Ventral anchoring of the conus medullaris: a new surgical technique preventing the radiographic recurrence of retethering after surgery for tethered spinal cord.

OBJECTIVE: Retethering is not an unusual operation for a congenital lumbosacral dysraphic spinal lesion. The present study aimed to assess a new surgical technique for preventing retethering. SURGICAL TECHNIQUE: After untethering the spinal cord, the pia mater or scar tissue at the caudal end of the conus medullaris is anchored to the ventral dura mater loosely using 8-0 thread, and the dura mater is closed directly. This technique is called ventral anchoring. RESULTS: Ventral anchoring was performed in 15 patients (aged 5 to 37 years old, average age: 12.1 years old) between 2014 and 2021. All but one patient showed improvement or stabilization of the preoperative symptoms. No complication directly related to the procedure was observed. Postoperative MRI demonstrated that the dorsal subarachnoid space was restored in 14 patients but was undetectable or absent in three patients on follow-up MRI. No patients have experienced a recurrence of the tethered cord syndrome during the follow-up period. CONCLUSION: Ventral anchoring is effective for restoring the dorsal subarachnoid space after untethering the spinal cord. This preliminary study suggested that ventral anchoring has the potential to prevent the postoperative radiographic recurrence of tethered spinal cord in patients with a congenital lumbosacral dysraphic spinal lesion.

Freeze-drying synthesis of an amorphous Zn(2+) complex and its transformation to a 2-D coordination framework in the solid state.

An amorphous and metastable precursor for a Zn two-dimensional coordination framework was synthesised via freeze drying. The precursor comprises randomly packed discrete clusters of a Zn complex. The amorphous-to-crystalline framework transformation, which was triggered by the gentle application of heat or pressure, was accompanied by a change in the coordination geometry of the Zn(2+) ions from tetrahedral to octahedral symmetry.

FOLFIRI plus bevacizumab as second-line therapy in patients with metastatic colorectal cancer after first-line bevacizumab plus oxaliplatin-based therapy: the randomized phase III EAGLE study.

BACKGROUND: A targeted agent combined with chemotherapy is the standard treatment in patients with metastatic colorectal cancer (mCRC). The present phase III study was conducted to compare two doses of bevacizumab combined with irinotecan, 5-fluorouracil/leucovorin (FOLFIRI) in the second-line setting after first-line therapy with bevacizumab plus oxaliplatin-based therapy. PATIENTS AND METHODS: Patients were randomly assigned to receive FOLFIRI plus bevacizumab 5 or 10 mg/kg in 2-week cycles until disease progression. The primary end point was progression-free survival (PFS), and secondary end points included overall survival (OS), time to treatment failure (TTF), and safety. RESULTS: Three hundred and eighty-seven patients were randomized between September 2009 and January 2012 from 100 institutions in Japan. Baseline patient characteristics were well balanced between the two groups. Efficacy was evaluated in 369 patients (5 mg/kg, n = 181 and 10 mg/kg, n = 188). Safety was evaluated in 365 patients (5 mg/kg, n = 180 and 10 mg/kg, n = 185). The median PFS was 6.1 versus 6.4 months (hazard ratio, 0.95; 95% confidence interval [CI] 0.75-1.21; P = 0.676), and median TTF was 5.2 versus 5.2 months (hazard ratio, 1.01; 95% CI 0.81-1.25; P = 0.967), respectively, for the bevacizumab 5 and 10 mg/kg groups. Follow-up of OS is currently ongoing. Adverse events, including hypertension and hemorrhage, occurred at similar rates in both groups. CONCLUSION: Bevacizumab 10 mg/kg plus FOLFIRI as the second-line treatment did not prolong PFS compared with bevacizumab 5 mg/kg plus FOLFIRI in patients with mCRC. If bevacizumab is continued after first-line therapy in mCRC, a dose of 5 mg/kg is appropriate for use as second-line treatment. CLINICAL TRIAL IDENTIFIER: UMIN000002557.

Synthesis of magnesium ZIF-8 from Mg(BH4)2.

Porous Mg(2-methyl imidazolate)2 (Mg-ZIF-8) was synthesised from Mg(BH4)2 as a precursor under an Ar atmosphere. It possesses an uncommon tetrahedral Mg(2+)-N coordination geometry that is stabilised by the formation of a framework, and it exhibits a Brunauer-Emmett-Teller surface area greater than 1800 m(2) g(-1).

Hume-Rothery stabilization mechanism and e/a determination for RT- and MI-type 1/1-1/1-1/1 approximants studied by FLAPW-Fourier analyses.

Full-potential linearized augmented plane wave (FLAPW) electronic band calculations were performed for two RT- (rhombic triacontahedron) and five MI- (Mackay icosahedron) type 1/1-1/1-1/1 approximants plus several complex metallic compounds in Al-TM (TM = transition metal element) binary alloy systems in order to elucidate the origin of a pseudogap from the viewpoint of Fermi surface-Brillouin zone (FsBz) interactions. The square of the Fermi diameter (2k(F))(2) and square of the critical reciprocal lattice vector |G|(2) or the critical set of lattice planes, with which electrons at the Fermi level E(F) are interfering, can be extracted from the FLAPW-Fourier method. We revealed that a pseudogap in both RT- and MI-type 1/1-1/1-1/1 approximants universally originates from interference phenomenon satisfying the matching condition (2k(F))(2) = |G|(2) equal to 50 in units of (2π/a)(2), where a is the lattice constant. The multi-zone effect involving not only |G|(2) = 50 but also its neighboring ones is also claimed to be responsible for constituting a pseudogap across E(F). The value of e/a for Mn, Fe, Re and Ru elements in the periodic table is deduced to be positive in the neighborhood of unity. All 1/1-1/1-1/1 approximants, regardless of RT- or MI-type atomic cluster involved, are stabilized at around e/a= 2.7, while their counterpart quasicrystals are at around e/a= 2.2. A new Hume-Rothery electron concentration rule linking the number of atoms per unit cell, e/uc, with a critical|G|(2) holds well for all complex intermetallic compounds characterized by a pseudogap at E(F).

Association between cardiac function and pulmonary function in hypertensive patients.

OBJECTIVE: This study examined the association between cardiac function and pulmonary function in hypertensive patients. METHODS: Hypertensive patients without overt cardiovascular disease were enrolled (n=43; mean±SD age 71±9 years). Pulmonary function was measured by the percentage of predicted forced vital capacity (%FVC) and the ratio of 1 s forced expiratory volume (FEV1) to FVC (FEV1/FVC ratio). Left ventricular ejection fraction (LVEF) and the ratio of peak early diastolic transmitral flow (E) to peak early diastolic mitral annular velocity (e') (E/e' ratio) were assessed using echocardiography. RESULTS: Multiple linear regression analysis revealed that E/e' was independently associated with %FVC and that LVEF was independently associated with FEV1/FVC ratio. Both LVEF and FEV1/FVC ratio were significantly lower in hypertensive former or current smokers than in hypertensive never smokers. CONCLUSIONS: Subclinical cardiac dysfunction was independently associated with reduced pulmonary function in hypertensive patients. Hypertensive patients with decreased pulmonary function may need preventive care to prevent the progression of heart failure.

Differences in left ventricular diastolic dysfunction between eccentric and concentric left ventricular hypertrophy in hypertensive patients with preserved systolic function.

Left ventricular (LV) hypertrophy (LVH) may be eccentric or concentric (2 × LV posterior wall thickness relative to LV end-diastolic dimension ≤ 0.42 or > 0.42, respectively). The LV diastolic function between age-matched hypertensive patients with eccentric and concentric LVH was compared in the present study. Echocardiography was used to measure LV mass index (LV mass/body surface area; LVMI) as an index of LVH. LV diastolic function was assessed by measurements of peak early transmitral flow velocity (E)/peak late transmitral flow velocity (A) (the E/A ratio), peak early diastolic mitral annular velocity (e') and the E/e' ratio. Although LVMI, E/A and e' did not differ between the two groups, E/e' was significantly higher (worse) in patients with concentric LVH (13.4 ± 5.4) than in those with eccentric LVH (11.1 ± 3.6). Among hypertensive patients with LVH, those with concentric LVH may, therefore, have more severe LV diastolic dysfunction than those with eccentric LVH even if their LVMIs, which reflect the degree of LVH, are similar.

Aortic root dilatation as a marker of subclinical left ventricular diastolic dysfunction in patients with cardiovascular risk factors.

Consensus is lacking about the clinical importance of aortic root dilatation in assessment of the risk of cardiovascular disease. In this study, correlations between aortic root diameter and echocardiographic features of left ventricular (LV) diastolic function were investigated in 333 patients with at least one cardiovascular risk factor (hypertension, diabetes or dyslipidaemia) and preserved LV systolic function. Aortic root diameter was measured by M-mode echocardiography, and LV diastolic function was evaluated by measuring the peak velocity of early (E) and late (A) diastolic transmitral blood flow and peak early diastolic mitral annular velocity (E') by Doppler echocardiography. Linear regression analysis showed that, in men, age was not related to aortic root diameter but hypertension and LV hypertrophy were, whereas the converse was true in women. The parameters E, E/A ratio and E', were related to aortic root diameter in both sexes. Stepwise multiple regression analysis confirmed that E in women and E' in men were independently associated with aortic root diameter. It is concluded that aortic root dilatation might be a useful marker of subclinical LV diastolic dysfunction. Patients with preserved systolic function showing aortic root dilatation should, therefore, be given preventative therapy against LV diastolic heart failure.

Fermi surface-Brillouin-zone-induced pseudogap in γ-Mg17Al12 and a possible stabilization mechanism of ß-Al3Mg2.

The electronic structure of γ phase in the system Mg(17)Al(12) containing 58 atoms per unit cell with space group I43m has been calculated by using the WIEN2k-FLAPW program package. A pseudogap is found across the Fermi level. The FLAPW-Fourier spectra at the symmetry points N and Γ of the bcc Brillouin zone revealed that electronic states across the Fermi level at these symmetry points are dominated by |G|(2) = 26 and 24 states corresponding to centers of {510} + {431} and {422} zone planes, respectively. The 1253-wave nearly-free-electron (NFE) band calculations identified that a combination of the two Fermi surface-Brillouin-zone (FsBz) interactions associated with |G|(2) = 26 and 24 account well for the observed DOS pseudogap in γ-Mg(17)Al(12), most likely leading to the stabilization of this complex metallic compound. The ß-Al(3)Mg(2) containing 1178 atoms per cubic unit cell is suggested to be stabilized by satisfying the Hume-Rothery matching condition expressed in terms of e/uc, the number of electrons per unit cell, versus critical |G|(2). A critical |G|(2) is predicted to be 200 in ß-Al(3)Mg(2), which results in 84 Brillouin zone planes interacting almost simultaneously with a more or less spherical Fermi surface.

Direct-puncture approach to the extraconal portion of the superior ophthalmic vein for carotid cavernous fistulae.

INTRODUCTION: The transvenous approach via the superior ophthalmic vein (SOV) is an available approach for carotid cavernous fistula (CCF), especially in the event that there is no other suitable approach route to the fistula. Surgical exposure of the peripheral roots of the SOV is commonly used; however, often, the SOV is often not accessible because of anatomical problems and/or complications. In this paper, we present and discuss our original direct-puncture approach to the extraconal portion of the SOV. METHODS: An attempt on three patients with traumatic CCF failed with the transarterial approach and the conventional venous approach via the inferior petrosal sinus; therefore, the patients were treated with the direct-puncture approach to the extraconal portion of the SOV using two-dimensional digital subtraction angiography with local anesthesia. RESULTS: All cases that had tortuous and partially stenotic division of the SOV were treated successfully with this approach and without complications. CONCLUSION: This approach will become an alternate approach, especially when the peripheral roots of the SOV are focally narrowed and tortuous, making it impossible to insert a catheter.

Does removable partial denture quality affect individuals' oral health?

The impact of oral disorders and interventions on individuals' perceived oral health and oral-health-related quality of life (OHRQoL) is being increasingly recognized as an important health component. This study examined the association between denture quality and OHRQoL in individuals wearing removable partial dentures (RPDs). The study participants were 245 consecutive patients (mean age: 63.3 +/- 8.7 yrs) at a university-based prosthodontic clinic who wore RPDs for more than one month. RPD quality and OHRQoL were determined by means of a 100-mm visual analog scale (VAS) and the 49-item Oral Health Impact Profile-Japanese version (OHIP-J49), respectively. Linear regression analysis between RPD quality and OHRQoL revealed that a 10-mm VAS increase in RPD quality rating was related to -2.8 OHIP-J49 units (95% confidence interval: -4.5 to -1.1, p = 0.001), which represents an improvement in OHRQoL. The results suggest that RPD quality influences individuals' OHRQoL to a clinically significant extent.

Feasibility of oral health-related quality of life assessment in prosthodontic patients using abbreviated Oral Health Impact Profile questionnaires.

To report about the feasibility of oral health-related quality of life assessment using two short forms of the Oral Health Impact Profile - OHIP-J14 and OHIP-J5 - in prosthodontic patients. Using the item pool of the Japanese version of the OHIP, two short forms based on a 14-item English-language version and a 5-item German-language questionnaire were derived. To test construct validity, the associations between summary scores of two short versions and self-reported oral health and self-reported denture quality have been investigated. Responsiveness was tested in 30 patients treated for their removable partial denture. Test-retest reliability using a time interval of 2 weeks and internal consistency were also tested. Associations between the two short form summary scores and self-reported oral health and denture quality supported construct validity of the instruments. Acceptable reliability for OHIP-J14 and OHIP-J5 was indicated by intra-class correlation coefficients of 0.73 and 0.75 (test-retest reliability) and CRONBACH'S alpha of 0.94 and 0.81 (internal consistency) respectively. Responsiveness was sufficient for OHIP-J14 and OHIP-J5 indicated by 'medium' effect sizes (0.50 and 0.57 respectively). In addition to sufficient discriminative psychometric properties, the ability to measure change of perceived oral health make OHIP-J14 and OHIP-J5 suitable for outcomes research.

Japanese version of the Oral Health Impact Profile (OHIP-J).

The objective of the study was to develop a Japanese version of the Oral Health Impact Profile (OHIP). The original 49 items were translated using a forward-backward method following accepted cultural adaptation guidelines. A de novo development of Japanese items was conducted to establish content validity. The associations between the OHIP summary score and self-reported oral health (n = 220) and self-reported denture quality (n = 155) were investigated for construct validity. The association between the OHIP summary score and six oral conditions (n = 227) were also tested. The responsiveness of the instrument was established by comparing the score before and after using newly fabricated removable partial dentures (n = 30). The test-retest reliability (n = 37) and internal consistency (n = 251) were also calculated. After the de novo development, five new items were added to the OHIP. The priori hypothesized associations between the OHIP score and oral health conditions were confirmed (P < 0.001). The change in the OHIP scores from 63.6 to 40.6 (P < 0.001) supports the responsiveness of the instrument. Intra-class correlation coefficients of 0.81 and Cronbach's alpha of 0.98 indicate high test-retest reliability and internal consistency of the instrument's summary score. Sufficient discriminative and evaluative psychometric properties of the currently developed Japanese version of the OHIP in typical target populations make the instrument suitable for assessing the oral health-related quality of life in cross-sectional as well as longitudinal studies.

Endoscopic submucosal dissection is useful and safe for intramucosal gastric neoplasms in the elderly.

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) has recently gained popularity for use against intramucosal gastric neoplasms in Japan, but few studies have examined whether ESD is feasible for elderly patients. This study aims are to evaluate the efficacy and safety of ESD according to age in consecutive elderly patients treated with ESD. PATIENTS AND METHODS: Subjects comprised 116 patients (90 men, 26 women) with 125 lesions treated using ESD from November 2002 to March 2006 at Nagoya City University Hospital and Iwata Municipal Hospital, Japan. Patients were categorized into: Group A, <65-years-old (n=34); Group B, > or =65-years-old but <75-years-old (n=41); and Group C, > or = 75-years-old (n=41). En bloc resection rate and treatment time were examined according to age, tumour size and location, and frequency of complications was examined according to age. RESULTS: Rate of concomitant disease was significantly higher in Group C than in the other groups. En bloc resection rates and median treatment times were 91.4% and 80 min in Group A, 91.1% and 97 min in Group B and 86.7% and 110 min in Group C, respectively. No significant differences were noted between groups, or for en bloc resection rate and treatment time according to tumour size and location, or between groups for frequency of complications. CONCLUSIONS: ESD for gastric neoplasms is effective and safe in elderly patients, and may be positively recommended to elderly patients with intramucosal gastric neoplasms.

A new camera trocar for gasless endoscopic thyroid surgery.

A commercially available camera trocar diminishes the working space because of its high profile and is not proof against blood stain. The authors designed a new camera trocar for gasless endoscopic thyroid surgery. The new trocar consists of a shaft for a 5-mm endoscope as well as a disc 18 mm in diameter and 2 mm thick. The trocar is inserted from an adjacent 3-cm working port, pushed out to an incision for a 5-mm endoscope, and placed with the shaft up and the disc down. Because of its disc, the trocar is designed to be proof against blood stain and to maintain more working space. The newly designed trocar might be very useful for gasless endoscopic thyroid surgery as well as other gasless surgical procedures.

[The effect of milrinone administrated before weaning from cardiopulmonary bypass in adult cardiac surgery].

We investigated the effect of milrinone (phoshphodiesterase III inhibitor) on postoperative hemodynamics in adult eighteen cardiac surgical patients (mean LVEF = 63%). Milrinone was administrated just after the aortic declamping during CPB. Comparing with control group, systemic vascular resistance decreased significantly and sufficient inotropic effect was sustained. In order to keep proper blood pressure much more cathechoramine dose was need when milrinone dose increased during this study. This is supposed that milrinone affected strong vasodilating effect and caused relative hypovolemic condition to the patient who showed good cardiac function. Milrinone causes best efficacy to the patient of poor cardiac function when he showed deconpensation or relatively hypervolemic hemodynamic condition.

Preparation and characterization of hyaluronate-hydroxyethyl acrylate blend hydrogel for controlled release device.

Hyaluronate-hydroxyethyl acrylate blend hydrogels were investigated as matrices for controlled release devices. Glycidyl methacrylate (GMA) derivatized HA (GMA-HA) was synthesized by coupling of GMA to HA in the presence of a suitable catalyst. These hydrogels were prepared by a free radical copolymerization of GMA-HA and hydroxyethyl acrylate. The water content of these hydrogels at equilibrium swelling in water (Ww) was 0.978+/-0.0073 (n=18); however, these hydrogel was mechanically tough and could be used as disk shape. The hydrogels swelling were found to depend on ionic strength and pH. The dried hydrogels quickly regained their original condition in water, and they swelled to more than 90% of its initial water contents after 30 min. This swelling-deswelling behavior was reproducible. The release of chlorpromazine HCl as a model cationic drug from the gels was suppressed significantly in water. The release increased with increasing the ionic strength and decreasing pH of bulk solutions.

Ewing's sarcoma/peripheral primitive neuroectodermal tumor (pPNET) arising in the omentum as a multilocular cyst with intracystic hemorrhage.

A rare case of Ewing's sarcoma/peripheral primitive neuroectodermal tumor arising in the greater omentum in a 41-year-old man is reported. The patient presented with a hemorrhagic mesenteric cyst that was disclosed by the results of an abdominal echogram, a computed tomography scan, and magnetic resonance imaging. A laparotomy showed a multilocular cyst with intra-cystic hemorrhage. Histologically, the tumor wall consisted of sheets of small round cells separated by thick desmoplastic stroma. Rosette formations or ribbon-like cell arrangements were absent. Further pathological examination revealed that the membrane of the tumor cells was positive for MIC-2, and negative for epithelial membrane antigen, cytokeratin, and desmin, which are usually positive in intra-abdominal desmoplastic small round-cell tumors. An EWS/FLI1 fused transcript was detected by reverse transcription-polymerase chain reaction. These findings confirmed the diagnosis of Ewing's sarcoma/peripheral primitive neuroectodermal tumor. The patient died of tumor recurrence 4 months after his first admission. The autopsied tumor tissue exhibited neural differentiation in certain regions. To our knowledge, this is the first case to be reported of Ewing's sarcoma/peripheral primitive neuroectodermal tumor arising in the omentum with unique pathological features and the occurrence of partial neural differentiation during the clinical course. This case pointed out to us, as gastroenterologists, that only thorough examination confirms a definitive diagnosis of small round-cell tumor of the abdomen, it also shows that Ewing's sarcoma/peripheral primitive neuroectodermal tumor should be included in the differential diagnosis of cystic lesions in the omentum.

Arborcandins A, B, C, D, E and F, novel 1,3-beta-glucan synthase inhibitors: production and biological activity.

Arborcandins A, B, C, D, E and F, which possess potent 1,3-beta-glucan synthase inhibitory activity, were isolated from the culture broth of a filamentous fungus, strain SANK 17397. Arborcandins are novel cyclic peptides, that are structurally different from known glucan synthase inhibitors such as echinocandins. The 1,3-beta-glucan synthases of Candida albicans and Aspergillus fumigatus were inhibited by arborcandins with IC50 ranging from 0.012 to 3 microg/ml. The apparent Ki value of arborcandin C for C. albicans and A. fumigatus were 0.12 microM and 0.016 microM, respectively. The inhibition against these two 1,3-beta-glucan synthases by arborcandin C was noncompetitive. These compounds exhibited potent fungicidal activity against Candida spp. with MIC ranging from 0.25 to 8 microg/ml. The growth of A. fumigatus was suppressed by arborcandins with concentrations ranging from 0.063 to 4 microg/ml.

[Total anomalous of pulmonary venous connection in infants less than 3 months old].

We examined the surgical results of total anomalous pulmonary venous connection (TAPVC) retrospectively in 6 infants, who were less than 3 months old and underwent a total repair at Ehime Prefectural Central Hospital between May, 1993 through May, 1998, in terms of the pre, peri, and postoperative management, the site of connection, and the surgical procedures. Aged at operation ranged from 1 day to 86 days (mean 39 days), and body weight ranged from 2.4 kg to 5.5 kg (mean 3.4 kg). All 6 patients had echocardiographic diagnosis and cardiac catheterization but one. In operative procedure, cut back method was done in a patient of paracardiac type of Darling's classification and posterior approach was used in total correction for 4 supracardiac and 1 infracardiac type. There were 3 hospital deaths who had poor conditions before operation, but no late deaths. Surgical results of TAPVC might have been improved with advances in non-invasive diagnosis by echocardiography, and pre and perioperative management. And we should take care of these patients of TAPVC in long term period to make sure that they have no pulmonary venous obstruction.