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Background: Although depression is a leading cause of disability worldwide, the pathophysiological mechanisms underlying this disorder-particularly those involving the gut microbiome-are poorly understood., Method: To investigate, we conducted a community-based observational study to explore complex associations between changes in the gut microbiome, cytokine levels, and depression symptoms in 52 participants (M age  = 49.56, SD = 13.31) receiving an immersive psychosocial intervention. A total of 142 multi-omics samples were collected from participants before, during, and three months after the nine-day inquiry-based stress reduction program., Results: Results revealed that depression was associated with both an increased presence of putatively pathogenic bacteria and reduced microbial beta-diversity. Following the intervention, we observed reductions in neuroinflammatory cytokines and improvements in several mental health indicators. Interestingly, participants with a Prevotella-dominant microbiome showed milder symptoms when depressed, along with a more resilient microbiome and more favorable inflammatory cytokine profile, including reduced levels of CXCL-1., Conclusions: These findings reveal a potentially protective link between the Prevotella-dominant microbiome and depression, as evidenced by a reduced pro-inflammatory environment and fewer depressive symptoms. These insights, coupled with observed improvements in neuroinflammatory markers and mental health from the intervention, may highlight potential avenues for microbiome-targeted therapies for managing depression., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.P.S. is a co-founder and scientific advisor for Crosshair Therapeutics, Exposomics, Filtricine, Fodsel, Iollo, InVu Health, January AI, Marble Therapeutics, Mirvie, Next Thought AI, Orange Street Ventures, Personalis, Protos Biologics, Qbio, RTHM, SensOmics. M.P.S. serves as a scientific advisor for Abbratech, Applied Cognition, Enovone, Jupiter Therapeutics, M3 Helium, Mitrix, Neuvivo, Onza, Sigil Biosciences, TranscribeGlass, WndrHLTH, Yuvan Research. M.P.S. is a co-founder of NiMo Therapeutics. M.P.S. is an investor and scientific advisor of R42 and Swaza. M.P.S. is an investor in Repair Biotechnologies. A.B.G. is a co-founder of Arben Ventures and Xthena Partners. B.R. is a co-founder of Arben Ventures, Enovone, and an advisor to Bexson and Northstar Care. After data collection was complete, as well as after most data analysis was completed, A.B.G. and B.R. co-founded what was formerly InquiryRx with Byron Katie, but ultimately decided not to continue the venture. Trudy Green was the 100 % owner of InquiryRx. Byron Katie lectured in Stanford BIOS 237, a class co-taught by A.B.G. and M.P.S. and spoke at the Stanford Mental Healthcare Innovations Summit. At the time of the initial publication of this article, the Academic Incubator Fund, managed by Arben Ventures, of which A.B.G. and B.R. are co-founders and managing partners, is an investor in 36 companies—namely, Bloch Quantum Imaging Solutions, Elemind Technologies, North-StarCare, Mercy BioAnalytics, Othership, Superbio.ai, Empo Health, Kelso Health, Acta Pharmaceuticals, Enovone, Superhumn, Parallel Health, Mitrix Bio, Bexson Biomedical, Allia Health, Glyphic Biotechnologies, RTHM, QBio, NextThought AI, ReMinded, Lynx Tech, Firefly VR-P, Amira Health, Imago Systems, SeeMedX, Vertility Health, OnFirm, ModoScript, Outro Health, Concha Labs, The Natural Nipple, Navan Technologies, TranscribeGlass, Dognosis, MoveJoy, and Kangaroo Bio–and an advisor to Bloch Quantum Imaging Solutions, Elemind Technologies, Allia Health, and SeeMedX. The remaining authors do not have any conflicts of interest with respect to this work., (Copyright © 2024. Published by Elsevier Inc.)

Background: The Scoliosis Research Society-30 (SRS-30) is a questionnaire that was originally developed from the SRS-22r questionnaire and is used to evaluate adolescent idiopathic scoliosis (AIS). It comprises two sections, with Section 1 containing 22 items related to the SRS-22r questionnaire and 1 item regarding self-image and Section 2 containing 7 items specifically related to postoperative status. The SRS-30 has been also found useful in evaluating spinal disorders or deformity in adults. However, the Japanese version of the SRS-30 (Japanese SRS-30) has been validated for adolescent idiopathic scoliosis, but not for adult spinal deformity (ASD). This study aimed to assess the internal consistency and external validity of the Japanese SRS-30 for ASD., Methods: Of the 30 questions on the SRS-30, 8 questions added from the SRS-22r were translated and back-translated to create the Japanese SRS-30. The Japanese SRS-30 was used to survey patients with ASD who underwent corrective fusion surgery within 1 postoperative year. The internal consistency of the responses was evaluated using Cronbach α coefficient. Additionally, we performed Spearman correlation analysis of the Oswestry Disability Index (ODI) and SRS-22r with the Japanese SRS-30., Results: We included 120 patients (20 males and 100 females; mean age at surgery, 53.3 years). The mean preoperative Cobb angle, sagittal vertical axis, and pelvic incidence minus lumbar lordosis were 36.9°, 81.8 mm, and 24.0°, respectively. The Cronbach α coefficient for the overall SRS-30 was 0.941, indicating high internal consistency. Moreover, the coefficients for each domain were as follows: function/activity, 0.864; pain, 0.783; self-image/appearance, 0.858; mental health, 0.916; and satisfaction, 0.763. The total SRS-30 score was significantly correlated with the total SRS-22r score (r = 0.966, P < 0.001) and ODI (r = -0.752, P < 0.001). The SRS-30 domains showed strong correlations with the corresponding SRS-22r domains, with the r values ranging from 0.878 to 1.000 (all P < 0.001 except mental health)., Conclusions: The Japanese SRS-30 demonstrated good internal and external validity. The Japanese SRS-30 can be used to assess health-related quality of life in patients with ASD., Competing Interests: Declaration of competing interest HA, YY, YS, HO, JT, KW, RS, KT, YA, TA, SD, TD, AM, SS, ST, TT, HU, and NH have nothing to disclose., (Copyright © 2024 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Percutaneous treatments, including thoracic duct embolization (TDE) and thoracic duct disruption (TDD), are reportedly effective and safe alternatives to surgical thoracic duct ligation for refractory chylothorax. When catheterization of the thoracic duct is impossible, TDD can be performed as long as the thoracic duct can be opacified by lymphangiography. However, no report has described percutaneous treatment when the thoracic duct cannot be visualized. In this case, TDE was not feasible because intranodal lymphangiography failed to opacify the thoracic duct: cannulation was not achieved. Therefore, we aimed to disrupt the thoracic duct by puncturing the retrocrural area where it was anatomically suspected to be located. Chylothorax improved thereafter. In cases without lymphangiographic thoracic duct visualization, TDD by puncturing the retrocrural space might improve refractory chylothorax., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Competing Interests: Declaration of competing interest The authors declare that they have no competing interests.

Objective: Wound dehiscence after cervical spine surgery is a well-known complication that can be a challenge for spine surgeons to manage, especially in cases of exposed implants. However, few studies have focused primarily on this phenomenon in cervical spine surgery to date. This investigation sought to determine the frequency of wound dehiscence following posterior cervical spine surgery and identify patient-based risk factors., Methods: The medical data of 405 consecutive patients (290 male and 115 female; mean age: 68.9 years) who underwent posterior cervical spine surgery were retrospectively examined. Logistic regression models were employed to examine the prevalence, characteristics, and risk factors of postoperative wound dehiscence., Results: We observed that 5.2% of cervical spine surgery patients experienced procedural postoperative wound dehiscence. In comparisons of dehiscence and non-dehiscence groups, significant differences were found for posterior instrumented fusion (81.0% vs. 45.3%; P < 0.01), extended T1 fusion (57.1% vs. 12.8%; P < 0.01), occipitocervical fusion (19.0% vs. 6.2%; P = 0.048), fused intervertebral levels (4.0 vs. 1.5; P < 0.01), surgical time (246 minutes vs. 165 minutes; P < 0.01), blood loss volume (228 mL vs. 148 mL; P = 0.023), and dialysis (14.3% vs. 1.8%; P = 0.011). Multivariate analysis identified extended T1 fusion and dialysis to be significantly associated with wound dehiscence with odds ratios of 5.82 and 10.70, respectively., Conclusions: The observed frequency of postoperative wound dehiscence in cervical spine surgery was 5.2%. As extended T1 fusion and dialysis may increase the risk of dehiscence after surgery, patients who display such risk factors may require additional observation and care., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: The management of cervical spine injuries in the elderly is often complicated by the presence of multiple medical comorbidities, and it is not uncommon for preoperative testing to reveal other conditions that require the postponement of surgery. However, the factors that affect the waiting time from injury to surgery have not been clarified. The purpose of this multicenter database study was to analyze the clinical features and identify the factors affecting the number of days waited between injury and surgery in elderly patients with a cervical spine injury., Methods: We retrospectively reviewed the case histories of 1512 Japanese patients with a cervical spinal injury, who were seen at 33 institutions. After excluding patients who were not initially receiving a surgery for cervical spinal injury, 694 patients were ultimately analyzed. Based on a multivariate mixed model, we determined the factors related to the number of days from injury to surgery., Results: The mean time from injury to surgery was 12.3 days. Multivariate analysis revealed delays of 10.7 days for a renal disorder, 7.3 days for anticoagulant use, and 15.2 days for non-surgical thoracolumbar fracture as factors prolonging wait time. In contrast, a C3 or lower spine injury was significantly associated with a shortening of 9.5 days to surgery., Conclusions: This multicenter database study identified several factors influencing the time between injury and cervical spine surgery in elderly patients. While renal impairment, anticoagulant use, and non-surgical thoracolumbar fracture may increase the number of days to surgery, trauma to C3 or lower may expedite surgical treatment., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The Japanese Scoliosis Society Morbidity & Mortality Committee performed a longitudinal nationwide complication survey of spinal deformity surgery from 2012 to 2017. The present study aimed to analyze the survey results and report the complication trends of pediatric spinal deformity surgery in Japan., Methods: All Japanese Scoliosis Society members were invited to participate in the survey. Diagnoses were grouped into idiopathic scoliosis, congenital scoliosis, neuromuscular scoliosis, other types of scoliosis, and pediatric kyphosis. Complications were grouped into death, blindness, neurological deficits (motor/sensory), infection, massive bleeding, hematoma, pneumonia, cardiac failure, deep vein thrombosis/pulmonary embolism, gastrointestinal perforation, and instrumentation failure., Results: The surveys were performed in 2012, 2014, and 2017. The overall complication rate decreased from 10.7% in 2012 to 8.1% in 2017. In particular, the complication rate in patients with idiopathic scoliosis decreased from 8.8% in 2012 to 4.0% in 2017. The complication rate of patients with neuromuscular scoliosis and kyphosis remained high. The rate of neurological deficits, especially in motor deficits, significantly decreased from 2.0% in 2012 to 0.7% in 2017, and tended to be highest in patients with kyphosis. The rate of massive bleeding was significantly decreased from 3.3% in 2012 to 0.8% in 2017, especially in patients with neuromuscular scoliosis (12.2-4.4%). However, patients with neuromuscular scoliosis had a high rate of postoperative pneumonia (3.7%, 2.6%, and 5.1%, respectively). The rate of instrumentation failure was also high (2.1%, 1.5%, and 2.2%, respectively), especially in patients with early onset idiopathic, congenital and other types of scoliosis., Conclusions: The overall surgical complication rates in pediatric patients decreased due to decreased rates of neurological deficits and massive bleeding, especially in patients with idiopathic scoliosis. However, the complication rates remain high in patients with neuromuscular scoliosis and kyphosis., Competing Interests: Declaration of competing interest Yu Yamato work at a donation-endowed laboratory in the Division of Geriatric Musculoskeletal Health and he has relevant financial relationship outside the submitted work with Medtronic Sofamor Danek Inc., Japan Medical Dynamic Marketing Inc., and Meitoku Medical institution Jyuzen Memorial Hospital. Morio Matsumoto has relevant financial activities outside the submitted work with Medtronic Sofamor Danek Inc., and Nuvasive Japan. The other authors declare no conflicts of interest., (Copyright © 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: The Japanese Scoliosis Society Morbidity & Mortality Committee performed a longitudinal nationwide complication survey of spinal deformity surgery from 2012 to 2017. The present study aimed to analyze the survey results and report the complication trends of adult spinal deformity surgery in Japan., Methods: All Japanese Scoliosis Society members were invited to participate in the survey. Adult spinal deformity was categorized into three groups by age: 20-39 years, 40-64 years and ≥65 years. Complications were grouped into death, blindness, neurological deficits (motor/sensory), infection, massive bleeding, hematoma, pneumonia, cardiac failure, deep vein thrombosis/pulmonary embolism, gastrointestinal perforation, and instrumentation failure., Results: The surveys were performed in 2012, 2014, and 2017. The overall complication rates were 21.6%, 26.0%, and 25.4%, respectively. The complication rates differed significantly by age group in all years such that older patients had a higher complication rate than younger patients. The rate of neurological deficits, particularly motor deficits, significantly increased in 2014 (3.1%-5.5%), and decreased in 2017 (4.3%). Massive bleeding and postoperative hematoma decreased significantly year by year (8.0%, 4.8%, 2.5% and 1.3%, 0.5%, 0.3%, respectively). The complication rate of instrumentation failure remained high, increasing without significant difference (5.2%, 5.8%, 6.5%, respectively), and was more common in the middle-aged and older patients., Conclusions: Surgical complication rates in patients with adult spinal deformity remain high, especially neurological deficits and instrumentation failure in patients aged over 40 years. However, the complication rates of massive bleeding and postoperative hematoma decreased over this period., Competing Interests: Declaration of Competing Interest Yu Yamato work at a donation-endowed laboratory in the Division of Geriatric Musculoskeletal Health and he has relevant financial relationship outside the submitted work with Medtronic Sofamor Danek Inc., Japan Medical Dynamic Marketing Inc., and Meitoku Medical institution Jyuzen Memorial Hospital. Morio Matsumoto has relevant financial activities outside the submitted work with Medtronic Sofamor Danek Inc., and Nuvasive Japan. The other authors declare no conflicts of interest., (Copyright © 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Locomotive syndrome (LS) was proposed by the Japanese Orthopedic Association and refers to a scenario in which imminent future nursing care services will be required by elderly adults to manage the functional deterioration of their locomotive organs. It is a social imperative to clarify the risk factors and treatment strategy for LS. However, the relationship between LS and adult spinal deformity (ASD) in those who are treated with spinal corrective surgery remains largely unknown., Methods: Forty consecutive patients who had ASD and underwent spinal surgery for their disorder were included in this study. Locomotive dysfunction was evaluated using the 25-item Geriatric Locomotive Function Scale-25 (GLFS-25) questionnaire and physical performance tests including the one-legged standing test, the two-step test, the stand-up test, the handgrip strength, and gait speed test which were measured preoperatively, 6 months after surgery, and 1 year after surgery., Results: Of the patients with ASD treated surgically, 95% of them had LS preoperatively and LS prevalence decreased significantly 1 year after surgery by 67.5% compared with the preoperative rate. Among physical performance tests, the walking stride and one-legged standing test improved significantly after spinal corrective surgery. The GLFS-25 items for the domains of pain, mobility, and domestic life improved overall postoperatively, whereas items in the self-care domain did not and the item for difficulty in putting on and taking off trousers and pants worsened., Conclusions: Spinal corrective surgery significantly improved physical performance tests as well as the frequency and severity of LS in patients with ASD. However, some GLFS-25 items can worsen after surgery and require attention., Competing Interests: Declaration of competing interest There are no conflict of interest. The manuscript submitted does not contain information about medical device(s)/drug(s). There were no relevant financial activities outside the submitted work. We did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors for this research., (Copyright © 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Musculocontractural Ehlers-Danlos syndrome caused by pathogenic variants in CHST14 (mcEDS-CHST14) is a recently delineated connective tissue disorder characterized by multisystem congenital malformations and progressive connective tissue fragility-related manifestations. With only 2 cases of mcEDS-CHST14 containing precise information on surgical spinal correction being reported to date, there remains no consensus on treatment standards. This study describes the detailed clinical and radiologic outcomes of the third known patient with mcEDS-CHST14 who successfully underwent surgery for severe kyphoscoliosis., Case Description: The patient was a 19-year-old girl with mcEDS-CHST14 who suffered from low back pain and decreased daily activities caused by progressive kyphoscoliosis. She underwent posterior spinal fusion with an all-pedicle screw construct from T4 to L4 for a preoperative main curve Cobb angle of 69 degrees and kyphotic angle of 27 degrees. Postoperative Cobb angle of the main curve and kyphotic angle were 26 and 6 degrees, respectively. Although sufficient correction was achieved without disseminated intravascular coagulation or other serious sequelae, a large amount of blood (2600 g) was lost due to tissue fragility. Her low back pain was decreased at 1 year after surgery., Conclusions: On the basis of the present and 2 earlier reported cases, posterior spinal fusion may be a reasonable surgical option for severe progressive spinal deformities in patients with mcEDS-CHST14. However, careful attention is needed for possible massive blood loss from tissue fragility., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Anomalous retro-psoas artery is an extremely rare congenital anomaly of the iliac arteries reported in the English-language literature. Using contrast-enhanced computed tomography, we incidentally diagnosed an anomalous retro-psoas artery in a 60-year-old male patient with right renal cancer. Although anomalous retro-psoas artery is extremely rare and mostly asymptomatic, knowledge of it is needed to avoid severe vascular complications in the event of vascular intervention and surgery., (© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: The purpose of this study was to determine the changes in the shape and volume of the infrapatellar fat pad (IPFP) associated with knee flexion angle in young healthy individuals., Methods: Young, healthy individuals without a history of knee injuries participated in this cross-sectional study. Behavior of the IPFP was quantified using three-dimensional (3D) models of the IPFP, patella, patellar tendon, femur, and tibia obtained from MRI taken at 0° and 30° flexion. The outcomes were movement and volume change of the IPFP, movement of the patella and the tibia, and change of the patellar tendon angle and length., Results: The anterior surface of the IPFP significantly moved anteriorly by 5.23 mm (p = .003) between 30° and 0°. Change in the volume of the IPFP was significantly increased or decreased in eight hyperoctants defined by the tibial coordinate system. The IPFP moved from the postero-supero hyperoctants to anterior hyperoctants. Significant correlations were observed between the IPFP and mobility of the patella, patellar tendon or tibia., Conclusion: The IPFP moves antero-inferiorly during quasi-static knee extension from 30 to 0° in young healthy individuals. Comparisons of IPFP behavior between the healthy and pathological knees may help us understand the role of IPFP and problems caused by IPFP contracture in future studies., Competing Interests: Declaration of competing interest Kazuyoshi Gamada is CEO of GLAB Corp. Inc., which had no influence on this study. No other authors have any conflicting interests to disclose., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Reducing the number of screw insertions while maintaining good clinical outcomes can improve the efficiency and cost-effectiveness of scoliosis surgery. However, the optimal minimum number of pedicle screws remains unclear. This study searched for factors to estimate the fewest number of pedicle screws required between end vertebrae in relation to preoperative main thoracic curve flexibility., Methods: Sixty-nine subjects (4 male and 65 female, mean age: 14.8 ± 2.5 years) who underwent skip pedicle screw fixation for Lenke type 1-4 or 6 curves and were followed for at least 1 year were enrolled. Intervention technique was selected according to the size and flexibility of the preoperative main thoracic curve. Surgery-related variables included pedicle screw number, rod material and diameter, and extent of Ponte osteotomy. The effect on postoperative correction angle (i.e., the difference between the preoperative supine position maximum bending and postoperative standing Cobb angles of the main thoracic curve) according to surgical intervention technique was estimated using multiple linear mixed regression models with the preoperative supine position maximum bending correction angle (i.e., the difference between the standing preoperative and supine position maximum bending Cobb angles) as a random effect., Results: The preoperative maximum bending correction angle was 8-42° and had a moderate negative correlation with postoperative correction angle (r = -0.65, P < 0.01). Multivariate analysis revealed a 1.7° (95% CI 0.7-2.6; P < 0.01) correction gain per single-screw insertion and a 1.8° (95% CI 0.5-3.1; P < 0.01) gain per intervertebral level in Ponte osteotomy., Conclusions: The number of pedicle screws necessary to correct main thoracic adolescent idiopathic scoliosis curves can be estimated by calculating correction gains of 1.7° per pedicle screw and 1.8° per Ponte osteotomy intervertebral level. Based on these results, it may be possible to reduce invasiveness and cost for patients requiring a smaller degree of correction., (Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Purpose: To evaluate the reproducibility of proton density fat fraction (PDFF) and T2* in a fat-water phantom on three different 3 T MRI systems using 6-point DIXON methods., Methods: A phantom which included varying fat volume percentages (true fat fraction [FF]) was scanned by three 3 T MR machines, and PDFF and T2* were measured., Results: The mean difference between true FF and PDFF was small in all vendors (-2.11% to 0.41%). However, the difference ratio for T2* values was large among vendors (1.79 to 3.36)., Conclusions: True FF and PDFF were consistent across vendors; however, T2* varied greatly., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: As the surgical treatment of scoliosis after a Fontan procedure is very challenging due to the risk of various perioperative complications, case reports are scarce. We herein describe three patients who were successfully treated for scoliosis following a Fontan procedure and discuss their clinical and radiological outcomes., Methods: We retrospectively reviewed three cases of scoliosis treated by posterior spinal fusion after a Fontan procedure., Results: Mean preoperative major curve Cobb angle was 83.7°, mean surgical time was 233.0 min, and mean blood loss was 1167 g. The mean correction rate of the major curve was 48.0%. Surgical outcome as evaluated by Scoliosis Research Society-22 patient questionnaires revealed acceptable results without any severe complications., Conclusions: Corrective surgery for scoliosis after a Fontan procedure becomes a stronger option if cardiac insufficiency is prevented during the perioperative period and a conservative plan is carried out with minimal invasiveness and operation time., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Purpose: In skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS), the mid-term effects of reducing screw number on correction and clinical results are uncertain. We clarified the mid-term outcomes of this technique in patients with Lenke type 1 and 2 AIS., Methods: Thirty-four patients who underwent skip pedicle screw fixation (mean screw density: 1.35 screws) for Lenke type 1 and 2 AIS were retrospectively reviewed. The follow-up period was at least 5 years (mean follow-up period: 6.1 years), and the follow-up rate was 89.5%. Radiological parameters and clinical symptoms were evaluated before, immediately after, and at 2 years and 5 years after surgery., Results: The mean Cobb angle of the main thoracic (MT) curve before, immediately after, at 2 years after surgery, and at the final 5-year minimum follow-up was 52.5°, 16.4°, 20.5°, and 19.4°, respectively. The Cobb angle of the MT curve was significantly improved immediately after, at 2 years after surgery, and at the final follow-up compared with that before surgery (p < 0.01). The mean correction rate immediately after surgery was 69.0% and the rate of correction loss at the final follow-up was 8.3%. All Scoliosis Research Society-22 patient questionnaire (SRS-22r) sub scores 5 years after surgery were significantly improved compared with those beforehand (p < 0.01)., Conclusions: Correction using skip pedicle screw fixation in AIS was well maintained from the initial follow-up measurements to the final follow-up. The SRS-22r sub scores at the final follow-up were significantly improved over preoperative levels., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: It is generally recognized that the main thoracic curve Cobb angle threshold for surgical correction is approximately 50 degrees in patients with adolescent idiopathic scoliosis (AIS). Although AIS with a Cobb angle of <50 degrees is sometimes treated surgically to improve cosmesis, the precise outcomes are unclear. This study analyzed the postoperative results for AIS with a main thoracic curve of 50 degrees., Methods: Thirty-nine consecutive patients with Lenke type 1-2 curves underwent posterior spinal fusion for AIS. These subjects were divided into the <50 degrees of main thoracic curve group (n = 14) and the ≥50 degrees group (n = 25). Clinical and radiographic data were compared., Results: The mean Cobb angle of the main thoracic curve before and at 2 years after surgery for the <50 degrees and ≥50 degrees groups was 44.5 and 60.3 degrees (p < 0.001) and 14.0 and 19.5 degrees (p = 0.016), respectively. Preoperatively, both groups had comparable Scoliosis Research Society-22 (SRS-22) scores (all p > 0.05). Patients with a Cobb angle of <50 degrees displayed significantly milder postoperative pain (4.7 vs. 4.3, p = 0.031), with no remarkable differences in other SRS-22 domain scores. These patients also had a significantly shorter operative time (194 vs. 235 min, p = 0.021) and fused level (9.2 vs. 10.8 vertebrae, p = 0.006) along with similar correction rate (68.1 vs. 65.8%, p = 0.622) and blood loss volume (932 vs. 1009 ml, p = 0.715)., Conclusions: Surgical correction of AIS with <50 degrees of main thoracic curve may less invasively achieve results that are comparable with those for AIS with 50 degrees or more, including improvements in self-image., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

We report a patient with Muenke syndrome who had repetitive apneic spell followed by focal status epilepticus in the early infancy. Ictal EEG showed focal spikes bursts originated from the left hemisphere and sifted to the right hemisphere, during which he had migrating tonic seizures from right side of the body to the left side of the body. Brain MRI showed abnormal development of bilateral hippocampus, which was characterized as abnormal folding of hippocampal gyri. However, the long-term seizure prognosis was favorable. Results from this and previous studies failed to support the notion that FGFR3 (P250) mutation results in epileptic encephalopathy., (Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Background: Residual leg numbness (LN) following lumbar surgery can lower patient satisfaction; however, prospective studies are sparse. The purpose of this study was to evaluate recovery from LN following decompression surgery for lumbar spinal stenosis (LSS)., Methods: A total of 145 patients with LSS were enrolled. All patients underwent decompressive surgery, with or without spinal fusion, followed by a 12 month prospective follow-up. The degree of LN and leg pain (LP) was assessed using the visual analog scale (VAS), a patient-reported outcome measure., Results: Six patients dropped out, and we evaluated 139 patients (average age, 68.1 years). The average VAS-LN scores were 5.9 ± 2.6, 1.8 ± 2.3, 2.0 ± 2.5, 2.1 ± 2.6, 2.2 ± 2.5, and 2.1 ± 2.6, and the average VAS-LP scores were 5.7 ± 2.8, 1.2 ± 1.7, 0.9 ± 1.5, 1.4 ± 2.0, 1.4 ± 2.0, and 1.4 ± 1.9 preoperatively and at 2 weeks, 3, 6, 9, 12 months following the surgery, respectively. Significant improvement in VAS-LN and VAS-LP scores was observed during the first 2 weeks after the surgery. At 12 months after the surgery, the VAS-LN score was significantly greater than the VAS-LP score. The change in the VAS-LN score between the preoperative and 12 month-postoperative values was significantly smaller than that in the VAS-LP score. Multivariate logistic analyses revealed that preoperative symptom duration and preoperative dural sac cross-sectional area (DCSA) were the significant independent predictive factors for residual LN., Conclusions: Following lumbar decompression surgery, LN improved significantly during the first 2 weeks after surgery. However, the improvement in the VAS-LN score was less than in the VAS-LP score. Patients with longer preoperative symptom duration and narrow preoperative DCSA showed less LN improvement., Level of Evidence: Level 3., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Lumbar decompression surgery is often used to treat neurological symptoms of the lower extremity as a result of lumbar disease. However, this method also leads to the improvement of the accompanying low back pain (LBP). We studied the extent of LBP improvement after lumbar decompression surgery without fusion and the associated preoperative factors., Methods: Patients (n = 140) with lumbar spinal stenosis (n = 90) or lumbar disc herniation (n = 50) were included. To evaluate the change in LBP, VAS scores and the Oswestry disability index scores were measured before surgery and 2 weeks, 3 months, and 6 months after surgery. The predictors of residual LBP were investigated using logistic regression analyses., Results: In total, 140 patients were examined. The VAS scores for LBP before surgery and 2 weeks, 3 months, and 6 months after surgery were 4.4 ± 3.0 (mean ± standard deviation), 1.1 ± 1.5, 1.3 ± 1.8, and 1.9 ± 2.2, respectively. LBP significantly improved 2 weeks after surgery (P < 0.001), stabilized between 2 weeks and 3 months after surgery, but was significantly aggravated 3-6 months after surgery (P < 0.001). At 6 months after surgery, 67 (47.9%) patients had a VAS score of >1. The predictors of residual LBP included severe preoperative LBP, degenerative scoliosis and the size of the Cobb angle. The independent predictors, determined by multivariate analysis were degenerative scoliosis and the size of the Cobb angle., Conclusions: LBP was alleviated at 2 weeks after lumbar decompression surgery for lumbar disc herniation and lumbar spinal stenosis. The predictors of residual LBP after decompression included more severe LBP at baseline, degenerative scoliosis and the size of Cobb angle., Level of Evidence: Level 3., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Study Design: A retrospective single-center and single-surgeon study., Objectives: This study investigated the clinical and radiological results of skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS)., Summary of Background Data: At present, the generally used technique for pedicle screw fixation for the surgical correction of AIS entails inserting a pedicle screw into every segment on the corrective side and into every or every other segment on the supportive side. To reduce operation time, blood loss, and cost, we developed skip pedicle screw fixation to achieve correction of AIS using fewer pedicle screws., Methods: We evaluated 62 consecutive patients who had undergone computer-assisted skip pedicle screw fixation from August 2005 to June 2014. All patients were followed up for at least two years. We investigated the clinical results of skip pedicle screw fixation for AIS., Results: The mean number of fused vertebrae was 10.3 ± 2.0, the mean surgical time was 242 ± 78 min, and the mean blood loss volume was 1060 ± 688 ml. The mean Cobb angle of main thoracic (MT) curve two years after surgery improved significantly compared with that before surgery (p < 0.01). The mean correction rate of MT curve immediately after surgery was 62.4 ± 12.4% and correction loss of MT curve at two years after surgery was 1.9 ± 5.8°. The SRS-22 subtotal score two years after surgery improved significantly compared to that before surgery (p < 0.01). Although no patients experienced major complications, eight (12.9%) encountered minor complications (two [3.2%] had massive blood loss [>3000 ml], three [4.8%] had a broken screw, one [1.6%] had a set-screw that dropped out, one [1.6%] experienced deep vein thrombosis, one [1.6%] experienced acute renal failure, and one [1.6%] experienced intercostal neuralgia). Revision surgery was not performed., Conclusions: Subjects with AIS who underwent skip pedicle screw fixation had significantly improved clinical and radiological parameters at two years after surgery, indicating that skip pedicle screw fixation could be used to successfully treat AIS., Level of Evidence: Level 4., (Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Gadolinium is highly toxic. Gadolinium-based contrast agents (GBCAs) consist of gadolinium ions and a chelating agent that binds the gadolinium ion tightly in order not to manifest its toxicity. Knowledge regarding gadolinium deposition in patients with normal renal function has advanced dramatically. Since 2014, increasing attention has been given to residual gadolinium known to accumulate in the tissues of patients with normal renal function. High signal intensity on T1-weighted images (T1WI) in the dentate nucleus, globus pallidus, and pulvinar region of the thalamus correlate roughly with the number of previous GBCA administrations. Pathological analyses have revealed that residual gadolinium is deposited not only in these brain regions, but also in extracranial tissues such as liver, skin and bone. The risks attendant with these deposits are unknown. Common sense dictates that gadolinium deposition be kept as low as possible, and that gadolinium contrast agents be used only when absolutely necessary, with preferential use of macrocyclic chelates, which seem to be deposited at lower concentrations., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Mutations in the elongation factor 1 alpha 2 (EEF1A2) gene have recently been shown to cause severe intellectual disability with early-onset epilepsy. The specific manifestations of mutations in this gene remain unknown., Case Report: We report two cases of severe intellectual disability accompanied by early-onset epilepsy with continuous delta activity evident on electroencephalography. Both cases presented with developmental delay and repetitive myoclonic seizures in early infancy. Both cases showed continuous high-voltage delta activity over both parietal areas when awake, as revealed by interictal electroencephalograms. After the emergence of continuous delta activity, development stagnated. One case showed some development after relief of the seizures and epileptic activity, but drug resistant seizures recurred, and the development again became stagnant. In both cases, a de novo recurrent heterozygous mutation in EEF1A2 [c.364G>A (p.E122K)] was identified by whole-exome sequencing., Conclusion: This report provides clinical data on epileptic encephalopathy in patients with EEF1A2 mutation. Continuous high-voltage delta activity seen over both parietal areas may be a unique manifestation of EEF1A2 mutation. Epileptic activity may aggravate the effect of the mutation on brain development., (Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Carcinoma-associated fibroblasts (CAFs) are associated with tumor progression and metastasis, and are able to activate estrogen receptor (ER) in breast cancer. We established a stable transformant of a human breast cancer cell line to detect CAF-specific ER-activating ability, and found that this CAF ability varied among tumors. Some studies have reported a high frequency of alterations among tumor suppressor genes in stromal cells, but do not generally agree as to the frequency. Moreover, the activation mechanism of CAF-induced estrogen signals, including the effects of these gene aberrations, is not fully understood. We investigated the relevance of tumor suppressor gene aberrations and ER-activating ability in CAFs derived from 20 breast cancer patients. Although CAF-specific ER-activating abilities varied among individual cases, all CAFs maintained wild-type alleles for TP53 and PTEN. Also, copy number aberrations in these genes were not observed in any CAFs. Our results suggest that the ER-activating ability of the CAFs is regulated independently of aberrations in these genes; and that other mechanisms of tumor-stromal interaction may affect activation of estrogen signals in breast cancer., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We described a 7-year-old girl with reversible cerebral vasoconstriction syndrome associated with brain parenchymal hemorrhage. She initially presented with high fever and pancytopenia, leading to a diagnosis of most severe type aplastic anemia. We treated her with cyclosporine, methylprednisolone and anti-thymocyte globulin. Thereafter she recurrently complained of a very severe headache called as thunderclap, and finally exhibited loss of consciousness. Brain imaging revealed massive parenchymal hemorrhage between the left occipital and parietal lobes on computed tomography, and diffuse cerebral vasoconstriction on magnetic resonance angiography. The cerebral vasoconstriction resolved within two months, and thus we diagnosed her as having reversible cerebral vasoconstriction syndrome associated with brain parenchymal hemorrhage. This syndrome has been frequently reported in adult females, but rarely in children. However, even in children, a so called thunderclap headache may become a clue for the diagnosis of reversible cerebral vasoconstriction syndrome, especially in cases taking immunosuppressive agents. Immediate magnetic resonance angiography is essential to diagnose this syndrome, and a prompt application of calcium channel inhibitors should be considered to resolve constriction of the vessels and to prevent subsequent brain damage., (Copyright © 2011 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

It remains to be clarified whether a positive sentinel lymph node biopsy (SLNB) can predict the number of metastatic axillary nodes. This study examined a consecutive series of women with unilateral invasive breast cancer who underwent axillary lymph node dissection after an intra-operative positive SLNB. The numbers of positive and negative sentinel lymph nodes (SLNs) were analyzed for a likelihood of pN1a, pN2a, and pN3a diseases as per the UICC TNM classification. Of the 368 study patients, 165 (45%) had one positive SLN and one or more negative SLNs. This result represented the most common combination of positive and negative SLNs. It was also the most predictive indicator (93%) of pN1a disease and the least predictive indicator (7% or 0%) of pN2a or pN3a disease, respectively. The numbers of positive and negative SLNs can predict the number of metastatic axillary nodes in breast cancer patients.

Ipsilateral breast tumor relapse (IBTR) is a potentially a significant problem after breast conserving surgery (BCS). With a median follow-up period of 64.7 months, IBTR occurred as a first relapse in 67 (3.0%) of a total of 2243 patients and distant recurrence occurred in 167 (7.4%). A positive surgical margin and the omission of radiotherapy (RT) were independently associated with IBTR. The five-year cumulative IBTR rates were 5.1% in patients with positive margins and 2.0% in the patients with negative margins. The five-year cumulative IBTR rates were 1.8% in patients with RT and 8.1% in patients without RT. IBTR was independently associated with distant-recurrence-free survival rates as well as age, nodal metastasis, lymphovascular invasion and progesterone receptor status. The five-year distant-recurrence-free survival rates were 81.9% in patients with IBTR and 93.2% in patients without IBTR. In order to prevent IBTR, a negative margin and the administration of RT are therefore considered to be important in patients who undergo BCS.