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Menstrual Health and Hygiene (MHH) require adequate sanitary facilities, clean water, product access, privacy and safety, and disposal. MHH can significantly influence girls' health and educational achievements. However, schools in some developing countries lack proper Water, Sanitation and Hygiene (WASH) amenities to manage healthy menstruation. Therefore, it is crucial to enhance WASH services to tackle menstrual-related difficulties effectively. Zambian government schools struggle with insufficient WASH infrastructures. Hence, it is imperative to reveal the status of WASH services for policy progress and to promote girls' optimal menstrual health. We conducted observations and a qualitative study to evaluate the school's WASH facilities, investigate the sociocultural factors impacting MHH, and examine coping mechanisms to manage menstruation. Thirty adolescent schoolgirls, aged 14–19, residing in Lusaka peri-urban areas, participated in five focus group discussions. Insufficient school security, inadequate sanitary facilities, absence of clean water, and limited access to menstrual materials presented notable challenges. Culturally, there was an expectation for girls to swiftly embrace womanhood despite being unprepared for the natural biological process it entailed. Girls formulated strategies for managing challenges associated with MHH. The fundamental needs of menstruating girls include a sufficient supply of menstrual materials, improved WASH services, increased safety, and enhanced privacy. HIGHLIGHTS Sociocultural beliefs influence menstrual health and hygiene (MHH).; Good MHH includes safe WASH.; Functional WASH facilities, clean and safe water, safety, and disposal facilities are crucial.; Girls need provisions that are female-friendly, socially acceptable, and appropriate. These provisions should also meet their culturally context-specific needs.; Girls’ needs continue to persist, including sufficient menstrual materials, improved WASH services, enhanced safety, and privacy.;

Poor hand hygiene practice has been linked to an increase in the number of infections among children in urban slums. Hands are considered an intersection for bacterial transmission, but it is unclear whether the handwashing technique affects bacteria elimination. This study investigated the effect of handwashing on the concentration of Escherichia coli (E. coli) and factors related to its reduction among children in an urban slum in Bandung, Indonesia. We observed handwashing and conducted repeated hand swabs before and after handwashing among 137 participants. The mean E. coli concentration on the hands decreased after handwashing, with a higher reduction in E. coli count among students who used soap and had soap contact for more than 10 s during handwashing. Cleaning in-between fingers, using soap, soap contact for more than 10 s, and drying hands with a single-use towel were effective factors for reducing E. coli concentration after handwashing (p < 0.05). More than half of the swab samples (59%) tested positive for E. coli after handwashing, indicating that the children's handwashing technique was not effective in completely removing E. coli from the hands. Moreover, sustained and consistent handwashing practice as a daily behavior in children would maximize the effect. HIGHLIGHTS Fecal contamination was detected on the hands of students before and after handwashing.; The children's handwashing practice falls short of the standard, which affects the level of reduction of fecal contamination.; The short duration of soap contact with the hand (

Summary: Purpose: Nursing is traditionally considered a female profession, and male nursing students face gender stereotype barriers. Most studies of male nursing students in Japan focus on their learning experiences in maternal nursing, and little is known about the experiences of male nursing students in their usual learning environment. Therefore, the purpose of this study is to explore the barriers and coping strategies of Japanese male nursing students in nursing education, including classroom and practical training. Methods: A qualitative descriptive design was used to study 20 male nursing students from eight Japanese universities. Purposive sampling using the snowball method was used to recruit participants. Semistructured interviews were used to gather data about the participants’ thoughts and experiences in nursing education. All interview data were analyzed using thematic analysis. Results: Four themes emerged from the data: (1) nursing choices of own volition; (2) loneliness due to the female-dominated environment and marginalization; (3) dealing with barriers and seeking support; and (4) positive experiences in nursing education. Male nursing students face barriers such as loneliness and feelings of alienation. Family support, mutual support among male nursing students, and the presence of role models were factors that addressed these barriers and positively influenced career choice. Conclusions: This research suggests that nursing educators need to understand the barriers faced by male nursing students and provide a gender-neutral learning environment for all students.

This study sought to clarify the lifestyle and physical and mental health status of homeless people in a cold region of Japan. 28 participants who visited a soup kitchen completed the physical health check-up and questionnaire surveys in 2017. Five were invited to participate in semi-structured interviews in 2018. Mental health was evaluated using the General Health Questionnaire-28 (GHQ-28). The results revealed that a high proportion of homeless people did not consume enough food. Their meat, fish, and vegetables intake were limited, indicating that inappropriate eating habits may affect physical health. Furthermore, four people consumed meals once or less every two days, and all of them were living on the street. In addition, 18% (n = 5) answered that they often consumed alcohol in the daytime, and 68% (n = 19) had a total GHQ-28 score above the cut-off point (>5). In this regard, among those with a GHQ-28 score of >5, seven drank in the daytime even though they consumed meals once or less a day. Indeed, qualitative results revealed physical and psychosocial distress experienced, including limited access to food, anxiety for the future, lack of social support, and erosion of self-esteem. These findings suggest that restrictions on food selection due to financial insecurity, alcohol issues, and mental disorders may impact the food intake and subsequently lead to deteriorating physical health and living on the street may also significantly impact mental health among the homeless. which are helpful for health and social workers to develop necessary interventions targeted at this population.

Abstract Sanitation facility conditions and waste disposal practices are hypothesized to affect the fecal contamination of drinking water and kitchenware. The present study aimed to examine the physical conditions of sanitation facilities and waste disposal locations as well as determine the concentrations of Escherichia coli in drinking water, cups, dishes, flies, toilet floors, and kitchen floors. A total of 336 samples were collected from 17 households in peri-urban Lusaka. Generalized linear mixed models showed that six out of seven physical pit-latrine conditions, waste disposal practices, and kitchen hygiene practices had significant effects on the contamination of either kitchenware or drinking water. The results highlighted that improving the physical pit-latrine conditions, dumpsite location, washing water, and kitchenware-drying location may potentially reduce fecal contamination of drinking water, cups, and dishes.

Fecal contamination with a poor water, sanitation and hygiene environment in urban informal settlements poses diarrhea risks. Little information is available on the contamination of environmental media with enteric pathogens in such settlements. We investigated the contamination of Escherichia coli, rotavirus, and Cryptosporidium spp. in water, on kitchenware, and on flies in urban informal settlements of Chawama and Kanyama, Lusaka, Zambia. These environmental media were examined by XM-G agar cultivation for E. coli and specific real-time RT-PCR assays to detect rotavirus and Cryptosporidium spp. E. coli; rotavirus, and Cryptosporidium spp. were detected in samples of household stored drinking water (6 of 10 samples, 3 of 10 samples, and 2 of 10 samples, respectively), cups (10 of 20 samples, 2 of 13 samples, 1 of 13 samples, respectively), and flies (35 of 55 samples, 5 of 17 samples, 1 of 17 samples, respectively). The ranges of rotavirus concentrations in household stored drinking water, on cups, and flies were 2.9 × 102–2.2 × 105 copies/L, 1.2 × 102–4.3 × 102 copies/cup, and 5.0 × 101–2.0 × 102 copies/fly, respectively. These results indicate the contribution of drinking water and kitchenware to enteric pathogen exposure and potential role of flies in microbial transmission. HIGHLIGHTS The study was conducted in a periurban informal settlement of sub-Saharan Africa.; Rotavirus and Cryptosporidium spp. were detected from point-of-use drinking water.; These two pathogens were also detected from drinking cups and flies.; People are exposed to these enteric pathogens from drinking water as well as cups.; The results imply the role of flies as a vector of these enteric pathogens.;

Abstract Background Symptomatic pseudarthrosis and cage migration/protrusion are difficult complications of transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). If the patient experiences severe radicular symptoms due to cage protrusion, removal of the migrated cage is necessary. However, this procedure is sometimes very challenging because epidural adhesions and fibrous union can be present between the cage and vertebrae. We describe a novel classification and technique utilizing a navigated osteotome and the oblique lumbar interbody fusion at L5/S1 (OLIF51) technique to address this problem. Methods This retrospective study investigated consecutive patients with degenerative lumbar diseases who underwent TLIF/PLIF. Symptomatic cage migration was evaluated by direct examination, radiography, and/or computed tomography (CT) at 1, 3, 6, 12, and 24 months of follow-up. Cage migration/protrusion was defined as symptomatic cage protrusion > 5 mm from the posterior border of the over and underlying vertebral body compared with initial CT. We evaluated patient characteristics including body mass index, smoking history, fusion level, and cage type. A total of 113 patients underwent PLIF/TLIF (PLIF n = 30, TLIF n = 83), with a mean age of 71.1 years (range, 28–87 years). Mean duration of follow-up was 25 months (range, 12–47 months). Results Cage migration was identified in 5 of 113 patients (4.4%). All cases of symptomatic cage migration involved the L5/S1 level and the TLIF procedure. Risk factors for cage protrusion were age (younger), sex (male), and level (L5/S1). The mean duration to onset of cage protrusion was 3.2 months (range, 2–6 months). We applied a new classification for cage protrusion: type 1, only low back pain without new radicular symptoms; type 2, low back pain with minor radicular symptoms; or type 3, cauda equina syndrome and/or severe radicular symptoms. According to our classification, one patient was in type 1, three patients were in type 2, and one patient was in type 3. For all cases of cage migration, revision surgery was performed using a navigated high-speed burr and osteotome, and the patient in group 1 underwent additional PLIF without removal of the protruding cage. Three revision surgeries (group 2) involved removal of the protruding cage and PLIF, and one revision surgery (group 3) involved anterior removal of the cage and OLIF51 fusion. Conclusions The navigated high-speed burr, navigated osteotome, and OLIF51 technique appear very useful for removing a cage with fibrous union from the disc in patients with pseudarthrosis. This new technique makes revision surgery after cage migration much safer, and more effective. This technique also reduces the need for fluoroscopy.

Children's faecal waste is a major environmental health issue despite increasing access to sanitation facilities and sanitary products in Indonesia. This cross-sectional study investigated child faecal management practice and disposable diaper usage among under-fives living in an urban slum of Indonesia. Data on household socio-demographics, child characteristics, and child faeces management practices were collected from 184 randomly selected pairs of mothers and children through interviews and observations. Findings revealed children's common defaecation sites as improved toilet, disposable diaper, and reusable diaper at 33.7, 33.2, and 16.3%, respectively. However, hygienic child faeces disposal was at 45%. Multivariate logistic regression indicated that the common use of disposable diapers and bathroom floor as the child's defaecation site increased unhygienic disposal. This prevalence decreased for mothers with higher education and those who had initiated toilet training. Promoting mothers' disposal of child faeces from disposable diapers, preventing child defaecation on the bathroom floor, and initiating toilet training as soon as a child can walk alone are thus potential interventions. HIGHLIGHTS The study explored faecal management trends of under-fives in an urban Indonesian slum.; Disposable diapers were a shortcut for mothers' unhygienic disposal practices.; Water bodies and trash bins were the preferred disposal sites for diapers.; Adult toilets were preferred for the initiation of child toilet training.; The bathroom floor was a common yet ultimately unhygienic defaecation site; mothers considered it safer.;

The novel coronavirus infectious disease (COVID-19) pandemic has negatively impacted not only our physical health but also mental health, including increasing depressive and anxiety symptoms. In particular, socially and physically vulnerable populations, such as people experiencing homelessness (PEH), may be more likely to have their mental health worsened by the pandemic due to having more difficulty meeting basic human needs. Therefore, this study aims to assess the impact of COVID-19 on mental health of the homeless in Japan by evaluating depressive and anxiety symptoms and identifying the associated factors particularly, sociodemographic variables as age, employment status and the fear and perceived risk of COVID-19 infection. A cross-sectional interview survey among 158 PEH in Osaka Prefecture was conducted from April to May 2022. The survey included sociodemographic questions and history and perceived risk of infection with COVID-19. Depressive symptoms were measured using the nine-item Patient Health Questionnaire (PHQ-9) and anxiety symptoms using the seven-item Generalized Anxiety Disorder Scale (GAD-7), and the fear of COVID-19 using the seven-item Fear of New Coronavirus Scale (FCV-19S). In this study, the prevalence of depression (PHQ-9≥10) was 38.6%, anxiety disorder (GAD≥10) was 19.0%, and high fear of COVID-19 (FCV-19S≥19) was 28.5%. Univariate logistic regression analysis revealed that PEH in younger age groups (18-34 years), and with joblessness, higher perceived infection risk, and higher fear of COVID-19 were more likely to suffer from depression and anxiety (p

Abstract Background Homo sapiens have experienced admixture many times in the last few thousand years. To examine how admixture affects local adaptation, we investigated genomes of modern Polynesians, who are shaped through admixture between Austronesian-speaking people from Southeast Asia (Asian-related ancestors) and indigenous people in Near Oceania (Papuan-related ancestors). Methods In this study local ancestry was estimated across the genome in Polynesians (23 Tongan subjects) to find the candidate regions of admixture-enabled selection contributed by Papuan-related ancestors. Results The mean proportion of Papuan-related ancestry across the Polynesian genome was estimated as 24.6% (SD = 8.63%), and two genomic regions, the extended major histocompatibility complex (xMHC) region on chromosome 6 and the ATP-binding cassette transporter sub-family C member 11 (ABCC11) gene on chromosome 16, showed proportions of Papuan-related ancestry more than 5 SD greater than the mean (> 67.8%). The coalescent simulation under the assumption of selective neutrality suggested that such signals of Papuan-related ancestry enrichment were caused by positive selection after admixture (false discovery rate = 0.045). The ABCC11 harbors a nonsynonymous SNP, rs17822931, which affects apocrine secretory cell function. The approximate Bayesian computation indicated that, in Polynesian ancestors, a strong positive selection (s = 0.0217) acted on the ancestral allele of rs17822931 derived from Papuan-related ancestors. Conclusions Our results suggest that admixture with Papuan-related ancestors contributed to the rapid local adaptation of Polynesian ancestors. Considering frequent admixture events in human evolution history, the acceleration of local adaptation through admixture should be a common event in humans.

Background: Retro-odontoid pseudotumor (ROPT) is a non-neoplastic pathology of the craniovertebral junction that is usually associated with atlantoaxial instability. The mass compresses the spinal cord, causing cervical myelopathy and potentially resulting in severe disability. Posterior atlantoaxial fixation without laminectomy is a suitable surgical option when the symptoms are mild and the static compression is moderate. In the setting of patients with severe symptoms and large ROPTs, posterior decompression becomes necessary. However, achieving solid posterior atlantoaxial fusion is difficult without a bony surface, namely the C1 posterior arch. Here, we describe a novel technique of C1 laminoplasty to achieve C1 decompression, and posterior atlantoaxial fusion with a modified Goel technique. Methods: An 83-year-old man was referred to our orthopedic department with quadriplegia due to atlantoaxial instability. His daily life had been affected by severe neck pain, clumsiness of bilateral hands, and gait disturbance for more than 2 years. Preoperative cervical radiograms revealed atlantoaxial instability, and magnetic resonance imaging showed a large pseudotumor compressing to the spinal cord. Results: The patient underwent C1 laminoplasty to decompress the spinal cord and retain the posterior arch as a bony surface for grafting and posterior atlantoaxial fusion. The procedure was well tolerated. The patient’s quadriparesis was improved and his Japanese Orthopedic Association score improved from 9/17 to 15/17 and his visual analog scale score for neck pain improved from 75 mm to 28 mm at the 1-year follow-up. Conclusion: C1 laminoplasty and posterior atlantoaxial fusion appears useful when C1 decompression and atlantoaxial fusion become necessary.

Background: Adult spinal deformity (ASD) is caused by spinal malalignment and results in severe low back pain, neurological dysfunction, and severe deformity. Surgical treatment, such as long spinal fusion offers improved patient-reported outcomes compared to conservative treatment. However, surgical complication of proximal screw pullout represents a difficult problem in minimally invasive ASD surgery. We describe a novel technique to prevent screw pullout in ASD. Case presentation: A 71-year-old woman was referred to our hospital with severe low back pain and gait difficulty. Her daily life had been affected by severe lower back pain for more than 6 months. Standing radiograms indicated severe kyphoscoliosis. Two-stage minimally invasive corrective T10-to-pelvis fixation was performed. The first surgery was an L1–S1 image-guided oblique lumbar interbody fusion, with an operation time of 3 h 57 min and an estimated blood loss of 240 mL. After 1 week, the second percutaneous pedicle screw (PPS) fixation was performed and proximal screws were inserted under a transdiscal approach (T11) and with a lower angulation trajectory (T10) to enhance pullout strength. For this second surgery, operation time was 3 h 33 min, and estimated blood loss was 320 mL. No postoperative complications or neurological compromise was reported. In terms of clinical outcomes, Oswestry Disability Index improved from 56% to 24%, and visual analog scale score for lower back pain improved from 62 mm to 24 mm at the 1-year follow-up. Conclusions: Minimally invasive circumferential surgery with triangular fixation is effective for preventing proximal screw back-out and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

Abstract Background Growth references (growth charts) are used to assess the nutritional and growth status of children. In developed countries, there are growth charts based on the country’s national surveys. However, many developing countries do not have their own growth references, so they usually use WHO and US CDC references. In such cases, it is known that the growth statuses of the subject are underestimated or overestimated. This study sought to accurately assess the growth status of children by developing a local growth chart for children living in the Southern Province of Zambia. Methods Anthropometric measurements were conducted on 1135 children aged 2–19 years in the target area. The height and weight data for each sex and age were smoothed using the LMS method, and a percentile curve of height and weight was developed. Based on the US CDC reference, three indicators of undernutrition (stunting, underweight, and thinness) were calculated to determine the proportion of those who are undernourished (z-score < − 2). Results The 50th percentile curve of height and weight in the growth chart of the target population was equivalent to the 5–25th percentile curve of the US reference, and the children of Zambia were both small and of low weight. Conversely, although many subjects are small and of low weight, it was found that there were few poor nutritional statuses as judged by BMI. Through comparison with a previous study in the Southern Province of Zambia, a secular change in the growth of children over 20 years was found. Although there was no significant increase in height and weight in the older age group, there was a significant increase in height and weight at an earlier age. This is thought to be due to an increase in the growth rate of children due to improved socioeconomic conditions, women’s education level, and improvement in health care standards. Conclusions The subjects were small and of low weight compared to the US population, but the nutritional status was not poor by BMI. The height and weight at an earlier age increased compared to 20 years ago.

Background: Indirect decompression for lumbar canal stenosis as a technique of minimally invasive surgery (MIS), is receiving considerable attention. Conventional MIS indirect decompression at L5-S1 is performed using intraoperative fluoroscopy. In this work, we describe a novel C-arm free simultaneous MIS indirect decompression technique for L5-S1 pathology. Methods: A 72-year-old woman with symptomatic L5 isthmic spondylolisthesis was referred to our hospital. The patient’s daily life had been affected by severe low back pain for 5 years and left leg pain for 2 years. The surgery was performed without C-arm fluoroscopy. The percutaneous pedicle screws and intervertebral cages were inserted only under navigation guidance in a single lateral position. Results: The patient was successfully treated with surgery. Her low back pain and left leg pain improved dramatically. Her clinical outcomes, the Oswestry disability index (ODI) improved from 48% to 14% and the low back pain visual analog scale (VAS) score improved from 78 mm to 23 mm at 1 year of final follow-up. Conclusions: C-arm-free simultaneous MIS indirect decompression for L5-S1 is a useful technique, which may reduce surgical time and blood loss. With this new technique, surgeons and operation room staff can avoid the risk of an adverse event of intraoperative radiation.

Abstract Background Good nutrition and physical activity of school-aged children are important for ensuring optimum growth and reducing obesity. This present study assessed associations between breakfast consumption, BMI-for-Age (BMI) and physical fitness in a cross-section of school-aged children attending government-owned primary schools in Kumasi, Ghana. Method The sample consisted of 438 pupils (boys = 213; girls = 225; mean age 11.1 ± 1.1), attending 10 randomly selected schools. Weight (kg), height (cm) and Mid Upper Arm Circumference (MUAC) were measured for each participant, and BMI-for-age z-scores determined using the World Health Organisation (WHO) anthroplus software. Participants were stratified into thinness, normal weight, overweight/obese using WHO cut offs. Physical fitness was assessed using forward jump, left and right handgrips, flexibility, sit-ups and 50 metre run following standard procedures and converted to scores of 1 to 10 following Japanese standards, based on which percentiles were derived. Total fitness score for each pupil was computed by adding all scores. A questionnaire was used to assess meal intake patterns. Results The mean BMI-for-age z-score for participants was − 0.24 ± 0.99. Thinness, normal weight and overweight/obesity were 2.7, 86.5, and 10.5% respectively among the pupils. Overweight was higher in girls (14.2%) compared to boys (4.2%), p = 0.003. Similarly, mean MUAC was significantly (p = 0.021) higher in the girls (22.0 ± 3.2 cm) than the boys (20.7 ± 7.3 cm). For physical fitness, the girls scored higher in forward jump (p

Background: Navigation surgery is becoming very popular for anterior cervical surgery. However, one difficult problem for anterior cervical surgery is setting the reference frame (RF), due to the lack of reliable structures. If the RF is attached to the head holder or operation table instead of the patient, the accuracy of navigation is not good. Materials and methods: This retrospective study included six patients who underwent anterior cervical surgeries with O-arm navigation. The RF was attached to the Caspar retractor using a special adaptor. Patients comprised three men and three women with a mean age of 62.8 years. Anterior cervical discectomy and fusion was performed in three cases, and anterior cervical corpectomy and fusion in three cases. We evaluated the accuracy of navigation, surgical time, intraoperative blood loss, complications, bony fusion, and clinical results. Results: Mean accuracy of anterior navigation was 1.1 ± 0.7 mm (range, 0–2 mm). Mean surgical time and blood loss were 166 ± 39 min (range, 121–359 min) and 280 ± 189 ml (range, 50–600 ml), respectively. Complications comprised one case of postoperative C5 palsy that recovered within 6 months. Mean Japanese Orthopedic Association (JOA) recovery rate was 52.4% (range, 20–100%). Adequate decompression and solid fusion were obtained in all cases. Conclusions: Intraoperative O-arm navigation-guided anterior cervical decompression and fusion is an effective technique for achieving precise decompression. This new navigation technique provides excellent results for severe cervical ossification of the posterior longitudinal ligament (OPLL) with minimum risk of adverse events from intraoperative radiation. We advocate the use of this novel technique in cases of cervical canal stenosis due to large disc osteophyte complex and OPLL, and also in cases of distorted cervical anatomy due to deformity, tumor, or revision surgery.

Study design: Technical note. Objectives: To present a novel C-arm-free technique guided by navigation to insert and place a C1 lateral mass screw. Background and Objectives: Atlantoaxial subluxation (AAS) is a relatively common sequelae in patients with rheumatoid arthritis (RA) and upper cervical trauma. If they present with severe symptoms, surgical intervention such as posterior fusion is indicated. The established treatment for AAS is fixation with a C1 lateral mass screw and C2 pedicle screw (modified Goel technique) to achieve bony fusion. However, this technique requires fluoroscopy for C1 screw insertion. To avoid exposing the operating team to radiation, we present here a novel C-arm-free C1 lateral mass screw insertion technique for AAS. Materials and Methods: A 67-year-old man was referred to our hospital with neck pain, quadriparesis, and clumsiness and numbness of both upper and lower limbs. He had undergone C3–6 posterior fusion previously in another hospital. In physical examination, he had severe muscle weakness of bilateral upper limbs and hypoesthesia of all four limbs. He had hyper-reflexia of bilateral lower limbs and pollakiuria. His Japanese orthopedic score was 8 points out of 17. Preoperative radiograms showed AAS with an atlantodental interval (ADI) of 7 mm. MRI indicated retro-odontoid pseudotumor and severe spinal cord compression at the C1–2 level. The patient underwent posterior atlantoaxial fixation under navigation guidance. To prevent epidural bleeding during the insertion and placement of a C1 lateral mass screw, we have here defined a novel screw insertion technique. Results: The surgical time was clocked as 127 min and blood loss was 100 mL. There were no complications per-operatively or in the postoperative period. The patient showed almost full recovery (JOA 16/17) at two months follow-up and a solid bony fusion was noticed in the radiograms at one year follow-up. Conclusions: This novel surgical procedure and C1 lateral mas screw placement technique is a practical and safe method in recent advances of AAS treatment. Procedurally, the technique helps prevent epidural bleeding from the screw entry point and also allows for proper C1 screw insertion under navigation guidance without exposing surgeons and staff to the risk of fluoroscopic radiation.

This is a prospective study that has been done to assess the lumbar sagittal alignment of patients positioned prone over an adjustable hinged carbon fiber operating table. The following three variations of table position have been considered: neutral, 20° convex, and 20° concave bending. A total of 33 patients who underwent lumbar disc herniation and lumbar canal stenosis surgery were enrolled. Patients who presented with spinal deformity akin to lumbar scoliosis or spondylolisthesis were excluded. For the surgical procedure, following the induction of endotracheal general anesthesia, patients were positioned prone on the adjustable hinged carbon fiber operating table. Radiographs of the lateral view of the lumbar spine were acquired for the three table positions, i.e., neutral, 20° convex, and 20° concave. The lumbar lordosis was measured on radiographs. The lumbar lordosis presented divergently in all three variations of the table (p < 0.01): 45.2 ± 11.0° in neutral; 52.0 ± 10.7° in 20° lumbar extension bending; and 35.9 ± 10.8° in 20° lumbar flexion bending. The efficacy of table bending was 46.5% in convex and 34.0% in concave bending. In conclusion, the lumbar lordosis in three different table positions were 35.9° in 20° convex bending, 45.2° in neutral, and 52.0° in concave bending. The efficacy of table bending was 46.5% in convex and 34.0% in concave bending.

Background: Surgical management of spondyloptosis (grade 5 spondylolisthesis) is challenging and controversial, from in situ fusion to complete reduction. In situ fusion is less technically demanding and offers the advantage of a low risk of neurological complications, but the pseudoarthrosis rate is high and sagittal alignment cannot be normalized. We present a relatively rare case of a patient with L5 spondyloptosis who needed revision surgery due to psuedoarthrosis and rod breakage. Case description: A 12-year-old girl with L5 spondyloptosis was referred to our hospital. She had a 3-year history of low back pain (visual analogue scale: VAS 8/10), bilateral L5 dermatomal pain (VAS 6/10) and paresthesia. The patient was successfully treated with surgery, partial reduction was performed and sagittal and coronal alignments were normalized. But at 1.5 year follow up, patient presented with low back pain, rod breakage and psuedoarthrosis, so revision surgery was done with fibula grafting, dual sacro-alar-iliac screws and additional rod. At the 3-year follow-up, VAS for low back pain had improved from 8/10 to 2/10 and leg pain had disappeared. Postoperative radiograms at final follow-up revealed no loss of reduction or loosening of implants. Conclusions: Sagittal reduction is more important than horizontal reduction for patients with spondyloptosis showing sagittal malalignment (SDSG type 5 or 6). Cantilever and table-bending techniques are useful to obtain good sagittal alignment for patients showing spondyloptosis. It is important to have circumferential fusion if reduction is aimed.

Background: Percutaneous pedicle screw (PPS) fixation as a minimally invasive surgery (MIS) is becoming the standard method for stabilizing thoracolumbar burst fractures. However, with the conventional PPS percutaneous reduction is difficult, and a great amount of usage of fluoroscopy is necessary. We describe a novel technique of C-arm free PPS with new reduction device for thoracolumbar fractures. Methods: A 22-year-old man presented to our hospital with severe low back pain and impending paraplegia secondary to T12 burst fracture. We performed short-segment fixation and reduction for this patent. The special PPS which have reduction mechanism were inserted under O-arm navigation guidance. The trauma reduction system was applied and the fracture was reduced without fluoroscopy. Results: Postoperative computed tomography (CT) showed the adequate screws position and complete reduction of the vertebral body. On one-year follow-up, the patient was asymptomatic, with the fracture healed and no implant loosening. Conclusions: C-arm free PPS and reduction is a useful MIS technique for thoracolumbar burst fractures.

Study design: Retrospective comparative study. Objective: Comparative study of C-arm free O-arm navigated minimally invasive cervical pedicle screw (MICEPS) fixation with conventional cervical pedicle screw fixation. Methods: Twenty-five patients with different cervical spine pathologies were operated with MICEPS with O-arm navigation (group M; 18 patients) and conventional pedicle screw (group C; 7 patients) from June 2017 to January 2020. Operative time, blood loss were recorded. Preoperative and postoperative radiograms, CT scans and MRI were evaluated. Postoperatively screw position accuracy and angulation was determined on CT. Breach rate was evaluated on CT scan and classified according to Neo grading. Complications if any were noted. Results: The average blood loss in group M and group C was 129 ml and 329 ml, respectively. The average operative time in group M and group C was 77.4 min and 82.3 min, respectively. A total of 148 screws were inserted. In group M, no patient showed grade 2 and 3 breach while in group C, grade 0 and 1 breach was found in 85.7% screws and grade 2 in 14.3% screws. Mean screw medial angulation was 45.2 degrees in group M and 33.4 degrees in group C. There was one dural tear and two C5 palsies in each group. Conclusion: With C -arm free O-arm navigated MICEPS fixation operative time and blood loss are less though not statistically significant. It has less pedicle breach rate, less incidence of neurovascular complications than conventional technique. There is no radiation exposure to operating surgeon and staff.

Background and Objectives: Gait ability and spinal postural balance affect ADL in patients who underwent adult spinal deformity (ASD) surgery. However, it is still unclear how to determine what the cause is. This study was done to investigate various factors affecting gait, postural balance and activities of daily living (ADL) in patients who were operated on for ASD over a period of one year, following corrective surgery. Materials and Method: A cohort of 42 (2 men, 40 women, mean age, 71.1 years) who were operated on for ASD were included in this study. According to Oswestry Disability Index (ODI), based on their ADL, patients were segregated into satisfied and unsatisfied groups. Gait and postural balance abilities were evaluated before and after the operative procedure. Radiographs of spine and pelvis as well as the rehabilitation data (static balance, standing on single-leg; dynamic postural adaptation, timed up and go test (TUG); Gait Capability, walk velocity for a distance of 10 m) were acquired 12 months after surgery and analyzed. Spinopelvic parameters such as (lumbar lordosis (LL), pelvic tilt (PT), sagittal vertical axis (SVA), pelvic incidence (PI)) were marked and noted. The factors which affect patients’ satisfaction with their ADL were evaluated. Results: The ADL satisfied group included 18 patients (1 man, 17 women, mean age 68.6 years) and the unsatisfied group included 24 patients (1 man, 23 women, mean age 73.1 years). One year after the surgery, the two groups were tested. TUG (8.5 s vs. 12.8 s), 10 m walk velocity (1.26 m/s vs. 1.01 m/s), and single leg standing test (25 s vs. 12.8 s) were regarded as notably different. According to logistic regression analysis, only TUG was extracted as a significant factor. The cut-off value was 9.7 s, with sensitivity 75%, specificity 83%, area under the curve 0.824, and a 95% confidence interval of 0.695–0.953. Conclusions: A significant factor among all evaluations in postoperative ASD patients was TUG, for which the cut-off value for ADL satisfaction was 9.7 s.

Background: Increasing dietary fibre (DF) intake through a habitual diet is recommended for preventing diabetes. Aim: To investigate a stepwise approach to nutrition education on DF intake among young adults in Japan with the largest deficit in habitual DF intake from the recommended value. Subjects and methods: Plasma glucose levels were measured in 54 adults in their 20s and 30s (29 men, 25 women) during fasting and at 30, 60, 90, and 120 minutes. Habitual DF intake and postprandial plasma glucose level were analysed. Results: DF intake was low (men = 5.7 ± 1.5 g/1000 kcal; women = 6.3 ± 1.2 g/1000 kcal) with no sex difference. Comparison between low- and high-DF groups based on the cut-off point (7.0 g/1000 kcal) showed that the pattern of changes in postprandial plasma glucose levels was significant, and a significant increase was observed at 30 minutes in the low-DF group. Comparison by food group demonstrated that habitual intake of potatoes, green/yellow vegetables, other vegetables, seaweed, peas and beans, and fruits was significantly higher in the high-DF group. Conclusion: This study provides valuable information regarding food selection for preventing diabetes and suggests that 7.0 g/1000 kcal of DF is an effective target value for a stepwise approach to nutrition education in Japan.

Background: Promoting continued physical activity during winter in snowy-cold regions would be of benefit as a health promotion strategy among elderly individuals. Aim: To evaluate the effect of a lower limb strength training programme for elderly individuals on the daily step counts during the snowy season. Subjects and methods: Fourteen community-dwelling elderly individuals were recruited from a snowy-cold region of northern Japan. Methods: Daily step counts were measured during the snowy season in 2018 (with no exercise intervention) and 2019 (after the exercise intervention). Physical function was measured before and after the intervention, including body mass index, 30-s chair test, grip strength, normal gait speed, short-test battery for locomotive syndrome, Kihon checklist and 25-question geriatric locomotive function scale. Results: The study group included 11 women and three men (78.6 ± 5.2 years old). The exercise intervention improved physical function, with a significant increase in step count among individuals with lower baseline strength. Improved lower limb strength positively correlated with an increase in step count. Conclusion: Lower limb muscle strengthening is an effective intervention to improve physical activity during the snowy season among community-dwelling elderly.

Tuberculosis is endemic in many parts of the world. With increasing immigration, we can state that it is prevalent throughout the globe. Tuberculosis of the spine is the most common form of bone and joint tuberculosis; the principles of treatment are different; biology, mechanics, and neurology are affected. Management strategies have changed significantly over the years, from watchful observations to aggressive debridement, to selective surgical indications based on well-formed principles. This has been possible due to the development of various diagnostic tests for early detection of the disease, effective anti-tubercular therapy, and associated research, which have revolutionized treatment. This picture is rapidly changing with the advent of minimally invasive spine surgery and its application in treating spinal infections. This review article focuses on the past, present, and future principles of surgical management of tuberculosis of the spine.

Abstract Background Although the benefits of physical activity are well-known, levels of physical inactivity are increasing in many countries. Physical activity, particularly for preventive care of the elderly, must be encouraged. The level of physical activity undertaken by people is influenced by season; however, little is known about seasonal fluctuations of physical activity and its relation to muscle strength/mass. Consequently, we clarified the association between physical activity levels and muscle strength/skeletal muscle mass during non-snowy and snowy seasons in northern Japan. Methods Participants were community-dwelling elderly people aged 65 years or older living in Tobetsu, northern Japan. A 30-s chair-stand test (CS-30) and body composition measurements using bioelectrical impedance analysis were conducted prior to physical activity measurement using a three-dimensional acceleration sensor in both non-snowy and snowy seasons. Daily steps for the non-snowy and snowy seasons were compared using Welch’s t test. The association between the CS-30/skeletal muscle index and daily steps in both seasons was estimated by fitting multiple linear regression models, with age and sex as covariates. Results Average daily step counts were significantly lower during the snowy season, compared to the non-snowy season (P

Background: Pedicle screw fixation is the standard method for stabilizing fractures in an ankylosed spine, as seen in diffuse idiopathic skeletal hyperostosis (DISH) or ankylosing spondylitis. However, with the conventional screw insertion technique, screw loosening, backout and loss of fixation are often encountered in osteoporotic bone. To enhance screw pull-out strength, we describe a new technique of percutaneous transdiscal pedicle screw (TPS) insertion in this technical note. Methods: A 74-year-old man with DISH presented with severe back pain and impending paraplegia secondary to osteoporotic T11 vertebral fracture. We performed short-segment PTS fixation under computer navigation guidance. Screws were inserted in a 25° cephalad direction to engage the superior endplate of the instrumented vertebrae. Increased insertional torque was appreciated by the surgeon when the screw engaged the superior endplate, but was not felt while crossing the pedicle. Results: Computed tomography (CT) immediately postoperatively showed the screws in the intended position engaging the superior end plate. On 1-year follow-up, the patient was asymptomatic, with the fracture healed and no implant loosening. Conclusions: The PTS insertion technique may be a useful option for spine fixation in DISH to overcome the problems of osteoporotic bone by enhancing screw pull-out strength.

Background: Anterior cervical corpectomy and fusion (ACCF) with floating technique is one of the best surgical interventions for severe ossification of the posterior longitudinal ligament (OPLL). However, insufficient decompression and a thinned ossification mass often lead to poor clinical outcome. This report describes a novel floating technique with intraoperative O-arm navigation to facilitate surgical treatment of the OPLL, which has not previously been described as a therapeutic option. Case description: An 82-year-old woman with myelopathy of the OPLL was referred to our hospital. Activities of daily living had been restricted by severe left arm pain, myelopathy hand, and gait disturbance for 3 years. ACCF was performed under the guidance of O-arm navigation and C-arm-free minimally invasive cervical pedicle screw fixation (MICEPS). The patient was successfully treated surgically and manual muscle test results and sensory function of the left arm had recovered fully by final follow-up at 1 year. Japanese Orthopedic Association score of the patient had improved from 10/17 to 16/17. Conclusions: Intraoperative O-arm navigation-guided ACCF with C-arm-free MICEPS is an effective technique for achieving precise decompression and strong, minimally invasive fixation. This new anterior navigation technique provides an excellent result for severe OPLL without the risk of adverse events from intraoperative radiation.

Adult spinal deformity (ASD) is highly prevalent in persons older than 65 years, affecting more than 30% of the total population. There are many important reports that describe excellent postoperative results for ASD surgery. However, there is no report that describes a chronological evaluation of gait ability and spinal balance after ASD surgery. The present prospective study aimed to determine the recovery time of gait and spinal balance ability after adult spinal deformity (ASD) surgery. Patients with ASD (n = 25: mean age, 73.0 years) who underwent corrective surgery and preoperative and postoperative gait and spinal balance ability evaluation. Spinal radiographs and gait analysis data (static balance; single-leg standing, dynamic balance; time-up and go test, gait ability; 10 m walk velocity) were acquired preoperatively, 1 month, 6 months, and 12 months after surgery. The radiographic parameters of the spine and pelvis (lumbar lordosis; LL, pelvic tilt; PT, sagittal vertical axis; SVA, pelvic incidence; PI) were measured. The mean postoperative SVA, LL, PT, and PI-LL became 30.0 mm, 50.1 degrees, 14.1 degrees, and 0.35 degrees, respectively. Preoperatively, all spinal balance and gait ability were worse than the normal threshold (one-leg standing; 14.2 s vs. 15.0 s, time-up and go test; 13.9 s vs. 13.5 s, 10-m walk speed; 0.91 m/s vs. 1.00 m/s). At 12 months after surgery, all spinal balance and gait ability became normal or improved (single-leg standing; 14.7 s, time-up and go test; 11.0 s, 10-m walk speed; 1.09 m/s). The ODI at one-year follow-up improved from 46.8 ± 12.6% to 27.8 ± 18.1%. In conclusion, gait and spinal balance analysis revealed that ASD patients could not recover gait and spinal balance ability one month after surgery. At 12 months after surgery, gait ability and dynamic spinal balance became better than preoperative levels. However, the static spinal balance was at the same level as that of preoperative status.

Study design: Prospective study. Objective: The aim of this study is to visualize the morphology of a lumbar herniated disc and Kambin’s triangle in three dimensions (3D) based on preoperative CT/MRI fusion images. Methods: CT/MRI fusion images of 23 patients (10 males and 13 females; mean age 58.2 years) were used to evaluate Kambin’s triangle, which is created between the superior articular process (SAP), exiting nerve root (ENR), inferiorly by the superior endplate of the lower lumbar vertebra and dural canal medially at 60 degree and 45 degree endoscopic approach angles. The percentage of the safe usage of transforaminal endoscopic approach was evaluated to utilize a 5 mm dilater without partial facet resection in the fusion image. The 3D lumbar nerve root sleeve angulation (3DNRA), which is the angle between the axis of the thecal sac and the nerve root sleeve, was calculated. The herniated discs were also visualized in the CT/MRI fusion image. Results: The 3DNRA became smaller from L2 to S1. The L2 3DNRA was statistically larger than those of the other root, and the S1 3DNRA was significantly smaller than the others (p < 0.05). (L2, 41.0°; L3, 35.6°; L4, 36.4°; L5, 33.9°; and S1, 23.2°). The SAP-ENR distance at 60° was greatest at L4/5 (5.9 mm). Possible needle passages at 60° to each disc level were 89.1% at L2/3, 87.0% at L3/4 and 84.8% at L4/5. However, the safe 5 mm dilater passage at 60° without bony resection to each disc level were 8.7% at L2/3, 28.3% at L3/4 and 37.0% at L4/5. The 60° corridor at L2/3 was the narrowest (p < 0.01). All herniated discs were visualized in the fusion image and the root compression site was clearly demonstrated especially with foraminal/extraforaminal herniations. Conclusion: The 3D lumbar CT/MRI fusion image enabled a combined nerve-bony assessment of Kambin’s triangle and herniated disc. A fully endoscopic 5 mm dilater may retract the exiting nerve root in more than 60% of total cases. This new imaging technique could prove to be very useful for the safety of endoscopic lumbar disc surgery.

Background and Objectives: The thoracolumbar burst fracture is one of the most common spinal injuries. If the patient has severe symptoms, corpectomy is indicated. Currently, minimally invasive corpectomy with a navigated expandable vertebral cage is available thanks to spinal surgical technology. The aim of this study is to retrospectively compare clinical and radiographic outcomes of conventional and navigational minimally invasive corpectomy techniques. Materials and Methods: We retrospectively evaluated 21 patients who underwent thoracolumbar minimally invasive corpectomy between October 2016 and January 2021. Eleven patients had a navigated expandable cage (group N) and 10 patients had a conventional expandable cage (group C). Mean follow-up period was 31.9 months for group N and 34.7 months for group C, ranging from 12 to 42 months in both groups. Clinical and radiographic outcomes are assessed using values including visual analogue scale (VAS) for back pain and Oswestry disability index (ODI). This data was collected preoperatively and at 6, 12, and 24 months postoperatively. Results: Surgical time and intraoperative blood loss of both groups were not significantly different (234 min vs. 267 min, 656 mL vs. 786 mL). Changes in VAS and ODI were similar in both groups. However, lateral cage mal-position ratio in group N was lower than that of group C (relative risk 1.64, Odds ratio 4.5) and postoperative cage sinking was significantly lower in group N (p = 0.033). Conclusions: Clinical outcomes are not significantly different, but radiographic outcomes of lateral cage mal-position and postoperative cage sinking were significantly lower in the navigation group.

Accounting for peri-urban sanitation poses a unique challenge due to its high density, unplanned stature, with limited space and funding for conventional sanitation instalment. To better understand users, needs and inform peri-urban sanitation policy, our study used multivariate stepwise logistic regression to assess the factors associated with use of improved (toilet) and unimproved (chamber) sanitation facilities among peri-urban residents. We analysed data from 205 household heads in 1 peri-urban settlement of Lusaka, Zambia on socio-demographics (economic status, education level, marital status, etc.), household sanitation characteristics (toilet facility, ownership and management) and household diarrhoea prevalence. Household water, sanitation and hygiene (WASH) facilities were assessed based on WHO-UNICEF criteria. Of particular interest was the simultaneous use of toilet facilities and chambers, an alternative form of unimproved sanitation with focus towards all-in-one suitable alternatives. Findings revealed that having a regular income, private toilet facility, improved drinking water and handwashing facility were all positively correlated to having an improved toilet facility. Interestingly, both improved toilets and chambers indicated increased odds for diarrhoea prevalence. Odds of chamber usage were also higher for females and users of unimproved toilet facilities. Moreover, when toilets were owned by residents, and hygiene was managed externally, use of chambers was more likely. Findings finally revealed higher diarrhoea prevalence for toilets with more users. Results highlight the need for a holistic, simultaneous approach to WASH for overall success in sanitation. To better access and increase peri-urban sanitation, this study recommends a separate sanitation ladder for high density areas which considers improved private and shared facilities, toilet management and all-inclusive usage (cancelling unimproved alternatives). It further calls for financial plans supporting urban poor access to basic sanitation and increased education on toilet facility models, hygiene, management and risk to help with choice and proper facility use to maximize toilet use benefit.

Background: A missense variant (rs373863828:G > A; p.Arg457Gln) of the CREBRF gene is strongly associated with a higher body mass index (BMI; kg/m2) in Polynesian populations. This variant has also been reported to be associated with lower total cholesterol in Samoans. Aim: The aim of this study is to examine the association of rs373863828:G > A with levels of serum lipids in four Pacific populations. Methods: A total of 613 adult subjects were recruited from Tonga (Polynesians) and the Solomon Islands (Melanesians and Micronesians). Multiple regression analyses adjusted for age and sex were performed to examine the association of rs373863828 with levels of serum lipids in each population. Results: A significant association of rs373863828:G > A with lower level of HDL-cholesterol was detected in the Tonga population (β = –3.32 and p-value = 0.030). The expected change in HDL-cholesterol with respect to a single copy of the rs373863828-A allele was 3.32 mg/dL. However, the association between rs373863828-A and lower levels of HDL-cholesterol was not significant after further adjustment for BMI in the Tonga population (β = –2.32 and p-value = 0.13). Conclusions: The rs373863828-A allele may not directly affect the level of serum HDL-cholesterol independent of BMI. To confirm the present findings, association studies with large sample sizes and functional analyses are required.

Background: Conventional L5 corpectomy requires a large incision and an extended period of intraoperative fluoroscopy. We describe herein a new L5 corpectomy technique. Methods: A 79-year-old woman was referred to our hospital for leg pain and lower back pain due to an L5 vertebral fracture. Her daily life had been affected by severe lower back pain and sciatica for more than 2 months. We initially performed simple decompression surgery, but this proved effective for only 10 months. Results: For revision surgery, the patient underwent minimally invasive L5 corpectomy with a navigated expandable cage without fluoroscopy. The second surgery took 215 min, and estimated blood loss was 750 mL. The revision surgery proved successful, and the patient could then walk using a cane. In terms of clinical outcomes, the Oswestry Disability Index improved from 66% to 24%, and the visual analog scale score for lower back pain improved from 84 to 31 mm at the 1-year follow-up. Conclusions: Minimally invasive L5 corpectomy with a navigated expandable vertebral cage is effective for reducing cage misplacement and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

Study design: Prospective study. Objective: Medical image fusion can provide information from multiple modalities in a single image. The present study aimed to determine whether three-dimensional (3D) lumbosacral vascular anatomy could be adequately portrayed using a non-enhanced CT–MRI medical image fusion technique. Summary of Background Data: Lateral lumbar interbody fusion has gained popularity for the surgical treatment of adult spinal deformity (ASD). Oblique lumbar interbody fusion at L5–S1 (OLIF51) is receiving considerable attention as a method of creating good L5–S1 lordosis. Access in OLIF51 requires evaluation of the vascular anatomy in the lumbosacral region. Conventional imaging modalities need a contrast medium to describe the vascular anatomy. Methods: Participants comprised 15 patients with ASD or degenerative lumbar disease who underwent corrective surgery at our hospital between January 2020 and June 2021. A 3D vascular image with bony structures was obtained by fusing results from MRI and CT. We processed the merged image and measured the distance between left and right common iliac arteries and veins at two levels: the lower end of the L5 vertebral body (Window A) and the upper end of the S1 vertebral body (Window B). Results: The mean sizes of Window A and Window B were 29.7 ± 10.7 mm and 36.9 ± 10.3 mm, respectively. The mean distance from the bifurcation to the lower end of the L5 vertebra was 23.7 ± 10.9 mm. Coronal deviation of the bifurcation was, from center to left, 12.6 ± 12.3 mm, and the distance from the center of the L5 vertebral body to the bifurcation was 0.79 ± 7.3 mm. Only one case showed a median sacral vein (6.7%). Clinically, we performed OLIF51 in 12 of the 15 cases (80%). Conclusion: Evaluating 3D lumbosacral vascular anatomy using a non-enhanced MRI and CT medical image fusion technique is very useful for OLIF51, particularly for patients in whom the use of contrast medium is contraindicated.

Latar belakang. Hormon tiroid adalah hormon yang dihasilkan oleh kelenjar tiroid yang berfungsi untuk mensintesis hormon tiroksin (T4) dan 3,5,3 triodotironine (T3). Tiroid diatur oleh thyroid stimulating hormone (TSH), glikoprotein yang diproduksi dan disekresi kelenjar hipofisis anterior. Dilaporkan bahwa hormon TSH meningkat pada obesitas, sedangkan FT3 dan FT4 masih menjadi perdebatan. Tujuan. Mengetahui hubungan fungsi tiroid dengan energy expenditure pada remaja obesitas dan normal. Metode. Penelitian dilakukan pada anak SMP usia 12-13 tahun di Semarang pada tahun 2008 dengan metode potong lintang. Semua subyek diperiksa komposisi tubuh (indeks masa tubuh / IMT dan persentase lemak tubuh) dengan menggunakan Tanita BC 545, total energy expenditure (TEE) dengan akselerometer dan resting energy expenditure (REE) dihitung berdasarkan rumus WHO. Data dianalisis menggunakan tes t tidak berpasangan dan uji korelasi Spearman. Hasil. Subyek penelitian 75 remaja (37 obesitas dan 38 normal), dengan rerata umur 13,2 tahun. FT4 dan TSHs remaja laki-laki obesitas lebih tinggi dibanding subyek normal. Terdapat korelasi negatif (r=-0,29) antara FT3 dengan persentase lemak tubuh, korelasi positif antara TSHs dengan IMT (r=0,30) dan persentase lemak tubuh (r=0,34). Tidak didapatkan korelasi antara hormon tiroid dengan REE, tetapi FT3 berkorelasi negatif dengan TEE (r=–0,29), dan TSHs berkorelasi positif dengan TEE (r=0,25). Kesimpulan. Didapatkan korelasi positif antara TSHs dengan komposisi tubuh dan TSHs dengan TEE. Kadar TSHs pada laki-laki obesitas lebih tinggi dibanding normal walaupun hasilnya tidak signifikan secara statistik.

Background: Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. Case description: A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. Conclusions: C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy.

Objective/Background: Flow is the holistic experience that occurs when an individual acts with total involvement. The objective of this study was to examine the effects of attention training that induces flow experience for patients with attention-deficit disorder after traumatic brain injury (TBI). Methods: A two-patient case report with a within-subject AB design was conducted. Two patients with attention deficit after TBI were recruited for attention training. Two types of video game tasks for attention training were created, one inducing flow (flow task) and the other not (control task). Patient A performed the flow task for 14 days after receiving general occupational therapy (OT) for 11 days. Patient B performed the flow task for 15 days after performing the control task for 10 days. We examined training effects using neuropsychological tests. The Flow State Scale for Occupational Tasks was administered to identify the patient's flow state. To evaluate the training effect, we used visual analysis, the two-standard deviation band method, and effect-size analyses. Results: Both Patient A and Patient B showed improvement on the Continuous Performance Test, Symbol Digit Modalities Test, and Moss Attention Rating Scale after the flow task. Patient B also showed improvement on the Trail Making Test. Conclusion: The results for Patient A suggested that the flow task was more effective than general OT for improving attention deficits. Moreover, the results for Patient B suggested that the flow task was more effective than the control task. Attention training inducing flow experience may thus facilitate improvement of attention.

Background: Maternal and child undernutrition is an important issue, particularly in low- and middle-income countries. Children at high risk of malnutrition should be prioritized to receive necessary interventions to minimize such risk. Several risk factors have been proposed; however, until now, there has been no appropriate evaluation method to identify these children. In sub-Saharan Africa, children commonly receive regular check-ups from community health workers. A simple and easy nutrition assessment method is therefore needed for use by semi-professional health workers. Objectives: The aim of this study was to develop and test a practical screening tool for community use in predicting growth stunting in children under two years in rural Zambia. Methods: Field research was conducted from July to August 2014 in Southern Province, Zambia. Two hundred and sixty-four mother-child pairs participated in the study. Anthropometric measurements were performed on all children and mothers, and all mothers were interviewed. Risk factors for the screening test were estimated by using least absolute shrinkage and selection operator analysis. After re-evaluating all participants using the new screening tool, a receiver operating characteristic curve was drawn to set the cut-off value. Sensitivity and specificity were also calculated. Results: The screening tool included age, weight-for-age Z-score status, birth weight, feeding status, history of sibling death, multiple birth, and maternal education level. The total score ranged from 0 to 22, and the cut-off value was eight. Sensitivity and specificity were 0.963 and 0.697 respectively. Conclusions: A screening tool was developed to predict children at high risk of malnutrition living in Zambia. Further longitudinal studies are needed to confirm the test’s validity in detecting future stunting and to investigate the effectiveness of malnutrition treatment.

The people of the Solomon Islands represent an Austronesian (AN)-speaking population's adaptation to a humid tropical environment and subsistence of tuberous crops. Genome-wide association studies (GWASs) of other populations (e.g. the Human Genome Diversity Project [HGDP]) have suggested the existence of genotypes adaptive to ecoregion, diet, and subsistence, and that those genotypes are also associated with metabolic and cardiovascular diseases. Recently, the incidence of non-communicable diseases has been increasing in the Solomon Islands. In the present study, we explored the association of genotypes adaptive to a tropical environment and tuberous crop diet with metabolic and cardiovascular conditions in rural and urban AN-speaking Melanesian and Micronesian populations of the Solomon Islands. A total of 561 participants were genotyped for single nucleotide polymorphisms (SNPs) potentially associated with a tropical environment (rs174570 and rs2237892) and a tuberous crop diet (rs162036, rs185819, and rs2722425). The results showed that the allele frequencies of the Solomon Islands populations adopted patterns similar to those in populations from other hot, tropical areas with a tuberous crop diet in previous studies. Furthermore, rs162036, rs185819, rs2237892, and rs2722425 were all strongly associated with one or more metabolic and cardiovascular conditions. The derived allele of rs2722425 (i.e. rs2722425-G) was significantly associated with an elevated LDL level (P = 0.000264) even after the significance level was adjusted for multiple testing (i.e., α = 0.0005). Our results suggest that the inhabitants of the Solomon Islands exhibit the effects of the tropical environment and tuberous crop diet on their allele frequencies, and that their susceptibility to metabolic and cardiovascular diseases is therefore considered to be associated with their environment and diet.

Background: The differences in geographic, sosioeconomic and lifestyle between children in rural and urban areas infl uence their nutritional status. The urban children tended to be less active. The evidence suggested that physical activity improves cardiorespiratory fi tness and mental health in young people but study that compare those indicators among rural and urban children was scarce. Objective: To compare the nutritional status, physical fi tness, and quality of life between elementary school children in rural and urban areas. Method: A cross-sectional study was conducted at Semarang (urban) and Mlonggo (rural) Central Java in 2009. Inclusion criteria was school children aged 9-11 years and had no physical disability. Body composition was measured by Bioelectrical Impedance Analysis, physical activity by Global Physical Activity Questionnaire (GPAQ), physical fi tness by 20-m shuttle run test and quality of life by Pediatrics Quality of Life Questionnaire (PedQoL 4.0). The differences between nutritional status and physical activity were assessed by Chi Square test, while the differences between physical fi tness and quality of life were tested by independent t test (p

Poor hand hygiene practice has been linked to an increase in the number of infections among children in urban slums. Hands are considered an intersection for bacterial transmission, but it is unclear whether the handwashing technique affects bacteria elimination. This study inves- tigated the effect of handwashing on the concentration of Escherichia coli (E. coli) and factors related to its reduction among children in an urban slum in Bandung, Indonesia. We observed handwashing and conducted repeated hand swabs before and after handwashing among 137 participants. The mean E. coli concentration on the hands decreased after handwashing, with a higher reduction in E. coli count among students who used soap and had soap contact for more than 10 s during handwashing. Cleaning in-between fingers, using soap, soap con- tact for more than 10 s, and drying hands with a single-use towel were effective factors for reducing E. coli concentration after handwashing (p, 0.05). More than half of the swab samples (59%) tested positive for E. coli after handwashing, indicating that the children’s handwashing technique was not effective in completely removing E. coli from the hands. Moreover, sustained and consistent handwashing practice as a daily behavior in children would maximize the effect. [ABSTRACT FROM AUTHOR]