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Open Journal of Orthopedics 2013年第3期3卷 183-188页

作者： Norio Imai Tomoyuki Ito yasuhito takahashi Yoji Horigome Ken Suda Dai Miyasaka Naoto Endo Department of Orthopedic Surgery Niigata University Medical and Dental Hospital Niigata Japan.

In this study, we have investigated the rotation of the pre-operative and post-operative femur, and stem anteversion to prevent impingement and dislocation. We studied 126 patients who had undergone primary total hip arthroplasty (THA) for the treatment of osteoarthritis. We compared preoperative tilt of anterior pelvic plane (APP), posterior condylar axis of the femur (PCA) relative to APP (APP-PCA) with those of postoperative ones in supine position. There was a moderate correlation between the preand post-operative APP-PCA values (r = 0.71). The postoperative APP-PCA decreased by approximately 6°. However, there was poor correlation between the stem anteversion and the postoperative APP-PCA (r = -0.27). A greater reduction in APP-PCA was observed among patients who exhibited greater external rotation of femur compared to those who showed less external rotation in supine position before THA. We also observed that the post-operative rotation of the femur was dependent on the pre-operative rotation of the femur while it was independent of the stem anteversion.

关键词： Anterior Pelvic Plane Posterior Condylar Axis Rotation Total Hip Arthroplasty

Physician’s Awareness of Home Blood Pressure in the Treatment of Hypertensive Patients with Chronic Kidney Disease

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Open Journal of Nephrology 2014年第1期4卷 28-36页

作者： Naoki Sugano Satoru Kuriyama Yoichiro Hara Koki Takane yasuhito takahashi Yasuko Suetsugu Takashi Yokoo Division of Kidney and Hypertension De-partment of Internal Medicine The Jikei University School of Medicine Tokyo Japan

Aim: The majority of guidelines recommended the significance of home-based blood pressure (home-BP) measurement. The present study explored that to what extent, general practitioners (GPs) were aware of the importance of home-BP in the daily clinical practice. Method: We sent out questionnaires to GPs who had been specialized in nephrology and hypertension. The questions focused on the awareness of home-BP and the selections of antihypertensive agents for refractory hypertension in chronic kidney disease (CKD) patients. Results: 1) The majority (95.9%) of the responding GPs had utilized home-BP in their clinical practice. 2) When prescribing a single agent for hypertensive CKD patients, the majority of GPs (87.3%) chose ARB for the first line drug, and Ca channel blockers (CCB) were the second. 3) As an add-on drug to the pre-treatment with an angiotensin receptor blocker (ARB), the majority preferred CCB (82.7%) to diuretics (21.8%). In addition, a fixed combination formula of antihypertensive medication consisting of ARB plus diuretic was accepted by the majority of GPs (78.7%). 4) To improve morning hypertension in patients treated with two or more drugs, 87.8% of the doctors agreed that additional night-time dosing could be useful. The choices of the agents given at night-time varied, mainly with α1-blockers (40.6%), followed by α-blockers (30.5%) and α-methyldopa (19.8%). Conclusion: The majority of GPs in Japan are aware of the importance of the home-BP-based management of CKD. They mainly chose ARB as a first line drug, and ARB plus CCB as an add-on therapy.

关键词： Home Blood Pressure Chronic Kidney Disease Guideline for High Blood Pressure Antihypertensive Agents

<i>In vivo</i>relationship between the clinical epicondylar axis and the anterior pelvic plane in normal subjects

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Journal of Biomedical Science and Engineering 2013年第9期6卷 863-868页

作者： Norio Imai Tomoyuki Ito yasuhito takahashi Yoji Horigome Ken Suda Dai Miyasaka Izumi Minato Naoto Endo Department of Orthopedic Surgery Niigata Rinko Hospital Niigata Japan Department of Orthopedic Surgery Niigata University Dental and Medical Hospital Niigata Japan

Background: Several researchers consider the clinical epicondylar axis (CEA) as the functional flexion-extension axis of the knee. The anterior pelvic plane (APP) is commonly used as an anatomical reference plane of the pelvis. However, no study has investigated the relationship of the APP with the CEA and PCA. In this study, we aimed to investigate the relationship of the APP with the CEA and posterior condylar axis (PCA) in the standing and supine positions. Methods: We recruited 77 healthy Japanese subjects for this study, and carried out measurements using the Hip CAS?system, a 3D system used for the assessment of lower extremity alignment. Results: The mean femoral neck anteversion was 16.33°. There was an approximate discrepancy of 6° between the male and the female in anatomy (15.73° and 21.15° in the male and female subjects, respectively). The mean condylar twist angle (CTA) was 6.86° and the mean APP-PCA value in the standing position was ﹣6.88°. The mean APP-CEA value in the standing position was 0.02°, and the discrepancy between males and females was only 0.21° (0.09° and ﹣0.13° for the male and female subjects, respectively). This meant that Xp axis of APP and CEA were almost parallel. On the other hand, the mean APP-CEA value in the supine position was 7.07° (male subjects = 9.48°;female subjects = 5.62°). Here, the CEA was approximately parallel to the horizontal axis of the APP, which was compatible with the neutral position of the knee and hip joint, and anatomically and kinesiologically justified in normal subjects. Conclusion: CEA was approximately parallel to the horizontal axis of the APP. These results are compatible with regard to the neutral position of the knee and hip joints, and anatomically and kinesiologically justified in normal subjects. Moreover, CEA is a potential reference axis for the insertion of the femoral component in THA.

关键词： Anterior Pelvic Plane Posterior Condylar Axis Clinical Epicondylar Axis Hip CAS System

A Greater Association of Hyperuricemia than of Metabolic Syndrome with the New Incidence of Chronic Kidney Disease

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Open Journal of Nephrology 2016年第1期6卷 17-27页

作者： Satoru Kuriyama Shinichiro Nishio Satoshi Kidoguchi Kosuke Honda yasuhito takahashi Naoki Sugano Yukio Maruyama Tatsuo Hosoya Tomoko Nakano Tomoko Tanabe Edward Stim Takashi Yokoo Division of Nephrology & Hypertension Department of Medicine Jikei University Tokyo Japan Health Management Center & Tokyo Regional Taxation Bureu Clinic Tokyo Japan Department of Pathophysiology & Therapy in Chronic Kidney Disease Jikei University School of Medicine Tokyo Japan Emergency Assistance Japan Tokyo

Background: To what extent uric acid (UA) levels and/or metabolic syndrome (Mets) contribute to the onset of chronic kidney disease (CKD) is largely unknown. The present study explores how these two factors have an association with the new incidence of CKD. Methods: Study design is a cohort study. A total of 14,485 participants were eligible for the cross-sectional analysis on UA levels and the prevalence of Mets. Among those individuals, 8,223 participants without CKD and 4,839 without Mets were eligible for the longitudinal analysis of the new incidence of CKD. Parameters monitored were body mass index, systolic and diastolic blood pressure, serum creatinine concentration, estimated glolerular filtration rate, lipid profiles, plasma glucose, HbA1c. The primary predictor was the level of UA and Mets to explain the newly-developed CKD. The observation period was 4 years. Results: In a cross-sectional analysis, higher UA levels were associated with the greater prevalence of Mets. In addition, UA levels were associated with the numbers of the Mets constituents in both genders. In a longitudinal analysis, higher UA levels were associated with the greater rate of CKD and the greater incidence of Mets. In addition, the incidence of CKD at year 4 was influenced by the presence of hyperuricemia, but not by that of the Mets. The odd ratio (OR) to predict the CKD incidence was 1.42 (95% confidence intervals (CI), 0.52 to 3.78) in the presence of Mets alone, 2.10 (95% CI, 1.36 to 3.23) in the presence of hyperuricemia alone, and 3.56 (95% CI, 1.55 to 8.21) in the presence of both. Conclusion: Hyperuricemia has a greater association with the incidence of CKD than Mets does. Hyperuricemia complicated by Mets is additionally detrimental.

关键词： Uric Acid Hypertension CKD Estimated Glomerular Filtration Rate