An experimental study on a new artificial vertebral body

This study was undertaken to develop a new artificial vertebral body (AVB) for metastatic tumors, and to confirm its feasibility for practical use. (1) In mechanical tests using bovine cancellous bone and the vertebrae of fresh human cadavers, six ways of fixing the AVBs to cancellous bone were compared. A rectangular plate with a blunt-toothed surface fixed into a bone groove with cement proved to be the best fixation method. (2) In experiments using seven dogs, small AVBs were applied to the 4th lumbar vertebra and the plate portions were fixed into the grooves made in the 3rd and 5th vertebrae. Undecalcified specimens of these vertebrae were examined 4, 8, 12, and 16 weeks after the operations. New bone formation was found around the grooves and endplates. The height of AVBs could be adjusted. By endurance tests AVBs were well tolerated and remained unchanged. The results of these experiments have indicated that the new AVB appeared to be feasible for clinical application.     

Endoscopically proven case of rapid esophagogastric variceal progression and rupture as a result of portal hypertension with liver sarcoidosis

Sarcoidosis is a multi‐systemic disease of unknown etiology that results in the development of non‐caseating epithelioid granulomas. The liver is the third most frequently involved organ after the lymph nodes and the lungs. Most cases of liver sarcoidosis do not present with symptoms and involve minimal liver dysfunction, but some cases display progression to portal hypertension and liver cirrhosis, and finally to liver failure. The mechanism and the risk of progression in liver sarcoidosis are still unknown because of the diagnostic difficulty associated with this condition, and because follow‐up examinations can only be done in an invasive manner. Here, we present an informative case of liver sarcoidosis with rapid progression of esophagogastric varices. Four months prior to the definitive diagnosis, no signs of varices were observed on endoscopy, and developmentof esophagogastric varices, rapid progression, and eventual rupture occurred in a short period of time. A liver biopsy, carried out after endoscopic sclerotherapy, revealed that granulomas primarily affected the portal area without fibrotic and cirrhotic changes, which is considered a primary cause of portal hypertension and esophagogastric varices. Following the liver biopsy, the patient was given systemic steroids and is currently receiving outpatient care. Thus, we should consider the possibility that liver sarcoidosis, even in the absence of cirrhotic changes, can cause serious events such as esophagogastric variceal rupture following rapid progression as a result of portal hypertension.     

The Development of Foveolar-type Gastric Adenocarcinoma during Maintenance Therapy of Vonoprazan for Reflux Esophagitis

We herein report the first case of foveolar-type gastric adenocarcinoma that developed after the initiation of vonoprazan (VPZ). A 51-year-old man had heartburn at the first visit and reflux esophagitis endoscopically, so he started taking VPZ. An approximately 5-mm-sized reddish polyp with a raspberry-like morphology was detected at the anterior wall of the upper body of the stomach 156 weeks after starting maintenance therapy with VPZ 10 mg/day. It was diagnosed as foveolar-type gastric adenocarcinoma based on a biopsy. Another approximately 4-mm-sized foveolar-type gastric adenocarcinoma was also detected at the posterior wall of the middle body of the stomach.     

Hepatocyte growth factor as a potential predictor of the presence of atherosclerotic aorto-iliac artery disease

Background Hepatocyte growth factor (HGF), a member of the endothelial-specific growth factors with the greatest mitogenic activity, may play a role in the protection and/or repair of vascular endothelial cells injured by atherosclerosis. As a result, plasma HGF concentration may increase in response to endothelial cell damage. To test this hypothesis, we measured plasma concentrations of HGF in patients with or without aorto-iliac artery atherosclerotic disease. Methods One hundred ten consecutive patients who underwent coronary angiography were enrolled in this study. Abdominal aortography was performed after coronary arteriography to determine whether aorto-iliac artery atherosclerotic disease was present. Peripheral venous blood samples were obtained to measure the plasma HGF concentration. Results Aortography revealed aorto-iliac atherosclerotic disease in 35 patients (32%). The plasma HGF concentration was significantly higher in patients with arteriosclerotic lesions (0.35 ± 0.11 ng/mL) than in patients without atherosclerotic lesions (0.27 ± 0.09 ng/mL, P = .0002). On the basis of multiple logistic regression analysis of the relationships between coronary risk factors, age, sex, severity of coronary artery disease, plasma HGF concentration, and the presence of arteriosclerotic lesions, plasma HGF concentration (P = .0005) and age (P = .035) were found to predict independently the presence of aorto-iliac arteriosclerosis. Conclusion Plasma HGF concentration can be used to predict the presence of arteriosclerotic lesions in the region from the abdominal aorta to the femoral arteries. (Am Heart J 2002;143:272-6.)     

Effect of temporary school closure due to COVID-19 on musculoskeletal function in elementary school children

Objective: In 2020, coronavirus disease-2019 (COVID-19) became the cause of a pandemic. In response, the Japan Sports Agency issued warnings about secondary damage to health, such as the threat to physical and mental well-being due to the lack of exercise in this situation. In this study, we report on cross-sectional and longitudinal examinations of standing trunk flexion to evaluate how temporary long-term school closures affected musculoskeletal function in elementary school students.Patients and Methods: All children in one public elementary school in T-city during the school years 2019 and 2020 were included in this study. A digital forward flexion meter was used to measure standing trunk flexion.Results: In this study, 284 (284/289: 98.3%) and 266 (266/274: 97.1%) children in school years 2020 and 2019, respectively, were found to have valid data for cross-sectional analysis. The standing trunk flexion did not show significant differences between grades or sexes. In the longitudinal analysis, the results of the comparison of standing trunk flexion in children for two consecutive years revealed significant differences only between grades 3 and 4 (P<0.05) and between girls in grades 3 and 4 (P<0.01), but no significant differences in other grades or among boys or girls were observed.Conclusion: Initially, we expected that there would be a difference in the results of functional assessment using standing trunk flexion depending on the period of absence from school. However, the results of this study showed no significant changes in standing trunk flexion. Moreover, since children’s musculoskeletal functions may be affected by various factors during the COVID-19 pandemic, they should be carefully monitored in the future.     

Prevalence and risk factors for lymph node metastasis after noncurative endoscopic resection for early gastric cancer: a systematic review and meta-analysis

Background

Additional surgery for all patients with noncurative resection after endoscopic resection (ER) for early gastric cancer (EGC) may be excessive due to the relatively low rate of lymph node metastasis (LNM) in such patients. However, the prevalence and risk factors for LNM after noncurative ER have not been consistent across studies.

Methods

We performed a systematic review of electronic databases through August 10, 2018 to identify cohort studies with patients who underwent additional surgery after noncurative ER for EGC. The prevalence of LNM in such patients was extracted for all studies. Odds ratios (ORs) were combined using random-effects meta-analyses to assess the risk of LNM, when possible.

Results

We identified 24 studies comprising 3877 patients with 311 having LNM (pooled prevalence, 8.1%). The risk of LNM was significantly increased in lymphatic invasion (OR [95% confidence interval] = 4.22 [2.88–6.19]), lymphovascular invasion (LVI) (4.17 [2.90–5.99]), vascular invasion (2.38 [1.65–3.44]), positive vertical margin (2.16 [1.59–2.93]), submucosal invasion depth of ≥ 500 μm (2.14 [1.48–3.09]), and tumor size > 30 mm (1.77 [1.31–2.40]). In contrast, there was no significant association between undifferentiated-type or ulceration (scar) and LNM. When studies were restricted to those that evaluated the adjusted OR, the risk of vascular invasion for LNM did not reach statistical significance.

Conclusions

Several pathological factors, most notably lymphatic invasion and LVI, were associated with LNM in patients with noncurative resection after ER for EGC. Lymphatic and vascular invasion should be assessed separately instead of LVI (PROSPERO CRD42018109996).

     

Endogenous cannabinoid, 2-arachidonoylglycerol, attenuates naloxone-precipitated withdrawal signs in morphine-dependent mice

In the present study, we examined the effects of endogenous ligand 2-arachidonoylglycerol (2-AG) on naloxone-precipitated withdrawal in morphine-dependent mice, in comparison with that of two cannabinoid agonists, an ingredient of Cannabis sativa Delta(8)-tetrahydrocannabinol (Delta(8)-THC) and the synthetic cannabinoid CB1 receptor agonist HU-210. 2-AG at a dose of 10 microg per mouse (i.c.v.) significantly inhibited both jumping and forepaw tremor as signs of withdrawal following naloxone challenge in morphine-dependent mice. Furthermore, both Delta(8)-THC and HU-210 significantly attenuated these symptoms of withdrawal in morphine-dependent mice. Therefore, it is suggested that inactivation of the endogenous cannabinoid system is related to the induction of withdrawal syndrome in morphine-dependent mice. Moreover, hyperlocomotor activity in morphine-dependent mice was markedly increased by Delta(8)-THC 10 mg/kg, which had no effect in naive mice. This finding suggested that in morphine dependence, upregulation of cannabinoid CB1 receptors occurred. Non-psychoactive CB1 receptor agonists or accelerators of endocannabinoid synthesis may be potential as therapeutic drugs for opiate withdrawal symptoms.     

Clinical study on laparoscopic approach to cholelithiasis in the elderly

The Authors report 66 cases of patients aged 75 years or older who underwent laparoscopic cholecystectomy: 28 cases presented a clinical picture of acute cholecystitis, 3 cases had associated common bile duct stones. A high percentage of patients had cardiovascular disease: 29 patients presented with cardiopaties, of these 9 cases had a history of myocardial infarction, 31 patients had artheriosclerotic hypertension, associated, in 7 patients with signs of brain ischemia. Five patients were suffering from Parkinson's disease, 7 were carriers of diabetes, 2 had liver cirrosis. Three patients were converted due to extensive presence of adhesions from previous surgery. Morbidity and mortality rates were respectively 12% and 1.5%. The Authors think that laparoscopic technique widens indications and reduces risks of cholecystectomy also in elderly patients.     

Measles virus strains circulating in Central and West Africa: Geographical distribution of two B3 genotypes

Africa remains one of the major reservoirs of measles infection. Molecular epidemiological studies have permitted different measles virus isolates to be grouped into clades and genotypes; the major group, which has been identified as indigenous to Africa, is clade B. The viruses from epidemics in the Gambia (1993) and in the Cameroon (2001) were examined. In both studies, the homogeneity of the virus isolates within the epidemic as shown by sequence analysis revealed less than 0.2% variation of nucleotides between isolates. The measles viruses isolated in 1983 in Yaoundé, Cameroon, were designated as the B1 genotype. However, in 2001 only viruses belonging to the B3 genotype were found in this city. The viruses in the Gambia (1993) were also of the B3 genotype. However, these viruses could be distinguished from each other at the antigenic level and by comparative sequence analysis. The B3 Cameroon (2001) viruses were related to the proposed B3.1 subgroup, whereas the Gambian (1993) isolates corresponded to the B3.2 subgroup. The geographical distribution for the period 1993-2001 of these two viruses shows that B3.1 is found from the Sudan to Nigeria and Ghana extending south to the Cameroon, whereas the B3.2 genotype is found in West Africa. In Nigeria and Ghana, the viruses co-circulate. The identification of these viruses will permit more meaningful epidemiological studies after the proposed increase in measles vaccination coverage.