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Introduction: Patients with adult spinal deformity (ASD) lean forward with their trunks when walking, even if they can remain upright during static standing. However, it remains unclear which part of the spinal column is involved in forward trunk tilt and the details of the relationships between sagittal alignment during static standing and changes in dynamic parameters during walking. Therefore, this study aimed to clarify the above by analyzing the walking motion of ASD patients using inertial measurement units (IMUs). Methods: Preoperative ASD patients were included in this study. Dynamic parameters during gait were measured by IMUs attached on the skin at the T1, T12, and S1 spinous processes, thigh, and lower leg. Walking data were divided into three phases of 10 s each (initial, middle, and final), and the average dynamic parameters at each phase were statistically compared. The relationships between the standing radiographic and dynamic parameters in the final phase were evaluated by linear regression analyses. Results: A total of 34 patients were included in this study. Their mean age was 72 years. The inclination of IMUs on the T1, T12, and S1 and the flexion angle of T12-S1 IMUs significantly increased over time. Pelvic tilt (PT) of standing radiography was positively correlated with the inclination angles of T12 (r2=0.22, p=0.0048) and S1 (r2=0.16, p=0.0178) and the flexion angle of T12-S1 IMUs (r2=0.29, p=0.0011). Conclusions: This study showed that anteversion of the trunk in patients with ASD is due to an increase in lumbar forward bending and anterior tilt of the pelvis. Lumbar forward bending was significantly correlated with PT on standing radiography. It is important to consider the presence of poorer posture during gait than during standing when we evaluate patients with high PT.

Abstract Background This study aimed to evaluate the association between spinopelvic alignment parameters and hip osteoarthritis progression after spinal alignment correction surgery for adult spinal deformity, focusing on the preoperative to postoperative change in spinopelvic alignment. Methods This retrospective study enrolled 100 adult spinal deformity patients (196 hip joints) who underwent spinal fusion surgery, after excluding four joints with previous total hip arthroplasty. Acetabular roof obliquity (ARO), center edge angle (CE) and Kellgren and Lawrence (KL) grade were measured in the hip joint. Spinopelvic alignment parameters were measured preoperatively and 1-month postoperatively and the changes (Δ) during this period were calculated. Patients were followed-up for ≥ 5 years and factors associated with KL grade progression at 5-years postoperatively were determined by logistic regression analysis. Results In the analysis with all cases, KL grade progressed in 23 joints. Logistic regression analysis revealed age (OR: 1.098, 95% CI: 1.007–1.198, p = 0.019), ARO (OR: 1.176, 95% CI: 1.01–1.37, p = 0.026), and Δ PI (OR: 0.791, 95% CI: 0.688–0.997, p

Abstract Background The natural history of the congenital spinal deformity and its clinical magnitude vary widely in human species. However, we previously reported that the spinal deformities of congenital scoliosis mice did not progress throughout our observational period according to soft X-ray and MRI data. In this study, congenital vertebral and intervertebral malformations in mice were assessed via magnetic resonance (MR) and histological images. Methods Congenital spinal anomalies were chronologically assessed via soft X-ray and 7 T MR imaging. MR images were compared to the histological images to validate the findings around the malformations. Results Soft X-ray images showed the gross alignment of the spine and the contour of the malformed vertebrae, with the growth plate and cortical bone visible as higher density lines, but could not be used to distinguish the existence of intervertebral structures. In contrast, MR images could be used to distinguish each structure, including the cortical bone, growth plate, cartilaginous end plate, and nucleus pulposus, by combining the signal changes on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). The intervertebral structure adjacent to the malformed vertebrae also exhibited various abnormalities, such as growth plate and cartilaginous end plate irregularities, nucleus pulposus defects, and bone marrow formation. In the chronological observation, the thickness and shape of the malformed structures on T1WI did not change. Conclusions Spinal malformations in mice were chronologically observed via 7 T MRI and histology. MR images could be used to distinguish the histological structures of normal and malformed mouse spines. Malformed vertebrae were accompanied by adjacent intervertebral structures that corresponded to the fully segmented structures observed in human congenital scoliosis, but the intervertebral conditions varied. This study suggested the importance of MRI and histological examinations of human congenital scoliosis patients with patterns other than nonsegmenting patterns, which may be used to predict the prognosis of patients with spinal deformities associated with malformed vertebrae.

Introduction Oligometastatic prostate cancer can be well‐controlled through combined local and metastasis‐directed therapies. However, the effects of cytoreductive radical prostatectomy and metastasectomy remain unclear. Case presentation A 52‐year‐old man presented with prostate cancer and isolated bone metastasis to the thoracic spine. Six months after neoadjuvant hormonal therapy, the patient underwent cytoreductive radical prostatectomy and total en bloc spondylectomy. The postoperative course was uneventful. Hormonal therapy was terminated 5 years after surgery, and no biochemical or radiological progression was observed at 7 years postoperatively. Conclusion Although careful patient selection is necessary, cytoreductive radical prostatectomy and metastasectomy are effective treatments for well‐selected patients with oligometastatic prostate cancer.

Abstract Background Progesterone therapy is a relatively inexpensive treatment option for endometrial and breast cancers, with few side effects. Two signaling pathways usually mediate the physiological effects of progesterone, namely genomic and non‐genomic actions. Genomic action occurs slowly via the nuclear progesterone receptor (PR), whereas the membrane progesterone receptor (mPR) induces rapid non‐genomic action. Aims We investigated the effects of progesterone and various PR agonists on ovarian cancer cells. Methods and Results PR expression of six serous ovarian cancer cell lines was examined by western blotting, and mPR expression was examined by reverse transcription‐quantitative polymerase chain reaction (RT‐qPCR). PR‐negative and mPR‐positive ovarian cancer cells were exposed to progesterone and seven types of PR agonists (medroxyprogesterone acetate [MPA], dehydroepiandrosterone, dienogest, levonorgestrel, drospirenone, pregnenolone, and allopregnanolone) at 10–400 μM, and viable cell counts after exposure for 30 min were measured using the water‐soluble tetrazolium (WST‐1) assay. Ovarian cancer cell lines were exposed to 100 μM progesterone, and the expression of BAX, a pro‐apoptotic protein, after 1–5 min was examined by western blotting. Western blotting detected no PR expression in the six serous ovarian cancer cell lines. In contrast, RT‐qPCR detected mPR expression in all six serous ovarian cancer cell lines. Progesterone and MPA‐induced cell death in all tested ovarian cancer cell lines in a concentration‐dependent manner, whereas no effect was observed for other PR agonists. Western blotting revealed that pro‐apoptotic protein BAX expression occurred 1 min after exposure to progesterone, suggesting that the cytocidal effects are mediated by rapid non‐genomic action. Conclusion Progesterone and MPA exhibited a rapid cytocidal effect on PR‐negative ovarian cancer cells through non‐genomic action. Progesterone and MPA could be novel adjuvant therapies for ovarian cancer.

Aim: In Japan, Niraparib maintenance therapy for primary and recurrent ovarian cancer was approved in September 2020 and is expected to improve the prognosis of ovarian cancer. However, the safety of niraparib maintenance therapy in Japanese patients has not been fully evaluated. Methods: Patients with ovarian cancer (including fallopian tube and peritoneal cancer) treated with niraparib at Jichi Medical University Hospital from September 2020 to August 2022 were enrolled in this study. Patient background, starting dose, rates of interruption, reduction, or discontinuation, adverse events (AEs) during treatment, and estimated glomerular filtration rate (eGFR) trends were retrospectively analyzed. Results: Twenty‐nine patients received niraparib maintenance therapy during the study period, including 21 with primary cancer and 8 patients with recurrent cancer. Seventeen patients (58.6%) required dose interruptions and 16 patients (55.2%) required dose reductions. Only two patients (6.9%) discontinued treatment due to fatigue and nausea. The most frequent AE was creatinine increases in 18 patients (62.1%, all grades). Although eGFR levels decreased significantly after niraparib therapy compared to before niraparib therapy (59.3 vs. 50.3 mL/min/1.73 m2, p < 0.001), the levels returned to pre‐niraparib initiation levels after discontinuation of niraparib (64.6 vs. 64.6 mL/min/1.73 m2, p = 0.96). Multivariate regression analysis showed that diabetes was independently associated with decreased eGFR (p = 0.013). Conclusions: Niraparib maintenance therapy frequently increased serum creatinine, but the change was reversible. Further studies are needed to determine the effects of niraparib on renal function in Japanese patients. [ABSTRACT FROM AUTHOR]