Effect of atherothrombotic aorta on outcomes of total aortic arch replacement

ObjectiveThe effect of an atherothrombotic aorta on the short- and long-term outcomes of total aortic arch replacement, including postoperative neurologic deficits, remains unknown. We evaluated this relationship and also elucidated the synergistic effect of multiple other risk factors, in addition to an atherothrombotic aorta, on the neurologic outcome.MethodsA group of 179 consecutive patients undergoing total aortic arch replacement were studied. An atherothrombotic aorta was present in 34 patients (19%), more than moderate leukoaraiosis in 71 (39.7%), and significant extracranial carotid artery stenosis in 27 (15.1%). In-hospital deaths occurred in 2 patients, 1 (2.9%) of 34 patients with and 1 (0.7%) of 145 patients without an atherothrombotic aorta (P = .26). Permanent neurologic deficits occurred in 4 (2.2%) and transient neurologic deficits in 17 (9.5%) patients. Multivariate analysis demonstrated that the risk factors for transient neurologic deficits were an atherothrombotic aorta (odds ratio, 4.4), extracranial carotid artery stenosis (odds ratio, 5.5), moderate/severe leukoaraiosis (odds ratio, 3.6), and cardiopulmonary bypass time (odds ratio, 1.02). To calculate the probability of transient neurologic deficits, the following equation was derived: probability of transient neurologic deficits = {1 + exp [7.276 − 1.489 (atherothrombotic aorta) − 1.285 (leukoaraiosis) − 1.701 (extracranial carotid artery stenosis) − 0.017 (cardiopulmonary bypass time)]}−1. An exponential increase occurred in the probability of transient neurologic deficits with presence of an atherothrombotic aorta and other risk factors in relation to the cardiopulmonary bypass time. Survival at 3 years after surgery was significantly reduced in patients with vs without an atherothrombotic aorta (75.0% ± 8.8% vs 89.2% ± 3.1%, P = .01).ConclusionsPatients with an atherothrombotic aorta and associated preoperative comorbidities might be predisposed to adverse short- and long-term outcomes, including transient neurologic deficits

Lyα\alpha Emission at z=7−13z=7-13: Clear Lyα\alpha Equivalent Width Evolution Indicating the Late Cosmic Reionization History

We present the evolution of Ly$\alpha$ emission derived from 53 galaxies at $z=6.6-13.2$ that are identified by multiple JWST/NIRSpec spectroscopy programs of ERS, GO, DDT, and GTO. These galaxies fall on the star-formation main sequence and are the typical star-forming galaxies with UV magnitudes of $-22.5\leq M_\mathrm{UV}\leq-17.0$. We find that 15 out of 53 galaxies show Ly$\alpha$ emission at the $>3\sigma$ levels, and obtain Ly$\alpha$ equivalent width (EW) measurements and stringent $3\sigma$ upper limits for the 15 and 38 galaxies, respectively. Confirming that Ly$\alpha$ velocity offsets and line widths of our galaxies are comparable with those of low-redshift Ly$\alpha$ emitters, we investigate the redshift evolution of the Ly$\alpha$ EW. We find that Ly$\alpha$ EWs statistically decrease towards high redshifts on the Ly$\alpha$ EW vs. $M_{\rm UV}$ plane for various probability distributions of the uncertainties. We then evaluate neutral hydrogen fractions $x_{\rm HI}$ with the Ly$\alpha$ EW redshift evolution and the cosmic reionization simulation results on the basis of a Bayesian inference framework, and obtain $x_{\rm HI}<0.79$, $=0.62^{+0.15}_{-0.36}$, and $0.93^{+0.04}_{-0.07}$ at $z\sim7$, $8$, and $9-13$, respectively. These moderately large $x_{\rm HI}$ values are consistent with the Planck CMB optical depth measurement and previous $x_{\rm HI}$ constraints from galaxy and QSO Ly$\alpha$ damping wing absorptions, and strongly indicate a late reionization history. Such a late reionization history suggests that major sources of reionization would emerge late and be hosted by moderately massive halos in contrast with the widely-accepted picture of abundant low-mass objects for the sources of reionization.Comment: Accepted for publication in Ap

Census for the Rest-frame Optical and UV Morphologies of Galaxies at z=4−10z=4-10: First Phase of Inside-Out Galaxy Formation

We present the rest-frame optical and UV surface brightness (SB) profiles for $149$ galaxies with $M_{\rm opt}< -19.4$ mag at $z=4$-$10$ ($29$ of which are spectroscopically confirmed with JWST NIRSpec), securing high signal-to-noise ratios of $10$-$135$ with deep JWST NIRCam $1$-$5\mu$m images obtained by the CEERS survey. We derive morphologies of our high-$z$ galaxies, carefully evaluating the systematics of SB profile measurements with Monte Carlo simulations as well as the impacts of a) AGNs, b) multiple clumps including galaxy mergers, c) spatial resolution differences with previous HST studies, and d) strong emission lines, e.g., H$\alpha$ and [OIII], on optical morphologies with medium-band F410M images. Conducting S\'ersic profile fitting to our high-$z$ galaxy SBs with GALFIT, we obtain the effective radii of optical $r_{\rm e, opt}$ and UV $r_{\rm e, UV}$ wavelengths ranging $r_{\rm e, opt}=0.05$-$1.6$ kpc and $r_{\rm e, UV}=0.03$-$1.7$ kpc that are consistent with previous results within large scatters in the size luminosity relations. However, we find the effective radius ratio, $r_{\rm e, opt}/r_{\rm e, UV}$, is almost unity, $1.01^{+0.35}_{-0.22}$, over $z=4$-$10$ with no signatures of past inside-out star formation such found at $z\sim 0$-$2$. There are no spatial offsets exceeding $3\sigma$ between the optical and UV morphology centers in case of no mergers, indicative of major star-forming activity only found near a mass center of galaxies at $z\gtrsim 4$ probably experiencing the first phase of inside-out galaxy formation.Comment: 33 pages, 18 figures, 6 table

The Masquelet technique for septic arthritis of the small joint in the hands: Case reports

Septic arthritis in distal interphalangeal (DIP) joints sometimes occurs in association with mucous cysts or after the surgical treatment of mallet fingers. Recently, several studies have demonstrated the effectiveness of the Masquelet technique in the treatment of bone defects caused by trauma or infection. However, only few studies have reported the use of this technique for septic arthritis in small joints of the hand, and its effectiveness in treating septic arthritis in DIP joints remains unclear. We report the clinical and radiological outcomes of three patients who were treated with the Masquelet technique for septic arthritis in DIP joints. One patient had uncontrolled diabetes and another had rheumatoid arthritis treated with methotrexate and prednisolone. The first surgical stage involved thorough debridement of the infection site, including the middle and distal phalanx. We placed an external fixator from the middle to the distal phalanx and then packed the cavity of the DIP joint with antibiotic cement bead of polymethylmethacrylate (40 g) including 2 g of vancomycin and 200 mg of minocycline. At 4-6 weeks after the first surgical stage, the infection had cleared, and the second surgical stage was performed. The external fixator and cement bead were carefully removed while carefully preserving the surrounding osteo-induced membrane. The membrane was smooth and nonadherent to the cement block. In the second surgical stage, an autogenous bone graft was harvested from the iliac bone and inserted into the joint space, within the membrane. The bone graft, distal phalanx, and middle phalanx were fixed with Kirschner wires and/or a soft wire. Despite the high risk of infection, bone union was achieved in all patients without recurrence of infection. Although the Masquelet technique requires two surgeries, it can lead to favorable clinical and radiological outcomes for infected small joints of the hand.Septic arthritis in distal interphalangeal (DIP) joints sometimes occurs in association with mucous cysts or after the surgical treatment of mallet fingers. Recently, several studies have demonstrated..

Outcome of elective total aortic arch replacement in patients with non–dialysis-dependent renal insufficiency stratified by estimated glomerular filtration rate

ObjectiveLittle is known about the impact of preoperative renal function stratified by estimated glomerular filtration rate (eGFR) on outcomes of total aortic arch replacement (TAR). The current study addressed this issue and identified a cutoff value of eGFR for the requirement of postoperative renal replacement therapy.MethodsFrom January 2000 to May 2011, 229 consecutive patients who did not require preoperative hemodialysis were retrospectively studied after elective TAR. Patients were grouped into the following categories: those with normal renal function (eGFR >90 mL/min/1.73 m2; n = 11) and those with mild (eGFR, 60-90 mL/min/1.73 m2; n = 86), moderate (eGFR, 30-59 mL/min/1.73 m2; n = 111), or severe (eGFR <30 mL/min/1.73 m2; n = 21) renal dysfunction. Linear trend tests demonstrated that the lower categories of eGFR were associated with a higher age, hypertension, coronary artery disease, peripheral arterial disease, and a higher EuroSCORE II.ResultsThe overall hospital mortality was 2.2%. A lower categories of eGFR were an independent risk factor for hospital mortality (odds ratio, 0.91; P = .002) and postoperative renal replacement therapy (odds ratio, 0.94; P < .002). A cutoff value for the requirement of postoperative renal replacement therapy was 26.0 mL/min/1.73 m2. Patients in the lower categories of eGFR had significantly higher hospital mortality (P = .03) and more morbidities, such as renal replacement therapy (P < .01), postoperative permanent neurologic deficits (P = .013), and prolonged mechanical ventilatory support (P < .01). Midterm survival and freedom from major adverse cerebrocardiovascular events were worse across the levels of the lower categories of eGFR.ConclusionsPreoperative eGFR is a strong predictor of short- and midterm outcomes in contemporary TAR

Lumbar Canal Stenosis Caused by Marked Bone Overgrowth after Decompression Surgery

Narrowing of the lumbar canal due to bone regrowth after lumbar decompression surgery generally occurs at the facet joint; it is exceedingly rare for this phenomenon to occur at the laminar arch. Herein, we describe a case of restenosis caused by marked bone overgrowth at the facet joints and laminar arch after lumbar decompression surgery. A 64-year-old man underwent partial hemilaminectomy for lumbar canal stenosis at the L3/L4 level 12 years ago. His symptoms recurred 7 years after the first surgery. Overgrowth of the laminar arch and facet joints was observed at the decompression site. Thus, partial laminectomy of L3 and L4 was performed as a second surgery. Four years after the second surgery, a laminectomy of L3-L4 was performed for bone restenosis and disc herniation. The underlying mechanism of the remarkable overgrowth of the removed lamina remains unclear. Endochondral ossification signals and mechanosignals should be comprehensively examined

Full-endoscopic decompression for fifth lumbar radiculopathy due to a fragility sacral fracture associated with far-lateral L5/S1 disc herniation: A technical note

The prevalence of fragility sacral fractures has been increasing with the rise in the number of osteoporotic patients and the development of diagnostic imaging. Sacral fracture can cause injury to the fifth lumbar (L5) nerve, although the incidence is low. The therapeutic strategy for sacral fracture with neurological injury has not yet been established, and the surgical strategy for fragility sacral fracture is more controversial. We describe a new therapeutic method using endoscopic surgery for L5 nerve root involvement caused by far-lateral lumbar disc herniation triggered by a fragility sacral fracture. A 55-year-old woman presented with right buttock and right lower limb pain without signs of trauma. Neurological examination revealed paresis of the right lower limb and hypoesthesia in the region innervated by the right L5 nerve root. Neuroimaging demonstrated a U-shaped sacral fracture, including the sacral ala, and right L5 extra-foraminal stenosis. The L5 nerve root was located near the vertical fracture, and compressed by far-lateral L5/S1 disc herniation. Full-endoscopic spine surgery (FESS) was performed to partially remove the right S1 superior articular process and to resect the degenerated disc material. L5 radiculopathy improved partially after the surgery. We suggest that FESS is an effective and safe therapeutic method for fragility sacral fractures associated with far-lateral lumbar disc herniation