Gluteal Compartment Syndrome After Femoral Nail Extraction: A Case Report.

Gluteal compartment syndrome is a rare disorder and no definitive treatment has yet been established. Fasciotomy is often the treatment of choice for gluteal compartment syndrome, but there have been only a few cases that have improved with conservative therapy. A 26-year-old male with a body mass index of 40.5 who underwent femoral nail extraction surgery had severe pain in the right buttock and numbness in the right lower extremity. Initially, we suspected transient pain due to prolonged exposure to the same posture, but muscle weakness in the lower extremities and worsening of renal function appeared over time. Orthopedic evaluation revealed physical examination findings and MRI imaging findings consistent with gluteal compartment syndrome. Conservative treatment with temporary dialysis was chosen instead of fasciotomy because of the time required for diagnosis. Dialysis was started on postoperative day 3, renal function and muscle weakness recovered over time, and the patient was discharged home on postoperative day 37. At six months post-op, the patient was walking without pain and he had no changes in his peripheral neurologic examination compared to his preoperative baseline. Orthopedic surgeons should always be aware of the possibility of gluteal compartment syndrome when especially obese patients with prolonged operation times appeal to acute buttock pain. Diagnosis should be made as early as possible to get a good prognosis.

Bisphosphonates Prescription for Patients With Hip Fractures Based on Evaluation by a Dentist.

Background The purpose of this study is to clarify the current status of the prescription of postoperative bisphosphonates for patients with hip fractures and to explore the factors that prevent the postoperative prescription of bisphosphonates. Methods Of 180 patients with hip fractures treated surgically at our hospital between August 2019 and April 2020, 149 patients (46 men and 103 women; mean age: 83.9 ± 9.0 years), excluding 31 patients already prescribed bisphosphonates or denosumab, were included in the study. All patients were treated based on our clinical pathway, and their risk of jaw osteonecrosis was evaluated prior to the initiation of bisphosphonates by a dentist in our hospital. We collected data from the medical records on osteoporosis treatment interventions at admission and discharge, the reasons why postoperative bisphosphonates could not be prescribed at discharge, the proportion of patients who had follow-ups at our hospital, and patients' osteoporosis treatment status. Results Eighteen (12.8%) and 95 (63.8%) patients were prescribed anti-osteoporosis drugs at admission and discharge, respectively. One hundred and twenty-one patients (86.8%) could not be prescribed postoperative bisphosphonates at discharge - 71 (58.7%) because of oral hygiene problems, 34 (28.1%) because they did not have regular dental consultations, seven (5.8%) because of renal dysfunction, eight (6.6%) because of poor cognitive and swallowing function, and one (0.8%) because of medication side effects. Forty-nine patients (32.9%) went to our hospital for follow-up and 11 were introduced to bisphosphonates or denosumab at follow-up. Conclusions The number of patients with hip fractures who were prescribed postoperative bisphosphonates was low in our study. The oral hygiene problems identified by dentists accounted for responsible for the low prescription rate of postoperative bisphosphonates. Therefore, coordination with dentists may be important to increase the postoperative bisphosphonate prescription.

Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful.

Introduction Posterior ring apophyseal fracture (PRAF) is characterized by the separation of bone fragments and sometimes coexists with lumbar disc herniation (LDH). However, how often these conditions coexist and the details of the clinical course remain unclear. Methods We analyzed 200 patients who underwent surgical treatment for LDH at our hospital from January 2016 to December 2020. Among these, we reviewed 21 patients who underwent microendoscopic surgery to treat PRAF. They consisted of 11 male and 10 female patients, ranging in age from 15 to 63 years. The average age was 32.8 months, and the average follow-up period was 39.8 years. We performed simple roentgenography and magnetic resonance imaging for all patients and computed tomography for about 80% of the patients. We evaluated the type of PRAF fragment (Takata classification), disease level, Japanese Orthopedic Association (JOA) score, Roland-Morris Disability Questionnaire (RDQ) score, operating time, intraoperative blood loss, and perioperative complications. Results A total of 10.5% of patients with LDH also had PRAF. The mean JOA score significantly improved from 10.6 ± 5.7 points before surgery to 21.4 ± 5.1 points at the final observation (p < 0.05). The mean RDQ score significantly improved from 17.1 ± 4.5 preoperatively to 5.5 ± 0.5 at the final observation (p < 0.05). The average operation time was 88.6 minutes. There were no complications requiring early surgery that were due to postoperative infection or epidural hematoma, but one patient required reoperation. Conclusion This study showed that PRAF coexisted with LDH in about 10% of cases, and the outcomes of surgical treatment were generally good. Computed tomography is recommended to improve the diagnostic rate and assist with surgical planning and intraoperative decision-making.

Efficacy of Corticosteroid Addition to a Periarticular Cocktail Injection to Counteract Nausea and Vomiting After Total Knee Arthroplasty.

BACKGROUND: Intraoperative periarticular injection of a "cocktail" of drugs is undertaken commonly in total knee arthroplasty (TKA). The addition of a corticosteroid to the periarticular injection is believed to offer greater pain relief because of its local anti-inflammatory effects, but the prevalence of postoperative nausea and vomiting (PONV) is not known. This retrospective observational study aimed to elucidate the relationship between corticosteroid addition to a periarticular cocktail injection (PCI) and PONV. MATERIALS AND METHODS: Fifty-nine patients who underwent unilateral TKA for primary osteoarthritis were divided into two groups: corticosteroid and non-corticosteroid. The former had triamcinolone acetonide (40 mg) added to the same PCI. The primary outcome was the prevalence of nausea and vomiting within 48 hours following TKA. RESULTS: There was no significant difference between the two groups in terms of patient demographics. The overall prevalence of PONV was 16.9%. Fewer patients in the corticosteroid group complained of PONV than in the non-corticosteroid group (6.4% vs. 58.3%; p = 0.012). CONCLUSIONS: The addition of a corticosteroid to a PCI suppressed PONV. Our results suggested that cocktail injections may have local and systemic effects.

Home-Made Membraneless Vaporization Gas-Liquid Separator for Colorimetric Determination of Ethanol in Alcoholic Beverages.

This work utilized the simplicity of a so-called membraneless vaporization (MBL-VP) unit as a gas separator for the colorimetric determination of ethanol in alcoholic beverages. A beverage sample with a volume of 1 mL was directly injected into a small container which was hung from a lid inside a closed 40 mL reused glass bottle without pretreatment such as distillation. An acidified potassium dichromate (Cr2O7 2-) acceptor solution, preadded to the glass bottle, was reduced to Chromium (III) ion by the diffusion of vaporized ethanol from the sample. After 5 min, the absorbing solution was collected for colorimetric detection at 590 nm. The unit manually quantifies ethanol in the range 1.0-90% (v/v) with satisfactory interday precision but without matrix effect (recovery 89-109%). The method was validated with the conventional distillation/pycnometer method which showed no significant difference of ethanol contents between those two methods and the declared values of 12 alcoholic beverages, indicating sufficient accuracy. Analyses of alcoholic beverages using this method were successful with benefits of simplicity, cheapness, and less energy consumption.

Synthesis of Forms of a Chiral Ruthenium Complex Containing a Ru-Colefin(sp2) Bond and Their Application to Catalytic Asymmetric Cyclopropanation Reactions.

Organometallic complexes [Ru-Colefin(sp2)-Ru(II)-Pheox 2a-2d] containing a Ru-Colefin(sp2) bond have been prepared from unsaturated chiral oxazoline derivatives and evaluated for asymmetric cyclopropanation reactions. The corresponding optically active cyclopropanes were obtained with high yields and high stereoselectivities (≥99/<1 trans/cis, 99% trans ee). The enantioselectivities were found to be affected by the geminal substituent on the Ru-C(sp2) bond. In particular, Ru(II)-Prox catalyst 2c, in which there was no geminal substituent on the metal, was shown to have the highest enantioselectivities.

Highly stereoselective intramolecular Buchner reaction of diazoacetamides catalyzed by a Ru(ii)-Pheox complex.

This work reports the first efficient enantioselective intramolecular Buchner reaction of diazoacetamides. The Ru(ii)-Pheox catalyst was shown to be highly efficient in this transformation in terms of both the regio- and enantioselectivity (up to 99% ee) giving the desired products in quantitative yield.

High spatial resolution pixel synthesis structure for full-complex amplitude modulation with twisted nematic LCD.

Various optics applications require a low-cost twisted nematic LCD that can modulate phase and amplitude independently. We propose a high spatial resolution light-synthesis structure that achieves full-complex amplitude modulation with a twisted nematic LCD. The synthesis structure uses two sparse lateral-shift pixel arrays for the x direction and four sparse lateral-shift pixel arrays for the y direction. The structure recreates an image with two superpixels formed from pairs of adjacent pixels in both directions, and as a result, the spatial resolution is only halved in both directions, which yields an appropriate image quality for the synthesis technique. In experiments, we demonstrate the precise control of amplitude and phase using a twisted nematic LCD.

Reusable and highly enantioselective water-soluble Ru(II)-Amm-Pheox catalyst for intramolecular cyclopropanation of diazo compounds.

A reusable and highly enantioselective catalyst for the intramolecular cyclopropanation of various diazo ester and Weinreb amide derivatives was developed. The reactions catalyzed by a water-soluble Ru(II)-Amm-Pheox catalyst proceeded smoothly at room temperature, affording the corresponding bicyclic cyclopropane ring-fused lactones and lactams in high yields (up to 99%) with excellent enantioselectivities (up to 99% ee). After screening of various catalysts, the Ru(II)-Amm-Pheox complex having an ammonium group proved to be crucial for the intramolecular cyclopropanation reaction in a water/ether biphasic medium. The water-soluble catalyst could be reused at least six times with little loss in yield and enantioselectivity.

Curing dynamics of photopolymers measured by single-shot heterodyne transient grating method.

The heterodyne transient grating (HD-TG) method was first applied to the curing dynamics measurement of photopolymers. The curing dynamics for various monomers including an initiator (2.5 vol%) was monitored optically via the refractive index change after a single UV pulse irradiation. We could obtain the polymerization time and the final change in the refractive index, and the parameters were correlated with the viscosity, molecular structure, and reaction sites. As the polymerization time was longer, the final refractive change was larger, and the polymerization time was explained in terms of the monomer properties.

The whole process of phase transition and relaxation of poly(N-isopropylacrylamide) aqueous solution.

We observed the whole dynamics from the phase transition to the molecular relaxation of a poly(N-isopropylacrylamide) (PNIPAM) aqueous solution using the heterodyne transient grating (HD-TG) method combined with the laser temperature-jump technique. The initial phase transition corresponding to coil to globule conformational transition occurred with a time constant of 96 ± 7 µs. Then, the globule molecules aggregated due to hydrophobic interaction, and the size of the aggregates increased sufficiently to scatter light (11 ± 1 ms) when the temperature achieved by heating was high enough to exceed the phase transition temperature. The aggregates loosened due to thermal diffusion with a time constant of 44 ± 5 ms. Even after that, the released globule molecules returned back to the coil state with a lifetime of 1.5-5 s, as we reported in a previous paper (H. Inoue et al., Phys. Chem. Chem. Phys., 2012, 14, 5620-5627).

Local extraction and condensation under a microscope using the optically controlled phase separation of a thermoresponsive polymer.

In-situ extraction and condensation of various dyes were carried out in a phase-separation region of a thermoresponsive polymer aqueous solution generated by near infrared (NIR) laser heating under a microscope. The NIR laser irradiation was directed at a chromium line deposited on a glass substrate, thereby causing local heating of the solution due to the photothermal effect. A phase-separation region was formed by dehydration of the thermoresponsive polymer followed by ejection of water outside of the phase-separation region. When various dyes were included in the solution, some dye molecules were extracted into the phase-separation region, where they condensed. In the case of poly(N-isopropylacrylamide) (PNIPAM, 10 wt% in an aqueous solution) as the thermoresponsive polymer and crystal violet (CV) as the dye (0.1 mM), CV condensed by about 25 times. It was found that one of the necessary conditions for the extraction/condensation is the hydrophobicity of the dye molecule; however, the dominant cause for accumulating inside the PNIPAM chain is the molecular interaction between the amide group in the side chain of PNIPAM and the functional groups such as carbonyl or amino groups in the dye molecules.

Prognostic impact of nestin expression in resected large cell neuroendocrine carcinoma of the lung.

BACKGROUND: Large cell neuroendocrine carcinoma (LCNEC) of the lung is categorized as a high-grade neuroendocrine carcinoma with an aggressive clinical behavior. Nestin is a class VI intermediate filament protein expressed in stem/progenitor cells during central nervous system development. Recently, we reported that nestin expression is a prognostic indicator of a poorer survival probability in patients with resected NSCLC. In the present study, we aimed to determine its prognostic significance concerning survival in patients with resected LCNEC. MATERIALS AND METHODS: Nestin expression in tumor cells was immunohistochemically studied in 30 patients with resected LCNEC, and its associations with clinicopathologic parameters including the Ki-67 labeling index (LI) and TTF-1 expression were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of nestin expression on survival. RESULTS: Nestin expression was observed in 8 of the 30 (26.7%) LCNECs. Clinicopathologically, although no significant association between nestin expression and age, gender, smoking habits, p-TNM stage, tumor size, nodal status, or TTF-1 expression was observed, nestin expression was significantly associated with a high Ki-67 LI (P=0.012). On survival analysis, nestin expression was significantly associated with a poorer prognosis in patients with LCNEC (P=0.016). The Cox proportional regression model confirmed that the crude hazard ratio (95%CI) of nestin expression was 3.40 (1.18-9.77). CONCLUSIONS: The present study suggests that nestin expression seems to be a prognostic indicator of a poorer survival probability in patients with resected LCNEC, although its prognostic significance still requires confirmation with larger patient populations.

Conformational relaxation dynamics of a poly(N-isopropylacrylamide) aqueous solution measured using the laser temperature jump transient grating method.

We observed phase transition and phase relaxation processes of a poly(N-isopropylacrylamide) (PNIPAM) aqueous solution using the heterodyne transient grating (HD-TG) method combined with the laser temperature jump technique. The sample temperature was instantaneously raised by about 1.0 K after irradiation of a pump pulse to crystal violet (CV) molecules for heating, and the phase transition was induced for the sample with an initial temperature just below the lower critical solution temperature (LCST); the following phase relaxation dynamics was observed. Turbidity relaxation was observed in both the turbidity and HD-TG responses, while another relaxation process was observed only in the HD-TG response, namely via the refractive index change. It is suggested that this response is due to formation of globule molecules or their assemblies since they would have nothing to do with turbidity change but would affect the refractive index, which is dependent on the molar volume of a chemical species. Furthermore, the grating spacing dependence of the HD-TG responses suggests that the response was caused by the counter propagating diffusion of the coil molecules as a reactant species and the globule molecules as a product species and the lifetime of the globule molecules ranged from 1.5 to 5 seconds. Thus, we conclude that the turbidity reflects the dynamics of aggregate conditions, not molecular conditions. The coil and globule sizes were estimated from the obtained diffusion coefficient. The sizes of the coil molecules did not change at the initial temperatures below the LCST but increased sharply as it approaches LCST. We propose that the coil-state molecules associate due to hydrophobic interaction when the initial temperature was higher than LCST minus 0.5 K and that the globule-state molecules generated from the coil-state molecules showed a similar trend in temperature. The phase transition was also induced by heating under a microscope, and the relaxation process was followed using the fluorescence peak shift of a fluorescent molecule-labeled PNIPAM. The result also supports the existence of a globule molecule or its assembly remains for several seconds in the phase relaxation.

Prognostic significance of nestin expression in resected non-small cell lung cancer.

BACKGROUND: Nestin is a class 6 intermediate filament protein expressed in stem/progenitor cells during CNS development. Nestin expression has been detected in many kinds of tumors and was reported in a recent small-scale study in non-small cell lung cancer (NSCLC). We investigated the relationships between nestin expression and clinicopathologic parameters and determined its prognostic significance concerning survival in patients with resected NSCLC. METHODS: Nestin expression in tumor cells was studied immunohistochemically in 171 consecutive patients with NSCLC, and associations with clinicopathologic parameters were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of nestin expression on survival. RESULTS: Nestin expression was observed in tumor cell samples in 27 of the 171 patients with NSCLC (15.8%). Nestin had only cytoplasmic expression. Clinicopathologically, nestin expression was significantly associated with squamous cell carcinoma (P = .001), poorer differentiation (P = .007), lymph node metastasis (P = .008), intratumoral vascular invasion (P = .003), intratumoral lymphatic invasion (P = .008), pleural invasion (P = .039), and poorer prognosis (P < .001). Multivariable analysis confirmed that nestin expression increased the hazard of death after adjusting for other clinicopathologic factors (hazard ratio, 2.75; 95% CI, 1.39-5.46). CONCLUSIONS: The present study suggests that nestin expression is a prognostic indicator of poorer survival probability for patients with resected NSCLC and may be used as a potential marker for select patients who should receive adjuvant chemotherapy.

Expression of Epstein-Barr virus-encoded small nuclear RNA 1 in Japanese nasopharyngeal carcinomas.

An examination was made of the incidence of the Epstein-Barr virus (EBV) genome and its exact localization in 39 cases of nasopharyngeal carcinoma (NPC) in Japanese patients by means of in situ hybridization (ISH) with a digoxigenin-labeled Epstein-Barr virus-encoded small nuclear RNA 1 (EBER1) oligonucleotide probe. Hybridization signals were observed in the nucleus of tumor cells in all 39 NPCs, including keratinizing carcinomas. The signals varied greatly in intensity from case to case and even from cell to cell in the same tumor, but were recognized in most tumor cells in each case. Signals could occasionally be seen in limiting number of infiltrating small lymphocytes but were absent in all tumors of the tongue, midpharynx and hypopharynx. Combined immunohistochemistry-ISH studies indicated that EBER1 signals were restricted to tumor cells positive for cytokeratin. As a result of this study, it is now possible to perform large-scale retrospective analyses using routine formalin-fixed, paraffin-embedded tissue sections and to combine ISH for the EBV genome with immunohistochemistry for cytokeratin to determine the epithelial features of EBV genome-possessing cells. All NPCs were clearly shown to be EBV-infected, thus indicating that EBV is essential for the oncogenesis of NPCs.