Magnetic resonance imaging (MRI) detection of synovitis and bone lesions of the wrists and finger joints in early-stage rheumatoid arthritis: comparison of the accuracy of plain MRI-based findings and gadolinium-diethylenetriamine pentaacetic acid-enhanced MRI-based findings

Objective

To explore whether synovitis and bone lesions in the wrists and finger joints visualized by plain magnetic resonance imaging (MRI)-based findings correspond exactly or not to those judged by gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced MRI-based findings.

Methods

Magnetic resonance imaging of the wrists and finger joints of both hands were examined in 51 early-stage rheumatoid arthritis (RA) patients whose median disease duration from the onset of articular manifestations to entry was 5?months, by both plain (T1 and short-time inversion recovery images) and Gd-DTPA-enhanced MRI (post-contrast fat-suppressed T1-weighted images) simultaneously. We focused on 15 sites per hand, to examine the presence of synovitis and bone lesions (bone edema and bone erosion). Gd-DTPA-enhanced MRI-based findings were considered “true” lesions, and we evaluated the accuracy of plain MRI-based findings in comparison to Gd-DTPA-enhanced MRI-based findings.

Results

Synovitis, judged by plain MRI-based findings, appeared as false-positive at pretty frequency; thus, the specificity, positive predictive value and accuracy of the findings were low. The rate of enhancement (E-rate) in false-positive synovitis sites was significantly low compared with true-positive synovitis sites where Gd-DTPA enhancement appears. In contrast to synovitis, the false-positivity of bone lesions, judged by plain MRI-based findings, was very low compared with Gd-DTPA-enhanced MRI-based findings.

Conclusion

Synovitis judged by plain MRI-based findings is sometimes considered false-positive especially in sites where synovitis is mild. However, plain MRI is effective in identifying bone lesions in the wrist and finger joints in early-stage RA.     

Complex obstacle negotiation exercise can prevent falls in community‐dwelling elderly Japanese aged 75 years and older

Objectives: The aim of the present study was to evaluate whether a complex course obstacle negotiation exercise (CC), a 24‐week exercise program, can reduce falls and fractures in older adults, as compared with a simple course obstacle negotiation exercise (SC). Methods: This trial was carried out on older adults, aged 75 years and above in Japan. In total, 157 participants were randomized into the CC group (n = 78) and the SC group (n = 79). Participants were enrolled in the exercise class using the CC program or the SC program for 24 weeks. The outcome measure was the number of falls and fracture rates in CC and SC groups for 12 months after the completion of the 24‐week exercise class. Results: Two participants (2.8%) in the CC group and 19 (26.0%) in the SC group experienced falls during 12 months. During the 12‐month follow‐up period after the intervention, the incidence rate ratio (IRR) of falls in the SC group against the CC group was 9.37 (95% CI = 2.26–38.77). One participant (1.4%) in the CC group and eight (10.9%) in the SC group had experienced fractures during 12 months after the exercise class. The IRR of fractures in the SC group compared with the CC group was 7.89 (95% CI = 1.01–61.49). Conclusions: The results of the present trial show that the participants who received individualized obstacle avoidance training under complex tasks combined with a traditional intervention had a lower incidence rate of falls and fractures during the 12 months after the intervention. Geriatr Gerontol Int 2012; 12: 461–467.     

Inorganic/organic nanocomposite ion gels with well dispersed secondary silica nanoparticles

We have previously reported tough inorganic/organic nanocomposite (NC) ion gels composed of silica particles and poly(N,N-dimethylacrylamide) (PDMAAm) networks and a large amount of ionic liquid. In this study, the network structure and toughening mechanism of NC ion gels were investigated. The NC ion gels showed characteristic mechanical properties; i.e. the stress was significantly increased at a highly elongated state. In addition, the NC ion gels showed an almost elastic mechanical property, which was completely different from that of our other developed inorganic/organic tough ion gels named double-network (DN) ion gels. It was found from structural observation that secondary silica nanoparticles dispersed well in the NC ion gel. It was also found that some of the secondary silica nanoparticles had a ring-like structure which would incorporate PDMAAm chains. From the silica particle content dependency on stress–strain curves of inorganic/organic NC ion gels, it was inferred that the secondary silica particles could serve as a movable cross-linker of PDMAAm chains in the NC ion gel.

Tough inorganic/organic nanocomposite (NC) ion gels with silica nanoparticle aggregates having a characteristic structure.     

Combination therapy with single incision laparoscopic surgery and double-balloon endoscopy for small intestinal bleeding: report of three cases

The clinical introduction of double-balloon endoscopy (DBE) has brought about a revolution in the diagnosis and the treatment of diseases of the small intestine. DBE allows not only direct observation of the entire small intestine, but also interventional therapies, tissue sampling and India ink marking (tattooing). Single incision laparoscopic surgery (SILS) was developed from conventional laparoscopic surgery to further reduce the degree of invasiveness. SILS requires only one umbilical incision, thus resulting in almost scarless surgery. This report presents three cases of small intestinal bleeding successfully treated by SILS following tattooing under DBE. The average operative time was 67 min and average blood loss was 5 ml. All patients immediately recovered without any complications. SILS, in conjunction with presurgical tattooing by DBE for small intestinal bleeding is considered to be an ideal approach in terms of minimal surgical trauma and aesthetics.     

Cervical Lymph Node Dissection for Clinically Submucosal Carcinoma of the Thoracic Esophagus

Background

The purposes of this study were to clarify the risk factors for supraclavicular lymph node (SCLN) metastasis and the survival benefit from cervical lymph node (LN) dissections in patients with clinically submucosal (cT1b) carcinoma of the thoracic esophagus.

Methods

A total of 86 patients with this disease who underwent esophagectomy with 3-field lymph node dissection were retrospectively reviewed. Multivariate logistic regression and Cox proportional hazard model were used to identify the independent risk factors for SCLN metastasis and prognostic factors, respectively. An index calculated by multiplying the frequency of metastasis at nodal basin and the 5-year overall survival rate of patients with metastasis at that basin were used to assess the therapeutic outcomes.

Results

A total of 40 patients (47 %) were found to have pathological LN metastasis. Also, 13 patients (15 %) had cervical LN metastasis: 6 and 7 with carcinoma of the upper and mid-thoracic esophagus, respectively. SCLN metastasis was found in 6 patients (7 %); however, there was no independent risk factor for SCLN metastasis. The 5-year overall survival rate was 72.5 %. Cervical LN metastasis was an independent prognostic factor (p = .04; odds ratio 2.55; 95 % confidence interval 1.03–6.31); however, there was no significant difference in survival between patients with SCLN metastasis and those without (p = .06). The calculated index of estimated benefit from cervical LN dissections was 6.9, following upper mediastinal LN of 15.6 and perigastric LN of 8.3.

Conclusions

We could not identify risk factors to predict SCLN metastasis. Cervical LN dissection should not be omitted in patients with cT1b carcinoma, especially of the upper and mid-thoracic esophagus.     

Correction to: Association of initial prednisolone dose with remission,relapse, and infectious complications in adult‑onset minimal change disease

Clinical and Experimental Nephrology - In the original publication, the author has found few errors. The corrections are given below.     

Sex differences in clinical outcomes in Japanese incident dialysis patients: a prospective observational multicenter study

Clinical and Experimental Nephrology - A Dialysis Outcomes and Practice Patterns Study (DOPPS) has shown a one-to-one male-to-female mortality ratio, notwithstanding the statistically longer life...