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The Incidence of Iliac Screw-Related Complications After Long Fusion Surgery in Patients with Adult Spinal Deformity
Get PDFStudy Design: Retrospective study.
Objective: To investigate the long-term clinical outcome and incidence of iliac screw-related complications in patients with adult spinal deformity (ASD).
Summary of Background Data: Rigid lumbosacral fixation is crucial to achieve optimal global alignment and successful long-term clinical outcomes.
Methods: The data of eligible patients with ASD who underwent spinopelvic fixation using bilateral iliac screws with at least 5-year follow-up periods were retrospectively analyzed. Iliac screw loosening and rod breakage between the S1 and iliac (S1/IL) screws were defined as distal instability (DI). Demographic data, health-related quality of life scores, and spinopelvic parameters in the DI group were compared with those in the non-DI group. Sub-group analyses were performed between the cases with and without alignment change after rod fracture at S1/IL.
Results: Of the 159 patients, the data of 110 patients (15 men, 95 women; mean age, 67.8 years) were analyzed. The follow-up rate was 69%. Forty-five (41%) patients showed DI (29 cases [26%] in screw loosening, 16 cases [15%] in rod breakage). Eight patients (7.3%) required revision surgery because of iliac screw-related complications. No significant differences were observed in the Oswestry Disability Index and Scoliosis Research Society questionnaire (revised) scores between the DI and non-DI groups. The patients with iliac screw loosening showed significantly greater values of preoperative pelvic incidence, pelvic tilt (PT) and postoperative PT, and T1-pelvic angle. In patients with rod breakage at S1/IL, five patients (31%) who had associated mechanical complications showed an alignment change between pre and post rod breakage. They showed significantly higher and lower rates of high-grade osteotomies and L5/S interbody fusion, respectively.
Conclusion: The incidence rate of iliac screw-related complications was relatively high. However, they had a little effect on sagittal alignment deterioration and there were few cases that required revision surgery.Mini abstract:
Long fusion surgery with pelvic fixation using iliac screw resulted in higher incidence rates of iliac screw-related complications; however, the cases that required revision surgery were limited (7.3%). Iliac screw loosening and rod breakage at S1/IL had little effect on sagittal alignment deterioration.journal articl
Microscopy and Biomimetics: the NanoSuit? Method and Image Retrieval Platform
Get PDFThis review aims to clarify a suitable method towards achieving next-generation sustainability. As represented by the term “Anthropocene”, the Earth, including humans, is entering a critical era, therefore science has a great responsibility to solve it. Biomimetics, the emulation of the models, systems, and elements of nature, especially biological science, is a powerful tool to approach sustainability problems. Microscopy has made great progress with the technology of observing biological and artificial materials and its techniques have been continuously improved, most recently through the NanoSuit? method. As one of the most important tools across many facets of research and development, microscopy has produced a large amount of accumulated digital data. However, it is difficult to extract useful data for making things as biomimetic ideas despite a large amount of biological data. Here, we would like to find a way to organically connect the indispensable microscopic data with the new biomimetics to solve complex human problems.journal articl
Two pregnant cases of intracranial hemorrhage due to arteriovenous malformation of high Spetzler-Martin grades
Get PDF脳動静脈奇形Arteriovenous malformation（AVM）は妊娠中に頭蓋内出血を起こす主要な脳血管疾患であるが、妊娠中の破裂で初めて診断されることが多い。また、AVMが出血原因とわかっても、その大きさや病変部位により根治的治療が困難な症例では、再出血のリスクをかかえたまま妊娠継続をはかることになる。
今回、妊娠中期にAVM破裂をきたし、Spetzler-Martin分類grade 4、 5で外科的摘出が困難と診断され、保存的に治療した2症例を経験した。症例1は36歳、妊娠前に左前頭頭頂葉AVMを診断され経過観察されていたが、妊娠21週に脳室内出血を認め、妊娠37週に硬膜外麻酔下に選択的帝王切開術を行なった。症例2は31歳、妊娠24週で右被殻出血を認め、妊娠31週に全身麻酔下に選択的帝王切開術を行った。自験例を含め、過去に国内で報告された40症例について検討した。Arteriovenous malformation (AVM) is a major cerebrovascular disease that causes intracranial hemorrhage during pregnancy and is often first diagnosed due to rupture during pregnancy. Even if an AVM is known to be the cause of bleeding, in cases where curative treatment is difficult due to the size and location of the lesion, pregnancy will need to be continued in spite of the risk of re-bleeding.
We have managed two cases of AVM rupture during the second trimester of pregnancy. The lesions were of high Spetzler-Martin grades (grades 4 and 5); therefore, surgical removal was deemed difficult in these patients and they were treated conservatively. The first patient was a 36-year-old woman who was under surveillance after being diagnosed with a left frontal parietal lobe AVM before pregnancy. Intraventricular hemorrhage was observed during week 21 of gestation, and delivery was achieved through caesarean section at 37 weeks, under epidural anesthesia. The second case was a 31-year-old woman in whom right putamen hemorrhage was noted during week 24 of gestation. She underwent selective caesarean section under general anesthesia during week 31 of gestation. We examined 40 prior cases reported in Japan, along with our cases.journal articl
A DNA adductome analysis revealed a reduction in the global level of C5-hydroxymethyl-2′-deoxycytidine in the non-tumoral upper urinary tract mucosa of urothelial carcinoma patients
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Background: DNA adducts, covalent modifications to DNA due to exposure to specific carcinogens, cause the mispairing of DNA bases, which ultimately results in DNA mutations. DNA methylation in the promoter region, another type of DNA base modification, alters the DNA transcription process, and has been implicated in carcinogenesis in humans due to the down-regulation of tumor suppressor genes. Difficulties are associated with demonstrating the existence of DNA adducts or chemically modified bases in the human urological system. Apart from aristolochic acid-DNA adducts, which cause urothelial carcinoma and endemic nephropathy in a particular geographical area (Balkan), limited information is currently available on DNA adduct profiles in renal cell carcinoma and upper urinary tract urothelial carcinoma, including renal pelvic cancer and ureteral cancer.
Method: To elucidate the significance of DNA adducts in carcinogenesis in the urothelial system, we investigated 53 DNA adducts in the non-tumoral renal parenchyma and non-tumoral renal pelvis of patients with renal cell carcinoma, upper urinary tract urothelial carcinoma, and other diseases using liquid chromatography coupled with tandem mass spectrometry. A comparative analysis of tissue types, the status of malignancy, and clinical characteristics, including lifestyle factors, was performed.
Results: C5-Methyl-2′-deoxycytidine, C5-hydroxymethyl-2′-deoxycytidine (5hmdC), C5-formyl-2′-deoxycytidine, 2′-deoxyinosine, C8-oxo-2′-deoxyadenosine, and C8-oxo-2′-deoxyguanosine (8-OHdG) were detected in the renal parenchyma and renal pelvis. 8-OHdG was more frequently detected in the renal pelvis than in the renal cortex and medulla (p=0.048 and p=0.038, respectively). 5hmdC levels were significantly lower in the renal pelvis of urothelial carcinoma patients (n=10) than in the urothelium of patients without urothelial carcinoma (n=15) (p=0.010). Regarding 5hmdC levels in the renal cortex and medulla, Spearman’s rank correlation test revealed a negative correlation between age and 5hmdC levels (r=-0.46, p=0.018 and r=-0.45, p=0.042, respectively).
Conclusions: The present results revealed a reduction of 5hmdC levels in the non-tumoral urinary tract mucosa of patients with upper urinary tract urothelial carcinoma. Therefore, the urothelial cell epithelia of patients with upper urinary tract cancer, even in non-cancerous areas, may be predisposed to urothelial cancer.doctoral thesi
Nicotinic acetylcholine receptor agonist reduces acute lung injury after renal ischemia-reperfusion injury by acting on splenic macrophages in mice
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Acute kidney injury (AKI) contributes to the development of acute lung injury (ALI) via proinflammatory responses. We hypothesized that activation of a nicotinic acetylcholine receptor (nAChR), which exerts cholinergic anti-inflammatory effects on macrophages, could reduce ALI after AKI. We aimed to determine whether nAChR agonists could reduce ALI after AKI and which macrophages in the lung or spleen contribute to the improvement of ALI by nAChR agonists. We induced AKI in male mice by unilateral ischemia-reperfusion injury (IRI) with contralateral nephrectomy and administered nAChR agonists in three experimental settings: 1) splenectomy, 2) deletion of splenic macrophages and systemic mononuclear phagocytes via intravenous administration of clodronate liposomes, and 3) alveolar macrophage deletion via intratracheal administration of clodronate liposomes. Treatment with GTS-21, an a7nAChR-selective agonist, significantly reduced the levels of circulating IL-6, a key proinflammatory cytokine, and lung chemokine (C-X-C motif) ligand (CXCL)1 and CXCL2 and neutrophil infiltration, and Evans blue dye (EBD) vascular leakage increased after renal IRI. In splenectomized mice, GTS-21 did not reduce circulating IL-6 and lung CXCL1 and CXCL2 levels and neutrophil infiltration, and EBD vascular leakage increased after renal IRI. In mice depleted of splenic macrophages and systemic mononuclear phagocytes, GTS-21 treatment did not reduce lung neutrophil infiltration, and EBD vascular leakage increased after renal IRI. In mice depleted of alveolar macrophages, GTS-21 treatment significantly reduced lung neutrophi infiltration, and EBD vascular leakage increased after renal IRI. Our findings show that nAChR agonist reduces circulating IL-6 levels and acute lung injury after renal IRI by acting on splenic macrophages.NEW & NOTEWORTHY Acute lung injury associated with acute kidney injury contributes to high mortality. This study showed, for the first time, that nicotinic acetylcholine receptor agonists reduced circulating IL-6 and ALI after renal ischemia-reperfusion injury in mice. These effects of a7nAChR agonist were eliminated in both splenectomized and splenic macrophage (including systemic mononuclear phagocyte)-depleted mice but not alveolar macrophage-depleted mice. nAChR agonist could reduce ALI after AKI via splenic macrophages and provide a novel strategy in AKI.doctoral thesi
Detection of highly abundant small molecules in the stratum corneum of healthy young women using desorption electrospray ionization-mass spectrometry imaging
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Aging reflects skin appearance drastically, which reduces skin juvenescence. However, the small molecules underlying skin juvenescence have not been well studied. We aimed to explore the molecules potentially responsible for young-looking skin. Eleven healthy women aged 24?59 years were recruited and divided into young and middle-aged groups. Multiple layers of the stratum corneum from the cheek area were taken by tape-stripping, followed by desorption electrospray ionization mass spectrometry imaging (DESI-MSI). Overall, five molecules (m/z 284.33, 340.39, 488.39, 628.37, and 863.65) were highly abundant in young subjects. Among them, m/z 284.33 and 340.39 were dominantly detected in each layer of all young subjects. Interestingly, m/z 488.39 and 628.37 were prominent in young subject 4. All of these molecules were gradually decreased in the successive layers of the stratum corneum in subjects 3 and 4 of the young group. These molecules could be endogenous, co-related with youthful skin, or retained from topical cosmetics. Extensive research is indispensable to characterize them and find the relationship between these molecule’s retention capacity in the stratum corneum with different skin parameters. Our findings provide a novel perspective on young skin that could be advantageous in future cosmetic formulations to improve skin juvenescence.doctoral thesi
