Evaluation of economic burden of colonic surgical site infection at a Japanese hospital

BACKGROUND

Several reports have been published regarding cost increases attributable to surgical site infections (SSIs) in Europe and the USA. However, such studies have been limited in Japan.

AIM

To evaluate the economic burden of colorectal SSIs on hospitals in Japan.

METHODS

This study was undertaken at a Japanese university hospital. Amongst 265 patients who had undergone colorectal surgery in the Department of Coloproctological Surgery between November 2014 and March 2016, 16 patients who developed SSIs and could be allocated a diagnosis procedure combination code were selected as SSI cases. Individual SSI cases were matched to non-SSI cases based on a combination of surgical category, age band, sex, wound class, presence of stoma and risk index. Median length of stay (LOS) and piecework reference cost were compared between SSI episodes and non-SSI episodes.

FINDINGS

The median LOS for patients with SSI and without SSI was 25.5 [interquartile range (IQR) 21.5-39.3] and 16.5 (IQR 12.5-18.5) days, respectively (P<0.01). The median piecework reference cost for patients with SSI and without SSI was ¥842,155 (IQR ¥716,423-1,388,968) and ¥575,795 (IQR ¥529,638-680,105), respectively (P<0.01).

CONCLUSION

SSIs led to a significant increase in LOS and economic burden. Although the SSI episodes appear to be more profitable than the non-SSI episodes, the economic profit for SSI episodes was less than that for non-SSI episodes in the observation period, when opportunity costs were taken into account.

Comparison of spinal alignment, muscular strength, and quality of life between women with postmenopausal osteoporosis and healthy volunteers

This study compared spinal alignment, muscular strength, and quality of life (QOL) between women with postmenopausal osteoporosis and healthy volunteers. The results indicated that lower QOL in osteoporosis patients may be associated with increased thoracic kyphosis, reduced lean muscle mass, and generalized muscle weakness.

INTRODUCTION

Increased spinal kyphosis is common in patients with osteoporosis and negatively impacts quality of life (QOL). Muscular strength is also important for QOL in patients with osteoporosis. However, spinal kyphosis and muscle weakness also occur in healthy individuals with advancing age. The purposes of this study were thus to compare spinal alignment, muscular strength, and QOL between women with postmenopausal osteoporosis and healthy volunteers.

METHODS

Participants comprised 236 female patients with postmenopausal osteoporosis (mean age, 68.7 years) and 93 healthy volunteer women (mean age, 71.0 years). Body mass index (BMI), angles of spinal kyphosis, back extensor strength, grip strength, and QOL were compared between groups.

RESULTS

BMI, back extensor strength, and grip strength were significantly higher in the volunteer group than in the osteoporosis group (p < 0.01). Both thoracic kyphosis and lumbar lordosis were significantly greater in the osteoporosis group than in the volunteer group (p < 0.01). With regard to QOL, the 36-Item Short-Form Health Survey (SF-36) subscale scores of role physical, bodily pain, general health, and role emotional were all significantly lower in the osteoporosis group than in the volunteer group (p < 0.05 each). SF-36 physical component summary (PCS) score was significantly lower in the osteoporosis group than in the volunteer group (p < 0.001). SF-36 PCS score correlated positively with thoracic kyphosis and negatively with BMI only in the osteoporosis group (p < 0.05 each).

CONCLUSIONS

These results indicated that lower QOL in osteoporosis patients may be associated with increased thoracic kyphosis, reduced lean muscle mass, and generalized muscle weakness.

Synthesis of single-phase L10-FeNi magnet powder by nitrogen insertion and topotactic extraction

Tetrataenite (L1₀-FeNi) is a promising candidate for use as a permanent magnet free of rare-earth elements because of its favorable properties. In this study, single-phase L1₀-FeNi powder with a high degree of order was synthesized through a new method, nitrogen insertion and topotactic extraction (NITE). In the method, FeNiN, which has the same ordered arrangement as L1₀-FeNi, is formed by nitriding A1-FeNi powder with ammonia gas. Subsequently, FeNiN is denitrided by topotactic reaction to derive single-phase L1₀-FeNi with an order parameter of 0.71. The transformation of disordered-phase FeNi into the L1₀ phase increased the coercive force from 14.5 kA/m to 142 kA/m. The proposed method not only significantly accelerates the development of magnets using L1₀-FeNi but also offers a new synthesis route to obtain ordered alloys in non-equilibrium states.

Real-Time Imaging of Gap Progress during and after Composite Polymerization

The aims of this study were to observe the behavior of composite and formation of gaps during and immediately after light polymerization using swept source optical coherence tomography (OCT) and to compare the interfacial integrity of adhesives in cavities through 3-dimensional (3D) image analysis. Forty tapered cylindrical cavities (4-mm diameter, 2-mm depth) were prepared in bovine incisors and restored using Bond Force (BF), Scotchbond Universal Adhesive (SBU), OptiBond XTR (XTR), or Clearfil SE Bond 2 (SE2), followed by Estelite Flow Quick flowable composite. Real-time imaging was performed at the center of restoration by the OCT system (laser center wavelength: 1,330 nm; frequency: 30 KHz) during and up to 10 min after light curing. The 3D scanning was performed 0, 1, 3, 5, and 10 min after light curing. The percentages of sealed enamel and dentin interface area (E%, D%) were calculated using Amira software. In real-time videos, the initial gaps appeared as a bright scattered area mainly on dentin floor and rapidly progressed along the cavity floor. The timing, rate, and extent of gap formation were different among the specimens. From 3D visualization, gap progress could be seen on both enamel and dentin even after irradiation; furthermore, typical toroidal gap patterns appeared at the dentin floor of BF and SBU. XTR and SE2 showed nearly perfect sealing performance on the dentin floor up to the 10 min that images were recorded. From quantitative analysis, SE2 and XTR showed significantly higher E% and D% than other groups. SBU showed the smallest E% and BF showed a significantly smaller D% than other groups ( P < 0.05). In conclusion, real-time observation of composite placement and 3D quantification of interfacial gaps were implemented within the experimental limitations. Interfacial gap formation during polymerization of the composite depended on the adhesive system used. The formed gaps continued to propagate after composite light curing finished.

Phylogenetic diversity and in situ detection of eukaryotes in anaerobic sludge digesters

Eukaryotic communities in aerobic wastewater treatment processes are well characterized, but little is known about them in anaerobic processes. In this study, abundance, diversity and morphology of eukaryotes in anaerobic sludge digesters were investigated by quantitative real-time PCR (qPCR), 18S rRNA gene clone library construction and catalyzed reporter deposition-fluorescence in situ hybridization (CARD-FISH). Samples were taken from four different anaerobic sludge digesters in Japan. Results of qPCR of rRNA genes revealed that Eukarya accounted from 0.1% to 1.4% of the total number of microbial rRNA gene copy numbers. The phylogenetic affiliations of a total of 251 clones were Fungi, Alveolata, Viridiplantae, Amoebozoa, Rhizaria, Stramenopiles and Metazoa. Eighty-five percent of the clones showed less than 97.0% sequence identity to described eukaryotes, indicating most of the eukaryotes in anaerobic sludge digesters are largely unknown. Clones belonging to the uncultured lineage LKM11 in Cryptomycota of Fungi were most abundant in anaerobic sludge, which accounted for 50% of the total clones. The most dominant OTU in each library belonged to either the LKM11 lineage or the uncultured lineage A31 in Alveolata. Principal coordinate analysis indicated that the eukaryotic and prokaryotic community structures were related. The detection of anaerobic eukaryotes, including the members of the LKM11 and A31 lineages in anaerobic sludge digesters, by CARD-FISH revealed their sizes in the range of 2–8 μm. The diverse and uncultured eukaryotes in the LKM11 and the A31 lineages are common and ecologically relevant members in anaerobic sludge digester.

Effects of Dentin Characteristics on Interfacial Nanoleakage

Water emanating from dentinal tubules during air-drying and light-curing of adhesives leads to entrapment of droplets at the resin-dentin interface and contributes to nanoleakage. This study tested the null hypothesis that characteristics of substrate dentin and type of adhesive used for bonding would not affect the occurrence of nanoleakage. Three self-etch adhesives were used to bond to 4 types of dentin with different characteristics in 12 groups. After silver challenge, nanoleakage percentage was measured within the hybrid layer of each sample. The deep dentin cut perpendicular to tubules always showed a significantly higher nanoleakage percentage compared with that of the other 3 types of dentin. The percentages of nanoleakage within the hybrid layers were not statistically different among adhesives. However, when bonding to deep perpendicular dentin, both all-in-one adhesives revealed more distinct nanoleakage within the adhesive layer compared with that achieved with Clearfil SE Bond, a two-step self-etch adhesive. The results did not support the null hypothesis.

Three-Dimensional Analysis of Enamel Crack Behavior Using Optical Coherence Tomography

The aim of this study was to nondestructively analyze enamel crack behavior on different areas of teeth using 3D swept source-optical coherence tomography (SS-OCT). Ten freshly extracted human teeth of each type on each arch ( n = 80 teeth) were inspected for enamel crack patterns on functional, contact and nonfunctional, or noncontact areas using 3D SS-OCT. The predominant crack pattern for each location on each specimen was noted and analyzed. The OCT observations were validated by direct observations of sectioned specimens under confocal laser scanning microscopy (CLSM). Cracks appeared as bright lines with SS-OCT, with 3 crack patterns identified: Type I - superficial horizontal cracks; Type II - vertically (occluso-gingival) oriented cracks; and Type III - hybrid or complicated cracks, a combination of a Type I and Type III cracks, which may or may not be confluent with each other. Type II cracks were predominant on noncontacting surfaces of incisors and canines and nonfunctional cusps of posterior teeth. Type I and III cracks were predominant on the contacting surfaces of incisors, cusps of canines, and functional cusps of posterior teeth. Cracks originating from the dental-enamel junction and enamel tufts, crack deflections, and the initiation of new cracks within the enamel (internal cracks) were observed as bright areas. CLSM observations corroborated the SS-OCT findings. We found that crack pattern, tooth type, and the location of the crack on the tooth exhibited a strong correlation. We show that the use of 3D SS-OCT permits for the nondestructive 3D imaging and analysis of enamel crack behavior in whole human teeth in vitro. 3D SS-OCT possesses potential for use in clinical studies for the analysis of enamel crack behavior.

SPARCL1-containing neurons in the human brainstem and sensory ganglion

Secreted protein, acidic and rich in cysteine-like 1 (SPARCL1) is a member of the osteonectin family of proteins. In this study, immunohistochemistry for SPARCL1 was performed to obtain its distribution in the human brainstem, cervical spinal cord, and sensory ganglion. SPARCL1-immunoreactivity was detected in neuronal cell bodies including perikarya and proximal dendrites, and the neuropil. The motor nuclei of the IIIrd, Vth, VIth, VIIth, IXth, Xth, XIth, and XIIth cranial nerves and spinal nerves contained many SPARCL1-immunoreactive (-IR) neurons with medium-sized to large cell bodies. Small and medium-sized SPARCL1-IR neurons were distributed in sensory nuclei of the Vth, VIIth, VIIIth, IXth, and Xth cranial nerves. In the medulla oblongata, the dorsal column nuclei also had small to medium-sized SPARCL1-IR neurons. In addition, SPARCL1-IR neurons were detected in the nucleus of the trapezoid body and pontine nucleus within the pons and the arcuate nucleus in the medulla oblongata. In the cervical spinal cord, the ventral horn contained some SPARCL1-IR neurons with large cell bodies. These findings suggest that SPARCL1-containing neurons function to relay and regulate motor and sensory signals in the human brainstem. In the dorsal root (DRG) and trigeminal ganglia (TG), primary sensory neurons contained SPARCL1-immunoreactivity. The proportion of SPARCL1-IR neurons in the TG (mean ± SD, 39.9 ± 2.4%) was higher than in the DRG (30.6 ± 2.1%). SPARCL1-IR neurons were mostly medium-sized to large (mean ± SD, 1494.5 ± 708.3 μm(2); range, 320.4-4353.4 μm(2)) in the DRG, whereas such neurons were of various cell body sizes in the TG (mean ± SD, 1291.2 ± 532.8 μm(2); range, 209.3-4326.4 μm(2)). There appears to be a SPARCL1-containing sensory pathway in the ganglion and brainstem of the spinal and trigeminal nervous systems.