Mechanism of the compression effect on visual duration perception caused by temporally sandwiching sounds.

When task-irrelevant nontarget sound temporally sandwiches brief target visual stimuli, its perceived duration is compressed (time compression). Since little is known about the mechanisms of time compression, this study examined its causal factors. Experiment 1 measured the effects of preceding, trailing, and sandwiching sounds on visual duration perception and examined whether adding the first two effects predicts the empirical effect of the third. The time compression occurred only when the target visual stimulus was 300 ms, but not for a target duration ≥500 ms. However, the predicted additive effect did not match the time compression. Experiment 2 examined the weighted integration of unisensory estimates (visual filled interval and auditory empty interval) by measuring the perceived duration of unimodal and multimodal stimuli. The predicted duration by weighted integration fitted the time compression occurring at the target duration of 300 ms. However, when the target was 500 ms or longer, no time compression occurred and the predicted durations were longer than the empirical durations. These results suggest that the visual system with weak temporal resolution integrated more accurate and reliable temporal information, rather than additive effect, resulting in time compression only when the target duration was too short. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mobile application for home exercise adherence in patients with knee osteoarthritis: A pilot study.

BACKGROUND: The adherence to home exercise is generally low despite its well-known effect on knee osteoarthritis. Therefore, we developed a home exercise application, LongLifeSupport, to provide patients with daily basic exercise videos and an automatic recording calendar. We hypothesized that this application would encourage patients to exercise and help maintain their motivation; this pilot study aimed to determine their exercise adherence rates. Using outcome measures, we also aimed to determine the effect of home exercise using this application and the factors for its continuation. METHODS: Twenty patients with knee osteoarthritis were included. The participants exercised for 12 weeks. Using pre- and post-tests, we examined their satisfaction with continuation (only in the post-test), Japanese knee osteoarthritis measure score, short physical performance battery score, bilateral knee extension muscle strength, and short test battery for locomotive syndrome. Furthermore, we investigated correlations between adherence rates and pretest scores of Japanese knee osteoarthritis measure and short test battery and between pretest scores and variations in Japanese knee osteoarthritis measure and short test battery. RESULTS: The mean adherence rate was 82.4%. The participants showed ease of continuation (100%) and significant improvements in the degree of knee pain, pain, and stiffness, and daily life conditions using the Japanese knee osteoarthritis measure score, total score, walk seconds, and chair stand seconds of the short physical performance battery, as well as the extension muscle strength of the right- and pain-side knee. No significant correlations were identified between the adherence rate and the pretest or variation. CONCLUSION: The adherence rate to the application was over 80%. Participants with knee osteoarthritis showed almost full satisfaction, reduced pain, and improved physical ability. Therefore, the use of this application provided a safe exercise program and maintained the exercise motivation of participants. Thus, it may be useful for unsupervised home exercise.

Comparison between ilioinguinal approach and modified Stoppa approach for the treatment of acetabular fractures: An updated systematic review and meta-analysis.

BACKGROUND: The modified Stoppa (MS) approach is an alternative to the ilioinguinal (IL) approach and three meta-analyses comparing these two approaches for the treatment of acetabular fractures were published previously. The aim of this study was to provide an updated systematic review and meta-analysis comparing the MS approach with the IL approach for the treatment of acetabular fractures and to answer the following question: are the results of the MS approach superior to those of the IL approach in terms of reduction quality, operative time, operative blood loss, complications, and clinical outcomes for treatment of acetabular fractures? PATIENTS AND METHODS: An updated systematic literature review was conducted using relevant original studies from various databases (PubMed, Web of Science and the Cochrane Library). Pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value of<0.05 was considered to be significant. We calculated the mean differences (MDs) for continuous data and odds ratio (OR) for dichotomous data with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed based on I2 using the standard Chi2 test. When I2>50%, significant heterogeneity was assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. RESULTS: Six studies were included in this meta-analysis. The findings demonstrated that the rate of anatomical reduction was significantly higher in the MS approach than in the IL approach (I2=0%, OR=1.75, 95% CI: 1.13-2.69, p=0.01), the operative time was significantly shorter in the MS approach than in the IL approach (I2=88%, MD=-63.60, 95% CI: -93.01 - (-34.20), p<0.0001) and operative blood loss was significantly lower in the MS approach than in the IL approach (I2=75%, MD=-350.51, 95% CI: -523.45 - (-177.58), p<0.0001). There was no significant difference in the rate of nerve injury (I2=0%, OR=0.47, 95% CI: 0.16-1.39, p=0.17), the rate of vascular injury (I2=0%, OR=0.51, 95% CI: 0.17-1.49, p=0.22), the rate of infection (I2=0%, OR=0.53, 95% CI: 0.25-1.12, p=0.10), the rate of heterotopic ossification (I2=45%, OR=0.63, 95% CI: 0.22-1.85, p=0.40), and the rate of excellent or good clinical score (I2=21%, OR=1.15, 95% CI: 0.56-2.38, p=0.70) between the two approaches. DISCUSSION: The MS approach provided better reduction quality, shorter operative time, lower operative blood loss, although there were no significant differences in the rate of complications, and excellent or good clinical score between the two approaches. LEVEL OF EVIDENCE: III.

Minimally invasive anterolateral approach versus lateral transmuscular approach for total hip arthroplasty: A systematic review and meta-analysis.

BACKGROUND: Total hip arthroplasty (THA) using a minimally invasive (MI) approach is a commonly performed procedure, and several approaches are now being used clinically. The MI anterolateral (MIAL) approach is one of the MI approaches used in clinical practice. Whether the MIAL approach is superior to non-MI approaches remains controversial. To resolve this controversy, we performed a systematic review and a meta-analysis of results of THA procedures that used the MIAL approach. We assessed whether the MIAL approach was superior to the lateral transmuscular (LT) approach in terms of operative time, operative blood loss, radiological parameters, and clinical outcomes. METHODS: We performed a methodical search for all literature published on PubMed, Web of Science, and the Cochrane Library, and pooled data using the RevMan software. A p value < 0.05 was considered statistically significant. We calculated the mean differences (MD) for continuous data with 95% confidence intervals (CI) for each outcome. RESULTS: This meta-analysis included 6 studies. Pooled results indicated no statistically significant differences between the groups in terms of operative time (MD = 5.13, 95% CI -2.49 to 12.75, p = 0.19), cup abduction angle (MD = 1.64, 95% CI -1.32 to 4.60, p = 0.28), and cup anteversion angle (MD = 0.75, 95% CI -1.09 to 2.59, p = 0.43). Operative blood loss was significantly greater in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 68.01, 95% CI 14.69 to 121.33, p = 0.01). The postoperative Harris hip score (HHS) assessed at the time of final follow-up was significantly higher in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 1.41, 95% CI 0.50 to 2.33, p = 0.002). CONCLUSION: We conclude that the MIAL approach is superior to the LT approach in terms of clinical outcomes. LEVEL OF EVIDENCE: Level Ⅱ.

Is a portable accelerometer-based navigation system useful in total hip arthroplasty?: A systematic review and meta-analysis.

BACKGROUND: Precise implant alignment is a crucial prognostic factor for successful outcomes following total hip arthroplasty (THA). A portable accelerometer-based navigation (PN) device may achieve the same accuracy as that achieved by the computer-assisted navigation surgery technique, with the convenience of a conventional technique. Although the usefulness of PN in THA (PN-THA) has been reported, whether it is more accurate than performing THA with a conventional technique (CON-THA) remains controversial. The difference in surgical time between PN-THA and CON-THA is also unclear. Therefore, we conducted a systematic review and meta-analysis of studies comparing results of PN-THA with those of CON-THA. We focused on the following question: is PN-THA superior to CON-THA in terms of radiological parameters and surgical time? PATIENTS AND METHODS: A literature search was conducted in PubMed, Web of Science, and Cochrane Library, to identify studies that met the following inclusion criteria: randomised controlled trials (RCT) or non-RCT, studies involving patients who underwent PN-THA and patients who underwent CON-THA, studies including data on radiological parameters and surgical outcomes. Author names, publication year, country, study design, surgical approach, demographic characteristics of the participants (diagnosis, gender, age, and body mass index), and surgical outcomes (the radiological parameters and the surgical time) were extracted. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome. p<0.05 was considered significant. RESULTS: Three studies were included in this meta-analysis. The meta-analysis showed that absolute deviation of the postoperative measured angles from the target position for the cup anteversion was significantly smaller in PN-THA than in CON-THA (MD=-1.70, 95% CI=-2.91 to -0.50, [p=0.005]). There was no significant difference in the absolute deviation of the postoperative measured angles from the target position for cup abduction between the groups (MD=-1.82, 95% CI=-4.32-0.67, [p=0.15]). The surgical time was significantly longer in PN-THA than in CON-THA (MD=8.58, 95% CI=4.05-13.10, [p=0.0002]). DISCUSSION: This systematic review and meta-analysis of studies comparing the results of PN-THA with those of CON-THA showed that the PN-THA is advantageous for precise cup implantation compared to CON-THA, although PN-THA has a longer surgical time compared to CON-THA. LEVEL OF EVIDENCE: III.

Characteristics of stepladder fall injuries: a retrospective study.

BACKGROUND: Stepladders are used to work at heights in daily life, but their structure and usage differs from that of a ladder; stepladders can fold and stand without support, whereas ladders cannot fold and, thus, require support from other objects. We hypothesised that this difference made ladder and stepladder fall injuries to differ in characteristics. To clarify this hypothesis, we performed a retrospective cohort study on the stepladder fall injuries and compared their characteristics with that of ladder fall injuries. MATERIALS AND METHODS: We conducted a retrospective cohort study of injuries sustained from either ladder or stepladder falls. In this study, data were retrieved from the computerised database of Teikyo University Chiba Medical Center. Patients admitted to the orthopaedic department because of injury from ladder or stepladder fall were included. The following data were retrieved from the patient records: sex, age, height, body weight, body mass index (BMI), injury severity score (ISS), season, number of injury sites, details of injury and treatment option. RESULTS: One hundred thirty-two patients were included in this study. 101 patients were injured from stepladder falls, and 31 patients were injured from ladder falls. The number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. The most frequent type of injury after fall from stepladder was fracture (48.9%), whereas the most frequent type of injury after fall from ladder was contusion/sprain (56.4%). The most frequently injured body part from stepladder fall was lower extremity (32.6%). In contrast, the most frequently injured body part due to a ladder fall was spine (27.3%). CONCLUSION: The current study found that the number of females sustaining injuries due to a stepladder fall was significantly higher than those due to a ladder fall. Furthermore, the most frequent body parts that needed surgery following a ladder fall injury were spine and upper extremity, whereas the most frequent body parts that needed surgery following a stepladder fall injury was lower extremity. Our study indicated that stepladder falls cause severe injuries and physical disability and can be a huge financial burden.

A new closed reduction technique using a traction table to treat a traumatic posterior dislocation of the hip joint.

Traumatic hip dislocations should be reduced gently and promptly to prevent complications such as osteonecrosis of the femoral head, heterotopic ossification, incomplete recovery of sciatic nerve injury, and fractures of the femoral neck. Many closed reduction manoeuvres have been reported; however, these manoeuvres require forceful and sustained traction, which places an enormous physical burden on surgeons. The aim of the present technical note is to describe a new reduction manoeuvre that uses a traction table to decrease the physical burden experienced by surgeons.

No definite advantage of a portable accelerometer-based navigation system over conventional technique in total knee arthroplasty: A systematic review and meta-analysis.

BACKGROUND: Precise implant alignment is a crucial prognostic factor in total knee arthroplasty (TKA). Portable navigation systems (PN-TKA) were reported to be better than the conventional technique (CON-TKA). We hypothesized that PN-TKA offered greater radiologic precision than CON-TKA in mechanically aligning components. We investigated whether (1) it improved global mechanical alignment, and (2) optimized component placement with respect to the tibial and femoral mechanical axes. PATIENTS AND METHODS: A systematic literature review compared PN-TKA versus CON-TKA. PubMed, Web of Science and Cochrane Library search retrieved ten studies. Their data were pooled using RevMan 5.3. Odds ratios (OR) for dichotomous data were calculated with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed as I2 using a standard χ2 test. I2>50% denoted significant heterogeneity requiring a random effects model; otherwise, a fixed effects model was applied. RESULTS: There were significantly fewer outliers for mechanical axis (I2=24%, OR=0.62, 95% CI=0.42-0.91, p=0.02) and coronal femoral component angle (I2=58%, OR=0.31, 95% CI=0.13-0.73, p=0.007) using PN-TKA; however, no significant difference was observed for coronal tibial component angle outliers (I2=0%, OR=0.66, 95% CI=0.38-1.15, p=0.14). DISCUSSION: Although PN-TKA appeared to improve global alignment, it had no effect on coronal tibial alignment, which is a key factor in predicting the long-term success of component fixation. There thus appeared to be no definite advantage of PN-TKA over CON-TKA. LEVEL OF EVIDENCE: III.

Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: A systematic review and meta-analysis.

BACKGROUND: Several studies have reported regarding total hip arthroplasty (THA) for osteonecrosis of the femoral head after failed transtrochanteric rotational osteotomy (TRO). However, to our knowledge, no formal systematic review and meta-analysis have been published yet summarizing the clinical results of a THA after failed TRO. Therefore, we conducted a systematic review and meta-analysis of the THA outcomes after failed TRO. We focussed on the issue whether a previous TRO affects the results of subsequent THA, including operative time, operative blood loss, radiological parameters, postoperative complications, and clinical outcomes. METHODS: Literatures published up to January 2018 were searched in the PubMed, Web of Science, and Cochrane Library, and the pooling of data was performed using a RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value<0.05 was considered statistically significant. We calculated the mean differences (MD) for continuous data and the odds ratio (OR) for dichotomous data with 95% confidence intervals (CI) for each outcome. Statistical heterogeneity was assessed based on I2 using the standard Chi2. When I2>50%, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. RESULTS: Five studies were included in this meta-analysis. The results showed that operative time was significantly longer in the THA after the TRO than that for the THA without previous osteotomy (I2=92%; MD=31.62; 95% CI: 5.95 to 57.28; p=0.02). Operative blood loss was significantly greater in the THA after the TRO than that in the THA without previous osteotomy (I2=71%; MD=123.30; 95% CI: 22.21 to 224.39; p=0.02). The rate of stem malalignment was significantly higher in the THA after the TRO than that in the THA without previous osteotomy (I2=0%; OR=5.23, 95% CI: 1.95 to 14.06; p=0.001). There was no significant difference in the dislocation rate (I2=0%; OR=2.12; 95% CI: 0.64 to 6.99; p=0.22), and the postoperative Harris hip score at the final follow-up (I2=75%, MD=-0.46, 95% CI: -3.92 to 3.01, p=0.80) between the groups. CONCLUSION: The results demonstrate that, performing the THA after the TRO is technically more demanding than the THA without previous osteotomy. TRO does not affect the clinical results of future THA, and is a sufficient therapeutic alternative in younger patients. LEVEL OF EVIDENCE: III, systematic and meta-analysis of case control studies.

[Reliability and validity of the Japanese version of the Thinking Style Inventory].

This study examined the internal and external validity of the Japanese version of the Thinking Styles Inventory (TSI: Hiruma, 2000), which was originally developed by Sternberg and Wagner (1991) based on the framework of Sternberg's (1988) theory of mental self-government. The term "thinking style" refers to the concept that individuals differ in how they organize, direct, and manage their own thinking activities. We administered the Japanese version of the TSI to Japanese participants (N = 655: Age range 20-84 years). The results of item analysis, reliability analysis, and factor analysis, were consistent with the general ideas of the theory. In addition, there were significant relationships between certain thinking styles and 3 participant characteristics: age, gender, and working arrangement. Furthermore, some thinking styles were positively correlated with social skill. Implications of these results for the nature of Japanese thinking styles are discussed.

Quantitative evaluation of fatty degeneration of the supraspinatus and infraspinatus muscles using T2 mapping.

BACKGROUND: Although fatty degeneration of the rotator cuff muscles has been reported to affect the outcomes of rotator cuff repairs, only a few studies have attempted to quantitatively evaluate this degeneration. T2 mapping is a quantitative magnetic resonance imaging technique that potentially evaluates the concentration of fat in muscles. The purpose of this study was to investigate fatty degeneration of the rotator cuff muscles by using T2 mapping, as well as to evaluate the reliability of T2 measurement. METHODS: We obtained magnetic resonance images including T2 mapping from 184 shoulders (180 patients; 110 male patients [112 shoulders] and 70 female patients [72 shoulders]; mean age, 62 years [range, 16-84 years]). Eighty-three shoulders had no rotator cuff tear (group A), whereas 101 shoulders had tears, of which 62 were incomplete to medium (group B) and 39 were large to massive (group C). T2 values of the supraspinatus and infraspinatus muscles were measured and compared among groups. Intraobserver and interobserver variabilities also were examined. RESULTS: The mean T2 values of the supraspinatus in groups A, B, and C were 36.3 ± 4.7 milliseconds, 44.2 ± 11.3 milliseconds, and 57.0 ± 18.8 milliseconds, respectively. The mean T2 values of the infraspinatus in groups A, B, and C were 36.1 ± 5.1 milliseconds, 40.0 ± 11.1 milliseconds, and 51.9 ± 18.2 milliseconds, respectively. The T2 value significantly increased with the extent of the tear in both muscles. Both intraobserver and interobserver variabilities were more than 0.99. CONCLUSION: T2 mapping can be a reliable tool to quantify fatty degeneration of the rotator cuff muscles.

In vivo 3D analysis of clavicular kinematics during scapular plane abduction: comparison of dominant and non-dominant shoulders.

The purpose of this study was to evaluate side-to-side differences in three-dimensional clavicle kinematics in normal shoulders during dynamic scapular plane elevation using model-image registration techniques. Twelve healthy males with a mean age of 32 years (range, 27-36 years old) were enrolled in this study. Clavicle rotations were computed with bilateral fluoroscopic images and CT-derived bone models using model-image registration techniques and compared between dominant and nondominant shoulders. There was no difference in retraction between both shoulders. The clavicle in dominant shoulders was less elevated during abduction than in nondominant shoulders (P=0.03). Backward rotation angles of dominant shoulders were significantly smaller than those of nondominant shoulders throughout the activity (P=0.03). Clavicular kinematics during scapular plane abduction were different according to hand-dominance.

Quality of gastric cancer care in designated cancer care hospitals in Japan.

OBJECTIVE: To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan. DESIGN: A retrospective medical record review. SETTING: Eighteen designated cancer care hospitals throughout Japan. PARTICIPANTS: A total of 1685 patients diagnosed with gastric cancer in 2007. MAIN OUTCOME MEASURES: Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan. RESULTS: Overall, the patients received 68.3% of the care processes recommended by the QIs. While 'deep venous thrombosis prophylaxis before major surgery' was performed for 99% of the cases, 'documentation before endoscopic resection' was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001). CONCLUSIONS: Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan.

Short-segment fixation without fusion for thoracolumbar burst fractures with neurological deficit can preserve thoracolumbar motion without resulting in post-traumatic disc degeneration: a 10-year follow-up study.

STUDY DESIGN: Prospective consecutive series. OBJECTIVE: To evaluate the post-traumatic disc degeneration and range of motion 10 years after short-segment fixation without fusion for thoracolumbar burst fractures with neurological deficit. SUMMARY OF BACKGROUND DATA: Early clinical results of short-segment fixation without fusion for thoracolumbar burst fractures were satisfactory. However, the long-term results have not been reported, and post-traumatic disc degeneration and preservation of thoracolumbar motion have not been elucidated. METHODS: Twelve patients who had thoracolumbar burst fractures and associated incomplete neurological deficit, operatively treated within 4 days of admission and had their implants removed within 1 year, were prospectively followed for at least 10 years. Following indirect reduction and pedicle screw fixation, transpedicular intracorporeal hydroxyapatite grafting to the fractured vertebrae was performed. RESULTS: Sagittal alignment was improved from a mean preoperative kyphosis of 17° to -2° (lordosis) by operation, but was found to have slightly deteriorated to 2° at the final follow-up observation. With respect to back pain, 8 patients did not report back pain. Three reported occasional minimal pain, and 1 reported moderate pain. None reported severe pain or needed daily dosages of analgesics.Regarding disc degeneration, the shape of the disc adjacent to the fractured vertebra had not changed from the preoperative to the 10-year postoperative magnetic resonance image (MRI). Although signal intensity of the disc had decreased by 1 grade from the preoperative to the 2-year postoperative MRI, the intensity had not changed from the 2-year postoperative MRI to the 10-year postoperative MRI. At the 10-year follow-up, flexion-extension radiographs revealed that a mean range of motion at the disc adjacent to the fractured vertebra was 12º (range; 5-19). CONCLUSION: This unprecedented 10-year follow-up study demonstrated that posterior indirect reduction, transpedicular hydroxyapatite grafting, and pedicle screw fixation does not require fusion to a segment, thereby preserves thoracolumbar motion without resulting in post-traumatic disc degeneration. LEVEL OF EVIDENCE: 4.

Transient heating of expressed breast milk up to 65°C inactivates HIV-1 in milk: a simple, rapid, and cost-effective method to prevent postnatal transmission.

The postnatal transmission of human immunodeficiency virus (HIV) from mothers to children occurs through breastfeeding. Although heat treatment of expressed breast milk is a promising approach to make breastfeeding safer, it is still not popular, mainly because the recommended procedures are difficult to follow, or time-consuming, or because mothers do not know which temperature is sufficient to inactivate HIV without destroying the nutritional elements of milk. To overcome these drawbacks, a simple and rapid method of heat treatment that a mother could perform with regular household materials applying her day-to-day art of cooking was examined. This structured experiment has demonstrated that both cell-free and cell-associated HIV type 1 (HIV-1) in expressed breast milk could be inactivated once the temperature of milk reached 65°C. Furthermore, a heating method as simple as heating the milk in a pan over a stove to 65°C inhibited HIV-1 transmission retaining milk's nutritional key elements, for example, total protein, IgG, IgA, and vitamin B(12) . This study has highlighted a simple, handy, and cost-effective method of heat treatment of expressed breast milk that mothers infected with HIV could apply easily and with more confidence.

A novel therapeutic strategy for chylous ascites after gynecological cancer surgery: a continuous low-pressure drainage system.

PURPOSE: Postoperative chylous ascites is an unusual complication following retroperitoneal surgery. A search of the English literature showed only 44 cases of chylous ascites following gynecological cancer surgery. The treatment is primarily conservative, but surgical treatment is considered in resistant cases. We developed a novel non-surgical therapeutic strategy for postoperative chylous ascites. METHODS: We report a case of severe chylous ascites following pelvic lymph node dissection for gynecological cancer. RESULTS: Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, and systematic pelvic lymph node dissection were performed for a stage II G1 endometrioid adenocarcinoma (FIGO 2009). Forty-one days after surgery, the patient was readmitted due to massive ascites. Repeated paracentesis and a low-fat diet were only partially effective. Fifty-one days after surgery, we started paracentesis with a continuous low-pressure drainage system. Nine days later, there was no further fluid drainage. The patient was asymptomatic and without recurrent disease at follow-up 3 months later. CONCLUSIONS: Pelvic lymph node dissection may cause postoperative chylous ascites. Paracentesis with a continuous low-pressure drainage system can be an effective conservative treatment for postoperative chylous ascites.

Asymmetrical pedicle subtraction osteotomy for rigid degenerative lumbar kyphoscoliosis.

STUDY DESIGN: A prospectively study. OBJECTIVE: Our objective was to clarify the safety and efficacy of asymmetrical pedicle subtraction osteotomy (PSO) in the treatment of severe adult lumbar deformities prospectively. SUMMARY OF BACKGROUND DATA: Vertebral wedge osteotomy provides good correction of kyphosis but has rarely been applied to degenerative lumbar kyphoscoliosis. METHODS: A total of 14 patients who had undergone corrective osteotomy were enrolled. The average age at PSO was 67 years (range, 45-76 yr). The minimum follow-up was 2 years. Patient questionnaires were administered prospectively. Radiographical parameters including sagittal and coronal balance were analyzed. RESULTS: Average operative time was 310 minutes (range, 254-375 min). Average blood loss was 1090 mL (range, 700-2900 mL).Mean preoperative lumbar lordosis improved from -3° to 42° at the final follow-up, and sagittal balance improved from 12 to 3 cm, respectively. Mean lumbar scoliosis improved from 40° to 12°, and coronal offset improved from 3 to 1 cm, respectively. There was also statistically significant improvement from preoperative to final evaluation in all clinical domains. There were 4 complications: 1 dural tear, 2 hook dislodgements at the cephalad side requiring revision instrumentation, and 1 rod breakage not requiring surgical intervention. Overall, all 14 patients were satisfied with their surgical management and would choose to repeat the procedure. CONCLUSION: Our data suggest that the surgical procedure of asymmetrical PSO is to correct the scoliosis, to restore the lumbar lordosis by way of convex-sided posterolateral wedge osteotomy, and may go a long way toward solving the problems of rigid lumbar degenerative kyphoscoliosis.

Platelet-rich plasma combined with hydroxyapatite for lumbar interbody fusion promoted bone formation and decreased an inflammatory pain neuropeptide in rats.

STUDY DESIGN: A prospective interventional trial, using a rat model of lumbar interbody fusion. OBJECTIVE: To examine the potential efficacy of platelet-rich plasma (PRP) for lumbar interbody fusion, using hydroxyapatite (HA). SUMMARY OF BACKGROUND DATA: PRP is an autologous product containing a high concentration of platelets in a small volume of plasma and has osteoinductive effects. HA has osteoconductive ability and has been used in combination with autogenous bone for spine fusion. However, reports using PRP with HA for spine fusion are very few. The purpose of this study was to examine the efficacy of PRP with HA for spinal interbody fusion and at the same time to estimate the change in immunoreactivity of the inflammatory neuropeptide, calcitonin gene-related peptide (CGRP), in dorsal root ganglion (DRG) neurons innervating spinal discs. METHODS: A total of 35 Sprague-Dawley rats were used in this study. Twenty-one rats were used for conducting interbody fusion experiments, 7 rats were used as immunostaining controls, and 7 other rats were used as blood donors for making PRP. L5-L6 interbody fusion was performed on 21 rats using HA + PRP (n = 7), HA + platelet-poor plasma (n = 7), or HA + saline (n = 7). Simultaneously, Fluoro-Gold neurotracer was applied to the intervertebral space to detect DRG neurons innervating the discs. L5-L6 lumbar radiographs were obtained and lumbar DRGs were immunostained for CGRP. The rate of bone union and the change in CGRP immunoreactive DRG neurons innervating the discs were evaluated and compared among groups. RESULTS: All L5-L6 lumbar discs were fused in the PRP + HA group (fused 7/total 7), whereas only 1 case was fused in the platelet-poor plasma group (1 of 7) and no cases in the HA-only group (0 of 7), which was a significant difference. Upon immunohistochemical analysis, CGRP-positive neurons innervated L5-L6 intervertebral discs in nonunion cases, and these were significantly increased compared with those in union cases. CONCLUSION: Our study suggests that using PRP with HA was beneficial for spine fusion. This combination may promote bone union and also decrease inflammatory neuropeptide in sensory neurons innervating the discs.

Dynamic in vivo glenohumeral kinematics during scapular plane abduction in healthy shoulders.

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To measure superior/inferior translation and external rotation of the humerus relative to the scapula during scapular plane abduction using 3-D/2-D model image registration techniques. BACKGROUND: Kinematic changes in the glenohumeral joint, including excessive superior translation of the humeral head and inadequate external rotation of the humerus, are believed to be a possible cause of shoulder impingement. Although many researchers have analyzed glenohumeral kinematics with various methods, few articles have assessed dynamic in vivo glenohumeral motion. METHODS: Twelve healthy males with a mean age of 32 years (range, 27-36 years) were enrolled in this study. Fluoroscopic images of the dominant shoulder during scapular plane elevation were taken, and computed tomography-derived 3-D bone models were matched with the silhouette of the bones in the fluoroscopic images using 3-D/2-D model image registration techniques. The kinematics of the humerus relative to the scapula were determined using Euler angles. RESULTS: On average, there was 2.1 mm of initial humeral translation in the superior direction from the starting position to 105° of humeral elevation. Subsequently, an average of 0.9 mm of translation in the inferior direction occurred between 105° and maximum arm elevation. The average amount of external rotation of the humerus was 14° from the starting position to 60° of humeral elevation. The humerus then rotated internally an average 9° by the time the shoulder reached maximum elevation. These changes in superior/inferior translation and external/internal rotation were statistically significant (P<.001 and P = .001, respectively), based on 1-way repeated-measures analysis of variance. CONCLUSION: The observed glenohumeral translations and rotations characterize healthy shoulder function and serve as a preliminary foundation for quantifying pathomechanics in the presence of glenohumeral joint disorders.