Long-Term Results of Posterior Vertebral Column Resection for Severe Thoracolumbar Kyphosis with Achondroplastic Patients: A Case Series

Background and Objectives: Thoracolumbar kyphosis is one of the most frequent skeletal manifestations in patients with achondroplasia. Few papers have been published on the surgical treatment of this condition, especially in skeletally mature patients. With this study, we presented a retrospective case series of long-term surgical results for achondroplastic patients with severe thoracolumbar kyphosis. This study was conducted to evaluate the outcome of surgical treatment for thoracolumbar kyphosis in patients associated with achondroplasia presenting with paraparesis. Materials and Methods: Three patients with achondroplasia who developed neurologic deficits due to severe thoracolumbar kyphosis and underwent surgical treatment were evaluated (mean age 22.3 years; mean follow-up 9.3 years). All patients were treated with posterior vertebral column resection (p-VCR) of hypoplastic apical vertebrae with a cage and segmental instrumentation. Neurologic outcomes (JOA scores), correction of kyphosis, and operative complications were assessed. Results: All patients had back pain, neurological deficits, and urinary disturbance before surgery. The average preoperative JOA score was 8.3/11 points, which was improved to 10.7/11 points at the final follow-up (mean recovery rate 83%). All patients obtained neurologic improvement after surgery. The mean preoperative kyphotic angle was 117 degrees (range 103 degrees-126 degrees). The postoperative angles averaged 37 degrees (range 14 degrees-57 degrees), resulting in a mean correction rate of 67%. All patients had postoperative complications such as rod breakage and/or surgical site infection. Conclusions: The long-term results of p-VCR were acceptable for treating thoracolumbar kyphosis in patients with achondroplasia. To perform this p-VCR safely, spinal navigation and neuromonitoring are inevitable when resecting non anatomical fused vertebrae and ensuring correct pedicle screw insertion. However, surgical complications such as rod breakage and surgical site infection may occur at a high rate, making informed consent very important when surgery is indicated

Holographic QCD and Pion Mass

To realize massive pions, we study variations of the holographic model of massless QCD using the D4/D8/anti-D8 brane configuration proposed by Sakai and Sugimoto. We propose deformations which break the chiral symmetry explicitly and compute the mass of the pions and vector mesons. The observed value of the pion mass can be obtained. We also argue a chiral perturbation corresponding to our deformation.Comment: 23pages, minor changes, references adde

気管支喘息におけるハウスダストアレルギー. 血清IgE値とIgE抗体価と年齢との関連

Serum IgE levels and IgE antibody values in relation to patient age were examined in 50 patients with house dust mite (HDm) sensitive asthma, 1. IgE antibody values to HDm were highest in patients between the ages of 10 and 19, and the　values generally low in those over the age of 40. 2. High IgE antibody values to HDm　were accompanied by high serum IgE levels in patients between 10 and 19. IgE antibody values and serum IgE levels were in general low in patients over age 40. In patient under　age 9, serum IgE levels were less than 500 IU/ml in 5 of the 10 subjects despite an increased value of IgE antibodies to HDm. These results suggest that an increased　production of IgE antibodies to HDm is usually accompanied by an increased production of total IgE in younger subjects. However, an increase in production of IgE antibodies is not always related to an increase in production of total IgE in patients under age 9. The results also show that production of IgE antibodies to HDm and total IgE is in general low in older patients despite the hyperreactivity to HDm.ハウスダストが原因抗原であるアトピー型気管支喘息50例を対象に,血清IgE値とIgE抗体価を年齢との関連のもとに検討した｡1.IgE抗体価は10-19才の年齢層の症例において最も高く,一方40才以上の症例では全般的に低い傾向が見られた｡2.10-19才の年齢層の症例では,IgE抗体価の高値と同時に血清IgE値も高い値を示したが,40才以上の症例では,IgE抗休価および血清IgE値いずれも10-19才の症例に比べ全般的に低い値を示した｡9才以下の症例では,IgE抗体価の高値にもかかわらず,血清IgE値は比較的低く,500IU/ml以下を示した症例が10例中5例に観察された｡これらの結果は,若年症例では,IgE抗体の産生亢進と総IgEの産生亢進が同時に見られること が多いが,9才以下ではIgE抗体産生亢進に総IgE産生亢進が必ずしもともなわない場合があることを示している｡また,40才以上の症例では,ハウスダストに対する過敏性は有しているものの,IgE抗体価および血清IgEは全般的に低い値を示す傾向が示唆された

気管支喘息における気道炎症反応の臨床的意義｡慢性閉塞性細気管支炎との比較検討

Clinical significanoce of airway inflammation was assessed in 28 patients with bronchial asthma, and the results were compared with those in 9 patients with chronic obstructive bronchiolitis (COB). 1. Total cell number in bronchoalveolar lavage(BAL) fluid was markedly increased in patients with COB (51.0×10(6)), which was significantly greater than that in those with bronchial asthma (9.6×10(6) ). 2. The proportion of BAL macrophages was significantly higher in patients with bronchial asthma than in those with COB. However, the, absolute number of BAL macrophages was not significantly different between them. 3. The proportion of BAL lymphocytes was higher in patients with bronchial asthma than in those with COB, but this difference was not signifcant. In contrast, the absolute number of BAL lymphocytes was significantly greater in patients with COB than in those with bronchial asthma. 4. The proportion and the number of BAL neutrophils were markedly increased in patients with COB compared to those with bronchial asthma. 5. The proportion and the number of BAL eosinophils were higher in patients with bronchial asthma than in those with COB, although these defferences were not significant. The results suggest that airway inflammation in bronchial asthma is not so intensive as that in COB.気管支喘息28例および慢性閉塞性細気管支炎9例を対象に,気道炎症反応の臨床的意義について検討を加えた｡1.気管支肺胞洗浄(BAL)液中の総細胞数は,慢性閉塞性細気管支炎において著明に増加しており(51.0×10(6)),気管支喘息(9.6×10(6))との間に有意の差が見られた｡2.BAL液中マクロファージの頻度は気管支喘息において,慢性閉塞性細気管支炎に比べ有意に高い値を示したが,絶対数での比較では両疾患群間に有意の差は見られなかった｡ 3.BAL液中リンパ球の頻度は,気管支喘息においてやや高い傾向が見られたが,絶対数の比較では慢性閉塞性細気管支炎において有意に高い値であった｡ 4.BAL液中の好中球は,その頻度および絶対数とも慢性閉塞性細気管支炎において著明に増加しており,これは気管支喘息と比べ有意に高い値であった｡ 5.BAL液中好酸球の頻度および絶対数は,気管支喘息においてやや高い値であったが,両疾患群間に有意の差は見られなかった｡以上の結果より,気管支喘息における気道炎症反応は,慢性閉塞性細気管支炎ほど高度ではない ことが明らかにされた

Multi-Pronged Strings and BPS Saturated Solutions in SU(N) Supersymmetric Yang-Mills Theory

Extending our previous work on SU(3), we construct spherically symmetric BPS saturated regular configurations of N=4 SU(N) supersymmetric Yang-Mills theory preserving 1/4 supersymmetry, and investigate their features. We also give exact solutions in the case some of the free parameters of the general solutions take certain values. These field theory BPS states correspond to the string theory BPS states of multi-pronged strings connecting N different D3-branes by regarding the N=4 supersymmetric Yang-Mills theory as an effective field theory on parallel D3-branes. We compare our solutions with multi-pronged strings in string picture.Comment: 38 pages, 9 eps figures, LaTeX, minor changes, a reference adde

Hand-assisted laparoscopic splenectomy for a huge splenic vascular lesion with aneurysms in a patient with impending Kasabach-Merritt syndrome-like phenomenon

Splenic vascular lesions are relatively rare and are usually found incidentally. However, the vascular lesions associated with Kasabach-Merritt syndrome, such as hemangioma, can be life-threatening. We herein describe the case of a young adult female patient with a huge splenic vascular lesion, aneurysms of the splenic artery, and increased plasma levels of fibrin/fibrinogen degradation products and D-dimers. Hand-assisted laparoscopic splenectomy was performed, after which the coagulopathy was drastically improved. Minimally invasive surgical intervention such as hand-assisted laparoscopic splenectomy should be considered as the first treatment choice in such a case

老年者気管支喘息における液性および細胞性免疫反応について

Humoral and cellular immune responses in bronchial asthma were examined by comparing the results of older asthmatics (group OA) with those of older healthy subjects (group OH) and of younger asthmatics (group YA). In humoral immune response, IgE-mediated immune system expressed by elevated serum IgE levels and IgE antibodies for house dust mite (HDm) and/or Candida albicans was clearly found in older asthmatics, while there was no finding showing the presence of IgE-mediated immune response in older healthy subjects. There was no significant difference in levels of serum IgG and IgA among the three groups. However, the serum IgM level was significantly lower in older asthmatics than in younger asthmatics. IgE antibodies to HDm and/or Candida albicans were more frequently found in older asthmatics compared with older healthy subjects. In contrast, IgG(4) antibodies to HDm were not different among the three groups. IgG(4) antibodies to Candida albicans were significantly higher in both older groups than in younger group. However, there was no significant difference between asthmatic and healthy subjects in the elderly. Delayed skin reaction to PPD was significantly more decreased in older asthmatics. These results show that bronchial asthma in the elderly is characterized by the presence of IgE-mediated immune response and by the changes of immune response with aging.気管支喘息における液性および細胞性免疫反応について,老年者気管支喘息,老年者健常人,および若年者気管支喘息の間で比較検討を行った｡1.まず,液性免疫では,血清IgE値高値,ハウスダストやカンジダに対するIgE抗体陽性などのIgE系反応は,老年者気管支喘息においては明らかに観察されたが,老年者健常人では全く観察されなかった｡血清IgGおよびIgA値には3者間に有意の差は見られなかったが,血清IgMは,若年者喘息に比べ老年者喘息で有意に低い値を示した｡2.ハウスダストやカンジダに対するIgE抗体は老年者喘息において老年者健常人に比べより高い頻度で陽性であったが,一方,ハウスダストに対するIgG(4)抗体は3者聞に有意の差は見られなかった｡また,カンジダに対するIgG(4)抗体は,老年者喘息および健常人において,若年者喘息に比べ有意の高値を示した｡しかし,老年者の喘息と健常人との間には有意の差は見られなかった｡3.PPDによる遅延型皮膚反応は,若年者喘息に比べ老年者喘息において有意の減弱傾向を示した｡これらの結果は,老年者喘息はIgE系反応を有していること,そして,加齢による免疫反応の変化の影響を受けること,を示している

VALPROIC ACID PROTECTS KIDNEYS FROM CISPLATIN

Cisplatin treatment is effective against several types of carcinomas. However, it frequently leads to kidney injury, which warrants effective prevention methods. Sodium valproic acid is a prophylactic drug candidate with a high potential for clinical application against cisplatin-induced kidney injury. Therefore, in this study, we aimed to elucidate the mechanism underlying the prophylactic effect of valproic acid on cisplatin-induced kidney injury in a mouse model and HK2 and PODO cells with cisplatin-induced toxicity. In the mouse model of cisplatin-induced kidney injury, various renal function parameters and tubular damage scores were worsened by cisplatin, but they were significantly improved upon combination with valproic acid. No difference was observed in cisplatin accumulation between the cisplatin-treated and valproic acid-treated groups in whole blood and the kidneys. The mRNA expression levels of proximal tubular damage markers, apoptosis markers, and inflammatory cytokines significantly increased in the cisplatin group 72 h after cisplatin administration but significantly decreased upon combination with valproic acid. In HK2 cells, a human proximal tubular cell line, the cisplatin-induced decrease in cell viability was significantly suppressed by co-treatment with valproic acid. Valproic acid may inhibit cisplatin-induced kidney injury by suppressing apoptosis, inflammatory responses, and glomerular damage throughout the kidneys by suppressing proximal tubular cell damage. However, prospective controlled trials need to evaluate these findings before their practical application