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Bone & Joint Research
Vol. 12, Issue 9 | Pages 590 - 597
20 Sep 2023
Uemura K Otake Y Takashima K Hamada H Imagama T Takao M Sakai T Sato Y Okada S Sugano N

Aims

This study aimed to develop and validate a fully automated system that quantifies proximal femoral bone mineral density (BMD) from CT images.

Methods

The study analyzed 978 pairs of hip CT and dual-energy X-ray absorptiometry (DXA) measurements of the proximal femur (DXA-BMD) collected from three institutions. From the CT images, the femur and a calibration phantom were automatically segmented using previously trained deep-learning models. The Hounsfield units of each voxel were converted into density (mg/cm3). Then, a deep-learning model trained by manual landmark selection of 315 cases was developed to select the landmarks at the proximal femur to rotate the CT volume to the neutral position. Finally, the CT volume of the femur was projected onto the coronal plane, and the areal BMD of the proximal femur (CT-aBMD) was quantified. CT-aBMD correlated to DXA-BMD, and a receiver operating characteristic (ROC) analysis quantified the accuracy in diagnosing osteoporosis.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_2 | Pages 5 - 5
1 Jan 2017
Kobayakawa K Shiba K Harimaya K Matsumoto Y Kawaguchi K Hayashida M Ideta R Maehara Y Iwamoto Y Okada S
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Spinal cord injury (SCI) is a devastating disorder for which the identification of exacerbating factors is urgently needed. Although age, blood pressure and infection are each considered to be prognostic factors in patients with SCI, exacerbating factors that are amenable to treatment remain to be elucidated.

Microglial cells, the resident immune cell in the CNS, form the first line of defense after being stimulated by exposure to invading pathogens or tissue injury. Immediately after SCI, activated microglia enhance and propagate the subsequent inflammatory response by expressing cytokines, such as TNF-α, IL-6 and IL-1β. Recently, we demonstrated that the activation of microglia is associated with the neuropathological outcomes of SCI. Although the precise mechanisms of microglial activation remain elusive, several basic research studies have reported that hyperglycemia is involved in the activation of resident monocytic cells, including microglia. Because microglial activation is associated with secondary injury after SCI, we hypothesized that hyperglycemia may also influence the pathophysiology of SCI by altering microglial responses.

The mice were anesthetized with pentobarbital (75 mg/kg i.p.) and were subjected to a contusion injury (70 kdyn) at the 10th thoracic level using an Infinite Horizons Impactor (Precision Systems Instrumentation). For flow cytometry, the samples were stained with the antibodiesand analyzed using a FACS Aria II flow cytometer and the FACSDiva software program (BD Biosciences). We retrospectively identified 528 SCI patients admitted to the Department of Orthopaedic Surgery at the Spinal Injuries Center (Fukuoka, Japan) between June 2005 and May 2011. The patients' data were obtained from their charts.

We demonstrate that transient hyperglycemia during acute SCI is a detrimental factor that impairs functional improvement in mice and human patients after acute SCI. Under hyperglycemic conditions, both in vivo and in vitro, inflammation was enhanced through promotion of the nuclear translocation of the nuclear factor kB (NF-kB) transcription factor in microglial cells. During acute SCI, hyperglycemic mice exhibited progressive neural damage, with more severe motor deficits than those observed in normoglycemic mice. Consistent with the animal study findings, a Pearson χ2 analysis of data for 528 patients with SCI indicated that hyperglycemia on admission (glucose concentration ≥126 mg/dl) was a significant risk predictor of poor functional outcome. Moreover, a multiple linear regression analysis showed hyperglycemia at admission to be a powerful independent risk factor for a poor motor outcome, even after excluding patients with diabetes mellitus with chronic hyperglycemia (regression coefficient, −1.37; 95% confidence interval, −2.65 to −0.10; P < 0.05). Manipulating blood glucose during acute SCI in hyperglycemic mice rescued the exacerbation of pathophysiology and improved motor functional outcomes.

Our findings suggest that hyperglycemia during acute SCI may be a useful prognostic factor with a negative impact on motor function, highlighting the importance of achieving tight glycemic control after central nervous system injury.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 230 - 230
1 Nov 2002
Okada S Ito S Furuno H Ueta T Shiba K Takemitsu Y Ohta H Mori E Yugue I Kitamura T
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In cases above C4 cervical cord injury a respiratory distress and serious pulmonary complications occur with frequent obstruction of air way by increased excretion and difficult evacuation. Long term tracheal intubation often provides many general complications. We analized advantage and demerit of early tracheotomy in such cases of cervical cord injury patients.

Material and Methods: 1) We proposed early tracheotomy to prevent complications and ease respiration when pts showed low vital capacity (v.c.) less than 500cc showing deltoid/biceps palsy and respiratory distress with much excretion and difficult evacuation. 2) We have analysed 91 patients who needed ventilator out of 845 cervical cord injury patients who admitted in our hospital. 2) 25 pts were treated by tracheotomy from the beginning of treatment, and others were switched over from management of tracheal intubation. 3) We used a double cuff tracheotomy tube to prevent continuous pressure to the tracheal wall. 4) Weaning from ventilator was done when Fi02< 0.3, PEEP< 5cmH2O and PaO2> 80mmHg in room air.

Results: 1) 4 (16%) out of 25 pts who had been treated with tracheotomy from the beginning had atelectasis, whereas 15 (23%) out of 66 pts treated with intubation occurred that symtome, and 20% of the pts suffered pneumonia. 2) Out of 46 pts treated with intratracheal intubation in the beginning and then changed to tracheotomy within 4 days 7(15%) had atelectasis, whereas 20 (29%) of the pts who underwent tracheotomy after 5 days occurred the complication. 3) As complication of tracheotomy? Infection and? tracheal stenosis were observed but all uneventful healed.

Discussion/Conclusion: 1) Acutecervical cord injury pts showing deltoid/biceps palsy have impending respiratory distress. Examination of spirometer is essential. In such cases low v.c. < 500 tracheotomy should be indicated. 2) Continuing respiratory distress > 4days of intubation it is advised tracheotomy in order to prevent genera l complications. 3) Combination with frequent position changing and chest tapping is also essential for evacuation.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages - 227
1 Nov 2002
Okada S Ohta H Shiba K Ueta T Takemitsu Y Mori E Kaji K Yugue I
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There are increasing opportunity of operative treatment for advanced aged patients with degenerative spinal disease aiming for better quality of life. We have studied such patients concerning operative result, complication and problem in pre- and peri- operative management, and achievement of their aims.

Patients and Results: 1) 26 patients were analyzed; 16 males and 10 females, av. aged 82.3, pts of 19 lumbar canal stenosis with marked intermittent claudication and 7 disc herniation. 2) Low back pain and neurogenic disabilities are evaluated on JOA scoring criteria excepting ADL points (full score:15).

Results: 1) 25 of 26 pts had following complications before operation; hypertension in 16, neurogenic bladder 7, arrhythmia 6, prostata hypertrophy 6, cardiac ischemic disease 4, DM 3, cerebral infarction 3, advanced OA of the knee joints 3. asthma 2, pulmonary emphysema 2, Parkinsonism 1, respectively. 2) All patients underwent laminectomy of av. 2.2 segments(1~4), and 3 pts had PL fusion. 3) One had postlaminectomy haematoma complicated with neurologic deterioration 3 hrs after operaion. He underwent immediate revision which resulted complete recovery of neurology. 4) One pt with pulmonary emphysema was operated successfully with lumbar anaesthesia as general anaesthesia was refused. 5) Improvement evaluated with modified JOA pain score accounted for as follows; av. preoperative score showed 7.16 improved to 10.73 (45.8%), objective symptoms 4.23–4.66, subjective symptome 3.0–6.08 (51.3%), ambulant ability improved from 0.35–2.0 (62.3%), and pain ± numbness of L/E 0.96–2.04 (52.9%) resp. 6) 2 patient