[A case of chondroblastoma arising from the temporal bone]

A 33-year-old male sustained hearing disturbance in the left ear that exacerbated over a period of three years. The patient was referred to the department of otorhynolaryngology for severe stenosis of the left external auditory canal, where neuroimaging study revealed a huge tumor in the left temporal fossa. On first examination, he showed a significant facial nerve paresis and conductive hearing loss. CT scans identified a 4.5×4.5×4.5 cm mass with intralesional calcification and extensive bony destruction in the squamous and petrous parts of the temporal bone and middle cranial fossa floor. MR imaging demonstrated the tumor of heterogenous intensity on T1-and hypointensity on T2-weighted image. The patient underwent gross total resection of the lesion via frontotemporal craniotomy. The bony and ligamentous structures around the temporomandibular joint appeared mostly intact and did not need any reconstructive surgery after tumor resection. Postoperatively the patient's facial nerve paresis showed a transient exacerbation which resolved gradually, while hearing disturbance did not improve. Histological findings of the tumor were consistent with the qualities of chondroblastoma. We should assume chondroblastoma as differential diagnosis when we encounter a temporal bone tumor that is curable by surgical resection.

Metastatic skull base tumor from thymic carcinoma mimicking Tolosa-Hunt syndrome

A 39-year-old male without contributory medical history had sustained progressive double vision, ptosis, and trigeminal pain for 2 weeks. Physical examination revealed total ophthalmoplegia and visual field defect with normal blood examination and chest radiography. Cranial computed tomography revealed a hyperdense mass in the left frontotemporal fossae with bony erosion. Magnetic resonance imaging confirmed a broad-based, intensely enhanced extraaxial tumor of 4x4x4 cm diameter with dural tail sign. Cerebral angiography demonstrated insignificant blood supply both from the internal carotid and middle meningeal arteries. Nearly total tumor resection was achieved via orbitofrontotemporal craniotomy. Intraoperative findings revealed the extraaxial tumor with broad attachment to the dura mater and invasion to the optic and oculomotor nerves. Histological examination revealed hypercellular tumor with significant cell atypism, mitotic activity, and focal necrosis. Immunohistochemical staining was positive for AE1/3 and c-kit, but negative for glial fibrillary acidic protein. Systemic examination performed postoperatively revealed a thymic tumor without additional remote lesions. The final diagnosis was metastatic brain tumor from thymic carcinoma. Rapid progression of neurological impairment inconsistent with a benign extraaxial tumor needs prompt surgical intervention.

Evaluation of neck pain by using a visual analog scale before and after laminoplasty in patients with cervical myelopathy: relationship with clinical results

Object

In this study the authors investigated the neck pain of patients with cervical myelopathy by using a visual analog scale (VAS) before and after laminoplasty, and they analyzed the association of amount of neck pain with the clinical results.

Methods

A retrospective review was conducted in 41 patients with cervical myelopathy who underwent cervical laminoplasty. The patients were assessed using questionnaires to evaluate the neck pain intensity before surgery, and 2 years after surgery, the outcome was assessed using a VAS. The degree of cervical lordosis and range of motion (ROM) of the cervical spine were evaluated before and after laminoplasty. The neurological status was also evaluated before and after surgery.

Results

The patients were classified into 2 groups according to their preoperative neck pain: 1) the pain (PA) group, which included patients whose preoperative VAS score was more than 1 mm; and 2) the no pain (NP) group, which included patients whose preoperative VAS score was 0 mm. Inclusion in the PA group indicated a restriction of the cervical ROM before laminoplasty; however, the improvement of neck pain in this group and the deterioration of pain status in the NP group eliminated this difference after laminoplasty. Thereafter, the PA group was classified into 2 subgroups according to the improvement of the preoperative neck pain: 1) the improved group, which included patients whose postoperative VAS score decreased; and 2) the no improvement group, which included patients who were not in the improved group. No significant differences were observed in the average recovery and radiographic results between these 2 subgroups.

Conclusions

Neck pain before surgery in the PA group indicated a restriction of the cervical ROM; however, the improvement of neck pain in this group and the deterioration of pain status in the NP group indicated the disappearance of this difference postoperatively. Moreover, improvement of preoperative neck pain was not associated with the radiographic results and the neurological recovery rate.

Huge supratentorial extraventricular anaplastic ependymoma presenting with massive calcification--case report

A 15-year-old boy presented with an anaplastic supratentorial ependymoma causing massive intratumoral calcification, without contributory medical and family history, and manifesting as persistent headache for 2 months. Physical examination found no neurological deficit except for visual defect in the right lower quadrant, with intact visual acuity. Blood examination showed no abnormalities. Cranial computed tomography revealed a huge calcified mass in the left parietooccipital lobe, with extensive perilesional brain edema. Cranial radiography showed diffuse and symmetrical thinning of the calvarial bone. Magnetic resonance imaging confirmed the tumor as an assembly of medullated masses with extraventricular location, 7 x 6.5 x 6.5 cm in diameter, and appearing as heterogeneous intensity on both T(1)- and T(2)-weighted images with inhomogeneous enhancement except for the central cores. The patient underwent tumor resection. Intraoperative findings revealed that the cortical veins overlying the tumor were reddish and moderately engorged. The hypervascular tumor, entirely extraventricular in location, was totally resected without neurological deterioration. Histological examination revealed that the tumor was highly cellular with hyperchromatic nuclei and cell atypia. Necrosis, mitotic figures, and perivascular pseudorosette formations were frequently seen. Immunohistochemical study showed positive staining for glial fibrillary acidic protein, S-100 protein, vimentin, and epithelial membrane antigen, but negative for synaptophysin. The MIB-1 labeling index was 26.5%. The findings were compatible with anaplastic ependymoma (World Health Organization classification grade 3). Ependymoma should be included in the differential diagnosis of a supratentorially located, extraventricular mass with massive intratumoral calcification.

Multiple meningeal cysts affecting the whole craniospinal axis. Case report

A 61-year-old female presented with multiple meningeal cysts arising along the whole craniospinal axis, manifesting as trigeminal neuralgia, truncal ataxia, and gradually aggravating headache persisting for 2 years. The patient had suspected Sjögren syndrome, but no other contributory medical history such as infection, subarachnoid hemorrhage, trauma, malignancies affecting the central nervous system, or habitual drug use. Cerebral magnetic resonance imaging revealed displaced trigeminal root and midbrain, distorted cerebellar hemisphere, and ventriculomegaly, which were relieved by microsurgical resection of the cyst wall. Histological examination confirmed the diagnosis of arachnoid cysts without concomitant meningeal inflammatory reactions. We thought that the multiple meningeal cysts might have originated from undetected meningitis or undetermined underlying mechanism associated with the autoimmune reactions occurring in the arachnoid membrane covering the central nervous system.

Lumbar congestive myelopathy mimicking neoplasia without concurrent vascular malformation

A 78-year-old male presented with congestive myelopathy manifesting as progressive gait disturbance following conservative therapy for lumbar spinal canal stenosis, with suspected spinal cord tumor in the conus medullaris. His past medical history was unremarkable and he was not aware of any traumatic injury in the back or infectious disease. On admission, he had clumsy hand, moderate paraparesis, significant sensory disturbance below the L5 level, and severe vesicorectal dysfunction. The deep tendon reflex was promoted in the upper extremities, but poorly induced in the lower extremities. Blood examination found no abnormalities including values of tumor markers. Cerebral, cervical, and thoracic magnetic resonance (MR) imaging revealed no contributory pathology without spondylotic change at the C3-C6 levels. Lumbar MR imaging showed fusiform swelling of the cord from the T10 to T12-L1 levels, with rimlike enhancement at the T12-L1 levels by gadolinium. The patient underwent surgery. Intraoperatively, the dorsal surface of the affected cord was pale, not swollen, and sparsely vascularized without tortuous vessels. Midline myelotomy caused escape of creamy material that was identified as necrotic neural tissue. A collapsed vessel, located on the surface of the cord, was histologically identified as a thrombosed vein. The histological findings were compatible with spinal infarction caused by congestive myelopathy. Whole craniospinal and iliac angiography performed postoperatively failed to reveal any dural and paraspinal vascular malformation. His paraparesis, sensory disturbance, and vesicorectal dysfunction improved significantly after surgery. Congestive myelopathy may be caused by various angiographically occult etiologies other than dural arteriovenous fistula.

Diagnosis of a previously unidentified primary site in patients with spinal metastasis: diagnostic usefulness of laboratory analysis, CT scanning and CT-guided biopsy

When the primary site is unknown in patients with spinal metastases, there can be problems in locating the site of tumor origin. Most previous reports on metastases of unknown origin have not been limited to the spine. The purpose of this study is to assess the usefulness of laboratory analysis, chest, abdominal and pelvic CT and CT-guided biopsy in patients with spinal metastases of unknown origin (SMUO). A retrospective review of the clinical histories of 27 patients with SMUO was done. A total of 43 patients with SMUO were seen at our institution between 2002 and 2007. Of the 43 patients, 27 who underwent all 3 tests (laboratory analysis including M protein and tumor markers, chest, abdominal and pelvic CT and CT-guided biopsy) were included in this study. We retrospectively assessed the diagnostic usefulness of those 3 tests in the 27 patients. In 27 patients, the final diagnosis was obtained in 26 patients. Myeloma was the most common malignancy followed by lung carcinoma. M protein was positive in all 7 patients with myeloma and negative in patients with other malignancies. The level of tumor markers was elevated in 16 of 17 patients with a solid tumor and in all 3 with lymphoma. CA15-3 was elevated in 4 of 27 patients, CA19-9 in 5 of 27 patients, CA125 in 2 of 27 patients, CEA in 6 of 27 patients, SCC in 2 of 27 patients, NSE in 7 of 27 patients, AFP in 1 of 27 patients, PIVKA-II in 1 of 27 patients, TPA in 6 of 27 patients, IAP in 3 of 12 patients, thyroglobulin in 2 of 27 patients, sIL-2R in 3 of 24 patients, and PSA in 5 of 17 male patients. Myeloma, lymphoma and prostate carcinoma had a marker with high sensitivity and specificity (M protein, sIL-2R and PSA). Eleven primary tumor sites (40.7%) were detected (6 lung, 1 prostate, 1 kidney, 1 thyroid, 1 liver, and 1 pancreas) by chest, abdominal and CT scanning. Biopsy led to determination of the final diagnosis in 12 (44.4%) of 27 patients (5 myelomas, 3 lymphomas, 2 prostate carcinomas, 1 renal-cell carcinoma, 1 thyroid carcinoma). In the remaining 15 patients, biopsy did not lead to determination of the final diagnosis, because the histological diagnosis was either an adenocarcinoma or an undifferentiated carcinoma, the tissue sample was not diagnostic. A laboratory analysis limited to specific tumor markers such as PSA and protein electrophoresis is considered to be useful in making a final diagnosis. Chest, abdominal and pelvic CT is considered to be useful for making a final diagnosis in solid tumors, but not for hematologic tumors. A CT-guided biopsy had a low determination rate in the final diagnosis in comparison to a laboratory analysis and CT scanning for solid tumors and it is not considered to be essential for the diagnosis of hematologic tumors.

Foot drop due to lumbar degenerative conditions: mechanism and prognostic factors in herniated nucleus pulposus and lumbar spinal stenosis

OBJECT

The aim of this study was to analyze the mechanism and prognostic factors of foot drop caused by lumbar degenerative conditions.

METHODS

The authors retrospectively reviewed the charts of 28 patients with foot drop due to a herniated nucleus pulposus (HNP) or lumbar spinal stenosis (LSS), scoring between 0 and 3 on manual muscle testing for the tibialis anterior muscles. They analyzed the mechanism of foot drop and whether the duration before the operation, preoperative tibialis anterior and extensor hallucis longus strength, age, gender, and diabetes mellitus were all found to be prognostic factors for postoperative tibialis anterior recovery. They also investigated whether the diagnosis had any influence on the prognosis.

RESULTS

The compression of double roots and a sequestrated fragment were observed, respectively, in 9 and 13 of 16 patients with HNP. Multiple levels including the L4-5 segment were decompressed in 8 of 12 patients with LSS. Analysis did not demonstrate any prognostic factor in surgically treated HNP, but significant associations with prognosis were observed with respect to preoperative tibialis anterior (p = 0.033) and extensor hallucis longus (p = 0.020) strength in patients with LSS. In addition, the postoperative muscle recovery in patients with HNP was significantly superior to that in patients with LSS (p = 0.011).

CONCLUSIONS

Double root compression was the most common condition associated with foot drop due to HNP. The diagnosis and preoperative tibialis anterior and extensor hallucis longus strength in LSS were factors that influenced recovery following an operation.

[Simultaneous presentation of Tolosa-Hunt syndrome and oculomotor nerve palsy due to the nonruptured internal carotid-posterior communicating artery aneurysm: a case report]

A 45-year-old female developed mild dysesthesia and swelling, followed by ptosisand trigeminal pain, in the right side of the face. Her past medical history was unremarkable, and she had not been aware of any infectious sign. A local otolaryngologist administered glucocorticoid therapy that resolved the face pain, but the ptosis persisted. Neurological examination found complete right oculomotor nerve paresis and mild sensory loss in the first and second segments of the right trigeminal nerve. Blood examination found no abnormalities. Neuroimaging revealed a saccular aneurysm at the branching site of the posterior communicating artery, projecting posteriorly and adjacent to the dorsum sellae, without other intracranial abnormalities. Cerebral angiography demonstrated poor opacification of the superior ophthalmic vein and cavernous sinus on the right side. The patient underwent coil embolization under a diagnosis of symptomatic aneurysm, but her oculomotor neuropathy was only partially improved. We thought that the impairment of the oculomotor function by inflammatory reaction in the cavernous sinus and mechanical compression by the aneurysm had already persisted for too long for post-treatment recovery. We think that the simultaneous occurrence of Tolosa-Hunt syndrome and oculomotor nerve palsy may have resulted because trigeminal neuralgia had increased the blood pressure to induce rapid growth of the preexisting aneurysm, or the inflammatory reaction in the cavernous sinus had promoted the growth of the aneurysm, or that the association was by chance.

[Case with large abdominal abscess associated with a ventriculoperitoneal shunt]

Abdominal abscess is a rare shunt-related complication with few reported cases. A 6-year-old female presented with a large staphylococcal abdominal abscess manifesting as abdominal distension without significant clinical signs or blood and cerebrospinal fluid findings of infection. The patient had undergone repeated surgeries for craniopharyngioma at 2 years of age and had suffered central pontine and extrapontine myelinolysis during the clinical course, had severely impaired hypothalamic function, and was in a vegetative state on presentation. In addition, she had previously suffered epidural, subdural, and cerebral parenchymal abscesses, which had resolved completely. She underwent percutaneous irrigation drainage of pus and removal of the shunt coupled with intense antibiotic administration, which cured the abscess without recurrence. Culture revealed methicillin-resistant Staphylococcus aureus. We thought that preexisting intracranial infection, which had extended down into the abdominal cavity through the peritoneal tube of the shunt, coupled with the patient's impaired immune function, had probably caused the abdominal abscess. Abdominal abscess is a potential complication of ventriculoperitoneal shunting, and timely diagnosis and treatment may achieve a good outcome.

Basilar apex aneurysm manifesting as third ventricular mass and obstructive hydrocephalus--case report--

A 58-year-old male, with a past history of hypertensive thalamic hemorrhage 12 years before, presented with gradually exaggerating gait disturbance, memory disturbance, and urinary incontinence. On admission, he had gait disturbance represented by petit pas and anteropulsion in addition to significant recent memory disturbance. Cranial computed tomography (CT) revealed a hyperdense mass in the third ventricle with triventricular dilation. Cerebral magnetic resonance (MR) imaging and MR angiography identified the third ventricular lesion as saccular basilar apex aneurysm. No other intracranial abnormal intensity contributing to his clinical symptoms was recognized. Cervical MR angiography showed normal findings. Cerebral blood flow (CBF) measurements revealed diffuse CBF reduction in the cerebral hemisphere. The patient underwent coil embolization which accomplished complete aneurysm occlusion. He showed only slight improvement in his gait disturbance after embolization, and CT following embolization revealed persistent ventriculomegaly. Ventriculoperitoneal shunting was carried out. Intraoperative neuroendoscopy demonstrated cerebrospinal fluid (CSF) obstruction caused by the embolized aneurysm at the level of the third ventricle, with normal CSF findings. Postoperatively his gait disturbance and intellectual impairment showed remarkable improvement. Basilar apex aneurysm associated with obstructive hydrocephalus has complex underlying pathology and should be treated by a combination of definitive aneurysm obliteration and CSF diversion.

[Rare complication of anterior spinal surgery: Horner syndrome]

Horner syndrome due to injury to the cervical sympathetic trunk (CST) is a very rare complication of anterior cervical decompression and fusion (ACDF). We have not mentioned the possibility of Horner syndrome as a postoperative complication in patients before surgery. We present a patient with Horner syndrome after ACDF and discuss the anatomical background of the CST and the causes and preventative measures against postoperative Homer syndrome. A 48-year-old man presented with disturbance of fine movement and reduction of grasping power in the right hand. MRI revealed osteophytes and a prolapsed disc compressing the spinal cord at C5-6 and C6-7. Two-level ACDF with inclusion of titan cages was performed via a right-sided exposure. Anisocoria (right > left) and right blepharoptosis were observed immediately after surgery. Postoperatively, disturbance of fine movement was resolved. Japanese Orthopaedic Association (JOA) score improved from 12 to 16. Horner syndrome disappeared at 6 months after surgery. The CST runs 10-15 mm lateral to the medial edge of the longus colli muscle (LCM) and exists in the loose fascia and approaches most medially at C6. During the decompressive procedure under microscopic viewing, the right blade of a retractor was found to come out of the medial edge of the LCM on the level of C6. It is postulated that the blade injured the right CST. Knowledge of the anatomical relation between the CST and the LCM is very important to avoid Horner syndrome in ACDF. The tip of a retractor blade must be placed between the medial edge of the LCM and the vertebral body.

Correlation between colonic motility and defecatory disorders after anterior resection of the rectum in canine models

The objective of this study was to describe the correlation between changes in colonic motility and defecatory disorders in four experimental canine models, with an emphasis on denervation. Therefore, we constructed a model by dividing 20 healthy mongrel dogs into four groups, i.e. control, denervation, transection and anterior resection of the rectum (AR) (denervation plus transection), and focused on the correlation between colonic motility and defecatory disorders by counting the colonic migrating motor complexes (CMMCs) and colonic non-migrating motor complexes (CNMCs). Gastrointestinal and colonic contractile activities were continuously recorded on a computer with strain gauge force transducers. The dogs' feces were checked daily, and their consistency was recorded as normal, semisolid, or watery. Compared with the control group, the transection group showed elongation of the propagation time (P < 0.05), and the mean motility index of colonic contractile activity at C4 and C5 in the denervation group was greater than that in the control group (P < 0.05). The AR group showed three features of colonic motility: (i) elongation of the mean CMMC cycle (P < 0.05); (ii) shortening of the propagation time (P < 0.05); and (iii) increment of the number of CNMCs. Concerning fecal consistency, the AR group only showed watery diarrhoea. In conclusion, we revealed the existence of a correlation between defecatory disorders and changes in colonic motility. Increased knowledge among colorectal surgeons of the changes in colonic motility that occur following colorectal surgery is very important and could lead to the curtailment of defecatory disorders among patients.

[Huge falx meningioma resected en bloc following acute brain swelling: a case report]

Surgery of a meningioma is composed of four essential consecutive steps; devascularization, detachment, debulking, and dissection. However, this is not the case with a huge meningioma in which circumferential devascularization and detachment may be difficult to complete before debulking is attempted. We report a case of a 37-year-old female presented headache, memory disturbance, and character change and sustaining a huge falx meningioma, with hypervascular appearance. Intraoperatively her blood pressure decreased to 45/30 mmHg due to profuse bleeding caused by "premature debulking" followed by significant brain swelling, which pushed out the tumor from the underlying brain after detachment of the tumor from the falx, and, consequently, yielded en bloc removal like a birth delivery. The histopathological diagnosis was angiomatous meningioma with prominent capillary proliferation without findings of celluar atypia. We thought that relative hyperemia in the brain surrounding the tumor, which was induced by the craniotomy, and acute brain ischemia caused by the intraoperative significant hypotension, might facilitate en bloc removal. We should be aware that huge meningiomas may cause intraoperative acute brain swelling as well as significant blood loss. Also we should carefully consider the indication and select proper candidates for presurgical cerebral angiography and tumor embolization because of the inherent risk that is apt to be underestimated.

Orbital dermoid cyst with intratumoral inflammatory hemorrhage: case report

An 85-year-old female presented with a 3-month history of worsening hyperlacrimation and blurred vision following blunt head injury. Her past medical history was unremarkable. Her blood examination identified no abnormal findings. Neuroophthalmological inspection revealed extraocular movement disorder and mild exophthalmos on the affected side. Her visual acuity was not disturbed. Neuroimaging showed a cystic mass located extraconally in the superolateral compartment of the anterior orbit, without enhancement by contrast medium. Surgical exploration resulted in escape of chocolate-colored, liquefied hematoma during dissection. No vascular lesion was found. A grayish-white cyst wall was found adhering strongly to the lateral and superior rectus muscles. The lacrimal gland was not identified. The mass was totally resected. Histological examination indicated dermoid cyst with inflammatory interstitial hemorrhage. No component of vascular malformation or atypia was found. Hyperlacrimation and extraocular movement improved postoperatively. We thought that the previous blunt head injury might have induced intratumoral hemorrhage in the preexisting dermoid cyst and that the escaped contents caused inflammatory irritation, resulting in the hyperlacrimation. Dermoid cyst may show atypical presentation with intratumoral hemorrhage and should always be included in the differential diagnosis of orbital tumor.

Idiopathic calvarial thinning

An 82-year-old diabetic female had been aware of gradually enlarging, painless scalp depressions in the bilateral parietal regions for more than 6 years. She had no history of head injury, or inflammatory or malignant disease. Her family history was unremarkable for hereditary bone disease. She had diabetes mellitus which had been well controlled with orally administered drugs. Blood examination showed normal renal and liver functions with normal serum calcium, magnesium, and phosphorus concentrations, in addition to normal parathyroid hormone and calcitonin levels. Neuroimaging including skull radiography, head computed tomography, and magnetic resonance imaging demonstrated symmetric thinning in the bilateral parietal bones attributed to loss of diploe and thinning of the outer table. The inner table was intact without associated soft tissue mass or vascular lesions. Technetium-99m methylene diphosphate systemic bone scintigraphy showed mild hypoaccumulation in the affected calvarium on the left. No other pathological findings were found by systemic examination. She underwent open biopsy for histological verification which revealed homogeneous membranous bone tissue with regressed diploe, absence of osteoblasts, absence of osteoclastic appearance, and absence of findings of underlying malignancy. There was no markedly fibrovascular connective tissue typical of Gorham-Stout disease. Calvarial thinning in the present case may have been caused by an undetermined complex mechanism.

Impact of stent design on intra-aneurysmal flow. A computer simulation study

SUMMARY

In addition to providing a skeleton for vessel reconstruction, stent implantation as used for cerebral aneurysm treatment can induce flow redirection, thus reducing vortical flow velocities within the aneurysm cavity. Further, stent characteristics such as strut size, porosity and cell shape influence the changes in intra-aneurysmal flow by analog simulations. The purpose of this computer simulation study was to visualize the flow pattern over the entire neck area of a side wall aneurysm while changing the stent parameters. A 3-D computer model aneurysm was constructed to have a parent artery of 5 mm diameter and an aneurysm of 10 mm diameter. The distance between the midline of main artery and center point of the aneurysm was 6.8 mm, providing a neck length of 5 mm, a width of 3.6 mm, and a neck area of 14 mm 2. The simulations were carried out with a Finite Element Method based flow simulation package. The incompressible Navier-Stokes equation was solved for a steady flow with a mean speed of 290 mm/s, steady viscosity of 3.83 cp, and density of 1.0 g/cm3. Two parallel stent struts (dimensions: 100 mum m 100 mum m 2.0 mm) were introduced into the plane of the aneurysm neck. The fraction of the aneurysm neck cross-section occupied by the stent was 2.83% in all cases. The velocity distribution through the neck of the aneurysm was calculated for three different choices of separation between the struts for each of two orientations of the struts (parallel and perpendicular) relative to the vessel axis. The flow pattern in the aneurysm was composed of an inflow zone at the distal neck and of an outflow zone at the proximal neck. The placement of stent struts at the aneurysm neck resulted in a decrease in the mean speed in the aneurysm. The degree of reduction and the distribution of flow through the neck did depend on the orientation of the stent struts. The struts, when placed parallel or perpendicular to the parent vessel axis affected the mean speed through the aneurysm neck differently.

Atypical dural arteriovenous fistula associated with meningitis

A 49-year-old male presented with hemisensory disturbance and gait unsteadiness following a previous episode of meningitis. He had no contributory medical or head injury history. Magnetic resonance imaging revealed innumerable medullary vessels in the white matter of the left cerebral hemisphere, which had not been recognized in the previous imaging study. Cerebral angiography showed variant superior sagittal sinus (SSS) arteriovenous fistula (AVF) fed by the bilateral middle meningeal and superficial temporal arteries, and drained directly to the cortical veins with marked venous engorgement in the affected hemisphere. The fistulas were located on the cortical veins, apart from the SSS. Initial percutaneous transarterial embolization failed, so the AVF was completely obliterated with a combination of surgical and endovascular techniques. The symptoms ameliorated postoperatively. Meningitis may be an underlying pathology of dural AVF. Variant SSS AVF can be treated with a combination of surgical and endovascular techniques.

Simultaneous bilateral vertebral artery occlusion in the lower cervical spine manifesting as bow hunter's syndrome

A 59-year-old male had suffered near-syncopal episodes for more than one year that occurred immediately on turning his head to the left. Cerebral magnetic resonance (MR) imaging did not detect any contributing lesions with well-developed posterior communicating arteries. Dynamic radiography of the cervical spine showed mild instability at C5-6 and concomitant intramedullary hyperintensity confirmed by T(2)-weighted MR imaging. Cervical computed tomography demonstrated an osseous protrusion in the right foramen transversarium at C5. Dynamic cerebral angiography revealed simultaneous vertebral artery (VA) occlusion at C6 on the right and C5 on the left associated with leftward head rotation. The VA showed an intact course at the C1 to C2 levels. The patient underwent anterior fusion followed by decompressive foraminotomy at C5-6 and C6-7 and meticulous resection of the markedly thickened fibroligamentous structure which was considered to contribute to the rotational VA occlusion. Postoperatively he no longer suffered near-syncope during head rotation. Bow hunter's syndrome is an infrequent type of vertebrobasilar insufficiency that may need surgical management for potential threat of ischemic stroke. Simultaneous VA occlusion at the lower cervical level can cause bow hunter's syndrome. Dynamic cerebral angiography is a useful modality for evaluating bow hunter's syndrome even if the patient cannot tolerate dynamic examination for the immediate symptom. Accurate anatomical knowledge of the uncovertebral foraminal region combined with intraoperative dynamic study is essential for safe surgery to the VA and favorable outcome.

Isolated angiitis in the hypothalamus mimicking brain tumor

A 64-year-old female presented with exaggerating somnolence without contributory medical and lifestyle histories. She was not aware of any preceding infection or headache. Cerebral magnetic resonance imaging demonstrated an isolated enhanced mass in the hypothalamus without meningeal enhancement. Blood and cerebrospinal fluid examinations showed no significant findings except for hypernatremia and hyperprolactinemia. She underwent an open biopsy via the interhemispheric route. Histological examination revealed marked perivascular lymphocytic aggregation with polyclonal immunostaining both for B and T lymphocytes. No findings suggestive of underlying malignancy were recognized. Extensive work-up aiming at systemic vasculitis and lymphoma revealed no signs of extracranial lesion, so the most probable diagnosis was isolated angiitis in the hypothalamus. Angiitis may originate from the hypothalamus and should be considered in the differential diagnosis of hypothalamic lesion mimicking brain tumor on neuroimaging.

A small molecule cell-impermeant Hsp90 antagonist inhibits tumor cell motility and invasion

Heat shock protein 90 (Hsp90) is a molecular chaperone that maintains function of numerous intracellular signaling nodes utilized by cancer cells for proliferation and survival. Hsp90 is also detected on the plasma membrane of tumor cells and its expression has been suggested to correlate with metastatic potential. Given the abundance and diverse functions of the intracellular pool of this protein, the precise contribution of cell surface Hsp90 to cell motility and tumor metastasis remains to be determined. In this study we utilized the small molecule DMAG-N-oxide, a novel cell-impermeable Hsp90 inhibitor, to specifically examine the role of cell surface Hsp90 in cell motility. We observed that, while not affecting intracellular Hsp90 function, DMAG-N-oxide significantly retarded tumor cell migration and integrin/extracellular matrix-dependent cytoskeletal reorganization. Concomitant with these findings, targeting cell surface Hsp90 significantly inhibited tumor cell motility and invasion in vitro, and had a dramatic impact on melanoma cell lung colonization in vivo. These data indicate that cell surface Hsp90 plays an important role in modulating cancer cell migration that is independent of the function of the intracellular Hsp90 pool, and that small molecule inhibitors of surface Hsp90 may provide a new approach to targeting the metastatic phenotype.

Wobble inosine tRNA modification is essential to cell cycle progression in G(1)/S and G(2)/M transitions in fission yeast

Inosine (I) at position 34 (wobble position) of tRNA is formed by the hydrolytic deamination of a genomically encoded adenosine (A). The enzyme catalyzing this reaction, termed tRNA A:34 deaminase, is the heterodimeric Tad2p/ADAT2.Tad3p/ADAT3 complex in eukaryotes. In budding yeast, deletion of each subunit is lethal, indicating that the wobble inosine tRNA modification is essential for viability; however, most of its physiological roles remain unknown. To identify novel cell cycle mutants in fission yeast, we isolated the tad3-1 mutant that is allelic to the tad3(+) gene encoding a homolog of budding yeast Tad3p. Interestingly, the tad3-1 mutant cells principally exhibited cell cycle-specific phenotype, namely temperature-sensitive and irreversible cell cycle arrest both in G(1) and G(2). Further analyses revealed that in the tad3-1 mutant cells, the S257N mutation that occurred in the catalytically inactive Tad3 subunit affected its association with catalytically active Tad2 subunit, leading to an impairment in the A to I conversion at position 34 of tRNA. In tad3-1 mutant cells, the overexpression of the tad3(+) gene completely suppressed the decreased tRNA inosine content. Notably, the overexpression of the tad2(+) gene partially suppressed the temperature-sensitive phenotype and the decreased tRNA inosine content, indicating that the tad3-1 mutant phenotype is because of the insufficient I(34) formation of tRNA. These results suggest that the wobble inosine tRNA modification is essential for cell cycle progression in the G(1)/S and G(2)/M transitions in fission yeast.

Atypical cervical astrocytoma manifesting as occipitalgia

A 23-year-old female presented with chronic occipitalgia without signs of increased intracranial pressure followed by worsening headache and slight gait unsteadiness. Cerebral magnetic resonance (MR) imaging showed no corresponding lesions. Cervical MR imaging revealed a cervical intramedullary tumor. Intraoperatively the subpial tumor was found to stretch the 3rd-5th dorsal nerve roots posteriorly, which was thought to cause the intolerable headache. Total tumor resection was achieved without requiring myelotomy using electrophysiological monitoring with somatosensory and motor evoked potentials. Histological examination identified diffuse astrocytoma. Postoperatively the headache had completely resolved. Cervical astrocytoma of subpial location is a very rare cause of headache in adults. The subpial location enables surgical extirpation because minimal or no myelotomy is needed.

Perinatal bisphenol A affects the behavior and SRC-1 expression of male pups but does not influence on the thyroid hormone receptors and its responsive gene

Bisphenol A (BPA) has been shown to interfere with thyroid hormone receptors (THRs) and to influence the expression of THR-responsive elements in vivo and in vitro, while some studies reported hyperactivity induced by BPA treatment. In the present study, our purpose was to investigate the effect of BPA exposure on behavioral alteration and its mechanism of action, especially focusing on the thyroid hormone pathway. Significant sexual difference on behaviors was observed in perinatal BPA exposure, as manifested by hyperactivity and impaired spatial learning/memory in male pups after matured. Dams treated with 0.1mg/l BPA showed transient hypothyroidism, while male pups were found to exhibit a transient hyperthyroidism followed by hypothyroidism. Furthermore, significant up-regulated expression levels of mRNA and protein of SRC-1 in the hippocampus were observed in male pups by 0.1mg/l BPA treatment. However the expression of THRalpha/beta and RC3/neurogranin were not affected by BPA treatment. These results indicate that perinatal BPA exposure at a very low level may influence thyroid function and then consequently affects brain development, but at the same time, suggest that thyroid hormone receptor may not be a direct target of BPA action, but instead, another factor may be involved in this action.

Transplantation of autologous rabbit BM-derived mesenchymal stromal cells embedded in hyaluronic acid gel sponge into osteochondral defects of the knee

BACKGROUND

Mesenchymal stromal cells (MSC) have the potential to differentiate into distinct mesenchymal tissues including cartilage, suggesting that these cells are an attractive cell source for cartilage tissue engineering approaches. Various methods, such as using hyaluronan-based materials, have been employed to improve transplantation for repair. Our objective was to study the effects of autologous transplantation of rabbit MSC with hyaluronic acid gel sponges into full-thickness osteochondral defects of the knee.

METHODS

Rabbit BM-derived MSC were cultured and expanded with fibroblast growth factor (FGF). Specimens were harvested at 4 and 12 weeks after implantation, examined histologically for morphologic features, and stained immunohistochemically for type II collagen and CD44.

RESULTS

The regenerated area after autologous transplantation of hyaluronic acid gel sponge loaded with MSC into the osteochondral defect at 12 weeks after surgery showed well-repaired cartilage tissue, resembling the articular cartilage of the surrounding structure, of which the histologic score was significantly better than that of the untreated osteochondral defect. In the regenerated cartilage, type II collagen was found in the pericellular matrix of regenerative chondrocytes, while CD44 expression in the regenerative tissue could not be revealed.

DISCUSSION

These data suggest that the autologous transplantation of MSC embedded in hyaluronan-based material may support chondrogenic differentiation and be useful for osteochondral defect repair.

Molecular characterization of GDD1/TMEM16E, the gene product responsible for autosomal dominant gnathodiaphyseal dysplasia

The human GDD1/TMEM16E gene has been found to be mutated in gnathodiaphyseal dysplasia, an unusual skeletal syndrome with autosomal dominant inheritance. The molecular and biochemical function(s) of GDD1 protein has not yet been elucidated. In this study, we examined the murine GDD1 gene expression pattern during embryonic development, and characterized the cellular and tissue localizations of its gene product using a GDD1-specific antibody. In the developing embryos, GDD1 mRNA expression was principally associated with differentiating and developing somites, with a highly complex spatiotemporal pattern that involved the myotomal and sclerotomal lineages of somites. Biochemical studies indicated that GDD1 protein is an integral membrane glycoprotein that resides predominantly in intracellular vesicles. Immunohistochemical analysis showed a high level of murine GDD1 protein expression in cardiac and skeletal muscle tissues, and in growth-plate chondrocytes and osteoblasts in bone. These observations suggest diverse cellular role(s) of GDD1 in the development of musculoskeletal system.

Experimental results and early clinical experience with an easy method for intracorporeal knot tying using a novel laparoscopic needleholder

BACKGROUND

Intracorporeal suturing and knot tying are among the most difficult procedures in laparoscopic operations. An easy and inexpensive method for intracorporeal instrumental ligation with a modified laparoscopic needle driver is presented.

METHODS

The needle driver developed in this study has a novel mechanism that can fix the suturing thread in a hook at the distal site of the holder's jaw hinge. This hook projects out from the rod only when the jaw of the holder is open. After the needle is removed from the tissue using the grasper, the needle driver is placed under the grasper, which the surgeon manipulates by the left hand. Then the thread is hooked on the needle driver by withdrawal of the driver with the jaw opening. The tip of the needle driver is moved over the shaft of the grasper by keeping the thread on the hook. The thread is entwined during a series of crossing movements of the rods of the forceps. The short tail of the suture material is gripped and tied up as a first throw of ligation. The side edge of the jaw, used for thread cutting, is sharpened by grinding.

RESULTS

When the angle of the forceps is set at 90 degrees in the box trainer, no difference in terms of ligation time and degree of error is observed between the hook and conventional C-loop methods. In the case of the 30 degree forceps angle, the novel method is superior to the conventional method.

CONCLUSION

The novel needle driver provides an easy and inexpensive method for performing an intracorporeal ligation, particularly in a case involving a sharp axis angle of the forceps. More clinical experience is necessary for evaluation of this method, but it has potential advantages in laparoscopic operations.

Identification of novel androgen response genes in prostate cancer cells by coupling chromatin immunoprecipitation and genomic microarray analysis

The androgen receptor (AR) plays a key role as a transcriptional factor in prostate development and carcinogenesis. Identification of androgen-regulated genes is essential to elucidate the AR pathophysiology in prostate cancer. Here, we identified androgen target genes that are directly regulated by AR in LNCaP cells, by combining chromatin immunoprecipitation (ChIP) with tiling microarrays (ChIP-chip). ChIP-enriched or control DNAs from the cells treated with R1881 were hybridized with the ENCODE array, in which a set of regions representing approximately 1% of the whole genome. We chose 10 bona fide AR-binding sites (ARBSs) (P<1e-5) and validated their significant AR recruitment ligand dependently. Eight upregulated genes by R1881 were identified in the vicinity of the ARBSs. Among the upregulated genes, we focused on UGT1A and CDH2 as AR target genes, because the ARBSs close to these genes (in UGT1A distal promoter and CDH2 intron 1) were most significantly associated with acetylated histone H3/H4, RNA polymerase II and p160 family co-activators. Luciferase reporter constructs including those two ARBSs exhibited ligand-dependent transcriptional regulator/enhancer activities. The present study would be powerful to extend our knowledge of the diversity of androgen genetic network and steroid action in prostate cancer cells.

Orbital Pseudotumor Associated With Retrobulbar Hematoma-Case Report-

A 75-year-old male suffered sudden onset of retroorbital pain, visual loss, periorbital ecchymosis, and double vision without preceding trauma, paranasal sinus surgery, or infectious signs. Neuroophthalmological inspection also revealed marked restriction of the extraocular movements, visual defect, and exophthalmos on the affected side. Neuroimaging showed an irregular-shaped retrobulbar mass centered in the inferolateral aspect and partially protruding between the inferior and lateral rectus muscles without enhancement by contrast medium. High dose steroid therapy provided little improvement in the visual symptoms. Needle aspiration biopsy revealed only fluid hematoma. Surgical exploration via the lateral wall of the orbit resulted in escape of chocolate-colored, liquefied hematoma during dissection between the inferior and lateral rectus muscles. No obvious vascular lesion was recognized. A small purplish elastic soft mass with irregular contours was recognized adherent to the inferior rectus muscle within the capsule of the hematoma. The mass was subtotally resected. The histological diagnosis was inflammatory pseudotumor with hemorrhagic change. No component of vascular malformation was found. Visual function and extraocular movement improved postoperatively and neuroimaging showed no abnormal structures in the affected orbit. Pseudotumor may bleed and form a retrobulbar hematoma which carries the risk of visual loss.

Effects of the Second National Acute Spinal Cord Injury Study of high-dose methylprednisolone therapy on acute cervical spinal cord injury-results in spinal injuries center

STUDY DESIGN

Retrospective single-center study.

OBJECTIVE

To evaluate the recovery of motor function and the early complications in patients with acute cervical spinal cord injury after receiving a high dose of methylprednisolone sodium succinate (MPSS) within 8 hours of injury.

SUMMARY OF BACKGROUND DATA

High-dose MPSS therapy has been demonstrated to improve the neurologic recovery in patients with acute spinal cord injury. However, it remains a controversial treatment.

METHODS

Seventy patients were included in this study: 37 in the MPSS group who were treated with MPSS within 8 hours of their injury according to the Second National Acute Spinal Cord Injury Study protocol, and 33 in non-MPSS group who were not administered with MPSS. Improvements in the American Spinal Injury Association motor score were compared between the MPSS group and the non-MPSS group. In patients with complete motor loss at admission and follow-up periods, improvements of myotomal levels between the MPSS (n = 15) and non-MPSS groups (n = 21) were compared. Early complications within 6 weeks of high-dose MPSS therapy were compared with those of no MPSS therapy.

RESULTS

Among the patients with incomplete paralysis at admission, the American Spinal Injury Association motor scores in the MPSS group were improved more significantly than those in the non-MPSS group at 6 weeks and 6 months after injury. Meanwhile, among the patients with complete paralysis at admission, the patients in the MPSS group did not show significantly more change in motor score than those in the non-MPSS group. Improvement in myotomal level had no significant difference between the MPSS and non-MPSS groups. The MPSS group had 10 patients with early complications, while the non-MPSS group had 14. The differences between the 2 groups showed no statistical significance.

CONCLUSIONS

MPSS should be administered to patients with incomplete cervical spinal cord injury according to the Second National Acute Spinal Cord Injury Study protocol.

Microsurgical anatomy of the central retinal artery

OBJECTIVE

To define the microsurgical anatomy of the central retinal artery (CRA) and to provide a guide to avoiding damage to it during surgery.

METHODS

The anatomic characteristics of the CRA and small arteries distributed to the optic sheath were examined in 109 orbits. The origin, course, and site of entry of the artery into the optic sheath and the distance between the orbital apex and the site of entry into the sheath were examined.

RESULTS

The CRAs originated directly from the intraorbital ophthalmic artery or in a common trunk with a posterior ciliary or a muscular branch. The CRAs most commonly originated on the inferomedial side of the ophthalmic artery an average of 8.4 mm distal to the orbital end of the optic canal. They penetrated the optic sheath near the junction of the middle and anterior thirds of the length of the intraorbital optic nerve an average of 18.6 mm distal to the optic canal. More than 70% of CRAs penetrated near the midline of the lower surface of the optic sheath, 21% entered the inferomedial surface, and 7% the inferolateral or lateral surface of the optic sheath. Only one CRA gave off a branch before penetrating the nerve.

CONCLUSION

The CRA is at risk of being damaged or occluded during procedures involving a large part of the orbit. Procedures directed along the lower half of the proximal two-thirds of the optic sheath have the greatest risk of interrupting the artery.

A genomic analysis of adult T-cell leukemia

Adult T-cell leukemia (ATL) is an intractable malignancy of CD4+ T cells that is etiologically associated with infection by human T-cell leukemia virus-type I. Most individuals in the chronic stage of ATL eventually undergo progression to a highly aggressive acute stage. To clarify the mechanism responsible for this stage progression, we isolated CD4+ cells from individuals in the chronic (n=19) or acute (n=22) stages of ATL and subjected them to profiling of gene expression with DNA microarrays containing >44,000 probe sets. Changes in chromosome copy number were also examined for 24 cell specimens with the use of microarrays harboring approximately 50,000 probe sets. Stage-dependent changes in gene expression profile and chromosome copy number were apparent. Furthermore, expression of the gene for MET, a receptor tyrosine kinase for hepatocyte growth factor (HGF), was shown to be specific to the acute stage of ATL, and the plasma concentration of HGF was increased in individuals in either the acute or chronic stage. HGF induced proliferation of a MET-positive ATL cell line, and this effect was blocked by antibodies to HGF. The HGF-MET signaling pathway is thus a potential therapeutic target for ATL.

Hepatocellular carcinoma in Txnip-deficient mice

The molecular pathogenesis and the genetic aberrations that lead to the progression of hepatocellular carcinoma (HCC) are largely unknown. Here, we demonstrate that the thioredoxin interacting protein (Txnip) gene is a candidate tumor suppressor gene in vivo. We previously showed that the recombinant inbred congenic strain HcB-19 has a spontaneous mutation of the Txnip gene, and we now show that the strain has dramatically increased incidence of HCC, and that the HCC cosegregates with the Txnip mutation. Approximately 40% of the Txnip-deficient mice developed hepatic tumors with an increased prevalence in male mice. Visible tumors develop as early as 8 months of age. Histological analysis confirmed the morphology of HCC in the Txnip-deficient mice. Molecular markers of HCC, alpha-fetoprotein and p53, were increased in tumors of Txnip-deficient mice. The upregulation of p53 preceded tumor development; however, bromodeoxyuridine (BrdU) labeling of normal hepatic tissue of Txnip-deficient mice did not reveal increased cell proliferation. Finally, microarray analyses of tumor, non-tumor adjacent, and normal tissue of Txnip-deficient mice highlighted the genetic differences leading to the predisposition and onset of HCC. Our findings suggest that Txnip deficiency is sufficient to initiate HCC and suggest novel mechanisms in hepatocarcinogenesis.

Celecoxib upregulates endoplasmic reticulum chaperones that inhibit celecoxib-induced apoptosis in human gastric cells

Nonsteroidal anti-inflammatory drugs (NSAIDs) induce apoptosis in cancer cells and this effect is involved in their antitumor activity. We recently demonstrated that NSAIDs upregulate GRP78, an endoplasmic reticulum (ER) chaperone, in gastric mucosal cells in primary culture. In the present study, induction of ER chaperones by NSAIDs and the effect of those chaperones on NSAID-induced apoptosis were examined in human gastric carcinoma cells. Celecoxib, an NSAID, upregulated ER chaperones (GRP78 and its cochaperones ERdj3 and ERdj4) but also C/EBP homologous transcription factor (CHOP), a transcription factor involved in apoptosis. Celecoxib also upregulated GRP78 in xenograft tumors, accompanying with the suppression of tumor growth in nude mice. Celecoxib caused phosphorylation of eukaryotic translation initiation factor 2 kinase (PERK) and eukaryotic initiation factor-2alpha (eIF2alpha) and production of activating transcription factor (ATF)4 mRNA. Suppression of ATF4 expression by small interfering RNA (siRNA) partially inhibited the celecoxib-dependent upregulation of GRP78. Celecoxib increased the intracellular Ca2+ concentration, while 1,2-bis(2-aminophenoxy)ethane-N,N,N'N'-tetraacetic acid, an intracellular Ca2+ chelator, inhibited the upregulation of GRP78 and ATF4. These results suggest that the Ca2+-dependent activation of the PERK-eIF2alpha-ATF4 pathway is involved in the upregulation of ER chaperones by celecoxib. Overexpression of GRP78 partially suppressed the apoptosis and induction of CHOP in the presence of celecoxib and this suppression was stimulated by coexpression of either ERdj3 or ERdj4. On the other hand, suppression of GRP78 expression by siRNA drastically stimulated cellular apoptosis and production of CHOP in the presence of celecoxib. These results show that upregulation of ER chaperones by celecoxib protects cancer cells from celecoxib-induced apoptosis, thus may decrease the potential antitumor activity of celecoxib.

Interlaminar bony fusion after cervical laminoplasty: its characteristics and relationship with clinical results

STUDY DESIGN

A radiographic study in 32 patients with cervical myelopathy.

OBJECTIVE

To investigate postoperative interlaminar bony fusion, and its characteristics and relationship to clinical results in patients undergoing laminoplasty.

SUMMARY OF BACKGROUND DATA

Laminoplasty is being increasingly performed for multi-segmental cervical myelopathy, and its superior long-term results have been reported in some articles. We often see cases that develop postoperative interlaminar bony fusion after laminoplasty.

METHODS

In 32 patients, lateral cervical radiographs were obtained every year after surgery, and postoperative interlaminar bony fusion was evaluated. Range of motion (ROM) of the cervical spine at last follow-up was compared with the respective preoperative values. Furthermore, the neurologic recovery rates at last follow-up were compared to preoperative values.

RESULTS

Postoperative interlaminar bony fusion was shown in 17 patients (53%, group 1), and in most, fusion appeared within 3 years after surgery. Average age at surgery in group 1 and the remaining 15 patients (group 2) was 64.6 years and 57.0 years, respectively (P < 0.04). Preoperative and postoperative ranges of motion in group 1 were 45.6 degrees and 28.1 degrees on average, respectively. However, those of group 2 were 50.3 degrees and 39.8 degrees on average, respectively. Postoperative ROM in group 2 was significantly better maintained than that in group 1(P < 0.04). In group 1, the average preoperative Japanese Orthopedic Association score was 9.56 points, which improved to 13.6 points at the final follow-up, providing a 55.6% average recovery. In group 2, it was 10.9 points, which improved to 14.1 points at the final follow-up, providing a 56.5% average recovery. There was no significant difference in the average percentage of recovery between the 2 groups (P > 0.93).

CONCLUSIONS

Postoperative interlaminar bony fusion occurred in 53% of patients, with marked frequency at C2/3 after laminoplasty. It did not influence neurologic recovery, but it did reduce the postoperative sagittal ROM of the cervical spine.

Clinical Results After Cervical Laminoplasty

OBJECTIVE

This investigation assessed the relationship between the duration of wearing a cervical collar and clinical results in patients undergoing laminoplasty.

METHODS

Twenty-five patients with cervical myelopathy who underwent laminoplasty and wore a cervical collar for 8 weeks postoperatively were followed for an average of 27.3 months. A second group of 26 patients who underwent laminoplasty and wore a cervical collar for 4 weeks was followed for an average of 32.8 months.

RESULTS

In both groups, neurologic recovery rate and range of motion on lateral cervical radiographs were longitudinally compared with those obtained preoperatively. There was no significant difference in neurologic recovery between the two groups. In patients who wore the cervical collar for 4 weeks, the total range of the cervical spine was better maintained, especially the extension range of the cervical spine, compared with that in the patients who wore the cervical collar for 8 weeks.

CONCLUSIONS

It is speculated that early removal of the cervical collar prevents contracture of the facet joint and postoperative atrophy and dysfunction of the extensor musculature of the cervical spine.

Motility and growth of human bone-marrow mesenchymal stem cells during ex vivo expansion in autologous serum

Human bone-marrow mesenchymal stem cells have an important role in the repair of musculoskeletal tissues by migrating from the bone marrow into the injured site and undergoing differentiation. We investigated the use of autologous human serum as a substitute for fetal bovine serum in the ex vivo expansion medium to avoid the transmission of dangerous transfectants during clinical reconstruction procedures.

Autologous human serum was as effective in stimulating growth of bone-marrow stem cells as fetal bovine serum. Furthermore, medium supplemented with autologous human serum was more effective in promoting motility than medium with fetal bovine serum in all cases. Addition of B-fibroblast growth factor to medium with human serum stimulated growth, but not motility. Our results suggest that autologous human serum may provide sufficient ex vivo expansion of human bone-marrow mesenchymal stem cells possessing multidifferentiation potential and may be better than fetal bovine serum in preserving high motility.

Efficacy of a posterior implant support for extra shortened dental arches: a biomechanical model analysis

The purpose of this study was to test the efficacy of utilizing implants underneath distal free-end denture bases to establish a stable occlusal support for extreme shortened dental arches (ESDA). The authors constructed a two-dimensional finite element model of the ESDA where only lower anterior teeth remain. Posterior occlusal support was provided by a fixed partial denture with an osseointegrated implant (IFPD), fixed cantilever partial denture (CFPD), or a removable partial denture with or without an implant underneath (IRPD and RPD). A dentate mandible model was the control. When muscle vectors simulating clenching force were applied, stress levels on the temporal bone surface area under each configuration were compared, to evaluate the efficacy in establishing the occlusal support. The largest stress increase in temporal bone was found in the ESDA situation followed by the RPD. The least amount of stress increase was found with the IFPD followed by IRPD when the implant was placed in the molar region. The stress increase with IRPD was about 20-45% of the amount with RPD. Our results suggest that IFPD provides most favourable and stable occlusal support, however, IRPD with a single posterior implant also provide stable occlusal support with reducing the stress levels in the temporomandibular joint.

Molecular cloning and characterization of the murine gnathodiaphyseal dysplasia gene GDD1

Mutations in the GDD1 gene cause gnathodiaphyseal dysplasia, a rare human skeletal syndrome with autosomal dominant inheritance. The biochemical function(s) of GDD1 protein and the molecular pathophysiology of GDD1 mutations leading to GDD have not yet been elucidated. In this study, we characterized the complete cDNA sequence and genomic organization of the mouse GDD1 gene. Analysis of GDD1 mRNA revealed a complex alternative splicing pattern, involving five exons of the GDD1 gene. GDD1 isoforms lacking conserved amino acids at the N-terminus cytoplasmic tails, and with changes in transmembrane topology, are presumably associated with changes in protein functions and subcellular localizations of GDD1. We found GDD1 expression to be up-regulated during the course of myogenic differentiation in the murine pluripotent mesenchymal precursor cell line C2C12, whereas its expression was diminished during osteoblastic differentiation. These observations suggest diverse cellular roles of GDD1 protein.

Endoplasmic reticulum stress response is involved in nonsteroidal anti-inflammatory drug-induced apoptosis

Apoptosis induced by nonsteroidal anti-inflammatory drugs (NSAIDs) is involved not only in the production of NSAID-induced gastric lesions but also in the antitumor activity of these drugs. The endoplasmic reticulum (ER) stress response is a cellular mechanism that aids in protecting the ER against ER stressors and is involved in ER stressor-induced apoptosis. Here, we examine the relationship between this response and NSAID-induced apoptosis in cultured guinea-pig gastric mucosal cells. Exposure of cells to indomethacin, a commonly used NSAID, induced GRP78 as well as CHOP, a transcription factor involved in apoptosis. Three factors that positively regulate CHOP expression (ATF6, ATF4 and XBP-1) were activated and/or induced by indomethacin. NSAIDs other than indomethacin (diclofenac, ibuprofen and celecoxib) also induced CHOP. Monitoring of the transcriptional activities of ATF6 and CHOP by luciferase assay revealed that both were stimulated in the presence of indomethacin. Furthermore, indomethacin-induced apoptosis was suppressed in cultured guinea-pig gastric mucosal cells by expression of the dominant-negative form of CHOP, or in peritoneal macrophages from CHOP-deficient mice. These results suggest that ER stress response-related proteins, particularly CHOP, are involved in NSAID-induced apoptosis.

Multidimensional support vector machines for visualization of gene expression data

MOTIVATION

Since DNA microarray experiments provide us with huge amount of gene expression data, they should be analyzed with statistical methods to extract the meanings of experimental results. Some dimensionality reduction methods such as Principal Component Analysis (PCA) are used to roughly visualize the distribution of high dimensional gene expression data. However, in the case of binary classification of gene expression data, PCA does not utilize class information when choosing axes. Thus clearly separable data in the original space may not be so in the reduced space used in PCA.

RESULTS

For visualization and class prediction of gene expression data, we have developed a new SVM-based method called multidimensional SVMs, that generate multiple orthogonal axes. This method projects high dimensional data into lower dimensional space to exhibit properties of the data clearly and to visualize a distribution of the data roughly. Furthermore, the multiple axes can be used for class prediction. The basic properties of conventional SVMs are retained in our method: solutions of mathematical programming are sparse, and nonlinear classification is implemented implicitly through the use of kernel functions. The application of our method to the experimentally obtained gene expression datasets for patients' samples indicates that our algorithm is efficient and useful for visualization and class prediction.

CONTACT

komura@hal.rcast.u-tokyo.ac.jp.

Novel roles of the autocrine motility factor/phosphoglucose isomerase in tumor malignancy

Autocrine motility factor (AMF) stimulates cell motility in an autocrine manner and is related to tumor malignancy. AMF is a multifunctional molecule, also known as phosphoglucose isomerase and neuroleukin. Signal cascades of the AMF-stimulated motility and novel functions of this protein contributing to tumor malignancy have been presented recently. AMF stimulation activated small Rho-like GTPases and subsequently induced actin fiber rearrangement, which was removed by the C3 exoenzyme, a specific inhibitor of Rho. The expression of Jun N-terminal kinase (JNK)1, JNK2 and the Rho GDP dissociation inhibitor-beta was upregulated by AMF. The addition of AMF to culture medium stimulated the motility of the endothelial cells and the formation of tube-like structures in collagen gels. Highly AMF-expressing HT1080 cells induced aggressive angiogenesis in vivo. The expression of fms-like tyrosine kinase (Flt)-1, a vascular endothelial growth factor (VEGF) receptor, was enhanced in AMF-expressing tumors dependent on protein kinase C and phosphatidylinositol 3 kinase (PI3K) activation; meanwhile kinase insert domain-containing receptor, another receptor of VEGF, was not. Permeability of mesothelial and endothelial cell monolayers was increased by AMF, and numerous gaps were observed in the monolayers after treatment with AMF. AMF gene transfection transformed NIH3T3 cells to proliferate quickly and acquire anti-apoptosis ability induced by serum deprivation in a PI3K-dependent manner. The anti-apoptotic effect of AMF has been described by other authors who have shown that the AMF over-expressing cells were resistant to mitomycin-C-induced apoptosis showing regression of Apaf-1 and caspase-9 dependent on PI3K and MAP kinase. These novel functions of AMF makes it a likely target for cancer therapy.

The novel gene encoding a putative transmembrane protein is mutated in gnathodiaphyseal dysplasia (GDD)

Gnathodiaphyseal dysplasia (GDD) is a rare skeletal syndrome characterized by bone fragility, sclerosis of tubular bones, and cemento-osseous lesions of the jawbone. By linkage analysis of a large Japanese family with GDD, we previously mapped the GDD locus to chromosome 11p14.3-15.1. In the critical region determined by recombination mapping, we identified a novel gene (GDD1) that encodes a 913-amino-acid protein containing eight putative transmembrane-spanning domains. Two missense mutations (C356R and C356G) of GDD1 were identified in the two families with GDD (the original Japanese family and a new African American family), and both missense mutations occur at the cysteine residue at amino acid 356, which is evolutionarily conserved among human, mouse, zebrafish, fruit fly, and mosquito. Cellular localization to the endoplasmic reticulum suggests a role for GDD1 in the regulation of intracellular calcium homeostasis.