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Background The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine. Methods The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members. Results Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature. Conclusions The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.

Purpose This study was to evaluate clinical outcomes using a patient-oriented test that scores health-related quality of life (HRQOL) for patients after minimally invasive surgery using microendoscopic discectomy (MED) for lumbar disc hernia. Few studies regarding MED in terms of disease-specific quality of life measures using Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) have been published. Methods Retrospective analysis of the surgical and clinical outcomes with regard to reducing pain and improving the functional status for 31 patients who underwent MED for lumbar disc hernia was conducted. These patients were evaluated at 3-year follow-up. The evaluations were based on a visual analogue scale (VAS), the Japanese Orthopaedic Association (JOA) scoring system, and the JOABPEQ, which is an objective, patient-oriented test that assesses HRQOL in patients with lumbar disorders. Results A low rate of improvement was seen only in mental health until 1 year, the low rate of improvement in mental health and was independently correlated with body mass index (BMI), pre-operative scores on the Brief Scale for Psychiatric problems in Orthopaedic Patients (BS-POP), and scores on the BS-POP at 12 months post-operatively. Conclusions All categories of VAS, JOA scores, and all domains of JOABPEQ were significantly higher over 3 years than those obtained pre-operatively. But only mental health domain showed mild improvement until 1 year. Moreover, BMI showed a negative correlation with improvements in the mental health domain post-operatively. As patients may be mentally exhausted from lumbar disc herniation, pre-operative mental health may be improved by surgical treatment.

Therapy for chronic, nonspecific low back pain is mainly conservative: medication and/or exercise. Pharmacotherapy, however, has side effects, and the quantities of concomitant drugs in older persons require attention. Although exercise promises improved function, its use to alleviate pain is controversial. Thus, we compared the efficacy of pharmacotherapy versus exercise for treating chronic nonspecific low back pain. The pharmacotherapy group (n=18: 8 men, 10 women) were prescribed celecoxib monotherapy. The exercise group (n=22: 10 men, 12 women) undertook stretching exercises. Because of drop-outs, the NSAID group (n=15: 7 men, 8 women) and the exercise group (n =18: 8 men, 10 women) were finally analyzed. We applied a visual analog scale, Roland–Morris disability scores, and the 36-Item Short Form Health Survey. We used a paired t-test for within-group analyses and an unpaired t-test for between-group analyses. Pain relief was achieved after 3 months of pharmacotherapy or exercise. Quality of life improved only in the exercise group. Recovery outcomes for the two groups were not significantly different. Efficacy of exercise therapy for strictly defined low back pain was almost equivalent to that of pharmacotherapy and provided better quality of life.

Background Pregabalin is a well-accepted treatment option for patients with neuropathic pain. However, the therapeutic efficacy of pregabalin for reducing the incidence of spinal surgery to treat leg symptoms in patients with lumbar spinal stenosis remains unknown. The purpose of this study was to analyze the therapeutic efficacy of pregabalin for reducing the incidence of spinal surgery for leg symptoms in patients with lumbar spinal stenosis during the first year of treatment.Methods Consecutive patients diagnosed with lumbar spinal stenosis at our hospital from January to June 2009 were treated with nonsteroidal anti-inflammatory drug monotherapy and formed the control group (n = 47; 22 males, 25 females). Patients diagnosed with lumbar spinal stenosis at our hospital between August 2010 and October 2011 were treated with a nonsteroidal anti-inflammatory drug and pregabalin combination therapy and formed the pregabalin group (n = 49; 27 males, 22 females). The proportions of patients who underwent spinal surgery during the first year of treatment were assessed and compared between the two groups using the Mann-Whitney U test. In addition, the periods in which patients decided to undergo spinal surgery were compared using the Kaplan-Meier method.Results Six patients (12.2 %) in the pregabalin group and 22 patients (46.8 %) in the control group underwent spinal surgery during the first year of treatment (P = 0.0035). The period in which patients decided to undergo spinal surgery was significantly delayed in the pregabalin group compared with the control group in those for whom spinal surgery was necessary (P = 0.0128).Conclusions Nonsteroidal anti-inflammatory drug and pregabalin combination therapy may result in a lower incidence of spinal surgery during the first year of treatment or a delayed period before undergoing spinal surgery if necessary compared with nonsteroidal anti-inflammatory drug monotherapy in patients with leg symptoms caused by lumbar spinal stenosis.

The purpose of this study was to evaluate the therapeutic efficacy of pregabalin in patients with leg symptoms due to lumbar spinal stenosis. Study subjects were classified into two groups according to their pharmacotherapy: the pregabalin group, treated with nonsteroidal anti-inflammatory drug and pregabalin combination therapy, and the control group, treated with nonsteroidal anti-inflammatory drug monotherapy. The two groups were compared in terms of the duration of pain after the onset of leg symptoms and the type of neurogenic intermittent claudication, whether radicular-, caudal-, or mixed-type. Numerical rating scale and Roland-Morris Disability Questionnaire scores were evaluated before and 3 months after treatment. After 3 months of treatment, there were significant differences in the numerical rating scale for radicular- and mixed-types, but not for caudal-type, between the two groups in the subjects with leg symptoms for greater than 3 months. There were significant differences between the two groups in Roland-Morris Disability Questionnaire scores for mixed-type, but not for radicular- and caudal-types, in the subjects with leg symptoms for less than 3 months and for radicular- and mixed-types, but not for caudal-type, in the subjects with leg symptoms for greater than 3 months. Nonsteroidal anti-inflammatory drug and pregabalin combination therapy may be more effective than nonsteroidal anti-inflammatory drug monotherapy for the relief of leg symptoms due to lumbar spinal stenosis, preventing aggravation of subjective symptoms and improving quality of life for patients with radicular- and mixed-types in subjects with leg symptoms for greater than 3 months, although it may be necessary to consider alternative therapy for patients with caudal-type.

A 22-year-old woman presented with complaints of severe pain in a wide region of the thoracolumbar spine. She developed severe pain in the thoracolumbar spine region 2 months after her first delivery and was referred 1 month later. A lateral thoracic X-ray showed depressed degenerative vertebrae (T7, T9). One month after the initial examination, thoracic sagittal magnetic resonance imaging showed low intensity areas on T1-weighted imaging and iso-high intensity areas on T2-weighted imaging at T5, 7, 8, 9 and 11. Bone mineral density measured by ultrasound was low (%YAM 76%). The bone metabolic markers were high, suggesting accelerated osteoclast activity. These findings prompted a diagnosis of pregnancy-associated osteoporosis. She was asked to stop breastfeeding and to wear a lumbar brace, and treatment with nutritional calcium, activated vitamin D3, and risedronate sodium was started. Her low back pain almost disappeared after treatment. Bone metabolic markers showed normalization 8 months after the initial examination. Risedronate sodium was stopped 2 years and 2 months after the initial examination. Teriparatide treatment was started because her bone mineral density remained low; however, the osteoblast marker P1NP was not increased 5 months after the start of teriparatide treatment.

Objective: To describe a rare case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome caused by gouty arthritis. Clinical Presentation and Intervention: A 76-year-old man presented with swelling and pain in the dorsum of feet and hands bilaterally. From the laboratory and radiologic findings, the diagnosis of gout-induced RS3PE syndrome was made. Conservative therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular corticosteroid injection in the wrist joint completely and rapidly resolved all symptoms. The patient was successfully treated with oral administration of NSAIDs and a one-time intra-articular corticosteroid injection in the left wrist joint. Conclusion: This case demonstrated the importance of considering the possibility of crystal-induced arthritis such as gout and pseudogout, as well as malignant disease, when diagnosing the primary disease responsible for RS3PE syndrome.

1) Thermostability of catalase of liver extracts of poecilothermic animals namely five kinds of fresh-water fishes (cold water fishes: rain-bow trout and Oncorhynchus formosunus; semicold water fish: Plecoglossus altivelis; warm-water fishes: carp and crucian) was constrasted with that of homoesthermic animal, domestic fowl. 2) Stability of catalase of liver extracts in relation to temperature was found to vary considerably with species of the animals studied, and to stand in close relation with temperatures suited for leading their life. 3) Liver catalase of the cold-water fishes was stable at 20°C but inactivated slowly at 30°C and rapidly at 40°C. 4) The same of the semi-cold water fish, Plecoglossus altivelis, was stable at 30°C but inactivated slowly at 40°C and rapidly at 45°C. 5) On the other hand, a slight augmentation of activity of the warm water fishes was observed at 25°C and a much remarkable one at 30°-40°C, but followed by inactivation after 30-60 minutes' exposure. A rapid inactivation of it was evident from the start when experimented at 45°C. 6) Liver-extract of the domestic fowl was found continuously increasing it activity at 30°-40°C. Rapid activation of it took place at 45°-55°C but gradual inactivation appeared at heels after 60 minutes' lapse of time. Neither augmentation nor decrease in activity of the enzyme in question was observed at 60°C. 7) Liver catalase is extremely stable at temperatures wich are either optima for living or ordinary body temperatures of animals. But heating beyond the ranges tends to cause slow or rapid inactivation. Sometimes such treatment leads to appearent activation of the enzyme at first but it is bound to end in opposite direction. 8) Energies of inactivation are shown in Table 2.

Fig. 1 shows representative examples of the change of succinic dehydrogenase activity of fish tissues with incubation at 25°C. Although great variations in the enzymatic activity were observed among various tissues, a decrease in the enzyme activity of a certain sample tissue showed a significant correlation with decrease of its freshness. Therefore, the freshness of sample fish under test can be judged from decrease in the enzyme activity (freshness-index value E) of various sample tissues, and the values were compared with those values of fresh fish of the same kind. The freshness-index values of several fresh fish and deteriorated fish are given in Table 1.

The present report deals with a proposal of a rapid method for the determination of succinic dehydrogenase in fish tissues. The reaction system consists of 2.0ml. of 0.1M Na-succinate, 0.3ml. of 0.1M KCN, 2.0ml. of 0.1mM Na-dichlorophenolindo-o-chlorophenol, aml. of enzyme soln. (10% suspension of homogenized sample tissue), and (5.7-a)ml. of 0.1M KH2PO4-Na2 HPO4 (7:3) buffer solution. The enzyme solution can be prepared by homogenizing with Waring blendor under ice-cooling, an aliquot of sample tissue (2 ?? 10 gr.) added with a small amount of water for 2 ?? 3 minutes at a speed of about 10, 000 r. p. m., diluting 5 ?? 10 times, and filtering through double-fold cotton gauze. This enzyme solution should be used within 10 minutes after its preparation. The enzyme activity is determined by measuring the rate of fading of the blue dye after adding the enzyme solution to a mixture of the other components of the reaction system. The rate of decrease of color intensity of the dye is traced by measuring the time ?? t required for the change of 0.1 degree of optical density after the addition of the enzyme at 20°C. One unit of succinic dehydrogenase activity is defined as the activity capable of reducing the color intensity of the dye by 0.1 of optical density after 30 seconds in the initial stage of the reaction under the stated conditions.

In an attempt to toxicity of some substances to aquatic animals, linearly arranged five pots supplied with running water were used (Fig. 1). Any change of behaviour of the experimental animals in them when exposed to waterborne toxic substances was noted against uormal conduct of the controls. Evaluation of toxicity was done by adding different weights on different signs of vector as revealed by locomotion of the animals in question and also on time required for the conduct. Toxicity was read in terms of minutes in reference to poisoning (Fig. 3). Threshold toxic concentration was graphically determined (Fig. 3). The limens for the teleost, Oryzias latipes, were found 1/16000000 CuS04, 1/15000000 KCN, and 1/1050000 NaOH.

In the previous papers1, 2), it was shown that the nutritive value of wheat germ was excellent and heat treatment of wheat germ improved its nutritive values for carp, Cyprinus carpio and roasting of the wheat germ by the dry method was more effective than autoclaving by the wet method. The present paper deals with the nutritive values of formulated diet of wheat germ and other materials, such as wheat germ and soybean, wheat germ and white fish meal, wheat germ and rice bran and so on. The results obtained are as follows: 1) The nutritive values of formulated diets consisting of defatted wheat germ and defatted soybean showed depressed values in proportion to the decrease of the wheat wheat germ content. 2) The nutritive values of defatted wheat germ with defatted white fish meal showed improvements when used as a formulated diet as compared with the case of single usage. 3) The formulated diets tentatively prepared with wheat germ, white fish meal, defatted rice bran, magna yeast, etc, showed higher value in feed efficiency than the commercial diet for carp.

Antiseptic treatments of fishing cotton yarns with the Cu-naphthenate and other metallic salts of naphthenic acid were carried on by two bath method : firstly treated with 1, 5, 10, 20, or 50% soln. of naphthenic acid in 0.5-1% ammonia and then dipped in 5% soln. of metallic salts, such as Cu, Hg, Zn, Al salts. Effectivness of these treatments are shown in Fig. 1-4 and Table 1. and summarized as follows : Hg and Cu-naphthenates are most effective, and practically 10-20% solns. of naphthenic acid in the 1% ammonia were applied to the yarn, and nextly fixed in the 5% metallic salt soln. Application of Cu-naphthenate, accompanied by Cu2O, is more effective than the simple treatment with Cu-naphthenate.

Catalase activities are determined on the liver extracts of the various species of teleost, and optimum pH of each species are shown graphycally. Optimum pH of liver catalase of the many saline water fishes are found to be 6.9-7.2, but of the several fresh water fishes are found at low optimum pH, 6.1-6.2. These low values of opt. pH seem to be characteristic of the fresh water fishes.

“Shiokara” is one of favorite diets in Japan which is prepared through autolysis of fish gut, e.g., stomack, intestine, pyrolic caeca, liver, etc., in presence of a comparatively large amount of common salt. But owing to the readiness of deterioration of oil in raw gut, unfavorable odour, taste and colour, “Shiokara” is very apt to be deprived of its market value. The author attempt to prevent “Shiokara” from deterioration by applying Sustane-1F (tert.-Butyl hydroxy anisole, B. H. A.) or Lintone C (Isoamyl gallate+Citric acid) as antioxidant of oil. It has observed that “Shiokara” can be stored for more than 60 days in a good condition as food if Sustane is used by 0.01% of raw gat; but when the amount of Sustane is reduced to 0.005%, it becomes somewhat degraded even within 20 days. In respect of antioxidant effct, 0.005% Sustane is nearly equal to 0.1% Lintone; but the latter, having a defect of darkening the cobur of the product, is less durable than the former. Oil rich fish guts are usable for the raw of “Shiokara” with the addition of antioxidant, such as Sustane.