Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study

[Study Design] Multicenter, prospective study. [Purpose] To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. [Overview of Literature] To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. [Methods] The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. [Results] JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. [Conclusions] Poor glycemic control might prevent postoperative functional recovery of the spinal cord

The Effect of Bidet Use on Severity of Constipation and Quality of Life Among Pregnant Women

Background: Constipation is a common problem in pregnancy. This study aims to elucidate the efficacy of using a bidet before defecation to reduce the severity of constipation and improve the quality of life in pregnancy. Methods: The sample consisted of an experimental group (n = 30) and a control group (n = 30), a total of 60 pregnant women. Randomization was performed using the pitch-and-toss method from simple probability randomization methods. The research data were collected using the Personal Information Form, the Constipation Assessment Scale for Pregnancy, and the Constipation Quality of Life Scale. Results: There was a statistically significant difference between the pregnant women’s mean scores on the Constipation Assessment Scale for Pregnancy due to the intervention of bidet before defecation. Although the members of the intervention group had severe constipation at first, they reported only “some problems” on defecation after the intervention. In addition, statistically significant improvements were observed in the intervention group via all subscales of the Constipation Quality of Life Scale except the satisfaction subscale. Conclusion: Providing pregnant women with training on constipation and information about how to control constipation using a bidet is very important in terms of reducing the severity of constipation, enabling them to feel better and continue their daily activities, and thus to improve their quality of life

A New Method of Microcatheter Heat-Forming for Cerebral Aneurysmal Coiling Using Stereolithography Three-Dimensional Printed Hollow Vessel Models

[Background] To perform successful coil embolization of cerebral aneurysms, it is crucial to make an appropriately shaped microcatheter tip for an aneurysm and its parent artery. So far, we manually shaped a mandrel by referencing two-dimensional (2D) images of a rotation digital subtraction angiography (DSA) on a computer screen. However, this technique requires a lot of experience, and often involves trial and error. Recently, there have been increasing reports of manual mandrel shaping using a full-scale three-dimensional (3D) model of an aneurysm and its parent artery output by various types of 3D printer. We have further developed this method by producing a hollow model of an aneurysm and its parent artery with a stereolithography 3D printer and inserting a mandrel inside the model to fit and stabilize a microcatheter tip. [Methods] Based on digital imaging and communications in medicine (DICOM) data obtained by rotational DSA, 3D images of an aneurysm and its parent artery were created and converted into standard triangulated language (STL) data. A hollow model was produced by extruding the STL data outward in the normal direction, and then a hole was made at the tip of the aneurysm using these STL data. We output these STL data to a stereolithography 3D printer. After cleaning and sterilizing the model, the mandrel was inserted in the direction of the parent artery through the hole made in the tip of the aneurysm and pushed in, creating the ideal mandrel shape. Twelve cases (14 aneurysms) were included in this study. A microcatheter tip was shaped by this method for patients who were scheduled to undergo coil embolization for an unruptured aneurysm. [Results] In 13 of the 14 aneurysms, the microcatheter was easily guided into the aneurysms in one or two trials, the position of the microcatheter tip in the aneurysm was appropriate, and the stability during coil embolization was high. [Conclusion] Our method differs from the conventional one in that a hollow model made of resin is produced with a stereolithography 3D printer and that the mandrel is shaped by inserting it retrogradely into the hollow model. Using our new method, it will be possible to shape the tip of a microcatheter suitable for safe and stable coil embolization without relying on an operator’s experience

Phase Lag Analyses on Ictal Scalp Electroencephalography May Predict Outcomes of Corpus Callosotomy for Epileptic Spasms

Objective: We aimed to clarify the patterns of ictal power and phase lag among bilateral hemispheres on scalp electroencephalography (EEG) recorded pre-operatively during epileptic spasms (ESs) and the correlation with the outcomes following corpus callosotomy.Methods: We enrolled 17 patients who underwent corpus callosotomy for ESs before 20 years of age. After corpus callosotomy, seven patients did not experience further ESs (favorable outcome group), and the remaining 10 patients had ongoing ESs (unfavorable outcome group). We used pre-operative scalp EEG data from monopolar montages using the average reference. The relative power spectrum (PS), ictal power laterality (IPL) among the hemispheres, and phase lag, calculated by the cross-power spectrum (CPS) among symmetrical electrodes (i.e., F3 and F4), were analyzed in the EEG data of ESs from 143 pre-operative scalp video-EEG records. Analyses were conducted separately in each frequency band from the delta, theta, alpha, beta, and gamma range. We compared the means of those data in each patient between favorable and unfavorable outcome groups.Results: Among all frequency bands, no significant differences were seen in the individual mean relative PSs in the favorable and unfavorable outcome group. Although the mean IPLs in each patient tended to be high in the unfavorable outcome group, no significant differences were found. The mean CPSs in the delta, theta, and gamma frequency bands were significantly higher in the unfavorable than in the favorable outcome group. Using the Youden index, the optimal cutoff points of those mean CPS values for unfavorable outcomes were 64.00 in the delta band (sensitivity: 100%, specificity: 80%), 74.20 in the theta band (100, 80%), and 82.05 in the gamma band (100, 80%). Subanalyses indicated that those CPS differences originated from pairs of symmetrical electrodes in the bilateral frontal and temporal areas.Significance: Ictal power and laterality of the ictal power in each frequency band were not associated with the outcomes of CC; however, the phase lags seen in the delta, theta, and gamma frequency bands were larger in the unfavorable than in the favorable outcome group. The phase lags may predict outcomes of CC for ESs on pre-surgical scalp-ictal EEGs

Electrochemical Glycosylation as an Enabling Tool for the Stereoselective Synthesis of Cyclic Oligosaccharides

Electrochemical glycosylation of a linear oligosaccharide with a protecting-group-free primary hydroxyl group afforded cyclic oligo-saccharides, up to hexasaccharides, in high yields. Precursors of the cyclic oligosaccharides were prepared by automated electro-chemical assembly-a method for the automated electrochemical solution-phase synthesis of oligosaccharides. We demonstrated that electrochemical glycosylation is useful not only for intermolecular glycosylation but also for intramolecular glycosylation to synthesize cyclic oligosaccharides

The Influence of Illumination Color on the Subjective Visual Recognition of Biological Specimens

[Background] Visual examination by the naked eye is integral to medical diagnosis and surgery. The illumination in conditioned color is widely used for visual inspection in the industry but has not been introduced to the biomedical context. The color that can enhance the visual recognition of individual tissues is still unknown. Therefore, we carried out a visual recognition experiment on biological specimens to determine the subjective preference for illumination color based on questionnaires. [Methods] Twenty healthy subjects were asked to compare the visual recognizability of several rat tissues between the illuminations in test colors and white. The rats were anesthetized, and the femoral vein and abdominal cavity were exposed. Seven tissues were selected for a visual recognition test. Illumination was generated using a multi-color LED light. The subjects observed the tissues under the illuminations of white and one of the test colors alternately and reported which illumination is suitable for visual recognition using a questionnaire. [Results] The analysis of the questionnaires showed that the blue test color was more effective than white illumination in the visual recognition of fine structures such as the branching of blood vessels and nerves, and red illumination disturbed the visual recognizability of the same tissues. On the other hand, the red but not the blue illumination improved the visual recognizability of the vein beneath the intact skin. As to the recognition of individual tissues in the abdominal cavity, the white illumination gave a better visual recognizability compared to every other test color. [Conclusion] This study shows that the illumination color influences the visual recognition of biological specimens and the adequate color for the visual recognition of specific tissue parts is distinct among biological specimens. Using the lighting system to make fine adjustments to the illumination color may be useful in medical diagnosis and surgery