Yazaki (United States)

【背景・目的】宮崎県内保育施設における食物アレルギー（FA）対応の実態を明らかにする．

Introduction with Objective: Tibial shaft fractures are the most prevalent type of tibia fracture. Intramedullary nailing is the standard procedure for surgical treatment of displaced tibial shaft fractures. Tibial nail insertion with suprapatellar approach with the knee in semi extended position which has advantage over infrapatellar approach. The aim of this study is to compare the surgical and clinical outcome of suprapatellar and infrapatellar approach for the tibial intramedullary nailing in patient with tibial shaft fractures. Methods: This Prospective Study was carried out among 48 patients attending at the department of Orthopedics Surgery at Chittagong Medical College Hospital; Chittagong for the treatment tibial fracture within the defined period from May 2022 to April 2023. Total 4 patients were dropped out in the middle of follow up. So follow up was done among 44 patients. All the data were compiled and sorted properly and the quantitative data was analyzed statistically by using Statistical Package for Social Science. Results: Twenty two patients in each group completed the study per protocol and included in the analysis. Both groups are comparable in terms of their age, fracture type and fracture location (P>0.05) .The average time of union was 3.52±0.898 months and 3.36±0.790 months respectively in suprapatellar and infrapatellar approach group (P=0.535). The average duration of operation was 90.04±8.035 and 76.46±9.060 minutes respectively in suprapatellar and infrapatellar approach group (P<0.001). Mean ± SD fsluroscopy time in suprapatellar approach was 115.58 ± 8.387 seconds and in infrapatellar approach was 105.38±9.102 (P<0.001). There was no significant difference among the two groups of nailing according P Value regarding complication like malalignment. Average ROM in suprapatellar approach group was 130.91±1.5 and in infrapatellar approach group was 125.38±1.88 (P<0.001). Suprapatellar approach shows significantly better outcome by mean Lysholm Knee score in comparison to infrapatellar approach according (P Value). The proportion of patients achieved excellent functional outcome was 18(81.8%) and 17(77.3%) in suprapatellar and infrapatellar approach group (P=0.892). Conclusion: It can be concluded that suprapatellar approach produced better functional outcome than infrapatellar approach in the treatment of tibial shaft fracture when considering mean lysholm knee score, range of motion and rate of malalignment in this present clinical trial. Medicine Today 2026, Vol.38 (1): 56-59

Purpose:The purpose of this study was to analyze national trends in knee and shoulder arthroscopy to identify seasonal and annual variability using the Healthcare Cost and Utilization Project-Nationwide Ambulatory Surgery Sample (HCUP-NASS) dataset.Methods:Estimated national rates of ambulatory knee and shoulder arthroscopy were analyzed using HCUP-NASS data from 2016 to 2021. Time trend plots were generated to identify potential seasonal trends in these procedures.Results:There was a decreasing trend in the number of procedures (shoulder arthroscopy, rotator cuff repair [RCR], knee arthroscopy, meniscal repair [MR]/meniscectomy, and anterior cruciate ligament reconstruction [ACLR]) done from 2016 to 2021. There were an estimated 264,987 (95% confidence interval [CI] = 251,205 to 276,770) patients who underwent shoulder arthroscopy and 381,125 (95% CI = 362,555 to 399,696) patients who underwent knee arthroscopy in 2021, as compared with 345,892 (95% CI = 326,224 to 365,559) patients who underwent shoulder arthroscopy and 521,912 (95% CI = 496,905 to 546,919) patients who underwent knee arthroscopy in 2016. Male patients showed markedly higher rates of shoulder arthroscopy, RCR, knee arthroscopy, MR, and ACLR procedures as compared with female patients, whereas female patients showed markedly higher rates of knee arthroscopy done without MR and ACLR. Shoulder and knee arthroscopy rates peaked in the 55 to 75-year-old age group. In addition, both procedures were most frequently done in December and had the lowest utilization in the month of July.Conclusion:There was a nonlinear decrease in the estimates of shoulder arthroscopy, RCR, MR/meniscectomy, knee arthroscopy, and anterior cruciate ligament reconstruction procedures from 2016 to 2021, with peaks in 2016 and 2019, and a low point in 2020. There are notable variations in rates of knee and shoulder arthroscopy procedures by age and sex.Clinical relevance:Recent data on commonly done ambulatory orthopaedic arthroscopies are important for policy makers and for understanding utilization trends.

要旨 【背景】 カセットコンロガスの主成分であるブタンを吸引し心室細動に至ることは広く知られておらず，また，救命例の報告は少ない。今回，ブタン吸入後に心室細動（VF）に至ったが，救急隊AEDにて自己心拍再開し，蘇生管理後，社会復帰した1例を経験した。 【症例】 17歳の男性。友人とガス吸入中に警察官から声をかけられ，逃走しようとした際に卒倒し救急要請された。初期心電図はVFであったため，除細動が3回施行され，心拍再開後に当院へ搬送となった。来院時GCS E1V1M1，心停止時間22分であり，体温管理療法を行った。経過は良好で，第13病日に独歩退院となった。 【結語】 ブタン吸入には，心筋感受性亢進に伴う不整脈誘発作用がある。そこに警察官の声かけによる逃走動作が加わり，より交感神経を亢進させVFを誘発したと考えられた。救急医は，ブタン吸入の病態と初期蘇生の重要性を認識し，治療にあたる必要がある。

Background: Patellar fractures are relatively uncommon, accounting for about 1% of all skeletal injuries and transverse fracture pattern is the most common pattern. Early and appropriate management is essential to restore knee function and minimize long-term complications. This study aimed to describe the profile of patients with closed transverse patellar fractures managed in a tertiary level teaching hospital in Bangladesh. Materials and methods: The prospective study of 20 closed transverse patellar fracture cases was conducted at the Department of Orthopaedics of Chittagong Medical College Hospital from January 2019 to December 2020. Patients were managed by open reduction and internal fixation with Tension Band Wiring (TBW) using parallel Cannulated compression screws. Results: The mean age of the patients was 38.91 ±12.01 years, ranging from 19 to 60 years. Most (80%) of the patients were male and farming was the predominant occupation (30%). Thirteen patients (65%) presented with right-sided fractures and the majority of the injuries were caused by either motor-vehicle accidents (45%) or accidental falls (45%). After six months of injury, 15 (75%) and 5 (25%) patients had full extension and 120 degree and 90-120 degree Range of Motion (ROM) respectively. The main complication was knee stiffness, observed in 10% of patients. Conclusion: Transverse patellar fractures are most commonly seen in young adult males and result from direct trauma to the knee. Six-month outcomes were favourable with appropriate management. JCMCTA 2025 ; 36 (1) : 10-13

Atrial fibrillation (AF) after bioprosthetic valve (BPV) replacement is common in older patients with multiple comorbidities and is associated with a heightened risk of thromboembolism. Anticoagulation therapy is often indicated, but renal impairment and other comorbidities elevate bleeding risk, making clinical decisions complex. This study compared clinical outcomes between warfarin and direct oral anticoagulants (DOACs) in this high-risk population. This subgroup analysis of the BPV-AF Registry included 612 patients treated with oral anticoagulants after BPV replacement, stratified by renal function: normal or mild impairment (creatinine clearance [CCr] ≥50 mL/min), mild-to-moderate impairment (30 mL/min ≤ CCr < 50 mL/min), and moderate-to-severe impairment (15 mL/min ≤ CCr < 30 mL/min). Baseline characteristics and outcomes were analyzed within each stratum. The composite outcome of stroke, systemic embolism, and cardiovascular events was numerically less frequent in the DOAC than warfarin group across all strata, although the differences were not statistically significant. Major bleeding also tended to be lower in the DOAC group. In this study from a Japanese nationwide registry comparing outcomes of AF patients after BPV replacement with severe renal impairment between those treated with DOACs and those treated with warfarin, comparative conclusions between DOACs and warfarin cannot be drawn because of the small sample size. Nonetheless, both anticoagulants may be acceptable in clinical practice, highlighting the need for individualized decision-making based on patient risk.

Abstract Background Isolated atrial amyloidosis (IAA) is the most common form of cardiac amyloidosis caused by the deposition of atrial natriuretic peptide (ANP) type amyloid in atrium. Although amyloid deposition has been suggested to be a clinically important pathogenesis for left atrial dysfunction, it is difficult to predict IAA from clinical information and noninvasive studies. Purpose The study aims to comprehensively evaluate the impact of left atrial dysfunction associated with IAA by integrating pathological confirmation of IAA and echocardiographic assessment of left atrial function. Methods 232 consecutive patients who underwent cardiothoracic surgery and underwent their left atrial appendage resection between August 2015 and May 2024 were retrospectively examined. Standard transthoracic echocardiography, including left atrial strain analysis, was performed to evaluate cardiac function. ANP amyloid deposition was evaluated immunohistologically and graded on a four-point scale based on the extent of myocardial interstitial accumulation: 0 = none; 1+ = mild, focal (&amp;lt;5%); 2+ = moderate, multifocal (≥5% but &amp;lt;50%); and 3+ = severe, extensive (≥50%); Cases with a grade of 2+ or 3+ were classified as IAA-positive. Results After adjustment for the exclusion criteria, 189 patients were evaluated. The higher the degree of amyloid deposition, the lower the left atrial reservoir strain, indicating impaired left atrial function (p&amp;lt;0.001) (Figure 1). 105 (55.5%) patients were classified as IAA-positive. Left atrial reservoir strain was significantly lower in IAA-positive group (p&amp;lt;0.001). In a multivariable analysis adjusted for multiple factors affecting left atrial reservoir strain values, lower reservoir strain values were an independent predictor of IAA-positive (odds ratio 0.74 [95% confidence interval 0.64–0.85]; p&amp;lt;0.001) (Figure 2). Conclusions Left atrial reservoir strain decreased in correlation with ANP type amyloid deposition. The lower left atrial reservoir strain was a useful predictor of IAA-positive, independent of left atrial volume, left atrial pressure, and left ventricular ejection fraction, all of which affect left atrial reservoir strain. The possible involvement of IAA as a contributing factor to left atrial dysfunction should also be considered.Amyloid burden and LA strain analysis Multivariable predictors of IAA

In modern manufacturing, historical data are often underutilized for optimizing processes like wire crimping, a critical operation in automotive production. Achieving consistent quality and efficiency in crimping typically relies on expert knowledge and intensive physical testing. Although machine learning models offer the potential for data-driven optimization, their black-box nature and lack of interpretability hinder adoption in many industrial settings. This paper introduces a novel explainable framework that digitally emulates the physical simulation and refinement processes used in wire crimping. Our framework focuses on predicting crimp attributes in specifications and identifying suitable tooling combinations for toolset selection in an explainable manner. Validated on a real-world manufacturing dataset, the framework demonstrates its ability to accomplish both tasks with high accuracy. By integrating explainable AI techniques, the framework provides high predictive performance and highlights the potential to improve the efficiency, reliability, and transparency of wire crimping processes.

AimsThe clinical impact of tricuspid regurgitation (TR) in patients after acute myocardial infarction (AMI) is largely unknown. The aim of this study was to clarify the prevalence and prognostic impact of TR in post‐AMI patients treated with appropriate primary percutaneous coronary intervention (PCI).Methods and resultsThree hundred fifty‐one consecutive patients with first‐onset AMI who underwent successful primary PCI from July 2014 to December 2018 were retrospectively examined. Standard two‐ and three‐dimensional echocardiography were performed at discharge. Based on the presence or absence of mild or greater TR, patients were divided into TR (+) and TR (−) groups, respectively. The primary outcome was the incidence of major adverse cardiac events (MACE), defined as the composite of death, re‐hospitalization for congestive heart failure and recurrent MI. Seventy‐eight (22.2%) patients had mild or greater TR. Kaplan–Meier analysis showed that the cumulative 6‐year incidence of MACE was significantly higher in the TR (+) group (hazard ratio, 2.56 [95% confidence interval, 1.48–4.44]; P < 0.001). In the analysis of the severity of TR, the prognosis of patients with mild TR was significantly worse than that of patients without TR (P = 0.026). Multivariable analysis identified the left anterior descending coronary artery as the culprit vessel, left atrial dilation (>34 mL/m2), reduced left ventricular ejection fraction (<50%) and the presence of significant (≥mild) ischaemic mitral regurgitation as independent predictors of mild or greater residual TR after primary PCI for AMI at discharge. Following adjustment for significant clinical parameters, mild or greater TR at discharge was still associated with a significant hazard ratio for the occurrence of MACE (1.87, [95% confidence interval, 1.01–3.48]; P = 0.048).ConclusionsThe presence of mild or greater TR at discharge may serve as a poor prognostic marker in patients with first‐onset AMI. In addition to traditional clinical risk factors, it is important to pay more attention to TR and to manage it appropriately.