Objective: This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD). Methods: A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups. Results: The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006). Conclusion Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.

Objective: This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD). Methods: A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups. Results: The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006). Conclusion Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.

Objective: This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD). Methods: A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups. Results: The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006). Conclusion Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.

Objective: This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD). Methods: A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups. Results: The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006). Conclusion Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.

Objective: This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD). Methods: A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups. Results: The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006). Conclusion Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.

Vertebral artery stump syndrome (VASS) is a rare condition that can cause posterior circulation ischemic stroke due to occlusion of the ipsilateral vertebral artery (VA) orifice, resulting in blood flow stagnation and embolus formation. Although there is no established treatment for this condition, we observed 3 cases of VASS out of 326 acute ischemic stroke cases at a single institution from April 2021 to October 2022. Despite the best possible antithrombotic treatment, all 3 patients had recurrent ischemic strokes. One patient underwent drug-eluting stenting of the VA orifice to relieve occlusive flow. The other 2 patients received coil embolization, which resulted in the disappearance of their culprit collateral flow. None of the patients had recurrent ischemic strokes after endovascular intervention. Based on our observations, stenting and coil embolization are effective methods for preventing future recurrences of VASS.

Background: Consideration of cultural aspects is important in medical care. We explored regional differences in cancer and palliative care among Okinawa, Tohoku, and Tokyo metropolitan area. Methods: We conducted a questionnaire survey of physicians involved in cancer medicine from September to November 2020. A total of 11 items related to physician experiences were rated using a 5-point Likert-type scale. Results: Responses were received from 553 physicians (187 in Okinawa, 219 in Tohoku, 147 in the Tokyo metropolitan area). In Okinawa, “When patients die, it is important that all family members are present at the last moment,” “Patients/family members primarily consult the elders of the family about the medical treatments,” “Family members hope the patients die at home, because the soul will not return when they die at the hospital,” “Patients/family members get advice from religious advisors about the medical treatments,” and “Family members wish to take the patient home when he/she is about to die and to confirm death at home” were significantly more frequently observed. In Tohoku, “Patients wish to be hospitalized at a specific season” was significantly more frequently reported. In Tohoku and Okinawa, “Patients hide cancer from neighbors and relatives” and “Elderly patients do not want treatment, because they cover the living expenses and education expenses for their children and grandchildren.” were significantly more frequently experienced. Conclusion: There are regional differences in cancer and palliative care in Japan. Being sensitive to the culture of the region is needed.

A 2-month-old female Holstein calf and a 5-month-old female Japanese black calf presented with gingival vascular hamartoma located in the interdental space between the second and third mandibular incisors in the right and left mandibles, respectively. On radiographic or computed tomographic images, osteolytic changes appeared within the mandibular bones adjacent to the masses. The masses were removed along with affected mandibular bone by using unilateral rostral mandibulectomy. After surgery, both cases exhibited a normal appetite and grew normally, with no cosmetic changes or recurrences. Unilateral rostral mandibulectomy can be applied for invasive gingival vascular hamartomas associated with osteolytic changes.
Animals ; Appetite ; Asian Continental Ancestry Group ; Cattle ; Female ; Hamartoma ; Humans ; Incisor ; Infant ; Mandible ; Mandibular Osteotomy ; Radiography ; Recurrence

BACKGROUND: Leukotriene receptor antagonists have been used to prevent virus-induced asthma exacerbations in autumn. Its efficacy, however, might differ with age and sex. OBJECTIVE: This study aimed to investigate whether pranlukast added to usual asthma therapy in Japanese children during autumn, season associated with the peak of asthma, reduces asthma exacerbations. It was also evaluated the effect of age and sex on pranlukast's efficacy. METHODS: A total of 121 asthmatic children aged 1 to 14 years were randomly assigned to receive regular pranlukast or not according to sex, and were divided in 2 age groups, 1–5 years and 6–14 years. The primary outcome was total asthma score calculated during 8 weeks by using a sticker calendar related to the days in which a child experienced a worsening of asthma symptoms. This open study lasted 60 days from September 15 to November 14, 2007. RESULTS: Significant differences in pranlukast efficacy were observed between sex and age groups. Boys aged 1 to 5 years had the lower total asthma score at 8 weeks (p = 0.002), and experienced fewer cold episodes (p = 0.007). There were no significant differences between pranlukast and control group in total asthma score at 8 weeks (p = 0.35), and in the days in which a child experienced a worsening of asthma symptoms (p = 0.67). CONCLUSION: There was a substantial benefit of adding pranlukast to usual therapy in asthmatic children, especially in boys aged 1 to 5 years, during autumn season.
Asian Continental Ancestry Group ; Asthma ; Child ; Child, Preschool ; Humans ; Leukotriene Antagonists ; Seasons

Objective: To develop and confirm the validity of a Biological Prognostic Score using only blood test results for prediction of prognosis in patients with advanced cancer. Methods: We conducted parametric survival time analysis using blood test results, age, sex, and primary diagnosis as independent variables, and event of death as a dependent variable, among patients in a palliative care unit (a development cohort). We then developed the Biological Prognostic Score (BPS). Thereafter, we confirmed the accuracy of the BPS and the Palliative Prognostic Index (PPI) prospectively among patients, who withdrew or withheld further curative or life-prolonging therapies, in other facilities (a validation cohort). Results: We developed the BPS, which consists of cholinesterase, blood urea nitrogen, and total iron-binding capacity, from 122 patients in a development cohort. We then examined 195 patients in a validation cohort and found that the area under the receiver operating characteristic curve for 1-9 week survival prediction was BPS=0.76-0.86 and PPI=0.69-0.73. Discussion: Our results suggest that the BPS was valid. It will be necessary to perform further examinations in multiple facilities and to explore more generalized parameters that could replace total iron-binding capacity in our BPS.