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Scoliosis is a common clinical manifestation of Rett syndrome, a neurodevelopmental disorder that almost exclusively affects females. The spinal curve in patients with Rett syndrome is typically a long C curve of a neuromuscular type. As the onset of the scoliosis is very early and shows rapid progression, early surgical intervention has been recommended to prevent a life-threatening collapsing spine syndrome. However, there are high perioperative risks in Rett syndrome patients who undergo spinal surgery, such as neurological compromise and respiratory dysfunction due to rigid spinal curve. We herein report the surgical result of treating severe rapid progressive thoracic scoliosis in a 16-year-old girl with Rett syndrome. Posterior segmental pedicle screw fixation was performed from T1 to L3 using a computer-assisted technique. Post-operative radiography demonstrated a good correction of the curve in both the sagittal and coronal alignment. There were no postoperative complications such as neurological compromise. The patient had maintained satisfactory spinal balance as of the 3-year follow-up examination.

Amphiphysin I, known as a major dynamin-binding partner localized on the collars of nascent vesicles, plays a key role in clathrin-mediated endocytosis (CME) of synaptic vesicles. Amphiphysin I mediates the invagination and fission steps of synaptic vesicles by sensing or facilitating membrane curvature and stimulating the GTPase activity of dynamin. Amphiphysin I may form a homodimer by itself or a heterodimer with amphiphysin II in vivo. Both amphiphysin I and II function as multilinker proteins in the clathrin-coated complex. Under normal physiological conditions, the functions of amphiphysin I and some other endocytic proteins are known to be regulated by phosphorylation and dephosphorylation. During hyperexcited conditions, the most recent data showed that amphiphysin I is truncated by the ca2-dependent protease calpain. Overexpression of the truncated form of amphi-physin I inhibited transferrin uptake and synaptic vesicle endocytosis (SVE). This suggests that amphi-physin I may be an important regulator for SVE when massive amounts of Ca2 flow into presynaptic terminals, a phenomenon observed in neurodegenerative disorders such as ischemia/anoxia, epilepsy, stroke, trauma and Alzheimer's disease. This review describes current knowledge regarding the general properties and functions of amphiphysin I as well as the functional regulations such as phosphorylation and proteolysis in nerve terminals.

Conventionally, the carrying angle of the elbow is measured using simple two-dimensional radiography or goniometry, which has questionable reliability. This study proposes a novel method for estimating carrying angles using computed tomography that can enhance the reliability of the angle measurement. Data of CT scans from 25 elbow joints were processed to build segmented three-dimensional models. The cross-sectional centerlines of the ulna and the humerus were traced from the 3D models, and the angle between 2 vectors formed from the centerlines of the humerus and the ulna was defined as the "three-dimensional carrying angle." These angles were compared with those measured by simple radiograph. Two cases of angular deformity were underwent surgery based on this preoperative surgical planning, and the postoperative 3D carrying angles were evaluated using the proposed method. The mean value of the calculated three-dimensional carrying angle was 20.7 degrees +/-3.61, while it was 16.3 degrees +/-3.21 based on simple radiography without statistical difference. Based on the 3D carrying angle estimations, 2 surgical cases of cubitus deformities were planned by comparison with the normal contra-lateral elbow. Postoperative angle estimations confirmed that the corrected angles were nearly identical to the planned angles for both cases. The results of this study showed that the carrying angle can be accurately estimated using three-dimensional CT and that the proposed method is useful in evaluating deformities of the elbow with high reliability.

Angiogenesis is an essential event in the development of synovial inflammation in rheumatoid arthritis (RA). The aim of the current study was to investigate the expression of vasohibin-1, a novel endothelium-derived vascular endothelial growth factor (VEGF)-inducible angiogenesis inhibitor, in the RA synovium, and to test the effect of inflammatory cytokines on the expression of vasohibin-1 by RA synovial fibroblasts (RASFs). Synovial tissue samples were obtained at surgery from patients with osteoarthritis (OA) and RA, and subjected to immunohistochemistry to investigate the expression and distribution of vasohibin-1 relevant to the degree of synovial inflammation. In an in vitro analysis, RASFs were used to examine the expression of vasohibin-1 and VEGF mRNA by real-time PCR after stimulation with VEGF or inflammatory cytokines under normoxic or hypoxic conditions. The immunohistochemical results showed that vasohibin-1 was expressed in synovial lining cells, endothelial cells, and synovial fibroblasts. In synovial tissue, there was a significant correlation between the expression of vasohibin-1 and histological inflammation score (p0.002, r0.842). In vitro, stimulation with VEGF induced the expression of vasohibin-1 mRNA in RASFs under normoxic conditions, and stimulation with cytokines induced vasohibin-1 mRNA expression under a hypoxic condition. These results suggest that vasohibin-1 was expressed in RA synovial tissue and might be regulated by inflammatory cytokines.

The vision-screening program for 3.5-year-old children in Japan consists of 3 steps:questionnaires and home visual acuity testing, visual acuity testing by nurses and inspection by medical officers at regional Public Health Centers, and examinations by ophthalmologists. In this study, we tested refraction with a hand-held autorefractometer in addition to visual acuity testing and inspection to reveal whether or not autorefraction leads to better detection of eye problems. Autorefraction was performed in 6 consecutive sessions by a single examiner in 265 children at 3.5 years of age who all visited the same center. The children were sent to the third step of examinations by ophthalmologists based on refractive error criteria:3 diopters myopia or 1 diopter hyperopia, and/or 2 diopters astigmatism in either eye, in addition to the current criteria:1) failure in either eye for 0.5 visual acuity at the center, 2) eye-related symptoms revealed by the questionnaires, or 3) eye problems detected by medical officers. Notices to visit ophthalmologists were issued for 64 children (24%), and 37 of those (58%) made the visits, so that documents containing final diagnoses were sent back to the Public Health Office. Of the 64 children, 12 were sent to ophthalmologists based on the current criteria only, 10 based on both the current criteria and the refractive error criteria, and 42 based on the refractive error criteria only. Twelve of the 13 children visiting ophthalmologists by the current criteria had diagnoses such as amblyopia and strabismus. In contrast, 15 of 24 children visiting ophthalmologists by only the refractive error criteria had mainly diagnoses of refractive errors, with no serious problems. In conclusion, autorefraction in addition to visual acuity testing and inspection led to detection of only one additional case of an eye disease at 3.5 years, while tripling the number of children sending to the third-step examination by an ophthalmologist. Thus, from a cost-effectiveness standpoint, autorefraction is not recommended as an additional test when the current system is conducted as designed.

We present a middle-aged, heterosexual Japanese man with mixed infections including human intestinal spirochetosis, which led us to the detection of human immunodeficiency virus (HIV) infection. The patient had syphilis without related physical or neurological findings. An examination for the serum antibody for HIV performed 9 years previously was negative. In a complete medical checkup at the present time, human intestinal spirochetosis and unspecified entamebic cysts were suggested by histological examination of colonic biopsy material and parasitic examination of the intestinal fluid, respectively. Moreover, a serological test for the antibody for HIV was positive. In specimens obtained by colonoscopy, Brachyspira aalborgi was diagnosed by ultrastructural study and the polymerase chain reaction method for bacterial 16S ribosomal deoxyribonucleic acid. Although HIV infection remains at low prevalence in Japan, we recommend examination for HIV infection in patients with human intestinal spirochetosis, especially when other co-infections are apparent.

For patients with acute myocardial infarction (MI), the immediate therapeutic goal is to establish the patency of the infarct-related artery. Prolonged myocardial ischemia, however, often breaks down the coronary microvasculature, and the flow to the infarct myocardium may be markedly reduced. This is called the no-reflow phenomenon. This phenomenon is important not solely because it correlates with infarct size but because it provides additional prognostic information. With recent advances in imaging modalities, the no-reflow phenomenon is observed more frequently than when clinical judgment alone is used. Patients with this phenomenon are associated with poor functional and clinical outcomes. Now, the no-reflow phenomenon can be a parameter with which to predict high-risk patients. The focus of reperfusion therapy has shifted toward the improvement of myocardial perfusion. The improvement of myocardial perfusion could promote the functional recovery of viable muscle and reduce infarct expansion, which is associated with favorable clinical outcomes. For this purpose, pharmacological interventions and catheter-based devices to retrieve embolic materials have been proposed. Advances in our understanding of the pathophysiology of microvascular dysfunction would aid the development of therapeutic strategies for its prevention and treatment.

Toremifene citrate is expected to prevent drug resistance in cancer patients by inhibiting p-glycoprotein activity. The safety and efficacy of combination therapy with high-dose toremifene citrate and paclitaxel were investigated. Between December 2003 and June 2004, 15 women with a mean age of 53 years old with metastatic breast cancer were enrolled. The administration schedule was 80mg/m2 of paclitaxel given on Days 1, 8, and 15, and 120mg/day of toremifene citrate orally administered starting on Day 18. On Days 32 and 39, paclitaxel was concurrently administered again. Toxicities, response rate, and time to treatment failure were assessed. All patients had been treated with endocrine or chemotherapy. Grade 3 leukopenia occurred in 2 patients on the administration of paclitaxel alone, and grade 3 febrile neutropenia occurred in 1 patient given the combination therapy. There was no grade 3 or greater non-hematological toxicity. There was no complete response and 1 partial response, producing a response rate of 6.7%. Median time to treatment failure was 2.7 months. Combination therapy of paclitaxel and toremifene was safe and well tolerated with minimal toxicity. Further clinical trials targeting patients with functional p-glycoprotein are warranted.

The annual number of suicides in Japan increased sharply in 1998, and since that time it has consistently exceeded 30,000 per year. In this study, we analyze a database of personal and background characteristics of 824 cases (605 men, 219 women) who completed suicide in Okayama Prefecture in 2002 and 2003. The data were obtained with cooperation from the police. Using the methodologies in a previous European study as a model, we classified the suicide methods into 8 categories. To examine the generational and regional differences in the choice of methods, we stratified the sample into 4 age groups (<-24, 2544, 4564, and >-65) and 2 regional groups (Okayama/Kurashiki vs. other areas). Our results on gender differences in 7 of the suicide methods were mostly similar to the European data. However, our data showed a remarkably higher proportionate male-to-female mortality ratio for poisoning by other substances (ICD-10, X65-X69 codes) (1.83, 1.15-2.92). In terms of generational differences in the choice of suicide methods, the Mantel-Haenszel test of homogeneity was significant for most of the categories in our study, suggesting an impact of age on how people commit suicide. There were no remarkable regional differences in our sample. An epidemic curve for suicides via carbon monoxide poisoning using charcoal briquets revealed a trend of time clustering not observed in the other 6 means. The database constructed and used in this study contains richer information than conventional death statistics and is expected to provide helpful knowledge and insights for future epidemiological studies.

This retrospective study assessed the radiographic results of 16 patients with avascular necrosis following treatment for developmental dislocation of the hip (DDH) who were subsequently treated between 1991 and 2005 by rotation acetabular osteotomy (RAO) combined with femoral intertrochan-teric osteotomy (FIO). Initial treatment was by Pavlik harness, cast fixation, or overhead traction. The parameters that showed consistent improvement were the index of centralization, the index of acetabular coverage, adequate reduction of the greater trochanter, and abductor sufficiency. The combined procedure appears to be effective in cases in which preoperative planning shows a reasonable expectation of congruency and osteoarthritis is limited to the early stages.

A 23-year old woman with acute biphenotypic leukemia (ABL) complained of chest pain with cough, high fever and hemoptysis during induction chemotherapy, although she had been treated with anti-biotics and micafungin. We made a clinical diagnosis of invasive pulmonary aspergillosis (IPA) based on a consolidation in the right upper lung field on a chest radiograph as well as a high level of serum beta-D-glucan (with no evidence of tuberculosis and candidiasis). We changed her treatment from micafungin to voriconazole. Later, we discovered an air-crescent sign by CT scan that supported the diagnosis of IPA. Following voriconazole treatment, clinical symptoms ceased and abnormal chest shadows improved gradually and concurrently with a recovery of neutrophils. IPA must be considered in immunocompromised patients with pulmonary infiltrates who do not respond to broad-spectrum antibiotics. Serological tests and CT findings can aid in early diagnosis of IPA, which, along with treatment for IPA, will improve clinical outcomes.

Interaction between the receptor for advanced glycation end products (RAGE) and its ligands has been implicated in the pathogenesis of various inflammatory disorders. In this study, we establish an in vitro binding assay in which recombinant human high-mobility group box 1 (rhHMGB1) or recombinant human S100A12 (rhS100A12) immobilized on the microplate binds to recombinant soluble RAGE (rsRAGE). The rsRAGE binding to both rhHMGB1 and rhS100A12 was saturable and dependent on the immobilized ligands. The binding of rsRAGE to rhS100A12 depended on Ca2 and Zn2, whereas that to rhHMGB1 was not. Scatchard plot analysis showed that rsRAGE had higher affinity for rhHMGB1 than for rhS100A12. rsRAGE was demonstrated to bind to heparin, and rhS100A12, in the presence of Ca2, was also found to bind to heparin. We examined the effects of heparin preparations with different molecular sizesunfractionated native heparin (UFH), low molecular weight heparin (LMWH) 5000Da, and LMWH 3000Da on the binding of rsRAGE to rhHMGB1 and rhS100A12. All 3 preparations concentration-dependently inhibited the binding of rsRAGE to rhHMGB1 to a greater extent than did rhS100A12. These results suggested that heparin's anti-inflammatory effects can be partly explained by its blocking of the interaction between HMGB1 or S100A12 and RAGE. On the other hand, heparin would be a promising effective remedy against RAGE-related inflammatory disorders.

Es wurden einige expenmentelle Untersuchungen uber den Entstehungsmechanismus der Warmeempfindung bei intravenoser Kalziuminjektion an Menschen, Kaninchen, Froschen und glatten Muskeln angestellt. Die Resultate derVersuche lassen sich folgendermaBen zusammenfassen : (1) Bei intravenoser Einspritzung 5 cc. 3 prozentiger Chlorkalziumlosung tritt immer eine Warmeempfindung am Rachen und Damm, bzw. am ganzen Korper auf. Die Latenzzeit der Empfindung wird durch die Schnelligkeit der Injektion, den Zustand der Herztatigkeit und der peripheren GefaBe, stark beeinfluBt (Tabelle 1, 2, 3). Diese Warmeempfindung kommt nicht vor bei den Fallen, bei denen die Versuchspersonen ein Bad von ca. 45℃ nahmen, oder warmes Wasser im Mund hielten. (2) Bei Kaninchen erfolgt durch intravenose Kalziumeinspritzung Blutdrucksenkung, GefaBerweiterung und Erwarmung der Ohrmuschel. (3) Durch Kalziumzusatz zur Durchspulungsflussigkeit in 0,1 prozentiger Konzentration kommt eine GefaBerweiterung an den Froschhinterbeinen zustande. Mit Hilfe des Mikroskops ist die gleiche Wirkung durch Instillation von Kalziumlosung auf den GefaBen der Schwimmhaut und Nickhaut des Frosches zu beobachten. (4) Kalzium wirkt auf die Blutegelmuskeln erschlaffend, auf den Retractor penis des Hundes verkurzend. (5) Aus den obigen Resultaten wurde der Entstehungsmechanismus der Warmeempfindung nach intravenoser Kalziuminjektion als Folge von GefaBerweiterung erklart.

(1) Das intravenos injizierte Kongorot wurde in normalem Zu-stand durch die Nieren im Harn sparlich oder gar nicht ausgeschieden. (a) Durch die Phlorhidzingabe kam der Farbstoff im Harn vor. Diese Erscheinung hangt mit der Tatsache zusammen, daB das Phlorhidzin auf die Permeabilitat der Niere steigernd wirkt. (b) Bei Muskelanstrengung wird der Farbstoff in geringen Mengen im Harn ausgeschieden. Dies beruht auf dem erhohten Filtrationsdruck in der Niere infolge der Blutdrucksteigerung. (c) Diuretika haben keinen EinfluB darauf. (2) Die normale Froschhaut laBt das Kongorot von innen nach auBen oder in umgekehrter Richtung nicht durchpassieren. (a) Durch Phlorhidzinapplikation wird der Farbstoffdurchtritt in beiden Richtungen moglich. (b) Durch die Wirkung von Phlorhidzin nahm der elektrische Ruhestrom der Froschhaut allmahlich ab. (3) Hinsichtlich der Erregbarkeit des Nervmuskelpraparates des Frosches ubt das Phlorhidzin auf den Schwellenwert eine erniedrigende Wirkung aus.

1) The effect of acetylcholine and vagostigmine on isolated muscle of frog and nerve-muscle preparations, with single induction shocks was studied. 2) Direct application of acetylcholine or vagostigmine to the muscle preparation produces a depressant action on the excitability as well as on the shortening height of the maximum contraction. The effects are more marked when the two drugs are applied simultaneously or successively than when applied separately. 3) Direct application of acetylcholine or vagostigmine to the nervous portion of the nerve-muscle preparation also produces a slight depressant action on the excitability of muscle to indirect stimulation applied to the nerve. 4) The applicability of the chemical transmission theory to amphibian muscles was discussed.

1. Die Autotransplantation der Kaninchenepithelkorperchen, die mit Femurfraktur ausgefuhrt wurde, ergab Hypertrophie und Hyper-funktion des Transplantats, wie beim Knochenbruch im normalen Zustand. 2. Die Homoiotransplantation der Kaninchenepithelkorperchen mit einmaliger Fraktur ergab zwar eine Epithelkorperchenhypertrophie, d. i. Hyperfunktion des Transplantats wie bei der genannten Autotransplantation, aber im Laufe der 2. Woche trat im Transplantat, gerade wie bei der Verpflanzung ohne Knochenbruch, eine Infiltration der Lymphozyten ein. 3. Wenn man nach der Homoiotransplantation eine zweimalige beiderseitige Femurfraktur in einem Zwischenraum von 9 Tagen ausfuhrt, so ergibt sich eine Hypertrophie des Transplantats. In einigen Fallen lieB sich selbst nach Verlauf von 2 Monaten keine Infiltration der Lymphozyten nachweisen. Daher waren diese histologischen Befunde gerade wie die bei der Autotransplantation. 4. Bei Fallen, bei denen nach der Homoiotransplantation drei Knochenbruche, d. h. beiderseitige Femurfraktur und Tibiafraktur, in Intervallen von je 9 Tagen ausgefuhrt wurden, trat augenfallig die Hypertrophie bzw. Hyperfunktion des Transplantats ein und es war keine Infiltration der Lymphozyten selbst nach Verlauf von 2 Monaten erkennbar. Der Befund war wie der bei der Autotransplantation. Das Gelingen der Homoiotransplantation konnte erst durch diesen Versuch genau festgestellt werden.