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Purpose: Corrective long spinal fusion is a widely accepted surgical method for patients with adult spinal deformities. However, instrumented long fusion is associated with a significant risk of complications. Therefore, we aimed to assess the success of short-segment spinal fusion, particularly for bone marrow edema (BME) adjacent to the vertebral endplate, in patients with low back pain (LBP) and spinal deformity. Methods: A prospective study was performed at multiple hospitals wherein we monitored patients with spinal deformities and accompanying LBP. Patients aged ≥ 50 years with a minimum LBP severity score of 40 mm on the visual analog scale (VAS) were included in the study. We also included patients with lumbar BME on magnetic resonance imaging. Short spinal fusion was performed on segments with BME. Clinical evaluations of LBP on VAS and Oswestry Disability Index (ODI), and radiological parameters for sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL) and pelvic tilt (PT) were carried out. Results: Overall, 35 patients (22 men and 13 women), with a mean age of 66.7 years and a mean follow-up period of 32 months, were included in the study. The mean VAS and ODI scores were 72.4 mm and 49.0% before surgery and 25.5 mm and 29.9% at the final follow-up, respectively; these parameters significantly improved after surgery. The SVA, PI-LL, and PT scores were 70.1 mm, 20.9°, and 22.8° before surgery and 85.4 mm, 13.8°, and 22.7° at the final follow-up, respectively. The spinal alignment parameters did not change significantly after surgery. Conclusions: Short-segment spinal fusion is effective for treating LBP and spinal deformity with BME adjacent to the vertebral endplate without spinal correction. [ABSTRACT FROM AUTHOR]

Purpose: To determine the relationship between postural sway and the severity of lumbar spinal canal stenosis as well as the effect on postoperative improvement. Methods: Stabilometry was performed before and 6 months after surgery in 52 patients (29 men and 23 women; mean age, 74.1 ± 7.8 years) who underwent decompression surgery for lumbar spinal canal stenosis. The environmental area (EA; the area surrounding the circumference of the stabilogram) and locus length per EA (L/EA) were evaluated. The patients were divided into moderate (n = 22) and severe (n = 30) groups according to the severity of canal stenosis. Patient characteristics and parameters were compared between the groups before and after surgery, including the visual analog scale (VAS) score for leg pain, Oswestry Disability Index (ODI), EA, and L/EA. In addition, factors affecting EA and L/EA were evaluated using multiple regression analysis. Results: Age (p = 0.031), preoperative EA (p < 0.001), preoperative L/EA (p = 0.032), and sagittal vertical axis (p = 0.033) were significantly different between groups. The VAS score and ODI significantly improved postoperatively in both groups (p < 0.001). The EA significantly improved postoperatively only in the severe group (p < 0.001), whereas the L/EA did not significantly improve in either group. Multiple regression analysis showed that only the severity of canal stenosis was significantly associated with preoperative EA (p = 0.030), whereas age (p = 0.040) and severity of canal stenosis (p = 0.030) were significantly associated with preoperative L/EA. Diabetes was significantly associated with postoperative EA (p = 0.046) and L/EA (p = 0.030). Conclusion: The severity of canal stenosis affected abnormal postural sway, which improved after decompression surgery. [ABSTRACT FROM AUTHOR]

Purpose: Surgical treatment for cervical myelopathy with athetoid cerebral palsy remains unestablished. Instrumented fusion is reported to have good clinical results; however, there are no data of decompression surgery for this pathology in recent years. This study aimed to assess the surgical outcomes of laminoplasty with or without posterior instrumented fusion for cervical myelopathy in patients with athetoid cerebral palsy. Methods: A multi-centre surgical series of patients with cervical myelopathy and athetoid cerebral palsy were enrolled in this study. All patients showed symptoms and signs suggestive of cervical myelopathy and underwent laminoplasty with or without instrumented fusion. The Japanese Orthopaedic Association (JOA) score, Barthel index (BI), and changes in the C2–C7 sagittal Cobb angle in the lateral plain radiograph were analysed. Results: There were 25 patients (16 men and 9 women; mean age, 54.4 ± 10.8 years) with cervical myelopathy and athetoid cerebral palsy who underwent surgical treatment. The mean follow-up period was 41.9 ± 35.6 months. Overall, the BI significantly improved after surgery, whereas the JOA score and C2–C7 angle did not improve postoperatively. The recovery rate of the JOA score in the laminoplasty group was significantly higher than that of the fusion group (P = 0.02). Conclusions: Cervical laminoplasty with or without instrumented fusion for treating cervical myelopathy due to athetoid cerebral palsy is effective in improving activities of daily living. Cervical laminoplasty may be an effective and less invasive surgical method for selective patients, especially for those with small involuntary movements and no remarkable cervical kyphosis nor instability. [ABSTRACT FROM AUTHOR]

Background: To determine the optimal treatment for spontaneous spinal epidural hematoma (SSEH). The aim of this study was to identify factors associated with SSEH. Methods: In 62 patients with SSEH, several patient-related parameters were analyzed as candidate factors associated with Frankel grade before treatment or at the last follow-up. These parameters were compared between patients with and without surgery. In addition, multivariate ordinal logistic regression analysis was used to identify factors significantly associated with Frankel's grade before treatment or at the last follow-up. Results: There were significant differences in age, location of the hematoma, and Frankel grade before treatment and at the last follow-up between surgical and nonsurgical cases in all patients, but there were no significant differences in any of these parameters when comparing patients with pre-treatment Frankel grade C. The location of the hematoma was significantly associated with the severity of paralysis before treatment. In surgical cases, the time from onset to surgery and the location of the hematoma was significantly associated with the prognosis. When the time from onset to surgery was evaluated using the criteria of 12, 24, and 48 h, 24 and 48 h had a significant impact on the prognosis. In the analysis of nonsurgical cases, only the vertical size of the hematoma was significantly associated with prognosis. Conclusion: The time from onset to surgery and the location of the hematoma were prognostic factors in surgical cases, while the vertical size of the hematoma was a prognostic factor in nonsurgical cases. [ABSTRACT FROM AUTHOR]

Purpose: Treatment of low back pain (LBP) associated with elderly degenerative lumbar scoliosis (DLS) remains controversial. We have developed percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI) targeting to the intervertebral vacuum as a minimally invasive surgery. The present study compared the long-term clinical outcomes of PIPI to that of nonoperative treatment. Methods: Patients with de novo DLS, aged ≥ 65 years, who had LBP with visual analog scale (VAS) of ≥ 50 for ≥ 6 months with intervertebral vacuum on computed tomography and bone marrow edema (BME) on magnetic resonance imaging were included. The clinical outcomes were evaluated using VAS and the Oswestry Disability Index (ODI) at baseline, 1, 6, 12, 24 months, and at the final follow-up. The course of BME was also evaluated. Results: One hundred and one patients underwent PIPI and 61 received nonoperative treatment. The mean follow-up duration after PIPI and nonoperative treatment was 63.7 ± 32.4 and 43.9 ± 20.9 months, respectively. VAS and ODI after PIPI were significantly improved compared to post-nonoperative treatment. BME decreased substantially in the PIPI group and it was significantly correlated with VAS and ODI improvement. Following PIPI, LBP recurred in 28 patients (35%). LBP recurrence was identified at the same level of PIPI in 10 patients, at the adjacent level of PIPI in 11 patients, and at the non-adjacent level of PIPI in seven patients. Eighteen patients underwent additional PIPIs, and both VAS and ODI were significantly improved after additional PIPIs. Conclusion: Bone marrow lesions of the endplate are strongly associated with the presence of LBP. PIPI can be considered as an effective, safe and repeatable treatment for LBP in elderly DLS patients. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to explore the anti-inflammatory effect, underlying mechanism, and chemistry of Halodule pinifolia extract. Methods: The ethyl acetate (EHP) and methanol (MHP) extracts of Halodule pinifolia were screened for pro-inflammatory cytokine inhibition effect under various in vitro (LPSand crystal-induced inflammation) and in vivo models (LPS-induced endotoxaemia model, carrageenan-induced paw oedema model, and oxalate-induced renal nephropathy model of inflammation). The effect of EHP on the expression of inflammatory markers using western blot analysis (in vitro) was investigated. Chemical constituents of bioactive EHP were isolated through chromatography and characterised using NMR spectroscopy. Furthermore, EHP was standardised for rosmarinic acid, vanillic acid, and ethyl protocatechuate using HPLC. Also, total phytosterols, phenolic, and flavonoid content of EHP were determined by UV spectroscopy. Key findings: EHP was comparatively more effective than MHP in inhibiting cytokines secretions under LPS-induced in vitro models. Furthermore, EHP was screened under endotoxaemia in vivo model, EHP (250 mg/kg) reduced plasma IL-6, TNF-α, and IL-1β levels by 88.3%, 78.2%, and 74.5%, respectively. In the carrageenan-induced oedema model, EHP (200 mg/kg) reduced paw volume and release of TNF-α (69.3%) and IL-1β (43.1%). EHP (200 mg/kg) further controlled renal nephropathy by inhibiting plasma IL-1β and BUN levels. Also, a significant reduction of mRNA expressions of TNF-α and IL-1β and KIM-1 in renal tissues was observed. Through western blot, EHP was identified to regulate the expression of pro-form as well as mature-form of IL-1β and caspase-1. EHP constituted rosmarinic acid (RA), vanillic acid (VA), ethyl protocatechuate (EP), sitosterol, stigmasterol, campesterol, and dihydrobrassicasterol. It was determined that 4.6 mg/g of RA, 2.92 mg/g of VA, 0.76 mg/g of EP, 21.7 mg/g of total phenolics, 29.8 mg/g of total flavonoids, and 48.2 mg/g of total phytosterols were present in dry EHP. The presence of anti-inflammatory constituents such as RA, VA, and PE in EHP corroborated the in vitro and in vivo anti-inflammatory activity of EHP. Conclusion: The anti-inflammatory property of EHP and its action through attenuation of pan-cytokines suggest that it can be developed into an oral pharmaceutical drug. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to explore the inhibition efficacy of new synthetic coumarinolignans (SCLs) against the secretion of pro-inflammatory cytokines in two in vivo models of inflammation. Methods: Four SCLs 1–4 were screened for their pro-inflammatory cytokine inhibitory potential through oral administration at a dose of 50 mg/kg body weight in lipopolysaccharide-induced mouse endotoxaemia and carrageenan-induced mouse paw oedema models. Levels of pro-inflammatory cytokines (IL-1β, TNFα and IL-6) in blood and paw tissue samples were estimated using ELISA. Paw oedema was measured using a plethysmometer. Results were compared with a natural coumarinolignan, cleomiscosin A (5), and the structure–activity relationship (SAR) was interpreted. Results and discussion: Compound 2 had the greatest potential in the endotoxaemia model, exhibiting 66.41%, 62.56% and 43.15% inhibition of plasma IL-1β, TNFα and IL-6 secretions, respectively. Further dose-dependent study revealed its anti-inflammatory potential even at dose of 10 mg/kg body weight with 24.42% decline in the level of IL-1β. Nevertheless, SCLs 1, 3 and 4 showed marked inhibitory activity with 57.54%, 51.48% and 62.46% reduction in the levels of IL-1β, respectively. Moreover, compound 2 decreased the plasma TNFα and IL-1β levels to 50.03% and 36.58% along with the reduction of paw oedema volume in the local inflammation induced by carrageenan. All compounds including cleomiscosin A (5) were more effective against IL-1β. By studying SAR, the presence of dihydroxyl groups in the phenyl ring of lignans was identified to be essential for the activity. Also, esterification of lignans and presence of a 4-methyl substituent in the coumarin nucleus were found to play some role in enhancing the activity. Conclusion: All four SCLs, especially compound 2, have shown vast potential to emerge out as promising anti-inflammatory drugs. [ABSTRACT FROM AUTHOR]

The aim of this study was to conduct a cross-sectional survey of investigations related to the bone mineral density (BMD) of both non-metastatic prostate cancer (NMPC) patients who have not yet received androgen deprivation therapy (ADT) and patients receiving prolonged ADT in Japan. Japanese male patients with NMPC who received continuous ADT or who were planning to receive ADT were enrolled in this study. Lumbar spine and femoral neck BMD was measured using dual-energy X-ray absorptiometry (DEXA). To assess patient characteristics, we searched medical records and questionnaires to determine whether they had any factors that could possibly affect BMD. A total of 230 patients with a mean age of 76.6 ± 6.4 years were evaluated. Of these, 151 (65.7%) were receiving ADT, and 79 (34.4%) had not yet received ADT. The mean duration of ADT was 37.4 ± 30.7 months. DEXA showed that as the duration of ADT increased, lumbar spine and femoral neck BMD decreased gradually (p = 0.0005 and p = 0.0014, respectively). Stepwise regression analyses revealed that the duration of ADT was a significant variable of both lumbar spine and femoral neck BMD. Moreover, as the duration of ADT increased, the prevalence of osteoporosis increased statistically (p = 0.0002). This study showed that ADT negatively affected lumbar spine and femoral neck BMD. It also showed a progressive increase in the prevalence of osteoporosis in Japanese NMPC patients with ADT. [ABSTRACT FROM AUTHOR]

The absolute stereochemistry of (+)-solaniol (5,8-dihydroxy-7-(2-hydroxypropyl)-2-methoxy-6-methyl-1,4-naphthoquinone) (1) was deduced to be S using Mosher's method. Our result did not accord with the R configuration of (+)-solaniol recently proposed by Maharjan et al., but agreed with the S configuration determined by X-ray crystallographic analysis by Kyekyeku et al. In addition, complete and unambiguous assignments of 13C NMR signals for 1 are reported. [ABSTRACT FROM AUTHOR]

The tea shot-hole borer beetle (TSHB, Euwallacea fornicatus) causes serious damage in plantations of tea, Camellia sinensis var. assamica, in Sri Lanka and South India. TSHB is found in symbiotic association with the ambrosia fungus, Monacrosporium ambrosium (syn. Fusarium ambrosium), in galleries located within stems of tea bushes. M. ambrosium is known to be the sole food source of TSHB. Six naphthoquinones produced during spore germination in a laboratory culture broth of M. ambrosium were isolated and identified as dihydroanhydrojavanicin, anhydrojavanicin, javanicin, 5,8-dihydroxy-2-methyl-3-(2-oxopropyl)naphthalene-1,4-dione, anhydrofusarubin and solaniol. Chloroform extracts of tea stems with red-colored galleries occupied by TSHB contained UV active compounds similar to the above naphthoquinones. Laboratory assays demonstrated that the combined ethyl acetate extracts of the fungal culture broth and mycelium inhibited the growth of endophytic fungi Pestalotiopsis camelliae and Phoma multirostrata, which were also isolated from tea stems. Thus, pigmented naphthoquinones secreted by M. ambrosium during spore germination may prevent other fungi from invading TSHB galleries in tea stems. The antifungal nature of the naphthoquinone extract suggests that it protects the habitat of TSHB. We propose that the TSHB fungal ectosymbiont M. ambrosium provides not only the food and sterol skeleton necessary for the development of the beetle during its larval stages, but also serves as a producer of fungal inhibitors that help to preserve the purity of the fungal garden of TSHB. [ABSTRACT FROM AUTHOR]

We conducted a cross-sectional study and found that intervertebral vacuum without bone marrow edema (BME) was not related to LBP but bone marrow lesions on MRI are closely associated with the presence of LBP in elderly DLS [[1]]. 2015; 44: 1-7. 10.1007/s00132-014-3060-1 6 Sola C, Camino Willhuber G, Kido G, Pereira Duarte M, Bendersky M, Mereles M, Petracchi M, Gruenberg M. Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients. Thank you for your interest in our paper entitled " I Long-Term Outcome of Targeted Therapy for Low Back Pain in Elderly Degenerative Lumbar Scoliosis i .". [Extracted from the article]

The study was aimed at exploring cytotoxic activity of Oldenlandia umbellata and its chemical constituents. Cell viability assay of crude methanolic extract of aerial parts of O. umbellata (HUM), its ether soluble fraction (HUM-E) and butanol soluble fraction (HUM-B) against colon cancer HT-29, lung epithelial A549 and breast adenocarcinoma MDA-MB-231 cell lines showed HUM-E to be significantly cytotoxic with IC values of 25.7, 67.7 and 69.3 μg/mL, against HT-29, A549 and MDA-MB-231, respectively. Chemical investigation of HUM-E and HUM-B resulted in the isolation of a novel symmetrical coumarin dimer named oledicoumarin ( 1), together with eleven known compounds, hedyotiscone B ( 2), cedrelopsin ( 3), pheophorbide A methyl ester ( 4), deacetyl asperuloside ( 5), scandoside methyl ester ( 6), asperulosidic acid ( 7), scandoside ( 8), nicotinic acid ( 9), 6α-hydroxy geniposide ( 10) anthragallol 1,2-dimethyl ether ( 11) and anthragallol 1,3-dimethyl ether ( 12). All compounds were isolated for the first time from O. umbellata except anthragallols. This is the foremost report exploring the presence of coumarin derivatives in O. umbellata. Testing of cytotoxicity of isolated constituents revealed that compounds 3, 4, 11 and 12 showed significant inhibition against A549 cells with IC values of 3.6-5.9 μg/mL. Compounds 4, 11 and 12 showed marked inhibitory effect against MDA-MB-231 cells (IC 3.6-9.1 μg/mL). Compounds 4 (IC 1.7 μg/mL) and 7 (IC 6.1 μg/mL) were highly active against HT-29 cells. In summary, the less polar fraction of O. umbellata and its constituents were found to be cytotoxic. [ABSTRACT FROM AUTHOR]

Flacourtia inermis Roxb. (Flacourtiaceae), is a moderate sized tree cultivated in Sri Lanka for its fruits known as Lovi. The current study was undertaken to study the biological activity of extracts of the fruits in an attempt to increase the value of the under exploited fruit crops. Fruits of F. inermis were found to be rich in phenolics and anthocyanins. Polyphenol content of the fruits was determined to be 1.28 g gallic acid equivalents per 100 g of fresh fruit and anthocyanin content was estimated as 108 mg cyanidin-3-glucoside equivalents per 100 g of fresh fruits. The EtOAc extract showed moderate antioxidant activity in the DPPH radical scavenging assay with IC value of 66.2 ppm. The EtOAc and MeOH extracts of the fruits also exhibited inhibitory activities toward α-glucosidase, α-amylase and lipase enzymes with ICvalues ranging from 549 to 710 ppm, 1021 to 1949 ppm and 1290 to 2096 ppm, respectively. The active principle for the enzyme inhibition was isolated through activity-guided fractionation and was characterized as ( S)-malic acid. The results of this study indicate that F. inermis fruits have the potential to be used in health foods and in nutritional supplements. [ABSTRACT FROM AUTHOR]

Introduction: The number of cases of osteoporotic vertebral compression fracture (OVCF) with intravertebral cleft (IVC) with delayed neurologic deficit (DND) is increasing as the population ages. However, the cause of DND is poorly understood, and no definitive treatment of the disease has been established. The purpose of this study was to clarify the radiographic parameters contributing to the occurrence of DND, and to evaluate the efficacy and safety of percutaneous vertebroplasty for this pathology. Methods: Percutaneous vertebroplasty was prospectively performed for 244 patients with OVCF with IVC; 30 had DND and 214 did not. Radiographic parameters of local kyphotic angle, percent spinal canal compromise and intravertebral instability were investigated for correlations to DND. Procedural outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Frankel grades. Results: Before vertebroplasty, no substantial difference in local kyphotic angle was seen between OVCF with IVC with and without DND, but percent spinal canal compromise and intravertebral instability were greater in OVCF with IVC with DND ( P < 0.001). After vertebroplasty, 25 of 30 cases (84 %) of OVCF with IVC with DND achieved clinically meaningful improvement (CMI), but 5 (17 %) did not. Patients with CMI showed substantial improvements in intravertebral instability ( P < 0.001), and no change in local kyphotic angle or percent spinal canal compromise. In five patients without CMI, four showed an initial improvement, but subsequent vertebral fracture adjacent to the treated vertebra caused neurologic re-deterioration. One patient with percent spinal canal compromise 54.9 % and intravertebral instability 4° achieved no neurologic improvement following vertebroplasty. No serious complications or adverse events related to the procedure were encountered. Conclusions: Intravertebral instability is the dominant cause of DND. Percutaneous vertebroplasty appears effective and safe in the treatment of OVCF with IVC with DND. Patients with less intravertebral instability and severe spinal canal compromise could be candidates for conventional surgical treatment. [ABSTRACT FROM AUTHOR]

Motor evoked potentials (MEPs) study using transcranial magnetic stimulation (TMS) may give a functional assessment of corticospinal conduction. But there are no large studies on MEPs using TMS in myelopathy patients. The purpose of this study is to confirm the usefulness of MEPs for the assessment of the myelopathy and to investigate the use of MEPs using TMS as a screening tool for myelopathy. We measured the MEPs of 831 patients with symptoms and signs suggestive of myelopathy using TMS. The MEPs from the abductor digiti minimi (ADM) and abductor hallucis (AH) muscles were evoked by transcranial magnetic brain stimulation. Central motor conduction time (CMCT) is calculated by subtracting the peripheral conduction time from the MEP latency. Later, 349 patients had surgery for myelopathy (operative group) and 482 patients were treated conservatively (nonoperative group). CMCTs in the operative group and nonoperative group were assessed. MEPs were prolonged in 711 patients (86%) and CMCTs were prolonged in 493 patients (59%) compared with the control patients. CMCTs from the ADM and AH in the operative group were significantly more prolonged than that in the nonoperative group. All patients in the operative group showed prolongation of MEPs or CMCTs or multiphase of the MEP wave. MEP abnormalities are useful for an electrophysiological evaluation of myelopathy patients. Moreover, MEPs may be effective parameters in spinal pathology for deciding the operative treatment. [ABSTRACT FROM AUTHOR]

We studied the serum phosphorus (P) level of 110 patients with multiple myeloma (MM) (age range 42–83 years, median 62 years) and evaluated the relationship between that and other prognostic factors. Serum P level significantly correlated with the prognostic factors that are relevant to renal dysfunction: serum creatinine ( P<0.00000001), serum β2-microglobulin ( P=0.00000088), serum uric acid ( P=0.0000014), and corrected serum calcium (cCa P=0.000067). Although it also correlated with the percentage of plasma cells in bone marrow nucleated cells (BMPC%) and the hemoglobin (Hb) and leukocyte counts, the significance was less than for the other four prognostic factors. Serum creatinine, BMPC%, leukocyte count, serum uric acid, bone lesions, β2-microglobulin, and serum cCa were all significantly higher and Hb significantly was lower in the MM patients with hyperphosphatemia (serum P>3.8 mg/dl). The survival time was significantly shorter in these patients ( P=0.000087). Multivariate analysis (Cox’s proportional hazards regression model) showed that the serum P level is a significant negative prognostic factor in MM patients. [ABSTRACT FROM AUTHOR]

Background: As the immature spinal cord was nerve growth permissive, we examined glial reactions that influence regeneration of the spinal cord in a fetal rat spinal cord injury model. Methods: Three, 7, 21, and 35 days after intrauterine surgery, offsprings were killed and the thoracic and lumbar spinal cords were carefully removed from the spinal column and then cut into 10 μm longitudinal sections. These sections were stained with hematoxylin-eosin, anti-glial fibrillary acidic protein antibody (GFAP) as a marker of astrocytes, and anti-complement CR3 antibody (OX-42) as a marker of microglia. A cordotomy model in a young adult rat was utilized as a control. Results: In the present study, collagen fibers and scar formation were seen in the severed spinal cords of mature rats, but scar formation was not seen in the fetal rat cordotomy group, regardless of spinal continuity. In the control group, biological activity of GFAP-positive cells increased over time. In the fetal rat cordotomy model, activity elevated slightly immediately after cordotomy, and disappeared shortly thereafter. In the control group, OX-42-positive macrophage-like cells proliferated over time. However, in the fetal rat cordotomy model, OX-42- positive macrophage-like cells were recognized on postoperative days 3 and 7, and then disappeared. At 5 mm from the cordotomy site, reactive microglia were recognized in the white matter of control group spinal cords, but these microglia were not recognized in the fetal rat cordotomy model. Conclusions: In the present study, collagen fibers and scar formation were seen in the severed spinal cords of adult rats, but scar formation was not seen in the fetal rat cordotomy group. Lack of inflammation and scar formation thus appear advantageous for regeneration of the fetal spinal cord. Between fetal and mature rats, chronological changes in the immunohistochemical reactions of astrocytes and microglia following cordotomy were compared, and the results confirmed many differences. The results of the present study suggest that the presence of activated glial cells around damaged central nervous tissue and the quick disappearance of these cells after injury are important for the repair of damaged central nervous system tissue, and that the role of glial cells in nerve regeneration can change depending on the level of maturity of glial cells or surrounding cells, site of injury, or the state of tissue around the injury. [ABSTRACT FROM AUTHOR]

The ligamentum flavum is considered to be one of the important causes of radiculopathy in lumbar degenerative disease. Although there have been several reports anatomically examining the positional relationship between the ligamentum flavum and nerve root, there are few reports on ventral observation. The purpose of this study is to clarify the shape of the ligamentum flavum seen ventrally, and to obtain anatomic findings related to nerve root compression. The subjects were 18 adult embalmed cadavers, with an average age of 78 years at the time of death. The ventral shapes of the ligamentum flavum were observed. The relationships between the morphological change of the ligamentum flavum and nerve root compression or radiographic findings were statistically evaluated. Among the shapes of the ligamentum flavum, bulging of the ligament was most frequently observed. Proximal bulging indicates the type with the cranial portion bulging from the subarticular zone to the foraminal zone of the ligamentum flavum. In this type associated with a decrease in disc height, nerve root compression was frequently observed. Thus, we could more realistically grasp the relationship between bulging morphology of the ligamentum flavum and nerve root compression. [ABSTRACT FROM AUTHOR]

This article cites a study that identified independent prognostic factors for survival in patients with renal cell carcinoma after curative surgery. The records of 482 patients who underwent curative surgery for renal cell carcinoma at Gifu University Hospital and its affiliated hospitals between 1991 and 2000 were reviewed. The average follow-up period was 42 months. Clinical characteristics of the 482 patients were divided into three categories: patient factors, tumor factors, and treatment factor. Stepwise multivariate Cox proportional hazards regression modeling was performed to identify independent determinants of survival. Of the patient factors, performance status and mode of tumor discovery were independent factors predicting survival. Of the tumor factors, venous invasion and mode of infiltration were independent factors predicting survival.

To clarify whether genetic polymorphisms in exon 14 of Coagulation factor XIII A-subunit gene ( FXIIIA) affect phenotype expressions, we studied genetic polymorphisms in exon 14 of FXIIIA in a Japanese population and the relationship between the genetic polymorphisms and phenotype expression. Genetic polymorphisms in exon 14 of FXIIIA of 144 unrelated Japanese were analyzed by single-strand conformation polymorphism. Plasma FXIIIA antigen concentrations, FXIII activities, and phenotype were also determined by two-dimensional electrophoresis. The frequencies of the three genotypes, the homozygote (AD), the homozygote (BC) and the heterozygote (AD/BC), were 77.1, 0.7, and 22.2%, respectively. The gene frequencies of AD and BC were 0.88 and 0.12. We detected AD (GTTand BC (ATTat codon 650 and 651 of exon 14. There were no significant differences of FXIIIA antigen concentrations and FXIII activities between these genotypes. We detected three pl differences among them as being pls of 5.3, 5.6, 5.8 in the homozygote (AD) and the heterozygote (AD/BC), and a pl of 5.8 in the homozygote (BC). These polymorphisms affected isoelectric mobility, but did not affect protein levels, enzyme activities, or the molecular weight of FXIII. [ABSTRACT FROM AUTHOR]

Previous studies have suggested that spinal cord compression by the vertebral bodies and intervertebral discs during neck flexion cause cervical flexion myelopathy (CFM). However, the exact pathophysiology of CFM is still unknown, and surgical treatment for CFM remains controversial. We examined retrospectively patients with CFM based on studies of the clinical features, neuroradiological findings, and neurophysiological assessments. The objectives of this paper are to investigate the pathophysiology of CFM, and to examine an optimal surgical treatment. Twenty-three patients (20 male, three female) with age of onset ranging from 11 to 23 years (mean 15.7 years) were examined for the study. All patients were inspected by magnetic resonance imaging (MRI), myelogram, or computed tomographic myelogram (CTM) of the cervical spine. In eight patients, dynamic motor evoked potentials (MEP) studies were performed. Five patients underwent surgical treatment; two patients had cervical duraplasty with laminoplasty, two patients had musculotendinous transfer, one patient had both of these procedures, and the remaining 18 patients were treated conservatively. Amyotrophy of the hand intrinsic and flexor muscle group of the forearm except the brachioradial muscle was observed hemilaterally in 20 patients and bilaterally in three patients. In three patients, T1-weighted MRI with neck flexion showed linear high intensity regions in the epidural space. In all patients, axial MRI/CTM demonstrated flattening of the spinal cord with the posterior surface of the dura mater shifting anteriorly. The amplitude of MEPs decreased after cervical flexion in two patients with progressive muscular atrophy. In three patients, dysesthesia of the upper extremities disappeared following cervical duraplasty. Musculotendinous transfer for three patients significantly improved the performance of their upper extremity. The findings of this study suggest that degenerative changes of the dura mater may be a characteristic pathology of CFM. Cervical duraplasty with laminoplasty is effective for cases at an early stage, and musculotendinous transfer should be selected in patients at a late stage. [ABSTRACT FROM AUTHOR]

We investigated the expression and genomic alteration of nm23-H1 (which encodes a nucleoside diphosphate, kinase A) in 12 human hepatocellular carcinomas (HCCs) and four hepatoma cell lines. The expression of nm23-H1 protein was significantly reduced in HCCs with intrahepatic metastasis (72%) compared with expression in HCCs without intrahepatic metastasis (38%). However, in two of three HCCs examined that had marked reduction of nm23-H1 protein, the nm23-H1 mRNA level was not reduced. A hepatoma cell line, HLF (phenotype, poorly differentiated carcinoma) revealed marked reduction of nm23-H1 protein compared with two other hepatoma cell lines, HuH-1 and HuH-2, although the mRNA level was similar in the three cell lines. No allelic deletion of the nm23-H1 gene was detected in the 12 HCCs examined. No point mutation in the coding region of the nm23-H1 gene was observed in any of the 12 HCCs or the four hepatoma cell lines. These findings suggest that: (i) the expression of nm23-H1 protein is inversely associated with high metastatic potential of HCC, (ii) regulation of nm23-H1 expression may occasionally occur at both the transcriptional and post-transcriptional levels in HCC; and (iii) genomic alteration of nm23-H1 is a rare event in HCC. [ABSTRACT FROM AUTHOR]

We report changes in free radical-metabolizing enzymes and the increased generation of lipid peroxides associated with extreme metal accumulation in the liver of the Long-Evans with cinnamon-like coat color (LEC) rat, a new mutant strain displaying hereditary hepatitis and subsequent hepatocellular carcinoma. The activity of free radical-metabolizing enzymes and lipid peroxides, and the concentration of metal in the liver were determined sequentially after birth. Mn-superoxide dismutase activity significantly increased immediately after the onset of hepatitis in LEC rats, whereas no remarkable change was observed in control rats. Cu, Zn-superoxide dismutase activity in LEC rats was similar to that in control rats. Glutathione reductase activity increased, while glutathione peroxidase activity was lower in LEC rats than in control rats throughout the observation periods. Lipid peroxides, estimated by thiobarbituric acid reaction, also increased 4- to 5-fold immediately after the onset of hepatitis in LEC rats. Copper concentration was 30- to 50-fold higher in the liver of LEC rats than in control rats, and the iron content also increased significantly before and after the onset of hepatitis. These findings suggested that an oxidant injury generated by toxic metals could be one of the factors responsible for hepatocellular damage in this unique hereditary hepatitis. [ABSTRACT FROM AUTHOR]

Fischer rats became resistant to syngeneic hepatocellular carcinoma (FAA-HTC1) cells on repeated sensitization with mitomycin C-treated FAA-HTC1 cells. In contrast, FAA-HTC1 cells injected into the liver killed normal control Fischer rats within 2 months. Histopathological studies revealed massive accumulation of mononuclear cells in the tumor tissues of sensitized rats that rejected syngeneic FAA-HTC1 cells, whereas very few mononuclear cells were found in the tumor tissues of control rats. Cell populations infiltrating the tumor tissues were identified by flow cytometric analysis. Mononuclear cells found within the regressing tumors of the sensitized rats were identified as mostly T cells, and two-thirds of these T cells were CD8-positive. Compared with the activity in control rats, the killer activity of mononuclear cells infiltrating tumors was significantly increased in the sensitized rats 7 days after tumor inoculation. Depletion of CD8(+) T cells significantly reduced the cytotoxicity of mononuclear cells infiltrating tumors obtained from sensitized rats. In contrast, depletion of CD16(+) cells reduced the cytotoxicity of mononuclear cells infiltrating tumors obtained from both control and sensitized rats. Furthermore, the CD16(+) cell-depleted fraction of mononuclear cells infiltrating tumors showed significant cytotoxicity against FAA-HTC1 cells, but failed to show cytotoxicity against other syngeneic tumor cells or allogeneic hepatoma cells. [ABSTRACT FROM AUTHOR]

The effectiveness of adjuvant chemotherapy in transitional cell carcinoma of the bladder (T/G and >=T) and the upper urinary tract were evaluated. Among a group of 136 patients (male 107, female 29) with such tumors, complete tumor resection was possible in 108, in whom durationof survival and disease-free interval with or without chemotherapy were compared. The combination of antineoplastic agents used was changed from 5-fluorouracil (5-FU)+vincristine (VCR)+bleomycin (BLM) or pepolomycin (PEP)+mitomycin C (MMC) or 5-FU+VCR+PEP+cyclophosphamide (CPM)+adriamycin (ADM) to CPM+ADM+ cis-platinum (DDP) or methotrexate (MTX)+vinblastine (VBL)+ADM+DDP. Of the 59 patients in the chemotherapy group, 23 (39%) had side effects due to the treatment; however, fever and gastrointestinal symptoms were the chief adverse effects and were well tolerated. The 5-year survival rate and mean disease-free interval in the chemotherapy group were 76.3% and 24.6+ months, respectively, in bladder cancer patients, and 78.2% and 25.8+ months in those with upper urinary tract tumors. However, in the nonchemotherapy group ( n=49) the corresponding values were 62.7% and 21.1+ months in patients with bladder cancer and 67.3% and 42.0+ months in those with upper urinary tract tumor. There was a statistically significant difference ( P<0.05) in the disease-free intervals of the two treatment groups for bladder cancer patients. Recurrence, regardless of time, was observed in 25% of chemotherapy cases and in 65% of non-chemotherapy cases, and this difference was also statistically significant ( P<0.001). These results suggest that adjuvant chemotherapy for uroepithelial transitional cell carcinoma may be effective in extending survival and significant by protracting the disease-free period, especially in cases of advanced bladder cancer. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a study on Multiple Myeloma, a B-cell Malignancy.

The article presents a letter to the editor reporting an observed case of splenic vein aneurysm that developed and enlarged with the advance of portal hypertension.