Small sagittal vertical axis accompanied with lumbar hyperlordosis as a risk factor for developing postoperative cervical kyphosis after expansive open-door laminoplasty.

OBJECTIVE Preoperative positive cervical sagittal imbalance and global sagittal imbalance are risk factors for postoperative cervical kyphosis after expansive open-door cervical laminoplasty (ELAP). The purpose of this study was to investigate the relationship between the incidence of postoperative cervical kyphosis after ELAP and the preoperative global sagittal spinal alignment in patients with cervical spondylotic myelopathy (CSM) without spinal sagittal imbalance. METHODS Among 84 consecutive patients who underwent ELAP for CSM at the authors' hospital, 43 patients without preoperative cervical kyphosis (C2-7 angle ≥ 0°) and spinal sagittal imbalance (C2-7 sagittal vertical axis [SVA] ≤ 80 mm and C-7 SVA ≤ 95 mm) were included in the study. The global spinal sagittal parameters were measured on lateral whole-spine standing radiographs preoperatively and at 1 year postoperatively. The difference in preoperative global sagittal spinal alignment between the postoperative cervical lordosis group and the cervical kyphosis group was analyzed. RESULTS The incidence of postoperative cervical kyphosis after ELAP was 25.6% (11 of 43 cases). Thirty-two patients (16 men and 16 women; mean age 67.7 ± 12.0 years) had lordosis, and 11 (7 men and 4 women; mean age 67.2 ± 9.6 years) had kyphosis. The preoperative C-7 SVA and pelvic incidence minus lumbar lordosis (PI-LL) in the kyphosis group were significantly smaller than those in the lordosis group (p < 0.05). The smaller C-7 SVA accompanied by a small PI-LL, the "truncal negative offset," led to postoperative cervical kyphosis due to posterior structural weakening by ELAP. CONCLUSIONS In patients with CSM without preoperative cervical and global spinal sagittal imbalance, a small SVA accompanied by lumbar hyperlordosis is the characteristic alignment leading to postoperative cervical kyphosis after ELAP.

Spinal Sagittal Alignment in Patients With Dropped Head Syndrome.

STUDY DESIGN: This is a retrospective radiographic study of a consecutive case series of dropped head syndrome (DHS) at a single tertiary referral center. OBJECTIVE: The aim was to clarify the spinal sagittal alignment of DHS. SUMMARY OF BACKGROUND DATA: DHS is characterized by chin-on-chest deformity and devastatingly impedes activities of daily living in affected individuals. Among various forms of DHS, isolated neck extensor myopathy (INEM) is considered to cause the chin-on-chest symptom in the absence of specific abnormality. There is a paucity of literature about spinal sagittal alignment, of this condition however. METHODS: Thirty-seven patients diagnosed with INEM DHS were enrolled. Radiographic measurements were made, including the following parameters: C2 slope (C2S), C2-C7 A, C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), C7-S1 SVA, T1-T4 thoracic kyphosis (TK), T4-T12 TK, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Sixty-one patients with cervical spondylosis were enrolled as a control group. RESULTS: C2-C7 SVA was greater in INEM DHS (52.0 ±â€Š2.9 vs. 18.6 ±â€Š1.9 mm). C2S and T1S were larger to the control (C2S: 52.6°â€Š±â€Š2.0° vs. 13.0°â€Š±â€Š1.4°, T1S: 37.3°â€Š±â€Š2.2° vs. 22.7°â€Š±â€Š1.4°). C2-C7 A was smaller in INEM DHS (-7.8°â€Š±â€Š2.6° vs. 15.2°â€Š±â€Š2.7°). Among sagittal parameters, C2S, T1S, and T1-T4 TK positively correlated with C2-C7 SVA (r = 0.63, r = 0.54, and r = 0.58). For these correlations with C2-C7 SVA, both logistic and linear regression models predicted threshold of 40° for C2S, 40° for T1S, and 15° for T1-T4 TK responsible for C2-C7 SVA > 40 mm, respectively. CONCLUSION: Increased offset of the gravity axis of the head represented by C2-C7 SVA was observed in INEM DHS. Magnified offset of the gravity axis of the head was affected by enlarged C2S, T1S, and T1-T4 TK for the strong correlation with C2-C7 SVA, respectively. Cervical kyphosis was considered as some of the anthropometric characteristics due to regressive changes in affected individuals; a correlation between C2-C7 A and C2-C7 SVA was exhibited. LEVEL OF EVIDENCE: 4.

Study of Atypical Femoral Fracture Cases Coupled in a Multicenter Study.

UNLABELLED: There are several causes of atypical femoral fractures (AFF) in elderly Japanese patients, including longterm bisphosphonate (BP) use or bowed femoral shaft stress fractures, but the available sample size for examining AFF etiology in a single institution is limited. The purpose of this study was to categorize the characteristics of AFF by analyzing the data compiled on patients treated at our hospital and at affiliated institutes. This multicenter, retrospective, observational study included 34 AFF cases (bilateral AFF 10) in one male and 23 female patients (age range 30-90 years, mean age 73.0 years). Evaluation measures included the presence/absence of BP use, duration of BP use, history of other drug use, presence/absence of comorbidities, fracture site, presence/absence of femoral lateral bowing, bone biopsy parameters, and time to bone union. Nineteen patients were prescribed BP for osteoporosis (duration range 4-10 years, mean duration 6.1 years). Subtrochanteric and femoral shaft fractures were seen in 16 and 18 cases, respectively (complete fractures 22, incomplete fractures 12). Femoral lateral bowing (n = 16) occurred with femoral shaft fractures. Mean time to bone union was 9.0 months (complete fractures 11.3 months, incomplete fractures 3.7 months). AFF could be substantially caused by three factors: BP use, drugs other than BP/comorbidity, and femoral lateral bowing. Twenty four patients were classified as having BP-related-type (n = 2), drug/comorbidity-type (n = 3), lateral bowing-type (n = 2), or mixed-type (n = 17) AFF. AFF etiology cannot be explained by a single cause; thus, a multifactorial etiology, including poor bone quality due to mutual interactions and mechanical stress, seems to be responsible for the occurrence of AFF. LEVEL OF EVIDENCE: Ⅳ diagnostic.

Sagittal lumbo-pelvic alignment in the sitting position of elderly persons.

INTRODUCTION: In elderly persons, the sitting position in daily life is very important due to the weakness in locomotion. In previous studies, sagittal spinal alignment was mainly analyzed in the standing position. However, in order to study the sagittal spinal alignment of elderly persons, the estimation of spinal alignment in the sitting posture is also important. We proposed that there is a characteristic spinal alignment in elderly persons in the sitting position. The purpose of this study was to evaluate the sagittal lumbo-pelvic alignment in the standing and sitting positions in elderly persons. SUBJECTS & METHODS: This study included 73 young adult subjects (48 men and 25 women; age 34.4 ± 8.1 years) and 107 elderly subjects (65 men and 42 women; age 67.6 ± 8.3 years). The following radiographic parameters were determined by computer-assisted measurement: L1L5 angle (L1L5), lumbosacral angle (LSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). RESULTS: L1L5 decreased and the pelvis rotated posteriorly in the sitting position in both young adults and elderly persons. However, the extent of alignment difference between standing and sitting in elderly persons was nearly half that of young adults (in particular, the lumbo-pelvic junction, LSA, was smaller). Regarding the extent of correlation between aging and lumbo-pelvic alignment parameters, there were significant correlations. In elderly persons, the correlation between L1L5 and PT had a tendency to be poor in the sitting position. CONCLUSION: The elderly in the sitting position showed greater lumbar lordosis and higher sacral slope than in young adults, and the correlations among lumbo-pelvic parameters were poorer than those of young adults. Thus, when moving from sitting to standing, the lumbo-pelvic mobility in the sagittal plane is suspected to be poor in elderly persons.

Directing positional specificity in enzymatic synthesis of bioactive 1-phosphatidylinositol by protein engineering of a phospholipase D.

Phosphatidylinositol (PI) holds a potential of becoming an important dietary supplement due to its effects on lipid metabolism in animals and humans manifested as a decrease of the blood cholesterol and lipids, and relief of the metabolic syndrome. To establish an efficient, enzymatic system for PI production from phosphatidylcholine and myo-inositol as an alcohol acceptor, our previous study started with the wild-type Streptomyces antibioticus phospholipase D (SaPLD) as a template for generation of PI-synthesizing variants by saturation mutagenesis targeting positions involved in acceptor accommodation, W187, Y191, and Y385. The isolated variants generated PI as a mixture of positional isomers, among which only 1-PI exists in nature. Thus, the current study has focused to improve positional specificity of W187N/Y191Y/Y385R SaPLD (NYR) which generates PI as a mixture of 1-PI and 3-PI in the ratio of 76/24, by subjecting four residues of its acceptor-binding site to saturation mutagenesis. Subsequent screening pointed at NYR-186T and NYR-186L as the most improved variants producing PI with a ratio of 1-/3-PI = 93/7 and 87/13, respectively, at 37°C. Lowering the reaction temperature further improved the specificity of both variants to 1-/3-PI > 97/3 at 20°C with no change in total PI yield. Structure model analyses imply that G186T and G186L mutations increased rigidity of the acceptor-binding site, thus limiting the possible orientations of myo-inositol. The two newly isolated PLDs are promising for future application in large-scale 1-PI production.

PGE1 Attenuates IL-1ß-induced NGF Expression in Human Intervertebral Disc Cells.

STUDY DESIGN: In vitro study using isolated human intervertebral disc (IVD) cells. OBJECTIVE: To investigate the effects of prostaglandin (PG)E1 and its orally available derivative limaprost on the regulation of nerve growth factor (NGF) expression and to compare their actions with other prostanoids using interleukin (IL)-1-stimulated human IVD cells. SUMMARY OF BACKGROUND DATA: We previously reported that a selective COX-2 inhibitor enhanced, whereas PGE2 suppressed the induction of NGF by IL-1 in human IVD cells, and proposed that PGE2 can suppress NGF expression by a negative feedback mechanism. METHODS: Isolated human IVD cells were stimulated with IL-1 in the presence or absence of increasing concentrations of PGE2, PGE1, limaprost, PGI2, PGD2, or PGF2α (10-10,000 nM). For some experiments, an E-series prostanoid receptor (EP)4 antagonist (L-161,982) was added prior to the stimulation. NGF expression was determined by real-time polymerase chain reaction and its protein level was quantified by enzyme-linked immunosorbent assay. RESULTS: PGE2, PGE1, and limaprost inhibited the IL-1-mediated induction of NGF in a concentration-dependent manner, with IC50 values of 9.9, 10.6, and 70.9 nM, respectively. PGI2 also suppressed NGF expression but to a much less extent. PGD2, on the other hand, significantly enhanced NGF expression, whereas PGF2α had no effect. Protein expression levels of NGF mirrored its mRNA levels. The suppression of NGF expression by PGE2 and PGE1 was partly reversed by L-161,982. CONCLUSION: PGE1 and limaprost exhibited a novel pharmacological action that suppresses NGF expression in human IVD cells, and other prostanoids differentially regulated NGF expression. Limaprost has been used to treat patients with lumbar spinal stenosis in Japan and was proved to be effective in relieving symptoms. Our in vitro results may explain, in part, the mechanism of action of limaprost for low back pain. LEVEL OF EVIDENCE: N/A.

Gait Analysis in Cervical Spondylotic Myelopathy.

STUDY DESIGN: Gait analysis of patients with cervical spondylotic myelopathy (CSM) by using a sheet-type gait analysis system. PURPOSE: The aim of this study was to compare the gait patterns of patients with CSM, evaluated by the Nurick grades, and to determine the threshold values of gait parameters predicting the occurrence of a fall by using a gait recorder. OVERVIEW OF LITERATURE: Gait disorder due to CSM may progress to severe paraplegia, following even a minor trauma such as a fall. The indications for the surgery of CSM without severe paralysis remain controversial. The quantitative gait analysis and the decision for decompressive surgery in patients with CSM are important in order to prevent severe paraplegia from a fall. METHODS: One hundred thirty-two subjects (normal, 34; CSM, 98) underwent gait analysis by using a sensor sheet. Measurements of gait cycle parameters included the step and stride length, step width, foot angle, swing phase, and stance phase. CSM was assessed by Nurick grade. RESULTS: Although the clinical symptoms were lacking, Nurick grade 1 had significant abnormalities in the parameters of velocity, step length, and step angle (p<0.05). Regarding the Nurick grade and walking phase, the length of the stance phase was increased to more than 70% of the entire walking cycle in Nurick grade 4. CONCLUSIONS: Gait analysis was an objective tool for evaluating the gait stability. Our results suggested that when the percentage of the stance phase in the gait cycle increases to above 70%, the CSM patients have an increased fall risk.

Characteristics of sagittal spino-pelvic alignment in Japanese young adults.

STUDY DESIGN: Radiological analysis of normal patterns of sagittal alignment of the spine. PURPOSE: This study aimed to clarify the characteristics of normal sagittal spino-pelvic alignment in Asian people. OVERVIEW OF LITERATURE: It is known that there are differences in these parameters based on age, gender, and race. In order to properly plan for surgical correction of the spine for Asian patients, it is necessary to understand the normal spino-pelvic alignment parameters for this population. METHODS: This study analyzed 86 Japanese healthy young adult volunteers (48 men and 38 women; age 35.9±11.1 (mean±standard deviation [SD]). The following parameters were measured on lateral standing radiographs of the entire spine: sagittal vertical axis (SVA), horizontal distance between the C7 plumb line and the posterior superior corner of the superior margin of S1, thoracic kyphotic angle (TK), lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). RESULTS: The values (mean±SD) of SVA, TK, LLA, SS, PT, and PI were 8.45±25.7 mm, 27.5±9.6°, 43.4±14.6°, 34.6±7.8°, 13.2±8.2°, and 46.7±8.9°, respectively. The Japanese young adults evaluated in this study tended to have a smaller PI, LLA, TK, and SVA than most Caucasian people. Regarding gender differences, SVA was significantly longer and TK was significantly smaller in men; however, there was no statistically significant difference in LLA, SS, PA, and PI. CONCLUSIONS: Japanese young adults apparently have smaller PI and LLA values than Caucasian people. When making decisions for optimal sagittal spinal alignment, racial differences should be considered.

Chemotaxis behavior toward an odor is regulated by constant sodium chloride stimulus in Caenorhabditis elegans.

We studied the chemotaxis behavior of Caenorhabditis elegans toward a chemoattractant in the presence of background sensory stimulus. Chemotaxis toward an odor butanone was greater in the presence of sodium chloride (NaCl) than that without NaCl. By contrast, chemotaxis toward NaCl was not affected by a butanone background. The salt-sensing ASE neuron-deficient che-1(p674) mutants and worms with ASE genetically ablated showed high chemotaxis toward butanone, regardless of the presence of a NaCl background. Therefore, in wild-type worms, information from ASE in the absence of NaCl suppresses butanone chemotaxis, while the suppression is removed in the presence of NaCl.

Kinematic analysis of the cervical cord and cervical canal by dynamic neck motion.

STUDY DESIGN: Normal cervical sagittal length patterns were measured by magnetic resonance imaging (MRI). PURPOSE: The aim of this study was to evaluate the relationship of sagittal length patterns between the cervical cord and the cervical canal in flexion-extension kinematics. OVERVIEW OF LITERATURE: Cervical dynamic factors sometimes cause a cervical spondylotic myelopathy in elderly subjects and an overstretching myelopathy in juvenile subjects. Previous studies showed the length changing of the cervical cord in flexion and extension. However, there is no detailed literature about the relationship between cervical vertebral motion and cord distortion yet. METHODS: Sixty-two normal subjects (28 male and 34 female, 42.1±8.5 years old) without neck motion disturbances and abnormalities on cervical X-ray and MRI were enrolled in this study. RESULTS: The cervical cord length was significantly longer in flexion and significantly shorter in extension in all cervical cord sagittal lines. The cervical canal length pattern was also the same as the cervical cord. The elongation of the cervical cord and canal was the largest at the site of the posterior cervical canal and the shortest at the anterior canal site. The positions of the cerebellar tonsils were verified at each neck position. CONCLUSIONS: The posterior elements of the cervical canal were most affected by neck motion. Movement directions of the upper cervical cord were verified among the various neck positions.

Sagittal lumbar and pelvic alignment in the standing and sitting positions.

BACKGROUND: The sitting position has become the most common posture in today's workplace. In relation to this position, kinematic analysis of the lumbar spine is helpful in understanding the causes of low back pain and its prevention. METHODS: In this study, we investigated the relationship between sagittal lumbar alignment and pelvic alignment in the standing and sitting positions for 50 healthy adults. Lumbar lordotic angle (LLA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured on lateral lumbar spine standing and sitting radiographs. RESULTS: Regarding changes from the standing to sitting positions, average LLA, SS, and PT were -16.6° (-49.8 %), -18.7° (-50.3 %), and 18.3° (284.8 %), respectively (P < 0.01). In the sitting position, lumbar lordosis was reduced and pelvic rotation became posterior. CONCLUSIONS: This study showed that LLA decreased by approximately 50 % and PT increased by approximately 25 % in the sitting position compared with the standing position. No significant gender differences were observed for LLA, SS, and PT in the standing position. In the sitting position, however, LLA and SS were markedly larger for women.

Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication.

STUDY DESIGN: Cross-sectional study of total sagittal spinal alignment in lumbar spinal canal stenosis (LCS) patients with and without intermittent claudication. OBJECTIVE: To evaluate total sagittal spinal alignment in LCS. SUMMARY OF BACKGROUND DATA: The sagittal spinal alignment is an important factor in the management of lumbar degenerative diseases and lower back pain. Patients with LCS accompanied by intermittent claudication adopt a forward-bending posture during walking. However, few studies have quantitatively assessed the abnormal posture in LCS in relation to clinical symptoms. METHODS: This study analyzed 93 patients with LCS. They were divided into two groups according to the presence of neurogenic intermittent claudication; patients of the Claudicant group had intermittent claudication of the cauda equina (n = 53; mean age, 66.7) and those of the Nerve root group had no claudication (n = 40; mean age, 67.0). The following parameters were measured on the lateral whole-spine standing radiographs: the distance between the C7 plumb line and the posterior superior corner on the superior margin of S1 (sagittal vertical axis), the angle between the superior margin of the first lumbar vertebra and the first sacral vertebra (L1S1), lumbar lordotic angle, pelvic tilting angle (PA), and pelvic morphologic angle (PRS1). RESULTS: The sagittal vertical axis of the Claudicant group (57.6 +/- 37.5 mm) was significantly larger than that of the Nerve root group (40.3 +/- 42.3 mm) and was larger in both groups compared with the standard values. Lumbar lordotic angle was smaller (18.8 degrees +/- 13.2 degrees ) and pelvic tilting angle was larger (27.2 degrees +/- 8.3 degrees ) in patients with the Claudicant group than those with the Nerve root group (22.4 degrees +/- 14.0 degrees and 22.7 degrees +/- 7.2 degrees , respectively). CONCLUSION: Patients of the Claudicant group exhibited forward bending of the trunk and pelvis backtilt, compared with those of the Nerve root group.

Clasped position for measurement of sagittal spinal alignment.

Lateral whole-spine radiography is a useful tool in the management of spinal deformity, but the most appropriate arm position during radiography has yet to be determined. In this prospective study, we evaluated 26 adult volunteers and 22 patients with lumbar spinal canal stenosis. Lateral whole-spine radiographs were acquired in the most stable and relaxed position while the subjects were standing with their arms extended and their hand gently clasped in front of the trunk (clasped position). The following parameters were measured: sagittal vertical axis (SVA), lumbar lordotic angle (LLA), pelvic angle (PA), pelvic lordosis angle (PRS1), pelvic tilt (PT), and pelvic incidence (PI). The reliability of measurements was assessed by interclass correlation coefficients. The SVA was slightly positive in volunteers. LLA, PA, PRS1, PT, and PI were compatible with standard normal values. The results showed "almost perfect agreement" with regard to intra- and interobserver reliability. The clasped position can be used effectively and reliably for measurement of sagittal spinal alignment for the lumbar region in adults.

Sagittal spinal alignment in patients with lumbar disc herniation.

A retrospective cross-sectional study was designed to evaluate total sagittal spinal alignment in patients with lumbar disc herniation (LDH) and healthy subjects. Abnormal sagittal spinal alignment could cause persistent low back pain in lumbar disease. Previous studies analyzed sciatic scoliotic list in patients with lumbar disc herniation; but there is little or no information on the relationship between sagittal alignment and subjective findings. The study subjects were 61 LDH patients and 60 age-matched healthy subjects. Preoperative and 6-month postoperatively lateral whole-spine standing radiographs were assessed for the distance between C7 plumb line and posterior superior corner on the top margin of S1 sagittal vertical axis (SVA), lumbar lordotic angle between the top margin of the first lumbar vertebra and first sacral vertebra (L1S1), pelvic tilting angle (PA), and pelvic morphologic angle (PRS1). Subjective symptoms were evaluated by the Japanese Orthopedic Association (JOA) score for lower back pain (nine points). The mean SVA value of the LDH group (32.7 +/- 46.5 mm, +/- SD) was significantly larger than that of the control (2.5 +/- 17.1 mm), while L1S1 was smaller (36.7 +/- 14.5 degrees ) and PA was larger (25.1 +/- 9.0 degrees ) in LDH than control group (49.0 +/- 10.0 degrees and 18.2 +/- 6.0 degrees , respectively). At 6 months after surgery, the malalignment recovered to almost the same level as the control group. SVA correlated with the subjective symptoms measured by the JOA score. Sagittal spinal alignment in LDH exhibits more anterior translation of the C7 plumb line, less lumbar lordosis, and a more vertical sacrum. Measurements of these spinal parameters allowed assessment of the pathophysiology of LDH.

Bilateral osteochondritis dissecans of the lateral trochlea of the femur: a case report.

Osteochondritis dissecans of the bilateral trochlea of femur is unusual case for orthopedic surgeon. The patient was a healthy 15-year-old male with symptomatic osteochondritis dissecans of the bilateral distal lateral femoral condyle of the trochlea. A surgery on the bilateral knee joints was performed simultaneously. The osteochondral free fragment of the right knee was resected by a minimum open surgery after arthroscopic evaluation. In the left knee the fragment was stabilized with multiple cortical bone pegs harvested from the proximal tibia. The surgery was successful, and the patient was able to play basketball 3 months postoperatively. The course of the right knee is currently under careful observation because of the possibility of recurrence. The left knee has remained in an excellent condition for 18 months following surgery with bone pegs.

Treatment of myelopathy due to cervicothoracic OPLL via open door laminoplasty.

STUDY DESIGN: Postoperative long-term follow-up study of open door laminoplasty for the ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. OBJECTIVES: Techniques and outcomes of open door laminoplasty were described. The efficacy of this procedure was discussed and compared with other surgical methods for thoracic OPLL reported in the literature. SUMMARY OF BACKGROUND DATA: OPLL of the thoracic spine is often associated with cervical OPLL or ossification of the yellow ligament (OYL) of the thoracic spine; therefore, it is extremely difficult to determine the most appropriate surgical therapeutic procedure. There are very few detailed reports about extensive laminoplasty for OPLL of the thoracic spine. METHODS: The subjects included in this study consisted of 13 consecutive patients of thoracic OPLL who were surgically treated between 1994 and 2003 by the open door laminoplasty using the spinal processes and ligament complex as spacers for the open side. The number of manipulated lamina, including the cervical spine, was from 7 to 14 (mean 10 laminae), the follow-up period was 75 months on average. We evaluated the clinical symptoms by the JOA scoring method and postoperative bone union and thoracic kyphosis by plain x-ray photograph and computed tomography. RESULTS: Postoperatively, the JOA score improved from an average of 5.5 to 8.5 out of a maximum of 11 points and the mean recovery rate by Hirabayashi method was 54.5%. In all cases, bone union was seen at the hinge side between the opened lamina and the lateral mass. Neither restenosis of the opened lamina nor marked progression of kyphosis were seen on the final follow-up observation in any patient. There was no postoperative spinal cord injury. CONCLUSIONS: Open door laminoplasty is a useful procedure for OPLL of the thoracic spine. This method enables wide-range posterior decompression, especially for the continuous type OPLL extending from the cervical spine to the thoracic spine, even if the apex of the thoracic kyphosis is included.

Molecular monitoring of bacterial community structure in long-aged nukadoko: pickling bed of fermented rice bran dominated by slow-growing lactobacilli.

Nukadoko is the fermented rice bran bed traditionally used for pickling vegetables in Japan. Here, we investigate the bacterial community structure of nukadoko using several culture-independent methods. Denaturing gradient gel electrophoresis (DGGE) and sequence analysis of V2-V3 16S rRNA gene (16S rDNA) fragments amplified from a long-aged nukadoko bacterial community indicated seven predominant operational taxonomic units (OTUs) closely related to known Lactobacillus species. Phylogenetic analysis of these OTUs indicated a major cluster consisting of six OTUs including a dominant OTU closely related to Lactobacillus acidifarinae and one distinct OTU corresponding to Lactobacillus acetotolerans. L. acetotolerans was commonly detected as a dominant species in samples from different seasons. The succession of microbial community structure in the fermentation and ripening processes was investigated using a laboratory model nukadoko. The L. acidifarinae-like bacteria grew rapidly with a pH decrease in the first few days after inoculation, whereas L. acetotolerans grew slowly and became dominant after one week. Real-time quantitative polymerase chain reaction (Q-PCR) showed that the doubling time of L. acetotolerans was 12 h, while that of total bacteria was 4 h. Real-time quantitative reverse transcription polymerase chain reaction (Q-RT-PCR) targeting 16S rRNA showed a low metabolic activity of L. acetotolerans throughout the fermentation and ripening processes. Fluorescence in situ hybridization (FISH) showed that L. acetotolerans was a dominant bacterium in the ripening period and had a low metabolic activity. These results indicate that the slow-growing L. acetotolerans stably dominated nukadoko microbiota after the L. acidifarinae-like bacteria mainly contributed to the lactic acid fermentation of the rice bran.

Congenital (infantile) pseudarthrosis of the fibula associated with osteofibrous dysplasia.

We describe a recently noted association of congenital (infantile) pseudarthrosis of the lower leg with osteofibrous dysplasia. The patient was a 2-year-old boy who presented with a deformed left ankle joint and three cutaneous cafe-au-lait spots. Radiography demonstrated pseudarthrosis of the left distal fibula and a round lucent lesion adjacent to the proximal part of the pseudarthrosis. Histologically, the surgically removed fibula with pseudarthrosis showed a fibromatosis-like fibrovascular proliferation and nonspecific reparative changes. The focal lucent area demonstrated a fibro-osseous lesion, which was histologically identical to osteofibrous dysplasia. This case provides further evidence that osteofibrous dysplasia may be associated with congenital (infantile) pseudarthrosis of the lower leg.

Nosological study of Borna disease virus infection in race horses.

To investigate the prevalence of diseases in the Borna disease virus (BDV) antibody positive race horses, we undertook seroepidemiological studies of BDV infection on 125 culled race horses in Hokkaido, Japan. The serological study disclosed the presence of antibodies only to BDV-p40 or -p24 in 19.2% (24/125) and 3.2% (4/125) of culled horses, respectively. Antibodies to both BDV-p40 and -p24 were found in 24.0% (30/125) of these horses. Of particular note was the finding that locomotorium disorders were detectable at a significantly higher rate in BDV antibody positive horses than that in the seronegative horses. These results imply that BDV infection may possibly contribute to an increase in the incidence rate of locomotorium disorders in race horses.