Whole-genome sequencing and analysis of two azaleas, Rhododendron ripense and Rhododendron kiyosumense.

To enhance the genomics and genetics of azalea, the whole-genome sequences of two species of Rhododendron were determined and analysed in this study: Rhododendron ripense, the cytoplasmic donor and ancestral species of large-flowered and evergreen azalea cultivars; and Rhododendron kiyosumense, a native of Chiba prefecture (Japan) seldomly bred and cultivated. A chromosome-level genome sequence assembly of R. ripense was constructed by single-molecule real-time sequencing and genetic mapping, while the genome sequence of R. kiyosumense was assembled using the single-tube long fragment read sequencing technology. The R. ripense genome assembly contained 319 contigs (506.7 Mb; N50 length: 2.5 Mb) and was assigned to the genetic map to establish 13 pseudomolecule sequences. On the other hand, the genome of R. kiyosumense was assembled into 32,308 contigs (601.9 Mb; N50 length: 245.7 kb). A total of 34,606 genes were predicted in the R. ripense genome, while 35,785 flower and 48,041 leaf transcript isoforms were identified in R. kiyosumense through Iso-Seq analysis. Overall, the genome sequence information generated in this study enhances our understanding of genome evolution in the Ericales and reveals the phylogenetic relationship of closely related species. This information will also facilitate the development of phenotypically attractive azalea cultivars.

Safety and Efficacy of Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Multicenter Retrospective Study in Japan.

Purpose: Bone cement enhancement by percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures remains unapproved, as it has not been fully evaluated in Japan. The current multicenter study was conducted in Japan to verify the safety and efficacy of PVP in patients with painful osteoporotic vertebral fractures. Material and Methods: In this retrospective study, we referred to previous studies to evaluate the non-inferiority of PVP to balloon kyphoplasty (BKP). We reviewed consecutive patient data from April 2017 to March 2018 from four institutions based on the medical records of the intervention. We statistically investigated the adverse events due to cement leakage or other factors associated with PVP, and new vertebral compression fractures after PVP were evaluated for safety, pain relief, and gait improvement. Results: This study included 485 patients; most of whom were in the middle- to oldest- age groups (mean age, 81.4 years). No serious adverse events were reported in patients available for safety evaluation (n = 485). Cement leakage and new vertebral compression fractures occurred in 35.7% and 18.6% (26.2%-38.4% and 8.9%-20.7%) of the patients undergoing PVP, respectively, both of which were also judged to be equivalent to those of BKP. The pain score improved in those undergoing PVP, and this improvement was maintained during a one-year follow-up. Of the 206 patients who had difficulty walking at baseline, 156 had restored walking at discharge. Conclusions: PVP was shown to be a safe and effective treatment, even in elderly patients with painful osteoporotic vertebral fractures.

Do not attempt resuscitation order in Japan.

Aim: In Japan, the do not attempt resuscitation (DNAR) order is practised routinely even though no related laws or guidelines exist. This study aimed to clarify the current status of DNAR, reveal existing DNAR-related issues, and improve the application of DNAR. Methods: A questionnaire survey of medical institutions in Kanagawa Prefecture (total population, 9,120,000) about the current status of DNAR was carried out. Results: The results showed that DNAR has been practised at approximately 90% of the hospitals surveyed, but only about 30% have developed in-hospital DNAR guidelines. Approximately 80% of the hospitals do not involve patients in the decision on their own DNAR orders. Because the DNAR order has not been legislated, it is often unclear whether to resuscitate patients when a request for an ambulance is made for a cardiac arrest at home. Conclusion: It is necessary for prefectures, municipalities, and local medical control authorities to take the initiative in establishing an ordinance on DNAR orders and developing guidelines.

Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations.

Cytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with various entities. CLOCCs have been found in association with drug therapy, malignancy, infection, subarachnoid hemorrhage, metabolic disorders, trauma, and other entities. In all of these conditions, cell-cytokine interactions lead to markedly increased levels of cytokines and extracellular glutamate. Ultimately, this cascade can lead to dysfunction of the callosal neurons and microglia. Cytotoxic edema develops as water becomes trapped in these cells. On diffusion-weighted magnetic resonance (MR) images, CLOCCs manifest as areas of low diffusion. CLOCCs lack enhancement on contrast material-enhanced images, tend to be midline, and are relatively symmetric. The involvement of the corpus callosum typically shows one of three patterns: (a) a small round or oval lesion located in the center of the splenium, (b) a lesion centered in the splenium but extending through the callosal fibers laterally into the adjacent white matter, or (c) a lesion centered posteriorly but extending into the anterior corpus callosum. CLOCCs are frequently but not invariably reversible. Their pathologic mechanisms are discussed, the typical MR imaging findings are described, and typical cases of CLOCCs are presented. Although CLOCCs are nonspecific with regard to the underlying cause, additional imaging findings and the clinical findings can aid in making a specific diagnosis. Radiologists should be familiar with the imaging appearance of CLOCCs to avoid a misdiagnosis of ischemia. When CLOCCs are found, the underlying cause of the lesion should be sought and addressed. ©RSNA, 2017 An earlier incorrect version of this article appeared online. This article was corrected on February 13, 2017.

Long-lasting Corolla Cultivars in Japanese Azaleas: A Mutant AP3/DEF Homolog Identified in Traditional Azalea Cultivars from More Than 300 Years Ago.

Floral shape in higher plants typically requires genetic regulation through MADS transcription factors. In Japan, hundreds of azalea cultivars including flower shape mutations have been selected from the diversity of endogenous species and natural hybrids since the early 17th century, the Edo era (1603-1867). The long-lasting trait, known as "Misome-sho" in Japanese, has been identified in several species and cultivar groups of evergreen azaleas (Rhododendron L.) from three hundred years ago in Japan. However, the natural mutation conferring the long-lasting trait in azalea remains unknown. Here, we showed MADS-box gene mutations in long-lasting flowers, R. kaempferi 'Nikko-misome,' R. macrosepalum 'Kocho-zoroi,' R. indicum 'Chojyu-ho,' and R. × hannoense 'Amagi-beni-chojyu.' All of the long-lasting flowers exhibited small-sized corollas with stomata during long blooming. In the long-lasting flowers, transcript of the APETALA3 (AP3)/DEFICIENS (DEF) homolog was reduced, and an LTR-retrotransposon was independently inserted into exons 1, 2, and 7 or an unknown sequence in exon 1 in gDNA of each cultivar. This insertion apparently abolished the normal mRNA sequence of the AP3/DEF homolog in long-lasting flowers. Also, long-lasting flowers were shown from F2 hybrids that had homozygous ap3/def alleles. Therefore, we concluded that the loss of function of the AP3/DEF homolog through a transposable element insertion may confer a stable long-lasting mutation in evergreen azaleas.

Mycorrhizal Formation and Diversity of Endophytic Fungi in Hair Roots of Vaccinium oldhamii Miq. in Japan.

The root diameters as well as colonization and diversity of the root-associating fungi of Vaccinium oldhamii Miq. were investigated in order to obtain information on their mycorrhizal properties. The distal regions of roots had typical hair roots with diameters of less than 100 µm. Ericoid mycorrhizal fungi (ErMF) and dark septate endophytes (DSE) were frequently observed in the roots. Ascomycetes, particularly helotialean fungi, appeared to be dominant among the endophytic fungi of V. oldhamii roots. Furthermore, Rhizoscyphus ericae (Read) Zhuang & Korf and Oidiodendron maius Barron known as ErMF were detected more frequently than other fungal species.

Contrast-enhanced MRI for detecting intravertebral cleft formation: relation to the time since onset of vertebral fracture.

OBJECTIVE: The purpose of this study was to investigate the advantages of contrast-enhanced MRI (CE-MRI) for detecting intravertebral clefts over unenhanced MRI in relation to the time since onset of vertebral fracture. MATERIALS AND METHODS: In this retrospective study, a total of 115 patients (88 women, 27 men; mean age, 77.1 years) who underwent percutaneous vertebroplasty for a single-level compression fracture within 7 days of preprocedural MRI were enrolled. Two radiologists evaluated preprocedural unenhanced MRI (T1-weighted and STIR) and CE-MRI examinations for intravertebral clefts on separate days by consensus. The time from the onset of fracture to MRI was classified into three groups: early phase fractures (< 1 month), late phase fractures (1-3 months), and chronic phase fractures (≥ 3 months). The cement distribution during percutaneous vertebroplasty was used as a reference standard, and detectability of clefts was compared between unenhanced MRI and CE-MRI in relation to the time frame. An analog of the McNemar test was used for analyses. RESULTS: There were 104 patients (90.4%) with and 11 patients (9.6%) without a cleft. The sensitivities of unenhanced MRI and CE-MRI, respectively, for detecting clefts were 60.9% and 91.3% for early phase fractures (p = 0.02); 78.6% and 100% for late phase fractures (p = 0.014); and 92.5% and 94.3% for chronic phase fractures (p = 0.3). The specificities were the same for both groups (100% for each time frame). CONCLUSION: CE-MRI is more sensitive than unenhanced MRI for detecting intravertebral clefts in patents with benign compression fractures less than 3 months old.

Radiological findings as favorable predictors of pain relief in patients with osteoporotic compression fractures after percutaneous vertebroplasty: a retrospective study of 156 cases.

PURPOSE: We evaluated the relationships between pre-procedural radiological findings and short-term pain relief in patients with osteoporotic compression fractures after percutaneous vertebroplasty (PVP). MATERIALS AND METHODS: A retrospective review of pre-procedural radiological images of 156 patients with painful osteoporotic compression fracture was performed. Pain was measured with a visual analogue scale (VAS). Complete pain relief was defined as a VAS pain score of 0 or 1 at 3 months after PVP. Statistical analyses were conducted to evaluate the relationship between the pre-procedural imaging factors and pain relief using Pearson's chi-squared test. Multivariate logistic regression analysis was also performed. RESULTS: Complete pain relief was obtained in 45.5% of patients. An intravertebral cleft larger than half the height of the fractured vertebral body (FVB) was a significant key factor in the complete pain relief group after 3 months. Further, ≥40% of the spinal canal occupied by bony fragments of the FVB was related to incomplete pain relief. CONCLUSION: A large intravertebral cleft was a favorable short-term outcome predictor in patients with osteoporotic compression fractures after PVP, while severe protrusion of the FVB causing lumbar spinal canal stenosis was not a favorable short-term outcome predictor of complete pain relief.

New vertebral compression fractures after prophylactic vertebroplasty in osteoporotic patients.

OBJECTIVE: Previous studies have shown the possible efficacy of prophylactic cement injection for nonfractured vertebrae during percutaneous vertebroplasty for compression fractures. The purpose of this study was to investigate risk factors for subsequent fractures after prophylactic percutaneous vertebroplasty. MATERIALS AND METHODS: This retrospective study included 116 patients with osteoporotic compression fractures who underwent prophylactic percutaneous vertebroplasty. The patients were monitored with physical examinations and radiographs at 1 day and at 3 and 12 months after percutaneous vertebroplasty, and if back pain recurred. We analyzed the following multiple covariates to determine whether they were associated with recurrence: age, sex, steroid use, and the preoperative number of unhealed or chronic compression fractures. RESULTS: Subsequent fractures in any vertebra occurred within 3 months after the procedure at 26 vertebrae in 21 patients (18.1%), and 36 occurred in 28 patients (24.1%) within 12 months. The occurrence of subsequent fractures within 12 months depended on the preoperative number of unhealed vertebrae: the occurrence rate was 16.9% (11/65) for one vertebra, 27.0% (10/37) for two vertebrae, and 50.0% (7/14) for three or more vertebrae. The incidence of subsequent fractures was significantly higher in patients with three or more fractures than in those with one fracture (p < 0.05). There were no statistically significant differences for the other factors. CONCLUSION: Patients with three or more fractures tended to have subsequent fractures, despite undergoing prophylactic percutaneous vertebroplasty. However, there was no increased risk of subsequent fractures related to prophylactic percutaneous vertebroplasty.

Therapeutic effects of percutaneous vertebroplasty for vertebral metastases.

PURPOSE: We have performed percutaneous vertebroplasty (PV) using polymethylmethacrylate (PMMA) for patients with vertebral metastases since 2002. This study investigated the therapeutic effects of PV on vertebral metastases. MATERIALS AND METHODS: A retrospective (2002-2008) review was conducted for 69 consecutive patients with 141 metastatic vertebrae treated with PV using PMMA. The clinical background of the patients, visual analog scale (VAS), improvement rate, outcomes, and complications were evaluated. RESULTS: The mean preoperative VAS score was 7.3 and significantly improved to 1.9 postoperatively (at discharge), with a mean improvement rate of 73.3%. With regard to complications, no new fractures of adjacent vertebral bodies were encountered, but cement leakage was seen in 49% of the patients. Most patients were asymptomatic during the postoperative course, although two patients (3%) experienced dyspnea that was suspected to be adult respiratory distress syndrome or a pulmonary embolism. CONCLUSION: PV can offer pain relief to patients with painful vertebral metastases and short life expectancy whose general condition makes surgery difficult.

Azalea phylogeny reconstructed by means of molecular techniques.

Plants belonging to the Rhododendron subgenera Pentanthera (deciduous) and Tsutsusi and Azaleastrum (evergreen) are called azaleas. Concerning their mutual phylogenetic positions, the Pentanthera subgenus is closer to evergreen rhododendrons (subgenera Rhododendron and Hymenanthes) than to the Tsutsusi subgenus. Both azalea types are important ornamentals with a long breeding tradition. Different hybrid groups are often named after the supposed principal ancestor species. Molecular techniques for phylogenetic and kinship research have been evaluated to a great extent. First, some studies using comparative gene sequencing are presented; this approach was then widened to the use of molecular markers to reveal more detailed genetic relationships. Finally, the use of candidate genes as functional markers for the assessment of genetic diversity is presented. This opens new research lines to the genetic mapping of plant traits and azalea genomics.

Metachronous gliomas following cranial irradiation for mixed germ cell tumors.

INTRODUCTION: Cranial irradiation has been widely used as a therapeutic tool for treating various lesions, particularly neoplastic diseases. Even though radiation therapy is usually well-tolerated, it occasionally causes clinically significant long-term toxicity such as radiation necrosis and irradiation-related arteriopathy with stroke. DISCUSSION AND CASE REPORT: The development of neoplasms following therapeutic cranial irradiation is also rare, but may cause serious and potentially fatal complications. Various radiation-induced tumors, including meningioma, glioma, and sarcoma have been reported (Child Nerv Syst 24:793-805, 12). However, metachronous intracranial double tumors induced by radiation therapy are extremely rare. In here, we report a case of metachronous different gliomas including astrocytoma and glioblastoma following irradiation therapy after 41 and 46 months, respectively.

Prophylactic vertebroplasty: cement injection into non-fractured vertebral bodies during percutaneous vertebroplasty.

RATIONALE AND OBJECTIVES: We investigated the efficacy of prophylactic cement injection into the vertebral body adjacent to fractured vertebra to prevent new fractures after percutaneous vertebroplasty (PV). MATERIALS AND METHODS: Between February 2002 to August 2004, PV was performed for osteoporotic compression fractures in 89 consecutive patients. All patients underwent PV for only fractured vertebrae. Between September 2004 and October 2006, we performed prophylactic cement injection for 155 patients, with cement injected into the non-fractured vertebra adjacent to the fractured vertebra, immediately above the fractured vertebra in the same procedure. We evaluated the frequency of new vertebral fractures and the efficacy of prophylactic therapy. RESULTS: In the non-prophylactic group, 15 of 89 patients (16.8%) developed new fractures within 3 months and 20 of 89 patients (22.4%) developed new painful compression fractures within a year after the first PV. These fractures occurred mostly in adjacent vertebra, particularly in the vertebra immediately superior to the treated one and occurred in the lower thoracic and upper lumbar spine. In the prophylactic group, 7 of 155 patients (4.5%) developed new compression fractures within 3 months and 15 of 155 patients (9.7%) developed new compression fractures within 1 year. Statistical analysis showed that fewer new fractures developed in the prophylactic group than in the non-prophylactic group at both 3 months (P = .0020, Fisher's exact test) and 1 year (P = .0079). CONCLUSIONS: Prophylactic cement injection into non-fractured vertebrae adjacent to fractured vertebrae may prevent new compression fractures after vertebroplasty for osteoporotic patients.

Surveys on the prevalence of pediatric bronchial asthma in Japan: a comparison between the 1982, 1992, and 2002 surveys conducted in the same region using the same methodology.

BACKGROUND: We conducted and reported the first (1982; 55,388 subjects), and second (1992; 45,674 subjects), epidemiological surveys conducted on bronchial asthma in elementary students across 11 prefectures in western Japan. The 2 surveys were conducted in the same regions using the same methodology employing a modified Japanese version of the American Thoracic Society-Division of Lung Diseases (ATS-DLD) Epidemiology Questionnaire. We conducted the third survey in 2002, and compared the findings to those of previous studies. METHODS: In the third survey, 37,036 students attending the same schools as in previous surveys (in 11 prefectures) were given the questionnaire. A total of 35,582 responses (96.1%) were collected. An ATS-DLD Epidemiology Questionnaire was also used in this study, and the findings were compared to those of previous studies. RESULTS: 1. The prevalence of bronchial asthma (BA) in boys, girls, and all students was 3.8%, 2.5%, and 3.2%, respectively, for the first survey; 5.6%, 3.5%, and 4.6% for the second survey; and 8.1%, 4.9%, and 6.5% for the third survey. 2. A decline in the BA prevalence in older subjects which could be seen in the first survey was absent in the second and third surveys. There were no regional differences in the third survey. 3. The boys-to-girls ratio in the first, second, and third surveys was 1.5, 1.6, and 1.6, respectively. 4. BA was more prevalent among subjects with a past history of respiratory disease in infancy and those with a family history of allergic disease. 5. The prevalence of asthma symptoms and wheezing in the first, second, and third surveys was 7.1%, 9.8%, and 11.8%, respectively. 6. A comparison of the prevalence of other allergic diseases between the second and third surveys revealed a decrease in atopic dermatitis and an increase in allergic rhinitis, allergic conjunctivitis, and cedar pollinosis. CONCLUSIONS: BA prevalence in the third survey increased 2.1 and 1.4 times respectively compared to the first survey and second survey, indicating an upward trend in all regions and age groups surveyed.

Percutaneous pediculoplasty for vertebral hemangioma involving the neural arch: a case report.

Vertebral hemangiomas occasionally involve the neural arch and they can be symptomatic. We report a case of symptomatic vertebral hemangioma mainly involving the unilateral neural arch which was successfully treated with percutaneous pediculoplasty using a single-needle technique.

Preprocedural MR imaging for percutaneous vertebroplasty: special interest in contrast enhancement.

PURPOSE: The success of percutaneous vertebroplasty (PVP) depends greatly on preprocedural evaluation of the patients. The purpose of this study was to evaluate the efficacy of preprocedural magnetic resonance imaging (MRI) for the indications of PVP. MATERIALS AND METHODS: A retrospective review of 122 osteoporotic compression fractures in 63 patients who underwent preprocedural gadolinium-enhanced MRI and PVP was performed. Based on the extent of contrast enhancement on preprocedural MRI, each case was classified into one of two groups: group 1, which represented more than 50% of the vertebral body enhanced; and group 2, which represented less than 50% of the vertebral body enhanced. The most enhancing level was evaluated in multilevel PVP sessions. We evaluated the difference of pre- and postprocedural pain scales between groups 1 and 2 using Mann-Whitney's U-test. RESULTS: There was a trend toward higher preoperative pain score in group 1, but it was not statistically significant (P = 0.0537). In addition, the postoperative pain score in group 2 was significantly higher than that in group 1 (P = 0.0007). The difference between the pre- and postoperative pain scores was significantly higher in group 1 than in group 2 (P = 0.0001). CONCLUSION: Contrast enhancement on MRI indicates a painful lesion and extensive contrast enhancement predicts better pain relief after PVP.

Intravertebral cleft sign on fat-suppressed contrast-enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty.

RATIONALE AND OBJECTIVES: Filling intravertebral clefts during percutaneous vertebroplasty (PVP) is considered to be important for optimal pain control. It is often difficult to detect clefts on non-contrast MR and some fractures show a solid pattern distribution of injected cement without a cleft sign on non-contrast MR. In this study, we evaluated usefulness of fat-suppressed contrast-enhanced MR to predict a solid pattern distribution of injected cement on PVP. MATERIALS AND METHODS: Twenty-six patients with 35 vertebral compression fractures due to osteoporosis were studied. We performed sagittal T1-weighted, T2-weighted and fat-suppressed contrast-enhanced T1-weighted images prior to PVP. First we evaluated the presence of fluid-filled or gas-containing clefts on non-contrast MR. Next we evaluated contrast-enhanced MR of the same vertebrae for the presence of cleft-shaped unenhanced areas within the diffuse enhancement area. We correlated MR findings with cement distribution patterns of injected cement. RESULTS: Based on MR findings, 35 osteoporotic fractures were divided into 3 types. Type 1 (11 fractures, 31%): There were no clefts on non-contrast MR and no unenhanced areas on contrast-enhanced MR; Type 2 (13, 37%): There were no clefts on non-contrast MR but there were unenhanced areas on contrast-enhanced MR; Type 3 (13, 37%): There were clefts on non-contrast MR and unenhanced areas on contrast-enhanced MR. Of 35 osteoporotic fractures, thirteen vertebral fractures (37%) were noted to contain clefts on non-contrast MR, while 24 vertebral fractures (69%) contained unenhanced areas on contrast-enhanced MR. Cement distributed as a solid pattern within clefts or unenhanced areas in all fractures with them. CONCLUSION: Fat-suppressed contrast-enhanced MR is useful to predict a solid pattern distribution of injected cement prior to PVP.

Percutaneous sacroplasty for hemorrhagic metastases from hepatocellular carcinoma.

Percutaneous injection of bone cement is a promising treatment for metastatic tumors. We present a case of hemorrhagic sacral metastases from hepatocellular carcinoma treated successfully by percutaneous sacroplasty with combined injections of bone cement and n-butyl cyanoacrylate resulting in pain relief.