Radiological Findings of the Lumbar Spine in High School and Collegiate Sumo Wrestlers.

Background: Sumo wrestling is a traditional sport in Japan and becoming popular worldwide. Risk factors for lower back injuries in sumo wrestlers are heavier weight and larger body mass index (BMI). The mawashi (loincloth belt) worn by sumo wrestlers has been shown to restrict motion of the lumbar spine. Purpose: To study the effects of sumo wrestling on the lumbar spine of high school and freshmen collegiate wrestlers, investigating the relationship between radiological findings, wearing of the mawashi during training, and lower back symptoms. Study Design: Case series; Level of evidence, 4. Methods: From 2001 to 2017, a total of 197 members of the Japanese Sumo Federation (55 high school and 142 college freshman students) underwent routine radiographic examination of their lumbar spines and answered a questionnaire regarding lumbar symptoms. Wrestlers were classified as symptomatic and asymptomatic based on responses to a custom questionnaire. We used the unpaired t test to evaluate patient demographics and the chi square test to analyze radiographic lumbar spine abnormalities between symptomatic and asymptomatic wrestlers. Results: The wrestlers' mean height, weight, BMI, and duration in the sport were 174.0 ± 6.7 cm, 107.1 ± 22.4 kg, 35.2 ± 6.4, and 8.0 ± 3.2 years, respectively. There were 91 participants in the symptomatic group (46.2%) and 106 (53.8%) in the asymptomatic group. Ten wrestlers (5.1%) had osteophyte formations in the lumbar body; 8 of the 11 osteophytes (72.7%) appeared in the upper lumbar spine. Of the total, 48 wrestlers (24.4%) had deformities (Schmorl nodules) in the lumbar body, and 23 of 50 (46.0%) and 10 of 16 (62.5%) deformities were found in the upper lumbar spine of collegiate and high school wrestlers, respectively. Five wrestlers of the total 197 athletes (2.5%) had disc space narrowing in the lumbar body, with 3 of the 5 cases of disc space narrowing (60.0%) found in the upper lumbar spine. Spondylolysis in the lumbar body was found in 25 wrestlers (12.7%); 19 of the 91 symptomatic wrestlers (20.9%) had spondylolysis, compared with 6 of the 106 (5.7%) asymptomatic wrestlers (P = .0028). Conclusion: Almost one-third of sumo wrestlers had ≥1 abnormal radiological finding in the lumbar spine. There was a significant relationship between symptomatic wrestlers and spondylolysis.

Taxonomic revision of the Agaraceae with a description of Neoagarum gen. nov. and reinstatement of Thalassiophyllum.

We confirmed the monophyly of the Agaraceae based on phylogenetic analyses of six mitochondrial and six chloroplast gene sequences from Agarum, Costaria, Dictyoneurum, and Thalassiophyllum species, as well as representative species from other laminarialean families. However, the genus Agarum was paraphyletic, comprising two independent clades, A. clathratum/A. turneri and A. fimbriatum/A. oharaense. The latter clade was genetically most closely related to Dictyoneurum spp., and morphologically, the species shared a flattened stipe bearing fimbriae (potential secondary haptera) in the mid- to upper portion. The phylogenetic position of Thalassiophyllum differed between the two datasets: in the chloroplast gene phylogeny, Thalassiophyllum was included in the A. clathratum/A. turneri clade, but in the mitochondrial gene phylogeny, it formed an independent clade at the base of the Agaraceae, the same position it took in the phylogeny when the data from both genomes were combined despite a larger number of bp being contributed by the chloroplast gene sequences. Considering the remarkable morphological differences between Thalassiophyllum and other Agaraceae, and the molecular support, we conclude that Thalassiophyllum should be reinstated as an independent genus. Dictyoneurum reticulatum was morphologically distinguishable from D. californicum due to its midrib, but because of their close genetic relationship, further investigations are needed to clarify species-level taxonomy. In summary, we propose the establishment of a new genus Neoagarum to accommodate A. fimbriatum and A. oharanese and the reinstatement of the genus Thalassiophyllum.

A NEW LOOK AT AN ANCIENT ORDER: GENERIC REVISION OF THE BANGIALES (RHODOPHYTA)(1).

The red algal order Bangiales has been revised as a result of detailed regional studies and the development of expert local knowledge of Bangiales floras, followed by collaborative global analyses based on wide taxon sampling and molecular analyses. Combined analyses of the nuclear SSU rRNA gene and the plastid RUBISCO LSU (rbcL) gene for 157 Bangiales taxa have been conducted. Fifteen genera of Bangiales, seven filamentous and eight foliose, are recognized. This classification includes five newly described and two resurrected genera. This revision constitutes a major change in understanding relationships and evolution in this order. The genus Porphyra is now restricted to five described species and a number of undescribed species. Other foliose taxa previously placed in Porphyra are now recognized to belong to the genera Boreophyllum gen. nov., Clymene gen. nov., Fuscifolium gen. nov., Lysithea gen. nov., Miuraea gen. nov., Pyropia, and Wildemania. Four of the seven filamentous genera recognized in our analyses already have generic names (Bangia, Dione, Minerva, and Pseudobangia), and are all currently monotypic. The unnamed filamentous genera are clearly composed of multiple species, and few of these species have names. Further research is required: the genus to which the marine taxon Bangia fuscopurpurea belongs is not known, and there are also a large number of species previously described as Porphyra for which nuclear SSU ribosomal RNA (nrSSU) or rbcL sequence data should be obtained so that they can be assigned to the appropriate genus.

Neck muscle strength before and after cervical laminoplasty: relation to axial symptoms.

STUDY DESIGN: A prospective study to investigate serial changes in neck muscle strength before and after cervical laminoplasty. OBJECTIVES: To examine the correlation between neck muscle strength and axial symptoms, and to clarify the risk factors for axial symptoms. SUMMARY OF BACKGROUND DATA: Axial symptoms are common complications after posterior cervical spinal surgery. Although several technical considerations have reduced axial symptoms, the causes of axial symptoms are still largely unknown. Previous studies have indicated that neck muscle strength is reduced in patients with neck pain. MATERIALS AND METHODS: Nineteen consecutive patients underwent cervical expansive laminoplasty for cervical spondylotic myelopathy. Age, sex, operative time, blood loss, clinical results, cervical curvature, range of motion, visual analog scale (VAS) for axial symptoms, and manual muscle strengths were examined before and after surgery. At 3 and 12 months, these factors were compared statistically between the no pain (NP) group (VAS <3) and the pain (P) group (VAS >or=3). The correlation between VAS and neck muscle strength, and the reduction in neck muscle strength in extension were analyzed statistically. RESULTS: Six patients (31.5%) complained of axial symptoms at 3 months, and the symptoms continued in 3 patients (15.8%) at 12 months. At 3 months, cervical lordosis was 15.7 degrees in the NP group and 5.0 degrees in the P group, and neck strength in extension was 104.9% and 61.8%, respectively. At 12 months, neck strength in extension was 124.3% and 62.2%, respectively. These differences were statistically significant. The correlation between neck pain VAS and neck muscle strength, and the reduction in neck muscle strength in extension were statistically significant. CONCLUSIONS: Neck muscle strength recovered to the preoperative value by 3 months and increased to 120% by 12 months in the NP group, whereas in the P group, neck muscle strength remained reduced by 60% and did not recover. Neck muscle strength and axial symptoms were strongly correlated.

O-C2 angle as a predictor of dyspnea and/or dysphagia after occipitocervical fusion.

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: To confirm the impact of the O-C2 angle on dyspnea and dysphagia after posterior occipitocervical (O-C) fusion. SUMMARY OF BACKGROUND DATA: Dyspnea and dysphagia are complications of posterior O-C fusion with malalignment, and may be prolonged or occasionally serious. However, it is difficult to select a safe alignment during surgery, and no indicators of the appropriate alignment have been available to preclude these complications. METHODS: The authors retrospectively reviewed 29 consecutive patients who had undergone O-C or occipitocervicothoracic fusion between 2003 and 2008. Data were analyzed for O-C2 angles on plain radiographs and the axial computed tomographic cross-sectional areas of the oropharynx just cranial to the epiglottis before and after surgery. The patients were grouped according to whether they developed postoperative dyspnea and/or dysphagia (group A) or not (group B). RESULTS: After surgery, 4 patients complained of dysphagia, and 1 patient had dyspnea and dysphagia, although they had all undergone short O-C fusions. The difference in the O-C2 angle (dOC2A = postoperative O-C2 angle--preoperative O-C2 angle) and the percentage change in the cross-sectional area of the oropharynx (S) before and after surgery (% dS) were linearly correlated. Both dOC2A and % dS were significantly lower in group A than in group B. All patients with dOC2A of less than -10 degrees showed % dS of less than -40%, and developed dyspnea and/or dysphagia after surgery. Conversely, no patients with positive dOC2A developed these complications. CONCLUSION: The O-C2 angle has considerable impact on dyspnea and/or dysphagia after O-C fusion. The O-C2 angle is easily measured during surgery and can be a practical index with which to avoid postoperative dyspnea and dysphagia.

Double-door cervical laminoplasty with the use of suture anchors: technical note.

STUDY DESIGN: Technical note. OBJECTIVE: To introduce a new simple technique using suture anchors to stabilize the elevated laminae in double-door cervical laminoplasty. SUMMARY OF BACKGROUND DATA: Double-door cervical laminoplasty is a well-recognized procedure for the treatment of cervical spinal myelopathy. One of its complications is lamina reclosure that may cause restenosis of the spinal canal. The use of suture anchors for expansive open-door laminoplasty has previously been reported, but no study has ever been made of the use of suture anchors for double-door laminoplasty. METHODS: The authors retrospectively reviewed 182 consecutive patients who had undergone double-door cervical laminoplasty using suture anchors. Data were available for 145 of the 182 patients over a minimum 12-week follow-up. These included 95 men and 50 women, and the mean age was 62 years (range, 33 to 92 y). The average follow-up period was 91 weeks (range, 12 to 313 wk). The data were analyzed for the displacement of the suture anchors, lamina reclosure, and dural expansion. RESULTS: No displacement of the suture anchors was observed during the follow-up period, which was confirmed with serial radiographs. Fifty-six patients underwent postoperative computed tomography more than 3 months after surgery. Lamina reclosure that was evaluated with computed tomography, was observed in 4 patients, but no spinal cord compression by the closed laminae was observed. Postoperative magnetic resonance imaging was performed in 103 patients, which revealed adequate dural expansion in all of them. There were no suture-anchor-related complications. CONCLUSIONS: Double-door cervical laminoplasty with suture anchors is a technically easy and safe procedure that provides secure placement of the split laminae.

Is rheumatoid arthritis a risk factor for a high-riding vertebral artery?

STUDY DESIGN: A retrospective comparative study on the morphologic characteristics of the axis in patients with or without rheumatoid arthritis (RA). OBJECTIVE: To compare the morphologic risk of vertebral artery (VA) injury during atlantoaxial transarticular screw fixation between patients with or without RA. SUMMARY OF BACKGROUND DATA: VA injury is a potentially serious complication during atlantoaxial transarticular screw fixation. Although this operation is frequently performed on RA patients, there have been few comparative studies on the morphologic risk of VA injury between RA and non-RA patients. METHODS: A total of 107 three-dimensional computed tomography images of the cervical spine including the C1-C2 complex were evaluated. Forty-seven RA patients and 60 non-RA patients were included in the study. The maximum atlantoaxial transarticular screw diameter (MSD) that could be inserted without breaching the cortex was measured 3-dimensionally using a computer- assisted navigation system. A high-riding-VA carrier was defined as a patient with either MSD of 4 mm or less. In RA patients, the space available for the spinal cord in flexion (SAC in flexion), duration of disease, RA stage, and type of disease were examined. RESULTS: In the RA group, 45 of 94 MSDs (47.9%) were 4 mm or less, and 33 of 47 patients (70.2%) were high-riding-VA carriers. In the non-RA group, 11 of 120 MSDs (9.2%) were 4 mm or less, and 9 of 60 (15.0%) patients were high-riding-VA carriers. MSD, C3 A-P diameter, and the ratio of MSD to C3 A-P diameter were significantly smaller in the RA group than in the non-RA group. Multiple logistic regression analysis showed that SAC in flexion was a significant risk factor for a high-riding-VA carrier in the RA group. CONCLUSION: RA was a significant risk factor for the presence of a high-riding VA. When performing atlantoaxial transarticular screw fixation, particularly on RA patients, thorough preoperative evaluation of the bony architecture is of great importance to avoid inadvertent VA injury.

Rheumatoid arthritis as a risk factor for a narrow C-2 pedicle: 3D analysis of the C-2 pedicle screw trajectory.

OBJECT: Vertebral artery (VA) injury is a potentially serious complication of C-2 pedicle screw (PS) fixation. Although this surgery is frequently performed in patients with rheumatoid arthritis (RA), few studies have compared the risk of VA injury in patients with and without RA. In this study, the authors compare the morphological risk of VA injury relating to C-2 PS fixation in patients with and without RA. METHODS: A total of 110 3D CT images of the cervical spine including the axis were evaluated. Fifty patients with RA and 60 patients without RA were included in the study. The maximum PS diameter (MPSD) that could be used at C-2 without breaching the cortex was measured in 3D using a computer-assisted navigation system. A narrow-pedicle carrier was defined as a patient with an MPSD of 4 mm or less. RESULTS: In the RA group, 42 of 100 MPSDs were < or = 4 mm, and 30 of 50 patients (60%) were narrow-pedicle carriers. In the non-RA group, 10 of 120 MPSDs (8%) were < or = 4 mm, and 8 of 60 (13%) patients were narrow-pedicle carriers. The MPSD, the anteroposterior (AP) diameter of C-3, and the ratio of MPSD to the AP diameter of C-3 were significantly smaller in the RA group than in the non-RA group. Multiple logistic regression analysis showed that RA and narrow C-3 AP diameter were significant risk factors for a narrow-pedicle carrier. CONCLUSIONS: Rheumatoid arthritis is a significant risk factor for a narrow C-2 pedicle. When performing PS placement at C-2, particularly in patients with RA, thorough preoperative evaluation of the bone architecture is very important for avoiding inadvertent injury to the VA.

Atlantoaxial transarticular screw fixation with posterior wiring using polyethylene cable: facet fusion despite posterior graft resorption in rheumatoid patients.

STUDY DESIGN: A comparative retrospective study on the posterior graft union and the facet fusion in atlantoaxial transarticular screw fixation. OBJECTIVE: To evaluate the posterior graft union and the facet fusion in atlantoaxial transarticular screw fixation when a polyethylene (PE) cable was used in rheumatoid and nonrheumatoid patients. SUMMARY OF BACKGROUND DATA: In atlantoaxial transarticular screw fixation, metal wires or cables for posterior bone graft fixation can cause intraoperative or delayed spinal cord compression. PE cables do not have the risk, but there has been no comparative report. Also, a precise evaluation on the posterior graft union and the facet fusion has not been reported. METHODS: Thirty-eight patients who submitted to atlantoaxial transarticular screw fixation and posterior bone graft without any concomitant operation were followed up for more than 2 years. The posterior graft union and the facet fusion were evaluated by functional radiographs and computed tomography scans. RESULTS: Seven patients showed the posterior graft nonunion. All of them were rheumatoid patients and received PE cable wiring for posterior internal fixation. However, 5 of the 7 cases presented stable C1-C2 with the facet fusion demonstrated by functional radiographs and computed tomography scans, achieving an overall fusion rate of 95%. CONCLUSION: In atlantoaxial transarticular screw fixation, the use of PE cable and rheumatoid background are 2 of the unfavorable factors for the posterior graft union. However, atlantoaxial transarticular screws can bring the facet fusion despite the posterior graft failure in such cases.

Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations.

STUDY DESIGN: Retrospective survey. OBJECTIVE: To clarify the present incidence and management of iatrogenic vertebral artery injury (VAI) during cervical spine surgery. SUMMARY OF BACKGROUND DATA: VAI is a rare complication of cervical spine surgery, but it may be catastrophic. Anterior cervical decompression (ACD) and posterior atlantoaxial transarticular screw fixation (Magerl fixation) have been the main causes, with reported incidences of 0.3% to 0.5% and 0% to 8.2%, respectively. Popular new surgical techniques, such as cervical pedicle screw or C1 lateral mass screw fixation, also entail the potential risk of VAI. METHODS: A questionnaire was sent to our affiliated hospitals requesting information regarding iatrogenic VAI during cervical spine surgery. RESULTS: Seven spine surgeon groups and 25 general orthopedist groups responded to the questionnaire, with a response rate of 89%. The overall incidence of VAI was 0.14% (8 cases among 5641 cervical spine surgeries). The incidence in anterior cervical decompression procedures was 0.18% and that in Magerl fixation was 1.3%. Inexperienced surgeons tended to commit VAI more frequently. One case of VAI during C1 lateral mass screw fixation was included, whereas there was no case of VAI caused by cervical pedicle screw fixation. In the case of "VAI in the screw hole," hemostasis was obtained by tamponade or screw insertion, whereas "VAI in the open space" sometimes caused uncontrollable bleeding, in which embolization eventually stopped the bleeding. There were no deaths or apparent neurologic sequelae. CONCLUSION: The incidence of VAI during cervical spine surgery from this survey was similar to or slightly less than that in the literature. Tamponade was effective in many cases, but prompt consultation with an endovascular team is recommended if the bleeding is uncontrollable. Preoperative careful evaluation of the vertebral artery seems to be most important to prevent iatrogenic VAI and to avoid postoperative neurologic sequelae.

Giant adrenal myelolipoma: report of a case.

Adrenal myelolipomas are rare benign tumors composed of mature adipose tissue and hematopoietic elements that resemble bone marrow. They are usually asymptomatic, and most cases are incidentally found at radiological examination or autopsy. Symptoms such as abdominal pain and increasing girth occur only when the tumor grows large. We report the case of a giant adrenal myelolipoma in a 51-year old man who presented with a huge abdominal mass and abdominal pain. The resected tumor weighed 6,000 g and could represent the largest such tumor ever documented in the literature. We discuss the diagnosis and treatment of this unusual tumor.

[Changes in cytokines during perioperative period of hip arthroplasty in patients older than 80 years of age].

BACKGROUND: Elevations of plasma inflammatory cytokines are related to the surgical intervention. We have examined the circulating interleukin 6, 8 (IL-6, IL-8) and CRP responses in patients older than 80 years during orthopedic hip arthroplasty. METHODS: After taking the signed informed consent, 8 patients were enrolled in this study. All patients received standard spinal anesthesia combined with epidural catheterization. Samples were collected just before and after the surgery, and on 1st, 2nd and 7th day after the operation. RESULTS: Plasma IL-6 levels showed a significant increase on the day after surgery (5.6 +/- 3.7 vs. 52.2 +/- 24.1 pg.ml-1, mean +/- SD, P < 0.05), whereas although the levels of IL-8, increased (minimum 7.9 +/- 3.2 to maximum 70.3 +/- 80.2 pg.ml-1, mean +/- SD), the change was not significant. CRP levels were slightly elevated in the preoperative examination (2.8 +/- 3.5 mg.dl-1) and further increased on the 2nd day of surgery (8.3 +/- 5.4 mg.dl-1), but returned to a normal level on the 7th day. CONCLUSIONS: From the viewpoint of cytokines, this study showed that, although IL-8 level did not return to the preoperative value, the surgical stress of orthopedic hip arthroplasty in patients older than 80 years was almost of the same level as reported previously.

Underexpression of mRNA in human hepatocellular carcinoma focusing on eight loci.

Genetic alterations associated with human hepatocellular carcinoma (HCC) have been reported previously, but are not sufficient to specify differences of HCCs from precancerous diseases of the liver, such as hepatitis, hepatic fibrosis, and cirrhosis. In the present study, we performed differential gene display analysis (DGDA) to clarify the specific genetic alterations associated with gene expression changes in the course of development of HCC from chronic viral hepatitis. Four pairs of surgically resected HCCs and hepatitis tissues were investigated. We found 1,028 expression sequence tags (ESTs) that were decreased or increased in HCC tissues compared with hepatitis tissues in the same patient. Nucleotide sequencing showed that they included 55 EST clones in the GenBank database, which were considered candidates for specific messenger RNA (mRNA) expression alterations in HCCs. After excluding 9 ESTs that code mitochondrial DNA, we performed quantitative real-time reverse-transcription polymerase chain reaction (RT-PCR) for the 46 remaining EST clones. We found 8 mRNAs underexpressed in primary HCC tissues in 20 patients in higher percentages than found in previous studies, including 18 cases (90%) for aldolase B (ALDOB), 15 cases (75%) for carbamyl phosphate synthetase 1 (CPS1), albumin (ALB), plasminogen (PLG), and EST 51549, 13 cases (65%) for cytochrome P450 subfamily 2E1 (CYP2E1), 12 cases (60%) for human retinol-binding protein 4 (RBP4), and 11 cases (55%) for human organic anion transporter C (OATP-C) gene. In conclusion, underexpression of key gene products may be important in the development and/or progression of HCC.

Effects of nicardipine and diltiazem on fractal features of short-term heart rate variability--application of coarse graining spectral analysis.

PURPOSE: This study was designed to investigate the effects of nicardipine and diltiazem on the fractal features of short-term heart rate variability (HRV), using coarse graining spectral analysis (CGSA). METHODS: Eighteen healthy volunteers participated in this study; they were divided into two groups according to the drug administered. Five-minute electrocardiogram and arterial pressure recordings were made during stepwise infusions of either nicardipine (0.4, 0.8, 1.6, and 3.2 microg.kg(-1).min(-1)) or diltiazem (2, 4, 8, and 16 microg.kg(-1).min(-1)) under rate-controlled breathing at 0.25 Hz. CGSA broke down the total power of the time series into harmonic (low frequency [0.0-0.15 Hz; LF] and high frequency [0.15-0.5 Hz; HF]) and nonharmonic (fractal) components. Cardiac sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) activity indicators were evaluated as the ratios LF/HF and HF/TP (total spectral power), respectively. Fractal components were evaluated as %fractal and the spectral exponent beta of 1/f(beta). RESULTS: Compared with control measurements, the maximum dose of nicardipine infusion caused a significant decrease in systolic arterial pressure, a significant increase in the mean heart rate, and a significant increase in plasma norepinephrine level, findings that were associated with significant increases in %fractal and beta values (54.2 +/- 13.3 vs 75.6 +/- 9.8, and 0.86 +/- 0.22 vs 1.32 +/- 0.46, respectively; P < 0.05). PNS and SNS indicators showed decreased and increased values, respectively. Diltiazem caused a reduction in arterial pressure; however, no other parameters, including the nonharmonic components of HRV, were affected by this drug. CONCLUSIONS: These findings strongly suggest that nicardipine suppresses vagal cardiac neural outflow and activate the SNS, an action which, subsequently, causes changes in the fractal features of HRV. Although diltiazem reduces arterial pressure, it preserves the basic neural balance of the autonomic nervous system in regard to heart rate control.