Maximum flexion and lateral rollback revealed better patient satisfaction after total knee arthroplasty.

INTRODUCTION: Patient satisfaction is an important outcome of total knee arthroplasty (TKA). However, we cannot predict how and why patients are satisfied or dissatisfied with TKA. The hypothesis of this study was that patient-reported outcomes (PROs) correlate with in vivo kinematics after TKA. MATERIALS AND METHODS: One hundred knees were analyzed after TKA. The in vivo kinematics of deep knee bending motion were estimated from single-plane fluoroscopy using a two-to-three-dimensional registration technique. Active knee flexion, femoral rotation and rollback were evaluated. The PROs were obtained after surgery using the 2011 Knee Society Scoring System (KSS), and their relationship with in vivo kinematics was determined. RESULTS: The average minimum and maximum flexion were -2.4 ± 7.3° and 113.2 ± 13.6°, respectively. The average femoral rotation was 7.4 ± 3.4°, and the average medial and lateral rollback were 2.4 ± 4.8 mm and 7.2 ± 5.6 mm, respectively. The multiple regression analysis revealed that the maximum flexion angle significantly contributed to symptoms and satisfaction. In addition, lateral rollback was also a significant factor affecting patient satisfaction. Lateral rollback and lateral Anterior-Posterior (AP) position at maximum flexion were correlated with the maximum flexion angle, whereas femoral rotation did not correlate with flexion angles. CONCLUSIONS: Maximum flexion and lateral rollback are important for better patient satisfaction after TKA. To obtain the maximum flexion angle, it was necessary to perform the normal kinematic pattern with a large amount of lateral rollback.

The second offshore production of methane hydrate in the Nankai Trough and gas production behavior from a heterogeneous methane hydrate reservoir.

Following the first attempt at producing gas from a naturally occurring methane hydrate (MH) deposit in the Daini-Atsumi Knoll in the eastern Nankai Trough area off Honshu Island, Japan in 2013, a second attempt was made in April to June of 2017 at a nearby location using two producer wells sequentially and applying the depressurization method. The operation in the first borehole (AT1-P3) continued for 12 days with a stable drawdown of around 7.5 MPa and 41 000 m3 of methane gas being produced despite intermittent sand-production events. The operation of the other borehole (AT1-P2) followed, with a total of 24 days of flow and 222 500 m3 of methane gas being produced without sand problems. However, the degree of drawdown was limited to 5 MPa because of a higher water production rate than expected in the second hole. The pressure and temperature sensors deployed in the two producers, along with the two monitoring holes drilled nearby, gathered reservoir response data and information about the long-term MH dissociation processes in the vicinity of the production holes in the temporal and spatial domains. Although the ratio of energy return to the input was considerably larger than that for the depressurization operation, some observations (e.g., the high contrast in the production rates between the two holes and the almost constant or slightly reduced gas production rates) were not predicted by the numerical models. This failure in prediction raises questions about the veracity of the reservoir characteristics modeled in the numerical simulations. This paper presents the operation summaries and data obtained with thought-experiment based-anticipated production behaviors and preliminary analysis of the obtained data as the comparison with expected behaviors. Detailed observations of gas and water production, as well as the pressure and temperature data recorded during the gas flow tests, indicate that the heterogeneous MH distribution within the reservoir was mainly responsible for the discrepancies observed between the anticipated and actual behaviors. Furthermore, the motion of the water that does not originate from MH dissociation introduces complexity, such as the occurrence of concentrated water-producing intervals and unexpected gas production responses to decreases in pressure, into the production behavior. The influence of heterogeneity should be clearly understood for the accurate prediction of gas production behavior based on MH reservoirs.

Effectiveness and safety of a new regimen of polyethylene glycol plus ascorbic acid for same-day bowel cleansing in constipated patients.

BACKGROUND AND STUDY AIMS: In an exploratory study we compared a new regimen of low-volume polyethylene glycol plus ascorbic acid (PEG-Asc) with the standard regimen for same-day bowel cleansing in constipated patients. PATIENTS AND METHODS: Between January and June 2015 we studied consecutive patients with constipation (Rome III constipation criteria) scheduled for colonoscopy. The initial group received the standard regimen of PEG-Asc. The subsequent group received the new regimen. The new regimen involved ingestion of 10 mL of sodium picosulfate and 50g of magnesium citrate dissolved in 0.2 L of water followed by 0.2 L of PEG-Asc +0.2 L of water given 6 or 7 times over 3 hours. Bowel cleansing was prospectively evaluated using the Boston bowel preparation scale (BBPS). Bowel cleansing, adenoma detection rates and adverse events were reviewed using electronic medical records and endoscopic filing system. RESULTS: Sixty-two patients used the standard regimen and sixty used the new regimen. The basic characteristics of the two groups were similar. The mean volume of PEG-Asc and total liquid intake was less with the new regimen compared to the standard regimen (1.3 L vs. 2.0 L, P<0.001; 2.6 L vs. 3.0 L, P<0.001). The proportion of patients with a BBPS score ≥ 6 was significantly greater with the new than the standard regimen (93% vs. 76%, P=0.008). Nausea and/or vomiting was also significantly less frequent than with the standard regimen (5% vs. 16%, P=0.046). CONCLUSIONS: The new regimen of PEG-Asc gave improved same-day bowel cleansing for colonoscopy in constipated patients.

Fungal meningitis caused by Lomentospora prolificans after allogeneic hematopoietic stem cell transplantation.

Central nervous system lomentosporiosis is a rare pathological condition in immunocompromised patients. We describe a fatal case of meningitis caused by Lomentospora prolificans (which was previously named Scedosporium prolificans), after an allogeneic hematopoietic stem cell transplantation (allo-HSCT). To our knowledge, no cases of Lomentospora meningitis following allo-HSCT have been reported previously. Particularly in neutropenic patients, it is important to consider L. prolificans when a fungal infection is suspected and antifungal agents are ineffective.

Ozone microbubble treatment at various water temperatures for the removal of residual pesticides with negligible effects on the physical properties of lettuce and cherry tomatoes.

UNLABELLED: In this study, the effects of ozone microbubbles (OMCB) treatment at various water temperatures on the removal of residual fenitrothion (FT) pesticides and on the physical properties of lettuce and cherry tomatoes was examined. The residual FT percentage in lettuce and cherry tomatoes was shown decreased by using higher water temperatures, particularly at 30 °C, resulting in a decrease within the range of 32% to 52%, after the 20-min treatment. In addition, bubbling OMCB treatment did not alter the color and pulling strength of lettuce and cherry tomatoes. These results indicate that bubbling OMCB treatment at 30 °C is a highly effective method for the removal of FT residues in lettuce and cherry tomatoes, with relatively little effect on crop quality. PRACTICAL APPLICATION: The bubbling OMCB has a potential of reducing the FT reduces on vegetables with no adverse effect on the sensory quality of vegetables.

Removal of residual pesticides in vegetables using ozone microbubbles.

The removal of fenitrothion (FT) pesticide residues from vegetables by immersion in ozone-microbubbled solution was demonstrated. FT-treated lettuce, cherry tomatoes, and strawberries were immersed in ozone-microbubbled, ozone-millibubbled, and dechlorinated water. After that the percentage of residual FT in the vegetables was determined. Residual FT was efficiently removed from lettuce by immersing it in ozone-microbubbled solution containing more than 1.0 ppm dissolved ozone, or continuously generated ozone-microbubbled solution containing 2.0 ppm dissolved ozone. Similarly, for cherry tomatoes and strawberries, the continuously generated ozone-microbubbled solution containing 2.0 ppm dissolved ozone was highly effective. These results showed that ozone microbubbles effectively removed residual pesticides not only from leafy vegetables but also from fruity vegetables.

[Repeated catamenial pneumothorax with pleural and diaphragmatic endometriosis; report of a case].

A 31-year-old female with 2 episodes of right pneumothorax related to onset of menstruation was reported. Thoracoscopy revealed the presence of some cystic lesions in the diaphragm. Partial resection of the diaphragm including the lesions was performed. Histologial findings of the resected diaphragm showed stromal endometriosis. One month after operation, she had a recurrent right pneumothorax related to onset of menstruation. A pinhole perforation of the lower lobe was noted at 2nd surgery. Microscopic examination of the resected lung disclosed endometrial stroma in the macroscopically normal lung tissue. Since air leakage from chest tube continued after surgery, the hormonal therapy with a gonadotropin-releasing hormone analogue was started, and she was discharged from the hospital 3 weeks after hormonal therapy. Report of the demonstration of endmetriosis in the visceral pleura and diaphragm is very rare and the present case is very suggestive is considering the mechanism of the development of this disease.

[Giant left atrial myxoma with ossification on having a fever; report of a case].

A 37-year-old female with a fever had a medical examination, and was pointed out cardiac murmur. She was referred to our hospital for a further examination. Blood cultures were positive for Streptococcus milleri group. Thoracic echocardiogram demonstrated a giant left atrial tumor, arising from the portion of the interatrial septum, and mitral insufficiency. We removed the tumor completely and performed mitral annuloplasty. The tumor was diagnosed as myxoma with ossification by histopathological examination. She discharged from our hospital 25 days after the operation without complication and does not recur for 3 years. We consider our case as extremely rare, because it revealed giant left atrial myxoma with ossification and mitral insufficiency at the same time.

[Mediastinal lymph node carcinoma of unknown primary site; report of a case].

A 44-year-old woman was admitted to our hospital because of mediastinal mass. Serum levels of carcinoembryonic antigen (CEA) were found to be elevated. No preoperative examination could detect the primary lesion. The tumor was resected through right thoracotomy. Histological examination revealed poorly differentiated adenocarcinoma. She was diagonosed as metastatic mediastinal lymph node carcinoma of unknown primary site. She received radiotherapy and chemotherapy and is desease free 29 months after operation. Good results may be obtained by multimodality therapies for cancer in mediastinal lymph node of unknown primary site.

[Congenital chylothorax treated with video-assisted thoracic surgery].

A 35-day-old female was referred to our department because of congenital chylothorax. Medical treatment with dietary restriction was undertaken for 5 weeks without resolution of the effusion. A video-assisted thoracic surgery was performed. The mediastinal pleura was covered with fibrin glue. The postoperative course was satisfactory. She was discharged with resolution of the effusion. Video-assisted thoracic surgery offers an effective means of treating chylothorax.

Medical rehabilitation of the patients with spinal cord injury caused by aortic aneurysm and its operation.

OBJECTIVES: To determine the natural course of spinal cord injury (SCI) after aortic aneurysm surgery. SETTING: Acute care and semi-acute wards in Osaka Rosai Hospital, Japan. METHODS: From 1998 to 2003, 12 patients with thoracic SCI (eight men and four women; mean age: 69 years) were enrolled and evaluated by the American Spinal Injury Association (ASIA) impairment scale and Functional Independence Measure (FIM), and the results were analyzed. RESULTS: The level of SCI was distributed from T5 to L1. The ASIA impairment scale was A in four patients, B in four, C in three and D in one. Finally, six patients were discharged to home, and two patients died during hospitalization. Excluding the value of the deceased patients, the mean motor FIM was initially 32+/-15.6 (13-59) points and became 61+/-21.4 (29-88) points at discharge. Referencing the databases of SCI in Japan and USA revealed that the complication rates of pneumonia and aspiration were higher in our cases. The motor FIM before rehabilitation and at discharge were relatively lower than in the databases, but the gain and the rate of gain were similar to the Japanese database. CONCLUSION: SCI associated with aortic aneurysm surgery was noticed especially in the elderly patients using airways (for example, tracheostomy). The higher age and recurrent nerve palsy were associated with deconditioning state to develop aspiration pneumonia. This state impaired the general condition, and such vicious cycle led to poor prognosis and functional outcome.

Coil Embolization for Ruptured Cerebral Aneurysms of 2x3 mm Diameter.

SUMMARY: Small ruptured cerebral aneurysms, such as those of 2x3 mm diameter, are considered to be difficult to embolize by detachable coils because of the risk of procedural perforation of the aneurysms. We have treated these small aneurysms and report the techniques and pitfalls of these embolizations. Twenty-four patients with ruptured cerebral aneurysms of 2x3 mm diameter were intended for treatment by coil embolization. Before coil embolization, three-dimensional digital subtraction angiography was performed, and the simulation of the volume embolization ratio (VER) was performed in all patients, except for the first basilar artery aneurysm patient. The tip of the microcatheter was steam-shaped several times and was placed on the neck of the aneurysm. A balloon neck remodeling technique was used for two aneurysms. GDC 10 softs and soft SRs were used for the first ten aneurysms, and Ultrasofts were used for the last eleven aneurysms. Out of twentyfour aneurysm embolizations, we aborted the procedure in three cases, because of a failure in catheterization; we performed clipping surgery for these cases. For the first case of a basilar tip aneurysm, the aneurysm was perforated, due to the use of too long a coil and the insertion of the tip of the microcatheter into the aneurysmal dome. Minor infarction occurred in one patient. The mean VER was 33.9%, and two aneurysms recanalized, and out of these one needed a second embolization. Six months postoperatively, 81% of patients had made in a good recovery or had a moderate disability.We recommend the following techniques to embolize aneurysms of 2x3 mm diameter: the tip of the microcatheter should be stabilized on the aneurysmal neck by steam shaping of the microcatheter, GDC 10 soft and Ultrasoft should be selected for use, and the simulation of the VER should be performed before embolization to select coils of a suitable length.

Endovascular surgery as the first-choice treatment for ruptured cerebral aneurysms: how far has it come?

SUMMARY: One hundred and seventy patients with ruptured cerebral aneurysms were treated by coil embolization from September 1997 to December 2002. After January 2000, coil embolization was selected as the first-choice treatment for ruptured aneurysms. During this period, the authors investigated the number of aborted cases, the number of complications, and how many patients could be treated by coil embolization according to the locations of ruptured cerebral aneurysms. One hundred and ninety-five sessions were performed on 170 patients, and 13 sessions (6.7%) were aborted mainly because of the difficulty of the approach and the wide necks of the aneurysms. In four patients, although procedural perforation and haemorrhage occurred, the outcome was good or excellent. Eight poorgrade patients experienced haemorrhage after coil embolization and seven patients died. The volume embolization ratios of small and large aneurysms were 27% and 21%, and the recanalization of small and large aneurysms occurred in 9% and 38% of patients, respectively. From January 2000 to December 2002, 119 (66%) of 180 ruptured cerebral aneurysms were treated by coil embolization. According to the location of aneurysms, 89% vertebrobasilar, 87% anterior cerebral, 65% internal carotid and 24% middle cerebral artery aneurysms could be treated by coil embolization. Because the tight packing of large aneurysms was difficult, the recanalization rate of large aneurysms was high. However, the results of small aneurysms were satisfactory. Almost 90% of vertebrobasilar and anterior cerebral artery aneurysms could be treated by coil embolization.

[Subdiaphragmatic bronchogenic cyst in the left crus of diaphragm: report of a case].

A 39-year-old man who had a subdiaphragmatic bronchogenic cyst in the left crus of diaphragm received surgical treatment. The cyst was located in the retroperitoneum just below the diaphragm and was adhered to the left crus of diaphragm and unconnected with any other structures. The surgically resected cyst was 50 x 25 x 22 mm diameter and the wall was thin and contained white turbid mucus. Histologically, the cyst consisted of ciliated epithelium, mucus glands, smooth muscle, cartilage and this evidence established the final diagnosis of bronchogenic cyst. The post operative course was uneventful and the patient was discharged 10 days after operation. This is the 4th reported case of a subdiaphragmatic bronchogenic cyst in the Japanese literature.

[Three cases of emergency video-assisted thoracoscopic surgery for spontaneous hemopneumothorax].

We experienced 3 cases of video-assisted thoracoscopic surgery for spontaneous hemopneumothorax. All the patients had received emergent operations because of massive intrathoracic bleeding. At the operation, a 3 cm-minithoracotomy and 2 trocar ports were fashioned. In the head up position, massive blood clots in the apex in the thoracic cavity was removed by using grasping forceps and the source of bleeding point was detected easily. The bleeding was successfully stopped. It was difficult to remove massive blood clots from trocar port by suction, however it was easy to remove massive blood clots from a 3 cm-minithoracotomy window by using a large grasping forceps. Post operative course was satisfactory and the all patients discharged within 2 weeks after admission. We concluded that the spontaneous hemopneumothorax may be a good indication for video-assisted thoracoscopic surgery.

Fast, efficient and selective deprotection of the tert-butoxycarbonyl (Boc) group using HCl/dioxane (4 m).

Fast, efficient and selective deprotection of the tert-butoxycarbonyl (Boc) group of various amino acids and peptides was achieved by using hydrogen chloride (4 m) in anhydrous dioxane solution for 30 min at room temperature. In the cases studied in our laboratory, this protocol provided superior selectivity to deprotect Nalpha-Boc groups in the presence of tert-butyl esters and tert-butyl ethers, including thio-tert-butyl ethers, but not phenolic tert-butyl ethers.

[Clinical outcome of potassium-titanyl-phosphate (KTP/532) laser vaporization prostatectomy for benign prostate hyperplasia].

OBJECTIVE: To study the feasibility of vaporization prostatectomy by potassium-titanyl-phosphate (KTP/532) laser in men with bladder outlet obstruction due to benign prostatic hyperplasia (BPH) and to evaluate their clinical and voiding outcome 2 weeks and 6 months after operation. PATIENTS AND METHODS: Laser vaporization prostatectomy with the KTP/532 laser at 20 W was performed in 21 BPH patients varying from 56 to 75 years of age. All cases were performed under the spinal anesthesia. The laser was produced by MODEL SL20/50 and ADD/Stat side-firing fibers were used. A urethral catheter was inserted post-operatively and was removed within 6 days after operation. The hemoglobin value was examined on the first day after operation and uroflowmetry was executed 2 weeks and 6 months after operation with the examination of the residual urine volume. IPSS and QOL score were recorded by patients 2 weeks and 6 months after operation. RESULTS: The prostate volumes ranged from 22 to 52 mL (mean 37.3 +/- 10.4). None of the 21 patients had any significant blood loss or any fluid absorption. The voiding parameters improved: mean peak flow rate increased from 7.1 to 16.5 mL/s 2 weeks after operation and to 15.2 mL/s 6 months after operation and residual volume decreased from 172 to 45 mL 2 weeks after operation and to 43 mL 6 months after operation. IPSS and QOL score improved significantly in Wilcoxon signed-ranks test. The ratio of excellent and good in efficacy criteria of Kawabe group was 71.4% 2 weeks after operation and that was 71.4% 6 months after operation. Mean catheterization term was 4.5 days. Only one patient showed transient urinary retention when the catheter was removed the third postoperative day. None had incontinence postoperatively. No other significant complications were recognized. The prostate volume was more than 50 mL in 3 cases and the postoperative 6 months outcomes of the 3 cases were all poor in their symptoms in the efficacy criteria of Kawabe group. CONCLUSIONS: KTP laser vaporization prostatectomy is safe and effective for obstructive prostates up to 50 mL in volume and produces good results 2 weeks post operatively that are sustained for 6 months after operation.

Sensitization of human malignant glioma cell lines to tumor necrosis factor-induced apoptosis by cisplatin.

Most tumors, including gliomas, are resistant to tumor necrosis factor (TNF) cytotoxicity unless protein or RNA synthesis is inhibited. We investigated the effects of the combined use of TNF-alpha and cisplatin (CDDP) on cultured malignant glioma cells, T98G, U373MG, A172, and U87MG. All glioma cell lines were sensitive to treatment with CDDP but resistant to TNF-alpha during 24 h-incubation. The combined use of CDDP and TNF-alpha had synergistic effects on T98G and U87MG but not on U373MG and A172 cells. Sequential treatments showed that only pretreatment with CDDP for 2 h followed by TNF-alpha for 22 h was synergistic on cell cytotoxicity. Annexin V-flow cytometry and terminal deoxynucleotidyl transferase-mediated dUTP nick-end-labeling assay showed that TNF-alpha can induce apoptosis in cells treated with CDDP. Although only sensitive cell lines express transcripts for p75 TNF receptor 2, changes in TNF receptors were not found to contribute to the susceptibility to TNF-alpha. The production of interleukin-6, a representative cytoprotective cytokine, from glioma cells stimulated by TNF-alpha was suppressed by the combined use of actinomycin D, but not CDDP. Our results indicate that CDDP can sensitize glioma cells to TNF-alpha-induced apoptosis by a mechanism other than blocking the cytoprotective protein production.

Involvement of disregulated c-myc but not c-sis/PDGF in atypical and anaplastic meningiomas.

We investigated the expression of c-myc and c-sis/PDGF mRNA and protein products in 20 cases of meningiomas of various grades: 10 benign, 5 atypical and 5 anaplastic meningiomas. All cases of atypical and anaplastic meningiomas were positive for c-myc protein and mRNA by immunohistochemistry and in situ hybridisation, respectively, while all 10 benign meningiomas were negative for c-myc immunostaining, with only one benign tumour positive for c-myc mRNA. Expression of PDGF-BB protein and c-sis mRNA were seen in more than 80% of the meningioma cases and was not restricted to the histological grades of meningiomas. Semiquantitative analysis showed that the frequency of c-myc immunopositive cells positively correlated with Ki-67 proliferative indices. Our findings suggest that c-myc, but not c-sis/PDGF, has some concern to the malignancy of meningiomas.