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The incidence of surgical site infection (SSI) is higher in spinal surgeries than in general orthopedic operations. In this study, we aimed to develop a scoring system with reduced health care costs for detecting spinal surgery patients at high risk for SSI. Retrospective cohort study. In total, 824 patients who underwent spinal surgery at 2 university hospitals from September 2005 to May 2011. We reviewed the medical records of 824 patients, and we examined 19 risk factors to identify high-risk patients. After narrowing down the variables by univariate analysis, multiple logistic analysis was performed for factors with P values <.2, using SSI as a dependent variable. Only factors that showed P values <.05 were included in the final models, and each factor was scored based on the β coefficient values obtained. The clinical prediction rules were thereby prepared. \"Emergency operation,\" \"blood loss >400 mL,\" \"presence of diabetes,\" \"presence of skin disease,\" and \"total serum albumin value <3.2 g/dL\" were detected by multivariable modeling and were incorporated into the risk scores. Applying these 5 independent predictive factors, we were able to predict the infection incidence after spinal surgery. Our present study could aid physicians in making decisions regarding prevention strategies in patients undergoing spinal surgery. Stratification of risks employing this scoring system will facilitate the identification of patients most likely to benefit from complex, time-consuming and expensive infection prevention strategies, thereby possibly reducing healthcare costs.

Introduction Patients with lumbar spine disease sometimes complain of nocturnal leg cramps. We sought to investigate the effectiveness of blocking the medial branch of the deep peroneal nerve as treatment for nocturnal leg cramps after spinal surgery for lumbar spine disease. Methods We evaluated 66 postoperative patients in this prospective comparative study of a group of patients with a nerve block (n = 41) and a control group without (n = 25). In the block group, the medial branch of the deep peroneal nerve was blocked at the distal two‐thirds of the interspace between the first and second metatarsals using 5.0 mL of 1.0% lidocaine. Results Two weeks after the block, the frequency of nocturnal leg cramps was reduced to less than a quarter of pretreatment baseline frequency in 61.0% of patients (n = 25) and less than half in 80.5% (n = 33). In the control group, the frequency of the leg cramps was reduced from baseline in 32.0% of patients (n = 8), and was unchanged or increased in 68.0% (n = 17) at 2 weeks. Cramp frequency was reduced to less than a quarter or less than half of baseline frequency in a significantly (P < 0.05 and P < 0.01, respectively) larger percentage of patients in the block group. The severity of each cramp was less in about two‐thirds of patients (63.4%; n = 26) in the block group and was unchanged in one‐third (31.7%; n = 13). Conclusions Blocking the medial branch of the peroneal nerve can be an effective, long‐lasting, and simple treatment with low risk for nocturnal cramps sustained after lumbar spine surgery. Frequency of nocturnal leg cramps was reduced to less than quarter in 61.0% and less than half in 80.5% at 2 weeks after the medial branch blockade of the deep peroneal nerve. Severity of each cramp improved in approximately two‐thirds of patients after the medial branch blockade of the deep peroneal nerve. The block of the medial nerve branch of the peroneal nerve could be an effective treatment for nocturnal cramps sustained after lumbar surgery, which is easy to perform with low risk, and long lasting.

Background Jeune syndrome (asphyxiating thoracic dystrophy) is an autosomal recessive disorder with constriction and narrowing of the thorax. To our knowledge, there are no reports regarding spinal deformity and correction in Jeune syndrome. Herein, we report two cases of spinal correction in patients with Jeune syndrome, and review the literature. Case Presentation We experienced cases of spinal scoliosis in an adolescent boy and a young adult woman, both with Jeune syndrome. Their spinal deformities had progressed by the time they came to our hospital for surgical correction. After preoperative evaluation of their general condition, including respiratory function in detail to confirm that they could undergo surgery, we treated both cases with posterior spinal correction and fusion. Spinal correction was performed safely and there were no severe complications, including respiratory depression, associated with surgery, and relatively satisfactory correction was obtained in both cases. In case 1, coronal deformity was corrected from 70° to 36° and from 82° to 42°, respectively. In case 2, Cobb angle was corrected from 52° to 20° and from 55° to 21°. Conclusions Posterior spinal correction can be performed safely in young patients with Jeune syndrome who have survived their infant stage and matured without a severe general condition.

We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.

Studying the genetic regulation of protein expression (through protein quantitative trait loci (pQTLs)) offers a deeper understanding of regulatory variants uncharacterized by mRNA expression regulation (expression QTLs (eQTLs)) studies. Here we report cis -eQTL and cis -pQTL statistical fine-mapping from 1,405 genotyped samples with blood mRNA and 2,932 plasma samples of protein expression, as part of the Japan COVID-19 Task Force (JCTF). Fine-mapped eQTLs ( n  = 3,464) were enriched for 932 variants validated with a massively parallel reporter assay. Fine-mapped pQTLs ( n  = 582) were enriched for missense variations on structured and extracellular domains, although the possibility of epitope-binding artifacts remains. Trans -eQTL and trans -pQTL analysis highlighted associations of class I HLA allele variation with KIR genes. We contrast the multi-tissue origin of plasma protein with blood mRNA, contributing to the limited colocalization level, distinct regulatory mechanisms and trait relevance of eQTLs and pQTLs. We report a negative correlation between ABO mRNA and protein expression because of linkage disequilibrium between distinct nearby eQTLs and pQTLs. Statistical fine-mapping of mRNA and protein quantitative trait loci in blood samples from the Japan COVID-19 Task Force sheds light on regulatory mechanisms and disease associations.

There is a close relationship between diabetes mellitus and heart failure, and diabetes is an independent risk factor for heart failure. Diabetes and heart failure are linked by not only the complication of ischemic heart disease, but also by metabolic disorders such as glucose toxicity and lipotoxicity based on insulin resistance. Cardiac dysfunction in the absence of coronary artery disease, hypertension, and valvular disease is called diabetic cardiomyopathy. Diabetes-induced hyperglycemia and hyperinsulinemia lead to capillary damage, myocardial fibrosis, and myocardial hypertrophy with mitochondrial dysfunction. Lipotoxicity with extensive fat deposits or lipid droplets is observed on cardiomyocytes. Furthermore, increased oxidative stress and inflammation cause cardiac fibrosis and hypertrophy. Treatment with a sodium glucose cotransporter 2 (SGLT2) inhibitor is currently one of the most effective treatments for heart failure associated with diabetes. However, an effective treatment for lipotoxicity of the myocardium has not yet been established, and the establishment of an effective treatment is needed in the future. This review provides an overview of heart failure in diabetic patients for the clinical practice of clinicians.

Iron (Fe) is an essential nutrient, but is poorly bioavailable because of its low solubility in alkaline soils; this leads to reduced agricultural productivity. To overcome this problem, we first showed that the soil application of synthetic 2′-deoxymugineic acid, a natural phytosiderophore from the Poaceae, can recover Fe deficiency in rice grown in calcareous soil. However, the high cost and poor stability of synthetic 2′-deoxymugineic acid preclude its agricultural use. In this work, we develop a more stable and less expensive analog, proline-2′-deoxymugineic acid, and demonstrate its practical synthesis and transport of its Fe-chelated form across the plasma membrane by Fe(III)•2’-deoxymugineic acid transporters. Possibility of its use as an iron fertilizer on alkaline soils is supported by promotion of rice growth in a calcareous soil by soil application of metal free proline-2’-deoxymugineic acid. Iron is an essential plant nutrient that is poorly bioavailable in alkaline soils, resulting in reduced agricultural productivity. Here, the authors report the synthesis of stable and cheap iron-chelator, proline-2’-deoxymugineic acid (PDMA), and demonstrate its utility as potential fertilizer.

Parasitic plants in the Orobanchaceae cause serious agricultural problems worldwide. Parasitic plants develop a multicellular infectious organ called a haustorium after recognition of host-released signals. To understand the molecular events associated with host signal perception and haustorium development, we identified differentially regulated genes expressed during early haustorium development in the facultative parasite Phtheirospermum japonicum using a de novo assembled transcriptome and a customized microarray. Among the genes that were upregulated during early haustorium development, we identified YUC3, which encodes a functional YUCCA (YUC) flavin monooxygenase involved in auxin biosynthesis. YUC3 was specifically expressed in the epidermal cells around the host contact site at an early time point in haustorium formation. The spatio-temporal expression patterns of YUC3 coincided with those of the auxin response marker DR5, suggesting generation of auxin response maxima at the haustorium apex. Roots transformed with YUC3 knockdown constructs formed haustoria less frequently than nontransgenic roots. Moreover, ectopic expression of YUC3 at the root epidermal cells induced the formation of haustorium-like structures in transgenic P. japonicum roots. Our results suggest that expression of the auxin biosynthesis gene YUC3 at the epidermal cells near the contact site plays a pivotal role in haustorium formation in the root parasitic plant P. japonicum.

Ability to form cellular aggregations such as tumorspheres and spheroids have been used as a morphological marker of malignant cancer cells and in particular cancer stem cells (CSC). However, the common definition of the types of cellular aggregation formed by cancer cells has not been available. We examined morphologies of 67 cell lines cultured on three dimensional morphology enhancing NanoCulture Plates (NCP) and classified the types of cellular aggregates that form. Among the 67 cell lines, 49 cell lines formed spheres or spheroids, 8 cell lines formed grape-like aggregation (GLA), 8 cell lines formed other types of aggregation, and 3 cell lines formed monolayer sheets. Seven GLA-forming cell lines were derived from adenocarcinoma among the 8 lines. A neuroendocrine adenocarcinoma cell line PC-3 formed asymmetric GLA with ductal structures on the NCPs and rapidly growing asymmetric tumors that metastasized to lymph nodes in immunocompromised mice. In contrast, another adenocarcinoma cell line DU-145 formed spheroids in vitro and spheroid-like tumors in vivo that did not metastasize to lymph nodes until day 50 after transplantation. Culture in the 3D nanoenvironment and in a defined stem cell medium enabled the neuroendocrine adenocarcinoma cells to form slowly growing large organoids that expressed multiple stem cell markers, neuroendocrine markers, intercellular adhesion molecules, and oncogenes in vitro. In contrast, the more commonly used 2D serum-contained environment reduced intercellular adhesion and induced mesenchymal transition and promoted rapid growth of the cells. In addition, the 3D stemness nanoenvironment promoted secretion of HSP90 and EpCAM-exosomes, a marker of CSC phenotype, from the neuroendocrine organoids. These findings indicate that the NCP-based 3D environment enables cells to form stem cell tumoroids with multipotency and model more accurately the in vivo tumor status at the levels of morphology and gene expression.