Isolation of mesenchymal stem cells from bone marrow wastes of spinal fusion procedure (TLIF) for low back pain patients and preparation of bone dusts for transplantable autologous bone graft with a serum glue

Low back pain and subsequent disabilities are common. A lumbar spinal fusion procedure is an effective treatment with autologous bone grafts, but harvesting the bone from the iliac crest is associated with risks of complications. New treatments using stem cells together with osteoconductive and otesoinductive materials have made the procedure safer, but the inconsistency of the amount of stem cells harvested from bone marrow aspirate still remains to be solved. This study reports that the bone dusts, usually discarded as surgical wastes during transforaminal lumbar interbody fusion procedure (TLIF procedure), yielded cells which had the characteristics of mesenchymal stem cells (MSCs) in vitro. The cells were positive for the MSC markers and were able to differentiate in osteogenic and adipogenic directions. The cells grew robustly in an osteoconductive material, Bolheal (serum glue), and also proliferated well in culture medium supplemented with autologous serum. Therefore, the bone dust is a good candidate for the alternative source of stem cells other than bone marrow aspirate to increase the safety of the TLIF procedure.

Radiolunate fusion using vascularized radius bridging graft for the treatment of advanced Kienböck disease: two cases report

We present here two cases wherein we performed radiolunate fusion using vascularized radius graft with the vascular pedicle of the fourth extensor compartment artery (fourth ECA) for the treatment of Bain's grade 2A Kienböck disease with incongruity of the radiolunate joint. The dorsodistal radius graft was levered out and mobilized on the pedicle of the fourth ECA; then the vascularized dorsodistal radius was shifted 1 cm distally and bridges were created between the radius and the lunate. The radiolunate joint was completely fused in both cases at three months after surgery. The capitolunate joint maintained congruity after surgery. The Mayo wrist score was 75 points, and the DASH (JSSH version) score for the two cases was 2.5 and 4.2 points, respectively. Radiolunate fusion using the vascularized radius bridging procedure is one of the satisfactory methods for treating advanced Kienböck disease, especially in Bain's grade 2A cases.

[Paraplegia associated with acute aortic dissection complicated with pulmonary embolism and re-dissection]

Paraplegia associated with acute aortic dissection is one of the most serious complications. We experienced a case of Stanford type A acute aortic dissection with paraplegia and cardiac tamponade because the dissection was already thrombosed, conservative therapy was chosen. After drainage of pericardial effusion, a spinal drainage tube was inserted. Eleven days later, pulmonary embolism and re-dissection occurred, and an emergency operation was performed. Although the operation was successful, paraplegia did not improve. Even if type A acute aortic dissection is complicated with paraplegia, early surgical repair of aortic dissection should be considered, when paraplegia does not improve rapidly in spite of treatment.

Evidence for biological nitrification inhibition in Brachiaria pastures

Nitrification, a key process in the global nitrogen cycle that generates nitrate through microbial activity, may enhance losses of fertilizer nitrogen by leaching and denitrification. Certain plants can suppress soil-nitrification by releasing inhibitors from roots, a phenomenon termed biological nitrification inhibition (BNI). Here, we report the discovery of an effective nitrification inhibitor in the root-exudates of the tropical forage grass Brachiaria humidicola (Rendle) Schweick. Named "brachialactone," this inhibitor is a recently discovered cyclic diterpene with a unique 5-8-5-membered ring system and a gamma-lactone ring. It contributed 60-90% of the inhibitory activity released from the roots of this tropical grass. Unlike nitrapyrin (a synthetic nitrification inhibitor), which affects only the ammonia monooxygenase (AMO) pathway, brachialactone appears to block both AMO and hydroxylamine oxidoreductase enzymatic pathways in Nitrosomonas. Release of this inhibitor is a regulated plant function, triggered and sustained by the availability of ammonium (NH(4)(+)) in the root environment. Brachialactone release is restricted to those roots that are directly exposed to NH(4)(+). Within 3 years of establishment, Brachiaria pastures have suppressed soil nitrifier populations (determined as amoA genes; ammonia-oxidizing bacteria and ammonia-oxidizing archaea), along with nitrification and nitrous oxide emissions. These findings provide direct evidence for the existence and active regulation of a nitrification inhibitor (or inhibitors) release from tropical pasture root systems. Exploiting the BNI function could become a powerful strategy toward the development of low-nitrifying agronomic systems, benefiting both agriculture and the environment.

[Treatment of a persistent postoperative chylothorax with octreotide]

Chylothorax is a serious postoperative complication in the field of thoracic surgery. To treat refractory chylothorax, various methods including surgery are employed. In this study, we report a patient with refractory chylothorax in whom treatment with octreotide acetate was successful, although the chylorrhea site could not be determined during additional thoracotomy.

Risk factors for cardiac and pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment

BACKGROUND AND STUDY AIMS

Bleeding and perforation are major complications of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), but post-ESD stenosis represents a severe delayed complication that can result in clinical symptoms such as dysphagia and nausea. The aims of this study were to determine the risk factors and evaluate the clinical treatment for post-ESD stenosis.

METHODS

A total of 2011 EGCs resected by ESD at our institution between 2000 and 2005 were reviewed retrospectively. Resection was defined as cardiac when any mucosal defect was located in the squamocolumnar junction, and as pyloric when any mucosal defect was located < 1 cm from the pylorus ring. Post-ESD stenosis was defined when a standard endoscope could not be passed through the stenosis. We examined the incidence of post-ESD stenosis, its relationship with relevant factors, and the clinical course of post-ESD stenosis patients.

RESULTS

Post-ESD stenosis occurred with seven of 41 cardiac resections (17 %) and eight of 115 pyloric resections (7 %). Circumferential extent of the mucosal defect of > 3/4 and longitudinal extent > 5 cm were each significantly related to occurrence of post-ESD stenosis with both cardiac and pyloric resections. All 15 affected patients were successfully treated by endoscopic balloon dilation.

CONCLUSIONS

A circumferential extent of the mucosal defect of > 3/4 or longitudinal extent of > 5 cm in length were both demonstrated to be risk factors for post-ESD stenosis, in both cardiac and pyloric resections, and endoscopic balloon dilation was shown to be effective in treating post-ESD stenosis.

Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection--an analysis of risk factors

BACKGROUND AND STUDY AIM

Endoscopic submucosal dissection (ESD) has been reported to be associated with a higher complication rate than standard endoscopic mucosal resection. We aimed to clarify the risk factors for delayed bleeding after ESD for early gastric cancer (EGC).

METHODS

1083 EGCs in 968 consecutive patients undergoing ESD during a 4-year period were reviewed. Post-ESD coagulation (PEC) preventive therapy of visible vessels in the resection area, using a coagulation forceps, was introduced and mostly performed during the later 2 years. Various factors related to patients, tumors, and treatment including PEC were investigated using univariate and multivariate analysis with regard to delayed post-ESD bleeding, evidenced by hematemesis or melena, that required endoscopic treatment.

RESULTS

Delayed bleeding occurred after ESD of 63 lesions (5.8 % of all lesions and 6.5 % of patients), controlled in all cases by endoscopic hemostasis; blood transfusion was required in only one case. Tumor location in the upper third of the stomach and PEC were independent factors indicating a lower rate of delayed bleeding according to both univariate and multivariate analysis.

CONCLUSIONS

This retrospective study suggested that preventive coagulation of visible vessels in the resection area after ESD may lead to a lower bleeding rate.

Gastric perforation during endoscopic resection for gastric carcinoma and the risk of peritoneal dissemination

BACKGROUND

The potential risk of peritoneal seeding following perforation caused by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is unknown.

METHODS

Between January 1991 and December 2003, 90 patients suffered gastric perforation during EMR or ESD at the National Cancer Centre Hospital, Tokyo. The clinical and pathological evidence for peritoneal dissemination in these patients was assessed retrospectively.

RESULTS

Eighty-four patients were followed up at this hospital for a median of 53.6 (range 7.0-136.6) months; the remaining six patients were followed up at other institutions. In 83 patients the perforation was repaired by endoscopic clip application and seven patients underwent emergency surgery. Gastrectomy was carried out in 33 patients who had non-curative endoscopic surgery. Among these, peritoneal fluid was sampled during operation in nine patients and was cytologically negative for malignancy. The other 24 patients who had a gastrectomy did not have ascites so cytology was not performed. No peritoneal dissemination was noted during follow-up.

CONCLUSION

This study suggests that perforation associated with EMR and ESD does not lead to peritoneal dissemination even in the long term.

Rapid-prototyped temporal bone and inner-ear models replicated by adjusting computed tomography thresholds

Purpose:

This study aimed to investigate the validity of adjusting computed tomography thresholds in order to replicate a temporal bone model suitable for dissection training and education.

Materials and methods:

A simulated three-dimensional model of a human temporal bone was prototyped using selective laser sintering. The powder layers were laser-fused, based on detailed computed tomography data, and accumulated to create a three-dimensional structure. The computed tomography threshold value of the stapes was modified on standard triangular language file in order to replicate the stapes. The intensity value was determined to select the fluid lumen of the inner ear and the bone surface, in order to replicate the inner ear.

Results:

The model could be shaved, using surgical instruments, in the same manner as during real surgery. The stapes could be reproduced, making this model even more realistic than a previous version. The inner ear was recreated, along with the surrounding bony wall and the ossicles.

Conclusion:

This model facilitates dissection training and easy understanding of the relation between the labyrinth and the surrounding structures.

Apparent motion of monocular stimuli in different depth planes with lateral head movements

A stationary monocular stimulus appears to move concomitantly with lateral head movements when it is embedded in a stereogram representing two front-facing rectangular areas, one above the other at two different distances. In Experiment 1, we found that the extent of perceived motion of the monocular stimulus covaried with the amplitude of head movement and the disparity between the two rectangular areas (composed of random dots). In Experiment 2, we found that the extent of perceived motion of the monocular stimulus was reduced compared to that in Experiment 1 when the rectangular areas were defined only by an outline rather than by random dots. These results are discussed using the hypothesis that a monocular stimulus takes on features of the binocular surface area in which it is embedded and is perceived as though it were treated as a binocular stimulus with regards to its visual direction and visual depth.