Long-term outcomes of progestin plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer patients / 부인종양

OBJECTIVE: The present study investigated long-term outcomes of medroxyprogesterone acetate (MPA) plus metformin therapy in terms of control of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC), and post-treatment conception. METHODS: We retrospectively analyzed 63 patients (42 with EC; 21 with AEH) who underwent fertility-sparing management using MPA plus metformin. MPA (400 mg/day) and metformin (750–2,250 mg/day) were administered to achieve complete response (CR). Metformin was administered until conception, even after MPA discontinuation. RESULTS: Of the total patients, 48 (76%) had a body mass index (BMI) ≥25 kg/m² and 43 (68%) showed insulin resistance. Sixty-one patients (97%) achieved CR within 18 months. CR rates at 6, 8–9, and 12 months were 60%, 84%, and 90%, respectively. During a median follow-up period of 57 months (range, 13–115 months), relapse occurred in 8 of 61 patients (13.1%) who had achieved CR. Relapse-free survival (RFS) in all patients at 5 years was 84.8%. Upon univariate analysis, patients with BMI ≥25 kg/m² had significantly better prognoses than did those with BMI <25 kg/m2 (odds ratio=0.19; 95% confidence interval=0.05–0.66; p=0.009). Overall pregnancy and live birth rates per patient were 61% (19/31) and 45% (14/31), respectively. CONCLUSIONS: MPA plus metformin is efficacious in terms of RFS and post treatment conception. Moreover, metformin may be more efficacious for patients with BMI ≥25 kg/m².

Influence of Skeletal Muscle Mass and Spinal Alignment on Surgical Outcomes for Lumbar Spinal Stenosis

STUDY DESIGN: Retrospective observational study. PURPOSE: We considered the relationship between spinal alignment and skeletal muscle mass on clinical outcomes following a surgery for lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: There are no reports of preoperative factors predicting residual low back pain following surgery for LSS. METHODS: Our target population included 34 women (mean age, 74.4 years) who underwent surgery for LSS. Prior to and 6 months after the surgery, systemic bone mineral density and lean soft tissue mass were measured using dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was calculated as the sum of the arm and leg lean mass in kilograms divided by height in meters squared. The spinal alignment was also measured. Clinical outcomes were evaluated using the Japanese Orthopedic Association scoring system, leg and low back pain Visual Analog Scale, and Roland–Morris Disability Questionnaire (RDQ). Additionally, we examined the bone mineral density, skeletal muscle mass, and spinal alignment before and after the surgery. We used the Spearman correlation coefficient to examine the associations among clinical outcomes, preoperative muscle mass, and spinal alignment. RESULTS: Sarcopenia (SMI 6.12), RDQ was significantly higher in subjects with sarcopenia (p=0.04). RDQ was significantly negatively correlated with SMI (r=−0.42, p<0.05). There was a significant positive correlation between postoperative RDQ and pelvic tilt (PT; r=0.41, p<0.05). SMI and PT were significantly negatively correlated (r=−0.39, r<0.05). CONCLUSIONS: Good postoperative outcomes were negatively correlated with low preoperative appendicular muscle mass, suggesting that postoperative outcomes were inferior in cases of decreased appendicular muscle mass (sarcopenia). Posterior PT due to decreased limb muscle mass may contribute to postoperative back pain, showing that preoperatively reduced limb muscle mass and posterior PT are predictive factors in the persistence of postoperative low back pain.

Assessment of Clinical Symptoms in Lumbar Foraminal Stenosis Using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire

OBJECTIVE: It is important to develop an easy means of diagnosing lumbar foraminal stenosis (LFS) in a general practice setting. We investigated the use of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) to diagnose LFS in symptomatic patients. METHODS: Subjects included 13 cases (mean age, 72 years) with LFS, and 30 cases (mean age, 73 years) with lumbar spinal canal stenosis (LSCS) involving one intervertebral disc. The visual analogue scale score for low back pain and leg pain, the JOABPEQ were evaluated. RESULTS: Those with LFS had a significantly lower JOA score (p<0.001), while JOABPEQ scores (p<0.05) for lumbar dysfunction and social functioning impairment (p<0.01) were both significantly lower than the scores in LSCS. The following JOABPEQ questionnaire items (LFS vs. LSCS, p-value) for difficulties in: sleeping (53.8% vs. 16.6%, p<0.05), getting up from a chair (53.8% vs. 6.6%, p<0.001), turning over (76.9% vs. 40%, p<0.05), and putting on socks (76.9% vs. 26.6%, p<0.01) such as pain during rest, and signs of intermittent claudication more than 15 minutes (61.5% vs. 26.6%, p<0.05) were all significantly more common with LFS than LSCS. CONCLUSION: Results suggest that of the items in the JOABPEQ, if pain during rest or intermittent claudication is noted, LFS should be kept in mind as a cause during subsequent diagnosis and treatment. LFS may be easily diagnosed from LSCS using this established patient-based assessment method.

Discrimination between Lumbar Intraspinal Stenosis and Foraminal Stenosis using Diffusion Tensor Imaging Parameters: Preliminary Results

STUDY DESIGN: Retrospective observational study. PURPOSE: To examine fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values of damaged nerves to discriminate between lumbar intraspinal stenosis (IS) and foraminal stenosis (FS) using diffusion tensor imaging (DTI) OVERVIEW OF LITERATURE: It is important in the selection of surgical procedure to discriminate between lumbar IS and FS, but such discrimination is difficult. METHODS: There were 9 cases of IS, 7 cases of FS, and 5 healthy controls. The regions of interest were established in the lumbar intraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez). The FA and ADC values were measured on the affected and unaffected sides of the nerves. The FA ratio and the ADC ratio were calculated as the affected side/unaffected side ×100 (%). RESULTS: In the Ez, the FA value was significantly lower in FS than in IS (p<0.01). FA ratio was significantly lower in FS than in IS for the Ez (p<0.01). In the Iz, the ADC value was significantly higher in IS than FS (p<0.01). ADC ratio was significantly higher in FS than in IS for the N and Ez (p<0.05). For the Ez, receiver operating characteristic analysis of parameters revealed that the FA values showed a higher accuracy for the diagnosis of FS than the ADC values, and the FA value cut-off value was 0.42 (sensitivity: 85.7%, false positive: 11.1%) and the FA ratio cut-off value was 83.9% (sensitivity: 85.7%, false positive: 22.2%). CONCLUSIONS: The low FA value in the extraforaminal zone suggests the presence of foraminal stenosis. When the FA value and FA ratio cut-off value were established as 0.42 and 83.9%, respectively, the accuracy was high for the diagnosis of foraminal stenosis. It may be possible to use DTI parameters to help in the discrimination between IS and FS.

Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging

Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis.

Multiple variant mRNAs with different length tandem repeats of (CAYYCC)n produced from bovine selenoprotein P-like protein gene

In contrast to selenoprotein Ps (SeIPs) from other animal species, bovine selenoprotein P-like-protein (SeIPLP) was found to contain a tandem repeat of (CAYYCC)(11). During an investigation into whether SeIPLP was a bovine substitute for SeIP or uniquely bovine, its mRNA was found to consist of multiple variants with different length tandem repeat, namely p(0) with (CAYYCC)(11), p(-4) lacking (CAYYCC)(4), p(-8) lacking (CAYYCC)(8), and p(-9) lacking (CAYYCC)(9). Although they were encoded on a single gene locus, neither classicalGT-AG: nor minor classAT-AC: donator-acceptor sequences for alternative splicing were identified. A subsequent S1 protection assay using oligonucleotides, whose sequence may occur as variants, performed against bovine poly(A)(+)RNA identified a total of nine variants. Judging from the sequence of these variants and the branch point mapping, the consensus sequence for recognition of the donator was CACCCCCAC: and of the acceptor and the branch point A nucleotide,ACCCC: CAT orACCCC: CATCCCCAT. Furthermore, when the p(0) insert mRNA was expressed in COS-7 cells derived from an African green monkey kidney, cDNAs corresponding to p(-8) and p(-9) could be isolated. Therefore, the bovine SeIPLP mRNAs consisted of multiple variants probably due to a novel splicing mechanism which was not bovine-specific but common to other mammals.

Multiple Variant mRNAs with Different Length Tandem Repeats of (CAYYCC)n Produced from Bovine Selenoprotein P-like Protein Gene

In contrast to selenoprotein Ps (SelPs) from other animal species, bovine selenoprotein P-like-protein (SelPLP) was found to contain a tandem repeat of (CAYYCC)11. During an investigation into whether SelPLP was a bovine substitute for SelP or uniquely bovine, its mRNA was found to consist of multiple variants with different length tandem repeat, namely p(0) with (CAYYCC)11, p(-4) lacking (CAYYCC)4, p(-8) lacking (CAYYCC)8, and p(-9) lacking (CAYYCC)9. Although they were encoded on a single gene locus, neither classical GT-AG nor minor class AT-AC donator-acceptor sequences for alternative splicing were identified. A subsequent S1 protection assay using oligonucleotides, whose sequence may occur as variants, performed against bovine poly(A)+RNA identified a total of nine variants. Judging from the sequence of these variants and the branch point mapping, the consensus sequence for recognition of the donator was CACCCCCAC and of the acceptor and the branch point A nucleotide, ACCCCCAT or ACCCCCATCCCCAT. Furthermore, when the p(0) insert mRNA was expressed in COS-7 cells derived from an African green monkey kidney, cDNAs corresponding to p(-8) and p(-9) could be isolated. Therefore, the bovine SelPLP mRNAs consisted of multiple variants probably due to a novel splicing mechanism which was not bovine-specific but common to other mammals.

Clinical Observations on Cervical Brachialgia / 全日本鍼灸学会雑誌

Making external reference observations the object of our study, we attempted to assume the root disease in 60 subjects afflicted with cervical brachialgia.<br>Results showed 3 cases of cervical-spinal disease symptoms assumed from sensory disturbances of the upper and lower extremities or gait disturbances, etc.; 27 cases of cervical nerve root symptoms determined by the Spurling Test and pain and tenderness with backward flexion of the cervical vertebrae; 18 cases of thoracic outlet syndrome determined through the Wright Test, and Morley Test, etc. 5 cases of cervico-scapulo-brachial syndrome did not show the above mentioned disease conditions and 7 cases were undetermined.<br>The above was not conclusive diagnosis but it did help in assuming an outline of the disease conditions. From the point of view of therapeutic results it was observed that acupuncture therapy was not appropriate for spinal symptoms, appropriate to a degree for nerve root symptoms and appropriate for thoracic outlet syndrome.

Clinical Observation on Periartthite Scapulohumera / 全日本鍼灸学会雑誌

Using 69 patients afflicted with arthralgia of the shoulder joint accompanied by motor limitations as subjects we conducted research to determine to what extent the nature of the shoulder arthralgia could be assumed based upon clinical observations centered around interview and palpation tests.<br>Our method was to determine guide symptoms for various shoulder joint diseases and make assumptions as to the origin of the patient's condition based on the rate of occurrence of these symptoms.<br>Results revealed 34 (49%) cases of adherent inflammation of the articular capsule, 12 cases of inflammation of the synovial bursa of the acromion and 9 cases of tendonitis of the long head of the biceps brachii muscle. In addition cases of tendinitis of the rotator cuff tendonits of the supraspinatus muscle and inflammation of the coracoidal process were assumed. In some cases there was pain in the posterior area of the shoulder and tenderness was observed in the tendon of the triceps brachii muscle in 5 cases. It was shown that assumptioons such as these based upon clinical observation are to some extent helpful in diagnosis.

Clinical observation and assumption of disease origin for sciatica / 全日本鍼灸学会雑誌

From the clinical point of view of the acupuncturist 105 cases of sciatica were classified according to Interview Impressions (age, sex, affected limb, degree of pain in local areas, motor pain in lumbar vertebrae); Observation Impressions (structural disorders of lumbar vertebrae); Palpation Impressions (tenderness, sensitivity disorders); Special Test Information (SLR, Bonnet Test, ATR, PTR, muscular strength disorders, etc.); and the original disease assumed.<br>It was possible to assume the original disease in a high percentage -68%- that is 71 of 105 cases. Spondylosis deformans occurred in patients middle aged or over and was characterized by pain upon walking, spinous process irregularities, etc., Lumbar hernia occurred in young patients and was characterized by remarkable SLR results, tenderness between the spinous processes, etc., Slipped disc was characterized by deformation of lumbar disc arrangement, ATR disturbances, palpation disturbances, etc., Spinal canal stenosis was characterized by intermittent claudication, pain relief with anterior bending of the lumbar spine, sensory disturbance in the lower limbs, etc. In piriformis muscle syndrome cases Bonnet Test results were positive, SLR light and ATR normal.