The efficacy of surgical treatment on locomotive syndrome and physical function in patients with lumbar spinal canal stenosis

BackgroundLocomotive syndrome is a condition of reduced mobility due to problems with locomotive organs. Although lumbar spinal canal stenosis is one of the major diseases constituting locomotive syndrome, only few studies have focused on the association between the two pathologies. We aimed to investigate the effect of surgery on lumbar spinal canal stenosis with respect to locomotive syndrome using various physical function tests, including locomotive syndrome risk tests, before and after surgery.MethodsClinical data of 101 consecutive patients (male = 46; female = 55; mean age, 69.3 years) who underwent surgery for lumbar spinal canal stenosis at our institute were prospectively collected. Results of physical function tests, including stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale, and the sagittal vertical axis were evaluated before and 1 year after surgery. The association between several parameters and improvement of risk level in locomotive syndrome was evaluated.ResultsIn the total assessment, 93.1% of cases were in stage 2 and 6.9% in stage 1 preoperatively, while 72.4% were in stage 2, 22.4% in stage 1, and 5.2% in stage 0 at 1 year postoperatively. Postoperative improvement in the total assessment was observed in 28.7% of cases. Several physical function tests and sagittal vertical axis showed significant improvement after surgery. On multiple logistic regression analysis, age >75 years (odds ratio = 10.9, confidence interval = 1.09–109) and postoperative sagittal vertical axis >40 mm (odds ratio = 17.8, confidence interval = 1.78–177) were significant risk factors associated with non-improvement in risk level of locomotive syndrome.ConclusionsSurgical treatment for lumbar spinal canal stenosis improved physical function, including locomotive syndrome. Risk factors associated with non-improvement of locomotive syndrome were later-stage elderly and postoperative sagittal balance impairment.     

Hobson’s choice two-stage hepatectomy for multiple and bilobar colorectal liver metastases with portal vein embolization: report of two cases

Liver resection is recognized as the preferred treatment for patients with colorectal liver metastases (CLM) because it offers long-term survival; it is the only hope for a cure. However, in the majority of cases, liver surgery is contraindicated due to the small volume of the future remnant liver. To extend the surgical indications for CLM, a planned two-stage hepatectomy procedure with portal vein embolization (PVE) was developed specifically for patients with multiple and bilobar CLM. The rationale for performing the procedure was a concern about the possible overgrowth of intrafuture remnant liver lesions following PVE, and it was therefore recommended for all multiple bilobar CLM cases, even when one-stage hepatectomy was technically feasible. We recently performed Hobson’s choice two-stage hepatectomy in two cases for reasons different from those of the original planned two-stage hepatectomy. In the present report, we describe our Hobson’s choice two-stage hepatectomy strategy, which provided favorable short-term outcomes.     

Cervical ossification of the posterior longitudinal ligament: Biomechanical analysis of the influence of static and dynamic factors

Objective

Cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) is induced by static factors, dynamic factors, or a combination of both. We used a three-dimensional finite element method (3D-FEM) to analyze the stress distributions in the cervical spinal cord under static compression, dynamic compression, or a combination of both in the context of OPLL.

Methods

Experimental conditions were established for the 3D-FEM spinal cord, lamina, and hill-shaped OPLL. To simulate static compression of the spinal cord, anterior compression at 10, 20, and 30% of the anterior–posterior diameter of the spinal cord was applied by the OPLL. To simulate dynamic compression, the OPLL was rotated 5°, 10°, and 15° in the flexion direction. To simulate combined static and dynamic compression under 10 and 20% anterior static compression, the OPLL was rotated 5°, 10°, and 15° in the flexion direction.

Results

The stress distribution in the spinal cord increased following static and dynamic compression by cervical OPLL. However, the stress distribution did not increase throughout the entire spinal cord. For combined static and dynamic compression, the stress distribution increased as the static compression increased, even for a mild range of motion (ROM).

Conclusion

Symptoms may appear under static or dynamic compression only. However, under static compression, the stress distribution increases with the ROM of the responsible level and this makes it very likely that symptoms will worsen. We conclude that cervical OPLL myelopathy is induced by static factors, dynamic factors, and a combination of both.     

Effect of surface conditioning and restorative material on the shear bond strength and resin-dentin interface of a new one-bottle nanofilled adhesive.

OBJECTIVES: To determine the effect of different combinations of surface conditioning (DeTrey Conditioner 36, NRC, no etching) and restorative materials (Dyract AP, Spectrum TPH) on the shear bond strength of Prime and Bond NT to enamel and dentin, and to characterize the resin-dentin interface produced by these combinations. METHODS: Shear bond strength was tested on 30 enamel and 30 dentin flat labial surfaces of extracted bovine teeth. The enamel and dentin specimens were randomly assigned to six groups of five teeth each and treated using different combinations of surface conditioners and restorative materials with Prime and Bond NT. Scanning electron microscope (SEM) observation of argon-ion-etched specimens was done to evaluate the resin-dentin interface. RESULTS: The type of surface conditioning and restorative material had significant effects on dentin bond strengths. Etching the dentin prior to application of Prime and Bond NT significantly increased bond strength and caused formation of a hybrid layer for Spectrum TPH. For Dyract AP, dentin etching generally did not improve bond strength despite the formation of a hybrid layer. On enamel, Prime and Bond NT had consistently high bond strengths on etched specimens. SIGNIFICANCE: The results showed that Dyract AP and Spectrum TPH, when used with Prime and Bond NT have different bonding mechanisms and the effect of surface conditioning on their shear bond strength differs. Clinicians should be aware of these effects in order to optimize bonding.     

Degradation of single bottle type self-etching primer effectuated by the primer's storage period

PURPOSE: To examine the hydrolytic stability of the functional methacrylate monomer utilized in single bottle type self-etching primers, by using the 13C nuclear magnetic resonance (NMR) technique in order to understand why the bond strength of resin to the dentin decreased, when the primer's storage duration was prolonged. METHODS: After deuterium oxide was added to the Mega Bond Primer (MB), or Unifil Bond Primer (UB), the MB or UB solutions were then stored at 37 degrees C for 0, 3, and 10 weeks, respectively. At the end of the storage periods, 13C NMR observations of the MB or UB solution were performed at 25 degrees C by using an EX-270 spectrometer. RESULTS: The acidic and/or hydrophilic methacrylate monomer utilized in single bottle type self-etching primers became altered during the primer's storage period. Alteration of the functional monomer was possible since the acidic monomer, utilized in the self-etching primer, could supply sufficient amounts of hydronium ions, which were the result of the dissociation of the acidic group in the acidic monomer. The degradation of the primer, caused by the alteration of the functional monomer, would result in the degradation of the etching and/or priming efficacy on the tooth. The bond strength, as a result, would become decreased as the storage period was prolonged.     

New findings on the structure-phototoxicity relationship and photostability of fluoroquinolones with various substituents at position 1

The present study examined the phototoxicities of a series of 7-(3-aminopyrrolidinyl) quinolones containing various substituents at position 1 (in which the substituent at R8 is a hydrogen or a halogen) by use of a mouse model. For the 7-(3-aminopyrrolidinyl) quinolones with a halogen atom at position 8, well-known substituent groups such as a cyclopropyl, an ethyl, or a difluorophenyl at position 1 were found to be responsible for severe phototoxicity. However, when an aminodifluorophenyl or an isoxazolyl group was placed at position 1, even 8-halogeno quinolones were found to be mildly phototoxic. This is the first report of 8-halogeno quinolones that are not severely phototoxic. Two structurally similar 8-chloro quinolones (the 1-aminodifluorophenyl 8-chloro quinolone and the 1-difluorophenyl 8-chloro quinolone) were investigated further. The former was mildly phototoxic; the latter was severely phototoxic. We demonstrate that these two 8-chloro quinolones have practically the same areas under the concentration-time curves from 0 to 4 h in auricular tissue, suggesting that the mild phototoxicity is not due to pharmacokinetic instability. The rates of UV photodegradation of these compounds were also measured. We found that these two quinolones photodegrade at similar rates, suggesting that the mild phototoxicity is not attained through increased photostability. In conclusion, the phototoxic potentials of fluoroquinolones are influenced not only by the substituent at position 8 but also by that at position 1 (a new finding from this study). We also discovered a mildly phototoxic 8-chloro quinolone which did not have increased photostability.