Narrowing of the Parent Artery Angle Is Associated With Intracranial Aneurysm Growth.

OBJECTIVE: Although risk factors for intracranial aneurysm growth have been reported, studies investigating the influence of the parent artery angle are limited. In this study, we examined the relationship between intracranial aneurysm growth and parent artery angle narrowing by analyzing long-term follow-up magnetic resonance angiography data. METHODS: We retrospectively reviewed data of patients with untreated aneurysms and those treated by simple coil embolization, who were followed up by magnetic resonance angiography for over 24 months at the Steel Memorial Yawata Hospital between August 2007 and March 2023. We investigated the relationship of aneurysm growth with parent artery angle narrowing, age, sex, follow-up duration, previous subarachnoid hemorrhage, hypertension, smoking, aneurysm location, aneurysm type, maximum size, and neck size. RESULTS: A total of 180 aneurysms of 162 patients (women, n=113; untreated, n=136) were included. The median age at aneurysm diagnosis was 71 (63.8-76) years and the median follow-up duration was 69 (45-120) months. Among the 180 aneurysms, 41 (untreated, n=30; treated by simple coil embolization, n=11) showed growth during the follow-up period, with a risk of 4.4%/patient-year. In the univariable analysis, the parent artery angles on the initial and last follow-up images and angle change were significantly associated with aneurysm growth. However, in the multivariable analysis, the association remained significant only for angle change (odds ratio, 2.21; 95% confidence interval, 1.42-3.45). The cutoff value of parent artery angle change for intracranial aneurysm growth was -3.4°. CONCLUSION: Parent artery angle narrowing was significantly associated with intracranial aneurysm growth. This parameter may be useful for the monitoring of patients with unruptured intracranial aneurysms and may contribute to discerning the mechanism of intracranial aneurysm growth.

Utility of salivary cortisol profile as a predictive biomarker in nurses' turnover risk: a preliminary study.

BACKGROUND: Predicting nurse turnover risk is crucial due to the global nursing shortage; however, existing predictors, such as fatigue and burnout, lack objectivity. Salivary cortisol is a non-invasive marker of stress and fatigue, but its utility in predicting nurse turnover risk is unknown. We examined whether salivary cortisol profiles across three different day shifts in a month are predictors of the extent of nurses' reluctance to stay in their current jobs. METHODS: This preliminary longitudinal study followed forty female nurses who engaged in shift work at a university hospital for 3 months. Data at enrollment were collected including demographics, working conditions, chronic fatigue (the Japanese version of the Occupational Fatigue/Exhaustion Recovery Scale), and burnout (Japanese Burnout scale). Salivary cortisol was measured before the three different day shifts (after awakening) during the first month, and the means of these measurements were used as the cortisol profile. The extent of reluctance to stay was assessed using the numerical rating scale at 3 months. RESULTS: Among the forty female nurses (mean [SD] age, 28.3 [5.1]), all completed follow-up and were included in the analysis. The cortisol profile was associated with the extent of reluctance to stay (P = 0.017), and this association was significant despite adjustments for chronic fatigue and burnout (P = 0.005). A multiple regression model with chronic fatigue, burnout, and job tenure explained 41.5% of the variation in reluctance to stay. When the cortisol profile was added to this model, the association of the cortisol profile was significant (P = 0.006) with an R2 of 0.529 (ΔR2 = 0.114). CONCLUSIONS: This preliminary study conducted in an actual clinical setting indicated the potential of the salivary cortisol profile across three different day shifts in a month to predict nurses' reluctance to stay in their current jobs. The combination of subjective indicators and the cortisol profile would be useful in predicting nurses' turnover risk.

Finite element analysis predictions in the canine lumbar spine are useful and correlate with ex vivo biomechanical studies.

OBJECTIVE: To verify the validity of finite element analysis (FEA) predictions obtained from a canine lumbar segment model in comparison with experimental biomechanical testing results from the same subjects. ANIMALS: 6 healthy beagle dogs were euthanized for other purposes. METHODS: The L1-2 and L5-6 segments were harvested from euthanized animals and subjected to rotation tests and compression tests, respectively, using both ex vivo mechanical testing and FEA. For each method, we recorded the maximum torque value and angle of vertebral body rotation at rupture observed in rotation tests, as well as the maximum stress value and displacement of the vertebral body endplate at rupture measured from compression tests. We then calculated Pearson's correlation coefficient to determine correlations between the angle of gyration and displacement at rupture determined by mechanical testing and FEA. The study started on March 26, 2021, and ended on March 18, 2023. RESULTS: For the rotation test, correlation coefficients for the maximum torque and rotation angle of the vertebral body at rupture were r = 0.92 and 0.96, respectively. For the compression test, correlation coefficients for the maximum stress and displacement of the vertebral body endplate at rupture were r = 0.73 and 0.94, respectively. All results showed strong correlations between the FEA predictions and ex vivo mechanical test results. CLINICAL RELEVANCE: These findings suggest that FEA predictions are sufficiently reliable for ex vivo mechanical test results for biomechanical studies of canine lumbar segment models.

Vertebral fixation does not affect recovery or recurrence of cervical intervertebral disc herniation in small dogs (< 15 kg).

OBJECTIVE: To compare the prognosis of small dogs with cervical intervertebral disc herniation (C-IVDH) when treated with ventral slot decompression (VSD) alone or with concomitant vertebral fixation (VF). ANIMALS: Small dogs (n = 303) weighing < 15 kg diagnosed with C-IVDH and treated with VSD. PROCEDURES: We recorded signalment, cervical myelopathy grade, surgical site, use of VF, degree of adjacent disc degeneration, recovery, recurrence, recurrence site, and postoperative course, including the time elapsed from recovery to recurrence. We examined factors associated with recovery and recurrence during the 30-month postoperative period using multivariate logistic regression analysis. RESULTS: VF did not affect recovery (P = .79). However, nonchondrodystrophic breeds had poorer recovery (OR, 5.89; P = .023) than chondrodystrophic breeds, and a higher preoperative cervical myelopathy grade (grade 3 or 4) was associated with poorer recovery (OR, 7.09 or 3.46, respectively; P = .019 or .042, respectively), compared with grade 1. VF did not affect recurrence (P = .79); however, increasing age was associated with recurrence (OR, 1.79; P = .001). CLINICAL RELEVANCE: In small dogs weighing < 15 kg, there was no difference in postoperative recovery and recurrence rates after VSD with or without concomitant VF. Therefore, in small dogs with C-IVDH, even if the slot volume is increased to remove sufficient disc material during VSD, a good prognosis can be achieved with or without VF.

Salivary Biomarker Profiles and Chronic Fatigue among Nurses Working Rotation Shifts: An Exploratory Pilot Study.

Although nurses' fatigue affects their well-being and patient safety, no effective objective measurements exist. We explored the profiles of salivary biomarkers associated with nurses' chronic fatigue across several shifts. This longitudinal study involved 45 shiftwork nurses and collected their saliva samples before two night and two day shifts for a month. Chronic fatigue was measured using the Cumulative Fatigue Symptom Index before the first night shift. Biomarker profiles were analyzed using hierarchical cluster analysis, and chronic fatigue levels were compared between the profiles. Cortisol profiles were classified into high- and low-level groups across two day shifts; the low-level group presented significantly higher irritability and unwillingness to work. Secretory immunoglobulin A (s-IgA) profiles across the four shifts were classified into high- and low-level groups; the high-level group had significantly higher depressive feelings, decreased vitality, irritability, and unwillingness to work. Cortisol (two day shifts) and s-IgA (four shifts) profiles were combined, and (i) cortisol low-level and s-IgA high-level and (ii) cortisol high-level and s-IgA low-level groups were identified. The former group had significantly higher chronic fatigue sign and irritability than the latter group. The profiles of salivary cortisol and s-IgA across several shifts were associated with nurses' chronic fatigue.

Effects of 90 Min Napping on Fatigue and Associated Environmental Factors among Nurses Working Long Night Shifts: A Longitudinal Observational Study.

For nurses working long night shifts, it is imperative that they have the ability to take naps to reduce fatigue, and that an appropriate environment is prepared where such naps can be taken. We verified the effects of 90 min napping on fatigue and the associated factors among nurses working 16-h night shifts. We investigated 196-night shifts among 49 nurses for one month. Wearable devices, data logging devices, and questionnaires were used to assess nap parameters, fatigue, and environmental factors such as the napping environment, ways of spending breaks, and working environment. Nurses who nap at least 90 min on most night shifts had more nursing experience. Multivariable logistic regression analysis showed that the environmental factors significantly associated with total nap duration (TND) ≥ 90 min were noise, time spent on electronic devices such as cellphones and tablets during breaks, and nap break duration. The night shifts with TND ≥ 90 min showed lower drowsiness after nap breaks and less fatigue at the end of night shift compared to those with TND < 90 min. Nurses and nursing managers should recognize the importance of napping and make adjustments to nap for at least 90 min during long night shifts.

Post-Work Recovery from Fatigue and Sleep Episodes among Nurses Who Are Engaged in 16-Hour Night Shifts: A Prospective Observational Study.

Poor recovery from fatigue among shift-working nurses can cause a transition from acute to chronic fatigue. We aimed to clarify the relationship between nurses' recovery from fatigue and sleep episodes after 16 h night shifts while considering age. This prospective study included 62 nurses who worked 16 h night shifts. Fatigue was assessed by a questionnaire before, during, and after the night shift, and the morning following the night shift. Sleep episodes were continuously measured using a wearable device. We performed a hierarchical cluster analysis of multivariate sleep parameters in first and main sleep episodes after night shifts. A linear mixed model was used to estimate the difference between clusters in recovery from fatigue after the night shift, considering age. The participants were classified into a high sleep quality group (HSQG) and low sleep quality group (LSQG) in sleep episodes after the night shift. There was a significant main effect of clusters, and HSQG was significantly more effective than LSQG in recovering from fatigue. However, no main effects of age or interaction were observed. The quality of first and main sleep episodes at home was associated with recovery from the night shift to the next day, regardless of age.

Psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery Scale among shift-work nurses.

OBJECTIVES: Shift-work nurses are at a higher risk of inadequate recovery from fatigue and developing maladaptive fatigue with significant health consequences. Therefore, it is necessary to monitor fatigue and recovery levels with a reliable scale. We investigated psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery scale (OFER-J) for shift-work nurses. METHODS: Japanese shift-work nurses responded to self-administered questionnaires at baseline (n = 942) and one month later (n = 334). The confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted to verify the structural validity and the correlation analysis and one-way analysis of variance were conducted to test the construct and discriminative validity. Cronbach's alpha coefficient, intra-class correlation coefficient (ICC), and smallest detectable change (SDC) were calculated to assess reliability. RESULTS: The CFA showed high correlations between the factors and whilst the goodness-of-fit of the three-factor model was suboptimal, it was in an acceptable range. Most modifications included the error covariance of the Acute Fatigue (AF) and Intershift Recovery (IR) items. The EFA showed that Chronic Fatigue (CF) and AF were not clearly separated, indicating that the two AF items dropped out. Construct and discriminative validity were also well indicated. Cronbach's alpha coefficients were 0.75-0.85. Only CF showed sufficient reproductivity (ICC = 0.74). The SDC for CF, AF, and IR was 14.0, 17.1, and 18.7, respectively. CONCLUSIONS: The validity and reliability of the OFER-J were verified as acceptable for shift-work nurses. The OFER-J could contribute to a data-based approach to fatigue management in nursing management practice.

Effectiveness of the Digging through Thrombus Technique by Using an Aspiration Catheter and Stent Retriever for Cerebral Venous Thrombosis.

Cerebral venous thrombosis (CVT) is a rare cause of stroke, and the first-line treatment is systemic anticoagulation. Patients unresponsive to standard therapy for CVT present with rapid neurological deterioration and require endovascular treatment. We encountered two patients with severe CVT who underwent endovascular treatment. In our cases, the thrombus was too hard and extensive to pass through using currently existing techniques. We performed the "digging through thrombus technique" using an aspiration catheter and stent retriever and achieved rapid sinus recanalization and favorable outcomes.

Influence of ventral fixation techniques on atlantoaxial joint fusion in canine models with dens partial resection.

We evaluated the completeness of bony fusion of the atlantoaxial joint (AAJ) through polymethylmethacrylate fixation (PMF) and atlantoaxial plate fixation (APF) using six canine models with dens partial resection. In both groups, the hydroxyapatite content at the AAJ was measured up to 7 months postoperatively using quantitative computed tomography. Histological assessment revealed fibrous fusion in the PMF group. Meanwhile, in the APF group, only one dog achieved fibrous fusion, whereas the remaining three showed bony fusion. To our knowledge, this study was the first to evaluate AAJ fusion histologically after PMF and APF. The present study demonstrates that PMF and APF may stabilize the AAJ without clinical complications. Therefore, PMF and APF are clinically useful fixation methods for atlantoaxial instability.

Efficacy of combined use of a stent retriever and aspiration catheter in mechanical thrombectomy for acute ischemic stroke.

BACKGROUND: The efficacy of combined stent retriever (SR) and aspiration catheter (AC; combined technique: CBT) use for acute ischemic stroke (AIS) is unclear. We investigated the safety and efficacy of single-unit CBT (SCBT)-retrieving the thrombus as a single unit with SR and AC into the guide catheter-compared with single use of either SR or contact aspiration (CA). METHODS: We analysed 763 consecutive patients who underwent mechanical thrombectomy for AIS between January 2013 and January 2020, at six comprehensive stroke centers. Patients were divided into SCBT and single device (SR/CA) groups. The successful recanalization with first pass (SRFP) and other procedural outcomes were compared between groups. RESULTS: Overall, 240 SCBT and 301 SR/CA (SR 128, CA 173) patients were analyzed. SRFP (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2c, 43.3% vs 27.9%, p<0.001; mTICI 3, 35.8% vs 25.5%, p=0.009) and final mTICI ≥2b recanalization (89.1% vs 82.0%, p=0.020) rates were significantly higher, puncture-to-reperfusion time was shorter (median (IQR) 43 (31.5-69) vs 55 (38-82.2) min, p<0.001), and the number of passes were fewer (mean±SD 1.72±0.92 vs 1.99±1.01, p<0.001) in the SCBT group. Procedural complications were similar between the groups. In subgroup analysis, SCBT was more effective in women, cardioembolic stroke patients, and internal carotid artery and M2 occlusions. CONCLUSIONS: SCBT increases the SRFP rate and shortens the puncture-to-reperfusion time without increasing procedural complications.

Meningitis retention syndrome associated with complicated mild encephalitis/encephalopathy with reversible splenial lesion in a young adult patient: a case report.

Meningitis retention syndrome (MRS), comprising aseptic meningitis and urinary retention, is a self-limiting disease that resolves within a few weeks. Refractory urinary retention and encephalitic syndromes are rare. A 32-year-old man presented with acute fever and headache followed by acute urinary retention (UT). Neurological examination revealed meningeal irritation, UT, constipation and ataxic gait. The cerebrospinal fluid showed mononuclear leukocytosis, and the etiological examination was negative. We suspected MRS. However, magnetic resonance imaging demonstrated an abnormally intense lesion in the splenium of the corpus callosum (SCC). He also developed delirium on day 4 of hospitalization. We diagnosed the patient with MRS associated with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). While his delirium and constipation improved, and the SCC lesion disappeared, UT was refractory and required 6 months to complete recovery. Our case suggests that severe MRS can exhibit refractory UT and may associate with MERS.

Narrowing of the angle of the parent artery after coil embolization increases the risk for aneurysm recurrence.

OBJECTIVE: Aneurysm recurrence after coiling is a major complication in some cases, including cases of repeated recurrences. In this study, we identified a relationship between the recurrence of a coiled aneurysm and angle change of the parent artery. METHODS: From April 2008 to December 2019, we performed 283 coil embolizations to treat 256 aneurysms in 251 patients. Among these, 21 cases of recurrent saccular aneurysms were selected. The parent artery angle changes between the initial treatment and the first re-treatment were compared between those who underwent single re-treatment and showed no recurrence after the first re-treatment (Group SR, n = 14) and those who required multiple re-treatments (Group MR, n = 7). RESULTS: The parent artery angles at the first treatment [medians (interquartile ranges)] were 121.6° (109.3-135.6°) in Group SR and 104.9° (89.9-131.0°) in Group MR; at the second treatment, these angles were 121.2° (105.5-132.7°) and 81.9° (67.0-111.4°), respectively, revealing angle changes of -2.2° (-4.0 to -0.4°) and -16.4° (-30.1 to -8.6°) in Groups SR and MR between the first and second treatments. The between-group differences in the parent artery angles at the second treatment and the changes in the parent artery angle between the first and second treatments were statistically significant. CONCLUSION: In patients with recurrent aneurysms, simple aneurysm coiling is not effective when the angle of the parent artery becomes narrower after treatment, relative to that before treatment. Stent placement should be considered for straightening the parent artery or diverting blood flow.

Fluctuations in Moyamoya Vasculopathy Associated with Basedow Disease Depending on Thyroid Hormone Status.

A 31-year-old woman presented with sudden onset of weakness in her left upper limb. Magnetic resonance imaging revealed acute cerebral infarctions in the right frontal and parietal lobes. Magnetic resonance angiography showed stenosis in the proximal portions of the bilateral middle cerebral arteries and terminal portions of the bilateral internal carotid arteries. The patient also complained of thyrotoxic symptoms, such as tachycardia, goiter, and fine finger tremor. She was diagnosed with acute ischemic stroke due to moyamoya vasculopathy (MMV) associated with Basedow disease. The patient's thyroid hormone status normalized and intracranial artery stenosis gradually improved. However, after 6 months, she developed transient left hemiparesis during the 7th week of gestation. Her thyroid function deteriorated, and MMV progressed. Then, MMV improved again with the normalization of her thyroid function. This case shows that MMV associated with Basedow disease could worsen or improve depending on the thyroid hormone status.

Effect of durotomy in dogs with thoracolumbar disc herniation and without deep pain perception in the hind limbs.

OBJECTIVE: To determine the effectiveness of durotomy as an adjunct to surgical decompression in dogs with thoracolumbar intervertebral disc herniation (TL-IVDH) and loss of deep pain perception (DPP) in the hind limbs. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n = 116) with TL-IVDH and loss of DPP treated with hemilaminectomy. METHODS: Signalment, surgical site, recovery rate, incidence of progressive myelomalacia (PMM), time elapsed from onset of paraplegia of the hind limbs to surgery (TPS), and the length of area of hyperintensity of the spinal cord on magnetic resonance T2-weighted images compared with L2 vertebral body length (LHT2) were compared between dogs treated with hemilaminectomy alone and those treated with adjunct durotomy. Multivariate logistic regression analyses were used to test the association between outcomes and the external view of the spinal cord parenchyma after durotomy. RESULTS: The percentage of dogs regaining ambulation was greater when durotomy was performed (56.9%) than when dogs were treated with hemilaminectomy alone (38.5%; P = .04). In the hemilaminectomy group, 14 dogs died of suspected PMM, while no PMM was detected in the durotomy group. Durotomy, breed, surgical site, and LHT2 influenced recovery. No association was detected between age, sex, body weight, and TPS and recovery. CONCLUSION: Performing a durotomy in combination with decompression improved the return to function and prevented PMM in our clinical setting. CLINICAL SIGNIFICANCE: Surgeons should consider durotomy in dogs with TL-IVDH and loss of DPP in hind limbs to improve surgical outcome.

Effects of differences in wiping pressure applied by nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations.

AIM: To clarify the actual condition and examine the effects of differences in wiping pressure applied by clinical nurses during daily bed baths on skin barrier function, cleanliness, and subjective evaluations. METHODS: For the purposes of the present quasi-experimental interventional study, "wiping pressure" was defined as the "force applied vertically to the skin surface during bed baths." Two types of bed baths, one using ordinary wiping (pressure: 23-25 mmHg) and the other using weak wiping (pressure: 12-14 mmHg), were performed on the forearms (right and left) of 30 healthy adult men and women, and the effects on transepidermal water loss, stratum corneum hydration, cleanliness, and subjective evaluations were examined. RESULTS: The results showed no differences between ordinary and weak wiping pressure in regard to the effects on skin barrier function and cleanliness. In terms of subjective evaluations, a significant association was seen between wiping pressure and the "sensation of having dirt removed" (P = .036). Regarding "degree of pain," some participants reported that the wiping pressure felt "slightly painful" under both conditions (ordinary: 31.1%; weak: 10.7%), while some with sensitive skin reported feeling pain even during weak wiping pressure. CONCLUSIONS: The results of the present study suggest that skin assessments should be performed before and after bed baths, and that wiping pressure should be controlled and evaluated while considering the patient's feelings.

Reocclusion of the treated vessel due to endothelial injury after mechanical thrombectomy in a patient with acute ischaemic stroke.

A 92-year-old woman developed sudden consciousness disturbance, global aphasia and right hemiparesis. She had atrial fibrillation and cardioembolic stroke was diagnosed. Tissue plasminogen activator was administered, and endovascular treatment was initiated. The left middle cerebral artery was occluded and complete recanalisation was achieved after direct aspiration first-pass technique. However, MRI immediately after treatment showed reocclusion. Endovascular treatment was repeated and complete recanalisation was achieved. There was no evidence of cerebral artery dissection, but angiography soon after the second procedure revealed early reocclusion. Ozagrel, an antiplatelet agent, was administered intravenously and prevented reocclusion. Endothelial injury was speculated to have occurred during the first mechanical thrombectomy, leading to recurrent occlusion. Though the patient continued to have right hemiparesis, she recovered from her consciousness disturbance and aphasia after re-treatment.

Evaluation of atlantooccipital overlapping and cerebral ventricle size in dogs with atlantoaxial instability.

This study investigated cerebral ventricle size and concurrent craniocervical junction abnormality in relation to atlantooccipital overlapping (AOO) in dogs with atlantoaxial instability (AAI). A total of 61 dogs were treated with atlantoaxial ventral fixation. Medical records of each dog, including magnetic resonance (MR) and computed tomography (CT) images, were retrospectively reviewed. CT images were assessed for the presence of AOO and the dogs were then assigned to either an AOO group or a non-AOO group accordingly. CT images were also evaluated to determine the foramen magnum (FM) index. Syringomyelia, cerebellar compression, dorsal compression, and the degree of enlargement of each cerebral ventricle were evaluated using MR images. Of the 61 dogs, 23 had AOO and 38 did not. Furthermore, the ventricle/brain height ratio, the fourth ventricle height/cerebellum length ratio, and the fourth ventricle width/cerebellum length ratio were significantly higher in the AOO group than in the non-AOO group. However, the FM index, third ventricle/brain height ratio, and incidence of syringomyelia did not differ significantly between the two groups. Dogs with concurrent AOO exhibited significantly more dilatation of the lateral and fourth ventricles.

Epidemiological and morphological characteristics of incomplete ossification of the dorsal neural arch of the atlas in dogs with atlantoaxial instability.

OBJECTIVE To retrospectively evaluate the epidemiological and morphological features and outcome of surgical treatment of incomplete ossification of the dorsal neural arch of the atlas (IODA) in dogs with atlantoaxial instability (AAI). ANIMALS 106 AAI-affected dogs that underwent ventral fixation of the atlantoaxial joint. PROCEDURES Medical records and CT images for each dog were reviewed. Dogs were allocated to 1 of 2 groups on the basis of the presence or absence of IODA or of dens abnormalities (DAs) in CT images. RESULTS Of the 106 dogs with AAI, 75 had and 31 did not have IODA; 70 had and 36 did not have DAs. Incomplete ossification was present in the cranialmost, central, or caudalmost portion of the dorsal neural arch of the atlas in 59, 39, and 28 dogs, respectively; 2 or 3 portions were affected in 29 and 11 dogs, respectively. The mean CT value (in Hounsfield units) for the midline of the dorsal neural arch of the atlas in dogs with IODA was significantly lower than that for the same site in the dogs without IODA. The mean age at surgery for dogs with central IODA was significantly higher than that of the non-IODA group. The severity of spinal cord injury before or after atlantoaxial ventral fixation did not differ between the IODA and non-IODA groups. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that concomitant DAs or IODA is common in dogs with AAI. In dogs with incomplete ossification in the central part of the dorsal neural arch of the atlas, surgical treatment of AAI generally occurs at a middle to advanced age.