Lymphopenia at 4 Days Postoperatively Is the Most Significant Laboratory Marker for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

Eiichiro Iwata,Hideki Shigematsu,Akinori Okuda,Yasuhiko Morimoto,Keisuke Masuda,Hiroshi Nakajima,Munehisa Koizumi,Yasuhito Tanaka 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.6

Study Design: Case control study. Purpose: To identify the most significant laboratory marker for early detection of surgical site infection (SSI) using multiple logistic regression analysis. Overview of Literature: SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial. Methods: We retrospectively reviewed the laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spinal disease from January 2003 to December 2014. Six laboratory markers for early SSI detection were considered: renewed elevation of the white blood cell count, higher at 7 than 4 days postoperatively; renewed elevation of the C-reactive protein (CRP) level, higher at 7 than 4 days postoperatively; CRP level of >10 mg/dL at 4 days postoperatively; neutrophil percentage of >75% at 4 days postoperatively; lymphocyte percentage of <10% at 4 days postoperatively; and lymphocyte count of <1,000/μL at 4 days postoperatively. Results: Ninety patients were enrolled; five developed deep SSI. Multivariate regression analysis showed that a lymphocyte count of <1,000/μL at 4 days postoperatively was the sole significant independent laboratory marker for early detection of SSI (p =0.037; odds ratio, 11.9; 95% confidence interval, 1.2–122.7). Conclusions: A lymphocyte count of <1,000/μL at 4 days postoperatively is the most significant laboratory marker for early detection of SSI.

Biceps-Related Physical Findings Are Useful to Prevent Misdiagnosis of Cervical Spondylotic Amyotrophy as a Rotator Cuff Tear

Eiichiro Iwata,Hideki Shigematsu,Kazuya Inoue,Takuya Egawa,Masato Tanaka,Akinori Okuda,Yasuhiko Morimoto,Keisuke Masuda,Yusuke Yamamoto,Yoshihiro Sakamoto,Munehisa Koizumi,Yasuhito Tanaka 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.1

Study Design: Case–control study. Purpose: The aim of the present study was to identify physical findings useful for differentiating between cervical spondylotic amyotrophy (CSA) and rotator cuff tears to prevent the misdiagnosis of CSA as a rotator cuff tear. Overview of Literature: CSA and rotator cuff tears are often confused among patients presenting with difficulty in shoulder elevation. Methods: Twenty-five patients with CSA and 27 with rotator cuff tears were enrolled. We included five physical findings specific to CSA that were observed in both CSA and rotator cuff tear patients. The findings were as follows: (1) weakness of the deltoid muscle, (2) weakness of the biceps muscle, (3) atrophy of the deltoid muscle, (4) atrophy of the biceps muscle, and (5) swallow-tail sign (assessment of the posterior fibers of the deltoid). Results: Among 25 CSA patients, 10 (40.0%) were misdiagnosed with a rotator cuff tear on initial diagnosis. The sensitivity and specificity of each physical finding were as follows: (1) deltoid weakness (sensitivity, 92.0%; specificity, 55.6%), (2) biceps weakness (sensitivity, 80.0%; specificity, 100%), (3) deltoid atrophy (sensitivity, 96.0%; specificity, 77.8%), (4) biceps atrophy (sensitivity, 88.8%; specificity, 92.6%), and (5) swallow-tail sign (sensitivity, 56.0%; specificity, 74.1%). There were statistically significant differences in each physical finding. Conclusions: CSA is likely to be misdiagnosed as a rotator cuff tear; however, weakness and atrophy of the biceps are useful findings for differentiating between CSA and rotator cuff tears to prevent misdiagnosis.

Reliability Comparison between “Distal Radius and Ulna” and “Simplified Tanner–Whitehouse III” Assessments for Patients with Adolescent Idiopathic Scoliosis

Okuda Akinori,Shigematsu Hideki,Fujii Hiromasa,Iwata Eiichiro,Tanaka Masato,Morimoto Yasuhiko,Masuda Keisuke,Yamamoto Yusuke,Tanaka Yasuhito 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3

Study Design: This is a retrospective clinical study.Purpose: In this study, we aim to evaluate the reliability of the distal radius and ulna assessment (DRU) and simplified Tanner-Whitehouse III classification (sTW3) in Japanese patients with adolescent idiopathic scoliosis (AIS).Overview of Literature: The greatest curvature of a scoliotic spine occurs at peak-height velocity (PHV), which is the time during which an individual’s height increases at the maximum rate. Diagnosing and appropriately treating AIS before PHV is the most effective way in order to prevent unnecessary deterioration of the scoliosis curve. Although it is difficult to detect scoliosis before PHV, DRU and sTW3, which involve evaluations using a left-hand radiograph, have been reported to be effective.Methods: We retrospectively evaluated 54 hands of 40 girls with AIS who visited Nara Medical University Hospital from 2000 to 2015 using previously collected radiographs. The examiners included a spine surgeon and a pediatric orthopedic surgeon, each with over 10 years of experience. The reliability of the DRU and sTW3 was evaluated using the kappa coefficient.Results: The left-hand radiographs of 40 female patients with AIS (mean age, 13.9±1.7 years; N=54 hands) were evaluated by two blinded examiners using the sTW3 and DRU methods. The highest inter-observer and intra-observer reliabilities (kappa, 0.64 and 0.62, respectively) for radius evaluation were determined. Radius evaluation by the DRU showed the highest agreement rate and smallest error between the inter- and intra-observer examinations.Conclusions: The DRU was the most reliable assessment tool, and it has the potential to be useful for precisely determining the stage of skeletal maturity in outpatient clinics.

Lymphopenia and Elevated Blood C-Reactive Protein Levels at Four Days Postoperatively Are Useful Markers for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

Eiichiro Iwata,Hideki Shigematsu,Munehisa Koizumi,Hiroshi Nakajima,Akinori Okuda,Yasuhiko Morimoto,Keisuke Masuda,Yasuhito Tanaka 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.2

Study Design: Case-control study. Purpose: To identify the characteristics of candidate indexes for early detection of surgical site infection (SSI). Overview of Literature: SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial for the welfare of the patient postoperation. Methods: We retrospectively reviewed laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spine disease. The sensitivity and specificity of six laboratory markers for early detection of SSI were calculated: greater elevation of the white blood cell count at day 7 than at day 4 postoperatively, greater elevation of the C-reactive protein (CRP) level at day 7 than at day 4 postoperatively, a CRP level of >10 mg/dL at 4 days postoperatively, neutrophil percentage of >75% at 4 days postoperatively, a lymphocyte percentage of <10% at 4 days postoperatively, and a lymphocyte count of <1,000/μL at 4 days postoperatively. Statistical analysis was via Fisher’s exact test and a p -value of <0.05 was considered significant. Results: In total, 85 patients were enrolled. Of these, five patients developed deep SSI. The sensitivity and specificity of each index were as follows: index 1, 20.0% and 77.5%; index 2, 20.0% and 83.8%; index 3, 40.0% and 97.5%; index 4, 40.0% and 86.3%; index 5, 0% and 96.3%; and index 6, 80.0% and 80.0%. A significant difference was noted for indexes 3 and 6. Conclusions: A CRP level of >10 mg/dL at 4 days postoperatively would be useful for definitive diagnosis of SSI, and a lymphocyte count of <1,000/μL at 4 days postoperatively would be a useful screening test for SSI. Although laboratory markers for early detection of SSI have been frequently reported, we believe that it is important to understand the characteristics of each index for a precise diagnosis.

A Multi-Stage Encryption Technique to Enhance the Secrecy of Image

( Arindom Mondal ),( Kazi Md ),( Rokibul Alam ),( G. G. Md. Nawaz Ali ),( Peter Han Joo Chong ),( Yasuhiko Morimoto ) 한국인터넷정보학회 2019 KSII Transactions on Internet and Information Syst Vol.13 No.5

This paper proposes a multi-stage encryption technique to enhance the level of secrecy of image to facilitate its secured transmission through the public network. A great number of researches have been done on image secrecy. The existing image encryption techniques like visual cryptography (VC), steganography, watermarking etc. while are applied individually, usually they cannot provide unbreakable secrecy. In this paper, through combining several separate techniques, a hybrid multi-stage encryption technique is proposed which provides nearly unbreakable image secrecy, while the encryption/decryption time remains almost the same of the exiting techniques. The technique consecutively exploits VC, steganography and one time pad (OTP). At first it encrypts the input image using VC, i.e., splits the pixels of the input image into multiple shares to make it unpredictable. Then after the pixel to binary conversion within each share, the exploitation of steganography detects the least significant bits (LSBs) from each chunk within each share. At last, OTP encryption technique is applied on LSBs along with randomly generated OTP secret key to generate the ultimate cipher image. Besides, prior to sending the OTP key to the receiver, first it is converted from binary to integer and then an asymmetric cryptosystem is applied to encrypt it and thereby the key is delivered securely. Finally, the outcome, the time requirement of encryption and decryption, the security and statistical analyses of the proposed technique are evaluated and compared with existing techniques.

An Offline Electronic Payment System Based on an Untraceable Blind Signature Scheme

( Md. Abdullah Al Rahat Kutubi ),( Kazi Md. Rokibul Alam ),( Rafaf Tahsin ),( G. G. Md Nawaz Ali ),( Peter Han Joo Chong ),( Yasuhiko Morimoto ) 한국인터넷정보학회 2017 KSII Transactions on Internet and Information Syst Vol.11 No.5

This paper proposes a new offline electronic payment (e-payment) system that satisfies the major security requirements of e-payment, i.e. anonymity, unlinkability, unforgeability, double spending control, conditional traceability, and fraud prevention. The central idea is the use of Hwang et al.`s RSA-based untraceable blind signature (BS), which disables the link between the e-coin and its owner and ensures the anonymity of both the customer and the merchant. It attaches an expiration, a deposit and the transaction dates to each e-coin in order to manage the database of the bank effectively, to correctly calculate the interest on the e-coin and to aid arbitration if a dishonest customer attempts to double-spend the coin. It also ensures the anonymity of the customer as long as the coin is spent legitimately. Only when a fraudulent e-coin transaction is detected can the bank, with the help of the central authority (a trusted entity), determine the identity of the dishonest customer. The system is referred to as offline since the bank does not need to be concurrently involved in transactions between a customer and a merchant. Finally, analyses of the performance of the prototype and the primary security requirements of the proposed system are also presented.