PURPOSE: Some investigators have noted that the renal scarring that occurs after pyelonephritis is closely related to the inflammation or the free oxygen radicals rather than to direct injury by the bacterial infection. We examined whether delayed administration of the antioxidant agent selenium only or its combined administration with antibiotics suppresses renal scarring in a rat model of pyelonephritis. MATERIALS AND METHODS: An inoculum of 1x10(8) colony-forming units/ 0.1ml of Escherichia coli was injected directly into the renal parenchyma of both kidneys of 12 rats (n=24). The control group with 2 rats (n=4 kidneys) received injections of isotonic saline instead of bacterial solution. Three days after surgery, the animals were given the following treatment. In the pyelonephritis group, 2 rats (n=4) received isotonic saline intramuscularly twice daily for 5 days. For the antibiotic treatment group (antibiotic only), 3 rats (n=6) were treated with only with an antibiotic, ciprofloxacin (intramuscular injection, 15mg/kg twice daily) for 5 days. For the selenium treatment only group (selenium only), 4 rats (n=8) were treated with selenium (intraperitoneal injection, 0.5mg/kg twice daily). For the combined group (selenium antibiotic), 3 rats (n=6) received selenium (0.5mg/kg, intraperitoneal injection twice daily) and ciprofloxacin (15mg/kg, intramuscular injection twice daily) together. Six weeks after the bacterial inoculation, all the rats were killed and all the kidneys were examined histopathologically for renal scarring by using an OLYMPUS BX 51 microscope and I-solution. RESULTS: Delayed treatment with antibiotics-only or selenium-only had no effect on scarring compared with the untreated controls. However, the addition of selenium to the delayed antibiotic therapy significantly inhibited renal scarring compared with the pyelonephritis group or the antibiotic treated-only group or the selenium-treated only group (p<0.0001). CONCLUSIONS: These results suggest that selenium is effective in preventing renal scar formation during pyelonephritis when the initiation of antimicrobial treatment is delayed in this rat model of pyelonephritis.
Animals ; Anti-Bacterial Agents ; Bacterial Infections ; Cicatrix ; Ciprofloxacin ; Escherichia coli ; Humans ; Inflammation* ; Injections, Intramuscular ; Injections, Intraperitoneal ; Kidney ; Models, Animal* ; Pyelonephritis* ; Rats* ; Reactive Oxygen Species ; Research Personnel ; Selenium*

Over the past few decades, interest in minimally invasive spine surgery (MISS) has increased tremendously due to its core principle of minimizing approach-related injury while providing outcomes similar to traditional open spine procedures. With technical and technological advancements, MISS has expanded its utility not only to simple spinal stenosis, but also to complex spinal pathologies such as metastasis, trauma, or adult spinal deformity. In this article, we review the techniques and technology in MISS and discuss the indications, benefits, and limitations of MISS.

PURPOSE: Clostridium difficile (C. difficile)-associated colitis, a known complication of colon and rectal surgery, can increase perioperative morbidity and mortality, leading to increased hospital stay and costs. Several contributing factors, including advanced age, mechanical bowel preparation, and antibiotics, have been implicated in this condition. The purpose of this study was to determine the clinical features of and factors responsible for C. difficile-associated colitis after colorectal cancer surgery. METHODS: The medical records of patients who had undergone elective resection for colorectal cancer from January 2008 to April 2010 were reviewed. Cases that involved procedures such as transanal excision, stoma creation, or emergency operation were excluded from the analysis. RESULTS: Resection with primary anastomosis was performed in 219 patients with colorectal cancer. The rate of postoperative C. difficile-associated colitis was 6.8% in the entire study population. Preoperative metallic stent insertion (P = 0.017) and aged sixty and older (> or = 60, P = 0.025) were identified as risk factors for postoperative C. difficile-associated colitis. There were no significant differences in variables such as preoperative oral non-absorbable antibiotics, site of operation, operation procedure, and duration of prophylactic antibiotics. CONCLUSION: Among the potential causative factors of postoperative C. difficile-associated colitis, preoperative metallic stent insertion and aged sixty and older were identified as risk factors on the basis of our data. Strategies to prevent C. difficile infection should be carried out in patients who have undergone preoperative insertion of a metallic stent and are aged sixty and older years.
Aged ; Anti-Bacterial Agents ; Clostridium ; Clostridium difficile ; Colitis ; Colon ; Colorectal Neoplasms ; Emergencies ; Humans ; Length of Stay ; Medical Records ; Risk Factors ; Stents

BACKGROUND: In this study, we assessed the 50% effective concentration (EC50) of sevoflurane for reducing a rocuronium-induced reaction, based on the Dixon's up-and-down method. We also assessed the 50 and 95% effective end-tidal concentration of sevoflurane (ETsev), based on the probit regression curve of the probability of nonwithdrawal reaction. METHODS: We conducted a prospective, double-blind study in 23 males and 24 females. After using 2.5% thiopental sodium (4 mg/kg), anesthesia was induced in the patients. The patients then inhaled sevoflurane with 5 vol% in 6 L/min of oxygen. When the target ETsev was achieved, a nurse injected the intubating dose of rocuronium (0.6 mg/kg) for 5-10 s under the free flow of intravenous fluid. After the nurse evaluated the response, the nurse recorded the maximum heart rate during 30 s and the mean arterial pressure after rocuronium injection. RESULTS: Based on Dixon's up-and-down method, the EC50 of sevoflurane was 2.5 alpha 0.5 vol% in males and 2.5 alpha 0.3 vol% in females. The probit regression curve of the probability of nonwithdrawal reaction showed that in males the 50% effective ETsev was 2.4 vol% (95% confidence interval [CI], 1.5-3.1 vol%) and the 95% effective ETsev was 3.5 vol% (95% CI, 2.9-11.0 vol%); in females, the 50% effective ETsev was 2.4 vol% (95% CI, 2.1-2.7 vol%) and the 95% effective ETsev was 3.0 vol% (95% CI, 2.7-4.5 vol%). CONCLUSIONS: The inhalation of sevoflurane during the induction period may provide a simple and reliable means of reducing rocuronium-induced reactions without adverse hemodynamic changes. There was no significant difference between males and females.
Adult* ; Anesthesia ; Arterial Pressure ; Double-Blind Method ; Female ; Heart Rate ; Hemodynamics ; Humans ; Inhalation ; Male ; Oxygen ; Prospective Studies ; Thiopental

To evaluate the effectiveness of centralizing device, three groups of patients on whom cemented total hip arthroplasty with three types of implant was performed respectively were analyzed and compared; SL stems without centralizing device were used in Group I, Interlok stems with central sleeve in Group II, and MS-30 stems with distal centralizer in Group III .The size of each group was 20. Cement mantle thickness, the amount of displacement of stem tip, and axis alignment of femoral stem on A-P radiograph checked at 2 weeks after operation were assessed. More optimal cement mantle thickness (3~6mm) was achieved in Group II (P=0.046) and Group III (P=0.01) than in Group I. Centralizing effect of the distal femoral stem in the intramedullary canal was significantly better (P<0.05) in Group III ( 4.55% ) than in Group I (11.60%) and Group II (12.35%). Neutral alignment of femoral stem was achieved in 15% of Group I, in 90% of Group II, and in 95% of Group III. Compared to stem without centralizing device, cemented femoral stem with distal centralizer resulted in 1) significantly more centralized distal femoral stem, 2) significantly more neutrally aligned femoral stem,and 3) significantly more optimal cement mantle thickness at zone V. Compared to stem without centralizing device, cemented femoral stem with central sleeve resulted in 1) significantly more neutrally aligned femoral stem, and 2) significantly more optimal cement mantle thickness at zone VI.
Arthroplasty, Replacement, Hip ; Axis, Cervical Vertebra ; Humans

Minimally invasive spine surgery (MISS) has revolutionized the treatment of spinal disorders over the past few decades. This review provides an in-depth analysis of MISS techniques, technologies, outcomes, and future directions. The evolution of MISS techniques–including tubular retractor systems, percutaneous pedicle screw fixation, minimally invasive transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and endoscopic spine surgery–has expanded the scope of treatable spinal pathologies while minimizing tissue trauma. Technological advancements such as intraoperative navigation, robotics, and augmented reality applications have enhanced precision and capabilities. Clinical evidence supports the efficacy and safety of MISS techniques for various spinal pathologies, demonstrating comparable or superior outcomes to traditional open approaches with reduced tissue trauma, blood loss, and hospital stays. Cost-effectiveness analyses also favor MISS over open techniques. Future directions in MISS include expanding indications, integrating artificial intelligence and machine learning, advancing tissue engineering and biologics, and refining robotic and augmented reality applications. As MISS continues to evolve, it is poised to play an increasingly important role in the treatment of spinal disorders, offering improved patient outcomes with reduced morbidity. However, ongoing rigorous evaluation of new techniques and technologies is crucial to balance potential benefits with associated risks and costs.

STUDY DESIGN: Review article. OBJECTIVES: To present the latest knowledge on spine surgery using augmented reality (AR). SUMMARY OF LITERATURE REVIEW: AR is a new technology that simulates interactions with real-world surroundings using computer graphics, and it is a field that has recently been highlighted as part of the fourth industrial revolution. MATERIALS AND METHODS: Review of related literature and introduction of latest research. RESULTS: Spine surgery using AR is currently in its early stages. If industry, academia, and research institutes cooperate and develop, spine surgery using AR is highly likely to develop to the next level. CONCLUSIONS: Spine surgeons should strive to develop relevant technology.
Academies and Institutes ; Computer Graphics ; Spine ; Surgeons

Purpose: To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). Methods: The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. Results: The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p < 0.001). However, the percentage of ECD reduction was not significantly greater in the ACA group than in the other groups (p > 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05). Conclusions Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.

Purpose: To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). Methods: The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. Results: The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p < 0.001). However, the percentage of ECD reduction was not significantly greater in the ACA group than in the other groups (p > 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05). Conclusions Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.

OBJECTIVES: To present the latest knowledge on spine surgery using augmented reality (AR).SUMMARY OF LITERATURE REVIEW: AR is a new technology that simulates interactions with real-world surroundings using computer graphics, and it is a field that has recently been highlighted as part of the fourth industrial revolution. MATERIALS AND METHODS: Review of related literature and introduction of latest research. RESULTS: Spine surgery using AR is currently in its early stages. If industry, academia, and research institutes cooperate and develop, spine surgery using AR is highly likely to develop to the next level. CONCLUSIONS Spine surgeons should strive to develop relevant technology.