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Objective This study is an investigator-initiated, prospective, randomized, controlled study to evaluate the efficacy and safety of the combined use of recombinant human BMP-2 (rhBMP-2) and a hydroxyapatite (HA) carrier in multilevel fusion in patients with adult spinal deformity (ASD). Methods Thirty patients underwent posterolateral fusion for lumbar spinal deformities at 3 to 5 segments between L1 and S1. The patients received rhBMP-2+HA or HA on the left or right side of the transverse processes. They were followed up regularly at 1, 3, 6, and 12 months postoperatively. Fusion was defined according to the bone bridging on computed tomography scans. The fusion rate per segment was subanalyzed. Function and quality of life as well as pain in the lower back and lower extremities were evaluated. Results The union rate for the rhBMP-2+HA group was 100% at 6 and 12 months. The union rate for the HA group was 77.8% (21 of 27) at 6 months and 88.0% (22 of 25) at 12 months (p = 0.014 at 6 months; not significant at 12 months). All segments were fused at 6 and 12 months in the rhBMP-2+HA group (p < 0.001). In the HA group, 108 of 115 segments (93.5%) were fused at 6 months and 105 of 109 segments (96.3%) at 12 months. Other clinical parameters (visual analogue scale, 36-item Short Form Health Survey, and Scoliosis Research Society-22 scores) improved compared to baseline. Conclusion Combining rhBMP-2 and an HA carrier is a safe and effective method to achieve multilevel fusion in patients with ASD.

Objective Total en bloc spondylectomy (TES) is a curative surgical method for spinal tumors. After resecting the 3 spinal columns, reconstruction is of paramount importance. We present cases of mechanical failure and suggest strategies for salvage surgery. Methods The medical records of 19 patients who underwent TES (9 for primary tumors and 10 for metastatic tumors) were retrospectively reviewed. Previously reported surgical techniques were used, and the surgical extent was 1 level in 16 patients and 2 levels in 3 patients. A titanium-based mesh-type interbody spacer filled with autologous and cadaveric bone was used for anterior support, and a pedicle screw/rod system was used for posterior support. Radiotherapy was performed in 11 patients (pre-TES, 5; post-TES, 6). They were followed up for 59 ± 38 months (range, 11–133 months). Results During follow-up, 8 of 9 primary tumor patients (89%) and 5 of 10 metastatic tumor patients (50%) survived (mean survival time, 124 ± 8 months vs. 51 ± 13 months; p=0.11). Mechanical failure occurred in 3 patients (33%) with primary tumors and 2 patients (20%) with metastatic tumors (p=0.63). The mechanical failure-free time was 94.4 ± 14 months (primary tumors, 95 ± 18 months; metastatic tumors, 68 ± 16 months; p=0.90). Revision surgery was performed in 4 of 5 patients, and bilateral broken rods were replaced with dual cobalt-chromium alloy rods. Repeated rod fractures occurred in 1 of 4 patients 2 years later, and the third operation (with multiple cobalt-chromium alloy rods) was successful for over 6 years. Conclusion Considering the difficulty of reoperation and patients’ suffering, preemptive use of a multiple-rod system may be advisable.

Abstract We aimed to investigate the effect of chronic particulate matter (PM) exposure on bleomycin-induced lung fibrosis in a rat model using chest CT, histopathologic evaluation, and RNA-sequencing. A bleomycin solution was intratracheally administrated to 20 male rats. For chronic PM exposure, after four weeks of bleomycin treatment to induce lung fibrosis, PM suspension (experimental group) or normal saline (control group) was intratracheally administrated for 10 weeks. Chest CT was carried out in all rats, and then both lungs were extracted for histopathologic evaluation. One lobe from three rats in each group underwent RNA sequencing, and one lobe from five rats in each group was evaluated by western blotting. Inflammation and fibrosis scores in both chest CT and pathologic analysis were significantly more aggravated in rats with chronic PM exposure than in the control group. Several genes associated with inflammation and immunity were also upregulated with chronic PM exposure. Our study revealed that chronic PM exposure in a bleomycin-induced lung fibrosis rat model aggravated pulmonary fibrosis and inflammation, proven by chest CT, pathologic analysis, and RNA sequencing.

Purpose Although chest CT has been discussed as a first-line test for coronavirus disease 2019 (COVID-19), little research has explored the implications of CT exposure in the population. To review chest CT protocols and radiation doses in COVID-19 publications and explore the number needed to diagnose (NND) and the number needed to predict (NNP) if CT is used as a first-line test. Materials and Methods We searched nine highly cited radiology journals to identify studies discussing the CT-based diagnosis of COVID-19 pneumonia. Study-level information on the CT protocol and radiation dose was collected, and the doses were compared with each national diagnostic reference level (DRL). The NND and NNP, which depends on the test positive rate (TPR), were calculated, given a CT sensitivity of 94% (95% confidence interval [CI]: 91%–96%) and specificity of 37% (95% CI: 26%–50%), and applied to the early outbreak in Wuhan, New York, and Italy. Results From 86 studies, the CT protocol and radiation dose were reported in 81 (94.2%) and 17 studies (19.8%), respectively. Low-dose chest CT was used more than twice as often as standarddose chest CT (39.5% vs.18.6%), while the remaining studies (44.2%) did not provide relevant information. The radiation doses were lower than the national DRLs in 15 of the 17 studies (88.2%) that reported doses. The NND was 3.2 scans (95% CI: 2.2–6.0). The NNPs at TPRs of 50%, 25%, 10%, and 5% were 2.2, 3.6, 8.0, 15.5 scans, respectively. In Wuhan, 35418 (TPR, 58%; 95% CI: 27710–56755) to 44840 (TPR, 38%; 95% CI: 35161–68164) individuals were estimated to have undergone CT examinations to diagnose 17365 patients. During the early surge in New York and Italy, daily NNDs changed up to 5.4 and 10.9 times, respectively, within 10 weeks. Conclusion Low-dose CT protocols were described in less than half of COVID-19 publications, and radiation doses were frequently lacking. The number of populations involved in a first-line diagnostic CT test could vary dynamically according to daily TPR; therefore, caution is required in future planning.

Abstract In vivo presentation of airway hyper-responsiveness (AHR) at the different time points of the allergic reaction is not clearly understood. The purpose of this study was to investigate how AHR manifests in the airway and the lung parenchyma in vivo following exposure to different stimuli and in the early and late phases of asthma after allergen exposure. Ovalbumin (OVA)-induced allergic asthma model was established using 6-week female BALB/c mice. Enhanced pause was measured with a non-invasive method to assess AHR. The dynamic changes of the airway and lung parenchyma were evaluated with ultra-high-resolution computed tomography (128 multi-detector, 1024 × 1024 matrix) for 10 h. While the methacholine challenge showed no grossly visible changes in the proximal airway and lung parenchyma despite provoking AHR, the OVA challenge induced significant immediate changes manifesting as peribronchial ground glass opacities, consolidations, air-trapping, and paradoxical proximal airway dilatations. After resolution of immediate response, multiple episodes of AHRs occurred with paradoxical proximal airway dilatation and peripheral air-trapping in late phase over a prolonged time period in vivo. Understanding of airflow limitation based on the structural changes of asthmatic airway would be helpful to make an appropriate drug delivery strategy for the treatment of asthma.

We applied quantitative CT image matching to assess the degree of motion in the idiopathic ILD such as usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). Twenty-one normal subjects and 42 idiopathic ILD (31 UIP and 11 NSIP) patients were retrospectively included. Inspiratory and expiratory CT images, reviewed by two experienced radiologists, were used to compute displacement vectors at local lung regions matched by image registration. Normalized three-dimensional and two-dimensional (dorsal-basal) displacements were computed at a sub-acinar scale. Displacements, volume changes, and tissue fractions in the whole lung and the lobes were compared between normal, UIP, and NSIP subjects. The dorsal-basal displacement in lower lobes was smaller in UIP patients than in NSIP or normal subjects (p = 0.03, p = 0.04). UIP and NSIP were not differentiated by volume changes in the whole lung or upper and lower lobes (p = 0.53, p = 0.12, p = 0.97), whereas the lower lobe air volume change was smaller in both UIP and NSIP than normal subjects (p = 0.02, p = 0.001). Regional expiratory tissue fractions and displacements showed positive correlations in normal and UIP subjects but not in NSIP subjects. In summary, lung motionography quantified by image registration-based lower lobe dorsal-basal displacement may be used to assess the degree of motion, reflecting limited motion due to fibrosis in the ILD such as UIP and NSIP.

Abstract Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and the traditional variables extracted from computed tomography (CT) images may not be sufficient to describe all the topological features of lung tissues in COPD patients. We employed an unsupervised three-dimensional (3D) convolutional autoencoder (CAE)-feature constructor (FC) deep learning network to learn from CT data and derive tissue pattern-clusters jointly. We then applied exploratory factor analysis (EFA) to discover the unobserved latent traits (factors) among pattern-clusters. CT images at total lung capacity (TLC) and residual volume (RV) of 541 former smokers and 59 healthy non-smokers from the cohort of the SubPopulations and Intermediate Outcome Measures in the COPD Study (SPIROMICS) were analyzed. TLC and RV images were registered to calculate the Jacobian (determinant) values for all the voxels in TLC images. 3D Regions of interest (ROIs) with two data channels of CT intensity and Jacobian value were randomly extracted from training images and were fed to the 3D CAE-FC model. 80 pattern-clusters and 7 factors were identified. Factor scores computed for individual subjects were able to predict spirometry-measured pulmonary functions. Two factors which correlated with various emphysema subtypes, parametric response mapping (PRM) metrics, airway variants, and airway tree to lung volume ratio were discriminants of patients across all severity stages. Our findings suggest the potential of developing factor-based surrogate markers for new COPD phenotypes.

Abstract Our aim was to correlate chest CT and pathologic findings of polyhexamethylene guanidine phosphate (PHMG)-induced lung injuries in a rat model, to determine whether PHMG exposure causes lung tumors, and to explore genetic alterations according to PHMG exposure under the guidance of CT. A PHMG solution was intratracheally administrated to 40 male rats. Chest CT was carried out in all rats and both lungs were collected for histopathologic evaluation. At 4- and 8-weeks post-instillation, one lobe of the right lung from 3 rats was subjected to RNA sequencing. At least one abnormal CT finding was found in all rats at all weeks. The major CT findings were inflammation, fibrosis, and tumors in the pathologic analysis, where significant changes were observed over time. The lung lesions remained persistent after 8 weeks of PHMG exposure. In the pathologic analysis, the extent/severity of inflammation did not show statistically significant changes over time, whereas the extent/severity of fibrosis increased continuously up to 6 weeks after PHMG exposure and then decreased significantly at 8 weeks. Bronchiolar-alveolar adenomas which have malignant potential were found in 50% of rats at 6 and 8 weeks after PHMG exposure. Also, several genes associated with lung cancer, acute lung injury, and pulmonary fibrosis were detected. Our study revealed that PHMG-induced lung injury and its changes according to the number of weeks after exposure were demonstrated using chest CT and pathologic evaluation. In addition, we showed that PHMG exposure caused lung tumors and genetic alterations according to PHMG exposure under the guidance of CT.

Abstract Physicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process.

Abstract Chronic obstructive pulmonary disease (COPD) is a respiratory disorder involving abnormalities of lung parenchymal morphology with different severities. COPD is assessed by pulmonary-function tests and computed tomography-based approaches. We introduce a new classification method for COPD grouping based on deep learning and a parametric-response mapping (PRM) method. We extracted parenchymal functional variables of functional small airway disease percentage (fSAD%) and emphysema percentage (Emph%) with an image registration technique, being provided as input parameters of 3D convolutional neural network (CNN). The integrated 3D-CNN and PRM (3D-cPRM) achieved a classification accuracy of 89.3% and a sensitivity of 88.3% in five-fold cross-validation. The prediction accuracy of the proposed 3D-cPRM exceeded those of the 2D model and traditional 3D CNNs with the same neural network, and was comparable to that of 2D pretrained PRM models. We then applied a gradient-weighted class activation mapping (Grad-CAM) that highlights the key features in the CNN learning process. Most of the class-discriminative regions appeared in the upper and middle lobes of the lung, consistent with the regions of elevated fSAD% and Emph% in COPD subjects. The 3D-cPRM successfully represented the parenchymal abnormalities in COPD and matched the CT-based diagnosis of COPD.

Abstract Background Previous studies suggested that the prone position (PP) improves oxygenation and reduces mortality among patients with acute respiratory distress syndrome (ARDS). However, the mechanism of this clinical benefit of PP is not completely understood. The aim of the present study was to quantitatively compare regional characteristics of lung functions in the PP with those in the supine position (SP) using inspiratory and expiratory computed tomography (CT) scans. Methods Ninety subjects with normal pulmonary function and inspiration and expiration CT images were included in the study. Thirty-four subjects were scanned in PP, and 56 subjects were scanned in SP. Non-rigid image registration-based inspiratory-expiratory image matching assessment was used for regional lung function analysis. Tissue fractions (TF) were computed based on the CT density and compared on a lobar basis. Three registration-derived functional variables, relative regional air volume change (RRAVC), volumetric expansion ratio (J), and three-dimensional relative regional displacement (s*) were used to evaluate regional ventilation and deformation characteristics. Results J was greater in PP than in SP in the right middle lobe (P = 0 .025), and RRAVC was increased in the upper and right middle lobes (P

Abstract Background Dust exposure has been reported as a risk factor of pulmonary disease, leading to alterations of segmental airways and parenchymal lungs. This study aims to investigate alterations of quantitative computed tomography (QCT)-based airway structural and functional metrics due to cement-dust exposure. Methods To reduce confounding factors, subjects with normal spirometry without fibrosis, asthma and pneumonia histories were only selected, and a propensity score matching was applied to match age, sex, height, smoking status, and pack-years. Thus, from a larger data set (N = 609), only 41 cement dust-exposed subjects were compared with 164 non-cement dust-exposed subjects. QCT imaging metrics of airway hydraulic diameter (D h), wall thickness (WT), and bifurcation angle (θ) were extracted at total lung capacity (TLC) and functional residual capacity (FRC), along with their deformation ratios between TLC and FRC. Results In TLC scan, dust-exposed subjects showed a decrease of D h (airway narrowing) especially at lower-lobes (p

Background: Asthma is a heterogeneous inflammatory airway disorder with various phenotypes. Quantitative computed tomography (QCT) methods can differentiate among lung diseases through accurate assessment of the location, extent, and severity of the disease. The purpose of this study was to identify asthma clusters using QCT metrics of airway and parenchymal structure, and to identify associations with visual analyses conducted by radiologists. Methods: This prospective study used input from QCT-based metrics including hydraulic diameter (Dh), luminal wall thickness (WT), functional small airway disease (fSAD), and emphysematous lung (Emph) to perform a cluster analysis and made comparisons with the visual grouping analysis conducted by radiologists based on site of airway involvement and remodeling evaluated. Results: A total of 61 asthmatics of varying severities were grouped into 4 clusters. From C1 to C4, more severe lung function deterioration, higher fixed obstruction rate, and more frequent asthma exacerbations were observed in the 5-year follow-up period. C1 presented non-severe asthma with increased WT, Dh of proximal airways, and fSAD. C2 was mixed with non-severe and severe asthmatics, and showed bronchodilator responses limited to the proximal airways. C3 and C4 included severe asthmatics that showed a reduced Dh of the proximal airway and diminished bronchodilator responses. While C3 was characterized by severe allergic asthma without fSAD, C4 included ex-smokers with high fSAD% and Emph%. These clusters correlated well with the grouping done by radiologists and clinical outcomes. Conclusions: Four QCT imaging-based clusters with distinct structural and functional changes in proximal and small airways can stratify heterogeneous asthmatics and can be a complementary tool to predict clinical outcomes.

Polyhexamethylene guanidine phosphate (PHMG-p), a humidifier disinfectant, is known to cause lung toxicity, including inflammation and pulmonary fibrosis. In this study, we aimed to investigate the effect of PHMG-p on human lung tissue models (2D epithelial cells and 3D organoids) under conditions of oxidative stress and viral infection. The effect of PHMG-p was studied by evaluating the formation of stress granules (SGs), which play a pivotal role in cellular adaptation to various stress conditions. Under oxidative stress and respiratory syncytial virus (RSV) infection, exposure to PHMG-p remarkably increased eIF2α phosphorylation, which is essential for SG-related signalling, and significantly increased SG formation. Furthermore, PHMG-p induced fibrotic gene expression and caused cell death due to severe DNA damage, which was further increased under oxidative stress and RSV infection, indicating that PHMG-p induces severe lung toxicity under stress conditions. Taken together, toxicity evaluation under various stressful conditions is necessary to accurately predict potential lung toxicity of chemicals affecting the respiratory tract.

Aquatic environmental problems, such as algae, turbid water, and poor oxygen content, have become increasingly common. In river analysis, hydrological and water quality characteristics are used for evaluating aquatic ecological health, which necessitates continuous monitoring. In addition, because measurements are conducted using a fixed measurement method, the hydrological and water quality characteristics are not investigated for the entire river. Furthermore, obtaining high-resolution data is tedious, and the measurement area and time are limited. Hence, low-resolution data acquisition is generally preferred; however, this requires an appropriate interpolation method to obtain a wide range of data. Therefore, a 3D interpolation method for river data is proposed herein. The overall hydraulic and water quality information of a river is presented by visualizing the low-resolution measurements using spatial interpolation. The Kriging technique was applied to the river mapping to improve the mapping precision through data visualization and quantitative evaluation.

Block copolymers generally have peculiar morphological characteristics, such as strong phase separation. They have been actively applied to polymer electrolyte membranes for proton exchange membrane fuel cells (PEMFCs) to obtain well-defined hydrophilic regions and water channels as a proton pathway. Although molecular simulation tools are advantageous to investigate the mechanism of water channel formation based on the chemical structure and property relationships, classical molecular dynamics simulation has limitations regarding the model size and time scale, and these issues need to be addressed. In this study, we investigated the morphology of sulfonated block copolymers synthesized for PEM applications using a mesoscale simulation based on the dynamic mean-field density functional method, widely applied to investigate macroscopic systems such as polymer blends, micelles, and multi-block/grafting copolymers. Despite the similar solubility parameters of the monomers in our block-copolymer models, very different morphologies in our 3D mesoscale models were obtained. The model with sulfonated monomers, in which the number of sulfonic acid groups is twice that of the other model, showed better phase separation and water channel formation, despite the short length of its hydrophilic block. In conclusion, this unexpected behavior indicates that the role of water molecules is important in making PEM mesoscale models well-equilibrated in the mesoscale simulation, which results in the strong phase separation between hydrophilic and hydrophobic regions and the ensuing well-defined water channel. PEM synthesis supports the conclusion that using the sulfonated monomers with a high sulfonation degree (32.5 mS/cm) will be more effective than using the long hydrophilic block with a low sulfonation degree (25.2 mS/cm).

Our previous research revealed the advantages of separate feeding (SF) systems compared to total mixed ration (TMR) in terms of ruminal methane (CH4) production. The purpose of this experiment was to confirm the advantage of SF as a nutritional strategy for CH4 mitigation, and to determine the effects of different feeding systems (TMR and SF) on the rumen microbiome and associated metagenome of two different breeds and on CH4 emissions. We randomly allocated four Holstein (305 ± 29 kg) and four Hanwoo steers (292 ± 24 kg) to two groups; the steers were fed a commercial concentrate with tall fescue (75:25) as TMR or SF, in a crossover design (two successive 22-day periods). Neither feeding systems nor cattle breeds had an effect on the total tract digestibility of nutrients. The TMR feeding system and Hanwoo steers generated significantly more CH4 (P < 0.05) and had a higher yield [g/d and g/kg dry matter intake (DMI)] compared to the SF system and Holstein steers. A larger rumen acetate:propionate ratio was observed for the TMR than the SF diet (P < 0.05), and for Hanwoo than Holstein steers (P < 0.001), clearly reflecting a shift in the ruminal H2 sink toward CH4 production. The linear discriminant analysis (LDA) effect size (LEfSe) revealed a greater abundance (α < 0.05 and LDA > 2.0) of operational taxonomic units (OTUs) related to methanogenesis for Hanwoo steers compared to Holstein steers. Kendall’s correlation analysis revealed wide variation of microbial co-occurrence patterns between feeding systems, indicating differential H2 thermodynamics in the rumen. A metagenome analysis of rumen microbes revealed the presence of 430 differentially expressed genes, among which 17 and 27 genes exhibited positive and negative associations with CH4 production, respectively (P < 0.001). A strong interaction between feeding system and breed was observed for microbial and metagenomic abundance. Overall, these results suggest that the TMR feeding system produces more CH4, and that Hanwoo cattle are higher CH4 emitters than SF diet and Holstein cattle, respectively. Interestingly, host-associated microbial interactions differed within each breed depending on the feeding system, which indicated that breed-specific feeding systems should be taken into account for farm management.

Abstract Background Quantitative computed tomographic (QCT) imaging-based metrics enable to quantify smoking induced disease alterations and to identify imaging-based clusters for current smokers. We aimed to derive clinically meaningful sub-groups of former smokers using dimensional reduction and clustering methods to develop a new way of COPD phenotyping. Methods An imaging-based cluster analysis was performed for 406 former smokers with a comprehensive set of imaging metrics including 75 imaging-based metrics. They consisted of structural and functional variables at 10 segmental and 5 lobar locations. The structural variables included lung shape, branching angle, airway-circularity, airway-wall-thickness, airway diameter; the functional variables included regional ventilation, emphysema percentage, functional small airway disease percentage, Jacobian (volume change), anisotropic deformation index (directional preference in volume change), and tissue fractions at inspiration and expiration. Results We derived four distinct imaging-based clusters as possible phenotypes with the sizes of 100, 80, 141, and 85, respectively. Cluster 1 subjects were asymptomatic and showed relatively normal airway structure and lung function except airway wall thickening and moderate emphysema. Cluster 2 subjects populated with obese females showed an increase of tissue fraction at inspiration, minimal emphysema, and the lowest progression rate of emphysema. Cluster 3 subjects populated with older males showed small airway narrowing and a decreased tissue fraction at expiration, both indicating air-trapping. Cluster 4 subjects populated with lean males were likely to be severe COPD subjects showing the highest progression rate of emphysema. Conclusions QCT imaging-based metrics for former smokers allow for the derivation of statistically stable clusters associated with unique clinical characteristics. This approach helps better categorization of COPD sub-populations; suggesting possible quantitative structural and functional phenotypes.

Background Anterior mediastinal lesions account for approximately half of all mediastinal masses and computed tomography (CT) is known to exhibit limited differentiating performance. Our aim was to evaluate the age‐ and gender‐specific distribution of anterior mediastinal lesions and the diagnostic accuracy of multi‐detector CT (MDCT). Methods This retrospective study included 549 consecutive patients with proven anterior mediastinal lesions and diagnostic MDCT scans. The age‐ and gender‐specific distribution of proven diagnoses and diagnostic accuracy were reviewed. The CT features of malignant and benign diseases having the lowest accuracy were compared with those of the most commonly misdiagnosed diseases. Results The proportion of malignancy showed a V‐shape relationship with age (lowest, 52.7% [50s]). The most prevalent malignancies were lymphoma (20s), lymphoma/thymoma (30s), thymoma (40s–50s), and thymoma/thymic carcinoma (≥60s). The most prevalent benign diseases were thymic remnant/hyperplasia (20s–30s), and thymic bed cyst (≥40s). The first‐choice diagnostic accuracy of MDCT decreased with age regardless of gender: 75.4% (20s), 75.0% (30s), 67.8% (40s), 58.5% (50s), and 53.4% (≥60s), primarily due to incorrect diagnoses of thymic bed cyst and thymic carcinoma (accuracy, 42.3% and 30.5%), which were prevalent in older patients and mostly misdiagnosed as thymoma. The most powerful differentiating MDCT features were water attenuation (≤20 HU) (OR, 42.7 [95%CI, 8.8–‐208.3], P

Context: Eclipta prostrata L. (Asteraceae) (EP) has been widely used for the treatment of skin disease in Asian traditional medicine. Objective: This study investigates the potency of EP in promoting hair growth in vivo and in vitro. Materials and methods: C57BL/6N mice were divided into four groups (n = 4) as follows: control (topical treatment of normal saline), topical 3% minoxidil to the dorsal skin of mice for 14 days, and low (1 mg/day) and high (10 mg/day) doses of EP orally administered once a day for 14 days. Dorsal hairs of C57BL/6N mice were depilated to synchronize anagen induction. Hair growth activity was evaluated by gross and microscopic observations. Sections of dorsal skin were stained with haematoxylin and eosin. We also treated the various concentrations of EP (5, 10 and 50 μg/mL) for 24 h on the human dermal papilla cells (HDPs) and examined the effects of EP on the expression of FGF-7 and mTOR signalling. Results: EP enhanced the induction of anagen in the dorsal skin of mice, characterized by the appearance of inner root sheath along with hair shaft, the emergence of hair shaft through the epidermis. EP increased the expression of FGF-7, while decreased the level of FGF-5 in C57/BL6 mice. EP also increased the expression of FGF-7, activated the mTOR signalling in HDPs. Discussion and conclusions: These results suggest that EP has a potency to enhance the growth of hair follicle, promoting hair growth through regulation of FGF-7 and FGF-5.

There have been no studies on the effects of polyhexamethylene guanidine phosphate (PHMG) after a long period of exposure in the rodent model. We aimed to evaluate long-term lung damage after PHMG exposure using conventional chest computed tomography (CT) and histopathologic analysis in a rat model. A PHMG solution was intratracheally administrated to 24 male rats. At 8, 26, and 52 weeks after PHMG instillation, conventional chest CT was performed in all rats and both lungs were extracted for histopathologic evaluation. At 52 weeks after PHMG instillation, four carcinomas had developed in three of the eight rats (37.5%). Bronchiolo-alveolar hyperplasia and adenoma were found in rats at 8, 26, and 52 weeks post-instillation. The number of bronchiolo-alveolar hyperplasia significantly increased over time (P-value for trend< 0.001). The severity of lung fibrosis and fibrosis scores significantly increased over time (P-values for trend = 0.002 and 0.023, respectively). Conventional chest CT analysis showed that bronchiectasis and linear density scores suggestive of fibrosis significantly increased over time (P-value for trend < 0.001). Our study revealed that one instillation of PHMG in a rat model resulted in lung carcinomas and progressive and irreversible fibrosis one year later based on conventional chest CT and histopathologic analysis. PHMG may be a lung carcinogen in the rat model.

ObjectiveThe demand for treating degenerative lumbar spinal disease has been increasing, leading to increased utilization of medical resources. Thus, we need to understand how the budget of insurance is currently used. The objective of the present study is to overview the utilization of the National Health Insurance Service (NHIS) by providing the direct insured cost between patients receiving surgery and patients receiving nonsurgical treatment for degenerative lumbar disease.MethodsThe NHIS-National Sample Cohort was utilized to select patients with lumbar disc herniation, spinal stenosis, spondylolisthesis or spondylolysis. A matched cohort study design was used to show direct medical costs of surgery (n = 2,698) and nonsurgical (n = 2,698) cohorts. Non-surgical treatment included medication, physiotherapy, injection, and chiropractic. The monthly costs of the surgery cohort and nonsurgical cohort were presented at initial treatment, posttreatment 1, 3, 6, 9, and 12 months and yearly thereafter for 10 years.ResultsThe characteristics and matching factors were well-balanced between the matched cohorts. Overall, surgery cohort spent $50.84/patient/month, while the nonsurgical cohort spent $29.34/patient/month (pConclusionSurgical treatment initially led to more government reimbursement than nonsurgical treatment, but the charges during follow-up period were not different. The results of the present study should be interpreted in light of the costs of medical services, indirect costs, societal cost, quality of life and societal willingness to pay in each country. The monetary figures are implied to be actual economic costs but those in the reimbursement system instead reflect reimbursement charges from the government.

Alkaline water electrolysis (AWE) refers to a representative water electrolysis technology that applies electricity to synthesize hydrogen gas without the production of carbon dioxide. The ideal polymer electrolyte membranes for AWE should be capable of transporting hydroxide ions (OH−) quickly in harsh alkaline environments at increased temperatures. However, there has not yet been any desirable impedance measurement method for estimating hydroxide ions’ conduction behavior across the membranes, since their impedance spectra are significantly affected by connection modes between electrodes and membranes in the test cells and the impedance evaluation environments. Accordingly, the measurement method suitable for obtaining precise hydroxide ion conductivity values through the membranes should be determined. For this purpose, Zirfon®, a state-of-the-art AWE membrane, was adopted as the standard membrane sample to perform the impedance measurement. The impedance spectra were acquired using homemade test cells with different electrode configurations in alkaline environments, and the corresponding hydroxide ion conductivity values were determined based on the electrochemical spectra. Furthermore, a modified four-probe method was found as an optimal measurement method by comparing the conductivity obtained under alkaline conditions.

ObjectiveTo evaluate the compliance and satisfaction of rehabilitation recommendations for advanced cancer patients hospitalized in the palliative care unit.MethodsAdvanced cancer patients admitted to a hospice palliative care unit were recruited. Patients with advanced cancer and a life expectancy of less than 6 months, as assumed by the oncologist were included. Patients who were expected to die within 3 days were excluded. ECOG and Karnofsky performance scales, function ambulatory category, level of ambulation, and survival days were evaluated under the perspective of comprehensive rehabilitation. Problem-based rehabilitations were provided categorized as physical therapy at the gym, bedside physical therapy, physical modalities, medications and pain intervention. Investigation of compliance for each category was completed. Patient satisfaction was surveyed using a questionnaire.ResultsForty-five patients were recruited and received evaluations for rehabilitation perspective. The subjects were reported to have gait-related difficulties (71.1%), pain (68.9%), poor medical conditions (68.9%), bladder or bowel problems (44.4%), dysphagias (11.1%), mental status issues (11.1%), edemas (11.1%), spasticity (2.2%), and pressure sores (2.2%). In the t-test, patients with good compliance for GymPT showed higher survival days (p

This study reports on an innovative press-loaded blister hybrid system equipped with gas-chromatography (PBS-GC) that is designed to evaluate the mechanical fatigue of two representative types of commercial Nafion membranes under relevant PEMFC operating conditions (e.g., simultaneously controlling temperature and humidity). The influences of various applied pressures (50 kPa, 100 kPa, etc.) and blistering gas types (hydrogen, oxygen, etc.) on the mechanical resistance loss are systematically investigated. The results evidently indicate that hydrogen gas is a more effective blistering gas for inducing dynamic mechanical losses of PEM. The changes in proton conductivity are also measured before and after hydrogen gas pressure-loaded blistering. After performing the mechanical aging test, a decrease in proton conductivity was confirmed, which was also interpreted using small angle X-ray scattering (SAXS) analysis. Finally, an accelerated dynamic mechanical aging test is performed using the homemade PBS-GC system, where the hydrogen permeability rate increases significantly when the membrane is pressure-loaded blistering for 10 min, suggesting notable mechanical fatigue of the PEM. In summary, this PBS-GC system developed in-house clearly demonstrates its capability of screening and characterizing various membrane candidates in a relatively short period of time (

In this research, a series of innovative and stable cross-linked gel polymer reinforced membranes (GPRMs), were successfully prepared and investigated for application in lithium-ion batteries. Herein, a gel directly within the commercial polyethylene (PE) separator is supported via electron-beam simultaneous irradiation cross-linking of commercial liquid electrolyte and poly(ethylene glycol) methacrylate (PEGMA) oligomers. The physical and electrochemical properties of the GPRMs were characterized by SEM, TEM, mechanical durability, heating shrinkage, and ion conductivity, etc. The GPRMs demonstrated excellent mechanical durability and high ion conductivity compared with traditional PE membranes. Moreover, coin-typed cells were assembled and cycle performance was also studied compared with same-typed cells with commercial PE membrane and liquid electrolyte. As a result, the coin-typed cells using GPRMs also showed a relatively good efficiency on the 50th cycles at a high 1.0 C-rate. These GPRMs with excellent properties present a very promising material for utilization in high-performance lithium-ion batteries with improved safety and reliability.

CeOx hybrid nanoparticles were synthesized and evaluated for use as radical scavengers, in place of commercially available Ce(NO3)3 and CeO2 nanoparticles, to avoid deterioration of the initial electrochemical performance and/or spontaneous aggregation/precipitation issues encountered in polymer electrolyte membranes. When CeOx hybrid nanoparticles were used for membrane formation, the resulting membranes exhibited improved proton conductivity (improvement level = 2–15% at 30–90 °C), and thereby electrochemical single cell performance, because the –OH groups on the hybrid nanoparticles acted as proton conductors. In spite of a small amount (i.e., 1.7 mg/cm3) of introduction, their antioxidant effect was sufficient enough to alleviate the radical-induced decomposition of perfluorinated sulfonic acid ionomer under a Fenton test condition and to extend the chemical durability of the resulting reinforced membranes under fuel cell operating conditions.

In this paper, a hybrid checkerboard metasurface is proposed for controlling radar cross-sections (RCSs) using a small number of active devices. The proposed metasurface consists of passive and active artificial magnetic conductors. The passive metasurface contributes to reducing the RCS level owing to the dispersion characteristics of the checkerboard arrangement, while the active metasurface aids in controlling the RCS. The active RCS pattern of the proposed hybrid checkerboard metasurface in response to changes in phase distribution is also investigated. The results show that the RCS level at the boresight changed from −20.3 dBsm to 4.4 dBsm, and the main lobe of the RCS pattern steered up to 31°. The fabrication and measurement results of the proposed hybrid checkerboard metasurface are also described in this study.

Abstract Background Patients undergo regular clinical follow-up after laminoplasty for cervical myelopathy. However, those whose symptoms significantly improve and remain stable do not need to conform to a regular follow-up schedule. Based on the 1-year postoperative outcomes, we aimed to use a machine-learning (ML) algorithm to predict 2-year postoperative outcomes. Methods We enrolled 80 patients who underwent cervical laminoplasty for cervical myelopathy. The patients’ Japanese Orthopedic Association (JOA) scores (range: 0–17) were analyzed at the 1-, 3-, 6-, and 12-month postoperative timepoints to evaluate their ability to predict the 2-year postoperative outcomes. The patient acceptable symptom state (PASS) was defined as a JOA score ≥ 14.25 at 24 months postoperatively and, based on clinical outcomes recorded up to the 1-year postoperative timepoint, eight ML algorithms were developed to predict PASS status at the 24-month postoperative timepoint. The performance of each of these algorithms was evaluated, and its generalizability was assessed using a prospective internal test set. Results The long short-term memory (LSTM)-based algorithm demonstrated the best performance (area under the receiver operating characteristic curve, 0.90 ± 0.13). Conclusions The LSTM-based algorithm accurately predicted which group was likely to achieve PASS at the 24-month postoperative timepoint. Although this study included a small number of patients with limited available clinical data, the concept of using past outcomes to predict further outcomes presented herein may provide insights for optimizing clinical schedules and efficient medical resource utilization. Trial registration This study was registered as a clinical trial (Clinical Trial No. NCT02487901), and the study protocol was approved by the Seoul National University Hospital Institutional Review Board (IRB No. 1505-037-670).

Objective Classification guides the surgical approach and predicts prognosis. However, existing classifications of spinal schwannomas often result in a high ‘unclassified’ rate. Here, we aim to develop a new comprehensive classification for spinal schwannomas based on their presumed origin. We compared the new classification with the existing classifications regarding the rate of ‘unclassified’. Finally, we assessed the surgical strategies, outcomes, and complications according to each type of the new classification. Methods A new classification with 9 types was created by analyzing the anatomy of spinal nerves and the origin of significant tumor portions and cystic components in preoperative magnetic resonance images. A total of 482 patients with spinal schwannomas were analyzed to compare our new classification with the existing classifications. We defined ‘unclassified’ as the inability to classify a patient with spinal schwannoma using the classification criteria. Surgical approaches and outcomes were also aligned with our new classification. Results Our classification uniquely reported no ‘unclassified’ cases, indicating full applicability. Also, the classification has demonstrated usefulness in predicting the surgical outcome with the approach planned. Gross total removal rates reached 88.0% overall, with type 1 and type 2 tumors at 95.3% and 96.0% respectively. The approach varied with tumor type, with laminectomy predominantly used for types 1, 2, and 9, and facetectomy with posterior fixation used for type 3 tumors. Conclusion The new classification for spinal schwannomas based on presumed origin is applicable to all spinal schwannomas. It could help plan a surgical approach and predict its outcome, compared with existing classifications.

Silver nanoparticle-modified graphene oxide (Ag/GO) was reliably prepared by using sodium borohydride (NaBH4) in the presence of citric acid capping agent via a simple wet chemistry method. This rapidly formed Ag/GO composite exhibited good dispersity in a solution containing hydrophilic polyacrylonitrile (PAN). Subsequent electrospinning of this precursor solution resulted in the successful formation of nanofibers without any notable defects. The Ag/GO-incorporated PAN nanofibers showed thinner fiber strands (544 ± 82 nm) compared to those of GO-PAN (688 ± 177 nm) and bare-PAN (656 ± 59 nm). Subsequent thermal treatment of nanofibers resulted in the preparation of thin membranes to possess the desired pore property and outstanding wettability. The Ag/GO-PAN nanofiber membrane also showed 30% higher water flux value (390 LMH) than that of bare-PAN (300 LMH) for possible microfiltration (MF) application. In addition, the resulting Ag/GO-PAN nanofiber membrane exhibited antibacterial activity against Escherichia coli (Gram-negative) and Staphylococcus aureus (Gram-positive). Furthermore, this composite membrane exhibited outstanding anti-fouling property compared to the GO-PAN nanofiber membrane in the wastewater treatment. Therefore, the simple modification strategy allows for the effective formation of Ag/GO composite as a filler that can be reliably incorporated into polymer nanofiber membranes to possess improved overall properties for wastewater treatment applications.

Saline water electrolysis (SWE) is an electrochemical process to simultaneously produce hydrogen (H2), chlorine (Cl2), and sodium hydroxide (NaOH) with high purity levels (e.g., 99.999%) by applying electric power to saline water. The state-of-the art SWE membrane, Flemion®, has excellent chemical resistance to harsh SWE conditions, but still needs to lower its energy consumption by reducing its ohmic resistance to Na+ ion transport. Meanwhile, most of cation exchange membranes (CEMs) have been suffering from chemical degradation under the alkaline conditions, owing to their single layer matrices composed of sulfonic acid moieties, though they show fast Na+ ion transport behavior. Here double-layered SWE membranes were prepared on the basis of design strategies composed of the incorporation of a chemically stable carboxylic acid layer (C layer) via UV irradiation onto one surface of perfluorinated Nafion®212 membrane chosen as one of commercially available CEMs, and the thickness control of the C layer. The resulting membranes showed excellent SWE performances and improved electrochemical service life, when compared with those of Nafion®212 and Flemion®, respectively.

Previous epidemiological reports have emphasized the impact of ambient particulate matter (PM) on pneumonia-related hospitalizations. However, these reports vary across different study populations. We aimed to evaluate the impact of short-term exposure to PM on hospital admissions due to pneumonia. A systematic literature review was performed to identify studies quantifying the impact of PM ≤2.5 μ g m ^−3 (PM _2.5 ) and PM ≤10 μ g m ^−3 (PM _10 ) on pneumonia-related hospitalizations. A meta-analysis was performed by using pooled analyses of each pollutant with a random effects model. Subgroup analyses were performed according to various lag times and age groups, along with meta-regression analyses. A total of ten studies were eligible for analysis. In the overall population, a 10 μ g m ^−3 increase in the daily PM _2.5 was associated with an increased risk ratio (RR) of hospitalization for pneumonia (pooled RR 1.007, 95% confidence interval [CI]: 1.000–1.014 per 10 μ g m ^−3 increase), but the PM _10 was not (pooled RR 1.008, 95% CI: 0.998–1.018 per 10 μ g m ^−3 increase). A lag effect was not observed in the subgroup analysis of different lag times. In the subgroup analysis of elderly individuals (≥65 years), both the PM _2.5 and PM _10 resulted in increased RRs for pneumonia-related hospitalizations, with pooled RRs of 1.026 (95% CI: 1.006–1.047 per 10 μ g m ^−3 increase) and 1.016 (95% CI: 1.013–1.019 per 10 μ g m ^−3 increase), respectively. By contrast, studies that included young patients revealed a nonsignificant relationship between exposure to high levels of PM _2.5 and pneumonia-related hospitalizations (RR 1.003, 95% CI: 0.999–1.008 per 10 μ g m ^−3 increase). In the meta-regression analysis, results from recent study periods indicated that the effect of PM _2.5 on pneumonia-related hospitalizations was less than that of earlier studies ( P = 0.009). Our results suggest that PM _2.5 and PM _10 may affect elderly individuals in terms of pneumonia-related hospitalizations, which may vary over time.

Few studies have examined the effects of feeding total mixed ration (TMR) versus roughage and concentrate separately (SF) on ruminant methane production. Therefore, this study compared differences in methane production, ruminal characteristics, total tract digestibility of nutrients, and rumen microbiome between the two feeding methods in Holstein steers. A total six Holstein steers of initial bodyweights 540 ± 34 kg were divided into two groups and assigned to a same experimental diet with two different feeding systems (TMR or SF) in a crossover design with 21 d periods. The experimental diet contained 73% concentrate and 27% forage and were fed twice a day. The total tract digestibility of crude protein, neutral detergent fibre, and organic matter were not affected by the two different feeding systems. Steers fed TMR emitted more methane (138.5 vs. 118.2 L/d; P < 0.05) and lost more gross energy as methane energy (4.0 vs. 3.5% gross energy intake; P = 0.005) compared to those fed SF. Steers fed TMR had greater (P < 0.05) total volatile fatty acid (VFA), ammonia-N concentrations and propionate proportion of total VFA at 1.5 h, whereas lower after that compared to steers fed SF. The greater (P < 0.05) acetate: propionate ratio at 4.5 h for steers fed TMR reflected the shift of H2 sink from propionate towards acetate synthesis. The lower (P < 0.05) isobutyrate and isovalerate proportions of total VFA observed in steers fed TMR implies decrease in net consumption of H2 for microbial protein synthesis compared to SF. There were no differences in both major bacterial and archaeal diversity between TMR and SF, unlike several minor bacterial abundances. The minor groups such as Coprococcus, Succiniclasticum, Butyrivibrio, and Succinivibrio were associated with the changes in ruminal VFA profiles or methanogenesis indirectly. Overall, these results indicate that SF reduces methane emissions from ruminants and increases propionate proportion of total VFA without affecting total tract digestion compared to TMR. There were no evidences that the response differed due to different major underlying microbial population.

PURPOSEWe aimed to describe the computed tomography (CT) features of pulmonary mucormycosis including sequential changes between follow-ups. MATERIALS AND METHODSBetween June 2001 and May 2011, five patients (three males and two females; median age, 43 years; age range, 13–73 years) who had been pathologically diagnosed with pulmonary mucormycosis constituted our study population. Their clinical and CT features including sequential changes over follow-ups were evaluated retrospectively. RESULTSAll patients were immunocompromised due to either hematologic diseases (n=3), diabetes mellitus (n=1), or steroid administration for autoimmune hepatitis (n=1). All patients had symptoms such as fever (n=5), tachycardia (n=1), or pleuritic chest pain (n=1) on admission. Regarding the clinical outcome after treatment, one patient died, and the remaining four recovered from the disease. In terms of initial CT features, the morphologies of pulmonary mucormycosis included a single mass (n=3), consolidation (n=1), or multiple masses (n=1). There were seven pulmonary lesions in total, 3–7 cm in size, which showed a CT halo sign (n=3), reversed-halo sign (n=2), or air-fluid levels (n=2). On follow-up CTs, the lesions of all patients contained necrosis. All three patients with a mass or masses with a CT halo sign on initial CT had a decreased surrounding halo followed by central necrosis, and the lesions gradually decreased in size on recovery. CONCLUSIONPulmonary mucormycosis usually manifests as a mass or masses with a halo or reversed-halo sign on the initial CT scan followed by a decreased extent of surrounding ground-glass opacities with the development of internal necrosis during follow-up.

Abstract Dual-position oblique lumbar interbody fusion with fluoroscopy (D-OLIF) requires repositioning the patient to a prone position for pedicle screw insertion. Recently, single-position surgery with navigation has been introduced. However, there are concerns regarding pedicle screw accuracy and achieving appropriate sagittal balance in single-position OLIF with navigation (S-OLIF). The purpose of this study is to evaluate the clinical and radiological outcomes of S-OLIF compared to D-OLIF. A retrospective analysis was conducted on 102 patients who underwent single-level OLIF at a single institution. The patients were divided into two groups: 55 in the S-OLIF group and 47 in the D-OLIF group. The numeric rating scale for back and leg, Oswestry disability index, and walking distance improvements showed no significant difference. However, the EuroQol 5-dimension 5-level index showed higher improvement in the S-OLIF (P = 0.029). The segmental lordosis, lumbar lordosis, and C7 sagittal vertical axis showed no significant difference. S-OLIF had significantly fewer cases of pedicle screw malposition (P = 0.045). Additionally, the surgery time was shorter in the S-OLIF (P = 0.002). In conclusion, S-OLIF exhibited clinical and radiological outcomes comparable to D-OLIF, with the added advantages of reduced surgery time and enhanced accuracy in pedicle screw placement.

Abstract Background Lumbar spinal stenosis (LSS) and spondylolisthesis (SPL) are characterized as degenerative spinal pathologies and share considerable similarities. However, opinions vary on whether to recommend exercise or restrict it for these diseases. Few studies have objectively compared the effects of daily physical activity on LSS and SPL because it is impossible to restrict activities ethnically and practically. We investigated the effect of restricting physical activity due to social distancing (SoD) on LSS and SPL, focusing on the aspect of healthcare burden changes during the pandemic period. Methods We included first-visit patients diagnosed exclusively with LSS and SPL in 2017 and followed them up for two years before and after the implementation of the SoD policy. As controls, patients who first visited in 2015 and were followed for four years without SoD were analyzed. The common data model was employed to analyze each patient’s diagnostic codes and treatments. Hospital visits and medical costs were analyzed by regression discontinuity in time to control for temporal effects on dependent variables. Results Among 33,484 patients, 2,615 with LSS and 446 with SPL were included. A significant decrease in hospital visits was observed in the LSS (difference, -3.94 times/month·100 patients; p = 0.023) and SPL (difference, -3.44 times/month·100 patients; p = 0.026) groups after SoD. This decrease was not observed in the data from the control group. Concerning medical costs, the LSS group showed a statistically significant reduction in median copayment (difference, -$45/month·patient; p

Abstract Although the role of plain radiographs in diagnosing lumbar spinal stenosis (LSS) has declined in importance since the advent of magnetic resonance imaging (MRI), diagnostic ability of plain radiographs has improved dramatically when combined with deep learning. Previously, we developed a convolutional neural network (CNN) model using a radiograph for diagnosing LSS. In this study, we aimed to improve and generalize the performance of CNN models and overcome the limitation of the single-pose-based CNN (SP-CNN) model using multi-pose radiographs. Individuals with severe or no LSS, confirmed using MRI, were enrolled. Lateral radiographs of patients in three postures were collected. We developed a multi-pose-based CNN (MP-CNN) model using the encoders of the three SP-CNN model (extension, flexion, and neutral postures). We compared the validation results of the MP-CNN model using four algorithms pretrained with ImageNet. The MP-CNN model underwent additional internal and external validations to measure generalization performance. The ResNet50-based MP-CNN model achieved the largest area under the receiver operating characteristic curve (AUROC) of 91.4% (95% confidence interval [CI] 90.9–91.8%) for internal validation. The AUROC of the MP-CNN model were 91.3% (95% CI 90.7–91.9%) and 79.5% (95% CI 78.2–80.8%) for the extra-internal and external validation, respectively. The MP-CNN based heatmap offered a logical decision-making direction through optimized visualization. This model holds potential as a screening tool for LSS diagnosis, offering an explainable rationale for its prediction.

Abstract This study aims to identify healthcare costs indicators predicting secondary surgery for degenerative lumbar spine disease (DLSD), which significantly impacts healthcare budgets. Analyzing data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database of Republic of Korea (ROK), the study included 3881 patients who had surgery for lumbar disc herniation (LDH), lumbar spinal stenosis without spondylolisthesis (LSS without SPL), lumbar spinal stenosis with spondylolisthesis (LSS with SPL), and spondylolysis (SP) from 2006 to 2008. Patients were categorized into two groups: those undergoing secondary surgery (S-group) and those not (NS-group). Surgical and interim costs were compared, with S-group having higher secondary surgery costs ($1829.59 vs $1618.40 in NS-group, P = 0.002) and higher interim costs ($30.03; 1.86% of initial surgery costs vs $16.09; 0.99% of initial surgery costs in NS-group, P

Objective Although adult spinal deformity (ASD) surgery aims to restore and maintain alignment, proximal junctional kyphosis (PJK) may occur. While existing scoring systems predict PJK, they predominantly offer a generalized 3-tier risk classification, limiting their utility for nuanced treatment decisions. This study seeks to establish a personalized risk calculator for PJK, aiming to enhance treatment planning precision. Methods Patient data for ASD were sourced from the Korean spinal deformity database. PJK was defined a proximal junctional angle (PJA) of ≥ 20° at the final follow-up, or an increase in PJA of ≥ 10° compared to the preoperative values. Multivariable analysis was performed to identify independent variables. Subsequently, 5 machine learning models were created to predict individualized PJK risk post-ASD surgery. The most efficacious model was deployed as an online and interactive calculator. Results From a pool of 201 patients, 49 (24.4%) exhibited PJK during the follow-up period. Through multivariable analysis, postoperative PJA, body mass index, and deformity type emerged as independent predictors for PJK. When testing machine learning models using study results and previously reported variables as hyperparameters, the random forest model exhibited the highest accuracy, reaching 83%, with an area under the receiver operating characteristics curve of 0.76. This model has been launched as a freely accessible tool at: (https://snuspine.shinyapps.io/PJKafterASD/). Conclusion An online calculator, founded on the random forest model, has been developed to gauge the risk of PJK following ASD surgery. This may be a useful clinical tool for surgeons, allowing them to better predict PJK probabilities and refine subsequent therapeutic strategies.

BackgroundAchieving and maintaining anatomical reduction during the treatment of pediatric humerus fractures, classified as Gartland type III or IV, presents a clinical challenge. Herein, we present a minimally invasive surgical approach using a novel and simple K-wire push technique that aids in achieving and maintaining anatomical reduction.MethodsWe reviewed data of children receiving treatment for supracondylar fractures of the humerus at our hospital between January 2016 and December 2020. Patients were divided into two groups based on the method of treatment: Group 1 was treated with the K-wire push technique, and Group 2 was treated with the standard technique as described by Rockwood and Wilkins. The medical records and radiographic images were reviewed. In total, 91 patients with Gartland types III and IV fractures were included, with 37 and 54 patients in Groups 1 and 2, respectively.ResultsThe postoperative reduction radiographic parameters and Flynn scores at final follow-up were not significantly different between the two groups.ConclusionThe minimally invasive K-wire push technique for unstable supracondylar fractures in children is a safe and effective alternative for improving reduction. Using this technique, complications can be minimized, and the requirement for open reduction can be reduced.