One-stage posterior transpedicular debridement, hemi-interbody and unilateral-posterior bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis: a retrospective study

PURPOSE

To investigate the clinical efficacy and feasibility of the surgical treatment of thoracic spinal tuberculosis using one-stage posterior instrumentation, transpedicular debridement, and hemi-interbody and unilateral posterior bone grafting.

METHODS

Fifty-six patients with thoracic spinal tuberculosis who underwent surgery performed by a single surgeon between September 2009 and August 2020 were enrolled in this study. Based on data from the erythrocyte sedimentation rate (ESR), Visual Analog Scale (VAS), and Cobb angle before surgery, after surgery, and at the most recent follow-up, clinical effectiveness was assessed using statistical analysis. The variables investigated included operating time, blood loss, complications, neurological function, and hemi-interbody fusion.

RESULTS

None of the patients experienced significant surgery-associated complications. At the last follow-up, 23 of the 25 patients (92%) with neurological impairment showed improvement. The thoracic kyphotic angle was significantly decreased from 24.1 ± 9.9° to 13.4 ± 8.6° after operation (P < 0.05), and the angle was 14.44 ± 8.8° at final follow-up (P < 0.05). The Visual Analog Scale significantly decreased from 6.7 ± 1.4 preoperatively to 2.3 ± 0.8 postoperatively (P < 0.05) and finally to 1.2 ± 0.7 at the last follow-up (P < 0.05). Bone fusion was confirmed in 56 patients at 3-6 months postoperatively.

CONCLUSIONS

One-stage posterior transpedicular debridement, hemi-interbody and unilateral posterior bone grafting, and instrumentation are effective and feasible treatment methods for thoracic spinal tuberculosis.

Eighteen-year trends in the management of patients with diabetes in the Shiga Diabetes Clinical Survey: overall trends and differences by age group

Aim

To examine the trends in the management of patients with diabetes over an 18-year period in Japan.

Participants and methods

We recorded the height, body mass, laboratory data, diabetes treatment, and screening status of diabetic complications from the data collected during the Shiga Diabetes Clinical Survey, which has been performed every 6 years since 2000. We then evaluated the management of patients with diabetes in Shiga Prefecture. The study included 17,870, 18,398, 24,243, and 26,624 participants in each of the 4 years of measurements.

Results

The mean age and body mass index (BMI) of the participants gradually increased. The percentage of patients with BMI of ≥ 25 kg/m² was higher in younger patients. Glycemic control significantly improved over 18 years (hemoglobin A1c: 7.3% ± 1.4% in 2000 to 7.1% ± 1.1% in 2018, P for trend < 0.001). The mean hemoglobin A1c levels were higher in younger patients than in elderly patients and increased from 2012 to 2018 in patients aged ≥ 65 years. The proportion of participants who underwent screening for albuminuria and diabetic retinopathy increased. The mean blood pressure and low-density lipoprotein cholesterol concentration decreased.

Conclusions

Glycemic control has been maintained at an acceptable level since the previous survey. Although glycemic control has become less strict in elderly patients with diabetes, glycemic control is poorer in younger patients than in elderly patients. Obesity is an increasingly important problem, particularly in younger patients. The frequency of screening for diabetic complications and the control of blood pressure should be improved.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-022-00573-2.

Marijuana use among patients with epilepsy at a tertiary care center

The expansion of medical and recreational marijuana legalization facilitates patient access to cannabis, and many patients with epilepsy pursue marijuana as a treatment for seizures. We administered a nine-item survey on marijuana use to patients seen in an epilepsy clinic over a 9 month period at a tertiary care center in Oregon where recreational use was legalized in 2015. The majority of respondents (n = 39) reported cannabis use for the purpose of treating epilepsy (87.2%, n = 34), and strongly agreed (53.8%, n = 21) or agreed (28.2%, n = 11) that cannabis use improved seizure control. The most commonly selected cannabis strains were high cannabidiol (CBD) (30.8%, n = 12) or multiple types (30.8%, n = 12), with administration methods of smoking (66.7%, n = 26), edibles (48.7%, n = 19), and concentrates (43.6%, n = 17). More participants reported using marijuana with primarily CBD than primarily tetrahydrocannabinol (THC) or equal CBD:THC content, and very few women reported using marijuana with primarily THC compared with men (10% of female versus 47% of male respondents). Only 2 of 39 participants were able to give an exact dosage used in milligrams. Medical and recreational dispensaries were the most common cannabis sources, followed by homegrown and friends/family members. Although pharmaceutical CBD extract is now Food and Drug Administration (FDA)-approved for certain epilepsy types, access remains limited. Further research is needed to understand recreational cannabis use among patients with epilepsy while clinical research for pharmaceutical cannabis products continues.

Twelve-year trends of increasing overweight and obesity in patients with diabetes: the Shiga Diabetes Clinical Survey

The prevalence of obesity is increasing globally in patients with diabetes. This study aimed to examine 12-year trends of increasing obesity in Japanese patients with diabetes, and their clinical features. The study used results of the Shiga Diabetes Clinical Survey, which recorded medical performance in diabetic patients in 2000, 2006 and 2012. Data were analyzed from 14,205, 14,407 and 21,449 adult patients in these three years, respectively. Overweight and obesity prevalence and the clinical features of diabetes patients were examined, stratified by body mass index (BMI) and age. The prevalence of overweight (BMI 25-30 kg/m²) and obesity (BMI ≥30 kg/m²) were 27.0% and 5.1% in 2000, 28.9% and 7.3% in 2006 and 30.9% and 10.0% in 2012. Glycemic control, blood pressure and serum lipid profile improved over 12 years in all BMI categories. However, glycemic and triglyceride control were insufficient in obese patients aged <65 years (hemoglobin A1c 7.5 ± 1.4%, triglyceride 197.7 ± 178.4 mg/dL in 2012). The percentage of patients who used antihypertensive and lipid-lowering drugs increased and patients with higher BMI had increased frequency of using these drugs, both in young and old age groups. Higher BMI was significantly and positively associated with albuminuria. In summary, overweight and obesity have increased in Japanese diabetic patients, particularly for younger generations. Findings suggest that obesity may lead to poorer glycemic control, blood pressure and lipid profiles. Overweight and obesity are important modifiable risk factors for diabetes, suggesting that more active weight-control interventions are warranted.

Clinical survey over the past 35 years at the clinic for maxillofacial prosthetics Tokyo Medical and Dental University

PURPOSE

The purpose of this survey was to examine the overview of maxillofacial prosthetic treatment at our department, in order to ascertain the actual status of patients and discuss future needs.

METHODS

Subjects were all patients who visited Clinic for Maxillofacial Prosthetics, Dental Hospital, Tokyo Medical and Dental University (TMDU) in the period from January 1, 1980 to December 31, 2014. Using medical records of the Clinic for Maxillofacial Prosthetics, Dental Hospital, TMDU, patients' data including sex, address, referring institution, and primary condition were analyzed throughout the period.

RESULTS

The number of patients over 35 years was 6219, with a man-to-woman ratio of 6:4. The number of patients in their 60s, 70s, and 80s showed an increasing trend. Patients with tumors accounted for about 50 % of cases in 1980-1984 and increased to 80 % in 2010-2014.

CONCLUSIONS

The survey showed an increasing number of elderly patients and patients with tumors. This suggests that more awareness and education about maxillofacial prosthetics are needed.

Attitudes and preferences for the clinical management of hypertension and hypertension-related cerebrovascular disease in the general practice: results of the Italian hypertension and brain survey

Background

The aim of this survey was to evaluate attitudes and preferences for the clinical management of hypertension and hypertension-related cerebrovascular diseases (CVD) in Italy.

Methods

A predefined 16-item survey questionnaire was anonymously administered to a large community sample of general practitioners (GPs), trained by specialized physicians (SPs), who have been included in an educational program between January and November 2015.

Results

A total of 591 physicians, among whom 48 (8%) training SPs and 543 (92%) trained GPs, provided 12,258 valid answers to the survey questionnaire. Left ventricular hypertrophy was considered the most frequent marker of hypertension-related organ damage, whereas atrial fibrillation and carotid atherosclerosis were considered relatively not frequent (10–20%). The most appropriate blood pressure (BP) targets to be achieved in hypertensive patients with CVD were <140/90 mmHg for SPs and <135/85 mmHg for GPs. To achieve these goals, ACE inhibitors were considered the most effective strategies by GPs, whereas SPs expressed a preference for ARBs, both in monotherapies and in combination therapies with beta-blockers.

Conclusions

This survey demonstrates that Italian physicians considered left ventricular hypertrophy frequently associated to CVD and that drugs inhibiting the renin-angiotensin system the most appropriate therapy to manage hypertension and hypertension-related CVD.

Electronic supplementary material

The online version of this article (doi:10.1186/s40885-017-0066-0) contains supplementary material, which is available to authorized users.

Design and conduct of a provider survey to determine a clinically persuasive effect size in planning VA Cooperative Study #590 (Li+)

Background

The estimation of an effect size is an important step in designing an adequately powered, feasible clinical trial intended to change clinical practice. During the planning phase of VA Cooperative Study #590, “Double-Blind Placebo-Controlled Study of Lithium for Preventing Repeated Suicidal Self-Directed Violence in Patients with Depression or Bipolar Disorder (Li+),” it was not clear what effect size would be considered large enough to influence prescribing behavior among practicing clinicians.

Methods

We conducted an online survey of VA psychiatrists to assess their interest in the study question, their clinical experience with lithium, and their opinion about what suicide reduction rate would change their prescribing habits. The 9-item survey was hosted on SurveyMonkey^© and VA psychiatrists were individually emailed an invitation to complete an anonymous online survey. Three email waves were sent over three weeks.

Results

Overall, 862 of 2713 VA psychiatrists (response rate = 31.8%) responded to the anonymous survey. 74% of the respondents would refer a patient to the proposed trial, 9% would not, and 17% were unsure. Presented with suicide reduction rates in 10% increments ranging from 10 to 100%, 61% of respondents indicated that they would use lithium if suicide attempts were reduced by at least 40%; 83% would use lithium if it reduced attempts by at least 50%.

Conclusions

Even with the limitations of response bias and the reliability of responses on future prescribing behavior, a survey of potential users of a clinical trial's results offers a convenient, empirical method for determining and justifying clinically relevant effect sizes.

Trends in medical performance in diabetic patients in primary care clinics compared with those in hospitals: Shiga Diabetes Clinical Survey, Japan, 2000-2012

Aims

This study aimed to clarify trends in clinical performance in diabetic patients over a 12-year period in primary care clinics and hospitals in Japan.

Materials and methods

The Shiga Diabetes Clinical Survey records medical performance in diabetic patients in primary care clinics and hospitals in Shiga Prefecture, Japan. In this study, laboratory data, modality of treatment for diabetes, and status of examination for diabetic complications were examined using results of surveys in 2000, 2006, and 2012. The study included 17,870, 18,398, and 24,219 patients for those years, respectively.

Results

Mean glycated hemoglobin (HbA1_c) level significantly improved over 12 years and was significantly lower in the primary care clinics group than the hospitals group (7.3 ± 1.5 vs. 7.4 ± 1.4 % in 2000, 7.2 ± 1.2 vs. 7.4 ± 1.3 % in 2006, and 6.9 ± 1.0 vs. 7.1 ± 1.1 % in 2012). With regard to diabetic treatment modality, patients treated in hospitals used insulin more frequently than those in primary care clinics. The proportion of patients examined for diabetic complications increased but did not reach 50 % in 2012. Mean blood pressure and low-density lipoprotein cholesterol levels were lowered, but blood pressure control was worse than that of low-density lipoprotein cholesterol.

Conclusions

This study shows that glycemic control in both primary care clinics and hospitals has improved and was almost acceptable. However, examinations for diabetic complications and the control of blood pressure were still insufficient.

Attitudes and preferences for the clinical management of patients with hypertension and hypertension with chronic obstructive pulmonary disease in Italy: main results of a survey questionnaire

Hypertension treatment and control represent a clinical challenge, particularly in case of concomitant risk factors and comorbidities, including chronic obstructive pulmonary disease (COPD). To evaluate attitudes and preferences for the clinical management of hypertension and hypertension associated with COPD by a large community sample of physicians in Italy. A predefined 18-item survey questionnaire was anonymously administered to both specialised physicians (SPs) and general practitioners (GPs), who have been included in an educational programme, performed between January and June 2014. A total of 1181 physicians (767 males, mean age 55.8 ± 7.3 years, average age of medical activity 27.6 ± 8.3 years), among whom 64 (5.4 %) SPs and 1117 (94.6 %) GPs, provided 21,809 valid answers to the survey questionnaire. Concomitant presence of hypertension and COPD was frequently associated (21-40 %) with hypertension-related organ damage and comorbidities. Concomitant presence of hypertension and COPD was able to affect physicians' ability to achieve the recommended therapeutic targets. To achieve the recommended BP goals, ACE inhibitors or ARBs were considered the most effective antihypertensive strategies, both in monotherapies and in combination therapies with either diuretics or calcium-channel blockers. This observational, cross-sectional survey provides useful information on physicians' attitudes and preferences for the clinical management of patients with hypertension and hypertension associated with COPD.