Comparison between minimally invasive plate osteosynthesis and the deltopectoral approach with allogenous fibular bone graft in proximal humeral fractures

Background@#Both allogenous fibular bone graft and minimally invasive plate osteosynthesis have been developed to reduce issues such as fixation failure, displacement, angulation, and nonunion after plate fixation of proximal humeral fractures. However, there have been no studies investigating the differences in clinical results between these methods. The purpose of this study was to investigate the clinical differences between open reduction and plate fixation via a deltopectoral approach with allogenous fibular bone graft and a minimally invasive approach, in Neer's classification two-, three-part proximal humeral fractures. @*Methods@#In this retrospective study, 77 patients with Neer classification two-, three-part proximal humeral fractures were treated at two different institutions. Clinical and radiological evaluations were performed in 39 patients who underwent minimally invasive plate osteosynthesis at one institution (group A) and 38 patients who underwent the deltopectoral approach with allogenous fibular bone graft at another institution (group B). The results between the groups were compared. @*Results@#The minimally invasive plate osteosynthesis procedure (group A) was significantly less time- consuming and caused less bleeding than allogenous fibular bone graft through a deltopectoral approach (group B) (P<0.05). The duration of the fracture union was significantly reduced in group A (14.5±3.4 weeks; range, 10–22 weeks) compared to group B (16.4±4.3 weeks; range, 12–28 weeks) (P<0.05). There were no statistically significant differences between the two groups when evaluating the visual analog scale and Constant scores 1 year postoperatively. Radiological evaluation including neck-shaft angle and plate height were measured on the final follow-up X-ray image. There was no difference in radiological outcomes between the two groups. There were no statistically significant differences in malunion between the two groups; there were three malunion cases (7.7%) in group A and four (10.5%) in group B. @*Conclusions@#The minimally invasive plate osteosynthesis procedure and deltopectoral approach with allogenous fibula bone graft for Neer's classification two-, three-part proximal humeral fractures demonstrated similar clinical and radiological results. However, allogenous fibula grafts require longer surgery, cause more bleeding, and result in longer fracture healing time than the minimally invasive plate osteosynthesis procedure.

Inter-eye Comparison of Peripapillary Choroidal Thickness in Patients with Treatment-naïve Unilateral Open-angle Glaucoma

Purpose@#We investigated the relationship between optic nerve damage and peripapillary choroidal thickness in patients with treatment-naïve primary open-angle glaucoma. @*Methods@#Peripapillary choroidal thicknesses of 78 eyes of 39 patients with primary open-angle glaucoma were measured on 360° scans of enhanced-depth optical coherence tomography images using the inbuilt manual segmentation function. Inter-eye peripapillary choroidal thicknesses were compared and factors associated with glaucoma were analyzed. @*Results@#Eyes with primary open-angle glaucoma exhibited thinner peripapillary choroidal thickness (133.2 ± 52.1 vs. 144.1 ± 53.0 μm; p < 0.001), higher intraocular pressure (16.7 ± 3.9 vs. 15.4 ± 2.6 mmHg; p = 0.005), thinner corneal thickness (523.8 ± 32.5 vs. 527.6 ± 35.0 μm; p = 0.030), and thinner retinal nerve fiber layer (72.2 ± 13.7 vs. 89.3 ± 13.1 μm; p < 0.001), compared with healthy fellow eyes. On multivariate, conditional, logistic regression analysis, thinner peripapillary choroidal thickness (odds ratio [OR] 0.910, 95% confidence interval [CI] 0.834-0.993; p = 0.035) and higher intraocular pressure (OR 3.368, 95% CI 1.285-8.828; p = 0.014) were significantly associated with glaucoma. @*Conclusions@#Thinner peripapillary choroid and higher intraocular pressure were significantly associated with glaucoma in patients with unilateral primary open-angle glaucoma, suggesting that poor perfusion around the optic nerve head may be associated with glaucoma pathogenesis.

Inter-eye Comparison of Peripapillary Choroidal Thickness in Patients with Treatment-naïve Unilateral Open-angle Glaucoma

Purpose@#We investigated the relationship between optic nerve damage and peripapillary choroidal thickness in patients with treatment-naïve primary open-angle glaucoma. @*Methods@#Peripapillary choroidal thicknesses of 78 eyes of 39 patients with primary open-angle glaucoma were measured on 360° scans of enhanced-depth optical coherence tomography images using the inbuilt manual segmentation function. Inter-eye peripapillary choroidal thicknesses were compared and factors associated with glaucoma were analyzed. @*Results@#Eyes with primary open-angle glaucoma exhibited thinner peripapillary choroidal thickness (133.2 ± 52.1 vs. 144.1 ± 53.0 μm; p < 0.001), higher intraocular pressure (16.7 ± 3.9 vs. 15.4 ± 2.6 mmHg; p = 0.005), thinner corneal thickness (523.8 ± 32.5 vs. 527.6 ± 35.0 μm; p = 0.030), and thinner retinal nerve fiber layer (72.2 ± 13.7 vs. 89.3 ± 13.1 μm; p < 0.001), compared with healthy fellow eyes. On multivariate, conditional, logistic regression analysis, thinner peripapillary choroidal thickness (odds ratio [OR] 0.910, 95% confidence interval [CI] 0.834-0.993; p = 0.035) and higher intraocular pressure (OR 3.368, 95% CI 1.285-8.828; p = 0.014) were significantly associated with glaucoma. @*Conclusions@#Thinner peripapillary choroid and higher intraocular pressure were significantly associated with glaucoma in patients with unilateral primary open-angle glaucoma, suggesting that poor perfusion around the optic nerve head may be associated with glaucoma pathogenesis.

Development of cell models for high-throughput screening system of Charcot-Marie-Tooth disease type 1

PURPOSE: Charcot-Marie-Tooth disease (CMT) is a peripheral neuropathy mainly divided into CMT type 1 (CMT1) and CMT2 according to the phenotype and genotype. Although molecular pathologies for each genetic causative have not been revealed in CMT2, the correlation between cell death and accumulation of misfolded proteins in the endoplasmic reticulum (ER) of Schwann cells is well documented in CMT1. Establishment of in vitro models of ER stress-mediated Schwann cell death might be useful in developing drug-screening systems for the treatment of CMT1. MATERIALS AND METHODS: To develop high-throughput screening (HTS) systems for CMT1, we generated cell models using transient expression of mutant proteins and chemical induction. RESULTS: Overexpression of wild type and mutant peripheral myelin protein 22 (PMP22) induced ER stress. Similar results were obtained from mutant myelin protein zero (MPZ) proteins. Protein localization revealed that expressed mutant PMP22 and MPZ proteins accumulated in the ER of Schwann cells. Overexpression of wild type and L16P mutant PMP22 also reduced cell viability, implying protein accumulation-mediated ER stress causes cell death. To develop more stable screening systems, we mimicked the ER stress-mediated cell death in Schwann cells using ER stress inducing chemicals. Thapsigargin treatment caused cell death via ER stress in a dose dependent manner, which was measured by expression of ER stress markers. CONCLUSION: We have developed genetically and chemically induced ER stress models using Schwann cells. Application of these models to HTS systems might facilitate the elucidation of molecular pathology and development of therapeutic options for CMT1.

Clinical Outcomes of Cataract Surgery with Correction of Corneal Spherical Aberration

PURPOSE: To evaluate preoperative and postoperative spherical aberrations after cataract surgery based on selecting spherical or aspheric intraocular lens (IOL) according to preoperative corneal aberration. METHODS: The medical records of patients who underwent phacoemulsification and IOL implantation in the posterior chamber by a surgeon (H.J.C) were reviewed (68 patients, 97 eyes). IOL was selected based on preoperative corneal spherical aberration measured by corneal topography (ATLAS 9000, Carl Zeiss). The target postoperative total ocular spherical aberration was set to zero (0) and one of the following lenses was chosen: Acrysof SA60AT (n = 25), Acrysof IQ (n = 36) or Tecnis(R) ZCB00 (n = 36). The Wavescan aberrometer and the corneal topography were obtained postoperatively. Absolute prediction errors of postoperative total ocular spherical aberration were analyzed. RESULTS: Preoperative corneal spherical aberration was 0.241 microm; total postoperative ocular spherical aberration was 0.0509 microm (Acrysof SA60AT: 0.0954 microm, Tecnis(R) ZCB00: 0.0374 microm, Acrysof IQ: 0.0335 microm). Postoperative corneal spherical aberration was 0.232 microm, which was not significantly different from the preoperative value (p = 0.199). Postoperative ocular spherical aberration was 0.051 microm; 0.095 microm (Acrysof SA60AT), 0.034 microm (Acrysof IQ), and 0.037 microm (ZCB00). The reducing amounts of spherical aberration were 0.185 microm (Acrysof IQ) and 0.311 microm (ZCB00). The overall absolute prediction error was 0.068 microm. The absolute prediction error of the Acrysof SA60AT group was 0.092 microm, Tecnis(R) ZCB00 group was 0.067 microm and Acrysof IQ group was 0.054 microm. There was no significant difference among the 3 groups (p = 0.089). CONCLUSIONS: Aspheric IOLs can efficiently reduce total ocular spherical aberrations according to preoperative corneal spherical aberrations.

Dynamic Transcriptional Events in Distal Sural Nerve Revealed by Transcriptome Analysis

Compared with biochemical information available about the diseases in the central nervous system, that for peripheral neuropathy is quite limited primarily due to the difficulties in obtaining samples. Characterization of the core pathology is a prerequisite to the development of personalized medicine for genetically heterogeneous diseases, such as hereditary motor and sensory neuropathy (HMSN). Here, we first documented the transcriptome profile of distal sural nerve obtained from HMSN patients. RNA-seq analysis revealed that over 12,000 genes are expressed in distal sural nerve. Among them 4,000 transcripts are novel and 10 fusion genes per sample were observed. Comparing dataset from whole exome sequencing revealed that over 1,500 transcriptional base modifications occur during transcription. These data implicate that dynamic alterations are generated when genetic information are transitioned in distal sural nerve. Although, we could not find significant alterations associated with HMSN, these data might provide crucial information about the pathophysiology of HMSN. Therefore, next step in the development of therapeutic strategy for HMSN might be unveiling biochemical and biophysical abnormalities derived from those potent variation.

A Survey of the Use of Antiepileptic Drugs in Stroke Patients

BACKGROUND: Seizures occur in 2-20% of stroke patients. Recent studies have reported that post-stroke seizures are associated with poorer functional outcomesand higher mortality. However there are no official guidelines on how to use antiepileptic drugs (AEDs) in stroke-related seizures. In this study we surveyed neurologists and neurosurgeons and compared the responses of subgroups categorized by department, specialty and workplace discrimination using a questionnaire containing questions concerning the present tendency to use AEDs in stroke patients. METHODS: 256 neurologists and neurosurgeons participated in the survey. The research instrument was a questionnaire comprising 9 parts and 30 questions. The questions concerned stroke mechanism, the prophylactic use of AEDs, and the choice of AED in early and late onset post-stroke seizures. RESULTS: Tendencies to use prophylactic AEDs in stroke differed depending on specialty and workplace(neurologist vs. neurosurgeon; 17.8% vs. 83.1%, p<0.001, hospital vs. university staff; 46.2% vs. 28.4%, p=0.05). The most commonly used prophylactic AEDs were valproic acid (75%) and levetiracetam (60%). Carbamazepine was the most commonly used AED and phenytoin and phenobarbital were still used in all subgroups to treat post-stroke seizures. CONCLUSIONS: There are significant differences between neurologists (17.8%) and neurosurgeons (83.1%) in the use of prophylactic AEDs after stroke. Valproic acid and levetiracetam are considered first-line prophylactic AEDs by neurosurgeon. Phenytoin and phenobarbital are still used in post-stroke seizure although they have been reported to have an adverse influence on motor recovery. We suggest that proper guidelines should be established for the use of AEDs in stroke-related seizures.