A prospective, single institution, clinical case-matched, radiographic study was undertaken. Thirty-two patients underwent posterior lumbar interbody fusion with cages containing laminectomized bone chips and posterolateral lumbar fusion with pedicle screws. Autogenous bone graft (3 mL) plus 3 mL of hydroxyapatite was placed in one side of a posterolateral gutter, and 6 mL of autogenous iliac bone graft was placed on the other side. Bony union, volumes of fusion mass, and bone absorption rates were postoperatively evaluated using simple radiographs and 3D-CT scans. Average postoperative Lenke scores at 3 and 6 months in the hydroxyapatite group were statistically higher than in the autograft group, but at 12 months no difference was found between the hydroxyapatite and autograft groups in terms of fusion rate. Complete fusion rates by 3D-CT were 86.7% in the hydroxyapatite group and 88.9% in the autograft group, which are not significantly different. Volumes of fusion mass and bone absorption rates at 12 months were 2.35 mL in the hydroxyapatite group and 1.31 mL in the autograft group. The mean fusion mass volume was greater in the hydroxyapatite group than in the autograft group. Lumbar posterolateral fusion using a mixture of hydroxyapatite artificial bone and autogenous bone graft showed good bony union similar to that shown with autogenous bone only. This study suggests that hydroxyapatite bone chips could be used usefully as a bone-graft extender in short-segment posterolateral spinal fusion.

In this study, a wrist human-machine interface with a single internal rotation center, which is efficient in terms of performance, size, and avoidance of kinematic interference, is proposed to realize the 3-degree-of-freedom rotational motion of the human wrist. For this purpose, an over-actuated coaxial spherical parallel mechanism is applied. The over-actuated mechanism is specially considered to improve the force feedback performance and to overcome the workspace limitations caused by the singularity. From a mechanical perspective, two links are coaxially connected to the base, and this rotation axis is designed to coincide with the wrist pronation-supination, which has the largest operating range in wrist motion. A prototype was fabricated and evaluated to validate the proposed mechanism. In addition, a usable design index was proposed for the design that prevents interference with the user in the workspace while minimizing the link inertia to optimize the device. This index is optimized with the general performance indices, that is, condition index and stiffness index. It was verified through simulation that the optimized wrist human-machine interface exhibited higher performance than other similar devices. In addition, range of motion is at least 104.3% than a daily living range of motion of the human wrist, guaranteeing all ranges of motion.

Objective. High disease activity of ankylosing spondylitis (AS) is associated with poor sleep quality. The purpose of this study was to identify which of the representative tools for evaluating the disease activity of AS best reflect the quality of sleep. Methods. A total of 107 AS patients were enrolled in the study and the sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Age, sex, concomitant medication, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) level, Beck Depression Inventory second edition (BDI-II), Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAS)-ESR, ASDAS-CRP, pain visual analog scale, Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS) were analyzed as covariates. Results. Overall, 65% (70/107) of subjects reported poor sleep quality (PSQI＞5). There was a positive correlation between the sleep quality and disease activity as measured by the BASDAI, ASDAS-ESR, and ASDAS-CRP. In addition, the BASDAI demonstrated good correlations with ISI, ESS, and BDI-II, respectively. However, only BASDAI showed reliable correlation with PSQI among the disease activity parameters of AS (adjusted odd ratio 5.36, p=0.023). Conclusion. BASDAI is the most reliable parameter of disease activity associated with the sleep quality in patients with AS.

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis of the skin and internal organs. Despite the recent advances in the pathogenesis and treatment of SSc, effective therapies for fibrosis caused by SSc have not yet been established. In this study, we investigated the potential role of mirodenafil, a potent phosphodiesterase 5 (PDE5) inhibitor, in the treatment of fibrosis in SSc. We used a bleomycin (BLM)-induced SSc mouse model to mimic the typical features of fibrosis in human SSc and examined the dermal thickness to assess the degree of skin fibrosis after staining with hematoxylin and eosin or Masson’s trichrome stains. The effect of mirodenafil on the expression of profibrotic genes was also analyzed by treating fibroblasts with transforming growth factor (TGF)-β and mirodenafil. We showed that mirodenafil ameliorated dermal fibrosis and downregulated the protein levels of fibrosis markers including COL1A1 and α-SMA in the BLM-induced SSc mouse model. Further, using mouse embryonic fibroblasts and human lung fibroblasts, we demonstrated that the expression of collagen and profibrotic genes was reduced by treatment with mirodenafil. Finally, we showed that mirodenafil inhibited TGF-β-induced phosphorylation of Smad2/3 in fibroblasts, which suggested that this drug may ameliorate fibrosis by suppressing the TGF-β/Smad signaling pathway. Our findings suggest that mirodenafil possesses a therapeutic potential for treating fibrosis in SSc.

Background and Objectives: We investigated whether nutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphoycte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are associated with the presence of osteoporosis (OP) and vertebral fractures in patients with rheumatoid arthritis (RA). Materials and Methods: This retrospective cohort study included 413 postmenopausal patients with RA and 200 healthy controls who underwent dual-energy X-ray absorptiometry (DEXA) between January 2005 and December 2017. DEXA examination data were defined as the index date, and all laboratory values were measured within one month from the index date. OP was defined as a T-score < −2.5, and incident vertebral fractures were defined as the first occurrence of non-traumatic fractures after the index date. NLR, PLR, and MLR measures were dichotomized by a median split (low vs. high). Results: The median NLR, PLR, and MLR in RA patients were significantly higher than those in controls. The frequencies of OP of the lumbar spine, hip, and either site in postmenopausal patients with RA were 24.7%, 15.5%, and 32%, respectively, and were significantly higher than those in controls. After adjusting for confounding factors, a high baseline NLR was significantly associated with OP at either site (OR = 1.61, p = 0.041). In addition, high baseline NLR (OR = 2.11, p = 0.025) and PLR (OR = 2.3, p = 0.011) were related with the presence OP at hip. During the follow-up period, 53 (12.8%) patients with RA developed vertebral fractures incidentally. In multivariable Cox regression models, a high baseline NLR (HR = 4.72, p < 0.001), PLR (HR = 1.96, p = 0.024), and MLR (HR = 2.64, p = 0.002) were independently associated with a higher risk of incidental vertebral fractures. Conclusions: Our data suggest that NLR, PLR, and MLR can be used as potential markers of systemic bone loss among individuals with RA.