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The Japanese Society for Spine Surgery and Related Research previously developed a diagnostic support tool for lumbar spinal stenosis (LSS-DST). Using the LSS-DST, general physicians can identify potential cases of LSS. However, in the LSS-DST, measurement of the ankle brachial pressure index (ABI) is required to exclude peripheral artery lesions in the lower limbs. We can expect further application of the LSS-DST if we can identify a simpler and easier method than ABI measurement. Therefore, in this large-scale, multicenter, cross-sectional study, we verified whether palpation of the posterior tibial (PT) artery could be used instead of ABI in the LSS-DST.This survey was conducted at 2177 hospitals and included 28,883 participants. The sensitivity and specificity of the original LSS-DST method using the ABI and that of the LSS-DST ver2.0 with PT artery palpation were assessed to screen their ability for diagnosing LSS, using the physicians' final diagnosis based on the patients' history, physical examination and radiographic findings as the gold standard.The sensitivity and specificity [95%CI] of the LSS-DST were 88.2% [87.5, 88.8] and 83.9% [83.4, 84.5], respectively, whereas the sensitivity and specificity of the LSS-DST ver2.0 were 87.7% [87.0, 88.3] and 78.3% [77.7, 78.9], respectively, indicating that LSS-DST ver2.0 is a useful screening tool for LSS with good sensitivity.When the item of ABI in the LSS-DST is replaced by palpation of the PT artery (LSS-DST ver2.0), its sensitivity is maintained as a screening tool for LSS.Level 3.

Junichi Handa, Koji Otani, Takuya Nikaido, Shin-ichi Kikuchi ,†Shin-ichi Konno Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan†Shin-ichi Kikuchi passed away on February 22th, 2022Correspondence: Junichi Handa, Tel +81-24-547-1276, Fax +81-24-548-5505, Email hanhan@fmu.ac.jpPurpose: Nocturnal leg cramps are considered to be a symptom of lumbar spinal stenosis (LSS). However, the relationship between LSS and nocturnal leg cramps in the general population remains unclear. The purpose of this study was to investigate the prevalence and characteristics of nocturnal leg cramps in LSS in the community.Patients and Methods: 328 voluntary participants were enrolled in this study. The presence of LSS was assessed by a validated and self-administered diagnostic support tool. The presence of nocturnal leg cramps and neurological findings were evaluated by one experienced spine surgeon. To investigate the relationship between leg cramps and anatomical factors, the participants underwent an MRI scan, and the dural sac cross-sectional area (DCSA) at each lumbar intervertebral disc level was measured.Results: A total of 214 participants (65.2%) had nocturnal leg cramps, and 94 of 328 participants (28.7%) showed typical LSS symptoms. In the typical LSS symptom group, 31 participants (33.0%) had nocturnal leg cramps. In the atypical LSS symptom group, 83 participants (35.5%) had nocturnal leg cramps. There was no statistically significant difference in the prevalence of nocturnal leg cramps between the two groups. The narrowest DCSA (< 25 mm2 and 25– 49.4mm2) was statistically related to the presence of nocturnal leg cramp. Statistically significant differences in sensory disturbance and motor weakness were not observed between the subjects with and those without nocturnal leg cramps. Moreover, impaired PTR was statistically related to the presence of nocturnal leg cramp.Conclusion: The prevalence of nocturnal leg cramps did not differ with or without typical LSS symptoms in the community. The degree of dural tube compression that is determined by DCSA had a direct effect on the presence of nocturnal leg cramps. Neurological impairment, such as PTR abnormalities, was associated with the presence of nocturnal leg cramps.Keywords: nocturnal leg cramps, lumbar spinal stenosis, general population, magnetic resonance imaging, sensory disturbance, motor weakness

Background: Lumbar spinal stenosis (LSS) is a clinical syndrome based on anatomic narrowing of the spinal canal. It is well known that anatomic narrowing of the spinal canal is essential for manifestation, but not all of them cause symptoms. There are many studies assessing the relationship between dural tube compression on MRI and clinical symptoms; however, most of them are cross-sectional. The purpose of this study was to reveal the magnitude of dural tube compression’s influence on the presence or development of LSS symptoms at the six-year follow-up and the occurrence of surgery during the follow-up period or not in the community setting. Methods: This was a longitudinal observational study of 459 participants who were assessed for typical LSS symptoms, and whose Roland–Morris Disability Questionnaire and numerical rating scale of leg pain and numbness was recorded using a questionnaire and conventional MRI of the lumbar spine. Typical LSS symptoms were judged using an LSS diagnostic support tool, which was a self-administered, self-reported history questionnaire (LSS-SSHQ). After six years, 232 subjects (follow-up rate 50.5%) were followed-up with typical LSS symptoms using LSS-SSHQ by mail. The relationship between the magnitude of dural tube compression evaluated by dural tube cross-sectional area (DCSA) in the initial assessment and the time course of typical LSS symptoms for the six-year duration were analyzed. In addition, predictors of the presence of typical LSS symptoms at the six-year follow-up were assessed. Furthermore, we investigated the relationship between typical LSS symptoms and DCSA during the initial assessment of patients who underwent surgery during the follow-up period. A multivariate logistic regression analysis was performed for statistical analysis. Results: (1) Severe dural tube compression did not show that LSS symptoms continued after six years. (2) Severe dural tube compression could not detect development of LSS-symptoms and surgery during the six-year period. Conclusion: Severe dural tube compression could not detect typical LSS symptom development and occurrence of surgery during the six-year period.

Associations between attention-deficit/hyperactivity disorder (ADHD) and chronic pain disorders, such as fibromyalgia, have been reported. However, associations between persistent chronic nonspecific low back pain (CNLBP) and ADHD have not yet been investigated.This study aimed to investigate the positive rates of possible ADHD, as assessed by self-reported ADHD scales, in patients with persistent CNLBP, using data from self-reported questionnaires completed by patients and their families. This study also aimed to compare the self-reported scores obtained from existing standardized data for healthy individuals, and to examine whether the ADHD scale scores of patients with persistent CNLBP are associated with pain variables.Cross-sectional study.The specialized pain clinic at our university hospital.This cross-sectional study included 60 consecutive patients with persistent CNLBP who were diagnosed with a possible somatic symptom disorder and were referred to a psychiatrist in our pain clinic. The Conners' Adult ADHD Rating Scales (CAARS) self-report (CAARS-S) and observer-rated (CAARS-O) questionnaires were utilized. We investigated the CAARS scores, and the association between the CAARS subscale scores and pain variables (pain duration and pain Numeric Rating Scale) in patients with persistent CNLBP.Of the 60 patients, 19 (31.7%) were positive on both CAARS-S and CAARS-O questionnaires (T-score65). The ADHD indices, which comprised subscales of the CAARS estimating the necessity of treatment for ADHD, were significantly higher in both male and female patients with persistent CNLBP than in the Japanese standardized sample (P0.005). CAARS-S hyperactivity/restlessness, CAARS-O hyperactivity/restlessness, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition hyperactive-impulsive symptom subscale scores also correlated with the pain intensity (P0.05).In this study, ADHD tendency was evaluated using only a self-reported questionnaire. Hence in the future, accurate and precise assessments of ADHD symptoms using structured clinical interviews conducted by ADHD experts are warranted. Additionally, the study only included patients with persistent CNLBP. Therefore in the future, it will be valuable to investigate ADHD scale scores (e.g., CAARS) among patients with CNLBP and nonspecific low back pain with larger sample sizes.Our findings revealed that the subscale scores on an ADHD scale were considerably high in patients with persistent CNLBP. As a previous study of our clinical experience indicates that persistent CNLBP can be substantially relieved by administering ADHD medications, ADHD screening is warranted in the treatment of persistent CNLBP.

Background Numbness in the soles of both feet at rest or bowel/bladder dysfunction can occur in patients with lumbar spinal stenosis (LSS), especially in patients with cauda equina lesions. The purpose of this study was to clarify the relationship between cauda equina symptoms at rest and quality of life (QOL) in LSS patients using standardized questionnaires developed for the Japanese population. Methods A survey was conducted in 564 hospitals and general practice clinics nationwide from December 1, 2011 to December 31, 2012. All patients who visited hospital or clinic because of low back pain were included. Patients were diagnosed with LSS using the LSS-Diagnostic Support Tool (LSS-DST), and the severity of the disease was measured using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) for quality of life. Presence of both sole numbness and/or bowel/bladder dysfunction were determined by medical interview. 3647 patients were diagnosed with LSS according to the results of the LSS-DST. 1294 of these patients (35.5%) had symptoms at rest. Of these patients, 359 patients with sole numbness, 135 patients with bowel/bladder dysfunction, and 52 patients with both numbness and bowel/bladder dysfunction were compared to the patients without rest symptoms (n = 2182). Comparisons between groups with or without sole numbness and bowel/bladder dysfunction were performed using statistical analysis of JOABPEQ responses in the categories of pain-related disorder, lumbar spine disorder, gait disturbance, social life disturbance, and psychological disorder. Results All groups with sole numbness and/or bowel/bladder dysfunction had statistically lower (worse) scores in all categories of the JOABPEQ compared to the group without these symptoms at rest. Conclusion LSS patients having numbness in the soles of both feet at rest or bowel/bladder dysfunction had lower measurements of QOL and activities of daily living than those patients without symptoms at rest. These symptoms appear to be related to QOL of LSS patients.

There is little evidence regarding long-term outcomes of locomotor dysfunction such as cardiovascular events, quality of life, and death. We are conducting a prospective cohort study to evaluate risk of cardiovascular disease, quality of life, medical costs, and mortality attributable to locomotor dysfunction. The present study determined baseline characteristics of participants in the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS).Cohort participants were recruited from residents between 40 and 80 years old who received regular health check-ups conducted by local government each year between 2008 and 2010 in Minami-Aizu Town and Tadami Town in Fukushima Prefecture, Japan. Musculoskeletal examination included assessment of physical examination of the cervical and lumbar spine, and upper and lower extremities and of physical function, such as grasping power, one-leg standing time, and time for the 3-m timed up-and-go test. Cardiovascular risk factors, including blood pressure and biological parameters, were measured at annual health check-ups. We also conducted a self-administered questionnaire survey.LOHAS participants comprised 1,289 men (mean age 65.7 years) and 1,954 women (mean age 66.2 years) at the first year. The proportion of obese individuals (body mass index 25.0 kg/m(2)) was 31.9% in men and 34.3% in women, and 41.0% of participants reported being followed up for hypertension, 7.0% for diabetes, and 43.6% for hypercholesterolemia. Prevalence of lumbar spinal stenosis was 10.7% in men and 12.9% in women, while prevalence of low back pain was 15.8% in men and 17.6% in women.The LOHAS is a novel population-based prospective cohort study that will provide an opportunity to estimate the risk of cardiovascular disease, quality of life, medical costs, and mortality attributable to locomotor dysfunction, and to provide the epidemiological information required to develop policies for detection of locomotor dysfunction.

Trends in the stability of Laves phases in the pseudo-binary alloy systems RE(Mg,Cd) 2 (RE: rare earth element) are studied experimentally. Alloys are synthesized with various compositional ratios between Mg and Cd and with different REs. For most REs except Yb, a Laves phase forms only in the Mg-rich part of the phase diagram including the binary limit REMg 2 , while for Yb a Laves phase is maintained throughout the whole compositional range between YbMg 2 and YbCd 2 . A thorough analysis on the compositions of the Laves phases in the Mg-rich part is performed, which reveals a systematic tendency towards off-stoichiometry with Mg-enrichment of about 5–10 atomic %. The phenomenon can be understood as a consequence of an unbalanced mixing of atomic species between two kinds of atomic sites. Rietveld refinements of the crystal structures reveal that a better fit is achieved by allowing the RE-positions to be replaced partially by Mg, which provides a supporting evidence for the atomistic model of off-stoichiometry.

The objective of the current study was to test the hypothesis that crush injury to nerve root increases endoneurial fluid pressure (EFP) and decreases blood flow in the associated dorsal root ganglion (DRG). A total of 21 adult, female Sprague-Dawley rats had their left L5 nerve root and DRG exposed. The L5 nerve root was clamped for 2 s with a vascular suture clip just proximal to the DRG (compression group). Sham-operated animals without compression were used for control (control group). EFP was recorded with a servo-null micropipette system using a glass micropipette with tip diameter of 4 mum before and after 3 h of treatment. After the final measurement of EFP, DRG was excised and processed for histology. Blood flow in the DRG was continuously monitored by laser Doppler flow meter for 3 h. Three hours after treatment, EFP was 4.7+/-2.7 cm H(2)O in the compression group and 2.2+/-1.2 cm H(2)O in the control group (P

原子力施設が集中する東海村とひたちなか市にまたがる那珂台地を中心に土壌の環境放射線測定と化学組成の検討を行って，那珂台地とその中に存在する原子力施設敷地の環境放射線の評価を行った．調査研究はJCO事故直後に始めた．γ線測定と土壌採取は500 mメッシュをきり，その交点を測定地点とした．那珂台地地域の土壌は主成分化学組成の特徴から3タイプに分類でき，このタイプ分けは地形地質区分に対応している．すべての測定地点で，日本の花崗岩の放射線平均値や一般公衆の年間の実効線量限度を越える地点はなかった．環境放射線の強度分布は土壌タイプの分布と相関がよい．また，K20含量およびRb含量とγ線強度によい相関がみられた．これらの結果はこの地域の環境放射線は主として自然放射線のものであることを示している．

The progression of squamation and the formation of ctenii in developing juveniles of completely ambicolorate specimens of the Japanese flounder, Paralichthys olivaceus (Temmink et Schlegel), have been examined and compared with those of normally colored fish. The squamation developed with a similar pattern on both the ocular and blind sides of completely ambicolorate fish and of normal fish. In the normal fish, formation of ctenii occurred only on the ocular side and not on the blind side. In the completely ambicolorate fish, the formation of ctenii occurred on both the ocular and the blind side, but the formation of ctenii on the blind side differed from that on the ocular side in both normal and completely ambicolorate fish in terms of both mode and pattern. On the blind side of ambicolorate fish, the formation of ctenii progressed not from the lateral axis as is the case in the normal fish, but from the dorsal and ventral edges just after the formation of ctenii reached the edges on the ocular side, suggesting the diffusion of an unknown factor(s) through the dermal tissue.

The aims of this study were to investigate the anti-tumor effects of consecutive low-dose cisplatin (LD-CDDP) in comparison with single high-dose CDDP (HD-CDDP) in combination with caffeine.Human fibrosarcoma cells (HT-1080) were transplanted in BALB/C-nu mice. According to the administration of CDDP and caffeine, 5 groups were defined: HD-CDDP, LD-CDDP, HD-CDDP +caffeine, LD-CDDP +caffeine and control group. The total dose of CDDP was 3.5 or 6 mg/kg. CDDP was injected i.p. bolus (HD-CDDP) or divided into 5 days (LD-CDDP). Caffeine was injected i.p. at a dose of 60 mg/kg twice a day for 4 days.Significant inhibition of tumor growth and prolongation of survival time were recognized in the HD- and LD-CDDP groups with and without caffeine compared to the control group. The caffeine-assisted groups had no advantage compared to the CDDP alone groups.The effects of LD-CDDP were similar to the effect of HD-CDDP.

Many types of block are used for treatment of low back pain. In the current paper, trigger-point block, facet block, ilio-sacral joint block, epidural block and nerve root infiltration (nerve root block), quite common procedures for treatment of low back pain, are introduced and technical notes are described. There are two important points for block treatment, one is the knowledge of anatomy and another is the knowledge of side effects. We must remember to prepare everything for side effects when block treatment is done.

A prospective study was performed to clarify the therapeutic effect on calcitonin in the patients with osteoporosis using patient-based outcome measures. A total of 67 patients with primary osteoporosis who complained back pain were included in this study. All patients were administered calcitonin 20 Unit/week intramuscularly. The therapeutic effects were assessed using various patient-based outcome measures before treatment, 2, 4 weeks and 3 months after treatment. We used Short form 12 for measuring general well-being, Roland Morris disability questionnaire for functional status associated with back pain, and visual analogue scale for pain intensity. Statistic analysis was performed using paired-t test. Pain intensity and functional status were significantly recovered at 2 weeks follow-up time and the effects were continued at 3 months follow-up time. Physical component summary (PCS) was recovered at 3 months follow-up tme, whereas mental component summary (MCS) was improved at 2 weeks follow-up time. These facts suggest that improvement of back pain using calcitonin correlates directly with recovery in functional status, indirectly with recovery in general well being.

Three elements contribute to the neurologic symptoms of the lumbar spine or its multiplicity from an anatomical viewpoint. The first element is the problem of neural tissue. The second element is the bone or the soft tissue existing around the circumference of the neural tissue. The third element is the correlation of the above two. In other words, the neural tissue as content is too large or the adjacent tissue as container is too narrow or else an aberration in the correlation of the aforesaid is involved. Therefore, it is necessary to study those three elements to comprehend the neurologic symptoms of the lumbar spine.

Neurophysiologic function and ischemia causes neurogenic symptoms in lumbar spinal stenosis. Neurophysiologic function and potential therapeutic agents were investigated using a chronic cauda equina compression model that was developed according to a clinical pathogenesis. In the chronic cauda equina compression model, nerve conduction velocity and blood flow in spinal nerves decreased but mechanical allodynia was not induced. Prostaglandins and 5-HT receptor antagonist effected to improve blood flow in nerve roots after cauda equina compression;therefore, they might be potential agents for lumbar spinal stenosis.

[figure: see text] Various phosphine oxides are efficiently reduced by the use of a methylation reagent and lithium aluminum hydride. Optically active P-chirogenic phosphine oxides are also reduced with inversion of configuration at phosphorus atom by treatment with methyl triflate, followed by reaction with LiAlH4.

[figure: see text] Various phosphine oxides are efficiently reduced by the use of a methylation reagent and lithium aluminum hydride. Optically active P-chirogenic phosphine oxides are also reduced with inversion of configuration at phosphorus atom by treatment with methyl triflate, followed by reaction with LiAlH4.

Ossification of the posterior longitudinal ligament (OPLL) at the thoracic level tends to be multiple or extensive, depending on the degree and number of impingements on the spinal cord. In the case of thoracic myelopathy caused by OPLL, excision of OPLL is the most effective method of relieving pressure on the spinal cord, but the anterior approach for OPLL excision is technically demanding. Moreover, in the case of highly impinging OPLL, postoperative neurological deterioration resulting in complete paraplegia, although infrequent, has been reported [1-3]. So far, thoracic OPLL has remained a challenge to the spinal surgeon in Japan. Postoperative neurological catastrophes are thought to arise from inadvertent trauma of the spinal cord, resulting from the excision maneuvers in an OPLL-narrowed spinal canal. Moreover, the spinal cord has probably lost its vital resistance to trauma following severe and long-standing compression by OPLL.

Endocardial lining cells in the heart of certain teleosts are phagocytic against foreign materials. In the medaka Oryzias latipes, in addition to the endocardial lining cells, cells in the subendocardial spaces are also phagocytic. Most subendocardial cells contain yellowish-brown pigments and are often aggregated to form nodules resembling splenic and kidney melano-macrophage centres. Subendocardial cells are positive to PAS and Schmorl's reaction. Macrophages containing large heterogeneous inclusions together with lymphocytes, were observed with the TEM. The definitive characteristics of reticular cells, including the cell sheaths, were not observed. Because of these two characteristics they were regarded as more primitive aggregates of macrophages than the ordinary melano-macrophage centres. The possible analogy between these structures and MMCs is discussed.

Anode/electrolyte two-layer ceramic composites for tubular solid oxide fuel cells were prepared through coextrusion of multiple pastes containing a water-based binder (an aqueous solution of hydroxypropyl methylcellulose). The multibillet extrusion (MBE) technique was found to be effective in achieving the anode/electrolyte composite pipes. Furthermore, it is possible to reduce the wall thickness of both anode and electrolyte layers by raising the extrusion ratio of each layer. The extrusion pressure and binder content required to obtain sound extrudates decreased with an increase in the fraction of nickel oxide in an anode layer. It is feasible to decrease the difference in the sintering shrinkage between the anode and electrolyte layers by incorporating calcined coarse yttria-stabilized zirconia (YSZ) powder in the electrolyte layer. The incorporation of coarse YSZ powder in an anode is effective in forming a continuous NiO network within the YSZ matrix.

A series of bis(phosphanes) (SP,SP′)-R1(Me)PCH2CH2P′R2R3 (1a−k; R1, R2, and R3 = 1-adamantyl, tert-butyl, cyclohexyl, cyclopentyl, isopropyl, methyl, phenyl; abbreviated as unsymmetrical BisP*) has successfully been synthesized, by coupling of the (RP)-configured tosylates 5a−d or mesylates 6a−g with lithiated (SP)-R1(Me)PH−BH3 adducts. Asymmetric hydrogenations catalyzed by rhodium complexes of the unsymmetrical BisP* moieties as ligands revealed extremely high enantioselectivities − 99% (9b) and 98% (9e) − when the trisubstituted and tetrasubstituted dehydro-α-amino acid derivatives 8b and 8e, respectively, were used as substrates. It was found that unsymmetrical BisP* species tended to exhibit higher enantioselectivity than C2-symmetrical BisP* species in the Rh-catalyzed hydrogenation of (Z)-dehydro-β-amino acid and enamide derivatives. These results implied that the differentiation between the chiral environments at the two phosphorus atoms could effectively achieve higher enantioselectivity. For each substrate, moreover, it was possible to improve the enantioselectivity by changing the combination of substituents on the two phosphorus atoms. (© Wiley-VCH Verlag GmbH, 69451 Weinheim, Germany, 2002)