MRI characteristics of disc degeneration after condoliase injection in young patients: A consecutive case series.

BACKGROUND: Lumbar disc herniation (LDH) results in low back pain due to nerve root compression caused by nucleus pulposus degeneration. Chemonucleolysis of the nucleus pulposus by injection of condoliase is less invasive than surgery, but may cause disc degeneration. The purpose of the study was to examine outcomes of condoliase injection in patients in their teens and twenties using Pfirrmann criteria on MRI. METHODS: A single-center retrospective study was performed in 26 consecutive patients (19 men, 7 women) who underwent condoliase injection (1 mL, 1.25 U/mL) for LDH and had MRI scans at 3 and 6 months. Cases with and without an increase in Pfirrmann grade at 3 months post-injection were included in groups D (disc degeneration, n = 16) and N (no degeneration, n = 10). Pain was measured on a visual analogue scale (VAS). MRI findings were evaluated using the % change in disc height index (ΔDHI). RESULTS: The mean age of the patients was 21.1 ± 4.1 years and 12 were <20 years old. At baseline, 4, 21 and 1 were in Pfirrmann grades II, III and IV. In group D, no case had a further increase in Pfirrmann grade from 3 to 6 months. Pain significantly decreased in both groups. There were no adverse events. MRI showed a significant decrease in ΔDHI from 100% pre-injection to 89.4 ± 9.7% at 3 months in all cases (p < 0.05). There was a significant recovery in ΔDHI in group D from 3 to 6 months (85.4 ± 9.3% vs. 86.7 ± 9.1%, p < 0.05). CONCLUSIONS: These results suggest that chemonucleolysis with condoliase is effective and safe for LDH in young patients. Progression of Pfirrmann criteria at 3 months post-injection occurred in 61.5% of cases, but disc degeneration showed recovery in these patients. A longer-term study of the clinical symptoms related to these changes is required.

Ambipolar to Unipolar Conversion in C70/Ferrocene Nanosheet Field-Effect Transistors.

Organic cocrystals, which are assembled by noncovalent intermolecular interactions, have garnered intense interest due to their remarkable chemicophysical properties and practical applications. One notable feature, namely, the charge transfer (CT) interactions within the cocrystals, not only facilitates the formation of an ordered supramolecular network but also endows them with desirable semiconductor characteristics. Here, we present the intriguing ambipolar CT properties exhibited by nanosheets composed of single cocrystals of C70/ferrocene (C70/Fc). When heated to 150 °C, the initially ambipolar monoclinic C70/Fc nanosheet-based field-effect transistors (FETs) were transformed into n-type face-centered cubic (fcc) C70 nanosheet-based FETs owing to the elimination of Fc. This thermally induced alteration in the crystal structure was accompanied by an irreversible switching of the semiconducting behavior of the device; thus, the device transitions from ambipolar to unipolar. Importantly, the C70/Fc nanosheet-based FETs were also found to be much more thermally stable than the previously reported C60/Fc nanosheet-based FETs. Furthermore, we conducted visible/near-infrared diffuse reflectance and photoemission yield spectroscopies to investigate the crucial role played by Fc in modulating the CT characteristics. This study provides valuable insights into the overall functionality of these nanosheet structures.

Impact of the COVID-19 Pandemic on Adherence to Denosumab Therapy: A Single Center Study.

STUDY DESIGN: A retrospective comparative study of denosumab therapy adherence before and during the coronavirus disease 2019 (COVID-19) pandemic. PURPOSE: To evaluate the effect of the COVID-19 pandemic on denosumab therapy adherence in Japan. OVERVIEW OF LITERATURE: Denosumab is a monoclonal antibody for osteoporosis treatment. Delayed denosumab injections are associated with reduced treatment responses, which was a concern during the COVID-19 pandemic. METHODS: Participants included 376 patients who received denosumab (60 mg every 6 months) from January 2013 to June 2021. The time from therapy initiation to discontinuation was used to measure persistence, and that between initial and subsequent injections was used to determine adherence. The pandemic period was from March 2020 to December 2021. RESULTS: Patients were divided into those treated after March 2020 (pandemic group, n=244) and those who discontinued treatment before March 2020 (non-pandemic group, n=132). Non-persistent cases accounted for 154, including 24 (20%), 64 (19%), and 66 (53%) aged ≤59 years, 60-79 years, and ≥80 years, respectively. The overall persistence rate at 78 months was 59.2%. Postponed cases were significantly lower in the non-pandemic group than in the pandemic group (8% vs. 15%, p =0.042). Postponement with a delay of 1-2 months did not significantly differ between the two groups, but with a significant difference for a delay of ≥3 months (0% vs. 36%, p =0.024). CONCLUSIONS: Denosumab adherence remained constant but postponed cases significantly increased during the COVID-19 pandemic. Better communication by health providers on denosumab adherence and alternative administration may reduce dosing interruptions in similar pandemic situations.

Retrospective multicenter (TRON group) study of humeral shaft fragility fractures: Analysis of mortality rates and risk factors.

AIMS: This study aimed to show the mortality rate following humeral shaft fragility fractures (HSFF) in the elderly. The secondary aim was to examine the predictors associated with mortality in elderly patients who have sustained HSFF. METHODS: From 2011 to 2020, all elderly patients aged 65 years and older with HSFF managed at our nine hospitals were retrospectively identified from our TRON database. Patient demographics and surgical characteristics were extracted from medical records and radiographs, and multivariable Cox regression analysis was used to identify factors affecting mortality. RESULTS: In total, 153 patients who sustained HSFF were included. The mortality rate for HSFF in the elderly was 15.7% at 1 year and 24.6% at 2 years. Multivariable Cox regression analysis showed significant differences in survival for the following variables: older age (p < 0.001), underweight (p = 0.022), severely ill (p = 0.025), mobility limited to indoors (p = 0.003), dominant-side injury (p = 0.027), and nonoperative treatment (p = 0.013). CONCLUSION: The outcome following HSFF in the elderly population appears to be relatively grim. The prognosis of elderly patients with HSFF is closely related to their medical history. In the elderly patients with HSFF, operative treatment should be positively considered while taking into account their medical status.

Changes in medical costs for adolescent idiopathic scoliosis over the past 15 years.

Use of instrumentation has become widespread in spinal surgery due to intraoperative spinal cord monitoring, navigation, and improvement and development of implant materials. However, recent advances in spine surgery may have also led to an increase in medical costs. The purpose of this study is to investigate the trends of operative resource utilization and the costs of surgery for adolescent idiopathic scoliosis (AIS) over 15 years. Surgery for AIS was performed for 118 patients from January 2004 to December 2019 at national University Hospital. Trends were examined through retrospective calculation of the costs for outpatient, inpatient, and surgical services, and changes over time and the characteristics of fees were examined. Differences between groups were analyzed by Mann-Whitney U test and Student t-test. During the 15-year period, the length of hospital stay decreased, but costs for scoliosis surgery increased by 1.6 times and the total cost increased by 1.3 times. The fee for intensive care per day per person increased by 1.5 times. There were slight increases in MRI and CT fees, but no changes in fees for radiography, rehabilitation, subsequent visits, and prescriptions. New charges for medical supervision, medical clerk support, medical safety measures, and prevention of infection were added at different times during the 15-year period. Itemized costs related to surgery have increased with technological advances. Although these results only show changes in costs for AIS surgery, the findings indicate the challenges faced by the healthcare economy and the need for spine surgeons to understand medical costs.

Early weight bearing and mobilization decrease perioperative complications in patients after ankle fracture; the retrospective multicenter (TRON group) study.

BACKGROUND: Open reduction and internal fixation (ORIF) for unstable ankle fractures (AF) are relatively predictable with excellent outcomes. Rehabilitation strategies are still being debated after surgical intervention for AF: non-weight bearing and cast immobilization for six weeks after the surgical repair of unstable AF or early functional treatment with partial weight bearing. This study aimed to compare early weight bearing and functional outcomes and complications. METHODS: Between April 2014 and March 2019, 1421 patients with AF underwent ORIF at 11 institutions (TRON group). The patients were divided into two groups: Group E started weight bearing within six weeks after surgery, and group L started weightbearing for more than six weeks after. To adjust for baseline difference between groups, a propensity score-matched algorithm was used to match Group E with Group L in a 1:1 ratio of 294 cases each. We compared the American Orthopedic Foot and Ankle Society (AOFAS) score as the functional outcome, the rate of wound dehiscence, superficial and deep infections, blistering, nonunion, neurapraxia, and reoperation at 3, 6, and 12 months after surgery. RESULTS: The mean period of non-weight bearing was significantly shorter in group E (3.68 ± 1.02 vs. 6.67 ± 1.43; P < 0.001). The mean period of cast immobilization term were shorter in group E (1.84 ± 1.35 vs. 2.65 ± 1.51; P < 0.001). There were no differences in the AOFAS score at any period. The rates of deep infection and reoperation in Group E were significantly lower than those in Group L (1.7% vs. 6.1%; P = 0.009, 2.0% vs. 7.8%; P = 0.002, respectively). There were no significant differences in superficial infection (9 vs. 15; P = 0.297), nonunion (9 vs. 15 P = 0.30), blistering (4 vs. 3; P = 1.00), neurapraxia (2 vs. 1; P = 1.00), and wound dehiscence (15 vs. 18; P = 0.72). CONCLUSIONS: Although functional outcome was similar depending on whether early weight bearing was allowed, the rates of deep infection and reoperation decreased in patients with early weight bearing. We recommend early postoperative weight bearing in patients with a surgically treated AF.

Factors associated with disc degeneration based on Pfirrmann criteria after condoliase treatment for lumbar disc herniation.

BACKGROUND: Lumbar disc herniation (LDH) is a common cause of low back pain and is associated with degeneration of the nucleus pulposus causing nerve root compression. Chemonucleolysis of the nucleus pulposus with condoliase is a low-invasive treatment for LDH. The purpose of this study was to investigate changes in Pfirrmann criteria, which are used to evaluate disc degeneration, after injection of condoliase into a herniated intervertebral disc, and to identify factors associated with disc degeneration at 3 months post-injection. METHODS: Medical records and radiographic findings were reviewed retrospectively for 127 patients with LDH (88 male, 39 female, mean age: 46.6 ± 17.1 years, mean follow-up: 9.8 ± 7.8 months) who underwent chemonucleolysis with intradiscal condoliase injection at our center since September 2018. Condoliase (1.25 U/mL; 1 mL volume) was injected toward the middle of the affected intervertebral nucleus pulposus using a 21-gauge disc-puncture needle. RESULTS: Cases in which the Pfirrmann grade did and did not progress in the 3 months after the injection were included in groups P (progression, n = 49) and NP (non-progression, n = 78), respectively. Logistic regression analysis of progression of Pfirrmann grade post-injection showed significant associations with age <40 years (p = 0.013, odds ratio (OR): 3.69, 95% confidence interval (CI): 1.32-10.31), Pfirrmann Grade II or III at baseline (p = 0.021, OR: 3.51, 95% CI: 1.24-9.64), and a high-intensity MRI signal in the herniation (p = 0.047, OR: 2.97, 95% CI: 1.03-8.87). Patients in group P had significantly higher rates of disc height decrease ≥20%, reduced herniated disc size, and improved VAS for pain, but both groups had significant decreases in pain. No cases had anaphylactic shock or neurologic sequelae. CONCLUSIONS: These results show the safety and efficacy of chemonucleolysis with condoliase for treatment of painful LDH. Progression of Pfirrmann criteria on MRI at 3 months after injection was significantly associated with an improved clinical outcome.

Do heel-unloading orthoses improve clinical outcomes in patients after surgical treatment of calcaneal fracture? A propensity-matched, multicenter analysis of the TRON database.

BACKGROUND: Postoperative protocols after surgical treatment of calcaneal fracture have not been standardized to date. There are only a few reports on the efficacy of heel-unloading orthoses (HUOs; Mars shoe, Graffin orthosis), and thier efficacy is uncertain. OBJECTIVES: The purpose of this study was to compare postoperative radiologic and clinical outcomes in patients with calcaneal fractures who used Graffin orthosis. STUDY DESIGN: Multicenter retrospective study. METHODS: We finally extracted 182 patients from a database of the Trauma Research Group of Nagoya and divided them into two groups: group C (underwent casting or splinting only) and group O (Graffin orthosis was used). A propensity score algorithm was used to match group C to group O in a 1:1 ratio. We evaluated American Orthopaedic Foot and Ankle Society (AOFAS) score at three and six months after surgery and at final follow-up. Differences in reduction of the Böhler angle between the two groups were evaluated radiographically. All data were analyzed with a t-test or Fisher's exact test. P < .05 was considered statistically significant. RESULTS: The AOFAS score 3 months after surgery in group O was significantly higher than that in group C (69.57 vs. 77.22; P = .004). However, there were no statistically significant differences between group C vs. group O in AOFAS scores at 6 months after surgery and at final follow-up (81.92 vs. 85.67 and 89.18 vs. 88.13; P = .087 and 0.597, respectively). There was no significant statistical difference in the reduction of the Böhler angle (5.07 vs. 5.89; P = .529). CONCLUSIONS: At 3 months postoperatively, the orthosis group showed predominantly better functional results. We believe that heel-unloading orthoses are useful for patients who require an early return to work and to daily life.

Risk factors for subchondral insufficiency fracture of the femoral head in renal transplant patients.

INTRODUCTION: Risk factors associated with subchondral insufficiency fracture (SIF) of the femoral head have not been established. The aim of the present study was to determine the incidence and risk factors for SIF of the femoral head following renal transplantation (RT). MATERIALS AND METHODS: We analyzed the cases of 681 RT patients (mean age at surgery: 49.5 ± 13.6 years, 249 women, 432 men) to determine the incidence of SIF. Hip magnetic resonance imaging (MRI) was performed 6 months post-RT. The following potential predictors of SIF were evaluated: (1) patient's condition at RT: bone mineral density (BMD), pre-RT laboratory values including calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca × P), and intact parathyroid hormone; the patient and donor's blood relationship; and mismatching number of human leukocyte antigens (HLAs), and (2) post-RT dosage(s) of steroid(s), the immunosuppressive regimen, and the incidence of acute rejection. RESULTS: SIF was observed in 15 hips (13 patients, 1.9%). We successfully matched 39 patients without SIF. A multivariate logistic regression analysis adjusted for cumulative dosages of steroids, revealed the following were risk factors for SIF: osteoporosis (OR: 11.4, p = 0.046), lumbar BMD (OR: 0.003, p = 0.038), pre-RT serum P (OR 2.68, p = 0.004), and pre-RT serum Ca × P (OR: 1.11, p = 0.005). CONCLUSION: Since osteoporosis, the lumbar BMD, serum P, and serum Ca × P were identified as risk factors for a post-RT SIF, these factors should be evaluated before RT for the prediction of the SIF risk.

Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study.

PURPOSE: Fragility fractures of the pelvis (FFP) are becoming a commonly encountered disease in aging societies. We aimed to (1) clarify the overall survival rate of FFP, (2) compare survival rates by Rommens and Hofmann classification FFP type, (3) investigate the complications during hospitalization, and (4) investigate walking ability before and after injury depending on the type of fracture in patients with FFP treated conservatively. METHODS: This retrospective, multicenter study included 867 patients with FFP treated conservatively between 2014 and 2018 and excluded patients with insufficient follow-up for two years, lost data, and operative cases. This is a retrospective multicenter study. We established the database, which is named as TRON. We evaluated survival rate by fracture type using the log-rank test. We compared walking ability as defined by a new mobility score and the modified Majeed Pelvic Score among fracture types. RESULTS: We reviewed 552 cases (98 males and 454 females) with conservative treatment. The overall survival rates of patients with FFP treated conservatively were 0.90 at 1 year and 0.83 at 2 years. Although the survival rate was the lowest in FFP Type III, there was no significant difference in survival rates between fracture types (P = 0.143). The rates of complications during hospitalization were high for both Type III and Type IV fractures. Walking ability post-injury was worse in the patients with Type III fracture. CONCLUSIONS: The survival rate of patients treated by conservative treatment was relatively good. Type III in the Rommens and Hofmann classification was related to lower life expectancy and loss of walking ability.

Platinum nanocluster catalysts supported on Marimo carbon via scalable dry deposition synthesis.

The development of efficient fuel cells greatly promotes reducing the consumption of fossil energy, and it is crucial to enhance the platinum (Pt) catalytic activity by optimizing both the nanoparticle size and support effect. In this study, we generate a smaller and uniform size of naked Pt nanocluster (NC) catalysts via a dry process in the gas phase, and using the direct powder embedded trapping method, the Pt NCs are spatioselectively supported on Marimo carbon (MC) that comprises a high density of carbon nanofilaments. At a minimum Pt loading of 0.05 mgPt cm-2 for both the anode and cathode in a single cell configuration, a membrane-electrode assembly (MEA) formed by the dry-deposition Pt-NC(d)/MC exhibits superior power density (rated) of 0.105 gPt kW-1 at a current density of 1.2 A cm-2, which is better output power density than the conventional MEA formed by Pt catalysts via a wet process. The origin of the improved performance is investigated using transmission electron microscopy; dry-deposition Pt catalysts that are monodispersely loaded on the outer surface of MC can facilitate not only the gas reaction but also leaving the generated water. The present results demonstrate that the dry deposition of Pt NCs on MC can be used as a scalable catalyst synthesis method to reduce the Pt loading.

Preventive Effects of Continuous Betaine Intake on Cognitive Impairment and Aberrant Gene Expression in Hippocampus of 3xTg Mouse Model of Alzheimer's Disease.

BACKGROUND: The deposition of amyloid-ß (Aß) and hyperphosphorylation of tau are well-known as the pathophysiological features of Alzheimer's disease (AD), leading to oxidative stress and synaptic deficits followed by cognitive symptoms. We already demonstrated that betaine (glycine betaine) prevented cognitive impairment and hippocampal oxidative stress in mice intracerebroventricularly injected with an active fragment of Aß, whereas the effect of betaine in chronic models of AD remains unknown. OBJECTIVE: Our objective was to investigate the effects of chronic betaine intake on cognitive impairment and aberrant expression of genes involved in synapse and antioxidant activity in the hippocampus of a genetic AD model. METHODS: We performed cognitive tests and RT-PCR in the hippocampus in 3xTg mice, a genetic AD model. RESULTS: Cognitive impairment in the Y-maze and novel object recognition tests became evident in 3xTg mice at 9 months old, and not earlier, indicating that cognitive impairment in 3xTg mice developed age-dependently. To examine the preventive effect of betaine on such cognitive impairment, 3xTg mice were fed betaine-containing water for 3 months from 6 to 9 months old, and subsequently subjected to behavioral tests, in which betaine intake prevented the development of cognitive impairment in 3xTg mice. Additionally, the expression levels of genes involved in synapse and antioxidant activity were downregulated in hippocampus of 3xTg mice at 9 months old compared with age-matched wild-type mice, which were suppressed by betaine intake. CONCLUSION: Betaine may be applicable as an agent preventing the progression of AD by improving the synaptic structure/function and/or antioxidant activity.

Incidence and risk factors for osteonecrosis of the hip in renal transplant patients: a prospective single-centre study.

BACKGROUND: There is a lack of evidence about the risk factors associated with osteonecrosis of the femoral head (ONFH). PURPOSES: To determine the incidence and risk factors for ONFH following renal transplantation (RT). METHODS: In total, data of 681 RT patients (mean age at surgery, 49.5 ± 13.6 years; 249 women and 432 men) were evaluated to determine the incidence of ONFH. Hip magnetic resonance imaging (MRI) was performed six months after RT. The following potential predictors of ONFH were evaluated: (1) patient's condition at RT; laboratory test results including calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca × P), and intact parathyroid hormone before RT; blood relationship between the patient and donor; and mismatching number of human leukocyte antigens (HLAs), especially HLA class I and class II and (2) dosages of steroids after RT, immunosuppressive regimen, and incidence of acute rejection. RESULTS: ONFH was observed in 30 hips (21 cases, 3.1%). We successfully matched 63 patients without ONFH. Multivariate logistic regression analysis, adjusted for cumulative dosages of steroids, revealed that mismatching number of HLA (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.10-2.36; p = 0.014), HLA class II (HR, 3.73; 95% CI, 1.46-9.56; p = 0.001), P before RT (HR, 1.62; 95% CI, 1.02-2.58; p = 0.041), and Ca × P  before RT (HR, 1.06; 95% CI, 1.01-1.11; p = 0.024) were risk factors for ONFH. CONCLUSION: A greater number of HLA mismatches, HLA class II, serum P, and serum Ca × P were risk factors for ONFH after RT. Therefore, these factors should be evaluated in order to predict ONFH after RT.

Structural changes of layered alkylsiloxanes during the reversible melting-solidification process.

Through various in situ analyses, we have revealed the structural changes that occur during the reversible melting-solidification process of layered alkylsiloxanes (CnLSiloxanes) with carbon numbers (n) of 18 and 16. In situ high-resolution solid-state (13)C nuclear magnetic resonance (NMR) analysis at controlled temperatures indicates drastic conformational changes of the long alkyl chains during the melting-solidification process. A (13)C NMR signal at 33 ppm, which shows the highest intensity at room temperature (RT), is assigned to an inner methylene group with an all-trans conformation. As the temperature increases, the 33-ppm signal intensity decreases while the signal intensity at 30.5 ppm simultaneously increases. The 30.5 ppm signal is assigned to an inner methylene group with a trans-gauche conformation. Subsequently, upon cooling, the signal at 33 ppm recovers, even after CnLSiloxanes have melted. In situ X-ray diffraction measurements at controlled temperatures reveal that the ordered arrangement of the long alkyl chains becomes disordered with elevating temperatures and reordered upon cooling to RT. In situ high-resolution solid-state (29)Si NMR analysis shows that the melting-solidification process progresses without any structural change in siloxane sheets of the CnLSiloxanes. Thus, the in situ analyses show that disordering of the long alkyl chains causes the CnLSiloxanes to melt. Because the majority of long alkyl chains are packed again in the ordered arrangement with the all-trans conformation upon cooling, the CnLSiloxanes are reversibly solidified and the CnLSiloxane structure is recovered.

Comparison of the percutaneous screw placement precision of isocentric C-arm 3-dimensional fluoroscopy-navigated pedicle screw implantation and conventional fluoroscopy method with minimally invasive surgery.

STUDY DESIGN: Retrospective clinical study to compare the percutaneous screw placement precision of isocentric C-arm (Iso-C) 3-dimensional fluoroscopy-navigated pedicle screw implantation and conventional fluoroscopy. OBJECTIVE: The purpose of this study was to evaluate the accuracy of clinical percutaneous pedicle screw placement (PPSP) using Iso-C 3-dimensional fluoroscopy navigation. SUMMARY OF BACKGROUND DATA: The technique of PPSP recently has been applied to internal fixation for segmental lumbar instability as a form of minimally invasive spine surgery. The percutaneous insertion technique requires surgical skill and experience. The 3-dimensional fluoroscopy-based image-guidance navigation system has been proven to be effective in guiding accurate PPSP in the lumbar area of cadavers. However, there have been few clinical reports comparing the accuracy of Iso-C 3-dimensional fluoroscopy-navigated pedicle screw implantation and the conventional fluoroscopy method. METHODS: Here, 300 percutaneous pedicle screws were evaluated; half of them were inserted under Iso-C 3-dimensional navigation and the others under fluoroscopy. The accuracy of pedicle screw placement was examined postoperatively using an axial 2-mm slice computed tomography. Screw malpositioning was classified either as exposed screw (<50% of the screw outside the pedicle) or perforated pedicle (>50% of the screw outside the pedicle boundaries). RESULTS: Of the 150 pedicle screws placed with Iso-C 3-dimensional fluoroscopy-based image-guide assistance, 11 (7.3%) were classified as exposed screws and 0 (0%) as perforated pedicle. Of the 150 pedicle screws inserted under fluoroscopy, 18 (12%) were classified as exposed screw and 5 (3.3%) as perforated pedicle. The difference in frequency of screw misplacement between the procedure using Iso-C 3-dimensional fluoroscopy-based image-guide assistance and that using fluoroscopy was statistically significant (P<0.05; chi test). CONCLUSIONS: This study demonstrates the feasibility of placing percutaneous posterior lumbar pedicle screws with the assistance of Iso-C 3-dimensional navigation.

Anesthesia for pancreatoduodenectomy in a patient with history of coronary artery bypass graft surgery: determination of optimal surgical management by the graft clamping test.

We report a case of a 72-year-old man undergoing pancreatoduodenectomy, who had a history of coronary artery bypass graft surgery using the right gastroepiploic artery. We intraoperatively used the graft clamping test, which was assessed via electrocardiography and transesophageal echocardiography, to verify patency of the right gastroepiploic artery graft. Because the graft clamping test was positive, first, we interposed the saphenous vein graft between the splenic artery and right coronary artery. The abdominal surgery was then successfully performed without any cardiac complications. In such a complicated case, anesthesiologists who are responsible for assessment of the graft clamping test play a crucial role in determining the optimal surgical procedure.

Polymorphisms of the factor VII gene associated with the low activities of vitamin K-dependent coagulation factors in one-month-old infants.

Despite administration of vitamin K (VK), some infants show lower activity of VK-dependent coagulation factors and they could develop intracranial hemorrhage. For preventing VK deficiency bleeding (VKDB) in infants, oral administration of VK and a screening test for VK deficiency are carried out in Japan. For the screening, the total activity of VK-dependent coagulation factors is measured using a commercial product, Normotest. This study was undertaken to clarify the importance of the following genetic and environmental factors on the coagulation status in one-month-old infants: two polymorphisms in the factor VII gene, -323P0/10 (a 10-bp insertion in the promoter region at position -323) and R353Q (the replacement of arginine [R] with glutamine [Q] at residue 353) and sex, age, gestational age, birth weight, and feeding regimen. Two hundred Japanese infants (34.6 +/- 4.0 days old) were screened for VK-dependent coagulation activity with Normotest and were genotyped for the two polymorphisms. Among the subjects screened, 18 infants (9%) carried the P10 allele and 26 (13%) carried the R353Q allele. Multiple regression analysis showed that the 10-bp inserted (P10) allele or the Q allele was associated with the lower coagulation activities. The coagulation activities for the R/Q genotype were significantly lower than those for the R/R genotype and those for the P0/P10 genotype were significantly lower than those for the P0/P0 genotype. Therefore, infants who carry the P10 allele or the Q allele show lower activity of VK-dependent coagulation factors. These infants may have a higher risk of VKDB manifestation.

Structure and electrochemical properties of carbon films prepared by a electron cyclotron resonance sputtering method.

This paper describes the characterization, electrochemical properties, and applications of carbon films prepared by the electron cyclotron resonance (ECR) sputtering method. The ECR-sputtered carbon film was deposited within several minutes at room temperature. The optimized sputtering conditions significantly change the film structure, which includes many more sp3 bonds (sp3/sp2 = 0.702) than previously reported film (sp3/sp2 = 0.274)1 with an extremely flat surface (0.7 A). The ECR-sputtered carbon films exhibit excellent electrochemical properties. For example, they have nearly the same potential window in the positive direction as that of high-quality, boron-doped diamond (moderately doped, 10(19)-10(20) boron atoms/cm3)2 and an even wider potential window in the negative direction with a low background current, high stability, and suppression of fouling by electroactive species without pretreatment. The electron-transfer rates at ECR-sputtered carbon films are similar to those of glassy carbon (GC) for Ru(NH3)(6)(2+)/(3+) and Fe(CN)(6)(3-)/(4-), whereas they are much slower than those of GC for Fe2+/3+, dopamine oxidation, and O2 reduction due to weak interactions between electroactive species and the ECR-sputtered carbon film surface. Such a response can be attributed to the ultraflat surface and low surface O/C ratios of ECR-sputtered carbon films. ECR-sputtered carbon film is advantageous for measuring biochemicals with high oxidation potentials because of its wide potential window and high stability. Highly reproducible and well-defined cyclic voltammograms were obtained for histamine and azide ions with a peak potential at 1.25 and 1.12 V vs Ag/AgCl, respectively. The film is very stable for continuous voltammetry measurements in 10 microM bisphenol A, which usually fouls the electrode surface with oxidation products.

Prevalence of hepatitis E virus infection in Japanese children.

BACKGROUND: Recently, sporadic cases of acute hepatitis and fulminant hepatitis caused by hepatitis E virus (HEV) have been reported in Japan. However, few reports have addressed the issue of HEV infection during childhood. METHODS: This study included 5 patients with fulminant hepatitis, 30 patients with acute hepatitis, and 309 patients without history of hepatic dysfunction or hepatitis in childhood as control. RNA was extracted from each serum sample, and HEV specific reverse-transcriptase polymerase chain reaction was performed. Anti-HEV immunoglobulin (Ig)M and IgG were measured by enzyme-linked immunoadsorbent assay. RESULTS: HEV RNA, anti-HEV IgM, and anti-HEV IgG were not detected in the sera of any of the five patients with fulminant hepatitis. In the 30 patients with acute hepatitis, only one (3.3%) was positive for anti-HEV IgG, and all were negative for anti-HEV IgM and HEV RNA. Of the 309 control patients, 8 (2.6%) were positive for anti-HEV IgG, and 2 (0.6%) were positive for anti-HEV IgM, respectively. CONCLUSION: The result of patients with fulminant hepatitis suggests that HEV is an unlikely cause of fulminant hepatitis in children. However, the detection rate of anti-HEV IgG shows that a history of HEV infection is not so rare among children in Japan.

[Anesthetic management for a patient of myotonic dystrophy with pheochromocytoma].

We experienced an anesthetic management for a patient of myotonic dystrophy with pheochromocytoma. Much attention is required to manage myotonic dystrophy on surgical manipulation. This disease interacts with anesthetic drugs. It may cause prolongation of drug action used during anesthesia compared with the usual case. It also may cause dangerous interactions such as severe arrhythmia and malignant hyperthermia. That is why we were faced with serious limitation in choosing anesthetic and adjuvant drugs. At the same time, the case of pheochromocytoma must be handled with scrupulous care. Pheochromocytoma causes severe hypertension and sometimes tachycardia leading to intracranial hemorrhage or adrenaline-induced severe hypovolemia. Besides, laparoscopic operation was scheduled to resect the pheochromocytoma. This operation demanded the anesthetic management with artificial ventilation. It must be difficult to cope with these conditions by limited number of drugs. This time, we managed this case by epidural anesthesia with propofol and nitrous oxide without opioid and muscular relaxant. Though, this patient was not fully awake from anesthesia and could not take enough breaths on his own. We extended the period of spontaneous breathing with careful check whether the patient has resumed spontaneous breathing. It took us fourteen days till extubation.