Rheumatoid arthritis (RA), one of the most common autoimmune diseases, is characterized by multiple-joint synovitis with subsequent destruction of bone and cartilage. The excessive autoimmune responses cause an imbalance in bone metabolism, promoting bone resorption and inhibiting bone formation. Preliminary studies have revealed that receptor activator of NF-κB ligand (RANKL)-mediated osteoclast induction is an important component of bone destruction in RA. Synovial fibroblasts are the crucial producers of RANKL in the RA synovium; novel analytical techniques, primarily, single-cell RNA sequencing, have confirmed that synovial fibroblasts include heterogeneous subsets of both pro-inflammatory and tissue-destructive cell types. The heterogeneity of immune cells in the RA synovium and the interaction of synovial fibroblasts with immune cells have recently received considerable attention. The current review focused on the latest findings regarding the crosstalk between synovial fibroblasts and immune cells, and the pivotal role played by synovial fibroblasts in joint destruction in RA.

PURPOSE: Our previous NECO phase II studies on high-grade osteosarcoma suggested that administering ifosfamide (IF; 16 g/m ² [4g/m ² once on day 1, then 2g/m ² once on days 2-7] × six) to patients showing a poor response (PrRsp) to preoperative chemotherapy with methotrexate, doxorubicin, and cisplatin (MAP) improves their prognoses. In this Japan Clinical Oncology Group (JCOG) study, JCOG0905, we aimed to investigate the efficacy and safety of IF in patients with PrRsp. METHODS: JCOG0905 is a multicenter, open-label, multi-institutional, randomized trial. Eligible patients (50 years and younger) had resectable, high-grade osteosarcoma (stage II or III, Union for International Cancer Control TNM) of the extremities, limb girdles, and thoracic wall. After two MAP cycles and tumor resection, patients with PrRsp were randomly assigned to either the MAP or MAP plus 15 g/m ² (3g/m ² once daily on days 1-5) × six IF (MAP + IF [MAPIF]) group. The primary end point was disease-free survival (DFS); secondary end points were overall survival (OS) and safety. The planned sample size was 100 patients with a one-sided α of .1 and a power of 0.7, assuming a 3-year DFS of 50% and 65% for MAP and MAPIF, respectively. This trial is registered with the Japan Registry of Clinical Trials (jRCT; jRCTs031180126). RESULTS: Of the 287 patients registered between February 2010 and August 2020, 51 and 52 patients with PrRsp were assigned to the MAP and MAPIF groups, respectively. As of March 2022, DFS did not differ between groups (hazard ratio [HR], 1.05 [95% CI, 0.55 to 1.98]) and OS was numerically inferior in the MAPIF group (HR, 1.48 [95% CI, 0.68 to 3.22]). Nine and zero patients in the MAPIF and MAP groups discontinued treatment because of adverse events, respectively. CONCLUSION: Evidence from JCOG0905 does not support the addition of IF for patients with PrRsp.

The retear rate after arthroscopic rotator cuff repair for small/medium tears is considered lower than that for large/massive tears. However, few studies have reported risk factors for small/medium retears. Therefore, this study investigated the risk factors for small/medium retears following arthroscopic rotator cuff repair. The retrospective study involved 129 patients who underwent arthroscopic rotator cuff repair for small/medium rotator cuff tears at our hospital between January 2018 and June 2021. Clinical evaluations at preoperative and final follow-up were conducted using the criteria of University of California, Los Angeles score and Constant Shoulder score, and the achievement of minimal clinically important difference of those scores were recorded. Physical examination findings, imaging findings (stump classification and Goutallier classification), suturing methods, and past medical history including smoking history and diabetes were investigated to assess their relevance to clinical outcomes and retear. At the final postoperative follow-up, structural outcome was evaluated using magnetic resonance images, and Sugaya classification type 4 or 5 was defined as a retear. In total, 76 male and 53 female patients with a mean age of 64.2 ± 9.1 years were enrolled. The shortest follow-up period was 12 months postoperatively (range, 12–44 months; mean, 22.09 ± 7.27 months). All clinical scores of 129 patients showed significant postoperative improvement (P < .001). Based on the Cofield classification, 44 patients had small tears compared with 85 patients who had medium tears, whereas 15 (11.6%) patients experienced retears. Multivariate analysis of retear-related factors revealed that symptom duration, absence of traumatic episode, tendon edge status (stump classification), Goutallier classification of the supraspinatus (stages ≥2), and absence of the long head of the biceps tendon during surgery were significant risk factors for retears (P < .01). The correlation analysis between symptom duration and other factors showed a significant association with traumatic absence only (P < .0001). This study showed that after arthroscopic rotator cuff repair for small/medium rotator cuff tears, patients are exposed to a substantial number of risk factors of postoperative retears of which symptom duration and absence of traumatic episodes were the only inter-related factors.

Background/Objectives: Skeletal muscle functions as an endocrine organ by secreting myokines in response to exercise, with interleukin-6 (IL-6) recognized as a representative intensity-dependent biomarker that rapidly increases immediately after exercise and is strongly dependent on exercise intensity. However, it is unclear how changes in mechanical stress affect the response of myokines after exercise. This randomized crossover study aimed to investigate the effect of mechanical stress on acute myokine secretion during matched metabolic exercise under different mechanical stress. Methods: Ten healthy adult males performed 30 min of cycling at 60% of peak $\stackrel{·}{\mathrm{V}}$O₂ in both semi-recumbent position and side-lying positions. Blood samples were collected before, immediately after, and at 30 and 60 min post-exercise to evaluate IL-6, brain-derived neurotrophic factor (BDNF), and lactate. Results: BDNF and lactate levels peaked immediately after exercise, and IL-6 reached its peak at 30 min post-exercise in both the semi-recumbent position and side-lying positions. All markers showed significant elevations in response to exercise. However, no significant differences were found between the two postures in any of the measured variables. Conclusions: These findings suggest that reduced mechanical load does not impair endocrine responses when the intensity of metabolic stress is maintained. This study provides scientific evidence that, regardless of posture or environment, sufficient exercise intensity can induce adequate IL-6 and BDNF secretion, through which the beneficial effects of exercise may be expected.

Anaplastic large cell lymphoma (ALCL) represents one of the rare types of non-Hodgkin lymphoma. We describe a case of primary bone anaplastic lymphoma kinase (ALK)-positive ALCL presented as a giant extraskeletal mass with extensive coagulation necrosis. There have been only a few case reports detailing radiological imaging of primary bone ALCL with extraskeletal extension and to the best of our knowledge this is the first documented case associating ALCL with coagulation necrosis.

Muscle strength and joint and nervous system functions decline with age and in patients undergoing hemodialysis. The Japanese Orthopaedic Association has defined locomotive syndrome (LoS) as a musculoskeletal disorder primarily caused by aging. Therefore, this study aimed to investigate the prevalence of LoS and identify factors associated with its development in patients undergoing hemodialysis. Patients receiving outpatient hemodialysis at Kurume University Hospital were categorized into LoS and non-LoS groups using the cutoff value of 25-question Geriatric Locomotive Function Scale (GLFS-25). We analyzed differences in malnutrition, biochemical examinations, and Kt/V (a measure of dialysis adequacy) between the 2 groups using Wilcoxon rank-sum tests. Additionally, we evaluated factors that correlated with GLFS-25 through pairwise correlations. Multivariate analysis was performed to determine the independent factors associated with LoS. Nineteen patients were included. The median GLFS-25 score was 18. The LoS group (n = 11) had a significantly higher age (P = .0056) and chloride levels than the non-LoS group (n = 8) (P = .0175). Furthermore, the Nutritional Risk Index for Japanese Hemodialysis patients, creatinine levels, and Kt/V were significantly lower in the LoS group than in the non-LoS group (P = .0156, .0026, and .0163, respectively). The GLFS-25 showed significant correlations with age, total protein levels, C-reactive protein, chloride, creatinine, Nutritional Risk Index for Japanese Hemodialysis patients, and Kt/V (with correlation coefficients of −0.6133, −0.4779, 0.4738, 0.5381, −0.7923, 0.6508, and 0.5747, respectively). Multivariate analysis identified life-space assessment (odds ratio [OR], 3.06; 95% confidence interval [CI], −676 to 674; P < .0001) and age (OR, 31.29; 95% CI, −2061 to 2067; P = .0007) as risk factors for LoS. Age and physical activity were found to be associated with the development of LoS in patients with end-stage renal disease undergoing outpatient hemodialysis at our hospital. This emphasizes the importance of implementing preventative measures for LoS, especially for older and less physically active patients.