[Classification of mild cognitive impairment and normal cognition using an automated voice-based testing application].

AIM: An easy-to-use tool that can detect cognitive decline in mild cognitive impairment (MCI) is required. In this study, we aimed to construct a machine learning model that discriminates between MCI and cognitively normal (CN) individuals using spoken answers to questions and speech features. METHODS: Participants of ≥50 years of age were recruited from the Silver Human Resource Center. The Japanese Version of the Mini-Mental State Examination (MMSE-J) and Clinical Dementia Rating (CDR) were used to obtain clinical information. We developed a research application that presented neuropsychological tasks via automated voice guidance and collected the participants' spoken answers. The neuropsychological tasks included time orientation, sentence memory tasks (immediate and delayed recall), and digit span memory-updating tasks. Scores and speech features were obtained from spoken answers. Subsequently, a machine learning model was constructed to classify MCI and CN using various classifiers, combining the participants' age, gender, scores, and speech features. RESULTS: We obtained a model using Gaussian Naive Bayes, which classified typical MCI (CDR 0.5, MMSE ≤26) and typical CN (CDR 0 and MMSE ≥29) with an area under the curve (AUC) of 0.866 (accuracy 0.75, sensitivity 0.857, specificity 0.712). CONCLUSIONS: We built a machine learning model that can classify MCI and CN using spoken answers to neuropsychological questions. Easy-to-use MCI detection tools could be developed by incorporating this model into smartphone applications and telephone services.

Actual Clinical Practice Assessment: A Rapid and Easy-to-Use Tool for Evaluating Cognitive Decline Equivalent to Dementia.

Background Screening tests reveal the early signs of cognitive decline, enabling better self-care and preparation for the future. We developed and evaluated the accuracy of a rapid (20 s) and easy-to-use tool called ONSEI, assessing the cognitive decline equivalent to dementia in actual clinical practice by correlating clinical diagnoses with the ONSEI classification. Methods In this retrospective observational study, data were collected from individuals who visited three neurosurgical clinics in neighboring prefectures of Tokyo, Japan. ONSEI analysis was performed using a smartphone or tablet. The tool adopts a machine-learning algorithm using the speaker's age, time-orientation task score, and acoustic features of spoken responses to that task. Significant differences in accuracy, sensitivity, and specificity were evaluated by Fisher's exact test. Results The overall classification accuracy of ONSEI was 98.1% (p<0.001). The sensitivity and specificity were 97.3% (p<0.001) and 98.5% (p<0.001), respectively. The proportion of correct classifications was consistent across different age groups. Conclusion ONSEI showed high classification accuracy for dementia in cognitively normal individuals in actual clinical practice, regardless of the facility at which the tests were conducted or the age of the participants. Thus, ONSEI can be useful for dementia screening and self-care.

Surgical Outcomes of Colorectal Cancer Surgery for ≥ 85-year-old Patients in Our Hospital: Retrospective Comparison of Short- and Long-term Outcomes with Younger Patients.

OBJECTIVES: To evaluate future problems in colorectal cancer surgery for elderly patients. METHODS: We conducted a retrospective review of patients receiving colorectal cancer surgery in our hospital from January 2010 to December 2018. Patients were divided into the ≥ 85-year-old patient group and the younger patient group. We compared patient backgrounds, surgical outcomes (surgical procedure, reduction of lymph node dissection range, operative duration, and blood loss), postoperative short-term outcomes (mortality, morbidity, and postoperative length of stay) and prognosis. RESULTS: We performed colorectal cancer surgery on 1,240 patients during the study period. Of them, 109 (8.7%) were ≥ 85 years old, and 1,131 (91.2%) were < 85 years old. The American Society of Anesthesiologists physical status (ASA-PS) was significantly poorer in the elderly group than in the younger group and patients with a history of cardiac disease and anticoagulant use were significantly more in the elderly group. The rate of reduction of lymph node dissection range was significantly higher in the elderly group (16.8% vs. 3.8%, p < 0.05). Overall morbidity was significantly higher in the elderly group (42.2% vs. 21.9%, p < 0.05), as were the respective frequencies of pneumonia and thromboembolism (8.2% vs. 0.7%, p < 0.05 and 3.6% vs. 0.8%, p < 0.05, respectively). Postoperative hospital stay was significantly longer in the elderly group (17 vs. 12 days, p < 0.05). Overall survival was significantly lower in the elderly group (p < 0.05), but relapse-free survival and colorectal cancer-specific survival were not statistically different between the groups (p = 0.05 and p = 0.15, respectively). CONCLUSIONS: Prevention of postoperative pneumonia and thromboembolism remains a problem. After proper assessment and careful management of peri-operative surgical risks, surgery can be indicated in elderly patients.

Jasmonate-Induced Defense Mechanisms in the Belowground Antagonistic Interaction Between Pythium arrhenomanes and Meloidogyne graminicola in Rice.

Next to their essential roles in plant growth and development, phytohormones play a central role in plant immunity against pathogens. In this study we studied the previously reported antagonism between the plant-pathogenic oomycete Pythium arrhenomanes and the root-knot nematode Meloidogyne graminicola, two root pathogens that co-occur in aerobic rice fields. In this manuscript, we investigated if the antagonism is related to imbalances in plant hormone levels, which could be involved in activation of plant defense. Hormone measurements and gene expression analyses showed that the jasmonate (JA) pathway is induced early upon P. arrhenomanes infection. Exogenous application of methyl-jasmonate (MeJA) on the plant confirmed that JA is needed for basal defense against both P. arrhenomanes and M. graminicola in rice. Whereas M. graminicola suppresses root JA levels to increase host susceptibility, Pythium inoculation boosts JA in a manner that prohibits JA repression by the nematode in double-inoculated plants. Exogenous MeJA supply phenocopied the defense-inducing capacity of Pythium against the root-knot nematode, whereas the antagonism was weakened in JA-insensitive mutants. Transcriptome analysis confirmed upregulation of JA biosynthesis and signaling genes upon P. arrhenomanes infection, and additionally revealed induction of genes involved in biosynthesis of diterpenoid phytoalexins, consistent with strong activation of the gene encoding the JA-inducible transcriptional regulator DITERPENOID PHYTOALEXIN FACTOR. Altogether, the here-reported data indicate an important role for JA-induced defense mechanisms in this antagonistic interaction. Next to that, our results provide evidence for induced expression of genes encoding ERF83, and related PR proteins, as well as auxin depletion in P. arrhenomanes infected rice roots, which potentially further contribute to the reduced nematode susceptibility seen in double-infected plants.

Field-tuned superconductor-insulator transitions and Hall resistance in thin polycrystalline MoN films.

We report on the superconductor-insulator transitions (SITs) of disordered molybdenum nitride (MoN) thin films on (1 0 0) MgO substrates as a function of the film thickness and magnetic fields. The T c of the superconducting MoN films, which exhibit a sharp superconducting transition, monotonically decreases as the normal state R sq increases with a decreasing film thickness. For several films with different thicknesses, we estimate the critical field H c and the product zν ≃ 0.6 of the dynamical exponent z and the correlation length exponent ν using a finite scaling analysis. The value of this product can be explained by the (2 + 1) XY model. We found that the Hall resistance ΔR xy (H) is maximized when the magnetic field satisfies H HP(T) [Formula: see text] |1 - T/T C0| in the superconducting state and also in the normal states owning to the superconducting fluctuation corresponding to the ghost critical magnetic field. We measured the Hall conductivity δσ xy (H) = σ xy (H) - [Formula: see text] and fit the Gaussian approximation theory for δσ xy (H) to the experimental data. Agreement between the data and the theory beyond H c suggests the survival of the Cooper pair in the insulating region of the SIT.

Silicon induces resistance to the brown spot fungus Cochliobolus miyabeanus by preventing the pathogen from hijacking the rice ethylene pathway.

Although numerous studies have shown the ability of silicon (Si) to mitigate a wide variety of abiotic and biotic stresses, relatively little is known about the underlying mechanism(s). Here, we have investigated the role of hormone defense pathways in Si-induced resistance to the rice brown spot fungus Cochliobolus miyabeanus. To delineate the involvement of multiple hormone pathways, a multidisciplinary approach was pursued, combining exogenous hormone applications, pharmacological inhibitor experiments, time-resolved hormone measurements, and bioassays with hormone-deficient and/or -insensitive mutant lines. Contrary to other types of induced resistance, we found Si-induced brown spot resistance to function independently of the classic immune hormones salicylic acid and jasmonic acid. Our data also rule out a major role of the abscisic acid (ABA) and cytokinin pathways, but suggest that Si mounts resistance to C. miyabeanus by preventing the fungus from hijacking the rice ethylene (ET) machinery. Interestingly, rather than suppressing rice ET signaling per se, Si probably interferes with the production and/or action of fungal ET. Together our findings favor a scenario whereby Si induces brown spot resistance by disarming fungal ET and argue that impairment of pathogen virulence factors is a core resistance mechanism underpinning Si-induced plant immunity.

Primary metabolism plays a central role in moulding silicon-inducible brown spot resistance in rice.

Over recent decades, a multitude of studies have shown the ability of silicon (Si) to protect various plants against a range of microbial pathogens exhibiting different lifestyles and infection strategies. Despite this relative wealth of knowledge, an understanding of the action mechanism of Si is still in its infancy, which hinders its widespread application for agricultural purposes. In an attempt to further elucidate the molecular underpinnings of Si-induced disease resistance, we studied the transcriptome of control and Si-treated rice plants infected with the necrotrophic brown spot fungus Cochliobolus miyabeanus. Analysis of brown spot-infected control plants suggested that C. miyabeanus represses plant photosynthetic processes and nitrate reduction in order to trigger premature senescence and cause disease. In Si-treated plants, however, these pathogen-induced metabolic alterations are strongly impaired, suggesting that Si alleviates stress imposed by the pathogen. Interestingly, Si also significantly increased photorespiration rates in brown spot-infected plants. Although photorespiration is often considered as a wasteful process, recent studies have indicated that this metabolic bypass also enhances resistance during abiotic stress and pathogen attack by protecting the plant's photosynthetic machinery. In view of these findings, our results favour a scenario in which Si enhances brown spot resistance by counteracting C. miyabeanus-induced senescence and cell death via increased photorespiration. Moreover, our results shed light onto the mechanistic basis of Si-induced disease control and support the view that, in addition to activating plant immune responses, Si can also reduce disease severity by interfering with pathogen virulence strategies.

[A case of recurrent pancreatic cancer effectively responding to S-1 combined irinotecan third-line chemotherapy with PSK].

A case of recurrent pancreatic cancer effectively responded to S-1 and irinotecan combined with third-line chemotherapy (IRIS) with PSK. The patient was a 75-year-old female. In October 2007, a pancreatoduodenectomy was performed, followed with 6 courses of systemic adjuvant chemotherapy of gemcitabine (GEM). Three months after finishing the adjuvant chemotherapy, a recurrence of para-aortic lymph node metastasis was confirmed. We resumed the second-line chemotherapy of S-1/GEM (GS) with PSK. GS therapy was continued for about 3 years, until the recurrent lesion was found to have increased after 30 courses. Nevertheless, we continued up to 39 courses. In November 2011, we started third-line chemotherapy using S-1/irinotecan (IRIS) with PSK. The regimen was S-1 of 80 mg/body/day, continuously administered for day 1-14th, followed by a discontinuation for 2 weeks. CPT-11 100 mg/body/day was administered on day 1 and 15th; and PSK of 3 g/ body/day was continued, until it resulted in increased recurrent lesions. After the end of 4 courses, recurrent lesions started to respond partially. Currently, the patient is being treated as an outpatient. This case indicates that IRIS (S-1/CPT-11) is an effective therapy when pancreatic cancer fails to respond to GS therapy.

BSTA promotes mTORC2-mediated phosphorylation of Akt1 to suppress expression of FoxC2 and stimulate adipocyte differentiation.

Phosphorylation and activation of Akt1 is a crucial signaling event that promotes adipogenesis. However, neither the complex multistep process that leads to activation of Akt1 through phosphorylation at Thr³°8 and Ser47³ nor the mechanism by which Akt1 stimulates adipogenesis is fully understood. We found that the BSD domain-containing signal transducer and Akt interactor (BSTA) promoted phosphorylation of Akt1 at Ser47³ in various human and murine cells, and we uncovered a function for the BSD domain in BSTA-Akt1 complex formation. The mammalian target of rapamycin complex 2 (mTORC2) facilitated the phosphorylation of BSTA and its association with Akt1, and the BSTA-Akt1 interaction promoted the association of mTORC2 with Akt1 and phosphorylation of Akt1 at Ser47³ in response to growth factor stimulation. Furthermore, analyses of bsta gene-trap murine embryonic stem cells revealed an essential function for BSTA and phosphorylation of Akt1 at Ser47³ in promoting adipocyte differentiation, which required suppression of the expression of the gene encoding the transcription factor FoxC2. These findings indicate that BSTA is a molecular switch that promotes phosphorylation of Akt1 at Ser47³ and reveal an mTORC2-BSTA-Akt1-FoxC2-mediated signaling mechanism that is critical for adipocyte differentiation.

Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia.

BACKGROUND: Early studies of community-acquired pneumonia showed that nonsurvivors had higher blood urea nitrogen levels and lower serum albumin levels than survivors. Therefore, elevation of the blood urea nitrogen to serum albumin (B/A) ratio may identify patients with community-acquired pneumonia who are becoming critically ill. This study investigated the correlation between commonly used laboratory markers, in particular the B/A ratio, and clinical outcomes of community-acquired pneumonia. METHODS: This observational study was performed in consecutive patients with community-acquired pneumonia admitted to our hospital over a period of one year. Blood counts, commonly used laboratory markers, microbiological tests, and calculation of Pneumonia Severity Index (PSI) and CURB-65 were done on admission. The endpoints were mortality within 28 days of admission and requirement for intensive care. RESULTS: One hundred and seventy-five patients with community-acquired pneumonia were enrolled. Nineteen patients died within 28 days of admission and 29 patients required intensive care. Using multivariate analysis, independent factors associated with mortality were the requirement for intensive care (odds ratio [OR] 14.96, 95% confidence interval [CI] 3.73-60.03, P < 0.001), PSI class (OR 3.55, 95% CI 1.08-11.66, P = 0.037), and B/A ratio (OR 1.10, 95% CI 1.01-1.20, P = 0.037). Similarly, independent factors associated with need for intensive care were PSI class (OR 5.35, 95% CI 1.90-15.06, P = 0.002), CURB-65 (OR 2.37, 95% CI 1.26-4.45, P = 0.007), and B/A ratio (OR 1.27, 95% CI 1.09-1.47, P = 0.002). CONCLUSION: The B/A ratio is a simple but independent predictor of mortality and severity of community-acquired pneumonia.

CDPK-mediated abiotic stress signaling.

Calcium-dependent protein kinases (CDPKs) constitute a large multigene family in various plant species. CDPKs have been shown to have important roles in various physiological processes, including plant growth and development and abiotic and biotic stress responses in plants. Functional analysis using gain-of-function and loss-of-function mutants has revealed the biological function of CDPKs in planta. Several CDPKs have been shown to be essential factors in abiotic stress tolerance, positively or negatively regulating stress tolerance by modulating ABA signaling and reducing the accumulation of reactive oxygen species (ROS). This review summarizes recent results describing the biological function of CDPKs that are involved in abiotic stress tolerance.

A rice calcium-dependent protein kinase OsCPK12 oppositely modulates salt-stress tolerance and blast disease resistance.

Calcium-dependent protein kinases (CDPKs) regulate the downstream components in calcium signaling pathways. We investigated the effects of overexpression and disruption of an Oryza sativa (rice) CDPK (OsCPK12) on the plant's response to abiotic and biotic stresses. OsCPK12-overexpressing (OsCPK12-OX) plants exhibited increased tolerance to salt stress. The accumulation of hydrogen peroxide (H(2) O(2) ) in the leaves was less in OsCPK12-OX plants than in wild-type (WT) plants. Genes encoding reactive oxygen species (ROS) scavenging enzymes (OsAPx2 and OsAPx8) were more highly expressed in OsCPK12-OX plants than in WT plants, whereas the expression of the NADPH oxidase gene, OsrbohI, was decreased in OsCPK12-OX plants compared with WT plants. Conversely, a retrotransposon (Tos17) insertion mutant, oscpk12, and plants transformed with an OsCPK12 RNA interference (RNAi) construct were more sensitive to high salinity than were WT plants. The level of H(2) O(2) accumulation was greater in oscpk12 and OsCPK12 RNAi plants than in the WT. These results suggest that OsCPK12 promotes tolerance to salt stress by reducing the accumulation of ROS. We also observed that OsCPK12-OX seedlings had increased sensitivity to abscisic acid (ABA) and increased susceptibility to blast fungus, probably resulting from the repression of ROS production and/or the involvement of OsCPK12 in the ABA signaling pathway. Collectively, our results suggest that OsCPK12 functions in multiple signaling pathways, positively regulating salt tolerance and negatively modulating blast resistance.

Comparative analysis of root transcriptome profiles of two pairs of drought-tolerant and susceptible rice near-isogenic lines under different drought stress.

BACKGROUND: Plant roots are important organs to uptake soil water and nutrients, perceiving and transducing of soil water deficit signals to shoot. The current knowledge of drought stress transcriptomes in rice are mostly relying on comparative studies of diverse genetic background under drought. A more reliable approach is to use near-isogenic lines (NILs) with a common genetic background but contrasting levels of resistance to drought stress under initial exposure to water deficit. Here, we examined two pairs of NILs in IR64 background with contrasting drought tolerance. We obtained gene expression profile in roots of rice NILs under different levels of drought stress help to identify genes and mechanisms involved in drought stress. RESULTS: Global gene expression analysis showed that about 55% of genes differentially expressed in roots of rice in response to drought stress treatments. The number of differentially expressed genes (DEGs) increased in NILs as the level of water deficits, increased from mild to severe condition, suggesting that more genes were affected by increasing drought stress. Gene onthology (GO) test and biological pathway analysis indicated that activated genes in the drought tolerant NILs IR77298-14-1-2-B-10 and IR77298-5-6-B-18 were mostly involved in secondary metabolism, amino acid metabolism, response to stimulus, defence response, transcription and signal transduction, and down-regulated genes were involved in photosynthesis and cell wall growth. We also observed gibberellic acid (GA) and auxin crosstalk modulating lateral root formation in the tolerant NILs. CONCLUSIONS: Transcriptome analysis on two pairs of NILs with a common genetic background (~97%) showed distinctive differences in gene expression profiles and could be effective to unravel genes involved in drought tolerance. In comparison with the moderately tolerant NIL IR77298-5-6-B-18 and other susceptible NILs, the tolerant NIL IR77298-14-1-2-B-10 showed a greater number of DEGs for cell growth, hormone biosynthesis, cellular transports, amino acid metabolism, signalling, transcription factors and carbohydrate metabolism in response to drought stress treatments. Thus, different mechanisms are achieving tolerance in the two tolerant lines.

Thoracoacromial vessels as recipients for head and neck reconstruction and cause of vascular complications.

BACKGROUND: The choice of recipient vessels is an important factor for successful head and neck reconstruction. Finding good recipient vessels for neck microsurgery can be difficult after patients have undergone radiation therapy, previous neck dissection or developed neck infections due to pharyngocutaneous fistulae. Thoracoacromial arteries and veins can be good alternatives to common recipient vessels in such patients. We reviewed the complications, advantages and disadvantages associated with using thoracoacromial arteries and veins as recipient vessels. METHODS: We reviewed eight patients whose thoracoacromial arteries and veins served as recipient vessels for head and neck reconstruction between 2002 and 2009. Preoperative status, reconstruction method and operative outcomes with complications were evaluated. RESULTS: Postoperative complications related to microsurgical anastomosis developed in two of the eight patients. One arterial and venous thrombosis developed in each patient. We considered that the arterial thrombosis was derived from a technical problem with the operation and the venous thrombosis was derived from postoperative external pressure. CONCLUSIONS: Thoracoacromial arteries and veins are good recipient vessels for patients who have undergone ablative or reconstructive surgery, radiation therapy, or have a neck infection due to complications. However, we believe that using these vessels as recipients requires specific precautions that differ from those associated with general head and neck reconstruction.

Free jejunal patch graft for reconstruction after partial hypopharyngectomy with laryngeal preservation.

OBJECTIVES: To examine postoperative complications and swallowing function associated with free jejunal patch graft transfer after partial hypopharyngectomy with laryngeal preservation. DESIGN: Retrospective medical record review. SETTING: Academic research. PATIENTS: A consecutive series of 43 patients who underwent free jejunal patch graft transfer after partial hypopharyngectomy with laryngeal preservation composed the study sample. They represented the following 3 groups based on the type of hypopharyngeal defect: 13 patients with defects of the posterior wall (PW group), 28 patients with defects extending to the unilateral piriform sinus (PS-PW group), and 2 patients with defects extending to the bilateral piriform sinuses (PS-PS group). MAIN OUTCOME MEASURES: Postoperative complications and oral intake ability were compared among the groups. RESULTS: Except for 1 patient, all the patients in the PW and PS-PS groups resumed oral intake within 2 weeks after surgery. Four patients in the PS-PW group had severe dysphagia, 2 of whom could not discontinue tube feeding. CONCLUSIONS: Free jejunal patch graft transfer after partial hypopharyngectomy allows satisfactory swallowing function, with a low complication rate. Postoperative dysphagia was slightly more common in the PS-PW group than in the PW group.

New application of the gluteal-fold flap for the treatment of anorectal stricture.

PURPOSE: Total intersphincteric resection (total ISR) is a surgical option for patients with advanced cancer of the lower rectum. However, anorectal stricture can develop after total ISR, which stretches from the anus to the lower rectum. Conventional anoplasty for anal stricture is often ineffective for them because the areas of stricture are long and the most proximal points of the strictures are too far for advancement flaps or rotation flaps to reach. We have developed a new surgical treatment method using a gluteal-fold flap (GFF) for anal stricture after total ISR. METHODS: From April 2004 through June 2007, hemilateral GFFs were transferred to treat anorectal strictures after total ISR in three patients at the National Cancer Center Hospital East, Chiba, Japan. Postoperative results and anal function were evaluated. RESULTS: In all three patients, GFFs were successfully transferred, and good dilation of the anorectal stenosis was achieved. Postoperative anal function was satisfactory. CONCLUSION: The GFF has a rich vascular supply and can be simply and reliably transferred. We believe that GFF transfer is an excellent option for treating anorectal strictures after total ISR.

Functional characterisation of OsCPK21, a calcium-dependent protein kinase that confers salt tolerance in rice.

Calcium acts as a messenger in various signal transduction pathways in plants. Calcium-dependent protein kinases (CDPKs) play important roles in regulating downstream components in calcium signaling pathways. In rice, the CDPKs constitute a large multigene family consisting of 29 genes, but the biological functions and functional divergence or redundancy of most of these genes remain unclear. Using a mini-scale full-length cDNA overexpressor (FOX) gene hunting system, we generated 250 independent transgenic rice plants overexpressing individual rice CDPKs (CDPK FOX-rice lines). These CDPK FOX-rice lines were screened for salt stress tolerance. The survival rate of the OsCPK21-FOX plants was higher than that of wild-type (WT) plants grown under high salinity conditions. The inhibition of seedling growth by abscisic acid (ABA) treatment was greater in the OsCPK21-FOX plants than in WT plants. Several ABA- and high salinity-inducible genes were more highly expressed in the OsCPK21-FOX plants than in WT plants. These results suggest that OsCPK21 is involved in the positive regulation of the signaling pathways that are involved in the response to ABA and salt stress.

Morphologic study of mandibles in Japanese patients for mandibular reconstruction with fibula free flaps.

BACKGROUND: In mandibular reconstruction with a fibula flap, 3-dimensional models are sometimes used but are not available to all plastic surgeons. To establish a simpler method, we performed a morphologic study of the mandible. METHODS: Three-dimensional images of the mandible from 79 Japanese patients were analyzed. Four theoretical osteotomy points were placed on each image and the lengths of each segment and the angles between every 2 segments were measured. RESULTS: The SDs of the angle formed by the right and left canines and the left mandibular angle; the angle formed by the left canine, the left mandibular angle, and the left condyle; and the segment between the canines were so small that these values would easily be exceeded by manipulation errors during an osteotomy. CONCLUSION: Mandibular bones show a close similarity among Japanese patients. Acceptably accurate osteotomies can thus be performed in Japanese patients without requiring accurate templates.

Use of vascularized free fibular head grafts for upper limb oncologic reconstruction.

BACKGROUND: Transfer of a vascularized fibular graft is the method of first choice for reconstruction of defects of long bones. In particular, the vascularized fibula head graft is preferred for patients with bone defects of the upper limb involving the distal radius or the proximal humerus. The aim of the present study was to analyze the operative results, complications, and postoperative function after vascularized fibula head graft transfer and the indications for this procedure. METHODS: From 1998 through 2008, vascularized fibula head graft transfer was performed in eight patients to reconstruct bone defects following resection of tumors of the upper limb. The primary site of the tumor was the proximal humerus in four patients and the distal radius in four patients. The postoperative course of the transferred bone was examined, and functional results were evaluated. RESULTS: All vascularized fibula head grafts were transferred successfully. During the follow-up period, absorption of the transferred fibula head was not observed. The mean overall functional rating of the reconstructed shoulder joint was 70 percent. The range of motion of the reconstructed wrist joint showed no specific patterns, and instability of the wrist joint was observed in only one case. CONCLUSIONS: The authors believe that the vascularized fibula head graft transfer is a safe and reliable method for reconstructing the upper limb, especially for patients with a defect of the distal radius or the proximal humerus. This procedure is also useful for pediatric patients, in whom bone growth is expected after transplantation, and for salvage procedures after reconstructive materials of an artificial joint have failed.

Pharmacokinetics of [6]-shogaol, a pungent ingredient of Zingiber officinale Roscoe (Part I).

To investigate the pharmacokinetics of [6]-shogaol, a pungent ingredient of Zingiber officinale Roscoe, the pharmacokinetic parameters were determined by using (14)C-[6]-shogaol (labeled compound) and [6]-shogaol (non-labeled compound). When the labeled compound was orally administered to rats, the maximum plasma concentration (C (max)) and the area under the curve (AUC) of plasma radioactivity concentration increased in a dose-dependent manner. When the labeled compound was orally administered at a dose of 10 mg/kg, 20.0 + or - 1.8% of the radioactivity administered was excreted into urine, 64.0 + or - 12.9% into feces, and 0.2 + or - 0.1% into breath. Thus, more of the radioactivity was excreted into feces than into urine, and almost no radioactivity was excreted into breath. Furthermore, when the labeled compound was orally administered at a dose of 10 mg/kg, cumulative biliary radioactivity excretion over 48 h was 78.5 + or - 4.5% of the radioactivity administered, and cumulative urinary radioactivity excretion over 48 h was 11.8 + or - 2.7%, showing that about 90% of the dose administered orally was absorbed from the digestive tract and most of the fecal excretion was via biliary excretion. On the other hand, when the non-labeled compound [6]-shogaol was orally administered, the plasma concentration and biliary excretion of the unchanged form were extremely low. When these results are combined with those obtained with the labeled compound, it would suggest that [6]-shogaol is mostly metabolized in the body and excreted as metabolites.