Evaluation of Skeletal Muscle Mass in Patients with Chronic Liver Disease Shows Different Results Based on Bioelectric Impedance Analysis and Computed Tomography.

OBJECTIVE: We aimed to evaluate the difference between computed tomography (CT)-based and bioelectrical impedance analysis (BIA)-based assessment of sarcopenia in patients with chronic liver disease (CLD). METHODS: We enrolled a total of 257 patients who were evaluated with or without sarcopenia. Sarcopenia was defined as a low skeletal muscle mass index (SMI) with low muscular strength by the Japan Society of Hepatology. To evaluate whether or not the different methods influence the diagnosis of sarcopenia for patients with CLD, we assessed the number and characteristics of mismatches between the low SMI using BIA and CT. We also compared the overall survival (OS) in patients with and without sarcopenia based on CT and BIA to evaluate the appropriate methods. RESULTS: The numbers of patients with low SMI using BIA or CT were 53 (20.6%) and 114 (44.3%) patients, respectively. Multivariate analysis revealed that hepatic ascites and body weight were independent factors of mismatch between SMI using BIA versus CT (hazard ratio [HR] 3.232, p < 0.001; HR 2.347, p = 0.005, respectively). The median OS in patients with sarcopenia based on CT was significantly lower than that in patients without sarcopenia (p = 0.006). In contrast, there was no difference between patients with sarcopenia based on BIA (p = 0.217). CONCLUSION: Muscle mass in patients with CLD may be overestimated by the BIA method compared to CT when assessing sarcopenia, especially in cases of fluid retention.

Prospective study for an independent predictor of prognosis in liver cirrhosis based on the new sarcopenia criteria produced by the Japan Society of Hepatology.

AIM: There are limited data from prospective studies showing the clinical usefulness of the new criteria for sarcopenia in liver disease produced by the Japan Society of Hepatology. Therefore, we aimed to evaluate the clinical usefulness of this new criteria for prognosis in cirrhotic patients. METHODS: This prospective study was performed at six centers. The 300 enrolled patients, aged more than 20 years with liver cirrhosis, were evaluated over a 3-year period for skeletal muscle mass index and grip strength. Sarcopenia was defined according to the Japan Society of Hepatology criteria by grip strength and computed tomography-based skeletal muscle mass index values. We investigated the correlation between sarcopenia and the survival rate of cirrhotic patients. RESULTS: Among the 300 assessed patients there were 99 (33%) patients with sarcopenia. The number of deaths in the sarcopenia and non-sarcopenia groups was 34 (34.3%) and 38 (18.9%), respectively (p = 0.002). Multivariate analysis confirmed that sarcopenia, decompensated phase, albumin-bilirubin grade, and hepatocellular carcinoma (HCC) stage 3/4 were independent factors correlated with death in patients with liver cirrhosis during the observation period. The interaction between sarcopenia and the presence of HCC was statistically significant (p < 0.001), and the presence of HCC had the highest hazard ratio of 6.665 for deaths in cirrhotic patients when non-sarcopenia and the absence of HCC were used as references. CONCLUSIONS: The new Japan Society of Hepatology criteria for sarcopenia are accurate predictors of poor prognosis in patients with liver cirrhosis.

Cervical Extradural Arteriovenous Fistula without Intradural Drainage Successfully Treated with Endovascular Treatment Using Both Transvenous and Transarterial Approach: Case Report and Review of Literatures.

The classification of spinal extradural arteriovenous fistulas (AVFs) was reported based on a case series treated by microsurgery in 2009 and endovascular interventions in 2011. The present report describes a patient with extradural AVFs at the cervical spine manifesting gradual progressive radiculomyelopathy of bilateral upper extremities. Magnetic resonance imaging (MRI) revealed a mass sign from C1 to C4 at the right ventral side and the spinal cord was deviated to the left and indicated as a flow void sign. Diagnostic angiography revealed an extradural AVFs located at the C1-C4 level that was supplied by bilateral radicular artery from the vertebral artery (VA) and right ascending cervical artery (ACA). The shunting points were recognized multiply at C2/3 and C3/4 levels on the right. The transvenous embolization to the enlarged extradural venous plexus around the shunting points via right hypoglossal canal and the transarterial embolization against multi-feeders of the branch of left radicular artery, right ACA achieved complete occlusion of the lesions. His symptom was gradually recovered, and angiography performed 2 weeks after embolization showed no recurrence. When the arteriovenous shunts in the upper cervical spine were high flow shunts, transvenous approach via the hypoglossal canal might be one option for the treatment of spinal extradural AVFs.

Full-Endoscopic Transcervical Ventral Decompression for Pathologies of Craniovertebral Junction: Case Series.

Odontoidectomy is very effective for the decompression of the ventral craniovertebral junction (CVJ). Various approaches are available for the direct ventral decompression of the CVJ. Because there are many disadvantages of open transoral approach, endoscopic odontoidectomy was developed. There are 3 approaches in endoscopic odontoidectomy. We report transcervical retropharyngeal endoscopic approach for the ventral CVJ in this paper. Three patients with different pathologies received operations using this approach. The decompression was enough and surgical invasion was less in all patients. Each endoscopic approach has some advantages and different working regions due to their approach trajectories, but transcervical retropharyngeal approach is very familiar for our neurospinal surgeons and has a relatively large working area. This approach might have the chance to take the place of open transoral approach for endoscopic spinal surgeons.

Clinical outcome and radiological findings after cervical open door laminoplasty with titanium basket.

OBJECT: Cervical laminoplasty, which is well described in the Japanese literature, is the gold standard for decompressing multilevel spinal cord compression. Several spacers have been introduced to provide enough decompression of the spinal canal and reconstruct the stable posterior elements. The purpose of this study was to retrospectively evaluate radiological outcomes after open door laminoplasty using the titanium spacer (Laminoplasty Basket: L-Basket; Ammtec, Tokyo). METHODS: Between July 2014 and June 2016, 31 patients with cervical spondylotic disease, including OPLL, were underwent open door laminoplasty with this device. All patients were clinically assessed by JOA score. The average follow-up period was 48.9 months with a range of 37-60 months. Postoperative radiological evaluation revealed bone union on both the open side and the gutter side from 12 months to 36 months after surgery on computed tomography. RESULTS: The clinical outcome improved from 10.9 points on the Japanese Orthopaedic Association scale to 15.8 points at 3 months after surgery and there were no significant major complications such as the implant failure. The bone union rate of the gutter side was 85.9% (85/99) at 1 year, 96.0% (95/99) at 3 years after surgery and of the open side was 57.6% (57/99) at 1 year, 89.9% (89/99) at 3 years after surgery. Circumferential fusion was confirmed 85.9% (85/99) of the time. CONCLUSION: This titanium spacer seemed to have the potential of promoting bone union between the spacer and both lamina, and lateral mass in cervical laminoplasty which is a safe procedure with satisfactory clinical results.

Initial radiological findings utilizing titanium basket for cervical open door laminoplasty.

BACKGROUND: Cervical laminoplasty, utilizing different spacers to ''keep the door open,'' is the gold standard in Japan for treating ossification of the posterior longitudinal ligament (OPLL) and cervical spondylotic myelopathy (CSM). Here, we utilized a novel titanium ''basket'' spacer (Laminoplasty Basket: L-Basket; Ammtec, Tokyo) to perform open door cervical laminoplasty to keep the "door open" while also allowing for bony fusion across the open door. METHODS: Twenty-seven patients with/without OPLL were treated with open door laminoplasty utilizing the basket spacer. Patients were analyzed with preoperative/postoperative JOA scores, and X-rays/computed tomography (CT) at least 12 months (range, 12-19 months) postoperatively. RESULTS: Improvement from the preoperative JOA score of 10.3 points to the postoperative JOA of 14.8 points was noted 3 months postoperatively. There were no complications except one patient who had transient C5 palsy. Twelve months postoperatively, X-rays/CT documented fusion on both the open (62%) and hinge sides (90.2%); circumferential fusion was observed 59.8% of the time. CONCLUSION: This titanium "basket" spacer (Laminoplasty Basket: L-Basket; Ammtec, Tokyo) promoted bone union between the spacer and both lamina, lateral masses following cervical laminoplasty without undue complications.

Effects of green-leafy vegetable intake on postprandial glycemic and lipidemic responses and α-tocopherol concentration in normal weight and obese men.

Vegetable consumption has been encouraged as a component of nutritional education for obese and insulin-resistant patients. However, the benefits of vegetable intake in a therapeutic diet on postprandial glycemic and lipidemic responses have not been clarified. We studied the effects of the intake of spinach, a green-leafy vegetable rich in dietary fiber and α-tocopherol, with a fat-rich meal on postprandial glycemic and lipidemic changes. Fourteen normal weight and 10 obese men consumed three test meals of bread, as a control, bread and butter, and bread and butter with boiled spinach. Blood samples were obtained prior to and 30, 60, 120, 180 and 240 min after consuming the test meals. Compared with the bread meal, consumption of the bread and butter meal showed a reduced peak glucose response at 30 min in normal (p<0.05) but not in obese subjects. The increase in triglyceride and decrease in LDL-cholesterol were greater after the butter-containing meal than after the bread meal (p<0.05). The α-tocopherol/lipid level decreased and remained low after the bread and butter meal, but the decrease was smaller with the spinach-containing meal in obese subjects (p<0.05). These results suggest that green-leafy vegetable intake with a fat-rich meal is effective for supplying postprandial α-tocopherol in obese subjects, but consumption of a regular-sized dish cannot be expected to improve abnormal postprandial hyperglycemic or hyperlipidemic responses.