Feasibility of methotrexate discontinuation following tocilizumab and methotrexate combination therapy in patients with long-standing and advanced rheumatoid arthritis: a 3-year observational cohort study.

Objectives: Methotrexate (MTX) is associated with extensive side effects, including myelosuppression, interstitial pneumonia, and infection. It is, therefore, critical to establish whether its administration is required after achieving remission with tocilizumab (TCZ) and MTX combination therapy in patients with rheumatoid arthritis (RA). Therefore, the aim of this multicenter, observational, cohort study was to evaluate the feasibility of MTX discontinuation for the safety of these patients.

Increased Incidence of Late-Onset Circulatory Collapse after Changing Clinical Practice: A Retrospective Investigation of Causative Factors.

Objective: Acute primary profound circulatory failure responsive to glucocorticoid therapy after the first week of age in preterm infants is termed late-onset circulatory collapse (LCC). This study was performed to identify factors that notably increased the incidence of LCC after various management practices were changed.

Study Design: We retrospectively studied the clinical characteristics of infants (<29 weeks' gestation) before (n=26) and after (n=35) implementing the following practice changes: stress reduction, conservative replacement of thyroid hormone, positive antenatal glucocorticoid administration, sedation with fentanyl (<7 days after birth), and hydrocortisone therapy for hypotension.

Premature rupture of membranes and neonatal respiratory morbidity at 32-41 weeks' gestation: a retrospective single-center cohort study.

Aim: To ascertain whether premature rupture of membranes (PROM) independently affects the risk of neonatal respiratory morbidity at 32-41 weeks' gestation because previous reports have given insufficient consideration to the mode of delivery and labor onset.

Methods: Data on 4,629 consecutive singleton infants were retrospectively collected. Respiratory morbidity was limited to respiratory distress syndrome and transient tachypnea of the newborn, both of which are related to prematurity.

Fatty degeneration of gluteus minimus muscle as a predictor of falls.

The cause of falls is multifactorial, however, hip fractures in elderly would be prevented if accidental falls are predictable. We assessed magnetic resonance images of 38 patients with groin pain after taking a fall whose fracture could not be detected by plain X-rays, and 45 patients with no episode of falls. Their ages were over 65 years.

Oscillometric and intra-arterial blood pressure in preterm and term infants: extent of discrepancy and factors associated with inaccuracy.

Objective: Securing an arterial line to monitor continuous blood pressure (BP) is difficult in infants. We aimed to reveal the extent of discrepancies between oscillometric and direct BP.

Study Design: Infants who required continuous BP monitoring were prospectively enrolled.

Intramuscular hemangioma in the right ventricle.

Intramuscular cardiac hemangiomas are extremely rare. We describe a 74-year-old man with a tumor occupying the apex of the right ventricle that was incidentally diagnosed by echocardiography. Computed tomography and coronary angiography showed that the tumor arose from the ventricular septum and that the feeding artery was a branch of the right coronary artery.

Inherited risk factors for deep venous thrombosis following total hip arthroplasty in Japanese patients: matched control study.

Background: Inherited predisposing risk factors for deep venous thrombosis (DVT) have been clearly identified in Caucasians, but there are fewer reports evaluating these factors in the Japanese. This study was undertaken to assess the predisposing risk factors for DVT following elective total hip arthroplasty (THA) in Japanese patients.

Methods: We studied 60 patients who underwent THA.

Condylar Stabilizing Technique with AO/ASIF Distal Radius Plate for Colles' Fracture Associated with Osteoporosis.

The author established a new reduction and fixation technique for osteoporotic distal radius fracture with a use of AO/ASIF volar distal radius plate, referring to the condylar plating technique in distal femoral fracture. This technique is performed in three steps. First, distal fixation is through the insertion of buttress pins just beneath the subchondral bone with a convergent angle of 10 degrees to the articular surface under fluoroscopic assistance.

Condylar stabilizing technique for intra-articular fracture of distal radius.

I previously reported a new reduction and fixation technique for extra-articular distal radius fracture associated with osteoporosis. I developed the technique and applied it to intra-articular fracturea. I present here the technique and verify its reliability, comparing the functional results of intra-articular fracture cases to those of extra-articular cases.

Trisomy 1 in a case of a missed abortion.

Most chromosomal trisomies lead to miscarriages. In all trisomies, trisomy 1 is the most rare case. We herein present a patient who demonstrated a gestational sac and a yolk sac on transvaginal ultrasound.

Closed-Wedge osteotomy for osteochondritis dissecans of the capitellum. A 7- to 12-year follow-up.

This article details a 7- to 12-year follow-up of seven young male baseball players with osteochondritis dissecans of the capitellum that we treated using closed-wedge osteotomy. This procedure was established by Yoshizu in 1986 for the treatment of "Little League elbow." The bone of the capitellum was revascularized and remodeled within 6 months in all seven patients.

Critical displacement of neural injuries in supracondylar humeral fractures in children.

To investigate a relation between the degree of initial fracture displacement and nerve complication, 53 consecutive acute extension-type supracondylar humeral fractures in children during 10 years were analyzed. From the initial roentgenographs, the direction and degree of displacement of each fracture were plotted on the coronal two-dimensional coordinates at the fracture site. The degree of displacement was represented by a diameter of the humeral shaft.

Effect of hyperbaric oxygen therapy as a monitoring technique for digital replantation survival.

There have been few clinical reports of successful replantation assisted with hyperbaric oxygen (HBO) therapy. In order to improve replant survival, the author has used HBO in ten digital replantations of crush, avulsion, and degloving amputations. Seven of ten replants survived and the other three failed.

Intramedullary bone-cement fixation for proximal humeral fracture in elderly patients. A report of 5 cases.

We treated 5 proximal humeral fractures associated with advanced osteoporosis with conventional plate and screw fixation augmented by intramedullary bone cement. These osteosyntheses remained stable during a 1-year follow-up and the outcome was similar to that after fractures in younger patients without osteoporosis.

Fracture and dislocation of snowboarder's elbow.

Background: This study focuses on the analysis of snowboarding versus skiing injuries, especially fracture, dislocation, or both, of the elbow, based on 7 years of medical records and roentgenograms of patients injured at a ski-snowboard area, Mt. Zao National Park, and demonstrates the precise characteristics of snowboard injury in the elbow region.

Methods: A retrospective study of 1,445 injured snowboarders and 10,152 injured skiers was undertaken to assess both snowboarding and skiing injuries.

Snowboarder's wrist: its severity compared with Alpine skiing.

Background: Although the upper extremity, especially the wrist, has been reported to be the most commonly injured site in snowboarding, the severity of these injuries is still unknown. The purpose of this study is to compare the severity of wrist injuries in snowboarding with those in alpine skiing for insight into the treatment of snowboarder's wrist.

Materials And Methods: The cases of 11,598 patients injured while snowboarding and skiing who presented to the Zao clinic during the past 7 seasons were reviewed and compared.

Development and sexual difference in embryonic heart rates in pregnancies resulting from in vitro fertilization.

The purpose of this study was to investigate the gestational change of embryonic heart rates (EHRs) and to estimate the influence of embryonic sex on the EHR in pregnancies resulting from in vitro fertilization in the early first trimester. With transvaginal ultrasonography, we performed 92 and 105 examinations, on 27 male and 30 female embryos, respectively. The EHR increased gradually from 87 beats per min at 38 days of gestation to 189 beats per min at 62 days of gestation.

Color monitoring after replantation.

The recognition of postmicrosurgical minute skin color changes is an important element in assessing vascular insufficiency that has traditionally relied on a skilled microsurgeon's subjective clinical impression. This study investigates the use of a color monitor for the objective quantitative evaluation of such skin color changes. Twenty-two replanted digits were monitored postmicrosurgically with a color meter while deep skin temperature recordings, an established method of postmicrosurgical monitoring, were taken simultaneously.