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Purpose: The importance of coronal alignment is unclear, while the importance of sagittal alignment in the treatment of adult patients with spinal deformities is well described. This study sought to elucidate the impact of global coronal malalignment (GCMA) in surgically treated adult symptomatic lumbar deformity (ASLD) patients. Methods: A multicentre retrospective analysis of a prospective ASD database. GCMA was defined as GCA (C7PL-CSVL) ≥ 3 cm. GCMA is categorized based on the Obeid-Coronal Malalignment Classification (O-CM). Demographic, surgical, radiographic, HRQOL, and complication data were analysed. The risk for postoperative GCMA was analysed by univariate and multivariate analyses. Results: Of 230 surgically treated ASLD patients, 96 patients showed GCMA preoperatively and baseline GCA was correlated with the baseline SRS-22 pain domain score (r= − 30). Postoperatively, 62 patients (27%, O-CM type 1: 41[18%], type 2: 21[9%]) developed GCMA. The multivariate risk analysis indicated dementia (OR 20.1[1.2–304.4]), diabetes (OR 5.9[1.3–27.3]), and baseline O-CM type 2 (OR 2.1[1.3–3.4]) as independent risk factors for postoperative GCMA. The 2-year SRS-22 score was not different between the 2 groups, while 4 GCMA patients required revision surgery within 1 year after surgery due to coronal decompensation (GCMA+ vs. GCMA- function: 3.6 ± 0.6 vs. 3.7 ± 0.7, pain: 3.7 ± 0.8 vs. 3.8 ± 0.8, self-image: 3.6 ± 0.8 vs. 3.6 ± 0.8, mental health: 3.7 ± 0.8 vs. 3.8 ± 0.9, satisfaction: 3.9 ± 0.9 vs. 3.9 ± 0.8, total: 3.7 ± 0.7 vs. 3.7 ± 0.7). Additionally, the comparisons of 2-yr SRS-22 between GCMA ± showed no difference in any UIV and LIV level or O-CM type. Conclusions: In ASLD patients with corrective spine surgery, GCMA at 2 years did not affect HRQOL or major complications at any spinal fusion extent or O-CM type of malalignment, whereas GCA correlated with pain intensity before surgery. These findings may warrant further study of the impact of GCMA on HRQOL in the surgical treatment of ASLD patients.

Purpose: This study aimed to examine the changes in thoracolumbar kyphosis (TLK) following correction surgery in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS) and to evaluate its influence on postoperative spinal alignment and clinical outcomes. Methods: Sixty-six patients with Lenke type 5C AIS were included and followed up for a minimum of 5 years after surgery. First, the patients were divided into two groups according to the preoperative TLK angle (Study 1; Kyphosis and Lordosis group). The patients were further classified into two groups according to the presence or absence of postoperative changes in TLK (Study 2; Changed and Maintained groups). Finally, the outcome variables were compared between these groups and analyzed for spinal alignment and clinical outcomes. Results: In Study 1, patients demonstrated a significant kyphotic change in the Lordosis group and a significant lordotic change in the Kyphosis group postoperatively. No statistically significant differences were found between the two groups when comparing the pre- and postoperative coronal and sagittal alignment. In Study 2, there were no statistically significant differences between the Changed and the Maintained groups in each spinal alignment pre- and postoperatively. Each domain of the Scoliosis Research Society 22-item questionnaire remained unchanged at 5 years postoperation. Conclusion: In many patients with Lenke type 5C AIS, TLK changed significantly and approached 0° after surgery. However, the magnitude of the preoperative TLK and the presence or absence of improvement did not affect postoperative spinal alignment. Furthermore, the patients had satisfactory clinical outcomes irrespective of TLK modification. Level of evidence: III.

Study design: Retrospective multicenter study. Objectives: To evaluate how preoperative neck pain influences clinical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL). Setting: Fourteen medical institutions in Japan. Methods: We enrolled 90 patients with cervical OPLL who underwent posterior decompression and were followed for a minimum of two years. We collected demographic data, medical history, and imaging findings. Patients were divided into two groups based on preoperative neck pain presence (Pre-op. neck pain (−) and (+) groups), and their outcomes were compared. Results: There were no significant differences in patient demographics between the Pre-op. neck pain (−) and (+) groups. Both groups showed similar distributions of ossification types and K-line positivity. Perioperative complications were comparable between the two groups. Radiographic analysis revealed no significant differences in C2–7 angles or cervical range of motion, pre- and postoperatively. Both groups demonstrated significant improvement in postoperative Japanese orthopedic association (JOA) scores, but there were no significant differences in scores or recovery rates. In the Pre-op. neck pain (−) group, factors associated with appearance of postoperative neck pain included pre- and postoperative lower JOA scores and larger C2–7 angles in neutral and extension positions. Conclusions: It emerges that lower pre- and postoperative JOA scores or larger C2–7 angles in neutral and extension positions predispose to postoperative neck pain even in those patients without preoperative neck pain. Therefore, this is worth discussing at the time of consenting patients for surgical decompression and fixation.

Purpose: To investigate the influence of slippage reduction and correction of lumbosacral kyphosis by L5–S1 single-level posterior lumbar interbody fusion (PLIF) on spinal alignment and clinical outcomes including postoperative complications in patients with dysplastic spondylolisthesis (DS). Methods: Twenty consecutive patients with symptomatic and severe DS who underwent L5–S1 single-level PLIF with a minimum of 2 years of follow-up after surgery were included. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low back and leg pain obtained on preoperative and postoperative examinations. Postoperative instrumentation failure and L5 radiculopathy were also evaluated. The preoperative and postoperative spinopelvic parameters were measured. Results: The JOA score significantly improved from 21.5 ± 4.8 (preoperative) to 27.0 ± 2.5 (postoperative), with a mean recovery rate of 75.0% ± 30.4%. The VAS score for low back pain significantly improved from 44.5 ± 30.1 (preoperative) to 11.5 ± 15.9 (postoperative), and that for leg pain significantly improved from 31.0 ± 33.2 (preoperative) to 5.0 ± 10.2 (postoperative). The slip percentage (% slip) significantly improved from 59.6% ± 13.5% (preoperative) to 25.2% ± 15.0% (postoperative). The lumbosacral angle (LSA) significantly improved from 12.3° ± 9.5° (preoperative) to 1.0° ± 4.9° (postoperative). L5–S1 PLIF led to significant improvement of lumbar lordosis (from 52.0° ± 15.9° to 59.7° ± 8.0°) and pelvic incidence − lumbar lordosis mismatch (from 23.9° ± 20.6° to 13.3° ± 10.0°). Correction of lumbosacral kyphosis had a significant positive correlation with postoperative pelvic tilt (PT) (r = 0.50, P= 0.02), while postoperative % slip did not have a significant correlation with postoperative PT. Conclusions: L5–S1 PLIF for DS provided good clinical outcomes. Correction of lumbosacral kyphosis had a positive impact on regaining ideal spinopelvic balance and may be beneficial in the setting of treating DS.

As the scale of the power grid continues to expand, drone inspection operations are becoming increasingly popular. However, most of the existing inspection drones are for transmission line inspection in the open field environment, with the characteristics of large size and high quality, which is difficult to be directly applied to transmission line inspection around the city area. To address the above issues, in this article, a small unmanned aerial vehicle (UAV) inspection system is designed with the aim of achieving autonomous inspection of overhead ground wires in urban peripheral areas, combined with image processing technology, with a total weight of less than 400 g. Specifically, during the inspection of small UAV, Raspberry Pi uses traditional image processing methods, such as Hough transform, to obtain the position information and pixel error of ground wire from real-time video stream; the flight control system uses the results of image processing combined with data from millimeter-wave radar to achieve conversion from pixel error to actual distance error; finally, the ground wire is made to be in the center of the video as much as possible through the correction strategy, thus realizing the autonomous inspection task of the small UAV along the line. The experimental results show that the small UAV can stably identify the target transmission lines and achieve autonomous flight along the lines with horizontal deviation within plus or minus 0.3 m and height deviation within plus or minus 0.1 m, which is of great reference value for the application of small UAV in urban transmission line inspection.

In response to concerns about health due to radiation exposure, the Fukushima Prefecture launched the Thyroid Ultrasound Examination program for residents aged 0–18 years at the time of the earthquake. Herein, we considered the confounding factors involved in the regional differences in the development of thyroid cancer. In this study, the 242 065 individuals who participated in both first- and second-round surveys were classified into four groups by address according to their air radiation dose. The number of participants diagnosed as malignant or suspicious for malignancy by cytological examination were 17, 38, 10 and 4 with detection rates of 53.8, 27.8, 21.7 and 14.5 per 100 000 participants in Regions 1, 2, 3 and 4, respectively. Sex (P= 0.0400), age at the time of the primary examination (P< 0.0001) and interval between the first- and second-round surveys (P< 0.0001) were significantly different among the four regions, and these were suspected to be confounding factors affecting regional differences in malignant nodule detection rates. In addition, significant regional differences were observed in the participation rate in the confirmatory examination (P= 0.0037) and the fine needle aspiration cytology implementation rate (P= 0.0037), which could be potential biases. No significant regional differences in the detection of malignant nodules were found in the multivariate logistic regression analysis after adjusting for the survey interval alone or for sex, age and survey interval. The confounding factors and biases identified in this study that may have important impacts on thyroid cancer detection rate should be fully considered in future studies.

Study design Retrospective comparative study.Objectives The present study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes following tumor resection using spinous process-splitting laminectomy (SPSL) approach without fixation in patients with conus medullaris (CM) or cauda equina (CE) tumor.Methods Forty-one patients with CM or CE tumor (19 males, 22 females, mean age at surgery of 52.9 ± 13.0 years) were included in this study. The variations of outcome variables were analyzed in various GSSA profiles using radiographic outcomes. The clinical outcomes were assessed using Japan Orthopaedic Association (JOA) score and JOA back pain evaluation questionnaire (JOABPEQ).Results In all cases, the various GSSA parameters (sagittal vertical axis, C2–7 lordosis, T1 slope, thoracic kyphosis, T10–L2 kyphosis, lumbar lordosis [LL; upper, middle, and lower], sacral slope, pelvic incidence, and pelvic tilt) did not significantly change in the 2-years postoperative period. Moreover, age at surgery, the number of resected laminae, preoperative T12–L2 kyphosis, or LL did not affect the postoperative changes in T12–L2 kyphosis or LL, and had no statistically significant correlation among them. The scores of each postoperative JOA domain and the Visual Analogue Scale included in the JOABPEQ were significantly improved. There was no statistical significant group difference in each sagittal profile or clinical outcomes between CM and CE groups postoperatively.Conclusions Tumor resection using SPSL approach did not affected the various GSSA parameters examined and resulted in satisfactory clinical outcomes, indicating that SPSL approach is a suitable surgical technique for patients with CM or CE tumor.

Study Design A retrospective study.Objectives This study aimed to investigate the impact of cervical kyphosis on patients with cervical spondylotic myelopathy (CSM) following selective laminectomy (SL) regarding posterior spinal cord shift (PSS), and a number of SLs.Methods We evaluated 379 patients with CSM after SL. The patients with kyphosis (group K) were compared with those without kyphosis (group L). Moreover, groups K and L were divided into subgroups KS and KL (SLs ≤ 2) and LS and LL (SLs ≥ 3), respectively, and analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the cut-off value of the C2–C7 angle for satisfactory surgical outcomes, which was defined as a Japanese Orthopaedic Association (JOA) recovery rate of ≥50% in group KS.Results The average PSS (mm) in group K was smaller than that in group L (.8 vs 1.4; P< .01), but the JOA recovery rate was comparable between the 2 groups. Meanwhile, the mean PSS and JOA recovery rate (%) in group KS was lower than those in group KL, respectively (.3 vs 1.0; P< .01, 35.1 vs 52.3; P= .047). Moreover, the average PSS of group KS (.6) was smaller than those of other subgroups ( < .01). In addition, the ROC curve analysis showed that the C2–C7 angle of −14.5° could predict satisfactory surgical outcomes in group KS.Conclusion Selective laminectomy is not contraindicated for patients with kyphosis, but a larger number of SLs may be indicated for the patients with C2–C7 angles of ≤ −14.5°.

Study design: Retrospective multicenter study. Objectives: Although surgery is frequently selected for the treatment of idiopathic spinal cord herniation (ISCH), its impact on functional outcomes has yet to be fully understood given the limited number of patients in previous studies. This study aims to evaluate the symptomatic history and surgical outcomes of ISCH. Setting: Three institutions in Japan. Methods: A total of 34 subjects with ISCH were retrospectively enrolled and followed up for at least 2 years. Demographic information, imaging findings, and clinical outcomes were collected. Functional status was assessed using the JOA score. Results: The types of neurologic deficit were monoparesis, Brown–Sequard, and paraparesis in 5, 17, and 12 cases, with their mean disease duration being 1.2, 4.2, and 5.8 years, respectively. Significant differences in disease duration were observed between the monoparesis and Brown–Sequard groups (p&lt; 0.01) and between the monoparesis and paraparesis groups (p= 0.04). Surgery promoted significantly better recovery rates from baseline. Correlations were observed between age at surgery and recovery rate (p&lt; 0.01) and between disease duration and recovery rate (p= 0.04). The mean recovery rates were 82.6%, 51.6%, and 29.1% in the monoparesis, Brown–Sequard, and paraparesis groups, respectively. The monoparesis group had a significantly higher recovery rate than did the Brown–Sequard (p= 0.045) and paraparesis groups (p&lt; 0.01). Conclusions: Longer disease duration was correlated with the progression of neurologic deficit. Older age, and worse preoperative neurologic status hindered postoperative functional recovery. These results highlight the need to consider surgical timing before neurologic symptoms deteriorate.

Study Design: Retrospective single-center study.Objective: We investigated the risk factors of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) including the position of preoperative upper end vertebra (UEV).Methods: Seventy-five patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries from 2008 to 2018 were included. We included only patients whose upper instrumented vertebrae were at T2. The patients were divided into 2 groups based on radiographic shoulder height (RSH) at final follow-up, namely PSI group and non-PSI group, and PSI was defined as RSH > 10 mm. UEV, RSH, Cobb angle, curve flexibility, T1 and T2 tilt, correction rate, Risser grade, Scoliosis Research Society-22 scores, and demographic data were compared between the groups using independent t-tests or chi-square tests. Variables with Pvalue < 0.20 in univariate analysis were assessed in logistic regression analysis.Results: Thirty-four patients in the PSI group and 37 patients in the non-PSI group were analyzed. Univariate analysis revealed that there were more patients with UEV at T1 (PSI: 85%, non-PSI: 54%, P< 0.01) and Risser grade ≥ 3 (PSI: 88%, non-PSI: 62%; P< 0.05) in the PSI group than in the non-PSI group. Logistic regression analysis revealed that UEV at T1 (odds ratio [OR] = 4.1 [1.2–14.4], P< 0.05) and Risser grade ≥ 3 (OR = 3.9 [1.1–14.5], P< 0.05) are significantly associated with PSI.Conclusions: UEV at T1 and Risser grade ≥ 3 at the time of surgery are significant risk factors of PSI.

Objective:To determine whether endometrial thickening is an important factor for pregnancy outcomes in platelet-rich plasma (PRP) treatment for patients with thin endometrium.Methods:Data from the registry database of the Japan Gynecologic PRP Study Group from April 2019 to October 2021 were analyzed retrospectively. A total of 208 patients who underwent single blastocyst transfer (SBT) after PRP due to thin endometrium (¡8 mm) in their previous cycle were included in the study. Their pregnancy outcomes were compared with their own historical data before PRP infusion. The same patient group was then divided into 136 patients whose endometrium thickened after PRP and 72 patients whose endometrium did not, and the pregnancy outcomes of the two groups were compared. Furthermore, to eliminate embryonic confounding, 28 patients who had single euploid blastocyst transfer (SEBT) with preimplantation genetic testing for aneuploidy (PGT-A) were selected from the same patient group and divided into two groups of 22 patients whose endometrium thickened and 6 patients whose endometrium did not, and the pregnancy outcomes were compared in the same method.Results:After PRP administration, the clinical pregnancy rate, live birth rate, and miscarriage rate were all significantly improved compared with the historical controls (34.1 vs 20.0, P<0.01; 22.6 vs 3.9, P<0.01; 33.8 vs 73.4, P<0.01). There were no statistically significant differences in the respective rates between the “thickened endometrium” group and the “unthickened endometrium” group in SBT group (36.0 vs 30.5%, P=0.43; 25.7 vs 16.7%, P=0.11; 28.5 vs 45.4%, P=0.16, respectively). Likewise, in the SEBT with PGT-A group, there were no statistically significant differences in results between the two groups (36.4 vs 50%, P=0.30; 36.4 vs 50%, P=0.30; 0 vs 0%, respectively).Conclusions:PRP administration to patients with thin endometrium improves pregnancy outcomes even when endometrial thickening is not achieved.

Study Design: Retrospective cohort study.Objectives: Intraspinal solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is often misdiagnosed preoperatively as schwannoma or meningioma because its imaging characteristics are not well understood. As postoperative prognosis differs among the 3 lesions, predicting the probability of SFT/HPC preoperatively is essential. Thus, this study investigates the imaging characteristics of SFT/HPC compared with those of schwannoma or meningioma and evaluates surgical outcomes.Methods: The preoperative imaging findings, tumor resection extent, recurrence and regrowth rates, and neurological improvement were compared between 10 patients with SFT/HPC and 42 patients with schwannoma or 40 patients with meningioma.Results: Most patients with SFT/HPC showed isointensity on both T1- and T2-weighted images compared with patients with schwannoma (P= 0.011 and 0.029, respectively) and no significant difference compared with patients with meningioma (P= 0.575 and 0.845, respectively). Almost all patients with SFT/HPC showed highly uniformizing enhancement patterns, similar to those with meningioma (P= 0.496). Compared with meningioma, SFT/HPC lacked the dural tail sign and intratumoral calcification and exhibited irregular shape. Of the 5 patients who underwent partial resection, 60% exhibited tumor recurrence and regrowth following surgery.Conclusions: Complete en blocsurgical resection should be attempted in patients with intraspinal SFT/HPC to prevent postoperative recurrence or regrowth. As this tumor is often preoperatively misdiagnosed, we recommend that the imaging findings exhibited in this study should be used to positively suspect SFT/HPC. This will enhance patient outcomes by enabling more appropriate preoperative surgical planning.

Urban logistics has been the primary target for recent drone applications. However, these drones face varying weather conditions in their flight horizon that can limit their performance. From another perspective, this flight horizon is the focus of micro-meteorology data gathering for a city-wide accurate weather prediction system. Hence, these drones can carry out logistics while gathering micro-meteorology data. This paper focuses on the latter and aims to realize the drone capabilities required for forecasting micro-meteorology, especially observing highly accurate wind data and robust control capability against strong wind disturbances. The generation of wind maps using a 2D wind sensor mounted on a drone and wind gust estimation using a nonlinear disturbance observer (NDOB) are proposed as the capability for accurate wind observation. Next, the position and velocity control of the drone using super twisting sliding mode control (STSMC) and NDOB are designed for robust control. Lastly, numerical simulation and real-world experiments verify the effectiveness of the whole system proposed in this paper.

With the development of technology, unmanned aerial vehicles (UAVs) are playing an increasingly important role in the inspection of high-voltage power transmission line. The traditional inspection method relies on the operator to manually control the drone for inspection. Although many companies are using real-time dynamic carrier phase differencing technology to achieve high-precision positioning of UAVs, when UAVs fly autonomously at high altitudes to photograph specific objects, the objects tend to deviate from the center of the picture. To address this error, in this article, an autonomous UAV inspection system based on object detection is designed: 1) to detect inspection objects, the corresponding dataset is established on the basis of the UAV autonomous inspection task; 2) to obtain the position information of the target object, a lightweight object detector based on the YOLOX network model is designed. First, the backbone is replaced with MobileNetv3. Next, in the neck structure, the Ghost module is introduced and depthwise convolution is applied instead of normal convolution. Then, to embed the location information into the channel attention, coordinate attention (CA) is introduced after the output feature layer of the backbone, enabling the lightweight network to operate on a larger area of focus. Finally, to improve the accuracy of the bounding box regression, the ${\alpha }$ -distance-IoU (DIOU) loss function is introduced; 3) to obtain the best image acquisition position, the results of object detection combined with the real-time status of the UAV are used; and 4) to enable the UAV to complete the final corrections, position control and altitude control are used. Compared with the original YOLOX_tiny, the new model improves the mAP_0.5:0.95 metric by about 2% points, with a significant reduction in the number of parameters and computation, while running at 56 frames/s on Nvidia NX. This system can effectively solve the problem of the target deviating from the center of the picture when the UAV takes pictures during a high-altitude autonomous inspection, verified by many actual flight experiments.

This study describes the: (1) morphological nature of the calcites in the Toki granite, central Japan; (2) the difference in chemical compositions in terms of morphological classification; and (3) the identification of the stages of calcite formation and the corresponding mass transfer between minerals and fluid owing to hydrothermal alterations and groundwater-rock interactions, which reveals the sequential variations in fluid chemistry during the sub-solidus stage. Calcites in the Toki granite were classified into four types: (1) lenticular calcite in the chloritized biotite; (2) granular calcite in the altered plagioclase; (3) intergranular calcite; and (4) fracture-filling calcite. The lenticular, granular, and intergranular calcites contain greater amounts of iron, manganese, and magnesium than fracture-filling calcites. The lenticular calcite in the chloritized biotite, granular calcite in the altered plagioclase, and intergranular calcite formed due to the precipitation of calcium, iron, manganese, and magnesium released from biotite and plagioclase owing to hydrothermal alterations. The fracture-filling calcites formed at a later stage than the lenticular, granular, and intergranular forms. In the hydrothermal fluid, the concentrations of aluminum, iron, manganese, and magnesium gradually decrease, and the concentration of calcium gradually increases as the alteration proceeds. The chemical characteristics of the fluid at the late stage of hydrothermal alteration and those of the subsequent groundwater are consistent with those of fracture-filling calcites, indicating that the fracture-filling calcites precipitated from the fluid at a late stage of hydrothermal alterations and then from the groundwater. Elements released from biotite and plagioclase owing to hydrothermal alterations were incorporated into and fastened to the calcite. Therefore, the calcites influenced the sequential variations in fluid chemistry during the sub-solidus stage.

ABSTRACTCompact time-of-flight (TOF) measurement systems are desirable for easy installation in various facilities. To achieve such compact systems, one of the key considerations is the design of the neutron moderator. Therefore, systematic studies on moderators considering both neutron energy resolution and neutron intensity are important. In this paper, to design an epithermal neutron moderator at ambient temperature for short-distance TOF measurements, the neutron intensity and energy resolution of epithermal neutrons have been studied using the Monte Carlo simulation code PHITS with JENDL-4.0 for various types of moderators. The neutronic characteristics of a moderator comprising several components were evaluated. The relationships between the moderator dimensions and both the energy resolution and intensity of the epithermal neutrons were determined. From the obtained results, the appropriate high-resolution moderator designs for the short-distance TOF measurements were proposed.

Somatic mutations in the promoter region of telomerase reverse transcriptase (TERT) occur at a high frequency in several cancer types and are associated with malignancy potential and prognosis. Protein levels of TERT and phosphorylated TERT (p-TERT) are related to malignancy potential. To explore the association of TERT phosphorylation and malignancy or prognosis of thyroid cancer, we analyzed the expression of p-TERT and the clinical features of papillary thyroid carcinoma (PTC) in a cohort of 120 patients. We found that TERT and p-TERT were more abundant in tumors harboring TERTpromoter mutations. During the 5-year follow-up period, nine patients experienced disease recurrence. The hazard ratio for recurrence was higher in those with abundant TERT and p-TERT levels. The Kaplan–Meier analysis indicated that the recurrence-free survival was significantly worse in TERT-positive/p-TERT-positive patients than TERT-positive/p-TERT-negative and TERT-negative/p-TERT-negative patients. Higher p-TERT levels correlated with malignant clinicopathologic features and were an independent risk factor for PTC recurrence. These findings indicated the potential role of p-TERT level as a clinically prognostic biomarker in PTC.

Graphical Abstract

Study design: Retrospective multicenter study. Objective: To compare the surgical outcomes and complications of posterior decompression between individuals with cervical spondylotic myelopathy (CSM) and those with ossification of the posterior longitudinal ligament (OPLL). Setting: Seventeen medical institutions in Japan. Methods: This study included 814 individuals with CSM (n= 636) and OPLL (n= 178) who underwent posterior decompression. Propensity score matching of the baseline characteristics was performed to compare surgical outcomes and perioperative complications between the CSM and OPLL groups. Results: Before propensity score matching, the OPLL group had higher percentage of male individuals, body mass index, and number of stenosis levels and longer duration of symptoms (P&lt; 0.01, P&lt; 0.01, P&lt; 0.01, and P&lt; 0.01, respectively). After matching, the baseline characteristics were comparable between the CSM (n= 98) and OPLL (n= 98) groups. The postoperative Japanese Orthopaedic Association (JOA) scores, preoperative-to-postoperative changes in the JOA scores, and JOA score recovery rates were not significantly different between the groups (P= 0.42, P= 0.47, and P= 0.09, respectively). The postoperative visual analog scale (VAS) score for neck pain and preoperative-to-postoperative changes in the VAS score for neck pain were not significantly different between the groups (P= 0.25 and P= 0.50, respectively). The incidence of perioperative complications was comparable between groups. Conclusion: Neurological improvement and complication rates after surgery were comparable between individuals with CSM and those with OPLL, suggesting similar effectiveness and safety of posterior decompression for both conditions.

For the first time, cathodoluminescence (CL) was used to show oscillatory zoning in perthitic K‑feldspars from the equigranular Toki granite, central Japan. Based on the CL patterns, two types of zoning are identified: single core oscillatory zoning (SCOZ) and multiple core oscillatory zoning (MCOZ). The SCOZ is defined by oscillatory zoning around a single-crystal core within the K‑feldspar crystal, whereas the MCOZ depicts two or more such crystal cores. The crystal cores displayed in CL images reflect the nucleation parts of magmatic K‑feldspar. The existence of MCOZ patterns in K‑feldspars indicates multiple nuclei. CL patterns reveal crystal growth behavior of magmatic K‑feldspar in the equigranular Toki granite. CL intensities are positively correlated with titanium and barium concentrations, indicating that the CL variations depend on two factors: (1) titanium concentration as a CL activator and (2) density of Al-O−-Al structural defects. The analysis of CL images revealed that albite-rich phases in microperthite and patchperthite with low-luminescence intensities cut across the CL bands of the oscillatory zoning, indicating that the oscillatory zoning in the orthoclase-rich host phase of K‑feldspar was not perturbed by the formation of microperthite and patchperthite in the post-crystallization stage. The luminescence intensities of albite-rich phases in patchperthite are lower than those in microperthite, which is due to the diferences in titanium and barium concentrations between them. In the post-crystallization stage, the mass transfer of titanium and barium occurred during the formation of microperthite and patchperthite. Therefore, the diference in the luminescence intensities between microperthite and patchperthite lamellae reflects their diferent formation mechanisms between exsolution coarsening and dissolution-precipitation coarsening. In summary, CL analyses can be used for the evaluation of the nucleation and growth not only of anhedral K‑feldspar crystals in equigranular granite but also of K‑feldspar phenocrysts/megacrysts in porphyritic granite. It can reveal the spatial extent of element partitioning between the melt and crystal, along with that of mass transfer from the melt into crystals during the magma evolution. Moreover, the CL analyses can also be used for the interpretation of K‑feldspar textural development during the post-crystallization stage.

Study Design: Multicenter retrospective study.Objectives: We aim to investigate features of cervical spondylotic myelopathy (CSM) associated with anterior cervical spondylolisthesis (ACS) during posterior decompression surgery.Methods: A total of 732 patients with CSM were enrolled, who underwent posterior decompression surgery between July 2011 and November 2015 at 17 institutions. The patients with ACS (group A), defined as an anterior slippage of ≥2 mm on plain radiographs, were compared with those without ACS (group non-A). Also, the characteristics of patients with ACS progression (group P), defined as postoperative worsening of ACS ≥2 mm or newly developed ACS, were investigated. Moreover, kyphosis was defined as C2-C7 angle in neutral position ≤−5°. The Japanese Orthopedic Association (JOA) scoring system was used for clinical evaluation.Results: Group A consisting of 62 patients (8.5%) had worse preoperative clinical status but comparable surgical outcomes to group non-A. Furthermore, ACS was associated with greater age, and the degree of slippage did not affect myelopathy grades. Seventeen patients (2.3%) were observed in group P, and preoperative ACS was a significant predisposing factor for the progression without clinical impact. Among the patients in group A, preoperative cervical kyphosis was a risk factor for lower JOA recovery rate.Conclusions: Although the presence of ACS increases the risk of postoperative progression, it is not a contraindication for posterior decompression. However, surgeons need to consider the indication of fusion surgery for the patients who have ACS accompanied by kyphosis because of the poor surgical outcomes.

AimsDedifferentiation is a histological phenomenon characterised by abrupt transition of histology to a sarcomatous component with high-grade malignant potential in solitary fibrous tumour (SFT). The authors histologically reviewed SFT cases to reveal the histological background of dedifferentiated SFTs.MethodsClinicopathological and histopathological findings of 145 SFT cases were reviewed. Immunohistochemical staining and genetic analysis were also performed.ResultsThe non-dedifferentiated components showed a cellular component in 45 of 145 (31%), high mitotic rate (≥4/10 high-powered field) in 12 of 145 (8.2%) tumours, necrosis in 7 of 145 (4.8%) tumours, multinodular growth pattern in 39 of 132 (29.5%) available tumours and intratumoural fibrous septa in 37 of 131 (28.2%). Immunohistochemically, the non-dedifferentiated components were positive for CD34 in 128 of 141 (90.7%), bcl-2 in 101 of 133 (75.9%), nuclear pattern of β-catenin in 64 of 127 (50.3%) and p16 in 22 of 140 (15.7%). Loss of Rb protein expression was detected in 17 of 110 (15.4%) cases. Statistically, cellular component, multinodular structure, p16 overexpression and Rb protein loss were significantly associated with dedifferentiation. Moreover, cellular component and multinodular structure were significantly associated with p16 overexpression and Rb protein loss. All the non-deddifferentiated components showed wild type of p53 expression. The dedifferentiated components of all 10 dedifferentiated tumours presented positivity for p16 in 9 of 10 (90%) and mutational type of p53 in 5 of 10 (50%). Loss of Rb protein expression was detected in 6 of 10 (60%).ConclusionsThe authors propose that cellular or multinodular transformation may be associated with dedifferentiation. They also suggest that cellular and multinodular transformation may be associated with p16 overexpression and Rb downregulation.

Background: Despite the increasing utilization of transanal total mesorectal excision as a promising approach for low rectal cancer, the feasibility and safety of transperineal minimally invasive abdominoperineal resection (tp-APR) remain unclear. Methods: In total, 25 patients who underwent tp-APR between April 2017 and May 2020 (tp-APR group) and 27 patients who underwent conventional laparoscopic APR between May 2009 and September 2016 (lap-APR group) for low rectal cancer were enrolled in this retrospective study. Clinical outcomes were compared between the groups before and after propensity score matching. The primary outcome was the incidence of the overall postoperative complications with Clavien–Dindo grade II or above. Standardized technique of tp-APR was also demonstrated. Results: On comparison, operative time, intraoperative blood loss, and overall postoperative complications with Clavien–Dindo grade II or above were significantly less in the tp-APR group both before and after propensity score matching. The rates of urinary disturbance and perineal wound infection were significantly less in the tp-APR group after matching. Further, postoperative hospital stay was significantly shorter in the tp-APR group both before and after matching. However, pathological outcomes did not differ between the groups before and after matching. There has been no local recurrence in the tp-APR group with a median follow-up period of 18 months. Conclusion: Standardized tp-APR for low rectal cancer is feasible and seems superior to conventional laparoscopic APR in terms of short-term outcomes. Further larger-scale studies with a longer follow-up period are required to evaluate oncological outcomes.

Study design: Retrospective multicenter study. Objectives: To identify the usefulness of the baseline severity of myelopathy for predicting surgical outcomes for cervical spondylotic myelopathy (CSM). Setting: Seventeen institutions in Japan. Methods: This study included 675 persons with CSM who underwent posterior decompression. According to baseline severity, the individuals were divided into the mild (Japanese Orthopaedic Association [JOA] score ≥ 14.5), moderate (JOA score = 10.5–14), and severe (JOA score ≤ 10) groups. Surgical outcomes and clinical variables were compared between the groups. Logistic regression analysis was used to develop a prediction model for unsatisfactory symptom state (postoperative JOA score ≤ 14, residual moderate or severe myelopathy). Results: The mean (±standard deviation) age was 67 ± 12 years. The participants in the severe group were older than those in the mild group. Postoperative JOA scores were higher in the mild group than in the severe group. According to multivariate logistic regression analysis, the prediction model included preoperative JOA scores (odds ratio [OR] 0.60; 95% confidence interval [CI] 0.55–0.67) and age (OR 1.06, 95% CI 1.04–1.08). On the basis of the model, a representative combination of the thresholds to maximize the value of “sensitivity − (1 − specificity)” demonstrated a preoperative JOA score of 11.5 as a predictor of postoperative unsatisfactory symptom state in people around the mean age of the study cohort (67 years). Conclusions: The combination of the baseline severity of myelopathy and age can predict postoperative symptom states after posterior decompression surgery for CSM.

Mesenchymal stem cells (MSCs) have immunomodulatory properties and support hematopoiesis in the bone marrow (BM). To develop a new strategy to not only prevent graft‐vs‐host disease (GVHD) but also to enhance engraftment, a phase I trial of cord blood transplantation (CBT) combined with intra‐BM injection of MSCs (MSC‐CBT) was designed. Third‐party BM‐derived MSCs were injected intra‐BM on the day of CBT. The conditioning regimen varied according to patient characteristics. GVHD prophylaxis was tacrolimus and methotrexate. The primary endpoint was toxicity related to intra‐BM injection of MSCs. Clinical outcomes were compared with those of six controls who received CBT alone. Five adult patients received MSC‐CBT, and no adverse events related to intra‐BM injection of MSCs were observed. All patients achieved neutrophil, reticulocyte, and platelet recoveries, with median times to recoveries of 21, 35, and 38 days, respectively, comparable with controls. Grade II‐IV acute GVHD developed in three controls but not in MSC‐CBT patients. No patients developed chronic GVHD in both groups. At 1 year after transplantation, all MSC‐CBT patients survived without relapse. This study shows the safety of MSC‐CBT, and the findings also suggest that cotransplantation of MSCs may prevent GVHD with no inhibition of engraftment. This trial was registered at the University Hospital Medical Information Network Clinical Trials Registry as number 000024291. Mesenchymal stem cells (MSCs), which were derived from bone marrow (BM) of third‐party donor, were injected intra‐BM of recipient 4 hours before cord blood transplantation (CBT). This study shows the safety of CBT combined with intra‐BM injection of MSCs, and also suggests that co‐transplantation of MSCs may prevent graft‐vs‐host disease without inhibition of engraftment.

Various heterogeneous nuclear ribonucleoproteins (hnRNPs) are deposited in pathological inclusions of amyotrophic lateral sclerosis (ALS) and related diseases, such as frontotemporal lobar degeneration (FTLD). Recently, poly (rC)-binding protein 2 (PCBP2, hnRNP-E2), a member of the hnRNP family, was reported to be colocalized with transactivation-responsive DNA-binding protein 43 kDa (TDP-43)-immunopositive inclusions in cases of FTLD-TDP. Here, we used immunohistochemical methods to investigate PCBP1 and PCBP2 expression in the spinal cords of sporadic ALS patients, with special reference to TDP-43-positive inclusions. Thirty autopsy cases of sporadic ALS were examined by immunohistochemistry using antibodies against PCBP1, PCBP2, sequestosome 1 (p62), and TDP-43. In control subjects without neurological disorders, neurons predominantly expressed PCBP2, rather than PCBP1, in their cytoplasm and nuclei. Anterior horn cells of sporadic ALS patients often had various levels of PCBP2 expression, and motor neurons with skein-like inclusions often had reduced or lost cytoplasmic and nuclear PCBP2 staining. Notably, one case with FTLD-TDP subtype B pathology had marked colocalization of TDP-43 and PCBP2 in the cytoplasmic inclusions and dystrophic neurites of the cerebral cortex, hippocampus, and spinal cord. In conclusion, PCBP2 was reduced in anterior horn cells of sporadic ALS, but its occurrence in TDP-43 inclusions was a rare phenomenon.

Background: Although transanal total mesorectal excision (ta-TME) is adopted for rectal cancer surgery by an increasing number of surgeons, it is still technically challenging. We have employed a lateral-first approach for ta-TME to overcome technical difficulties. However, its outcomes and advantage over conventional laparoscopic TME remain unclear. Methods: Thirty-five consecutive patients who underwent ta-TME using a lateral-first approach (the ta-TME group) and 53 consecutive patients who underwent conventional laparoscopic TME (the lap-TME group) for low rectal cancer were included. Propensity score matching (PSM) was used to create balanced cohorts of ta-TME (n?=?28) and lap-TME (n?=?28). Their clinical outcomes were compared after PSM. Results: The operative time and intraoperative blood loss were significantly lower in the ta-TME group than in the lap-TME group (P?=?0.042 and P?&lt;?0.001, respectively). Postoperative complications?=?Clavien–Dindo grade II were significantly less and postoperative hospital stay was significantly shorter in the ta-TME group (35.7% vs. 78.6%, P?=?0.003, and 18 days vs. 32 days, P?&lt;?0.001, respectively). The distal margin was significantly larger in the ta-TME when excluding the abdominoperineal resection cases (20 mm vs. 10 mm, P?=?0.032). The positive radial margin was observed in 2 of 28 patients (7.1%) in the ta-TME group. Conclusions: Ta-TME using a lateral-first approach is feasible and may offer several advantages over lap-TME in terms of short-term outcomes. It might be an alternative safe approach for ta-TME. To confirm the oncological superiority of this surgery, further study in a larger population and for a longer follow-up period is warranted.

Background: During the past decade, minimally invasive esophagectomy (MIE) for esophageal cancer has been adopted worldwide with expectations of lower invasiveness. However, the rate of postoperative pneumonia, which is an independent risk factor for oncological prognosis in esophageal cancer, remains high. The aim of this retrospective follow-up study is to clarify whether there is a strong correlation between recurrent laryngeal nerve (RLN) palsy and postoperative pneumonia in MIE. Methods: This retrospective follow-up study included 209 patients with esophageal cancer who underwent thoracoscopic esophagectomy in the prone position (TEP) at Kobe University between 2011 and 2018. Inclusion criteria included age 18–85 years; cT1–3, cN0–3 disease; upper mediastinal lymphadenectomy; and ability to undergo simultaneous esophagectomy and reconstruction of the gastric conduit or pedicled jejunum. Univariate and multivariate logistic regression were conducted to identify independent risk factors for pneumonia. Results: Among 209 TEPs, pneumonia of Clavien–Dindo classification grade?>?II occurred in 44 patients (21%). In the pneumonia positive and negative groups, there were significant differences in age (67.9?±?7.5 vs. 64.9?±?8.6 years), 3-field lymph node dissection [27 (61%) vs. 67 (41%)], transfusion [20 (45%) vs. 41 (25%)], left RLN palsy [19 (43%) vs. 18 (11%)], and any RLN palsy [20 (45%) vs. 18 (11%)]. In multivariate analysis, any RLN palsy was associated with a higher incidence of pneumonia [odds ratio (OR), 6.210; 95% confidence interval (CI), 2.728–14.480; P?&lt;?0.0001]. In addition, age was associated with a higher incidence of pneumonia (OR, 1.049; 95% CI, 1.001–1.103; P?=?0.046). Changes in the rate of any RLN palsy over time were quite similar to changes in the incidence of pneumonia. Conclusion: There is a strong correlation between RLN palsy and pneumonia in MIE for esophageal cancer. Prevention of RLN palsy may reduce the incidence of pneumonia, leading to better oncological prognosis.

Study design: Retrospective cohort study. Objectives: Although intramedullary astrocytoma is associated with a high mortality rate, the optimal treatment has not reached a consensus. This study aimed at evaluating neurologic function and overall survival rate (OSR) in the treatment of this tumor. Setting: The single institution in Japan. Methods: This study enrolled 67 subjects who underwent surgical treatment for intramedullary astrocytoma. Demographic, imaging, and surgical information were collected from each participant. Tumors were histologically categorized using the World Health Organization classification, and subjects were divided into low-grade (I and II; n= 40) and high-grade (III and IV; n= 27) groups. Neurologic status was evaluated using the modified McCormick scale (MMS). OSR was assessed using Kaplan–Meier methods. Results: The OSR decreased when the pathological grade increased (p&lt; 0.01). Regarding the therapeutic efficacy for low-grade astrocytomas, subjects who underwent gross total resection (GTR) showed a higher OSR than those who did not (p= 0.02). GTR prevented worsening of MMS score, while non-GTR increased the MMS score (p&lt; 0.01). In the high-grade group, 19 and 10 underwent radiation therapy and chemotherapy, respectively. However, both treatments did not improve OSR. Cordotomy was performed for subjects whose lesional area was at the thoracic level, but the OSR did not significantly increase. Conclusions: The most beneficial therapeutic strategy for low-grade astrocytomas was GTR, whereas that for the high-grade tumors was unclear. Further studies with a larger sample size are warranted to validate the effective treatment for malignant astrocytomas.

AimsAlthough frameshift variants in the microsatellite area of shugoshin 1 (SGO1) have been reported in the context of microsatellite instability-high (MSI-H)/deficient mismatch repair gastrointestinal cancer, most have been evaluated only in early stage I–III patients, and only two of its five microsatellite regions have been evaluated. Therefore, we investigated the frequency and MSI status of microsatellite frameshift variants in gastric cancer cases, including stage IV.MethodsIn a total of 55 cases, 30 gastric cancer resection and 25 non-resection cases, DNA was extracted from both tumour and normal parts and PCR was performed. The variant was confirmed by TA cloning, and MSI was evaluated using GeneMapper software.ResultsA frameshift variant of c.973delA was observed in 16 of the 45 evaluable cases. Its frequency was 35.6%. Of the 25 cases that could be assessed for MSI status, two cases of MSI-H were associated with the c.973delA SGO1variant. However, c.973delA SGO1variant was also observed in four cases of microsatellite stable.ConclusionOur study shows that SGO1frameshift variants are not always associated with MSI status.

Background: Retrosternal reconstruction is associated with a lower risk of mediastinitis, gastro-tracheal fistula, and hiatal hernia. Historically, traumatic manual creation of the retrosternal tunnel has been performed using one’s fist. We report a novel and atraumatic laparoscopic procedure to create the retrosternal route. Methods: We have laparoscopically created the retrosternal route in 25 thoracoscopic, mediastinoscopic, or robot-assisted minimally invasive esophagectomies since August 2019. Specifically, a peritoneal incision is started at the dorsal side of the xiphoid process. Through a 12-mm port inserted slightly to the right of and superior to the umbilical camera port, we dissect loose connective tissues from the caudal to the cranial side using behind the sternum and inside the internal thoracic vessels as landmarks. The time required to create the route was calculated. Then, the cumulative sum (CUSUM) method and the simple moving average of five cases were used to evaluate the learning curve of this novel procedure. Operative outcomes were analyzed according to the learning curve results and also compared with 25 cases of postmediastinal reconstruction counterparts. Results: Twenty-five patients were divided into the early group (six patients) and late group (19 patients) based on the peak of the CUSUM chart. The time required for route creation was 28.5 min (median) in the early and 15 min in the late group, indicating a significant difference (P= 0.038). The overall incidence of pleural injury was 20% (5 of 25 patients), with no significant difference between the groups. There was no significant difference in the incidence of perioperative complications. Also, there were no significant differences in perioperative complications or gastric conduit functions 1 year after surgery between the retrosternal and the postmediastinal reconstruction. Conclusion: Laparoscopic creation of a retrosternal route for gastric conduit reconstruction is safe and feasible and has a short learning curve.

CD71 is an immunohistochemical marker used in diagnosing acute myeloid leukemia (AML) M6-Er in humans; however, to our knowledge, it has not been reportedly used for immunohistochemistry in veterinary medicine. We evaluated the pathologic features of AML M6-Er in a retrovirus-negative cat and used CD71 to support the diagnosis. A 4-y-old spayed female Scottish Fold cat was presented with lethargy, anorexia, and fever. Whole-blood PCR assay results for pro feline leukemia virus/pro feline immunodeficiency virus and feline vector-borne diseases were negative. Early erythroid precursors were observed in the peripheral blood smear. Fine-needle aspiration of the enlarged spleen and splenic lymph node showed many early erythroid precursors. Bone marrow aspirate smears revealed erythroid hyperplasia with 68.4% erythroid lineage and 3.6% rubriblasts. Dysplastic cells infiltrated other organs. The patient was diagnosed with myelodysplastic syndrome, progressing to the early phase of AML M6-Er. The patient died on day 121 despite multidrug treatments. Postmortem examination revealed neoplastic erythroblasts infiltrating the bone marrow and other organs. Neoplastic cells were immunopositive for CD71 but immunonegative for CD3, CD20, granzyme B, von Willebrand factor, CD61, myeloperoxidase, and Iba-1. Although further studies are necessary for the application of CD71, our results supported the morphologic diagnosis of AML M6-Er.

ABSTRACTIt is important to predict the growth of Sugi forest plantations in old age. When predictions about the growth of Sugi forest plantations are made and there is a lack of growth data from older trees, it is possible that the accuracy of these predictions becomes worse. For example, it is known that the growth of Sugi does not get slower at older ages as expected from past growth predictions based on growth data from young to middle-aged trees. This study investigated the changes in extrapolated values of diameter at breast height (DBH) in old Sugi forest plantations with changes in the observation period of training data for model calibration. The study sites were long-term growth observation sites of Sugi forest plantations in the University of Tokyo Chiba Forest and Chichibu Forest. In this study, both DBH of individual trees and mean DBH of stands were analyzed by fitting Richards growth functions. The results showed that the accuracy of growth predictions in old ages was improved by including growth data from a sufficient number of older trees. From another point of view, growth prediction in old ages tended to underestimate actual growth if growth data did not include enough older trees.

Gerstmann-Sträussler-Scheinker (GSS) disease with P102L mutation and familial Creutzfeldt-Jakob disease (CJD) with V180I mutation are 2 major hereditary prion diseases in Japan. GSS and some familial CJD [V180I] exhibit characteristic prion protein (PrP) plaques. Overexpression of the astrocytic water channel proteins aquaporin (AQP) 1 and AQP4 was recently reported in sporadic CJD. To clarify the pathological characteristics of AQP1 and AQP4 in prion disease patient brains with plaque-type deposition, we investigated 5 patients with GSS, 2 patients with CJD [V180I], and 2 age-matched control cases without neurological diseases using immunohistochemistry and double immunofluorescence methods. We demonstrated that there is the intense expression of AQP1 and AQP4 around prion plaques, especially in distal astrocytic processes deep inside these plaques. Similar results have been reported in the senile plaques and ghost tangles of Alzheimer disease brains and a protective role of AQP4 in which AQP4 is redistributed toward the plaques and works as a barrier against the deleterious effects of these plaques has been suggested. Our results, which show a similar clustering of AQPs around PrP plaques, therefore support the possibility that AQPs also have a protective role in plaque formation in prion diseases.

Background: Laparoscopic lateral pelvic lymph node dissection (LLND) has been reported to be feasible; however, studies comparing the outcomes of laparoscopic LLND with that of open LLND following preoperative chemoradiotherapy (CRT) are limited. Methods: Between November 2005 and October 2017, 38 patients with locally advanced rectal cancer underwent total mesorectal excision and LLND following preoperative CRT at Kobe University Hospital. The data of the patients who underwent open LLND (OP group, n= 19) and laparoscopic LLND (LAP group, n= 19) were retrospectively collected and compared. Results: The operative time was significantly longer in the LAP group compared with that in the OP group. However, the volume of blood loss was significantly higher, and transfusion was more frequently performed in the OP group than in the LAP group. The number of LLNs harvested in the LAP group was significantly higher than that in the OP group. The prevalence of perineal wound infection and bowel obstruction was significantly higher in the OP group than in the LAP group. However, no significant differences were observed between the groups in terms of 5-year overall survival, relapse-free survival, and local recurrence-free survival. Conclusions: Laparoscopic LLND is feasible and safe for patients with rectal cancer who were treated with preoperative CRT. Compared with open LLND, laparoscopic LLND might have several advantages such as higher yields of dissected LLNs and lower incidences of perineal wound infection and bowel obstruction.

The identification of thyroid cancers among children after the Chernobyl nuclear power plant accident propelled concerns regarding long-term radiation effects on thyroid cancer in children affected by the Fukushima Daiichi nuclear power plant accident in Fukushima, Japan. Herein we consider the potential association between absorbed dose in the thyroid and the risk of developing thyroid cancer as detected by ultrasonography on 300 473 children and adolescents aged 0–18 years in Fukushima. The absorbed dose mentioned in the present study indicates the sum of that from external exposure and that from internally deposited radionuclides. We grouped participants according to estimated absorbed doses in each of 59 municipalities in Fukushima Prefecture, based on The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2013 report. The 59 municipalities were assigned to quartiles by dose. We limited our analyses to participants aged ≥6 years because only one case of thyroid cancer was observed in participants aged ≤5 years; 164 299 participants were included in the final analysis. Compared with the lowest dose quartile, the age- and sex-adjusted rate ratios (95% confidence intervals) for the low-middle, high-middle and highest quartiles were 2.00 (0.84–4.80), 1.34 (0.50–3.59) and 1.42 (0.55–3.67) for the 6–14-year-old groups and 1.99 (0.70–5.70), 0.54 (0.13–2.31) and 0.51 (0.12–2.15) for the >15-year-old group, respectively. No dose-dependent pattern emerged from the geographical distribution of absorbed doses by municipality, as estimated by UNSCEAR, and the detection of thyroid cancer among participants within 4–6 years after the accident. Ongoing surveillance might further clarify the effects of low-dose radiation exposure on thyroid cancer in Fukushima.

ABSTRACTKuji amber is fossilized tree resin of the Late Cretaceous in Japan. In this study, new biological activities of ethanol extract of Kuji amber (EtOH ext.) and supercritical carbon dioxide fluid extract of Kuji amber (scCO2ext.) were examined. Both EtOH ext. and scCO2ext. inhibited melanin production in B16 mouse melanoma cells and promoted collagen production in human skin fibroblast SF-TY cells. The scCO2ext. had more potent activity than that of EtOH ext. and may depend on the efficiency of the extraction. The main new biologically active compound in Kuji amber, kujigamberol had no activities against melanin production, however, it promoted collagen production at low concentrations. A biologically active compound having a different structure, spirolactone norditerpenoid, showed both the inhibition activity against melanin production and the promotion activity of collagen production in a dose dependent manner. EtOH ext. and scCO2ext., which include both kujigamberol and spirolactone norditerpenoid, have not only anti-allergy activity, but also inhibit melanin production and promote collagen production.