Postural stability impairment in patients with bilateral hallux valgus: A case-control study using a stabilometer

BackgroundHallux valgus (HV) is an important risk factor for falls (in older people); however, the detailed relationship is less understood. We aimed to evaluate postural stability in bilateral HV patients.MethodsTwo groups of 20 female patients—an HV group and a C (i.e., non-HV) group—participated in this study. Evaluations were made using the Timed Up and Go (TUG) test, the Berg Balance Scale (BBS), the Falls Efficacy Scale (FES), track length (LNG), velocity (VEL), enveloped area (ENV), and root mean square area (RMS).ResultsTUG and FES scores were significantly higher and BBS scores were lower in the HV group than in the C group. LNG was significantly longer, VEL was higher, and ENV and RMS were wider in the HV group than in the C group.ConclusionsThe HV group exhibited impaired walking mobility, balance, and postural stability.     

Comparison of brain metabolic activity patterns induced by ketamine, MK-801 and amphetamine in rats: support for NMDA receptor involvement in responses to subanesthetic dose of ketamine

Subanesthetic doses of NMDA receptor antagonists induce positive, negative and cognitive schizophrenia-like symptoms in healthy humans and precipitate psychotic reactions in stabilized schizophrenic patients. These findings suggest that defining neurobiologic effects induced by NMDA antagonists could guide the formulation of experimental models relevant to the pathophysiology of schizophrenia and antipsychotic drug action. Accordingly, the effects of subanesthetic doses of the non-competitive NMDA antagonists ketamine and MK-801 were examined on regional brain [¹⁴C]-2-deoxyglucose (2-DG) uptake in rats. The effects of these drugs were compared to those of amphetamine, in order to assess the potential role of generalized behavioral arousal, motor activity and dopamine release in brain metabolic responses to the NMDA antagonists. Subanesthetic doses of MK-801 and ketamine induced identical alterations in patterns of 2-DG uptake. The most pronounced increases in 2-DG for both NMDA antagonists were in the hippocampal formation and limbic cortical regions. By contrast, amphetamine treatment did not increase 2-DG uptake in these regions. In isocortical regions, ketamine and MK-801 reduced uptake in layers 3 and 4, creating a striking shift in the laminar pattern of 2-DG uptake in comparison to control conditions. After amphetamine, the fundamental laminar pattern of isocortical labeling was similar to saline-treated rats. Administration of ketamine and MK-801 decreased 2-DG uptake in the medial geniculate and inferior colliculus, whereas amphetamine tended to increase uptake in these regions. Since ketamine induced similar effects on regional 2-DG uptake as observed for the selective antagonists MK-801, the effects of ketamine are likely related to NMDA antagonistic properties of the drug. The distinct differences in brain 2-DG uptake induced by amphetamine and NMDA antagonists indicate that generalized behavioral arousal, and increased locomotor activity mediated by dopamine release, are not sufficient to account for the alterations in brain metabolic patterns induced by ketamine and MK-801. Thus, the dramatic alteration in regional 2-DG uptake induced by ketamine and MK-801 reflects a state selectively induced by reduced NMDA receptor function.     

Triangle target principle for the placement of trocars during video-assisted thoracic surgery.

OBJECTIVE: The baseball-diamond principle is generally used for trocar placement during video-assisted thoracic surgery; however, we are unable to treat all peripheral lung lesions using this principle. Therefore, we have developed another method for determining trocar placement based on a modification of the conventional principle. We have termed this method the triangle target principle. This report describes the instrument positioning that we now use for many video-assisted thoracic surgical procedures. METHODS: We position 3 trocars in an equilateral triangle, with the target lesion at the apex. One vertex of the base becomes the site of the first trocar placement for introduction of the thoracoscopic camera. Another vertex of the base becomes the site for the second trocar for forceps or the endoscopic stapler. The third trocar is for forceps and is inserted to create the vicinity of target lesion. Four types of the triangle target principle were developed according to sites of the target lesion. RESULTS: Between January 2000 and December 2002, we used this principle for 161 patients who underwent video-assisted thoracic surgery and all intrathoracic lesions were accessible except in 3 patients requiring intraoperative modifications. CONCLUSIONS: We conclude that video-assisted thoracic surgery by this principle is more effective and easier than the conventional principle to treat intrathoracic disease.     

Preclinical and clinical studies for transplant tolerance via the mixed chimerism approach

Based upon observations in murine models, we have developed protocols to induce renal allograft tolerance by combined kidney and bone marrow transplantation (CKBMT) in non-human primates (NHP) and in humans. Induction of persistent mixed chimerism has proved to be extremely difficult in major histocompatibility complex (MHC)-mismatched primates, with detectable chimerism typically disappearing within 30–60?days. Nevertheless, in MHC mismatched NHP, long-term immunosuppression-free renal allograft survival has been achieved reproducibly, using a non-myeloablative conditioning approach that has also been successfully extended to human kidney transplant recipients. CKBMT has also been applied to the patients with end stage renal disease with hematologic malignancies. Renal allograft tolerance and long-term remission of myeloma have been achieved by transient mixed or persistent full chimerism. This review summarizes the current status of preclinical and clinical studies for renal and non-renal allograft tolerance induction by CKBMT. Improving the consistency of tolerance induction with less morbidity, extending this approach to deceased donor transplantation and inducing tolerance of non-renal transplants, are critical next steps for bringing this strategy to a wider range of clinical applications.     

From the Cover: Spatiotemporal variations of seismicity before major earthquakes in the Japanese area and their relation with the epicentral locations

Using the Japan Meteorological Agency earthquake catalog, we investigate the seismicity variations before major earthquakes in the Japanese region. We apply natural time, the new time frame, for calculating the fluctuations, termed β, of a certain parameter of seismicity, termed κ₁. In an earlier study, we found that β calculated for the entire Japanese region showed a minimum a few months before the shallow major earthquakes (magnitude larger than 7.6) that occurred in the region during the period from 1 January 1984 to 11 March 2011. In this study, by dividing the Japanese region into small areas, we carry out the β calculation on them. It was found that some small areas show β minimum almost simultaneously with the large area and such small areas clustered within a few hundred kilometers from the actual epicenter of the related main shocks. These results suggest that the present approach may help estimation of the epicentral location of forthcoming major earthquakes.In this study, we investigate the evolution of seismicity shortly before main shocks in the Japanese region, N2546E125148, using Japan Meteorological Agency (JMA) earthquake catalog as in ref 1. For this, we adopted the new time frame called natural time since our previous works using this time frame made the lead time of prediction as short as a few days (see below). For a time series comprising N earthquakes (EQs), the natural time χ_k is defined as χ_k = k/N, where k means the k^th EQ with energy Q_k (Fig. 1). Thus, the raw data for our investigation, to be read from the earthquake catalog, are χ_k = k/N and pk=Qk/∑n=1NQn, where p_k is the normalized energy. In natural time, we are interested in the order and energy of events but not in the time intervals between events.Open in a separate windowFig. 1.EQ sequence in (A) conventional time and (B) natural time. In B, Q_k is given in units of the energy ε corresponding to a 3.5M_JMA EQ.We first calculate a parameter called κ₁, which is defined as follows (2, 3), from the catalog.κ1=∑k=1Npkχk2−(∑k=1Npkχk)2=〈χ2〉−〈χ〉2.[1]We start the calculation of κ₁ at the time of initiation of Seismic Electric Signals (SES), the transient changes of the electric field of Earth that have long been successfully used for short-term EQ prediction (4, 5). The area to suffer a main shock is estimated on the basis of the selectivity map (4, 5) of the station that recorded the corresponding SES. Thus, we now have an area in which we count the small EQs of magnitude greater than or equal to a certain magnitude threshold that occur after the initiation of the SES. We then form time series of seismic events in natural time for this area each time a small EQ occurs, in other words, when the number of the events increases by one. The κ₁ value for each time series is computed for the pairs (χ_k,p_k) by considering that χ_k is “rescaled” to χ_k = k/(N +1) together with rescaling pk=Qk/∑n=1N+1Qn upon the occurrence of any additional event in the area. The resulting number of thus computed κ₁ values is usually of the order 10² to 10³ depending, of course, on the magnitude threshold adopted for the events that occurred after the SES initiation until the main shock occurrence. When we followed this procedure, it was found empirically that the values of κ₁ converge to 0.07 a few days before main shocks. Thus, by using the date of convergence to 0.07 for prediction, the lead times, which were a few months to a few weeks or so by SES data alone, were made, although empirically, as short as a few days (6, 7). In fact, the prominent seismic swarm activity in 2000 in the Izu Island region, Japan, was preceded by a pronounced SES activity 2 mo before it, and the approach of κ₁ to 0.07 was found a few days before the swarm onset (8). However, when SES data are not available, which is usually the case, it is not possible to follow the above procedure. To cope with this difficulty, in the previous work (1), we investigated the time change of the fluctuation of the κ₁ values during a few preseismic months for each EQ (which we call target EQ) over the large area N2546E125148 (Fig. 2A) for the period from 1 January 1984 to 11 March 2011, the day of M9.0 Tohoku EQ. Setting a threshold M_JMA = 3.5 to assure data completeness of JMA catalog, we were left with 47,204 EQs in the concerned period of about 326 mo: ∼150 EQs per month. For calculating the β values, we chose 200 EQs before target EQs to cover the seismicity in almost one and a half months.Open in a separate windowFig. 2.(A) The 47,204 EQs with M_JMA ≥ 3.5 that occurred during the period of our study. (B) Contours of the number of EQs per month within R = 250 km. Solid diamonds show the epicenters of six shallow EQs investigated in this study. (C) Contours of the natural time window W used in each of the 12,476 areas of radius R = 250 km with offset 0.1° from one another that have at least eight EQs per month.To obtain the fluctuation β of κ₁, we need many values of κ₁ for each target EQ. For this purpose, we first took an excerpt comprised of W successive EQs just before a target EQ from the seismic catalog. The number W was chosen to cover a period of a few months. For this excerpt, we form its subexcerpts Sj={Qj+k−1}k=1,2,…,N of consecutive N = 6 EQs (since at least six EQs are needed (2) for obtaining reliable κ₁) of energy Q_j+k?1 and natural time χ_k = k/N each. Further, pk=Qj+k−1/∑k=1NQj+k−1, and by sliding S_j over the excerpt of W EQs, j=1,2,…,W−N+1 (= W − 5), we calculate κ₁ using Eq. 1 for each j. We repeat this calculation for N=7,8,…,W, thus obtaining an ensemble of [(W − 4)(W − 5)]/2 (= 1 + 2 +…+ W − 5) κ₁ values. Then, we compute the average μ(κ₁) and the SD σ(κ₁) of thus obtained ensemble of [(W − 4)(W − 5)]/2 κ₁ values. The variability β of κ₁ for this excerpt W is defined to be β ≡ σ(κ₁)/μ(κ₁) and is assigned to the (W + 1)^th EQ, i.e., the target EQ.The time evolution of the β value can be pursued by sliding the excerpt through the EQ catalog. Namely, through the same process as above, β values assigned to (W + 2)^th, (W + 3)^th, … EQs in the catalog can be obtained.We found in ref. 1 that the fluctuation β of κ₁ values exhibited minimum a few months before all of the six shallow EQs of magnitude larger than 7.6 that occurred in the study period. A minimum of β ≡ σ(κ₁)/μ(κ₁) means large average and/or small deviation of κ₁ values (e.g., see ref. 9).In the present work, we calculate the β values for small areas before the six large EQs, which showed β minima of the large area.     

Huge inflammatory pseudotumor of the spleen with postoperative portal vein thrombosis: report of a case

We report the rare case of a splenic inflammatory pseudotumor associated with massive splenomegaly, diagnosed after surgery. A 51-year-old woman was admitted to our hospital for investigation of anemia. Physical examination revealed a palpable left upper quadrant mass. Computed tomography and magnetic resonance imaging showed a splenic mass, 20 cm in diameter. We performed splenectomy for both diagnosis and treatment. The spleen weighed 2400 g, and histologic examination of the mass confirmed an inflammatory pseudotumor. Portal vein thrombosis (PVT) developed the day after surgery, but resolved with anticoagulation therapy. This case highlights that there is a risk of PVT after splenectomy in patients with massive splenomegaly, and that anticoagulant therapy should be initiated promptly.     

NK026680 inhibits T-cell function in an IL-2-dependent manner and prolongs cardiac allograft survival in rats

NK026680 is a triazolopyrimidine derivative that has been shown to inhibit dendritic cell maturation and activation. Here, we examined the immunosuppressive properties of NK026680 on T-cell function and assessed its immunosuppressive efficacy in an ACI (RT1^av1 haplotype) to Lewis (RT1^l) rat heart transplantation model. The effects of NK026680 on T-cell proliferation, activation, and cytokine production were investigated in vitro. Heart transplant recipient rats were administered NK026680 daily for 14 days post-transplantation. In addition to graft survival time, alloimmune responses and graft histology at 4-10 days post-transplantation were assessed. NK026680 was found to inhibit proliferation, CD25 upregulation, IL-2 production, and cell cycle progression in αCD3/αCD28-stimulated murine T cells. These effects were likely due to suppression of the p38 mitogen-activated protein kinase pathway and the subsequent inhibition of p65, c-Fos, and to a lesser extent, c-Jun. Daily NK026680 treatment suppressed alloimmune responses, prevented cellular infiltration into allografts, and prolonged graft survival. The anti-rejection effects of NK026680 were enhanced by tacrolimus. In conclusion, NK026680 inhibits the activation of T cells and prolongs cardiac allograft survival in rats. These features make it a potential candidate immunosuppressant for the treatment of organ transplant patients in the future.