Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute

The treatment of rheumatoid arthritis (RA) has improved dramatically with the advent of the latest generation of disease-modifying antirheumatic drugs. Despite these advances, in some patients inflammation is not diminished sufficiently to prevent irreversible musculoskeletal damage, thereby necessitating surgical intervention to reduce pain and improve function. For RA treatment, Japanese orthopedic surgeons also prescribe medication. In this study, we examined whether this Japanese system is effective for RA treatment. We analyzed the clinical condition of RA patients treated by rheumatologists and those treated by orthopedists in a linked registry study using information from a large observational cohort of RA patients followed every half year from 2000 to 2010 (the IORRA cohort). Two groups of patients were compared: patients treated by rheumatologists (rheumatologic group) and patients treated by orthopedists (orthopedic group). The results revealed that patients in the orthopedic group were older, more likely to be female, and had a longer disease duration than patients in the rheumatologic group. The proportion of patients with a history of joint surgery was also much higher in the orthopedic group than in the rheumatologic group. The average scores on the Japanese version of the Health Assessment Questionnaire, and the remission ratio determined using a Boolean-based definition gradually increased from 2000 until 2010, and these findings were consistently better in the rheumatologic group than in the orthopedic group. These data suggest that patients treated primarily by orthopedists are more likely to have long-standing RA compared to patients treated by rheumatologists. Therefore, it is critical for rheumatologists and orthopedists to complement each other medically in the treatment of RA patients.     

Genetic variants in antioxidant pathway: risk factors for hepatotoxicity in tuberculosis patients

Tuberculosis (TB) treatment can cause serious sequelae including adverse effects such as anti-TB drug-induced hepatotoxicity (ATDH). We performed a candidate gene-based association study between single nucleotide polymorphisms (SNPs) in 10 genes in the antioxidant pathway and ATDH susceptibility. The subjects comprised 100 Japanese patients with pulmonary TB who received a treatment regimen including isoniazid and rifampicin. Out of them, 18 patients had ATDH. Thirty-four tag SNPs in 10 genes were analyzed by PCR-restriction fragment length polymorphism or PCR-direct DNA sequencing. The frequencies of alleles and genotypes between patients with and without ATDH were compared in three different genetic models. Statistical analyses revealed that a C/C genotype at rs11080344 in NOS2A, a C/C genotype at rs2070401 in BACH1, and a G/A or A/A genotype at rs4720833 in MAFK independently conferred ATDH susceptibility. Remarkably, the association of the latter two tag SNPs with ATDH susceptibility was highly statistically significant (P?=?0.0006) with an odds ratio of 9.730. This study is the first report to demonstrate that NOS2A, BACH1, and MAFK appear to be genetic determinants of ATDH in Japanese patients with TB. Furthermore, a combination of BACH1 and MAFK polymorphisms may be useful as new biomarkers to identify high-risk Japanese TB patients for ATDH.     

Manserin as a novel histochemical neuroendocrine marker in prostate cancer

ObjectivesTo investigate the presence of manserin in human prostate cancers and to correlate manserin expression with pathologic outcomes and progression-free survival.MethodsEighty-seven patients with recent prostate cancer were classified into 4 groups based on Gleason score, and manserin immunohistochemistry was correlated with Gleason sum grade. To investigate the validity of manserin as a prognostic factor, the Cox proportional hazards regression model was performed on 48 patients in our cohort with T3 or T4 prostate cancer who were initially treated with androgen deprivation therapy.ResultsThe manserin-positive rates of patients with Gleason sums of 6, 7, 8, and ≥9 were 0%, 20.0%, 35.0%, and 48.1%, respectively. Manserin-positive rates were positively correlated with Gleason sums (P = 0.0001). Median times to cancer progression in groups with (n = 8) and without (n = 40) manserin expression were 8 months and 28 months, respectively (P = 0.01). Univariate Cox analysis revealed that manserin expression, clinical stage T4, and high Gleason sum were significantly associated with progression. Multivariate analysis revealed that only 2 factors, manserin expression (hazard ratio (HR) 4.99, P = 0.01) and clinical stage T4 (HR 4.77, P = 0.03), were independent risk factors for progression.ConclusionsThis is the first report of manserin expression in human prostate cancers. Manserin may serve as a marker of prostate cancer progression.     

Definitions of the physical properties of pressure ulcers and characterisation of their regional variance

A pressure ulcer is a localised injury of the skin and underlying tissue that usually develops over a bony prominence. A decrease in the pressure over the bony prominence effectively prevents pressure ulcers; however, no studies have systematically assessed the physical properties of existing pressure ulcers. To characterise pressure ulcers, we established new terminology that clarifies the physical properties of pressure ulcers: wound mobility was defined as movement using the bony prominence as a predefined specific marker, and wound deformity was defined as a change in the three‐dimensional shape of the wound. Observational studies using this terminology showed that the distinct physical properties of pressure ulcers depend on the site of development and the wound depth according to the National Pressure Ulcer Advisory Panel criteria. Most grade IV sacrum pressure ulcers exhibited mobility and deformity. Superficial sacrum pressure ulcers below grade II showed only mobility. In contrast, foot pressure ulcers did not exhibit mobility or deformity. We propose a new concept, ‘wound physical property’, for understanding the unique pathogenesis of pressure ulcers.     

Adult umbilical hernia with vertical dislocation

We present a case of adult umbilical hernia with vertical dislocation along the abdominal wall. The hernial sac arose from the internal ring and connected to the umbilicus 20?mm below the internal ring. The postoperative course was uneventful. Two years and four months after the operation there was no evidence of recurrent hernia even when abdominal pressure was increased, and the umbilicus looked acceptable. An umbilical hernia is usually within the umbilicus. The hernial sac arose from the internal ring so should be called an umbilical hernia not an epigastric hernia. It is unusual that the umbilical hernia dislocates vertically along the abdominal wall, while the umbilicus stays depressed. This atypical form of umbilical hernia has not been described previously as far as we know.     

Epithelioid myoepithelioma of the hard palate

Background

Myoepithelioma, a generally benign tumor comprised of myoepithelial cells, is an uncommon salivary gland tumor. Among four morphologic variants of myoepithelioma, epithelioid type has not been reported in the oral and maxillofacial region.

Case report

A 61-year-old man first noticed the mass 3 years previously. The oral examination revealed a firm, non-tender, and well-circumscribed mass in the middle of the hard palate. A magnetic resonance imaging scan showed a well-circumscribed mass with low signal intensity (T₁-weighted image) or increased signal intensity (T₂-weighted image).

Discussion

Immunohistochemically, the tumor cells in the present case reacted to the epithelial (CK HMW and CAM5.2) and the mesenchymal (vimentin) markers. However, myoepithelial markers (S-100 protein, α-smooth muscle actin, glial fibrillary acidic protein, and calponin), except p63, were not expressed in the tumor cells. These results indicated that the epithelial myoepithelioma cells differentiated into epithelial cells rather than myoepithelial cells. We believe that epithelioid myoepithelioma of the palate is a distinctive subtype of myoepithelioma that should be included in the differential diagnosis of tumors of the palate.