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Byline: Y. Sato (1), M. Kaji (1), F. Higuchi (2), I. Yanagida (2), K. Oishi (3), K. Oizumi (4) Keywords: Key words:Bone formation -- Bone resorption -- Hip fracture -- Immobilization -- Vitamin D Abstract: Although hip fracture is one of the most common causes of acute immobilization in elderly patients, little is known about the influence of immobilization on changes in bone and calcium metabolism following this event. We therefore compared serum biochemical indices of bone and calcium metabolism in 20 elderly subjects with hip fracture with those measured in 20 healthy age-matched controls. Rankin scores, a measure of functional dependence with 0 representing independence and 5 representing total dependence, were assigned. We also examined serial changes in these biochemical indices from shortly following the fracture to the early recovery period. Ionized calcium, intact parathyroid hormone (PTH), intact bone Gla protein (BGP), pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), 25-hydroxyvitamin D (25-OHD), and 1,25-dihydroxyvitamin D (1,25-[O[H].sub.2]D) were measured. One week after the fracture, mean serum concentrations of calcium and ICTP were elevated in correspondence to degree of immobilization (mean Rankin score 4.4), while serum concentrations of BGP, PTH, 25-OHD, and 1,25-[O[H].sub.2]D were depressed. Rankin score (mean: 4.4) correlated positively with ICTP and negatively with BGP at this time. At 2 months, calcium and ICTP elevation decreased and BGP, PTH and 1,25-[O[H].sub.2]D were less depressed, coinciding with a decline in Rankin score from 4.2 to 2.2. Indices were further improved at 3 months (mean Rankin score, 1.3), with calcium and BGP returning to normal. We concluded that increased bone resorption, and decreased bone formation, and hypercalcemia are present by 1 week following the hip fracture, and some resorption increase persists for at least 3 months. These changes could explain in part the high risk of another hip fracture. Author Affiliation: (1) Department of Internal Medicine, JP (2) Department of Orthopedics, JP (3) Department of Anesthesiology, Kurume University Medical Center, Kurume, Japan , JP (4) First Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan, JP Article note: Received: 3 April 2000 / Accepted: 15 December 2000

Objectives: The main histological change in rheumatoid arthritis (RA) is the villous proliferation of synovial lining cells, an important source of cytokines and chemokines, which are associated with inflammation. The aim of this study was to evaluate gene expression in the microdissected synovial lining cells of RA patients, using those of osteoarthritis (OA) patients as the control.Methods: Samples were obtained during total joint replacement from 11 RA and five OA patients. Total RNA from the synovial lining cells was derived from selected specimens by laser microdissection (LMD) for subsequent cDNA microarray analysis. In addition, the expression of significant genes was confirmed immunohistochemically.Results: The 14 519 genes detected by cDNA microarray were used to compare gene expression levels in synovial lining cells from RA with those from OA patients. Cluster analysis indicated that RA cells, including low- and high-expression subgroups, and OA cells were stored in two main clusters. The molecular activity of RA was statistically consistent with its clinical and histological activity. Expression levels of signal transducer and activator of transcription 1 (STAT1), interferon regulatory factor 1 (IRF1), and the chemokines CXCL9, CXCL10, and CCL5 were statistically significantly higher in the synovium of RA than in that of OA. Immunohistochemically, the lining synovium of RA, but not that of OA, clearly expressed STAT1, IRF1, and chemokines, as was seen in microarray analysis combined with LMD.Conclusions: Our findings indicate an important role for lining synovial cells in the inflammatory and proliferative processes of RA. Further understanding of the local signalling in structural components is important in rheumatology. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hyaluronan (HA) improves postoperative recovery after flexor tendon surgery, preventing postoperative adhesion. However, its influence on the rotator cuff tendon after cuff repair has not yet been clarified in detail. HYPOTHESIS: Hyaluronan is likely to modulate cell proliferation and mRNA expression of procollagens alpha1 (I) and alpha1 (III) in tendon-derived fibroblasts in patients with rotator cuff disease. STUDY DESIGN: Controlled laboratory study. METHODS: The study subjects were 10 patients with rotator cuff disease, with an average age of 62 years (range, 44-72). Various concentrations of HA (1.0-5.0 mg/mL) were added to monolayer-cultured tendon-derived fibroblasts from these patients. Hyaluronan binding and CD44 expression on the tendon-derived fibroblasts were evaluated by confocal microscopy using fluorescein-conjugated HA and antihuman CD44 antibody (OS/37). Cell proliferation was evaluated by recording changes in cell number. The levels of expression of procollagen alpha1 (I) and alpha1 (III) mRNA were measured by real-time reverse transcriptase polymerase chain reaction. RESULTS: Immunofluorescence cytochemistry detected constitutive binding of HA and CD44 expression on the tendon-derived cells. Treatment with various concentrations of HA significantly inhibited cell proliferation and decreased the expression level of procollagen alpha1 (III) mRNA, but not that of procollagen alpha1 (I) mRNA, in the tendon-derived fibroblasts. CONCLUSION: Hyaluronan modulates cell proliferation and the expression level of procollagen alpha1 (III) mRNA, but not that of pro-collagen alpha1 (I), in fibroblasts from patients with rotator cuff disease. CLINICAL RELEVANCE: Postoperative use of exogenous HA may allow the healing of a repaired rotator cuff tendon with minimal adhesion. [ABSTRACT FROM AUTHOR]

The characteristics of a thermo tube type thermal gas flowmeter were analyzed and experimental results were described. The output of this flowmeter is temperature difference between two points along an electrically heated capillary. An analytical expression of its outputs was derived assuming a simple flow condition. An experimental prototype was constructed. The temperature distribution was measured and the outputs were obtained for three kinds of gases: nitrogen, carbon dioxide, and argon. Those outputs were compared with theoretical ones, and those agree well in the case of small flow rate. The relationship among temperature difference, mass flow rate, and specific heat of gas was discussed. [ABSTRACT FROM AUTHOR]

There is little information concerning the changes in the muscles supporting the fractured hip joint. Morphologic and histochemical examinations of biopsy specimen from the middle gluteal muscles were performed at surgery in 42 elderly women with hip fracture caused by a fall. On the basis of serum 25-hydroxyvitamin D (25-OHD) concentration, the patients were divided into a sufficient group (25-OHD concentration >39 nmol/L, n = 20) and a deficient group (25-OHD concentration <39 nmol/L, n = 22). Reflecting the muscular trauma in the fall-induced hip fracture, the following pathologic changes were common in both the sufficient and deficient groups: degenerating and regenerating fibers; fiber necrosis; and inflammatory reaction. The mean type II fiber diameter in the deficient group (15.4 ± 4.2 μm) was significantly smaller than that in the sufficient group (38.7 ± 8.1 μm) (p < 0.0001). In the deficient group, the mean type II fiber diameter correlated with the serum 25-OHD concentration (r = 0.714, p = 0.0011). This correlation was not observed in the sufficient group. Low physical activity along with vitamin D deficiency prior to the hip fractures may have caused the severe type II fiber atrophy in the deficient group. Such changes may weaken the support of the hip joint and lead to falls. We believe that severe type fiber II atrophy is an independent risk factor for hip fractures and this should be studied in a classic case-control study. Severe type II fiber atrophy may also have contributed to the poor functional outcome in the deficient group. Further research is needed to develop treatments and rehabilitation protocols that might improve gait and body function by attenuating type II fiber atrophy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the effect of patient transfer slide boards with automatic couch height positioning compensation (AHC) on image quality and radiation dose during computed tomography (CT) examinations., Methods: The chest phantom for Kyoto Kagaku (Kyoto) Type PBU-SS 2 was performed helical scan using a Canon Medical Systems (Tochigi) 80-row CT Aquilion Prime SP/i Edition. Scan parameters were tube voltage: 120 kV, tube current: min 50 mA max 500 mA with AHC for noise index: 15, slice thickness: 5.0 mm, rotation time: 0.35 s/rotation, pitch factor: 0.813, reconstruction kernel: FC03. Filtered back projection was used for image reconstruction. We compared the image noise and volume computed tomography dose index (CTDI vol ) displayed on the console with and without the patient transfer slide boards by using or not using the AHC., Results: When using the AHC, CTDI vol was increased (p<0.05), and image noise was decreased (p<0.05). Without the AHC, there was no significant difference in CTDI vol (p=0.11) and image noise (p=0.29)., Conclusion: The slide board utilized in this experiment did not have a notable impact on either image quality or exposure dose. Nonetheless, the use of the slide board was found to result in excessive exposure during CT scans that employed AHC.

Background: A previous Phase II clinical trial, conducted from 1995 to 2003, evaluated CNS germ cell tumors (GCTs) using a three-group treatment stratification based on histopathology. The primary objective of the study was to assess the long-term efficacy of standardized treatment regimens, while the secondary objective focused on identifying associated long-term complications., Methods: Total 228 patients were classified into three groups for treatment: germinoma (n=161), intermediate prognosis (n=38), and poor prognosis (n=28), excluding one mature teratoma case. Treatment involved stratified chemotherapy regimens and varied radiation doses/coverage. Clinical data was retrospectively analyzed at a median follow-up of 18.5 years., Results: The treatment outcomes for germinoma, with or without syncytiotrophoblastic giant cell, were similar. The 10- and 20-year event-free survival rates for the germinoma, intermediate, and poor prognosis groups were 82/76/49% and 73/66/49%, respectively. Overall survival (OS) rates were 97/87/61% at 10 years and 92/70/53% at 20 years. Germinomas in the basal ganglia, treated without whole-brain radiation therapy (WBRT), frequently relapsed but were effectively managed with subsequent WBRT. Deaths in germinoma cases had varied causes, whereas deaths in the poor prognosis group were predominantly disease-related. Nineteen treatment-related complications were identified in 16 patients, with cumulative event rates of 1.9% at 10 years and 11.3% at 20 years. OS rates at 1 and 2 years post-relapse for tumors initially classified as germinoma, intermediate, and poor prognosis were 94/88/18% and 91/50/9%, respectively., Conclusions: Initial treatment intensity is crucial for managing non-germinomatous GCTs, while long-term follow-up for relapse and complications is imperative in germinomas. Irradiation extending beyond the immediate tumor site is essential for basal ganglia germinomas. Addressing relapse in non-germinomatous GCT remains a significant challenge., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Adverse childhood experiences (ACEs) have been reported to detrimentally impact physical and mental health. While experiencing multiple ACEs is common, previous research primarily assessed ACEs by their total count, neglecting the impacts of different experience types. Furthermore, sex-based differences in ACEs and their influences remain unclear. This study employed Latent Class Analysis (LCA) to uncover patterns of ACEs with consideration for sex differences, aiming to elucidate their effects on adult physical and mental health. A geographically nationally representative dataset from the "Japan COVID-19 and Society Internet Study (JACSIS)" conducted in 2022 was used. 13,715 men and 14,327 women retrospectively reported their experiences across fifteen ACEs. The analysis revealed four distinct ACE patterns for both sexes: a Multiple Adversities class with a wide range of severe ACEs, a Psychological Abuse class experiencing emotional abuse at home and bullying at school, a Poverty class facing economic hardships, and a Low Adversities class with the fewest ACEs. Multinomial logistic regression analysis indicated that more severe patterns of exposure correlated with heightened adverse adult outcomes. However, the extent of these impacts varied by sex and ACE pattern. For instance, men in Multiple Adversities and Psychological Abuse classes exhibited higher tendencies towards conducting physical and psychological abuse behaviors. While ACEs in men were linked to both underweight (in cases of psychological abuse) and obesity (across all classes), women with ACEs generally leaned towards higher body weight. These findings highlight the importance of developing support strategies sensitive to sex differences and the specific content of ACEs., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Trapped temporal horn (TTH) is a subtype of focal obstructive hydrocephalus. Although a ventriculoperitoneal shunt is a traditional treatment approach, it poses risks of shunt failure and infection. The emergence of neuroendoscopy has led to an increased interest in ventriculocisternostomy as an alternative. This study aimed to evaluate the efficacy and safety of endoscopic ventriculocisternostomy with stent placement (EVSP) for TTH., Methods: We collected data of TTH cases treated with EVSP at our institutions between September 2013 and September 2021 and evaluated baseline characteristics and outcomes. A ventricular stoma was created at the medial wall of the abnormally enlarged temporal horn using a neuroendoscope, and a ventricular stent tube with multiple side holes was placed through the stoma to maintain patency., Results: The study included 10 patients (4 women and 6 men) with a mean age of 56.7 ± 19.7 years. The average follow-up period was 35.0 months (range, 1-96 months). The underlying pathologies were postoperative scarring (5 cases), intraventricular tumor (3 cases), and extraventricular tumor (2 cases). There were no procedural complications; however, one patient experienced recurrence and underwent additional cisternostomy. All patients exhibited partial or complete resolution of the preoperative symptoms and demonstrated shrinkage of the trapped ventricle, with a mean reduction rate of 84.5% ± 14.9%., Conclusions: EVSP is a safe and feasible option for the treatment of TTH and is a viable alternative to ventriculo-peritoneal shunt., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Nature therapies are gaining attention as non-pharmacological treatments for depressive and anxiety disorders, but research on their effectiveness in patients is limited. This study investigates the mood-improving effects of visual stimulation with natural environmental images in patients with depressive and anxiety disorders., Methods: We conducted a randomized crossover comparison trial involving 60 right-handed adult participants with depressive or anxiety disorders and receiving outpatient treatment. Visual stimuli of natural environments consisted of green-themed nature images, while the control stimuli featured urban scenes dominated by buildings. The stimulation lasted for 3 min, during which orbital prefrontal brain activity was measured using a 2-channel Near-infrared Spectroscopy (NIRS) system, and heart rate variability was assessed using fingertip accelerated plethysmography., Results: Mood enhancement effects were observed in both the depressive and anxiety disorder groups following visual stimulation with nature images. In the depression group, orbital prefrontal oxygenated hemoglobin concentration significantly increased after visual stimulation with nature images, while there were no significant changes in the anxiety group. However, in the anxiety group, a correlation was found between reduced orbital prefrontal oxygenated hemoglobin in response to nature images and increased mood-enhancement. Furthermore, the severity of depressive symptoms did not significantly affect the intervention effects, whereas heightened anxiety symptoms was associated with a smaller mood enhancement effect., Discussion: Our study demonstrates the benefits of nature image stimulation for patients with depressive and anxiety disorders. Differential orbital prefrontal brain activity impacts notwithstanding, both conditions exhibited mood enhancement, affirming the value of nature image stimulation., Competing Interests: Declaration of competing interest C.C. is the author of CleverLand: The Psychology of How Nature Nurtures. The other authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

A mixed germ cell tumor (MGCT) in the neurohypophysis is very rare, with only a few reported cases 1-4 but none with surgical videos. In this report, the endoscopic endonasal transsphenoidal approach for MGCT in the neurohypophysis is presented (Video 1). A 12-year-old girl with ocular pain, fatigue, and nausea presented with gradual onset of quadrant hemianopsia and left oculomotor palsy. Magnetic resonance imaging showed an enhanced mass in the sella turcica with multiple components involving the pituitary gland and stalk. Her endocrinological examination showed decreased levels of pituitary hormones and simultaneously elevated serum levels of alpha-fetoprotein and beta-human chorionic gonadotropin. After pituitary hormone replacement, endoscopic endonasal transsphenoidal surgery was planned. The tumor was strongly adherent to the surrounding structures, and gross total resection was achieved. The histological diagnosis was MGCT with a teratoma component. Postoperatively, her vision and oculomotor palsy improved swiftly, and adjuvant chemotherapy and radiotherapy were administered. In this case, 3-dimensional computer graphics were created from the preoperative computed tomography and magnetic resonance imaging studies. Preoperative simulation with the 3-dimensional computer graphic images and intraoperative verification with indocyanine green images facilitated our understanding of the surrounding anatomy, including the tumor components, pituitary gland, and internal carotid arteries. 5 After removal of the tumor, multilayer fascial closure was performed for skull base reconstruction. 6 MGCT in the neurohypophysis can be strongly adherent to the surrounding structures, requiring careful dissection and resection under endoscopy. At the last follow-up (8 months after surgery), the tumor was successfully controlled, and the patient had no neurological symptoms with pituitary hormone replacement therapy., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The purpose of this study was to investigate the risk of overexposure associated with automatic tube current modulation (ATCM) and automatic couch height positioning compensation mechanism (AHC) in computed tomography (CT) systems, particularly in scenarios involving a gap between the subject and the couch. Results revealed that when AHC was enabled, CT dose index volume (CTDI vol ) increased by approximately 10% at 2.5 cm, 20% at 5.0 cm, and 40% at 10.0 cm gaps compared to close contact conditions. While the AHC function ensures consistent exposure doses and image quality regardless of subject positioning relative to the CT gantry isocenter, the study highlights a potential risk of overexposure when a gap exists between the subject and the couch. These findings offer valuable insights for optimizing CT imaging protocols and underscore the importance of carefully considering subject positioning in clinical practice., (© 2024. The Author(s), under exclusive licence to Japanese Society of Radiological Technology and Japan Society of Medical Physics.)

Background: Schizophrenia is a complex mental disorder characterized by significant cognitive and neurobiological alterations. Impairments in cognitive function and eye movement have been known to be promising biomarkers for schizophrenia. However, cognitive assessment methods require specialized expertise. To date, data on simplified measurement tools for assessing both cognitive function and eye movement in patients with schizophrenia are lacking., Objective: This study aims to assess the efficacy of a novel tablet-based platform combining cognitive and eye movement measures for classifying schizophrenia., Methods: Forty-four patients with schizophrenia, 67 healthy controls, and 41 patients with other psychiatric diagnoses participated in this study from 10 sites across Japan. A free-viewing eye movement task and 2 cognitive assessment tools (Codebreaker task from the THINC-integrated tool and the CognitiveFunctionTest app) were used for conducting assessments in a 12.9-inch iPad Pro. We performed comparative group and logistic regression analyses for evaluating the diagnostic efficacy of the 3 measures of interest., Results: Cognitive and eye movement measures differed significantly between patients with schizophrenia and healthy controls (all 3 measures; P<.001). The Codebreaker task showed the highest classification effectiveness in distinguishing schizophrenia with an area under the receiver operating characteristic curve of 0.90. Combining cognitive and eye movement measures further improved accuracy with a maximum area under the receiver operating characteristic curve of 0.94. Cognitive measures were more effective in differentiating patients with schizophrenia from healthy controls, whereas eye movement measures better differentiated schizophrenia from other psychiatric conditions., Conclusions: This multisite study demonstrates the feasibility and effectiveness of a tablet-based app for assessing cognitive functioning and eye movements in patients with schizophrenia. Our results suggest the potential of tablet-based assessments of cognitive function and eye movement as simple and accessible evaluation tools, which may be useful for future clinical implementation., (©Kentaro Morita, Kenichiro Miura, Atsuhito Toyomaki, Manabu Makinodan, Kazutaka Ohi, Naoki Hashimoto, Yuka Yasuda, Takako Mitsudo, Fumihiro Higuchi, Shusuke Numata, Akiko Yamada, Yohei Aoki, Hiromitsu Honda, Ryo Mizui, Masato Honda, Daisuke Fujikane, Junya Matsumoto, Naomi Hasegawa, Satsuki Ito, Hisashi Akiyama, Toshiaki Onitsuka, Yoshihiro Satomura, Kiyoto Kasai, Ryota Hashimoto. Originally published in JMIR Mental Health (https://mental.jmir.org), 30.05.2024.)