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Objectives Salter osteotomy is widely used to improve acetabular coverage in the treatment of developmental dysplasia of the hip. Herein we describe angulated Salter osteotomy (ASO) as the modified Salter osteotomy, which creates a two-point contact between the proximal and distal fragments and better stabilizes the fixation of the fragments. We reported our results of ASO and compared it with that of Salter osteotomy performed previously by us. Methods We retrospectively reviewed 41 unilateral hips that underwent ASO, with no other accompanying procedures, between 2012 and 2018. We investigated the radiographic measurements included the preoperative values of the acetabular index and center-edge angle (CEA), immediate postoperative values of distance d (lateral displacement of the distal fragment), lateral rotation angle (LRA), the ratio of the obturator height (ROH), pelvic height increase percentage (PHIP) and the values of acetabular index and CEA during the last follow-up. Measurements were compared with 20 unilateral hips that underwent Salter osteotomy. Results The mean age at the time of surgery was 5.4 years, and the mean follow-up duration was 3.3 years. Immediately after surgery, the mean distance d, LRA, ROH and PHIP were 8 mm, 19°, 70 and 1%, respectively. The last follow-up values of acetabular index and CEA significantly improved from the preoperative values by 18° and 21°, respectively. Patients treated with ASO showed significantly larger distance d, more improvement in CEA, and lesser PHIP than those treated with Salter osteotomy. Conclusions The short-term outcomes of ASO are favorable. ASO was as effective as or better than Salter osteotomy in pulling out and stabilizing the distal fragment anterolaterally. ASO prevents elongation of the ilium, which causes pelvic obliquity.

Background There are many reports of Achilles tendon lengthening procedures for equinus deformity of the ankle. We previously modified an Achilles tendon lengthening to prevent overextension with a locking mechanism suture before performing a sliding lengthening. The purpose of this study was to compare the biomechanical properties of the locking mechanism suture with sliding lengthening (L-SL) and Z-lengthening (ZL) using a rabbit model. Methods Thirty-six male Japanese white rabbits were assigned to two groups - half undergoing the L-SL technique and half undergoing the ZL technique on the flexor hallucis longus (FHL) tendon. Six rabbits in each group were sacrificed at one week, three weeks, and six weeks postoperatively and evaluated, while five rabbits underwent radiographical and biomechanical evaluation and one underwent histological evaluation. Results In extension length, L-SL was significantly lower than ZL one week postoperatively. In the L-SL group, elongation one week postoperatively was significantly lower than that three and six weeks postoperatively. In the ultimate failure load, L-SL was significantly higher than ZL one and three weeks after lengthening. In the L-SL group, the ultimate failure load one week postoperatively was significantly lower than that three and six weeks postoperatively. In the ZL group, there were significant differences at all time points. Conclusion L-SL had higher mechanical property in vivo.

Developmental coordination disorder (DCD) is the most common childhood movement disorder. It is characterized by clumsiness of fine and gross motor skills in developing children. Children with DCD have low ability to effectively use tactile information for movements, instead relying on visual information. In addition, children with DCD have deficits in visuo-motor temporal integration, which is important in motor control. These traits subsequently lead to clumsiness of movements. Conversely, however, imperceptible vibrotactile noise stimulation (at 60%-intensity of the sensory threshold) to the wrist provides stochastic resonance (SR) phenomenon to the body, improving the sensory and motor systems. However, the effects of SR have not yet been validated in children with DCD. Thus, we conducted a single case study of a 10-year-old boy with a diagnosis of DCD to investigate the effect of SR on visual dependence, visuo-motor temporal integration, and manual dexterity. SR was provided by vibrotactile noise stimulation (at an intensity of 60% of the sensory threshold) to the wrist. Changes in manual dexterity (during the SR on- and off-conditions) were measured using the manual dexterity test of the Movement Assessment Battery for Children-2nd edition. The point of subjective equality measured by visual or tactile temporal order judgment task served as a quantitative indicator reflecting specific sensory dependence. The delay detection threshold and steepness of delay detection probability curve, which were measured using the delayed visual feedback detection task, were used as quantitative indicators of visuo-motor temporal integration. The results demonstrated alleviated visual dependence and improved visuo-motor temporal integration during the SR on-conditions rather than the SR off-conditions. Most importantly, manual dexterity during the SR on-conditions was significantly improved compared to that during the SR off-conditions. Thus, the present results highlighted that SR could contribute to improving poor movement in children with DCD. However, since this was a single case study, a future interventional study with a large sample size is needed to determine the effectiveness of SR for children with DCD.

Social communication uses verbal and nonverbal language. We examined the degree of trust and brain activity when verbal and facial expressions are incongruent. Fourteen healthy volunteers viewed photographs of 8 people with pleasant (smile) or unpleasant expressions (disgust) alone or combined with a verbal [positive/negative] expression. As an index for degree of trust, subjects were asked to offer a donation when told that the person in the photograph was troubled financially. Positive emotions and degree of trust were evaluated using the Visual Analogue Scale (VAS). Event-related potentials (ERPs) were obtained at 170–240 ms after viewing the photographs. Brain activity during incongruent conditions was localized using standardized Low Resolution Brain Electromagnetic Tomography (sLORETA). VAS scores for positive × smile condition were significantly higher than those for the other conditions (p<0.05). The donation offered was significantly lower for incongruence between verbal and facial expressions, particularly for negative × smile condition. EEG showed more activity in the parietal lobe with incongruent than with congruent conditions. Incongruence [negative × smile] elicited the least positive emotion, degree of trust, and amount of offer. Our results indicate that incongruent sensory information increased activity in the parietal lobe, which may be a basis of mentalizing.

BACKGROUND: Studies suggest that the observation of others’ actions leads to enhanced motor skill learning. OBJECTIVE: We examined whether others’ or self-action observation is effective for standing balance learning. In addition, we examined cortical activation during action observation using functional near-infrared spectroscopy. METHODS: Thirty-nine healthy young subjects were assigned randomly to the Control, Other-Observation (O-O), and SelfObservation (S-O) groups. The subjects learned to stand on a tilting platform while maintaining a horizontal position. The Control group alternated each trial with a rest period. The O-O and S-O groups were provided with information related to their performance during the rest period: the O-O group observed another person, while the S-O group observed their previous performance. Cortical activation was assessed by changes of hemoglobin oxygenation (oxyHb). RESULTS: A 2-way analysis of variance with repeated measures on balance performance revealed a significant difference in post-training (p < 0.05) and retention (p < 0.01) only in the S-O group. And an increase of oxyHb levels at post-training in the S-O group was observed in the supplementary motor area. CONCLUSION: Self-action observation improved standing balance and brain activity during training and at 24 h after training.

ofolate. the methyl donor for methylation of Hcy to methionine. is the most frequent genetic cause of elevated Hcy concentration [3]. An identified C to T substitution at 677 in the MTHFR gene [C677T/MTHFR (A222V)] relatively increases Hcy concentration in subjects with the TT genotype. In this present study. we aim to evaluate the effects of nutritional and genetic factors on plasma Hcy concentration among neonatal girls and their mothers in Japan. Prior to this study ， ethical approval was obtained from a special committee at Nagasaki University (project registration number 100614189). Bl ood samples were obtained the day after delivery from 200 healthy mothers with uncomplicated pregnancies at Nagasaki University Hospital and four clinics/hospital s

Objective: To investigate the feasibility of peripheral sensory nerve stimulation combined with task-oriented training in patients with stroke during inpatient rehabilitation. Design: A pilot randomized crossover trial. Setting: Two rehabilitation hospitals. Subjects: Twenty-two patients with subacute stroke. Interventions: Participants were randomly assigned to two groups and underwent two weeks of training in addition to conventional inpatient rehabilitation. The immediate group underwent peripheral sensory nerve stimulation combined with task-oriented training in the first week, followed by another week with task-oriented training alone. The delayed group underwent the same training in reverse order. Main measures: Outcome measures were the level of fatigue and Wolf Motor Function Test. Patients were assessed at baseline, one and two weeks. Results: All participants completed the study with no adverse events. There was no significant difference in level of fatigue between each treatment. From baseline to one week, the immediate group showed larger improvements than the delayed groups in the Wolf Motor Function Test (decrease in mean time (± SD) from 41.9 ± 16.2 seconds to 30.6 ± 11.4 seconds versus from 46.8 ± 19.4 seconds to 42.9 ± 14.7 seconds, respectively) but the difference did not reach significance after Bonferroni correction ( P = 0.041). Within-group comparison showed significant improvements in the Wolf Motor Function Test mean time after the peripheral sensory nerve stimulation combined with task-oriented training periods in each group ( P < 0.01). Conclusion: Peripheral sensory nerve stimulation is feasible in clinical settings and may enhance the effects of task-oriented training in patients with subacute stroke.

Pain is a multidimensional experience with sensory-discriminative, cognitive-evaluative and affective-motivational components. Emotional factors such as unpleasantness or anxiety are known to have influence on pain in humans. The aim of this single-blinded, cross over study was to evaluate the effects of transcranial direct current stimulation (tDCS) on emotional aspects of pain in pain alleviation. Fifteen subjects (5 females, 10 males) volunteered to participate in this study. In an oddball paradigm, three categories of 20 pictures (unpleasant, neutral, and pleasant) served as rare target pictures from the International Affective Picture System (IAPS). The power of the delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–25 Hz), and gamma (30–40 Hz) frequency bands in the three categories were measured using electroencephalography during an oddball paradigm at pre- and post-anodal or sham tDCS above the left dorsolateral prefrontal cortex (DLPFC). Results showed that the beta band power was significantly increased, and the alpha band power was significantly decreased during unpleasant pictures after anodal tDCS compared with sham tDCS. Furthermore, regarding unpleasant pictures, subjective reports of Self Assessment Manikin (SAM) for emotional valence after anodal tDCS showed a significant decrease of unpleasantness. Therefore, emotional aspects of pain may be effectively alleviated by tDCS of the left DLPFC as was shown not only by subjective evaluation, but also by objective observation of cerebral neural activity. This processing may be mediated by facilitation of the descending pain inhibitory system through enhancing neural activity of the left DLPFC.

Objective: To determine whether plantar perception training using a hardness discrimination task efficiently improves stabilization of standing posture balance in the old old as well as the very old.Design: A randomized two-group parallel controlled trial.Setting: Nursing homes.Participants: Forty-six elderly persons 75 years of age or older living in nursing facilities were randomly assigned evenly to either an intervention or a control group.Intervention: The intervention group was given a task to discriminate hardness differences while standing on foam rubber of different levels of hardness, while the control group was given the task to simply remain standing on foam rubber. The tasks were imposed for 10 successive days.Outcome measures: Outcome assessment was made by determinations of centre-of-gravity sway in the standing position and the Functional Reach Test.Results: Planter perception was significantly improved and centre-of-gravity sway in the standing position was also significantly reduced in the intervention group after the intervention. In the control group, however, there were no significant changes in perception or in sway ( P Conclusion: These results suggested that plantar perception exercises might efficiently stabilize standing postural balance in the old old as well as the very old.

〔目的〕在宅脳卒中患者に対する運動介入および栄養指導が動脈硬化指数および運動機能に及ぼす影響を調査した。〔対象〕地域在住の脳卒中患者16名。〔方法〕運動は2時間のプログラムを週2回，3ヶ月間実施し，栄養指導は管理栄養士による定期的な食事調査と栄養指導が行われた。評価項目は心臓足関節血管指数（Cardio Ankle Vascular Index: CAVI），足関節上腕血圧比（Ankle Brachial Index: ABI），歩行速度，握力，Functional reach test（FRT），Timed Up and Go test（TUG），30秒立ち上がりテストとした。〔結果〕麻痺側のCAVI値は介入前に比較して有意に低下した。運動機能面ではFRTおよびTUGのみに有意な改善が認められた。〔結語〕今回の結果から運動介入と栄養指導による学際的介入が運動機能面および動脈機能の面からも有効であることが示唆された。

Hiroshi Maeoka, Makoto Hiyamizu, Atsushi Matsuo, Shu MoriokaDepartment of Physical Therapy, Faculty of Health Science, Kio University, Koryo-cho, Kitakatsuragi-gun, Nara, Japan Purpose: Pain is a multidimensional experience with sensory-discriminative, cognitive-evaluative, and affective-motivational components. Emotional factors, such as unpleasantness or anxiety, are known to have influence on pain in humans. Repeated painful stimulation has been reported to reduce subjective pain intensity. Nevertheless, there is little evidence of the influence of such stimulation on the emotional factors of pain. The aim of this study was to evaluate the influence of repeated painful stimulation on the experience of unpleasantness and anxiety. Materials and methods: Eight subjects (six females, two males) volunteered to participate in this study. Subjects received repeated painful stimulation for 3 consecutive days each instance lasting 6 seconds, 60 times per day, on the medial side of the forearm of the nondominant hand. We examined the following items to evaluate changes of responses to painful stimulation: pain thresholds, pain tolerance levels, pain intensities, unpleasantness, and anxiety. Furthermore, pain thresholds and pain tolerance levels were compared between different sites on the ipsilateral and contralateral forearms. Results: No immediate or chronological changes in pain thresholds or pain tolerance levels were observed. Pain intensities were reduced significantly over the 3-day experimental period (P

The aim of this study was to examine patients with post-stroke hemiplegia for space estimation disorder during visual reaching for a target. Six patients with post-stroke hemiplegia with no parietal damage were studied, as well as 6 healthy older adults and 6 healthy younger adults as a control group. A target was placed on the table in front of the subject, and then the subject was asked to verbally indicate the farthest reachable point while the target was gradually being moved further away from the subject. The difference was then obtained by measuring the distance from the subject to the indicated point. There was no significant difference in the errors between the estimated and actual values in the healthy older and younger adults. No significant difference was also observed between dominant and non-dominant hands. There were significant differences between the paretic and non-paretic side in the hemiplegic patients, as well as between the paretic side of hemiplegic patients and the dominant hand in the healthy older adults. Compared with healthy subjects, the hemiplegic patients showed a greater difference between the estimated and actual values for both the non-paretic and paretic sides, which indicates an estimation disorder during visual reaching in patients with post-stroke hemiplegia. These results are discussed based on a conversion of the visual coordinates into movement coordinates during visual reaching.

症例は28歳,男性.以前より胆石を指摘されていたが無症状の為放置していた.職場の検便検査でサルモネラ菌の排菌を指摘され,抗菌薬にて除菌治療を行った.しかし,その後も同様に除菌治療を行ってもサルモネラ菌の排菌を繰り返し,再び抗菌薬治療を行ってもサルモネラ菌を便中に排菌する可能性が高いと考えられた.原因の一つとして胆石が疑われた為,胆嚢摘出術を行った.術後の細菌学的検査では,破砕胆石より便培養で検出されたものと同種のサルモネラ菌を検出した.術後経過良好にて術後第12病日に退院した.術後11カ月後に便培養を行ったがサルモネラ菌を検出しなかった.胆石や胆嚢奇形があるとサルモネラ菌無症候性長期保菌者になりやすいといわれている.胆石を有するサルモネラ菌長期保菌者は,原因の1つとして胆石症を疑い,積極的に胆嚢切除を考慮する必要があるものと思われた.

We reviewed 17 patients (15 males and 2 females) who had undergone re-operations for degenerative lumbar disease. They were operated for lumbar disc herniation (LDH) in 12, lumbar spinal canal stenosis (LSCS) in 4, and destructive spondyloarthropathy (DSA) in 1. Among the LDH cases, seven were re-operated for recurrence of LDH, and five for postoperative lumbar spinal stenosis. Their symptoms were due to degenerative changes, and additional herniotomy or laminectomy was done with good results. One was combined with root injury during operation. Re-operation proved insufficient for scar formation. In LSCS cases, recurrence of symptoms was due to insufficient decompression as a result of a too narrow laminotomy in the transverse or caudocranial direction. Additional laminectomy and lumbar fusion provided good results. In the DSA case, one of the reasons for incomplete union was insufficient range of spinal fusion. Additional lumbar fusion provided good results.

To assess the efficacy of cancer chemotherapy, an important index is apoptosis of the target cells, which can usually be confirmed by electron microscopy (EM). We established a new experimental technique, whereby cancer cells (MKN45) were distributed in thin collagen gel as one or two cell layers, and cultured with anti‐cancer drugs (5‐FU and CDDP). The cells were stained with fluorescent Hoechst 33258 (Ho) and photographed, then with hematoxylin and eosin (H&E) and again photographed, and processed for EM. This approach allowed us to characterize the patterns of death of single cells in detail. There were six patterns of cell damage: two patterns of apoptosis, early peripheral condensation of chromatin and late apoptotic bodies, two patterns of necrosis, cytoplasmic swelling and washed‐out images, and two further patterns, with morphological features of both apoptosis and necrosis, neither classified into necrosis nor apoptosis. The results show that cell death patterns can be mostly determined by combining observations of Ho and H&E‐stained cells without the necessity for EM observation.

Between 1979 and 1996, 99 lumbar canal stenosis patients over 65-years were treated with posterior decompression surgery. The mean age at surgery was 71.6 years (range, 65 to 83) and the length of follow-up was an average of 23.7 months (range, 6 to 90). These patients were divided into two groups (with fusion or without fusion). The clinical scores were evaluated retrospectively with the Japanese Orthopedic Association low back pain rating score (JOA-score). The JOA-score was an average of 8.9 preoperatively and 15.9 postoperatively (improving rate: 49.6%). There was no significant difference between these two groups. However, low back pain improved in fusion groups more than in the no-fusion groups.

Disease-related changes in prostaglandin (PG) levels may contribute to a bleeding tendency and local vasodilation in the portal circulation in patients with liver cirrhosis. We measured the plasma and tissue PG metabolite levels (6-keto PGF1α and thromboxane TXB2) in the systemic and portal circulation in 12 rats with CCl4-induced liver cirrhosis (LC rats) and ten with portal hypertension induced by 2 weeks of partial portal ligation (PH rats) and compared them with normal control rats (n=10). We also compared the plasma PG metabolite levels in the systemic and portal circulations in 11 cirrhotic patients with hepatocellular carcinoma (HCC) and five patient controls without liver disease. In the animal study, LC rats had significantly higher portal blood 6-keto PGF1α (P

Assessing abdominal complications in patients who have previously suffered high spinal cord injury is very difficult because the resultant loss of sensory, motor, and reflux function of the abdominal wall can mask the typical signs of acute abdomen such as tenderness, muscle rigidity, and peritoneal rebound pain. We recently diagnosed a small intestinal perforation in a 77-year-old man with a C6-7 spinal cord injury sustained 14 years earlier. The patient was correctly diagnosed as having an acute abdominal condition, despite palsy of abdominal wall sensation. An emergency laparotomy was done and a 40-cm length of affected ileum, about 180 cm distal to the Treitz ligament, including a 1-cm perforation, was resected, followed by an end-to-end anastomosis. We report this case to raise awareness of the need for appropriate diagnosis and early surgical treatment of abdominal complications in spinal-cord-injured patients.

Chronic pain emerges not only because of the injury of peripheral organs or a plastic change in spinal nerves, but also because of plasticity in the brain [1]. Therefore, the development of interventions dedicated to the rehabilitation of pain must occur via approaches that cause changes in the brain, instead of approaches that treat only peripheral organs. In particular, pain is composed of three facets, including a sensory aspect, a cognitive aspect, and an emotional aspect [2]. Thus, the rehabilitation of the brain represents an approach to that will address the cognitive and emotional aspects in particular.

The ability to maintain a one-leg standing position and the relation between plantar two-point discrimination and standing time on one leg were assessed. Participants were 1,241 apparently healthy people aged 2–92 years. Participants were asked to stand on one leg with eyes open (EO group) or closed (EC group) for up to 120 seconds. Coefficients of determination (COD) between subjects’ ages and results for both groups were calculated by quadratic and cubic functions. The slope of the tangent line drawn against the resultant curve was calculated by a differential formula. COD for the quadratic function were 0.65 (EO) and 0.33 (EC); age at maximum values in both groups was 37 years. COD for the cubic function were 0.77 (EO) and 0.52 (EC); maximum values were at ages 30 (EO) and 28 (EC) and minimum values at ages 88 (EO) and 77 (EC). The ability to remain standing on one leg with eyes closed appears to begin deteriorating in the late 20s. Age and plantar two-point discrimination distance had a significant positive correlation, and the two-point discrimination distance and standing time on one leg had a significant negative correlation. Decreased plantar sensation appears to be related to the decline in duration of one-leg standing.

Purpose: This study investigates the effect of presenting the target as an intrinsic reward on the physical performance of healthy subjects. Methods: Fifteen healthy people (62.9 ± 11.6 years old, mean ± standard deviation; 6 females and 9 males) were enrolled in this study. The task for physical performance was the Functional Reach Test, and participants performed the pre- and post-test. Participants were assigned randomly to a Control group, a High Target group (HT group) or Low Target group (LT group). In the control group, participants received feedback about each result and encouragement. In the HT group, participants received feedback about each result and were presented a target score that increased the result by 20%. In the LT group, participants received feedback about each result and were presented the target score that decreased the result by 20%. Results: The main effect of group was no significance (p=0.88). The main effect of time was significant (p=0.011). The group × time interaction was no significance (p=0.13). The post hoc test that compared the pre-test and post-test within each group was significant only in the HT group (p

Background: Sensory amplitude electrical stimulation has been reported to induce changes in corticospinal excitability. The aim of this review is to evaluate the effects of sensory electrical stimulation on hand and arm function in stroke patients. Methods: A literature search was undertaken to locate papers that used sensory electrical stimulation in stroke patients. The methodological quality of each study was assessed using the Physiotherapy Evidence Database (PEDro) score. Results: Ten studies were considered suitable for inclusion in this review. Six of the 10 studies provided the PEDro score, with the mean (standard deviation) score being 5.7 (1.0). There were no adverse effects in any of the studies. In only one study, the patients with acute stroke were included. There was much study of patients with mild arm hemiparesis. Most studies reported that sensory electrical stimulation was delivered at 10 Hz with pulse duration of 1 millisecond for 2 hours at the paretic wrist (median and/or ulnar nerve). Five studies reported sensory stimulation should not be used in isolation, but rather in combination with task training, to improve arm and hand function. Conclusions: Sensory electrical stimulation may improve hand and arm function if it combines with functional task training in patients with mild arm paresis but there are no studies with high methodological quality. In addition, it is uncertain whether sensory electrical stimulation would be of benefit for patients with severe paresis and be effective in the acute phase. Therefore, the results of this review remain inconclusive due to a lack of suitable randomized controlled trials.

We developed a mental task with gaze direction recognition (GDR) by which subjects observed neck rotation of another individual from behind and attempted to recognize the direction of gaze. A randomized controlled trial was performed in test ( 𝑛 = 9 ) and control ( 𝑛 = 8 ) groups of subjects with chronic neck pain undergoing physical therapy either with or without the GDR task carried out over 12 sessions during a three-week period. Primary outcome measures were defined as the active range of motion and pain on rotation of the neck. Secondary outcome measures were reaction time (RT) and response accuracy in the GDR task group. ANOVA indicated a main effect for task session and group, and interaction of session. Post hoc testing showed that the GDR task group exhibited a significant simple main effect upon session, and significant sequential improvement of neck motion and relief of neck pain. Rapid effectiveness was significant in both groups. The GDR task group had a significant session-to-session reduction of RTs in correct responses. In conclusion, the GDR task we developed provides a promising rehabilitation measure for chronic neck pain.

We developed a mental task with gaze direction recognition (GDR) by which subjects observed neck rotation of another individual from behind and attempted to recognize the direction of gaze. A randomized controlled trial was performed in test (n=9) and control (n=8) groups of subjects with chronic neck pain undergoing physical therapy either with or without the GDR task carried out over 12 sessions during a three-week period. Primary outcome measures were defined as the active range of motion and pain on rotation of the neck. Secondary outcome measures were reaction time (RT) and response accuracy in the GDR task group. ANOVA indicated a main effect for task session and group, and interaction of session (p

肝硬変(LC)では動脈硬化の進展が他疾患に比し少ないとされている.当教室の病理解剖例中のLC57名と他疾患患者50名において心筋,腎皮質内の小動脈を用いて定量的に動脈硬化度を算出し,血清脂質を加え,両群で比較検討を行った.次に入院患者で,血清脂質とアポ蛋白を比較検討した.LCでは他疾患患者に比し動脈硬化の程度は肉眼的及び組織学的検討の双方で軽度であった.また.年齢別の硬化度は加齢に従い他疾患患者で増加,LCで低下し明らかな較差が見られた(p

A case of giant malignant schwannoma growing out of chest wall to intrathoracic space which was associated with von Recklinghausen disease and caused dyspnea is presented here. An 8-year-old male visited another hospital because of fever and cough, and a chest tumor extending from the right lateral chest wall to intrathoracic space was suspected. The patient was admitted to the hospital for operation, because he developed stridor and dyspnea due to a rapid growth of the tumor. In the right lateral chest, an elastic hard subcutaneous tumor (13.5×5cm) was noted. On chest X-ray and CT, right intrathoracic space was occupied by the tumor and the mediastinum was shifted to the left. Incision biopsy revealed a malignant shwanoma. The operation was performed by posterolateral approach. The tumor was subtotally resected in combination with the 4th and 5th rib. Reexpansion pulmonary edema occurred postoperatively, but was improved by artificial respiration and the dyspnea disappeared. Eight months later, however, he died of the regrowth of the tumor in spite of chemotherapy, second resection and radiation.

The effect of transcranial direct current stimulation (tDCS) on the precise nondominant hand movement was investigated by applying anodal stimulation over the right primary motor cortex. We recruited 14 healthy participants for this single-blind, sham-controlled crossover trial. A circle-drawing task was performed before, immediately after, and at 30 min after 20 min of 1 mA anodal or sham tDCS. Anodal tDCS, compared with sham stimulation, significantly improved the circle-drawing task compared with sham stimulation. The deviation area and path length of the task were significantly decreased after anodal tDCS application and were further enhanced at 30 min after stimulation. These results suggest that anodal tDCS over the primary motor cortex enhances the precise movement of the nondominant hand for 30 min in healthy participants.

Transposition osteotomy of the acetabulum (TOA) was the first periacetabular osteotomy in which the acetabulum was transposed with articular cartilage. TOA improves coverage of the femoral head and joint congruity. The purpose of this study was to investigate whether TOA is an appropriate option for treating osteoarthritis of the hips at the advanced stage by comparing it with matched control hips at the early stage.Between 1998 and 2001, TOA was performed in 104 hips of 98 patients. Altogether, 16 of 17 hips (94%) with osteoarthritis at the advanced stage were examined and compared with 37 matched control hips at the early stage. The mean age at the operation was 48 years (38-56 years), and the mean follow-up period was 88 months (65-107 months).TOA corrected the acetabular dysplasia and significantly improved containment of the femoral head. Clinical scores were also significantly improved in both groups. In the advanced osteoarthritis cases, there was a tendency for abduction congruity before transposition osteotomy of the acetabulum to reflect the clinical outcome.TOA is a promising treatment option for advanced osteoarthritis of the hips as well as for patients at an early stage when preoperative radiographs show good congruity or containment of the joint.

The present study sought to verify object size perception through internal modeling while lifting an object. Electromyography (EMG) activity of the upper limb muscles was recorded while 20 healthy females alternately lifted two containers of the same weight, but were unequal in size. When subjects lifted the small container, a significant increase was observed in the EMG activity. Most subjects determined that the small container was heavier than the large container, and predicted that the large container would be heavier than the small container due to size difference. The results may be explained by supporting that subjects predict object weight based on perception of size through internal modeling; however, predictions are cross-checked and modified through sensory feedback based on subjective weight.

Clinical in vivo and in vitro studies have revealed pronounced gastric cancer activity using the combination of 5-fluorouracil (5-FU) and cisplatin (CDDP). In addition, the combination of 5-fluorouracil plus cisplatin (FP treatment) possesses synergistic cytotoxicity against gastric cancer. Sensitivity of two gastric cancer cell lines to anti-cancer drugs, 5-fluorouracil (5-FU) and/or cisplatinum (CDDP), was evaluated by use of either flow cytometric analysis (FACS) or morphological observation in terms of induction of apoptosis. In morphological observation, a new experimental technique was used in which cancer cells were distributed in thin collagen gel as one or two cell layers, and cultured with anti-cancer drugs. Thereafter, cells were stained with fluorescent Hoechst 33258 (Ho) and photographed, then stained with hematoxylin and eosin (H&E) and photographed again. Cell death patterns were determined by combining observations of Ho- and H&E-stained cells. While combined administration of 5-FU and CDDP did not induce apoptosis of MKN-28 (mutant-type p53), apoptotic cells were markedly observed in the case of MKN45 (wild-type p53). In addition, consecutive administration of CDDP for 3 h and 5-FU for 21 h effectively induced apoptosis of MKN45. These results indicated that the type of p53 expression in cancer cells could be a promising factor in predicting response to FP therapy and the administration of CDDP prior to 5-FU may be more effective in inducing apoptosis of gastric cancer cells with wild-type p53 expression. These data may provide evidence to support the idea that p53 expression is related to multidrug resistance (MDR) in FP therapy of gastric cancer cell lines.

The combination of 5-fluorouracil (5-FU) plus Cisplatin (CDDP) (FP treatment) possesses synergistic cytotoxicity against colon cancer. The molecular mechanisms by which chemotherapeutic agents induce apoptosis have been clarified by identifying apoptosis-related genes such p53 and bcl-2. We previously established a new experimental technique in which cancer cells are distributed in thin collagen gel as 1 or 2 cell layers. additionally, we evaluated the efficacy and toxicity of FP treatment in the gastric and colon cancer cell lines, and examined the relationship between the response to FP treatment and apoptosis. In these results we reported transfection of normal p53 gene into p53 mutant and analyzed the impact of the p53 gene in a sensitivity test. In this study, we examined induced apoptosis in colon cancer cell lines and the status of p53 expression in response to treatment of HCT116, COLO320, SW480 and DLD1 with 5-FU alone, CDDP alone and FP treatment under flow cytometric analysis. Transfection of SW480 and DLD1 cells was performed to compare the chemosensitivity of naturally occurring mutant-type p53 SW480 and DLD1 cells with neo-transfected SW480 and DLD1 cells and transfected SW480 and DLD1 cells. Appreciable apoptosis was induced in HCT116 and COLO320 (p53 wild-type) but not in SW480 and DLD1 cells (p53 mutant-type). Transfected SW480 and DLD1 cells underwent significantly more apoptosis (p

Objective Progressive cirrhosis is associated with increasing difficulty to handle free water. We examined the therapeutic potential of an orally active nonpeptide vasopressin-2 receptor antagonist (OPC-31260) in the management of edema and ascites in patients with cirrhosis. By means of its chemical blockade of the vasopressin-2 receptor in the kidney, we also assessed the ability of renal water handling in the early stage of cirrhosis. Methods A single 30 mg dose of OPC-31260 was administered orally to eight biopsy-proven patients with cirrhosis who had ascites or peripheral edema. The aquaretic responses were compared with those in six healthy subjects. Results In the patients with cirrhosis, OPC-31260 significantly (p < 0.01) increased the urinary excretion rate at 0 to 2 hours, and significantly (p < 0.01) lowered urine osmolality at 2 to 4 hours after administration. Free water clearance increased from −0.48 ± 0.14 to +0.19 ± 0.21 ml/min (p < 0.05) at 0 to 4 hours after administration. However, these aquaretic responses in the patients with cirrhosis were only approximately half the responses observed in the healthy subjects. A significant (p < 0.05) inverse relationship was observed between indocyanine green retention at 15 minutes after administration and the maximal free water clearance after administration to the patients with cirrhosis. Urinary sodium excretion did not change significantly in the patients, whereas it increased twofold in the healthy subjects. Urinary vasopressin excretion tended to increase in the patients, whereas it increased twofold to threefold (p < 0.01 to 0.05) from the baseline in the healthy subjects. Urinary prostaglandin E2 excretion was not increased, and serum sodium and plasma vasopressin levels were elevated only slightly in both groups. Conclusions Even though a hyporesponsiveness was observed in the group of patients with cirrhosis compared with the healthy group, the novel vasopressin-2 antagonist induced hypotonic diuresis in patients with cirrhosis, suggesting a therapeutic potential in managing water excess. This drug response may be a new index to assess impairment of water handling in patients with cirrhosis. Clinical Pharmacology & Therapeutics (1998) 63, 561–570; doi