Diagnostic utility of C-reactive Protein combined with brain natriuretic peptide in acute pulmonary edema: a cross sectional study

Introduction Discriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) using the plasma level of brain natriuretic peptide (BNP) alone remains controversial. The aim of this study was to determine the diagnostic utility of combination measurements of BNP and C-reactive protein (CRP) in critically ill patients with pulmonary edema

歯根をトルク移動する際に生じる応力

舌側に転位した側切歯を歯体移動させるには，歯冠を唇側に傾斜移動した後，舌側にある歯根を唇側移動させる必要がある。その際，歯根およびその周囲組織にはトルク力が生じており，このトルクコントロールを適切に行うことが歯科矯正臨床上きわめて重要である。本研究では，舌側転位した右側上顎側切歯の歯根を唇側移動する際に側切歯および両隣在歯に生じる応力について有限要素解析を行った。上顎右側中切歯から犬歯の歯列モデルは頭蓋骨モデル（ニッシン）のCT 画像を，0.018”×0.025”スロットブラケットおよび0.018”×0.025”ステンレススチールワイヤーについては3 次元CAD データをもとに，3 次元有限要素モデルを構築した。荷重条件として，ワイヤーの側切歯部分に6°のリンガルクラウントルクを負荷した。その結果，側切歯に生じるvon Mises 相当応力の大きさは約11.0×10−3 MPa であり，唇側歯頸部および根尖部に集中していた。一方，両隣在歯には，最大で約4.5×10−3 MPa のvon Mises 相当応力が根尖部および舌側歯頸部に認められた。本研究結果より，舌側転位した上顎側切歯の歯根を唇側移動する際にはリンガルクラウントルク負荷によって当該歯ならびに隣在歯に生じる作用・反作用を考慮し，歯の移動を行う必要が示唆された。In case of lingual displacement of lateral incisor, we should apply labial root torque after labial tipping movement of lateral incisor. The torque moment generated by third order bend is one of the important keys for orthodontic tooth movement. The objective of this study was to investigate the stress distribution on root surface and in surround periodontal ligament (PDL) when labial root torque is applied to lingually displaced lateral incisor by finite element (FE) analysis. The FE models of maxillary incisors and canine were developed from three-dimensional (3 D) point data sets of CT-image. The models of 0.018” slot sizes stainless steel brackets and 0.018 x 0.025-inch stainless steel (SS) wires were constructed based on 3 D CAD data. As a loading condition, 6 degrees labial root torque moment was applied to the archwire at lateral incisor. The distribution of the von Mises equivalent stresses (equivalent stress) on the root surface and in surrounding PDL of incisors and canine was evaluated using an FE analysis. When applying labial root torque at lateral incisor, greater equivalent stress was observed at the labial cervical margin and root apex. The values of equivalent stresses on the root surface of lateral incisor were less than 11.0 × 10-3 MPa, while the maximum equivalent stress of the neighboring teeth (central incisor and canine) were 4.5 × 10-3 observed at the lingual cervical margin and root apex. These results indicate the neighboring teeth are considerably affected as a reaction force when the torque moment is applied to the targeted tooth

Ligand-receptor co-evolution shaped the jasmonate pathway in land plants

The phytohormone jasmonoyl-isoleucine (JA-Ile) regulates defense, growth and developmental responses in vascular plants. Bryophytes have conserved sequences for all JA-Ile signaling pathway components but lack JA-Ile. We show that, in spite of 450 million years of independent evolution, the JA-Ile receptor COI1 is functionally conserved between the bryophyte Marchantia polymorpha and the eudicot Arabidopsis thaliana but COI1 responds to different ligands in each species. We identified the ligand of Marchantia MpCOI1 as two isomeric forms of the JA-Ile precursor dinor-OPDA (dinor-cis-OPDA and dinor-iso-OPDA). We demonstrate that AtCOI1 functionally complements Mpcoi1 mutation and confers JA-Ile responsiveness and that a single-residue substitution in MpCOI1 is responsible for the evolutionary switch in ligand specificity. Our results identify the ancestral bioactive jasmonate and clarify its biosynthetic pathway, demonstrate the functional conservation of its signaling pathway, and show that JA-Ile and COI1 emergence in vascular plants required co-evolution of hormone biosynthetic complexity and receptor specificity

State of the Art : Elbow Arthroscopy : Review of the Literature and Application for Osteochondritis Dissecans of the Capitellum

Elbow arthroscopy has become a safe and effective treatment option for a number of elbow disorders. The most rewarding and successful indication is the removal of loose bodies. Loose bodies are often a result of osteochondritis dissecans (OCD) of the　capitellum, and arthroscopy in this case is useful for performing debridement, thereby eliminating the need for a more extensive open procedure associated with complications. In this review, we describe our arthroscopic technique for OCD of the capitellum. We usually conduct arthroscopy in the supine position, and use 2.9-mm arthroscopes of 30°and 70°. The 70°arthroscope provides a greater operative field than the 30°arthroscope. Arthroscopic treatment for OCD may require 2 anterior and 2 posterior portals. Loose bodies are commonly found in the radial fossa, coronoid fossa, and in the olecranon fossa. Once the loose bodies are removed, all unstable cartilage of the capitellum lesion is removed to create a stable bed. If any sclerotic changes to the lesion bed are observed, we create microfractures in the lesion bed. The most significant complication in arthroplasty is neurovascular injury. However, we have never experienced this devastating complication, which can be avoided by paying careful attention to detail

State of the Art : Transforaminal Approach for Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

Minimally invasive percutaneous endoscopic discectomy (PED) with a transforaminal approach under local anesthesia was started in the late 20th century. As the procedure requires a skin incision of only 8mm, it is the least invasive disc surgery procedure at present, and owing to advances in instruments and optics, the use of this technique has gradually spread. In Japan, Dr. Dezawa from Teikyo University Mizonokuchi Hospital introduced this technique in 2003. Thanks to his efforts, the number of surgeons who can perform PED has increased, although the number of active PED surgeons is still only around 20. The first author (K.S.) started PED in 2010. In this review article, we explain the state-of-the-art PED transforaminal technique for minimally invasive disc surgery and present three successful cases

State of the art : Intraoperative neuromonitoring in spinal deformity surgery

Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques, including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery

Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player

Percutaneous endoscopic discectomy (PED) is the least invasive disc surgery available at present. The procedure can be performed under local anesthesia and requires only an 8 mm skin incision. Furthermore, damage to the back muscle is considered minimal, which is particularly important for disc surgery in athletes. However, employing the transforaminal (TF) PED approach at the lumbosacral junction can be challenging due to anatomical constraints imposed by the iliac crest. In such cases, foraminoplasty is required in addition to the standard TF procedure. A 28-year-old man who was a very active rugby player visited us complaining of lower back and left leg pain. His visual analog scale (VAS) score for pain was 8/10 and 3/10, respectively. MRI revealed a herniated nucleus pulposus at L5-S level. TF-PED was planned ; however, the anatomy of the iliac crest was later found to prevent access to the herniated mass. Foraminoplasty was therefore performed to enlarge the foramen, thereby allowing a cannula to be passed through the foramen into the canal without causing exiting nerve injury. The herniated mass was then successfully removed via the TF-PED procedure. Pain resolved after surgery, and his VAS score decreased to 0/10 for both back and leg pain. The patient returned to full rugby activity 8 weeks after surgery. In conclusion, even with an intracanalicular herniated mass at the lumbosacral junction, a TF-PED procedure is possible if additional foraminoplasty is adequately performed to enlarge the foramen

A review of the pathomechanism of forward slippage in pediatric spondylolysis : The Tokushima theory of growth plate slippage

Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI ; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate.We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis

State-of-the-art ultrasonographic findings in lower extremity sports injuries

Athletes sometimes experience overuse injuries. To diagnose these injuries, ultrasonography is often more useful than plain radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography can show both bone and soft tissue from various angles as needed, providing great detail in many cases. In conditions such as osteochondrosis or enthesopathies such as Osgood-Schlatter disease, Sinding- Larsen-Johansson disease, bipartite patella, osteochondritis dissecans of the knee, painful accessory navicular, and jumper’s knee, ultrasonography can reveal certain types of bony irregularities or neovascularization of the surrounding tissue. In patients of enthesopathy, ultrasonography can show the degenerative changes at the insertion of the tendon. Given its usefulness in treatment, ultrasonography is expected to become essential in the management of overuse injuries affecting the lower limb in athletes