HindawiActa Medica Okayama0278-02402018Serum Procalcitonin Levels in Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion2380179ENYosukeFujiiDepartment of Pediatric Acute Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasatoYashiroDepartment of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMutsukoYamadaDepartment of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomonobuKikkawaDepartment of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesNobuyukiNosakaDepartment of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukieSaitoDepartment of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoheiTsukaharaDepartment of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry andMasanoriIkedaDepartment of Pediatric Acute Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTsuneoMorishimaDepartment of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHirokazuTsukaharaDepartment of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesProcalcitonin (PCT) is used as a biomarker in severe infections. Here, we retrospectively investigated levels of serum PCT, C-reactive protein (CRP), and inflammatory cytokines (IL-6, TNF-alpha, and IFN-gamma) in the second phase of patients with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD). Nine AESD pediatric patients (4 men, 5 women; AESD group) admitted to Okayama University Hospital from 2010 to 2016 were compared with 10 control patients with febrile seizures (FS) (3 men, 7 women; FS group). Mean PCT concentrations (ng/mL) in the AESD and FS groups were significantly different, at 9.8 +/- 6.7 and 0.8 +/- 0.9, respectively (p = 0 0006). CRP (mg/dL) were 0.79 +/- 0.89 and 1.4 +/- 1.0 (p = 0 94), respectively; IL-6 (pg/mL) were 449.7 +/- 705.0 and 118.3 +/- 145.4 (p = 0 20), respectively; TNF-alpha (pg/mL) were 18.6 +/- 12.5 and 16.6 +/- 6.0 (p = 0 67), respectively; and IFN-gamma (pg/mL) were 79.6 +/- 158.5 and 41.9 +/- 63.7 (p = 0 56), respectively. Ratios of PCT to CRP were 27.5 +/- 34.2 and 3.2 +/- 6.8 (p < 0 0001), respectively. The sensitivity and specificity in the diagnosis of AESD using a cutoff of PCT/CRP ratio of 1.0 were 79% and 100%, respectively. These results suggest that PCT and the PCT/CRP ratio are useful in auxiliary diagnosis of the second stage of AESD, and in AESD, PCT is likely to increase through a different mechanism.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7142017Residual Femoral Deformity and Femoroacetabular Impingement after Intertrochanteric Osteotomy for Slipped Capital Femoral Epiphysis315323ENYosukeFujiiDepartment of Orthopaedic Surgery, Okayama University HospitalHirosukeEndoDepartment of Orthopaedic Surgery, Okayama University HospitalShigeruMitaniDepartment of Orthopaedic Surgery, Kawasaki Medical SchoolHirofumiAkazawaDepartment of Orthopaedic Surgery, Asahigawasou Rehabilitation and Medical CenterTomonoriTetsunagaDepartment of Orthopaedic Surgery, Okayama University HospitalTakamasaMiyakeDepartment of Orthopaedic Surgery, Okayama University HospitalKazukiYamadaDepartment of Orthopaedic Surgery, Okayama University HospitalKiyoshiAokiDepartment of Orthopaedic Surgery, Asahigawasou Rehabilitation and Medical CenterToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University HospitalOriginal Article10.18926/AMO/55308We retrospectively reviewed 29 hips in which intertrochanteric osteotomies were performed for severe slipped capital femoral epiphyses. Mean age at surgery: 12.6 years. Mean follow-up period: 6 years. At the final follow-up evaluation, one patient had coxalgia, and six hips showed a limited range of motion. A pistol-grip deformity was observed in 13 hips, osteoarthritis in two hips, and a bump existed in 19 hips on the latest radiographs. Gradual remodeling of the bumps was observed post-operatively in 22 hips. The mean and angles and offset and improved over time. The remodeling proceeded rapidly for 1 year post-surgery. We compared hips classified as angles of ≥ 63 to < 63 at the final follow-up evaluation, the mean angle 1 year post-surgery, and the mean ratio of improvement of the angle per year from 1 year post-surgery to the final follow up, which differed significantly. Nearly all of the patients who underwent intertrochanteric osteotomies had residual morphologic abnormalities, but few had clinical symptoms. The angle 1 year post-surgery and the ratio of remodeling of the bump from 1 year post-surgery to the final follow-up can be regarded as a potential predictor of morphologic results after intertrochanteric osteotomy.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7142017An Analysis of the Characteristics and Improved Use of Newly Developed CT-based Navigation System in Total Hip Arthroplasty279289ENYosukeFujiiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazuoFujiwaraDepartment of Intelligent Orthopaedic System Development, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomonoriTetsunagaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakamasaMiyakeDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazukiYamadaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHirosukeEndoDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesNobuhiroAbeDepartment of Orthopaedic Surgery, Kawasaki Medical schoolNaohikoSugitaDepartment of Mechanical Engineering, School of Engineering, The University of TokyoMamoruMitsuishiDepartment of Mechanical Engineering, School of Engineering, The University of TokyoTakayukiInoueTEIJIN NAKASHIMA MEDICAL CO., LTDYoshioNakashimaTEIJIN NAKASHIMA MEDICAL CO., LTDToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/55304We developed a surface matching-type computed tomography (CT)-based navigation system for total hip arthroplasty (the N-navi; TEIJIN NAKASHIMA MEDICAL, Okayama, Japan). In the registration step, surface matching was performed with digitizing points on the pelvic bone surface after coarse paired matching. In the present study, we made model bones from the CT data of patients whose acetabular shapes had various deformities. We measured the distances and angles after surface matching from the fiducial points and evaluated the ability to correct surface-matching registration on each pelvic form, using several areas and numbers of points. When the surface-matching points were taken on the superior area of the acetabulum, the correction was easy for the external direction, but it was difficult to correct for the anterior and proximal directions. The correction was difficult for external and proximal directions on the posterior area. Each area of surface-matching points has particular directions that are easily corrected and other directions that are difficult to correct. The shape of the pelvis also affected the correction ability. Our present findings suggest that checking the position after coarse paired matching and choosing the surface-matching area and points that are optimal to correct will improve the accuracy of total hip arthroplasty and reduce surgical times.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7122017Intracranial Pressure Monitoring for Pediatric Acute Encephalopathy179180ENNobuyukiNosakaAdvanced Emergency and Critical Care Medical Center, Okayama University HospitalKoheiTsukaharaAdvanced Emergency and Critical Care Medical Center, Okayama University HospitalEmilyKnaupAdvanced Emergency and Critical Care Medical Center, Okayama University HospitalToshihikoYabuuchiDepartment of Pediatrics, Okayama University HospitalTomonobuKikkawaDepartment of Pediatrics, Okayama University HospitalYosukeFujiiDepartment of Pediatrics, Okayama University HospitalMasatoYashiroDepartment of Pediatrics, Okayama University HospitalTakaoYasuharaDepartment of Neurological Surgery, Okayama University HospitalAyumiOkadaDepartment of Pediatrics, Okayama University HospitalToyomuUgawaAdvanced Emergency and Critical Care Center of Okayama University HospitalAtsunoriNakaoAdvanced Emergency and Critical Care Medical Center, Okayama University HospitalHirokazuTsukaharaDepartment of Pediatrics, Okayama University HospitalIsaoDateDepartment of Neurological Surgery, Okayama University HospitalShort Communication10.18926/AMO/54987Newly published clinical practice guidelines recommend intracranial pressure (ICP) monitoring in critical care for the management of pediatric acute encephalopathy (pAE), but the utility of ICP monitoring for pAE has been poorly studied. We recently performed direct ICP monitoring for two patients. We observed that although the direct ICP monitoring had clinical benefits with less body weight gain and no vasopressor use in both cases, this monitoring technique is still invasive. Future studies should determine the utility of non-invasive ICP monitoring systems in pAE to further improve the quality of intensive-care management.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6952015For Vol.69, No.4, pp205-212 Venous Thromboembolism after Total Hip Arthroplasty Diagnosed by Enhanced Computed Tomography : Comparison of Selective Thromboprophylaxis and No Thromboprophylaxis325325ENYoshikiOkadaHirosukeEndoShigeruMitaniKazuoFujiwaraTomonoriTetsunagaYoheiKagawaYosukeFujiiToshiyukiKunisadaToshifumiOzakiErratum10.18926/AMO/53680Total hip arthroplasty (THA) is the most effective treatment for advanced or end-stage hip osteoarthritis. However, venous thromboembolism (VTE) remains one of its unresolved complications. We reviewed the records of 322 patients undergoing primary THA and investigated the efficacy of anticoagulant prophylaxis for VTE. Our study cohort consisted of 60 patients who received no anticoagulants, 100 patients who received a factor Xa inhibitor (fondaparinux), 100 patients who received low molecular weight heparin (enoxaparin), and 62 patients who selectively received no anticoagulant prophylaxis due to perioperative bleeding, weight, and/or hemoglobin concentration. Enhanced 64-slice multidetector row computed tomography was performed postoperatively for 7 days in all cases. The incidence of VTE in the four groups was 15%, 9.0%, 6.0%, and 6.4%, respectively. The incidence of VTE was significantly lower in the groups receiving anticoagulant prophylaxis and the group selectively receiving no anticoagulant prophylaxis than in the group receiving no anticoagulants. Complications of fondaparinux therapy included hepatic dysfunction in 4 cases (4.0%), minor bleeding in 2 cases (2.0%), persistent wound drainage in 3 cases (3.0%), and eruption in 1 case (1.0%). The complications of enoxaparin therapy were persistent wound drainage in 1 case (1.0%) and progression of anemia in 1 case (1.0%). The incidence of VTE was low in patients who selectively received no anticoagulant prophylaxis, so we conclude that anticoagulant prophylaxis should be used selectively in THA cases.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6952015Inhibitory Effects of Edaravone, a Free Radical Scavenger, on Cytokine-induced Hyperpermeability of Human Pulmonary Microvascular Endothelial Cells:A Comparison with Dexamethasone and Nitric Oxide Synthase Inhibitor279290ENYukieSaitoYousukeFujiiMasatoYashiroMitsuruTsugeNobuyukiNosakaNobukoYamashitaMutsukoYamadaHirokazuTsukaharaTsuneoMorishimaOriginal Article10.18926/AMO/53674Lung hyperpermeability affects the development of acute respiratory distress syndrome (ARDS), but therapeutic strategies for the control of microvascular permeability have not been established. We examined the effects of edaravone, dexamethasone, and N-monomethyl-L-arginine (L-NMMA) on permeability changes in human pulmonary microvascular endothelial cells (PMVEC) under a hypercytokinemic state. Human PMVEC were seeded in a Boyden chamber. After monolayer confluence was achieved, the culture media were replaced respectively by culture media containing edaravone, dexamethasone, and L-NMMA. After 24-h incubation, the monolayer was stimulated with tumor necrosis factor- (TNF-) and interleukin-1 (IL-1). Fluorescein-labeled dextran was added. Then the trans-human PMVEC leak was measured. Expressions of vascular endothelial-cadherin (VE-cadherin) and zonula occludens-1 protein (ZO-1) were evaluated using real-time quantitative polymerase chain reaction and immunofluorescence microscopy. The results showed that TNF-{IL-1 markedly increased pulmonary microvascular permeability. Pretreatment with edaravone, dexamethasone, or L-NMMA attenuated the hyperpermeability and inhibited the cytokine-induced reduction of VE-cadherin expression on immunofluorescence staining. Edaravone and dexamethasone increased the expression of ZO-1 at both the mRNA and protein levels. Edaravone and dexamethasone inhibited the permeability changes of human PMVEC, at least partly through an enhancement of VE-cadherin. Collectively, these results suggest a potential therapeutic approach for intervention in patients with ARDS.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6942015Venous Thromboembolism after Total Hip Arthroplasty Diagnosed by Enhanced Computed Tomography : Comparison of Selective Thromboprophylaxis and No Thromboprophylaxis205212ENYoshikiOkadaHirosukeEndoShigeruMitaniKazuoFujiwaraTomonoriTetsunagaYoheiKagawaYosukeFujiiToshiyukiKunisadaToshifumiOzakiOriginal Article10.18926/AMO/53556Total hip arthroplasty (THA) is the most effective treatment for advanced or end-stage hip osteoarthritis. However, venous thromboembolism (VTE) remains one of its unresolved complications. We reviewed the records of 322 patients undergoing primary THA and investigated the efficacy of anticoagulant prophylaxis for VTE. Our study cohort consisted of 60 patients who received no anticoagulants, 100 patients who received a factor Xa inhibitor (fondaparinux), 100 patients who received low molecular weight heparin (enoxaparin), and 62 patients who selectively received no anticoagulant prophylaxis due to perioperative bleeding, weight, and/or hemoglobin concentration. Enhanced 64-slice multidetector row computed tomography was performed postoperatively for 7 days in all cases. The incidence of VTE in the four groups was 15, 9.0, 6.0, and 6.4, respectively. The incidence of VTE was significantly lower in the groups receiving anticoagulant prophylaxis and the group selectively receiving no anticoagulant prophylaxis than in the group receiving no anticoagulants. Complications of fondaparinux therapy included hepatic dysfunction in 4 cases (4.0), minor bleeding in 2 cases (2.0), persistent wound drainage in 3 cases (3.0), and eruption in 1 case (1.0). The complications of enoxaparin therapy were persistent wound drainage in 1 case (1.0) and progression of anemia in 1 case (1.0). The incidence of VTE was low in patients who selectively received no anticoagulant prophylaxis, so we conclude that anticoagulant prophylaxis should be used selectively in THA cases.No potential conflict of interest relevant to this article was reported.