Adhesiolysis and targeted steroid/local anesthetic injection during epiduroscopy alleviates pain and reduces sensory nerve dysfunction in patients with chronic sciatica.

PURPOSE: The aim of this study was to evaluate the effect of adhesiolysis followed by the injection of steroid and local anesthetic during epiduroscopy on sensory nerve function, pain, and functional disability in patients with chronic sciatica. METHODS: Epidural adhesiolysis, using epiduroscopy, followed by the injection of steroid and local anesthetic, was scheduled in 19 patients with chronic sciatica refractory to lumbar epidural block. Sensory nerve function in the legs was tested with a series of 2000-Hz (Abeta-fiber), 250-Hz (Adelta-fiber), and 5-Hz (C-fiber) stimuli, using the current perception threshold (CPT), and CPT values and intensity of pain and Roland Morris Disability Questionnaire (RMDQ) scores were assessed before and 1 and 3 months after the epiduroscopy. RESULTS: At all frequencies, the CPT values in the affected legs of patients before the epiduroscopy were significantly higher than those in the unaffected legs. Epidural adhesiolysis was successfully performed in 16 of the 19 patients. In these patients, the CPT values at 2000 and 250 Hz, and the pain and RMDQ scores 1 and 3 months after the epiduroscopy were significantly lower than those before the epiduroscopy, while the CPT value at 5 Hz did change. CONCLUSION: Epidural adhesiolysis followed by the injection of steroid and local anesthetic during epiduroscopy alleviated pain, and functional disability, and reduced dysfunction of Abeta and Adelta fibers in patients with chronic sciatica

The effect of dynamic stretching on hamstrings flexibility with respect to the spino-pelvic rhythm

Objectives : To ascertain the dynamic stretch effects of flexibility of the hamstrings on lumbar spine and pelvic kinematics. Background : Tight hamstrings are positively correlated with low back pain. However, it is unclear how flexibility of the hamstrings affects spino-pelvic rhythm. Methods : Twelve healthy men participated in the study. The straight leg raising (SLR) angle, finger floor distance (FFD), and spino-pelvic rhythm was measured before and after the 6-week stretching protocol. The forward bending task was divided into 4 phases. The paired t-test was used to determine significant differences before and after the FFD, SLR angle, lumbar motion, and pelvic motion, and spino-pelvic rhythm in each phase (p<0.05). Results : After 6 weeks of stretching, significant improvements were seen in the FFD with maximum forward bending and in the SLR angle. Total pelvic rotation was also significantly increased in contrast to total lumbar flexion. A decreased spino-pelvic ratio was seen in the final phase. Conclusion : Dynamic stretching could change the spino-pelvic rhythm to a pelvis-dominant motion, indicating that flexible hamstrings are important for preventing low back pain

Prognostic factors for progression of visual field deterioration in patients with primary open-angle glaucoma

Regulatory T cells (Tregs) play an important role in the maintenance of self-tolerance and immune homeostasis. Interleukin-2 (IL-2) is critical for Treg expansion, activity and survival. Previous studies have demonstrated that low-dose IL-2 resulted in the selective expansion of Tregs and the clinical improvement of auto-immune disease. To examine the mechanisms whereby IL-2 affects Treg apoptosis through the intrinsic pathway, we used BH3 profiling, and quantitated mitochondrial apoptotic priming. This pattern suggests that Tregs were more primed than conventional CD4 T cells (Tcons) in a BCL2-dependent manner. Tregs expressed lower levels of BCL2 than Tcons. To examine the functional effects of IL-2, sorted Tregs and Tcons were cultured with different concentrations of IL-2. Low-dose IL-2 (10 IU/mL) lowered priming and increased BCL2 expression in Tregs. However, higher concentrations of IL-2 (>100 IU/mL) were required to increase BCL2 expression and decrease priming in Tcons. Apoptosis assays also revealed that low-dose IL-2 reduced susceptibility to apoptosis only in Tregs. ABT-199, a selective BCL2 inhibitor, enhanced the priming and apoptosis of both Tcells. IL-2 reversed the effects of ABT-199 for Tregs only. This provides further evidence that the inhibition of intrinsic pathway apoptosis mediated by IL-2 in Tregs is dependent on BCL2

Prognostic factors for progression of visual field deterioration in patients with primary open-angle glaucoma

Regulatory T cells (Tregs) play an important role in the maintenance of self-tolerance and immune homeostasis. Interleukin-2 (IL-2) is critical for Treg expansion, activity and survival. Previous studies have demonstrated that low-dose IL-2 resulted in the selective expansion of Tregs and the clinical improvement of auto-immune disease. To examine the mechanisms whereby IL-2 affects Treg apoptosis through the intrinsic pathway, we used BH3 profiling, and quantitated mitochondrial apoptotic priming. This pattern suggests that Tregs were more primed than conventional CD4 T cells (Tcons) in a BCL2-dependent manner. Tregs expressed lower levels of BCL2 than Tcons. To examine the functional effects of IL-2, sorted Tregs and Tcons were cultured with different concentrations of IL-2. Low-dose IL-2 (10 IU/mL) lowered priming and increased BCL2 expression in Tregs. However, higher concentrations of IL-2 (>100 IU/mL) were required to increase BCL2 expression and decrease priming in Tcons. Apoptosis assays also revealed that low-dose IL-2 reduced susceptibility to apoptosis only in Tregs. ABT-199, a selective BCL2 inhibitor, enhanced the priming and apoptosis of both Tcells. IL-2 reversed the effects of ABT-199 for Tregs only. This provides further evidence that the inhibition of intrinsic pathway apoptosis mediated by IL-2 in Tregs is dependent on BCL2

Isoform D of vascular endothelial growth factor in systemic capillary leak syndrome : a case report

Background: Systemic capillary leak syndrome is a rare condition characterized by episodic attacks of hypovolemia due to systemic capillary hyperpermeability, which results in profound hypotension and edema. Although the implication of vascular endothelial growth factor, angiopoietin-2, and C-X-C motif chemokine 10 has been suggested, the pathogenesis of systemic capillary leak syndrome remains unclear. In this report, we describe a case of systemic capillary leak syndrome in which serum isoform D of vascular endothelial growth factor was elevated. To the best of our knowledge, this is the first reported case of systemic capillary leak syndrome in which isoform D of vascular endothelial growth factor is suggested as the plausible biomarker. Case presentation: A 41-year-old Japanese man was transferred to our emergency department. He was hypotensive, tachycardic, and edematous over the trunk and all four limbs. He received aggressive intravenous fluid therapy and underwent fasciotomy of the right forearm to prevent muscle necrosis. A diagnosis of systemic capillary leak syndrome was suspected. The presence of serum monoclonal immunoglobulin G and κ light chain supported this diagnosis. Prevention of hypotensive crises was unsuccessfully attempted with theophylline, intravenous immunoglobulin, high-dose dexamethasone, bortezomib, melphalan, and prednisolone; however, the patient’s attacks dramatically disappeared after the introduction of thalidomide. The serum of the patient was stored soon after the onset of hypotensive crisis and analyzed to profile possible mediators responsible for the capillary leak. The concentration of vascular endothelial growth factor, angiopoietin-2, and C-X-C motif chemokine 10 were all within normal ranges. Meanwhile, we found that isoform D of vascular endothelial growth factor was elevated, which was normalized after the introduction of thalidomide. Conclusions: In our patient, isoform D of vascular endothelial growth factor (instead of vascular endothelial growth factor) may have been a causative factor of hypotensive crises, since isoform D contributes to vascular endothelial growth factor receptor-2 signaling, which is the major mediator of the permeability-enhancing effects of vascular endothelial growth factor. We suggest the measurement of isoform D of vascular endothelial growth factor in patients with systemic capillary leak syndrome in whose serum vascular endothelial growth factor is not elevated

Sideward Peak of Intermediate Mass Fragments in High Energy Proton Induced Reactions

Intermediate mass fragment (IMF) formation in the 12 GeV proton induced reaction on Au target is analyzed by using a combined framework of a transport model (JAM/MF) and a newly developed non-equilibrium percolation (NEP) model. In this model, we can well reproduce the mass distribution of fragments. In addition, the sideward peaked angular distribution would emerge under the condition that the fragment formation time is very short, around 20 fm/c. Within this short time period, the un-heated part of the residual nucleus is kept to have doughnut shape, then the Coulomb repulsion from this shape strengthens the sideward peak of IMF.Comment: 22 pages, Latex, 6 embedded PS figure

The Type Ic Hypernova SN 2002ap

Photometric and spectroscopic data of the energetic Type Ic supernova (SN) 2002ap are presented, and the properties of the SN are investigated through models of its spectral evolution and its light curve. The SN is spectroscopically similar to the "hypernova" SN 1997ef. However, its kinetic energy [$\sim (4-10) \times 10^{51}$ erg] and the mass ejected (2.5-5 $M_{\odot}$) are smaller, resulting in a faster-evolving light curve. The SN synthesized $\sim 0.07 M_{\odot}$ of $^{56}$Ni, and its peak luminosity was similar to that of normal SNe. Brightness alone should not be used to define a hypernova, whose defining character, namely very broad spectral features, is the result of a high kinetic energy. The likely main-sequence mass of the progenitor star was 20-25 $M_{\odot}$, which is also lower than that of both hypernovae SNe 1997ef and 1998bw. SN 2002ap appears to lie at the low-energy and low-mass end of the hypernova sequence as it is known so far. Observations of the nebular spectrum, which is expected to dominate by summer 2002, are necessary to confirm these values.Comment: 10 pages, 4 figures, accepted for publication in ApJL, 30 April 2002 (minor changes to match the accepted version, with figures being colored

Trastuzumab-Based Combination Chemotherapy in Patients with Human Epidermal Growth Factor Receptor-2-Positive Metastatic Carcinoma ex Pleomorphic Adenoma

Background: Carcinoma ex pleomorphic adenoma (CXPA) is a rare histologic subtype of lacrimal gland and submandibular gland cancer. Currently, there is no standard treatment for metastatic CXPA, although some case reports have explored the role of targeted agents in chemotherapy. A few histopathologic analyses have shown that some of these tumors overexpress human epidermal growth factor receptor-2 (HER2), suggesting a potential role for HER2-based therapy. We report here two cases of metastatic CXPA that were treated with trastuzumab-based chemotherapy (IRB approved) with rapid and significant responses. Case Report 1: A 66-year-old male was diagnosed as HER2-positive CXPA of the right lacrimal gland with multiple bone and lymph node metastases. Combination chemotherapy with trastuzumab (Tmab) and nanoparticle albumin-bound paclitaxel (nabPTX) was initiated. A rapid response was confirmed, and after seven cycles of treatment, CR(complete response) was achieved. Case Report 2: A 67-year-old female was diagnosed with HER2 positive CXPA of the right submandibular gland. Multiple pulmonary metastatic lesions were detected after surgery, and combination chemotherapy with Tmab and nab-PTX was initiated. A rapid partial response (PR) was confirmed, and she eventually became disease-free. Conclusion: In the absence of definitive clinical trials, which are unlikely to be performed due to the rarity of HER2-positive CXPA, therapeutic information must be obtained from case reports. Some reports, such as this one, have suggested a potential utility of trastuzumab-based chemotherapy