Temporal coexistence mechanisms contribute to the latitudinal gradient in forest diversity.

The tropical forests of Borneo and Amazonia may each contain more tree species diversity in half a square kilometre than do all the temperate forests of Europe, North America, and Asia combined. Biologists have long been fascinated by this disparity, using it to investigate potential drivers of biodiversity. Latitudinal variation in many of these drivers is expected to create geographic differences in ecological and evolutionary processes, and evidence increasingly shows that tropical ecosystems have higher rates of diversification, clade origination, and clade dispersal. However, there is currently no evidence to link gradients in ecological processes within communities at a local scale directly to the geographic gradient in biodiversity. Here, we show geographic variation in the storage effect, an ecological mechanism that reduces the potential for competitive exclusion more strongly in the tropics than it does in temperate and boreal zones, decreasing the ratio of interspecific-to-intraspecific competition by 0.25% for each degree of latitude that an ecosystem is located closer to the Equator. Additionally, we find evidence that latitudinal variation in climate underpins these differences; longer growing seasons in the tropics reduce constraints on the seasonal timing of reproduction, permitting lower recruitment synchrony between species and thereby enhancing niche partitioning through the storage effect. Our results demonstrate that the strength of the storage effect, and therefore its impact on diversity within communities, varies latitudinally in association with climate. This finding highlights the importance of biotic interactions in shaping geographic diversity patterns, and emphasizes the need to understand the mechanisms underpinning ecological processes in greater detail than has previously been appreciated.

Water-Induced Crystal Transition and Accelerated Relaxation Process of Polyamide 4 Chains in Microfibers.

Microplastics have recently been identified as one of the major contributors to environmental pollution. To design and control the biodegradability of polymer materials, it is crucial to obtain a better understanding of the aggregation states and thermal molecular motion of polymer chains in aqueous environments. Here, we focus on melt-spun microfibers of a promising biodegradable plastic, polyamide 4 (PA4), with a relatively greater number density of hydrolyzable amide groups, which is regarded as an alternative to polyamide 6. Aggregation states and thermal molecular motion of PA4 microfibers without/with a post-heating drawing treatment under dry and wet conditions were examined by attenuated total reflectance-Fourier transform infrared spectroscopy and wide-angle X-ray diffraction analysis in conjunction with dynamic mechanical analysis. Sorbed water molecules in the microfibers induced the crystal transition from a meta-stable γ-form to a thermodynamically stable α-form via activation of the molecular motion of PA4 chains. Also, the post-drawing treatment caused a partial structural change of PA4 chains, from an amorphous phase to a crystalline phase. These findings should be useful for designing PA4-based structural materials applicable for use in marine environments.

Aboveground biomass increments over 26 years (1993-2019) in an old-growth cool-temperate forest in northern Japan.

Assessing long-term changes in the biomass of old-growth forests with consideration of climate effects is essential for understanding forest ecosystem functions under a changing climate. Long-term biomass changes are the result of accumulated short-term changes, which can be affected by endogenous processes such as gap filling in small-scale canopy openings. Here, we used 26 years (1993-2019) of repeated tree census data in an old-growth, cool-temperate, mixed deciduous forest that contains three topographic units (riparian, denuded slope, and terrace) in northern Japan to document decadal changes in aboveground biomass (AGB) and their processes in relation to endogenous processes and climatic factors. AGB increased steadily over the 26 years in all topographic units, but different tree species contributed to the increase among the topographic units. AGB gain within each topographic unit exceeded AGB loss via tree mortality in most of the measurement periods despite substantial temporal variation in AGB loss. At the local scale, variations in AGB gain were partially explained by compensating growth of trees around canopy gaps. Climate affected the local-scale AGB gain: the gain was larger in the measurement periods with higher mean air temperature during the current summer but smaller in those with higher mean air temperature during the previous autumn, synchronously in all topographic units. The influences of decadal summer and autumn warming on AGB growth appeared to be counteracting, suggesting that the observed steady AGB increase in KRRF is not fully explained by the warming. Future studies should consider global and regional environmental factors such as elevated CO2 concentrations and nitrogen deposition, and include cool-temperate forests with a broader temperature range to improve our understanding on biomass accumulation in this type of forests under climate change.

A spatially explicit empirical model of structural development processes in natural forests based on climate and topography.

Stand structure develops with stand age. Old-growth forests with well-developed stand structure support many species. However, development rates of stand structure likely vary with climate and topography. We modeled structural development of 4 key stand variables and a composite old-growth index as functions of climatic and topographic covariates. We used a hierarchical Bayesian method for analysis of extensive snap-shot National Forest Inventory (NFI) data in Japan (n = 9244) to account for differences in stand age. Development rates of structural variables and the old-growth index exhibited curvilinear responses to environmental covariates. Flat sites were characterized by high rates of structural development. Approximately 150 years were generally required to attain high values (approximately 0.8) of the old-growth index. However, the predicted age to achieve specific values varied depending on environmental conditions. Spatial predictions highlighted regional variation in potential structural development rates. For example, sometimes there were differences of >100 years among sites, even in the same catchment, in attainment of a medium index value (0.5) after timber harvesting. The NFI data suggested that natural forests, especially old natural forests (>150 years), remain generally on unproductive ridges, steep slopes, or areas with low temperature and deep snow, where many structural variables show slow development rates. We suggest that maintenance and restoration of old natural forests on flat sites should be prioritized for conservation due to the likely rapid development of stand structure, although remaining natural forests on low-productivity sites are still important and should be protected.

Un Modelo Empírico Espacialmente Explícito de Procesos de Desarrollo Estructural en Bosques Naturales Basado en el Clima y la Topografía Resumen La estructura de un rodal se desarrolla con la edad. Los bosques maduros con una estructura bien desarrollada dan sustento a muchas especies. Sin embargo, las tasas de desarrollo de los rodales probablemente varían con el clima y la topografía. Modelamos el desarrollo estructural de 4 variables clave de un rodal y un índice de crecimiento antiguo compuesto como funciones de covariables climáticas y topográficas. Utilizamos un método bayesiano jerárquico para analizar datos (n = 9,244) en fotografías del inventario nacional forestal (INF) de Japón para entender las diferencias en la edad de los rodales. Las tasas de desarrollo de las variables estructurales y el índice de crecimiento antiguo mostraron respuestas curvilíneas a las covariables ambientales. Los sitios planos se caracterizaron por altas tasas de desarrollo estructural. Por lo general, se requerían 150 años para alcanzar valores altos (∼0.8) en el índice de crecimiento antiguo. Sin embargo, la edad prevista para alcanzar valores específicos varió dependiendo de las condiciones ambientales. Las predicciones espaciales pusieron de relieve la variación regional en las potenciales tasas de desarrollo estructural. Por ejemplo, a veces había diferencia de >100 años entre sitios, aun en la misma cuenca, en el consecución de un valor de índice medio (0.5) después de la cosecha de madera. Los datos de INF sugieren que los bosques naturales, especialmente los bosques maduros (>150 años) permanecen generalmente en crestas improductivas, pendientes pronunciadas o en áreas con baja temperatura y nieve profunda, donde muchas variables estructurales muestran tasas de desarrollo lentas. Sugerimos que el mantenimiento y la restauración de bosques naturales maduros en sitios planos deben priorizarse para conservación debido al probable desarrollo rápido de la estructura del rodal, aunque los bosques naturales restantes en sitios de baja productividad también son importantes y deben ser protegidos.

Survival rate and environmental response of current-year seedlings of the temperate liana Wisteria floribunda across a heterogeneous environment.

Lianas have a huge influence on forest structure and function. However, it is unclear how the surrounding environment affects the establishment of liana seedlings in temperate forests. We addressed the following questions: (1) Can current-year seedlings persist under a closed canopy? (2) Do current-year seedlings form aggregated distribution and how has their spatial distribution varied over the years? (3) How does the light condition, soil moisture content, forest floor litter, understory vegetation, and the distance from the conspecific adults affect the establishment and survival of seedlings? We examined the distribution pattern and survivorship of current-year seedlings of the temperate liana species, Wisteria floribunda, across a heterogeneous environment for 6 years using 1 m2 sub-quadrats (n = 651) in a 6 ha plot within the Ogawa Forest Reserve, an old-growth, temperate, deciduous forest in central Japan. In total, 908 current-year seedlings were observed during the study period, 87% of which emerged in 2014. Over half (56%) of these seedlings survived until 1 year after germination, which was relatively high compared with other tree species in this forest. The seedlings formed significantly aggregated distribution, but the degree of aggregation decreased over time. The number of emerged seedlings was negatively associated with the presence of dwarf bamboo (Sasa borealis) and the distance from the nearest conspecific adult. However, the survival rate of the seedlings was negatively associated with the presence of dwarf bamboo and soil moisture content and was positively associated with the openness of the canopy and the distance from the nearest conspecific adult. An enhanced survival rate under more intense light conditions and the ability to persist within the shaded understory may be important for the survival of this species in the earlier stage of the life history.

Height-related variations of leaf traits reflect strategies for maintaining photosynthetic and hydraulic homeostasis in mature and old Pinus densiflora trees.

Because tree size and age co-vary, it is difficult to separate their effects on growth and physiological function. To infer causes for age-related height-growth decline, we compared various leaf traits between mature (ca. 100 years) and old (ca. 300 years) trees of Pinus densiflora, having similar heights (ca. 30 m) and growing in the same stand. For many leaf traits, mature and old trees showed similar height-related trends reflecting acclimation to height-related hydraulic limitation for maintaining photosynthetic and hydraulic homeostasis. Photosynthetic capacity was constant within crowns of both age-classes, though 4.9-5.4 µmol CO2 m-2 s-1 lower for old than for mature trees. Biochemical acclimation of photosynthesis, allocating more nitrogen to treetop leaves, was observed only for mature trees. Leaf turgor loss point was also constant within crowns of both age-classes with no significant effect of age on leaf hydraulic traits. In mature trees, leaf capacitance increased, while bulk tissue elastic modulus decreased with height, whereas opposite height-related trends were observed for old trees. For both age-classes, leaf mass per area (LMA), transfusion-tissue area, and xylem area all increased with height, but LMA was ca. 30 g m-2 greater for old than for mature trees. In old trees, mesophyll area decreased with height, suggesting anatomical acclimation to height may negatively affect photosynthetic capacity. We inferred that old trees rely more on morphological than biochemical acclimation and that such post-maturational shift in resource allocation could underlie height-growth decline of P. densiflora after reproductive maturity.

When and why do trees begin to decrease their resource allocation to apical growth? The importance of the reproductive onset.

Trees reduce their allocation to apical growth compared with that to radial growth during later life stages. This has often been attributed to hydraulic and mechanical limitations; however, a growth-reproduction tradeoff might also play an important role. To test whether the height-diameter (H-D) relationship in trees changes with the timing of the onset of reproduction, we analyzed the H-D relationship of 13 deciduous broad-leaved tree species in a Japanese old-growth temperate forest using linear and segmented-linear regression models. These models showed a better fit than common continuous models (simple allometry and saturating curve). For 11 out of 13 species having break points on the H-D lines, we assessed whether the height at the breakpoint (BPH) was related to the height at the onset of reproduction determined by multiyear observatory records on several trees. Although BPH estimates for these 11 species were highly variable, most were within 3.1 m of the stable flowering height (staFLH), or the height at which trees achieve the ability to flower regardless of their growth conditions. The interspecies mean value of the difference between staFLH and BPH was only 45 cm, which suggested a causal relationship between these parameters. BPHs of nine out of 11 species were within the canopy layer and, for the two remaining species, were within the subcanopy layer. These results suggest that several species in this forest begin to reduce their allocation to apical growth around the canopy layer at the onset of stable reproduction.

Resolving the paradox of clumped seed dispersal: positive density and distance dependence in a bat-dispersed species.

One of the hypothesized benefits of seed dispersal is to escape density- and distance-responsive, host-specific, natural enemies near maternal plants where conspecific seed and seedling densities are high. Such high conspecific neighbor densities typically result in lower offspring growth and survival (i.e., negative density-dependent effects), yet many dispersal modes result in clumped seed distributions. New World leaf-nosed bats transport fruits to their feeding roosts and deposit seeds, thereby creating high-density seed/seedling patches beneath feeding roosts in heterospecific trees away from maternal trees, which seemingly nullifies a key benefit of seed dispersal. Such dispersal may still be adaptive if negative density-dependent effects are reduced under feeding roosts or if the benefit of being dispersed away from maternal trees outweighs negative effects of conspecific seed/seedling density below roosts. We mapped the entire post-germination population of a bat-dispersed tree species Calophyllum longifolium (Calophyllaceae) in a 50-ha plot on Barro Colorado Island, Panama in each of three successive years. We tested two hypotheses: (1) distance-dependent effects are stronger than density-dependent effects on seedling performance because seedlings far from conspecific adults are more likely to escape natural enemies even when at high densities and (2) negative density-dependent effects will be reduced far from vs. near conspecific adults. Density and distance were naturally decoupled, as expected. However, in contrast to our expectation, we found positive density effects on seedling survival and density-dependent effects did not differ with distance from conspecific adults. Both density and distance had positive effects on seedling survival when considered together, while only year had a significant effect on seedling growth. Thus, both being dispersed under bat feeding roosts and escaping the vicinity of conspecific adults were beneficial for C. longifolium seedling survival, supporting the directed dispersal and escape hypotheses, respectively. Despite resulting in high densities of conspecific seedlings, favorable habitat under bat feeding roosts and lack of negative density-dependent effects appear to provide evolutionary advantages in C. longifolium.

Large contribution of clonal reproduction to the distribution of deciduous liana species (Wisteria floribunda) in an old-growth cool temperate forest: evidence from genetic analysis.

Background and Aims: Extensive clonal (vegetative) reproduction in lianas is a common and important life history strategy for regeneration and colonization success. However, few studies have evaluated the contribution of clonal reproduction to stand-level distribution of lianas in their natural habitat using genetic tools. The objectives of the present study were to investigate (1) the contribution of clonal reproduction to the distribution of Wisteria floribunda, (2) the size of clonal patches and (3) how the distribution patterns of W. floribunda clones are affected by micro-topography. Methods: The contribution of clonal reproduction to the distribution of the deciduous liana species W. floribunda was evaluated using genetic analysis across a 6-ha plot of an old-growth temperate forest in Japan and preference in landform between clonal ramets and non-clonal ramets was assessed. Key Results: Of the 391 ramets sampled, clonal reproduction contributed to 71 and 62 % of the total abundance and basal area, respectively, or 57 and 31 % when the largest ramet within a genet was excluded. The large contribution of clonal reproduction to the density and basal area of W. floribunda was consistent with previous observational studies. The largest genet included a patch size of 0.47 ha and ranged over 180 m. Preferred landforms of clonal and non-clonal ramets were significantly different when evaluated by both abundance and basal area. Non-clonal ramets distributed more on lower part of the slope than other landforms in comparison with clonal ramets and trees, possibly reflecting the limitation of clonal growth by stolons. Conclusions: Using genetic analysis, the present study found evidence of a large contribution of clonal reproduction on the distribution of W. floribunda in its natural habitat. The results indicate that clonal reproduction plays an important role not only in the formation of populations but also in determining the distribution patterns of liana species.

Effects of temporal variation in community-level fruit abundance on seed dispersal by birds across woody species.

PREMISE OF THE STUDY: In animal-dispersed plants, seed dispersal patterns of the same species in the same habitat can greatly differ among individuals and temporally. Many studies have revealed the pervasive effects of spatial variation in fruit abundance on seed dispersal of individual plants. By contrast, very few studies have investigated the temporal variation in seed dispersal. METHODS: We investigated the effects of conspecific and community-level fruit abundance on fruit removal rate and seed dispersal distance of six bird-dispersed woody species in a Japanese temperate forest for 3 yr. The six species share similar fruit characteristics but have different fruiting seasons. In addition, we also considered the effects of bird seasonality in diet and species composition on seed dispersal. KEY RESULTS: Inter-annual and inter-seasonal variation in community-level fruit abundance determined both fruit removal and the seed dispersal distance across species, but the effect differed with seasonal changes in bird behavior. Abundant fruit satiated fruit removal by birds only during fruit-feeding periods, not during insect-feeding periods. A scarcity of fruit increased the dispersal distance, but only during the migratory period. This difference was probably due to the different foraging behaviors of passing migrants and territorial birds. CONCLUSIONS: Our results illustrated that temporal variation in community-level fruit abundance could be a determining factor for seed dispersal in temperate forests. The effects of temporal variations in fruit abundance on seed dispersal patterns should be investigated in other ecosystems in order to understand their importance and associations with frugivore phenology.

The use of soil pollen to determine the sex of overhead individuals of a temperate dioecious shrub.

PREMISE OF THE STUDY: In dioecious species, determining the sex of individual plants from one-time phenological observations is rarely feasible when some individuals capable of reproducing are not flowering or fruiting at the time of observation. Currently, sexing those individuals requires long-term phenological data on individuals and populations, but such data are rarely available or feasible to collect. We tested the hypothesis that differences in soil pollen concentrations beneath the crowns of female and male plants would exist and be sufficient to reliably determine the sex of the individual plant overhead in a dioecious species. We predicted that soil pollen concentrations beneath male plants would be significantly higher than beneath female plants because only males produce pollen and pollen should accumulate in the soil underneath the male plants over repeated flowering events. METHODS: We collected samples from surface soil under both sexes of the insect-pollinated dioecious shrub, Aucuba japonica (Garryaceae). KEY RESULTS: Pollen grains were present in surface soil in both Oe and A horizons, and mean pollen concentration under males was significantly higher than under females. Pollen concentrations beneath males were positively correlated with male plant height, potentially reflecting greater pollen production by larger individuals. CONCLUSIONS: Considering the small plant size and relatively low pollen production of A. japonica, this method may hold promise for sexing other dioecious species in the absence of direct phenological data. Our phenology-free and relatively low-cost method for sexing dioecious plants may be especially useful in tropical forests where many species are dioecious.

Surveillance after endoscopic mucosal resection or endoscopic submucosal dissection for esophageal squamous cell carcinoma.

The objectives of surveillance after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma are: (i) early detection and treatment of recurrence; and (ii) early detection and treatment of metachronous esophageal squamous cell carcinoma and second primary cancers. Protocols for follow up after EMR or ESD for esophageal squamous cell carcinoma should be based on the risks of lymph node metastasis and distant metastasis as assessed on the basis of tumor staging at initial treatment. Early detection of recurrence or metachronous carcinomas often allows curative or less invasive treatment. Particular attention should be paid to the development of metachronous esophageal squamous cell carcinomas and second primary cancers (in particular, head and neck cancer and gastric cancer because of their high incidence).

Fleshy fruit characteristics in a temperate deciduous forest of Japan: how unique are they?

This study investigated the fleshy fruit characteristics of 28 woody species in a Japanese temperate forest where large sedentary seed-dispersing mammals are present. We tested whether the findings in previous studies in temperate forests of Europe and North America are universal or not. Results have suggested that fruits of all species were eaten both by birds and mammals except for four species with larger fruits, which were eaten only by mammals. A gradient was found from a syndrome characterized by small, oily, and large-seeded fruits to a syndrome characterized by large, succulent, non-oily, and small-seeded fruits. The sizes and colors of the fruits were not conspicuously different from previous findings in Europe and North America. On the other hand, nitrogen and lipids in the fleshy part did not show seasonally increasing trends, or even seasonally decreasing trends in terms of dry weight. This result, suggesting the absence of community-level adaptation of fruit traits to migratory bird dispersers, contrasted with findings in Europe and North America. Large sedentary arboreal or tree-climbing mammals may have a greater effect on the evolution of fruit-disperser relations than opportunistic migratory birds.

Use of two population metrics clarifies biodiversity dynamics in large-scale monitoring: the case of trees in Japanese old-growth forests: the need for multiple population metrics in large-scale monitoring.

Many indicators/indices provide information on whether the 2010 biodiversity target of reducing declines in biodiversity have been achieved. The strengths and limitations of the various measures used to assess the success of such measures are now being discussed. Biodiversity dynamics are often evaluated by a single biological population metric, such as the abundance of each species. Here we examined tree population dynamics of 52 families (192 species) at 11 research sites (three vegetation zones) of Japanese old-growth forests using two population metrics: number of stems and basal area. We calculated indices that track the rate of change in all species of tree by taking the geometric mean of changes in population metrics between the 1990s and the 2000s at the national level and at the levels of the vegetation zone and family. We specifically focused on whether indices based on these two metrics behaved similarly. The indices showed that (1) the number of stems declined, whereas basal area did not change at the national level and (2) the degree of change in the indices varied by vegetation zone and family. These results suggest that Japanese old-growth forests have not degraded and may even be developing in some vegetation zones, and indicate that the use of a single population metric (or indicator/index) may be insufficient to precisely understand the state of biodiversity. It is therefore important to incorporate more metrics into monitoring schemes to overcome the risk of misunderstanding or misrepresenting biodiversity dynamics.

Interspecific variation in mortality and growth and changes in their relationship with size class in an old-growth temperate forest.

Understanding trade-offs between demographic parameters is crucial when investigating community assembly rules in high-diversity forests. To this end, we estimated mortality and growth parameters, and correlations among them, across entire size classes for 17 tree species (Betula, Carpinus, Fagus, Quercus, Castanea, Acer, Cerasus, Swida, Kalopanax, and Styrax) using a dataset over 18 years obtained from an old-growth forest in Japan.Size classes were represented by 12 categories determined by age, height, and diameter at breast height (DBH) from new seedlings to stems of DBH >85 cm. We derived the annual mortality and growth for each species and class using estimates of transition probabilities between classes. Trade-offs or synergies in growth and survival among species per size class were analyzed with and without the inclusion of phylogenetic relationships.Annual mortality showed U-shaped patterns across size classes for species that could potentially reach a DBH ≥55 cm: 0.2-0.98 for seedlings, 0.002-0.01 at DBH 35-45 cm, and ca. 0.01 at DBH ≥55 cm. Other species demonstrated monotonically decreasing mortality toward specific maximum size classes. When phylogenetic information was included in analyses, the correlations between survival and growth changed across size classes were significant for some classes: As an overall tendency, synergy was observed in growth and survival for seedling to sapling classes, trade-offs for juvenile to DBH 15-25 cm classes, and synergy again for larger classes. When phylogenetic information was not included, a significant trade-off was observed only at DBH 5-15 cm. Synthesis. Trade-offs at intermediate classes imply differentiation in demographic characteristics related to life history strategies. However, evolutionarily obtained demographic characteristics are not substantial drivers of niche differentiation in the study area. The polylemma of mortality, growth, and other parameters such as the onset of reproduction may also be important factors driving species-specific demographic traits.

Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?

Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in Duchenne muscular dystrophy (DMD) and is recommended to correct pelvic obliquity. The caudal extent of instrumentation and fusion in the surgical treatment of scoliosis in DMD has remained a matter of considerable debate, and there have been few studies on the use of segmental pedicle screw instrumentation for this pathology. From 2004 to 2007, a total of 28 patients with DMD underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. All patients had a curve with the apex at L2 or higher preoperatively. Preoperative coronal curve averaged 74 degrees, with a postoperative mean of 14 degrees, and 17 degrees at the last follow-up. The pelvic obliquity improved from 17 degrees preoperatively to 6 degrees postoperatively, and 6 degrees at the last follow-up. Good sagittal plane alignment was recreated after surgery and maintained long term. In 23 patients with a preoperative L5 tilt of less than 15 degrees, the pelvic obliquity was effectively corrected to less than 10 degrees and maintained by adequately addressing spinal deformity, while five patients with a preoperative L5 tilt of more than 15 degrees had a postoperative pelvic obliquity of more than 15 degrees. Segmental pedicle screw instrumentation and fusion to L5 was effective and safe in patients with DMD scoliosis with a minimal L5 tilt (<15 degrees) and a curve with the apex at L2 or higher, both initially and long term, obviating the need for fixation to the sacrum/pelvis. Segmental pedicle screw instrumentation and fusion to L5 was safe and effective in patients with DMD scoliosis with stable L5/S1 articulation as evidenced by a minimal L5 tilt of less than 15 degrees, even though pelvic obliquity was significant. There was no major complication. With rigid segmental pedicle screw instrumentation, the caudal extent of fusion in the treatment of DMD scoliosis should be determined by the degree of L5 tilt. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of DMD scoliosis.

Two-year results for scoliosis secondary to Duchenne muscular dystrophy fused to lumbar 5 with segmental pedicle screw instrumentation.

BACKGROUND: Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in patients with Duchenne muscular dystrophy since the development of the intrailiac post. It is recommended for correcting pelvic obliquity. However, caudal extent of instrumentation and fusion has remained a matter of considerable debate. This study was performed to determine the efficacy and safety of stopping segmental pedicle screw constructs at L5 during surgical treatment of scoliosis associated with Duchenne muscular dystrophy (DMD). METHODS: From May 2005 to June 2007, a total of 20 consecutive patients underwent posterior spinal fusion and segmental pedicle screw instrumentation only to L5 for scoliosis secondary to DMD. All patients had progressive scoliosis, difficulty sitting, and back pain before surgery. A minimum 2-year follow-up was required for inclusion in this study. Assessment was performed clinically and with radiological measurements. The Cobb angles of the curves and spinal pelvic obliquity were measured on the coronal plane. Thoracic kyphosis and lumbar lordosis were measured on the sagittal plane. These radiographic assessments were performed before surgery, immediately after surgery, and at a 3-month interval thereafter. The operating time, blood loss, and complications were evaluated. Patients were questioned about whether they had difficulty sitting and felt back pain before surgery and at 6 weeks, 1 year, and 2 years after surgery. RESULTS: A total of 20 patients, aged 11-17 years, were enrolled. The average follow-up period was 37 months. Preoperative coronal curves averaged 70 degrees (range 51 degrees -85 degrees ), with a postoperative mean of 15 degrees (range 8 degrees -25 degrees ) and a mean of 17 degrees (range 9 degrees -27 degrees ) at the last follow-up. Pelvic obliquity improved from 13 degrees (range 7 degrees -15 degrees ) preoperatively to 5 degrees degrees (range 3 degrees -8 degrees ) postoperatively and 6 degrees (range 3 degrees -9 degrees ) at the last follow-up. Good sagittal plane alignment was recreated and maintained. Only a small loss of correction of scoliosis and pelvic obliquity was noted. The mean operating time was 271 min (range 232-308 min). The mean intraoperative blood loss was 890 ml (range 660-1260 ml). The mean total blood loss was 2100 ml (range 1250-2880 ml). There was no major complication. All patients reported that difficulty sitting and back pain were alleviated after surgery. CONCLUSION: Segmental pedicle screw instrumentation and fusion only to L5 is safe and effective in patients with DMD scoliosis of <85 degrees and pelvic obliquity of <15 degrees . Good sagittal plane alignment was achieved and maintained. All patients benefited from surgery in terms of improved quality of life. There was no major complication.

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction.

In a previous study, the authors reported the clinical and radiological results of Duchenne muscular dystrophy (DMD) scoliosis surgery in 14 patients with a low FVC of <30%. The purpose of this study was to determine if surgery improved function and QOL in these patients. Furthermore, the authors assessed the patients' and parents' satisfaction. %FVC increased in all patients after preoperative inspiratory muscle training. Scoliosis surgery in this group of patients presented no increased risk of major complications. All-screw constructions and fusion offered the ability to correct spinal deformity in the coronal and pelvic obliquity initially, intermediate and long-term. All patients were encouraged to continue inspiratory muscle training after surgery. The mean rate of %FVC decline after surgery was 3.6% per year. Most patients and parents believed scoliosis surgery improved their function, sitting balance and quality of life even though patients were at high risk for major complications. Their satisfaction was also high.

Clinicopathological analyses of fifty supracricoid laryngectomized specimens: evidence base supporting minimal margins.

OBJECTIVES: Supracricoid laryngectomy (SCL) is a reliable laryngeal preservation surgery. However, close surgical margins are often inevitable. Based on clinicopathological analyses of supracricoid laryngectomized specimens, we evaluated the evidence base supporting minimal margins. METHODS: The distance between tumor edge and resected margin was measured macro- and microscopically at the anterior, posterior, superior and inferior edges, using 50 surgical specimens. The margins were correlated with pathological T staging and the prognoses. RESULTS: The anterior and posterior margins were the shortest, and the superior margin was the longest. The inferior margin was the only edge at which a positive margin was encountered. Cancer extending 10 mm below the glottal free edge significantly decreased the inferior margin. CONCLUSIONS: The surgical potential of SCL with cricohyoidoepiglottopexy was confirmed to be able to cope with tumor extensions showing margins of a few millimeters at the anterior, posterior and superior ends. Accurate assessment and management at the inferior margin is the key to stable local control.

[Clinical review of supracricoid laryngectomy with CHEP and CHP: 50 patients treated in 11 years].

An analysis of clinical data on 50 patients undergoing supracricoid laryngectomy (SCL) between 1997 and 2008 i.e., cricohyoidoepiglottopexy (CHEP) in 47 and cricohyoidopexy (CHP) in 3 cases showed that the number of SCL cases operated on within a year surpassed that of Total Laryngectomy after 2003. Selection criteria included performance status 0-1 and blood gas PO2>80 torr, especially in those patients over 70-years-old. Postoperative wound infection occurred in 16 patients (32%), with four requiring additional surgical intervention (two ruptured pexis and two chondritis induced by C3-C4 osteophytes). A history of radiotherapy and systemic complications, i.e., diabetes and renal failure, added to the risk of wound infection. Introducing a clinical pathway shortened hospitalization. Vocal function was achieved in 96% and swallowing function in 89% of patients. Five-year crude survival in CHEP was 69% and in TL 51%. Laryngeal preservation was 70%, increasing to 89% after the introduction of SCL. SCL-CHEP is thus indicated for unfavorable T2 (ASCO 2006), well-selected T3, T4, and rT1-4 (radiation failures). Effort should emphasize a good balance in prognosis and function in organ preservation for laryngeal cancer.