Reactive Sulfur Species Produced by Cystathionine γ-lyase Function in the Establishment of Mesorhizobium loti-Lotus japonicus Symbiosis.

Reactive sulfur species (RSS) are present in root nodules; however, their role in symbiosis and the mechanisms underlying their production remain unclear. We herein investigated whether RSS produced by the cystathionine γ-lyase (CSE) of microsymbionts are involved in root nodule symbiosis. A cse mutant of Mesorhizobium loti exhibited the decreased production of hydrogen sulfide and other RSS. Although the CSE mutation of M. loti did not affect the early stages of symbiosis, i.e., infection and nodulation, with Lotus japonicus, it reduced the nitrogenase activity of nodules and induced their early senescence. Additionally, changes in the production of sulfur compounds and an increase in reactive oxygen species (ROS) were observed in the infected cells of nodules induced by the cse mutants. The effects of CSE inhibitors in the L. japonicus rhizosphere on symbiosis with M. loti were also investigated. All three CSE inhibitors suppressed infection and nodulation by M. loti concomitant with decreased RSS levels and increased ROS and nitric oxide levels. Therefore, RSS derived from the CSE activity of both the microsymbiont and host plant are required for symbiosis, but function at different stages of symbiosis, possibly with crosstalk with other reactive mole-cular species.

Clinical Features Requiring Sacroiliac Joint Arthrodesis in Patients with Sacroiliac Joint Pain.

PURPOSE: This study aimed to reveal the clinical features requiring sacroiliac joint (SIJ) arthrodesis, which was performed for patients who complain of severe SIJ pain. METHODS: The differences in clinical features between a surgical treatment group (n=20) and a conservative treatment group (n=66) were investigated. All patients were definitively diagnosed with SIJ pain by the use of SIJ injections. RESULTS: Six significant features were identified in the surgical treatment group, namely, sitting tolerance (<15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and any accident that induced SIJ pain (P<0.01). Univariate logistic regression analysis revealed that sitting tolerance <15 minutes (odds ratio : 31.73), pain in the supine position (13.07), and pain while lying on the painful side (18.30) showed a high odds ratio. CONCLUSIONS: Sitting tolerance (<15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and a history of any accident that induced SIJ pain may be considered as indicators for surgery after >?6 months of continued substantial conservative treatment. J. Med. Invest. 70 : 123-128, February, 2023.

Sacrotuberous Ligament Pain in Patients who Underwent Sacroiliac Joint Arthrodesis: Incidence and Management of Post-Surgical Lower-Buttock Pain.

Introduction: Most sacroiliac joint (SIJ) disorders are conservatively treated; however, patients with severe pain occasionally require SIJ arthrodesis after failure of continuous conservative management for more than 6 months. We investigated the incidences of preoperative tenderness in the sacrotuberous ligament (STL) and postoperative lower-buttock pain originating from the STL to determine the best way to manage these symptoms to achieve good outcomes. Methods: We retrospectively investigated 33 patients (14 men and 19 women) with a mean age of 47.7 years (range: 25-79 years) who underwent SIJ arthrodesis for severe pain confirmed using diagnostic SIJ injections between April 2009 and December 2019. We investigated the pain improvement at or around the posterior superior iliac spine (PSIS) pre- and postoperatively using the visual analogue scale (VAS) values, incidence of tenderness of the STL before surgery, rate of the persisting STL tenderness, incidence of new-onset STL pain, and treatment options for STL pain postoperatively. Results: The mean VAS value at or around the PSIS was significantly relieved postoperatively from 85.6 to 31.5 mm (P<0.001). Preoperative tenderness of the STL was identified in 21 of 33 patients (63.6%). The STL tenderness resolved after surgery in 12 of these 21 patients (57.1%); however, it persisted in nine patients (42.9%), all of whom were women. Of the 12 patients who did not have preoperative STL tenderness, 4 (33.3%) developed lower-buttock pain and had STL tenderness. In total, 9 (27.3%) of the 33 patients whose progress could be followed up after SIJ arthrodesis had pain originating from the STL; the STL pain in 8 of the 9 patients was relieved after the STL injections and physical therapy. Conclusions: The STL pain can occur pre- and postoperatively, and management of both persisting and new-onset STL pain after SIJ arthrodesis should be considered to achieve better outcomes.

The psoas major muscle is essential for bipedal walking - An analysis using a novel upright bipedal-walking android model.

BACKGROUND: Bipedalism is a unique function in humans. Various investigations in bipedal walking have assessed the kinetic chain from the pelvis to the lower limbs. However, few studies have investigated the functions of the upper body including the psoas major muscles. In the present study, a bipedal-walking human full-body skeletal model, "the bipedal android model", was generated by attaching air cylinder devices to simulate the contraction and relaxation of various muscles required for bipedal walking, including the psoas major muscles. The bipedal-walking principle was discussed using the model. METHODS: Every part of a human full-body skeletal model was connected by wires or cables to retain the mobility of each joint. Then the psoas major (PM), gluteus minimus (GM), long head of biceps femoris (BF), quadriceps femoris (QF), and semimembranosus (SM) muscles were simulated in the skeletal model using air cylinders. The gait pattern was observed by synchronizing the contraction of PM, GM, QF and SM, and relaxation of BF of the ipsilateral side together with the reversed patterns in the contralateral side, and then switching the phase by every step. The gait pattern in dysfunction of PM or GM muscles was also observed by disconnecting the corresponding air cylinders. RESULTS: The synchronized contraction of PM, GM, QF and SM generates the force to tilt the upper body to ipsilateral side, followed by elevation of the lower limb together with the forward rotation of the pelvis in the contralateral side to swing the leg forward. The next step was generated by reversing the contraction phase at the landing of the swung leg. The dysfunction of PM muscle disabled effective gait in the model, while GM did not. SIGNIFICANCE: The bipedal android model indicated that the psoas major muscles play a crucial role in bipedal walking in human.

Three-Year Clinical Outcomes after Minimally Invasive Sacroiliac Joint Arthrodesis Using Triangular Implants in Japan: A Pilot Study of Five Cases.

INTRODUCTION: Sacroiliac joint (SIJ) arthrodesis using a minimally invasive technique, particularly the triangular implant system, is performed in patients with SIJ dysfunction in the United States and Europe. We report three-year clinical outcomes of the first minimally invasive SIJ arthrodesis procedures using the implants performed in Japan. METHODS: Five patients (one man and four women; age: 56.4±16.9 years) with SIJ pain who underwent SIJ arthrodesis using a triangular implant system in 2017 were included. In addition to operation time and blood loss, pain intensity (visual analog scale [VAS]) and functional impairment (Oswestry disability index [ODI]) were assessed preoperatively and at a 36-month follow-up. Implant loosening and osseous bridging across the joint were evaluated using computed tomography images, and patients' satisfaction with the surgery was also assessed at 12 and 36 months. RESULTS: The surgical time was 67.7±13.1 minutes, and blood loss was 7.4±6.9 mL. The mean VAS value improved significantly from 88.0±8.4 mm to 33.6±31.9 mm at 3 months and was maintained at 46.4±30.9 mm at 36 months (P<0.05). The mean ODI improved significantly from 76.4%±3.8% to 46.2%±21.9% at 6 months postoperatively (P<0.05) but had no significant improvements thereafter: 46.94±23.7% (12 months) and 66.4±8.6% (36 months). Three of five patients presented with at least one implant loosening on the sacrum side. No patient had osseous bridging across the joint. A total of 80% (4/5) of patients reported satisfaction with the surgery at 12 months and 60% (3/5) at 36 months. CONCLUSIONS: The mean VAS value and ODI significantly improved until 6 months after the surgery. However, the mean ODI was reaggravated at 36 months after the surgery. Osseous bridging across the joint was not observed in all patients. We should carefully keep an eye on further long-term results to evaluate the implant.

Factors Associated with Thickening of the Ligamentum Flavum on Magnetic Resonance Imaging in Patients with Lumbar Spinal Canal Stenosis.

STUDY DESIGN: Experimental study of the ligamentum flavum (LF) thickness among patients with lumbar spinal canal stenosis (LSCS). OBJECTIVES: To elucidate the factors associated with thickening of the LF on magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA: Thickening of the LF is a major contributor to LSCS. This thickening is attributed to tissue hypertrophy or buckling of the ligament, and there may be several associated factors on MRI; however, these factors remain unclear. METHODS: We studied the LF in 56 patients (a total of 106 ligaments) with LSCS, who underwent decompressive surgery; among them, 23 were receiving haemodialysis. The Pearson correlation coefficient was used to assess relationships between the thickness of the LF on MRI and the thickness of the LF tissue, age, disc height, disc degeneration, and disc level. Patients were also categorised into 2 groups based on whether they were undergoing haemodialysis, and the relationships were assessed similarly. RESULTS: Among patients with LSCS, the thickness of the LF on MRI showed a significant positive linear relationship with the thickness of the LF tissue, and no association with disc height. Except for in those receiving haemodialysis, the thickness of the LF on MRI showed a significant positive relationship with age, disc degeneration, and disc level among patients with LSCS. CONCLUSION: In patients with LSCS, thickening of the LF on MRI appears to represent tissue hypertrophy. The association between the thickness of the LF on MRI and age, disc degeneration, and disc level may indicate simultaneous alterations of spine components along with aging that was cancelled by the effects of haemodialysis.

Physical therapeutic options for residual sacrotuberous ligament pain after treatment of sacroiliac joint dysfunction.

[Purpose] To evaluate the incidence of pain originating from the sacrotuberous ligament after sacroiliac joint treatment, and to determine effective physical therapeutic options for sacrotuberous ligament pain. [Participants and Methods] Among 303 patients with sacroiliac joint dysfunction, 57 patients (20 males, 37 females) with persistent lower-buttock pain after sacroiliac joint injections were included in the study. The incidence of sacrotuberous ligament pain and the physical findings from the first evaluation were investigated by physical therapists. [Results] Diagnostic sacrotuberous ligament injections identified lower-buttock pain originating from the sacrotuberous ligament in 57.9% of the patients (33 out of 57 patients) after treatment of sacroiliac joint dysfunction. Of these, 11 patients experienced relief after sacrotuberous ligament injection alone; the others required physical therapy. Sacrotuberous ligament relaxation alone was effective in eight patients; biceps femoris relaxation was required in eight patients; and gluteus maximus contraction exercise was required in six patients. [Conclusion] After sacroiliac joint treatment, the incidence of residual sacrotuberous ligament pain in the persisting lower-buttock pain was 57.9%. In addition to sacrotuberous ligament relaxation, biceps femoris relaxation was effective in patients who showed both higher differences in the straight leg raising test and biceps femoris tenderness, while gluteus maximus contraction exercises were effective in patients with gluteus maximus weakness.

Surgical Outcomes of Patients with Sacroiliac Joint Pain: An Analysis of Patients with Poor Results Regarding Activities of Daily Living.

INTRODUCTION: Sacroiliac joint (SIJ) arthrodesis is the last resort for patients with severe SIJ pain. However, this technique does not always provide good outcomes regarding activities of daily living (ADL). This study aims to reveal the preoperative clinical features associated with poor outcomes of SIJ arthrodesis. METHODS: Twenty-six consecutive patients who underwent SIJ arthrodesis between 2009 and 2018 were evaluated. Good-outcome was defined as ≥30% improvement in ADL, quantified by the Roland-Morris Disability Questionnaire (RDQ). The good-outcome group (17 patients; 10 men and 7 women, 42.5±8.4 years old) and the poor-outcome group (9 patients; 1 man and 8 women, 47.0±17.9 years old) were compared to identify the preoperative clinical features of poor surgical outcomes. RESULTS: No significant differences were observed between the two groups regarding age, preoperative RDQ score, time between onset and the confirmed diagnosis of SIJ pain, and the time between diagnosis and surgical treatment. The following preoperative clinical features associated with poor surgical outcomes were identified: female sex, pain in multiple regions, walking with a cane, and the use of a wheelchair before surgery (P<0.05). CONCLUSIONS: The present study demonstrated that poor postoperative outcomes in patients with severe SIJ pain were associated with the following preoperative clinical features: female sex, pain in multiple regions, walking with a cane, or use of a wheelchair. Ample attention is warranted in patients with such features who are indicated for surgical treatments.

Quantitative evaluation of the sacroiliac joint fixation in stress reduction on both sacroiliac joint cartilage and ligaments: A finite element analysis.

BACKGROUND: The sacroiliac joint fixation is the last resort for patients with prolonged and severe joint pain. Although the clinical results of anterior fixations are conclusive, there exist several inevitable drawbacks with the surgical method such as the difficulty performing the surgery due to the presence of many organs. The posterior fixation technique has thus been developed to overcome those inconveniences. This study aims to assess in silico the mechanical environment following posterior and anterior fixations, focusing on stresses in both the sacroiliac cartilage and dorsal ligamentous part, as well as loads experienced by the pelvic ligaments. METHODS: Sacroiliac joint cartilage, dorsal ligamentous part stresses and pelvic ligaments loads were evaluated with three types of fixation models. A vertical load of 600 N was applied, equally distributed via both acetabula when standing and sitting. FINDINGS: Results show that the anterior sacroiliac joint fixation reduced von Mises stresses in the cartilage and dorsal ligamentous part and decreased ligaments loads more extensively than the posterior fixation when compared to the untreated model as a reference. However, the posterior fixation still remains the desirable and preferential treatment. INTERPRETATION: The anterior sacroiliac joint fixation showed better performances compared to the posterior one; however, the lower invasive aspect of the latter is a fundamental clinical advantage which also has the possibility to be improved by considering various screws and cages configurations. This study provides a beneficial suggestion to improve the current fixation technique.

Finite element analysis of load transition on sacroiliac joint during bipedal walking.

The sacroiliac joint (SIJ) is burdened with variant loads. However, no methods have allowed to measure objectively how the SIJ deforms during bipedal walking. In this study, in-vivo walking conditions were replicated in a kinematic model combining the finite element method with 3D walking analysis data divided into five phases in order to visualize the load transition on the SIJ and clarify the role of the SIJ. Both models with and without inclusion of the SIJ were investigated. In models with bilateral SIJs, the displacement differed greatly between the sacrum and both hip bones on the SIJ as the boundary. The movements of the sacrum involved a nutation movement in the stance phase and a counter-nutation in the swing phase relative to the ilium. In models without SIJs, the displacement of the pelvis and loads of pelvic ligaments decreased, and the equivalent stress of the SIJs increased compared to the model with SIJs. The walking loads cause distortion of the entire pelvis, and stress concentration at the SIJ are seen due to the morphology of the pelvic ring. However, the SIJs help dissipate the resulting stresses, and the surrounding ligaments are likewise involved in load transmission.

Criteria for Identifying Technically Difficult Cases when Performing Sacroiliac Intraarticular Injections Based on the Grade of Sacroiliac Arthrogram.

OBJECTIVE: An intraarticular sacroiliac joint (SIJ) injection cannot always be performed successfully. Based on the patterns of the sacroiliac arthrogram, we explored possible indicators of technically difficult and technically easy injections into the SIJ including demographic features and anatomical features evident on preprocedural imaging. DESIGN: Observational study. METHODS: We evaluated 76 patients with painful SIJ (total 108 joints) diagnosed by SIJ injections. The sacroiliac arthrogram was graded as follows: Grade (G) 0 = the margin of the joint was partially outlined; G1 = the margin was completely outlined; G2 = intraarticular space was substantially outlined; and G3 = intraarticular space was fully outlined. Two multivariable ordered logistic regression analyses were performed to test the relationships between gender, age, and Grade, as well as between computed tomography (CT) findings and grade. RESULTS: In men, the totals by Grade were G0 = 8 (joints); G1 = 33; G2 = 3; and G3 = 0. In women, these were G0 = 4; G1 = 28; G2 = 22; and G3 = 10. The Grade was significantly higher in women and was also higher with age (P < 0.05). Regarding morphological features in CT, minor osteophytes increased the odds in favor of better Grades of arthrogram (odds ratio = 3.50). Substantial vacuum phenomena strongly increased the odds of better arthrograms (20.52). CONCLUSIONS: Outlining the SIJ cavity fully is significantly more difficult in male patients of any age than in aged female patients. The presence of minor osteophytes and substantial vacuum phenomena on preprocedure CT scans can be reasonably reassuring to the practitioner that they are unlikely to encounter difficulties during injection.

Reactive Sulfur Species Interact with Other Signal Molecules in Root Nodule Symbiosis in Lotus japonicus.

Reactive sulfur species (RSS) function as strong antioxidants and are involved in various biological responses in animals and bacteria. Few studies; however, have examined RSS in plants. In the present study, we clarified that RSS are involved in root nodule symbiosis in the model legume Lotus japonicus. Polysulfides, a type of RSS, were detected in the roots by using a sulfane sulfur-specific fluorescent probe, SSP4. Supplying the sulfane sulfur donor Na2S3 to the roots increased the amounts of both polysulfides and hydrogen sulfide (H2S) in the roots and simultaneously decreased the amounts of nitric oxide (NO) and reactive oxygen species (ROS). RSS were also detected in infection threads in the root hairs and in infected cells of nodules. Supplying the sulfane sulfur donor significantly increased the numbers of infection threads and nodules. When nodules were immersed in the sulfane sulfur donor, their nitrogenase activity was significantly reduced, without significant changes in the amounts of NO, ROS, and H2S. These results suggest that polysulfides interact with signal molecules such as NO, ROS, and H2S in root nodule symbiosis in L. japonicus. SSP4 and Na2S3 are useful tools for study of RSS in plants.

Rate of spinal surgery in a rapidly aging society: the 27-year changes in Miyagi prefecture, Japan.

BACKGROUND: Japan has had a rapidly aging population during the past 30 years. This study aimed to investigate longitudinal changes in the surgical rate for spinal disorders in Miyagi Prefecture (2.35 million inhabitants) with a similar population composition to Japan. METHODS: Data of spinal surgeries were collected using the spine registry by Tohoku University Spine Society. Data on the annual number of spinal surgeries between 1988 and 2014 of all populations, in those aged ≥65 years old, in those aged ≥75 years old, and for each pathology were collected. The annual surgical rate per 100,000 inhabitants was calculated. RESULTS: The surgical rate in 2010-2014 in total, at ≥65 years old, and at ≥75 years old showed 3.2-, 3.8- and 7.1-fold increases, respectively, compared with that in 1988-1989. Degenerative spinal disorders, spinal trauma and pyogenic spondylitis markedly increased, while metastatic spinal tumor and tuberculous spondylitis decreased over time. The surgical rate at ≥75 years with lumbar spinal stenosis showed a 12.6-time increase. CONCLUSIONS: During a rapid period of aging, the rate of spinal surgeries has markedly increased, particularly, that for degenerative disorders. This is the first report on the long-term longitudinal changes in the rate of spinal surgery.

Characterizing standard genetic parts and establishing common principles for engineering legume and cereal roots.

Plant synthetic biology and cereal engineering depend on the controlled expression of transgenes of interest. Most engineering in plant species to date has relied heavily on the use of a few, well-established constitutive promoters to achieve high levels of expression; however, the levels of transgene expression can also be influenced by the use of codon optimization, intron-mediated enhancement and varying terminator sequences. Most of these alternative approaches for regulating transgene expression have only been tested in small-scale experiments, typically testing a single gene of interest. It is therefore difficult to interpret the relative importance of these approaches and to design engineering strategies that are likely to succeed in different plant species, particularly if engineering multigenic traits where the expression of each transgene needs to be precisely regulated. Here, we present data on the characterization of 46 promoters and 10 terminators in Medicago truncatula, Lotus japonicus, Nicotiana benthamiana and Hordeum vulgare, as well as the effects of codon optimization and intron-mediated enhancement on the expression of two transgenes in H. vulgare. We have identified a core set of promoters and terminators of relevance to researchers engineering novel traits in plant roots. In addition, we have shown that combining codon optimization and intron-mediated enhancement increases transgene expression and protein levels in barley. Based on our study, we recommend a core set of promoters and terminators for broad use and also propose a general set of principles and guidelines for those engineering cereal species.

The association between sacroiliac joint-related pain following lumbar spine surgery and spinopelvic parameters: a prospective multicenter study.

PURPOSE: To prospectively calculate the incidence of postoperative sacroiliac joint-related pain (SIJP) and investigate the association between spinopelvic parameters and postoperative SIJP after lumbar spine surgery. METHODS: We prospectively enrolled consecutive patients who underwent lumbar spine surgery. We defined postoperative SIJP as unilateral buttock pain according to fulfillment of the following criteria within 3 months of the surgery: a sacroiliac joint (SIJ) score higher than 4/9 postoperatively; positive response to analgesic periarticular SIJ injection with fluoroscopy; no other complications related to the surgery. The patients were divided into the SIJP group and non-SIJP group. We compared the background information and analyzed the differences in spinopelvic parameters in both groups. Additionally, receiver-operating characteristic curve analyses were performed to evaluate the cutoff values of spinopelvic parameters. RESULTS: Of the 281 patients enrolled, 265 were included and eight developed postoperative SIJP (3.0%). There were no significant differences in the background information between groups. Preoperative and postoperative radiological evaluations revealed that the pelvic incidence (PI) in the SIJP group was significantly higher than that in the non-SIJP group, and there were no significant differences in lumbar lordosis (LL), pelvic tilt, sacral slope, and PI minus LL. For preoperative PI, the area under the curve, cutoff value, sensitivity, and specificity were 0.73739, 59, 62.5%, and 81.9%, respectively. CONCLUSIONS: The incidence of postoperative SIJP after lumbar spine surgery was 3.0%. Higher PI values were associated with a higher risk of postoperative SIJP. These slides can be retrieved under Electronic Supplementary Material.

Pitfalls during Sacroiliac Joint Arthrodesis for Patients with Severe Sacroiliac Joint Pain: Report of Three Cases with Sacral Dysmorphism Induced by Lumbosacral Transitional Vertebrae.

INTRODUCTION: Lumbosacral transitional vertebrae (LSTV) can cause sacral dysmorphism. Sacroiliac joint (SIJ) arthrodesis has been widely performed as the last resort for severe SIJ pain. We report three kinds of technical pitfalls identified in the surgical records of SIJ arthrodesis for the patients with sacral dysmorphism induced by LSTV. CASE REPORT: For the cases of a 34-year-old man with LSTV Castellvi's Type IV, anterior SIJ arthrodesis using a plate and screws was performed. The most cranial sacral foramen was larger and irregularly round, and the nerve root ran to the lateral side from the deformed foramen more than usual. A firm medial traction of the nerve root together with the psoas major muscle for the purpose of attaching a plate and inserting screws on the sacrum side could cause the temporary radiculopathy. For a 26-year-old woman with a thin sacral alar due to IIIb, SIJ arthrodesis using multi screws with the posterolateral approach was performed. The most cranial screw penetrated the anterior margin of the sacrum and caused nerve root injury. For a 35-year-old man with Ib, posterior SIJ arthrodesis was attempted using screws and cylinder cages. The insertion of the implants using the posterior approach was technically challenging due to the small size of the sacrum. CONCLUSIONS: Pre-surgical planning for SIJ arthrodesis, including a surgical approach, is particularly important when we see patients with sacral dysmorphism induced by each type of LSTV. The presented surgical pitfalls will be valuable when surgeons perform SIJ arthrodesis for patients with LSTV.

Sacroiliac joint arthrodesis for chronic sacroiliac joint pain: an anterior approach and clinical outcomes with a minimum 5-year follow-up.

OBJECTIVE The authors evaluated the outcomes of sacroiliac joint (SIJ) arthrodesis via an original anterior approach to the upper anterior surface of the SIJ in patients with a minimum of 5 years' follow-up. METHODS The authors performed anterior SIJ arthrodesis in 45 patients between 2001 and 2015. Of these patients, 27 (11 men and 16 women; mean age at surgery 49 [24-86] years) were followed up for a minimum of 5 years (average 113 months, range 61-157 months). In the 14 patients in the earlier period of this study, the authors used an anterior approach to expose the SIJ by separating the iliac muscle from the iliac bone and performed internal fixation. In the 13 patients later in the study, the authors changed to a pararectal approach, which involved an incision along the lateral border of the rectus abdominal muscle. Then, extraperitoneally, the upper anterior surface of the SIJ was exposed between the psoas major muscle and the iliac muscle. RESULTS Among the 27 patients, 21 had unilateral anterior arthrodesis alone, 4 required additional posterior arthrodesis, and 2 required pelvic ring arthrodesis because of later pain on the opposite side. In the 21 patients with a unilateral anterior arthrodesis, outcome according to the modified Macnab criteria was excellent in 7, good in 11, and fair in 3. Outcomes were excellent, good, fair, and poor in 1 patient each among the 4 with additional posterior fusion. Outcomes were good and poor for 1 patient each among those with pelvic ring arthrodesis. All 27 patients demonstrated bone union of the SIJ on CT. Lateral femoral cutaneous neuralgia developed in 7 of the 27 patients; 6 patients had undergone the initial anterior method and 1 the later method. CONCLUSIONS Anterior SIJ arthrodesis was effective in most patients with severe SIJ pain resistant to conservative therapy. This approach has the advantage of direct curettage and bone graft into the wide area of the SIJ, which result in good bone union. In particular, the authors' current pararectal approach could decrease the potential risk of lateral cutaneous injury.

Epidermal LysM receptor ensures robust symbiotic signalling in Lotus japonicus.

Recognition of Nod factors by LysM receptors is crucial for nitrogen-fixing symbiosis in most legumes. The large families of LysM receptors in legumes suggest concerted functions, yet only NFR1 and NFR5 and their closest homologs are known to be required. Here we show that an epidermal LysM receptor (NFRe), ensures robust signalling in L. japonicus. Mutants of Nfre react to Nod factors with increased calcium spiking interval, reduced transcriptional response and fewer nodules in the presence of rhizobia. NFRe has an active kinase capable of phosphorylating NFR5, which in turn, controls NFRe downstream signalling. Our findings provide evidence for a more complex Nod factor signalling mechanism than previously anticipated. The spatio-temporal interplay between Nfre and Nfr1, and their divergent signalling through distinct kinases suggests the presence of an NFRe-mediated idling state keeping the epidermal cells of the expanding root system attuned to rhizobia.

Treatment strategy for sacroiliac joint-related pain at or around the posterior superior iliac spine.

OBJECTIVE: Pain at or around the posterior superior iliac spine (PSIS) is characteristic of sacroiliac joint (SIJ) -related pain. This pain can be treated by either a peri- or intra-articular injection into the joint, with the former being much easier to perform. We investigated whether peri- or intra-articular injections were more frequently effective in patients with SIJ-related pain, and aimed to create an efficient treatment strategy for SIJ-related pain at or around the PSIS. DESIGN: Prospective case-control study. PATIENTS AND METHODS: We evaluated 85 patients with pain at or around the posterior superior iliac spine as indicated by the one finger test. First, we performed a peri-articular sacroiliac joint injection. If it was ineffective, an intra-articular injection was later given. Groin pain, sitting pain, sacroiliac joint shear test results, and posterior superior iliac spine and sacro-tuberous ligament tenderness were also compared between patients for whom a peri- or intra-articular injection was effective. RESULTS: Seventy-two (85%) of 85 patients had an effective injection. Out of these 72 patients, 58 (81%) had a positive peri-articular injection and 14 (19%) had a positive intra-articular injection. Four items, excluding tenderness of the sacro-tuberous ligament had no significant difference between these two injection types. CONCLUSION: To treat sacroiliac joint-related pain at or around the posterior superior iliac spine, a peri-articular injection should be performed first, and only if it is not effective should an intra-articular injection be administered. Using this strategy, we expect that most patients with sacroiliac joint-related pain will be efficiently diagnosed and treated.

Groin pain associated with sacroiliac joint dysfunction and lumbar disorders.

OBJECTIVE: We investigated the prevalence of groin pain in patients with sacroiliac joint (SIJ) dysfunction, lumbar spinal canal stenosis (LSS), and lumbar disc herniation (LDH) who did not have hip disorders, and evaluated the clinical features that distinguished SIJ dysfunction from LSS and LDH. PATIENT AND METHODS: We evaluated 127 patients (57 men, 70 women, average age 55 years) with SIJ dysfunction, 146 (98 men, 48 women, average age 71 years) with LSS, and 124 (83 men, 41 women, average age 50 years) with LDH. The following data were retrospectively collected from the patients' medical charts: (1) the prevalence of groin pain for each pathology; (2) corresponding spinal level of LSS and LDH in the patients with groin pain; (3) the pain areas in the buttocks and back; pain increase while in positions such as sitting, lying supine, and side-lying; an SIJ shear test; and four tender points composed of the posterior superior iliac spine (PSIS), long posterior sacroiliac ligament (LPSL), sacrotuberous ligament (STL), and iliac muscle. RESULTS: Fifty-nine (46.5%) patients with SIJ dysfunction, 10 (6.8%) with LSS, and 10 (8.1%) with LDH reported groin pain. Of the 10 patients with LSS, five presented with cauda equina symptoms, two had stenosis of L2-L3, and three had stenosis below L3-L4. The other five presented with radiculopathy: the corresponding nerve root was L2, L3, and L4 in one patient each, and L5 in two. Of the 10 patients with LDH, eight presented with radiculopathy: the corresponding nerve root was L2 and L4 in three patients each, and L5 in two. Two patients presented with L4-L5 discogenic pain without radiculopathy. In patients with groin pain, pain provoked by the SIJ shear test and the tenderness of the PSIS and LPSL were significant physical signs that differentiated SIJ dysfunction from LSS and LDH. (Fisher's exact test, P<0.05) CONCLUSION: The prevalence of groin pain in patients with SIJ dysfunction was higher than in those with LSS or LDH. When patients who do not have hip disorders complain of groin and lumbogluteal pain, not only lumbar disorders but also SIJ dysfunction should be considered.