A placebo-controlled, single-blind study to determine the appropriate alendronate dosage in postmenopausal Japanese patients with osteoporosis. The Alendronate Research Group

Alendronate (4-amino-1-hydroxybutylidene-1,1-bisphosphonate) is a potent inhibitor of bone resorption. The efficacy and safety of 36 weeks of treatment with alendronate were evaluated in Japanese women with osteoporosis, osteoporotic osteopenia or artificial menopause. The bone mineral density (BMD) of the lumbar vertebrae, markers of bone and calcium metabolism and clinical symptoms were monitored. A total of 113 randomly selected patients with osteoporosis or osteopenia were enrolled in the study, of whom 12 were excluded from the analyses because of lack of data. As a result, 101 patients were evaluated for the safety of the drug. Since eight patients were excluded from the efficacy analysis, 93 were evaluated. The incidence of adverse effects in the placebo (P), alendronate 2.5 mg/day (L) and alendronate 10 mg/day (H) groups increased with increasing dose of alendronate, being 6.1, 14.3 and 18.2%, respectively. The most common adverse effects were gastrointestinal symptoms, none of which was serious. Lumbar BMD increased after 36 weeks of drug administration to 5.21%, 5.64% and -0.90% in the L, H and P groups, respectively (P < 0.001, L vs. P and H vs. P). Serum alkaline phosphatase activity, serum osteocalcin and urinary deoxypyridinoline excretion were significantly decreased in a dose-related manner. Serum calcium and phosphorus were also significantly decreased after alendronate administration. Serum intact PTH was transiently increased. The present results indicate that alendronate effectively decreases bone turnover in a dose-related manner and increases lumbar BMD at a dosage of 2.5 mg/day, the lowest dose used in this study, in Japanese patients with osteoporosis.

[Clinical experiences of minimally invasive direct coronary artery bypass (MIDCAB)]

From Jan. to Oct. in 1997, we performed 18 minimally invasive direct coronary artery bypass (MIDCAB), aged from 45 to 86 years (the mean age of 69 years). They had single LAD disease post PTCA failure in 2 patients, and multiple vessel disease in 16 patients including left main stenosis in 2 patients. Sixteen patients had associated risk factors for using cardiopulmonary bypass, such as cerebrovascular disease in 9 patients, calcification of ascending aorta in 5 patients, renal failure in 2 patients, old age over 80 years in 4 patients and cancer in one patient. Single bypass grafting of left internal thoracic artery (LITA) to left anterior descending artery (LAD) underwent through left anterior small thoracotomy in 9 patients, double bypass grafting of gastroepiploic artery or right ITA to right coronary artery with LITA to LAD in 9 patients through subxiphoid small incision or right anterior small thoracotomy. The mean number of distal anastomosis was 1.5/patient. All patients are alive and asymptomatic, and postoperative angiography demonstrated the patency rate of 96.2% (26/27). MIDCAB is considered as a justified and safe technique for the patients who are ineligible for standard coronary artery bypass grafting.

The effects of rigid spinal instrumentation and solid bony fusion on spinal kinematics. A posterolateral spinal arthrodesis model

STUDY DESIGN

Spinal kinematics after the implementation of rigid spinal instrumentation or the achievement of a solid fusion was studied using a sheep posterolateral spinal arthrodesis model.

OBJECTIVE

To investigate the effects of rigid spinal instrumentation or solid fusion on spinal kinematic parameters.

SUMMARY OF BACKGROUND DATA

Numerous studies have attempted to define spinal instability in terms of kinematics. Recent in vitro studies have documented the neutral zone, or a measure of spinal laxity, as more sensitive to spinal instability than the range of motion.

METHODS

Seven skeletally mature sheep underwent a single-level posterolateral lumbar arthrodesis using autologous bone graft augmented with transpedicular screw fixation. The animals were killed 4 months after surgery. The identical surgical procedures were performed in seven sheep cadaveric spines, which served as acute postoperative controls. Each functional spinal unit was tested biomechanically before and after hardware removal. The experimental control groups consisted of destabilized spines and spines that underwent transpedicular screw fixation alone, whereas the fusion groups included spines that underwent posterolateral fusion alone or posterolateral fusion with instrumentation.

RESULTS

Rigid instrumentation and solid fusion significantly decreased the neutral zone and range of motion in all testing modes. In axial rotation and lateral bending, solid fusion reduced the range of motion significantly more than transpedicular screw fixation alone. However, in all testing modes, the neutral zones showed no statistical difference between transpedicular screw fixation alone and fusion groups.

CONCLUSIONS

The range of motion was an equivalent or better indicator of fixation or fusion stability compared with the neutral zone. Moreover, the immediate postoperative fixation stability, even if using transpedicular screw fixation, was less than the stability present after a solid fusion.

The effects of spinal fixation and destabilization on the biomechanical and histologic properties of spinal ligaments. An in vivo study

STUDY DESIGN

An animal study was conducted to assess whether different surgical procedures of spinal fixation and destabilization would influence the biomechanics and histology of lumbar spinal ligaments.

OBJECTIVES

To investigate the effects of spinal fixation and destabilization as well as surgical intervention itself on the biomechanical and histologic properties of lumbar spinal ligaments.

SUMMARY OF BACKGROUND DATA

Although several investigators have reported normal biomechanical properties of different spinal ligaments, there have been no studies in which changes in spinal ligament properties, secondary to the altered biomechanical environment provided by such surgical procedures as spinal fixation and destabilization, have been investigated.

METHODS

Thirty-six mature sheep were divided into four groups: Group I: nonsurgical control: Group II: sham operation consisting of bilateral posterolateral exposure at L4-L5; Group III: spinal fixation using transpedicular screws and plates and bilateral posterolateral bone graft at L4-L5; and Group IV: spinal destabilization consisting of bilateral facetectomy and anterior discectomy at L4-L5. Four months after surgery, the biomechanical analysis included destructive tensile testing of four different bone-ligament-bone complexes at the operative and proximal adjacent levels: anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, and supraspinous and interspinous ligaments combined. Histomorphometric analyses of the vertebral body and spinal ligaments were performed histomorphometrically.

RESULTS

Biomechanical analysis results demonstrated remarkable changes in the structural and mechanical ligament properties at the operative level. The fixation group's ligaments showed consistent decreases in the ultimate load and elastic modulus compared with those parameters in the control group (P < 0.05). Histologically, the fixation group's ligamentum flavum showed marked vacuolation in the ligament substance, whereas the interspinous ligament exhibited significant insertion changes compared with little change in substance. In all eight sheep in Group IV, unintentional bilateral facet fusions were obtained; and in all eight animals in Group III with pedicle instrumentation and posterolateral fusion, solid arthrodesis was exhibited. This allowed a distinction to be made between the stress-shielding effect of spinal instrumentation and arthrodesis (Group III) versus spinal fusion alone (Group IV) on both spinal ligament and vertebral body. Group II (sham) had a significant decrease in supraspinous and interspinous ligaments, but nonsignificant decreases in the stress-shielding effect of 10-12% in other ligaments.

CONCLUSIONS

Posterior spinal instrumentation and fusion led to decreased biomechanical properties of the ligamentum flavum, posterior longitudinal ligament, and interspinous and supraspinous ligaments. The stress-shielding effects were ligament dependent and were most pronounced on the posterior side. The altered biomechanical environment produced by spinal fixation, surgical intervention itself, or nonphysiologic mobilization can affect the ligamentous properties in vivo, possibly serving as the impetus for low back pain.

Biomechanical analysis of limited intercarpal fusion for the treatment of Kienböck's disease: a three-dimensional theoretical study

Although several types of intercarpal fusion have been advocated for the treatment of Kienbock's disease, the clinical outcome of each procedure is still inconclusive. The joint load and ligament tension based on a three-dimensional model were measured to determine which intercarpal fusion procedures unload the lunate and whether they alter the force transmission through the entire wrist joint. Ten theoretical models of wrists were used to simulate three different operative procedures: capitate-hamate fusion, scapho-trapezial-trapezoidal fusion, and scaphocapitate fusion. A discrete element analysis technique was used to perform these investigations. The joint force and ligament tension of normal wrists and of simulated operative procedures were calculated according to the deformation of each spring element, simulating the articular cartilage and the carpal ligaments. Scaphocapitate and scapho-trapezial-trapezoidal fusions significantly decreased the joint force at the radiolunate joint and the lunocapitate joint compared with the intact wrist. In contrast, these fusions significantly increased this value at the radioscaphoid joint in comparison with the intact wrist. In the midcarpal joint, scaphocapitate fusion also increased the joint force at the scapho-trapezial-trapezoidal joints and at the triquetral-hamate joint, whereas scapho-trapezial-trapezoidal fusion increased it at the scapho-capitate joint. Capitate-hamate fusion yielded no significant changes of the joint forces through the entire wrist joint. In the analysis of ligament tension, scaphocapitate and scapho-trapezial-trapezoidal fusions significantly decreased the tension only in the dorsal scapholunate ligament. These findings demonstrate that scaph-ocapitate and scapho-trapezial-trapezoidal fusions are effective in decompressing the lunate. By contrast, capitate-hamate fusion is ineffective in reducing lunate compression. Although scaphocapitate and scapho-trapezial-trapezoidal fusions are recommended for the treatment of Kienbock's disease, clinicians should consider that the increase of force transmission through the radioscaphoid and the midcarpal joints may lead to early degenerative changes after these procedures have been performed.

Endothelin-1-induced vasoconstriction causes a significant increase in portal pressure of rat liver: localized constrictive effect on the distal segment of preterminal portal venules as revealed by light and electron microscopy and serial reconstruction

Intraportal infusion of endothelin-1 (ET-1), a potent vasoconstrictor, significantly elevates portal venous pressure. To determine the major site of vascular constriction in the intrahepatic porto-sinusoidal system, we performed an in situ perfusion of rat livers with 1 nmol/L ET-1 at a flow rate of 20 mL/min. Portal pressure rose from 22 cm H2O to 54 cm H2O within 25 minutes. Specimens were prepared for light-microscopic serial reconstruction and electron microscopy. The distal segment of preterminal portal venules (DS/PPV) with an inner diameter of 40 to 80 microm showed complete obliteration of the lumen over a 300-microm distance caused by the intense contraction of perivascular smooth muscle cells and protruding of endothelial cells into the lumen. The proximal segment of preterminal portal venules (PS/PPV) with a larger diameter up to 150 microm also underwent strong constriction, but still had luminal space for the flow, while the PS/PPV with a diameter of 150 to 400 microm showed moderate or mild constriction and retained a wide lumen. Neither terminal portal venules, inlet venules, sinusoids, nor central veins, however, exhibited demonstrable constriction. Liver parenchyma fed by the inlet venules that emerged from the PS/PPV exhibited a wide sinusoidal lumen and vacuolated hepatocytes caused by the influx of excess portal perfusate that escaped from the occlusive areas. The present study has revealed that the DS/PPV functions as a presinusoidal quasi-sphincter mechanism and is involved in the redistribution of intrahepatic portal flow under increased portal pressure.

Involvement of intrasinusoidal hemostasis in the development of concanavalin A-induced hepatic injury in mice

Concanavalin A (Con A) stimulation induces T-cell activation-associated hepatic injury. This study is designed to show the involvement of microcirculatory disturbance in the pathogenesis. Con A administration led to prominent intrasinusoidal hemostasis, which consisted of erythrocyte agglutination, lymphocyte/neutrophil sticking to endothelial cells, and platelet aggregation and degranulation, resulting in a marked decrease in the intrahepatic blood flow and elevation of portal perfusion pressure. After hemostasis, confluent hepatic necrosis occurred within the congested area of liver parenchyma. Reduction in the extent of hemostasis by the treatment with heparin (thrombin inhibitor) or cyproheptadine (serotonin inhibitor) decreased hepatic injury. Pretreatment with either anti-tumor necrosis factor alfa (TNF-alpha) or anti-interferon gamma (IFN-gamma) monoclonal antibody (MAb) moderately decreased hemostasis and hepatic injury, whereas combined use of two MAbs almost perfectly protected mice from these disorders. Complete obliteration of hemostasis and hepatic injury was also accomplished by the pretreatment with FK506 which suppressed TNF-alpha and IFN-gamma production. Intrasinusoidal accumulation of leukocytes and platelets was, however, not blocked by FK506, indicating that Con A activities other than the stimulation of cytokine production are responsible for this event. The administration of anti-CD3 MAb, a T-cell stimulant without agglutination activities, which elevated plasma cytokine levels in a comparable degree without inducing prominent leukocyte infiltration, did not induce hepatic congestion and injury. These findings indicate that the agglutination activities of Con A and T-cell activation mediated TNF-alpha/IFN-gamma production are both required for the induction of intrasinusoidal hemostasis, which is indispensable for the development of hepatic injury.

Occipitoatlantal instability associated with articular tropism

The authors report the case of a patient with rotatory posterior subluxation of the occiput on the atlas associated with tropism of the O-C1 articulations. Lateral flexion-extension plain films demonstrated 5 mm of posterior translation of the occiput on the atlas. Tomographs revealed tropism of the O-C1 articulations, and CT scans on extension demonstrated posterior rotatory subluxation of the occiput on the atlas. The patient had no osseous abnormality caudally below the atlantoaxial joint, and underwent posterior occipitoatlantal fusion by wiring. At the 4-year follow-up, the grafted bone had been incorporated, and the patient was completely free from preoperative symptoms. In the present patient, occipitoatlantal instability is presumed to have derived from articular tropism.

Strain difference in the induction of T-cell activation-associated, interferon gamma-dependent hepatic injury in mice

A single intravenous injection of concanavalin A (Con A) induces T-cell activation-associated inflammatory injury selectively in the liver. This study investigated the strain difference in the development of Con A-induced hepatic injury. Normal C57BL/6 and BALB/c spleen cells produced comparable levels of T-cell-derived lymphokines (interferon gamma [IFN-gamma], tumor necrosis factor alpha [TNF-alpha], and interleukin-2 [IL-2]) following in vitro stimulation with Con A. A single intravenous injection of Con A to C57BL/6 mice induced the plasma levels of TNF-alpha and IL-2 comparable with or slightly higher than those observed in BALB/c mice, whereas the same treatment resulted in an apparently lower level of IFN-gamma production in C57BL/6 mice. RNA from livers of Con A-treated C57BL/6 mice exhibited lower levels of IFN-gamma mRNA than RNA of BALB/c livers. Unexpectedly, a dramatic difference in the severity of hepatic injury was observed between C57BL/6 and BALB/c. Namely, the peak alanine transaminase (ALT) level was more than 15,000 U/L and inducible as early as 8 hours after injection of 0.2 mg Con A per mouse in the C57BL/6 strain, whereas the peak was approximately 3,000 U/L and induced as late as 24 hours after Con A injection in the BALB/c strain. The increase in plasma ALT levels was limited to less than 10% by injection of anti-IFN-gamma monoclonal antibody (mAb) in both strains. The C57BL/6 strain inducing lower levels of IFN-gamma exhibited higher IFN-gamma responsiveness as exemplified by the intrahepatic expression of an IFN-gamma-inducible gene, an inducible type of nitric oxide (NO) synthase (iNOS). These results indicate that, while IFN-gamma produced in vivo by activated T cells induces hepatic injury, there exists a striking strain difference in the induction of IFN-gamma-dependent hepatic injury.

CJ-12,373, a novel topoisomerase II inhibitor: fermentation, isolation, structure elucidation and biological activities

A novel isochroman carboxylic acid CJ-12,373 was isolated from Penicillium sp. CL22557. CJ-12,373 inhibits both DNA gyrase-mediated supercoiling and relaxation without the formation of a cleavage intermediate, suggesting that CJ-12,373 inhibits DNA gyrase at a stage distinct from the religation step. CJ-12,373 is not selective for procaryotic DNA gyrase as it also inhibits relaxation mediated by eukaryotic topoisomerase II. The antimicrobial potency of CJ-12,373, however, is largely attributed to its inhibition of DNA gyrase.

Suppressive effect of the angiogenesis inhibitor TNP-470 on the development of carcinogen-induced hepatic nodules in rats

Tumor metastasis can be prevented by inhibiting angiogenesis. In the present study, we have demonstrated that the angiogenesis inhibitor TNP-470 also suppresses the development of primary hepatic nodules. Hepatocarcinogenesis was performed by the feeding of 2-acetylaminofluorene to hepatectomized rats during 8-14 weeks of age. Predominantly arterial-to-portal circulation and sinusoidal capillarization were determined by the staining of nodules with arterially infused ink and immunostaining for factor VIII-related antigen, respectively. Intraperitoneal administration of 30 mg/kg b.w. of TNP-470 twice a week significantly reduced the number of hepatic nodules. Among the nodules, hyperplastic nodules stained with ink, atypical hyperplastic nodules and hepatocellular carcinoma, all of which possess structurally altered sinusoidal endothelial cells or capillary-type endothelial cells, were dramatically decreased in number. Suppression was observed equally in nodules of all sizes. TNP-470 was more effective when administered during 8-20 weeks than during 14-26 weeks. In contrast, ink-non-stained hyperplastic nodules, which have normal sinusoidal endothelial cells, were not affected at all. The present results indicate that TNP-470 suppresses the development of primary hepatic nodules whose microvessels are capillaries or transitional forms from sinusoids to capillaries.

[Techniques for evaluating neuronal death of the retina in vitro and in vivo]

This review describes the techniques to evaluate retinal neurodegeneration induced by excitatory amino acids and transient ischemia. Glutamate-induced neurotoxicity was examined in cultured rat cortical cells. Cultures obtained from the retinas of fetal rats were incubated in Eagle's minimal essential medium supplemented with 10% fetal calf serum or 10% horse serum at 37 degrees C in a humidified 5% CO2 atmosphere for 10-14 days. The neurotoxicity induced by glutamate was quantified by trypan blue exclusion. The viability of cultures was markedly reduced by a 10-min exposure to glutamate followed by incubation with glutamate-free medium for 1 hr. N-methyl-D-aspartate (NMDA)-induced retinal damage was examined in adult rats. Transverse sections of the retinas through the optic disk were stained with hematoxylin and eosin. A single intravitreal injection of NMDA damaged the ganglion cell layer and the inner plexiform layer without affecting the other retinal layers 7 days after injection. Retinal ischemia was induced by elevating the intraocular pressure for 45 min through the needle which was placed in the anterior chamber. Ischemia-induced retinal damage was inhibited by MK-801. These results indicate that the techniques described in this review can be employed to develop new drugs possessing neuroprotective action against neurodegeneration that occurs during retinal ischemia.

Effect of SA4503, a novel sigma1 receptor agonist, against glutamate neurotoxicity in cultured rat retinal neurons

We examined the effects of sigma1 receptor agonists against glutamate-induced neurotoxicity in cultured retinal neurons. Primary cultures obtained from fetal rat retinas (16-19 d gestation) were used. The neurotoxic effect of glutamate was quantitatively assessed using the trypan blue exclusion method. A brief exposure of retinal cultures to glutamate (500 microM) led to delayed neuronal cell death. The glutamate-induced neurotoxicity was inhibited by (5R,10S)-(+)-5-methyl-10,11-dihydro-5H-dibenzo-[a,b]-cyclohepten-5 ,10-imine hydrogen maleate (MK-801). The sigma1 receptor agonists, 1-(3,4-dimethoxyphenethyl)-4-(3-phenylpropyl)-piperazine dihydrochloride (SA4503) and (+)-pentazocine at a concentration range of 0.1 approximately 100 microM reduced the glutamate-induced neurotoxicity in a dose-dependent manner. In addition, the neuroprotective effects of both SA4503 and (+)-pentazocine were antagonized by co-treatment with N,N-dipropyl-2-[4-methoxy-3-(2-phenylethoxy)phenyl]ethylamine monohydrochloride (NE-100), a putative sigma1 receptor antagonist. These findings suggest that sigma1 receptor agonists protect retinal cells against glutamate-induced neurotoxicity.

[Acute renal failure in non-fulminant acute hepatitis without hepatitis A, B or C virus infection]

Here, we report a 35-year-old man with non-fulminant acute non A, non B, non C hepatitis which developed into acute renal failure. The patient was admitted to hospital with the chief complaints of general fatigue, nausea and a high-grade fever of 40 degrees C. Laboratory examination revealed severe liver dysfunction and renal insufficiency on admission: his serum glutamic oxaloacetic transaminase was 3.203 IU/ml, serum glutamic pyruvic transaminase was 3.825 IU/ml, lactic dehydrogenase was 2.840 IU/ml, blood urea nitrogen was 65 mg/dl, and creatinine was 7.6 mg/dl. Hemodialysis was conducted during the initial 19-day period after admission because anuria was manifested on admission. On the 36th day after onset, renal functions returned to normal and the patient was negative for IgM-HA antibody. HBs antigen, IgM-HBC antibody, HCV antibody, cytomegalovirus antibody, and Epstein-Barr virus antibody. However, liver biopsy for histological examination on the 44th day after onset revealed no specific findings except the healing stage of acute hepatitis. Renal biopsy on the 49th day showed the healing stage of acute tubular necrosis without any glomerular change. It has been infrequently reported that acute renal failure develops following a non-fulminant acute state without hepatitis A, B or C virus infection. It is necessary to take acute renal failure into account in the clinical course of non-fulminant non A, non B, non C hepatitis.

Developmental changes in distribution patterns of phencyclidine-induced c-Fos in rat forebrain

In the forebrain of 56-day-old rats, histochemical studies revealed that the subcutaneous injection of a psychotomimetic phencyclidine (PCP; 1 and 10 mg/kg) induced a dose-related and dense nuclear c-Fos-like immunoreactivity in the pyriform cortex, layers IV-VI of the neocortex and septum, but a sparse c-Fos immunostaining in the olfactory tubercle and mid-lateral striatum. Infant rats at postnatal day 8 expressed much fewer and more confined c-Fos-positive cells in the neocortex than young adult rats following PCP injection. However, a similar expression pattern of PCP-induced c-Fos was observed in the pyriform cortex, mid-lateral striatum, olfactory tubercle and septum between the infant and adult periods. These developmental changes in the regional distribution of a neuronal activity marker, c-Fos, suggest that neuronal populations involved in PCP-induced abnormal behavior are influenced by postnatal development, at least, in the neocortex.

Maturation of the posterolateral spinal fusion and its effect on load-sharing of spinal instrumentation. An in vivo sheep model

We investigated the temporal relationship among the biomechanical, radiographic, and histological properties of a posterolateral spinal fusion mass to elucidate the changes in load-sharing of the spinal instrumentation and that of the fusion mass throughout the healing process. Destabilization of the posterior spinal column and transpedicular screw fixation at the segments between the third and fourth and the fifth and sixth lumbar vertebrae was performed in twenty-four sheep. A posterolateral spinal arthrodesis with use of autologous corticocancellous bone graft was done randomly at one of the two segments; the other segment (without bone graft) served as the instrumented control. Six animals each were killed at four, eight, twelve, and sixteen weeks postoperatively. Biomechanical testing showed that the posterolateral fusion mass had increased mechanical stiffness after the fourth week. The strain on the hardware, measured with use of rods instrumented with strain-gauges, decreased significantly (p < 0.01) beginning at eight weeks. Radiographically, three independent observations of each of the six animals at each time-period showed that, although all of the fusion masses were considered solid unions at sixteen weeks, bridging of trabecular bone was noted during only ten of eighteen observations at twelve weeks, three of eighteen observations at eight weeks, and none of eighteen observations at four weeks. Computerized tomography and histomorphometric analyses demonstrated that mineralization in the fusion mass increased in a linear fashion even after eight weeks. Histologically, the fusion mass consisted predominantly of woven bone at eight weeks; thereafter, it was gradually trabeculated.

CLINICAL RELEVANCE

We found a great discrepancy between biomechanical stability and histological maturation of the posterolateral fusion mass. The biomechanical properties of a stable spinal fusion preceded the radiographic appearance of a solid fusion by at least eight weeks, suggesting that immature woven bone provided substantial stiffness to the fusion mass. The spinal instrumentation was subjected predominantly to bending stress rather than to axial stress, and the load-sharing of the spinal instrumentation decreased concurrently with the development of the spinal fusion.

Effects of in situ freezing and stress-shielding on the ultrastructure of rabbit patellar tendons

The effects of in situ freezing and the combination of in situ freezing and stress-shielding on the microstructure and ultrastructure of the patellar tendon were studied with use of 20 mature rabbits. The patellar tendon was frozen in situ with liquid nitrogen to kill fibroblasts and then was completely released from stress by chronically pulling a stainless-steel wire installed between the patella and the tibial tubercle. Microstructurally, the freezing treatment induced separation of collagen fiber bundles and fibroblast necrosis at 3 weeks, although the separation disappeared at 6 weeks. Ultrastructurally, small collagen fibrils with a diameter of less than 90 nm were predominant; at 6 weeks, the area occupied by collagen fibrils had decreased. In the frozen-shielded tendon, numerous large spaces were observed in the matrix at 3 weeks. This treatment increased the number of fibrils with a diameter greater than 360 nm and decreased the number of collagen fibrils per unit of area and the area occupied by collagen fibrils at 3 weeks. This study demonstrated that in situ freezing and the combination of in situ freezing and stress-shielding leads to a smaller volume of collagen fibrils per unit of cross section of the patellar tendon by mechanisms that remain to be defined.

Feasibility of using a magnetic tracking device for measuring carpal kinematics

While several different methods have been used to measure carpal kinematics, biplanar radiography is generally considered to be the most accurate and popular one. However, biplanar radiography is tedious and so only pseudo-dynamic kinematics can be measured. Recently, magnetic tracking system has been developed for the measurement of joint kinematics which is versatile and easy to use and so the possibility of measuring motions dynamically. In this study, the capability of a magnetic tracking device to accurately measure carpal kinematics was investigated by comparing it with biplanar radiography. The kinematics of the third metacarpal, scaphoid, and lunate in five fresh cadaveric specimens were measured using both methods as the wrists were placed in eight positions. The finite screw rotation of each bone with respect to the distal radius during selecting the seven wrist motions was calculated for both measuring techniques and compared. In general, the kinematics for all three bones measured by using either magnetic tracking device or biplanar radiography was identical and showed no statistical difference. The averaged differences ranged from 0.0 to 2.0 degrees. These differences were due to the potential effect of the weight of the sensors and the interference of the attaching rod to the surrounding tissue. It is concluded that the application of the magnetic tracking device to carpal kinematics is warranted, if proper technical procedures as suggested are followed.

CJ-12,954 and its congeners, new anti-Helicobacter pylori compounds produced by Phanerochaete velutina: fermentation, isolation, structural elucidation and biological activities

Seven new phthalide compounds with anti-Helicobacter pylori activities were isolated from the basidiomycete Phanerochaete velutina CL6387. The two most potent phthalide compounds, CJ-12,954 and CJ-13,014, have MICs of 5 ng/ml. The structure-activity relationship shows that the presence of a spiroketal part in addition to the phthalide part, greatly enhances the activity. The phthalide compounds appear to be specific for H. pylori, since they did not show antibacterial activities when tested against a panel of other microorganisms.

The tumor-bearing state induces augmented responses of organ-associated lymphocytes to high-dose interleukin-2 therapy in mice

A high-dose bolus regimen for interleukin(IL)-2 administration to cancer patients frequently causes serious side-effects in which various organs are involved. In order to reveal the mechanism of toxicities associated with this regimen, we compared the augmenting effect of high-dose IL-2 on murine organ-associated lymphocytes between neoplastic and non-neoplastic states. Intraperitoneal administration of IL-2 at a dose of 10(5) JRU (Japanese Reference Units) twice daily for 3 days led to the death of all the syngeneic MH134-hepatoma- or X5563-myeloma-bearing mice, whereas it had no lethal effect on non-tumor-bearing mice. Histological and morphometric analyses demonstrated that tumor-bearing mice displayed more extensive infiltration of large granular lymphocytes and agranular lymphocytes in the liver and lungs than did the non-tumor-bearing mice. Large granular lymphocytes had the ultrastructural characteristics of lymphokine-activated killer cells. Lymphocytes often underwent extravasation into the interstitial space and exhibited local proliferation without causing any direct injury to apposed parenchymal cells. Flow-cytometric analysis of hepatic mononuclear cells demonstrated that IL-2-receptor-beta (IL-2R beta)-bearing lymphocytes, i.e., natural killer cells and intermediate CD3 cells, were increased in number in the neoplastic state before the IL-2 injection. The present study indicates that the tumor-bearing state increases the number of organ-associated IL-2R beta + lymphocytes, which are then greatly amplified by the challenge of high-dose IL-2, leading to the functional disturbance of organs. We have further demonstrated here that an intermittent low-dose IL-2 regimen has a potential therapeutic effect on tumor regression without causing lethal side-effects.

Macrophage migration inhibitory factor induces phagocytosis of foreign particles by macrophages in autocrine and paracrine fashion

Exposure to foreign particles sometimes causes inflammatory reactions through production of cytokines and chemoattractants by phagocytic cells. In this study, we focused on macrophage migration inhibitory factor (MIF) to evaluate its pathophysiological role in the phagocytic process. Immunohistochemical analysis of human pseudosynovial tissues retrieved at revision of total hip arthroplasty showed that infiltrating mononuclear and multinuclear cells were positively stained by both an anti-CD68 antibody and anti-human MIF antibody. For in vitro study, MIF was released from murine macrophage-like cells (RAW 264.7) in response to phagocytosis of fluorescent-latex beads in a particle dose-dependent manner. Northern blot analysis showed marked elevation of the MIF mRNA level in the phagocytic macrophage-like cells. Moreover, pretreatment of RAW 264.7 cells with rat recombinant MIF increased the extent of phagocytosis by 1.6-fold compared with the control. Taken together, these results suggest that MIF plays an important role by activating macrophages in autocrine and paracrine fashion to phagocytose foreign particles.

Pedicle screw fixation for nontraumatic lesions of the cervical spine

STUDY DESIGN

This retrospective study was conducted to analyze the clinical results in 45 patients with nontraumatic lesions of the cervical spine treated by pedicle screw fixation.

OBJECTIVES

To evaluate the effectiveness of pedicle screw fixation in reconstructive surgery for nontraumatic cervical spinal disorders.

SUMMARY OF BACKGROUND DATA

Pedicle screw fixation for hangman's fracture of the axis and traumatic lesions of the middle and lower cervical spine has been reported; however, there have been no reports on pedicle screw fixation for nontraumatic lesions of the cervical spine.

METHODS

Forty-five patients with nontraumatic lesions of the cervical spine underwent reconstructive surgery including pedicle screw fixation and fusion. Five patients underwent occipitocervical fixation for the lesion of the upper cervical spine, and one patient underwent separate occipitocervical fixation and cervicothoracic fixation. Cervical or cervicothoracic fixation was performed in 39 patients. Twenty-six of these patients underwent simultaneous laminectomy or laminoplasty. Supplemental anterior surgery was conducted for 15 patients.

RESULTS

Solid fusion was obtained in all patients except eight with metastatic vertebral tumors who did not receive bone graft. Correction of kyphosis was adequate. There were no neurovascular complications, except one case of transient radiculopathy caused by screw threads.

CONCLUSIONS

Pedicle screw fixation is a useful procedure for posterior reconstruction of the cervical spine. This procedure does not require the lamina for stabilization, and should be especially valuable for simultaneous posterior decompression and fusion. The risk to neurovascular structures, however, cannot be completely eliminated.

Homogeneity of Borrelia japonica and heterogeneity of Borrelia afzelii and 'Borrelia tanukii' isolated in Japan, determined from ospC gene sequences

Borrelia afzelii, B. japonica, and 'B. tanukii' isolated from various sources and geographical origins in Japan were characterized by restriction fragment length polymorphism (RFLP) analysis and sequencing analysis of the outer surface protein C (OspC) amplicon. B. afzelii and 'B. tanukii' generated variable RFLP patterns and differences in ospC gene sequence were confirmed. In contrast, 26 isolates of B. japonica generated one OspC RFLP type, and sequence similarity between B. japonica ranged from 96.4 to 99.7%. These finding suggests that B. japonica is unique in comparison with other members of B. burgdorferi sensu lato species with respect to homogeneity of the ospC gene.

Effects of chondroitinase ABC and chymopapain on spinal motion segment biomechanics. An in vivo biomechanical, radiologic, and histologic canine study

STUDY DESIGN

The biomechanical effects of chondroitinase ABC and chymopapain related to spinal segmental instability were investigated using a canine model, as well by as radiologic and histologic analyses.

OBJECTIVES

To evaluate the biomechanical, radiologic, and histologic affects on the lumber intervertebral disc of chondroitinase ABC compared with chymopapain.

SUMMARY OF BACKGROUND DATA

No study on the biomechanical effects of chondroitinase ABC has been reported.

METHODS

Forty-eight lumbar intervertebral discs in eight beagles were randomly assigned to three groups and received one of three materials: chondroitinase ABC, chymopapain, or buffered saline, using a lateral percutaneous procedure. One week after injection, the animals were killed and the lumbar spinal motion segments were removed. Spinal segmental instability after chemonucleolysis was evaluated in spinal motion segments without posterior elements. Radiologic and histologic changes were also investigated.

RESULTS

Spinal segmental instability and disc space narrowing were more greater in the chymopapain group than in the chondroitinase ABC group. Destruction of nucleus and anulus proteoglycans, indicated by loss of safranin-O staining, was less intense in chondroitinase ABC-injected discs.

CONCLUSIONS

Chondroitinase ABC results in less spinal segmental instability, disc space narrowing, and destruction of proteoglycans in intervertebral disc matrix than chymopapain.

Glycosphingolipid-binding protein of Borrelia burgdorferi sensu lato

The binding of Borrelia burgdorferi, the causative agent of Lyme disease, to glycosphingolipids present in various types of cells was examined. B. burgdorferi bound specifically to galactosylceramide (GalCer) and glucosylceramide (GlcCer) but not to other glycosphingolipids, as determined by a thin-layer chromatography (TLC) overlay assay. The binding specificity of B. burgdorferi to various glycosphingolipids suggested that the binding receptor in this species is ceramide monohexoside. The levels of binding of B. burgdorferi virulent strain 297 to GlcCer, sulfatide, lactosylceramide, and galactosylgloboside were 56.2, 1.6, 15.9, and 9.7%, respectively, relative to that to GalCer. Virulent low-passage strains of B. burgdorferi were serially subcultured in BSK II medium, and the resultant high-passage strains were not capable of infecting mice and did not induce footpad swelling. The levels of binding of the low-passage strains to GalCer on TLC plates and to CHO-K1 cells in vitro were threefold higher than those of high-passage strains. Binding was not affected by pretreatment of Borrelia with monospecific anti-outer surface protein C (OspC) antiserum. These results indicated that the binding of Borrelia to glycosphingolipid expressed on the cell surface plays an essential role in infection of mammalian hosts. However, OspC was not associated with binding. The necessity of the sugar and N-acyl moieties in GalCer for the binding of Borrelia was shown by a TLC overlay assay using chemically modified GalCer. Furthermore, three proteins, 67-kDa protein, 62-kDa Hsp60, and 41-kDa flagellin, were involved in binding of B. burgdorferi to GalCer, as shown by blotting assay using biotinylated GalCer as a probe.

Establishment of a new continuous clear cell sarcoma cell line. Morphological and cytogenetic characterization and detection of chimaeric EWS/ATF-1 transcripts

Clear cell sarcoma (CCS), a rare tumour of deep soft tissues, often has a t(12; 22) (q13; q12) translocation that induces the formation of a hybrid EWS/ATF-1 gene. To investigate these alterations further, we established a new continuous cell line directly from a CCS taken from a 9-year-old girl. The cultures were characterized with respect to morphological, ultrastructural, immunohistochemical and karyotypical features and were tested by reverse transcription PCR (RT-PCR) for chimaeric EWS/ATF-1 transcripts. The continuous cell line, designated KAO, is tumorigenic in nude mice, and the resultant tumours resemble the primary CCS. The tumour cells and the cultured cells have melanosomes in their cytoplasm and are immunoreactive with the melanoma-specific antibody HMB45, but do not express S-100 protein. The cultured CCS cells have the t(12; 22)(q13; q12) translocation and express the hybrid EWS/ATF-1 gene. No transcripts of the hybrid gene were detected in a malignant cutaneous melanoma tested simultaneously. Although CCS and malignant melanoma are morphologically related, the present results suggest that their geneses differ at the chromosome and molecular levels. They also indicate that chromosome analysis and detection of fusion EWS/ATF-1 transcripts may be useful adjuvant tools for the diagnosis of CCS.

[Back pain and neurological deficits in osteoporotic spinal fractures]

Generally osteoporotic compression fractures of the spine cause only localized pain and kyphosis without other significant complications. These fractures usually heal without difficulty by conservative treatment. However, it becomes to be accepted as a general concept that a small number of patients with osteoporotic fracture of the thoracolumbar spine result in delayed vertebral body collapse with neural compromise. We analyzed our series of osteoporotic-posttraumatic vertebral collapse. We had treated 51 consecutive patients with posttraumatic vertebral collapse following osteoporotic compression fractures of the thoracolumbar spine between Jan. 1987 and June 1994. Surgery consisted of anterior spinal reconstruction by strut grafting using a bioactive ceramic vertebral prosthesis (A-WGC) and autogenous rib in combination with the Kaneda device after resecting the collapsed vertebral bodies. After surgery, 80% of the patients with initial neurological deficits showed remarkable neurological recovery. The causes of neural compression were retropulsion of the posterior part of the collapsed vertebral body into the spinal canal and unstable kyphosis. The collapsed portion of the resected vertebral bodies was always less bloody or ischemic. Histology confirmed ischemic necrosis of the collapsed portion. The collapse would be resulted in by the compromised healing process due to repeated micro-traumas to the fragile trabecular bone following osteoporotic vertebral fracture. Autogenous iliac bone as well as fibula cannot be used as another alternative strut graft because of the fragility of the graft and grafted site. The anterior reconstruction with a bioactive ceramic vertebral prosthesis and the Kaneda device has been useful in osteonecrotic-posttraumatic vertebral collapse of the thoracolumbar spine.

Anterior correction of thoracic scoliosis with Kaneda anterior spinal system. A preliminary report

STUDY DESIGN

Analysis of the clinical results of 20 patients with thoracic scoliosis treated by anterior procedure with Kaneda anterior spinal system.

OBJECTIVES

To evaluate the efficacy of the anterior surgical correction procedure with a new anterior instrumentation in thoracic scoliosis.

SUMMARY OF BACKGROUND DATA

Posterior correction and fusion with posterior instrumentation has been a main component of the surgical management of thoracic scoliosis. However, to the best of the authors' knowledge, no clinical results of anterior instrumentation surgery for thoracic scoliosis have been published in the English literature.

METHODS

Anterior correction and fusion using Kaneda anterior spinal system was performed in 20 patients with thoracic scoliosis (3 patients with King Type II curve, 13 with Type III, and 4 with Type IV). The average follow-up was 3 years, with a range of 2 years, 3 months to 4 years, 1 month. There were 1B patients with idiopathic scoliosis (13 adolescents and 5 adults) and 2 patients with a single thoracic curve caused by other etiologies. All patients had correction of scoliosis by fusion within the major thoracic curve. Radiographic evaluations were performed to analyze frontal, sagittal, and rotational deformities of the spine.

RESULTS

The average correction rate of scoliosis was 71%. Above the instrumented levels, the correction rate was 75%. Preoperative kyphosis of the instrumented levels of 7 degrees was corrected to 14 degrees of kyphosis. The trunk shift was improved from 17 mm before surgery to 9 mm at final follow-up evaluation. The average improvement of the tilt-angle in the lower and vertebra of fusion was 81%, and was 83% in the stable vertebra. Apical vertebral rotation showed correction rate of 15% in patients without performing resection of the rib head joints and rod rotation maneuver (n = 6). However, the correction rate was improved to 58% after introduction of the technique discussed (n = 14). The angle of tangential rib deformity (rib hump) showed a correction rate of 50%. There was 1.2 degrees of frontal plane and 1.0 degree of sagittal plane correction loss within the instrumented area at final follow-up evaluation. At final follow-up, nonunion at the uppermost segment of the fusion range developed in one patient, and decompensation in the lumbar spine was observed in one patient with Type II curve.

CONCLUSIONS

Anterior correction with Kaneda anterior spinal system provides excellent correction of the frontal curvature and sagittal alignment by fusing within the range of the major curve, without a significant loss of correction and implant failure. Rigid rotational deformity of the thoracic scoliosis is effectively corrected by resection of the rib head joints and rod rotation maneuver. However, too much correction of the thoracic curve should be avoided, to prevent decompensation of the lumbar curve, especially in Type II curves.

Effects of carboxy-PTIO on systemic hemodynamics, liver energetics, and concentration of liver metabolites during endotoxic shock in rabbits: a 31P and 1H magnetic resonance spectroscopic study

OBJECTIVE

To investigate the effects of 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (carboxy-PTIO), a nitric oxide scavenger, on the lipopolysaccharide-induced hypotension, hepatocellular dysfunction, and liver damage in endotoxic rabbits.

DESIGN

Experimental, comparative study.

SETTING

Laboratory of a university hospital.

SUBJECTS

Eighteen Japanese white rabbits (3.0 to 3.2 kg body weight) anesthetized with ketamine-xylazine were studied.

INTERVENTIONS

We randomly divided the rabbits into three groups: saline controls (group 1, n = 5); animals receiving lipopolysaccharide (400 micrograms/kg) alone (group 2, n = 8); and animals receiving lipopolysaccharide plus carboxy-PTIO at a rate of 0.17 mg/kg/min for 3 hrs (group 3, n = 5). Blood gases and mean arterial pressure (MAP) were monitored. In vivo phosphorus-31 magnetic resonance spectra were continuously obtained every 30 mins. In addition, the livers were sampled and underwent fractionation at 7 hrs after lipopolysaccharide administration. The hydrophilic and hydrophobic extracts from the livers were analyzed by in vitro hydrogen-1 and phosphorus-31 magnetic resonance spectroscopy.

MEASUREMENTS AND MAIN RESULTS

After the administration of lipopolysaccharide, the first phase of decrease in MAP within 30 mins was followed by partial recovery within the next 30 mins. In group 2, MAP started to decrease progressively within 180 mins after lipopolysaccharide administration (second phase) and decreased by 33% from the baseline value to 49 +/- 9 mm Hg at 420 mins. In contrast, the infusion of carboxy-PTIO significantly attenuated the second decrease in MAP (68 +/- 10 mm Hg, at 420 mins). In group 2, a slow and progressive decrease in adenosine triphosphate (ATP) and increase in inorganic phosphate concentrations occurred from 120 mins after lipopolysaccharide administration, and continued throughout the observation period. These changes were accompanied by a progressive decrease in intracellular pH. On the other hand, in group 3, there were no significant changes in ATP and inorganic phosphate concentrations compared with the controls from 120 to 360 mins after lipopolysaccharide administration. Moreover, restorations of both arterial and hepatocellular acidosis were observed in group 3. The differences of the degree of liver damage--as determined by the total amount of phospholipid, free fatty acids concentration, and membrane fluidity--were not significant among the three groups. Three of eight rabbits in group 2 died within 7 hrs, but no animal in the other two groups died during the study.

CONCLUSIONS

The results of this study indicate that the infusion of carboxy-PTIO: a) prevented the delayed hypotension associated with endotoxic shock in rabbits; b) returned the hepatocellular ATP concentrations nearly to the level of the controls and alleviated hepatocellular acidosis; c) normalized various hydrophilic metabolites, such as lactate and alanine in the liver; and d) did not exacerbate liver injury after the administration of lipopolysaccharide. These findings indicate that carboxy-PTIO, a nitric oxide scavenger, may have a positive vasopressor effect during hypodynamic septic shock without exacerbating liver injury.

In vivo induction of apoptosis in the thymus by administration of mycobacterial cord factor (trehalose 6,6'-dimycolate)

It is reported that some bacteria or bacterial components cause thymic atrophy via the apoptotic process. The present study demonstrated for the first time in vivo induction of apoptosis in the mouse thymus by mycobacterial cord factor (CF) (trehalose 6,6'-dimycolate). When 300 microg of purified CF from Mycobacterium tuberculosis was intravenously administered to BALB/c mice in the form of water-in-oil-in-water (w/o/w) emulsion, thymic atrophy and pulmonary granulomas were induced with a peak on day 7, whereas, in the form of liposomes, CF induced thymic atrophy on days 14 to 21 in parallel with the development of hepatic granulomas. Thymic atrophy resulted from the depletion of cortical lymphocytes via apoptosis as revealed by DNA fragmentation and karyorrhectic changes. In contrast, mycobacterial sulfatide (2,3,6,6'-tetraacyl trehalose 2'-sulfate) caused neither thymic atrophy nor granuloma formation. Compared to lipopolysaccharide-induced thymocyte apoptosis, CF (w/o/w)-induced thymocyte apoptosis developed more slowly, reached a maximum later, and lasted longer but was less intense. Although serum tumor necrosis factor alpha (TNF-alpha) levels in CF-treated mice were not significantly elevated, administration of anti-TNF-alpha antibody almost completely inhibited thymic atrophy and granuloma formation. Serum corticosterone levels were only slightly elevated by CF administration. The present results indicate that mycobacterial CF induces thymic atrophy via apoptosis, which is closely linked with granuloma formation.

Protective effects of methylcobalamin, a vitamin B12 analog, against glutamate-induced neurotoxicity in retinal cell culture

PURPOSE

To examine the effects of methylcobalamin on glutamate-induced neurotoxicity in the cultured retinal neurons.

METHODS

Primary cultures obtained from the fetal rat retina (gestation days 16 to 19) were used for the experiment. The neurotoxicity was assessed quantitatively using the trypan blue exclusion method.

RESULTS

Glutamate neurotoxicity was prevented by chronic exposure to methylcobalamin and S-adenosylmethionine (SAM), which is formed in the metabolic pathway of methylcobalamin. Chronic exposure to methylcobalamin and SAM also inhibited the neurotoxicity induced by sodium nitroprusside that release nitric oxide. By contrast, acute exposure to methylcobalamin did not protect retinal neurons against glutamate neurotoxicity.

CONCLUSIONS

Chronic administration of methylcobalamin protects cultured retinal neurons against N-methyl-D-aspartate-receptor-mediated glutamate neurotoxicity, probably by altering the membrane properties through SAM-mediated methylation.

Effects of B vitamins on glutamate-induced neurotoxicity in retinal cultures

The effects of B vitamins on glutamate-induced neurotoxicity were examined using primary cultures obtained from the rat retina. Cell viability was markedly reduced by a brief exposure to glutamate followed by incubation with glutamate-free media for 1 h. Glutamate cytotoxicity was reduced in the cultures that had been maintained in thiamine-, pyridoxine- or nicotinamide-containing medium before the exposure to glutamate. Glutamate cytotoxicity was also reduced by chronic application of thiamine pyrophosphate and pyridoxal phosphate, which are active coenzyme forms of thiamine and pyridoxine, respectively. By contrast, chronic application of riboflavin, pantothenate, biotin, folic acid and inositol did not affect glutamate cytotoxicity. None of the B vitamins tested had any effect on glutamate cytotoxicity when added only during the exposure to glutamate. These findings suggest that chronically applied thiamine, pyridoxine and nicotinamide protect retinal neurons against glutamate cytotoxicity.

Granuloma formation activity and mycolic acid composition of mycobacterial cord factor

We analyzed the mycolic acid composition of trehalose 6,6'-dimycolate (TDM) obtained from Mycobacterium, using thin layer chromatography, gas chromatography and gas chromatography-mass spectrometry. Utilizing TDM, whose structure was confirmed, granuloma formation in mice was investigated. All TDM used exhibited considerable granuloma formation activity in the lung and spleen. In particular, TDM from M. bovis showed the greatest activity and toxicity among mycobacterial TDM. We therefore discussed the relationship between the chemical structure and granuloma-forming activity of TDM, especially in relation to the structure of mycolic acid in TDM.

Risk factors and probability of vertebral body collapse in metastases of the thoracic and lumbar spine

STUDY DESIGN

The associations between vertebral body collapse and the size or location of the metastatic lesions were analyzed statistically to estimate the critical point of collapse.

OBJECTIVES

To determine risk factors for collapse, to estimate the predicted probability of collapse under various states of metastatic vertebral involvement, and to establish the criteria of impending collapse.

SUMMARY OF BACKGROUND DATA

Pathologic vertebral collapse brings about severe pain and paralysis in patients with cancer. Prevention of collapse plays a significant role in maintaining or improving their quality of life. Because no previous study has clarified the critical point of vertebral collapse, however, the optimum timing for prophylactic treatment has been unclear.

METHODS

The size and location of metastatic tumor from Th1 to L5 were evaluated radiologically for 100 thoracic and lumbar vertebrae with osteolytic lesions. The correlations between collapse and the following risk factors (x1-x4) were determined by means of a multivariate logistic regression model: x1, tumor size (the percentage of tumor occupancy in the vertebral body [% TO]); x2, pedicle destruction, x3, posterior element destruction; and x4, costovertebral joint destruction.

RESULTS

Significant risk factors were costovertebral joint destruction (odds ratio, 10.17; P = 0.021) and tumor size (odds ratio of every 10% increment in %TO, 2.44; P = 0.032) in the thoracic region (Th1-Th10), whereas, tumor size (odds ratio of every 10% increment in %TO, 4.35; P = 0.002) and pedicle destruction (odds ratio, 297.08; P = 0.009) were main factors in the thoracolumbar and lumbar spine (Th10-L5). The criteria of impending collapse were: 50-60% involvement of the vertebral body with no destruction of other structures, or 25-30% involvement with costovertebral joint destruction in the thoracic spine; and 35-40% involvement of vertebral body, or 20-25% involvement with posterior elements destruction in thoracolumbar and lumbar spine.

CONCLUSIONS

With respect to the timing and occurrence of vertebral collapse, there is a distinct discrepancy between the thoracic and thoracolumbar or lumbar spine. When a prophylactic treatment is required, the optimum timing and method of treatment should be selected according to the level and extent of the metastatic vertebral involvement.

FREE VASCULARISED FIBULAR STRUT GRAFT FOR ANTERIOR SPINAL FUSION

A vascularised fibular strut graft was used for anterior spinal fusion in 16 patients with spinal kyphosis. The procedure was abandoned in three because of difficulty in establishing a vascular anastomosis and in one because the grafted fibula dislodged two days after operation. One patient died after five days. Of the 11 remaining patients, there were seven males and four females. Their ages at the time of operation averaged 30.9 years (12 to 71). The number of vertebrae fused averaged 6.7 (5 to 9) and the length of fibula grafted averaged 10.9 cm (6.5 to 18).

Average follow-up was 54 months (27 to 84). Bone union occurred at both ends of the grafted fibula in all 11 patients, with an average time to union of 5.5 months (3 to 8). We did not see a fracture of the grafted fibula. Two patients had postoperative complications; the graft dislodged in one and laryngeal oedema occurred two days after operation in the other.

A vascularised fibular strut graft provides a biomechanically stable and long-standing support in spinal fusion because the weak phase of creeping substitution does not take place in the graft.

Onset of ossification of the tarsal bones in congenital clubfoot

Subjects of this study were 45 patients with 56 idiopathic congenital clubfeet (34 boys with 42 feet and 11 girls with 14 feet) who underwent successful conservative treatment. Radiologic examinations were performed at intervals of 3 months. In anteroposterior radiographs of bilateral feet, the period of appearance of the ossification center was observed for the first, second, and third cuneiform and the tarsal navicular. The ossification of the tarsal bones in the congenital clubfeet occurred later than that in the unaffected feet in boys. The difference between the clubfeet and the unaffected feet was particularly statistically significant for the tarsal navicular and the second cuneiform (p < 0.01). The tarsal naviculars, the first cuneiforms, and the second cuneiforms in clubfeet and in unaffected feet started to be ossified significantly earlier in girls than in boys. Ossification occurred out of order in three of 56 clubfeet and three of 34 unaffected feet.

Effects of initial graft tension on clinical outcome after anterior cruciate ligament reconstruction. Autogenous doubled hamstring tendons connected in series with polyester tapes

We conducted a prospective, randomized, short-term study to clarify the effects of initial graft tension on clinical outcome after arthroscopically assisted anterior cruciate ligament reconstruction with autogenous doubled semitendinosus and gracilis tendons connected in series with polyester tapes. Seventy Japanese patients with chronic, "isolated" anterior cruciate ligament tears were entered in the study. The patients were randomly divided into three groups based on initial graft tension: Group 1 (20 N), Group 2 (40 N), or Group 3 (80 N). No statistical differences were noted among the three groups with regard to their background factors. The patients were observed for 2 years or more after surgery. Postoperatively, the average side-to-side difference in anterior laxity was 2.2 +/- 2.4 mm in Group 1, 1.4 +/- 1.8 mm in Group 2, and 0.6 +/- 1.7 mm in Group 3. Analysis of variance testing showed that the postoperative laxity in Group 3 was significantly less than that in Group 1. Spearman's rank-order correlation analysis also demonstrated significant correlation between the magnitude of initial graft tension and the magnitude of the postoperative laxity. This study demonstrates that relatively high initial tension (up to 80 N) reduces the postoperative anterior laxity of the knee joint after anterior cruciate ligament reconstruction using the doubled autogenous hamstring tendons connected in series with polyester tapes.

Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits

One hundred and fifty consecutive patients who had a burst fracture of the thoracolumbar spine and associated neurological deficits were managed with a single-stage anterior spinal decompression, strut-grafting, and Kaneda spinal instrumentation. At a mean of eight years (range, five years to twelve years and eleven months) after the operation, radiographs showed successful fusion of the injured spinal segment in 140 patients (93 per cent). Ten patients had a pseudarthrosis, and all were managed successfully with posterior spinal instrumentation and a posterolateral arthrodesis. The percentage of the canal that was obstructed, as measured on computed tomography, improved from a preoperative mean of 47 per cent (range, 24 to 92 per cent) to a postoperative mean of 2 per cent (range, 0 to 8 per cent). Despite breakage of the Kaneda device in nine patients, removal of the implant was not necessary in any patient. None of the patients had iatrogenic neurological deficits. After the anterior decompression, the neurological function of 142 (95 per cent) of the 150 patients improved by at least one grade, as measured with a modification of the grading scale of Frankel et al. Fifty-six (72 per cent) of the seventy-eight patients who had preoperative paralysis or dysfunction of the bladder recovered completely. One hundred and twenty-five (96 per cent) of the 130 patients who were employed before the injury returned to work after the operation, and 112 (86 per cent) of them returned to their previous job without restrictions. We concluded that anterior decompression, strut-grafting, and fixation with the Kaneda device in patients who had a burst fracture of the thoracolumbar spine and associated neurological deficits yielded good radiographic and functional results.

Free vascularised fibular strut graft for anterior spinal fusion

A vascularised fibular strut graft was used for anterior spinal fusion in 16 patients with spinal kyphosis. The procedure was abandoned in three because of difficulty in establishing a vascular anastomosis and in one because the grafted fibula dislodged two days after operation. One patient died after five days. Of the 11 remaining patients, there were seven males and four females. Their ages at the time of operation averaged 30.9 years (12 to 71). The number of vertebrae fused averaged 6.7 (5 to 9) and the length of fibula grafted averaged 10.9 cm (6.5 to 18). Average follow-up was 54 months (27 to 84). Bone union occurred at both ends of the grafted fibula in all 11 patients, with an average time to union of 5.5 months (3 to 8). We did not see a fracture of the grafted fibula. Two patients had postoperative complications; the graft dislodged in one and laryngeal oedema occurred two days after operation in the other. A vascularised fibular strut graft provides a biomechanically stable and long-standing support in spinal fusion because the weak phase of creeping substitution does not take place in the graft.

Immunohistochemical and ultrastructural analyses of in situ activation of hepatic stellate cells around Propionibacterium acnes-induced granulomas in the rat liver

Stellate cells embrace the hepatic sinusoids as pericytes. To demonstrate their activation in juxta-sinusoidal location, we induced hepatic granulomatous inflammation, which did not accompany liver injury nor fibrosis, by administrating a low dose (10 mg/kg b.w.) of heat-killed Propionibacterium acnes into rats. Macrophages and lymphocytes migrated out of the sinusoid and made compact granulomas in the space of Disse. Stellate cells which faced on the granulomas were closely attached to the sinusoidal endothelial cells and extended projections into the spaces between the constituent mononuclear cells of granulomas. They did not migrate into granulomas nor displayed mitosis. Immunohistochemically, stellate cells around the granulomas expressed alpha-smooth muscle actin (alpha-SMA), whereas those in the non-granulomatous regions did not. Small deposits of type III collagen were found at the periphery of granulomas. Biochemical analysis showed an increased amount of alpha-SMA protein and type III collagen mRNA in the granuloma-bearing liver. Transforming growth factor-beta and platelet-derived growth factor were detected within the granulomas. The present study has revealed that stellate cells are activated in situ by extrasinusoidal macrophages in a paracrine manner without being detached from the sinusoidal wall.

Morphological study of endothelin-1-induced contraction of cultured hepatic stellate cells on hydrated collagen gels

Hepatic stellate cells become activated and aquire contractility on being cultured. In order to characterize the morphology of contracted and relaxed stellate cells, we performed light- and electron-microscopic analyses of cultured stellate cells on collagen gels. Incubation of stellate cells with medium alone, 10 nM endothelin (ET)-1, or 1 mM N6,2' dibutyryladenosine 3':5'-cyclic monophosphate (dBcAMP) for 48 h induced contraction of the underlying collagen gels to 83%, 57%, and 97%, respectively, of their original size. Stellate cells relaxed by dBcAMP exhibited a round cell body and extended several long thin cytoplasmic processes with several varicosities. Culture with ET-1 accelerated spreading of the stellate cells on collagen gels and decreased the number of processes. Each such flattened stellate cell attached itself to the underlying collagen matrix by bending its cell body. Collagen fibers around the cell were pulled toward the cell and stretched. Thus, the present study has revealed that ET-1-stimulated cultured stellate cells adduct associated collagen fibers by the retraction of cytoplasmic processes and the bending of their spread cell bodies.

Identification of macrophage migration inhibitory factor in murine neonatal calvariae and osteoblasts

Bone resorption and formation are dynamic processes that occur in both normal and injured bone tissues. Regulation of these processes is mediated at the local level by cytokines and growth factors. Macrophage migration inhibitory factor (MIF) is one of the proinflammatory cytokines that activates macrophages and regulates production of other cytokines, such as tumour necrosis factor-alpha and interleukin-1. We here demonstrate, by reverse transcription-polymerase chain reaction, high expression of MIF mRNA in murine osteoblasts obtained from mouse neonatal calvariae and murine osteoblastic MC3T3-E1 cells. The presence of MIF protein in the osteoblasts was confirmed by Western blot analysis using anti-rat MIF antibody. Moreover, the immunohistochemical study revealed that MIF was localized largely in the cytoplasm. The pathophysiological function of MIF remains undefined; however, the present results suggest that MIF takes part in the osseous metabolism as well as in immunological events.

IFN-gamma-inducing factor up-regulates Fas ligand-mediated cytotoxic activity of murine natural killer cell clones

NK cells, non-T non-B immune effector lymphocytes, are localized in many organs, including liver, as well as in the circulation. To investigate the regulatory mechanism of killing apparatus in hepatic NK cells, we established IL-2-dependent NK cell clones from liver lymphocytes of BALB/c nude mice. To generate the NK cell clones, we incubated liver lymphocytes with a high dose of IL-2 in the presence of irradiated Kupffer cells, as feeder cells and as the source of IL-12, originally identified as NK cell stimulatory factor. Unless liver lymphocytes were incubated with both IL-2 and Kupffer cells, no cell growth was observed. Hepatic NK cell clones were established from this cell line by limiting dilution. The surface phenotypes of cloned NK cells were IL-2R beta-chain+ CD16+ CD3- IgM-. The clones did not express NK2.1, which is expressed by a half of NK-enriched spleen cells of BALB/c mice. Although the cells contained dense granules reactive to mAb against perforin, they exerted no conventional cytolytic activity against YAC-1. They constitutively expressed Fas ligand (FasL) and specifically killed Fas-positive target cells by fragmenting DNA. This Fas-FasL-mediated killing activity was enhanced by IFN-gamma-inducing factor, a recently identified novel cytokine produced by activated Kupffer cells, but was not affected by other Kupffer cell-produced cytokines, such as IL-12, IL-1beta, and TNF-alpha. Taken together, these findings suggest that hepatic NK cells participate in the immune response as effector cells through the Fas-FasL system in collaboration with cytokines from Kupffer cells.

IFN-gamma-inducing factor up-regulates Fas ligand-mediated cytotoxic activity of murine natural killer cell clones

NK cells, non-T non-B immune effector lymphocytes, are localized in many organs, including liver, as well as in the circulation. To investigate the regulatory mechanism of killing apparatus in hepatic NK cells, we established IL-2-dependent NK cell clones from liver lymphocytes of BALB/c nude mice. To generate the NK cell clones, we incubated liver lymphocytes with a high dose of IL-2 in the presence of irradiated Kupffer cells, as feeder cells and as the source of IL-12, originally identified as NK cell stimulatory factor. Unless liver lymphocytes were incubated with both IL-2 and Kupffer cells, no cell growth was observed. Hepatic NK cell clones were established from this cell line by limiting dilution. The surface phenotypes of cloned NK cells were IL-2R beta-chain+ CD16+ CD3- IgM-. The clones did not express NK2.1, which is expressed by a half of NK-enriched spleen cells of BALB/c mice. Although the cells contained dense granules reactive to mAb against perforin, they exerted no conventional cytolytic activity against YAC-1. They constitutively expressed Fas ligand (FasL) and specifically killed Fas-positive target cells by fragmenting DNA. This Fas-FasL-mediated killing activity was enhanced by IFN-gamma-inducing factor, a recently identified novel cytokine produced by activated Kupffer cells, but was not affected by other Kupffer cell-produced cytokines, such as IL-12, IL-1beta, and TNF-alpha. Taken together, these findings suggest that hepatic NK cells participate in the immune response as effector cells through the Fas-FasL system in collaboration with cytokines from Kupffer cells.

Kinetics of organ-associated natural killer cells and intermediate CD3 cells during pulmonary and hepatic granulomatous inflammation induced by mycobacterial cord factor

We investigated here the kinetics of natural killer (NK) cells and extrathymic T cells, which include intermediate CD3 cells and gamma delta T cells, in the cord factor-induced granulomatous inflammation of the lungs and liver. In Balb/c mice, pulmonary inflammation elevated the proportion of NK cells and that of extrathymic T cells to mononuclear cells in the lungs. C3H/He mice exhibited shorter-term inflammation of the lungs than Balb/c mice and accordingly showed a smaller increase in the proportions of pulmonary NK cells and intermediate CD3 cells. In the liver of Balb/c mice, hepatic NK cells increased as well with the granulomatous changes, while intermediate CD3 cells exhibited a transient decrease before they increased. The present study has demonstrated that granulomatous inflammation is accompanied by the increase of lung-associated NK cells and extrathymic T cells and that there exists a difference between these two mouse strains in the induction of these lymphocyte subsets by cord factor.

Interleukin 12 augments the liver-associated immunity and reduces liver metastases

BACKGROUND/AIMS

It has been reported recently that in vivo administration of interleukin-12 (IL-12) augments the cytotoxic activity of natural killer (NK)/T cells and shows a powerful anti-tumor activity. In this study, we evaluated that the IL-12 effect on liver-associated immunity and in vivo efficacy on the hepatic metastases in a rat model.

MATERIALS AND METHODS

Varying amounts of mouse recombinant IL-12 were injected intraperitoneally for 5 days to adult male Fischer rats and hepatic sinusoidal lymphocytes (HSL) were collected. Purified HSL are spontaneously cytolytic to both conventional NK-sensitive target (YAC-1) and NK-resistant target (RCN-H4) tumor cells.

RESULTS

IL-12 was found to increase the number of HSL and the cytolytic activity against these target cells in a dose-dependent fashion. Flow cytometric analysis showed that IL-12 caused an increase of CD8+ subpopulation in HSL and a double staining study revealed that the increased subpopulation was not CD3+8+ (cytotoxic T cell) fraction, but actually CD3-8+ (NK cell) fraction. Experimental liver metastases was markedly reduced in rats treated intraperitoneally with IL-12.

CONCLUSION

These results demonstrate that IL-12 augments the cytolytic activity of HSL and suggests this cytokine as an attractive choice for liver metastases therapy.

Characterization of Borrelia sp. isolated from Ixodes tanuki, I. turdus, and I. columnae in Japan by restriction fragment length polymorphism of rrf (5S)-rrl (23S) intergenic spacer amplicons

Borrelia isolated from various sources in Japan, including rare species of ixodid ticks, Ixodes tanuki, I. turdus, and I. columnae, were characterized by restriction fragment length polymorphism analysis and sequencing analysis of the 5S-23S rRNA intergenic spacer amplicon. Borrelia sp. isolated from I. tanuki, I. turdus and I. columnae generated restriction fragment length polymorphism patterns different from those of known B. burgdorferi sensu lato isolates previously reported. Furthermore, some B. afzelii and B. garinii isolated in Japan showed unique RFLP patterns which were not observed among European B. afzelii and B. garinii.