Electroacupuncture to Increase Neuronal Stem Cell Growth.

Background: Neuropathic intestinal disorders continue to pose a significant burden, and current treatment options do not target the underlying cellular deficiencies. The goal of this study is to determine whether acupuncture and electroacupuncture (EA) can affect the growth of neuronal cells. Methods: Three groups of Lewis rats received 25 minutes of acupuncture twice a week for 10 weeks. The 3 groups of rats received treatment with either sham acupuncture (SA), real acupuncture (RA), or EA. After 10 weeks of treatment, skin and intestinal tissue were collected and analyzed for histology and mRNA expression of neuronal marker genes. Results: Compared with rats that received SA, rats that received RA and EA showed a significant increase in the mRNA expression levels of multiple neuronal genes in the skin. No significant histologic changes were seen. Conclusions: Acupuncture and EA result in significant changes in the expression of genes implicated as markers for neural stem cells, neural cell development, and neurons. This may, therefore, provide a novel avenue for developing treatments in patients suffering from intestinal aganglionic and neuropathic diseases.

Wide-band/angle Blazed Surfaces using Multiple Coupled Blazing Resonances.

Blazed gratings can reflect an oblique incident wave back in the path of incidence, unlike mirrors and metal plates that only reflect specular waves. Perfect blazing (and zero specular scattering) is a type of Wood's anomaly that has been observed when a resonance condition occurs in the unit-cell of the blazed grating. Such elusive anomalies have been studied thus far as individual perfect blazing points. In this work, we present reflective blazed surfaces that, by design, have multiple coupled blazing resonances per cell. This enables an unprecedented way of tailoring the blazing operation, for widening and/or controlling of blazing bandwidth and incident angle range of operation. The surface can thus achieve blazing at multiple wavelengths, each corresponding to different incident wavenumbers. The multiple blazing resonances are combined similar to the case of coupled resonator filters, forming a blazing passband between the incident wave and the first grating order. Blazed gratings with single and multi-pole blazing passbands are fabricated and measured showing increase in the bandwidth of blazing/specular-reflection-rejection, demonstrated here at X-band for convenience. If translated to appropriate frequencies, such technique can impact various applications such as Littrow cavities and lasers, spectroscopy, radar, and frequency scanned antenna reflectors.

Focusing metasurface quantum-cascade laser with a near diffraction-limited beam.

A terahertz vertical-external-cavity surface-emitting-laser (VECSEL) is demonstrated using an active focusing reflectarray metasurface based on quantum-cascade gain material. The focusing effect enables a hemispherical cavity with flat optics, which exhibits higher geometric stability than a plano-plano cavity and a directive and circular near-diffraction limited Gaussian beam with M2 beam parameter as low as 1.3 and brightness of 1.86 × 106 Wsr-1m-2. This work initiates the potential of leveraging inhomogeneous metasurface and reflectarray designs to achieve high-power and high-brightness terahertz quantum-cascade VECSELs.

Efficacy and limitations of intraoperative spinal cord monitoring using nasopharyngeal tube electrodes.

OBJECT: Motor evoked potentials are widely used for intraoperative spinal cord monitoring. However, there are problems with anesthetic constraints and high trial-by-trial variability of compound muscle action potential amplitude in muscle motor evoked potential monitoring. It is difficult to determine when to warn the surgeon of an occurrence of spinal cord risk. A method of estimation for motor function in the spinal cord has not been established. To monitor spinal cord function with reliable evoked potentials, including the upper cervical spinal cord and the ventral spinal cord, the authors developed a nasopharyngeal tube electrode that can be placed in front of the upper and ventral cervical spinal cord. The purpose of this study was to investigate the origins and pathways of descending or ascending spinal cord evoked potentials (SCEPs) elicited with this electrode, and the usefulness and limitations of this method. METHODS: A nasopharyngeal tube electrode was inserted into the nostril. A catheter electrode was placed in the epidural or subarachnoid space at the thoracic spine. Ventral SCEP was recorded from the thoracic spinal cord after transpharyngeal stimulation, and dorsal SCEP was recorded with the nasopharyngeal electrode after thoracic spinal cord stimulation. There was no restriction of anesthetic technique in recording. When the amplitude of either of the SCEPs declined to 80% of the baseline, a warning was provided to the surgeon during the observed operative procedure. At the end of surgery, less than 50% or more than 30% of the baseline amplitude was considered a significant change in both SCEPs. The sensitivity and specificity for both SCEPs to detect neurological deterioration were calculated. RESULTS: The electrode provided noninvasive access to the ventral cervicomedullary junction. The SCEPs showed stable responses. A response change was only observed in situations involving a risky procedure for the spinal cord. Ventral SCEPs showed high sensitivity (73.1%) for identifying patients with new neurological deficits or an exacerbation of preexisting neurological deficits after surgery, but dorsal SCEPs showed lower sensitivity (46.1%) in the total number of cases. Both SCEPs showed high specificities. The sensitivities of ventral SCEP, dorsal SCEP, and either SCEP were 100.0%, 50.0%, and 100.0% for the upper cervical spinal cord, 33.3%, 0%, and 55.6% for the lower cervical spinal cord, and 77.8%, 64.7%, and 88.2% for the thoracic spinal cord. CONCLUSIONS: Combined recording of both SCEPs estimated the ventral and dorsal white matter function in the spinal cord. Measuring the SCEPs with the nasopharyngeal electrode can be another useful approach for upper cervical and thoracic spinal cord monitoring. Ventral SCEP was more reliable for monitoring postoperative spinal cord function than dorsal SCEP. Ventral SCEP does not estimate the gray matter and spinal root functions in the lower cervical spinal cord.

Association of genetic variants with myocardial infarction in Japanese individuals with metabolic syndrome.

OBJECTIVE: The purpose of the present study was to identify genetic variants that confer susceptibility to myocardial infarction (MI) in individuals with metabolic syndrome (MetS). METHODS: The study population comprised 1887 Japanese individuals with MetS, including 773 subjects with MI and 1114 controls. The genotypes for 136 polymorphisms of 97 candidate genes were determined. RESULTS: An initial screen by the chi-square test revealed that seven polymorphisms were significantly (false discovery rate<0.05) associated with the prevalence of MI in individuals with MetS. Subsequent multivariable logistic regression analysis with adjustment for covariates revealed that the G-->A (Ser89Asn) polymorphism of UTS2 [odds ratio (OR), 1.90; 95% confidence interval (CI), 1.18-3.08], the 2445G-->A (Ala54Thr) polymorphism of FABP2 (OR, 1.72; 95% CI, 1.23-2.40), the -11377C-->G polymorphism of ADIPOQ (OR, 1.43; 95% CI, 1.15-1.79), the -231A-->G polymorphism of EDNRA (OR, 0.65; 95% CI, 0.48-0.89), and the -108/3G-->4G polymorphism of PDX1 (OR, 0.64; 95% CI, 0.48-0.87) were significantly (P<0.05) associated with MI. The variant alleles of UTS2, FABP2, and ADIPOQ were risk factors for MI, whereas the variant alleles of EDNRA and PDX1 were protective against this condition. A stepwise forward selection procedure demonstrated that UTS2, FABP2, ADIPOQ, EDNRA, and PDX1 genotypes were significant (P<0.05) and independent determinants of MI. CONCLUSIONS: Determination of genotypes for these polymorphisms of UTS2, FABP2, ADIPOQ, EDNRA, and PDX1 may prove informative for assessment of the genetic risk for MI in Japanese individuals with MetS.

Diagnosis of toxic shock syndrome by two different systems; clinical criteria and monitoring of TSST-1-reactive T cells.

Two methods of TSS diagnosis were evaluated: comparison of symptoms with clinical criteria and monitoring for evidence of selective activation of Vbeta2(+) T cells by the causative toxin, TSS toxin-1 (TSST-1). Ten patients with acute and systemic febrile infections caused by Staphylococcus aureus were monitored for increase in TSST-1-reactive Vbeta2(+) T cells during their clinical courses. Nine of the ten patients were diagnosed with TSS based on evidence of selective activation of Vbeta2(+) T cells by TSST-1; however, clinical symptoms met the clinical criteria for TSS in only six of these nine patients. In the remaining patient, clinical symptoms met the clinical criteria, but selective activation of Vbeta2(+) T cells was not observed. Time taken to reach the diagnosis of TSS could be significantly shortened by utilizing the findings from tracing Vbeta2(+) T cells. In vitro studies showed that TSST-1- reactive T cells from TSS patients were anergic in the early phase of their illness. Examining selective activation of Vbeta2(+) T cells could be a useful tool to supplement clinical criteria for early diagnosis of TSS.

Effect of bone marrow grafting on the titanium porous-coated implant in bilateral total knee arthroplasty.

BACKGROUND AND PURPOSE: Poor bone ingrowth into the porous coating of tibial components has been reported. We hypothesized that iliac marrow grafting might be useful to enhance bone ingrowth into a porous-coated implant. The first part of this study was to examine the presence of fibroblast colony-forming units (CFUF) containing osteogenic precursor cells in tibial bone marrow and iliac bone marrow. The second aim was to compare the clinical and radiographic results after bilateral total knee arthroplasty (TKA) with and without autologous bone marrow transplantation to the bone-implant interface. METHODS: Simultaneous bilateral TKA was performed in 21 patients with osteoarthritis. Aspirated iliac bone marrow was transplanted to the interface of one randomly selected porous-coated tibial component in each patient, and contralateral knees served as controls. All of the 21 patients were followed for 5 years. RESULTS: The average number of CFU-F was significantly lower in tibial marrow than in iliac marrow (p = 0.008). The final fluoroscopically-guided radiographs revealed a decrease in the number of knees with radiolucent lines after marrow grafting compared to those without grafting (p = 0.004). INTERPRETATION: Iliac bone marrow is useful as a bone grafting material to enhance the biological fixation in porous-coated implants.

Relation between atlantoaxial (C1/2) and cervical alignment (C2-C7) angles with Magerl and Brooks techniques for atlantoaxial subluxation in rheumatoid arthritis.

BACKGROUND: A few studies have reported the relation between the atlantoaxial (C1/2) angle and cervical alignment (C2-C7) angle after a Magerl and Brooks (M&B) surgical procedure to treat atlantoaxial subluxation (AAS) in patients with rheumatoid arthritis (RA). However, no study has examined an optimum preoperative C1/2 angle reduction. We aimed to assess the relation between the C1/2 angle reduction and the C2-C7 angle change in patients with progressive RA who underwent the M&B procedure. METHODS: We retrospectively analyzed the relation between the preoperative C1/2 angle and C2-C7 angle in 28 consecutive RA patients using their clinical and radiological data. Differences in the preoperative and postoperative C1/2 and C2-C7 angles were detected. Correlations of these angles and the reduced degree of angles were examined. The Ranawat grading scale and Japanese Orthopaedic Association (JOA) scores were used to determine myelopathy. Pain was categorized into five categories according to severity. Clinical and X-ray evaluations were collected before surgery, at 3 and/or 6 months after surgery, and at final follow-up. RESULTS: Clinical symptoms, Ranawat grade, and JOA scores improved postoperatively, and patients achieved bony union within 3 months. We observed a strong and significant correlation between the reduced C1/2 angle and the change in the C2-C7 angle. Patients with a preoperative C1/2 angle of <20 degrees had markedly reduced cervical lordotic angle but this condition was not seen in patients with a preoperative C1/2 angle of >or=20 degrees . The optimum C1/2 angle was estimated as [20 degrees - (preoperative C1/2 angle)] in patients with a C1/2 angle <20 degrees or as an in situ angle in patients with a C1/2 angle of >or=20 degrees . CONCLUSIONS: Surgeons performing the M&B procedure need to select patients carefully and avoid complete or overreduction of the C1/2 angle to prevent serious postoperative SAS and myelopathy.

Gene expression of bone-resorbing cytokines in rat osteolysis model.

Osteolysis after single-injection polyethylene (PE) administration has been analyzed, but this experimental model did not reflect the clinical postoperative condition. Therefore, we investigated the bone-resorbing cytokines interleukin and tumor necrosis factor (IL-1alpha, IL-6, TNFalpha) produced by continuous PE administration using histomorphologic findings and the reverse transcription polymerase chain reaction. TNFalpha mRNA was continuously detected in the PE continuous-infusion group, whereas it was not expressed in the PE single-injection group. IL-1alpha and IL-6 mRNA were detected in both groups. As for histomorphological findings, in the PE continuous-infusion group proliferating fibrous tissue penetrated subchondral bone and the interface membrane around the K-wire inserted into the femur. Numerous osteoclasts were observed in the vicinity of resorbed bone. In the PE single-injection group, proliferation of fibrous tissue with bone resorption was not observed. TNFalpha may play a major role in fibrous tissue formation and osteoclastic bone resorption caused by PE debris. This osteolysis model is useful for investigating osteolysis associated with bone-resorbing cytokines under conditions similar to those seen with a human prosthesis.

Osteoporosis is more prevalent in adrenal than in pituitary Cushing's syndrome.

Osteoporosis is the most common complication of Cushing's syndrome. We retrospectively examined the prevalence and risk factors for osteoporosis in 42 female patients with Cushing's syndrome. Osteoporosis and atraumatic fractures were assessed by bone mineral density of the lumbar vertebral spine (L2-L4) using dual energy X-ray absorptiometry (DXA) and X-ray examination. The prevalence of osteoporosis and fracture were 54.8% and 21.4%, respectively. The prevalence of osteoporosis (69.6% vs. 37.8%) and atraumatic bone fracture (26.1% vs. 15.8%) were significantly higher in patients with adrenal Cushing's than in those with pituitary Cushing's. AP and lateral BMD was significantly higher in patients with pituitary origin than in those with adrenal origin. Among several variables examined by multiple logistic regression, the etiology of Cushing's syndrome (adrenal vs. pituitary origin) was a significant factor affecting the prevalence of osteoporosis. Neither age, body mass index, duration of amenorrhea, nor extent of hypercortisolism were significant factors in this analysis. Plasma DHEA-S and urinary 17-KS excretion were significantly higher in pituitary Cushing's than in adrenal Cushing's. The present study shows that the prevalence of osteoporosis in patients with Cushing's syndrome is influenced by its etiology. A factor associated with pituitary Cushing's syndrome, such as adrenal androgen, may protect these patients from glucocorticoid-induced osteoporosis.

Clinical evaluation of Luque's segmental spinal instrumentation for upper cervical metastases.

We reviewed clinical data from eight patients with upper cervical metastases who were treated with an occipitocervical fusion procedure using Luque's segmental spinal instrumentation with a fan-shaped rod. All patients had diffuse involvement of the entire anterior vertebral body, extreme instability at C1/2, and severe preoperative neck pain, but no neurological deficits. This procedure provided significant postoperative pain relief, with only one patient experiencing deterioration. The activities of daily living (ADL) levels of four patients improved; ADLs in four patients who were severely impaired were unchanged. Even though tissue destruction continued after surgery, this procedure prevented further deformity and instability. There were two major surgical complications: respiratory quadriplegia and hydro-cephalic coma. Great care must be taken to avoid these problems. Of the various instrumentation possibilities now available, we strongly advocate consideration of this particular stabilization procedure for upper cervical metastases to provide dying patients with an optimal quality of life during their final days.

A novel bisphosphonate inhibits inflammatory bone resorption in a rat osteolysis model with continuous infusion of polyethylene particles.

This study examined the inhibitory effect of a new bisphosphonate (TRK-530) on wear debris-mediated bone resorption in a rat osteolysis model involving continuous infusion of high density polyethylene (HDPE) particles. TRK-530 (TRK) is a novel synthetic bisphosphonate that has been shown to decrease the level of tumor necrosis factor alpha (TNF-alpha) in the bone marrow of rats with adjuvant arthritis. Forty Wistar rats were randomized to two groups (n = 20 each). In each rat, a Kirshner (K) wire was inserted into the femur and HDPE particles were continuously infused into the knee joint. Thereafter, the animals were subcutaneously injected with saline (control group) or 1 mg/kg of TRK (TRK group) every second day, and were sacrificed at 4 or 8 weeks after surgery. Radiographs obtained at the time of sacrifice were evaluated for periprosthetic osteolysis. We also examined the thickness of the reactive membrane as well as the number of osteoclast-like cells around the K-wire. In addition, we examined the expression of genes for bone-resorbing cytokines in the reactive membrane. Radiographic peri-implant osteolysis was more frequent in the control group compared with the TRK group at each time of assessment (p < 0.01). The interfacial membrane was significantly thinner in the TRK group compared with the control group (p < 0.01) and the average number of osteoclast-like cells around the K-wire was significantly fewer in the TRK group (p < 0.01). In addition, the expression of interleukin 1-alpha messenger ribonucleic acid (IL-1alpha mRNA) and TNF-alpha mRNA was suppressed in the TRK group at each time of assessment. We conclude that the TRK can inhibit the formation of inflammatory peri-implant osteolysis induced by HDPE particles.