Language：English   Publishing type：Research paper (scientific journal)  

Direct isolation and RNA-seq reveal environment-dependent properties of engrafted neural stem/progenitor cells
Neural stem/progenitor cell (NSPC) transplantation is a promising treatment for various neurodegenerative disorders including spinal cord injury, however, no direct analysis has ever been performed on their in vivo profile after transplantation. Here we combined bioimaging, flow-cytometric isolation and ultra-high-throughput RNA sequencing to evaluate the cellular properties of engrafted NSPCs. The acutely transplanted NSPCs had beneficial effects on spinal cord injury, particularly neuroprotection and neurohumoral secretion, whereas their in situ secretory activity differed significantly from that predicted in vitro. The RNA-sequencing of engrafted NSPCs revealed dynamic expression/splicing changes in various genes involved in cellular functions and tumour development depending on graft environments. Notably, in the pathological environment, overall transcriptional activity, external signal transduction and neural differentiation of engrafted NSPCs were significantly suppressed. These results highlight the vulnerability of engrafted NSPCs to environmental force, while emphasizing the importance of in situ analysis in advancing the efficacy and safety of stem cell-based therapies. © 2012 Macmillan Publishers Limited. All rights reserved.

DOI： 10.1038/ncomms2132

Language：English   Publisher：Spine  

Study Design. Multicenter, prospective registry study. Objective. To clarify minimal clinically important differences (MCIDs) for surgical interventions for spinal metastases, thereby enhancing patient care by integrating quality of life assessments with clinical outcomes. Background. Despite its proven usefulness in degenerative spinal diseases and deformities, the MCID remains unexplored regarding surgery for spinal metastases. Patients and Methods. This study included 171 (out of 413) patients from the multicenter "Prospective Registration Study on Surgery for Metastatic Spinal Tumors"by the Japan Association of Spine Surgeons. These were evaluated preoperatively and at 6 months postoperatively using the Face Scale, EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), including the Visual Analog Scale, and performance status. The MCIDs were calculated using an anchor-based method, classifying participants into the improved, unchanged, and deteriorated groups based on the Face Scale scores. Focusing on the improved and unchanged groups, the change in the EQ-5D-5L values from before to after treatment was analyzed, and the cutoff value with the highest sensitivity and specificity was determined as the MCID through receiver operating characteristic curve analysis. The validity of the MCIDs was evaluated using a distribution-based calculation method for patient-reported outcomes. Results. The improved, unchanged, and deteriorated groups comprised 121, 28, and 22 participants, respectively. The anchor-based MCIDs for the EQ-5D-5L index, EQ-Visual Analog Scale, and domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were 0.21, 15.50, 1.50, 0.50, 0.50, 0.50, and 0.50, respectively; the corresponding distribution-based MCIDs were 0.17, 15,99, 0.77, 0.80, 0.78, 0.60, and 0.70, respectively. Conclusion. We identified MCIDs for surgical treatment of spinal metastases, providing benchmarks for future clinical research. By retrospectively examining whether the MCIDs are achieved, factors favoring their achievement and risks affecting them can be explored. This could aid in decisions on surgical candidacy and patient counseling.

DOI： 10.1097/BRS.0000000000005062

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Language：English   Publisher：Global Spine Journal  

Study Design: Prospective multicenter study. Objectives: Palliative surgery is crucial for maintaining the quality of life (QOL) in patients with spinal metastases. This study aimed to compare the short-term outcomes of QOL after palliative surgery between patients with metastatic spinal tumors at different segments. Methods: We prospectively compared the data of 203 patients with spinal metastases at 2-3 consecutive segments who were divided into the following three groups: cervical, patients with cervical spine lesions; thoracic, patients with upper–middle thoracic spine lesions; and TL/L/S, patients with lesions at the thoracolumbar junction and lumbar and sacral regions. Preoperative and postoperative EuroQol 5-dimension (EQ5D) 5-level were compared. Results: All groups exhibited improvement in the Frankel grade, performance status, pain, Barthel index, EQ5D health state utility value (HSUV), and EQ5D visual analog scale (VAS) postoperatively. Although preoperative EQ5D HSUVs did not significantly differ between the groups (cervical, 0.461 ± 0.291; thoracic, 0.321 ± 0.292; and TL/L/S, 0.376 ± 0.272), the thoracic group exhibited significantly lower postoperative EQ5D HSUVs than the other two groups (cervical, 0.653 ± 0.233; thoracic, 0.513 ± 0.252; and TL/L/S, 0.624 ± 0.232). However, postoperative EQ5D VAS was not significantly different between the groups (cervical, 63.4 ± 25.8; thoracic, 54.7 ± 24.5; and TL/L/S, 61.7 ± 21.9). Conclusions: Palliative surgery for metastatic spinal tumors provided comparable QOL improvement, irrespective of the spinal segment involved. Patients with upper and middle thoracic spinal metastases had poorer QOL outcomes than those with metastases in other segments; however, sufficient QOL improvement was achieved.

DOI： 10.1177/21925682241297948

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STUDY DESIGN: Retrospective study of prospectively collected data. OBJECTIVE: To investigate the influence of cartilaginous endplates (CEs) in herniated discs on clinical symptoms and postoperative outcomes in patients with lumbar disc herniation (LDH) in different age groups. SUMMARY OF BACKGROUND DATA: LDH involving CEs, which are hard and less resorptive, is frequently observed with increasing age and appears to affect the natural course and clinical outcomes following discectomy. METHODS: Overall, 239 patients who underwent microscopic discectomy were included. Main outcomes were evaluated using motor strength, visual analog scale (VAS) for back and leg pain, and Rolland-Morris Disability Questionnaire. The effects of CEs on clinical variables and postoperative outcomes were compared between two groups (<50 y and ≥50 y). Furthermore, we investigated the characteristics of CE avulsions in each group and examined the association between CE occupancy rate and clinical symptoms. RESULTS: CEs were predominantly observed with increasing age and were more frequently detected in patients with Modic changes in both groups (P<0.001). A higher proportion of LDH with a ≥20% occupancy rate was found in patients aged <50 years (P=0.009) and was associated with a decrease in motor strength preoperatively (P=0.007). Postoperative VAS score for low back pain (LBP) was higher in patients with CEs than in those without CEs in the ≥50-year-old group (P<0.001). In multiple regression analysis, the presence of CEs was independently associated with residual LBP at 1 year postoperatively in older patients (β=0.46, P<0.001). CONCLUSION: Avulsion-type herniations in patients aged <50 years had a higher CE occupancy rate, which is a potential cause of preoperative motor weakness. Clinical outcomes following discectomy improved regardless of the presence of CEs, however, cartilaginous herniation in patients aged ≥50 years may affect residual LBP at 1 year.

DOI： 10.1097/BRS.0000000000005178

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Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【背景】転移性脊椎腫瘍患者の治療方針は骨関連事象の症候化予測，全身状態を考慮した予後予測を元に決定されているが，ADLにおいて重要な神経学的機能の予後予測ツールは現時点で存在しない．【目的】胸椎転移性脊椎腫瘍患者におけるShape factor（SF）と手術治療成績の関係を調査し神経学的機能の予後予測が可能か検証すること．【対象】2013年1月～2023年6月に当院において胸椎転移性脊椎腫瘍の診断で手術を施行した73例を対象とした．神経学的評価はJOA scoreとPSを術前後で評価した．また，画像評価として術前MRIT2強調画像を用いて脊髄最大圧迫レベルにおけるSFを計算し，SFと術前後のJOA score，PSとの関係を検討した．【結果】SFは術前のJOA scoreと有意に相関したが，術後のJOA scoreとの相関は認めなかった．SFはPS2以下のグループで有意に大きかったが術後は有意差を認めなかった．【結語】Shape factorは術前の神経機能を評価するツールとしては有用だったが術後の神経機能予測は出来なかった．</p>

DOI： 10.5035/nishiseisai.73.409

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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<p>【はじめに】環軸椎後方固定術（Magerl法）では片側固定にBrooks法などの後方ワイヤリングを併用することで固定性は十分とされているが，片側固定の手術成績ついての報告は限られており十分な検討は行われていない．【対象と方法】当院でMagerl法を施行し1年以上経過観察可能であった26例（片側固定11例，両側固定15例）について調査を行った．片側固定と両側固定の偽関節率について調査した．偽関節例については患者背景（年齢，既往，環軸椎不安定性），スクリュー設置位置を癒合例と比較し，その要因を検討した．【結果】偽関節率は片側固定27％（3/11），両側固定0％（0/15）で片側固定が高かった（p＝0.03）．偽関節は片側固定でのみ生じており，偽関節例は癒合例と比較しスクリュー設置位置が不良であった．【結論】Magerl法は骨癒合の面からは両側固定が望ましく，片側固定では良好なスクリュー設置が重要と考えられた．</p>

DOI： 10.5035/nishiseisai.73.76

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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【はじめに】環軸椎後方固定術(Magerl法)では片側固定にBrooks法などの後方ワイヤリングを併用することで固定性は十分とされているが,片側固定の手術成績ついての報告は限られており十分な検討は行われていない.【対象と方法】当院でMagerl法を施行し1年以上経過観察可能であった26例(片側固定11例,両側固定15例)について調査を行った.片側固定と両側固定の偽関節率について調査した.偽関節例については患者背景(年齢,既往,環軸椎不安定性),スクリュー設置位置を癒合例と比較し,その要因を検討した.【結果】偽関節率は片側固定27%(3/11),両側固定0%(0/15)で片側固定が高かった(p=0.03).偽関節は片側固定でのみ生じており,偽関節例は癒合例と比較しスクリュー設置位置が不良であった.【結論】Magerl法は骨癒合の面からは両側固定が望ましく,片側固定では良好なスクリュー設置が重要と考えられた.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】環軸椎後方固定術(Magerl法)では片側固定にBrooks法などの後方ワイヤリングを併用することで固定性は十分とされているが,片側固定の手術成績ついての報告は限られており十分な検討は行われていない.【対象と方法】当院でMagerl法を施行し1年以上経過観察可能であった26例(片側固定11例,両側固定15例)について調査を行った.片側固定と両側固定の偽関節率について調査した.偽関節例については患者背景(年齢,既往,環軸椎不安定性),スクリュー設置位置を癒合例と比較し,その要因を検討した.【結果】偽関節率は片側固定27%(3/11),両側固定0%(0/15)で片側固定が高かった(p=0.03).偽関節は片側固定でのみ生じており,偽関節例は癒合例と比較しスクリュー設置位置が不良であった.【結論】Magerl法は骨癒合の面からは両側固定が望ましく,片側固定では良好なスクリュー設置が重要と考えられた.(著者抄録)

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【はじめに】アルカプトン尿症は稀な先天性代謝異常症であり,色素沈着をきたした関節軟骨の変性により大関節に関節症性変化,脊椎に強直性変化が見られる.脊椎強直は特に胸腰椎に多く認め,頸椎ではまれであるが,今回我々は下位頸椎の強直により環軸椎の不安定性をきたし,脊髄症を発症したアルカプトン尿症の1例を経験したので報告する.【症例】65歳男性.歩行障害,四肢のしびれ,巧緻運動障害が出現し当科紹介.初診時の単純X線にて下位頸椎の強直及び環軸椎亜脱臼を認め,MRIではC1レベルでの脊髄の萎縮を認め,同レベルでの脊髄症と診断した.棘突起間スペーサーを用いた環軸椎関節の整復とMagerl+Brooks法による後方固定を施行し,脊髄症による症状は改善した.【結語】アルカプトン尿症において頸椎の強直性変化を認める症例は,環軸椎の不安定性をきたしやすく,脊髄症をきたす可能性を念頭に置くことが重要と思われた.(著者抄録)

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Spinal metastases can impair mobility, worsening the Karnofsky Performance Status (KPS). Surgery for spinal metastases has the potential to improve KPS and extend prognosis, but it is crucial to recognize the elevated risk of perioperative complications. Therefore, the development of a new scoring system to accurately predict perioperative complications in spinal metastatic surgery is essential. METHODS: We conducted a retrospective observational study with 86 patients who underwent surgical intervention for spinal metastases. Patients were divided into two groups based on the presence or absence of perioperative complications within 14 days after surgery. Various factors related to perioperative complications were assessed through univariate and multivariate analyses. We established a clinical prognostic scoring system called the Perioperative Complications following Metastatic Spinal Surgery (PERCOM) score and evaluated its precision using receiver operating characteristic (ROC) analysis. RESULTS: Five variables (age, KPS, primary prostate cancer, Albumin, and Hemoglobin) identified in the univariate analysis were assigned binary values of 0 or 1. The PERCOM score was then calculated for each patient by summing the individual points, ranging from 0 to 5. The optimal threshold determined by ROC curve analysis for the PERCOM score was 2 points, with a sensitivity of 86 % and a specificity of 56 %. CONCLUSIONS: The composite PERCOM score effectively predicted perioperative complications in spinal metastasis surgery. To further validate its precision, a prospective multicenter study is needed.

DOI： 10.1016/j.heliyon.2024.e25180

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BACKGROUND: In patients with cervical spinal cord injury (SCI), we need to make accurate prognostic predictions in the acute phase for more effective rehabilitation. We hypothesized that a multivariate prognosis would be useful for patients with cervical SCI. METHODS: We made two predictive models using Multiple Linear Regression (MLR) and Artificial Neural Networks (ANNs). We adopted MLR as a conventional predictive model. Both models were created using the same 20 clinical parameters of the acute phase data at the time of admission. The prediction results were classified by the ASIA Impairment Scale. The training data consisted of 60 cases, and prognosis prediction was performed for 20 future cases (test cohort). All patients were treated in the Spinal Injuries Center (SIC) in Fukuoka, Japan. RESULTS: A total of 16 out of 20 cases were predictable. The correct answer rate of MLR was 31.3%, while the rate of ANNs was 75.0% (number of correct answers: 12). CONCLUSION: We were able to predict the prognosis of patients with cervical SCI from acute clinical data using ANNs. Performing effective rehabilitation based on this prediction will improve the patient's quality of life after discharge. Although there is room for improvement, ANNs are useful as a prognostic tool for patients with cervical SCI.

DOI： 10.3390/jcm13010253

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Language：English   Publisher：Journal of Orthopaedic Science  

Objective: This study aimed to elucidate postoperative outcomes in patients with spinal metastases of prostate cancer, with a focus on patient-oriented assessments. Methods: This was a prospective multicenter registry study involving 35 centers. A total of 413 patients enrolled in the Japanese Association for Spine Surgery and Oncology Multicenter Prospective Study of Surgery for Metastatic Spinal Tumors were evaluated for inclusion. The eligible patients were followed for at least 1 year after surgery. The Frankel Classification, Eastern Cooperative Oncology Group Performance Status, visual analog scale for pain, face scale, Barthel Index, vitality index, indications for oral pain medication, and the EQ-5D-5L questionnaire were used for evaluating functional status, activities of daily living, and patient motivation. Results: Of the 413 eligible patients, 41 with primary prostate cancer were included in the study. The patient-oriented assessments indicated that the patients experienced postoperative improvements in quality of life and motivation in most items, with the improvements extending for up to 6 months. More than half of the patients with Frankel classifications B or C showed improved neurological function at 1 month after surgery, and most patients presented maintained or improved their classification at 6 months. Conclusion: Surgical intervention for spinal metastases of prostate cancer significantly improved neurological function, quality of life, and motivation of the patients. Consequently, our results support the validity of surgical intervention for improving the neurological function and overall well-being of patients with spinal metastases of prostate cancer.

DOI： 10.1016/j.jos.2024.07.012

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In osteoclastogenesis, the metabolism of metal ions plays an essential role in controlling reactive oxygen species (ROS) production, mitochondrial biogenesis, and survival, and differentiation. However, the mechanism regulating metal ions during osteoclast differentiation remains unclear. The metal-binding protein metallothionein (MT) detoxifies heavy metals, maintains metal ion homeostasis, especially zinc, and manages cellular redox levels. We carried out tests using murine osteoclast precursors to examine the function of MT in osteoclastogenesis and evaluated their potential as targets for future osteoporosis treatments. MT genes were significantly upregulated upon differentiation from osteoclast precursors to mature osteoclasts in response to receptor activators of nuclear factor-κB (NF-κB) ligand (RANKL) stimulation, and MT3 expression was particularly pronounced in mature osteoclasts among MT genes. The knockdown of MT3 in osteoclast precursors demonstrated a remarkable inhibition of differentiation into mature osteoclasts. In preosteoclasts, MT3 knockdown suppressed the activity of mitogen-activated protein kinase (MAPK) and NF-κB signaling pathways upon RANKL stimulation, leading to affect cell survival through elevated cleaved Caspase 3 and poly (ADP-ribose) polymerase (PARP) levels. Additionally, ROS levels were decreased, and nuclear factor erythroid 2-related factor 2 (NRF2) (a suppressor of ROS) and the downstream antioxidant proteins, such as catalase (CAT) and heme oxygenase 1 (HO-1), were more highly expressed in the MT3 preosteoclast knockdowns. mitochondrial ROS, which is involved in mitochondrial biogenesis and the production of reactive oxygen species, were similarly decreased because cAMP response element-binding (CREB) and peroxisome proliferator-activated receptor γ coactivator 1β (PGC-1β) were less activated due to MT3 depletion. Thus, by modulating ROS through the NRF2 pathway, MT3 plays a crucial role in regulating osteoclast differentiation and survival, acting as a metabolic modulator of intracellular zinc ions.

DOI： 10.1038/s41420-023-01729-y

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STUDY DESIGN: Retrospective study. OBJECTIVE: To investigate the characteristics of newly developing Modic changes following discectomy and their impact on residual low back pain (LBP) in the early postoperative stage of lumbar disc herniation. METHODS: We included 96 patients who underwent microscopic discectomy. Through MRI, we assessed new developments of Modic changes and the progression of disc degeneration at the surgical level. The presence of cartilaginous endplates was evaluated using resected specimens, and the main outcome was assessed using the visual analog scale (VAS). Further, the prevalence and time course of Modic changes, and their effects on clinical outcomes in the early postoperative period were examined. RESULTS: A new development of Modic changes was detected in 28% of cartilaginous herniations at 6 months. Modic changes were observed more frequently in patients with cartilaginous herniation than in those without cartilaginous herniation postoperatively (P < .001). The VAS scores for LBP up to 6 months were greater in patients with Modic changes (P < .001) than those without; however, no significant differences were identified in the presence or absence of Modic changes over the year follow-up. The development of Modic changes was closely associated with residual LBP at 6 months (β:0.511, P < .001). CONCLUSIONS: Modic changes develop predominantly in patients with avulsion-type herniation than in those with annular rupture at an earlier phase after discectomy. Furthermore, disc herniation with cartilaginous endplates may be associated with a slower decrease in LBP for up to 6 months, supporting the notion that newly developing endplate changes may cause residual LBP.

DOI： 10.1177/21925682231220893

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BACKGROUND: Spinal cord injury (SCI) is a devastating disease that results in permanent paralysis. Currently, there is no effective treatment for SCI, and it is important to identify factors that can provide therapeutic intervention during the course of the disease. Zinc, an essential trace element, has attracted attention as a regulator of inflammatory responses. In this study, we investigated the effect of zinc status on the SCI pathology and whether or not zinc could be a potential therapeutic target. METHODS: We created experimental mouse models with three different serum zinc concentration by changing the zinc content of the diet. After inducing contusion injury to the spinal cord of three mouse models, we assessed inflammation, apoptosis, demyelination, axonal regeneration, and the number of nuclear translocations of NF-κB in macrophages by using qPCR and immunostaining. In addition, macrophages in the injured spinal cord of these mouse models were isolated by flow cytometry, and their intracellular zinc concentration level and gene expression were examined. Functional recovery was assessed using the open field motor score, a foot print analysis, and a grid walk test. Statistical analysis was performed using Wilcoxon rank-sum test and ANOVA with the Tukey-Kramer test. RESULTS: In macrophages after SCI, zinc deficiency promoted nuclear translocation of NF-κB, polarization to pro-inflammatory like phenotype and expression of pro-inflammatory cytokines. The inflammatory response exacerbated by zinc deficiency led to worsening motor function by inducing more apoptosis of oligodendrocytes and demyelination and inhibiting axonal regeneration in the lesion site compared to the normal zinc condition. Furthermore, zinc supplementation after SCI attenuated these zinc-deficiency-induced series of responses and improved motor function. CONCLUSION: We demonstrated that zinc affected axonal regeneration and motor functional recovery after SCI by negatively regulating NF-κB activity and the subsequent inflammatory response in macrophages. Our findings suggest that zinc supplementation after SCI may be a novel therapeutic strategy for SCI.

DOI： 10.3389/fimmu.2023.1290100

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BACKGROUND: Meningiomas, although benign, often require complete resection due to their tendency for recurrence. However, dural reconstruction poses significant challenges, especially in the case of ventral meningiomas. While some reports have highlighted the usefulness of dural reconstruction using an artificial dura mater, no studies have yet confirmed dural canal enlargement through MRI post-surgically. This study aimed to assess the effectiveness of the Fenestrated Durotomy with Oversized Graft (FDOG) technique in cases of meningiomas and other intradural extramedullary tumors and evaluated dural canal dilation through MRI after using an artificial dura mater. METHODS: This retrospective case series included 8 patients who underwent combined resection of intradural extramedullary tumors and dural repair using the FDOG technique. An artificial dura mater larger than that resected was inserted into the dural defect resulting from complete tumor resection on the ventral or lateral side of the spinal cord. The new dura mater was secured with a single dorsal suture. The dural incision was closed using watertight sutures following standard procedure. Measurement of the extent of dural canal enlargement was achieved via pre- and postoperative MRI scans. RESULTS: None of the patients required additional treatments or lumbar drainage. All achieved independent ambulation without complications, and imaging tests indicated satisfactory dural expansion without signs of cerebrospinal fluid leakage. CONCLUSIONS: The proposed method for dural repair in cases involving large dural defects on the ventral or lateral side of the spinal cord was shown to be a straightforward and effective approach with minimal postoperative complications.

DOI： 10.1016/j.jocn.2023.09.003

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BACKGROUND: Progression of kyphosis after laminoplasty sometimes results in the recurrence of myelopathy with lamina closure. However, only a few case reports have been published on the reoperation of double-door laminoplasty using the suture method. This study investigated the incidence and clinical features of reoperation cases caused by the recurrence of myelopathy with lamina closure after double-door laminoplasty using a modified Kirita-Miyazaki suture method. METHODS: A total of 169 patients who underwent double-door laminoplasty were included in this study, with a mean follow-up duration of 6.6 years (range: 2-16). All surgeries were double-door laminoplasties in which the open lamina was sutured to the paravertebral muscle. The reoperation rate for myelopathy recurrence due to lamina closure and the associated risk factors were investigated. The risk factors included age, history, cervical alignment, C2-7 lordosis, the cervical sagittal vertical axis, and C7 slope. RESULTS: The reoperation rate for recurrence of myelopathy by lamina closure was 3.0% (5/169). All patients showed kyphosis progression after surgery; the spinal cord was more compressed by closed lamina than before the initial surgery. The reoperation group had more patients with neuromuscular or psychiatric disorders (60% [3/5] vs. 2% [4/164]; p < 0.001), kyphotic alignments (60% [3/5] vs. 10% [16/164]; p < 0.001), and cases with less than -10° of C2-7 lordosis (60% [3/5] vs. 7% [11/164]; p < 0.001). CONCLUSIONS: Double-door laminoplasty with the suture method may not be suitable for patients with a neuromuscular or psychiatric disease or those with preoperative C2-7 lordosis less than -10°.

DOI： 10.1016/j.jor.2023.07.024

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Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【目的】脊椎転移に対する後方固定術後のスクリューのゆるみに影響しうる因子について検討すること．【対象と方法】2017年1月～2020年2月に脊椎転移に対し後方固定術を行なった33例を対象とした．平均手術時年齢は66.8歳，術後平均7.5ヶ月で評価した．ゆるみは画像上スクリュー周囲に1mm以上のradiolucent zoneを認めるものとした．【結果】固定範囲における術前後の矢状面アライメント変化が大きいほどゆるみを生じていた．通常の展開で固定したOpen群と経皮的スクリューを用いたpercutaneous pedicle screw（PPS）群ではゆるみに有意差はなかったが，術前後アライメント変化はPPS群で有意に大きかった．PPS群の中で，ゆるみを生じた群では生じていない群に比較しアライメント変化が大きい傾向にあった．【考察】Open群ではアライメントにあわせたロッドを連結するのに対し，PPSではロッドをスクリューに押し込むよう連結するため，インプラントに負荷がかかり，ゆるみが生じやすいことが示唆された．</p>

DOI： 10.5035/nishiseisai.72.579

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【はじめに】腰椎手術でのトラネキサム酸（TXA）投与の周術期出血量における影響を検討した．【対象と方法】腰椎手術を行った116例を対象とした．TXAは術直前に1000 mg投与した．年齢，身長，体重，術式（固定，非固定），手術椎間数，手術時間，術中出血量，術後1日目の出血量を検討項目とし，TXA投与群と非投与群で比較検討行った．【結果】投与群は57例，非投与群は59例であった．年齢，身長，体重で有意差はなかった．術式は投与群で固定術25例，非固定32例，非投与群で固定術30例，非固定29例であった．手術椎間数，手術時間に有意差はなかった．術中出血量（ml）は投与群134±165，非投与群で165±152であり，両群間に有意差はなかった．術後1日目の出血量（ml）は投与群187±135，非投与群308±210であり，TXA投与で有意に減少していた（p＜0.05）．【考察】トラネキサム酸投与は，腰椎手術において，術後出血量の抑制に有効であると考えられた．</p>

DOI： 10.5035/nishiseisai.72.825

CiNii Research

Language：Japanese  

【はじめに】腰椎手術でのトラネキサム酸(TXA)投与の周術期出血量における影響を検討した.【対象と方法】腰椎手術を行った116例を対象とした.TXAは術直前に1000mg投与した.年齢,身長,体重,術式(固定,非固定),手術椎間数,手術時間,術中出血量,術後1日目の出血量を検討項目とし,TXA投与群と非投与群で比較検討行った.【結果】投与群は57例,非投与群は59例であった.年齢,身長,体重で有意差はなかった.術式は投与群で固定術25例,非固定32例,非投与群で固定術30例,非固定29例であった.手術椎間数,手術時間に有意差はなかった.術中出血量(ml)は投与群134±165,非投与群で165±152であり,両群間に有意差はなかった.術後1日目の出血量(ml)は投与群187±135,非投与群308±210であり,TXA投与で有意に減少していた(p<0.05).【考察】トラネキサム酸投与は,腰椎手術において,術後出血量の抑制に有効であると考えられた.(著者抄録)

Language：Japanese  

【目的】脊椎転移に対する後方固定術後のスクリューのゆるみに影響しうる因子について検討すること.【対象と方法】2017年1月～2020年2月に脊椎転移に対し後方固定術を行なった33例を対象とした.平均手術時年齢は66.8歳,術後平均7.5ヵ月で評価した.ゆるみは画像上スクリュー周囲に1mm以上のradiolucent zoneを認めるものとした.【結果】固定範囲における術前後の矢状面アライメント変化が大きいほどゆるみを生じていた.通常の展開で固定したOpen群と経皮的スクリューを用いたpercutaneous pedicle screw(PPS)群ではゆるみに有意差はなかったが,術前後アライメント変化はPPS群で有意に大きかった.PPS群の中で,ゆるみを生じた群では生じていない群に比較しアライメント変化が大きい傾向にあった.【考察】Open群ではアライメントにあわせたロッドを連結するのに対し,PPSではロッドをスクリューに押し込むよう連結するため,インプラントに負荷がかかり,ゆるみが生じやすいことが示唆された.(著者抄録)

Language：English   Publishing type：Research paper (scientific journal)  

Neonatal spinal cord injury (SCI) shows better functional outcomes than adult SCI. Although the regenerative capability in the neonatal spinal cord may have cues in the treatment of adult SCI, the mechanism underlying neonatal spinal cord regeneration after SCI is unclear. We previously reported age-dependent variation in the pathogenesis of inflammation after SCI. Therefore, we explored differences in the pathogenesis of inflammation after SCI between neonatal and adult mice and their effect on axon regeneration and functional outcome. We established two-day-old spinal cord crush mice as a model of neonatal SCI. Immunohistochemistry of the spinal cord revealed that the nuclear translocation of NF-κB, which promotes the expression of chemokines, was significantly lower in the astrocytes of neonates than in those of adults. Flow cytometry revealed that neonatal astrocytes secrete low levels of chemokines to recruit circulating neutrophils (e.g., Cxcl1 and Cxcl2) after SCI in comparison with adults. We also found that the expression of a chemokine receptor (CXCR2) and an adhesion molecule (β2 integrin) quantified by flow cytometry was lower in neonatal circulating neutrophils than in adult neutrophils. Strikingly, these neonate-specific cellular properties seemed to be associated with no neutrophil infiltration into the injured spinal cord, followed by significantly lower expression of inflammatory cytokines (Il-1β, Il-6 and TNF-α) after SCI in the spinal cords of neonates than in those of adults. At the same time, significantly fewer apoptotic neurons and greater axonal regeneration were observed in neonates in comparison with adults, which led to a marked recovery of locomotor function. This neonate-specific mechanism of inflammation regulation may have potential therapeutic applications in controlling inflammation after adult SCI.

DOI： 10.1089/neu.2023.0044

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Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】脊椎転移に対する後方固定術後のスクリューのゆるみに影響しうる因子について検討すること.【対象と方法】2017年1月～2020年2月に脊椎転移に対し後方固定術を行なった33例を対象とした.平均手術時年齢は66.8歳,術後平均7.5ヵ月で評価した.ゆるみは画像上スクリュー周囲に1mm以上のradiolucent zoneを認めるものとした.【結果】固定範囲における術前後の矢状面アライメント変化が大きいほどゆるみを生じていた.通常の展開で固定したOpen群と経皮的スクリューを用いたpercutaneous pedicle screw(PPS)群ではゆるみに有意差はなかったが,術前後アライメント変化はPPS群で有意に大きかった.PPS群の中で,ゆるみを生じた群では生じていない群に比較しアライメント変化が大きい傾向にあった.【考察】Open群ではアライメントにあわせたロッドを連結するのに対し,PPSではロッドをスクリューに押し込むよう連結するため,インプラントに負荷がかかり,ゆるみが生じやすいことが示唆された.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00766&link_issn=&doc_id=20231208110061&doc_link_id=%2Fdl8ortra%2F2023%2F007203%2F061%2F0579-0581%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdl8ortra%2F2023%2F007203%2F061%2F0579-0581%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】腰椎手術でのトラネキサム酸(TXA)投与の周術期出血量における影響を検討した.【対象と方法】腰椎手術を行った116例を対象とした.TXAは術直前に1000mg投与した.年齢,身長,体重,術式(固定,非固定),手術椎間数,手術時間,術中出血量,術後1日目の出血量を検討項目とし,TXA投与群と非投与群で比較検討行った.【結果】投与群は57例,非投与群は59例であった.年齢,身長,体重で有意差はなかった.術式は投与群で固定術25例,非固定32例,非投与群で固定術30例,非固定29例であった.手術椎間数,手術時間に有意差はなかった.術中出血量(ml)は投与群134±165,非投与群で165±152であり,両群間に有意差はなかった.術後1日目の出血量(ml)は投与群187±135,非投与群308±210であり,TXA投与で有意に減少していた(p<0.05).【考察】トラネキサム酸投与は,腰椎手術において,術後出血量の抑制に有効であると考えられた.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】腰椎手術でのトラネキサム酸(TXA)投与の周術期出血量における影響を検討した.【対象と方法】腰椎手術を行った116例を対象とした.TXAは術直前に1000mg投与した.年齢,身長,体重,術式(固定,非固定),手術椎間数,手術時間,術中出血量,術後1日目の出血量を検討項目とし,TXA投与群と非投与群で比較検討行った.【結果】投与群は57例,非投与群は59例であった.年齢,身長,体重で有意差はなかった.術式は投与群で固定術25例,非固定32例,非投与群で固定術30例,非固定29例であった.手術椎間数,手術時間に有意差はなかった.術中出血量(ml)は投与群134±165,非投与群で165±152であり,両群間に有意差はなかった.術後1日目の出血量(ml)は投与群187±135,非投与群308±210であり,TXA投与で有意に減少していた(p<0.05).【考察】トラネキサム酸投与は,腰椎手術において,術後出血量の抑制に有効であると考えられた.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00766&link_issn=&doc_id=20231208120059&doc_link_id=10.5035%2Fnishiseisai.72.825&url=https%3A%2F%2Fdoi.org%2F10.5035%2Fnishiseisai.72.825&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】腰椎手術でのトラネキサム酸(TXA)投与の周術期出血量における影響を検討した.【対象と方法】腰椎手術を行った116例を対象とした.TXAは術直前に1000mg投与した.年齢,身長,体重,術式(固定,非固定),手術椎間数,手術時間,術中出血量,術後1日目の出血量を検討項目とし,TXA投与群と非投与群で比較検討行った.【結果】投与群は57例,非投与群は59例であった.年齢,身長,体重で有意差はなかった.術式は投与群で固定術25例,非固定32例,非投与群で固定術30例,非固定29例であった.手術椎間数,手術時間に有意差はなかった.術中出血量(ml)は投与群134±165,非投与群で165±152であり,両群間に有意差はなかった.術後1日目の出血量(ml)は投与群187±135,非投与群308±210であり,TXA投与で有意に減少していた(p<0.05).【考察】トラネキサム酸投与は,腰椎手術において,術後出血量の抑制に有効であると考えられた.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00766&link_issn=&doc_id=20231208120059&doc_link_id=%2Fdl8ortra%2F2023%2F007204%2F059%2F0825-0828%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdl8ortra%2F2023%2F007204%2F059%2F0825-0828%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】脊椎転移に対する後方固定術後のスクリューのゆるみに影響しうる因子について検討すること.【対象と方法】2017年1月～2020年2月に脊椎転移に対し後方固定術を行なった33例を対象とした.平均手術時年齢は66.8歳,術後平均7.5ヵ月で評価した.ゆるみは画像上スクリュー周囲に1mm以上のradiolucent zoneを認めるものとした.【結果】固定範囲における術前後の矢状面アライメント変化が大きいほどゆるみを生じていた.通常の展開で固定したOpen群と経皮的スクリューを用いたpercutaneous pedicle screw(PPS)群ではゆるみに有意差はなかったが,術前後アライメント変化はPPS群で有意に大きかった.PPS群の中で,ゆるみを生じた群では生じていない群に比較しアライメント変化が大きい傾向にあった.【考察】Open群ではアライメントにあわせたロッドを連結するのに対し,PPSではロッドをスクリューに押し込むよう連結するため,インプラントに負荷がかかり,ゆるみが生じやすいことが示唆された.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】脊椎転移に対する後方固定術後のスクリューのゆるみに影響しうる因子について検討すること.【対象と方法】2017年1月～2020年2月に脊椎転移に対し後方固定術を行なった33例を対象とした.平均手術時年齢は66.8歳,術後平均7.5ヵ月で評価した.ゆるみは画像上スクリュー周囲に1mm以上のradiolucent zoneを認めるものとした.【結果】固定範囲における術前後の矢状面アライメント変化が大きいほどゆるみを生じていた.通常の展開で固定したOpen群と経皮的スクリューを用いたpercutaneous pedicle screw(PPS)群ではゆるみに有意差はなかったが,術前後アライメント変化はPPS群で有意に大きかった.PPS群の中で,ゆるみを生じた群では生じていない群に比較しアライメント変化が大きい傾向にあった.【考察】Open群ではアライメントにあわせたロッドを連結するのに対し,PPSではロッドをスクリューに押し込むよう連結するため,インプラントに負荷がかかり,ゆるみが生じやすいことが示唆された.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00766&link_issn=&doc_id=20231208110061&doc_link_id=10.5035%2Fnishiseisai.72.579&url=https%3A%2F%2Fdoi.org%2F10.5035%2Fnishiseisai.72.579&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

After spinal cord injury (SCI), inflammatory cells such as macrophages infiltrate the injured area, and astrocytes migrate, forming a glial scar around macrophages. The glial scar inhibits axonal regeneration, resulting in significant permanent disability. However, the mechanism through which glial scar-forming astrocytes migrate to the injury site has not been clarified. Here we show that migrating macrophages attract reactive astrocytes toward the center of the lesion after SCI. Chimeric mice with bone marrow lacking IRF8, which controls macrophage centripetal migration after SCI, showed widely scattered macrophages in the injured spinal cord with the formation of a huge glial scar around the macrophages. To determine whether astrocytes or macrophages play a leading role in determining the directions of migration, we generated chimeric mice with reactive astrocyte-specific Socs3-/- mice, which showed enhanced astrocyte migration, and bone marrow from IRF8-/- mice. In this mouse model, macrophages were widely scattered, and a huge glial scar was formed around the macrophages as in wild-type mice that were transplanted with IRF8-/- bone marrow. In addition, we revealed that macrophage-secreted ATP-derived ADP attracts astrocytes via the P2Y1 receptor. Our findings revealed a mechanism through which migrating macrophages attract astrocytes and affect the pathophysiology and outcome after SCI.

DOI： 10.1038/s41598-023-38301-8

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初代培養アストロサイトを用いてIII型コラーゲンの細胞遊走への影響を調査した。次にマウスの損傷脊髄内にIII型コラーゲン/G蛋白質共役受容体56(GPR56)/PBSを投与した。さらにGpr56遺伝子を細胞特異的にノックダウンしたマウスに脊髄損傷を作成し、各群で損傷後42日までの運動機能をBasso Mouse Scaleにて評価し、免疫染色による瘢痕組織の評価を行った。損傷部に沈着したIII型コラーゲンは、アストロサイトのGpr56を介してRhoAを活性化させ、アストロサイトの細胞遊走を低下させることで線維性瘢痕周囲にアストロサイトの集簇を起こしていることが明らかとなり、GPR56拮抗薬による新規治療法の実現可能性が示唆された。

Language：Japanese  

Language：Japanese   Publisher：日本脊髄障害医学会  

初代培養アストロサイトを用いてIII型コラーゲンの細胞遊走への影響を調査した。次にマウスの損傷脊髄内にIII型コラーゲン/G蛋白質共役受容体56(GPR56)/PBSを投与した。さらにGpr56遺伝子を細胞特異的にノックダウンしたマウスに脊髄損傷を作成し、各群で損傷後42日までの運動機能をBasso Mouse Scaleにて評価し、免疫染色による瘢痕組織の評価を行った。損傷部に沈着したIII型コラーゲンは、アストロサイトのGpr56を介してRhoAを活性化させ、アストロサイトの細胞遊走を低下させることで線維性瘢痕周囲にアストロサイトの集簇を起こしていることが明らかとなり、GPR56拮抗薬による新規治療法の実現可能性が示唆された。

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Language：Japanese   Publisher：日本脊髄障害医学会  

初代培養アストロサイトを用いてIII型コラーゲンの細胞遊走への影響を調査した。次にマウスの損傷脊髄内にIII型コラーゲン/G蛋白質共役受容体56(GPR56)/PBSを投与した。さらにGpr56遺伝子を細胞特異的にノックダウンしたマウスに脊髄損傷を作成し、各群で損傷後42日までの運動機能をBasso Mouse Scaleにて評価し、免疫染色による瘢痕組織の評価を行った。損傷部に沈着したIII型コラーゲンは、アストロサイトのGpr56を介してRhoAを活性化させ、アストロサイトの細胞遊走を低下させることで線維性瘢痕周囲にアストロサイトの集簇を起こしていることが明らかとなり、GPR56拮抗薬による新規治療法の実現可能性が示唆された。

Language：English   Publishing type：Research paper (scientific journal)  

Joint contracture causes distressing permanent mobility disorder due to trauma, arthritis, and aging, with no effective treatment available. A principal and irreversible cause of joint contracture has been regarded as the development of joint capsule fibrosis. However, the molecular mechanisms underlying contracture remain unclear. We established a mouse model of knee joint contracture, revealing that fibrosis in joint capsules causes irreversible contracture. RNA-sequencing of contracture capsules demonstrated a marked enrichment of the genes involved in the extracellular region, particularly periostin (Postn). Three-dimensional magnetic resonance imaging and immunohistological analysis of contracture patients revealed posterior joint capsule thickening with abundant type I collagen (Col1a2) and POSTN in humans. Col1a2-GFPTG ; Postn-/- mice and chimeric mice with Col1a2-GFPTG ; tdTomatoTG bone marrow showed fibrosis in joint capsules caused by bone marrow-derived fibroblasts, and POSTN promoted the migration of bone marrow-derived fibroblasts, contributing to fibrosis and contracture. Conversely, POSTN-neutralizing antibody attenuated contracture exacerbation. Our findings identified POSTN as a key inducer of fibroblast migration that exacerbates capsule fibrosis, providing a potential therapeutic strategy for joint contracture.

DOI： 10.1096/fj.202201598R

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Language：Japanese  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>総合せき損センターにおける腰椎椎間板ヘルニアに対するコンドリアーゼ（ヘルニコア®）椎間板内投与の治療効果について検討した．同院でコンドリアーゼ椎間板内投与を行い，投与後3ヶ月間フォローし得た7症例について，腰痛・殿部下肢痛・殿部下肢の痺れを調査した．いずれの項目でもVASは有意に低下し，JOAに関しても疼痛関連障害・社会生活障害の項目で有意な改善を認めた．さらに，投与翌日の症状改善効果についても検討を行った．対象はヘルニコア椎間板内投与後翌日に評価し得た7症例であり，腰痛のVASは統計学的に有意な改善を認め，下肢痛は改善の傾向が見られた．今回の症例からは，疼痛が高度であっても投与後早期から治療効果が得られる症例もあり，適応の症例は一般的に考えられているより広い可能性があることが示唆された．</p>

DOI： 10.5035/nishiseisai.72.295

CiNii Research

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】脊椎術後の頭蓋内出血はまれではあるが報告されている．しかし，頭部外傷を合併した脊椎外傷の術後合併症としてのテント上硬膜下血腫の報告はない．【症例】29歳，男性．4階から墜落して，右急性硬膜下血腫，第12胸椎脱臼骨折を含む胸腰椎多発骨折を受傷した．頭部外傷は保存的治療を選択し，CTによる厳密な評価を行った．血腫の増大はなく脳浮腫が改善した第7病日に，脊椎後方固定術を行った．第10病日に意識障害を来たし，CTで右慢性硬膜下血腫による鉤ヘルニアと診断した．穿頭血腫除去術を行い，速やかに意識は改善した．【考察】脊椎手術後合併症として，小脳出血の報告は多いが，テント上の頭蓋内出血はまれである．過去の頭部外傷が危険因子と考えられているが，報告は少ない．頭部外傷を合併した患者における脊椎手術では，術後に頭蓋内出血を合併する可能性を考慮し，意識の変容の有無を慎重に観察する必要がある．

DOI： 10.5035/nishiseisai.72.128

CiNii Research

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

総合せき損センターにおける腰椎椎間板ヘルニアに対するコンドリアーゼ(ヘルニコア)椎間板内投与の治療効果について検討した.同院でコンドリアーゼ椎間板内投与を行い,投与後3ヶ月間フォローし得た7症例について,腰痛・臀部下肢痛・臀部下肢の痺れを調査した.いずれの項目でもVASは有意に低下し,JOAに関しても疼痛関連障害・社会生活障害の項目で有意な改善を認めた.さらに,投与翌日の症状改善効果についても検討を行った.対象はヘルニコア椎間板内投与後翌日に評価し得た7症例であり,腰痛のVASは統計学的に有意な改善を認め,下肢痛は改善の傾向が見られた.今回の症例からは,疼痛が高度であっても投与後早期から治療効果が得られる症例もあり,適応の症例は一般的に考えられているより広い可能性があることが示唆された.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

総合せき損センターにおける腰椎椎間板ヘルニアに対するコンドリアーゼ(ヘルニコア)椎間板内投与の治療効果について検討した.同院でコンドリアーゼ椎間板内投与を行い,投与後3ヶ月間フォローし得た7症例について,腰痛・臀部下肢痛・臀部下肢の痺れを調査した.いずれの項目でもVASは有意に低下し,JOAに関しても疼痛関連障害・社会生活障害の項目で有意な改善を認めた.さらに,投与翌日の症状改善効果についても検討を行った.対象はヘルニコア椎間板内投与後翌日に評価し得た7症例であり,腰痛のVASは統計学的に有意な改善を認め,下肢痛は改善の傾向が見られた.今回の症例からは,疼痛が高度であっても投与後早期から治療効果が得られる症例もあり,適応の症例は一般的に考えられているより広い可能性があることが示唆された.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00766&link_issn=&doc_id=20230518130034&doc_link_id=%2Fdl8ortra%2F2023%2F007202%2F034%2F0295-0298%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdl8ortra%2F2023%2F007202%2F034%2F0295-0298%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】脊椎術後の頭蓋内出血はまれではあるが報告されている.しかし,頭部外傷を合併した脊椎外傷の術後合併症としてのテント上硬膜下血腫の報告はない.【症例】29歳,男性.4階から墜落して,右急性硬膜下血腫,第12胸椎脱臼骨折を含む胸腰椎多発骨折を受傷した.頭部外傷は保存的治療を選択し,CTによる厳密な評価を行った.血腫の増大はなく脳浮腫が改善した第7病日に,脊椎後方固定術を行った.第10病日に意識障害を来たし,CTで右慢性硬膜下血腫による鉤ヘルニアと診断した.穿頭血腫除去術を行い,速やかに意識は改善した.【考察】脊椎手術後合併症として,小脳出血の報告は多いが,テント上の頭蓋内出血はまれである.過去の頭部外傷が危険因子と考えられているが,報告は少ない.頭部外傷を合併した患者における脊椎手術では,術後に頭蓋内出血を合併する可能性を考慮し,意識の変容の有無を慎重に観察する必要がある.(著者抄録)

Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：The Japanese Society for Spine Surgery and Related Research  

<p><b>Introduction: </b>The spinal instability neoplastic score (SINS) is a classification system used to diagnose neoplastic spinal instability. Several reports have also described its use as a screening tool to identify patients at risk of skeletal-related events. We investigated the efficacy of SINS to detect the risk of neurological deficit in patients with spinal metastases by assessing spinal metastatic instability before the onset of myelopathy.</p><p><b>Methods: </b>We performed surgery on 81 patients with cervical or thoracic lesions classified as metastatic spine disease between 2004 and 2019. In this cohort, spinal instability was assessed in 29/81 patients before the occurrence of myelopathy. Spinal instability was evaluated by SINS with computed tomography (CT) performed within 6 months of the neurological deficit. We defined patients with a score of 7 or higher as at-risk patients.</p><p><b>Results: </b>CT was performed at an average of 72 days before the onset of neurological deficits. The SINS were 2 no-metastases cases, 4 of less than 7 (stability), 15 of 7-12 (indeterminate instability), and 8 of 13-18 (instability). We were unable to detect 21% (6/29) patients at risk of SINS.</p><p><b>Conclusions: </b>We may not be able to detect approximately 20% at-risk patients with neurological deficits by SINS before myelopathy presents.</p>

DOI： 10.34371/jspineres.2022-0021

CiNii Research

Language：Japanese  

はじめに:Spinal Instability Neoplastic Score(SINS)は転移性脊椎腫瘍の不安定性評価法であるが,骨有害事象リスク患者を検出する際のスクリーニング手段としても使用が報告されている.転移性脊椎腫瘍による脊髄症状発症例から,脊髄症状発症前のSINSを測定することにより,SINSによるリスク患者検出の有効性について検証した.対象と方法:2004年から2019年,頸胸椎部の転移性脊椎腫瘍に対する手術例81例から,脊髄症状発症前の画像評価が可能であった29例について調査した.脊髄症状発症半年以内に撮影されたCTからSINSを測定し,SINS7以上をリスク患者とした.結果:CT撮影時期は脊髄症状発症の平均72日前であった.SINSは転移なし2例,7未満(stability)4例,7以上～13未満(indeterminate instability)15例,13以上(instability)8例であり,21%(6/29)はリスク患者とならなかった.結語:脊髄症状発症前のSINSによる評価では約20%で脊髄症状発症の危険性を検出できない可能性が示唆された.(著者抄録)

Language：Japanese  

はじめに:Spinal Instability Neoplastic Score(SINS)は転移性脊椎腫瘍の不安定性評価法であるが,骨有害事象リスク患者を検出する際のスクリーニング手段としても使用が報告されている.転移性脊椎腫瘍による脊髄症状発症例から,脊髄症状発症前のSINSを測定することにより,SINSによるリスク患者検出の有効性について検証した.対象と方法:2004年から2019年,頸胸椎部の転移性脊椎腫瘍に対する手術例81例から,脊髄症状発症前の画像評価が可能であった29例について調査した.脊髄症状発症半年以内に撮影されたCTからSINSを測定し,SINS7以上をリスク患者とした.結果:CT撮影時期は脊髄症状発症の平均72日前であった.SINSは転移なし2例,7未満(stability)4例,7以上～13未満(indeterminate instability)15例,13以上(instability)8例であり,21%(6/29)はリスク患者とならなかった.結語:脊髄症状発症前のSINSによる評価では約20%で脊髄症状発症の危険性を検出できない可能性が示唆された.(著者抄録)

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

はじめに:Spinal Instability Neoplastic Score(SINS)は転移性脊椎腫瘍の不安定性評価法であるが,骨有害事象リスク患者を検出する際のスクリーニング手段としても使用が報告されている.転移性脊椎腫瘍による脊髄症状発症例から,脊髄症状発症前のSINSを測定することにより,SINSによるリスク患者検出の有効性について検証した.対象と方法:2004年から2019年,頸胸椎部の転移性脊椎腫瘍に対する手術例81例から,脊髄症状発症前の画像評価が可能であった29例について調査した.脊髄症状発症半年以内に撮影されたCTからSINSを測定し,SINS7以上をリスク患者とした.結果:CT撮影時期は脊髄症状発症の平均72日前であった.SINSは転移なし2例,7未満(stability)4例,7以上～13未満(indeterminate instability)15例,13以上(instability)8例であり,21%(6/29)はリスク患者とならなかった.結語:脊髄症状発症前のSINSによる評価では約20%で脊髄症状発症の危険性を検出できない可能性が示唆された.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J05510&link_issn=&doc_id=20230227380004&doc_link_id=10.34371%2Fjspineres.2022-0021&url=https%3A%2F%2Fdoi.org%2F10.34371%2Fjspineres.2022-0021&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

はじめに:Spinal Instability Neoplastic Score(SINS)は転移性脊椎腫瘍の不安定性評価法であるが,骨有害事象リスク患者を検出する際のスクリーニング手段としても使用が報告されている.転移性脊椎腫瘍による脊髄症状発症例から,脊髄症状発症前のSINSを測定することにより,SINSによるリスク患者検出の有効性について検証した.対象と方法:2004年から2019年,頸胸椎部の転移性脊椎腫瘍に対する手術例81例から,脊髄症状発症前の画像評価が可能であった29例について調査した.脊髄症状発症半年以内に撮影されたCTからSINSを測定し,SINS7以上をリスク患者とした.結果:CT撮影時期は脊髄症状発症の平均72日前であった.SINSは転移なし2例,7未満(stability)4例,7以上～13未満(indeterminate instability)15例,13以上(instability)8例であり,21%(6/29)はリスク患者とならなかった.結語:脊髄症状発症前のSINSによる評価では約20%で脊髄症状発症の危険性を検出できない可能性が示唆された.(著者抄録)

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

はじめに:Spinal Instability Neoplastic Score(SINS)は転移性脊椎腫瘍の不安定性評価法であるが,骨有害事象リスク患者を検出する際のスクリーニング手段としても使用が報告されている.転移性脊椎腫瘍による脊髄症状発症例から,脊髄症状発症前のSINSを測定することにより,SINSによるリスク患者検出の有効性について検証した.対象と方法:2004年から2019年,頸胸椎部の転移性脊椎腫瘍に対する手術例81例から,脊髄症状発症前の画像評価が可能であった29例について調査した.脊髄症状発症半年以内に撮影されたCTからSINSを測定し,SINS7以上をリスク患者とした.結果:CT撮影時期は脊髄症状発症の平均72日前であった.SINSは転移なし2例,7未満(stability)4例,7以上～13未満(indeterminate instability)15例,13以上(instability)8例であり,21%(6/29)はリスク患者とならなかった.結語:脊髄症状発症前のSINSによる評価では約20%で脊髄症状発症の危険性を検出できない可能性が示唆された.(著者抄録)

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Language：English  

DOI： 10.21203/rs.3.rs-2427082/v1

Language：English   Publishing type：Research paper (scientific journal)  

Spinal cord injury (SCI) causes reactive astrogliosis, the sequential phenotypic change of astrocytes in which naïve astrocytes (NAs) transform into reactive astrocytes (RAs) and subsequently become scar-forming astrocytes (SAs), resulting in glial scar formation around the lesion site and thereby limiting axonal regeneration and motor/sensory functional recovery. Inhibiting the transformation of RAs into SAs in the acute phase attenuates the reactive astrogliosis and promotes regeneration. However, whether or not SAs once formed can revert to RAs or SAs is unclear. We performed selective isolation of astrocytes from glial scars at different time points for a gene expression analysis and found that the expression of Sox9, an important transcriptional factor for glial cell differentiation, was significantly increased in chronic phase astrocytes (CAs) compared to SAs in the sub-acute phase. Furthermore, CAs showed a significantly lower expression of chondroitin sulfate proteoglycan (CSPG)-related genes than SAs. These results indicated that SAs changed their phenotypes according to the surrounding environment of the injured spinal cord over time. Even though the integrin-N-cadherin pathway is critical for glial scar formation, collagen-I-grown scar-forming astrocytes (Col-I-SAs) did not change their phenotype after depleting the effect of integrin or N-cadherin. In addition, we found that Col-I-SAs transplanted into a naïve spinal cord formed glial scar again by maintaining a high expression of genes involved in the integrin-N-cadherin pathway and a low expression of CSPG-related genes. Interestingly, the transplanted Col-I-SAs changed NAs into SAs, and anti-β1-integrin antibody blocked the recruitment of SAs while reducing the volume of glial scar in the chronic phase. Our findings indicate that while the characteristics of glial scars change over time after SCI, SAs have a cell-autonomous function to form and maintain a glial scar, highlighting the basic mechanism underlying the persistence of glial scars after central nervous system injury until the chronic phase, which may be a therapeutic target.

DOI： 10.1016/j.expneurol.2022.114264

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PubMed

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Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>【はじめに】特発性側弯症患者の呼吸機能に影響する因子を検討した．【対象と方法】後方矯正固定術を行なった特発性側弯症患者62例を対象とした．Lenke分類1-4を対象とし，男性12名，女性50名，平均年齢17歳（11歳～29歳）であった．年齢，身長，体重，胸椎Cobb角，頂椎高位，CTでの頂椎の回旋度を検討項目とし，呼吸機能検査における％VC，FEV1.0に対しての影響を検討した．【結果】Cobb角，頂椎の回旋度は，％VCとの有意な相関を認めた．年齢，身長，体重，頂椎高位には相関は認めなかった．FEV1はどの検討項目でも有意な相関を認めなかった．ROCカーブにおける検討では，Cobb角55度以上，頂椎回旋14度以上では，％VC≦80％となり，呼吸機能に異常を認める結果となった．【考察】Cobb角，頂椎回旋度は％VCに影響し，術前に呼吸機能に異常を認める可能性が高いことが示唆された．</p>

DOI： 10.5035/nishiseisai.71.545

CiNii Research

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【はじめに】特発性側彎症患者の呼吸機能に影響する因子を検討した.【対象と方法】後方矯正固定術を行なった特発性側彎症患者62例を対象とした.Lenke分類1-4を対象とし,男性12名,女性50名,平均年齢17歳(11歳～29歳)であった.年齢,身長,体重,胸椎Cobb角,頂椎高位,CTでの頂椎の回旋度を検討項目とし,呼吸機能検査における%VC,FEV1.0に対しての影響を検討した.【結果】Cobb角,頂椎の回旋度は,%VCとの有意な相関を認めた.年齢,身長,体重,頂椎高位には相関は認めなかった.FEV1はどの検討項目でも有意な相関を認めなかった.ROCカーブにおける検討では,Cobb角55度以上,頂椎回旋14度以上では,%VC≦80%となり,呼吸機能に異常を認める結果となった.【考察】Cobb角,頂椎回旋度は%VCに影響し,術前に呼吸機能に異常を認める可能性が高いことが示唆された.(著者抄録)

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In crush syndrome, massive muscle breakdown resulting from ischemia-reperfusion muscle injury can be a life-threatening condition that requires urgent treatment. Blood reperfusion into the ischemic muscle triggers an immediate inflammatory response, and neutrophils are the first to infiltrate and exacerbate the muscle damage. Since free zinc ion play a critical role in the immune system and the function of neutrophils is impaired by zinc depletion, we hypothesized that the administration of a zinc chelator would be effective for suppressing the inflammatory reaction at the site of ischemia-reperfusion injury and for improving of the pathology of crush syndrome. A crush syndrome model was created by using a rubber tourniquet to compress the bilateral hind limbs of mice at 8 weeks. A zinc chelator N,N,N',N'-tetrakis-(2-pyridylmethyl)-ethylenediamine (TPEN) was administered immediately after reperfusion in order to assess the anti-inflammatory effect of the chelator for neutrophils. Histopathological evaluation showed significantly less muscle breakdown and fewer neutrophil infiltration in TPEN administration group compared with control group. In addition, the expression levels of inflammatory cytokine and chemokine such as IL-6, TNFα, CXCL1, CXCL2, CXCR2, CCL2 in ischemia-reperfusion injured muscle were significantly suppressed with TPEN treatment. Less dilatation of renal tubules in histological evaluation in renal tissue and significantly better survival rate were demonstrated in TPEN treatment for ischemia-reperfusion injury in crush syndrome. The findings of our study suggest that zinc chelators contributed to the resolution of exacerbation of the inflammatory response and attenuation of muscle breakdown in the acute phase after crush syndrome. In addition, our strategy of attenuation of the acute inflammatory reaction by zinc chelators may provide a promising therapeutic strategy not only for crush syndrome, but also for other diseases driven by inflammatory reactions.

DOI： 10.1038/s41598-022-19903-0

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】特発性側彎症患者の呼吸機能に影響する因子を検討した.【対象と方法】後方矯正固定術を行なった特発性側彎症患者62例を対象とした.Lenke分類1-4を対象とし,男性12名,女性50名,平均年齢17歳(11歳～29歳)であった.年齢,身長,体重,胸椎Cobb角,頂椎高位,CTでの頂椎の回旋度を検討項目とし,呼吸機能検査における%VC,FEV1.0に対しての影響を検討した.【結果】Cobb角,頂椎の回旋度は,%VCとの有意な相関を認めた.年齢,身長,体重,頂椎高位には相関は認めなかった.FEV1はどの検討項目でも有意な相関を認めなかった.ROCカーブにおける検討では,Cobb角55度以上,頂椎回旋14度以上では,%VC≦80%となり,呼吸機能に異常を認める結果となった.【考察】Cobb角,頂椎回旋度は%VCに影響し,術前に呼吸機能に異常を認める可能性が高いことが示唆された.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】特発性側彎症患者の呼吸機能に影響する因子を検討した.【対象と方法】後方矯正固定術を行なった特発性側彎症患者62例を対象とした.Lenke分類1-4を対象とし,男性12名,女性50名,平均年齢17歳(11歳〜29歳)であった.年齢,身長,体重,胸椎Cobb角,頂椎高位,CTでの頂椎の回旋度を検討項目とし,呼吸機能検査における%VC,FEV1.0に対しての影響を検討した.【結果】Cobb角,頂椎の回旋度は,%VCとの有意な相関を認めた.年齢,身長,体重,頂椎高位には相関は認めなかった.FEV1はどの検討項目でも有意な相関を認めなかった.ROCカーブにおける検討では,Cobb角55度以上,頂椎回旋14度以上では,%VC≦80%となり,呼吸機能に異常を認める結果となった.【考察】Cobb角,頂椎回旋度は%VCに影響し,術前に呼吸機能に異常を認める可能性が高いことが示唆された.(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00766&link_issn=&doc_id=20221110070052&doc_link_id=10.5035%2Fnishiseisai.71.545&url=https%3A%2F%2Fdoi.org%2F10.5035%2Fnishiseisai.71.545&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

STUDY DESIGN: Basic science study. OBJECTIVE: The aim of this study was to examine whether epidural fat tissue (EFT) transplantation can prevent epidural adhesion after laminectomy more efficiently than subcutaneous fat tissue (SFT) transplantation. SUMMARY OF BACKGROUND DATA: Epidural adhesion is almost inevitable after laminectomy. Although many materials have been used to prevent adhesion, none has been widely accepted. As EFT is an ectopic fat tissue located on the dura mater and there is no adhesion between EFT and the dura mater, we focused on the efficacy of EFT for adhesion prevention. METHODS: We examined the differences in histology and gene expression between EFT and SFT of mice. We performed laminectomy at the 10th thoracic level and immediately transplanted EFT or SFT to the dura mater in mice. At 6 weeks after transplantation, we performed histological and gene expression analyses and evaluated the adhesion tenacity. In addition, we examined the characteristic differences between human EFT and SFT. RESULTS: The adipocytes of EFT were significantly smaller than those of SFT in mice and humans. The gene expression of inflammatory cytokine and fibrosis-related factors was significantly higher in SFT than in EFT. At 6 weeks after transplantation, the percentage of the remaining fat area over the dura mater was significantly greater in the EFT group than in SFT group, and the adhesion tenacity score was significantly lower in the EFT group than that in the SFT group. An RNA sequencing analysis revealed 1921 differentially expressed genes (DEGs) between human EFT and SFT, and a Gene Ontology term associated with the inflammatory response was most highly enriched in SFT. CONCLUSION: EFT has different molecular and histological profiles from SFT and EFT grafting is more effective for epidural adhesion prevention than conventional SFT transplantation after laminectomy in a mouse model.Level of Evidence: N/A.

DOI： 10.1097/brs.0000000000004281

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Publisher：メジカルビュー社  

DOI： 10.18885/jjs.0000000921

CiNii Research

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＜文献概要＞脊髄損傷急性期の高血糖は脊髄における過剰な炎症を惹起して組織の損傷を増大し,最終的な機能予後を増悪させる。機能予後の悪化を防止するために,インスリンを用いた急性期の積極的な血糖コントロールが重要である。

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＜文献概要＞脊髄損傷急性期の高血糖は脊髄における過剰な炎症を惹起して組織の損傷を増大し,最終的な機能予後を増悪させる。機能予後の悪化を防止するために,インスリンを用いた急性期の積極的な血糖コントロールが重要である。

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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OBJECTIVES: To elucidate the incidence and risk factors for pneumonia after acute traumatic cervical spinal cord injury (CSCI). DESIGN: Retrospective cohort study.Setting: Spinal injuries center in Japan.Participants: Of 184 individuals who were admitted within 2 weeks after acute traumatic cervical spinal injuries, 167 individuals who met the criteria were included in this study.Interventions: The occurrence of pneumonia, degree of dysphagia using the Dysphagia Severity Scale, patient age, history of smoking, presence of tracheostomy, vital capacity, level of injury, and the American Spinal Injury Association Impairment Scale (AIS) 2 weeks after injury were assessed.Outcomes: Incidence of pneumonia were analyzed. Moreover, the risk factors of pneumonia were evaluated using logistic regression analysis. RESULTS: From the 167 individuals who met the criteria, 30 individuals (18%) had pneumonia; in 26 (87%) of these individuals, pneumonia was aspiration related, defined as Dysphagia Severity Scale ≤ 4. The median occurrence of aspiration pneumonia was 11.5 days after injury. A logistic regression analysis revealed that severe AIS and severe Dysphagia Severity Scale scores were significant risk factors of pneumonia after CSCI. CONCLUSIONS: It was highly likely that the pneumonias following CSCI were related to aspiration based on the Dysphagia Severity Scale. In addition, most of the patients developed aspiration pneumonia within 1 month after injury. Aspiration and severe paralysis were significant risk factors for pneumonia. The treatment of dysphagia in the acute phase should be considered an important indicator to prevent pneumonia.

DOI： 10.1080/10790268.2022.2027323

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DOI： 10.1080/10790268.2021.1903139

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DOI： 10.1016/j.jocn.2020.11.026

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DOI： 10.3171/2019.10.SPINE19831

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DOI： 10.1038/s41393-019-0366-1

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The acute phase serum zinc concentration is a reliable biomarker for predicting the functional outcome after spinal cord injury
© 2019 The Authors Background: Spinal cord injury (SCI) is a devastating disorder for which the accurate prediction of the functional prognosis is urgently needed. Due to the lack of reliable prediction methods, the acute evaluation of SCI severity and therapeutic intervention efficacy is extremely difficult, presenting major obstacles to the development of acute SCI treatment. We herein report a novel method for accurately predicting the functional prognosis using the acute-phase serum zinc concentration after SCI. Methods: We produced experimental animal SCI models with different prognoses and examined the relationship among the SCI severity, functional outcome, and acute-phase serum zinc concentration. We also examined whether we could predict the functional prognosis by evaluating the serum zinc concentration within 72 h after SCI in a human prospective study. Findings: In a mouse model, the acute serum zinc concentrations decreased in proportion to SCI severity and the serum zinc concentrations at 12 h after SCI accurately predicted the functional prognosis. We clarified the mechanism underlying this serum zinc proportional decrease, showing that activated monocytes took up zinc from blood-serum and then infiltrated the lesion area in a severity-dependent manner. A non-linear regression analysis of 38 SCI patients showed that the serum zinc concentrations in the acute-phase accurately predicted the long-term functional outcome (R 2 = 0·84) more accurately than any other previously reported acute-phase biomarkers. Interpretation: The acute-phase serum zinc concentration could be a useful biomarker for predicting the functional prognosis. This simple method will allow for more objective clinical trials and the development of patient-tailored treatment for SCI.

DOI： 10.1016/j.ebiom.2019.03.003

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Pathological changes of distal motor neurons after complete spinal cord injury
© 2019 The Author(s). Traumatic spinal cord injury (SCI) causes serious disruption of neuronal circuits that leads to motor functional deficits. Regeneration of disrupted circuits back to their original target is necessary for the restoration of function after SCI, but the pathophysiological condition of the caudal spinal cord has not been sufficiently studied. Here we investigated the histological and biological changes in the distal part of the injured spinal cord, using a mice model of complete thoracic SCI in the chronic stage (3 months after injury). Atrophic changes were widely observed in the injured spinal cord both rostral and caudal to the lesion, but the decrease in area was mainly in the white matter in the rostral spinal cord while both the white and gray matter decreased in the caudal spinal cord. The number of the motor neurons was maintained in the chronic phase of injury, but the number of presynaptic boutons decreased in the lumbar motor neurons caudal to the lesion. Using laser microdissection, to investigate gene expressions in motor neurons caudal to the lesion, we observed a decrease in the expressions of neuronal activity markers. However, we found that the synaptogenic potential of postsynapse molecules was maintained in the motor neurons after SCI with the expression of acetylcholine-related molecules actually higher after SCI. Collectively, our results show that the potential of synaptogenesis is maintained in the motor neurons caudal to the lesion, even though presynaptic input is decreased. Although researches into SCI concentrate their effort on the lesion epicenter, our findings suggest that the area caudal to the lesion could be an original therapeutic target for the chronically injured spinal cord.

DOI： 10.1186/s13041-018-0422-3

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DOI： 10.2106/JBJS.17.01230

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Astrocyte reactivity and astrogliosis after spinal cord injury
© 2017 Elsevier Ireland Ltd and Japan Neuroscience Society After traumatic injuries of the central nervous system (CNS), including spinal cord injury (SCI), astrocytes surrounding the lesion become reactive and typically undergo hypertrophy and process extension. These reactive astrocytes migrate centripetally to the lesion epicenter and aid in the tissue repair process, however, they eventually become scar-forming astrocytes and form a glial scar which produces axonal growth inhibitors and prevents axonal regeneration. This sequential phenotypic change has long been considered to be unidirectional and irreversible; thus glial scarring is one of the main causes of the limited regenerative capability of the CNS. We recently demonstrated that the process of glial scar formation is regulated by environmental cues, such as fibrotic extracellular matrix material. In this review, we discuss the role and mechanism underlying glial scar formation after SCI as well as plasticity of astrogliosis, which helps to foster axonal regeneration and functional recovery after CNS injury.

DOI： 10.1016/j.neures.2017.10.004

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DOI： 10.1016/j.ajpath.2017.08.020

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DOI： 10.1016/j.ajpath.2016.11.010

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DOI： 10.1371/journal.pone.0169717

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The feasibility of in vivo imaging of infiltrating blood cells for predicting the functional prognosis after spinal cord injury
After a spinal cord injury (SCI), a reliable prediction of the potential functional outcome is essential for determining the optimal treatment strategy. Despite recent advances in the field of neurological assessment, there is still no satisfactory methodology for predicting the functional outcome after SCI. We herein describe a novel method to predict the functional outcome at 12 hours after SCI using in vivo bioluminescence imaging. We produced three groups of SCI mice with different functional prognoses: 50 kdyn (mild), 70 kdyn (moderate) and 90 kdyn (severe). Only the locomotor function within 24 hours after SCI was unable to predict subsequent functional recovery. However, both the number of infiltrating neutrophils and the bioluminescence signal intensity from infiltrating blood cells were found to correlate with the severity of the injury at 12 hours after SCI. Furthermore, a strong linear relationship was observed among the number of infiltrating neutrophils, the bioluminescence signal intensity, and the severity of the injury. Our findings thus indicate that in vivo bioluminescence imaging is able to accurately predict the long-term functional outcome in the hyperacute phase of SCI, thereby providing evidence that this imaging modality could positively contribute to the future development of tailored therapeutic approaches for SCI.

DOI： 10.1038/srep25673

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Disturbance of rib cage development causes progressive thoracic scoliosis the creation of a nonsurgical structural scoliosis model in mice
Background: The pathomechanism underlying idiopathic scoliosis remains unclear, and, to our knowledge, a consistent and relevant animal model has not been established previously. The goal of this study was to examine whether a disturbance of rib cage development is a causative factor for scoliosis and to establish a nonsurgical mouse model of progressive scoliosis. Methods: To examine the relationship between rib cage development and the pathogenesis of progressive scoliosis, a plastic restraint limiting anteroposterior rib cage development was placed on the chest of four-week-old mice. All mice were evaluated with whole-spine radiographs, and the severity of scoliosis was consecutively measured. The rib cage rotation angle and the anteroposterior chest dimension were measured with use of micro-computed tomography scanning. To examine whether the imbalanced load transmission through the ribs to the vertebral body was involved in our model, we performed a rib-neck osteotomy in a subgroup of the mice. Results: The thoracic restraint did not provoke spinal curvature immediately after it was applied, but nine of ten mice that wore the restraint but did not have rib osteotomy gradually developed progressive scoliosis. Radiographs and computed tomography images showed a right thoracic curvature, vertebral rotation, and narrow chest in the mice that had worn the restraint for eleven weeks but did not have rib osteotomy even after the restraint was removed. The anteroposterior chest dimension was significantly correlated with both the curve magnitude and the rib cage rotation angle. The progression of spinal deformity was observed only during the adolescent growth spurt, and it plateaued thereafter. The left-side rib osteotomy led to the development of progressive left-thoracic curvature, whereas the bilateral rib osteotomy did not cause scoliosis, even with restraint wear. Conclusions: We established a nonsurgical experimental model of progressive scoliosis and also demonstrated that a rib cage deformity with an imbalanced load to the vertebral body resulted in progressive structural scoliosis. Copyright © 2013 by the journal of bone and joint surgery, incorporated.

DOI： 10.2106/JBJS.L.01381

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Therapeutic activities of engrafted neural stem/precursor cells are not dormant in the chronically injured spinal cord
The transplantation of neural stem/precursor cells (NSPCs) is a promising therapeutic strategy for many neurodegenerative disorders including spinal cord injury (SCI) because it provides for neural replacement or trophic support. This strategy is now being extended to the treatment of chronic SCI patients. However, understanding of biological properties of chronically transplanted NSPCs and their surrounding environments is limited. Here, we performed temporal analysis of injured spinal cords and demonstrated their multiphasic cellular and molecular responses. In particular, chronically injured spinal cords were growth factorenriched environments, whereas acutely injured spinal cords were enriched by neurotrophic and inflammatory factors. To determine how these environmental differences affect engrafted cells, NSPCs transplanted into acutely, subacutely, and chronically injured spinal cords were selectively isolated by flow cytometry, and their whole transcriptomes were compared by RNA sequencing. This analysis revealed that NSPCs produced many regenerative/ neurotrophic molecules irrespective of transplantation timing, and these activities were prominent in chronically transplanted NSPCs. Furthermore, chronically injured spinal cords permitted engrafted NSPCs to differentiate into neurons/oligodendrocytes and provided more neurogenic environment for NSPCs than other environments. Despite these results demonstrate that transplanted NSPCs have adequate capacity in generating neurons/oligodendrocytes and producing therapeutic molecules in chronic SCI microenvironments, they did not improve locomotor function. Our results indicate that failure in chronic transplantation is not due to the lack of therapeutic activities of engrafted NSPCs but the refractory state of chronically injured spinal cords. Environmental modulation, rather modification of transplanting cells, will be significant for successful translation of stem cell-based therapies into chronic SCI patients. © AlphaMed Press.

DOI： 10.1002/stem.1404

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Ly6C⁺Ly6G^-Myeloid-derived suppressor cells play a critical role in the resolution of acute inflammation and the subsequent tissue repair process after spinal cord injury
Acute inflammation is a prominent feature of central nervous system (CNS) insult and is detrimental to the CNS tissue. Although this reaction spontaneously diminishes within a short period of time, the mechanism underlying this inflammatory resolution remains largely unknown. In this study, we demonstrated that an initial infiltration of Ly6C+Ly6G-immature monocyte fraction exhibited the same characteristics as myeloid-derived suppressor cells (MDSCs), and played a critical role in the resolution of acute inflammation and in the subsequent tissue repair by using mice spinal cord injury (SCI) model. Complete depletion of Ly6C+Ly6G-fraction prior to injury by anti-Gr-1 antibody (clone: RB6-8C5) treatment significantly exacerbated tissue edema, vessel permeability, and hemorrhage, causing impaired neurological outcomes. Functional recovery was barely impaired when infiltration was allowed for the initial 24 h after injury, suggesting that MDSC infiltration at an early phase is critical to improve the neurological outcome. Moreover, intraspinal transplantation of ex vivo-generated MDSCs at sites of SCI significantly reduced inflammation and promoted tissue regeneration, resulting in better functional recovery. Our findings reveal the crucial role of an Ly6C+Ly6G-fraction as MDSCs in regulating inflammation and tissue repair after SCI, and also suggests an MDSC-based strategy that can be applied to acute inflammatory diseases. Myeloid-derived suppressor cells (MDSCs) exert immunosuppressive effects in several inflammatory diseases, including cancer and autoimmune disease. We demonstrated that Ly6C+Ly6G-myeloid cells which infiltrated into injured spinal cord had a typical feature of MDSCs and played a critical role in the attenuation of acute inflammation and the subsequent tissue repair process after spinal cord injury (SCI). Our findings clarified the role of MDSCs after traumatic SCI, and suggested a potential MDSC-based therapeutic strategy for the acute phase of central nervous system injury. © 2012 International Society for Neurochemistry.

DOI： 10.1111/jnc.12135

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Neurological recovery is impaired by concurrent but not by asymptomatic pre-existing spinal cord compression after traumatic spinal cord injury
STUDY DESIGN. An in vivo animal study to examine the influence of pre-existing or concurrent spinal canal stenosis (SCS) on the functional recovery after spinal cord injury (SCI). OBJECTIVES. To clarify whether spinal cord compression before or after SCI results in less favorable neurological recovery. SUMMARY OF BACKGROUND DATA. The influence of spinal cord compression on the neurological recovery after SCI remains unclear. METHODS. We created mice with SCS using an extradural spacer before or after producing SCI and statistically analyzed the correlation between the extent of SCS and neurological outcomes. The extent of SCS was calculated by micro-computed tomography, and the spinal cord blood flow (SCBF) was measured serially with laser Doppler flowmetry. Molecular and immunohistochemical examinations were performed to evaluate the neovascularization at the site of cord compression. RESULTS. Spacer placement (<300 μm) alone in the control mouse resulted in no neurological deficits. Even with spacer placement that caused asymptomatic SCS, the functional recovery after SCI was progressively impaired as spacer sizes increased in the mice with SCS co-occurring with SCI, whereas no significant impact was observed in the mice with pre-existing SCS, irrespective of the spacer sizes. The SCBF progressively decreased immediately after SCS was produced, but it fully recovered at the later time points. Angiogenesis-related genes were upregulated, and neovascular vessels were observed after producing the SCS. We found that concurrent SCS resulted in a significant reduction and impaired the subsequent recovery of the SCBF, whereas pre-existing SCS did not affect the hemodynamics of the spinal cord after SCI. CONCLUSION. The dynamic reduction of the SCBF occurring immediately after spinal cord compression is a significant factor that impairs the neurological recovery after SCI, whereas pre-existing SCS is not always an impediment due to the potentially restructured SCBF. © 2012, Lippincott Williams &Wilkins.

DOI： 10.1097/BRS.0b013e31824ffda5

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Liposomal clodronate selectively eliminates microglia from primary astrocyte cultures
Background: There is increasing interest in astrocyte biology because astrocytes have been demonstrated to play prominent roles in physiological and pathological conditions of the central nervous system, including neuroinflammation. To understand astrocyte biology, primary astrocyte cultures are most commonly used because of the direct accessibility of astrocytes in this system. However, this advantage can be hindered by microglial contamination. Although several authors have warned regarding microglial contamination in this system, complete microglial elimination has never been achieved.Methods: The number and proliferative potential of contaminating microglia in primary astrocyte cultures were quantitatively assessed by immunocytologic and flow cytometric analyses. To examine the utility of clodronate for microglial elimination, primary astrocyte cultures or MG-5 cells were exposed to liposomal or free clodronate, and then immunocytologic, flow cytometric, and gene expression analyses were performed. The gene expression profiles of microglia-eliminated and microglia-contaminated cultures were compared after interleukin-6 (IL-6) stimulation.Results: The percentage of contaminating microglia exceeded 15&#37; and continued to increase because of their high proliferative activity in conventional primary astrocyte cultures. These contaminating microglia were selectively eliminated low concentration of liposomal clodronate. Although primary microglia and MG-5 cells were killed by both liposomal and free clodronate, free clodronate significantly affected the viability of astrocytes. In contrast, liposomal clodronate selectively eliminated microglia without affecting the viability, proliferation or activation of astrocytes. The efficacy of liposomal clodronate was much higher than that of previously reported methods used for decreasing microglial contamination. Furthermore, we observed rapid tumor necrosis factor-α and IL-1b gene induction in conventional primary astrocyte cultures after IL-6 stimulation, which was due to the activation of the Janus kinase/signal transducer and activator of the transcription pathway in contaminating microglia.Conclusions: Because contaminating microglia could result in erroneous data regarding the pro-inflammatory properties of astrocytes, astrocyte biology should be studied in the absence of microglial contamination. Our simple method will be widely applicable to experimental studies of astrocyte biology and provide clues for understanding the role of astrocytes in neural development, function and disease. © 2012 Kumamaru et al.; licensee BioMed Central Ltd.

DOI： 10.1186/1742-2094-9-116

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DOI： 10.1186/1749-799X-6-4

Event date： 2019.4

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Event date： 2016.5

Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Publisher：日本脊髄障害医学会  

初代培養アストロサイトを用いてIII型コラーゲンの細胞遊走への影響を調査した。次にマウスの損傷脊髄内にIII型コラーゲン/G蛋白質共役受容体56(GPR56)/PBSを投与した。さらにGpr56遺伝子を細胞特異的にノックダウンしたマウスに脊髄損傷を作成し、各群で損傷後42日までの運動機能をBasso Mouse Scaleにて評価し、免疫染色による瘢痕組織の評価を行った。損傷部に沈着したIII型コラーゲンは、アストロサイトのGpr56を介してRhoAを活性化させ、アストロサイトの細胞遊走を低下させることで線維性瘢痕周囲にアストロサイトの集簇を起こしていることが明らかとなり、GPR56拮抗薬による新規治療法の実現可能性が示唆された。

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】脊椎術後の頭蓋内出血はまれではあるが報告されている.しかし,頭部外傷を合併した脊椎外傷の術後合併症としてのテント上硬膜下血腫の報告はない.【症例】29歳,男性.4階から墜落して,右急性硬膜下血腫,第12胸椎脱臼骨折を含む胸腰椎多発骨折を受傷した.頭部外傷は保存的治療を選択し,CTによる厳密な評価を行った.血腫の増大はなく脳浮腫が改善した第7病日に,脊椎後方固定術を行った.第10病日に意識障害を来たし,CTで右慢性硬膜下血腫による鉤ヘルニアと診断した.穿頭血腫除去術を行い,速やかに意識は改善した.【考察】脊椎手術後合併症として,小脳出血の報告は多いが,テント上の頭蓋内出血はまれである.過去の頭部外傷が危険因子と考えられているが,報告は少ない.頭部外傷を合併した患者における脊椎手術では,術後に頭蓋内出血を合併する可能性を考慮し,意識の変容の有無を慎重に観察する必要がある.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00766&link_issn=&doc_id=20230518120032&doc_link_id=%2Fdl8ortra%2F2023%2F007201%2F032%2F0128-0131%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdl8ortra%2F2023%2F007201%2F032%2F0128-0131%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】特発性側彎症患者の呼吸機能に影響する因子を検討した.【対象と方法】後方矯正固定術を行なった特発性側彎症患者62例を対象とした.Lenke分類1-4を対象とし,男性12名,女性50名,平均年齢17歳(11歳～29歳)であった.年齢,身長,体重,胸椎Cobb角,頂椎高位,CTでの頂椎の回旋度を検討項目とし,呼吸機能検査における%VC,FEV1.0に対しての影響を検討した.【結果】Cobb角,頂椎の回旋度は,%VCとの有意な相関を認めた.年齢,身長,体重,頂椎高位には相関は認めなかった.FEV1はどの検討項目でも有意な相関を認めなかった.ROCカーブにおける検討では,Cobb角55度以上,頂椎回旋14度以上では,%VC≦80%となり,呼吸機能に異常を認める結果となった.【考察】Cobb角,頂椎回旋度は%VCに影響し,術前に呼吸機能に異常を認める可能性が高いことが示唆された.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00766&link_issn=&doc_id=20221110070052&doc_link_id=%2Fdl8ortra%2F2022%2F007103%2F052%2F0545-0548%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdl8ortra%2F2022%2F007103%2F052%2F0545-0548%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞はじめに 1906年にノーベル生理学・医学賞を受賞したスペインの神経解剖学者Cajal博士により発達後の神経細胞(ニューロン)の成長と再生が否定されて以来,一度傷ついた脊髄は再生不能と考えられてきた.しかし近年の研究により外傷後の脊髄にも実際には可塑性が存在し,組織学的自然修復が起こることが明らかとなった.本稿では,近年の研究で明らかになった脊髄損傷後の病態と自然修復メカニズム,およびそれらに基づいて考案された治療法についてわれわれの研究結果も交えて解説する.

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01554&link_issn=&doc_id=20220615170017&doc_link_id=10.11477%2Fmf.1408202373&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408202373&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(株)メジカルビュー社  

＜文献概要＞脊髄損傷急性期の高血糖は脊髄における過剰な炎症を惹起して組織の損傷を増大し,最終的な機能予後を増悪させる。機能予後の悪化を防止するために,インスリンを用いた急性期の積極的な血糖コントロールが重要である。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00282&link_issn=&doc_id=20220224050013&doc_link_id=%2Fap4kange%2F2022%2F004103%2F011%2F0289-0293%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fap4kange%2F2022%2F004103%2F011%2F0289-0293%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本移植学会  

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はじめに:頸髄損傷の重要な合併症の1つに嚥下障害があるが,その発生機序は十分に分かっておらず,頸髄損傷後の呼吸障害と嚥下障害の関係を調査した報告はない.本研究の目的は,頸髄損傷による呼吸機能障害が嚥下機能に及ぼす影響を明らかにすることである.対象と方法:2018年8月から2020年7月までの2年間のうちに,受傷後2週以内に急性頸髄損傷で当院に入院した患者を前向きに評価した.嚥下機能は嚥下障害臨床重症度分類(1:唾液誤嚥～7:正常)とFunctional Oral Intake Scale(FOIS,1:経口摂取なし～7:正常)で,呼吸機能は咳嗽時最大呼気流量・1秒量・1秒率・&#37;肺活量を2・4・8・12週で評価し,経時的変化と相関関係を解析した.結果:症例数は33例(男性28例,女性5例,平均年齢67歳)であった.経時的変化として,嚥下障害と呼吸障害は有意に改善していた.咳嗽時最大呼気流量,1秒量,&#37;肺活量は各時期において嚥下機能の重症度に有意な相関関係を認めた.結語:呼吸障害と嚥下障害は密接に関係しており,特に咳嗽力の評価は嚥下障害の評価にも重要な役割を果たすと思われる.(著者抄録)

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外傷性コンパートメント症候群の筋壊死に関連する因子について調査した。2013年4月～2016年12月に筋膜切開を施行した外傷性の下腿コンパートメント症候群11症例11肢を対象とし、筋壊死群と非筋壊死群の2群間で筋壊死に関連する因子について比較検討した。筋壊死に関与する因子は、Gustilo IIIcであることが示唆された。Gustilo IIIc症例では早期血行再建ができず、全例で筋壊死を認めた。血管再建に時間がかかる場合はシャントチューブなどを利用して、再灌流までの時間を短くする工夫をする必要があると考えられた。また、コミュニケーションがとれない状態の患者が5例含まれていたが、四肢の腫脹がないか積極的にコンパートメント症候群を疑い、疑わしければすぐに内圧測定を行うことで早期発見につなげることができたと考えられた。(著者抄録)

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思春期特発性側彎症患者の発見理由を調査した.【対象と方法】2008年から2015年に当院を受診した259例(女性236例,男性23例,平均13.7歳)の発見理由,主カーブCobb角,初期治療を調査した.【結果】発見理由は学校検診(S群)115例(44.4&#37;),家族・本人(F群)79例(30.5&#37;),病院・医院(H群)65例(25.1&#37;)であった.発見時年齢は各々平均12.9歳,13.1歳,13.7歳であり,S群は,H群よりも年齢が低かった.3群間の性差に有意差はなかった.主カーブは各々平均36.8°,40.4°,36.0°で,有意差はなかったが,40°以上の患者の割合はF群に比べてS群,H群で低い傾向にあった.3群間で初期治療に相関はなかったが,S群およびH群は,F群よりも手術率が低い傾向にあった.【考察】学校検診のあり方や早期発見方法について検討の余地があると考えられた.(著者抄録)

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DOI： 10.1186/1748-7161-10-s1-o21

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頸椎分離すべり症は比較的稀な疾患である.我々は第6頸椎分離すべり症に伴う頸髄症の一例を経験したので報告する.症例は62歳男性.外傷の既往なし.某年8月から,両手母指から中指の痺れを自覚していた.翌年1月に両下肢の痺れが出現し同年3月に当科を紹介受診した.手指巧緻運動障害,上肢腱反射の亢進,握力低下,四肢の痺れがあり,MRIではC5/6高位での頸髄の圧排とT2強調像での髄内高信号,およびL4/5高位での脊柱管狭窄を認めた.単純X線写真とCTで第6頸椎の二分脊椎と分離すべり症を認めた.頸髄症と腰部脊柱管狭窄症の合併と診断し,症状増悪傾向のため同年6月に頸椎椎弓切除術(C4尾側,5,6,7頭側)を施行した.術後6ヵ月の時点で上肢の痺れは軽減し,画像検査上も頸髄は除圧良好ですべりや不安定性の増悪なく,局所後彎も認めなかった.除圧術単独で短期経過に問題はないが,不安定性の増強等を中心に長期間の経過観察が必要である.(著者抄録)

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