Search

Fumi Nishiguchi,1,2 Akiko Kimura,1 Mana Okamoto,1 Yoichi Okita,1 Fumi Gomi1 1Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; 2Nishiguchi Eye Clinic, Kobe, Hyogo, JapanCorrespondence: Akiko KimuraDepartment of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, JapanTel +81 798 45 6462Fax +81 798 45 6464Email akis@hyo-med.ac.jpPurpose: To report the characteristics and outcomes of extraocular muscle (EOM) surgery for diplopia and abnormal head posture (AHP) after treatment of severe brain diseases such as brain tumor, severe cerebral bleeding and cerebral infarction.Patients and Methods: Sixty-four patients (mean age 53.7 ± 16.0 years) who underwent EOM surgery to eliminate diplopia or AHP after treatment for brain disease at Hyogo College of Medicine Hospital from March 2006 through February 2018 were included. We divided the patients into two groups: a severe cerebrovascular disorder (SCVD) group and a brain tumor (BT) group. Backgrounds, surgical outcomes and satisfaction with treatment outcomes were examined retrospectively and compared between the two groups. The NEI-VFQ 25, Japanese version, was used to quantify postoperative satisfaction.Results: There were 26 patients in the SCVD group and 38 patients in the BT group. The average age for the BT group was significantly younger than that for the SCVD group (P = 0.0236). The period from the onset of diplopia to EOM surgery was approximately 4 years for both groups. Abducens palsy was the most frequent disturbance (27% in the SCVD group and 52.6% in the BT group), and the numbers of operations were similar between the 2 groups (1.3 ± 0.7 and 1.3 ± 0.5 operations, respectively). In total, diplopia was eliminated in 82.8% of cases and AHP improved in 81.6% of cases. The BT group scored significantly higher than the SCVD group on 8 out of the 11 items on the VFQ 25.Conclusion: EOM surgery was effective in eliminating diplopia and AHP. Therefore, we recommend that these patients visit an ophthalmologist as soon as possible and undergo EOM surgery.Keywords: diplopia, abnormal head posture, strabismus surgery, brain disease, VFQ 25

Tomoko Fujitani,1 Kumiko Ohara,1 Katsuyasu Kouda,2 Tomoki Mase,3 Chiemi Miyawaki,4,5 Katsumasa Momoi,1,6 Yoshimitsu Okita,7 Maki Furutani,1 Harunobu Nakamura1 1Graduate School of Human Development and Environment, Kobe University, Kobe, 2Department of Public Health, Faculty of Medicine, Kindai University, Osaka-Sayama, 3Faculty of Human Development and Education, Kyoto Women’s University, 4Department of Early Childhood Education, Heian Jogakuin College, Kyoto, 5Kagoshima University Research Field in Education, Education, Law, Economics and the Humanities Area, Kagoshima, 6Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, 7Graduate School of Integrated Science and Technology, College of Engineering, Academic Institute, Shizuoka University, Hamamatsu, Shizuoka, Japan Purpose: Recent studies have shown that perceived social support is associated with gratitude and sense of coherence, but evidence for this concept remains scarce. In the present study, we investigated relationships between social support, gratitude, and sense of coherence, focusing on the construct of and source of social support among young women. Methods: The study was conducted in 2014 in Japan. Participants comprised 208 female university students (aged 19.9 ± 1.1 years), who completed a self-administered anonymous questionnaire regarding perceived social support, gratitude, and sense of coherence. Results: Emotional and instrumental social support from acquaintances were found to be lower than those from family and friends. Gratitude was positively correlated with all forms of social support except instrumental social support from acquaintances. However, sense of coherence was positively correlated with both emotional and instrumental social support from family and only emotional social support from acquaintances. Multiple regression analysis showed that ­emotional support from family and emotional support from acquaintances were positively associated with gratitude whereas emotional support from family was associated with sense of coherence. Conclusion: These results indicate that emotional social support from family was related to both gratitude and sense of coherence. Keywords: social support, gratitude, sense of coherence, well-being, female

A combined experimental and numerical study of interaction between cooling flow and mainstream gas flow in a turbine rotor-stator rim cavity is reported. Particular emphasis is put on the flow phenomena in a rim cavity downstream of rotor blades. The experiments are conducted on a rig simulating an engine HP-turbine in which cooling effectiveness distributions as well as velocities, turbulence quantities, pressure, and temperature profiles are measured. Numerical calculation, especially at a full 3D, unsteady solution level, can lead to satisfactory predictions in fluid and mass transfer inside the cavity. Both experimental and numerical results indicate that large turbulence stresses near the rotor disk intensify turbulent diffusion across the cavity and consequently axial distribution of the cooling effectiveness inside the cavity becomes uniform. In order to obtain an adequate distribution of cooling effectiveness across the rim cavity and to suppress the turbulence level near the rotor surface for more efficient cooling, a novel cooling method is developed using numerical simulation. The disk-front and -rear cavities are then redesigned according to the new cooling strategy and integrated in the test rig. Experimental results verify a significant advance in cooling performance with the new method. [DOI: 10.1115/1.1925647]

Aim: Precise biomarkers for predicting prognosis could help to identify high‐risk Crohn's disease (CD) patients to facilitate better follow‐up during the postoperative course. In this study, the primary aim is the identification of the most reliable nutrition marker that predicts surgical relapse in CD patients. Method: We first evaluated the predictive value of various nutrition markers for postoperative surgical relapse in CD patients and identified the advanced lung cancer inflammation index (ALI) as a promising biomarker. Then, we assessed the clinical significance of preoperative ALI in CD patients using two cohorts. Results: Preoperative ALI showed the highest correlation with reoperation rate compared with other nutritional parameters in CD patients receiving surgical resection (sensitivity 53%, specificity 86%, area under the curve 0.71). Lower levels of preoperative ALI were significantly correlated with the presence of perianal disease. A lower level of preoperative ALI was an independent prognostic factor for reoperation rate after an intestinal resection (hazard ratio 3.37, 95% CI 1.38–10.12, P = 0.006), and the prognostic impact of preoperative ALI was successfully validated in an independent cohort using the same cut‐off value. Conclusion: Preoperative ALI might be useful for postoperative management of CD patients. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between 11C-methionine positron-emission tomography (11C-methionine PET) findings, isocitrate dehydrogenase (IDH) gene mutation, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in patients with grade II and III gliomas.Materials and Methods: Data were collected from 40 patients with grade II and III gliomas who underwent both magnetic resonance imaging (MRI) and 11C-methionine PET as part of their pre-surgical examination. IDH mutation was examined via DNA sequencing, and MGMT promoter methylation via quantitative methylation-specific polymerase chain reaction (PCR).Results: A threshold of MGMT promoter methylation of 1% was significantly associated with tumour/normal tissue (T/N) ratio. The T/N ratio in samples with MGMT promoter methylation ≥1% was higher than that in samples with MGMT promoter methylation <1%, and the difference was statistically significant (p=0.011). Reliable prediction of MGMT promoter methylation (<1% versus ≥1%) was possible using the T/N ratio under the receiver operator characteristic (ROC) curve with a sensitivity and specificity of 75% each (cut-off value=1.6: p=0.0226, area under the ROC curve [AUC]=0.76172). Conversely, the T/N ratio had no association with IDH mutation (p=0.6). The ROC curve revealed no reliable prediction of IDH mutation using the T/N ratio (p=0.606, AUC=0.60577).Conclusion: 11C-methionine PET parameters can predict MGMT promoter methylation but not IDH mutation status. 11C-methionine uptake may have limited potential to reflect DNA methylation processes in grade II and III gliomas. [ABSTRACT FROM AUTHOR]

Background and Aim: Among elderly patients undergoing cardiac surgery, malnutrition is very common and related to muscle wasting known as sarcopenia. Cardiac surgery causes a further decline of nutritional status due to reduced dietary intake (DI); however, the impact of postoperative DI on functional recovery is unclear.Methods and Results: We enrolled 250 consecutive patients undergoing cardiac surgery. Daily DI was measured between postoperative days 3 and 7. Patients were categorized as having sufficient or insufficient DI based on whether their DI met or was less than estimated total energy requirements. Functional capacity was measured using the 6-minute walking distance (6MWD) preoperatively and at discharge. Mean postoperative DI was 22.4 ± 3.0 kcal/kg/day, and postoperative DI was insufficient in 92 patients (36.8%). The prevalence of sarcopenia was not different by postoperative DI. Although there was no significant difference in preoperative 6MWD results (P = 0.65), the sufficient DI group had longer 6MWD at discharge than the insufficient DI group (P = 0.04). In multivariate regression analysis, preoperative poor nutritional status (β = -0.29), duration of surgery (β = -0.18), and postoperative DI (β = 0.40) remained statistically significant predictors for improvement of 6MWD (P < 0.0001, adjusted R2 = 0.41).Conclusions: Postoperative DI was independently associated with functional recovery, but preoperative sarcopenia was not. Regardless of preoperative nutritional status or the presence of sarcopenia, aggressive nutritional intervention in the early stage after surgery helps support functional recovery. [ABSTRACT FROM AUTHOR]

Biological disease-modifying anti-rheumatic drugs (bDMARDs) against pathogenic proinflammatory cytokines and lymphocytes, such as tumour necrosis factor- (TNF- ), interleukin-6, T cells and B cells, have been developed and have become leading drugs in the treatment of rheumatoid arthritis (RA). Here, we focused on I TNFAIP3 i as a possible genetic marker for TNFi therapeutic response and examined the association of one of the representative disease-susceptible SNPs of I TNFAIP3 i , rs2230926, with therapeutic failure of TNFi. [Extracted from the article]

Aortoesophageal fistula is a critical and life-threatening disease. The cardiovascular strategy for graft replacement has been widely discussed. However, the surgical strategy of esophageal resection and reconstruction for aortoesophageal fistula has rarely been discussed. The objective of this study is to establish a surgical strategy and procedure of esophageal resection and reconstruction for aortoesophageal fistula. Eleven patients with aortoesophageal fistula who underwent aortic graft replacement and esophagectomy between 2008 and 2015 at Kobe University Hospital were enrolled in this study. Patient characteristics, operative methods, and clinical outcomes were obtained by retrospective chart review. All 11 patients underwent graft replacement, esophagectomy, and omental wrapping. Ten esophagectomies were simultaneously accomplished in the same operative field as aortic graft replacement. Seven patients underwent subtotal esophagectomy from a left thoracotomy, and three patients underwent upper hemiesophagectomy from a median sternotomy. The other patient underwent staged esophagectomy from a right thoracotomy. Seven of 11 patients (63.6%) successfully underwent staged esophageal reconstruction. Pedicled jejunal transfer with supercharge and superdrainage were performed in six patients, and ileocecal reconstruction was performed in one patient. Median survival time in the patients with esophageal reconstruction was 21 months while that in the patients without esophageal reconstruction was 10 months. Six of 7 patients (85.7%) who underwent esophageal reconstructions were alive. Our surgical strategy for aortoesophageal fistula, which includes simultaneous graft replacement and esophagectomy in the same operative field and staged reconstruction by pedicled jejunal transfer to ensure omental wrapping, is feasible and promising. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effect of muscle co-contraction on balance recovery by using a simulation model. The muscle-driven forward simulation model included an inverted pendulum with two ankle muscles, a plantar flexor muscle (PF), and a dorsal flexor muscle (DF). The model was created based on experimental data obtained from balance recovery after applying backward platform translation to a standing elderly woman. Baseline simulation was performed using this model. Additionally, we performed two simulations with increased DF excitation at the same level of simulation and at the same pattern of simulation. The same level of simulation had the same PF excitation level as the baseline simulation with increased DF excitation. The same pattern simulation had the same increased or decreased PF excitation pattern but with a constant increase in PF excitation level to offset the increased DF excitation. Our results revealed that the same pattern simulation decreased the maximum dorsal flexion angle after platform translation. During the same level of simulation, the insufficient PF force used to recover balance resulted in a forward fall. These results imply that co-contraction is an effective strategy for recovering balance at the expense of additional muscle excitation in the elderly. [ABSTRACT FROM AUTHOR]

Fast walking is considered as a factor that causes pain in patients suffering from knee disorders. This study examined the effect of walking speed on the medial knee contact force and identified contributions to the muscle tension on the medial knee contact force during fast walking using musculoskeletal simulation analysis. The muscle contribution to the medial knee contact force was calculated based on the joint angles and ground reaction force for the normal and fast walking experiments of seven subjects. The muscle force and joint reaction force were used to estimate the medial knee contact force. Results showed, in average, 70% increase in medial knee contact force at the first peak and 34% increase at the second peak with a fast walking speed, compared to when they walked at a normal walking speed. The remarkable increase in the first peak was mainly contributed by the increase in the quadriceps force resisting the external knee flexion moment. In contrast, the moderate increase of second peak was contributed by the increase in the gastrocnemius muscle force. These results suggest that the increase in medial knee contact force at fast walking speeds is caused by the increased muscle force. [ABSTRACT FROM AUTHOR]

Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with "kissing"-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment. [ABSTRACT FROM AUTHOR]

The effects of dimples, protrusions, and ribs on turbulent heat transfer were numerically investigated by using the large eddy simulation with a Lagrangian dynamic subgrid-scale model. The dimpled case gave the high heat transfer area in downstream half of the dimple and also in the downstream region behind the dimple. By adding the ribs on the dimpled walls, the heat transfer was further enhanced. On the other hand, the protrusions deteriorated the heat transfer due to the severe contraction caused by their height. [ABSTRACT FROM AUTHOR]

The inflammatory reaction is known to be controlled in neonates. We clarified the characteristics of cytokine profile in neonatal patients and assess its clinical significance. Serum levels of interleukin (IL)-6 and IL-1 receptor antagonist (ra) were determined in 152 pediatric patients and 33 each of maternal and cord bloods. Supernatant IL-1ra levels of cultured monocytes and granulocytes stimulated with IL-1beta or LPS, and IL-1ra mRNA expression of granulocytes were assayed in 15 each of cord and healthy adult bloods. Although surgical stress in neonates was heavier than that in infants, there was no difference in the occurrence of postoperative morbidity and mortality. In neonates, the perioperative serum level of IL-1ra was significantly raised, and the postoperative IL-6 response was well controlled. The serum concentration of IL-1ra in cord blood was not different from that in maternal blood, whereas, the serum concentration of IL-6 in cord blood was significantly reduced than that in maternal blood. In granulocytes, significantly more IL-1ra was produced from cord than from adult blood. An IL-1ra predominant immune status in neonates may be a naturally acquired adaptation system and play a crucial role in attenuating acute inflammatory reaction in a vulnerable host defense. [ABSTRACT FROM AUTHOR]

A 69-year-old hypertensive man who had 7 pseudoaneurysms caused by penetrating atherosclerotic ulcers underwent 2-staged endovascular grafting in the thoracic and thoracoabdominal aorta and a conventional graft replacement of the abdominal aorta. He had an uneventful postoperative course; follow-up computed tomography demonstrated that all aneurysmal lesions treated by endovascular grafting completely disappeared. He has been free from any aortic events 20 months after the last surgery. [ABSTRACT FROM AUTHOR]