Background: Implants with different neck offsets for hip replacement surgery are now available from various implant manufacturers and have become a widely used option for achieving postoperative hip stability. This study aimed to compare the impact of neck offset on initial stem fixation and the mechanical effects of different stem lengths when using cementless stems. Methods: We performed a finite element analysis using Mechanical Finder ver. 12.0. CAD models of the Profemur Preserve and Profemur TL cementless stems. Each stem was appropriately sized, and the von Mises stress was calculated. We defined micromotion as the relative displacement between the stem node and the surface of bone contact. The maximum micromotion values of these finite element models were compared under standing conditions. Results: The stress per zone for both stems (Preserve and TL) was the highest in zone 5, followed by zones 3 and 4, which were almost in line with each other. The high offset (HIGH) stress was higher than the standard offset (STD) stress in each stem and zone.The micromotion of each stem was higher at each load in the following order: Preserve HIGH, Preserve STD, TL HIGH, and TL STD, with HIGH being higher than STD at each stem. Conclusions The choice of higher offset or shorter length stems induced higher micromotion at the interface to the bone in the early postoperative period. Therefore, surgeons should be more careful to get appropriate initial fixation using shorter stems with higher offset necks due to the relatively high incidence of loosening or fractures.

Background: Implants with different neck offsets for hip replacement surgery are now available from various implant manufacturers and have become a widely used option for achieving postoperative hip stability. This study aimed to compare the impact of neck offset on initial stem fixation and the mechanical effects of different stem lengths when using cementless stems. Methods: We performed a finite element analysis using Mechanical Finder ver. 12.0. CAD models of the Profemur Preserve and Profemur TL cementless stems. Each stem was appropriately sized, and the von Mises stress was calculated. We defined micromotion as the relative displacement between the stem node and the surface of bone contact. The maximum micromotion values of these finite element models were compared under standing conditions. Results: The stress per zone for both stems (Preserve and TL) was the highest in zone 5, followed by zones 3 and 4, which were almost in line with each other. The high offset (HIGH) stress was higher than the standard offset (STD) stress in each stem and zone.The micromotion of each stem was higher at each load in the following order: Preserve HIGH, Preserve STD, TL HIGH, and TL STD, with HIGH being higher than STD at each stem. Conclusions The choice of higher offset or shorter length stems induced higher micromotion at the interface to the bone in the early postoperative period. Therefore, surgeons should be more careful to get appropriate initial fixation using shorter stems with higher offset necks due to the relatively high incidence of loosening or fractures.

Background: Implants with different neck offsets for hip replacement surgery are now available from various implant manufacturers and have become a widely used option for achieving postoperative hip stability. This study aimed to compare the impact of neck offset on initial stem fixation and the mechanical effects of different stem lengths when using cementless stems. Methods: We performed a finite element analysis using Mechanical Finder ver. 12.0. CAD models of the Profemur Preserve and Profemur TL cementless stems. Each stem was appropriately sized, and the von Mises stress was calculated. We defined micromotion as the relative displacement between the stem node and the surface of bone contact. The maximum micromotion values of these finite element models were compared under standing conditions. Results: The stress per zone for both stems (Preserve and TL) was the highest in zone 5, followed by zones 3 and 4, which were almost in line with each other. The high offset (HIGH) stress was higher than the standard offset (STD) stress in each stem and zone.The micromotion of each stem was higher at each load in the following order: Preserve HIGH, Preserve STD, TL HIGH, and TL STD, with HIGH being higher than STD at each stem. Conclusions The choice of higher offset or shorter length stems induced higher micromotion at the interface to the bone in the early postoperative period. Therefore, surgeons should be more careful to get appropriate initial fixation using shorter stems with higher offset necks due to the relatively high incidence of loosening or fractures.

Background: Implants with different neck offsets for hip replacement surgery are now available from various implant manufacturers and have become a widely used option for achieving postoperative hip stability. This study aimed to compare the impact of neck offset on initial stem fixation and the mechanical effects of different stem lengths when using cementless stems. Methods: We performed a finite element analysis using Mechanical Finder ver. 12.0. CAD models of the Profemur Preserve and Profemur TL cementless stems. Each stem was appropriately sized, and the von Mises stress was calculated. We defined micromotion as the relative displacement between the stem node and the surface of bone contact. The maximum micromotion values of these finite element models were compared under standing conditions. Results: The stress per zone for both stems (Preserve and TL) was the highest in zone 5, followed by zones 3 and 4, which were almost in line with each other. The high offset (HIGH) stress was higher than the standard offset (STD) stress in each stem and zone.The micromotion of each stem was higher at each load in the following order: Preserve HIGH, Preserve STD, TL HIGH, and TL STD, with HIGH being higher than STD at each stem. Conclusions The choice of higher offset or shorter length stems induced higher micromotion at the interface to the bone in the early postoperative period. Therefore, surgeons should be more careful to get appropriate initial fixation using shorter stems with higher offset necks due to the relatively high incidence of loosening or fractures.

Objective: This study evaluated the long-term safety and efficacy of niraparib in Japanese patients with platinum-sensitive recurrent ovarian cancer. Methods: This was a follow-up analysis of a phase 2, multicenter, open-label, single-arm study in Japanese women with platinum-sensitive, relapsed ovarian cancer. Participants received niraparib (starting dose 300 mg) once daily in continuous 28-day cycles. The primary endpoint was the incidence of Grade 3 or 4 thrombocytopenia-related events (defined as the overall incidence of the MedDRA Preferred Terms “thrombocytopenia” and “platelet count decreased”) occurring in the 30 days after initial administration of niraparib, and secondary endpoints included evaluation of treatment-emergent adverse events and progression-free survival. Results: Nineteen patients (median age, 62 years; median body weight, 53.9 kg) were enrolled. As previously reported, the incidence of Grade 3 or 4 thrombocytopenia-related events during the first 30 days of treatment was 31.6%. At data cutoff, median (range) treatment exposure was 504.0 (56–1,054) days and mean ± standard deviation dose intensity was 154.4±77.5 mg/day. The most common treatment-emergent adverse events were nausea (n=14, 73.7%), decreased platelet count (n=12, 63.2%), decreased neutrophil count (n=11, 57.9%), anemia, vomiting, and decreased appetite (all n=9, 47.4%). One patient was diagnosed with treatment-related leukemia, which resulted in death. Median (95% confidence interval) progression-free survival was 18.0 (5.6–26.7) months. Conclusion Overall, the safety profile of niraparib was considered manageable in this study population of Japanese patients with platinum-sensitive, relapsed ovarian cancer and was consistent with that observed in studies of non-Japanese patients.

Objective: This study evaluated the long-term safety and efficacy of niraparib in Japanese patients with platinum-sensitive recurrent ovarian cancer. Methods: This was a follow-up analysis of a phase 2, multicenter, open-label, single-arm study in Japanese women with platinum-sensitive, relapsed ovarian cancer. Participants received niraparib (starting dose 300 mg) once daily in continuous 28-day cycles. The primary endpoint was the incidence of Grade 3 or 4 thrombocytopenia-related events (defined as the overall incidence of the MedDRA Preferred Terms “thrombocytopenia” and “platelet count decreased”) occurring in the 30 days after initial administration of niraparib, and secondary endpoints included evaluation of treatment-emergent adverse events and progression-free survival. Results: Nineteen patients (median age, 62 years; median body weight, 53.9 kg) were enrolled. As previously reported, the incidence of Grade 3 or 4 thrombocytopenia-related events during the first 30 days of treatment was 31.6%. At data cutoff, median (range) treatment exposure was 504.0 (56–1,054) days and mean ± standard deviation dose intensity was 154.4±77.5 mg/day. The most common treatment-emergent adverse events were nausea (n=14, 73.7%), decreased platelet count (n=12, 63.2%), decreased neutrophil count (n=11, 57.9%), anemia, vomiting, and decreased appetite (all n=9, 47.4%). One patient was diagnosed with treatment-related leukemia, which resulted in death. Median (95% confidence interval) progression-free survival was 18.0 (5.6–26.7) months. Conclusion Overall, the safety profile of niraparib was considered manageable in this study population of Japanese patients with platinum-sensitive, relapsed ovarian cancer and was consistent with that observed in studies of non-Japanese patients.

Objective: This study evaluated the long-term safety and efficacy of niraparib in Japanese patients with platinum-sensitive recurrent ovarian cancer. Methods: This was a follow-up analysis of a phase 2, multicenter, open-label, single-arm study in Japanese women with platinum-sensitive, relapsed ovarian cancer. Participants received niraparib (starting dose 300 mg) once daily in continuous 28-day cycles. The primary endpoint was the incidence of Grade 3 or 4 thrombocytopenia-related events (defined as the overall incidence of the MedDRA Preferred Terms “thrombocytopenia” and “platelet count decreased”) occurring in the 30 days after initial administration of niraparib, and secondary endpoints included evaluation of treatment-emergent adverse events and progression-free survival. Results: Nineteen patients (median age, 62 years; median body weight, 53.9 kg) were enrolled. As previously reported, the incidence of Grade 3 or 4 thrombocytopenia-related events during the first 30 days of treatment was 31.6%. At data cutoff, median (range) treatment exposure was 504.0 (56–1,054) days and mean ± standard deviation dose intensity was 154.4±77.5 mg/day. The most common treatment-emergent adverse events were nausea (n=14, 73.7%), decreased platelet count (n=12, 63.2%), decreased neutrophil count (n=11, 57.9%), anemia, vomiting, and decreased appetite (all n=9, 47.4%). One patient was diagnosed with treatment-related leukemia, which resulted in death. Median (95% confidence interval) progression-free survival was 18.0 (5.6–26.7) months. Conclusion Overall, the safety profile of niraparib was considered manageable in this study population of Japanese patients with platinum-sensitive, relapsed ovarian cancer and was consistent with that observed in studies of non-Japanese patients.

Background: Common regional anesthesia approaches for video-assisted thoracoscopic surgery (VATS) include paravertebral block (PVB) and erector spinae plane block (ESPB). PVB is considered a deep nerve block which is contraindicated in antithrombotic therapy. ESPB is effective when administered as a bolus, as well as continuously. However, the recently proposed intertransverse process block (ITPB) ensures more effective diffusion of the local anesthetic into the paravertebral space.Case: We report cases of three patients who received bolus ITPB (costotransverse foramen block and mid-point transverse process-to-pleura block in one and two cases, respectively) combined with continuous ESPB when a deep nerve block could not be administered. Opioids were not required postoperatively, and all postoperative numerical rating scale scores (0–10) at rest were maintained below 4. Conclusions The combination of bolus ITPB and continuous ESPB may be an alternative analgesic method when deep nerve blocks are contraindicated in VATS.

Methods: We enrolled patients who underwent microscopic FMD with outer dural layer resection for CMI. The distance from the tip of the cerebellar tonsil to the C2 vertebral endplate on sagittal magnetic resonance imaging (MRI) was defined as the tonsillar distance (TD). Patients who showed a >20% syrinx diameter reduction on the 1-year follow-up MRI were defined as the syrinx reduction group while the others were categorized in the syrinx nonreduction group. Patients with syringomyelia were categorized into the clinically improved and unimproved groups using the Chicago Chiari Outcome Scale. The imaging and clinical parameters were evaluated pre- and postoperatively. Results: This study included 25 patients of whom 19 (76.0%) had syringomyelia. At the 1-year follow-up, the syrinx diameter had decreased in 11 patients (57.8%). The increased TD significantly differed between the syrinx reduction and nonreduction groups. At the 1-year follow-up, 12 and seven patients with syringomyelia were categorized into the clinically improved and unimproved groups, respectively. The clinically improved and unimproved groups showed significant differences in the mean age and increased TD. Conclusions Postoperative syrinx reduction was significantly correlated with the upward shifting of the cerebellar tonsil in patients with CMI. Our quantitative evaluation of the alterations in hindbrain position after FMD was easily performed and reflects the clinical outcomes.