RESULTS: The anatomic center of the MM posterior root footprint was located at a position of 79.2% posterior and 39.5% lateral. The mean of the tunnel center in the UMR guide was similar to that in the MMPRT guide (posterior direction, P = 0.096; lateral direction, P = 0.280). The mean distances between the tunnel center and the anatomic center were 4.06 and 3.99mm in the UMR and MMPRT guide group, respectively (P = 0.455). CONCLUSIONS The UMR guide, as well as the MMPRT guide, is a useful device to create favorable tibial tunnels at the MM posterior root attachment for pullout repairs in patients with MMPRTs.LEVEL OF EVIDENCE: IV

PURPOSE: Medial meniscus posterior root tear (MMPRT) causes progression of medial meniscus extrusion (MME). This study aims to calculate the progression rate of MME based on findings in two preoperative magnetic resonance imaging (MRI) scans and determine the associated factors. MATERIALS AND METHODS: We retrospectively reviewed 33 patients (27 females and 6 males; mean age, 60 years) who underwent MRI twice, at a mean interval of 48 days. We measured the medial meniscus body width, medial joint space width (MJSW), and MME. The MME progression rate was derived from regression analysis of the increase in MME (ΔMME) between the two MRI scans. In addition, the correlations of the MME increase rate with age, body mass index, femorotibial angle, and MJSW were evaluated. RESULTS: The mean MME increased from 3.4 mm to 4.5 mm (p<0.001). A good correlation was observed between ΔMME and the interval of MRI scans (R²=0.621), and the MME progression rate was 0.020 mm per day. A moderate correlation was observed between the MME increase rate and the MJSW (R²=0.432). CONCLUSIONS: The MME progression rate was rapid in MMPRT and narrowing of the MJSW was associated with the progression of MME. LEVEL OF EVIDENCE: V, Cross-sectional study
Body Mass Index ; Cross-Sectional Studies ; Female ; Humans ; Joints ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial ; Retrospective Studies ; Risk Factors ; Tears

Purpose: To evaluate the impact of severe erectile dysfunction (ED) on future major adverse cardiovascular events (MACE) in men on dialysis. Materials and Methods: This prospective cohort study included 71 men on dialysis. ED was assessed using the Sexual Health Inventory for Men (SHIM). Men were divided into the mild/moderate ED (SHIM score ≥8) and severe ED (SHIM score ≤7) groups. The primary endpoint was MACE-free survival. MACE was a composite of myocardial infarction, cardiovascular death, and stroke. The secondary endpoints were cardiac event-free survival and overall survival (OS). Moreover, the predictive abilities of severe ED for 5-year MACE, 5-year cardiac events, and 5-year overall mortality were evaluated. Results: The median age and follow-up period of the included men were 64 years and 58 months, respectively. The median SHIM score was 4.0; all had a degree of ED, and 64.7% had severe ED. In the background-adjusted multivariable analyses, severe ED was not significantly associated with shorter MACE-free survival (hazard ratio [HR], 1.890; 95% confidence interval [CI], 0.533–6.706; p=0.324), cardiac event-free survival (HR, 2.081; 95% CI, 0.687–6.304; p=0.195), and OS (HR, 0.817; 95% CI, 0.358–1.863; p=0.630). Severe ED did not significantly improve the predictive abilities for 5-year MACE, 5-year cardiac events, and 5-year overall mortality (p=0.110, p=0.101, and p=0.740, respectively). Conclusions ED severity was not associated with shorter MACE-free survival, cardiac event-free survival, or OS, and ED severity could not improve the predictive abilities for these outcomes in men undergoing dialysis.

PURPOSE: To verify the effectiveness of detecting medial meniscus posterior root tears (MMPRTs) using weight-bearing posterior-anterior (PA) radiographs. MATERIALS AND METHODS: Twenty-three patients were diagnosed with an MMPRT using magnetic resonance imaging (Group A), with 23 matched individuals forming the control group (Group B). The distance between medial tibial eminence and the lateral edge of the medial femoral condyle (MTE–MFC distance) and medial joint space (MJS) width were measured on weight-bearing PA radiographs, with the knee flexed at 45° (Rosenberg view). Absolute medial meniscus extrusion (MME) was measured on magnetic resonance images. RESULTS: The MTE–MFC distance was greater and the MJS width was smaller in Group A than Group B (7.7 ± 1.7mm versus 6.0 ± 1.24mm and 3.2 ± 0.8mm versus 4.5 ± 0.7 mm, respectively; P < 0.05). The MTE–MFC distance and MJS width correlated with MME (r = 0.603 and 0.579, respectively; P < 0.05), and the extent of MME was greater in Group A than Group B (4.1 ± 1.1mm versus 1.8 ± 1.5 mm, respectively; P < 0.05). CONCLUSIONS MMPRTs increase the MTE–MFC distance and decrease the MJS width, with these measurements correlating to the MME. Therefore, measurement of the MTE–MFC distance and MJS width on the Rosenberg view could be a useful preliminary method for the diagnosis of an MMPRT.LEVEL OF EVIDENCE: IV

The Professionalism subcommittee of Japan Society for Medical Education has been examining a diverse range of issues related to medical professionalism education for approximately the past 20 years. In July 2015, the committee formulated and presented a draft on “ The Attributes and Competencies of Physicians: An Exploration of Professionalism” Based on this, we have been conducting educational activities on professionalism education, but we had not documented this draft. We are now re-presenting the draft here with minor lexical corrections and additional notes. The professionalism of physicians is delineated in seven attributes and competencies :1. Sense of mission and responsibility towards society2. Practice of patient-centered health care3. Demonstration of integrity and justice4. Acceptance of diverse values and sharing of fundamental values5. Fulfilling roles as leaders/members in organizations and teams6. Pursuit of excellence and lifelong learning7. Self-management and career developmentThis document is presented with the expectation that it will contribute to future discussions on professionalism education.