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Summary: This study showed that bisphosphonate was safe and effective for the treatment of bone disorders in stage 4 chronic kidney disease (CKD) rats. Intermittent teriparatide therapy showed an anabolic action on bone even under secondary hyperparathyroidism conditions without having an adverse effect on mineral metabolism in late-stage CKD. Introduction: Patients with late-stage CKD are at high risk for fragility fractures. However, there are no consensus on the efficacy and safety of osteoporosis medications for patients with late-stage CKD. In the present study, we aimed to examine the efficacy and safety of alendronate (ALN) and teriparatide (TPD) for treating bone disorder in late-stage CKD with pre-existing secondary hyperparathyroidism using a rat model of CKD. Methods: Male 10-week-old Sprague-Dawley rats were subjected to a 5/6 nephrectomy or sham surgery and randomized into the following four groups: sham, vehicle (saline subcutaneous (sc) daily), ALN (50 μg/kg sc daily), and TPD (40 μg/kg sc daily). Medications commenced at 24 weeks of age and continued for 4 weeks. Micro-computed tomography, histological analysis, infrared spectroscopic imaging, and serum assays were performed. Results: Nephrectomized rats developed hyperphosphatemia, secondary hyperparathyroidism (SHPT), and high creatinine, equivalent to CKD stage 4 in humans. ALN suppressed the bone turnover and increased the degree of mineralization in cortical bone, resulting in an improvement in the mechanical properties. TPD further increased the bone turnover and significantly increased the degree of mineralization, micro-geometry, and bone volume, resulting in a significant improvement in the mechanical properties. Both ALN and TPD had no adverse effect on renal function and mineral metabolism. Conclusions: BP is safe and effective for the treatment of bone disorders in stage 4 CKD rats. Intermittent TPD therapy showed an anabolic action on bone even under SHPT conditions without having an adverse effect on mineral metabolism in late-stage CKD. [ABSTRACT FROM AUTHOR]

Background. Pre-emptive therapy with valganciclovir (VGCV) has become the standard therapy for preventing cytomegalovirus (CMV) infection after allogeneic hematopoietic stem cell transplantation (HSCT). The effectiveness of low-dose VGCV (900 mg per day) has been shown to be equal to that of standard-dose VGCV (900 mg twice daily); however, individualized optimal dosing and toxicity of VGCV have not been reported. Methods. We conducted a retrospective study to evaluate the optimal dose of VGCV as pre-emptive therapy for preventing CMV infection by comparing the frequency of adverse events (AEs) and clinical efficacy in a low-dose VGCV group with those in a standard-dose VGCV group. Thirty-eight patients who were administered VGCV because of CMV antigenemia after HSCT were analyzed. Results. Neutropenia (standard-dose group: 33%, low-dose group: 15%, P = 0.26) and thrombocytopenia (standard-dose group: 39%, low-dose group: 15%, P = 0.14) were frequent AEs of VGCV, and a significantly higher frequency of overall AEs was detected in the standard-dose group than in the low-dose group (P < 0.01). In comparison of dosage based on weight, dosage of VGCV >27 mg/kg was closely related to onset of AEs (P = 0.04). Conclusions. Low-dose VGCV was not inferior in clinical efficacy, including clearance rate of CMV antigenemia and incidence of consequent CMV disease, to standard-dose VGCV as was previously reported. Initial low-dose VGCV for pre-emptive CMV therapy markedly reduces hematologic toxicity and has clinical efficacy equivalent to that of standard-dose VGCV. It is therefore reasonable for patients, except for noticeably overweight patients, to be given initial low-dose VGCV. [ABSTRACT FROM AUTHOR]

Background Reactivation of hepatitis B virus ( HBV) infection, reverse seroconversion ( RS), is a serious complication after allogeneic stem cell transplantation (allo HSCT). We previously conducted a post-transplant hepatitis B vaccine intervention trial and demonstrated the vaccine efficacy in preventing HBV- RS. This report is an update of the hepatitis B vaccine study. Methods In this trial, 21 patients were enrolled and received a standard 3-dose regimen of hepatitis B vaccine after discontinuation of immunosuppressants, whereas 25 transplant recipients with previous HBV infection did not receive the vaccine and served as controls. Results None of the 21 patients in the vaccine group developed HBV- RS and 12 controls developed HBV- RS in median follow-up periods of 60 months (range 13-245). HBV vaccine resulted in a positive value of hepatitis B surface antibody ( HBsAb) titer in 9 patients, while HBsAb remained negative in 12 patients. Presence of a high titer of HBsAb before vaccination was associated with conversion into HBsAb positivity after vaccination. Conclusion These results demonstrated the long-term effects of HBV vaccine for preventing HBV- RS after allo HSCT. Of note, no HBV- RS occurred, even in patients who did not achieve conversion into HBsAb positivity after vaccination. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A retrospective review. OBJECTIVE: This study examined the clinical outcomes of circumferential spinal cord decompression through a posterior approach for thoracic ossification of posterior longitudinal ligament (OPLL), to determine the efficacy of this procedure and the incidence of complications. SUMMARY OF BACKGROUND DATA: Since posterior decompressive laminectomy is not always effective in the treatment of thoracic myelopathy caused by OPLL, circumferential spinal cord decompression through a single posterior approach seems to offer an effective treatment option. However, this procedure is technically demanding and has a high risk of postoperative neurologic deterioration. Long-term clinical outcome data and complication rates of this procedure are not well covered in the literature. METHODS: Medical records of sequentially treated 30 patients, who had undergone circumferential spinal cord decompression through a single posterior approach, were reviewed to determine demographic data, neurologic examination, imaging findings, surgical procedure, and follow-up data. The Japanese Orthopedic Association (JOA) score was used to assess physical dysfunction and neurologic impairment. RESULTS: The mean follow-up period was 8 years; the average operative time was 389 minutes; the mean blood loss was 1883 mL. An average of 4-level spinal cord decompression was performed on all 30 patients. Posterior spinal fusion was performed on 26 of the 30 patients. The mean preoperative JOA score was 3.4/11, and it improved to an average of 7.1/11 at final evaluation. Clinical symptoms and the JOA score improved in 24 patients, but were unchanged or worsened in the other 6 patients compared to the preoperative conditions. Surgical complications included dural tear in 12 patients (40%), deep infection in 3 (10%), and postoperative neurologic deterioration in 10 (33%). Statistical analysis showed that a risk factor associated with the unfavorable surgical outcomes was multiple level circumferential spinal cord decompression of 5 or more vertebral levels. CONCLUSION: Despite circumferential spinal cord decompression through posterior approach for thoracic OPLL providing effective neurologic recovery, there was a high rate of complications such as postoperative neurologic deterioration. Risk factor analysis shows that multiple level circumferential decompression of 5 or more vertebral levels to be associated with unfavorable surgical outcome. [ABSTRACT FROM AUTHOR]

A 43-year-old woman with severe aplastic anemia (SAA) received anti-thymocyte globulin and cyclosporin A (CyA) and achieved hematological remission. Although she had maintained hematological remission, the disease relapsed 10 months after arbitrary discontinuance of maintenance therapy with CyA. Resumption of CyA therapy was not effective, and her condition became complicated with progressive sinusitis with bone destruction, which was refractory to antibiotics, antifungal agents, granulocyte colony-stimulating factor, and surgical drainage. Because of the necessity for early neutrophil recovery (to resolve the infection), we proceeded with a combination therapy using allogeneic peripheral blood stem cell transplantation (PBSCT) promptly followed by granulocyte transfusion (GTX) from the same human leukocyte antigen-identical donor rather than carrying out a second immunosuppressive therapy. The patient showed temporal resolution of infection on the second day after a single GTX. Although the patient had pneumonia on day 11, it was resolved promptly after engraftment on day 16. This report suggests the clinical utility of a salvage therapy with allogeneic PBSCT followed by GTX in a particular case of recurrent SAA with refractory infections. [ABSTRACT FROM AUTHOR]

Posture control by statocysts is affected by leg condition in decapod crustaceans. We investigated how, in the crayfish brain, the synaptic response of local interneurons to statocyst stimulation was affected by leg movements on and off a substratum. The magnetic field stimulation method permitted sustained stimulation of statocyst receptors by mimicking body rolling. The statocyst-driven local interneurons were classified into four morphological groups (Type-I–IV). All interneurons except Type-IV projected their dendritic branches to the parolfactory lobe of the deutocerebrum where statocyst afferents project directly. Type-I interneurons having somata in the ventral-paired lateral cluster responded invariably to statocyst stimulation regardless of the leg condition, whereas others having somata in the ventral-unpaired posterior cluster showed response enhancement or suppression, depending on the cell, during leg movements on a substratum, but no response change during free leg movements off the substratum. The synaptic responses of Type-II and IV interneurons were also affected differently by leg movements depending on the substratum condition, whereas those of Type-III remained unaffected. These findings suggest that the statocyst pathway in the crayfish brain is organized in parallel with local circuits that are affected by leg condition and those not affected. [ABSTRACT FROM AUTHOR]

Crustacean postural control is modulated by behavioral condition. In this study, we investigated how the responses of descending statocyst interneurons were affected during leg movements. Intracellular recording was made from an animal whose statoliths had been replaced with ferrite grains so that statocyst receptors could be activated by magnetic field stimulation. We identified 14 morphological types of statocyst-driven descending interneurons. Statocyst-driven descending interneurons always showed an excitatory response to statocyst stimulation on either ipsilateral or contralateral side to the axon. The response of each statocyst-driven descending interneuron to statocyst stimulation was differently modulated by leg movements in different conditions. During active leg movements, six statocyst-driven descending interneurons were activated regardless of whether a substrate was provided or not. In other two statocyst-driven descending interneurons, the excitatory input during leg movements was stronger when a substrate was provided than when it was not. One statocyst-driven descending interneuron received an excitatory input only during leg movements on a substrate, whereas another statocyst-driven descending interneuron did not receive any input during leg movements both on a substrate and in the air. These results suggest that the descending statocyst pathways are organized in parallel, each cell affected differently by behavioral conditions. [ABSTRACT FROM AUTHOR]

A master equation approach including weak exciton–phonon coupling is applied to the exciton dynamics of a dendritic molecular aggregate modeled after a phenylacetylene dendrimer, D25, which exhibits an efficient light-harvesting property. The mechanism of exciton migration from the periphery to the core is studied by analyzing relaxation terms among the exciton states originating in weak exciton–phonon coupling. Partial overlaps of exciton distributions between neighboring exciton states are found to be important for realizing the unique migration behavior by stepwise transfer from the periphery to the core via multi-step exciton states. [Copyright &y& Elsevier]

Presents a case study of a successful allogeneic bone marrow transplantation from an hepatitis B virus-positive sibling donor into a patient with severe aplastic anemia complicated by chronic hepatitis B, using lamivudine. Background on allogeneic bone marrow transplantation; Clinical course of the patient; Discussion.

A 21-year-old woman with severe aplastic anemia received an allogeneic bone marrow transplant (allo-BMT) from an HLA-matched and ABO-matched sibling donor after conditioning with cyclophosphamide, rabbit ATG (Lymphoglobuline; Aventis-Pharma), and total lymphoid irradiation. She had a long history of cyclosporin A (CsA) therapy before conditioning. She complained of severe headache and convulsions on day 0, and findings on magnetic resonance images suggested CsA-induced encephalopathy. CsA was immediately stopped, and tacrolimus for prevention of graft-versus-host disease (GVHD) was started on day 2. Hematological engraftment was observed on day 14 without serious GVHD. Prompt diagnosis, replacement of immunosuppressive agents, and careful monitoring of serum drug concentrations are thought to have contributed to the patient’s good clinical course, since CsA-induced encephalopathy tends to be recurrent but to improve completely without any sequelae. Bone Marrow Transplantation (2001) 28, 713–715. [ABSTRACT FROM AUTHOR]

Summary: This study showed that autoimmune arthritis induces especially severe osteoporosis in the periarticular region adjacent to inflamed joints, suggesting that arthritis increases the fragility fracture risk near inflamed joints, which is frequently observed in patients with RA. Introduction: Periarticular osteoporosis near inflamed joints is a hallmark of early rheumatoid arthritis (RA). Here we show that rheumatic inflammation deteriorates the bone quality and bone quantity of periarticular bone, thereby decreasing bone strength and toughness in a mouse model of RA. Methods: Female BALB/c mice and SKG mice, a mutant mouse model of autoimmune arthritis on the BALB/c background, were used. At 12 weeks of age, BALB/c mice underwent either Sham surgery or bilateral ovariectomy (OVX), and SKG mice underwent intraperitoneal injection of mannan to induce arthritis. Eight weeks later, the mice were killed and the femurs and tibias were subjected to micro-computed tomography, Fourier transform infrared (FTIR) spectroscopic imaging, X-ray diffraction, histology, and mechanical testing. Results: SKG mice developed significant trabecular bone loss in both the distal metaphysis of the femur and the lumbar vertebral body, but the extent of the bone loss was more severe in the distal metaphysis. Neither SKG nor OVX mice exhibited changes in the geometry and matrix properties of the diaphysis of the femur, whereas SKG mice, but not OVX mice, did exhibit changes in these properties in the distal metaphysis of the femur. Bone strength and fracture toughness of the distal metaphysis of the tibia adjacent to the inflamed ankle joint were significantly decreased in SKG mice. Conclusions: Autoimmune arthritis induces periarticular osteoporosis, characterized by deterioration of cortical bone geometry and quality as well as by trabecular bone loss, leading to severe bone fragility in periarticular bone adjacent to inflamed joints. [ABSTRACT FROM AUTHOR]

Abstract: We performed quantum spin dynamics in anisotropic electron-spin systems to clarify the mechanism in single molecular magnets (SMM) theoretically. Usually, SMMs have large negative anisotropic D value and the large total spin angular moment (S total). The splitting ground spin states in one SMM molecule are usually caused by the anisotropic terms (D and E), which become more important as well as isotropic term (J). In order to examine the effects of such anisotropic magnetic terms, model systems with large spin multiplicity of the ground state (S total =5 and 2) were treated. First, energy diagram in external magnetic field is shown, since negative D terms are responsible to the zero-field magnetic moment. Next, the quantum Liouvile approach is used for our spin dynamics simulation involving the relaxation processes of the system. Our simulations in S total =5 system successfully reproduced magnetic quantum tunneling (MQT) behavior in DC-external magnetic field. Moreover, in S total =2 system under AC-external magnetic field, frequency dependence of real (χ′) and imaginary (χ″) parts of χ can be shown with Fourier transformation. Our theoretically drawn half circles in Cole-Cole plot (χ′ versus χ″) will give information to many experimental studies. [Copyright &y& Elsevier]

Crustacean posture control is based on a complex interaction between the statocyst input and other sensory inputs as well as the animal's behavioral context. We examined the effects of behavioral condition on the activity of descending statocyst pathways using an optical telemetry system that allowed underwater recording of neuronal signals from freely behaving crayfish. A functionally identified statocyst-driven interneuron that directionally responded to body tilting without a footboard and to tilting of the footboard was found to show complicated responses depending upon the ongoing behavior of the animal when it freely walked around in water on the aquarium floor. The spike firing frequency of the interneuron increased significantly during walking. When the animal stood or walked on the tilted floor, the interneuron activity represented the tilt angle and direction if the abdomen was actively flexed, but not if it was extended. Two other statocyst-driven descending interneurons were found to be affected differently by the animal's behavioral condition: the spike activity of one interneuron increased during walking, but its directional response on the tilted floor was completely absent during abdominal posture movements, whereas that of another interneuron was enhanced during abdominal extension only, representing the tilt angle and direction. The results obtained in this study provide the first experimental demonstration that crustacean postural control under natural conditions is dependent on very fine aspects of the animal's locomotor behavioral context, suggesting far more complex control mechanisms than those expected from the experimental data obtained in isolated and fixed animals. [ABSTRACT FROM AUTHOR]

Study Design:Prospective cross-sectional study.Objectives:To investigate the timing of deep vein thrombosis (DVT) onset secondary to spinal cord injury without anticoagulant therapies.Setting:Spinal Cord Injury Center in Hokkaido, Japan.Methods:Between November 2012 and June 2013, patients with spinal cord injury who were admitted to our hospital within 1 day after the injury and treated surgically within 24 h underwent a neurological examination, leg vein ultrasonography and D-dimer test 1, 3, 7, 14 and 28 days after surgery. All patients received treatment with intermittent pneumatic compression and elastic stockings, but without any anticoagulant.Results:DVT developed in 12 patients (11 men and 1 women), with a mean age of 62.2 years (range, 41-80 years; mean age of total sample, 63.2 years (range, 25-78 years)), all distal to the popliteal vein. DVT occurred more often with a more severe paralysis (66.3%, AIS A and B). The median (± standard error) length of time from the operation to DVT detection was 7.5±2.2 days. The mean D-dimer level upon DVT detection was 14.6±11.8 μg ml−1, with no significant differences between those who developed DVT and those who did not at any of the time points.Conclusion:These results suggest that DVT can develop at the very-acute stage of spinal cord injury and the incidence increases with a more severe paralysis. DVT detection was more reliable with ultrasonography, which should be used with DVT-preventive measures, beginning immediately after the injury, for the management of patients with spinal cord injury. [ABSTRACT FROM AUTHOR]

Despite the availability of newer classes of antibiotics, infection with multi-drug-resistant bacteria is a serious problem. To suppress the appearance of multi-drug-resistant bacteria and to avoid severe infection derived from febrile neutropenia (FN), we conducted cycling the administration of antibiotics for FN in patients with hematological malignancy. The treatment protocol consisted of the administration of four antibiotics each for 3 months in 1 year. The above regimen was repeated for 4 years. A total of 193 patients were registered in the protocol. The mean duration of the administration of cycling antibiotics was 5.9 days (range: 1-16 days). The frequency of FN before the study and during the study was unchanged until the third year, but decreased significantly in the fourth year. The frequency of detection of multi-drug-resistant bacteria in the first year was the same as that before the study was started, but dramatically decreased after the second year. Bacteriological treatment success rates were similar in each trimester and each year. The effective rate was not statistically different in each trimester and each year. We conclude that cycling the administration of antibiotics in patients with FN is useful for suppressing the appearance of multi-drug-resistant bacteria and for obtaining excellent clinical efficacy. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Retrospective multicenter study. OBJECTIVE: To review the clinical characteristics of traumatic cervical spinal cord injury (SCI) associated with ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Despite its potentially devastating consequences, there is a lack of information about acute cervical SCI complicated by OPLL. METHODS: This study included consecutive patients with acute traumatic cervical SCI (Frankel A, B, and C) who were admitted within 48 hours of injury to 34 spine institutions across Japan. For analysis of neurologic outcome, patients who had completed at least a 6-month follow-up were included. Neurologic improvement was defined as at least one grade conversion in Frankel grade. RESULTS: A total of 453 patients were identified (367 men, 86 women; mean age, 59 years). OPLL was found in 106 (23%) patients (87 men, 19 women; mean age, 66 years). Most of the patients with OPLL (94 of 106) were without bone injury, presenting with incomplete SCI. The prevalence of OPLL reached 34% in SCI without bone injury. The cause of SCI was predominantly falls (74%). Only 25% of the patients were aware of OPLL. Half of the OPLL patients reported gait disturbance before injury. Forty-eight (52%) OPLL patients without bone injury underwent surgery (median, 13.5 days after injury), mostly laminoplasty. Overall, no significant difference was noted in neurologic improvement between surgery group and conservative group. However, further stratification showed that surgery was associated with greater neurologic recovery in patients who had gait disturbance before injury (P = 0.04). CONCLUSION: Prevalence of OPLL among cervical SCI was alarmingly high, especially in those without bone injury. Most of cervical SCI associated with OPLL were incomplete, without bone injury, and caused predominantly by low-energy trauma. The majority of the patients were unaware of OPLL. Surgery produced better neurologic recovery in patients who had gait disturbance before injury. [ABSTRACT FROM AUTHOR]

A. Shigematsu, S. Yamamoto, J. Sugita, T. Kondo, M. Onozawa, K. Kahata, T. Endo, S. Shiratori, S. Ota, K. Yamaguchi, K. Wakasa, M. Takahata, H. Goto, S. Ito, R. Takemura, J. Tanaka, S. Hashino, M. Nishio, T. Koike, M. Asaka, M. Imamura. Increased risk of bacterial infection after engraftment in patients treated with allogeneic bone marrow transplantation following reduced-intensity conditioning regimen. Transpl Infect Dis 2010: 12: 412-420. All rights reserved Although bacterial infection is a major cause of death even after reduced-intensity conditioning (RIC) for allogeneic stem cell transplantation (SCT), little is known about the epidemiology and risk factors. The incidence of bacterial infection in 43 patients who received allogeneic bone marrow transplantation (BMT) using a RIC regimen was compared with that in 68 patients who received BMT using a myeloablative conditioning regimen, and risk factors for bacterial infection were identified. Before engraftment, incidences of febrile neutropenia (FN) and documented infections (DI) were significantly decreased in RIC patients (FN: 59.5% vs. 89.6%, P<0.01, DI: 4.8% vs. 17.9%, P<0.01). However, incidence of bacterial infection was significantly increased in RIC patients in the post-engraftment phase (53.8% vs. 11.1%, log-rank, P<0.01). Blood stream was the most frequent focus of infection in both groups. In multivariate analysis, RIC and acute graft-versus-host disease were revealed to be significant risk factors for bacterial infection in this phase. In summary, risk of bacterial infection after engraftment was significantly higher in RIC patients, although infection was decreased before engraftment, and we need to develop a RIC-specific strategy against bacterial infection after RIC SCT. [ABSTRACT FROM AUTHOR]

In this retrospective cohort study, two surgical methods of conventional open-door laminoplasty and deep extensor muscle-preserving laminoplasty were allocated for the treatment of cervical myelopathy, and were specifically compared in terms of axial pain, cervical spine function, and quality of life (QOL) with a minimum follow-up period of 2 years. Eighty-four patients were divided into two groups and received either a conventional open-door laminoplasty (CL group) or laminoplasty using a deep extensor muscle-preserving approach (MP group). The latter approach was performed by preserving multifidus and semispinalis cervicis attachments followed by open-door laminoplasty and re-suture of the bisected spinous processes at each decompression level. The average follow-up period was 38 months (25-53 months). The preoperative and follow-up evaluations included the original Japanese Orthopaedic Association (JOA) score, the new tentative JOA score including cervical spine function and QOL, and the visual analogue scale (VAS) of axial pain. Radiological analyses included cervical lordosis and flexion-extension range of motion (flex-ext ROM) (C2-7), and deep extensor muscle areas on MR axial images. The JOA recovery rates were statistically equivalent between two groups. The MP group demonstrated a statistically superior cervical spine function (84% vs 63%) and QOL (61% vs 45%) when compared to the CL group at final follow-up (P < 0.05). The average VAS scores at final follow-up were 2.3 and 4.9 in MP and CL groups (P < 0.05). The cervical lordosis and flex-ext ROM were statistically equivalent. The percent deep muscle area on MRI demonstrated a significant atrophy in CL group compared to that in MP group (56% vs 88%; P < 0.01). Laminoplasty employing the deep extensor muscle-preserving approach appeared to be effective in reducing the axial pain and deep muscle atrophy as well as improving cervical spine function and QOL when compared to conventional open-door laminoplasty. [ABSTRACT FROM AUTHOR]

High costs of molecule-targeted drugs, such as rituximab, ibritumomab, and tositumomab have given rise to an economical issue for treating patients with non-Hodgkin's lymphoma (NHL). Granulocyte colony-stimulating factors (G-CSFs), which are also expensive, are widely used for treating neutropenia after chemotherapy. In Japan, lenograstim at 2 μg/kg (about 100 μg/body) or filgrastim at 50 μg/m2 (about 75 μg/body) is commonly administered for patients with NHL after chemotherapy. Therefore, cost-effectiveness is an important issue in treatment for NHL. Patients with advanced-stage NHL who needed chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or a CHOP-like regimen with or without rituximab were enrolled in this randomized cross-over trial to investigate the efficacy and safety of low-dose G-CSF. Half of the patients were administered 75 μg filgrastim in the first course after neutropenia and 50 μg lenograstim in the second course, and the other half were crossed over. Forty-seven patients were enrolled in this cross-over trial, and 24 patients completed the trial. Frequencies and durations of grade 4 leukocytopenia and neutropenia were similar in the two groups. Severe infection was rare and was observed at similar frequency. Frequencies of antibiotics use were also similar. The total cost of G-CSF (cost/drug × duration of administration) was significantly lower in patients who received 50 μg lenograstim. Hence, a low dose of lenograstim might be safe, effective and pharmaco-economically beneficial in patients with advanced-stage NHL. [ABSTRACT FROM AUTHOR]

Study Design: The accuracy of pedicle screw placement was evaluated in posterior scoliosis surgeries with or without the use of computer-assisted surgical techniques. Objective: In this retrospective cohort study, the pedicle screw placement accuracy in posterior scoliosis surgery was compared between conventional fluoroscopic and computer-assisted surgical techniques. Summary Of Background Data: There has been no study systemically analyzing the perforation pattern and comparative accuracy of pedicle screw placement in posterior scoliosis surgery. Methods: The 45 patients who received posterior correction surgeries were divided into 2 groups: Group C, manual control (25 patients); and Group N, navigation surgery (20 patients). The average Cobb angles were 73.7 degrees and 73.1 degrees before surgery in Group C and Group N, respectively. Using CT images, vertebral rotation, pedicle axes as measured to anteroposterior sacral axis and vertebral axis, and insertion angle error were measured. In perforation cases, the angular tendency, insertion point, and length abnormality were evaluated. Results: The perforation was observed in 11% of Group C and 1.8% in Group N. In Group C, medial perforations of left screws were demonstrated in 8 of 9 perforated screws and 55% were distributed either in L1 or T12. The perforation consistently occurred in pedicles in which those axes approached anteroposterior sacral axis within 5 degrees . The average insertion errors were 8.4 degrees and 5.0 degrees in Group C and Group N, respectively, which were significantly different (P < 0.02). Conclusion: The medial perforation in Group C occurred around L1, especially when pedicle axis approached anteroposterior sacral axis. This consistent tendency was considered as the limitation of fluoroscopic screw insertion in which horizontal vertebral image was not visible. The use of surgical navigation system successfully reduced the perforation rate and insertion angle errors, demonstrating the clear advantage in safe and accurate pedicle screw placement of scoliosis surgery. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the case of a 44-year-old Japanese man who was diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia (PH+ALL) after a misleading diagnosis of donor cell leukemia (DCL) through chimerism analysis.

STUDY DESIGN: Case report. OBJECTIVE: To report an extremely rare case of hematoma derived from the ligamentum flavum within the thoracic spine. SUMMARY OF BACKGROUND DATA: Only one previous case has been reported of a hematoma derived from the ligamentum flavum in the thoracic spine. METHODS.: A 61-year-old man presented with gait disturbance and numbness below the navel. Magnetic resonance imaging on the 16th day after the onset of the symptoms showed spinal cord compression at the T10-T11 level caused by a round mass. This intraspinal, extradural space occupying lesion, continuous with ligamentum flavum was centrally hypointense and marginal hyperintense on a T1-weighted image and central heterogeneous and marginal hypointense on a T2-weighted image. The wall of the lesion was slightly enhanced after use of a contrast medium. RESULTS: The patient underwent a T10 laminectomy and the mass was carefully resected from the dura mater. Histologic examination showed that the wall of the mass comprised fibrous connective tissue that contained elastic fibers derived from a degenerative ligamentum flavum tear. It also revealed that evidence of previous hemorrhagic events within the mass. There was no evidence of neoplastic nor synovial tissue. After surgery, the patient's numbness and gait disturbance disappeared. CONCLUSION: This report identifies an extremely rare case of spinal cord compression by a hematoma from the ligamentum flavum within the thoracic spine. [ABSTRACT FROM AUTHOR]