Comparison of the Fixation Strengths of Screws between the Traditional Trajectory and the Single and Double Endplate Penetrating Screw Trajectories Using Osteoporotic Vertebral Body Models Based on the Finite Element Method

Study Design This is a finite element (FE) study. Purpose To compare the fixation strength of traditional trajectory (TT) and single and double endplate penetrating screw trajectories (SEPST/DEPST) to the osteoporotic vertebral body model based on the FE method. Overview of Literature SEPST/DEPST have been developed to enhance the fixation strength in patients with diffuse idiopathic hyperostosis (DISH). This technique was also applied to patients with osteoporosis. However, determining the superiority of SEPST/DEPST is difficult because of the heterogeneous patient backgrounds. Methods Twenty vertebrae (T12 and L1) from 10 patients with osteoporosis (two males and eight females; mean age, 74.7 years) were obtained to create the 10 FE models. First, a single screw was placed with TT and SEPST/DEPST, and the fixation strength was compared by axial pullout strength (POS) and multidirectional loading tests. Second, two screws were placed on the bilateral pedicles with TT and SEPST/DEPST, and the fixation force of the vertebrae in the constructs in flexion, extension, lateral flexion, and axial rotation was examined. Results SEPST and DEPST had 140% and 171% higher POS values than TT, respectively, and the DEPST result was statistically significant (p=0.007). The multidirectional fixation strength was significantly higher in DEPST and SEPST than in TT in the cranial, caudal, and medial directions (p<0.05) but not in the lateral direction (p=0.05). The vertebral fracture strength at the lower instrumented vertebra of the DEPST tended to be higher than that of TT. The vertebral motion angles in SEPST and DEPST were significantly smaller in lateral bending (p=0.02) and tended to be smaller in flexion and extension than in TT (p=0.13). Conclusions This study may provide useful information for spine surgeons in deciding whether to choose the SEPS or DEPS technique for augmenting fixation in osteoporotic vertebral fracture surgery

〈Cases Reports〉Recurrent focal intestinal perforation in extremely-low-birth-weight infant

[Abstract] In recent years, the incidence of focal intestinal perforation (FIP) has been increasing, as the survival rate of extremely-low-birth-weight(ELBW) infants has been rising. We present a case of an ELBW infant who suffered three recurrences of FIP in a very short period of time. The patient was a female infant who was born at 24 weeks and 2 days of gestation, with a birth weight of 579 g. On her 22^nd day of life, abdominal X-rays revealed free air, which suggested intestinal perforation, and an intraperitoneal drainage tube was placed. Intraperitoneal lavage was performed on day 28 of life,and the drained fluid was turbid with feces, suggesting a recurrence of perforation. On day 30 of life, laparotomy revealed a perforation of approximately 1cm in diameter located at 6 cm from the ileocecum on the oral side. The X-ray taken on day 34 again revealed free air, and, through another laparotomy, a new perforation was found at about 15 cm from the stoma on the oral side. This case provides suggestions that may shed light on our approach to determine the pathogenesis of FIP, especially since no other case of FIP recurring three times has ever been reported

〈Originals〉Evaluation of peripheral circulation in low-birth-weight infants using the peripheral perfusion index

[Abstract]　The peripheral perfusion index (PPI), mean arterial blood pressure, lactic acid value (Lac), left ventricular end-diastolic dimension (LVDd), and left ventricular ejection fraction (EF) within 24 hr and 48-72 hr after birth were measured in 16 infants admitted to a Neonatal Intensive Care Unit (NICU) to assess the usefulness of PPI for the evaluation of peripheral circulation in low-birth-weight infants. The mean PPI was 0.66± 0.4 (24 hr after birth) and 0.57+0.19 (48-72 hr after birth). The mean arterial blood pressure was 33.8+6.0 mmHg (24 hr after birth) and 34.3+4.1 mmHg (48-72 hr after birth). EF was 66.6+6.5％ (24 hr after birth) and 70.3±5.3％ (48-72 hr after birth), andLVDd was 1.24± 0.17 cm (24 hr after birth) and 1.21±0.14 cm (48-72 hr after birth). The correlation between variations in PPI and LVDd at two points showed a positive correlation (r＝0.74, p＜0.05), and PPI and mean arterial blood pressure (r＝0.72, p＜0.05), as well as PPI and EF (r＝0.85, p＜0.05), also showed positive correlations 24 hr after birth. These results suggest that PPI could be an effective way to evaluate peripheral circulation in low-birth-weight infants

〈Case Reports〉Growth hormone deficiency associated with short stature in a very low birth weight infant after treatment for suspected intracranial cavernous hemangioma

[Abstract] A female infant born at 30 weeks of gestation and weighing 1,276g developed a suspected intracranial cavernous hemangioma invading the sella turcica at the age of one month. She received high-dose steroid treatment with 5mg/ kg/ d of prednisolone, resulting in a reduction in the size of the hemangioma, and follow-up care began after discharge. At the age of six, it was noted that the girl’s growth in height was insufficient. Head magnetic resonance imaging (MRI) showed pituitary atrophy, and the results of a loading test led to a diagnosis of growth hormone deficiency resulting in a short stature. However, the administration of growth hormone brought her height up to the average by the age of 11.The patient’s intracranial lesion during the newborn period, which was suspected to be a cavernous hemangioma, may have contributed to her pituitary atrophy. The findings of this case suggest that infants who develop a space-occupying lesion in the sella turcica must be kept under long-term observation in view of the possible occurrence of a defective pituitary function

Systemic impact on preterm infants during treatment for retinopathy of prematurity: A comparison of retinal photocoagulation and intravitreal injection of anti-vascular endothelial growth factor drugs

Objectives: To compare the systemic impact of retinal photocoagulation with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibodies on preterm infants with retinopathy of prematurity. Methods: A retrospective study was conducted on infants with retinopathy of prematurity requiring treatment. A total of 20 infants received laser treatment (laser group) and 30 received anti-VEGF treatment (anti-VEGF group). Results: The laser treatment lasted longer than the anti-VEGF treatment (58.1 versus 2.2 min). In the laser group, 93% of infants required assisted ventilation during treatment, who did not require ventilation before treatment, while 9.1% of the anti-VEGF group required assisted ventilation. The C-reactive protein levels were significantly altered in the laser group (827.7%) than in the anti-VEGF group (126.9%), before and after treatment. Conclusions: In the anti-VEGF group, treatment duration was shorter, fewer cases required assisted ventilation, and C-reactive protein levels changed significantly less, suggesting that anti-VEGF treatment is less invasive than laser treatment.departmental bulletin pape

Comparison of Prognosis between Minimally Invasive and Abdominal Radical Hysterectomy for Patients with Early-Stage Cervical Cancer

Minimally invasive surgery (MIS) is performed to treat cervical cancer patients; however, a recent study showed that MIS was associated with higher recurrence and death rate compared with abdominal radical hysterectomy (ARH). In the current study, the prognosis of patients with early-stage cervical cancer who underwent MIS with vaginal closure or ARH was evaluated. One hundred and eighty-two patients underwent radical hysterectomy for cervical cancer with stage of IA2, IB1, and IIA1. MIS was performed by laparoscopy or a robot using the vaginal closure method. Disease-free survival (DFS) and overall survival (OS) were evaluated between the groups. Among the patients, 67 underwent MIS and 115 underwent ARH. The recurrence rate was 4.5% in MIS patients and 3.5% in ARH patients with a median follow-up (interquartile range) of 36 (18–60) and 78 (48–102) months, respectively. DFS and OS were not different between the groups (3y-DFS, 95.3% vs. 96.1%, p = 0.6; 3y-OS, 100% vs. 100%, p = 0.06). In early-stage cervical cancer patients, MIS with vaginal closure did not increase the risk for recurrence or death. Surgical techniques and procedures to avoid spillage of tumor cells could be important for a better prognosis

Fgf21 is essential for haematopoiesis in zebrafish

Fibroblast growth factors (Fgfs) function as key secreted signalling molecules in many developmental events. The zebrafish is a powerful model system for the investigation of embryonic vertebrate haematopoiesis. Although the effects of Fgf signalling on haematopoiesis in vitro have been reported, the functions of Fgf signalling in haematopoiesis in vivo remain to be explained. We identified Fgf21 in zebrafish embryos. Fgf21-knockdown zebrafish embryos lacked erythroid and myeloid cells but not blood vessels and lymphoid cells. The knockdown embryos had haemangioblasts and haematopoietic stem cells. However, the knockdown embryos had significantly fewer myeloid and erythroid progenitor cells. In contrast, Fgf21 had no significant effect on cell proliferation and apoptosis in the intermediate cell mass. These results indicate that Fgf21 is a newly identified factor essential for the determination of myelo-erythroid progenitor cell fate in vivo