Effect of tea catechins with caffeine on energy expenditure in middle-aged men and women: a randomized, double-blind, placebo-controlled, crossover trial.

PURPOSE: It has been reported that tea catechins increase energy metabolism, but their effect on resting metabolic rate (RMR) remains under debate. This study aimed to examine the effect of repeated intake of tea catechins on energy metabolism in the resting state in middle-aged men and women. METHODS: A total of 30 middle-aged men and women [13 women; age (mean ± SD) 52 ± 4 years; BMI 21.9 ± 2.2 kg/m2] were recruited. A randomized, double-blind, crossover study was conducted using a tea catechin-enriched beverage (611 mg catechins, 88 mg caffeine) and a placebo beverage (0 mg catechins, 81 mg caffeine) as test beverages. After 2 weeks of continuous test beverage intake, fasting RMR and energy expenditure (EE) after the ingestion of test beverage were measured. Measurements of forehead temperature (proxy for core temperature) and skin temperature were also obtained simultaneously. RESULTS: Among participants who underwent measurements, 26 (10 women; mean age 52 ± 4 years; mean BMI 22.1 ± 2.1 kg/m2) were analyzed. The EE increased significantly after ingestion of the tea catechin beverage compared with the placebo beverage (placebo treatment: 5502 ± 757 kJ/day; catechin treatment: 5598 ± 800 kJ/day; P = 0.041). No between-treatment differences in fasting RMR or the respiratory quotient were detected. In addition, the forehead and skin temperature did not differ significantly between the placebo and catechin treatments. CONCLUSION: This study revealed that continuous intake of tea catechins with caffeine for 2 weeks significantly increased EE after ingestion of the tea catechin but not fasting RMR in middle-aged men and women. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE: This trial was registered at www.umin.ac.jp/ctr/ as UMIN000025810 and UMIN000025811.

Cancer detection rate of prebiopsy MRI with subsequent systematic and targeted biopsy are superior to non-targeting systematic biopsy without MRI in biopsy naïve patients: a retrospective cohort study.

BACKGROUND: To determine whether prebiopsy multiparametric magnetic resonance imaging (mpMRI) with subsequent systematic plus targeted biopsies for suspicious lesions improve prostate cancer detection compared with standard non-targeting systematic biopsies without mpMRI in biopsy-naïve patients. METHODS: Patients who underwent their first prostate biopsy due to suspicion of prostate cancer were analyzed retrospectively to compare the biopsy outcomes between patients who received prebiopsy mpMRI (215 patients) and those who did not (281 patients). mpMRI was performed to determine pre-biopsy likelihood of the presence of prostate cancer using a three-point scale (1 = low level of suspicion, 2 = equivocal, and 3 = high level of suspicion). Systematic biopsies were performed in both groups. Targeted biopsies were added for a high level of suspicious lesions on mpMRI. All biopsies were performed by transperineal biopsy technique. After biopsy, Prostate Imaging Reporting and Data System ver. 2 (PIRADS-2) scoring was performed to describe the mpMRI findings and predictive value of PIRADS-2 was evaluated. RESULTS: The detection rate of total and clinically significant prostate cancer was significantly higher in patients who received prebiopsy mpMRI than in those who did not (55.3 and 46.0% vs. 42.0 and 35.2%, respectively; p = 0.004 and p = 0.016). The clinically insignificant prostate cancer detection rate was similar between the two groups (9.3% vs. 6.8%; p = 0.32). Of 86 patients who underwent systematic plus targeted biopsy in the MRI cohort and were diagnosed with prostate cancer, seven patients were detected by addition of targeted biopsy whereas 29 patients were missed by targeted biopsy but detected by systematic biopsy. There was a correlation between the PIRADS-2 and prostate cancer detection rate, and a receiver-operator curve analysis yielded an area under the curve of 0.801 (p <  0.0001). CONCLUSIONS: Prebiopsy mpMRI with subsequent systematic plus targeted biopsies for suspicious lesions can yield a higher cancer detection rate than non-targeting systematic biopsies. PIRADS-2 scoring is useful for predicting the biopsy outcome.

Launch light dependency of step-index multimode fiber connections analyzed by modal power distribution using encircled angular flux.

The propagating modal power distribution (MPD) of step-index multimode fibers (SI-MMFs), which strongly influences the performance of systems and components composed of these fibers, has not often been discussed, because, until recently, there has been no definition to show the MPD. Encircled angular flux (EAF) is a newly developed metric for defining the MPD in step-index multimode waveguides including fibers standardized by the International Electrotechnical Commission. Using the combined analysis of EAF and insertion loss, we studied the launch light dependency of SI-MMF connections. Our studies contribute to enhancing both current applications and future higher data rate communications using SI-MMFs.

Tooth size in Chinese Oroqen ethnic minority of Inner Mongolia Autonomous Region.

The Oroqen are Tungusic hunters of the Amur River basin. We analyzed dental crown measurements from their dental impression models for anthropological characteristics. Sex difference was comparatively larger in the mesiodistal diameters. To examine the Mongoloids' distribution in the Northeast Asia, the data were compared with the results from the previous studies on other Northeast Asian races, using deviation diagrams, cluster analysis, and Multidimensional Scaling from Q-mode correlation coefficients. The Oroqen dentition is classified as Sinodont by the large surface area of their crowns. In the deviation diagram, the Oroqen beared an inverse proportion to the Aleutian Islanders, while showing little difference from the Okhotsk culture people, which suggested a close relation between the two races. The Q-mode correlation coefficients clustered the Oroqen into the Central Asian group with the Buriats and Mongolians. In the analysis of the distances transformed from Q-mode correlation coefficients, the Oroqen was delineated in the neighboring cluster to the Epi-Jomon/Satsumon and the Okhotsk people. It is inferred that the Central Asian group, spreading from Lake Baikal to the Amur basin have gradually mixed with the Baikal group, which later moved into the Amur region from the south. The mixing of the two groups could have been influenced by the geographical features of this area. It would be valuable to gather more data on the groups around the lower Amur region and to evaluate the distribution of the Mongoloids in Eastern Asia.

[Cognitive function in patients with chronic obstructive pulmonary disease].

It is increasingly recognized that COPD is a multi-component disease, but little attention has been paid to its effects on cognition. Cognitive dysfunction is associated with increased disability of daily living and mortality. However, it remains to be elucidated in COPD. Our main findings are: 1) cognitive dysfunction in patients with COPD is related to the grade of activity of daily livings and hypoxemia, especially in exercise-induced hypoxemia; 2) cognitive impairment such as perception, attention and short memory are impaired; 3) attention function determined by Trail Making Test is improved by O2 inhalation with the increase in the prefrontal cortex oxygenation; 4) by 8 week exercise training, cognitive function in COPD is improved with the increase in the prefrontal circulation.

Diaphyseal tibiofibular synostosis in a runner.

Diaphyseal tibiofibular synostosis is a very rare cause of shin and ankle pain. A 35-year-old male presented with complaints of left shin and ankle pain of 3 years duration that was sometimes worse after running a few miles. One year before presenting to our hospital, the actual cause for his pain was missed when only lumbar radiographs were taken at another institution. A full-length tibia film revealed a diaphyseal tibiofibular synostosis at our hospital. The presence of a synostosis should alert the surgeon to search for the various abnormalities usually associated with this condition. Magnetic resonance imaging and enhanced 3-dimensional computed tomography are essential to rule out the possibility of a neoplastic process and to determine its relation to the neurovascular structures. Simple excision of the synostosis can provide excellent symptomatic relief with a minimal risk of complications.

Orientation Control of a Two-Dimensional Conductive Metal-Organic Framework Thin Film by a Pyridine Vapor-Assisted Dry Process.

Metal-organic frameworks (MOFs) are attractive materials with periodic pore structures constructed by coordinating metal ions and organic ligands. Recently, Cu3(HHTP)2 (HHTP = 2,3,6,7,10,11-hexahydroxytriphenylene), a two-dimensional conductive MOF, has attracted attention as a promising device material. Owing to the anisotropy of Cu3(HHTP)2 properties, oriented thin films of this MOF are desired for evaluating its physical properties and device integration. To date, wet processes have been used to fabricate Cu3(HHTP)2 films, whereas dry processes are essential for high-quality devices. However, oriented Cu3(HHTP)2 thin films have not yet been fabricated by using dry processes. In this study, we succeed in fabricating an orientation-controlled Cu3(HHTP)2 film on Al2O3 (001) by using a two-step dry process involving (1) the multilayer deposition of copper acetate and HHTP using a vapor deposition system and (2) pyridine vapor-assisted annealing. In-plane and out-of-plane X-ray diffraction patterns confirm the successful fabrication of the (001)-oriented Cu3(HHTP)2 films. The conductivity evaluated by four-probe measurements is 2.6 × 10-2 S cm-1, comparable to that of films fabricated by wet processes. This study provides a novel guideline for the orientation control of two-dimensional conductive MOF thin films via a dry process.

Effects of Ingesting Both Catechins and Chlorogenic Acids on Glucose, Incretin, and Insulin Sensitivity in Healthy Men: A Randomized, Double-Blinded, Placebo-Controlled Crossover Trial.

Epidemiologic studies have revealed that consuming green tea or coffee reduces diabetes risk. We evaluated the effects of the combined consumption of green tea catechins and coffee chlorogenic acids (GTC+CCA) on postprandial glucose, the insulin incretin response, and insulin sensitivity. Eleven healthy men were recruited for this randomized, double-blinded, placebo-controlled crossover trial. The participants consumed a GTC+CCA-enriched beverage (620 mg GTC, 373 mg CCA, and 119 mg caffeine/day) for three weeks; the placebo beverages (PLA) contained no GTC or CCA (PLA: 0 mg GTC, 0 mg CCA, and 119 mg caffeine/day). Postprandial glucose, insulin, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) responses were measured at baseline and after treatments. GTC+CCA consumption for three weeks showed a significant treatment-by-time interaction on glucose changes after the ingestion of high-fat and high-carbohydrate meals, however, it did not affect fasting glucose levels. Insulin sensitivity was enhanced by GCT+CCA compared with PLA. GTC+CCA consumption resulted in a significant increase in postprandial GLP-1 and a decrease in GIP compared to PLA. Consuming a combination of GTC and CCA for three weeks significantly improved postprandial glycemic control, GLP-1 response, and postprandial insulin sensitivity in healthy individuals and may be effective in preventing diabetes.

Drastic Reduction of the Solid Electrolyte-Electrode Interface Resistance via Annealing in Battery Form.

The origin of electrical resistance at the interface between the positive electrode and solid electrolyte of an all-solid-state Li battery has not been fully determined. It is well known that the interface resistance increases when the electrode surface is exposed to air. However, an effective method of reducing this resistance has not been developed. This report demonstrates that drastic reduction of the resistance is achievable by annealing the entire battery cell. Exposing the LiCoO2 positive electrode surface to H2O vapor increases the resistance by more than 10 times (to greater than 136 Ω cm2). The magnitude can be reduced to the initial value (10.3 Ω cm2) by annealing the sample in a battery form. First-principles calculations reveal that the protons incorporated into the LiCoO2 structure are spontaneously deintercalated during annealing to restore the low-resistance interface. These results provide fundamental insights into the fabrication of high-performance all-solid-state Li batteries.

Selective Epitaxial Growth of Ca2NH and CaNH Thin Films by Reactive Magnetron Sputtering under Hydrogen Partial Pressure Control.

Calcium compounds with N and H are promising catalysts for NH3 conversion, and their epitaxial thin films provide a platform to quantitatively understand the catalytic activities. Here we report the selective epitaxial growth of Ca2NH and CaNH thin films by controlling the hydrogen partial pressure (PH2) during reactive magnetron sputtering. We find that the hydrogen charge states can be tuned by PH2: Ca2NH containing H- is formed at PH2 < 0.04 Pa, while CaNH containing H+ is formed at PH2 > 0.04 Pa. In situ plasma emission spectroscopy reveals that the intensity of the Ca atomic emission (∼422 nm) decreases as PH2 increases, suggesting that Ca reacts with H2 and N2 to form Ca2NH at lower PH2, whereas at higher PH2, CaHx is first formed on the target surface and then sputtered to produce CaNH. This study provides a novel route to control the hydrogen charge states in Ca-N-H epitaxial thin films.

Lidocaine cytotoxicity to the bovine articular chondrocytes in vitro: changes in cell viability and proteoglycan metabolism.

PURPOSE: A lot of studies on the effect of intra-articular injections are clinical, but many questions on the effect of lidocaine to articular chondrocytes remain unanswered. This study was performed to determine the effects of varying concentrations and exposure times of lidocaine on the viability and proteoglycan metabolism of chondrocytes in vitro. METHOD: Cartilage was obtained from metatarsal joints of adult bovines. Chondrocytes in alginate beads were cultured in medium containing 6% fetal calf serum at 370 mOsmol at cell densities of 4 million cells/ml. They were then cultured for 24 h under 21% oxygen with 0.125, 0.25, 0.5, and 1% lidocaine and without lidocaine as control. The cell viability profile across intact beads was determined by manual counting using fluorescent probes and transmission electron microscopy. RESULT: Lactate production was measured enzymatically as a marker of energy metabolism. Glycosaminoglycan (GAG) accumulation was measured using a modified dimethylmethylene blue assay. Cell viability decreased in a time- and dose-dependent manner in the concentration range of 0.125-1.0% lidocaine under the confocal microscope. Under the electron microscope, apoptosis increased as the concentration of lidocaine increased. GAG accumulation/tissue volume decreases as the concentration of lidocaine increased. However, GAG produced per million cells and the rate of lactate production per live cell were significantly higher for cells cultured at 0.5 and 1% lidocaine than the control group. Bovine chondrocytes cultured in alginate beads under high oxygen pressure are negatively influenced by increasing concentrations of lidocaine. CONCLUSION: Cell viability and proteoglycan production (GAG accumulation/tissue volume) decreased as the concentration of lidocaine increased. These data suggest caution in prolonged exposure of cartilage to high concentration lidocaine. Repeated joint injection of lidocaine potentially worsens osteoarthrosis by accelerating cartilage degradation.

Microarray analysis of expression of cell death-associated genes in rat spinal cord cells exposed to cyclic tensile stresses in vitro.

BACKGROUND: The application of mechanical insults to the spinal cord results in profound cellular and molecular changes, including the induction of neuronal cell death and altered gene expression profiles. Previous studies have described alterations in gene expression following spinal cord injury, but the specificity of this response to mechanical stimuli is difficult to investigate in vivo. Therefore, we have investigated the effect of cyclic tensile stresses on cultured spinal cord cells from E15 Sprague-Dawley rats, using the FX3000 Flexercell Strain Unit. We examined cell morphology and viability over a 72 hour time course. Microarray analysis of gene expression was performed using the Affymetrix GeneChip System, where categorization of identified genes was performed using the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) systems. Changes in expression of 12 genes were validated with quantitative real-time reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The application of cyclic tensile stress reduced the viability of cultured spinal cord cells significantly in a dose- and time-dependent manner. Increasing either the strain or the strain rate independently was associated with significant decreases in spinal cord cell survival. There was no clear evidence of additive effects of strain level with strain rate. GO analysis identified 44 candidate genes which were significantly related to "apoptosis" and 17 genes related to "response to stimulus". KEGG analysis identified changes in the expression levels of 12 genes of the mitogen-activated protein kinase (MAPK) signaling pathway, which were confirmed to be upregulated by RT-PCR analysis. CONCLUSIONS: We have demonstrated that spinal cord cells undergo cell death in response to cyclic tensile stresses, which were dose- and time-dependent. In addition, we have identified the up regulation of various genes, in particular of the MAPK pathway, which may be involved in this cellular response. These data may prove useful, as the accurate knowledge of neuronal gene expression in response to cyclic tensile stress will help in the development of molecular-based therapies for spinal cord injury.

Metaphyseal-loading anterolaterally-flared femoral stem in cementless total hip arthroplasty: five- to eleven-year follow-up evaluation.

Using a nonlinear three-dimensional finite element analysis simulating loading conditions, we designed a new type of proximal-fitting, anterolaterally-flared, arc-deposit hydroxyapatite-coated anatomical femoral stem (FMS-anatomic stem; Japan Medical Materials, Osaka, Japan) for cementless total hip arthroplasty (THA) for Japanese patients with dysplastic hip osteoarthritis. The aim of the present study was to analyze the clinical and radiographic outcomes of the new stem. We reviewed 143 consecutive patients (164 hips; 13 men, 14 hips; 130 women, 150 hips; age at surgery, 56.6 +/- 7.6 years, mean +/- SD, range, 30-74) who underwent cementless THA using the FMS-anatomic stem at a single institution, with a follow-up period of 7.6 +/- 1.6 years (range, 5.3-11.0). Harris Hip score improved from 46.1 +/- 12.6 before surgery to 90.0 +/- 8.9 points post-THA. The 7.6-year survival rate of the stem was 99.0% after revision for aseptic loosening. Radiographs at follow-up confirmed the stability of the femoral stems within the femoral canal in all cases, with sufficient bone ingrowth. None of the patients had subsidence of the stem exceeding 2.0 mm within the femoral canal or changes in varus or valgus position of more than 2.0 degrees . The FMS-anatomic stem provided excellent results in patients with dysplastic hip osteoarthritis. Our analysis confirmed reduced radiolucency around the stem in Gruen zones, minimal subsidence, appropriate stress shielding, and promising medium-term stability within the femoral canal in our patients.

Rapidly progressive neuropathic arthropathy of the knee in possible association with a huge extruded cervical intervertebral disc herniation.

A 58-year-old woman with an insignificant stage of diabetes mellitus presented with rapidly progressive osteoarthritis of her right knee exhibiting painless but significant antero-posterior and lateral instability. In association, she had a huge extruded left-sided cervical intervertebral disc at the C4-5 level. Neurological examination of the upper limbs was normal but, she had diminished pinprick sensation on the right leg. Radiographic findings were consistent with neuropathic arthropathy of the knee. Anterior decompression with fusion of C4-5 and total knee arthroplasty using a semi-constrained-type artificial implant were performed in one stage. The patient regained nearly normal living activity following surgical intervention. We stress the possibility of rapid progression of knee joint arthropathy, as neuropathic knee, even in a patient with less significant symptoms and signs of cervical myelopathy caused by a huge extruded intervertebral disc.

Endometrioid adenocarcinoma arising from endometriosis of the rectosigmoid.

A case of endometrioid adenocarcinoma supposedly arising from endometriosis of the rectum is reported. Malignant transformation is uncommon but a well-known complication of endometriosis. In the present case, it was proved by histopathological findings and immunophenotype such as cytokeratin7+/cytokeratin20-/estrogen receptor+. The cause of rectal endometriosis in this case might have been related with previously received hormone replacement therapy for ovarian endometriosis. Following surgical removal of the lesion, this patient underwent adjuvant chemotherapy with paclitaxel and carboplatin, although this kind of therapy is still controversial as to its effectiveness.

Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine; evaluation of a new MRI staging classification and imaging findings as indicators of surgical management: a retrospective study of 37 patients.

INTRODUCTION: The aim of this study was to review the patients with lumbar epidural abscess in terms of neurological morbidity, therapeutic outcome, and prognosis, while assessing the usefulness of a new MRI staging classification and specific imaging findings as indicators for surgical management. MATERIALS AND METHODS: We reviewed 37 patients who sustained epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine. Ten patients were treated conservatively, while 27 required urgent or elective surgical drainage. We studied patients with respect to symptomatology, Frankel-American Spinal Injury Association (ASIA) scale evaluation and a new proposed system of MRI staging of pyogenic spondylodiscitis (stages I­V). RESULTS: Of the 37 patients with stage IV and V MRI lesions, 13 (35%) had septicemia and 8 (22%) presented with Frankel-ASIA scale C-D neurological status. All cases with ringlike enhancement on gadolinium-enhanced MRI in the epidural abscess lesions were treated surgically. Progression of local kyphosis and loss of intervertebral disk height were significantly prevented in the surgical group (P < 0.05). Improvements of neurological status and laboratory data were better in the surgical group than the conservative group (P < 0.05), with significantly short hospital stay (P < 0.05). DISCUSSION: Epidural abscess associated with pyogenic spondylodiscitis presents with various neurological symptoms. In addition to assessment of progression by clinical symptomatology, modified neurological Frankel-ASIA scaling and the currently proposed MRI staging regimen may help to consider the timing of surgical intervention. In the acute, subacute or acute-on-chronic phase and the ringlike enhancement pattern of epidural abscess on gadolinium-enhanced MRI may be an indicator for surgery.

[An autopsy case of alpha-fetoprotein-producing carcinoma of the sigmoid colon resulting in sudden death].

A 63-year-old woman was admitted to our hospital with complaints of abdominal distention and bilateral cervical masses. Her serum AFP was 11700 ng/dl. AFP was confirmed immunohistochemically by biopsy of a sigmoid colon tumor, yielding a diagnosis of AFP-producing carcinoma of the sigmoid colon, accompanied by multiple liver metastases, and systemic multiple lymph node metastases. Due to her poor general condition with mitral regurgitation, the patient began S-1 treatment. The patient's general condition rapidly worsened after 1 course of S-1 had no effect. She died on the 59th hospital day and a pathological autopsy was performed. We examined 67 cases of AFP-producing colon cancer in Japan, including our own, and report the findings with references.

A case of ileus surgery using the water pressure method against ileus caused by incarceration into the inverted bladder diverticulum.

BACKGROUND: Ileus is quite a common disease, but is associated with various causes. As far as we know, there have only been one case of ileus due to inverted bladder diverticulum, which is extremely rare. CASE PRESENTATION: The patient was a 53-year-old male. He made an emergency visit to our hospital with a chief complaint of left lower quadrant pain. He underwent right inguinal hernia surgery at 2 years of age with no history of laparotomy. An abdominal enhanced CT revealed inversion of the bladder left side wall where part of enlarged small intestine was found. Ascites were also found between the incarcerated small intestine and the bladder, leading to a diagnosis of strangulation ileus due to internal hernia and subsequent emergency surgery. A laparotomy revealed incarceration of the small intestine in the bladder left wall as a Richter type. The incarceration was rigid. We believed it would be difficult to pull out by extraction. Therefore, we inserted a Nelaton catheter between the incarcerated small intestine and the bladder and carried out the water pressure method to release the ileus. We did not perform an enterectomy since no manifest necrosis or perforation of the small intestine was found. The inverted bladder wall was a partial depression. We interpreted it to be a bladder diverticulum. We made a suture for occlusion with the bladder diverticulum inverted. Ileus arising from inverted bladder diverticulum is a very rare disease state. We hereinafter report on this case along with bibliographical considerations. CONCLUSIONS: We experienced a case of small intestine ileus due to inverted bladder diverticulum, which is very rare. In terms of preservation of the bowel, we believed the water pressure method to release the ileus was useful.

Anterior and posterior decompressive surgery for progressive amyotrophy associated with cervical spondylosis: a retrospective study of 51 patients.

OBJECT: The aims of this study were to review the clinicoradiological findings in patients who underwent decompressive surgery for proximal and distal types of muscle atrophy caused by cervical spondylosis and to discuss the outcome and techniques of surgical intervention. METHODS: Fifty-one patients (43 men and 8 women) with proximal (37, with arm drop) and distal muscle atrophy (14, with wrist drop) underwent cervical decompression (39 anterior decompressions and 12 open-door C3-7 laminoplasties with microsurgical foraminotomy) for muscle weakness in the upper extremities. The clinical course, type of spinal cord compression, abnormal signal intensity on high-resolution MR imaging, and postdecompression improvement in muscle power were reviewed at a mean follow-up of 2.6 years (range 0.8-9.4 years). RESULTS: The most commonly affected vertebrae were C4-5 and C5-6, and C5-6 and C6-7 in patients with proximal or distal muscle atrophy, respectively; the respective numbers of affected vertebrae were 1.5 and 2.2. Transaxial MR imaging showed medial compression of the spinal cord in 20 patients (in 12 with proximal and 8 with distal muscle atrophy), paramedial compression in 22 (17 and 5 patients, respectively), and foraminal compression in 9 (8 and 1 patient, respectively). Increased signal intensity on MR imaging was observed in 85.0, 22.7, and 11.1% of cases of medial, paramedial, and foraminal compression, respectively. Increased signal intensity at the affected muscle segment level was observed in 52.9, 40.0, and 0% of cases, respectively. Sixty-two percent of patients with proximal muscle atrophy gained 1 or more grades of muscle power on manual muscle testing (MMT), whereas 64.3% with distal muscle atrophy failed to gain even 1 grade of improvement. The recovery of muscle power correlated with disease duration and the percent voltage of Erb point or wrist-stimulated muscle evoked potentials but not with preoperative MMT, longitudinal range of spinal cord compression, signal change on T2-weighted MR imaging, or surgical procedure. CONCLUSIONS: Surgical outcome in patients with distal muscle atrophy was inferior to that in patients with proximal atrophy. The distal type was characterized by a long preoperative period, a greater number of cervical spine misalignments, a narrow spinal canal, and increased signal intensity on T2-weighted MR imaging. It is essential to perform a careful neurological evaluation, including sensory examination of the lower limbs, as well as neuroradiological and neurophysiological assessments to avoid confusion with motor neuron disease and to detect the coexistence of amyotrophic lateral sclerosis, especially when surgical treatment of cervical spondylosis is planned. The results of careful physical examination, MR imaging studies, and electromyography studies should be comprehensively evaluated to ascertain the pathophysiology of the muscle atrophy. It is very important to distinguish the pathophysiology caused by nerve root impingements from anterior horn dysfunction when making decisions about treatment strategy. Surgical treatment--with or without foraminotomy--for amyotrophy in cervical spondylosis requires urgent action with regard to human neuroanatomy and neural innervation of the paralyzed muscles.

Direct detection of pathogens in osteoarticular infections by polymerase chain reaction amplification and microarray hybridization.

BACKGROUND: Molecular biological techniques such as the polymerase chain reaction (PCR) and DNA microarray are used for the detection/identification of microorganisms; however, few reports have discussed the clinical utility of microarray analysis for identification of causative organisms of osteoarticular infections. It is important to examine the utility of PCR amplification followed by analysis of DNA microarray carrying specific oligonucleotides. METHODS: This study included 101 biological samples obtained from 96 patients who underwent conservative and/or surgical treatment for osteoarticular infections. In this double-blind comparative study, routine conventional testing and the research groups were unaware of each other's interpretation until identical specimens were identified by culture and microarray analysis. RESULTS: Results of PCR microarray analysis were positive for 25 samples and negative for the remaining 76 samples within 24 h, and the results of the cultures (available after a mean of 3.54 days) were positive in 26 samples and negative for the remaining 75 samples. The sensitivity of microarray analysis was 84.6% (22/26) and specificity was 88.0% (22/25). Discrepant results were identified in seven samples, including a negative culture and a positive microarray in three cases and a positive culture and a negative microarray in four other cases. CONCLUSIONS: The PCR microarray analysis is complementary to routine cultures in identifying causative microorganisms and should be used in patients with highly suspected infections and negative bacterial culture and in patients who require prompt diagnosis and early initiation of antibiotic therapy.