Suture anchor stabilization of symptomatic accessory navicular in adolescents: Clinical and radiographic outcomes.

BACKGROUND: Screw fixation used in modified Kidner procedures to treat persistent symptomatic accessory navicular in adult cases is often challenging in adolescent cases with a small accessory fragment. The present study aimed to document the clinical effect of a suture anchor stabilization technique applicable to such cases where osteosynthesis is considered an ideal outcome. METHODS: Consecutive clinical cases who received this surgical treatment from 2009 to 2016 were retrospectively reviewed. The focus of interest included radiographic union of the accessory bone, changes in symptoms evaluated using a validated clinical outcome scale introduced by the Japanese Society for Surgery of the Foot, and changes in the medial arch bony alignment measured in lateral weight-bearing plain radiographs. RESULTS: Twenty-two feet in 15 individuals (11 females and 4 males, age at surgery 10-16 years) were identified. In 14 feet (64%), radiographic bone union was confirmed within 8 weeks postoperatively. At the final follow-up ranging 12-51 months postoperation, the clinical scores have significantly improved (p < 0.001) to 96 ± 5.71 (mean ± standard deviation, range 87-100), from 54 preoperatively. Radiographic measurements revealed significant postoperative increase of the sagittal talar tilt angle (p < 0.001, increment 4 ± 3°, range 0-11) and the talo-first metatarsal angle (p < 0.001, increment 5 ± 4°, range 0-12). No significant changes were identified in the calcaneal pitch angle, first metatarsal tilt angle, calcaneo-navicular angle, and the navicular height. CONCLUSION: Despite the modest bone union rate, the clinical outcomes suggest distinct symptom-relieving effect, at least in the short- to midterm, while the radiographic measurements suggest positive biomechanical effects. The present suture-anchor stabilization concept appears to be a promising treatment option for persistent symptomatic accessory navicular in adolescent cases.

Fat Grafting for Facial Rejuvenation with Cryopreserved Fat Grafts.

Fat grafting to the face for volume augmentation, and skin rejuvenation have become a popular procedure. However, the main obstacles to fat grafting include the unpredictable volume maintenance rate and the unpredictable number of treatments needed to obtain a satisfactory rejuvenate effect. Therefore, many patients need repeat sessions. However, serial fat grafting with fresh fat imposes a burden on the patient not only because of the pain but also because of the downtime of harvesting. Therefore, if the fat can be cryopreserved, and used many times in 1 harvesting, those burdens can be reduced.

Serial Injections of Cryopreserved Fat at -196°C for Tissue Rejuvenation, Scar Treatment, and Volume Augmentation.

BACKGROUND: Fat grafting has become popular since the first report of structural fat grafting in 2001. Fat grafting is effective not only for volume augmentation but also for tissue revitalization. However, fat harvesting is necessary before fat grafting can be performed. Therefore, the performance of serial fat injections is very challenging when treating such patients. METHODS: From August 2015 to March 2017, we investigated 219 patients who underwent fat grafting using the fat that had already been cryopreserved at -196°C. RESULTS: Follow-up ranged from 3 months to 2 years. No complications occurred, and all outcomes were satisfactory. Three representative cases were also reviewed. CONCLUSIONS: The cryopreserved fat at -196°C could be served as a useful method for serial fat grafting for clinical use; however, further research involving longer follow-up and pathological findings are needed.

The delta opioid receptor agonist KNT-127 in the prelimbic medial prefrontal cortex attenuates veratrine-induced anxiety-like behaviors in mice.

We previously reported that systemic administration of the selective delta opioid receptor (DOP) agonist KNT-127 produces potent anxiolytic-like effects in rats. Although a higher distribution pattern of DOPs was reported in the prelimbic medial prefrontal cortex (PL-PFC) of rodents, the role of DOPs in PL-PFC and in anxiolytic-like effects have not been well examined. Recently, we demonstrated that activation of PL-PFC with the sodium channel activator veratrine increases glutamatergic neurotransmission and produces anxiety-like behaviors in mice. Therefore, we investigated the effects of co-perfusion with KNT-127 in PL-PFC on veratrine-induced anxiety-like behaviors in mice. We also simultaneously measured extracellular glutamate and GABA levels. In addition, we assessed the effect of KNT-127 on the expression of c-Fos in sub-regions of the amygdala. Extracellular glutamate levels were measured in seven-week-old male C57BL/6N mice using an in vivo microdialysis-HPLC/ECD system, and behaviors were assessed simultaneously in an open field test. Basal levels of glutamate were measured by collecting samples every 10min for 60min. The drug-containing medium was perfused for 30min, and the open field test was performed during the last 10min of drug perfusion. After drug treatments, the perfusion was switched from drug-containing medium to control medium without drugs and samples were collected for another 90min. KNT-127 co-perfusion completely diminished veratrine-induced anxiety-like behaviors and attenuated the veratrine-induced increase in extracellular glutamate levels in PL-PFC. Interestingly, KNT-127 perfusion alone in PL-PFC did not affect anxiety-like behaviors. Local perfusion of veratrine in PL-PFC induced c-Fos immunoreactivity in sub-regions of amygdala. Co-perfusion of KNT-127 diminished c-Fos expression. Here we demonstrate that the DOP agonist KNT-127 in PL-PFC attenuates veratrine-induced anxiety-like behaviors in mice. These effects may be caused by the presynaptic suppression of activated glutamatergic transmission in PL-PFC, which projects to sub-regions of the amygdala. We propose that compounds like KNT-127, which inhibit glutamatergic transmission in PL-PFC, are candidates for novel anxiolytics.

Ultrasound Diagnosis and Treatment of Breast Lumps after Breast Augmentation with Autologous Fat Grafting.

BACKGROUND: Breast augmentation with autologous fat has been performed in Japan for over 30 years. However, complications include breast lumps and oil cysts. Such breast lumps greatly reduce patient satisfaction, and are currently difficult to diagnose and treat for many cosmetic surgery clinics. This study aimed to elucidate the effectiveness of ultrasound diagnosis and treatment of patients with breast lumps after breast augmentation with autologous fat grafting. METHODS: We used diagnostic and therapeutic ultrasound to examine 256 patients with breast lumps between April 2012 and April 2017. We determined the nature, size, and location of the maximal lump. Breast lumps were classified into five types: cystic, complex, solid, calcification, and unclassifiable. The method of treatment (including fine-needle aspiration, VASER liposuction, lumpectomy, and extended lumpectomy) was selected according to the lump type, and the efficacy of treatment was determined by postoperative palpation and ultrasound. RESULTS: A total of 198 patients (198/256, 77%) requested treatment. Cystic lumps (79/256, 31%) were treated by fine-needle aspiration. VASER liposuction was used to treat complex (64/256, 25%) and solid lumps (50/256, 19%). Calcification (58/256, 23%) and unclassifiable lumps (5/256, 2%) were removed via periareolar incision. There were no serious complications. In all cases, the lumps were no longer palpable after treatment, and ultrasound showed that they had either contracted or disappeared. CONCLUSIONS: The appropriate treatment for breast lumps after breast augmentation with autologous fat grafting must be selected according to the nature of the lumps. Ultrasound is essential for diagnosing the breast lump type and determining the best treatment.

Our Experience with 131 Cases of Simultaneous Breast Implant Exhange with Fat (SIEF).

BACKGROUND: Breast augmentation with fat injection is a growing trend in Japan. Many Japanese patients experiencing breast implant complications are requesting to have their breast implants removed and simultaneously exchanged with autologous fat injection. The keys of our simultaneous implant exchange with fat (SIEF) process are to embrace the "Coleman technique" and to carefully detach implant capsules when removing breast implants. Furthermore, we carefully inject fat to avoid necrosis. METHODS: Between January 2010 and January 2015, we investigated consecutively 131 Japanese patients whom we could follow up for over 6 months postsurgery. We ascertained the usefulness of SIEF by assessing changes in breast size, complications, and a satisfaction survey. RESULTS: There were no serious complications. We had experienced mild complications in 9.2% of patients (12/131). Partial fat necrosis with inflammation occurred in 2.3% of patients (3/131), seroma in the capsule in 3.1% (4/131), complaints of nodules (cysts, lumps) in 3.1% (4/131), and 1 hematoma patient (0.8%). At 6 months after surgery (n = 131), breast cup size (by Japanese Industrial Standards) had decreased by less than 1 cup size, despite SIEF. At 6 months, we performed a postsurgery satisfaction survey, and only 4% of the patients (5/131) were not satisfied with their surgery results. CONCLUSIONS: SIEF is a very safe and effective procedure. Breast implants removed with a low invasive traumatic approach and centrifuged fat injected with the "Coleman technique" are important principles in our practice. Furthermore, avoiding fat necrosis is one of the most important considerations, and our SIEF approach allows us to better control this potential complication during the surgical process.

The infralimbic and prelimbic medial prefrontal cortices have differential functions in the expression of anxiety-like behaviors in mice.

The medial prefrontal cortex is a heterogeneous cortical structure composed of several nuclei, including the prelimbic (PL) and infralimbic (IL) cortices. We previously demonstrated in mice that PL activation with the sodium channel activator veratrine induces anxiety-like behaviors. However, the role of IL in the regulation of anxiety-like behaviors remained unclear. Therefore, in the present study, we investigated the role of the IL in the regulation of anxiety-like behaviors using pharmacological activation model with veratrine, and compared it with the role of the PL. Extracellular glutamate levels were measured by in vivo microdialysis-HPLC with an electrochemical detector, and behaviors were assessed using the open field test. In this study, extracellular glutamate levels rose significantly after perfusion of veratrine in the IL and PL. Interestingly, the PL activation produced anxiety-like behaviors, whereas the activation of the IL produced no anxiety-like behavior in mice. Although the IL is adjacent to the PL, these two regions of the brain have differential functions in the expression of anxiety-like behaviors.

The voltage-gated sodium channel activator veratrine induces anxiogenic-like behaviors in rats.

In this study, we investigated the anxiogenic-like effects of systemically administered veratrine in rat models of anxiety. In the light/dark test, veratrine (0.6 mg/kg, s.c.) significantly and dose-dependently decreased the time rats spent in and the number of entries into a light box 30 min after administration, suggesting that veratrine increases anxiety-like behaviors. These findings were also supported by results from the elevated-plus maze test and the tail-swing behavior test. In addition, veratrine (0.6 mg/kg, s.c.) significantly increased the plasma concentration of corticosterone, an endogenous biomarker for anxiety, compared to vehicle. On the basis of these results, we conclude that veratrine induces anxiogenic-like behaviors in rats. The anxiogenic-like behaviors induced by veratrine (0.6 mg/kg, s.c.) were completely abolished by co-treatment with the typical benzodiazepine anxiolytic diazepam (1 mg/kg, s.c.), when assessed in the elevated-plus maze test. Similar results were obtained with co-treatment with riluzole (10 mg/kg, p.o.), which directly affects the glutamatergic system and has recently been suggested to have anxiolytic-like effects. In conclusion, this study provides evidence that systemically administered veratrine induces anxiogenic-like behaviors in rats. We propose the veratrine model as a novel pathological animal model to explore possible candidate drugs for anxiolytics.

Induction of c-Fos immunoreactivity in the amygdala of mice expressing anxiety-like behavior after local perfusion of veratrine in the prelimbic medial prefrontal cortex.

Local perfusion of the sodium channel activator veratrine in mouse prelimbic medial prefrontal cortex (PL) induced c-Fos immunoreactivity in the sub-regions of amygdala. Co-perfusion of the NMDA receptor antagonist MK-801 diminished the c-Fos expression. Significant correlations were observed between c-Fos immunoreactivity and behavioral measures in the open-field test. The PL stimulation activates a neural network projecting to the amygdala via NMDA receptor-mediated glutamatergic neurotransmission. Anxiety-like behavior induced after the PL stimulation may be partly mediated through the activation of amygdala.

Riluzole in the prelimbic medial prefrontal cortex attenuates veratrine-induced anxiety-like behaviors in mice.

RATIONALE: We previously demonstrated in mice that the activation of prelimbic medial prefrontal cortex (PL) with the sodium channel activator veratrine induces anxiety-like behaviors via NMDA receptor-mediated glutamatergic neurotransmission. Riluzole directly affects the glutamatergic system and has recently been suggested to have an anxiolytic-like effect in both experimental animals and patients with anxiety disorders. OBJECTIVES: We investigated the effects of co-perfusion of riluzole on veratrine-induced anxiety-like behaviors in mice. METHODS: Extracellular glutamate levels were measured in 7-week-old male C57BL6 mice by using an in vivo microdialysis-HPLC/ECD system, and behaviors were assessed simultaneously in an open field (OF) test. Basal levels of glutamate were measured by collecting samples every 10 min for 60 min. The medium containing drugs was perfused for 30 min, and the OF test was performed during the last 10 min of drug perfusion. After the drug treatments, the drug-containing medium was switched to perfusion of control medium lacking drugs, and then samples were collected for another 90 min. RESULTS: Riluzole co-perfusion attenuated veratrine-induced increase in extracellular glutamate levels in the PL and completely diminished veratrine-induced anxiety-like behaviors. Interestingly, riluzole perfusion alone in the PL did not affect the basal levels of glutamate and anxiety-like behaviors. CONCLUSIONS: Our results suggest that compounds like riluzole that inhibit glutamatergic function in the PL are possible candidates for novel anxiolytics.

Activation of the prelimbic medial prefrontal cortex induces anxiety-like behaviors via N-Methyl-D-aspartate receptor-mediated glutamatergic neurotransmission in mice.

We investigated the possible roles of the prelimbic medial prefrontal cortex (PL) in the regulation of anxiety-like behaviors by pharmacologically activating the terminals of neuronal inputs or postsynaptic efferent neurons with a sodium channel activator veratrine. The extracellular glutamate levels were measured by in vivo microdialysis, and the behaviors were assessed with the open field (OF) test in mice simultaneously. The samples were collected every 10 min for 60 min, as basal levels of glutamate. The medium containing drugs were perfused for 30 min. The OF test was performed in the last 10 min of drug perfusion. After the drug treatments, the perfusion medium containing drugs was switched back to perfusion medium without drugs, and then samples were collected for another 90 min. The extracellular glutamate levels were significantly elevated after local perfusion of veratrine in the PL. At the same time, perfusion of veratrine in the PL produced anxiety-like behaviors in mice. Local coperfusion of a sodium channel blocker, lamotrigine, completely diminished the veratrine-induced elevated extracellular glutamate levels and the behavioral changes. Local coperfusion of an NMDA receptor antagonist, MK-801, but not a non-NMDA (AMPA/kainate) receptor antagonist, CNQX, completely diminished the behavioral changes without any effects on the veratrine-induced elevated extracellular glutamate levels. This study demonstrates that the activation of the PL with veratrine induces anxiety-like behaviors via NMDA receptor-mediated glutamatergic neurotransmission in mice.

Clinical significance of intracapsular and extratumoral venous invasion in hepatocellular carcinoma.

BACKGROUND/AIMS: The current study sought to clarify whether intracapsular venous invasion and extratumoral venous invasion confer different prognostic significance in patients undergoing hepatectomy for hepatocellular carcinoma. METHODOLOGY: A retrospective study of 275 consecutive patients who underwent hepatectomy for hepatocellular carcinoma was conducted. Extratumoral venous invasion was defined as gross or microscopic involvement of vessels within the peritumoral liver tissue, whereas intracapsular venous invasion was defined as microscopic involvement of vessels within the fibrous tumor capsule. The median follow-up time was 64 months. RESULTS: Vascular invasion was found in 104 (38%) of the 275 patients. Intracapsular venous invasion was present in 16 patients and extratumoral venous invasion observed in 88 patients. Overall cumulative survival rates were 64% at 5 years and 45% at 10 years. Vascular invasion was a strong prognostic factor by univariate (p = 0.0001) and multivariate (p = 0.006) analyses. Survival after hepatectomy was significantly worse in patients with extratumoral venous invasion (cumulative 10-year survival rate of 28%) than in patients with intracapsular venous invasion (cumulative 10-year survival rate of 70%; p = 0.0082). CONCLUSIONS: Extratumoral venous invasion adversely influences survival after hepatectomy for hepatocellular carcinoma compared to intracapsular venous invasion.

Histological evaluation of intracapsular venous invasion for discrimination between portal and hepatic venous invasion in hepatocellular carcinoma.

BACKGROUND AND AIM: Histological criteria for intracapsular venous invasion (IVI) that would allow its discrimination between portal and hepatic venous invasion in hepatocellular carcinoma (HCC) have not been established. METHODS: We evaluated IVI immunohistochemically to discriminate between portal and hepatic venous invasion in 89 resected specimens from patients with HCC. IVI was defined as the microscopic involvement of the vessels within the fibrous capsule of HCC. The hepatic venous system was subdivided into the central vein and the sublobular/hepatic vein. Immunohistochemical analysis with the D2-40 monoclonal antibody revealed lymphatic vessels. RESULTS: In non-neoplastic liver tissues, the portal veins (n = 4355) were accompanied by lymphatic vessels (99.7%), bile ductules (100%) and arteries (96%), whereas the central veins (n = 3932) and sublobular/hepatic veins (n = 662) were rarely accompanied by lymphatic vessels (0% and 17%, respectively) and bile ductules (12% and 33%, respectively). In total, 29 IVI foci were detected; three foci were clearly visible within vessels that contained a distinct layer of connective tissue fibers, signifying sublobular/hepatic venous invasion. As the remaining 26 foci were accompanied by lymphatic vessels (26/26 [100%]), bile ductules (21/26 [81%]) and arteries (10/26 [38%]), these foci were considered to reflect intracapsular portal venous invasion rather than venous invasion of the central vein. Intracapsular portal venous invasion was significantly associated with extratumoral portal venous invasion (P < 0.001). CONCLUSIONS: D2-40 immunoreactivity for the histological evaluation of IVI in HCC allows discrimination between portal and hepatic venous invasion for cases in which portal venous invasion predominates.