Posterior Occipitocervical Fixation and Intrathecal Baclofen Therapy for the Treatment of Basilar Invagination with Klippel-Feil Syndrome: A Case Report

Klippel-Feil syndrome (KFS) is characterized by the congenital fusion of the cervical vertebrae and is sometimes accompanied by anomalies in the craniocervical junction. In basilar invagination (BI), which is a dislocation of the dens in an upper direction, compression of the brainstem and cervical cord results in neurological defects and surgery is required. A 16-year-old boy diagnosed with KFS and severe BI presented with spastic tetraplegia, opisthotonus and dyspnea. CT scans showed basilar impression, occipitalization of C1 and fusion of C2/C3. MRI showed ventral compression of the medullocervical junction. Posterior occipitocervical reduction and fusion along with decompression were performed. Paralysis gradually improved postoperatively over 3 weeks. However, severe spasticity and opisthotonus persisted and intrathecal baclofen (ITB) therapy was initiated. Following this, opisthotonus disappeared and spasticity of the extremities improved. Rehabilitation therapy continued by controlling the dose of ITB. Five years after the surgery, self-propelled wheelchair driving was achieved and activities of daily life improved. The treatment strategy for patients with BI and congenital anomalies remains controversial. Posterior reduction and internal fixation using instrumentation were effective techniques in this case. Spasticity control achieved through a combination of surgery and ITB treatment enabled the amelioration of therapeutic efficacy of rehabilitation and the improvement of ADL.

Clinical Outcomes of Lateral Lumbar Interbody Fusion with Percutaneous Pedicle Screw for Dialysis-Related Spondyloarthropathy

Background: The usefulness and problems with lateral lumbar interbody fusion (LLIF) with a percutaneous pedicle screw (PPS) for dialysis-related spondyloarthropathy are not clear. Therefore, we investigated the usefulness and problems with LLIF with PPS in dialysis-related spondyloarthropathy. Methods: In total, 77 patients who underwent LLIF with PPS were divided into two groups: the dialysis-related spondyloarthropathy group ("Group D") consisted of 15 patients (10 males and 5 females) with a mean age of 70.4 years and a mean duration of hemodialysis of 10.8 years; and the lumbar degenerative disease group ("Group L") included 62 patients (31 males and 31 females) with a mean age of 71.0 years. The mean follow-up period was 4 years in Group D and 3 years 9 months in Group L. We compared surgical invasiveness (operative time, blood loss), perioperative complications, clinical outcomes (Improvement ratio of the JOA score), bone fusion rate, reoperation, sagittal alignment, and coronal imbalance between the two groups. Results: There were no significant differences in operative time, blood loss, or the improvement ratio of the JOA score, but dialysis-related spondyloarthropathy was observed in one patient with superficial infection, three patients with endplate failure, and one patient with restenosis due to cage subsidence. Conclusions: We consider LLIF with PPS for dialysis-related spondyloarthropathy to be an effective treatment option because its surgical invasiveness and clinical outcomes were comparable to those for cases of lumbar degenerative disease. However, as endplate failure due to bone fragility and a reduced bone fusion rate were observed in dialysis spondylolisthesis cases, we advise a careful selection of indications for indirect decompression as well as the application of suitable pre- and postoperative adjuvant therapies.

Muscle Evaluation and Hospital-Associated Disability in Acute Hospitalized Older Adults

OBJECTIVES

We aimed to examine the association of muscle evaluation, including muscle ultrasound, with hospital-associated disability (HAD), focusing on ADL categories.

DESIGN

A prospective observational cohort study.

SETTING AND PARTICIPANTS

We recruited patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital between October 2019 and September 2021.

MEASUREMENTS

Handgrip strength, bioimpedance analyzer-determined skeletal muscle mass, bilateral thigh muscle thickness (BATT), and the echo intensity of the rectus femoris on muscle ultrasound were performed as muscle assessments. HAD was evaluated separately for mobility impairments and self-care impairments.

RESULTS

In total, 256 individuals (mean age, 85.2 years; male sex, 41.8%) were analyzed. HAD in mobility was more common than HAD in self-care (37.5% vs. 30.0%). Only BATT was independently associated with HAD in mobility in multiple logistic regression analysis. There was no significant association between muscle indicators and HAD in self-care.

CONCLUSION

A lower BATT was associated with a higher prevalence of HAD in mobility, suggesting the need to reconsider muscle assessment methods in hospitalized older adults. In addition, approaches other than physical may be required, such as psychosocial and environmental interventions to improve HAD in self-care.

Hepatocyte growth factor regulates HIF-1α-induced nucleus pulposus cell proliferation through MAPK-, PI3K/Akt-, and STAT3-mediated signaling

Intervertebral discs are important for maintaining mobility and offer support to the body trunk. If these discs lose their biomechanical features, lower back pain can occur. We previously reported that hepatocyte growth factor (HGF) promotes cell proliferation and suppresses apoptosis, inflammation, and matrix degradation in nucleus pulposus (NP) cells. In the present study, we investigated the molecular mechanisms of how HGF promotes the proliferation of NP cells in hypoxic conditions. Hypoxic stimulation promoted modest cell proliferation, which was further upregulated by HGF. Expression of hypoxia-inducible factor (HIF-1α) protein, which contributes to the maintenance of homeostasis in NP cells, was also upregulated in hypoxia-treated cell groups; HGF further increased HIF-1α expression in NP cells. Additionally, knockdown of HIF-1α expression significantly reduced the proliferation of NP cells. An MAPK inhibitor inhibited the expression of HIF-1α and pERK, as well as cell proliferation in a dose-dependent manner. Similarly, inhibiting the PI3K/Akt and STAT3 pathways also decreased the expression of HIF-1α and cell proliferation. These results show that under hypoxic conditions, HGF promotes NP cell proliferation via HIF-1α-, MAPK-, PI3K/Akt-, and STAT3-mediated signaling which is involved in this pathway. The control of these signaling pathways may be a target for potential therapeutic strategies for the treatment of disc degeneration in hypoxic conditions.

The Potential Role of Hepatocyte Growth Factor in Degenerative Disorders of the Synovial Joint and Spine

This paper aims to provide a comprehensive review of the changing role of hepatocyte growth factor (HGF) signaling in the healthy and diseased synovial joint and spine. HGF is a multifunctional growth factor that, like its specific receptor c-Met, is widely expressed in several bone and joint tissues. HGF has profound effects on cell survival and proliferation, matrix metabolism, inflammatory response, and neurotrophic action. HGF plays an important role in normal bone and cartilage turnover. Changes in HGF/c-Met have also been linked to pathophysiological changes in degenerative joint diseases, such as osteoarthritis (OA) and intervertebral disc degeneration (IDD). A therapeutic role of HGF has been proposed in the regeneration of osteoarticular tissues. HGF also influences bone remodeling and peripheral nerve activity. Studies aimed at elucidating the changing role of HGF/c-Met signaling in OA and IDD at different pathophysiological stages, and their specific molecular mechanisms are needed. Such studies will contribute to safe and effective HGF/c-Met signaling-based treatments for OA and IDD.

Can a relatively large spinal cord for the dural sac influence severity of paralysis in elderly patients with cervical spinal cord injury caused by minor trauma?

Retrospective reviewThe degree of spinal cord compression and bony spinal canal stenosis are risk factors for the occurrence of spinal cord injury (SCI) without major fracture or dislocation, but they do not affect the severity of neurological symptoms. However, whether a relatively large spinal cord for the dural sac influences the severity of symptoms in SCI cases is unknown.The purpose of this study was to verify the influence of spinal cord size relative to dural sac on the severity of paralysis in elderly patients with cervical SCI caused by minor trauma.Subjects were 50 elderly patients with SCI caused by falls on flat ground. At 72 hours after injury, neurological assessment was performed using the Japanese Orthopaedic Association (JOA) scoring system. Bony canal anteroposterior diameters (APD) at mid C5 vertebral body were measured with computed tomography. We measured dural sac and spinal cord APD at the injured level and mid C5 with magnetic resonance imaging. Spinal cord compression ratio was calculated by dividing spinal cord at the injured level by spinal cord at mid C5. As the evaluation of spinal cord size relative to the dural sac, spinal cord/dural sac ratio was calculated at the injured level and mid C5. To clarify the factors influencing the severity of paralysis, the relationships between JOA score and those parameters were examined statistically.A significant negative correlation was observed between JOA score and spinal cord/dural sac ratio at mid C5. No clear relationship was observed between JOA score and bony canal APD or spinal cord compression ratio.In elderly patients with SCI caused by minor trauma, a relatively large spinal cord for the dural sac was shown to be a factor that influences the severity of paralysis. This result can be useful for the treatment and prevention of SCI in the elderly.

Osteoporotic effect on bone repair in lumbar vertebral body defects in a rat model

INTRODUCTION

The number of patients who suffered from osteoporotic vertebral fractures is increasing. Osteoporosis has been reported to affect the healing process using long bone models. However, few studies have reported using vertebrae. In this study, we created a bone defect in the anterior part of vertebral body in ovariectomized rat and evaluated the healing process.

METHODS

Fifty-six 12-week old Sprague Dawley rats were divided into ovariectomy (OVX) and sham operation groups. A bone defect was created in the vertebral body 8 weeks after the first surgery. In both groups, the vertebral bodies were harvested immediately or at 4, 8, or 12 weeks after the second surgery ( n = 7 at each time point). Bone volume (BV, mm³), bone volume fraction (BV/TV, %), trabecular thickness (Tb.Th, mm), trabecular number (Tb.N, 1/mm), and trabecular separation (Tb.Sp, µm) were evaluated by micro-computed tomography to assess the new bone formation. Histological analysis was also performed.

RESULTS

The BV and the BV/TV were significantly lower at 4 and 12 weeks in the OVX group compared with those in the sham group. The Tb.Th was significantly lower at 8 and 12 weeks in the OVX group. Histologically, at 12 weeks, in the OVX group, the bone had a thinner, layered structure on the surface of the defect, and the trabecular structure was less dense.

CONCLUSION

This study demonstrated that bone mass formation was suppressed and the quality of repaired bone was poor in the healing process of vertebral body defect under osteoporotic conditions. These findings could be the key to understand the pathology of osteoporotic vertebral fracture and to develop its therapies.

Clinical Outcome of Muscle-Preserving Interlaminar Decompression (MILD) for Lumbar Spinal Canal Stenosis: Minimum 5-Year Follow-Up Study

Introduction

Favorable short-term outcomes have been reported following muscle-preserving interlaminar decompression (MILD), a less invasive decompression surgery for lumbar spinal canal stenosis (LSCS). However, there are no reports of mid- to long-term outcomes. The purpose of this study was to evaluate the clinical outcomes five or more years after treatment of LSCS with MILD.

Methods

Subjects were 84 cases with LSCS (44 males; mean age, 68.7 years) examined five or more years after MILD. All patients had leg pain symptoms, with claudication and/or radicular pain. The patients were divided into three groups depending on the spinal deformity: 44 cases were without deformity (N group); 20 had degenerative spondylolisthesis (DS group); and 20 had degenerative scoliosis (DLS group). The clinical evaluation was performed using Japanese Orthopedic Association (JOA) scores, and revision surgeries were examined. Changes in lumbar alignment and stability were evaluated using plain radiographs.

Results

The overall JOA score recovery rate was 65.5% at final follow-up. The recovery rate was 69.5% in the N group, 65.2% in the DS group, and 54.0% in the DLS group, with the rate of the DLS group being significantly lower. There were 16 revision surgery cases (19.0%): seven in the N group (15.9%), three in the DS group (15.0%) and six in the DLS group (30.0%). There were no significant differences between pre- and postoperative total lumbar alignment or dynamic intervertebral angle in any of the groups, slip percentage in the DS group, or Cobb angle in the DLS group.

Conclusions

The mid-term clinical results of MILD were satisfactory, including in cases with deformity, and there was no major impact on radiologic lumbar alignment or stability. The clinical outcomes of cases with degenerative scoliosis were significantly less favorable and the revision rate was high. This should be taken into consideration when deciding on the surgical procedure.

Bone Regeneration of Osteoporotic Vertebral Body Defects Using Platelet-Rich Plasma and Gelatin β-Tricalcium Phosphate Sponges

The objective of the present study was to investigate the effect of platelet-rich plasma (PRP) combined with gelatin β-tricalcium phosphate (β-TCP) sponge on bone generation in a lumbar vertebral body defect of ovariectomized rat. After creating critical-size defects in the center of the anterior vertebral body, the defects were filled with the following materials: (1) no material (control group), (2) gelatin β-TCP sponge with PRP (PRP sponge group), and (3) gelatin β-TCP sponge with phosphate-buffered saline (PBS sponge group). Microcomputed tomography and histological evaluation were performed immediately after surgery and at 4, 8, and 12 weeks to assess bone regeneration. Biomechanical test was also performed at postoperative week 12. In the PRP sponge group, both imaging and histological examination showed that visible osteogenesis was first induced and additional growth of bone tissue was observed in the transplanted sponge, compared with the PBS sponge group. There was no negative effect of either PRP sponge or PBS sponge transplantation on bone tissue generation around the periphery of the defect. Biomechanical test showed increased stiffness of the affected vertebral bodies in the PRP sponge group. These results indicate that PRP-impregnated gelatin β-TCP sponge is effective for facilitating bone regeneration in lumbar vertebral bone defect under osteoporotic condition. PRP combined with gelatin β-TCP sponges could be potentially useful for developing a new approach to vertebroplasty for osteoporotic vertebral fracture.

Effect of three-dimensional rotational deformity correction in surgery for adult degenerative scoliosis using lumbar lateral interbody fusion and posterior pedicle screw fixation

Introduction

Corrective surgery for adult degenerative scoliosis using lateral interbody fusion (LIF) and additional posterior fixation is an efficient procedure. However, it is unclear how this procedure affects rotational deformity correction. Therefore, the goal of the present study was to use three-dimensional (3D) images, taken during surgery, to investigate rotational deformity correction in the treatment of adult degenerative scoliosis using LIF and posterior fixation using a pedicle screw system.

Methods

The subjects were 12 females who were treated using LIF and posterior fixation for adult degenerative scoliosis. The patients had a mean age of 72 (65-76) years. 3D images were acquired before surgery, after LIF, and after additional posterior fixation. Rotational angles of the upper vertebra with respect to the lower vertebra of each fixed segment were measured in 3 planes. Correction factors for rotational deformity were investigated after LIF and additional posterior fixation.

Results

There were significant improvements in radiographical parameters for global spinal balance. The correction angles per segment were 4.7° for lateral bending, 6.9° for lordosis, and 4.5° for axial rotation. LIF was responsible for correction of four-fifths of lateral bending and axial rotation, and two-thirds of lordotic changes.

Conclusions

Lateral bending, axial rotational deformities, and lordosis were primarily corrected by LIF. Further lordosis correction was achieved using additional posterior fixation. These results indicate that corrective surgery for adult degenerative scoliosis using these procedures is effective for rotational deformity correction and leads to an ideal global spinal alignment.

Work-sharing and male employees' mental health during an economic recession

Background

One approach to reducing occupational stress during an economic recession is to share work amongst employees. This may include reducing employees' working hours to avoid redundancies.

Aims

To examine whether work-sharing influenced the psychosocial work environment and depressive symptoms encountered by Japanese employees, and to determine which psychosocial factors predict employees' mental health during an economic recession.

Methods

A survey was performed in a Japanese manufacturing company at the beginning (T1) and end (T2) of a 6-month period during the 2008 economic recession using the validated Job Content Questionnaire (JCQ) and Self-Rating Depression Scale (SDS).

Results

Three hundred and thirty-six male employees completed the questionnaire. Twenty-four per cent of participants showed depressive symptoms at T1. Despite reductions in employees' working hours and job strain (P < 0.001), SDS scores showed no change after 6 months. Logistic regression analyses showed that low social support between the two surveys was associated with depressive symptoms at T2 after adjusting for demographic, lifestyle, workplace factors, scheduled working hours and depressive symptoms at T1.

Conclusions

Reductions in job strain did not affect employees' depressive symptoms. Employees with low social support during the study had a significantly higher risk of having depressive symptoms. These findings indicate that social and emotional support within the workplace is important during the work-sharing period.

Usefulness of anterior cervical fusion using titanium interbody cage for treatment of cervical degenerative disease with preoperative segmental kyphosis

Favorable bone fusion and clinical results have been reported for anterior cervical fusion (ACF) using titanium interbody cage (TIC). This method might induce postoperative subsidence and local kyphosis, but the relationship between radiological changes and preoperative local alignment is not known. The purpose of the present study is to investigate the impact of preoperative local alignment on the clinical and radiological outcomes of ACF using TIC.The study enrolled 36 patients (mean age 49.8 years) who underwent single-level ACF using TIC for cervical degenerative diseases. Patients were divided into 2 groups by preoperative segmental lordotic angle at the operative level: group L, ≥0° (n = 16); group K, <0° (n = 20). Clinical outcomes included recovery rate according to the Japanese Orthopaedic Association score and complication rates. Radiological assessment was conducted for the cervical and segmental lordotic angles, subsidence, and bone fusion. Mann-Whitney test and chi-square test were applied to compare the outcomes.The Japanese Orthopaedic Association score recovery rate was 77.2% in group L and 87.6% in group K, with no significant difference. No obvious complications were observed in any of the subjects. Mean cervical lordotic angles preoperatively and at last follow-up were 9.2 ± 9.5° and 11.3 ± 11.7°, respectively, in group L, and -1.3 ± 12.8° and 4.6 ± 13.3°, respectively, in group K. The mean segmental lordotic angles preoperatively and at last follow-up were 2.5 ± 2.2° and 2.6 ± 5.7°, respectively, in group L, and -4.5 ± 2.8° and -1.4 ± 5.8°, respectively, in group K. In group K, the cervical and segmental lordotic angles at the last follow-up were significantly greater than the preoperative angles. The change observed in group L was not significant. Subsidence of ≥3 mm was observed in 3 patients in group L and 4 patients in group K. None of the patients showed nonunion.Anterior cervical fusion using TIC provided favorable clinical results regardless of preoperative segmental alignment. Although postoperative subsidence and kyphotic changes are concerns in patients presenting segmental kyphosis, ACF using TIC corrected both the entire cervical spine and segmental alignment. The TIC is useful for correction of the cervical alignment for patients with cervical degenerative disease with local kyphotic changes.

Prevention of neurological complications using a neural monitoring system with a finger electrode in the extreme lateral interbody fusion approach

OBJECTIVE

Extreme lateral interbody fusion (XLIF) is a minimally disruptive surgical procedure that uses a lateral approach. There is, however, concern about the development of neurological complications when this approach is used, particularly at the L4–5 level. The authors performed a prospective study of the effects of a new neural monitoring system using a finger electrode to prevent neurological complications in patients treated with XLIF and compared the results to results obtained in historical controls.

METHODS

The study group comprised 36 patients (12 male and 24 female) who underwent XLIF for lumbar spine degenerative spondylolisthesis or lumbar spine degenerative scoliosis at L4–5 or a lower level. Using preoperative axial MR images obtained at the mid-height of the disc at the treated level, we calculated the psoas position value (PP%) by dividing the distance from the posterior border of the vertebral disc to the posterior border of the psoas major muscle by the anteroposterior diameter of the vertebral disc. During the operation, the psoas major muscle was dissected using an index finger fitted with a finger electrode, and threshold values of the dilator were recorded before and after dissection. Eighteen cases in which patients had undergone the same procedure for the same indications but without use of the finger electrode served as historical controls. Baseline clinical and demographic characteristics, PP values, clinical results, and neurological complications were compared between the 2 groups.

RESULTS

The mean PP% values in the control and finger electrode groups were 17.5% and 20.1%, respectively (no significant difference). However, 6 patients in the finger electrode group had a rising psoas sign with PP% values of 50% or higher. The mean threshold value before dissection in the finger electrode group was 13.1 ± 5.9 mA, and this was significantly increased to 19.0 ± 1.5 mA after dissection (p < 0.001). A strong negative correlation was found between PP% and threshold values before dissection, but there was no correlation with threshold values after dissection. The thresholds after dissection improved to 11 mA or higher in all patients. There were no serious neurological complications in any patient, but there was a significantly lower incidence of transient neurological symptoms in the finger electrode group (7 [38%] of 18 cases vs 5 [14%] of 36 cases, p = 0.047).

CONCLUSIONS

The new neural monitoring system using a finger electrode may be useful to prevent XLIF-induced neurological complications.

Dislodgement and gastrointestinal tract penetration of bone cement used for spinal reconstruction after lumbosacral vertebral tumor excision: A case report

INTRODUCTION

Polymethylmethacrylate (PMMA) cement is useful for spinal reconstruction, but can cause complications including new vertebral fractures, neurological disorders and pulmonary embolism. We report a case in PMMA cement used for spinal reconstruction after tumor curettage dislodged and penetrated the gastrointestinal tract.

DIAGNOSES

The patient was diagnosed with a retroperitoneal extragonadal germ cell tumor at age 27 years. After chemotherapy and tumor resection, the tumor remained. It gradually increased in size and infiltrated lumbosacral vertebrae, causing him to present at age 35 years with increased low back pain. Image findings showed bone destruction in the vertebral bodies accompanied by neoplastic lesions. The left and right common iliac arteries and inferior vena cava were enclosed in the tumor on the anterior side of the vertebral bodies. Lumbosacral bone tumor due to direct extragonadal germ cell tumor infiltration was diagnosed. A 2-step operation was planned; first, fixation of the posterior side of the vertebral bodies, followed by tumor resection using an anterior transperitoneal approach, and spinal reconstruction using PMMA cement. After surgery, the PMMA cement gradually dislodged towards the anterior side and, 2 years 9 months after surgery, it had penetrated the retroperitoneum. The patient subsequently developed nausea and abdominal pain and was readmitted to hospital. The diagnosis was intestinal blockage with dislodged PMMA cement, and an operation was performed to remove the cement present in the small intestine. There was strong intra-abdominal adhesion, the peritoneum between the vertebral bodies and intestine could not be identified, and no additional treatment for vertebral body defects could be performed. After surgery, gastrointestinal symptoms resolved.

CONCLUSION

Although this was a rare case, when using bone cement for vertebral body reconstruction, the way of anchoring for the cement must be thoroughly planned to assure no cement dislodgement can occur.

Hepatocyte growth factor/c-met promotes proliferation, suppresses apoptosis, and improves matrix metabolism in rabbit nucleus pulposus cells in vitro

The etiology of intervertebral disc (IVD) degeneration is closely related to apoptosis and extracellular matrix degradation in nucleus pulposus (NP) cells. These defects in NP cells are induced by excessive external stressors such as reactive oxygen species (ROS) and inflammatory cytokines. Recently, hepatocyte growth factor (HGF) has been shown to repair damage in various diseases through anti-apoptotic and anti-inflammatory activity. In this study, we investigated the effects of HGF on NP cell abnormality caused by ROS and inflammatory cytokines by using primary NP cells isolated from rabbit IVD. HGF significantly enhanced the proliferation of NP cells. Apoptosis of NP cells induced by H2 O2 or TNF-α was significantly inhibited by HGF. Induction of mRNA expression of the inflammation mediators cyclooxygenase-2 and matrix metalloproteinase-3 and -9 by TNF-α was significantly suppressed by HGF treatment. Expression of c-Met, a specific receptor for HGF, was confirmed in NP cells and was increased by TNF-α, suggesting that inflammatory cytokines increase sensitivity to HGF. These findings demonstrate that activation of HGF/c-Met signaling suppresses damage caused by ROS and inflammation in NP cells through multiple pathways. We further suggest the clinical potential of HGF for counteracting IVD degradation involved in NP cell abnormalities.

Outcomes in cases of lumbar degenerative spondylolisthesis more than 5 years after treatment with minimally invasive decompression: examination of pre- and postoperative slippage, intervertebral disc changes, and clinical results

OBJECT

There are reports that fusion is the standard treatment of choice for cases of lumbar degenerative spondylolisthesis (LDS) associated with lumbar spinal canal stenosis with a large degree of slippage. The reasons why, however, have not been clarified. On the other hand, it is known that the progress of slippage decreases and restabilization occurs over the natural course of LDS. Therefore, if minimally invasive decompression could be performed, there would be little possibility of it influencing the natural course of LDS, so it would not be necessary to include preoperative percentage slip in the criteria for the selection of fusion. This study examined the course of LDS cases more than 5 years after treatment with minimally invasive decompression to determine whether pre- and postoperative slippage and disc changes influence the clinical results.

METHODS

A total of 51 intervertebral segments in 51 cases with the chief complaint of radicular or cauda equina symptoms due to lumbar spinal canal stenosis were examined after prospective treatment with minimally invasive decompression for LDS. The mean age of the patients at the time of surgery was 66.7 years and the mean follow-up period was 7 years 4 months. Minimally invasive decompression was performed regardless of the degree of low-back pain or percentage slip. The outcome variables were clinical results and changes in imaging findings.

RESULTS

Over the follow-up period, postoperative percentage slip increased and disc height decreased, but the Japanese Orthopaedic Association score improved. Regardless of the preoperative percentage slip, disc height, or degree of intervertebral disc degeneration or segmental instability, the clinical results were favorable. In the high preoperative percentage slip group, low disc height group, and progressive disc degeneration group, there was little postoperative progress of slippage. In the group with a postoperative slippage increase of more than 5%, slippage increased significantly at postoperative year 2, but no significant difference was observed at the final follow-up.

CONCLUSIONS

When minimally invasive decompression was performed to treat LDS, the postoperative change in slippage was no different from that during the natural course. Furthermore, regardless of the degree of preoperative slippage or intervertebral disc degeneration, the clinical results were favorable. Also, the higher the preoperative percentage slip and the more that disc degeneration progressed, the more the progress of postoperative slippage decreased. Because the postoperative progress of slippage decreased, it is believed that even after minimally invasive decompression, restabilization occurs as it would during the natural course. If minimally invasive decompression can be performed to treat LDS, it is believed that preoperative percentage slip and intervertebral disc degeneration do not have to be included in the appropriateness criteria for fusion.

Differences in monthly variation, cause, and place of injury between femoral neck and trochanteric fractures: 6-year survey (2008-2013) in Kyoto prefecture, Japan

BACKGROUND

The incidence of femoral neck and trochanteric fractures reportedly differ by age and regionality. We investigated differences in monthly variations of the occurrence of femoral neck and trochanteric fractures as well as place and cause of injury in the Kyoto prefecture over a 6-year period.

METHODS

Fracture type (neck or trochanteric fracture), age, sex, place of injury, and cause of injury were surveyed among patients aged ≥ 65 years with hip fractures that occurred between 2008 and 2013 who were treated in 1 of 13 participating hospitals (5 in an urban area and 8 in a rural area). The proportion of sick beds in the participating hospitals was 24.7% (4,151/16,781). Monthly variations in the number of patients were investigated in urban and rural areas in addition to the entire Kyoto prefecture. Place of injury was classified as indoors or outdoors, and cause of injury was categorized as simple fall, accident, or uncertain.

RESULTS

There were 2,826 patients with neck fractures (mean age, 82.1 years) and 3,305 patients with trochanteric fractures (mean age, 85.0 years). There were similarities in the monthly variation of the number of fractures in addition to the place and cause of injury between neck and trochanteric fractures. Indoors (approximately 74%) and simple falls (approximately 78%) were the primary place and cause of injury, respectively. The place of injury was not significantly different by fracture type with each age group. Significantly more patients with neck fracture had "uncertain" as the cause of injury than trochanteric fracture in all age groups.

CONCLUSIONS

Based on the results of the present study, the injury pattern might not have a great effect on the susceptibility difference between neck and trochanteric fractures.

Mapping occipital bone thickness using computed tomography for safe screw placement

OBJECT Safe and effective insertion of occipital bone screws requires morphological analysis of the occipital bone, which is poorly documented in the literature. The authors of this study present morphological data for determining the area of screw placement for optimal internal fixation. METHODS The subjects of this institutional review board-approved retrospective study were 105 individuals without head and neck disease who underwent CT imaging at the authors' hospital. There were 55 males and 50 females, with a mean age of 57.1 years (range 20-91 years). Measurements using CT were taken according to a matrix of 55 points following a grid with 1-cm spacing based on the external occipital protuberance (EOP). RESULTS The maximum thickness of the occipital bone was at the level of the EOP at 16.4 mm. Areas with thicknesses > 8 mm were more frequent at the EOP and up to 2 cm in all directions, as well as up to 1 cm in all directions at a height of 1 cm inferiorly, and up to 3 cm from the EOP inferiorly. The male group tended to have a thicker occipital bone than the female group, and the differences were significant around the EOP. The ratio of the trabecular bone to the occipital bone thickness was > 30% in the central region. At positions more than 2 cm laterally, the ratio was < 15%, and the ratio gradually decreased further laterally. CONCLUSIONS Screws that are 8 mm long can be placed in the area extending 2 cm laterally from the EOP at the level of the superior nuchal line and approximately 3 cm inferior to the center. These results suggest that it may be possible to effectively insert a screw over a wider area than the conventional reference range.

Instrumented reduction and monosegmental fusion for Meyerding Grade IV developmental spondylolisthesis: a report of 3 cases

There are numerous reports of treatment methods for spondylolisthesis with a Meyerding Grade of more than III. In high dysplastic spondylosthesis, surgical treatment was selected because there is considered to be a high possibility of low back pain and lower limb neurological symptoms worsening if slippage progresses. Monosegmental lumbar interbody fusion (L5-S1) with a pedicle screw system (PPS) was used to treat three cases of Meyerding Grade IV developmental spondylolisthesis. Patients gave written informed consent. The spondylolisthesis was reduced to Meyerding Grade I and sagittal balance improved in all three cases. In two cases with severe spinal instability, there were no postoperative neurological complications and the course was favorable. However, in one case with little spinal mobility due to vertebral body dysplasia, despite performing sufficient decompression of the nerve root at L5 and slow reduction to avoid placing excessive tension on the nerve root, a transient neurological disorder was observed. A PPS was used to increase the reduction strength and favorable reduction was possible. However, in the case with a long clinical course and the case with poor spinal mobility, since the mobility and plasticity of the nerve root itself may have been reduced, it was considered that reduction should be performed carefully using intraoperative neurological monitoring.

Effects of stress-shielding on the dynamic viscoelasticity and ordering of the collagen fibers in rabbit Achilles tendon

We investigated the effects of stress-shielding on both viscoelastic properties and microstructure of collagen fibers in the Achilles tendon by proton double-quantum filtered ((1) H-DQF) NMR spectroscopy. The right hind-limbs of 20 Japanese white rabbits were immobilized for 4 weeks in a cast with the ankle in plantarflexion. Dynamic viscoelasticity of the Achilles tendons was measured using a viscoelastic spectrometer. Proton DQF NMR signals were analyzed to determine the residual dipolar coupling of bound water molecules in the Achilles tendons. Both the dynamic storage modulus (E') and dynamic loss modulus (E″) decreased significantly in the Achilles tendons of the stress-shielding group. The results of the (1) H-DQF NMR examination demonstrated significantly reduced residual dipolar coupling in the Achilles tendons of this same group. The disorientation of collagen fibers by stress-shielding should contribute to degradation of the dynamic storage and loss moduli. The alterations of the collagen fiber orientation that contributed to the function of tendinous tissue can be evaluated by performing an analysis of (1) H DQF NMR spectroscopy.

Urban versus rural differences in the occurrence of hip fractures in Japan's Kyoto prefecture during 2008-2010: a comparison of femoral neck and trochanteric fractures

BACKGROUND

To investigate the differences in the characteristics of femoral neck and trochanteric fractures between urban and rural areas of Kyoto Prefecture in Japan.

METHODS

Fracture type (neck vs. trochanteric), age, sex, place where fracture occurred (indoors vs. outdoors), and cause of injury were surveyed among patients aged ≥65 years who sustained hip fractures between 2008 and 2010 and who were treated at 1 of 13 participating hospitals (5 urban, 8 rural). The ratio of sick beds to total number of beds at the participating hospitals was 19.6% (2,188/11,158) in the urban area and 34.9% (1,963/5,623) in the rural area. We also investigated the incidence of hip fracture in Tango medical district as a representative rural area.

RESULTS

There were 1,346 neck (mean age, 82.4 years) and 1,606 trochanteric fractures (mean age, 85.0 years). The ratio of neck to trochanteric fractures was higher in the urban area than in the rural area in all age groups (65-74, 75-84, and ≥ 85 years). There were no apparent differences in place or cause of injury. The incidence of hip fracture in the women of Tango medical district was lower than the national average.

CONCLUSIONS

There was a difference in the ratio of neck to trochanteric fractures between urban and rural areas. This difference is estimated to be caused by the high and low incidence of neck fracture in urban and rural areas, respectively.

Clinical and safety profiles of bipolar transurethral vaporization of the prostate in saline: a preliminary report

Transurethral vaporization of the prostate in saline (TURisV) is an innovative endoscopic surgical modality for the treatment of benign prostatic hyperplasia (BPH) that vaporizes prostate tissue using a uniquely designed mushroom electrode. TURisV promises instant hemostatic tissue ablation under saline irrigation and offers clinical advantages for endoscopic BPH operations. From July 2008 to February 2009, TURisV was performed in 17 cases with clinically significant BPH. Median operation time was 127.0 min and median volume of vaporized prostate tissue was 41.1 g. Median International Prostate Symptom Score improved from 20 to 4 after 12 months. Median maximum flow rate increased from 5.3 mL/s to 13.8 mL/s after 12 months. Postoperative median residual urine improved from 48.0 mL to 7.0 mL after 12 months. No changes in hemoglobin or electrolyte levels were seen postoperatively. Our results suggest that TURisV is a safe and efficacious treatment for BPH.

Positive effect on bone fusion by the combination of platelet-rich plasma and a gelatin β-tricalcium phosphate sponge: a study using a posterolateral fusion model of lumbar vertebrae in rats

We developed a novel method for bone fusion by combining platelet-rich plasma (PRP) and a gelatin β-tricalcium phosphate (β-TCP) sponge. The PRP is an autologous concentration of platelets that includes several growth factors. The gelatin β-TCP sponge comprises gelatin and β-TCP, thus enabling the sustained release of growth factors and osteoconduction. To evaluate this method, we generated a posterolateral fusion model of lumbar vertebrae in rats and divided it into five groups by implanting the following materials between transverse processes of vertebrae, (1) the gelatin β-TCP sponge with PRP (PRP sponge), (2) the gelatin β-TCP sponge with platelet-poor plasma, (3) gelatin hydrogel with PRP, (4) autologous iliac bone (autograft), and (5) no material was implanted as a control. The assessment of bone fusion by a radiographic assessment, a biomechanical test, microcomputed tomography, and histological evaluations demonstrated that there were no significant differences between the PRP sponge and the autograft groups regarding the osteogenic effect. Subsequent examinations revealed that no significant differences existed between the PRP sponge and the autograft groups in either biomechanical stiffness or the bone volume over time; whereas the radiographic and histological composition underwent similar changes in the fusion process. These results indicate that the PRP sponge could, therefore, be potentially useful as an attractive and less invasive method for bone fusion.

[Coronary artery bypass grafting for simultaneous subacute stent thrombosis after sirolimus-eluting stent implantation]

An 82-year-old man developed simultaneous stent thrombosis 11 days after the implantation of a sirolimus-eluting stent (SES) in the proximal left anterior descending artery (LAD) and the proximal right coronary artery (RCA). The patient immediately underwent percutaneous coronary intervention; however, his condition became critical due to the development of recurrent stent thrombosis, and emergent coronary artery bypass grafting with saphenous vein grafts was performed. Postoperative angiography showed good patency of both grafts; thrombus formation in the LAD and RCA was negative. Since the patient had a history of liver dysfunction due to ticlopidine administration, the thienopyridine derivative was not administered; this was believed to be the main cause of subacute stent thrombosis. He was administered aspirin, cilostazol, and sarpogrelate instead. A good postoperative course was achieved only using aspirin. This case demonstrates that simultaneous SES thrombosis in multivessel lesions poses a life-threatening situation.

Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing

Circulation-derived cells play a crucial role in the healing processes of tissue. In early phases of tendon healing processes, circulation-derived cells temporarily exist in the wounded area to initiate the healing process and decrease in number with time. We assumed that a delay of time-dependent decrease in circulation-derived cells could improve the healing of tendons. In this study, we injected platelet-rich plasma (PRP) containing various kinds of growth factors into the wounded area of the patellar tendon, and compared the effects on activation of circulation-derived cells and enhancement of tendon healing with a control group (no PRP injection). To follow the circulation-derived cells, we used a green fluorescent protein (GFP) chimeric rat expressing GFP in the circulating cells and bone marrow cells. In the PRP group, the numbers of GFP-positive cells and heat-shock protein (HSP47; collagen-specific molecular chaperone)-positive cells were significantly higher than in the control group at 3 and 7 days after injury. At the same time, the immunoreactivity for types I and III collagen was higher in the PRP group than in the control group at early phase of tendon healing. These findings suggest that locally injected PRP is useful as an activator of circulation-derived cells for enhancement of the initial tendon healing process.

[Emergent coronary artery bypass grafting in a survivor of out-of-hospital cardiac arrest]

We report a case of emergent coronary artery bypass grafting (CABG) in a survivor of an out-of-hospital cardiac arrest. A 64-year-old male driver lost consciousness and collapsed in a rice paddy field. A bystander placed him in a car and immediately started cardiopulmonary resuscitation after confirming the presence of pulselessness and apnea. Emergency medical service providers performed a defibrillation of ventricular fibrillation by using an automated external defibrillator (AED), and the patient was transferred to the critical care center in our hospital. Coronary angiography revealed a thrombus in the left main trunk (LMT), total occlusion of the left anterior descending artery (LAD) and the right coronary artery (RCA), and 90% stenosis of the left circumflex artery (Cx). Since the patient recovered consciousness 1 hour after admission and did not undergo any critical trauma, an on-pump CABG was performed for 3 vessels. He was discharged on the postoperative day 23, and he resumed a normal life.

Intervertebral Disc Regeneration Using Platelet-Rich Plasma and Biodegradable Gelatin Hydrogel Microspheres

This study evaluated the regenerative effects of platelet-rich plasma (PRP) for the degenerated intervertebral disc (IVD) in vivo. After induction of IVD degeneration in rabbits, we prepared PRP by centrifuging blood obtained from these rabbits. These PRP were injected into the nucleus pulposus (NP) of the degenerated IVDs after impregnation into gelatin hydrogel microspheres that can immobilize PRP growth factors physiochemically and release them in a sustained manner with the degradation of the microspheres. As controls, microspheres impregnated with phosphate-buffered saline (PBS) and PRP without microspheres were similarly injected. Histologically, notable progress in IVD degeneration with time courses was observed in the PBS control, PRP-only, and sham groups. In contrast, progress was remarkably suppressed over the 8-week period in the PRP group. Moreover, in immunohistochemistry, intense immunostaining for proteoglycan in the NP and inner layer of the annulus fibrosus was observed 8 weeks after administration of PRP-impregnated microspheres. Almost all microspheres were indistinct 8 weeks after the injection, and there were no apparent side effects in this study. Our results suggest that the combined administration of PRP and gelatin hydrogel microspheres into the IVD may be a promising therapeutic modality for IVD degeneration.

Effects of prolactin and growth hormone on plasma immunoglobulin M levels of hypophysectomized rainbow trout, Oncorhynchus mykiss

Immunoglobulin M (IgM) is a major component of the humoral immune system of teleosts. This study examines the effects of hypophysectomy and subsequent replacement with prolactin (PRL) or growth hormone (GH) upon the plasma IgM levels of the rainbow trout (Oncorhynchus mykiss). Plasma IgM levels of the hypophysectomized fish were decreased to 30% of those in sham-operated fish 1 or 4 weeks after operation. Implantation of a cholesterol pellet containing salmon PRL or GH restored plasma IgM levels of the hypophysectomized fish, suggesting important roles for PRL and GH in the regulation of circulating IgM level in trout.

Molecular cloning of the cDNAs encoding pituitary glycoprotein hormone alpha- and gonadotropin II beta-subunits of the Japanese eel, Anguilla japonica, and increase in their mRNAs during ovarian development induced by injection of chum salmon pituitary homogenate

cDNAs encoding the glycoprotein hormone alpha- and gonadotropin (GTH) II beta-subunits of Japanese eel (Anguilla japonica) pituitary were cloned using the polymerase chain reaction. The nucleotide sequence of the glycoprotein hormone alpha-subunit cDNA was 364 base pairs (bp) long, encoding 117 amino acids, and that of the GTH II beta-subunit cDNA was 433 bp long, encoding 140 amino acids. The deduced amino acid sequence of each mature subunit showed high homology with those of other teleosts, indicating that the structure of GTH subunits has been conserved during the evolution of teleosts. Changes in the expression of these subunit genes during ovarian development induced artificially by the injection of chum salmon pituitary homogenate were examined using Northern blot analysis. Glycoprotein hormone alpha-subunit mRNA increased almost linearly during ovarian development, whereas GTH II beta-subunit mRNA was detected only at the late vitellogenic and migratory nucleus stages. These data indicate that eel GTH II is synthesized mainly at the late vitellogenic and migratory nucleus stages, and suggest that GTH II plays an important role in final oocyte maturation of Japanese eel. Changes in the expression of glycoprotein hormone alpha- and GTH II beta-subunits mRNA correlate with the serum estradiol-17 beta (E(2)) and testosterone profile during ovarian development. The increase in mRNA of both subunits is probably due to positive feedback of E(2) and testosterone produced by ovarian follicles in response to the GTH contained in chum salmon pituitary homogenate.

Monoclonal antibody against an amniotic protein carrying ABH blood group epitopes and its forensic application

A mouse monoclonal antibody against an amniotic protein carrying ABH antigenic epitopes was established. BALB/c mice were immunized by an amniotic protein of molecular weight over 200 kDa, which had proved to be the carrier protein of ABH blood group epitopes by analysis with SDS-PAGE and immunoblotting. The antibody, ASP-1, was directed to the amniotic carrier protein without affecting the ABH blood group antigenicity, and did not cross-react with other body fluids which included blood, saliva, semen, urine or vaginal secretion. The immunoglobulin class of ASP-1 was IgG1 with a titer of 1 : 1,600. ASP-1 was used to detect the ABH blood group of amniotic fluid by the sandwich ELISA in which wells of plates were coated with ASP-1, and the ABH blood group of the captured protein was detected with mouse IgM anti-A and -B antibodies and enzyme conjugated anti-mouse IgM. The sandwich ELISA could successfully detect the blood group of amniotic fluid in mixed body fluids.

Molecular biologic analyses of tetragametic chimerism in a true hermaphrodite with 46,XX/46,XY

OBJECTIVE

To investigate the mechanism of the formation of a tetragametic chimera with true hermaphroditism (46,XX/46,XY).

DESIGN

Molecular biologic analyses.

SETTING

Outpatient clinic and laboratories of a university hospital.

SUBJECTS

A true hermaphrodite with 46,XX/46,XY and the parents. MAIN OUTCOME ANALYSIS: Restriction fragment length polymorphism (RFLP) of the pseudoautosomal region on sex chromosomes.

RESULTS

Whereas a normal diploid individual showed two bands, the true hermaphrodite showed four bands in the RFLP analyses. Evaluation of the molecular weights of the bands revealed two of them to be of maternal origin and the other two to be of paternal origin.

CONCLUSION

The two cell lineages composing the true hermaphrodite are heterogeneous because those originated from the fertilization of two genetically different maternal haploid cells by two different spermatozoa.

The effect of cortisol administration on blood plasma immunoglobulin M (IgM) concentrations in masu salmon (Oncorhynchus masou)

Immunoglobulin M (IgM) is known as a main factor in the humoral immune system of teleosts. In the present study, the effect of cortisol on plasma IgM concentrations was investigated using a specific antibody to IgM in masu salmon (Oncorhynchus masou). Cortisol was orally administered each day for 2 weeks at a dose of 1 mg g(-1) in the diet, and for the following week the fish were fed a non-treated diet. Blood plasma samples were collected at 0, 1, 2 and 3 weeks after the initiation of treatment. Oral administration of cortisol elevated plasma cortisol concentrations to about 40 ng/ml for 2 weeks after administration and slightly reduced plasma IgM concentration; the suppression was statistically significant one week after the period of hormone administration. However, treatment with cortisol did not affect plasma concentrations of total protein or α1-protein, one of the major serum proteins, during the experimental period. These results indicate that cortisol specifically suppresses plasma IgM concentrations.

[Two unusual cases of half-sibling test with DNA polymorphism]

In usual paternity cases, the putative man and the mother-child couple are alive. However, there are some cases in which putative man and mother were deceased and only children were available for analyses. It is difficult to determine the presence or absence of half-sibling relationship from analyses of conventional blood group markers (CBGM). In this study, five kinds of single locus DNA probes were applied to 2 half-sibling cases. To decide usefulness of single locus DNA probes, we defined likelihood ratio of half-sibling (LRHS) based on the likelihood ratio of paternity (LRP) and also investigated the distribution curves of log10 LRHS in cases of unrelated combinations and half-sibling combinations. Distribution curves of log10 LRHS from DNA analyses in the cases of unrelated combinations and half-sibling combinations is more clearly separated than from CBGM. Single locus DNA probes are considered to be more informative for half-sibling cases.

Na(+)-H+ exchange inhibitors decrease neointimal formation after rat carotid injury. Effects on smooth muscle cell migration and proliferation

The presence of multiple growth stimuli at the sites of vascular injury following angioplasty suggests that therapies targeted toward common growth pathways will be more effective than therapies that inhibit only a single growth factor. We tested this hypothesis using amiloride and ethyl isopropyl amiloride (EIPA), which are inhibitors of the Na(+)-H+ exchanger, whose activity is required in many cells for proliferation and migration. In the rat carotid injury model, EIPA (100 micrograms/h for 15 days) significantly decreased intimal area and the ratio of intimal to medial area, whereas amiloride (25 micrograms/h) showed an inhibitory trend that was similar to that observed for captopril (80 mg/kg per day) and heparin (25 U/h). EIPA and amiloride inhibited rat vascular smooth muscle cell DNA synthesis, with IC50 values of 8.8 and 82.2 microM, respectively. Using platelet-derived growth factor as a chemoattractant, EIPA caused a concentration-dependent inhibition of migration (IC50, approximately 60 microM). Because amiloride and EIPA have nonspecific effects on cellular function (especially inhibition of tyrosine kinases), we sought to characterize the specific role of the Na(+)-H+ exchanger in vascular smooth muscle cell proliferation and migration. We generated a Na(+)-H+ exchanger-deficient mutant cell line [RNHE(-)]. Studies with these cells suggested that the inhibitory effects of EIPA and amiloride were mediated only in part via Na(+)-H+ exchange because (1) RNHE(-) cells grew well at pH 6.8 to 7.5 in bicarbonate-containing medium, and (2) there was no difference in migration in response to platelet-derived growth factor in the RHNE(-) cells. In summary, these data indicate that amiloride and EIPA inhibit neointimal formation in the rat carotid after injury. However, the mechanism of inhibition is likely to involve cellular events other than Na(+)-H+ exchange, such as an effect on tyrosine kinases.

Effects of thyroid hormone on gonadotropin-induced steroid production in medaka, Oryzias latipes, ovarian follicles

Blood and ovarian samples were collected at intervals of 4h prior to spawning time from medaka (Oryzias latipes) that were maturationally synchronized with artificial photoperiod (14h light: 10h dark). Plasma estradiol-17β (E2) levels increased rapidly from 16h before spawning and peaked at 8h before spawning. Follicle-enclosed oocytes (ovarian follicles) at different stages of development were isolated from the ovaries and used to study the in vitro effects of thyroid hormone (triiodothyronine; T3) on pregnant mare serum gonadotropin (GTH)-induced E2 production. GTH at a concentration of 100 IU/ml stimulated E2 production by ovarian follicles collected between 32 and 16h before spawning. At 32h before spawning, T3 (5 ng/ml) administered along with GTH (100 IU/ml) resulted in a 3.5 fold increase in E2 production, compared with GTH administered alone. These results suggest that T3 can act on ovarian follicles directly to modulate GTH-stimulated E2 production in the medaka.

Prenatal paternity testing with DNA analyses

Two PCR amplified loci and 3 single locus DNA probes were applied in a paternity case in which a married woman became pregnant after being raped. DNA analysis were performed using samples from the woman, her husband and amniotic fluid cells taken during the 16th week of pregnancy. The combined probability of paternity for her husband was calculated as 0.999997107. The application of PCR analyses and single locus DNA probes were considered to be extremely informative in prenatal paternity testing.

Blood grouping of minute samples using monoclonal anti-A,B antibody

The availability of a monoclonal anti-A,B antibody (AB-E6E2) for blood grouping of blood and saliva stains was investigated. The antibody, which was reacted with A, B and AB antigens but not with O antigen, was produced from BALB/c mouse-mouse hybridoma raised to group AB red blood cells. AB-E6E2 had heat-elutability enough to detect ABO antigens in blood and saliva stains by absorption-elution test, whereas it had extremely weak double combining potency in mixed agglutination test. Application of elution-ELISA method will enable the detection of smaller amount of ABH antigens. The antibody, therefore, would be useful to segregate group O minute samples from the other blood group ones.

Impact of influenza virus infection as a cause of pediatric hospitalization

From winter 1989 to spring 1990, a severe epidemic caused by influenza A (H3N2) and B viruses developed in Japan. During the epidemic (December 1989 to February 1990), 244 children were admitted to the pediatric ward of Nippon Kokan Hospital: 53 (21.7%) were hospitalized with influenza virus infection, 22 (9.0%) with rotavirus gastroenteritis, and 17 (7.0%) with respiratory syncytial virus infection. Among those with influenza, 24 had type A and 29 had type B. Most were young healthy children without underlying illnesses (mean age, 4.8 +/- 3.4 years). The impact of the influenza epidemic on pediatric hospitalization is probably much greater than generally thought when a severe epidemic occurs.

[Study of the profiles of prolactin and other hormones in both maternal plasma and amniotic fluid during labor]

The effects of a dopamine antagonist and stress of labor on prolactin (PRL) concentrations were studied in maternal plasma and amniotic fluid during term delivery. In procedure 1, maternal blood and amniotic fluid samples were obtained from 5 normal full-term deliveries at 20-minute intervals for 180 minutes after the intravenous bolus of 10 mg metoclopramide (MCP) during labor just before delivery. Amniotic fluid samples were drawn through a transcervical intrauterine pressure catheter to avoid contamination with maternal blood. PRL, 17 beta-estradiol (E2), progesterone (P) and cortisol were measured by means of radioimmunoassay (RIA), and free MCP concentrations were measured by high pressure liquid chromatography. In procedure 2, maternal blood and amniotic fluid samples were obtained from 12 full-term pregnancies with spontaneous delivery and 10 cases of elective cesarean section when birth was imminent. The amniotic fluid was obtained by direct sampling from the forewaters in spontaneous delivery and by means of a syringe inserted through amniotic membrane after the uterine wall had been incised in cesarean section. PRL, beta-endorphin (beta-EP) and cortisol were measured by RIA. The PRL levels in maternal plasma increased significantly (p less than 0.01) after the MCP injection. The peak value of PRL net increase (delta PRL) was 676.5 +/- 189.6 ng/ml. However, the PRL levels in amniotic fluid did not change significantly after the administration of this drug. Although the delta PRL levels in maternal plasma were significantly (p less than 0.001) correlated with MCP concentrations (r = 0.812) after the MCP injection, there was no correlation between delta PRL and MCP concentrations in amniotic fluid. No significant changes in E2, P and cortisol levels in both samples were observed after the MCP injection. The plasma PRL levels in vaginal delivery cases were significantly (p less than 0.05) lower than those in elective cesarean section cases (123.3 +/- 15.8 ng/ml vs. 181.0 +/- 22.2 ng/ml), and the plasma beta-EP and cortisol levels in vaginal delivery cases were significantly (p less than 0.01, p less than 0.001) higher than those in elective cesarean section cases respectively (beta-EP: 134.8 +/- 25.6 pg/ml vs. 49.7 +/- 12.3 pg/ml, cortisol: 79.4 +/- 5.8 micrograms/dl vs. 30.2 +/- 3.3 micrograms/dl). Therefore, a significant reduction in plasma PRL levels was accompanied by a marked rise in plasma beta-EP and cortisol levels during labor. In amniotic fluid, however, there were no significant differences of PRL, beta-EP and cortisol levels in vaginal delivery cases and elective cesarean cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Prolactin-releasing system in maternal, fetal, and amniotic compartments during labor

The effect of a dopamine antagonist on prolactin concentrations was studied in maternal, fetal plasma, and amniotic fluid in term gestation. Twenty-three women with normal full-term pregnancies received 10 mg metoclopramide intravenously during labor. The prolactin levels in maternal plasma increased significantly after metoclopramide. However, the prolactin levels in amniotic fluid and fetal plasma did not change significantly after administration of this drug. Although the increased values of prolactin in maternal plasma were significantly correlated with metoclopramide concentrations after metoclopramide injection, there was no correlation between these two values in amniotic fluid. The authors conclude that the prolactin-releasing system in amniotic fluid is independent of the maternal hypothalamopituitary axis.

Developmental changes in contractile protein adenosine 5'-triphosphatase in the rabbit heart

This study was designed to investigate developmental changes in contractile protein adenosine 5'-triphosphatase in the rabbit heart. Myofibrils and myosin were isolated from ventricular muscles from the fetal, newborn, and adult rabbits. Actin and troponin-tropomyosin complex were isolated from the adult skeletal muscle. Myofibrillar (actomyosin) adenosine 5'-triphosphatase measured at low ionic strength increased with development. In contrast, myofibrillar calcium adenosine 5'-triphosphatase at high ionic strength was the greatest in the newborn and the lowest in the adult. Myosin calcium adenosine 5'-triphosphatase and actin-activated myosin adenosine 5'-triphosphatase were also the greatest in the newborn and the lowest in the adult. The relative proportion of myosin isozyme V1 was the greatest in the newborn and the lowest in the adult. The addition of troponin-tropomyosin complex stimulated myosin adenosine 5'-triphosphatase in the presence of calcium in the adult, but not in the newborn and fetus. As a result, actin-activated myosin adenosine 5'-triphosphatase in the presence of troponin-tropomyosin complex was the greatest in the adult, followed by the newborn and fetus. These data suggest that the low myofibrillar adenosine 5'-triphosphatase activity at low ionic strength in the premature heart may be due to the age-related difference in the interaction of myosin with troponin-tropomyosin. Developmental change in myosin calcium adenosine 5'-triphosphatase (which is determined by the relative proportion of isomyosin V1 and V3) may not be directionally identical to that of the physiologically important myofibrillar adenosine 5'-triphosphatase.