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Study design This was a retrospective cohort study. Purpose We evaluated the predictive value of the Spinal Instability Neoplastic Score (SINS) system for spinal adverse events (SAEs) in patients with single spinal metastatic tumor. Overview of literature The SINS system was developed to assess spinal instability in patients with single metastatic spinal tumor. However, the system's potential predictive value for SAEs has been partially studied. Methods This system was applied to a retrospective cohort of 78 patients with single spinal metastatic tumors. The patients underwent surgical treatment and were postoperatively followed up for at least 2 years or until death. The attribution of each score and total SINS to SAE (vertebral compression fracture [VCF] and spinal cord compression [SCC]) occurrence was assessed using the Cox proportional hazards model. Results SAEs occurred on average 7 months after diagnosis of spinal metastasis. The mean survival rate post diagnosis was 43 months. Multivariate analysis using the Cox proportional hazards model revealed that the pain (p =0.029) and spinal alignment (p =0.001) scores were significantly related to VCF occurrence, whereas the pain (p =0.008) and posterolateral involvement (p =0.009) scores were related to SCC occurrence. Conclusions Among the components of the SINS system, while pain and spinal alignment showed a significant association with VCF occurrence, pain and posterolateral involvement showed association with SCC occurrence.

Background Studies have reported on the usefulness of whole spine magnetic resonance imaging (MRI) in evaluating specific diseases such as spinal tuberculosis, spinal trauma, spondyloarthropathies, and multiple myeloma. In studies concerning degenerative spinal disease, sample sizes were small and some did not provide information on how symptomatic coexisting lesions were treated. We evaluated the types and prevalence of coexisting spine lesions found on whole spine T2 sagittal screening performed at the time of routine cervical and lumbar spine MRI and evaluated the efficacy of such screening in degenerative diseases of the cervical and lumbar spine. Methods We reviewed 1,757 and 2,266 consecutive cases where whole spine T2 sagittal screening had been performed with routine cervical and lumbar spine MRI, respectively, in patients with cervical and lumbar spinal degenerative diseases. Coexisting spine lesions were documented and statistical analysis was performed to investigate significant differences according to sex, age, and initial diagnosis. Electronic medical records were reviewed to determine whether additional interventions were necessary following such findings. Results We reviewed 1,252 and 1,689 consecutive cases of routine cervical and lumbar spine MRI respectively, with whole spine T2 sagittal screening. Of the 1,252, 419 (33.5%) patients with cervical spinal degenerative disease had coexisting lesions in the thoracolumbar spine. Patients with ligament ossification disease of the cervical spine showed a higher prevalence of coexisting spine lesions. Sixty of the 419 (14.3%) patients with coexisting spine lesions warranted additional intervention or surgical treatment. Four hundred and eighty-one of 1,689 (28.5%) patients with lumbar degenerative disease had coexisting spine lesions in the cervicothoracic spine. Forty-eight of the 481 (10.0%) patients with coexisting spine lesions warranted additional intervention. In both patient groups, older patients showed a significantly higher prevalence of coexisting spine lesions than younger patients. Conclusion Considering the minimal extra time and cost in performing whole spine screening, its application to routine spine MRI can be considered in evaluating cervical and lumbar spinal degenerative diseases., Graphical Abstract

AIM The purpose of the present study was to evaluate and compare clinical outcomes in patients aged >65 years and

In this paper, a System Dynamics (SD) computer simulation model was developed to assess the effects of developing and providing an alternate water source on the management of a water supply system and customer satisfaction. A water supply service satisfaction index was also developed to estimate the level of overall customer satisfaction on water supply service. Data from the Busan water supply authority and the Korea Development Institute regarding the Nakdong riverbank filtration development were utilized for the construction of the model. Major managerial indicators of the system under study were analyzed by the simulations of the model that incorporates the development of the alternate water source for Busan. The developed SD model and the water service index may be further utilized as a tool that can assess the extent and timing of an additional service improvement project.

Eco-friendly grain refinement of A3003 alloy was studied by addition of non-toxic Al-Ti alloy because of toxic-fluorine in Al-Ti-B alloys which used as a representative grain refiner for aluminum and its alloys. TiAl3 phase in Al-Ti alloy bring to decrease grain size of A3003 alloy. But, grain growth occurred with prolonged holding time due to the solution of Ti into aluminum matrix. In contrast, lasting grain refinement of A3003 alloy was occurred in graphite crucible. It can be mentioned that carbon comes from graphite crucible was combined with Ti solute in aluminum melt and then TiC acts as a heterogeneous nucleation for A3003 alloy.

The anisotropy in mechanical strength and electrical conductivity in Cu-Ag alloy during cold rolling were investigated. The anisotropy in tensile strength and electrical conductivity was significant with increasing Ag content in Cu-Ag alloy. The cold rolled Cu-Ag alloys with higher Ag content have filamentary structure, which is composed of elongated eutectic phase and Cu matrix. In addition, the eutectic phase in Cu-Ag alloys with higher Ag content has a strong α-fiber texture. It can be mentioned that the eutectic phase in filamentary structure is promotes the anisotropy of electrical conductivity of Cu-Ag alloys. This strong a-fiber texture of eutectic phase was decreased by annealing process (300 OC for 1h), and the anisotropy in strength and conductivity was decreased.

Preoperative identification of aggressiveness is important for the establishment of a treatment strategy in patients with soft-tissue sarcoma (STS). We compared the predictive values of various metabolic parameters derived from PET/CT with (18)F-FDG, including maximal standardized uptake value (SUVmax), total lesion glycolysis (TLG) and metabolic tumour volume (MTV).A total of 66 patients with STS who had undergone FDG PET/CT before tumour resection were reviewed retrospectively. We determined SUVmax, TLG and MTV to compare their value in predicting disease progression, which was defined as local recurrence and metastases. Receiver operating characteristic curve (ROC) analysis was used to compare the accuracy. Univariate and multivariate analyses of conventional clinicopathological variables were used to compare the reliability of the metabolic parameters.TLG exhibited greater accuracy than SUVmax or MTV in ROC analysis (area under curve, AUC, 0.802, 0.726 and 0.681, respectively). The cut-off values for disease progression derived from the AUC data were TLG 250; SUVmax 6.0, and MTV 40 cm(3). In univariate analysis, TLG (250) was a more significant predictive factor than SUVmax and MTV (P0.001, P = 0.031 and P = 0.022, respectively). TLG was the only meaningful metabolic parameter in the multivariate analysis (P = 0.008) other than presence of metastasis at diagnosis (P = 0.003).TLG is a more accurate predictor of disease progression than SUVmax or MTV. TLG enables accurate preoperative assessment of aggressiveness comparable with conventional clinicopathological parameters.

Postoperative heterotopic ossification of the elbow after surgery for treatment of acute trauma such as fractures and ligament/tendon ruptures has been well-documented. However, literature concerning heterotopic ossification after medial epicondylectomy is scarce. We report on two cases of heterotopic ossification that occurred following medial epicondylectomy for medial epicondylitis and for cubital tunnel syndrome. Preoperatively, calcifications around the medial epicondyle were observed in both patients. These cases suggest that medial epicondylectomy, in the presence of pre-existing calcifications, may pose an increased risk of postoperative heterotopic ossification of the elbow.

Synovial sarcoma is a mesenchymal spindle cell tumor with variable epithelial differentiation; it usually occurs in adolescents and young adults. Synovial sarcomas, which account for 5% to 10% of soft-tissue sarcomas, may occur at any site; however, they are believed to arise initially from the synovium1. With the advancement of molecular genetics, synovial sarcomas now can be diagnosed by molecular genetic studies with the identification of the SYT and SSX novel genes2,3. Despite the advancement of diagnostic tools, intraneural synovial sarcomas arising in the peripheral nerves of the upper limb are very rare. To the best of our knowledge, only twenty-seven cases of intraneural synovial sarcomas previously have been reported4-20. Among these, only nine cases have noted the involvement of the peripheral nerves of the upper limb4-6,9,13,15,16,18. This case report describes a twenty-six-year-old man who presented with a painless mass on the volar-radial aspect of the index finger. Eighteen months prior, the patient had undergone excisional biopsy at a different hospital, and the mass had been diagnosed as a schwannoma. When the patient presented to us, we initially believed that the tumor had recurred; however, the final diagnosis, as shown by histology, immunohistochemistry, and molecular genetics, was an intraneural synovial sarcoma. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-six-year-old man visited our clinic because of a painless mass that was located on the volar side of the metacarpophalangeal joint of the right index finger. Eighteen months prior, he had visited another hospital because of the same lesion. At that time, magnetic resonance imaging (MRI) had revealed a schwannoma of the radial digital nerve in …