To investigate the magnitude and incidence of curve progression and identify clinical factors independently associated with late-stage progression in untreated female adolescent idiopathic scoliosis (AIS) patients with Risser grade ≥ 3. This retrospective cohort study included 915 female AIS patients with Risser grade ≥ 3 and a major Cobb angle ≥ 10° without prior treatment. The primary outcome was change in the major Cobb angle (ΔCobb). Patients were additionally divided into the progressive (ΔCobb ≥ 6°) and the non-progressive groups. Multivariable regression analyses were performed to evaluate independent factors associated with curve progression. Covariates included age, months since menarche, body mass index (BMI), residual height growth, and main curve location. Overall, 111 patients (12.1
Patients undergoing hemodialysis often experience impaired exercise tolerance and circulatory instability due to fluid removal and metabolic alterations during dialysis. Although rehabilitation is recommended for this population, the physiological effects of exercise performed after dialysis remain unclear. This study aimed to compare circulatory dynamics and skeletal muscle oxygenation during exercise performed post-dialysis and on non-dialysis days in maintenance hemodialysis patients, to characterize physiological differences that may inform rehabilitation timing. Twelve stable hemodialysis patients from Seirei Sakura Citizen Hospital participated in this cross-sectional study. After a graded exercise test to determine peak work rate (Peak WR), participants performed constant-load cycling exercise at 40
BACKGROUND CONTEXT:Lumbar segmental instability is an important factor in determining surgical strategies for degenerative lumbar spine disorders. Although dynamic slip comparing extension and flexion radiographs (DSEF) is commonly used, dynamic slip comparing upright and supine positions (DSUS) has been proposed as an alternative measure. PURPOSE:To examine the association between DSUS and postoperative outcomes after lumbar decompression surgery without fusion and to identify a DSUS threshold predictive of reoperation. STUDY DESIGN:Multicenter retrospective cohort study. PATIENT SAMPLE:A total of 188 patients who underwent initial single-level lumbar decompression surgery and were followed for at least 3 years. OUTCOME MEASURES:Symptomatic reoperation, Oswestry Disability Index (ODI), visual analogue scale (VAS) scores, and radiographic parameters. METHODS:DSUS and DSEF were measured using standing-supine imaging and flexion-extension radiographs. Patients were classified as DSUS-positive (≥3 mm) or DSUS-negative (<3 mm). Clinical and radiographic outcomes were compared longitudinally. Time-to-event outcomes were assessed using Kaplan-Meier and Cox proportional hazards models. Receiver operating characteristic (ROC) analyses were performed. RESULTS:DSUS and DSEF showed moderate correlation (r=0.37) with frequent discordance. A total of 33 patients (17.6%) were DSUS-positive. DSUS-positive patients had significantly higher reoperation rates, worse postoperative ODI and VAS scores, and greater postoperative slip progression. In Cox models, DSUS independently predicted reoperation after adjustment for key covariates. ROC analysis identified 3.0 mm as the optimal cutoff (area under the curve 0.90). CONCLUSIONS:DSUS is associated with poorer postoperative outcomes and increased reoperation risk after lumbar decompression surgery.
Background Brace treatment is the only evidence-based effective conservative therapy for adolescent idiopathic scoliosis (AIS). However, the relationship between brace treatment and health-related quality of life (HRQOL), and the extent to which brace-wearing time is associated with HRQOL, remain unclear. This study investigated longitudinal changes in HRQOL, assessed using the Scoliosis Japanese Questionnaire-27 (SJ-27) and their association with daily brace-wearing time. Methods This multicenter observational cohort study included 179 female patients with AIS undergoing brace treatment. Daily brace-wearing time at follow-up (> 1-year after brace initiation) was assessed by questionnaire and categorized using a 12 h/day cutoff (< 12 vs. ≥ 12 h/day). In the overall cohort and in each brace-wearing time group, the major Cobb angle and SJ-27 scores (Pain, Discomfort when wearing clothes, Cognition/psychological distress, Appearance/self-consciousness, Participation/physical activity, and total score) were compared between baseline and follow-up. Multivariate regression analyses were performed to examine the association between brace-wearing time and changes (Δ) in HRQOL as assessed by the SJ-27. Results The mean follow-up duration was 24.7 months. In the overall cohort, the SJ-27 Pain and Discomfort when wearing clothes domain scores worsened, whereas the Cognition/psychological distress and Participation/physical activity domain scores improved; the total SJ-27 score showed no significant change. In analyses stratified by brace-wearing time (< 12 vs. ≥ 12 h/day), neither group showed a significant change in the major Cobb angle from baseline to follow-up. Pain and clothing-related discomfort worsened regardless of wear time, whereas the ≥ 12 h/day group additionally showed deterioration in the Appearance/self-consciousness domain and the total score. In multivariate analysis, ≥ 12 h/day bracing was independently associated with worsening in ΔAppearance (p = 0.017), ΔParticipation (p = 0.036), and ΔTotal score (p = 0.033). Conclusion During brace treatment, pain and clothing-related discomfort worsened, whereas overall HRQOL was largely preserved. Longer daily brace wear (≥ 12 h/day) was independently associated with deterioration in appearance-related self-consciousness, physical activity, and overall HRQOL. These findings suggest that, in braced female patients with AIS, changes in HRQOL should be considered when discussing wear-time targets during follow-up.
Anomalous systemic arterial supply to the basal lung (ASASB) and partial anomalous pulmonary venous connection (PAPVC) are rare congenital anomalies; their coexistence in a patient with lung cancer has not been previously reported. A 68-year-old woman was referred for a right lower lobe mass detected on screening. Contrast-enhanced computed tomography showed an aberrant artery from the abdominal aorta supplying segments 9–10 and drainage of all right upper pulmonary veins into the superior vena cava. Qp/Qs on echocardiography was 1.3. Three-dimensional reconstruction clarified the vascular anatomy and guided thoracoscopic right lower lobectomy. The aberrant artery was doubly ligated at its intrathoracic origin and divided with a vascular stapler. Postoperative recovery was uneventful. Histology revealed papillary-predominant adenocarcinoma (pT2aN0M0). Twelve-month surveillance showed no recurrence or stump aneurysm; Qp/Qs decreased to 1.1. Careful cardiopulmonary evaluation and three-dimensional imaging permitted safe minimally invasive resection in this rare condition. However, the mechanisms underlying postoperative changes in Qp/Qs remain unclear and require cautious interpretation.
