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Thoracolumbar (TL) burst fracture is one of the most common indications for minimally invasive percutaneous pedicle screw fixation. Although the indication for surgical treatment of neurologically intact TL fractures remains under debate, studies have demonstrated that posttraumatic malalignment may lead to a deterioration in the patient's quality of life. For burst fractures with malalignment or fragments in the spinal canal, a reduction technique using ligamentotaxis is commonly used to improve long-term outcomes. The sagittal adjusting screw (SAS) system is a monoaxial screw system with a fixed head and concave sliding saddle that allows lordotic sliding of the rod in the sagittal plane after screw insertion. SAS also has a percutaneous option and has been used for TL spine fractures. Notably, the SAS only allows motion on the sagittal plane, allowing both secure fixation and angular reduction. The SAS has certain advantages over the conventional Schanz screw system or normal mono-/multiaxial pedicle screws for TL spine fracture treatment. In addition, specialized trauma reduction devices are available for the SAS system. In this video protocol, we discuss the indication for the SAS system in TL burst fracture and describe a technique of TL burst fracture reduction and fixation using the SAS system. Additionally, we describe our recent case series with radiological evaluation, including regional kyphotic angle and percent loss of anterior vertebral body height, to evaluate the newly introduced trauma reduction device.

Proximal junctional kyphosis and failure is a common complication of adult spinal deformity surgery, with osteoporosis as a risk factor. This retrospective study investigated the influence of long thoracolumbar fusion with pelvic fixation on regional bone density of adjacent vertebrae (Hounsfield units on computed tomography) and evaluated the association between bone loss and the incidence of proximal junctional kyphosis and failure. Patients who underwent long thoracolumbar fusion (pelvis to T10 or above) or single-level posterior lumbar interbody fusion (control group) between 2016 and 2022 were recruited. Routine computed tomography preoperatively and within 1-2 weeks postoperatively was performed. Postoperative changes in Hounsfield unit values in the vertebrae at one and two levels above the uppermost instrumented vertebrae (UIV + 1 and UIV + 2) were evaluated. Overall, 127 patients were recruited: 45 long fusion (age, 73.9 ± 5.6 years) and 82 proximal junctional kyphosis and failure (age, 72.5 ± 9.3 years). Postoperative computed tomography was performed at a median [interquartile range] of 3.0 [1.0-7.0] and 4.0 [1.0-7.0] days, respectively. In both groups, Hounsfield unit values at UIV + 2 were significantly decreased postoperatively. In the long-fusion group, Hounsfield unit values at UIV + 1 and UIV + 2 were significantly lower in patients with proximal junctional kyphosis and failure (within 18 months postoperatively) than in those without proximal junctional kyphosis and failure. Proximal junctional kyphosis and failure and long thoraco-pelvic fusion negatively affect regional Hounsfield unit values at adjacent levels immediately after surgery. Patients with subsequent proximal junctional kyphosis and failure show greater postoperative bone loss at adjacent levels than those without., (© 2024 Orthopaedic Research Society.)

Pyogenic spondylitis is generally managed conservatively; however, surgical intervention may be required depending on the patient's condition. In this report, we present a case of upper thoracic pyogenic spondylitis with a paravertebral abscess that was successfully treated using negative pressure wound therapy (NPWT) combined with a cranked rod construct and a minimally invasive posterior-only approach. This report was constructed based on previous medical records and imaging findings. A 51-year-old man with a paravertebral abscess developed pyogenic spondylitis of the upper thoracic spine (T2 and T3). Surgical treatment was chosen due to severe neurological deficits and the presence of a paravertebral abscess. However, a posterior approach for drainage and debridement was implemented to avoid damage to proximal organs. Posterior instrumented fixation surgery from the cervical spine (C6) to the thoracic spine (T6) was performed to reduce pain and maintain alignment owing to the instability of the affected vertebrae. After pedicle screw insertion, open debridement and drainage of the T2/T3 disc space and paravertebral abscess were performed using a costotransversectomy window. Because debridement was only partially possible intraoperatively with the posterior approach, NPWT was used in combination with this approach to ensure continuous postoperative drainage. To avoid exposure of the metal instrumentation to the contaminated area, the right-side rod was passed around the drainage side with connectors. Two weeks after NPWT, the wound was closed under general anesthesia. Herein, we describe the successful treatment of primary pyogenic spondylitis with a paravertebral abscess in the upper thoracic spine using posterior instrumentation surgery combined with NPWT. In cases where complete debridement of infected tissue is not achieved, NPWT may serve as a valuable adjunctive treatment., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hayakawa et al.)

Background: The scoring system for bile cytology (SSBC) aims to improve bile cytology diagnostic accuracy. Here, the practicality of SSBC was verified by multiple cytotechnologists., Methods: Bile cytological specimens were evaluated by 24 cytotechnologists using SSBC. The samples were assessed before using the SSBC (first-time assessment) according to three categories: benign, indeterminate, and malignant. A first scoring evaluation (FSE) was then performed using SSBC; each item in the scoring system was classified as present or absent. After distributing an instruction sheet with diagnostic criteria, a second scoring evaluation (SSE) was performed using SSBC. Each method was evaluated using diagnostic accuracy and interobserver and intraobserver agreement., Results: Several samples were assessed as indeterminate in the first-time assessment. Although the specificity of the SSE improved, the sensitivity and accuracy decreased compared with those of the FSE. The overall interobserver agreement was fair for all parameters, including abnormal chromatin, irregular internuclear distances, irregularly overlapped nuclei, irregular cluster margins, and final evaluation in the FSE and SSE. The final evaluation by histological type exhibited slight agreement for well-differentiated tubular adenocarcinoma and almost perfect agreement for poorly differentiated tubular adenocarcinoma in the FSE and SSE. For moderately differentiated tubular adenocarcinoma, agreement was moderate in the FSE and fair in the SSE. For cholangitis, a slight agreement was observed in the FSE, which improved to fair in the SSE., Conclusions: Although the SSBC is expected to improve specificity, there exists ambiguity regarding SSBC criteria and interindividual assessment differences. Therefore, the objective assessment method should be revised., (© 2024 Wiley Periodicals LLC.)

The objective of the present study was to evaluate the risk factors and outcomes associated with hyponatremia in patients with Guillain-Barré syndrome (GBS). We retrospectively studied 80 consecutive patients with GBS who visited our hospital and compared clinical, laboratory, and electrophysiological findings of patients with and without hyponatremia. Disability was evaluated using the Hughes grading system. Of the 80 patients, 18 (23%) had hyponatremia. Hyponatremia was significantly associated with older age (P = 0.003), urinary retention (P < 0.0001), Hughes grade ≥ 4 at admission and nadir (P = 0.003 and P < 0.001, respectively), acute inflammatory demyelinating polyneuropathy subtype (P = 0.017), sepsis (P = 0.001), mechanical ventilator support (P = 0.013), longer hospitalization length of stay (P < 0.0001), and inability to walk independently at 6 months (P < 0.001). Multivariate analysis performed to assess the risk factors of hyponatremia revealed that urinary retention (odds ratio [OR] 30.7, 95% confidence interval [CI] 3.6-264.4; P = 0.002) and mechanical ventilator support (OR 13.8, 95% CI 1.6-118.0; P = 0.017) were significant independent risk factors of hyponatremia. In assessing the outcomes of patients with hyponatremia, multivariate analysis showed that hyponatremia was independently associated with hospitalization length of stay ≥ 60 days and inability to walk independently at 6 month, with the former showing statistical significance but the latter not (OR 9.3, 95% CI 1.8-47.7; P = 0.007 and OR 4.9, 95% CI 0.9-26.3; P = 0.066, respectively). Therefore, we demonstrate that, along with mechanical ventilator support, urinary retention-possibly indicating autonomic dysfunction-is a risk factor of hyponatremia in GBS. Moreover, we confirm that hyponatremia is associated with poor outcome in GBS., (© 2024. The Author(s).)

Background: Thoracolumbar junctional kyphosis (TLJK) due to osteoporotic vertebral fracture (OVF) negatively impacts patients' quality of life. The necessity of pelvic fixation in corrective surgery for TLJK due to OVF remains controversial. This study aimed to: 1) evaluate the surgical outcomes of major corrective surgery for thoracolumbar junctional kyphosis due to osteoporotic vertebral fracture, and 2) identify the risk factors for distal junctional failure to identify potential candidates for pelvic fixation., Methods: Patients who underwent surgical correction (fixed TLJK>40°, OVF located at T11-L2, the lowermost instrumented vertebra at or above L5) were included. Sagittal vertical axis, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis (L1-S1), local kyphosis, and lower lumbar lordosis (L4-S1) were assessed. Proximal and distal junctional kyphosis (P/DJK) and failures (P/DJF) were evaluated. Pre/postoperative spinopelvic parameters were compared between DJF and non-DJF patients., Results: Thirty-one patients (mean age: 72.3 ± 7.9 years) were included. PJK was observed in five patients (16.1%), while DJK in 11 (35.5%). Twelve cases (38.7%) were categorized as failure. Among the patients with PJK, there was only one patient (20%) categorized as PJF and required an additional surgery. Contrary, all of eleven patients with DJK were categorized as DJF, among whom six (54.5%) required additional surgery for pelvic fixation. In comparisons between DJF and non-DJF patients, there was no significant difference in pre/postoperative LK (pre/post, p = 0.725, p = 0.950). However, statistically significant differences were observed in the following preoperative alignment parameters: SVA (p = 0.014), LL (p = 0.001), LLL (p = 0.006), PT (p = 0.003), and PI-LL (p < 0.001)., Conclusions: Spinopelvic parameters, which represent the compensatory function of lumbar hyperlordosis and pelvic retroversion, have notable impacts on surgical outcomes in correction surgery for TLJK due to OVF. Surgeons should consider each patient's compensatory function when choosing a surgical approach., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Significance: Perturbation and differential Monte Carlo (pMC/dMC) methods, used in conjunction with nonlinear optimization methods, have been successfully applied to solve inverse problems in diffuse optics. Application of pMC to systems over a large range of optical properties requires optimal "placement" of baseline conventional Monte Carlo (cMC) simulations to minimize the pMC variance. The inability to predict the growth in pMC solution uncertainty with perturbation size limits the application of pMC, especially for multispectral datasets where the variation of optical properties can be substantial., Aim: We aim to predict the variation of pMC variance with perturbation size without explicit computation of perturbed photon weights. Our proposed method can be used to determine the range of optical properties over which pMC predictions provide sufficient accuracy. This method can be used to specify the optical properties for the reference cMC simulations that pMC utilizes to provide accurate predictions over a desired optical property range., Approach: We utilize a conventional error propagation methodology to calculate changes in pMC relative error for Monte Carlo simulations. We demonstrate this methodology for spatially resolved diffuse reflectance measurements with ±20% scattering perturbations. We examine the performance of our method for reference simulations spanning a broad range of optical properties relevant for diffuse optical imaging of biological tissues. Our predictions are computed using the variance, covariance, and skewness of the photon weight, path length, and collision distributions generated by the reference simulation., Results: We find that our methodology performs best when used in conjunction with reference cMC simulations that utilize Russian Roulette (RR) method. Specifically, we demonstrate that for a proximal detector placed immediately adjacent to the source, we can estimate the pMC relative error within 5% of the true value for scattering perturbations in the range of [ - 15 % , + 20 % ] . For a distal detector placed at ∼ 3 transport mean free paths relative to the source, our method provides relative error estimates within 20% for scattering perturbations in the range of [ - 8 % , + 15 % ] . Moreover, reference simulations performed at lower ( μ s ' / μ a ) values showed better performance for both proximal and distal detectors., Conclusions: These findings indicate that reference simulations utilizing continuous absorption weighting (CAW) with the Russian Roulette method and executed using optical properties with a low ( μ s ' / μ a ) ratio spanning the desired range of μ s values, are highly advantageous for the deployment of pMC to obtain radiative transport estimates over a wide range of optical properties., (© 2023 The Authors.)

Background: Atypical femoral fracture (AFF) is a rare complication in patients with osteoporosis undergoing long-term bisphosphonate therapy. The most common symptom of incomplete AFF is nonspecific thigh pain, which is often difficult to distinguish from other causes., Case Presentation: We present two cases of AFF misdiagnosed as lumbar radiculopathy. Both patients visited our hospital for thigh pain, and in both cases the findings of lumbar spine magnetic resonance imaging showed substantial nerve compression. These patients had been treated for lumbar radiculopathy, but localized symptoms became conspicuous and femoral radiographs revealed complete AFF. The initial radiographs were reviewed retrospectively and revealed slight lateral cortical thickening in the affected femur, denoting a missed incomplete AFF. Internal fixation with intramedullary nails was performed., Conclusions: AFF may mimic lumbar radiculopathy. Therefore, clinicians should consider AFF as a differential diagnosis in older patients with lumbar canal stenosis who are undergoing long-term bisphosphonate therapy and present with thigh pain., (© 2022. The Author(s).)

Case: We present 3 patients with dropped head syndrome (DHS) caused by thoracolumbar kyphotic deformity who were successfully treated with thoracolumbar corrective surgery only. After the surgery, their symptoms, neck pain, and horizontal gaze difficulty disappeared, and cervical kyphotic alignment was improved indirectly. At the final follow-up, the whole spinal alignment was maintained, and there was no recurrence of symptoms., Conclusion: Surgeons should consider thoracolumbar spine deformity as the possible primary cause of typical DHS symptoms and recognize that thoracolumbar corrective surgery is an effective method for treating DHS patients with thoracolumbar deformity., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B939)., (Copyright © 2022 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

Three bacterial strains (Red232 T , Red267 T and Red630 T ) were isolated from paddy soils sampled in Japan. Cells of these strains were Gram-stain-negative, facultative anaerobic, long rod-shaped with monotrichous flagella or pilus-like structures for motility, and formed red colonies on agar plates. Phylogenetic trees based on 16S rRNA gene and multiple single-copy gene sequences showed that the three strains formed a cluster with the type strains of Anaeromyxobacter species, independent from any other strain genera. Similarity values of the 16S rRNA gene sequences and genomes among the three isolated strains and the type strain of Anaeromyxobacter , Anaeromyxobacter dehalogenans 2CP-1 T , were 95.4-97.4% for 16S rRNA gene sequence, 75.3-79.5% for average nucleotide identity, 19.6-21.7% for digital DNA-DNA hybridization and 64.1-72.6% for average amino acid identity, all of which are below the species delineation thresholds. Nitrogenase genes were observed in the genomes of the three novel strains, but not in A. dehalogenans 2CP-1 T . Moreover, multiple genomic, physiological and chemotaxonomic features supported the discrimination between these three strains. Based on the evidence in this study, the three isolates represent three novel independent species for which the following names are proposed: Anaeromyxobacter oryzae sp. nov., Anaeromyxobacter diazotrophicus sp. nov. and Anaeromyxobacter paludicola sp. nov. The type strains are Red232 T (=NBRC 114074 T =MCCC 1K03954 T ), Red267 T (=NBRC 114075 T =MCCC 1K04211 T ), and Red630 T (=NBRC 114076 T =MCCC 1K03957 T ), respectively.

We investigated the morphological effects of testosterone on placental development in a rat model of polycystic ovarian syndrome (PCOS). Testosterone propionate (TP), which was subcutaneously administered to pregnant rats with 5 mg/animal from gestation day (GD) 14 to GD 18, induced a maternal weight reduction without mortality or clinical signs from GD 19 onwards. A decrease in fetal and placental weight, an increase in intrauterine growth retardation (IUGR) rates, and histological changes in the placenta were observed on GD 21 but not on GD15 or 17. Histopathologically, on GD 21, the trophoblast septa thickened, and the maternal sinusoids were narrowed in the labyrinth zone, resulting in a small placenta. Additionally, the placental weight, thickness, and histological morphology in the labyrinth zone on GD 21 in the TP-treated group were nearly identical to those on GD 17 in the control and TP-treated groups. Therefore, it was assumed that the testosterone-induced small placenta was induced in association with the developmental inhibition of the fetal part of the placentas from GD 17 onwards., (©2022 The Japanese Society of Toxicologic Pathology.)

Purpose: Dropped head syndrome (DHS) is presumably caused by focal myopathy in the cervical posterior muscles; however, distinguishable radiological features of the cervical spine in DHS remain unidentified. This study investigated the radiological features of the cervical spine in dropped head syndrome., Methods: The records of DHS patients and age- and sex-matched cervical spondylotic myelopathy (CSM) patients were reviewed. Cervical spinal parameters (C2-7, C2-4, and C5-7 angles) were assessed on lateral cervical spine radiographs. Quantitative radiographic evaluation of cervical spine degeneration was performed using the cervical degenerative index (CDI), which consists of four elements: disk space narrowing (DSN), endplate sclerosis, osteophyte formation, and listhesis., Results: Forty-one DHS patients were included. Statistically significant differences were noted between the upper and lower cervical spine in the sagittal angle parameters on the neutral, flexion, and extension radiographs in DHS group, whereas no significant differences were observed in CSM group. CDI comparison showed significantly higher scores of DSN in C3/4, C4/5, C5/6, and C6/7; sclerosis in C5/6 and C6/7; and osteophyte formation in C4/5, C5/6, and C6/7 in DHS group than in CSM group. Comparison of listhesis scores revealed significant differences in the upper levels of the cervical spine (C2/3, C3/4, and C4/5) between two groups., Conclusion: Our results demonstrated that the characteristic radiological features in the cervical spine of DHS include lower-level dominant severe degenerative change and upper-level dominant spondylolisthesis. These findings suggest that degenerative changes in the cervical spine may also play a role in the onset and progression of DHS., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

In this study, we present the isolation and characterization of the structure of six gallotannins ( 1 - 6 ), three ellagitannins ( 7 - 9 ), a neolignan glucoside ( 10 ), and three related polyphenolic compounds (gallic acid, 11 and 12 ) from Trapa bispinosa Roxb. pericarp extract (TBE). Among the isolates, the structure of compound 10 possessing a previously unclear absolute configuration was unambiguously determined through nuclear magnetic resonance and circular dichroism analyses. The α-glucosidase activity and glycation inhibitory effects of the isolates were evaluated. Decarboxylated rugosin A ( 8 ) showed an α-glucosidase inhibitory activity, while hydrolyzable tannins revealed stronger antiglycation activity than that of the positive control. Furthermore, the identification and quantification of the TBE polyphenols were investigated by high-performance liquid chromatography coupled to ultraviolet detection and electrospray ionization mass spectrometry analysis, indicating the predominance of gallic acid, ellagic acid, and galloyl glucoses showing marked antiglycation properties. These findings suggest that there is a potential food industry application of polyphenols in TBE as a functional food with antidiabetic and antiglycation activities.

Purpose: While a change in the pelvic incidence (PI) after long spine fusion surgery has been reported, no studies have examined the change in the PI on the operating table. The present study examined the PI-change on the operating table and elucidated the patients' background characteristics associated with this phenomenon., Methods: This study included patients who underwent lumbar posterior spine surgery and had radiographs taken in a full-standing position preoperatively and a pelvic lateral radiograph in the prone position in the operative room. The patients with PI-change on the operating table (PICOT; PICOT group) and without PICOT (control group) were compared for their background characteristics and preoperative radiographic parameters., Results: There were 128 eligible patients (62 males, 66 females) with a mean age (± standard deviation) of 69.9 ± 11.7 (range: 25-93) years old. Sixteen patients (12.5%) showed a decrease in the PI > 10°, which indicated placement in the PICOT group. The preoperative lumbar lordosis (LL) and PI-LL in the PICOT group were significantly worse than those in the control group (LL: 20.8 ± 16.6 vs. 30.6 ± 16.2, p = 0.0251, PI-LL: 33.9 ± 19.0 vs. 17.3 ± 14.8, p < 0.0001). The PICOT group had a higher proportion of patients who underwent fusion surgery than the control group, but the difference was not significant (62.5% vs. 44.6%, p = 0.1799)., Conclusion: A decreased PI was observed in some patients who underwent lumbar posterior surgery on the operating table before surgery. Patients with a PI decrease on the operating table had a significantly worse preoperative global alignment than those without such a decrease., Level of Evidence I: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The manner in which inserted foreign coding sequences become transcriptionally activated and fixed in the plant genome is poorly understood. To examine such processes of gene evolution, we performed an artificial evolutionary experiment in Arabidopsis thaliana. As a model of gene-birth events, we introduced a promoterless coding sequence of the firefly luciferase (LUC) gene and established 386 T2-generation transgenic lines. Among them, we determined the individual LUC insertion loci in 76 lines and found that one-third of them were transcribed de novo even in the intergenic or inherently unexpressed regions. In the transcribed lines, transcription-related chromatin marks were detected across the newly activated transcribed regions. These results agreed with our previous findings in A. thaliana cultured cells under a similar experimental scheme. A comparison of the results of the T2-plant and cultured cell experiments revealed that the de novo-activated transcription concomitant with local chromatin remodelling was inheritable. During one-generation inheritance, it seems likely that the transcription activities of the LUC inserts trapped by the endogenous genes/transcripts became stronger, while those of de novo transcription in the intergenic/untranscribed regions became weaker. These findings may offer a clue for the elucidation of the mechanism by which inserted foreign coding sequences become transcriptionally activated and fixed in the plant genome., Competing Interests: The authors have declared that no competing interests exist.

Background: Pedicle screw loosening is a major complication following spinal fixation associated with osteoporosis in elderly. However, denosumab is a promising treatment in patients with osteoporosis. The effect of denosumab on pedicle screw fixation is unknown. Therefore, we investigated whether denosumab treatment improves pedicle screw fixation in elderly patients with osteoporosis., Methods: This was a 2-year prospective open-label study. From February 2015 to January 2016, we included 21 patients with postmenopausal osteoporosis who received initial denosumab treatment. At baseline, 12 months, and 24 months, we measured volumetric bone mineral density (BMD) using quantitative computed tomography (QCT) and performed CT-based finite element analysis (FEA). Finite element models of L4 vertebrae were created to analyze the bone strength and screw fixation., Results: BMD increased with denosumab treatment. FEA revealed that both pullout strength of pedicle screws and compression force of the vertebra increased significantly at 12 and 24 months following denosumab treatment. Notably, pullout strength showed a stronger correlation with three-dimensional volumetric BMD around pedicle screw placement assessed by QCT (r = 0.83, at 24 months) than with two-dimensional areal BMD assessed by dual energy X-ray absorptiometry (r = 0.35, at 24 months)., Conclusion: To our knowledge, this is the first study to reveal that denosumab treatment achieved strong pedicle screw fixation with an increase in BMD around the screw assessed by QCT and FEA; therefore, denosumab could be useful for osteoporosis treatment during spinal surgery in elderly patients with osteoporosis.

Chronic kidney disease leads to high morbidity rates among humans. Kidney transplantation is often necessary for severe symptoms; however, options for new curative treatments are desired because of donor shortage. For example, it has been established that the kidneys can efficiently generate urine after transplantation of the metanephros, ureter, and bladder as a group. After transplantation, the urine can indirectly flow into the recipient's bladder using a stepwise peristaltic ureter system method where the anastomosis is created via the recipient's ureter for urinary tract reconstruction. However, the growth of the regenerated metanephros varies significantly, whereas the time window for successful completion of the stepwise peristaltic ureter system that does not cause hydronephrosis of the metanephros with bladder (ureter) is quite narrow. Therefore, this study was conducted to periodically and noninvasively evaluate the growth of the transplanted metanephros, ureter, and bladder in rats through computed tomography and ultrasonography. The ultrasonographic findings highly correlated to the computed tomography findings and clearly showed the metanephros and bladder. We found that the degree of growth of the metanephros and the bladder after transplantation differed in each case. Most of the rats were ready for urinary tract reconstruction within 21 days after transplantation. Optimizing the urinary tract reconstruction using ultrasonography allowed for interventions to reduce long-term tubular dilation of the metanephros due to inhibited overdilation of the fetal bladder, thereby decreasing the fibrosis caused possibly by transforming growth factor-β1. These results may be significantly related to the long-term maturation of the fetal metanephros and can provide new insights into the physiology of transplant regeneration of the metanephros in higher animals. Thus, this study contributes to the evidence base for the possibility of kidney regeneration in human clinical trials., Competing Interests: The authors have declared that no competing interests exist.

Three bacterial strains, designated Red330 T , Red736 T and Red745 T , were isolated from forest and paddy soils in Japan. Strains Red330 T , Red736 T and Red745 T are flagella-harbouring and strictly anaerobic bacteria forming red colonies. A 16S rRNA gene sequence-based phylogenetic tree showed that all three strains were located in a cluster, including the type strains of Geomonas species, which were recently separated from the genus Geobacter within the family Geobacteraceae . Similarities of the 16S rRNA gene sequences among the three strains and Geomonas oryzae S43 T , the type species of the genus Geomonas , were 96.3-98.5 %. The genome-related indexes, average nucleotide identity, digital DNA-DNA hybridization, and average amino acid identity, among the three strains and G. oryza e S43 T were 74.7-86.8 %, 21.2-33.3 % and 70.4-89.8 %, respectively, which were lower than the species delineation thresholds. Regarding the phylogenetic relationships based on genome sequences, the three strains clustered with the type strains of Geomonas species, which were independent from the type strains of Geobacter species. The distinguishableness of the three isolated strains was supported by physiological and chemotaxonomic properties, with the profile of availability of electron donors and cellular fatty acids composition being particularly different among them. Based on genetic, phylogenetic and phenotypic properties, the three isolates represent three novel independent species in the genus Geomonas , for which the names Geomonas silvestris sp. nov., Geomonas paludis sp. nov. and Geomonas limicola sp. nov. are proposed. The type strains are Red330 T (=NBRC 114028 T =MCCC 1K03949 T ), Red736 T (=NBRC 114029 T =MCCC 1K03950 T ) and Red745 T (=NBRC 114030 T =MCCC 1K03951 T ), respectively.

Objective: The purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment., Methods: A retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases., Results: A total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001)., Conclusions: LLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

There is growing interest in "osteosarcopenia" as the coexistence of osteoporosis and sarcopenia exacerbates negative outcomes. However, limited information is available regarding the risk factors of osteosarcopenia development in patients with osteoporosis. Therefore, we retrospectively reviewed 276 consecutive patients with postmenopausal osteoporosis who regularly visited Showa University Hospital. Patients were eligible for the study if they were ≥65 years of age and underwent dual-energy X-ray absorptiometry, blood sampling, and physical performance assessment. Patients were divided into the osteosarcopenia and osteoporosis alone groups according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Of the 276 patients with osteoporosis, 54 patients (19.6%) had osteosarcopenia. Patients in the osteosarcopenia group had a greater risk of frailty than did those in the osteoporosis alone group (odds ratio 2.33; 95% confidence interval, 1.13-4.80, P = 0.028). Low body mass index seemed to be the strongest factor related to the development of osteosarcopenia, and none of the patients in the osteosarcopenia group were obese (BMI ≥27.5 kg/m2). Multiple logistic analyses revealed that patients aged 65-74 years who had comorbidities such as kidney dysfunction and high levels of HbA1c were at risk of developing osteosarcopenia. Thus, we strongly recommend the assessment of the key components of the diagnosis of osteosarcopenia in an osteoporosis clinic for patients with low body mass index. Furthermore, appropriate assessments, including comorbidities, will help in identifying patients at greater risk of developing osteosarcopenia., Competing Interests: The authors have declared that no competing interests exist.

Background: Most of the previous studies about the surgical treatment of dropped head syndrome (DHS) are small case series, and their primary outcome measures were cervical alignment parameters. Therefore, little is known about the associations between pre- and postoperative global sagittal alignment in the whole spine and the clinical outcomes of the surgical treatment of DHS. In this study, we investigated the surgical outcomes of DHS, including correction of cervical and global spinal sagittal alignment., Methods: This study was a retrospective observational study. Fifteen patients with DHS who had undergone correction surgery were enrolled. Surgical outcomes, including complications and implant failures, were investigated. We assessed cervical alignment parameters as well as spinopelvic global alignment parameters, including pelvic incidence (PI), lumbar lordosis (LL), and C7-sacral sagittal vertical axis (SVA). We examined the changes in these parameters using pre- and posoperative whole spine lateral radiographs. The parameters were compared between the failure and nonfailure groups., Results: Recurrence of sagittal imbalance and horizontal gaze difficulty was observed in 6 cases (40%). In all, 3 cases (20%) exhibited a distal junctional failure and required multiple surgeries with extension of fusion. Of all the radiographic parameters compared between the failure and nonfailure groups, significant differences were only observed in pre and postoperative SVA and PI-LL., Conclusions: Our results suggest that the global sagittal alignment parameters, including PI-LL and SVA, were different between the patients with failure and non failure, and these parameters might have notable impacts on surgical outcomes. Surgeons should consider PI-LL and SVA while determining the surgical course for patients with DHS.

Bacteria of the family Geobacteraceae are particularly common and deeply involved in many biogeochemical processes in terrestrial and freshwater environments. As part of a study to understand biogeochemical cycling in freshwater sediments, three iron-reducing isolates, designated as Red96 T , Red100 T , and Red88 T , were isolated from the soils of two paddy fields and pond sediment located in Japan. The cells were Gram-negative, strictly anaerobic, rod-shaped, motile, and red-pigmented on agar plates. Growth of these three strains was coupled to the reduction of Fe(III)-NTA, Fe(III) citrate, and ferrihydrite with malate, methanol, pyruvate, and various organic acids and sugars serving as alternate electron donors. Phylogenetic analysis based on the housekeeping genes (16S rRNA gene , gyrB, rpoB, nifD, fusA, and recA ) and 92 concatenated core genes indicated that all the isolates constituted a coherent cluster within the family Geobacteraceae. Genomic analyses, including average nucleotide identity and DNA-DNA hybridization, clearly differentiated the strains Red96 T , Red100 T , and Red88 T from other species in the family Geobacteraceae, with values below the thresholds for species delineation. Along with the genomic comparison, the chemotaxonomic features further helped distinguish the three isolates from each other. In addition, the lower values of average amino acid identity and percentage of conserved protein, as well as biochemical differences with their relatives, indicated that the three strains represented a novel genus in the family Geobacteraceae . Hence, we concluded that strains Red96 T , Red100 T , and Red88 T represented three novel species of a novel genus in the family Geobacteraceae , for which the names Oryzomonas japonicum gen. nov., sp. nov. , Oryzomonas sagensis sp. nov. , and Oryzomonas ruber sp. nov. are proposed, with type strains Red96 T (= NBRC 114286 T = MCCC 1K04376 T ), Red100 T (= NBRC 114287 T = MCCC 1K04377 T ), and Red88 T (= MCCC 1K03694 T = JCM 33033 T ), respectively., Competing Interests: The authors declare that they have no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

The morphological effects of β-naphthoflavone (β-NF) on placental development in pregnant rats were examined. β-NF, administered to pregnant rats intraperitoneally at 15 mg/kg bw from gestation day (GD) 9 to GD 14, had no effect on maternal body weight gain, mortality, or clinical sign. In the β-NF-exposed rats, intrauterine growth retardation (IUGR) rates increased on GDs 17 and 21, although there was no effect on fetal mortality rate, fetal or placental weight, or external fetal abnormality. Histopathologically, β-NF induced apoptosis and inhibition of cell proliferation of the trophoblastic septa in the labyrinth zone, resulting in its poor development. In the basal zone, β-NF induced spongiotrophoblast apoptosis and delayed glycogen islet regression, resulting in their cystic degeneration. β-NF-induced CYP1A1 expression was detected in the endothelial cells of the fetal capillaries in the labyrinth zone and in the endothelial cells of the spiral arteries in the metrial gland, but not in any trophoblasts. This indicates that CYP1A1 is inducible in the endothelial cells of the fetal capillaries in the labyrinth zone, and that these cells have an important role in metabolizing CYP1A1 inducers crossing the placental barrier., Competing Interests: The authors declare that there is no conflict of interest., (©2019 The Japanese Society of Toxicologic Pathology.)

Background: Benign and malignant cells need to be distinguished in any cytological examination of bile. Here, we report an original scoring system to improve the diagnostic accuracy of bile cytology., Methods: The study used 158 bile aspiration samples obtained for cytological examination. Fourteen cytological findings were used to differentiate benign and malignant samples. Statistical significance tests and multivariate analysis were used to determine and quantify significant findings and develop a scoring system., Results: Four cytological findings were significant in discriminating between benign and malignant cells: abnormal chromatin, irregularly arranged nuclei, irregularly overlapped nuclei, and irregular cluster margins. Our newly developed scoring system based on these four cytological findings yielded excellent results with a sensitivity of 87%, specificity of 98%, and an odds ratio of 329., Conclusions: The use of our new scoring system is expected to contribute to the diagnostic accuracy of cytological evaluations of bile samples., (© 2019 Wiley Periodicals, Inc.)

Study Design: Prospective feasibility study on consecutive patients., Objective: The aim of this study was to investigate the ability of regional BMD around the pedicle screw to predict the screw fixation., Summary of Background Data: Pedicle screw fixation is the gold standard technique for spinal fusion. Despite the advantage of biomechanical stability, screw loosening is a common complication. In previous studies, pullout strength and screw insertional torque were correlated, and most importantly, affected by bone mineral density (BMD). Although the density and structure of the vertebral body are not homogeneous, no study has yet evaluated the relationship between screw insertional torque and regional BMD around the pedicle screw in vivo., Methods: Consecutive 50 patients, scheduled for transpedicular fixation, were evaluated preoperatively for BMD measured by dual-energy absorptiometry (DXA) and quantitative computed tomography (QCT). Regional volumetric BMD around the pedicle screw (PS-vBMD) using the novel QCT technique was also evaluated. Among all patients, 190 screws (diameter, 7.5 to 8.5 mm; length, 40 to 45 mm, inserted from L1 to L5) were eligible for this study and were analyzed to identify factors contributing to insertional torque. The following factors were investigated: age, body mass index, laboratory data, pedicle diameter, screw diameter, screw length, and 5 types of bone mineral density measures [DXA: spine-areal BMD (aBMD), total hip-aBMD, femoral neck-aBMD, QCT: central-vBMD, PS-vBMD]., Results: Insertional torque was significantly correlated with each BMD measurement and strongest with PS-vBMD (r=0.61, P<0.001). Multiple regression analysis showed PS-vBMD was most strongly correlated with screw insertional torque (stdβ=0.494; P<0.001). A model containing the following 5 predictors was significantly associated with screw insertional torque: age, pedicle diameter, screw diameter, screw length, and PS-vBMD., Conclusions: The preoperative measurement of PS-vBMD was technically feasible and reliably predictive of screw insertional torque during transpedicular fixation in a clinical setting.

Due to its simplicity and low cost, laser speckle imaging (LSI) has achieved widespread use in biomedical applications. However, interpretation of the blood-flow maps remains ambiguous, as LSI enables only limited visualization of vasculature below scattering layers such as the epidermis and skull. Here, we describe a computational model that enables flexible in-silico study of the impact of these factors on LSI measurements. The model uses Monte Carlo methods to simulate light and momentum transport in a heterogeneous tissue geometry. The virtual detectors of the model track several important characteristics of light. This model enables study of LSI aspects that may be difficult or unwieldy to address in an experimental setting, and enables detailed study of the fundamental origins of speckle contrast modulation in tissue-specific geometries. We applied the model to an in-depth exploration of the spectral dependence of speckle contrast signal in the skin, the effects of epidermal melanin content on LSI, and the depth-dependent origins of our signal. We found that LSI of transmitted light allows for a more homogeneous integration of the signal from the entire bulk of the tissue, whereas epi-illumination measurements of contrast are limited to a fraction of the light penetration depth. We quantified the spectral depth dependence of our contrast signal in the skin, and did not observe a statistically significant effect of epidermal melanin on speckle contrast. Finally, we corroborated these simulated results with experimental LSI measurements of flow beneath a thin absorbing layer. The results of this study suggest the use of LSI in the clinic to monitor perfusion in patients with different skin types, or inhomogeneous epidermal melanin distributions., Competing Interests: The authors declare that there are no conflicts of interest related to this article.

The heat-sensitive transient receptor potential vanilloid 1 (TRPV1) channels are expressed in the peripheral and central nervous systems. However, there is no report on how the activation of TRPV1 causes the modulation of neuronal activity in the medullary respiratory center. We examined effects of capsaicin, a specific agonist of TRPV1 channels, on respiratory rhythm generation in brainstem-spinal cord preparation from newborn rats. Capsaicin induced a biphasic response in the respiratory rhythm (a transient decrease followed by an increase in the C4 rate). The second-phase excitatory effect (but not the initial inhibitory effect) in the biphasic response was partly blocked by capsazepine or AMG9810 (TRPV1 antagonists). Capsaicin caused strong desensitization. After its washout, the strength of C4 burst inspiratory activity was augmented once per four to five respiratory cycles. The preinspiratory and inspiratory neurons showed tonic firings due to membrane depolarization during the initial inhibitory phase. In the presence of TTX, capsaicin increased the fluctuation of the membrane potential of the CO 2 -sensitive preinspiratory neurons in the parafacial respiratory group (pFRG), accompanied by slight depolarization. The C4 inspiratory activity did not stop, even 60-90 min after the application of 50/100 μM capsaicin. Voltage-sensitive dye imaging demonstrated that the spatiotemporal pattern of the respiratory rhythm generating networks after application of capsaicin (50 μM, 70-90 min) was highly similar to the control. A histochemical analysis using TRPV1 channel protein antibodies and mRNA demonstrated that the TRPV1 channel-positive cells were widely distributed in the reticular formation of the medulla, including the pFRG. Our results showed that the application of capsaicin in the medulla has various influences on the respiratory center: transient inhibitory and subsequent excitatory effects on the respiratory rhythm and periodical augmentation of the inspiratory burst pattern. The effects of capsaicin were partially blocked by TRPV1 antagonists but could be also induced at least partially via the non-specific action. Our results also suggested a minor contribution of the TRPV1 channels to central chemoreception.

In order to elucidate the effect of chorioallantoic and yolk sac placenta on the embryonic/fetal toxicity in dibutyltin dichloride (DBTCl)-exposed rats, we examined the histopathological changes and the tissue distribution of dibutyltin in the placentas and embryos. DBTCl was orally administered to the groups at doses of 0 mg/kg during gestation days (GD)s 7-9 (control group) and 20 mg/kg during GDs 7-9 (GD7-9 treated group), and GDs 10-12 (GD10-12 treated group). The total fetal mortality was increased, and malformations characterized by craniofacial dysmorphism were detected in the GD7-9 treated group. The embryonic/fetal weight and placental weight showed a decrease in both DBTCl-treated groups. Histologically, some embryos on GD 9.5 in the GD7-9 treated group underwent apoptosis without any changes of yolk sac. In the laser ablation-inductively coupled plasma-mass spectrometry analysis (LA-ICP-MS), tin was detected in the embryo, allantois, yolk sac, ectoplacental cone and decidual mass surrounding the conceptus on GD 9.5 in the GD7-9 treated group. Thus, it is considered that the embryo in this period is specifically sensitive to DBTCl-induced apoptosis, compared with other parts. The chorioallantoic placentas in both DBTCl-treated groups showed the developmental delay and hypoplasia in the fetal parts of placenta, resulting from apoptosis and mitotic inhibition. Thus, it was speculated that the DBTCl-induced malformations and fetal resorption resulted from the apoptosis in the embryo caused by the direct effect of DBTCl. The DBTCl-induced lesions in the chorioallantoic placenta were a non-specific transient developmental retardation in the fetal parts of placenta, leading to intrauterine growth retardation.

In the clinical setting, the use of QX-314 (a quaternary derivative of lidocaine) has been proposed to achieve the selective inhibition of nociceptors that express transient receptor potential vanilloid 1 (TRPV1) channels with fewer motor deficits. However, it has been also reported that QX-314 may produce systemic CNS toxicities with relative potencies that are approximately twice as high as those of lidocaine. There are no reports concerning the effects of extracellular QX-314 on the rhythm-generating neurons in the respiratory center. In the present study, we examined the effects of QX-314 on respiratory rhythm generation in brainstem-spinal cord preparations from newborn rats. The extracellular application of QX-314 (200μM) decreased the C4 burst rate, amplitude and slope during the initial rising phase, and the effects slowly developed with a half-decay time of approximately 20min. The combined application of capsaicin (10 or 100μM) with QX-314 (100μM) showed no additional effect. The intracellular application of QX-314 (100μM) to respiratory neurons depressed the action potentials with a half-decay time of around 5min. Our findings could explain one of the mechanisms underlying the central toxicities that occur after the systemic application of QX-314., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background and Objectives: Laser based therapies are the standard treatment protocol for port wine stain in the United States, but complete removal is infrequently achieved. Intense pulsed light (IPL) offers a broadband light spectrum approach as a viable treatment alternative. Previous studies suggest that IPL can be more effective in treatment of port wine stain by utilizing multiple wavelengths to selectively target different peaks in oxy- and deoxy-hemoglobin. Our study objectives were to (i) determine a characteristic radiant exposure able to achieve persistent vascular shutdown with narrowband IPL irradiation, (ii) determine the degree to which narrowband IPL irradiation can achieve persistent vascular shutdown, and (iii) compare the effectiveness of narrowband IPL radiation to single wavelength pulsed dye laser (PDL) irradiation in achieving persistent vascular shutdown., Study Design/materials and Methods: We utlized either single pulse or double, stacked pulses in narrowband IPL experiments, with the IPL operating over a 500-600 nm wavelength range on the rodent dorsal window chamber model. We compared the results from our narrowband IPL experiments to acquired PDL data from a previous study and determined that narrowband IPL treatments can also produce persistent vascular shutdown. We ran Monte Carlo simulations to investigate the relationship between absorbed energy, wavelength, and penetration depth., Results: For single and double pulse narrowband IPL irradiation we observed (i) little to no change in blood flow, resulting in no persistent vascular shutdown, (ii) marked acute disruption in blood flow and vascular structure, followed by partial to full recovery of blood flow, also resulting in no persistent vascular shutdown, and (iii) immediate changes in blood flow and vascular structure, resulting in prolonged and complete vascular shutdown. Monte Carlo modeling resulted in a 53.2% and 69.0% higher absorbed energy distribution in the top half and the total simulated vessel when comparing the composite narrowband IPL to the 595 nm (PDL), respectively., Conclusions: Our data collectively demonstrate the potential to achieve removal of vascular lesions using a 500-600 nm range. Additionally, the narrowband IPL was tuned to optimize a specific wavelength range that can be used to treat PWS, whereas the PDL can only operate at one discrete wavelength., (© 2015 Wiley Periodicals, Inc.)

Starting from the radiative transport equation we derive the scaling relationships that enable a single Monte Carlo (MC) simulation to predict the spatially- and temporally-resolved reflectance from homogeneous semi-infinite media with arbitrary scattering and absorption coefficients. This derivation shows that a rigorous application of this single Monte Carlo (sMC) approach requires the rescaling to be done individually for each photon biography. We examine the accuracy of the sMC method when processing simulations on an individual photon basis and also demonstrate the use of adaptive binning and interpolation using non-uniform rational B-splines (NURBS) to achieve order of magnitude reductions in the relative error as compared to the use of uniform binning and linear interpolation. This improved implementation for sMC simulation serves as a fast and accurate solver to address both forward and inverse problems and is available for use at http://www.virtualphotonics.org/., (© 2011 Optical Society of America)

Purpose: The purpose of this study is to examine prognostic factors for seizures in 106 epileptic patients with SMIDS., Subjects and Methods: One-hundred-six epileptic patients with SMIDS were the subjects of this study. The study group consisted of 60 male and 46 female patients. The ages ranged from 4 to 61 years. They were all followed up for more than 4 years in our residential facility hospital "Kobato Gakuen". Fourteen possible prognostic factors were investigated statistically, and the validity is studied by factor analysis (principal component method)., Results: Statistically significant poor prognostic factors for epileptic seizures in SMIDS were (1) status epilepticus; (2) multifocal spikes (MFS) or Diffuse spike and waves (DSW) on final EEG; (3) symptomatic generalized epilepsy; (4) MFS or DSW on first EEG; (5) multi-antiepileptic drugs; (6) postnatal etiology; and (7) short duration of institutional hospitalization. As a result of factor analysis, the following five factors are elucidated: (1) Age/Time Passage; (2) Status epilepticus/Etiology; (3) Epileptic syndrome/EEG; (4) intensive medical care; and (5) Severity of Disabilities/Gender., Conclusion: Our findings indicate that intractability of epilepsy may be identified early in the course of the disease, even in SMIDS, and EEG and epileptic syndrome are the very important factors for predicting the seizure prognosis.

We design a special diffusing probe to investigate the optical properties of human skin in vivo. The special geometry of the probe enables a modified two-layer (MTL) diffusion model to precisely describe the photon transport even when the source-detector separation is shorter than 3 mean free paths. We provide a frequency domain comparison between the Monte Carlo model and the diffusion model in both the MTL geometry and conventional semiinfinite geometry. We show that using the Monte Carlo model as a benchmark method, the MTL diffusion theory performs better than the diffusion theory in the semiinfinite geometry. In addition, we carry out Monte Carlo simulations with the goal of investigating the dependence of the interrogation depth of this probe on several parameters including source-detector separation, sample optical properties, and properties of the diffusing high-scattering layer. From the simulations, we find that the optical properties of samples modulate the interrogation volume greatly, and the source-detector separation and the thickness of the diffusing layer are the two dominant probe parameters that impact the interrogation volume. Our simulation results provide design guidelines for a MTL geometry probe.

I2 was adsorbed on single-walled carbon nanotube from ethanol solution at 303 K. The I2 adsorption isotherm was Langmuirian, giving 35 (+/-10) mg g(-1) of the saturated adsorption amount (coverage 0.06-0.09). The I2-adsorption treatment of SWCNT bundles reduced the N2 adsorption amount at 77 K by only 3%; the adsorption amount of supercritical H2 at 77 K was decreased by 30% because of the I2-adsorption treatment, indicating the blocking of interstitial pores by adsorbed I2. These adsorption results indicated the adsorption of I2 molecules in the narrow interstitial pores. The I2-adsorption treatment increases the Raman intensity coming from metallic SWCNTs, and the dc electrical conductivity increased by 15% because of the I2-adsorption treatment, strongly suggesting the presence of charge-transfer interaction between I2 and SWCNTs irrespective of small coverage by I2.

Folic acid plays an important role in proliferating cells and tissues of the fetus. A randomized control trial demonstrated in 1991 that 4 mg of folic acid supplements successfully prevented 72% of recurrence of neural tube defects (NTDs) in women who had had afflicted pregnancy. In 2000, the Japanese Government recommended women of childbearing age to take 400 microgram of folate supplements per day from 4 weeks prior to and 12 weeks after conception. A questionnaire study was performed in pregnant women by post on their awareness of the role folic acid plays, their life style, and folate intake by dietary consumption. Thirty-five percent of 1,251 pregnant women were aware of the important role of folic acid in the critical stage of fetal development and 31% actually took the supplement. Information on folic acid was obtained through mass media in 47% of the women, through the internet in 17%, through healthcare providers in 13% and so forth. The food record analysis revealed that the dietary intake of folic acid averaged 341 microg/day that was 60 microg less than what was recommended by the Government and that 33 of 86 women took the supplement. Overall, a half of pregnant women are required to take 400 microg folate supplement per day. It is to be stressed that primary prevention of NTDs by periconceptional intake of folic acid is a major public health opportunity and that prevention is more important than cure in the management of NTDs.

The subjects were 106 SMIDS with epilepsy. They were classified into four epileptic syndromes: (1) SE-MISF (34.0%), (2) SGE (25.5%), (3) SLRE (20.7%), and (4) epileptic discharge-free patients (EDFP) (19.8%). Clinical electroencephalographic studies elucidated the following result: (1) The seizure disappearance rate was the highest in SLRE (54.5%), and it decreased in the order of EDFP (47.6%), SE-MISF (36.1%), and SGE (11.1%). (2) Status epilepticus was most frequently seen in SGE (62.4%), but it was not so often seen in EDFP (14.3%) or SLRE (22.7%). (3) The age at seizures onset was the lowest in SE-MISF (0.84 years), and it increased in the order of SLRE (1.3), SGE (2.3), and EDFP (6.7). (4) The rate of Ohshima's classification 1 was highest in SE-MISF (61.1%) and lowest in SGE (40.7%). In conclusion, epileptic syndrome and EEG findings are good indicators for predicting the seizure prognosis and some of the clinical features, and the majority of epileptic syndromes could be classified by the very first EEG findings. Since epilepsy in SMIDS is so frequent (70.3%) and intractable (seizure disappearance rate more than 3 years, 36.2%), more attention should be paid to electroencephalography and epileptic seizures in SMIDS.