Extraskeltal Outgrowth of Solitary Synovial Osteochondroma of the Cervical Spine: A Case Report.

We report a rare case of a solitary synovial osteochondroma (SSO) in the cervical canal. A 37-year-old man presented with neck pain and the forearm dysesthesia developed immediately after a trivial motor accident. Because of aggravation he visited our hospital though he was treated conservatively for 3 months. A computed tomography (CT) scan showed an oval shaped small mass with high density rim in the cervical canal at the level of the C6/7 facet joint. This mass compressing the dural sac was visualized with a high intensity signal in T2-weighted magnetic resonance imaging (MRI) and, interestingly, with high intensity in T1-weighted images. A surgical removal was carried out. Macroscopically, it consists of a solitary, firm, juxta-articular mass associated with synobia but lacking connection with the adjacent bone. Microscopically, it is similar to conventional osteochondromas. It differs from this entity by not arising from a bone surface and by a whole coverage of synobial tissue. The final diagnosis was a SSO. There have been anecdotal case reports of a SSO in various site including knee, fingers, buttocks, wrist, and so on. To the best of our knowledge, this is the first case report of SSO arising in the spinal canal.

Effect of Different Types of Messages on Readiness to Indicate Willingness to Register for Organ Donation During Driver's License Renewal in Japan.

BACKGROUND: In Japan, a recent opinion poll in 2017 showed that 41.9% of the respondents wished to donate their organs, but only 12.7% declared their intention to donate or not do so. Therefore, it is important to explore measures to prompt more individuals to register their intention about organ donation. METHODS: A field experimental questionnaire survey was conducted to confirm the effect of a prompt message for registering intentions for organ donation, which was communicated at a driver's license center. The study employed a prospective randomized control design. Seven thousand six hundred fifteen individuals visited the Tokyo Fuchu License Examination Center to update their driver's license and received leaflets including a message prompting organ donation registration and the questionnaire. Of the participants who received leaflets, 3224 respondents provided complete responses to the questionnaire (valid response rate: 42.3%). Subsequently, a questionnaire survey was conducted to assess the participants' willingness to register for organ donation. A control condition and the following types of messages were used: peer-framed, gain-framed, loss-framed, reciprocity-framed, and peer + reciprocity-framed. RESULTS: The reciprocity message emerged as a significant predictor of increase in immediate decision response. The loss-framed message was a significant predictor of decrease in no intention to register. CONCLUSIONS: This study found that reciprocity and loss-framed messages promoted the readiness to register for organ donation among individuals from a Japanese urban area. Mandatory distribution of prompt messages at every driver's license centers in Japan would be recommended.

Evaluation of the safety and efficacy of Glycyrrhiza uralensis root extracts produced using artificial hydroponic and artificial hydroponic-field hybrid cultivation systems III: anti-allergic effects of hot water extracts on IgE-mediated immediate hypersensitivity in mice.

To evaluate the safety and efficacy of Glycyrrhiza uralensis root extracts produced using artificial hydroponic and artificial hydroponic-field hybrid cultivation systems, we investigated anti-allergic action in mice using IgE-mediated immediate hypersensitivity. Hot water extracts obtained from the roots of Glycyrrhiza uralensis cultivated using two systems were orally administered at a dose of 100 mg/kg as glycyrrhizin (GL) and compared with the commercial crude drug, Glycyrrhizae Radix. Both the artificial hydroponic and artificial hydroponic-field hybrid cultivated root extracts showed anti-allergic effects on IgE-mediated immediate hypersensitivity in mice, as did the commercial crude drugs. These results highlight the potential for artificially cultivated roots of Glycyrrhiza uralensis to be used as an alternative medicinal source.

Mutagenetic and anti-allergic studies for evaluation of extracts of Coptis Rhizome produced by an artificial hydroponic system.

As a part of the investigation of the safety and efficacy of the cultivated Coptis japonica rhizome extracts using an artificial hydroponic cultivation system, the mutagenetic and anti-allergic activities were evaluated. Some extracts of commercial crude drugs of Coptis sp. were also evaluated for the comparison. None of the extracts showed a significant mutagenicity in Salmonella typhimurium TA102 by the Ames tests, but all the extracts showed in S. typhimurium TA98. The extracts of the hydroponically cultivated rhizomes showed anti-allergic activities against contact hypersensitivity as well as those of commercial crude drugs of Coptis sp. These results suggested the potential of the hydroponically cultivated rhizomes as one of the alternative sources for the medicinal usage.

Successfully Treated Traumatic Dislocation of a Thoracic Vertebra Caused by Minor Trauma in a Patient with Neurofibromatosis Type I A Case Report and Literature Review.

The authors reported a rare case of young women with neurofibromatosis type I (NF-I) who were successfully treated from the traumatic dislocation of a thoracic vertebra caused by a simple fall, and the relevant literature was reviewed. Due to various spinal dystrophic changes, the conventional posterior spinal fusion surgery was modified for the treatment. Spinal deformity is a common feature of NF-1, and a dystrophic lesion, like dural ectasia, provokes weakness in spinal structural. Unexpectedly, only seven similar cases were found. The review suggested that it is mandatory to thoroughly examine the spine in patients with NF-1, and that a good outcome can be expected even for patients with NF-1 in severe neurological condition after acute spinal cord injuries.

Public awareness, knowledge of availability, and readiness for cancer palliative care services: a population-based survey across four regions in Japan.

BACKGROUND: This study explores the distribution of public awareness, knowledge of availability, and readiness for palliative care services, and the perceived reliability of information resources as part of a nationwide palliative care implementation intervention in Japan (Outreach Palliative Care Trial of Integrated Regional Model [OPTIM]). METHODS: A cross-sectional anonymous questionnaire survey was conducted, and 3984 responses were used in the final analysis. RESULTS: A total of 63.1% of respondents admitted having no knowledge about palliative care, while 0.5% of respondents were using palliative care services. Respondents who knew about palliative care services, yet did not know about their availability were 18.6% of all respondents. Respondents who had cancer-related experiences were more likely to be aware of palliative care compared to the general population and availability of palliative care services. Only awareness of palliative care was significantly associated with two typical images, while cancer-related experiences were not. CONCLUSION: Findings show that the public awareness of palliative care services and their availability is insufficient, and cancer-related experiences affect awareness of cancer palliative care but not directly related to typical images for palliative care such as care for patients close to death.

Phenotypic plasticity in the range-margin population of the lycaenid butterfly Zizeeria maha.

BACKGROUND: Many butterfly species have been experiencing the northward range expansion and physiological adaptation, probably due to climate warming. Here, we document an extraordinary field case of a species of lycaenid butterfly, Zizeeria maha, for which plastic phenotypes of wing color-patterns were revealed at the population level in the course of range expansion. Furthermore, we examined whether this outbreak of phenotypic changes was able to be reproduced in a laboratory. RESULTS: In the recently expanded northern range margins of this species, more than 10% of the Z. maha population exhibited characteristic color-pattern modifications on the ventral wings for three years. We physiologically reproduced similar phenotypes by an artificial cold-shock treatment of a normal southern population, and furthermore, we genetically reproduced a similar phenotype after selective breeding of a normal population for ten generations, demonstrating that the cold-shock-induced phenotype was heritable and partially assimilated genetically in the breeding line. Similar genetic process might have occurred in the previous and recent range-margin populations as well. Relatively minor modifications expressed in the tenth generation of the breeding line together with other data suggest a role of founder effect in this field case. CONCLUSIONS: Our results support the notion that the outbreak of the modified phenotypes in the recent range-margin population was primed by the revelation of plastic phenotypes in response to temperature stress and by the subsequent genetic process in the previous range-margin population, followed by migration and temporal establishment of genetically unstable founders in the recent range margins. This case presents not only an evolutionary role of phenotypic plasticity in the field but also a novel evolutionary aspect of range expansion at the species level.

Subarachnoid hemorrhage caused by ruptured dissecting aneurysm arising from the extracranial distal posterior inferior cerebellar artery--case report.

A 50-year-old man presented with a dissecting aneurysm arising from the extracranial portion of the right posterior inferior cerebellar artery (PICA) causing subarachnoid hemorrhage (SAH) and manifesting as sudden onset of disturbed consciousness. Computed tomography showed SAH with ventricular reflux predominantly in the posterior fossa. Angiography revealed a fusiform aneurysm of the right PICA originating extracranially from the right vertebral artery. The aneurysm was isolated and excised. Histological examination showed dissection of the aneurysm wall. Dissecting aneurysm arising from the extracranial portion of the PICA is extremely rare.

Angiogenesis in atherosclerotic plaque obtained from carotid endarterectomy: association between symptomatology and plaque morphology.

Carotid plaque with hemorrhage leads to cerebral embolism and ischemic stroke. Plaque angiogenesis and angiogenetic factors such as vascular endothelial growth factor (VEGF) are critical in the progression of atherosclerotic carotid plaque and intraplaque hemorrhage. The correlation between plaque angiogenesis and presence of clinical symptoms was studied in 41 specimens obtained during carotid endarterectomy from 20 symptomatic and 21 asymptomatic patients treated for carotid artery stenosis. Histological findings using hematoxylin-eosin and immunohistochemical staining against von Willebrand factor and VEGF were examined. Intraplaque hemorrhage, calcification, necrosis, and invasion of foam cells were frequently observed in the carotid plaques from symptomatic patients compared with asymptomatic patients. Higher microvessel density was found in the carotid plaques with necrosis and invasion of foam cells compared with plaques without necrosis and/or foam cell invasion, and higher expression of VEGF was found from symptomatic patients compared with asymptomatic patents. These results suggest that plaque angiogenesis and higher level of VEGF expression may enhance the progression of ischemic symptoms in patients with carotid artery stenosis. Invasive macrophages in the plaque of symptomatic patients increase levels of VEGF and might enhance plaque angiogenesis and atherosclerosis progression.

Palliative care in Japan: current status and a nationwide challenge to improve palliative care by the Cancer Control Act and the Outreach Palliative Care Trial of Integrated Regional Model (OPTIM) study.

Palliative care is an essential part of integrated cancer treatment. To improve palliative care throughout Japan, a nationwide demonstration project, the Outreach Palliative Care Trial of Integrated Regional Model (OPTIM) study, is ongoing. This article reviews the current status and the problems of palliative care in Japan and introduces the OPTIM study. Although the number of palliative care services is increasing, empirical evidence shows the quality of life of cancer patients is still inadequate. The OPTIM study is an intervention trial targeting 4 areas across Japan. Primary end points are quality of care reported by patients as well as the bereaved family, number of patients who received specialized palliative care services, and place of death. The interventions are comprehensively designed to cover all areas identified by the national task force. The OPTIM study will contribute to improve patients' quality of life by proposing a regional palliative care model suitable for Japan.