A systematic review of diagnostic accuracy of vertebral fracture assessment (VFA) in postmenopausal women and elderly men.

UNLABELLED: This systematic review was performed to compare the diagnostic accuracy of vertebral fracture assessment (VFA) with that of spinal radiography for identification of vertebral fractures (VFs). VFA appeared to have moderate sensitivity and high specificity for detecting VFs when compared with spinal radiography. INTRODUCTION: VFs are recognized as the hallmark of osteoporosis, and a previous VF increases the risk of a future fracture. Therefore, the timely detection of VFs is important for prevention of further fractures. This systematic review examined the diagnostic accuracy of VFA using dual X-ray absorptiometry (DXA) to identify VFs. METHODS: We searched for potentially relevant studies using electronic databases, including Ovid-Medline, Ovid-EMBASE, Cochrane library, and four Korean databases, from their inception to May 2013. We compared the diagnostic accuracy of VFA with that of spinal radiography for detection of VFs by analyzing the sensitivity and specificity using a 2 × 2 contingency table. Subgroup analyses were also performed on studies with a low risk of bias and applicability. RESULTS: Twelve studies were analyzed for the diagnostic accuracy of VFA. The sensitivity and specificity were 0.70-0.93 and 0.95-1.00, respectively, analyzed on a per-vertebra basis, and 0.65-1.00 and 0.74-1.00 on a per-patient basis. The sensitivity and specificity of five studies in subgroups with a low risk of bias in the intervention test were 0.70-0.84 and 0.96-0.99, respectively. In studies with a low risk of bias in the patient selection, those based on a per-vertebra basis in three studies were 0.70-0.93 and 0.96-1.00, respectively. CONCLUSIONS: VFA had moderate sensitivity and high specificity for detecting VF when compared with spinal radiography. However, the present findings are insufficient to assess whether spinal radiography should be replaced by VFA.

Comparison of open and laparoscopic live donor left lateral sectionectomy.

BACKGROUND: The present study was undertaken to determine whether laparoscopic live donor left lateral sectionectomy (LLS) in paediatric liver transplantation is a feasible, safe and reproducible procedure, compared with open live donor left lateral sectionectomy (OLS). METHODS: A retrospective review was conducted of all consecutive live donor procedures for paediatric liver transplantation performed between May 2008 and October 2009. All live donor hepatectomies were carried out by a single surgeon. RESULTS: A total of 26 live donor procedures for paediatric liver transplantation were performed, of which 11 were LLS and 11 OLS; four left hepatectomies were excluded. The LLS group had a significantly shorter hospital stay (mean(s.d.) 6·9(0·3) versus 9·8(0·9) days; P = 0·001) and time to oral diet (2·1(0·3) versus 2·7(0·4) days; P = 0·012). Duration of operation, blood loss, warm ischaemia time and out-of-pocket medical costs were comparable between groups. There was no death in either donor group and only one complication, a wound seroma, in the OLS group. CONCLUSION: LLS seemed to be a safe, feasible and reproducible procedure, and was associated with reduced hospital stay.

Assessment of post-stroke extrapersonal neglect using a three-dimensional immersive virtual street crossing program.

OBJECTIVE: To investigate the potential of our newly developed three-dimensional immersive virtual reality (VR) program modeled on a real street crossing as an assessment tool for extrapersonal neglect in stroke patients. METHODS: Thirty-two patients with right-hemispheric stroke (neglect group, 16; non-neglect group, 16) were enrolled. The deviation angle, reaction time, left-to-right reaction time ratio, visual and auditory cue rates, and failure rate were evaluated during missions to keep a virtual avatar safe from a traffic accident in the VR program. The line bisection test and letter cancellation test were also evaluated. RESULTS: The deviation angle, left-to-right reaction time ratio, left visual and auditory cue rates and left failure rate in the VR program showed significant differences between the two groups (P < 0.05). Depending on the direction of approach of the virtual car, the left parameters were significantly higher than the right parameters in the neglect group (P < 0.05). In the neglect group, the line bisection test correlated significantly with the deviation angle (P < 0.05). None of the other virtual reality parameters significantly correlated with the paper and pencil tests. CONCLUSION: Post-stroke neglect in the extrapersonal space can be easily and safely detected and measured using our three-dimensional immersive virtual street crossing program.

Renal disease burden following liver transplantation.

UNLABELLED: Significant chronic kidney disease (CKD) occurs following orthotopic liver transplant (OLT). Since CKD is associated with increased cardiovascular events, mortality, and hepatic allograft dysfunction, early recognition of CKD and implementation of changes may improve the long-term outcome. The purpose of this study was to determine the burden of renal disease following OLT. PATIENTS AND METHODS: We retrospectively reviewed our OLT recipients from 1997 until 2004. We calculated glomerular filtration rates (GFR) using the Modification of Diet in Renal Disease study (MDRD) method. The GFRs were further subdivided into pre-MELD and post-MELD eras. RESULTS: During the study period, we performed 407 OLTs. We censored data from living donor liver transplants (n = 14), combined liver-kidney transplants (n = 12), and from patients whom we did not have complete data for 6 months after transplant (n = 40). Mean MELD score at the time of transplant was 18 +/- 7 (mean +/- standard deviation). The mean GFR at 6 months following OLT was 63.7 +/- 30.2 mL/min per 1.73 m(2). Only 14% (n = 47) of our patients had normal renal function at 6 months, while 78% (n = 266) of our patients had mild to moderate risk for renal failure. Eight percent (n = 28) had stage 4 or 5 CKD. There were no differences between the pre-MELD and post-MELD GFRs. CONCLUSIONS: The burden of renal disease is significant in our patient population at 6 months posttransplantation. It may be important to introduce CKD management as early as 6 months after transplant to impact the outcomes of OLT recipients.

Agricultural recycling of the by-product concentrate of livestock wastewater treatment plant processed with VSEP RO and bio-ceramic SBR.

One of the problems in a reverse osmosis process for livestock wastewater treatment is disposal of the by-product concentrate. The agricultural recycling of the concentrate is more cost saving than a further treatment. Application of the concentrate reduces the chemical fertilizer amendment. The agricultural recycling of the concentrate from the Kimhae livestock wastewater treatment plant, processed with the VSEP RO and bio-ceramic SBR, was studied. The concentrate includes non-biodegradable humic ubstance and residual inorganic ions (NH4+, NO3-, PO4(3-), K+, etc.). The contents of N, P and K were 1,650, 382 and 2,059 mg L(-1), respectively. The total acidity of humic acids extracted from the concentrate was 5.17 cmol(+) g(-1), composed of 2.38 cmol(+) g(-1) of carboxylic group and 2.79 cmol(+) g(-1) of phenolic hydroxyl group. Coliforms and E. coli were not detected in the concentrate. The yield of rice plant with the concentrate applied to it resulted in similar production to that with chemical fertilizer applied. The water extractable nitrate content of the concentrate-applied land did not exceed that of chemical fertilizer applied, at soil depths of 30 and 60 cm. The percolated amount of nitrate into the water table in arable land with the concentrate applied showed a similar level to that treated with the chemical fertilizer.

[Assessment of endoscopic embolization in the management of esophageal varices].

Between February 1984 and September 1987, endoscopic embolization (EE) was performed in 26 patients with esophageal varices. The effects of EE were evaluated with endoscopic findings according to the general rules for recording endoscopic findings on esophageal varices as specified by the Japanese Research Society for Portal Hypertension. 1) When the result was regarded as effective if a patient had Cw, F1, R-C sign (-), Li and Lm or disappearance of varices, the improvement was found in 66.7% for Color, 79.2% for R-C sign, 54.2% for Form and 45.8% for Location after EE. 2) Recurrence of varices was found in 50% of the patients (12/24) and 4 of 12 cases (33.3%) had rebleeding. 3) When the endoscopic findings before and after EE were compared between relapsed and unrelapsed cases, relapsed patients had more unfavorable endoscopic findings, furthermore, the extent of improvements was also worse than that of unrelapsed cases. 4) As complications, slight fever, dysphagia and epigastric pain were found in most cases, however, all were cured conservatively. In conclusion, EE is useful and safety tool for the improvement of endoscopic findings of the patients with esophageal varices.