Investigation of treatment outcomes for severe extremity trauma in an independent orthopedic trauma center: A case series.

BACKGROUND: Severe extremity trauma is one of the most challenging injuries to treat. Limb salvage after severe extremity trauma requires rapid revascularization, accurate and appropriate bone and soft tissue reconstruction, and appropriate management to address critical complications. The purpose of this study was to report the treatment outcomes for severe extremity trauma injuries at our independent orthopedic trauma center. METHODS: This study included patients with severe extremity trauma who underwent major vascular repair or soft tissue reconstruction. Bone reconstruction method, presence or absence of revascularization, and flap type were investigated. Complications were investigated, including revascularization failure, flap failure, infection, and ultimately, whether amputation was required. Additionally, we investigated the number of surgeries performed on each patient at the time of initial hospitalization. RESULTS: Thirty-five patients who underwent revascularization or soft tissue reconstruction were included in this study. Plate fixation was performed in 18 patients, intramedullary nail fixation in 8, screw fixation in 1, pinning in 4, and without implant fixation in 4. Revascularization was performed in six patients, and no vascular complications occurred. Pedicled and free flaps were used in 17 and 16 patients, respectively. Partial flap necrosis occurred in four patients, and arterial occlusion occurred in one. Infection occurred in 10 patients who were treated with frequent irrigation and high-concentration antibiotics local infusion therapy. None of the 35 patients required limb amputation. Mean number of surgeries was 12.5. CONCLUSIONS: The limb of all the 35 patients with severe extremity trauma treated at our independent orthopedic trauma center were salvaged.

Japanese attitude toward insects as food: The role of tradition.

This study investigated the influence of traditional insect food culture on the acceptance of novel insect foods by comparing a sample from the Kanto area (N = 485) as representative of the Japanese population, and a sample from Nagano Prefecture (N = 198), where entomophagy remains relatively commonly practiced. More than half of the Japanese participants had insect-eating experience (52.0% in the Kanto area, 81.8% in Nagano); however, among them, less than half were currently willing to eat insect foods. Furthermore, when questioned about the dietary substitution of meat and fish with insects, only 7.0% in the Kanto area and 15.7% in Nagano answered positively. Although the regions with a strong insect culture had a higher percentage of people who accepted traditional insect foods, the percentage of people who accepted novel insect foods was not significantly different between the two regions. Results of the regression analysis suggested that food neophobia and food technology neophobia have relatively positive impacts on willingness to eat novel insect foods in Nagano. However, concerns about the taste of insects owing to the experience of eating traditional insect foods counteracted this effect, indicating both positive and negative effects of tradition. Regression analysis of willingness-to-eat and willingness-to-substitute for edible insects suggested that the key to getting people to incorporate insects into their diets is not only to create awareness of the relationship between using insect foods and environmental conservation, but also to dispel concerns about the hygiene of insect foods and develop insect foods with a taste as good as that of meat and fish.

Attitude changes toward prenatal testing among women with twin pregnancies after the introduction of noninvasive prenatal testing: A single-center study in Japan.

AIM: This study aimed to evaluate changes in prenatal testing among women with twin pregnancies before and after the introduction of noninvasive prenatal testing (NIPT). To date, no consensus on prenatal testing for twin pregnancies has been reached in Japan. METHODS: Women pregnant with twins who requested prenatal testing at Kyushu Medical Center from 2005 to 2018 were included in this study. Genetic counseling was provided to all participants. Their chosen methods of testing were collected and classified as invasive diagnosis (ID), noninvasive screening (NIS), and no test requested (NR). Parity, chorionicity, and methods of conception were assessed as attributes. The study period was divided into three terms according to testing availability in our center. RESULTS: After NIPT was introduced in our center, the use of ID methods decreased and eventually disappeared while NIS came to the forefront. NR was also the preferred choice of women with twin pregnancies before the introduction of NIPT and decreased but did not disappear after introducing NIPT. Women with twin pregnancies who underwent assisted reproduction initially showed hesitation to undergo testing but showed a strong preference for NIS after the introduction of NIPT. Differences in choice according to parity, chorionicity, and methods of conception were found before the introduction of NIPT but disappeared after introducing NIPT. CONCLUSION: Increasing information about NIPT has apparently influenced the attitudes of women with twin pregnancies to prenatal testing in Japan. In particular, those who conceive through assisted reproductive technologies exhibited a strong preference for NIPT.

Real-world use of temsirolimus in Japanese patients with unresectable or metastatic renal cell carcinoma: recent consideration based on the results of a post-marketing, all-case surveillance study.

OBJECTIVE: A prospective, observational, post-marketing surveillance was conducted to assess the safety and effectiveness of temsirolimus in patients with renal cell carcinoma in Japan. METHODS: Patients prescribed temsirolimus for advanced renal cell carcinoma were registered and received temsirolimus (25 mg weekly, intravenous infusion for 30-60 minutes) in routine clinical settings (observation period: 96 weeks). RESULTS: Among 1001 patients included in the safety analysis data set (median age, 65.0 years; men, 74.8%; Eastern Cooperative Oncology Group performance status 0 or 1, 69.6%), 778 (77.7%) reported adverse drug reactions. The most common (≥10%) all-grade adverse drug reactions were stomatitis (26.7%), interstitial lung disease (17.3%) and platelet count decreased (11.1%). The incidence rate of grade ≥3 interstitial lung disease was 4.5%. The onset of interstitial lung disease was more frequent after 4-8 weeks of treatment or in patients with lower Eastern Cooperative Oncology Group performance status (21.6% for score 0 vs 8.3% for score 4, P < 0.001). Among 654 patients in the effectiveness analysis data set, the response and clinical benefit rates were 6.7% (95% confidence interval 4.9-8.9) and 53.2% (95% confidence interval 49.3-57.1), respectively. The median progression-free survival was 18.3 weeks (95% confidence interval 16.9-21.1). CONCLUSIONS: The safety and effectiveness profile of temsirolimus observed in this study was similar to that observed in the multinational phase 3 study. The results are generalizable to the real-world scenario at the time of this research, and safety and effectiveness of temsirolimus as a subsequent anticancer therapy for renal cell carcinoma warrants further investigation. (ClinicalTrials.gov identifier NCT01210482, NCT01420601).

Efficacy and safety of sunitinib in Japanese patients with progressive, advanced/metastatic, well-differentiated, unresectable pancreatic neuroendocrine tumors: final analyses from a Phase II study.

BACKGROUND: In an interim analysis of a Phase II trial in Japanese patients with pancreatic neuroendocrine tumors (panNETs), sunitinib demonstrated antitumor activity with an objective response rate (ORR) of 50% (95% confidence interval [CI], 21-79) and a median progression-free survival (PFS) of 16.8 months (95% CI, 9.3-26.2). Here, we report the final analyses of efficacy and safety, as well as additional analyses, from this Phase II study. METHODS: This was a multicenter, open-label, Phase II trial (NCT01121562) of sunitinib in Japanese patients with panNETs. Patients received oral sunitinib 37.5 mg/day on a continuous daily dosing schedule. Dose modifications were permitted. The primary endpoint was clinical benefit rate (CBR). Secondary endpoints included ORR, PFS, overall survival (OS), safety and pharmacokinetics. RESULTS: Of 12 patients enrolled and treated, all discontinued treatment-the majority (n = 8) owing to disease progression. Most patients were male (n = 8), <65 years of age (n = 11) and had a non-functional tumor (n = 10). The median (range) number of days on drug was 323.5 (22-727). The CBR (95% CI) was 75.0% (42.8-94.5). ORR (95% CI) was 50.0% (21.1-78.9). Median (95% CI) PFS was 16.8 (9.3-26.2) months; however, median (95% CI) OS was not reached (22.0-not estimable). Most common adverse events (AEs; all-causality) were diarrhea (n = 10; 83.3%), hand-foot syndrome (n = 8; 66.7%) and hypertension (n = 8; 66.7%). CONCLUSIONS: These results support the efficacy and safety of sunitinib in Japanese patients with panNETs. Appropriate AE management through dose reduction and interruption may prolong sunitinib treatment and maximize its efficacy.

Thermoelectric Array Sensors with Selective Combustion Catalysts for Breath Gas Monitoring.

Inflammable breath gases such as H2 and CH4 are used as bio markers for monitoring the condition of the colon. However, their typical concentrations of below 100 ppm pose sensitivity and selectivity challenges to current gas sensing systems without the use of chromatography. We fabricated a compact, gas-selective thermoelectric array sensor (TAS) that uses micro-machined sensor devices with three different combustion catalysts to detect gases such as H2, CO, and CH4 in breath. Using Pt/Pt-W thin-film micro-heater meanders, Pd/Al2O3, Pt,Pd,Au/Co3O4, and Pt/Al2O3 catalysts were heated to 320, 200, and 125 °C, respectively, and the gas sensing performances of the TAS for each gas and for a model breath gas mixture of 100 ppm H2, 25 ppm CO, 50 ppm CH4, and 199 ppm CO2 in air were investigated. Owing to its high catalyst temperature, the Pd/Al2O3 catalyst burned all three gases, while the Pt,Pd,Au/Co3O4 burned CO and H2 and the Pt/Al2O3 burned H2 selectively. To calibrate the gas concentration of the mixture gas without the use of a gas separation tool, linear discriminant analysis was applied to measure the sensing performance of TAS. To enhance the gas selectivity against H2, a double catalyst structure was integrated into the TAS sensor.

Hyperinsulinemic hypoglycemia in Beckwith-Wiedemann, Sotos, and Kabuki syndromes: A nationwide survey in Japan.

Beckwith-Wiedemann syndrome (BWS) is a congenital overgrowth syndrome that is occasionally associated with hyperinsulinemic hypoglycemia (HH) in the neonatal period. Sotos syndrome (SS) and Kabuki syndrome (KS) are other malformation syndromes that may be complicated with HH, however, the detailed clinical characteristics of HH accompanied with these syndromes remain unclear. We herein conducted a nationwide questionnaire survey in Japan. We sent a primary questionnaire concerning the clinical experience for these syndromes to 347 perinatal care institutions. As a result, 222 departments or hospitals returned the questionnaires and the total numbers of BWS, SS, and KS patients were 113, 88, and 51, respectively. We sent a secondary questionnaire to 31 institutions where patients with these syndromes presented with HH during infancy. The secondary questionnaires were returned from the institutions and the numbers of patients were 16 for BWS, 9 for SS, and 3 for KS, respectively. Then, we compared the clinical characteristics of infants suffering from transient HH with and without these dysmorphic syndromes. As a result, BWS, SS, and KS patients showed significantly larger body size, lower Apgar scores, higher insulin levels at HH, and shorter durations of HH than non-dysmorphic infants with transient HH. We propose that a careful observation for the signs of HH, even if not specific to the syndromes, is important for the diagnosis of patients with BWS, SS, and KS in the postnatal period. © 2016 Wiley Periodicals, Inc.

Diagnosis by Volatile Organic Compounds in Exhaled Breath from Lung Cancer Patients Using Support Vector Machine Algorithm.

Monitoring exhaled breath is a very attractive, noninvasive screening technique for early diagnosis of diseases, especially lung cancer. However, the technique provides insufficient accuracy because the exhaled air has many crucial volatile organic compounds (VOCs) at very low concentrations (ppb level). We analyzed the breath exhaled by lung cancer patients and healthy subjects (controls) using gas chromatography/mass spectrometry (GC/MS), and performed a subsequent statistical analysis to diagnose lung cancer based on the combination of multiple lung cancer-related VOCs. We detected 68 VOCs as marker species using GC/MS analysis. We reduced the number of VOCs and used support vector machine (SVM) algorithm to classify the samples. We observed that a combination of five VOCs (CHN, methanol, CH3CN, isoprene, 1-propanol) is sufficient for 89.0% screening accuracy, and hence, it can be used for the design and development of a desktop GC-sensor analysis system for lung cancer.

Cyclopiazonic acid biosynthesis gene cluster gene cpaM is required for speradine A biosynthesis.

Speradine A is a derivative of cyclopiazonic acid (CPA) found in culture of an Aspergillus tamarii isolate. Heterologous expression of a predicted methyltransferase gene, cpaM, in the cpa biosynthesis gene cluster of A. tamarii resulted in the speradine A production in a 2-oxoCPA producing A. oryzae strain, indicating cpaM is involved in the speradine A biosynthesis.

Sensing properties of Pd-loaded Co3O4 film for a ppb-level NO gas sensor.

We prepared 0.1 wt%-30 wt% Pd-loaded Co3O4 by a colloidal mixing method and investigated the sensing properties of a Pd-loaded Co3O4 sensor element, such as the sensor response, 90% response time, 90% recovery time, and signal-to-noise (S/N) ratio, toward low nitric oxide (NO) gas levels in the range from 50 to 200 parts per billion. The structural properties of the Pd-loaded Co3O4 powder were investigated using X-ray diffraction analysis and transmission electron microscopy. Pd in the powder existed as PdO. The sensor elements with 0.1 wt%-10 wt% Pd content have higher sensor properties than those without any Pd content. The response of the sensor element with a 30 wt% Pd content decreased markedly because of the aggregation and poor dispersibility of the PdO particles. High sensor response and S/N ratio toward the NO gas were achieved when a sensor element with 10 wt% Pd content was used.

[An Autopsy Case of Abnormal Behaviour Induced by Zolpidem].

Zolpidem is a widely used ultrashort-acting non-benzodiazepine in clinical practice; compared with benzodiazepines, it does not have side effects such as daytime hangover, rebound insomnia, and development of tolerance. We report an autopsy case of abnormal behaviour induced by zolpidem. A man in his 60's had suffered from postherpetic neuralgia about 2 months ago and had been prescribed zolpidem for insomnia. According to his family, he had no memory of his actions such as striking a wall, taking his futon outside, and eating 5 times a day after he took zolpidem. Because his postherpetic neuralgia did not improve, he was hospitalized and treated with an epidural block. During hospitalization, he took off his clothes, removed the epidural block catheter by himself, and slept on others' beds. He disappeared from the hospital one day; the next day, he was found dead in a narrow water storage tank 10 km away from the hospital. He was thought to have driven a car by himself to reach the place. Forensic autopsy revealed that the cause of death was drowning. Zolpidem and several other drugs were detected by toxicological analysis of his blood; the concentrations of these drugs were within therapeutic range. There are several reports about somnambulism induced by zolpidem such as sleepwalking, sleep driving, and eating. Considering the strange episodes following zolpidem administration, his behaviour on the day of his death was considered abnormal behaviour induced by zolpidem.

Japanese consumers' valuation of domestic beef after the Fukushima Daiichi Nuclear Power Plant accident.

After the radioactive contamination of agricultural and livestock products caused by the Fukushima Daiichi Nuclear Power Plant accident of March 11, 2011, consumer aversion against purchasing food products from the affected areas has become a major social problem in Japan. We examine how test results for radioactive materials in beef affect consumer valuation of beef produced in no-risk and affected areas using a choice experiment survey of consumers in the Tokyo metropolitan area (N = 392). Respondents were divided into two groups: one faced choice experiment tasks under the current test condition (the test status was only "under the limit"), and the other faced choice experiment tasks under the tightened test condition (with three levels: "below the limit," "below one-tenth of the limit," and "undetected"). We found that consumer valuation of "below the limit" beef in the affected area did not differ from that of "below one-tenth of the limit" beef in the affected area. Introducing the tightened status improved consumer valuations of all types of beef in the no-risk area regardless of the test status. However, consumer valuation of "undetected" beef in the affected area was lower than that in the no-risk area. The same measures need to be implemented with great care in both no-risk and affected areas. Otherwise, the effects of measures taken in the affected areas may be diluted.

Provisional resection of the nutrient artery in free anterolateral thigh flap debulking surgery.

Fix and flap surgery is the standard treatment for severe open-limb fractures. In cases of complex injuries, secondary surgeries such as additional osteosynthesis, implant removal, bone grafting, and debulking surgery may be required after the soft tissue condition has stabilized. During secondary surgery, if the nutrient vessels of the flap are resected haphazardly and an additional procedure is performed, flap necrosis may occur owing to insufficient blood flow. Creating a hemodynamic system that can withstand secondary surgery through increasing blood flow surrounding the flap is necessary in preventing necrosis. We report a case in which "provisional resection" of the nutrient artery was performed prior to the debulking surgery of a free anterolateral thigh flap. A 45-year-old man sustained an extensive degloving injury on the dorsum of the hand during a car accident. On the fifth day after injury, soft tissue reconstruction with a free anterolateral thigh flap was performed. Although the soft tissue condition was stable, debulking surgery was planned 4 months after the injury because of the thickness of the flap. Flap necrosis may occur if the nutrient artery was resected and debulking surgery was performed simultaneously. Therefore, staged surgery using "provisional resection" of the nutrient artery was selected. First, the nutrient artery was resected. After waiting for 1 week, skin graft removal and flap thinning were performed as the second step. No flap necrosis was observed. "Provisional resection" changes the hemodynamics of the flap to a random pattern due to the delay phenomenon and can prevent flap necrosis caused by secondary surgeries, such as debulking surgery.

Temporary Intravascular Shunting Using a Pruitt-F3 Carotid Shunt for Traumatic Popliteal Artery Injury.

Temporary intravascular shunting (TIVS) is an effective method to shorten the duration of ischemia and contribute to limb salvage in the treatment of popliteal artery injury (PAI). Traditionally used shunt tubes require ligation or clamping to the blood vessel, which has the disadvantage of causing secondary damage to the vessel. We present two cases in which TIVS was performed using the Pruitt-F3 Carotid Shunt (LeMaitre Vascular Inc., Burlington, Mass.) for traumatic PAI and report the effectiveness of the method. Two patients diagnosed with PAI had pallor of the feet and complete motor and sensory paralysis. The patients were immediately transferred to the operating room. PAI was confirmed in one patient by the medial approach and in the other by the posterior approach. In both patients, the vascular injury extended to the vicinity of the bifurcation into the anterior tibial artery. TIVS was performed using a 9Fr Pruitt-F3 Carotid Shunt. In both patients, the color tone of the feet improved. No vascular damage occurred secondary to TIVS. The popliteal artery was reconstructed using a great saphenous vein graft on the contralateral lower extremity, and the limb was salvaged. If the artery is injured near its bifurcation, it may be possible to preserve the branch vessel by using the Pruitt-F3 Carotid Shunt for TIVS.

Efficacy of Orthoplastic Management in the Treatment of Traumatic Popliteal Artery Injury.

Background: Popliteal artery injury (PAI) is a challenging condition. Even with appropriate initial treatment and reconstruction of the associated injuries, extensive soft-tissue necrosis may occur, requiring lower leg amputation. There are no reports on the effectiveness of orthoplastic surgery in treating traumatic PAI. However, orthoplastic surgery is also considered very effective in PAI treatment, which requires delicate handling of soft-tissue and blood vessels. This study aimed to examine the treatment outcomes of traumatic PAI at a trauma center with the capacity for orthoplastic management. Methods: Patients with PAI who were treated at our institution between August 2013 and December 2021 were included in this study. The surgeons included multiple orthoplastic surgeons with capabilities in vascular repair, bone and ligament reconstruction, and soft-tissue reconstruction. Patient demographics, injury characteristics, degree of ischemia, and treatment were investigated. We also investigated whether soft-tissue reconstruction and lower limb amputation were necessary as outcomes of treatment. Results: Fifteen limbs of 14 patients with PAI met the inclusion criteria. Extensive soft-tissue necrosis was observed in three limbs. Two of these limbs were covered with a free latissimus dorsi flap and could be salvaged. In the remaining limb, lower limb amputation was unavoidable because of unexplained cardiac arrest during the initial surgery, but a fillet flap was used to successfully preserve the knee joint. Conclusion: Orthoplastic management has the potential to improve limb salvage rates and provide good outcomes for the treatment of traumatic PAI.

A table-shaped tactile sensor for detecting triaxial force on the basis of strain distribution.

A slim and flexible tactile sensor applicable to the interaction of human and intelligent robots is presented. In particular, a simple sensing principle for decoupling of three-dimensional force is proposed. Sensitivity of the proposed tactile sensor is tested experimentally. To improve the sensitivity of the sensor, a table-shaped sensing element was designed. Table-shaped structure can convert an external acting force into concentrated internal stress. A "triaxial force decoupling algorithm" was developed by combining two-dimensional mapping data calculated by finite element analysis. The sensor was calibrated under normal and tangential forces. The external loads applied to the sensor could be decoupled independently as a function of the strain-gauge responses.

Traumatic popliteal artery spasm diagnosed using intraoperative angiography: A case report.

There are few reports of traumatic arterial spasm in large-sized vessels in the extremities, and many surgeons are skeptical of its existence. We report a case of traumatic popliteal artery injury (PAI), which was later diagnosed as traumatic popliteal artery spasm on intraoperative angiography. A male patient, aged 54 years, was injured when a heavy object weighing approximately 100 kg fell on his right knee. Three hours after the injury, the patient was transported to our trauma center. The dorsalis pedis and posterior tibial arteries were not palpable, and his right lower leg was cold. However, he could move his ankle and toes completely and had no numbness or paresthesia in his right lower limb. Computed tomography angiography showed an interruption of the popliteal artery at the knee joint level and an enhancement on the distal side of the injury site. We diagnosed lower limb ischemia resulting from PAI and operated for revascularization. Under general anesthesia, the popliteal artery was explored via a posterior S-shaped incision in the prone position. No arterial abnormalities were observed macroscopically, and the injured area remained unidentified. Therefore, a contrast medium was injected into the popliteal artery using a 20-gauge intravascular needle, and angiography was performed, which revealed that the popliteal artery was patent; however, there was circumferential arterial stenosis at the level of the knee joint. At this point, the right lower limb's coldness had disappeared. Arterial spasm was speculated to cause the transient popliteal occlusion and lower leg ischemia. Immediate revascularization should be attempted when PAI is suspected. If no gross vascular abnormalities are confirmed, intraoperative angiography is useful for diagnosing arterial spasm.

Distraction plating for bilaterally severely comminuted distal radius fracture: a case report.

We report a case in which distraction plating was performed for bilateral highly comminuted distal radius fractures. The upper extremities' range of motion and function was acceptable. Thus, distraction plating can be a good option for relatively young patients with severe comminution of the radius and soft tissue damage.

Transmission phase control by stacked metal-dielectric hole array with two-dimensional geometric design.

Transmission phase control is experimentally demonstrated using stacked metal-dielectric hole arrays with a two-dimensional geometric design. The transmission phase varies drastically with small frequency shifts due to structural resonances. Laterally propagating surface plasmon polaritons excited by the periodic hole array roughly determine the resonance frequency, whereas localized resonances in each hole determine the dispersion. The transmission phase at various frequencies is directly evaluated using interferometric microscopy, and the formation of an inclined wavefront is demonstrated using a beam steering element in which the hole shapes gradually change in-plane from square to circular.