Incidences and Risk Factors for Postoperative Non-Union after Posterior Lumbar Interbody Fusion with Closed-Box Titanium Spacers

Tsunehiko Konomi,Akimasa Yasuda,Kanehiro Fujiyoshi,Yoshiyuki Yato,Takashi Asazuma 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.1

Study Design: A retrospective, single-center clinical study with follow-up of more than 24 months. Purpose: To evaluate the union rates and relevant risk factors for non-union after posterior lumbar interbody fusion (PLIF) using porous-coated closed-box titanium spacers. Overview of Literature: Although the use of a closed-box interbody spacer for PLIF could avoid potential complications associated with the harvesting of autologous bone, few studies have reported detailed follow-up of fusion progression and risk factors for non-union in the early postoperative period. Methods: PLIF using closed-box spacers without filling the autologous bone was performed in 78 (88 levels) consecutive patients. Surgical procedures included PLIF using traditional pedicle screw fixation (PLIF, n=37), PLIF using cortical bone trajectory screw fixation (CBT-PLIF, n=30), and transforaminal lumbar interbody fusion with traditional pedicle screw fixation (TLIF, n=11). Lateral dynamic radiography and computed tomography findings were investigated, and the relationship between the union status and variables that may be related to the risk of non-union was tested statistically. Results: The overall bone union rates at 12 and 24 months were 68.0% and 88.5%, respectively. Incidences of bone cyst formation, subsidence, and retropulsion of spacers were 33.3%, 47.4%, and 14.1%, respectively. Union rates at 24 months were 94.6% in PLIF, 80.0% in CBT-PLIF, and 90.9% in TLIF. Multivariate logistic regression analyses showed that at 12 months postoperatively, the risk factor for non-union was age >75 years (p=0.02). In contrast, no significant risk factor was observed at 24 months. Conclusions: These findings demonstrated the efficacy of interbody closed-box spacers for PLIF without the need to fill the spacer with autologous bone. However, the risk of non-union should be considered in elderly patients, especially intra-operatively and during the early postoperative stage.

도시녹지로서 옥상녹화의 다면적 기능 평가를 위한 기준에 관한 연구

Bo Hyun Kim,Konomi Ikebe,Hajime Koshmizu,Jie woong Lee 한국인간·식물·환경학회 2013 인간식물환경학회지 Vol.16 No.1

Green roof policies has helped to advance urban greening by creating green spaces on previously unused rooftops. However, there are no requirements covering matters such as greening methods, operation and maintenance obligations and many problems for sustainability and functioning of green roof and green space have been pointed out. This research is intended to clarify the contents and criteria of green roof policies currently implemented in Korea, Japan and other countries, compare them with the evaluation criteria for sustainable and public benefit rating systems and propose comprehensive indices for evaluating the multidimensional functions of green roof from the perspective of urban open space. As a result, it is found that obligation, grant, reimbursement, density bonus and tax credit are frequently used as green roof policies and 41 criteria including percentage of greening area, percentage of trees or shrubs, reduction of heat island effect, open space, landscape, and promotion of biodiversity are identified as criteria applicable to evaluating the multidimensional functions of green roof from the perspective of urban open space, respectively.

Quality Indicators for the Detection of Helicobacter pylori-Negative Early Gastric Cancer: A Retrospective Observational Study

Fumiaki Ishibashi,Konomi Kobayashi,Keita Fukushima,Ryu Tanaka,Tomohiro Kawakami,Junko Kato,Kazuaki Sugihara 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.6

Background/Aims: While Helicobacter pylori (HP)-negative gastric cancer is frequently reported, little is known about the predictors for detecting HP-negative early gastric cancer (EGC). We aimed to evaluate the predictors for the detection of HP-negative EGC. Methods: We retrospectively reviewed 13,477 consecutive asymptomatic cases where upper endoscopy was performed by nine physicians from April 2017 to March 2019 and analyzed the detection rate of high-risk lesions (HRLs), including EGC, tubular adenoma, and lymphoma, according to the status of HP infection. The observation time was corrected for multiple regression analyses. Results: For all physicians, the average observation time for screening HP-eradicated and -naïve patients was shorter than that for screening HP-positive patients (p<0.05). Multiple regression analyses revealed that the observation time in the three groups was an independent predictor for detecting HRLs in HP-eradicated patients (p=0.03106, 0.01263, and 0.02485, respectively), while experience of endoscopy was an independent predictor for detecting HRLs in HP-naïve patients (p=0.02638). Conclusions: While observation time during screening endoscopy was a quality indicator for detecting HRLs in HP-eradicated patients, experience of endoscopy was a quality indicator for detecting HRLs in HP-naïve patients.

Influence of Helicobacter pylori Infection on Endoscopic Findings of Gastric Adenocarcinoma of the Fundic Gland Type

Fumiaki Ishibashi,Keita Fukushima,Takashi Ito,Konomi Kobayashi,Ryu Tanaka,Ryoichi Onizuka 대한위암학회 2019 Journal of gastric cancer Vol.19 No.2

Purpose: Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) was first reported as a rare adenocarcinoma found in the normal fundic mucosa. Recent studies have proposed the possibility that GA-FG-CCPs were also generated in the atrophic mucosa after Helicobacter pylori (HP) eradication therapy. However, little is known on the endoscopic findings of GA-FG-CCP generated in the atrophic mucosa due to its extreme rarity. Materials and Methods: A total of 8 patients who underwent endoscopic submucosal resection and were diagnosed with GA-FG-CCP generated in the HP-uninfected mucosa (4 cases, HP-uninfected group) or HP-eradicated atrophic mucosa (4 cases, HP-eradicated group) were retrospectively analyzed, and their endoscopic findings, including magnifying endoscopy with narrow band imaging (M-NBI), and pathological features were compared. Results: While GA-FG-CCPs in the 2 groups displayed similar macroscopic appearance, M-NBI demonstrated that characteristic microvessels (tapered microvessels like withered branches) were specifically identified in the HP-eradicated group. Pathological investigation revealed that a decreasing number of fundic glands and thinned foveolar epithelium covering tumor ducts were thought to lower the thickness of the covering layer over tumor ducts in the HP-eradicated group. Moreover, dilation of vessels just under the surface of the lesions contributed to the visualization of microvessels by M-NBI. Conclusions: The change in background mucosa due to HP infection influenced the thickness of the covering layer over the tumor ducts and M-NBI finding of GA-FG-CCP.

Influence of Helicobacter pylori Infection on Endoscopic Findings of Gastric Adenocarcinoma of the Fundic Gland Type

Ishibashi, Fumiaki,Fukushima, Keita,Ito, Takashi,Kobayashi, Konomi,Tanaka, Ryu,Onizuka, Ryoichi The Korean Gastric Cancer Association 2019 Journal of gastric cancer Vol.19 No.2

Purpose: Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) was first reported as a rare adenocarcinoma found in the normal fundic mucosa. Recent studies have proposed the possibility that GA-FG-CCPs were also generated in the atrophic mucosa after Helicobacter pylori (HP) eradication therapy. However, little is known on the endoscopic findings of GA-FG-CCP generated in the atrophic mucosa due to its extreme rarity. Materials and Methods: A total of 8 patients who underwent endoscopic submucosal resection and were diagnosed with GA-FG-CCP generated in the HP-uninfected mucosa (4 cases, HP-uninfected group) or HP-eradicated atrophic mucosa (4 cases, HP-eradicated group) were retrospectively analyzed, and their endoscopic findings, including magnifying endoscopy with narrow band imaging (M-NBI), and pathological features were compared. Results: While GA-FG-CCPs in the 2 groups displayed similar macroscopic appearance, M-NBI demonstrated that characteristic microvessels (tapered microvessels like withered branches) were specifically identified in the HP-eradicated group. Pathological investigation revealed that a decreasing number of fundic glands and thinned foveolar epithelium covering tumor ducts were thought to lower the thickness of the covering layer over tumor ducts in the HP-eradicated group. Moreover, dilation of vessels just under the surface of the lesions contributed to the visualization of microvessels by M-NBI. Conclusions: The change in background mucosa due to HP infection influenced the thickness of the covering layer over the tumor ducts and M-NBI finding of GA-FG-CCP.

Gallbladder, Carcinoma in the Era of Laparoscopic Cholecystectomy

Yamaguchi, Koji,Chijiiwa, Kazuno,Ichimiya, Hitoshi,Sada, Masayuki,Kawaka, Katsuhiko,Nishikata, Fujihiko,Konomi, Kohki,Tanaka, Masao MediMedia Korea 1997 JAMA-Korea Vol.12 No.2

Effects of Bone Cross-Link Bridging on Fracture Mechanism and Surgical Outcomes in Elderly Patients with Spine Fractures

Furukawa Mitsuru,Fujiyoshi Kanehiro,Okubo Toshiki,Yanai Yoshihide,Matsubayashi Kohei,Kato Takashi,Kobayashi Yoshiomi,Konomi Tsunehiko,Yato Yoshiyuki 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.4

Study Design: This study adopted a cross-sectional study design.Purpose: This study was designed to investigate the effects of bone cross-link bridging on fracture mechanism and surgical outcomes in vertebral fractures using the maximum number of vertebral bodies with bony bridges between adjacent vertebrae without interruption (maxVB).Overview of Literature: The complex interplay of bone density and bone bridging in the elderly can complicate vertebral fractures, necessitating a better understanding of fracture mechanics.Methods: We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2–8), and maxVB (9–18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes.Results: Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2–8) group had less A4 and more B1 and B2 fractures. The maxVB (9–18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2–8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9–18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9–18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups.Conclusions: The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.