We investigated whether endurance exercise training (EXT) ameliorates circadian rhythm (CR)-induced risk factors by improving skeletal muscle (SKM) mitochondrial biogenesis, reducing oxidative stress, and modulating apoptotic protein expression. We distinguished between regular and shift workers using the National Health and Nutrition Examination Survey (NHANES) and investigated the health problems caused by shift work (CR disturbance) and the potential therapeutic effects of exercise. In our animal study, 36 rats underwent 12 weeks of CR disturbance, divided into regular and irregular CR groups. These groups were further split into EXT (n = 12) and sedentary (n = 12) for an additional 8 weeks. We analyzed SKM tissue to understand the molecular changes induced by CR and EXT. NHANES data were analyzed using SAS 9.4 and Prism 8 software, while experimental animal data were analyzed using Prism 8 software. The statistical procedures used in each experiment are indicated in the figure legends. Our studies showed that CR disturbance increases dyslipidemia, alters circadian clock proteins (BMAL1, PER2), raises apoptotic protein levels, and reduces mitochondrial biogenesis in SKM. EXT improved LDL-C and HDLC levels without affecting muscle BMAL1 expression. It also enhanced mitochondrial biogenesis (AMPK, PGC-1α, Tfam, NADH-UO, COX-I), antioxidant levels (Catalase, SOD1, SOD2), and apoptotic protein (p53, Bax/Bcl2) expression or activity in SKM. We demonstrated that shift work-induced CR disturbance leads to dyslipidemia, diminished mitochondrial biogenesis, and reduced antioxidant capacity in SKM. However, EXT can counteract dyslipidemia under CR disturbance, potentially lowering the risk of cardiovascular disorders.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Objective: We propose that cervical intrafacetal fusion (cIFF) using bone chip insertion into the facetal joint space additional to minimal PLF is a supplementary fusion method to conventional posterolateral fusion (PLF). Methods: Patients who underwent posterior cervical fixation accompanied by cIFF with minimal PLF or conventional PLF for cervical myelopathy from 2012 to 2023 were investigated retrospectively. Radiological parameters including Cobb angle and C2–7 sagittal vertical axis (SVA) were compared between the 2 groups. In cIFF with minimal PLF group, cIFF location and PLF location were carefully divided, and the fusion rates of each location were analyzed by computed tomography scan. Results: Among enrolled 46 patients, 31 patients were in cIFF group, 15 in PLF group. The postoperative change of Cobb angle in 1-year follow-up in cIFF with minimal PLF group and conventional PLF group were 0.1° ± 4.0° and -9.7° ± 8.4° respectively which was statistically lower in cIFF with minimal PLF group (p = 0.022). Regarding the fusion rate in cIFF with minimal PLF group in postoperative 6 months, the rates was achieved in 267 facets (98.1%) in cIFF location, and 244 facets (89.7%) in PLF location (p < 0.001). Conclusion Postoperative sagittal alignment was more preserved in cIFF with minimal PLF group compared with conventional PLF group. Additionally, in cIFF with minimal PLF group, the bone fusion rate of cIFF location was higher than PLF location. Considering the concerns of bone chip migration onto the spinal cord and relatively low fusion rate in PLF method, applying cIFF method using minimized PLF might be a beneficial alternative for posterior cervical decompression and fixation.

Objective: Stereotactic radiosurgery (SRS) has been performed for spinal tumors. However, the quantitative effect of SRS on postoperative residual cervical dumbbell tumors remains unknown. This study aimed to quantitatively evaluate the efficacy of SRS for treating postoperative residual cervical dumbbell tumors. Methods: We retrospectively reviewed cases of postoperative residual cervical dumbbell tumors from 1995 to 2020 in 2 tertiary institutions. Residual tumors underwent SRS (SRS group) or were observed with clinical and magnetic resonance imaging (MRI) follow-up (observation group). Tumor regrowth rates were compared between the SRS and observation groups. Additionally, risk factors for tumor regrowth were analyzed. Results: A total of 28 cervical dumbbell tumors were incompletely resected. Eight patients were in the SRS group, and 20 in the observation group. The mean regrowth rate was not significantly lower (p = 0.784) in the SRS group (0.18 ± 0.29 mm/mo) than in the observation group (0.33 ± 0.40 mm/mo). In the multivariable Cox regression analysis, SRS was not a significant variable (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.18–1.79; p = 0.336). Conclusion SRS did not significantly decrease the tumor regrowth rate in our study. We believe that achieving maximal resection during the initial operation is more important than postoperative adjuvant SRS.

Objective: We propose that cervical intrafacetal fusion (cIFF) using bone chip insertion into the facetal joint space additional to minimal PLF is a supplementary fusion method to conventional posterolateral fusion (PLF). Methods: Patients who underwent posterior cervical fixation accompanied by cIFF with minimal PLF or conventional PLF for cervical myelopathy from 2012 to 2023 were investigated retrospectively. Radiological parameters including Cobb angle and C2–7 sagittal vertical axis (SVA) were compared between the 2 groups. In cIFF with minimal PLF group, cIFF location and PLF location were carefully divided, and the fusion rates of each location were analyzed by computed tomography scan. Results: Among enrolled 46 patients, 31 patients were in cIFF group, 15 in PLF group. The postoperative change of Cobb angle in 1-year follow-up in cIFF with minimal PLF group and conventional PLF group were 0.1° ± 4.0° and -9.7° ± 8.4° respectively which was statistically lower in cIFF with minimal PLF group (p = 0.022). Regarding the fusion rate in cIFF with minimal PLF group in postoperative 6 months, the rates was achieved in 267 facets (98.1%) in cIFF location, and 244 facets (89.7%) in PLF location (p < 0.001). Conclusion Postoperative sagittal alignment was more preserved in cIFF with minimal PLF group compared with conventional PLF group. Additionally, in cIFF with minimal PLF group, the bone fusion rate of cIFF location was higher than PLF location. Considering the concerns of bone chip migration onto the spinal cord and relatively low fusion rate in PLF method, applying cIFF method using minimized PLF might be a beneficial alternative for posterior cervical decompression and fixation.

Objective: Stereotactic radiosurgery (SRS) has been performed for spinal tumors. However, the quantitative effect of SRS on postoperative residual cervical dumbbell tumors remains unknown. This study aimed to quantitatively evaluate the efficacy of SRS for treating postoperative residual cervical dumbbell tumors. Methods: We retrospectively reviewed cases of postoperative residual cervical dumbbell tumors from 1995 to 2020 in 2 tertiary institutions. Residual tumors underwent SRS (SRS group) or were observed with clinical and magnetic resonance imaging (MRI) follow-up (observation group). Tumor regrowth rates were compared between the SRS and observation groups. Additionally, risk factors for tumor regrowth were analyzed. Results: A total of 28 cervical dumbbell tumors were incompletely resected. Eight patients were in the SRS group, and 20 in the observation group. The mean regrowth rate was not significantly lower (p = 0.784) in the SRS group (0.18 ± 0.29 mm/mo) than in the observation group (0.33 ± 0.40 mm/mo). In the multivariable Cox regression analysis, SRS was not a significant variable (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.18–1.79; p = 0.336). Conclusion SRS did not significantly decrease the tumor regrowth rate in our study. We believe that achieving maximal resection during the initial operation is more important than postoperative adjuvant SRS.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

We investigated whether endurance exercise training (EXT) ameliorates circadian rhythm (CR)-induced risk factors by improving skeletal muscle (SKM) mitochondrial biogenesis, reducing oxidative stress, and modulating apoptotic protein expression. We distinguished between regular and shift workers using the National Health and Nutrition Examination Survey (NHANES) and investigated the health problems caused by shift work (CR disturbance) and the potential therapeutic effects of exercise. In our animal study, 36 rats underwent 12 weeks of CR disturbance, divided into regular and irregular CR groups. These groups were further split into EXT (n = 12) and sedentary (n = 12) for an additional 8 weeks. We analyzed SKM tissue to understand the molecular changes induced by CR and EXT. NHANES data were analyzed using SAS 9.4 and Prism 8 software, while experimental animal data were analyzed using Prism 8 software. The statistical procedures used in each experiment are indicated in the figure legends. Our studies showed that CR disturbance increases dyslipidemia, alters circadian clock proteins (BMAL1, PER2), raises apoptotic protein levels, and reduces mitochondrial biogenesis in SKM. EXT improved LDL-C and HDLC levels without affecting muscle BMAL1 expression. It also enhanced mitochondrial biogenesis (AMPK, PGC-1α, Tfam, NADH-UO, COX-I), antioxidant levels (Catalase, SOD1, SOD2), and apoptotic protein (p53, Bax/Bcl2) expression or activity in SKM. We demonstrated that shift work-induced CR disturbance leads to dyslipidemia, diminished mitochondrial biogenesis, and reduced antioxidant capacity in SKM. However, EXT can counteract dyslipidemia under CR disturbance, potentially lowering the risk of cardiovascular disorders.

Objective: The present study aimed to verify the efficacy of calcium ions as a prognostic factor for massive transfusion (MT) in patients with upper gastrointestinal bleeding (UGIB), including those of variceal and non-variceal origin. Methods: This retrospective cohort study included adult patients with acute UGIB hospitalized through the prehospital emergency department between January 2018 and December 2022. The primary outcome was the need for MT. Secondary outcomes comprised hospital mortality, the need for angiographic intervention or surgery, length of hospital stay, and length of intensive care unit stay. Multivariate analysis using logistic regression was performed for possible candidates and included ionized calcium levels for predicting MT. Results: According to the multivariate logistic regression assessment, the primary outcome was independently correlated with hemoglobin (odds ratio [OR]=0.702; 95% confidence interval [CI], 0.554-0.889) and ionized calcium levels (OR=0.009; 95% CI, 0.0002-0.469). The optimal cutoff point for ionized calcium levels was determined to be a value of 1.105, with a sensitivity of 0.88 and a specificity of 0.488. Using this value, the lower ionized calcium group needed a nearly six-fold increase in MT compared to the upper group. However, the secondary outcomes did not show any statistical differences. Conclusion The statistical review in the present study indicates that low ionized calcium levels in UGIB patients, regardless of liver cirrhosis as a comorbidity, are a novel independent prognostic factor for MT. Quick measurement of ionized calcium levels using a blood gas analyzer will enable practitioners to rapidly identify UGIB patients who need urgent care in minutes.

Objective: We propose that cervical intrafacetal fusion (cIFF) using bone chip insertion into the facetal joint space additional to minimal PLF is a supplementary fusion method to conventional posterolateral fusion (PLF). Methods: Patients who underwent posterior cervical fixation accompanied by cIFF with minimal PLF or conventional PLF for cervical myelopathy from 2012 to 2023 were investigated retrospectively. Radiological parameters including Cobb angle and C2–7 sagittal vertical axis (SVA) were compared between the 2 groups. In cIFF with minimal PLF group, cIFF location and PLF location were carefully divided, and the fusion rates of each location were analyzed by computed tomography scan. Results: Among enrolled 46 patients, 31 patients were in cIFF group, 15 in PLF group. The postoperative change of Cobb angle in 1-year follow-up in cIFF with minimal PLF group and conventional PLF group were 0.1° ± 4.0° and -9.7° ± 8.4° respectively which was statistically lower in cIFF with minimal PLF group (p = 0.022). Regarding the fusion rate in cIFF with minimal PLF group in postoperative 6 months, the rates was achieved in 267 facets (98.1%) in cIFF location, and 244 facets (89.7%) in PLF location (p < 0.001). Conclusion Postoperative sagittal alignment was more preserved in cIFF with minimal PLF group compared with conventional PLF group. Additionally, in cIFF with minimal PLF group, the bone fusion rate of cIFF location was higher than PLF location. Considering the concerns of bone chip migration onto the spinal cord and relatively low fusion rate in PLF method, applying cIFF method using minimized PLF might be a beneficial alternative for posterior cervical decompression and fixation.