Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study

PURPOSE

Surgeons can treat debilitating conditions of uncontrollable complex anorectal fistulas with sepsis, even after repeated fistula surgeries, for curative intention. Adipose-derived stem cells have shown good outcomes for refractory Crohn fistula. Unfortunately, cell therapy has some limitations, including high costs. We have therefore attempted immediate cell-assisted lipotransfer (CAL) in treating refractory complex anal fistulas and observed its outcomes.

METHODS

In a retrospective study, CAL, using a mixture of freshly extracted autologous stromal vascular fraction (SVF) and fat tissues, was used to treat 22 patients of refractory complex anal fistula from March 2018 to May 2021. Preoperative and postoperative assessments were performed with direct visual inspection, digital palpation, and endoanal ultrasonography. A fistula was considered completely healed if (1) the patient had no symptoms of discharge or inflammation; (2) there were no visible secondary openings of fistula tract inside and outside of the anorectal unit and even in the perineum; and (3) there was no primary opening in the anus. The endpoint of complete remission was wound healing without signs of inflammation 3 months after CAL treatment.

RESULTS

In a total of 22 patients who received CAL treatment, 19 patients showed complete remission, 1 patient showed partial improvement, and 2 patients showed no improvement. One of the 2 patients without improvement at primary endpoint showed complete remission 9 months after CAL. There were no significant adverse effects of the procedure.

CONCLUSION

We found that the immediately-collected CAL procedure for refractory complex anal fistula showed good outcomes without adverse side effects. It can be strongly recommended as an alternative surgical option for the treatment of complex anal fistula that is uncontrollable even after repeated surgical procedures. However, considering the unpredictable characteristics of SVF, long-term follow-up is necessary.

Clinical predictors of polyps recurring in patients with chronic rhinosinusitis and nasal polyps: a systematic review and meta-analysis

BACKGROUND

Identification of perioperative risk factors for recurrent nasal polyps (RNPs) is important for selection of further treatment and determination of appropriate follow-up period. However, the relative prognostic significance of these risk factors has not been investigated.

METHODOLOGY

We compared the nasal symptoms, endoscopic polyp and Lund-Mackey computed tomography scores, and the laboratory and pathological findings of RNP and non-RNP patients. The risk of bias was assessed using the Newcastle-Ottawa scale.

RESULTS

Patients with poor nasal symptom scores and olfactory dysfunctions and high Lund-Mackey computed tomography scores were at higher risk of postoperative RNPs, as were those with allergic conditions and elevated tissue and serum eosinophil levels. The tissue neutrophil counts/percentages were significantly lower in the RNP than the other group. The tissue eosinophil level was of higher diagnostic utility than the serum eosinophil level. The RNP diagnostic odds ratio afforded by the tissue eosinophil count or percentage was 54.1247. The area under the receiver operating characteristic curve was 0.936. The sensitivity and specificity were 0.8809 and 0.8834, respectively.

CONCLUSION

The tissue eosinophil level reliably predicts RNP after endoscopic sinus surgery.

Reliability of synthetic diffusion-weighted imaging with a high b-value for paediatric abdominal MRI

AIM

To evaluate the reliability of synthetic diffusion-weighted imaging (DWI) using a high b-value in comparison to conventional DWI for paediatric abdominal MRI.

MATERIALS AND METHODS

Paediatric patients (<19 years old) who underwent liver or pancreatobiliary MRI with DWI using 10 b-values (b = 0, 25, 50, 75, 100, 200, 400, 600, 800, 1,500 s/mm2) from March to October 2021 were included in this retrospective study. Using the software, synthetic DWI using b = 1,500 s/mm2 was generated automatically by selecting the b-value required as output. Conventional and synthetic DWI values for b = 1,500 s/mm2 were measured at the liver, spleen, paraspinal muscle, and mass lesions, if present, and apparent diffusion coefficient (ADC) values were calculated using the mono-exponential model. Intraclass correlation coefficients (ICCs) were calculated to assess the reliability of conventional and synthetic DWI and ADC values with b = 1,500 s/mm2.

RESULTS

Thirty paediatric patients (M:F = 22:8, mean 10.8 ± 3.1 years old) were included and four had tumours on abdominal MRI. ICC values were 0.906-0.995 between conventional and synthetic DWI and ADC with b = 1,500 s/mm2 in the liver, spleen and muscle. For mass lesions, ICC values were 0.997-0.999 for both synthetic DWI and ADC images.

CONCLUSIONS

Synthetic DWI and ADC values obtained using a high b-value showed excellent agreement with conventional DWI for the liver, spleen, muscle, and mass in paediatric MRI.

Hydration-induced rapid growth and regression after indirect revascularization of an anterior choroidal artery aneurysm associated with Moyamoya disease: A case report

The prevalence of aneurysm formation in adults with Moyamoya disease (MMD) is higher than that in the general population. The treatment strategy is often individualized based on the patient's disease characteristics. A 22-year-old man was diagnosed with MMD after presenting a small thalamic intracerebral and subarachnoid hemorrhage in the quadrigeminal cistern. Cerebral angiography revealed a small aneurysm (2.42 mm) in the left anterior choroidal artery. Since the hemodynamics in the left hemisphere was compromised, an indirect bypass surgery was performed. The patient's condition deteriorated postoperatively because of poor perfusion of the internal carotid artery, and massive hydration was required. During neurocritical care, the aneurysm increased in size (5.33 mm). An observation strategy was adopted because of the distal aneurysmal location and the high risk involved. Subsequently, the patient recovered, and newly developed collateral flow appeared from the external carotid artery. Additionally, a dramatic size reduction of the aneurysm (1.51 mm) was noticed. Our case suggests that MMD-related dissecting aneurysms on a distal cerebral artery, which present a high risk of embolization, could be managed by indirectly reducing the hemodynamic burden. Massive hydration in such cases should be avoided or balanced to avoid the risk of rapid growth and aneurysm rupture.

Value of Additional Instrumented Fusion in the Treatment of Thoracic Ossification of the Ligamentum Flavum

Objective

The ossification of the ligamentum flavum (OLF) is one of the major causes of thoracic myelopathy. Surgical decompression with or without instrumented fusion is the mainstay of treatment. However, few studies have reported on the added effect of instrumented fusion. The objective of this study was to compare clinical and radiological outcomes between surgical decompression without instrumented fusion (D-group) and that with instrumented fusion (F-group).

Methods

A retrospective review was performed on 28 patients (D-group, n=17; F-group, n=11) with thoracic myelopathy due to OLF. The clinical parameters compared included scores of the Japanese Orthopedic Association (JOA), the Visual analogue scale of the back and leg (VAS-B and VAS-L), and the Korean version of the Oswestry disability index (K-ODI). Radiological parameters included the sagittal vertical axis (SVA), the pelvic tilt (PT), the sacral slope (SS), the thoracic kyphosis angle (TKA), the segmental kyphosis angle (SKA) at the operated level, and the lumbar lordosis angle (LLA; a negative value implying lordosis). These parameters were measured preoperatively, 1 year postoperatively, and 2 years postoperatively, and were compared with a linear mixed model.

Results

After surgery, all clinical parameters were significantly improved in both groups, while VAS-L was more improved in the F-group than in the D-group (-3.4±2.5 vs. -1.3±2.2, p=0.008). Radiological outcomes were significantly different in terms of changes in TKA, SKA, and LLA. Changes in TKA, SKA, and LLA were 2.3°±4.7°, -0.1°±1.4°, and -1.3°±5.6° in the F-group, which were significantly lower than 6.8°±6.1°, 3.0°±2.8°, and 2.2°±5.3° in the D-group, respectively (p=0.013, p<0.0001, and p=0.037). Symptomatic recurrence of OLF occurred in one patient of the D-group at postoperative 24 months.

Conclusion

Clinical improvement was achieved after decompression surgery for OLF regardless of whether instrumented fusion was added. However, adding instrumented fusion resulted in better outcomes in terms of lessening the progression of local and regional kyphosis and improving leg pain. Decompression with instrumented fusion may be a better surgical option for thoracic OLF.

Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends

Recent trends in benign anal disease treatment are minimizing surgery to preserve normal anorectal anatomical unit and its functions. However, some surgeons still prefer and are confident with the use of conventional solid surgical methods. In this report, we will investigate the recent trends in the treatment for hemorrhoids, fistula, and anal fissure. The practice guidelines of advanced countries, including UK, Italy, France, USA, Japan, and ESCP, are referred to in this review. Opinions suggested in international meetings were also added. In the management of hemorrhoids, surgical treatments and office procedures were recommended according to a patient's status and preference. For the management of complex anal fistula, novel sphincter-preserving surgical techniques are more widely accepted than a sphincter-dividing procedure of immediate repair following fistulectomy. The treatment of anal fissures is well covered in the guidelines of the ASCRS.

Leptomeningeal Spread at the Diagnosis of Glioblastoma Multiforme: A Case Report and Literature Review

Approximately two-thirds of glioblastoma (GBM) patients progress to leptomeningeal spread (LMS) within two years. While 90% of LMS cases are diagnosed during the progression and/or recurrence of GBM (defined as secondary LMS), LMS presentation at the time of GBM diagnosis (defined as primary LMS) is very rare. ¹⁸F-fluorodeoxy glucose positron emission tomography computed tomography (¹⁸F-FDG PET/CT) study helps to diagnose the multifocal spread of the malignant primary brain tumor. Our patient was a 31-year-old man with a tumorous lesion located in the right temporal lobe, a wide area of the leptomeninges, and spinal cord (thoracic 5/6, and lumbar 1 level) involvement as a concurrent manifestation. After the removal of the right temporal tumor, the clinical status progressed rapidly, showing signs of increased intracranial pressure and hydrocephalus caused by LMS. He underwent a ventriculoperitoneal shunt a week after craniotomy. During management, progression of cord compression, paraplegia, bone marrow suppression related to radiochemotherapy, intercurrent infections, and persistent ascites due to peritoneal metastasis of the LMS through the shunt system was observed. The patient finally succumbed to the disease nine months after the diagnosis of simultaneous GBM and LMS. The overall survival of primary LMS with GBM in our case was nine months, which is shorter than that of secondary LMS with GBM. The survival period after the diagnosis of LMS did not seem to be significantly different between primary and secondary LMS. To determine the prognostic effect and difference between primary and secondary LMS, further cooperative studies with large-volume data analysis are warranted.

Standardization of 129I using the movable 4πβ(LS)-X(NaI(Tl)) system

The ¹²⁹I standardization, using the movable 4πβ(LS)-X(NaI(Tl)) coincidence system, was performed for two ¹²⁹I radioactive sources - one was dissolved in 0.1M NaOH solution and the other in 0.1M HNO₃ solution. The system incorporates three movable PM tubes for a β-counter placed on a plane and a X-ray detector that can be moved up to the bottom of the vial. The β-efficiency depending on the amount of radioactive solution was investigated with 14 liquid scintillation samples prepared by gravimetrically dispensing 4.4-145 mg of ¹²⁹I radioactive solution. The β-efficiencies above 90% were observed at less than 56 mg, but it was at most 70% at 145 mg. This occurred regardless of the activity of the sample or the type of chemical solution used to dissolve ¹²⁹I source. The activity concentration of each ¹²⁹I source was determined by efficiency-extrapolation method for samples with an activity range of 0.28-4.5 kBq. The β-efficiency points were derived over 10 intervals by moving 3-PM tubes in fine steps of about 1 mm from the sample. The highest value for β-efficiency was 95%. The combined uncertainty were 0.25% and 0.26%, respectively. The stated precision obtained using the system is better than that previously reported in the literature obtained by the triple to double coincidence ratio (TDCR) or the CIEMAT/NIST efficiency tracing method.

Recurrent Cervical Spontaneous Spinal Epidural Hematoma with Conservative Management: A Case Report

Cervical spontaneous spinal epidural hematoma (CSSEH) is a rare condition that can be potentially fatal if not properly diagnosed and managed. While prompt surgical decompression and evacuation of the hematoma are generally considered as the first line of treatment, mild cases that were managed through observation and conservative treatment have been reported. Our patient was a 24-year-old man who experienced two CSSEH events 8 months apart, both of which were managed conservatively. This was a rare case of recurrent CSSEH in which recovery was achieved without surgical intervention. We believe conservative treatment with close observation may be effective in CSSEH patients presenting with mild neurologic symptoms who have a tendency towards spontaneous neurologic improvement.

Development of a movable 4πβ(LS)-γ coincidence counting system for activity standardization of β-γ emitters

A new movable 3PM-γ coincidence system, based on 4πβ(LS)-γ coincidence counting, for activity measurement of β-γ emitters has been designed at the Korea Research Institute of Standards and Science (KRISS). The system incorporates 3 PM tubes on the plane and two detectors placed above and below the center of the plane. The 3 PM tubes for β-counters in the plane are movable up to 100 mm from a liquid scintillation vial, thus enabling the variation of β-detection efficiencies by a geometrical technique. A NaI(Tl) γ-counter was set above for the present work. The β-event is determined by counting the logical sum of three double coincidences. All the necessary electronics, i.e., logical sum, adjusting the duration of dead-time of each counting channel and coincidence resolving times, and analyzing coincidence relation, were specially designed to be fabricated in an integrated circuit. Details of the detectors, the electronics, the overall movable 3PM-γ coincidence system are presented, as well as the results of investigations to assess its operating characteristics. Validation measurements have been performed with ⁶⁰Co and ⁵⁷Co sources. The highest β-detection efficiency achieved with ⁶⁰Co and ⁵⁷Co was 97% and 95%, respectively. The activity concentration determined with a new system agreed with calibrated values within the uncertainty range. Further results from validation measurements and the corresponding uncertainty budgets are presented.

The Korean Version of the Fugl-Meyer Assessment: Reliability and Validity Evaluation

Objective

To systematically translate the Fugl-Meyer Assessment (FMA) into a Korean version of the FMA (K-FMA).

Methods

We translated the original FMA into the Korean version with three translators and a translation committee, which included physiatrists, physical therapists, and occupational therapists. Based on a test-retest method, each of 31 patients with stroke was assessed by two evaluators twice, once on recruitment, and again after a week. Analysis of intra- and inter-rater reliabilities was performed using the intra-class correlation coefficient, whereas validity was analysed using Pearson correlation test along with the Motricity Index (MI), Motor Assessment Scale (MAS), and Berg Balance Scale (BBS).

Results

The intra- and inter-rater reliabilities were significant for the total score, and good to excellent reliability was noted in all domains except for the joint range of motion of the lower extremity domain of the K-FMA. The MI and MAS scores were significantly correlated with all domains, all with p<0.01. The results for the MI ranged from r=0.639 to r=0.891 and those for the MAS from r=0.339 to r=0.555. However, the BBS was not significantly correlated with any domain, as the K-FMA lacks balance evaluation items.

Conclusion

The K-FMA was found to have high reliability and validity. Additionally, the newly developed manual for the K-FMA may help minimise errors that can occur during evaluation and improve the reliability of motor function evaluation.

Posterior Approach in C2-3 Disc Herniation: C1 Laminectomy, C2-3 Laminoplasty and Posterior Fixation in C2-3 Disc Herniation

C2–3 disc herniation is rare and a definitive treatment of choice has not been established. The purpose of this case report is to suggest posterior approach as one of the best options. A 49-year-old man visited our clinic with a 7-year history of neck pain and occipital headache and a 2-month history of right arm pain. C2–3 intervertebral disc herniation of the central type was diagnosed on magnetic resonance imaging (MRI), and surgery was performed, including C1 laminectomy, C2–3 laminoplasty, and C2–3 posterior fixation. The posterior approach was used because the patient's neck was difficult to operate anteriorly. After 3 months postoperatively, MRI showed widened cerebrospinal fluid space at the C2–3 level. The visual analogue scale score for pain improved in the occipital area and right arm. However, the untouched protruded central disc, subjective weakness in right hand grasping, and numbness persisted. In conclusion, this case highlights posterior decompression and fixation as a good treatment of choice for decompression at the C2–3 level disc herniation, from where it is difficult to remove compressive lesions directly via the anterior corridor.

Observation of Coulomb-Assisted Nuclear Bound State of Ξ^{-}-^{14}N System

In an emulsion-counter hybrid experiment performed at J-PARC, a Ξ^{-} absorption event was observed which decayed into twin single-Λ hypernuclei. Kinematic calculations enabled a unique identification of the reaction process as Ξ^{-}+^{14}N→_{Λ}^{10}Be+_{Λ}^{5}He. For the binding energy of the Ξ^{-} hyperon in the Ξ^{-}-^{14}N system a value of 1.27±0.21  MeV was deduced. The energy level of Ξ^{-} is likely a nuclear 1p state which indicates a weak ΞN-ΛΛ coupling.

Incidentally Found Intramuscular Hemangioma, Mimicking Traumatic Hematoma after Military Training: A Case Report

This case report showed a young soldier complained of low back pain during military training. Intramuscular hematoma accompanied by the lumbar compression fracture was observed in computed tomography. However, the possibility of intramuscular tumors could not be ruled out through additional examinations, and thus surgically removed, and was diagnosed as cavernous hemangioma. This report is a rare and instructive case in which a hemangioma mimicked bleeding with the lumbar fracture.

Proteome Analysis of Human Natural Killer Cell Derived Extracellular Vesicles for Identification of Anticancer Effectors

Cancer immunotherapy is a clinically validated therapeutic modality for cancer and has been rapidly advancing in recent years. Adoptive transfer of immune cells such as T cells and natural killer (NK) cells has emerged as a viable method of controlling the immune system against cancer. Recent evidence indicates that even immune-cell-released vesicles such as NK-cell-derived exosomes also exert anticancer effect. Nevertheless, the underlying mechanisms remain elusive. In the present study, the anticancer potential of isolated extracellular vesicles (EVs) from expanded and activated NK-cell-enriched lymphocytes (NKLs) prepared by house-developed protocol was evaluated both in vitro and in vivo. Moreover, isolated EVs were characterized by using two-dimensional electrophoresis (2-DE)-based proteome and network analysis, and functional study using identified factors was performed. Our data indicated that the EVs from expanded and active NKLs had anticancer properties, and a number of molecules, such as Fas ligand, TRAIL, NKG2D, β-actin, and fibrinogen, were identified as effector candidates based on the proteome analysis and functional study. The results of the present study suggest the possibility of NK-cell-derived EVs as a viable immunotherapeutic strategy for cancer.

The Long-term Reoperation Rate Following Surgery for Lumbar Stenosis: A Nationwide Sample Cohort Study With a 10-year Follow-up

STUDY DESIGN

Retrospective cohort study of a nationwide sample database.

OBJECTIVE

The objective of the present study was to compare the long-term incidence of reoperation for lumbar spinal stenosis (LSS) after anterior fusion, posterior fusion, and decompression.

SUMMARY OF BACKGROUND DATA

Surgical treatment for LSS can be largely divided into 2 categories: decompression only and decompression with fusion. A previous nationwide study reported that fusion surgery was performed in 10% of patients with LSS, and the 10-year reoperation rate was approximately 17%. However, with the development of surgical techniques and changes in surgical trends, these results should be reassessed.

METHODS

The National Health Insurance Service-National Sample Cohort of the Republic of Korea was utilized to establish a cohort of adult patients (N = 1400) who first underwent surgery for LSS during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using a Fine and Gray regression model after adjustment for sex, age, diabetes, osteoporosis, Charlson comorbidity index, severity of disability, type of medical coverage, and type of hospital.

RESULTS

The overall cumulative incidence of reoperation was 6.2% at 2 years, 10.8% at 5 years, and 18.4% at 10 years. The cumulative incidence of reoperation was 20.6%, 12.6%, and 18.6% after anterior fusion, posterior fusion, and decompression, respectively, at 10 years postoperatively (P = 0.44). The first surgical technique did not affect the reoperation type (P = 0.27). Decompression was selected as the surgical technique for reoperation in 83.5% of patients after decompression, in 72.7% of patients after anterior fusion, and in 64.3% of patients after posterior fusion.

CONCLUSION

The initial surgical technique did not affect reoperation during the 10-year follow-up period. Decompression was the most commonly used technique for reoperation.

LEVEL OF EVIDENCE

4.

Features of "false positive" unruptured intracranial aneurysms on screening magnetic resonance angiography

BACKGROUND

Physicians can find it challenging to decide whether confirmative digital subtraction angiography (DSA) should be performed in patients who present with "suspicious small aneurysm-like structures" on magnetic resonance angiography (MRA). Factors associated with "false positive aneurysms on MRA" (FPAMs)," which are finally confirmed as negative on DSA, have rarely been reported. This study aimed to identify the clinical or radiologic clues indicative of FPAM on DSA.

METHODS

Patients who had undergone DSA between 2016 and 2019 for suspicious aneurysm-like structures < 5 mm in size on MRA were enrolled. Patient demographics and the details regarding the geometry of the structures were retrospectively reviewed. Univariate and multivariate logistic regression analyses were conducted to identify the associated factors. Receiver operating characteristic curve analysis was performed to assess the clinical implications.

RESULTS

Of the 107 suspicious structures, 46 were indicated as being false positive on DSA (42.96%). Location (positive on C7 and negative on C5-6 ICA) and lower dome to neck ratio were found to be significant parameters in the multivariate analysis. The dome to neck ratio threshold value was 0.99.

CONCLUSION

Suspicious aneurysm-like structures located not on C5-6 but on C7 ICA and having wide neck morphologies (dome to neck ratio < 0.99) are highly likely to be negative on DSA.

The primary system for measurement of beta emitting radioactive gases at KRISS

Korea Research Institute of Standards and Science (KRISS) is developing a length-compensated proportional counting (LCPC) system as a primary system for standardization of beta emitting radioactive gases. The pilot experiment was performed with ⁸⁵Kr and the optimized high voltage and pressure were found to be 1700 V and 0.203 MPa, respectively. The total activity of ⁸⁵Kr was deduced by the length compensation of each count. The expanded uncertainty was estimated to be around 0.8% (k = 2) for the ⁸⁵Kr measurement.

Design of optimal digital filter and digital signal processing for a CdZnTe high resolution gamma-ray system

We have developed an online digital signal processing system based on an FPGA. The system consists of pile-up rejection, baseline restorer, peak detection and pole-zero cancellation for evaluation of deposited energy in the detector. The shaping algorithm employed is a Moving Window Deconvolution (MWD) to shape digitized data into a trapezoidal form. For the purpose of verification, the developed digital system was tested for ¹³⁷Cs gamma rays. The entire system is programmed using the LabVIEW environment.

How Different is the Core of ^{25}F from ^{24}O_{g.s.} ?

The structure of a neutron-rich ^{25}F nucleus is investigated by a quasifree (p,2p) knockout reaction at 270A  MeV in inverse kinematics. The sum of spectroscopic factors of π0d_{5/2} orbital is found to be 1.0±0.3. However, the spectroscopic factor with residual ^{24}O nucleus being in the ground state is found to be only 0.36±0.13, while those in the excited state is 0.65±0.25. The result shows that the ^{24}O core of ^{25}F nucleus significantly differs from a free ^{24}O nucleus, and the core consists of ∼35% ^{24}O_{g.s.}. and ∼65% excited ^{24}O. The result may infer that the addition of the 0d_{5/2} proton considerably changes neutron structure in ^{25}F from that in ^{24}O, which could be a possible mechanism responsible for the oxygen dripline anomaly.

Progression of Ossification of the Posterior Longitudinal Ligament after Cervical Total Disc Replacement

Objective

Total disc replacement (TDR) is frequently performed anterior approaching method for the patients diagnosed with cervical disc herniation. This study aimed to assess the degree of ossification of the posterior longitudinal ligament (OPLL) progression after cervical TDR.

Methods

Twenty-two male soldiers who underwent cervical TDR surgery from 2009 to 2016 and were followed-up for more than 12 months were enrolled. The enrolled patients were classified as; 1) patients with pre-existing OPLL and without; and 2) patient showing progression of OPLL or not.

Results

Twenty-two men were included in the analysis. The mean follow-up period from the surgery was 41.4 months (range, 12–114 months). The mean age of all patients was 40.7 years (range, 31–52 years). TDR-only was used in 7 cases, and the hybrid surgery (TDR+ACDF) was used in 15 cases. The incidence of progression or newly development of OPLL was significantly higher in pre-existing OPLL group (p=0.01). In 11 cases showing the progression of the OPLL, the mean size of OPLL progression was 4.16 mm (range, 0.34–18.87 mm) in the longitudinal height and 1.57 mm (range, 0.54–3.91 mm) in thickness.

Conclusion

The progression of OPLL after cervical TDR was more frequent in patients with pre-existing OPLL than in patients without OPLL. Even though TDR is a major alternative to the treatment of cervical lesions to preserve vertebral segmental motion, careful attention should be paid to whether TDR should be used in patients with OPLL and this should be fully explained to the patient.

Risk Factors for Symptomatic Contralateral Foraminal Stenosis After Unilateral Transforaminal Lumbar Interbody Fusion

OBJECTIVE

The most common cause of contralateral symptoms after unilateral transforaminal lumbar interbody fusion (TLIF) is contralateral foraminal stenosis (FS). This retrospective cohort study aimed to investigate the cause of and risk factors for contralateral FS after unilateral TLIF with a single cage.

METHODS

Patients with degenerative lumbar spinal disorders who underwent unilateral TLIF at L4-5 were divided into 2 groups: those without contralateral radicular symptoms after surgery (group A; n = 340) and those with contralateral radicular symptoms after surgery (group B; n = 16). We investigated the influence of various radiological and cage-related factors on postoperative contralateral FS with radicular symptoms. The cage location indicates whether the cage's anterior tip crosses the disc midline-exceeding 50%-and in such a case, how far.

RESULTS

Group B showed significantly increased postoperative coronal angle and sagittal angle and decreased contralateral foraminal height and foraminal area. Statistically significant (P < 0.01) factors according to the multivariate logistic regression analysis were the preoperative sagittal range of motion (odds ratio [OR]: 1.562, P = 0.004) and cage location (OR: 2.047, P = 0.015). The cutoff values for the sagittal range of motion and the cage location were 9.0° and 50.5%, respectively. The preoperative and postoperative 6-month visual analog scale scores and Oswestry disability index values were not significantly different between the groups.

CONCLUSIONS

The 2 most meaningful risk factors were the preoperative sagittal range of motion and cage location. Inserting the cage beyond the disc midline, especially in patients with a high preoperative sagittal range of motion (≥9.0°), would help reduce postoperative complications.

The Efficacy of Ultrasonic Bone Scalpel for Unilateral Cervical Open-Door Laminoplasty: A Randomized Controlled Trial

BACKGROUND

In cervical open-door laminoplasty for cervical myelopathy, a high-speed rotatory drill and rongeurs are used to make unicortical troughs and bicortical openings in the laminae. The lamina is reflected at the trough to enlarge the spinal canal, followed by bone healing on the hinge side to stabilize laminoplasty. The ultrasonic bone scalpel (UBS) has been used due to theoretical advantages including a better hinge union rate, less soft tissue trauma, less neurological injury, and shorter operative time.

OBJECTIVE

To assess the superiority of UBS for hinge union compared to the drill through randomized controlled trial.

METHODS

In 190 randomly allocated cervical myelopathy patients, the trough and opening at the lamina were made using either the drill (n = 95) or UBS (n = 95) during 2015 to 2018. The primary outcome was the hinge union rate on 6-mo postoperative computed tomography. Secondary outcomes included the hinge union rate at 12 mo, the operative time, intraoperative/postoperative bleeding, neurological injury, complications, and clinical outcomes over a 24-mo follow-up.

RESULTS

Hinge union in all laminae was achieved in 60.0% (drill) and 43.9% (UBS) of patients at 6 mo (intention-to-treat analysis; P = .02; odds ratio, 2.1) and in 91.9% (drill) and 86.5% (UBS) at 12 mo. Dural injury only occurred in the drill group (2.1%), and the UBS group showed significantly less intraoperative bleeding (P < .01). The other secondary outcomes did not differ between groups.

CONCLUSION

The hinge union rate was inferior in the UBS group at 6 mo postoperatively, but UBS was efficacious in reducing dural injuries and bleeding.

Positional effect of preoperative neuronavigational magnetic resonance image on accuracy of posterior fossa lesion localization

OBJECTIVE

The aim of this study was to analyze the positional effect of MRI on the accuracy of neuronavigational localization for posterior fossa (PF) lesions when the operation is performed with the patient in the prone position.

METHODS

Ten patients with PF tumors requiring surgery in the prone position were prospectively enrolled in the study. All patients underwent preoperative navigational MRI in both the supine and prone positions in a single session. Using simultaneous intraoperative registration of the supine and prone navigational MR images, the authors investigated the images' accuracy, spatial deformity, and source of errors for PF lesions. Accuracy was determined in terms of differences in the ability of the supine and prone MR images to localize 64 test points in the PF by using a neuronavigation system. Spatial deformities were analyzed and visualized by in-house-developed software with a 3D reconstruction function and spatial calculation of the MRI data. To identify the source of differences, the authors investigated the accuracy of fiducial point localization in the supine and prone MR images after taking the surface anatomy and age factors into consideration.

RESULTS

Neuronavigational localization performed using prone MRI was more accurate for PF lesions than routine supine MRI prior to prone position surgery. Prone MRI more accurately localized 93.8% of the tested PF areas than supine MRI. The spatial deformities in the neuronavigation system calculated using the supine MRI tended to move in the posterior-superior direction from the actual anatomical landmarks. The average distance of the spatial differences between the prone and supine MR images was 6.3 mm. The spatial difference had a tendency to increase close to the midline. An older age (> 60 years) and fiducial markers adjacent to the cervical muscles were considered to contribute significantly to the source of differences in the positional effect of neuronavigation (p < 0.001 and p = 0.01, respectively).

CONCLUSIONS

This study demonstrated the superior accuracy of neuronavigational localization with prone-position MRI during prone-position surgery for PF lesions. The authors recommend that the scan position of the neuronavigational MRI be matched with the surgical position for more precise localization.

Effectiveness of Autologous Fat Graft in Treating Fecal Incontinence

Purpose

The most common risk factor for fecal incontinence (FI) is obstetric injury. FI affects 1.4%–18% of adults. Most patients are unaware when they are young, when symptoms appear suddenly and worsen with aging. Autologous fat graft is widely used in cosmetic surgical field and may substitute for injectable bulky agents in treating FI. Authors have done fat graft for past several years. This article reports the effectiveness of the fat graft in treating FI and discusses satisfaction with the procedure.

Methods

Fat was harvested from both lateral thighs using 10-mL Luer-loc syringe. Pure fat was extracted from harvests and mixed with fat, oil, and tumescent through refinement. Fats were injected into upper border of posterior ano-rectal ring, submucosa of anal canal and intersphincteric space. Thirty-five patients with FI were treated with this method from July 2016 to February 2017 in Busan Hangun Hospital. They were 13 male (mean age, 60.8 years) and 22 female patients (mean age, 63.3 years). The Wexner score was checked before procedure. We evaluated outcome in outpatients by asking the patients. For 19 patients we checked the Wexner score after procedure.

Results

Symptom improved in 29 (82.9%), and not improved in 6 (17.1%). In 2 of 6 patients, they felt better than before procedure, although not satisfied. No improvement in 4. Mean Wexner score was 9.7 before procedure. There were no serious complications such as inflammation or fat embolism.

Conclusion

Autologous fat graft can be an effective alternative treatment for FI. It is safe and easy to perform, and cost effective.

Lifetime measurement of the first excited 5/2+ state in 133Cs using NaI(Tl) and LaBr3(Ce) detectors

We report a new high-precision lifetime measurement of the first excited 5/2⁺ state of ¹³³Cs using NaI(Tl) and LaBr₃(Ce) detectors. The time difference between the coincident decays of two successive states was measured using fast-timing electronics. The 356-keV (1/2⁺→5/2⁺) gamma transition was tagged by the successive 81-keV (5/2⁺→7/2⁺) transition of ¹³³Cs. The half-life of the first excited 5/2⁺¹³³Cs state was measured as T_1/2=6.283±0.004 (stat.) ±0.011(syst.) ns.

Characteristics of Vanadium Oxide Thin Films Fabricated by Unbalanced Magnetron Sputtering for Smart Window Application

Vanadium oxide (VOx) thin films were deposited by an unbalanced magnetron (UBM) sputtering system with a vanadium metal target and O₂ reaction gas, and thermally treated at various annealing temperatures. In this work, the structural, electrical, and optical properties of the fabricated VOx films with various annealing temperatures were experimentally investigated. The UBM sputter grown VOx thin films exhibited amorphous structure, and had a very weak peak of V₂O₅ (002) owing to very thin films. However, the crystallite size of VOx films increased with increasing annealing temperature. The surface roughness of VOx films and average transmittance decreased with increasing annealing temperature. The resistivity of VOx films also decreased with increasing annealing temperature, while the electrical properties of films improved.

Characteristics of Sputtered Cr Thin Films and Application as a Working Electrode in Transparent Conductive Oxide-Less Dye-Sensitized Solar Cells

Cr metal electrode was suggested as the working electrode material to fabricate DSSCs without the TCO, and thin films were fabricated by an unbalanced magnetron sputtering system. The surface morphologies show uniform and smooth surfaces regardless of various film thicknesses, and the small crystallites of various sizes were showed with the vertical direction on the surface of Cr thin films with the increase of film thickness. And also, the root mean square (RMS) surface roughness value of Cr thin films increased, and the sheet resistance is decreased with the increase of film thickness. The maximum cell efficiency of the TCO-less DSSC was observed when a Cr working electrode with a thickness of 80 nm was applied to the TCO-less DSSC. Consequently, these results are related to the result of the optimization of conduction characteristics, transmission properties and surface properties of Cr thin films.

Increased Volume of Surgery for Lumbar Spinal Stenosis and Changes in Surgical Methods and Outcomes: A Nationwide Cohort Study with a 5-Year Follow-Up

OBJECTIVE

Examining spine surgery patterns over time is crucial to provide insights into variations and changes in clinical decision making. Changes in the number of surgeries, surgical methods, reoperation rates, and cost-effectiveness were analyzed for all patients who underwent surgery for lumbar spinal stenosis without spondylolisthesis in 2003 (2003 cohort) and 2008 (2008 cohort).

METHODS

The national health insurance database was used to create the 2003 cohort (n = 10,990) and 2008 cohort (n = 27,942). The surgical methods were classified into decompression and fusion surgery. The cumulative reoperation probability between those surgeries was calculated using the Kaplan-Meier method in the 2003 cohort and 2008 cohort. Comparison of the incremental cost-effectiveness ratios showed the additional direct cost of a 1% change in the reoperation probability.

RESULTS

The surgical volume increased 2.54-fold in the 2008 cohort. The age-adjusted number of surgeries per 1 million people increased 2.6-fold (from 154 in the 2003 cohort to 399 in the 2008 cohort) in aged patients and 1.9-fold (from 154 in the 2003 cohort to 291 in the 2008 cohort) in patients 20-59 years old in the 2008 cohort. The proportion of fusion surgeries increased from 20.3% in the 2003 cohort to 37.0% in the 2008 cohort. In total, the 5-year reoperation probabilities increased from 8.1% in the 2003 cohort to 11.2% in the 2008 cohort. Fusion decreased the reoperation probability by 1% at the cost of 1,711 U.S. dollars.

CONCLUSIONS

The increased numbers of spinal surgeries, fusion surgeries, and surgeries in older patients in a recent cohort were noteworthy. However, the increased surgical volume and fusion surgeries did not reduce the reoperation rate.

Postoperative Longitudinal Outcomes in Patients with Residual Disc Fragments after Percutaneous Endoscopic Lumbar Discectomy

BACKGROUND

Residual disc fragments are observed on immediate postoperative magnetic resonance imaging (MRI) in 2.8-15% of patients after percutaneous endoscopic lumbar discectomy (PELD). Considering the known postoperative longitudinal outcomes in patients with residual disc tissue, a 'watchful waiting' strategy may be preferable to immediate re-operation in patients with asymptomatic residual disc material.

OBJECTIVES

The aim of the present study was to compare the longitudinal clinical outcomes between PELD patients in whom the complete removal of disc fragments was achieved (complete group) and those in whom residual disc fragments were observed on postoperative MRI (residual group).

STUDY DESIGN

Retrospective nested case-control study.

METHODS

A total of 225 patients were included (complete group, n=187 and residual group, n=38). Clinical assessments were performed using the visual analog pain score for the leg (VAS-L, x/10) and back (VAS-B, x/10) and the Korean version of the Oswestry Disability Index (K-ODI, x/45). A linear mixed-effects model was used to analyze changes during the first 24 postoperative months.

RESULTS

One month after surgery, significant improvements in the VAS-L, VAS-B and K-ODI values were observed and were maintained during the first 24 postoperative months. No differences in these changes were noted between the groups. Early re-operation (during the first 3 postoperative months) was performed in 3 patients in the residual group (7.9%) and in 4 patients in the complete group (2.1%) (P = 0.10).

LIMITATIONS

First, the study design was retrospective. Moreover, the number of patients was relatively small and therefore insufficient to achieve robust statistical power. Second, we did not explore the radiological outcomes in patients with asymptomatic residual disc material because follow-up MRI was only obtained to document symptom recurrence.

CONCLUSION

When residual disc tissue is observed in asymptomatic patients, a 'watchful waiting' strategy may be preferable to immediate re-operation. However, an increased early re-operation rate is expected for patients with residual disc tissue.

KEY WORDS

Discectomy, endoscopes, longitudinal studies, patient-reported outcome, percutaneous, reoperation, spine, residual disc.

Differential Cross Section and Photon-Beam Asymmetry for the γ[over →]p → π^{-}Δ^{++}(1232) Reaction at Forward π^{-} Angles for E_{γ}=1.5-2.95 GeV

Differential cross sections and photon-beam asymmetries for the γ[over →]p→π^{-}Δ^{++}(1232) reaction have been measured for 0.7<cosθ_{π}^{c.m.}<1 and E_{γ}=1.5-2.95  GeV at SPring-8/LEPS. The first-ever high statistics cross-section data are obtained in this kinematical region, and the asymmetry data for 1.5<E_{γ}(GeV)<2.8 are obtained for the first time. This reaction has a unique feature for studying the production mechanisms of a pure uu[over ¯] quark pair in the final state from the proton. Although there is no distinct peak structure in the cross sections, a non-negligible excess over the theoretical predictions is observed at E_{γ}=1.5-1.8  GeV. The asymmetries are found to be negative in most of the present kinematical regions, suggesting the dominance of π exchange in the t channel. The negative asymmetries at forward meson production angles are different from the asymmetries previously measured for the photoproduction reactions producing a dd[over ¯] or an ss[over ¯] quark pair in the final state. Advanced theoretical models introducing nucleon resonances and additional unnatural-parity exchanges are needed to reproduce the present data.

The Recovery of Motor Strength after Posterior Percutaneous Endoscopic Cervical Foraminotomy and Discectomy

OBJECTIVE

Cervical radiculopathy infrequently presents with motor weakness. Motor weakness was improved in >90% of patients after anterior cervical discectomy and fusion or posterior cervical foraminotomy. Posterior percutaneous endoscopic cervical foraminotomy and discectomy (PECF) is an alternative surgical technique, but the outcome of motor weakness has not been reported. Our objective was to demonstrate the longitudinal outcomes of motor weakness after PECF.

METHODS

A retrospective review of 106 consecutive patients was performed. Preoperative motor weakness was graded as mild (IV/V strength) or severe (less than III/V strength). The patients visited the outpatient clinic at 1, 3, 6, and 12 months after surgery and yearly thereafter. Improvement was defined as an improved weakness of more than 1 grade, and normalization was defined as the recovery of complete motor strength.

RESULTS

Motor weakness preoperatively presented in 76 of 106 (72%) patients (49%, mild weakness; 23%, severe weakness). After PECF, the weakness improved in 72 of 76 (95%) patients and normalized in 65 of 76 (86%) patients. In the patients with mild weakness, the normalization rates were 48%, 81%, 90%, and 96% at postoperative months 1, 3, 6, and 12, respectively. In the patients with severe weakness, the improvement rates were 50%, 71%, 83%, 88%, and 92%, and the normalization rates were 8%, 38%, 58%, 58%, and 63% at postoperative months 1, 3, 6, 12, and 24, respectively.

CONCLUSIONS

Preoperative motor weakness was improved in 95% of the patients after PECF, but motor weakness was not normalized in 37% of the patients with severe weakness.

Evaluation of abundance of artificial radionuclides in food products in South Korea and sources

Food samples are collected nationwide from January 2016 to February 2017 and their contents of artificial radionuclides are measured to address the growing concerns regarding the radioactive contamination of food products in Korea. Specifically, 900 food samples are collected for this study and their contents of representative artificial radionuclides ¹³⁴Cs, ¹³⁷Cs, ^239,240Pu, and ⁹⁰Sr are analyzed. The analysis shows that the activity concentrations of ¹³⁷Cs in fish range from minimum detectable activity (MDA) to 340 mBq/kg of fresh weight. The concentration factor (CF) determined for ¹³⁷Cs as a measure of its bioavailability is calculated to be ca. 74 and found to be very similar to that (100) recommended by the International Atomic Energy Agency. With an MDA of <0.221 mBq/kg, the results reveal that ^239,240Pu values in fish are below the MDA. The activity concentrations of ¹³⁷Cs and ⁹⁰Sr are lower than the MDA in both shellfish and seaweed, while the activity concentrations of ^239,240Pu in shellfish range from 0.26 to 2.18 mBq/kg, and for seaweed samples range from 2.07 to 3.38 mBq/kg. The atom ratios of ²⁴⁰Pu/²³⁹Pu in shellfish caught at the Korean coast vary from 0.209 to 0.237, with a mean of 0.227. The higher ²⁴⁰Pu/²³⁹Pu atom ratio determined in shellfish is thought to be caused by the plutonium transported from the Pacific Proving Grounds rather than other sources such as the Fukushima nuclear power plant accident. The activity concentrations of ¹³⁷Cs in mushrooms are found to vary from 1.0 to 21.4 Bq/kg, with the highest concentrations observed in the Oak (shiitake) and Sarcodon asparatus. ¹³⁴Cs is detected in three mushroom specimens collected from Jeju Island and about 3-3.6% of ¹³⁷Cs present in the wild mushrooms native to the Jeju Island are introduced as a result of the Fukushima nuclear plant accident. The annual effective doses of ¹³⁷Cs received through consumption of mushrooms and fish are 2.0 × 10^-4 mSv yr^-1 and 3.9 × 10^-5 mSv yr^-1, and those values are negligible compared to the annual effective doses limit of 1 mSv yr^-1.

First Determination of the Level Structure of an sd-Shell Hypernucleus, _{Λ}^{19}F

We report on the first observation of γ rays emitted from an sd-shell hypernucleus, _{Λ}^{19}F. The energy spacing between the ground state doublet, 1/2^{+} and 3/2^{+} states, of _{Λ}^{19}F is determined to be 315.5±0.4(stat)_{-0.5}^{+0.6}(syst)  keV by measuring the γ-ray energy of the M1(3/2^{+}→1/2^{+}) transition. In addition, three γ-ray peaks are observed and assigned as E2(5/2^{+}→1/2^{+}), E1(1/2^{-}→1/2^{+}), and E1(1/2^{-}→3/2^{+}) transitions. The excitation energies of the 5/2^{+} and 1/2^{-} states are determined to be 895.2±0.3(stat)±0.5(syst) and 1265.6±1.2(stat)_{-0.5}^{+0.7}(syst)  keV, respectively. It is found that the ground state doublet spacing is well described by theoretical models based on existing s- and p-shell hypernuclear data.

The relationship between depression and periodontal diseases

OBJECTIVE

A cross-sectional study was conducted to investigate whether depression is associated with periodontal diseases in a representative sample of South Korean adults Methods: We used data from the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI), conducted in 2014. We included in this study 4328 participants aged over 20 years (1768 males and 2560 females). Depression was assessed with the Patient Health Questionnaire (PHQ-9) and history of physician-diagnosed depression. Periodontal diseases were assessed a gingival bleeding, calculus and periodontal pockets. The data were analyzed using the chi-square test and multiple logistic regression.

RESULTS

People with any periodontal diseases tended to be old, male, married, low income, poor education, blue-collar occupation, diabetes mellitus, hypertension, overweight, smoking, not using dental floss or interdental brush in univariate analysis. Neither self-reported nor diagnosed depression was associated with the presence of any or severe periodontal disease in the total sample. In participants aged 20-29 years only, the presence of any periodontal disease was associated with self-reported depression (OR, 2.031; 95% CI, 1.011-4.078). In the same age group, the presence of severe periodontal disease was associated with both self-reported depression (OR, 6.532; 95% CI, 2.190-19.483) and diagnosed depression (OR, 7.729; 95% CI, 1.966-30.389).

CONCLUSION

Self-reported depression was significantly associated with the presence of any or severe periodontal disease, and diagnosed depression was significantly associated with severe periodontal diseases only in participants aged 20-29 years.

Post-operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: A meta-analysis

BACKGROUND

Recently, topical steroid therapy delivery using high-volume sinonasal irrigations has been used more frequently, following endoscopic sinus surgery (ESS), to improve drug delivery into the paranasal sinuses.

OBJECTIVE

The goal of this study was to perform a systematic review with meta-analysis of the efficacy of steroid nasal irrigation on post-operative management of Chronic rhinosinusitis (CRS) following ESS.

METHODS

Five databases (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) from inception to March 2017 were independently reviewed by two researchers. Studies that scored CRS endoscopic findings and CRS-related quality of life (QOL) post-operatively before and after steroid nasal irrigation and that compared the effects of steroid nasal irrigation (treatment groups) with saline alone irrigation (control group) were included in the analysis.

RESULTS

Twelve studies (n = 360) met inclusion criteria. Steroid nasal irrigation significantly reduced the endoscopic score compared with pre-treatment values and also improved QOL. Adverse effects following steroid nasal irrigation such as increased intraocular pressure (IOP) and hypothalamus-pituitary-adrenal (HPA) axis disturbance were not significant. However, compared with saline alone irrigation, the additional effects of steroid irrigation were not significant in the view of the endoscopic score and disease-specific QOL.

CONCLUSION

Although steroid nasal irrigation would not induce adverse effects related to systemic steroid absorption, the beneficial effects of additional steroids in saline irrigation were ambiguous in regard to endoscopic score and CRS-related QOL improvement compared with saline alone irrigation. However, further clinical trials with robust research methodologies should be conducted to confirm the results of this study.

The Ratio-Based N Staging System Can More Accurately Reflect the Prognosis of T4 Gastric Cancer Patients with D2 Lymphadenectomy Compared with the 7th American Joint Committee on Cancer/Union for International Cancer Control Staging System

PURPOSE

The utility of N classification has been questioned after the 7th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) was published. We evaluated the correlation between ratio-based N (rN) classification with the overall survival of pathological T4 gastric cancer patients who underwent D2 lymphadenectomy.

MATERIALS AND METHODS

We reviewed 222 cases of advanced gastric cancer patients who underwent curative gastrectomy between January 2006 and December 2015. The T4 gastric cancer patents were classified into four groups according to the lymph node ratio (the number of metastatic lymph nodes divided by the retrieved lymph nodes): rN0, 0%; rN1, ≤13.3%; rN2, ≤40.0%; and rN3, >40.0%.

RESULTS

The rN stage showed a large down stage migration compared with pathological T4N3 (AJCC/UICC). There was a significant difference in overall survival between rN2 and rN3 groups in patients with pT4N3 (P=0.013). In contrast, the difference in metastatic lymph nodes was not significant in these patients (≥16 vs. <15; P=0.177). In addition, the rN staging system showed a more distinct difference in overall survival than the pN staging system for pathological T4 gastric cancer patients.

CONCLUSIONS

Our results confirm that rN staging could be a good alternative for pathological T4 gastric cancer patients who undergo D2 lymphadenectomy. However, before applying this system to gastric cancer patients who undergo D2 lymphadenectomy, a larger sample size is required to further evaluate the usefulness of the rN staging system for all stages, including less advanced stages.

Soluble epoxide hydrolase activity and pharmacologic inhibition in horses with chronic severe laminitis

BACKGROUND

The roles of soluble epoxide hydrolase and lipid mediators in inflammatory and neuropathic pain could be relevant in laminitis pain management.

OBJECTIVES

To determine soluble epoxide hydrolase (sEH) activity in the digital laminae, sEH inhibitor potency in vitro, and efficacy of a sEH inhibitor as an adjunct analgesic therapy in chronic laminitic horses.

STUDY DESIGN

In vitro experiments and clinical case series.

METHODS

sEH activity was measured in digital laminae from euthanised healthy and laminitic horses (n = 5-6/group). Potency of 7 synthetic sEH inhibitors was determined in vitro using equine liver cytosol. One of them (t-TUCB; 0.1 mg/kg bwt i.v. every 24 h) was selected based on potency and stability, and used as adjunct therapy in 10 horses with severe chronic laminitis (Obel grades 2, one horse; 3-4, nine horses). Daily assessments of forelimb lifts, pain scores, physiologic and laboratory examinations were performed before (baseline) and during t-TUCB treatment. Data are presented as mean ± s.d. and 95% confidence intervals (CI).

RESULTS

sEH activity in the digital laminae from laminitic horses (0.9±0.6 nmol/min/mg; 95% CI 0.16-1.55 nmol/min/mg) was significantly greater (P = 0.01) than in healthy horses (0.17±0.09 nmol/min/mg; CI 0.07-0.26 nmol/min/mg). t-TUCB as an adjunct analgesic up to 10 days (4.3±3 days) in laminitic horses was associated with significant reduction in forelimb lifts (36±22%; 95% CI 9-64%) and in pain scores (18±23%; 95% CI 2-35%) compared with baseline (P = 0.04). One horse developed gas colic and another corneal vascularisation in a blind eye during treatment. No other significant changes were observed.

MAIN LIMITATIONS

Absence of control group and evaluator blinding in case series.

CONCLUSIONS

sEH activity is significantly higher in the digital laminae of actively laminitic compared with healthy horses, and use of a potent inhibitor of equine sEH as adjunct analgesic therapy appears to decrease signs of pathologic pain in laminitic horses.

Interference Effect between ϕ and Λ(1520) Production Channels in the γp→K^{+}K^{-}p Reaction near Threshold

The ϕ-Λ(1520) interference effect in the γp→K^{+}K^{-}p reaction has been measured for the first time in the energy range from 1.673 to 2.173 GeV. The relative phases between ϕ and Λ(1520) production amplitudes were obtained in the kinematic region where the two resonances overlap. The measurement results support strong constructive interference when K^{+}K^{-} pairs are observed at forward angles but destructive interference for proton emission at forward angles. Furthermore, the observed interference effect does not account for the sqrt[s]=2.1  GeV bump structure in forward differential cross sections for ϕ photoproduction. This fact suggests possible exotic structures such as a hidden-strangeness pentaquark state, a new Pomeron exchange, or rescattering processes via other hyperon states.

Tunable optofluidic birefringent lens

An optofluidic birefringent lens is demonstrated using hydrodynamic liquid-liquid (L(2)) interfaces in a microchannel. The L(2) lens comprises a nematic liquid crystal (NLC) phase and an optically isotropic phase for the main stream and the surrounding sub-stream, respectively. When the optofluidic device is subjected to a sufficiently strong electric field perpendicular to the flow direction, NLCs are allowed to orient along the external field rather than the flow direction overcoming fluidic viscous stress. The characteristics of the optofluidic birefringence lens are investigated by experimental and numerical analyses. The difference between the refractive indices of the main stream and the sub-stream changes according to the polarization direction of incident light, which determines the optical behaviour of the lens. The incidence of s-polarized light leads to a short focal point, while p-polarized light has a relatively long focal distance from the same L(2) interface. The curvatures and focal lengths of the lens are successfully evaluated by a hydrodynamic theory of NLCs and a simple ray-tracing model.

Relationship between tinnitus and suicidal behaviour in Korean men and women: a cross-sectional study

OBJECTIVES

This study investigated the prevalence of suicidal ideation and behaviour in a representative sample of South Koreans with or without tinnitus.

DESIGN

A cross-sectional study.

SETTING

Based on data from the 2010 to 2012 Korean National Health and Nutrition Examination Survey (KNHANES).

PARTICIPANTS

The study included 17 446 Korean individuals.

MAIN OUTCOME MEASURES

Participants provided demographic, socio-economic and behavioural information, as well as responses to questionnaires assessing the presence and severity of tinnitus, mental health status regarding stress, depression, and suicidal ideation and attempts. In the univariate analysis, the Rao-Scott chi-square test and logistic regression analysis were used to test the association between tinnitus and risk factors. Simple and multiple linear regression analyses were used to examine the association between tinnitus and mental status.

RESULTS

A total of 20.9% and 1.2% of participants with tinnitus, and 12.2% and 0.6% of those without, reported suicidal ideation and attempts, respectively (P < 0.0001 and P = 0.001). Participants reporting suicide attempts showed a higher proportion of severe annoying (6.0%) and irritating (11.8%) tinnitus than those with suicidal ideation (1.4% and 10.2%, respectively). Risks for experiencing tinnitus were significantly associated with suicidal ideation and attempts after adjusting for confounding variables.

CONCLUSION

This study has important implications for enhanced screening and evaluation of mental health status and suicidal ideation/behaviour among tinnitus patients.

Ballistocardiogram of baby during sleep

Ballistocardiogram (BCG), which displays the mechanical activity of heart, has been a subject of interest for several years due to its advantages in taking unobtrusive physiological measurements. In the field of sleep science, researchers actively study sleep architecture and clinically apply various sleep-related conditions through BCG-derived biological information such as the heartbeat, respiration and body movements of subjects. However, most of these studies have involved only adults. This area of research may be even more important with babies to monitor their biological signals without confinement. For this reason, we developed a physiological signal monitoring bed for baby by using a load cell. Heartbeat and respiration information was assessed with average respective performance errors of 1.53% and 2.53% compared to commercial equipment. The results showed the possibility of applying BCG technology to baby. Therefore, we expect that BCG-derived signals can be extensively applied to analyze sleep architecture and clinical applications in baby as they are with adults.

Observation of Spin-Dependent Charge Symmetry Breaking in ΛN Interaction: Gamma-Ray Spectroscopy of _{Λ}^{4}He

The energy spacing between the spin-doublet bound state of _{Λ}^{4}He(1^{+},0^{+}) was determined to be 1406±2±2  keV, by measuring γ rays for the 1^{+}→0^{+} transition with a high efficiency germanium detector array in coincidence with the ^{4}He(K^{-},π^{-})_{Λ}^{4}He reaction at J-PARC. In comparison to the corresponding energy spacing in the mirror hypernucleus _{Λ}^{4}H, the present result clearly indicates the existence of charge symmetry breaking (CSB) in ΛN interaction. By combining the energy spacings with the known ground-state binding energies, it is also found that the CSB effect is large in the 0^{+} ground state but is vanishingly small in the 1^{+} excited state, demonstrating that the ΛN CSB interaction has spin dependence.

Inhibition of soluble epoxide hydrolase does not improve the course of congestive heart failure and the development of renal dysfunction in rats with volume overload induced by aorto-caval fistula

The detailed mechanisms determining the course of congestive heart failure (CHF) and associated renal dysfunction remain unclear. In a volume overload model of CHF induced by creation of aorto-caval fistula (ACF) in Hannover Sprague-Dawley (HanSD) rats we explored the putative pathogenetic contribution of epoxyeicosatrienoic acids (EETs), active products of CYP-450 dependent epoxygenase pathway of arachidonic acid metabolism, and compared it with the role of the renin-angiotensin system (RAS). Chronic treatment with cis-4-[4-(3-adamantan-1-yl-ureido) cyclohexyloxy]benzoic acid (c-AUCB, 3 mg/l in drinking water), an inhibitor of soluble epoxide hydrolase (sEH) which normally degrades EETs, increased intrarenal and myocardial EETs to levels observed in sham-operated HanSD rats, but did not improve the survival or renal function impairment. In contrast, chronic angiotensin-converting enzyme inhibition (ACEi, trandolapril, 6 mg/l in drinking water) increased renal blood flow, fractional sodium excretion and markedly improved survival, without affecting left ventricular structure and performance. Hence, renal dysfunction rather than cardiac remodeling determines long-term mortality in advanced stage of CHF due to volume overload. Strong protective actions of ACEi were associated with suppression of the vasoconstrictor/sodium retaining axis and activation of vasodilatory/natriuretic axis of the renin-angiotensin system in the circulating blood and kidney tissue.

Impact of pharmaceutical excipients on in vitro association of saquinavir to chylomicrons

This study was performed to investigate the impact of pharmaceutical excipients commonly used for lymphatic transport on in vitro drug association with chylomicrons (CM). A CM association study was conducted using saquinavir solubilized in four different pharmaceutical excipients. We observed a linear relationship between saquinavir solubility and drug association, suggesting that the solubility of saquinavir in excipients is a key determinant for successful lymphatic delivery. Broadly, these results suggest that excipients with good solubilization properties may be advantageous for enhancing lymphatic drug delivery.

Relationship between chewing ability and depressive symptoms

OBJECTIVE

Depression, as one of the most common mental health problems, has many related factors. Recent studies have suggested chewing difficulties as a risk factor for depression in the elderly. This study seeks to investigate whether chewing ability is associated with depressive symptoms in a Korean population.

METHODS

This study used data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V) conducted in 2010. Self-reported questionnaires assessed depressive symptoms and chewing ability for the purposes of this study. A total of 6,255 subjects aged over 19 years were included for this study (2,704 males and 3,551 females).

RESULTS

Comparing depressive symptoms with chewing ability (i.e., very poor, poor, moderate, good, and very good), the adjusted odds ratios (ORs) and confidence intervals (CI) were 1.05 (95% CI: 0.84-1.32) for good vs. very good (as a reference), 1.31 (95% CI: 1.00-1.73) for moderate vs. very good, 1.41 (95% CI: 1.12-1.78) for poor vs. very good, and 1.76 (95% CI: 1.16-2.76) for very poor vs. very good.

CONCLUSION

This study suggests that subjects with reduced chewing ability were more susceptible to having depressive symptoms.

The clinical efficacy, safety and functionality of anion textile in the treatment of atopic dermatitis

BACKGROUND

Several previous studies have suggested the improvement of atopic dermatitis (AD) in response to special fabrics. In particular, beneficial effects have been reported, following the use of anion textiles.

OBJECTIVE

The purpose of this study is to evaluate the effectiveness and safety of an anion textile in patients suffering from AD.

METHODS

We compared an anion textile with a pure cotton textile. Fifty-two atopic patients (n=52) were enrolled and divided into two groups. The patients in the test (n=25) and control (n=19) groups wore undergarments made of an anion textile or pure cotton over a period of 4 weeks. The overall severity of disease was evaluated using the SCORing atopic dermatitis (SCORAD) index, whereas, the treatment efficacy was measured using a Tewameter® (Courage & Khazaka, Cologne, Germany), Mexameter® (Courage & Khazaka) and Corneo meter® (Courage & Khazaka).

RESULTS

At the end of the study, a significant decrease in the SCORAD index was observed among the patients with AD in the test group (mean SCORAD decreased from 47.2 to 36.1). Similarly, improvements in the mean transepidermal water loss, skin erythema and stratum corneum hydration were significantly greater among the patients with AD in the test group than in the control group.

CONCLUSION

Anion textiles may be used to significantly improve the objective and subjective symptoms of AD, and are similar in terms of comfort to cotton textiles. The use of anion textiles may be beneficial in the management of patients with AD.

Pharmacokinetics and in vivo potency of soluble epoxide hydrolase inhibitors in cynomolgus monkeys

BACKGROUND AND PURPOSE

Soluble epoxide hydrolase inhibitors (sEHIs) possess anti-inflammatory, antiatherosclerotic, antihypertensive and analgesic properties. The pharmacokinetics (PK) and pharmacodynamics in terms of inhibitory potency of sEHIs were assessed in non-human primates (NHPs). Development of a sEHI for use in NHPs will facilitate investigations on the role of sEH in numerous chronic inflammatory conditions.

EXPERIMENTAL APPROACH

PK parameters of 11 sEHIs in cynomolgus monkeys were determined after oral dosing with 0.3 mg·kg(-1). Their physical properties and inhibitory potency in hepatic cytosol of cynomolgus monkeys were examined. Dose-dependent effects of the two inhibitors 1-trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl) urea (TPPU) and the related acetyl piperidine derivative, 1-trifluoromethoxyphenyl-3-(1-acetylpiperidin-4-yl) urea (TPAU), on natural blood eicosanoids, were determined.

KEY RESULTS

Among the inhibitors tested, TPPU and two 4-(cyclohexyloxy) benzoic acid urea sEHIs displayed high plasma concentrations (>10 × IC(50)), when dosed orally at 0.3 mg·kg(-1). Although the 4-(cyclohexyloxy) benzoic acid ureas were more potent against monkey sEH than piperidyl ureas (TPAU and TPPU), the latter compounds showed higher plasma concentrations and more drug-like properties. The C(max) increased with dose from 0.3 to 3 mg·kg(-1) for TPPU and from 0.1 to 3 mg·kg(-1) for TPAU, although it was not linear over this range of doses. As an indication of target engagement, ratios of linoleate epoxides to diols increased with TPPU administration.

CONCLUSION AND IMPLICATIONS

Our data indicate that TPPU is suitable for investigating sEH biology and the role of epoxide-containing lipids in modulating inflammatory diseases in NHPs.