Chiari Malformation with Thick Occipital Bone

A case of a Chiari malformation with an extraordinarily thick occipital bone is described. The thick occipital bone might make the posterior fossa narrow with consequent herniation of the cerebellar tonsils to the foramen magnum and formation of a syrinx. At dural plasty, well-developed marginal and occipital sinuses should be deliberately handled with the preservation of normal venous drainage. This case gives us the essence of the occurrence mechanisms of Chiari malformation and foramen magnum decompression

Drastic shift in flowering phenology of F₁ hybrids causing rapid reproductive isolation in Imperata cylindrica in Japan

1. Hybridization is a major source of phenotypic variation and a driving force for evolution. Although novel hybrid traits can often disrupt adaptive relationships between the parental phenotypes and their environments, how new hybrid traits disrupt local adaptation remains unclear. Here, we report how a new phenotype of hybrids between two Imperata cylindrica ecotypes contributes to rapid reproductive isolation from their parents and affects hybrid fitness. 2. We analysed 350 accessions of I. cylindrica collected from the 1980s to the 2010s throughout Japan to explore the genetic population structure of the hybrids. We surveyed the flowering periods, seed set, and germination of two ecotypes and their hybrids in both natural habitats and common gardens. 3. Genetic analyses of population structure revealed that the hybrid populations consisted of only F1 individuals, without advanced generation hybrids. The flowering phenology of the F1 plants was delayed until autumn, 5–6 months later than the parental ecotypes. The drastic shift in flowering phenology prevents F1s from backcrossing. In addition, it changes their seed dispersal time to winter. Germination is inhibited by low temperatures, and the seeds likely decay before the next spring, resulting in the absence of an F2 generation. We identified the environmental mismatch of the F1 population as a specific mechanism for the maintenance of an only F1 population. 4. Synthesis. We have demonstrated that this flowering phenology mismatch promotes reproductive isolation between the parents and F1s and affects various temporal components of the hybrids, resulting in a unique hybrid population consisting only of F1s. This system sheds light on the importance of hybrid traits in driving rapid reproductive isolation

セイジン ソケイ ヘルニア ノ アプローチホウ ニヨル ビョウケイ シンダンノウ ニ ツイテ

Objective : To compare a laparoscopic transabdomina approach and anterior approach for inguinal repair regarding detectability of type Ⅳ hernia. Summary Background Data : Advantages of laparoscopic transabdominal preperitoneal（TAPP）inguinal hernioplasty, the accuracy of diagnosis is strongly emphasized, but this theory has not verified. Herein, we study this advantage retrospectively. Methods : A retrospective comparative study of８０７elective repairs of a inguinal hernia repair was performed : a control group ０f ３４１ patients undergoing anterior hernia repair with or without prosthesis and a study group of ４６６patients undergoing TAPP repair. Intraoperative diagnosis type of hernia was studied. Result : Fifty-five patients（１１．８％）detected type Ⅳ lateral hernia in the TAPP group as compared to seven（２．０％）patients in the anterior group. （p ＜０．０１）. Conclusions : laparoscopic transabdominal approach can be considered significantly（p＜ ０．０１）superior to anterior approach with regard to detectability of type Ⅳ hernia

チツシュヨウ トノ カンベツ ガ コンナン ダッタ チョクチョウ ＧＩＳＴ ノ 1 レイ

We report a rare case of gastrointestinal stromal tumor of rectum. A 57-year-old-woman was admitted to our hospital complaining of genital bleeding. MRI showed the presence of an 11.2×8.7cm cystic tumor in pelvis. The border is unclear between the tumor and vagina and rectum. We could not get the diagnosis with biopsy and performed partial resection of vagina and rectal amptation considering the tumor as a vaginal tumor. Histologic examination revealed fascicular proliferation of spindle-shaped tumor cells developed from rectum. Immunohistochemical testing was c-ki（t +）, CD 34（+）, smooth muscle actin（‐）, desmin（‐）and S‐100 protein（‐）. The tumor was diagnosed as GIST of rectum. Post-operative course was uneventful and no evidence of recurrence is detected 13 months after the operation. We could not get the preoperative diagnosis and performed the operation as a vaginal tumor, however rectal GIST should be considered when detect a pelvic tumor

ジャクネン セイジン ノ TAPP リョウホウゴ チョウキ ケイカレイ ノ バンキ サイハツリツ バンキ ガッペイショウ マンゾクド ニ タイスル ケントウ

Objective : This study evaluated the long-term outcome after laparoscopic transabdominal preperitoneal（TAPP）inguinal hernioplasty for young adults cases. The first goal is to measure recurrence rate. The second goals are late symptoms, complication, and patient’s satisfaction rate. Method : Young adults patients who underwent TAPP repairs between １９９５ and ２００４ were requested to fill in a postal questionnaire,１９patients are eligible to this study. Study participants ranged from ２０ to ４０ years, with an average age of ３２ years. One participant was female and eighteen participants were male. Follow up range was ５ to１３years, with a mean of ８．２years. Pt’s satisfaction scales ranging from １（not satisfied）to ５（very satisfied）were used. Participants checked yes or no about late symptoms, complications, and recurrence. Result : Of１９operated patients,１４patients（７３．６％）responded. One patient（７．１％）had symptomatic hernia recurrence. Long-term groin discomfort（occasional）occurred in ４ patients（２８．６％）. But there are no patient feeling groin discomfort interfered with daily activity. Pt’s satisfaction rates were５（very satisfied）：２８．６％,４：５０．０％,３：１４．２％,２：０％,１（very dissatisfied）：７．１％. None of them were required mesh removal. CONCLUSION : TAPP repair is a feasible procedure for young adult with acceptable rate of recurrence, no severe complication, late symptoms, and pt’s satisfaction rate

セイジン ソケイ ヘルニア ジュツゴ カンセン ニヨル prosthesis ジョキョレイ ノ ケントウ

Objective : Prosthesis removal is one of important complication in the hernia repair. A clinical investigation was made on cases of prosthesis removal following surgery for inguinal hernia. Methods : We performed ４６６ laparoscopic transabdominal preperitoneal （TAPP） inguinal hernioplasty for inguinal hernia and ２３２ open mesh inguinal hernia repair at our institution from March １９９５ to March ２０１０. These ６９８ cases were enrolled in this clinical study. Prosthesis removal was retrospectively assessed. Result : The five cases who underwent open mesh repair were required the removal of the prosthesis. These all cases were delayed onset infection. On the other hand, no patients who underwent TAPP repair were required removal of the prosthesis. Patients who underwent open mesh repair had high risk for the removal of the prosthesis compared to patients who underwent TAPP repair. Conclusions : Patients with inguinal hernia who undergo TAPP repair have fewer removal of the prosthesis than those who underwent open mesh repair

Spinal Surgery after Bilateral Subthalamic Stimulation for Patients with Parkinson's Disease: A Retrospective Outcome Analysis of Pain and Functional Control

Parkinson's disease (PD) patients often suffer from spinal diseases requiring surgeries, although the risk of complications is high. There are few reports on outcomes after spinal surgery for PD patients with deep brain stimulation (DBS). The objective of this study was to explore the data on spinal surgery for PD patients with precedent DBS. We evaluated 24 consecutive PD patients with 28 spinal surgeries from 2007 to 2017 who received at least a 2-year follow-up. The characteristics and outcomes of PD patients after spinal surgery were compared to those of 156 non-PD patients with degenerative spinal diseases treated in 2013-2017. Then, the characteristics, outcomes, and spinal alignment of PD patients receiving DBS were analyzed in degenerative spinal/ lumbar diseases. The mean age at the time of spinal surgery was 68 years. The Hoehn and Yahr score regarding PD was stage 1 for 8 patients, stage 2 for 2 patients, stage 3 for 8 patients, stage 4 for 10 patients, and stage 5 for 0 patient. The median preoperative L-DOPA equivalent daily dose was 410 mg. Thirteen patients (46%) received precedent subthalamic nucleus (STN) DBS. Lumbar lesions with pain were common, and operation and anesthesia times were long in PD patients. Pain and functional improvement of PD patients persisted for 2 years after surgery with a higher complication rate than for non-PD patients. PD patients with STN DBS maintained better lumbar lordosis for 2 years after spinal surgery. STN DBS significantly maintained spinal alignment with subsequent pain and functional amelioration 2 years after surgery. The outcomes of spinal surgery for PD patients might be favorably affected by thorough treatment for PD including DBS

Intravenous administration of mesenchymal stem cells exerts therapeutic effects on parkinsonian model of rats: Focusing on neuroprotective effects of stromal cell-derived factor-1α

<p>Abstract</p> <p>Background</p> <p>Mesenchymal stem cells (MSCs) are pluripotent stem cells derived from bone marrow with secretory functions of various neurotrophic factors. Stromal cell-derived factor-1α (SDF-1α) is also reported as one of chemokines released from MSCs. In this research, the therapeutic effects of MSCs through SDF-1α were explored. 6-hydroxydopamine (6-OHDA, 20 μg) was injected into the right striatum of female SD rats with subsequent administration of GFP-labeled MSCs, fibroblasts, (i.v., 1 × 10⁷cells, respectively) or PBS at 2 hours after 6-OHDA injection. All rats were evaluated behaviorally with cylinder test and amphetamine-induced rotation test for 1 month with consequent euthanasia for immunohistochemical evaluations. Additionally, to explore the underlying mechanisms, neuroprotective effects of SDF-1α were explored using 6-OHDA-exposed PC12 cells by using dopamine (DA) assay and TdT-mediated dUTP-biotin nick-end labeling (TUNEL) staining.</p> <p>Results</p> <p>Rats receiving MSC transplantation significantly ameliorated behaviorally both in cylinder test and amphetamine-induced rotation test compared with the control groups. Correspondingly, rats with MSCs displayed significant preservation in the density of tyrosine hydroxylase (TH)-positive fibers in the striatum and the number of TH-positive neurons in the substantia nigra pars compacta (SNc) compared to that of control rats. In the <it>in vitro </it>study, SDF-1α treatment increased DA release and suppressed cell death induced by 6-OHDA administration compared with the control groups.</p> <p>Conclusions</p> <p>Consequently, MSC transplantation might exert neuroprotection on 6-OHDA-exposed dopaminergic neurons at least partly through anti-apoptotic effects of SDF-1α. The results demonstrate the potentials of intravenous MSC administration for clinical applications, although further explorations are required.</p

Proximal Vertebral Body Fracture after 4-Level Fusion Using L1 as the Upper Instrumented Vertebra for Lumbar Degenerative Disease: Report of 2 Cases with Literature Review

Some cases with lumbar degenerative diseases require multi-level fusion surgeries. At our institute, 27 and 4 procedures of 3- and 4-level fusion were performed out of a total 672 posterior lumbar interfusions (PLIFs) on patients with lumbar degenerative disease from 2005 to 2010. We present 2 osteoporotic patients who developed proximal vertebral body fracture after 4-level fusion. Both cases presented with gait disability for leg pain by degenerative lumbar scoliosis and canal stenosis at the levels of L1/2-4/5. After 4-level fusion using L1 as the upper instrumented vertebra, proximal vertebral body fractures were found along with the right pedicle fractures of L1 in both cases. One of these patients, aged 82 years, was treated as an outpatient using a hard corset for 24 months, but the fractures were exacerbated over time. In the other patient, posterolateral fusion was extended from Th10 to L5. Both patients can walk alone and have been thoroughly followed up. In both cases, the fracture of the right L1 pedicle might be related to the subsequent fractures and fusion failure. In consideration of multi-level fusion, L1 should be avoided as an upper instrumented vertebra to prevent junctional kyphosis, especially in cases with osteoporosis and flat back posture

Neuroprotective effects of edaravone-administration on 6-OHDA-treated dopaminergic neurons

<p>Abstract</p> <p>Background</p> <p>Parkinson's disease (PD) is a neurological disorder characterized by the degeneration of nigrostriatal dopaminergic systems. Free radicals induced by oxidative stress are involved in the mechanisms of cell death in PD. This study clarifies the neuroprotective effects of edaravone (MCI-186, 3-methyl-1-phenyl-2-pyrazolin-5-one), which has already been used for the treatment of cerebral ischemia in Japan, on TH-positive dopaminergic neurons using PD model both <it>in vitro </it>and <it>in vivo</it>. 6-hydroxydopamine (6-OHDA), a neurotoxin for dopaminergic neurons, was added to cultured dopaminergic neurons derived from murine embryonal ventral mesencephalon with subsequet administration of edaravone or saline. The number of surviving TH-positive neurons and the degree of cell damage induced by free radicals were analyzed. In parallel, edaravone or saline was intravenously administered for PD model of rats receiving intrastriatal 6-OHDA lesion with subsequent behavioral and histological analyses.</p> <p>Results</p> <p><it>In vitro </it>study showed that edaravone significantly ameliorated the survival of TH-positive neurons in a dose-responsive manner. The number of apoptotic cells and HEt-positive cells significantly decreased, thus indicating that the neuroprotective effects of edaravone might be mediated by anti-apoptotic effects through the suppression of free radicals by edaravone. <it>In vivo </it>study demonstrated that edaravone-administration at 30 minutes after 6-OHDA lesion reduced the number of amphetamine-induced rotations significantly than edaravone-administration at 24 hours. Tyrosine hydroxylase (TH) staining of the striatum and substantia nigra pars compacta revealed that edaravone might exert neuroprotective effects on nigrostriatal dopaminergic systems. The neuroprotective effects were prominent when edaravone was administered early and in high concentration. TUNEL, HEt and Iba-1 staining <it>in vivo </it>might demonstrate the involvement of anti-apoptotic, anti-oxidative and anti-inflammatory effects of edaravone-administration.</p> <p>Conclusion</p> <p>Edaravone exerts neuroprotective effects on PD model both <it>in vitro and in vivo</it>. The underlying mechanisms might be involved in the anti-apoptotic effects, anti-oxidative effects, and/or anti-inflammatory effects of edaravone. Edaravone might be a hopeful therapeutic option for PD, although the high therapeutic dosage remains to be solved for the clinical application.</p