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Endoscopic surgery, including endoscopic endonasal transsphenoidal surgery (ETSS), requires special psychomotor skills from surgeons. The learning curve in the acquisition of psychomotor skills varies among individuals, and studies about laparoscopy indicate that the difference can be predicted using spatial ability tests. We examined the association between the results of such tests and the learning curve in ETSS to determine the need for a personalized curriculum for ETSS skill training. A total of 30 fifth-year medical students from Kindai University School of Medicine (17 men, 13 women; mean age, 26 years) without ETSS experience completed the spatial orientation test (SOT) for the measurement of spatial visualization ability. They performed the dural incision task (DIT) twice on an ETSS training model for surgical psychomotor skill evaluation. The SOT scores (angle errors) exhibited substantial individual differences in spatial visualization ability, whereas the DIT scores significantly improved in the second trial (Wilcoxon signed-rank test, P = 0.0035). However, no significant difference was observed in the DIT scores between the smaller error and larger error groups of the SOT. The results indicated that two DIT trials were sufficient to acquire psychomotor skills for the DIT as the endoscope was almost fixed and learning only one viewpoint and line of sight combination was adequate. In conclusion, a personalized ETSS training program based on the trainee's spatial ability is not necessary for the DIT. Further research is warranted to determine the effect of spatial ability on more complex tasks, such as suturing in cranial base repair.

Objective: To compare the initial postoperative stability of opening-wedge high tibial osteotomy (HTO) and opening-wedge distal tuberosity osteotomy (DTO) and investigate the factors that influence initial stability. Methods: Patients with the same operative indications who underwent HTO (n = 51) and DTO (n = 55) were included. Demographic and preoperative radiographic data (weight-bearing line percentage [%WBL], femoral-tibial angle [FTA], medial proximal tibial angle [MPTA], posterior tibial slope and correction angle), and postoperative computed tomography (CT) scan data (initial postoperative stability [12 weeks postoperative], and hinge fracture [1 and 12 weeks postoperatively], and hinge length, flange thickness, flange length, axial flange osteotomy angle, sagittal flange osteotomy angle [1 week postoperatively]) were statistically analyzed. As a subgroup analysis, HTO and DTO patients were divided into Stable and Unstable groups respectively based on postoperative CT at 12 weeks; demographic and radiological data were compared. Results: Patients with DTO was significantly younger (median [range]; 59 [22, 73] vs 64 [45, 75], P = 0.02) and had a smaller preoperative deformity (%WBL: median [range]; 28.9 [12.8, 46.0] vs 24.3 [4.9, 44.3], P

Abstract Whether and how the non-lesional sensorimotor cortex is activated and contributes to post-injury motor recovery is controversial. Here, we investigated the role of interhemispheric pathway from the contralesional to ipsilesional premotor cortex in activating the ipsilesional sensorimotor cortex and promoting recovery after lesioning the lateral corticospinal tract at the cervical cord, by unidirectional chemogenetic blockade in macaques. The blockade impaired dexterous hand movements during the early recovery stage. Electrocorticographical recording showed that the low frequency band activity of the ipsilesional premotor cortex around movement onset was decreased by the blockade during the early recovery stage, while it was increased by blockade during the intact state and late recovery stage. These results demonstrate that action of the interhemispheric pathway changed from inhibition to facilitation, to involve the ipsilesional sensorimotor cortex in hand movements during the early recovery stage. The present study offers insights into the stage-dependent role of the interhemispheric pathway and a therapeutic target in the early recovery stage after lesioning of the corticospinal tract.

Abstract Aims This study aimed to elucidate age‐stratified clinical profiles and outcomes in patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HFpEF). Methods and results The Chronic Heart Failure Registry and Analysis in the Tohoku District‐2 (CHART‐2) Study included 2824 consecutive HFpEF patients with LVEF ≥ 50% (mean age 69.0 ± 12.3 years; 67.7% male) with a median follow‐up of 9.8 years. We stratified them into five age groups: ≤54 (N = 349, 12.4%), 55–64 (N = 529, 18.7%), 65–74 (N = 891, 31.6%), 75–84 (N = 853, 30.2%), and ≥85 years (N = 202, 7.2%), and we categorized these age groups into younger (≤64 years) and older (≥65 years) groups. We compared the clinical profiles and outcomes of HFpEF patients across age groups. Younger HFpEF groups exhibited a male predominance, elevated body mass index (BMI), and poorly controlled diabetes (haemoglobin A1c > 7.0%). Older HFpEF groups were more likely to be female with multiple comorbidities, including coronary artery disease, hypertension, renal impairment, and atrial fibrillation. The positive association between elevated BMI and HFpEF was more pronounced with lower classes of age from ≥85 to ≤54 years, especially in males. With higher classes of age from ≤54 to ≥85 years, mortality rates increased, and HF death became proportionally more prevalent (Ptrend

Abstract Aims The incidence and prognosis of symptomatic heart failure following acute myocardial infarction (AMI) in the primary percutaneous coronary intervention era have rarely been reported in the literature. This study aimed to (i) determine the incidence of heart failure admission among AMI survivors, (ii) compare 1 year outcomes between patients with heart failure admission and those without, and (iii) identify the independent risk factors associated with heart failure admission. Methods and results The Japan Acute Myocardial Infarction Registry is a prospective multicentre registry from which data on consecutively enrolled patients with AMI from 50 institutions between 2015 and 2017 were obtained. Among the 3411 patients enrolled, 3226 who survived until discharge were included in this study. The primary endpoint was all‐cause mortality. The secondary endpoints were major adverse cardiovascular events (defined as cardiovascular mortality, non‐fatal myocardial infarction, or non‐fatal cerebral infarction) and major bleeding events corresponding to Bleeding Academic Research Consortium Type 3 or 5. Clinical outcomes were compared between the patients who were and were not admitted for heart failure. Over a median follow‐up of 12 months, 124 patients (3.8%) were admitted due to heart failure. Independent risk factors for heart failure admission included older age, female sex, Killip class ≥2 on admission, left ventricular ejection fraction

A novel three-dimensional (3D) printed hybrid continuous fiber reinforced bi-matrix composite is proposed in this paper to improve the flexural fracture energy and the designability of flexural mechanical properties, combining the excellent wettability of thermosetting resin to distinct fibers and the wonderful extrusion forming ability of thermoplastic for nozzle based additive manufacturing (AM). Numerical simulations are conducted by finite element (FE) and peridynamics (PD) models, enabling an in-depth study for the influence of printed hybrid configuration on flexural mechanical properties. The results show that assigning more basalt fibers at bottom effectively enhances the capability of flexural energy absorption, with the maximum enhancement of 126.1% in contrast to single-type carbon fiber reinforced samples. The combination of experimental analysis and numerical simulation has reference significance for structural optimization and failure prediction of hybrid continuous fiber composites printed by co-extrusion process.

Introduction: The Scoliosis Research Society-30 (SRS-30) is a questionnaire originally developed from the SRS-22r questionnaire and is used to evaluate adolescent idiopathic scoliosis (AIS). It comprised questions on five domains: function, pain, self-image, mental health, and satisfaction, with seven additional questions related to postoperative aspects. In addition to the original English version, translations in multiple languages have been effectively applied. Herein, we evaluated the internal consistency and external validity of the Japanese version of the SRS-30 for AIS patients. Methods: Among the 30 questions in SRS-30, the eight additional questions from SRS-22r were translated and back-translated to create a Japanese version of the SRS-30. This translated questionnaire was then used to survey patients with AIS who underwent corrective fusion surgery one year postoperatively. The internal consistency of the responses was evaluated using the Cronbach α coefficient. Additionally, the Spearman correlation analyses were conducted to assess the correlation between the scores obtained from the SRS-30 Japanese version and SRS-22r and the Oswestry Disability Index (ODI) for the overall scale and the five domains. Results: A total of 81 cases (eight males and 73 females; mean age at surgery 14.4 years) were enrolled. The mean preoperative Cobb angle was 51.0°. The Cronbach α coefficient for the overall SRS-30 was 0.861, indicating high internal consistency, while the coefficients for each domain were as follows: function/activity, 0.697; pain, 0.405; self-image/appearance, 0.776; mental health, 0.845; and satisfaction, 0.559. The SRS-30 total score significantly correlated with the SRS-22r total (r=0.945, P

The menisci have a poor intrinsic healing capability. Biological augmentation is used to promote meniscal healing in conjunction with suture techniques as the result of their poor healing rate. A fibrin clot (FC) is a well-known treatment option for meniscal injuries that are difficult to heal. Several methods for delivering FCs to target sites have been reported; however, all available methods have drawbacks such as unstable delivery, low maneuverability, and/or clot sizes that are too large. We use a dedicated device to efficiently deliver FCs of a suitable size for the tear. In this method, an FC formed to a size of 5 mm is stored and delivered in a thin syringe with a built-in plunger. This method enables an accurate delivery of a suitably sized FC to the desired location and fixes FCs to the tear site when used in combination with conventional suture methods. In this report, we will succinctly describe how to make and deliver an FC using the aforementioned device with a step-by-step instructional technique and an illustrative video.

Abstract This investigation examined the clinical implications of mild vertebral fractures in older community-dwelling residents. Focusing on the locomotion health of older individuals, the earlier reported Obuse study enrolled 415 randomly sampled Japanese residents aged between 50 and 89 years, 411 of whom underwent X-ray evaluations for pre-existing vertebral fractures. A blinded assessment of vertebral fractures based on Genant’s criteria was conducted on the T5-L5 spine for rating on a severity scale. Grade 1 mild fractures were not linked to age in males, but increased with aging in females. Female participants had fewer Grade 1 and 2 fractures (P = 0.003 and 0.035, respectively) but more Grade 3 fractures (P = 0.013) than did males independently of age (Grade 1, 2, and 3: 25%, 16%, and 9% in females and 40%, 22%, and 6% in males, respectively). Weak negative correlations were observed between the number of fractures and bone mineral density in females for all fracture grades (Spearman’s rho: 0.23 to 0.36, P

A wind turbine comprises multiple components constructed from diverse materials. This complexity introduces challenges in designing the blade structure. In this study, we developed a structural optimization framework for Vertical Axis Wind Turbines (VAWT). This framework integrates a parametric Finite Element Analysis (FEA) model, which simulates the structure's global behavior, with a Genetic Algorithm (GA) optimization technique that navigates the design domain to identify optimal parameters. The goal is to minimize the mass of VAWT structures while adhering to a suite of complex constraints. This framework quantifies the mass reduction impact attributable to material selection and structural designs. The optimization cases indicate that blades made from Carbon Fiber Reinforced Plastics (CFRP) materials are 47.1 % lighter than those made from Glass Fiber Reinforced Plastics (GFRP), while the structural parts are 44.8 % lighter. This work also provides further recommendations regarding the scale and design of the structures. With the materials and structural design established, future studies can expand to include more load cases and detailed designs of specific components.

Introduction/Justification: Computed tomography (CT) scans are integral to cancer patient diagnosis, revealing changes in body composition linked to survival progression. The conventional approach to body composition analysis using CT scans is labor-intensive and expensive, demanding skilled professionals and licensed software for manual segmentation of Regions of Interest (ROIs). To address these challenges, we introduce a Deep Learning algorithm designed for automated CT image segmentation, presenting an efficient alternative that overcomes the limitations of the current methodology. Beyond the advantages of speed, automation enhances result uniformity and enables uncertainty estimation. In this presentation, we will show preliminary results from our algorithm, highlighting its potential contributions to survival analysis in cancer patients. Objectives: The primary goal of this study was to develop an automated segmentation algorithm for CT scans using Deep Learning models. Materials and Methods: In developing segmentation algorithms, a dataset of 453 CT slices at the L3 lumbar vertebral level from gastric cancer patients was utilized, with an 80% training and 20% testing partition. Employing the UNET+ResNet18 deep learning architecture, supervised training utilized manually generated segmentation masks as references. Four dedicated UNET+ResNet18 algorithms were trained for distinct ROIs: Skeletal Muscle (SM), Intramuscular Adipose Tissue (IMAT), Visceral Adipose Tissue (VAT), and Subcutaneous Adipose Tissue (SAT). Segmentation performance on the test set was evaluated using the Dice Coefficient, underestimation and overestimation percentages, Bland-Altman analyses, and qualitative visual inspection of segmented images. Results: The UNet+ResNet18 models demonstrated superior segmentation performance for SM, VAT, and SAT, achieving mean Dice scores exceeding 0.95. In comparison to manual segmentation, the Deep Learning algorithm exhibited minor average underestimations and overestimations, both below 5% for these tissues. However, IMAT segmentation exhibited relatively lower performance, with a mean Dice score of approximately 0.86 and underestimation and overestimation percentages around 15% and 13%, respectively. The Bland-Altman analysis revealed mean bias and limits of agreement for mean radiodensities of SM, VAT, SAT, and IMAT as follows: 0.14 [-0.82, 1.10] HU, -0.53 [-2.03, 0.98] HU, -0.18 [-1.70, 1.33] HU, and 0.48 [-3.86, 4.82] HU, respectively. Conclusion: The Deep Learning approach provides a standard and fast solution for CT image segmentation, demonstrating good results for SM, VAT and SAT. For these tissues, derived radiomics features could provide valuable insights into the analysis of cancer patient outcomes. Further studies are necessary for enhancing IMAT segmentation, given its challenging small area. Additionally, future investigations should focus on uncertainty estimation in CT images, exploring its impact on segmentation procedures and radiomic feature extraction.

Summary: Clinical evidence has revealed that high-level activation of NRF2 caused by somatic mutations in NRF2 (NFE2L2) is frequently detected in esophageal squamous cell carcinoma (ESCC), whereas that caused by somatic mutations in KEAP1, a negative regulator of NRF2, is not. Here, we aspire to generate a mouse model of NRF2-activated ESCC using the cancer-derived NRF2L30F mutation and cancer driver mutant TRP53R172H. Concomitant expression of NRF2L30F and TRP53R172H results in formation of NRF2-activated ESCC-like lesions. In contrast, while squamous-cell-specific deletion of KEAP1 induces similar NRF2 hyperactivation, the loss of KEAP1 combined with expression of TRP53R172H does not elicit the formation of ESCC-like lesions. Instead, KEAP1-deleted cells disappear from the esophageal epithelium over time. These findings demonstrate that, while cellular NRF2 levels are similarly induced, NRF2 gain of function and KEAP1 loss of function elicits distinct fates of squamous cells. The NRF2L30F mutant mouse model developed here will be instrumental in elucidating the mechanistic basis leading to NRF2-activated ESCC.

A continuous fiber reinforced two-matrix composites with multi-cavity structure was fabricated by a co-extrusion method, combining the excellent wettability of thermosetting resin to fiber and the wonderful extrusion forming ability of thermoplastic for nozzle based additive manufacturing (AM). Diversified component materials were utilized to enrich database for the AM of continuous fiber composites, including continuous carbon fiber (CCF), continuous basalt fiber (CBF), short fiber reinforced polyamide (SFRPA), polyamide (PA), polylactic acid (PLA) and epoxy resin. The tensile and flexural tests were conducted to investigate the effect of component materials on the mechanical properties. The micro-structures of printing filament and the fracture morphology of samples were characterized by optical microscope (OM) and scanning electron microscopy (SEM), respectively. A novel numerical model based on Peridynamics (PD) was proposed for the simulation of failure model. The three-dimensional (3D) printed continuous fiber reinforced two-matrix composites with multi-cavity structure show dissimilar mechanical behavior and failure characteristic for different combinations of component materials. The micro-structure of the fiber bundle pre-impregnated by epoxy resin after printing has a great influence on the mechanical properties and fracture modes of the samples. The failure modes mainly include pullout and breakage of fiber, stress whitening and crack of matrix, and interfacial debonding. The PD model effectively captures the tensile and flexural failure characteristic of 3D printed composites with multi-cavity structure. The results from experimental analysis and numerical simulation have reference significance for structural optimization and failure prediction of continuous fiber composites printed by co-extrusion process.

Background: In patients with chronic heart failure (CHF), comorbidities are often managed with multiple medications, characterized by polypharmacy, leading to increased risk of potentially inappropriate medication and adverse effects. Methods: We studied 4,876 consecutive patients with CHF (Stage C/D, age 69.0 ± 12.3 years) in the CHART-2 study to evaluate the association among polypharmacy, underuse of HF medications, and all-cause death. Polypharmacy was defined as the daily use of ≥ 8 medications for the survival classification and regression tree analysis. Results: The average number of medications was 10 in the polypharmacy group and 5 in the non-polypharmacy group, respectively. Over a median of 8.3 (4.1–11.7) years, the incidence rate of all-cause death was significantly higher in the polypharmacy group (n = 2,108) than in the non-polypharmacy group (57.3 % vs. 40.6 %; adjusted hazard ratio [aHR] 1.34 (95 %CI, 1.22–1.48), P

A large posterior tibial slope (PTS) has been widely recognized as a potential risk factor in loosening and retear after anterior cruciate ligament reconstruction. Anterior closed-wedge osteotomy is an effective surgical approach to mitigate this risk factor but presents several disadvantages. We describe in this Technical Note an original PTS correction technique called the posterior open-wedge osteotomy. The posterior surface of the proximal tibia is exposed, and 2 K-wires are inserted anteroposteriorly as osteotomy guides, and one wire is inserted mediolaterally as a hinge blocker. The osteotomy is performed from the posterior side and advanced to the anterior side using a single-bladed reciprocating saw. The slope is corrected by opening the osteotomy plane posteriorly with a spreader. The correction is maintained by inserting the harvested fibula fragments into the open space, and the fixation is completed with a locking plate to ensure firm fixation and allow early rehabilitation. This procedure can be an effective solution for patients with various risk factors for retear of the anterior cruciate ligament graft, including abnormal PTS.

Background: Limited data exist on the prognostic significance of a history of cancer and atrial fibrillation (AF) in patients with coronary artery disease (CAD). This study aimed to evaluate the associations among a history of cancer, AF, and long-term prognosis in patients with CAD. Methods: We studied 3,233 patients with CAD (69 ± 11 years; women, 23%) in a multicenter hospital-based cohort study, the CHART-2 and related a history of cancer and AF to cardiovascular outcomes with a median follow-up of 10.8 years. Results: Of the 3,233 patients enrolled, 10.7% and 11.2% had a history of cancer and AF, respectively, while 2.8% had both. Patients with AF and a history of cancer were characterized by older age, male sex, and higher BNP levels. Anticoagulant use with warfarin or direct oral anticoagulants increased from 43% at baseline to 56% at 10 years in patients with CAD with AF and no history of cancer and increased from 49% to 83% in those with both. Patients with CAD with both comorbidities had a higher risk of a composite outcome including stroke, thrombosis, and major bleeding (Hazard Ratio [HRadjusted], 2.26; 1.50–3.40, P

Background: The choice of operative method for lumbar spinal stenosis with Meyerding grade I degenerative spondylolisthesis remains controversial. The purpose of this study was to identify the preoperative factors affecting the 2-year postoperative patient-reported outcome in Meyerding grade I degenerative spondylolisthesis. Methods: Seventy-two consecutive patients who had minimally invasive decompression alone (D group; 28) or with fusion (DF group; 44) were enrolled. The parameters investigated were the Japanese Orthopaedic Association back pain evaluation questionnaire as patient-reported assessment, and L4 slippage (L4S), lumbar lordosis (LL), and lumbar axis sacral distance (LASD) as an index of sagittal alignment for radiological evaluation. Data collected prospectively at 2 years postoperatively were examined by statistical analysis. Results: Sixty-two cases (D group; 25, DF group; 37) were finally evaluated. In multiple logistic regression analysis, preoperative L4S and LASD were extracted as significant preoperative factors affecting the 2-year postoperative outcome. Patients with preoperative L4S of 6 mm or more have a lower rate of improvement in lumbar spine dysfunction due to low back pain (risk ratio=0.188, p=.043). Patients with a preoperative LASD of 30 mm or more have a higher rate of improvement in lumbar dysfunction due to low back pain (risk ratio=11.48, p=.021). The results of multiple logistic analysis by operative method showed that there was a higher rate of improvement in lumbar spine dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more in DF group (risk ratio=172.028, p=.01). Conclusions: Preoperative L4S and LASD were extracted as significant preoperative factors affecting patient-reported outcomes at 2 years postoperatively. Multiple logistic analyses by the operative method suggested that DF may be advantageous in improving lumbar dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more.

While written corrective feedback (WCF) has been studied extensively, engagement with WCF by students of less commonly taught languages, especially at the elementary level, has not yet received scholarly attention. To address this research gap, this case study explores how two learners of Japanese as a foreign language at the elementary level engaged with WCF, using the frameworks of Ellis (2010) and Mao and Lee (2022). In addition, the roles of individual and contextual factors were investigated. The participants included two beginner learners in an intensive language program. The data were collected through three multi-draft essays, retrospective stimulated recall, course documents, and class observation. The results reveal that the participants showed extensive overall engagement with WCF. However, each student responded to WCF differently due to individual factors, such as attitude toward WCF, and contextual factors, such as assignment type.

Abstract Myxoid liposarcoma (MLS) is a common subtype of liposarcoma. Although the prognosis is generally good, there are factors known to be associated with poor prognosis. Accurate indices are important to predict prognosis. We aimed to assess the usefulness of immunohistochemistry for phosphohistone H3 (PHH3) as a potential biomarker in comparison with Ki-67 antigen and other prognostic factors. Twenty-five patients with MLS were evaluated. Age, sex, depth of tumor, tumor size, surgical margin, oncological outcome, histological grade, presence of necrosis, proportion of round cell component (RC%), PHH3 index, and Ki-67 index were examined. Prognostic factors of the examination criteria were statistically analyzed, survival rate analyses were performed using the Kaplan–Meier method, and multivariate analysis was performed using Cox proportional-hazard regression analysis. The number of PHH3-positive tumor cells and the PHH3 and Ki-67 indices demonstrated a statistical correlation with the prognosis of MLS in univariate analysis (P

Study Design Retrospective cohort study. Purpose This study aimed to evaluate the relationship between C7 plumb line (C7PL) decompensation and the Scoliosis Research Society (SRS) 22-item patient questionnaire scores, including those related to self-image, preoperatively and 2 years after surgery. Overview of Literature In the surgical treatment of adolescent idiopathic scoliosis (AIS), inferior trunk balance caused by C7PL decompensation can negatively affect patients’ quality of life. However, there are few reports in the literature that describe or clarify how postoperative trunk imbalance affects each SRS-22 domain, including self-image domain scores. Methods A total of 120 patients with AIS who underwent posterior spinal fusion from August 2006 to March 2017 at our facility and were followed up for 2 years or more were included. Radiological parameters were measured on whole-spine anteroposterior and lateral radiographs. Revised SRS-22 (SRS-22r) values were also recorded. Coronal trunk imbalance was defined as a deviation of ≥2.0 cm between the C7PL and the central sacral vertical line. Patients with and without coronal trunk imbalance at 2 years after surgery were defined as D (+) (decompensation type) and D (−), respectively. Mean SRS-22r values, including function, pain, self-image, mental health, and subtotal were compared between the D (+) and D (−) groups. Logistic regression analysis was performed to detect the preoperative factors related to D (+) using predictors, including curve type, maximum Cobb angle, and coronal trunk imbalance. Results At 2 years after surgery, the D (+) group had a significantly lower self-image in the domain of SRS-22r scores compared with the D (−) group. Preoperative coronal trunk imbalance was significantly related to D (+) but not to significant changes in the postoperative SRS-22 score in any of the SRS-22 domains. Conclusions Postoperative C7PL deviation lowers the self-image in patients with AIS. Patients with preoperative coronal trunk imbalance were significantly more likely to be D (+).

Introduction: Corrective scoliosis surgery in patients with adolescent idiopathic scoliosis (AIS) increases thoracic volume but does not improve respiratory function (RF). This study evaluates the effect of physical flexibility (PF) improvement after scoliosis surgery on RF. Methods: This study reviewed the records of 61 consecutive patients with AIS (56 female and 5 male; mean±standard deviation age: 14.8±2.2 years, range: 11-20 years) who had undergone posterior spinal fusion (PSF) of the thoracic curve. PF evaluated as finger-floor distance (FFD) was measured preoperatively and one year after surgery. After dividing the cohort into the PF improvement group and the PF nonimprovement group, RF changes at two years postoperative were statistically compared. Using logistic regression analysis, we evaluated the impact of a PF improvement on % forced vital capacity (%FVC) two years after surgery. Results: The rate of patients with increased FVC, %FVC, and forced expiratory volume 1.0 second two years after surgery was 79%, 51%, and 80%, respectively. The PF improvement group exhibited a significantly higher gain in %FVC versus the PF nonimprovement group (P=0.043). Moreover, PF improvement significantly prevented a %FVC decrease (odds ratio 8.43, 95% confidence interval 1.92-59.70; P

Abstract Background Composite hemangioendothelioma (CHE) is an intermediate group of tumors with features between hemangioma and angiosarcoma both histologically and biologically. CHE is predominant in young and middle-aged adults, but very infrequently affects the spine. We describe the case of primary CHE in the cervical spine exhibiting kaposiform hemangioendothelioma (KHE)-like components that was associated with cervical myelopathy with vertebral body destruction in an elderly woman. We retrospectively reviewed the case of a primary cervical spinal tumor, diagnosed as CHE with KHE-like components in pathological findings, associated with cervical myelopathy and cervical vertebral body destruction. Case presentation An 80-year-old woman presented with progressive cervical myelopathy caused by a cervical spine tumor. Preoperative cervical MRI revealed a neoplastic lesion invading the cervical spine that strongly compressed the spinal cord, causing right upper-limb paralysis. We performed partial tumor resection along with posterior decompression and fixation. Postoperatively, pathological findings showed that the tumor was CHE with KHE-like features. Following radiotherapy, no recurrences have been observed in 21 months. Conclusions This is the first report of CHE with features of KHE in the spine of an elderly patient. Posterior decompression and fusion of the cervical spine and subsequent radiotherapy resulted in a good outcome.

Abstract No validated systems exist for selecting the upper instrumented vertebra (UIV) for optimal postoperative shoulder balance in Lenke type 2 adolescent idiopathic scoliosis (AIS). This study evaluated a new method for shoulder balance prediction using the modified Shinshu line (MSL) for UIV selection in AIS Lenke type 2 curves. Fifty-five consecutive AIS patients receiving posterior spinal fusion (PSF) for a Lenke type 2 AIS curve were retrospectively analyzed according to several UIV determination models. Shoulder imbalance was judged as absolute radiographic shoulder height ≥ 10 mm at the 2-year observational endpoint. The MSL was the line between the center of the spinous process of C7 and that of the lowest instrumented vertebra. The vertebral body first touched proximally by the MSL was defined as the MSL vertebra (MSLV) and recommended as the UIV. The group with the UIV matching the MSLV had a significantly lower prevalence of shoulder imbalance of 23% (odds ratio 4.08, 95% CI 1.22–13.7, P = 0.02). Setting the MSLV as the UIV in PSF for AIS Lenke type 2 may reduce the prevalence of postoperative shoulder imbalance.

Introduction: In recent years, lateral lumbar interbody fusion (LLIF), performed as extreme lateral interbody fusion (XLIF) and oblique lateral interbody fusion (OLIF), has also become widely used for anterior-posterior corrective fusion. However, there are few detailed reports comparing techniques in the treatment of two-level degenerative spondylolisthesis. We compared the surgical invasiveness and postoperative outcomes between posterior interbody fusion with posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) and LLIF for two-level lumbar degenerative spondylolisthesis. Methods: Fifteen patients underwent PLIF or TLIF at 2 vertebral intervals (posterior group) and 8 patients received XLIF or OLIF (LLIF group). The following parameters were examined: operative time, blood loss, preoperative %slip, preoperative sagittal parameters, postoperative %slip, postoperative 1-year %slip, postoperative 1-year sagittal parameters, bone fusion rate at 1 year postoperatively, pre- and postoperative visual analog scale scores, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, and complications. Results: In the LLIF group, blood loss was significantly lower and operative time was shorter than in the posterior group. There were no significant differences for 1-year postoperative %slip, sagittal vertical axis, or lumbar lordosis, although the frequency of cases with a 1-year postoperative pelvic incidence (PI)-LL ≤ 10 degrees was significantly higher in the LLIF group. In both groups, JOA scores were improved significantly at 1 year postoperatively (both p

Calcium phosphate-based synthetic bone is broadly used for the clinical treatment of bone defects caused by trauma and bone tumors. Synthetic bone is easy to use; however, its effects depend on the size and location of the bone defect. Many alternative treatment options are available, such as joint arthroplasty, autologous bone grafting, and allogeneic bone grafting. Although various biodegradable polymers are also being developed as synthetic bone material in scaffolds for regenerative medicine, the clinical application of commercial synthetic bone products with comparable performance to that of calcium phosphate bioceramics have yet to be realized. This review discusses the status quo of bone-regeneration therapy using artificial bone composed of calcium phosphate bioceramics such as β-tricalcium phosphate (βTCP), carbonate apatite, and hydroxyapatite (HA), in addition to the recent use of calcium phosphate bioceramics, biodegradable polymers, and their composites. New research has introduced potential materials such as octacalcium phosphate (OCP), biologically derived polymers, and synthetic biodegradable polymers. The performance of artificial bone is intricately related to conditions such as the intrinsic material, degradability, composite materials, manufacturing method, structure, and signaling molecules such as growth factors and cells. The development of new scaffold materials may offer more efficient bone regeneration.

The research examines the relationship between the planning fallacy and estimates of task duration. The planning fallacy refers to a prediction, in which people underestimate the time it will take to complete tasks, despite the knowledge that tasks have taken longer than planned tasks. This study tested two hypotheses concerning people’s predictions of task duration time. The first hypothesis is that good time managers accurately estimate task duration. Study1 attempts to analyze the relationship between the planning fallacy and time management by the time management behavior scale. The second is that a person with high levels of self-efficacy does not tend to underestimate task duration time. Study2 attempts to analyze the relationship between the planning fallacy and self-efficacy by the generalized self-efficacy scale. The result of study1 supported the first hypothesis slightly (r = .344), but study2 was unsupported (r = .103) the second hypothesis. This result suggests the possibility that those who tend to do time management improve the underestimation of task duration time. It will require more systematic research.

The rate of recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) is reported to occur around 11.3%-49%. This study aims to investigate the factors that influence the recanalization after coil embolization for UIAs in our institution. We retrospectively investigated 307 UIAs in 296 patients treated at our institution between April 2004 and December 2016. The stent-used cases were excluded. Cerebral angiography and 3D time-of-flight magnetic resonance angiography (TOF MRA) were used for evaluation of the postoperative occlusion status. Volume embolization ratio (VER), aneurysmal size, neck width, and aspect ratio (AR) were compared between the recanalized and non-recanalized groups. The mean follow-up period ranged from 6 to 172 months (mean: 79.0 ± 39.8 months). Recanalization was noted in 78 (25.4%) aneurysms, and 19 (6.2%) aneurysms required retreatment. There was no aneurysmal rupture during the follow-up period. Univariate analysis showed that the aneurysm size (p < 0.001), neck width (p < 0.001), AR (p = 0.003), and VER (p = 0.012) were associated with recanalization. Multivariate logistic regression analysis showed that the AR (p =0.004) and VER (p =0.015) were significant predictors of recanalization. To summarize, a higher AR and a lower VER could lead to recanalization after coil embolization of UIAs. Careful follow-up is required for coiled aneurysms with these features.

Abstract Aims This study aimed to examine the prognostic significance of a history of cancer and atrial fibrillation (AF) in antithrombotic therapy for patients with chronic heart failure (CHF). Methods and results We enrolled consecutive 4876 CHF patients (69 ± 12 years; women, 31.9%) in our multicentre, hospital‐based cohort study, the Chronic Heart Failure Analysis and Registry in the Tohoku District‐2 (CHART‐2), with a median follow‐up of 8.7 years. Among them, 14% and 41% had a history of cancer and AF, respectively. AF patients with a history of cancer were older, more frequently men. History of cancer was not statistically associated with higher rate of composite of stroke, systemic thrombosis, and major bleeding defined by International Society on Thrombosis and Haemostasis [Fine–Gray sub‐distribution hazard ratio (sHR) accounting for the competing risk of all‐cause death, 0.91; 95% confidence interval (CI), 0.56–1.48; P = 0.715]. The patients with history of cancer and AF had a heightened risk for the composite of stroke, systemic thrombosis, and major bleeding (sHR, 1.64; 95% CI, 1.04–2.60; P = 0.033), especially in those aged >75 years (sHR, 2.14; 95% CI, 1.01–4.53; P = 0.046) and those with ischaemic heart disease (IHD; 2.48; 1.30–4.72; P = 0.006). Furthermore, 36% of AF patients with a history of cancer did not receive anticoagulant therapy. Conclusions The CHF patients with history of cancer and AF had higher risk for stroke, systemic thrombosis, and major bleeding, especially in the elderly and those with IHD, but considerable number of the patients did not receive anticoagulant therapy, indicating the need for better optimal anticoagulation strategy.

In this report, we, the Research Committee on Moyamoya Disease (Spontaneous Occlusion of the circle of Willis), describe in detail the changes in the new “Diagnostic Criteria 2021” for moyamoya disease and its scientific basis to make it widely known to the world. The revised criteria cover all aspects of the disease, including a definition of the disease concept, diagnostic imaging, and the concept of quasi-moyamoya disease (moyamoya syndrome).

Ultra-high molecular weight polyethylene sutures are used for repair and reconstruction of extra-articular ligaments in the knee, elbow, and ankle joints. In recent years, the use of these sutures has become popular in a suture augmentation technique and has been applied for use in the reconstruction of the anterior cruciate ligament, which is an intra-articular ligament. Although several surgical techniques have been described in Technical Notes, all reports have been for single-bundle reconstruction, and none have applied the technique to double-bundle reconstruction. This Technical Note provides a detailed description of an anatomical double-bundle anterior cruciate ligament reconstruction combined with the suture augmentation technique.

Recent clinical trials have highlighted that percutaneous coronary intervention in patients with stable angina provides limited additional benefits on top of optimal medical therapy. This has led to much more attention being paid to coronary vasomotion abnormalities regardless of obstructive or non-obstructive arterial segments. Coronary vasomotion is regulated by multiple mechanisms that include the endothelium, vascular smooth muscle cells (VSMCs), myocardial metabolic demand, autonomic nervous system and inflammation. Over the years, several animal models have been developed to explore the central mechanism of coronary artery spasm. This review summarises the landmark studies on the mechanisms of coronary vasospasm demonstrating the central role of Rho-kinase as a molecular switch of VSMC hypercontraction and the important role of coronary adventitial inflammation for Rho-kinase upregulation in VSMCs.

Abstract The recent increase in the older adult population has led to a higher prevalence of cognitive impairment, which is often overlooked in routine health examinations. Citizens aged 50–89 years were targeted for this cohort survey by random sampling from the resident registry of a cooperating town in 2014. A total of 411 participants (202 male and 209 female) were enrolled. We analyzed the distribution of cognitive function test scores as determined by Montreal Cognitive Assessment and Mini-Mental State Examination tests in each age (50’s, 60’s, 70’s and 80’s) and sex group to examine whether cognitive decline could be detected by sagittal spinal balance measurement based on a radiological approach. Sagittal spinal balance was quantitatively measured as sagittal vertical axis (SVA). We observed significant associations for higher age and/or SVA anteriorization with lower cognitive function. In males, spinal balance anteriorization was associated with cognitive decline independently of age, with combinations of age and SVA also making valid cognitive decline determinations; male cases of SVA ≥ 100 mm at any age, SVA ≥ 90 mm at ≥ 70 years, and SVA ≥ 70 mm at ≥ 80 years were all more likely to have cognitive decline than cases below those values. For females, cognitive decline was more likely in cases of SVA ≥ 70 mm, regardless of age. Thus, spinal balance anteriorization can be regarded as an easily visible indicator of latent cognitive decline in community-dwelling older people.

Abstract Background Patients with congenital heart disease (CHD) are associated with an increased incidence of scoliosis, often with severe progression. We report a case of hemoptysis caused by rapid scoliosis progression subsequent to surgery for CHD that was successfully managed by surgical curve correction following coil embolization. Case presentation A 14-year-old girl with scoliosis had undergone open heart surgery for CHD at the age of 1 year. She was first noted to have scoliosis at 12 years of age, which began to progress rapidly. At age 13, her main thoracic curve Cobb angle was 46°, and hemoptysis with high pulmonary vein pressure due to vertebral rotation was detected. Nine months after coil embolization, she received posterior spinal fusion from T5 to L2 for scoliosis correction. Postoperatively, her pulmonary vein diameter was enlarged, with no detectable signs of hemoptysis. Conclusions We encountered a case of hemoptysis caused by advanced scoliosis after cardiac surgery that was successfully treated by correction of the scoliotic curve following coil embolization. Patients with secondary scoliosis after surgery for CHD should be carefully monitored for the possibility of cardiovascular system deterioration.

Background: – Neural tissue grafting is an acceptable form of cell therapy for brain injury and diseases. However, methods that can evaluate the graft integration and measure axonal extensions in a 3D environment are limited in scale, inconvenient, and operator intensive. Method: – We stained grafts with a fluorescent antibody and then quantified the amount of fluorescence through the entire brain. To achieve this, we created an automated computer program designed to sort out authentic staining from background noise without any user input, enabling the analysis of thousands of images. Results: – Our program could compensate for variations in the background brightness between images in all animals. Using this program, we show that human induced pluripotent stem cell (iPSC)-derived dopaminergic (DA) progenitor cells integrate better into the striatum of neonates than older rats. Conclusion: – Our program can quantify quickly and conveniently the integration of neural grafts in a 3D environment without depending on a blinded human operator. We expect this method to be a useful tool to assess the efficiency of graft-enhancing treatments for neurodegenerative diseases or other neural reconstruction attempts.

Peficitinib, a pan-JAK inhibitor, is known to suppress the activation of fibroblast-like synoviocytes (FLSs) and thereby reduces joint inflammation associated with rheumatoid arthritis (RA). However, the effect on osteoporosis in RA remains to be elucidated. In this study, the effect of peficitinib or etanercept on joint inflammation, and consequently decreased bone mineral density (BMD) was evaluated in mice with collagen-induced arthritis (CIA). Additionally, the effect on RANKL production from osteoblasts differentiated from the mesenchymal stem cells of RA patients was evaluated. Administration of peficitinib for established CIA ameliorated arthritis and improved BMD in the femoral metaphysis, but not in the femoral diaphysis. Conversely, etanercept suppressed an increase in synovial inflammatory markers but did not improve arthritic conditions or the reduction of BMD in either region. All elevated bone formation and bone resorption markers were decreased with peficitinib but only partially decreased with etanercept. Furthermore, production of RANKL by human osteoblasts was suppressed by peficitinib but enhanced by etanercept. Unlike etanercept, peficitinib is thought to increase BMD by ameliorating the high bone turnover associated with RA states, resulting in improvement of bone fragility. Our data provide evidence that peficitinib would be expected to show efficacy for osteoporosis associated with RA.

Introduction: Assessments of early postoperative bony union after posterior lumbar interbody fusion via computed tomography (CT) have revealed cases in which interbody fixation by bony union resulted in nonfusion due to bone absorption. The apparent bone union state reverted to a nonunion state several months later, exhibiting a so-called “fake union” phenomenon. Additionally, few reports have evaluated the effect of teriparatide on bony union. The present study aimed to evaluate the frequency of change in assessment from fusion to nonfusion in the postoperative follow-up of lumbar interbody fusion, compare the late postoperative bony union rates in groups with or without early postoperative fusion, and examine the effect of postoperative teriparatide in those groups. Methods: Sixty-nine subjects enrolled from multiple hospitals were prospectively evaluated following single-level lumbar interbody fusion. The patients were randomly allocated into treatment with or without weekly postoperative teriparatide. The subjects were then classified as having bony union or nonfusion at 2 months postoperatively, and fusion rates at 6 months were compared. For the evaluation of bony union, blinded radiological examinations were performed via CT. Additional comparisons were made according to teriparatide use. Results: The rate of nonunion at 6 months postoperatively in patients with fusion at 2 months postoperatively was 27.8%. Among subjects with bony union at 2 months postoperatively, the fusion rate at 6 months in those who received teriparatide was 93.3% (p=0.027) versus 57.1% in those who did not. Conclusions: The rate of nonunion at 6 months postoperatively in patients exhibiting union at 2 months after surgery was 27.8%. Postoperative weekly teriparatide treatment significantly reduced the rate of fake union.

Professor Maseri pioneered the research and treatment of coronary vasomotion abnormalities represented by coronary vasospasm and coronary microvascular dysfunction (CMD). These mechanisms can cause myocardial ischaemia even in the absence of obstructive coronary artery disease, and have been appreciated as an important aetiology and therapeutic target with major clinical implications in patients with ischaemia with non-obstructive coronary artery disease (INOCA). Coronary microvascular spasm is one of the key mechanisms responsible for myocardial ischaemia in patients with INOCA. Comprehensive assessment of coronary vasomotor reactivity by invasive functional coronary angiography or interventional diagnostic procedure is recommended to identify the underlying mechanisms of myocardial ischaemia and to tailor the best treatment and management based on the endotype of INOCA. This review highlights the pioneering works of Professor Maseri and contemporary research on coronary vasospasm and CMD with reference to endothelial dysfunction, Rho-kinase activation and inflammation.

Summary: Patients with damage to the primary visual cortex (V1) can respond correctly to visual stimuli in their lesion-affected visual field above the chance level, an ability named blindsight. Here, we present a protocol for making an animal model of blindsight in macaque monkeys. We describe the steps to perform pre-lesion training of monkeys on a visual task, followed by lesion surgery, post-lesion training, and evaluation of blindsight. This animal model can be used to investigate the source of visual awareness.For complete details on the use and execution of this protocol, please refer to Yoshida et al. (2008)1 and Takakuwa et al. (2021).2 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

Abstract Purpose The purpose of this study is to examine 1) the degree and frequency of laterality in posterior tibial slope (PTS) with control and anterior cruciate ligament (ACL) injury groups and 2) the laterality of PTS between sides of injury and dominant legs in patients with primary ACL injuries. Methods A total of 187 consecutive patients with clinically diagnosed noncontact ACL injuries and an age‐ and sex‐matched 1:1 control group were identified. PTS was measured using three different methods (aPTS = anterior PTS, mPTS = middle PTS, pPTS = posterior PTS) on a lateral knee radiograph. PTS of the left and right sides were compared between the patients in the control and ACL‐injured groups, and between the injured and non‐injured and dominant and non‐dominant legs among the patients in the ACL‐injured group. The patients with a difference in PTS of ≥ 3° in mPTS were selected. The percentages were compared between left and right between and among both groups, and between the injured and non‐injured, and non‐dominant and dominant leg, for the ACL group. Multiple regression analysis was performed to analyze the factors influencing the degree of mPTS. Results Both control (Right vs Left: aPTS; 9.0 ± 2.5 vs 10.5 ± 3.0, mPTS; 6.6 ± 2.3 vs 8.1 ± 2.7, pPTS; 4.0 ± 2.4 vs 5.6 ± 2.8, respectively, p

BackgroundDespite the advances in the treatment of cardiovascular diseases, effective treatment remains to be established to improve the quality of life and prognosis of patients with chronic coronary syndromes. This study was aimed to evaluate the effectiveness and safety of the low-intensity pulsed ultrasound (LIPUS) therapy, which we have developed as a novel non-invasive angiogenic therapy through upregulation of endothelial nitric oxide synthase (eNOS).Methods and findingsWe conducted a randomized, double-blind, placebo-controlled (RCT) pilot trial of the LIPUS therapy for patients with refractory angina pectoris. The patients who received optimal medical therapy without indication of PCI or CABG due to the lack of graftability or complexity of coronary lesions were enrolled. They were randomly divided into the LIPUS treatment group (N = 31) and the placebo group (N = 25) in a 1:1 fashion. The LIPUS therapy was performed in a transthoracic manner for 20 min for 3 sections each (mitral, papillary muscle, and apex levels) under the conditions that we identified; frequency 1.875 MHz, intensity 0.25 MPa, and 32 cycles. The primary endpoint was weekly use of nitroglycerin. Secondary endpoints included stress myocardial perfusion imaging and others. The average weekly nitroglycerin use (times/week) was decreased from 5.50 to 2.44 in the LIPUS group and from 5.94 to 2.83 in the placebo group. The changes in the average weekly nitroglycerin use were comparable; -3.06 (95% CI: -4.481 to -1.648) in the LIPUS group (PConclusionsIn the present study, the LIPUS therapy did not further ameliorate chest pain as compared with optimal medications alone in patients with refractory angina pectoris. The present findings need to be confirmed in another trial with a large number of patients. (Registration ID: UMIN000012369).

Background and objectives: We aim to verify the use of ML algorithms to predict patient outcome using a relatively small dataset and to create a nomogram to assess in-hospital mortality of patients with COVID-19. Methods: A database of 200 COVID-19 patients admitted to the Clinical Hospital of State University of Campinas (UNICAMP) was used in this analysis. Patient features were divided into three categories: clinical, chest abnormalities, and body composition characteristics acquired by computerized tomography. These features were evaluated independently and combined to predict patient outcomes. To minimize performance fluctuations due to low sample number, reduce possible bias related to outliers, and evaluate the uncertainties generated by the small dataset, we developed a shuffling technique, a modified version of the Monte Carlo Cross Validation, creating several subgroups for training the algorithm and complementary testing subgroups. The following ML algorithms were tested: random forest, boosted decision trees, logistic regression, support vector machines, and neural networks. Performance was evaluated by analyzing Receiver operating characteristic (ROC) curves. The importance of each feature in the determination of the outcome predictability was also studied and a nomogram was created based on the most important features selected by the exclusion test. Results: Among the different sets of features, clinical variables age, lymphocyte number and weight were the most valuable features for prognosis prediction. However, we observed that skeletal muscle radiodensity and presence of pleural effusion were also important for outcome determination. Integrating these independent predictors was successfully developed to accurately predict mortality in COVID-19 in hospital patients. A nomogram based on these five features was created to predict COVID-19 mortality in hospitalized patients. The area under the ROC curve was 0.86 ± 0.04. Conclusion: ML algorithms can be reliable for the prediction of COVID-19-related in-hospital mortality, even when using a relatively small dataset. The success of ML techniques in smaller datasets broadens the applicability of these methods in several problems in the medical area. In addition, feature importance analysis allowed us to determine the most important variables for the prediction tasks resulting in a nomogram with good accuracy and clinical utility in predicting COVID-19 in-hospital mortality.

Abstract Background A decrease in bone mineral density is common in patients with Williams syndrome. However, appropriate management for osteoporosis in Williams syndrome patients has not been established. We report the case of a 12-year-old female patient with Williams syndrome, who underwent denosumab treatment for osteoporosis. Case presentation A 12-year-old Japanese female patient with Williams syndrome was shown to have very low bone mineral density. Bone mineral density was evaluated before treatment and at 5, 9, 17, 23, and 29 months of treatment by dual-energy X-ray absorptiometry. After denosumab therapy for 29 months, lumbar and total hip bone mineral density values had increased by 51.6% and 37.6%, respectively. No new fractures occurred during the observation period. Conclusions To the best of our knowledge, this is the first experience with denosumab treatment in Williams syndrome patients with osteoporosis. Based on our findings, denosumab may be an effective treatment option for Williams syndrome patients with osteoporosis.

Introduction: In this study, we present “microscopic mini-open foraminotomy (MicroMOF)” as a new, less invasive method for posterior cervical foraminotomy. Technical Note: Using surgical microscope guidance, the spinous process is hemi-split, and the posterior muscle is detached from the laminar subperiosteal surface. Bony resection is then performed obliquely from medial posterior to lateral anterior under lateral-tilted surgical field exposure. MicroMOF has been performed successfully for cervical radiculopathy and cervical spondylotic amyotrophy, which achieved postoperative symptom improvement with few complications. Conclusions: The novel MicroMOF foraminotomy technique has been found to protect the nerve root and vertebral artery and help preserve muscle and cervical facet joint bone.

BackgroudThe aim of this study was to assess the prognostic association of plasma levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) with clinical outcomes of patients with microvascular angina (MVA). Methods: In this international prospective cohort study of MVA by the Coronary Vasomotor Disorders International Study (COVADIS) group, we examined the association between plasma NT-proBNP levels and the incidence of major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization due to heart failure or unstable angina. Results: We examined a total of 226 MVA patients (M/F 66/160, 61.9 ± 10.2 [SD] yrs.) with both plasma NT-proBNP levels and echocardiography data available at the time of enrolment. The median level of NT-proBNP level was 94 pg/ml, while mean left ventricular ejection fraction was 69.2 ± 10.9 % and E/e’ 10.7 ± 5.2. During follow-up period of a median of 365 days (IQR 365–482), 29 MACEs occurred. Receiver-operating characteristics curve analysis identified plasma NT-proBNP level of 78 pg/ml as the optimal cut-off value. Multivariable logistic regression analysis revealed that plasma NT-proBNP level ≥ 78 pg/ml significantly correlated with the incidence of MACE (odds ratio (OR) [95 % confidence interval (CI)] 3.11[1.14–8.49], P = 0.001). Accordingly, Kaplan-Meier survival analysis showed a significantly worse prognosis in the group with NT-proBNP ≥ 78 (log-rank test, P

Objective: An important issue in adolescent idiopathic scoliosis (AIS) correction surgery is postoperative pain management due to the procedure’s relatively high invasiveness. Although celecoxib is widely used as an analgesic for post-surgical pain, there have been several reports of drug eruptions. Such side effects may similarly occur in AIS patients following posterior spinal fusion (PSF). However, no studies have specifically addressed perioperative rash from analgesics in scoliosis surgery. We investigated the incidence of drug eruptions in PSF for AIS and their patient-related risk factors. Methods: We retrospectively reviewed the medical records of 134 consecutive patients who underwent PSF for AIS. Sixty-six patients had received celecoxib and 68 had taken NSAIDs, acetaminophen, or other painkillers after surgery. We investigated the incidence of drug eruptions between patients who took celecoxib (celecoxib group) or other painkillers (others group) and searched for factors associated with rash after surgery by means of a logistic regression model. Results: The overall incidence of drug eruptions after PSF for AIS was 11.9%. The incidence of eruptions in the celecoxib group (18.2%) was significantly higher than in the others group (5.9%) (p = 0.034). The patient-related factors of celecoxib intake and allergic history had significant associations with drug eruptions in multivariate analysis, with odds ratios of 3.88 and 3.53, respectively. Conclusion: In PSF surgery for AIS, patients who receive celecoxib and/or have a history of allergies are significantly more likely to exhibit a rash and should be observed closely for drug eruptions.