Methods: This study included 62 patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries. The patients were categorized into the PSI and non-PSI groups based on their radiographic shoulder height 2 years after surgery. Radiographic parameters, lower end vertebra (LEV), lower instrumented vertebra (LIV), sagittal stable vertebra (SSV), postoperative DA and DJK, and Scoliosis Research Society 22 scores were compared between the two groups using unpaired t -tests or Pearson’s chi-square tests. Results: Twenty-eight patients in the PSI group and 34 in the non-PSI group were evaluated. Three patients had DA in the PSI group and 10 with DA and four with DJK in the non-PSI group. LIV–LEV was higher in the PSI group than in the non-PSI group. Although the LIV–SSV was not significantly different between the two groups, among the three patients with DJK, two had LIV–SSV of −3, one had −1, and one had 0. No significant differences in other examinations were noted between the two groups. Conclusions Although more proximal LIV selection might lead to stable DA and DJK, the LIV selection should not be extended distally to prevent DA and DJK because favorable shoulder balance and clinical outcome can still be achieved.

Background: Multilocus sequence typing (MLST) is well-established for Pasteurella multocida but remains undeveloped for Pasteurella canis. We established MLST for P. canis using isolates from humans and companion animals in Japan and Korea to gain insights into its population biology. Methods: We analyzed 39 and 22 isolates from companion animals and humans, respectively. We selected seven housekeeping genes—adk, aroA, deoD, gdhA, g6pd, mdh, and pgi—used in P. multocida MLST. Primer pairs for PCR amplification and sequencing were designed based on conserved sites in 10 whole-genome sequences. We determined frag-ment sequences, variable sites, allelic profiles, and sequence types (STs) of each isolate. A phylogenetic tree of concatenated sequences was constructed using the goeBURST algo-rithm to identify STs and clonal complexes (CCs). ompAM, encoding outer membrane protein A, was genotyped for molecular characterization. Results: The sequenced fragment lengths and allele numbers of the seven genes wereHallym University College of Medicine, 424, 451, 483, 439, 429, 419, and 440 bp and 16, 13, 15, 18, 22, 19, and 18, respec-tively. ST1–ST47, including CC2, CC10, CC18, CC31, and CC33, were diversely distributed among the isolates from different hosts/countries. In the seven-gene phylogenetic tree, apart from P. multocida, all isolates clustered together. goeBURST diagrams revealed di-verse ST distributions among different hosts (animal/human) and countries (Japan/Ko-rea/others). We found clusters 1–4 in ompA genotyping, indicating that MLST discrimination is higher than ompA typing discrimination. Conclusions We established MLST for P. canis isolates from humans and companion ani-This is an Open Access article distributed under mals in Japan and Korea, thereby providing a robust tool for population biology studies.

A 75-year old man presented with diuretic-resistant leg edema. He had a history of three cardiac surgeries: mitral valve plasty, mitral valve replacement with a stentless valve made of autologous pericardium, and mitral valve replacement with a mechanical prosthesis. Six years had passed since his last cardiac surgery. The tests revealed right heart failure due to a chronic expanding intrapericardial hematoma. The hematoma was removed via left thoracotomy, and which had been covered with the ePTFE pericardial membrane used in the previous chest closure was removed via left thoracotomy. The chronic expanding intrapericardial hematoma is a rare condition, and it was suggested that extensive coverage with the sheet may have been a contributing factor to its formation.

In the present review, we systematically examine the diverse applications of whole-genome sequencing (WGS) and next-generation sequencing (NGS) to elucidate the evolution of clinical microbiology. The review aims to provide novel insight and to improve understanding of the applications of WGS in clinical microbiology laboratories. It is organized into the following sections: (1) the various types of NGS machines; (2) NGS workflows for obtaining genome sequences; (3) comparative genomic analysis; (4) RNA-seq (transcriptome) analysis; (5) genome-based bacterial typing; (6) genome-based antimicrobial resistance (AMR) detection;and (7) identification of integrative and conjugative elements carrying AMR gene(s). Four figures and three tables are provided to illustrate this information. The discussion focuses on WGS applications using several genera of microorganisms (Streptococcus, Enterococcus, Staphylococcus, Pasteurella, and Mycobacterium). Overall, WGS and related NGS technologies provide innovative clinical microbiology laboratory studies based on high-throughput genomic results for pathogen identification, tracking, and AMR/virulence profiling. In line with the concept of “One Health,” human and animal microbiology laboratories should pay careful attention to the drastically dynamic evolution of WGS and related NGS technologies.

Many cardiovascular surgeons are well aware of the importance of non-technical skills but don't know what behaviors with high quality non-technical skills are in the operating room. The Non-Technical Skills for Surgeons (NOTSS) system was developed to be used as a debriefing tool for supervisors to assess the non-technical skills of trainee surgeons and provide feedback immediately after surgery. The NOTSS system has the four categories containing three elements respectively, with "good behavior" and "bad behavior" indicated for each element. The purpose of this column is to introduce the NOTSS and to provide an opportunity to think about how cardiovascular surgeons should behave in the operating room. Jpn. J. Cardiovasc. Surg. 53(3): U1-U4 (2024)

Along with clinical practice and education, research is among the most important activities for medical doctors. The same is true in cardiovascular surgery: Young cardiovascular surgeons are expected to improve their surgical techniques and prioritize their clinical practice. However, their perspective on the role of research in their field of expertise is unknown. Therefore, we conducted a survey of and discussion with young cardiovascular surgeons to clarify their thoughts and concerns about performing research. Here we review and report the survey and discussion results.

Our extensive basic research on photodynamic therapy (PDT) application in models of intracranial malignant astrocytoma led to its clinical application for intracranial malignant astrocytoma in Japan. Having considered the safety and effectiveness of this pathology, we initiate a first-in-human clinical study of PDT for spinal cord malignant astrocytoma. This study has an open-label, single-arm design. The initial follow-up period is 12 months, at the end of which we will quantify survival after PDT for spinal cord malignant astrocytoma as primary objective. The secondary objective is to quantify the overall progression-free survival of treated patients and the percentage of patients surviving 6 months after PDT without recurrence. Twenty patients suffering from spinal cord malignant astrocytoma will be recruited. In particular, 10 of those should be newly diagnosed World Health Organization grade 4. After obtaining consent, each patient will receive a single intravenous injection of talaporfin sodium (40 mg/m2) 1 day before tumor resection. One day after completing tumor removal, the residual lesion and/or resection cavity will be irradiated using a 664-nm semiconductor laser with a radiation power density of 150 mW/cm2 and a radiation energy density of 27 J/cm2. The procedure will be performed 22–26 hours after talaporfin sodium administration. This study protocol has been reviewed and approved by the Certified Committee in the Japanese Ministry of Health, Labor, and Welfare University Hospital Medical Information Network Clinical Trials Registry (Japan Registry of Clinical Trials number, jRCT2021220040).

Methods: This study analyzed 143 patients who underwent decompression surgery between 2012 and 2014, who had symptomatic cervical disorders and MRI evidence of spinal cord or nerve compression but had no history of cervical spine surgery. Patient demographics, disease type, Japanese Orthopedic Association score, and follow-up periods were recorded. Spinal surgeons conducted radiological evaluations to determine stenosis levels using computed tomography myelography or MRI in neutral and extended positions. Measurements such as dural tube and spinal cord diameters, cervical alignment, range of motion, and various angles and distances were also analyzed. The residual space available for the spinal cord (SAC) was also calculated. Results: During extension, new stenosis frequently appeared caudal to the stenosis site in a neutral position, particularly at C5/C6 and C6/C7. A low SAC was identified as a significant risk factor for the development of new stenosis in both the upper and lower adjacent disc levels. Each 1-mm decrease in SAC resulted in an 8.9- and 2.7-fold increased risk of new stenosis development in the upper and lower adjacent disc levels, respectively. A practical SAC cutoff of 1.0 mm was established as the threshold for new stenosis development. Conclusions The study identified SAC narrowing as the primary risk factor for new stenosis, with a clinically relevant cutoff of 1 mm. This study highlights the importance of local factors in stenosis development, advocating for further research to improve outcomes in patient with cervical spine disorders.

Methods: The study participants were 249 patients who underwent intradiscal condoliase injection for LDH at nine participating institutions, including 241 patients with initial LDH (group C) and eight with recurrent LDH (group R). Patient characteristics including age, sex, body mass index, disease duration, intervertebral LDH level, smoking history, and diabetes history were evaluated. Low back pain/leg pain Numerical Rating Scale (NRS) scores and the Oswestry Disability Index (ODI) were used to evaluate clinical symptoms before treatment and at 6 months and 1 year after treatment. Results: Low back pain NRS scores (before treatment and at 6 months and 1 year after treatment, respectively) in group C (4.9 → 2.6 → 1.8) showed significant improvement until 1 year after treatment. Although a tendency for improvement was observed in group R (3.5 → 2.8 → 2.2), no significant difference was noted. Groups C (6.6 → 2.4 → 1.4) and R (7.0 → 3.1 → 3.2) showed significant improvement in the leg pain NRS scores after treatment. Group C (41.4 → 19.5 → 13.7) demonstrated significant improvement in the ODI up to 1 year after treatment; however, no significant difference was found in group R (35.7 → 31.7 → 26.4). Conclusions Although intradiscal condoliase injection is less effective for LDH recurrence than for initial cases, it is useful for improving leg pain and can be considered a minimally invasive and safe treatment method.