Breathing Metal-Organic Frameworks Supported by an Arsenic-Bridged 4,4'-Bipyridine Ligand.

Bent ligands bridged by heteroatoms have drawn significant interest as supramolecular coordination architectures. Traditionally, divalent group 16 elements are preferred over trivalent group 15 elements because of the anticipated steric hindrance. In this study, we explore metal-organic frameworks (MOFs) based on dipyridinoarsoles (DPAs), 4,4'-bipyridines bridged with an arsenic atom. An MOF with methyl-substituted DPA collapsed upon solvent removal, whereas that with phenyl-substituted DPA demonstrated breathing behavior due to guest molecule adsorption/desorption. In contrast, MOFs using the phosphorus analogue dipyridinophosphole exhibit inferior adsorption and lack breathing behavior. This is the first study to investigate the interplay among substituents, bridging elements, and dynamic behavior in MOFs using bent group 15 ligands.

Proximal junctional fracture and kyphosis after long spinopelvic corrective fixation for adult spinal deformity.

BACKGROUND: Proximal junctional fractures (PJFx) are the main cause for proximal junctional kyphosis (PJK), a complication of adult spinal deformity surgery. This study investigated risk factors for PJFx when performing long spinopelvic corrective fixation with lateral interbody fusion from T9 to ilium. METHODS: This was a retrospective study of 43 patients with a minimum follow-up of 2 years. Radiographic measurements including thoracic kyphosis (TK), sagittal vertical axis (SVA), T1 pelvic angle (TPA), proximal junctional angle (PJA), lumbar lordosis (LL), lower LL, and pelvic tilt were measured preoperatively, one-month postoperatively, and at final follow up. TK and LL were also measured in a fulcrum backward-bending position preoperatively. RESULTS: At final follow-up, PJK was found in 30/43 patients (69.8%); 20.9% of the cases had PJFx (9 patients). TPA (preoperative, and one-month postoperative) was significantly higher in the PJFx group than in the other groups. The differences in TPA, TK, and PJA between preoperative and one-month postoperative measurements in the PJFx group were significantly higher than those in the other groups. At final follow up, SVA was significantly higher in the PJFx group than in the "PJK without PJFx" group. TPA and TK were significantly higher in the PJFx group than in the other groups. PJA was significantly different between all groups. CONCLUSION: Preoperative large TPA was the only risk factor for PJFx. Preoperative flexibility of the thoracolumbar spine and overcorrection of sagittal deformity were not related to PJFx or PJK.

A case report of revision occipital-cervical fusion after atlanto-axial instrumentation failure for neurofibromatosis type I.

BACKGROUND: Neurofibromatosis type 1 is an autosomal dominant genetic disease with characteristic café-au-lait spots, neurofibroma, and dystrophic changes in the bones. However, complications involving atlanto-axial dislocation are rare. CASE PRESENTATION: We report a case of neurofibromatosis with atlanto-axial dislocation. The chief complaints were numbness of the upper limb and gait disturbance. We performed short fusion using the Brooks method. However, recurrence of the dislocation was found after 5 months recovery, and the patient underwent posterior fusion from the occipital bone to C4. Thereafter, she had a good postoperative course. CONCLUSIONS: Neurofibromatosis patients often exhibit a low bone mineral density because of dystrophic changes, and are prone to fragile bones. In the present case, the use of long fusion at the first surgery may have helped to form a strong fusion of fragile bone.

Comparison of patients with diagnosed and suspected sacral insufficiency fractures.

BACKGROUND: Patients with sacral insufficiency fractures can have a range of symptoms, and because these fractures are difficult to detect using plain radiographs, it can be tough to make a definitive diagnosis of fracture early after injury. The aim of this study was to compare the diagnosis and treatment of patients with known sacral insufficiency fractures to those with suspected insufficiency fractures to clarify the features of sacral insufficiency fractures. METHODS: We compared patients with sacral insufficiency fractures (S group) to those with suspected insufficiency fractures (N group) using demographic data, symptoms, time to definitive diagnosis, radiological methods, and treatments. RESULTS: Patients in the S group were older than those in the N group (p = 0.0042) and showed less localized sacral pain (p = 0.0042). Almost all of the patients in the S group (74%) required magnetic resonance imaging for definitive diagnosis. CONCLUSIONS: Sacral insufficiency fractures should not be diagnosed based on the site of pain or using plain radiographs. Patient age and magnetic resonance imaging are more informative to obtain a definitive diagnosis of sacral insufficiency fractures.

Limaprost or Pregabalin: Preoperative and Postoperative Medication for Pain due to Lumbar Spinal Stenosis.

PURPOSE: We aimed to evaluate the incidence of (and risk factors for) postoperative pregabalin and/or limaprost to treat persistent numbness and/or pain of the lower extremities after lumbar spinal stenosis (LSS) surgery. METHODS: Medical records of 329 patients (168 men, 161 women; average age 70 years) were retrospectively reviewed for data on the duration of LSS diagnosis; LSS disease; preoperative medication (limaprost, pregabalin, or combined limaprost/pregabalin; duration); symptoms; preoperative/postoperative intermittent claudication (IC); operation type; and postoperative medication and period. RESULTS: Limaprost, pregabalin, and combined limaprost/pregabalin were prescribed preoperatively for 43%, 7%, and 5% of patients, respectively. At an average of 21 months postoperatively, limaprost, pregabalin, and combined therapy were prescribed in 11%, 8%, 4% of patients, respectively. Medication requirement was significantly lower postoperatively than preoperatively (P < 0.0001). Significant risk factors for required postoperative medication were required preoperative medication (odds ratio [OR] 3.088, 95% confidence interval [CI] 1.679 to 5.681]; postoperative period (OR 1.063, 95% CI 1.031 to 1.096); and postoperative IC (OR 3.868, 95% CI 1.481 to 10.103). A negative impact from postoperative medication was seen in patients who had undergone decompression surgery (OR 0.589, 95% CI 0.377 to 0.918). CONCLUSIONS: Overall, 23% of LSS patients required medication for pain and/or numbness at 21 months postoperatively. Significant factors portending required postoperative medication were preoperative medication, longer postoperative period, and postoperative IC. A negative influence from postoperative medication was seen in patients who had undergone decompression surgery without fusion.

Comparison of Postoperative Results With Prognostic Nutritional Index for Lumbar Disc Herniation.

INTRODUCTION: The prognostic nutritional index (PNI) is an immune-nutritional index simply provided by a blood test. We retrospectively compared the postoperative outcomes of patients with lumbar disc herniation divided into two groups according to the PNI. MATERIALS AND METHODS: Seventy-three patients who underwent surgery at our hospital were included in the study. All patients had herniation between one of the L3/4, L4/5, or L5/S intervertebral discs and underwent one posterior lumbar interbody fusion. These patients were divided into two groups: patients with a PNI of <50 (poorly nourished (PN) group) and patients with a PNI of ≥50 (well-nourished (WN) group). Evaluation items included patient background characteristics, operative time, blood loss, postoperative complications, and length of hospital stay. RESULTS: The results showed that the body mass index was significantly higher in the WN group than in the PN group (p=0.0221). The rates of collagen disease, steroid use, and postoperative complications were significantly higher (p=0.0475, p=0.0073, and p=0.0211, respectively) and the length of hospital stay was significantly longer (p=0.021) in the PN group than in the WN group. CONCLUSION: In conclusion, this study indicates that postoperative complications and the length of hospital stay are significantly worse in PN patients than in WN patients.

Posterior-approach vertebral replacement with rectangular parallelepiped cages (PAVREC) for the treatment of osteoporotic vertebral collapse with neurological deficits.

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: To assess the efficacy of a new spinal reconstruction technique (posterior-approach vertebral replacement with rectangular parallelepiped cages: PAVREC) for the treatment of osteoporotic late vertebral collapse with neurological deficits. SUMMARY OF BACKGROUND DATA: Poor bone quality and medically complicated situations obfuscate precise treatment for paraplegia caused by osteoporotic vertebral collapse. Recently, posterior-approach corpectomy and replacement with a cylindrical cage have been proposed. However, postoperative cage subsidence and kyphosis progression frequently occurs. METHODS: Surgical invasiveness, perioperative complications, and clinical and radiographic outcomes in a total of 19 consecutive patients with osteoporosis (7 men and 12 women; mean age, 75 y) who underwent PAVREC with a mean follow-up period of 45.6 months (range, 16-79 mo) were reviewed. The affected vertebral levels ranged from T12-L4. The mean bone mineral density of the femoral neck was 0.611±0.077 g/cm(2) (mean±SD). RESULTS: Mean operative time was 261 minutes (range, 155-326 min). Mean blood loss was 664 mL (range, 197-1595 mL). There were no reported surgical complications. Neurological deficits evaluated with the Frankel grading score improved >1 grade after surgery in all patients. Mean preoperative visual analog scale scores for back or leg pain (7.2; range, 6-9) significantly improved after surgery (1.4; range, 0-2) (P<0.05). Local kyphosis improved from a mean of 24.6 degrees before surgery to a mean of 1.5 degrees after surgery (P< 0.05), and it was maintained at a mean of 2.5 degrees at the final follow-up. Although screw loosening, cage subsidence, and subsequent vertebral fracture were seen in several cases, no additional surgeries were needed. Solid bony fusion was confirmed in all cases. CONCLUSIONS: PAVREC provided a satisfactory clinical and radiologic outcome without severe complications. This procedure can be a treatment option for osteoporotic vertebral collapse and an alternative to an anterior-approach or single posterior-approach reconstruction with a cylindrical cage.

Robust and highly emissive copper(I) halide 1D-coordination polymers with triphenylarsine and a series of bridging N-heteroaromatic co-ligands.

Various 1D-coordination polymers with dinuclear rhombic {Cu2X2} cores (X = Br, I) were synthesized using a spontaneous evaporation method employing triphenylarsine (AsPh3) and six types of bidentate N-heteroaromatic co-ligands. The coordination polymers exhibited intense emission even at 298 K (quantum yield: up to 0.60), and their emission color was dependent on the N-heteroaromatic co-ligand. The emission efficiencies of these coordination polymers were higher than those of the discrete complexes with AsPh3 and monodentate N-heteroaromatic co-ligands reported in our previous work. In addition, the luminescence of these coordination polymers was more resistant to mechanical stimuli than that of the discrete ones.

Surgical technique of spine-shortening vertebral osteotomy for adult tethered cord syndrome: a case report and review of the literature.

BACKGROUND: Miyakoshi et al. reported three cases of tethered cord syndrome treated by spine-shortening vertebral osteotomy, which provided relief of the patients' symptoms with no complications. Although the details of these cases were described in a previous report, the surgical technique was not thoroughly explained. In the present report, we describe the details of our procedure with reference to a fourth case. CASE PRESENTATION: A 47-year-old Asian woman was admitted to our hospital with a 1-year history of worsening leg numbness and urinary dysfunction. Magnetic resonance imaging revealed a low-lying conus medullaris extending to the level of S2 and surrounded by fat tissue at that level. We diagnosed her condition as adult tethered cord syndrome, and spine-shortening vertebral osteotomy was planned. The target level for the osteotomy was L2. Bilateral pedicle screw implants were placed at L1 and L3 using an anterior-posterior image intensifier. In this procedure, it is essential to use monoaxial screws inserted exactly parallel to the rostral endplates of each vertebral body; this ensures appropriate alignment between the L1 caudal endplate and the L2 osteotomy surface. The upper one-third of the lamina of L2 was resected, and the bilateral two-thirds of the pedicle of L2 was removed with a surgical air drill. After exposure of the lateral side of the L1-2 disc, discectomy was performed with a knife and curette. Following complete discectomy of L1-2, the upper vertebral body of L2 was removed with a surgical air drill. After complete removal of the vertebral body, a straight rod was connected to two screws and applied pressure between the screws. Two polyethylene tapes were applied to the L2 lamina and bilateral rods. CONCLUSION: Spine-shortening osteotomy that preserves the caudal one-third of the pedicle and lamina with one-above and one-below instrumentation successfully reduced the spinal cord tension without causing neural damage.

A Comparison of Hidden Blood Loss Between Multilevel Posterior Lumbar Interbody Fusion and Lateral Lumbar Interbody Fusion in Adult Spinal Deformity Patients.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: This study aimed to compare transfusion and blood loss volumes, particularly hidden blood loss volume, in adult spinal deformity patients undergoing lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF). Corrective surgery for adults with spinal deformity patients can be performed via the traditional posterior approach (PLIF) or minimally invasive lateral approach (LLIF). LLIF is associated with longer or comparable operation times and lower intraoperative blood loss. However, hidden blood loss has not been compared between the two procedures. METHODS: We compared hidden blood loss and other blood loss volumes, transfusion volume, operation time, and radiographic surgical outcomes between LLIF patients (n = 71) and PLIF patients (n = 33) who underwent surgery in our institution from September 2011 to June 2018. All patients provided informed consent in accordance with the Declaration of Helsinki. Institutional ethics committee conducted this study approval was obtained. RESULTS: Transfusion volume and intraoperative and total blood loss volumes were significantly higher in the PLIF group. Operation time and HBL did not significantly differ. The hidden blood loss-to-intraoperative blood loss ratio was significantly higher in the LLIF group (113% vs 60%; P = .004). Radiographic measures of outcome were significantly better after surgery than before in both groups. CONCLUSIONS: Although intraoperative blood loss was less with LLIF than PLIF, HBL was similar between the approaches. Patients undergoing LLIF should be followed closely for postoperative anemia even if intraoperative blood loss is low.

Long-term follow-up of cases of rotator cuff tear treated conservatively.

BACKGROUND: This study clarified the long-term results of conservative treatment of rotator cuff tears. MATERIALS AND METHODS: This study focused on 103 shoulders diagnosed with rotator cuff tears by magnetic resonance imaging or arthrography at our institution from 1996 to 1999. Sixty-five shoulders were followed up by telephone survey and 43 of these shoulders were evaluated; 11 shoulders were excluded because the patient had died, 10 shoulders because of severe dementia, and 1 shoulder that had undergone trauma. The mean patient age for these 43 shoulders at the time of diagnosis was 62 years, and the mean follow-up period was 13 years. The pain score (30 points) and the activities-of-daily-life score (10 points) of the Japanese Orthopaedic Association shoulder scoring system were determined. RESULTS: The mean pain score was 25.4 points, and the proportion of patients with no pain or with only slight pain was 88%. The mean score for activities of daily life was 9.4 points, and the proportion of patients with no disturbance in daily life was 72%. The patients with fewer than 20 points out of the possible 40 points (30 points for pain score plus 10 points for activities-of-daily-life score) were significantly younger than the other patients. CONCLUSIONS: In cases of rotator cuff tears treated conservatively, at 13 years after diagnosis, about 90% of patients had no or only slight pain and about 70% had no disturbance in activities of daily life. However, the younger patients tended to have more significant pain or disorder in daily life more than 10 years after diagnosis.

Diagnosis and Surgical Treatment of Thoracic Dorsal Arachnoid Web: A Report of Two Cases.

INTRODUCTION: An arachnoid web (AW) is a relatively rare disease and shows clinical symptoms and radiological findings similar to those of an arachnoid cyst (AC) or spinal cord herniation (SCH). Since the operative procedures for an AW are generally different from those intrathecal disorders, correct preoperative differential diagnosis is important. The purposes of this study were to report the usefulness of magnetic resonance imaging (MRI) and computed tomography (CT) myelography for diagnosing AW and to show the histological findings and clinical results. Case Description. Two patients, a 79-year-old man and a 43-year-old woman, are presented. The primary diagnoses were AC with ossification of the ligamentum flavum and epidural hematoma, respectively, in previous hospitals. They were finally diagnosed by the characteristic MRI and CT myelogram finding called the "scalpel sign." Histological findings showed epithelial cells and fibrous tissue derived from arachnoid tissues and microcalcifications. After surgery, the scalpel sign has vanished, and aggravation of their symptoms was prevented. CONCLUSION: An AW is refractory, but early detection by MRI and CT myelography and early treatment improve outcomes after surgery.

Sarcomere length of torn rotator cuff muscle.

BACKGROUND: Sarcomere length is one of the factors related to the contractile ability of muscle. There is no report about sarcomere length of torn rotator cuff muscles. The purpose of this study was to clarify sarcomere length of torn rotator cuff muscles. MATERIALS AND METHODS: Twenty-eight embalmed cadaver shoulders (14 shoulders with intact rotator cuff and 14 shoulders with full-thickness rotator cuff tears: an isolated tear of the supraspinatus in 3, a combined tear of the supraspinatus and infraspinatus in 4, and a combined tear of the supraspinatus, infraspinatus and subscapularis in 7) were used in this study. Muscle fiber length was measured using a digital caliper. Sarcomere length was measured by laser diffraction method. RESULTS: Muscle fiber lengths of the supraspinatus and infraspinatus (33.0 +/- 6.5 mm and 61.5 +/- 14.0 mm, respectively) in the cuff tear group were significantly shorter than those in the intact cuff group (56.9 +/- 10.1 mm and 74.2 +/- 10.0 mm: P < .001 and P = .010). The sarcomere lengths of these muscles were 3.00 +/- 0.44 microm and 3.12 +/- 0.45 microm in the intact cuff group and 2.90 +/- 0.34 microm and 3.01 +/- 0.34 microm in the cuff tear group. The sarcomere lengths showed no significant difference (P = 0.46 and P = .37). CONCLUSION: The sarcomere lengths of the supraspinatus and infraspinatus with torn tendons were not significantly different from those with intact tendons, although the muscle fiber lengths were significantly shorter with torn tendons.

Hydrocephalus after foramen magnum decompression for Chiari I malformation successfully treated with the aspiration of pseudomeningocele: a case report.

BACKGROUND: Pseudomeningocele or cerebrospinal fluid leakage is one of the most common complications of foramen magnum decompression with duraplasty for Chiari I malformation. Usually, cerebrospinal fluid leakage is treated with lumbar drainage and/or secondary suture. However, if hydrocephalus occurs, spinal drainage may cause brain herniation. CASE PRESENTATION: A 54-year-old Japanese woman presented to our hospital with a 10-month history of bilateral finger extension weakness and clumsiness. Magnetic resonance imaging showed displacement of her cerebellar tonsils below the foramen magnum level, with syringomyelia presenting from the C4 to T8 level. Suboccipital craniectomy and C1 laminectomy with duraplasty were performed under general anesthesia. At 1 month after discharge, she again presented to our hospital due to severe headache and nausea. Magnetic resonance imaging of her cervical spine showed pseudomeningocele compressing her cerebellum and spinal cord. Magnetic resonance imaging of her brain also showed ventriculomegaly. Pseudomeningocele aspiration was performed, with 25 ml of fluid removed under X-ray control. Immediately after aspiration her headache and nausea decreased, and she reported improvement in her symptoms with increasing bilateral finger extension strength and decreasing bilateral upper extremity numbness at her 1-year follow-up. CONCLUSIONS: Although there is a considerable risk of meningitis with the aspiration procedure of pseudomeningocele, an aspiration procedure may be an easy and effective treatment option for postoperative hydrocephalus after suboccipital craniotomy with duraplasty in a patient treated for Chiari I malformation.

Comparison of Posterior Lumbar Interbody Fusion and Microendoscopic Muscle-preserving Interlaminar Decompression for Degenerative Lumbar Spondylolisthesis With >5-Year Follow-up.

STUDY DESIGN: Retrospective analysis of prospectively collected observational multicenter data. OBJECTIVE: To compare the clinical results and rates of revision surgery after posterior lumbar interbody fusion (PLIF) and microendoscopic muscle-preserving interlaminar decompression (ME-MILD) in patients with single-level, mild degenerative lumbar spondylolisthesis (DLS) and follow-up of at least 5 years. SUMMARY OF BACKGROUND DATA: Surgery for symptomatic DLS remains controversial. Evaluating long-term results may reveal problems such as adjacent segmental diseases of the PLIF and decreased quality of life because of slippage and restenosis of the ME-MILD. METHODS: We enrolled 116 patients who underwent PLIF (79 patients) or ME-MILD (37 patients). Operative times, blood losses, surgical complications, Short-Form 36 (SF-36), Japanese Orthopedic Association (JOA) score, the JOA Back Pain Questionnaire (JOABPEQ), visual analog scales (VAS), and Zurich Claudication Questionnaire (ZCQ) were evaluated. RESULTS: PLIF was observed to require significantly longer operative times and entailed greater operative blood losses than did ME-MILD (151.1 vs. 119.9 min; 202.2 vs. 6.4 mL, respectively). Surgery-related complications were identified in 3 cases in the PLIF group and 2 cases in the ME-MILD group. Seventy-eight patients (50 and 28 patients in the PLIF and ME-MILD groups, respectively) were successfully followed-up for >5 years. The follow-up rate was 67.2%. No significant differences between the groups were found in terms of preoperative and postoperative JOA scores, postoperative JOABPEQ, VAS, or ZCQ. Significant improvements in JOA scores were observed in both groups. Significant improvements in the SF-36 were observed in all subscales except in role physical, general health, vitality, and mental health in the ME-MILD group. Revision surgical procedures were performed in 2 patients in the ME-MILD group and 4 patients in the PLIF group. CONCLUSIONS: PLIF and ME-MILD resulted in equivalent improvements in SF-36 and JOA scores. There were no differences in revision surgery rates among patients with single-level, mild DLS. LEVEL OF EVIDENCE: Level III-a retrospective analysis.

Perioperative Medical Complications after Posterior Approach Spinal Instrumentation Surgery for Osteoporotic Vertebral Collapse: A Comparative Study in Patients with Primary Osteoporosis and Those with Secondary Osteoporosis.

STUDY DESIGN: A retrospective comparative study. PURPOSE: To compare perioperative medical complications after posterior approach spinal instrumentation surgery for osteoporotic vertebral collapse (OVC) between patients with primary osteoporosis and those with secondary osteoporosis. OVERVIEW OF LITERATURE: With increased aging of society, the demand for instrumentation surgery for an osteoporotic spine has been increasing. However, no studies have compared the rates or severities of perioperative complications after spinal instrumentation surgery between patients with primary osteoporosis and those with secondary osteoporosis. METHODS: Ninety-one patients with OVC aged ≥50 years (23 males and 68 females) who underwent posterior approach vertebral replacement with cages or posterior spinal fusion combined with vertebroplasty were divided into primary (n=56) and secondary (n=35) osteoporosis groups. Bone mineral density (BMD), osteoporosis treatment prior to OVC, operative invasiveness, and perioperative medical complications were compared. RESULTS: Diabetes mellitus (51.4%) was the most common cause of secondary osteoporosis, followed by glucocorticoid use (22.9%). No significant differences were seen in terms of age, gender, BMD, osteoporosis treatment, or operative invasiveness, including the number of levels fused, estimated blood loss, and number of patients requiring transfusion. No significant difference in the incidence of perioperative complications were observed between the primary and secondary osteoporosis groups (16.1% vs. 22.9%). However, surgical site infection (SSI) was significantly more frequently seen in the secondary osteoporosis group (11.4%) than in the primary osteoporosis group (1.8%; p<0.05). One patient in the secondary osteoporosis group developed methicillin-resistant Staphylococcus aureus infection that ultimately required instrument removal. CONCLUSIONS: The overall incidence of perioperative medical complications after posterior approach spinal instrumentation surgery for OVC was comparable between the primary and secondary osteoporosis groups under conditions of similar background characteristics and operative invasiveness. However, SSI (particularly more severe cases) occurred more frequently in patients with secondary osteoporosis.

Surgical intervention for vertebral metastases may benefit lung cancer patients no less than other patients: a retrospective study.

BACKGROUND: Spinal metastasis is considered to have a worse prognosis in lung cancer than in other cancers, but recent clinical studies report improved overall survival of lung cancer. We compared the postoperative prognoses of vertebral metastatic tumors from lung with other types of cancer. METHODS: From 2011 to 2015, 31 Japanese patients (mean age 73 years, range 55-88 years; 19 males, 12 females) underwent surgery for spinal metastasis at our center. We observed patients retrospectively in March 2016, dividing them into groups by cancer type: lung (LK group, n = 10); prostate, breast, or thyroid (PB group, n = 12); and other (OT group, n = 9). We compared survival and revised Tokuhashi score, which provides a basis for choosing a treatment course. Neurologic status was graded before and after surgery using the Frankel system. RESULTS: Mean follow-up was 16.5 months (range 1-62 months). Only seven of 31 patients (22.6%) were alive at final follow-up. Frankel grade significantly improved postoperatively only in the LK (P = 0.01) and PB (P = 0.048) groups. Revised Tokuhashi score differed across groups (P < 0.0001), and was significantly lower in the LK group than in the PB group (P = 0.00) and OT group (P = 0.02). Postoperative survival was significantly shorter in the LK group than in the PB group (P = 0.01) but did not differ between the LK and OT groups. CONCLUSIONS: The revised Tokuhashi score may underestimate the survival of lung cancer patients, who may derive the same benefit from surgical intervention as those with vertebral metastasis from other cancer types.

Sacral stress fracture in an amateur rugby player: a case report.

BACKGROUND: Sacral stress fracture is an uncommon cause of back pain. The majority of previously reported cases have been in runners. The purpose of this case report was to describe a case of sacral stress fracture in an amateur rugby player. CASE PRESENTATION: A healthy 18-year-old Japanese boy who was a rugby player presented with a 3-week history of lumbago. Sagittal and axial magnetic resonance imaging failed to reveal any reason for lumbago in his lumbar region. On his second presentation, 4 weeks later, his lumbago was so severe that he could not walk without a cane. A second magnetic resonance imaging revealed bone marrow edema with T1-weighted hypointensity and short inversion time inversion recovery hyperintensity at his left sacrum in coronal sections, consistent with stress fracture. Pain was relieved with rest and 1 year later he was able to return to rugby without lumbago or left buttock pain. CONCLUSIONS: Sacral stress fracture can cause low back pain in athletes. Coronal magnetic resonance imaging appears to be an effective option for diagnosis.

Acute neck pain caused by pseudogout attack of calcified cervical yellow ligament: a case report.

BACKGROUND: Calcification of the yellow ligament sometimes compresses the spinal cord and can induce myelopathy. Usually, the calcification does not induce acute neck pain. We report a case of a patient with acute neck pain caused by calcium pyrophosphate dihydrate in a calcified cervical yellow ligament. CASE PRESENTATION: A 70-year-old Japanese woman presented with acute neck pain. She had a moderately high fever (37.5 °C), and her neck pain was so severe that she could not move her neck in any direction. Computed tomography showed a high-density area between the C5 and C6 laminae suspicious for calcification of the yellow ligament. Magnetic resonance imaging showed intermediate-signal intensity on T1-weighted imaging and high-signal intensity on T2-weighted imaging surrounding a low-signal region on both T1- and T2-weighted imaging with cord compression. There was a turbid, yellow fluid collection in the yellow ligament at the time of operation. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament. CONCLUSIONS: Pseudogout attack of the cervical yellow ligament is rare, but this clinical entity should be added to the differential diagnosis of acute neck pain, especially when calcification of the yellow ligament exists.

A Microfluidic Channel Method for Rapid Drug-Susceptibility Testing of Pseudomonas aeruginosa.

The recent global increase in the prevalence of antibiotic-resistant bacteria and lack of development of new therapeutic agents emphasize the importance of selecting appropriate antimicrobials for the treatment of infections. However, to date, the development of completely accelerated drug susceptibility testing methods has not been achieved despite the availability of a rapid identification method. We proposed an innovative rapid method for drug susceptibility testing for Pseudomonas aeruginosa that provides results within 3 h. The drug susceptibility testing microfluidic (DSTM) device was prepared using soft lithography. It consisted of five sets of four microfluidic channels sharing one inlet slot, and the four channels are gathered in a small area, permitting simultaneous microscopic observation. Antimicrobials were pre-introduced into each channel and dried before use. Bacterial suspensions in cation-adjusted Mueller-Hinton broth were introduced from the inlet slot and incubated for 3 h. Susceptibilities were microscopically evaluated on the basis of differences in cell numbers and shapes between drug-treated and control cells, using dedicated software. The results of 101 clinically isolated strains of P. aeruginosa obtained using the DSTM method strongly correlated with results obtained using the ordinary microbroth dilution method. Ciprofloxacin, meropenem, ceftazidime, and piperacillin caused elongation in susceptible cells, while meropenem also induced spheroplast and bulge formation. Morphological observation could alternatively be used to determine the susceptibility of P. aeruginosa to these drugs, although amikacin had little effect on cell shape. The rapid determination of bacterial drug susceptibility using the DSTM method could also be applicable to other pathogenic species, and it could easily be introduced into clinical laboratories without the need for expensive instrumentation.