BepiColombo mission confirms stagnation region of Venus and reveals its large extent.

The second Venus flyby of the BepiColombo mission offer a unique opportunity to make a complete tour of one of the few gas-dynamics dominated interaction regions between the supersonic solar wind and a Solar System object. The spacecraft pass through the full Venusian magnetosheath following the plasma streamlines, and cross the subsolar stagnation region during very stable solar wind conditions as observed upstream by the neighboring Solar Orbiter mission. These rare multipoint synergistic observations and stable conditions experimentally confirm what was previously predicted for the barely-explored stagnation region close to solar minimum. Here, we show that this region has a large extend, up to an altitude of 1900 km, and the estimated low energy transfer near the subsolar point confirm that the atmosphere of Venus, despite being non-magnetized and less conductive due to lower ultraviolet flux at solar minimum, is capable of withstanding the solar wind under low dynamic pressure.

Large anisotropic deformation of skyrmions in strained crystal.

Mechanical control of magnetism is an important and promising approach in spintronics. To date, strain control has mostly been demonstrated in ferromagnetic structures by exploiting a change in magnetocrystalline anisotropy. It would be desirable to achieve large strain effects on magnetic nanostructures. Here, using in situ Lorentz transmission electron microscopy, we demonstrate that anisotropic strain as small as 0.3% in a chiral magnet of FeGe induces very large deformations in magnetic skyrmions, as well as distortions of the skyrmion crystal lattice on the order of 20%. Skyrmions are stabilized by the Dzyaloshinskii-Moriya interaction, originating from a chiral crystal structure. Our results show that the change in the modulation of the strength of this interaction is amplified by two orders of magnitude with respect to changes in the crystal lattice due to an applied strain. Our findings may provide a mechanism to achieve strain control of topological magnetic structures based on the Dzyaloshinskii-Moriya interaction.

Rikkunshito induces gastric relaxation via the ß-adrenergic pathway in Suncus murinus.

BACKGROUND: Rikkunshito (RKT) is a gastroprotective herbal medicine. In this study, we investigated the role of RKT in the relaxation of the gastric body (fundus and corpus) and antrum. METHODS: We used Suncus murinus, a unique small model animal with similar gastrointestinal motility to humans and dogs. RKT was added at 0.1, 1.0, and 5.0 mg/mL to induce relaxation in vitro; the outcome measure was the intensity of relaxation. The number of spontaneous antral contractions in the absence or the presence of RKT was also counted. KEY RESULTS: Rikkunshito induced the relaxation of the gastric body and antrum and decreased the number of spontaneous antral contractions in a dose-dependent manner. The responses to RKT (1.0 mg/mL) were not affected by pretreatment with atropine, N-nitro-l-arginine methyl ester, ritanserin, or ondansetron. On the other hand, timolol almost completely reversed the relaxation induced by RKT (1.0 mg/mL) on the gastric body and antrum and the occurrence of the spontaneous antral contractions. Both butoxamine, a ß(2) -adrenoreceptor antagonist, and L 748337, a ß(3) -adrenoreceptor antagonist, but not CGP 20712, a ß(1) -adrenoreceptor antagonist, significantly reversed the RKT-induced (1.0 mg/mL) gastric relaxation. CONCLUSIONS & INFERENCES: These results indicate that RKT stimulates and modulates gastric relaxation through ß(2) - and ß(3) -adrenergic, but not ß(1) -adrenergic, pathways in S. murinus.

Porphyromonas gingivalis lipopolysaccharide inhibits trophoblast invasion in the presence of nicotine.

INTRODUCTION: Periodontitis is a chronic infectious disease associated with Gram-negative subgingival microflora. In pregnant women, periodontitis is thought to be associated with adverse pregnancy outcomes, although the pathophysiology is unknown. Additionally, smoking is an established risk factor for adverse pregnancy outcomes. In the present study, we examined the direct effects of Porphyromonas gingivalis lipopolysaccharides (PGLPS) and nicotine on a trophoblast cell line. METHODS: HTR-8/SVneo cells were plated on Matrigel chambers with or without PGLPS and nicotine. The invasive activity of the cells was directly evaluated using microscopy. RESULTS: PGLPS alone did not reduce the invasive activity of the HTR-8/SVneo cells. The co-administration of nicotine with PGLPS significantly reduced the invasive activity of the cells. DISCUSSION: Our results suggest that although the direct pathogenic effects of P. gingivalis alone on trophoblast invasion may be limited, concurrent smoking reduces trophoblast invasion into the myometrium and inhibits maternal vascular reconstruction.

The prevalence of and factors related to calcium pyrophosphate dihydrate crystal deposition in the knee joint.

OBJECTIVES: The purpose of this study was to reveal the accurate prevalence and related factors to the presence of calcium pyrophosphate dihydrate (CPPD) crystal deposition in cadaveric knee joints. DESIGN: Controlled laboratory study. METHODS: Six hundred and eight knees from 304 cadavers (332 male knees and 276 female knees, formalin fixed, Japanese anatomical specimens) were included in this study. The average age of the cadavers was 78.3 ± 10.7 years. Knees were macroscopically evaluated for the existence of CPPD, and the depth of cartilage degeneration of the femoro-tibial joint following the Outerbridge's classification. CPPD crystal was confirmed under Fourier transform infrared spectroscopy (FTIR) analysis using light microscopy. Statistical analysis was performed to reveal the correlation between the occurrence of CPPD deposition in the knee joint and gender, age, and the depth of cartilage degeneration of the femoro-tibial joint. RESULTS: The prevalence of grossly visible CPPD crystal was 13% (79 knees). In all of these knees, CPPD crystal was confirmed under FTIR analysis. Statistical analysis showed significant correlation between the occurrence of CPPD deposition and gender (P < 0.001), and depth of cartilage degeneration in the femoro-tibial joint (P < 0.001). In the cartilage degeneration positive knees (Over grade 3 in Outerbridge's classification), average age of CPPD deposition knee was significantly higher than CPPD negative knees. CONCLUSIONS: In this study, the prevalence of CPPD deposition disease was evaluated in a relatively large sample size of cadaveric knees. The prevalence of CPPD deposition disease was 13%, and was significantly correlated with the subject's age, gender, and severity of cartilage degeneration in the femoro-tibial joint.

Muscle sympathetic nerve activity during intermittent handgrip exercise.

AIM: This study evaluated whether central command plays an important role in activating muscle sympathetic nerve activity (MSNA) during short-term maximal handgrip contractions. METHODS: The increase in MSNA was examined while influence of minimizing for other factors such as mechanoreflex, metaboreflex and fatigue during repetitive exercise in seven 19- to 26-year-old participants. Maximal voluntary handgrips (15-s contraction with a 45-s relaxation) were performed 10 times with a 15-s pause between alternate hands. MSNA was recorded from the tibial nerve analyzed using the burst frequency (BF) and total sympathetic nerve activity. RESULTS: The BF increased with the first unit, from 14.9±1.8 bursts·min-1 at baseline to 27.7±3.4 bursts·min-1 during contraction. The increase in the MSNA during contractions remained unchanged throughout the repetitions. The BF declined to baseline during the relaxation periods. The peak grip force decreased from 333±25 N for the first grip to 216±20 N for the last contraction. The MSAN increase remained constant despite a possible reduction in mechanoreflex during exercise as indicated from decreased maximal handgrip force. CONCLUSION: We suggested that the MSNA response was induced mainly by central command during short-term maximal handgrip contraction without metaboreflex influence and attenuated mechanoreflex input.

Histone deacetylase 9 as a negative regulator for choline acetyltransferase gene in NG108-15 neuronal cells.

The biological function of histone deacetylases (HDACs), namely, repression of gene expression by removing an acetyl group from a histone N-terminal tail, plays an important role in numerous biological processes such as cell cycle, differentiation, and apoptosis in the development of individual tissues, including the brain. We previously showed the possible role of HDAC activity in the regulation of gene expression of choline acetyltransferase (ChAT), a specific marker for cholinergic neurons and their function, in NG108-15 neuronal cells as an in vitro model of cholinergic neurons. The objectives of the present study were to specify key HDACs and investigate the essential role of HDACs in ChAT gene regulation in NG108-15 cells. The experiments using different types of HDAC inhibitors indicated that class IIa HDACs substantially participate in the regulation of ChAT gene expression. In addition, HDAC9, a class IIa enzyme, was dramatically decreased at the protein levels, and dissociated from the promoter region of ChAT gene during neuronal differentiation. Furthermore, knockdown of HDAC9 by siRNA increased ChAT gene expression in undifferentiated cells. These findings demonstrate that HDAC9 is responsible for repressing ChAT gene expression in NG108-15 neuronal cells, and thus plays an important role in cholinergic differentiation.

Shadowing the actions of a predator: backlit fluorescent microscopy reveals synchronous nonbinary septation of predatory Bdellovibrio inside prey and exit through discrete bdelloplast pores.

The Bdellovibrio are miniature "living antibiotic" predatory bacteria which invade, reseal, and digest other larger Gram-negative bacteria, including pathogens. Nutrients for the replication of Bdellovibrio bacteria come entirely from the digestion of the single invaded bacterium, now called a bdelloplast, which is bound by the original prey outer membrane. Bdellovibrio bacteria are efficient digesters of prey cells, yielding on average 4 to 6 progeny from digestion of a single prey cell of a genome size similar to that of the Bdellovibrio cell itself. The developmental intrabacterial cycle of Bdellovibrio is largely unknown and has never been visualized "live." Using the latest motorized xy stage with a very defined z-axis control and engineered periplasmically fluorescent prey allows, for the first time, accurate return and visualization without prey bleaching of developing Bdellovibrio cells using solely the inner resources of a prey cell over several hours. We show that Bdellovibrio bacteria do not follow the familiar pattern of bacterial cell division by binary fission. Instead, they septate synchronously to produce both odd and even numbers of progeny, even when two separate Bdellovibrio cells have invaded and develop within a single prey bacterium, producing two different amounts of progeny. Evolution of this novel septation pattern, allowing odd progeny yields, allows optimal use of the finite prey cell resources to produce maximal replicated, predatory bacteria. When replication is complete, Bdellovibrio cells exit the exhausted prey and are seen leaving via discrete pores rather than by breakdown of the entire outer membrane of the prey.

Effects of alpha-amylase and its inhibitors on acid production from cooked starch by oral streptococci.

This study evaluated acid production from cooked starch by Streptococcus mutans, Streptococcus sobrinus, Streptococcus sanguinis and Streptococcus mitis, and the effects of alpha-amylase inhibitors (maltotriitol and acarbose) and xylitol on acid production. Streptococcal cell suspensions were anaerobically incubated with various carbohydrates that included cooked potato starch in the presence or absence of alpha-amylase. Subsequently, the fall in pH and the acid production rate at pH 7.0 were measured. In addition, the effects of adding alpha-amylase inhibitors and xylitol to the reaction mixture were evaluated. In the absence of alpha-amylase, both the fall in pH and the acid production rate from cooked starch were small. On the other hand, in the presence of alpha-amylase, the pH fell to 3.9-4.4 and the acid production rate was 0.61-0.92 micromol per optical density unit per min. These values were comparable to those for maltose. When using cooked starch, the fall in pH by S. sanguinis and S. mitis was similar to that by S. mutans and S. sobrinus. For all streptococci, alpha-amylase inhibitors caused a decrease in acid production from cooked starch, although xylitol only decreased acid production by S. mutans and S. sobrinus. These results suggest that cooked starch is potentially acidogenic in the presence of alpha-amylase, which occurs in the oral cavity. In terms of the acidogenic potential of cooked starch, S. sanguinis and S. mitis were comparable to S. mutans and S. sobrinus. Alpha-amylase inhibitors and xylitol might moderate this activity.

Correlation between visual function and photoreceptor inner/outer segment junction in patients with retinitis pigmentosa.

PURPOSE: To determine whether a significant correlation exists between the visual acuity or foveal thickness and the status of the inner and outer segment junction (IS/OS) of the photoreceptor in patients with retinitis pigmentosa (RP). METHODS: Three hundred eyes of 163 patients with RP were examined with the optical coherence tomography (OCT). The IS/OS appeared as a distinct, highly reflective line just vitread of the retinal pigment epithelium in the OCT3 images. The IS/OS line was graded into three groups. The correlations between the grade of the IS/OS and age, best-corrected visual acuity (BCVA), and central foveal thickness (CFT) were determined. RESULTS: Grade 1 included 93 eyes (31.0%) in which an IS/OS line was not seen, Grade 2 included 67 eyes (22.3%) with an abnormal IS/OS, and Grade 3 included 140 eyes (46.7%) with a normal IS/OS. The correlation between the IS/OS grade and age was not significant (P=0.5536). The IS/OS grade was significantly correlated with BCVA and CFT (both P<0.0001). The BCVA was significantly better in Grade 3 eyes than Grades 1 and 2 (both P<0.0001). The CFT was significantly thinner in Grade 1 eyes than in Grades 2 and 3 (both P<0.0001). In Grade 3, the mean length of the IS/OS was 2.51+/-1.42 mm (+/-SD). The length of the IS/OS was significantly correlated with the BCVA (P<0.0001, r=-0.375). CONCLUSIONS: The presence of the IS/OS was associated with better visual acuity and thicker fovea in RP patients. The absence of an IS/OS may reflect a foveal dysfunction in RP patients.

Heart rate responses at onset of contraction.

We tested the hypothesis that the initial heart rate (HR) response at the onset of maximal handgrip contraction is altered after training. 17 volunteers (nine trained and eight controls) performed ten intermittent static handgrip contractions with maximal effort, alternating between 15-s contractions and 15-s pauses. High-intensity static handgrip training was performed using the nondominant arm alone for 4 weeks. Handgrip force (HGF) and HR were analyzed for the initial 7 s of every static handgrip exercise. Peak HR (pre-training: 94.5 +/- 12.8 beats/min; post-training: 89.7 +/- 10.2 beats/min, p < 0.05) decreased. However, the magnitude of HR change at the onset of contraction remained constant (pre-training: 23.0 +/- 7.7 beats/min; post-training: 25.7 +/- 6.5 beats/min, p = 0.0767), while the HR responses in the subsequent bouts increased after training (p < 0.001). The resting HR decreased (pre-training: 71.5 +/- 9.3 beats/min; post-training 64.1 +/- 5.7 beats/min, p < 0.05). Maximal HGF increased by 11.1 % in trained arms and by 8.7 % in untrained arms, although an increase in maximal forearm girth was only observed in the trained arm (2.0 %, p < 0.0001). Although high-intensity training modulated the abrupt HR responses, the magnitude of the response remained unchanged at the onset of maximal forearm contraction and the resting HR significantly decreased.

Diurnal change of thyroid-stimulating hormone mRNA expression in the rat pars tuberalis.

Thyroid-stimulating hormone (TSH)-producing cells (TSH cells), which account for a large fraction of the cells in the rat pars tuberalis (PT), have been found to express MT1 melatonin receptor and mammalian clock genes at high densities. Although these findings suggest that TSH production in the rat PT is regulated by melatonin and/or the biological clock, there have been no studies focusing on the diurnal change and regulation mechanism of TSH production in the rat PT. Therefore, in the present study, we examined diurnal changes of in TSH beta and alpha-glycoprotein subunit (alpha GSU) mRNA expression and TSH immunoreactivity (-ir) in the rat PT, and also examined the relationship between melatonin and TSH production in vivo. Both TSH beta mRNA expression and alpha GSU mRNA expression in the PT showed diurnal variations: the expression levels were lowest at the light phase [Zeitgeber time (ZT)4] and high at the dark phase (ZT12 and ZT20). TSH-ir in the PT showed the lowest level at ZT4, as was found for mRNA expression. Interestingly, TSH-ir, which was confined to the Golgi apparatus at ZT4, spread to the cytoplasm, and most of the TSH cells in the PT were uniformly immunostained in the cytoplasm at ZT20. Despite the fact that chronic administration of melatonin suppressed TSH beta and alpha GSU mRNA expression, TSH-ir in the PT was significantly enhanced. These findings results clearly show that there are diurnal changes in TSH expression and accumulation in rat PT-TSH cells and suggest that these fluctuations are regulated by melatonin.

Rapid microglial activation induced by traumatic brain injury is independent of blood brain barrier disruption.

Following CNS injury, microglia respond and transform into reactive species exhibiting characteristic morphological changes that have been termed "activated" or "ameboid" microglia. In an attempt to establish that microglial reactions induced immediately after injury are caused by intrinsic mechanisms rather than infiltration of blood and its constituents, oxygenized Ringer's solution was perfused into the cerebral circulation of rats so that the circulating blood could be eliminated prior to injury induction. Under artificial respiration, a catheter was inserted from the cardiac apex into the ascending aorta, and oxygenized Ringer's solution was immediately perfused with a pulsatile blood pump, resulting in wash out of the circulating blood from the brain within 1 min. Subsequently, a cortical contusion was induced in the unilateral parietal cortex using a controlled cortical impact (CCI) device. At 5 min following the injury, the brain was fixed by perfusion of fixative through the catheter and removed. Coronal vibratome sections were then processed for CR3 immunohistochemistry to examine the microglial activation. It appeared that microglial activation with both morphological transformation and an increase in CR3 immunoreactivity was induced throughout the hemisphere ipsilateral to the injury side exclusively, even in rats with elimination of circulating blood. The microglial reactions did not differ substantially from those observed in the control rats with extensive BBB disruption. The present results thus provide direct evidence that the microglial activation induced immediately after injury is independent of infiltration of circulating blood induced by concurrent BBB disruption.

Difference in the xylitol sensitivity of acid production among Streptococcus mutans strains and the biochemical mechanism.

Xylitol inhibits the glycolysis and growth of Streptococcus mutans, but to different degrees among strains. Thus, we studied the biochemical mechanism through which the inhibition varies, using S. mutans strains ATCC 31989, NCTN 10449, and NCIB 11723, which are highly sensitive, moderately sensitive, and resistant to xylitol, respectively, under strictly anaerobic conditions such as those found in deep layers of dental plaque. Xylitol (30 mM) decreased the rate of acid production from glucose (10 mM) in ATCC 31989, NCTC 10449, and NCIB 11723 by 86, 26, and 0%, respectively. The activities of the xylitol : phosphoenolpyruvate phosphotransferase system (PEP-PTS) relative to those of glucose : PEP-PTS were 120, 16, and 3%, respectively. In ATCC 31989 and NCTC 10449, intracellular accumulation of xylitol 5-phosphate and decreases of fructose 1,6-bisphosphate and glucose 6-phosphate were observed. Furthermore, in the presence of xylitol (30 mM), glucose : PEP-PTS activities decreased by 34, 17, and 0%, respectively. These findings indicated that the higher the xylitol : PEP-PTS activity was and the more effectively xylitol decreased glucose : PEP-PTS activity, the more sensitive the strain was to xylitol. These results suggest that the following inhibitory mechanisms are active in the xylitol-sensitive mutans streptococci: direct inhibition of glycolytic enzymes by xylitol 5-phosphate derived from xylitol : PEP-PTS and, possibly, indirect inhibition through competition for the phosphoryl donor, HPr-P, between glucose and xylitol : PEP-PTSs.

Ontogeny of the antigen-reactive lymph follicle-forming capacity of the popliteal lymph node in neonatal mice.

The ontogenetic development of the reactive lymph follicle-forming capacity of the popliteal lymph node was investigated immunohistochemically in young mice which had received a single injection of hemocyanin (KLH) in a rear footpad at a predetermined age (between 1 and 21 days). The mice were sacrificed at various intervals after injection. In non-stimulated young mice, primary lymph follicles first appeared in the popliteal node at 11 days of age. When KLH was given to 7-day-old or older mice, each draining popliteal node showed a marked increase in B lymphocytes in the extrafollicular zone 3 days after injection and produced a number of "new" lymph follicles outside the pre-existing follicles over the next few days. In mice injected at 2-4 days of age, these nodes showed an increase in B lymphocytes in the outer cortex and had produced several lymph follicles by 8 days of age. The number of lymph follicles produced by each node tended to increase in line with age at injection. These results indicate that neonatal popliteal nodes become able to produce lymph follicles in response to exogenous antigens some time before ontogenetically developing follicles appear. The formation of new lymph follicles observed in draining popliteal nodes after KLH injection at an early postnatal age is discussed in relation to the ontogenetic development of stromal cells (precursors of follicular dendritic cells) that are capable of interacting with B lymphocytes and the extent of B lymphocyte influx into the node induced by KLH stimulation.

Protease susceptibility of the Caulobacter crescentus flagellar hook-basal body: a possible mechanism of flagellar ejection during cell differentiation.

When motile swarmer cells of Caulobacter crescentus differentiate into sessile stalked cells, the flagellum is ejected. To elucidate the molecular mechanism of the flagellar ejection, flagellar hook-basal body (HBB) complexes from C. crescentus were purified and characterized. The purified HBBs were less stable against acidic pH or protease treatment than HBBs of Salmonella typhimurium, supporting the view that flagellar ejection from C. crescentus is initiated by destruction of the fragile basal structures. In addition, protease treatment of the purified flagella resulted in the specific digestion of the MS ring complex, revealing for the first time the intact structure of the whole rod.

p53 prevents maturation of T cell development to the immature CD4-CD8+ stage in Bcl11b-/- mice.

Signaling pathways such as the pre-TCR and Wnt pathways regulate alpha/beta T cell differentiation in thymus. Mice lacking an essential component of the pre-TCR exhibit arrest at the (CD4(-)CD8(-)) (CD44(-)CD25(+)) stage (DN3) of thymocyte development, and introduction of p53 deficiency into those mice abrogates this arrest, resulting in transition to the (CD4(+)CD8(+)) double-positive (DP) stage. This paper examines the effect of inactivation of p53 on thymocyte development in Bcl11b(-/-) mice that exhibit arrest at the DN3 or (CD4(-)CD8(+)) immature single-positive (ISP) stage. No DP thymocytes were detected in thymocytes of adoptive transfer experiments in scid mice that were derived from p53(-/-)Bcl11b(-/-) precursors but ISP thymocytes increased in the proportion and in the cell number approximately three times higher than those from Bcl11b(-/-) precursors. Consistently, the level of apoptosis decreased to the level of wild-type precursors. These results suggest that inactivation of p53 is sufficient for DN3 thymocytes to differentiate into the ISP, but not to DP, stage of thymocyte development in Bcl11b(-/-) mice. This provides evidence for a novel p53-mediated checkpoint that regulates the transition from the DN3 to ISP stage of thymocyte development.

Cytological basis for enhancement of radiation-induced mortality by Friend leukaemia virus infection.

PURPOSE: To analyse the cytological basis for enhancement of radiation-induced mortality by Friend leukaemia virus infection. MATERIALS AND METHODS: Cellularity in haematopoietic tissues of C3H mice infected with FLV and/or whole-body irradiation was examined. RESULTS: When mice were treated with a sublethal dose (3 Gy) of irradiation at 1 week after virus infection, most manifested a severe loss of cellularity in the spleen, bone marrow and peripheral blood 2 weeks after irradiation. More than 90% of the mice died within 1 month post-irradiation. However, this deleterious effect of virus infection on the survival of irradiated mice was observed only when they were irradiated at around 1 week after virus inoculation. Strain differences in the sensitivity to this effect were observed among virus-sensitive strains of mice. CONCLUSIONS: The results indicate that Friend leukaemia virus infection can cause enhancement of radiation sensitivity of haematopoietic cells in host animals in a restricted manner in terms of genetic background and the interval between infection and irradiation.

Diagnosis and treatment of progressive space-occupying radiation necrosis following stereotactic radiosurgery for brain metastasis: value of proton magnetic resonance spectroscopy.

BACKGROUND: There have been some reports that radiation necrosis can be controlled conservatively. There are rare cases showing progressive space-occupying radiation necrosis (PSORN). It is very difficult to control PSORN by conservative treatment. The purpose of this study was to evaluate the early diagnosis of those cases and the timing of surgery for patients with PSORN. METHOD: We have experienced some cases where quality of life was improved by the removal of PSORN after stereotactic radiosurgery (SRS) for brain metastases. Therefore, we evaluated retrospectively the diagnosis and treatment of six cases of symptomatic PSORN at approximately 6-12 months after SRS for metastatic brain tumours. FINDINGS: In all six cases, on Magnetic Resonance Imaging with Gd contrast material (Gd-MRI), PSORN was revealed as a ring-like enhanced mass with large perifocal oedema coupled with the appearance of neurological deficit. Proton Magnetic Resonance Spectroscopy ((1)H-MRS) enabled us to differentiate PSORN from recurrence of metastases in all six cases. Single Photon Emission Computed Tomography with thallium-201 chloride (201TlCl-SPECT) enabled us to do this in four cases of the six. In four cases of the six, lesionectomy of the ring-like enhanced mass (PSORN) was performed, and in two of these cases the removal was performed within 4 weeks from the time when conservative treatment became ineffective, and the neurological deficit and perifocal oedema was improved as was the quality of life. However, in the other two patients who were left for more than 16 weeks, the deficit was gradually progressive. The two patients who did not receive lesionectomy were treated by conservative means with steroids and/or heparin and warfarin and they had progressive neurological symptoms. INTERPRETATION: Although, the number of patients is small in this study, and more data will be needed, it is recommended that lesionectomy is performed at an early stage, if possible, when conservative management has failed.