Publications by authors named "Takashi Fujishiro"

69 Publications

The Structure of the Dimeric State of IscU Harboring Two Adjacent [2Fe-2S] Clusters Provides Mechanistic Insights into Cluster Conversion to [4Fe-4S].

Biochemistry 2021 May 3. Epub 2021 May 3.

Department of Biochemistry and Molecular Biology, Graduate School of Science and Engineering, Saitama University, Shimo-okubo 255, Sakura-ku, Saitama 338-8570, Japan.

IscU serves as a scaffold for the assembly of a [2Fe-2S] cluster prior to its delivery to recipient protein. It has also been proposed that on one dimer of bacterial IscU, two [2Fe-2S] clusters can be converted into a single [4Fe-4S] cluster. However, lack of structural information about the dimeric state of IscU has hindered our understanding of the underlying mechanisms. In this study, we determine the X-ray crystal structure of IscU from the thermophilic archaeon and demonstrate a dimer structure of IscU in which two [2Fe-2S] clusters are facing each other in close proximity at the dimer interface. Our structure also reveals for the first time that Asp40 serves as a fourth ligand to the [2Fe-2S] cluster with three Cys ligands in each monomer, consistent with previous spectroscopic data. We confirm by EPR spectroscopic analysis that in solution two adjacent [2Fe-2S] clusters in the wild-type dimer are converted to a [4Fe-4S] cluster via reductive coupling. Furthermore, we find that the H106A substitution abolishes the reductive conversion to the [4Fe-4S] cluster without structural alteration, suggesting that His106 is functionally involved in this process. Overall, these findings provide a structural explanation for the assembly and conversion of Fe-S clusters on IscU and highlight a dynamic process that advances via association and dissociation of the IscU dimer.
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http://dx.doi.org/10.1021/acs.biochem.1c00112DOI Listing
May 2021

Gap between flexion and extension ranges of motion: a novel indicator to predict the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy.

J Neurosurg Spine 2021 Apr 30:1-10. Epub 2021 Apr 30.

1Department of Orthopedic Surgery, Osaka Medical College, Takatsuki; and.

Objective: Kyphotic deformity resulting from the loss of cervical lordosis (CL) is a rare but serious complication after cervical laminoplasty (CLP), and it is essential to recognize the risk factors. Previous studies have demonstrated that a greater flexion range of motion (fROM) and smaller extension ROM (eROM) in the cervical spine are associated with the loss of CL after CLP. Considering these facts together, one can hypothesize that an indicator representing the gap between fROM and eROM (gROM) is highly useful in predicting postoperative CL loss. In the present study, the authors aimed to investigate the risk factors of marked CL loss after CLP for cervical spondylotic myelopathy (CSM), including the gROM as a potential predictor.

Methods: Patients who had undergone CLP for CSM were divided into those with and those without a loss of more than 10° in the sagittal Cobb angle between C2 and C7 at the final follow-up period compared to preoperative measurements (CL loss [CLL] group and no CLL [NCLL] group, respectively). Demographic characteristics, surgical information, preoperative radiographic measurements, and posterior paraspinal muscle morphology evaluated with MRI were compared between the two groups. fROM and eROM were examined on neutral and flexion-extension views of lateral radiography, and gROM was calculated using the following formula: gROM (°) = fROM - eROM. The performance of variables in discriminating between the CLL and NCLL groups was assessed using the receiver operating characteristic (ROC) curve.

Results: This study included 111 patients (mean age at surgery 68.3 years, 61.3% male), with 10 and 101 patients in the CLL and NCLL groups, respectively. Univariate analyses showed that fROM and gROM were significantly greater in the CLL group than in the NCLL group (40.2° vs 26.6°, p < 0.001; 31.6° vs 14.3°, p < 0.001, respectively). ROC curve analyses revealed that both fROM and gROM had excellent discriminating capacities; gROM was likely to have a higher area under the ROC curve than fROM (0.906 vs 0.860, p = 0.094), with an optimal cutoff value of 27°.

Conclusions: The gROM is a highly useful indicator for predicting a marked loss of CL after CLP. For CSM patients with a preoperative gROM exceeding 30°, CLP should be carefully considered, since kyphotic changes can develop postoperatively.
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http://dx.doi.org/10.3171/2020.10.SPINE201723DOI Listing
April 2021

Central visual field change after fornix-based trabeculectomy in Japanese normal-tension glaucoma patients managed under 15 mmHg.

Graefes Arch Clin Exp Ophthalmol 2021 Apr 30. Epub 2021 Apr 30.

Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan.

Purpose: To investigate how the central visual field would be changed after fornix-based trabeculectomy with mitomycin C in Japanese normal-tension glaucoma (NTG) patients monitored for more than 10 years including before surgery.

Methods: This is a retrospective cohort study. We identified twenty-eight eyes of 28 NTG cases regularly monitored for more than 5 years and examined static visual field (VF) tests for more than five times before and after fornix-based trabeculectomy (including combined surgery). Based on preoperative data for 6.3 years, we evaluated postoperative changes for 6.0 years in 10-2 VF and 30-2 VF.

Results: Six patients were male and 22 females, the mean age was 57.9 years, and the mean deviation was - 13.7 decibels. After surgery, mean IOP decreased from 13.9 to 9.0 mmHg (P ≤ 0.01), and medication score also did. The rate of 10-2 VF deterioration was significantly suppressed from - 1.0 dB/year preoperatively to - 0.4 dB/year postoperatively (P ≤ 0.01). And when 30-2 VF was divided into six relevant sectors, the rate of deterioration at cecocentral and arcuate areas of the superior hemifield was suppressed postoperatively (P ≤ 0.01 and P = 0.042, respectively).

Conclusion: Based on long-term preoperative data, a significant positive change in 10-2 VF was observed after fornix-based trabeculectomy with mitomycin C in Japanese NTG patients with a mean IOP of 13.9 mmHg. Central vision could be expected to be maintained for NTG patients even if its preoperative IOP is low after successful trabeculectomy.
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http://dx.doi.org/10.1007/s00417-021-05215-yDOI Listing
April 2021

Relative pelvic version displays persistent compensatory measures with normalised sagittal vertical axis after deformity correction.

Spine Deform 2021 Apr 29. Epub 2021 Apr 29.

Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.

Purpose: A normal sagittal vertical axis (SVA) after spinal deformity correction can yield mechanical complications of up to 30%. Post-operative compensatory pelvic orientation can produce a normal SVA. We assess relative pelvic version (RPV), an individualised measure, for persistent post-operative compensatory measures.

Methods: Adult spinal deformity (ASD) patients who were treated operatively, with a normal SVA (< ± 50 mm) at 6-week follow-up were included, who were then followed-up after 2 years. These only included patients with fusion of > 4 vertebrae extending to L5 or below. Six-week subgroups were made regarding pelvis orientation, relative pelvic version (RPV: anteversion, aligned, moderate or severe retroversion) with analysis of patient-related outcome measures (PROMs), complications and spino-pelvic sagittal parameters.

Results: At 6 weeks, 140 patients met the inclusion criteria, 5 (3.6%) patients had anteversion, 59 (42.1%) were aligned, 60 (42.9%) had moderate retroversion and 16 (11.4%) patients had severe retroversion. Follow-up after 2 years demonstrated increased RPV in all groups except the severe RPV group who were more likely to develop SVA > 50 mm. Complications occurred in all groups. Significant 2-year differences were observed between moderate and severe RPV for back pain and PROMs but not between other RPV groups.

Conclusion: Adult spinal deformity patients with a normal SVA after spino-pelvic instrumentation carry a significant risk of retroversion progression post-operatively, followed by increased positive sagittal balance. Relative pelvic version (RPV) measurements when categorised into anteversion, aligned, moderate retroversion and severe retroversion at 6 weeks were predictive of PROMs at 2 years.
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http://dx.doi.org/10.1007/s43390-021-00345-zDOI Listing
April 2021

A cyclic lipopeptide surfactin is a species-selective Hsp90 inhibitor that suppresses cyanobacterial growth.

J Biochem 2021 Mar 26. Epub 2021 Mar 26.

Department of Cell and Developmental Biology, Graduate School of Biostudies, Kyoto University, Kyoto, 606-8502, Japan.

Heat shock protein 90 (Hsp90) is essential for eukaryotic cells, whereas bacterial homologs play a role under stresses and in pathogenesis. Identifying species-specific Hsp90 inhibitors is challenging because Hsp90 is evolutionarily conserved. We found that a cyclic lipopeptide surfactin inhibits the ATPase activity of Hsp90 from the cyanobacterium Synechococcus elongatus (S. elongatus) PCC 7942 but does not inhibit Escherichia coli (E. coli), yeast and human Hsp90s. Molecular docking simulations indicated that surfactin could bind to the N-terminal dimerization interface of the cyanobacterial Hsp90 in the ATP- and ADP-bound states, which provided molecular insights into the species-selective inhibition. The data suggest that surfactin inhibits a rate-limiting conformational change of S. elongatus Hsp90 in the ATP hydrolysis. Surfactin also inhibited the interaction of the cyanobacterial Hsp90 with a model substrate, and suppressed S. elongatus growth under heat stress, but not that of E. coli. Surfactin did not show significant cellular toxicity toward mammalian cells. These results indicate that surfactin inhibits the cellular function of Hsp90 specifically in the cyanobacterium. The present study shows that a cyclic peptide has a great specificity to interact with a specific homolog of a highly conserved protein family.
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http://dx.doi.org/10.1093/jb/mvab037DOI Listing
March 2021

Preoperative Cyst Formation as a Predictive Feature of Spontaneous Regression of Retro-Odontoid Pseudotumor After Posterior Fusion.

World Neurosurg 2021 Mar 17. Epub 2021 Mar 17.

Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.

Objective: Although the spontaneous regression of pseudotumors after posterior fusion has been reported, the predictive factors remain unclear. We examined the radiological features that predict for the regression of retro-odontoid pseudotumors after posterior fusion, with a specific focus on cyst formation.

Methods: We included 28 patients with a diagnosis of retro-odontoid pseudotumor using preoperative magnetic resonance imaging. The radiographic parameters and pseudotumor thickness were measured pre- and postoperatively. The regression rate for each pseudotumor was calculated. The presence of a cyst around the retro-odontoid pseudotumor was investigated. If present, the cyst thickness was measured. To elucidate the predictors for the postoperative regression of pseudotumors, the patients were divided into 2 cohorts: the regression group with a regression rate >40% and the no-regression group with a regression rate of <40%. Multivariate logistic regression analysis, including the demographic data and preoperative radiographic parameters as independent variables, was performed.

Results: The mean pseudotumor size had decreased significantly from 8.8 ± 3.6 mm preoperatively to 5.3 ± 2.0 mm postoperatively (P < 0.0001). The mean regression rate was 35.9% during a magnetic resonance imaging follow-up period of 8.6 months (range, 6-12 months). Cystic lesions were noted in 10 patients (35.7%) preoperatively. The mean cyst size was 4.7 ± 1.9 mm. All cysts were located dorsal to the pseudotumors and were involved at the maximum spinal compression levels. Nevertheless, all the cysts had disappeared postoperatively. Multivariate logistic regression analysis revealed that the pseudotumor regression group had had a significantly greater proportion of cysts (57.1% vs. 14.3%; odds ratio, 11.7; P = 0.013).

Conclusions: The presence of cystic lesions protruding from retro-odontoid pseudotumors might serve as a predictive factor for the spontaneous regression of pseudotumors after posterior fusion.
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http://dx.doi.org/10.1016/j.wneu.2021.03.049DOI Listing
March 2021

Biologic Agents Preserve the C-2 Pedicle in Patients with Rheumatoid Arthritis: A Comparative Imaging Study Using Three-Dimensional Computed Tomography.

World Neurosurg 2021 May 27;149:e42-e50. Epub 2021 Feb 27.

Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.

Objective: To investigate whether biologic agents (BAs) reduce a narrow C-2 pedicle screw trajectory, which is often a key stabilizer in surgical treatment, in patients with rheumatoid arthritis (RA).

Methods: A total of 100 patients with RA treated with and without BAs (BA [+] group [n = 50] and BA [-] group [n = 50]), respectively, were included in the present study. Computed tomography (CT) images of their cervical spine, including C-2, were analyzed. The maximum screw diameter at C-2 that could be inserted without breaching the cortex, measured on 3-dimensional images using a CT-based navigation system, was compared between the groups with and without BA administration. Furthermore, the destruction of the atlantoaxial joint was examined using CT images. The risk factors for a narrow C-2 pedicle were elucidated among the patients treated with BAs.

Results: The pedicle in the BA (+) group had a significantly larger C-2 maximum screw diameter than the BA (-) group (6.00 mm vs. 5.13 mm, P < 0.001), with less destruction of the atlantoaxial joint. Among the BA (+) group, a longer period until the initial administration of BAs and RA disease duration were associated with a narrow C-2 pedicle.

Conclusions: This study suggests that BAs can maintain the trajectory for C-2 pedicle screws, which acts as a key stabilizer in surgical management for the rheumatoid cervical spine, by halting the destruction of the atlantoaxial joint. Early introduction of BAs can be especially important to prevent the narrowing of the C-2 pedicle.
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http://dx.doi.org/10.1016/j.wneu.2021.02.096DOI Listing
May 2021

Evaluation of fornix-based trabeculectomy outcomes in Japanese glaucoma patients based on concrete long-term preoperative data.

Jpn J Ophthalmol 2021 Mar 9;65(2):306-312. Epub 2021 Jan 9.

Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Purpose: To investigate the outcomes of fornix-based trabeculectomy in Japanese patients with glaucoma based on more than five years of preoperative data.

Study Design: Retrospective case series METHODS: This study consisted of 35 eyes of 35 Japanese glaucoma patients (mean age: 60.6, standard deviation (SD) 11.5 years) who received initial fornix-based trabeculectomy from a single ophthalmology clinic, with one or more reliable visual field test results per year from at least five years before and after the surgery. Measurements included postoperative mean intraocular pressure (IOP), standard deviation of IOP, medication scores, mean deviation slope, and total deviation slope were evaluated based on preoperative data. The relationship between mean IOP, SD-IOP and the visual field (VF) deterioration speed was also analysed.

Results: The mean follow-up period before surgery was 6.15 (SD 0.97) years and post surgery it was 5.95 (SD 0.63) years. The preoperative mean IOP of 14.6 (SD 2.3) mmHg significantly decreased to 9.2 (SD 2.2) mmHg (P <.001). The preoperative medication score 2.7 (SD 0.5) significantly decreased to 0.1 (SD 0.4, P <.001). The preoperative MD slope of -0.52 (SE 0.047) dB/year significantly improved to -0.31 (SE 0.14) dB/year (P <.01), with improvement in the superior hemifield (P ≤.018). Inferior hemifield (P >.10) did not follow the trend. Neither mean IOP nor SD-IOP correlated with the VF deterioration speed.

Conclusions: Fornix-based trabeculectomy is an acceptable procedure for initial surgical management of glaucoma, especially for maintenance of superior VF.
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http://dx.doi.org/10.1007/s10384-020-00797-2DOI Listing
March 2021

Twelve-month surgical outcome and prognostic factors of stand-alone ab interno trabeculotomy in Japanese patients with open-angle glaucoma.

PLoS One 2021 7;16(1):e0245015. Epub 2021 Jan 7.

Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.

The purpose of the study was to evaluate the 12-month surgical outcome and prognostic factors of stand-alone ab interno trabeculotomy. The changes in the intraocular pressure (IOP) and medication score and the success rate of the surgery were analyzed. Thirty-four eyes of 29 patients with primary open-angle glaucoma (POAG; n = 16) or pseudoexfoliation glaucoma (PEG; n = 18) with a 12-month follow-up period were included in the study. The decreases in IOP and medication score from the baseline to the all-time-point were statistically significant (P < 0.001). The surgical success rates were 97.1%, 76.5%, and 44.0% at 3 months (90 days), 6 months (180 days), and 12 months (365 days), respectively. A mixed effect Cox model revealed that the type of glaucoma (POAG) was significantly associated with surgical failure (P = 0.044). Furthermore, the surgical success rate was significantly higher in eyes with PEG than it was in those with POAG (P = 0.019). Stand-alone ab interno trabeculotomy significantly lowered both the IOP and the medication score in patients with glaucoma, although almost one quarter of the cases needed additional glaucoma surgeries. The surgical success rate was significantly higher in eyes with PEG than it was in those with POAG.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245015PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790371PMC
January 2021

Comparison of 12-month surgical outcomes of ab interno trabeculotomy with phacoemulsification between spatula-shaped and dual-blade microhooks.

Jpn J Ophthalmol 2021 May 7;65(3):402-408. Epub 2021 Jan 7.

Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.

Purpose: To compare 12-month clinical results of spatula-shaped and dual-blade microhooks ab interno trabeculotomy with phacoemulsification.

Study Design: Retrospective comparative study.

Methods: We conducted a retrospective chart review of Japanese open-angle glaucoma patients who underwent ab interno trabeculotomy with phacoemulsification with a 12-month follow-up. Two types of trabecular hook were used: the spatula-shaped Tanito Trabeculotomy ab interno Micro-hook and the Kahook Dual Blade. Changes in intraocular pressure (IOP) and medication scores comprised the main outcome metrics. We also analyzed and compared patient demographics and the occurrence of complications.

Results: Trabeculotomy was performed using a spatula-shaped hook in 17 eyes and a dual-blade hook in 15 eyes. Significant reductions in IOP (p < 0.001) and medication scores (p < 0.001) were noted in both groups after the 1-month time point. The percentage changes of IOP from baseline at each time point were not significantly different between groups, though there was a significant difference in medication scores at 12 months (p = 0.0192). Postoperative complications occurred similarly in both groups; one case in the dual-blade group required additional filtration surgery.

Conclusions: Ab interno trabeculotomy with phacoemulsification was effective in lowering IOP both with spatula-shaped and with double-blade microhooks. At 12 months more medications were used postoperatively in the spatula-shaped microhook group; however, the reductions in the medication scores from baseline were statistically significant in both groups.
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http://dx.doi.org/10.1007/s10384-020-00806-4DOI Listing
May 2021

Evidence for dynamic in vivo interconversion of the conformational states of IscU during iron-sulfur cluster biosynthesis.

Mol Microbiol 2021 Apr 5;115(4):807-818. Epub 2020 Dec 5.

Department of Biochemistry and Molecular Biology, Graduate School of Science and Engineering, Saitama University, Saitama, Japan.

IscU is a central component of the ISC machinery and serves as a scaffold for de novo assembly of Fe-S clusters. The dedicated chaperone system composed of the Hsp70-chaperone HscA and the J-protein cochaperone HscB synergistically interacts with IscU and facilitates cluster transfer from IscU to recipient apo-proteins. Here, we report that the otherwise essential roles of HscA and HscB can be bypassed in vivo by a number of single amino acid substitutions in IscU. CD spectroscopic studies of the variant IscU proteins capable of this bypass activity revealed dynamic interconversion between two conformations: the denatured (D) and the structured (S) state in the absence and presence of Zn , respectively, which was far more prominent than interconversion observed in wild-type IscU. Furthermore, we found that neither the S-shifted (more structured) variants of IscU nor the perpetually denatured variants could perform their in vivo role regardless of whether the chaperone system was present or not. The present study thus provides for the first time evidence that an in vivo D-state of IscU exists and implies that conformational interconversion between the S- and D-states of the scaffolding protein is a fundamental requirement for the assembly and transfer of the Fe-S cluster.
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http://dx.doi.org/10.1111/mmi.14646DOI Listing
April 2021

Relationship Between Macular Ganglion Cell Thickness and Ocular Elongation as Measured by Axial Length and Retinal Artery Position.

Invest Ophthalmol Vis Sci 2020 09;61(11):16

Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.

Purpose: We recently reported on the usefulness of retinal artery trajectory in estimating the magnitude of retinal stretch due to myopia. The purpose of the present study was to elucidate the relationship between the peripapillary retinal artery angle (PRAA) and thickness of the macular ganglion cell-inner plexiform layer (GCIPL).

Methods: This r included 138 healthy eyes of 79 subjects older than 20 years of age without any known eye disease. GCIPL thickness was separated into eight sectors according to quadrant and eccentricity from the fovea. The PRAA was calculated as the angle between the superior and inferior retinal arteries. Relationships between whole GCIPL thickness (average and sectorial) and the values of PRAA and axial length (AL) were investigated using a linear mixed model.

Results: Average GCIPL thickness in the whole scanned area decreased significantly with narrowing of the PRAA with and without adjusting for AL. Sectorized macular GCIPL thickness also decreased significantly, with narrowing of the PRAA in seven out of the eight with the adjustment of AL, the exception being the inferior peripheral temporal sector.

Conclusions: Macular GCIPL thickness decreased significantly with narrowing of the PRAA on average and in seven out of eight sectors.
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http://dx.doi.org/10.1167/iovs.61.11.16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488627PMC
September 2020

Clinical Performance and Concurrent Validity of the Adult Spinal Deformity Surgical Decision-making Score.

Spine (Phila Pa 1976) 2020 Jul;45(14):E847-E855

Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, France.

Study Design: Multicenter, retrospective study.

Objective: The aim of this study was to examine the performance and concurrent validity of the adult spinal deformity surgical decision-making (ASD-SDM) score compared to decision-making factors in the ASD population.

Summary Of Background Data: The ASD-SDM score, which has been recently proposed, is a scoring system to guide the selection of treatment modality for the ASD population. To secure the justification for its clinical use, it is necessary to verify its clinical performance and concurrent validity.

Methods: A multicenter prospective ASD database was retrospectively reviewed. The data were analyzed separately in younger (≤40 years) and older (≥41 years) age groups. The discriminating capacity of the ASD-SDM score in cases who selected surgical and nonsurgical management was compared using area under the receiver operator characteristic curves (AUROC). Concurrent validity was examined using Spearman correlation coefficients, comparing factors that are reported to be associated with the decision-making process for ASD, including baseline symptomatology, health-related quality of life measures, and the severity of radiographic spinal deformity.

Results: There were 338 patients (mean age: 26.6 years; 80.8% female; 129 surgical and 209 nonsurgical) in the younger age group and 750 patients (mean age: 63.5 years; 84.3% female; 410 surgical and 340 nonsurgical) in the older age group. In both younger and older patients, the ASD-SDM score showed a significantly higher performance for discriminating the surgical and nonsurgical cases (AUROC: 0.767, standard error [SE]: 0.026, P < 0.001, 95% confidence interval [CI]: 0.712-0.813; AUROC: 0.781, SE: 0.017, P < 0.001, 95% CI: 0.747-0.812, respectively) compared to the decision-making factors analyzed. In addition, the ASD-SDM showed significant correlations with multiple decision-making factors.

Conclusion: The ASD-SDM score alone can effectively grade the indication for surgical management whilst considering multiple decision-making factors.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000003434DOI Listing
July 2020

Comparison of the short-term effectiveness and safety profile of ab interno combined trabeculotomy using 2 types of trabecular hooks.

Jpn J Ophthalmol 2020 Jul 12;64(4):407-413. Epub 2020 Jun 12.

Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Purpose: To compare the short-term surgical effectiveness and safety profile of ab interno trabeculotomy using 2 types of trabecular hooks.

Study Design: Retrospective comparative study.

Patients And Methods: A retrospective chart review was performed on Japanese open-angle glaucoma patients who underwent ab interno trabeculotomy with phacoemulsification and who had a 6-month follow-up. Trabeculotomy was performed using 2 kinds of trabecular hooks, the Tanito ab interno Trabeculotomy Micro-hook (TMH) or the Kahook Dual Blade (KDB). The patients' demographics, preoperative and postoperative intraocular pressures (IOPs), medication scores, and occurrence of complications were analyzed and compared.

Results: Fifty-nine eyes with open-angle glaucoma were included in the final analysis. Trabeculotomy was performed using the TMH in 30 eyes (50.8%) and the KDB in 29 eyes (49.2%). Significant decreases in IOP from the baseline (P < 0.001, except for the 1-month time-point in the KDB group, when P < 0.01) after the 1-month time-point and the medication scores (P < 0.001) at all time-points were noted in both groups. However, the percentage changes in the IOP and medication scores from the baseline at each time-point did not differ significantly between the 2 groups, with the exception of the medication score at the 1-month time-point (P < 0.0283). The occurrence of postoperative complications was similar in the 2 groups.

Conclusions: The present study demonstrates the absence of significant differences in IOP and medication score reductions at almost all time-points between the TMH and KDB groups.
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http://dx.doi.org/10.1007/s10384-020-00750-3DOI Listing
July 2020

Assessing the Intraoperative Risk of Esophageal Perforation during Anterior Cervical Spine Surgery: A Study Using Intraoperative Computed Tomography.

Spine Surg Relat Res 2020 4;4(2):124-129. Epub 2019 Sep 4.

Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.

Introduction: Using intraoperative computed tomography (iCT), we aimed to clarify the course of the esophagus and pharynx during anterior cervical spine surgery to estimate the risk of intraoperative injury.

Methods: Sixteen patients who underwent anterior cervical spine surgery with intraoperative CT for registration of a navigation system without release of blade retraction were included. To investigate the status of the retracted esophagus and pharynx, the distance between the nasogastric tube and center of the vertebra (NVD) was measured at each disc and vertebral level (C4-7) using axial CT. The location of the cricoid cartilage, which may affect the shift of the esophagus and pharynx, was noted. Presence or absence of contact between the esophagus and the edge of the surgical blade was investigated.

Results: The NVDs were 28.0, 28.3, 28.9, 27.2, 24.7, 19.9, and 13.8 mm at C4, C4/5, C5, C5/6, C6, C6/7, and C7, respectively; NVDs at C6/7 or more caudal levels were significantly shorter than those at C6 or more cranial levels (P < 0.001). The cricoid cartilage was observed at the C4-C5/6 level. Esophageal contact with the edge of the blade was observed in nine cases at C6 or more caudal levels.

Conclusions: The esophagus, which was placed at C6 or more caudal levels, was directly retracted by the blade. Nevertheless, the pharynx, which was placed at C6 or more cranial levels, was mostly retracted with the cricoid cartilage. Thus, the risk of direct esophageal injury was higher at C6 or more caudal levels than at cranial levels.
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http://dx.doi.org/10.22603/ssrr.2019-0026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217672PMC
September 2019

Significance of flexion range of motion as a risk factor for kyphotic change after cervical laminoplasty.

J Clin Neurosci 2020 Jun 10;76:100-106. Epub 2020 Apr 10.

Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.

Kyphotic deformity is a rare but serious complication after cervical laminoplasty (CLP), and several studies have investigated its predictors. In these studies, a kyphotic Cobb angle of 0°-5° between C2 and C7 at a certain postoperative time-point was often used to detect kyphotic deformity. However, studies considering the amount of cervical lordosis loss compared to the preoperative measurement are scarce. This study aimed to elucidate risk factors for kyphotic change after CLP by comparing patients with and without marked loss of cervical lordosis postoperatively. The study population was divided into seven patients with and 92 patients without a loss of >10° of the C2-7 angle during the follow-up period compared to the preoperative measurements [cervical lordosis loss (CLL) group and no CLL (NCLL) group, respectively]; demographic characteristics, surgical information, preoperative radiographic sagittal parameters of the cervical spine, and posterior paravertebral muscle morphology evaluated by magnetic resonance imaging were compared between two groups. A univariate analysis revealed that the CLL group had significantly greater flexion range of motion (fROM) than the NCLL group (43.0° vs. 25.8°, P < 0.001); however, no statistical significance was identified for other parameters. The fROM had a high capacity to discriminate between the CLL and NCLL groups (area under the receiver-operating characteristic curve, 0.880; P < 0.001; 95% confidence interval, 0.589-0.974) with an optimal cutoff point of 37°. This study suggests that greater fROM is a risk factor for the development of kyphotic changes after CLP. For patients with preoperative fROM exceeding 40°, CLP should be carefully indicated.
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http://dx.doi.org/10.1016/j.jocn.2020.04.034DOI Listing
June 2020

Surgical Outcomes of Postural Instability in Patients With Cervical Myelopathy.

Clin Spine Surg 2020 Dec;33(10):E466-E471

Department of Orthopedic Surgery, Osaka Medical College, Takastuki, Japan.

Study Design: This is a retrospective study.

Objective: The objective of this study was to investigate the surgical outcomes of postural instability and its predictors in patients with cervical myelopathy (CM).

Summary Of Background Data: Although several studies have shown impaired postural stability in CM patients, there remains a paucity of literature examining its surgical outcome.

Materials And Methods: Postural stability was assessed using a stabilometer preoperatively, at the early phase (3-6 months postoperatively), and 1-year postoperatively, employing 2 stabilometric parameters: sway area [SwA (cm): the amount of sway of gravity center assessed by the outer peripheral area of the stabilogram] and sway density [SwD (/cm): the indicator of proprioceptive reflexes calculated by the locus length of the stabilogram per SwA]. Twenty-seven healthy age-matched, sex-matched, and body mass index-matched subjects were recruited as controls. To investigate the predictors of postoperative postural instability, univariate, and multivariate analyses were performed, including demographic data, preoperative neurological symptom severity, radiographic findings, and preoperative stabilometric parameters as independent variables.

Results: Altogether, 54 CM patients were included in the present study. SwA was 7.89±0.84, 4.78±0.68, and 4.85±0.49, and SwD was 14.63±0.85, 20.41±1.23, and 19.36±1.40 preoperatively, at the early phase, and 1-year postoperatively, respectively, and significant improvement was found in both parameters postoperatively. However, at all timepoints, these parameters were significantly worse in CM patients than in the healthy subjects (SwA: 2.68±0.24, SwD: 24.91±1.83). Multivariate analyses showed that worse preoperative stabilometric parameters were significantly related to worse postoperative stabilometric parameters.

Conclusions: Surgery significantly improved postural stability in CM patients; however, it did not reach the level observed in healthy controls, even postoperatively. A predictor of greater residual postoperative postural instability was a greater level of preoperative postural instability. In CM patients, to achieve better surgical outcome of postural stability, surgical intervention is recommended before the symptoms related to bodily imbalance deteriorate.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1097/BSD.0000000000000972DOI Listing
December 2020

The Relationship Between Corvis ST Tonometry Parameters and Ocular Response Analyzer Corneal Hysteresis.

J Glaucoma 2020 06;29(6):479-484

Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo.

Precis: Corvis ST Tonometry and Ocular Response Analyzer (ORA) measurements were conducted in primary open-angle glaucoma and normative subjects. Many parameters were significantly correlated, however, the strengths were weak to moderate.

Purpose: Reichert ORA parameters are derived from pressure information following the application of air-jet, whereas detailed structural observation can be made using the Corneal Visualization Scheimpflug Technology instrument (CST). The purpose of the study was to investigate the association between CST measurements and ORA measured corneal hysteresis (CH).

Methods: Measurements of CST, ORA, axial length, average corneal curvature, central corneal thickness (CCT) and intraocular pressure with Goldmann applanation tonometry were carried out in 104 eyes of 104 patients with primary open-angle glaucoma and 35 eyes from normative subjects. The association between CST and ORA parameters was assessed using linear regression analysis, with model selection based on the second order bias corrected Akaike Information Criterion index.

Results: Deformation amplitude ratio (corneal softness, R=-0.51), SP A1 (corneal stiffness, R=0.41), and Inverse Radius (integrated area under the curve of the inverse concave radius, R=-0.44) were significantly correlated with CH (P <0.05). The optimal model to explain CH using CST measurements was given by: CH=-76.3+4.6×A1 time (applanation time in the corneal inward movement)+1.9×A2 time (second applanation time in the corneal outward movement) + 3.1 × highest concavity deformation amplitude (magnitude of movement of the corneal apex from before deformation to its highest concavity) + 0.016×CCT (R=0.67; P<0.001).

Conclusions: CST parameters are significant, but weakly or moderately, related to ORA measured CH.
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http://dx.doi.org/10.1097/IJG.0000000000001486DOI Listing
June 2020

Structural Changes and Astrocyte Response of the Lateral Geniculate Nucleus in a Ferret Model of Ocular Hypertension.

Int J Mol Sci 2020 Feb 17;21(4). Epub 2020 Feb 17.

Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo 113-8655, Japan.

We investigated structural changes and astrocyte responses of the lateral geniculate nucleus (LGN) in a ferret model of ocular hypertension (OH). In 10 ferrets, OH was induced via the injection of cultured conjunctival cells into the anterior chamber of the right eye; six normal ferrets were used as controls. Anterograde axonal tracing with cholera toxin B revealed that atrophic damage was evident in the LGN layers receiving projections from OH eyes. Immunohistochemical analysis with antibodies against NeuN, glial fibrillary acidic protein (GFAP), and Iba-1 was performed to specifically label neurons, astrocytes, and microglia in the LGN. Significantly decreased NeuN immunoreactivity and increased GFAP and Iba-1 immunoreactivities were observed in the LGN layers receiving projections from OH eyes. Interestingly, the changes in the immunoreactivities were significantly different among the LGN layers. The C layers showed more severe damage than the A and A1 layers. Secondary degenerative changes in the LGN were also observed, including neuronal damage and astrocyte reactions in each LGN layer. These results suggest that our ferret model of OH is valuable for investigating damages during the retina-brain transmission of the visual pathway in glaucoma. The vulnerability of the C layers was revealed for the first time.
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http://dx.doi.org/10.3390/ijms21041339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072923PMC
February 2020

The effect of increasing body mass index on the pain and function of patients with adult spinal deformity.

J Spine Surg 2019 Dec;5(4):535-540

L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France.

Background: Both adult spinal deformity (ASD) and obesity are growing concerns internationally. This study therefore aims to determine the effect of increasing body mass index (BMI) on the pain and function of patients with ASD.

Methods: A retrospective review of prospectively collected data from a multicentre European database was undertaken. Initially a univariate analysis was performed on the effect of BMI on the initial presentation of functional scores in patients with ASD. The functional scores included the Numerical Rating Scale (NRS) back and leg score, Core Outcome Measures Index (COMI) back score, SRS22 total score, Short Form 36 (SF-36) [general health, physical component score (PCS) and mental component score (MCS)] and Oswestry Disability Index (ODI) score (including all domains). Subsequently a multivariate analysis controlling for age, sex, comorbidities, employment status, smoking status and radiological parameters [coronal cobb, coronal balance, sagittal balance, global tilt, and pelvic incidence minus lumbar lordosis (PI - LL) mismatch] was performed.

Results: A total of 1,004 patients were included in this study (166 male, 838 female). On univariate analysis a statistically significant (P<0.05) moderate correlation between NRS leg pain, ODI (walking, standing, sex life, social life and total score), SF-36 (physical component), sagittal balance, global tilt and age were recognised (P<0.05). A statistically significant low correlation was identified for all other outcomes, except coronal balance (P=0.640). On multivariate analysis BMI remained significantly related to all functional outcomes except ODI-pain and ODI-travelling (P>0.05).

Conclusions: Increasing BMI has a significant adverse effect on the pain and functioning of patients with ASD. Clinicians should recognise this association and treat patients accordingly.
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http://dx.doi.org/10.21037/jss.2019.11.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989938PMC
December 2019

Gas containing intraspinal synovial cyst in the lumbar spine: Case report and literature review.

J Clin Neurosci 2020 Feb 23;72:449-451. Epub 2020 Jan 23.

Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.

Intraspinal synovial cyst (ISC) is a well-documented pathology. It is sometimes found in the degenerative lumbar spine and can result in neurological disorders. ISC typically contains xanthochromic fluid, blood, inflammatory tissue, and/or osseous structures, enclosed by fibrous tissue. Regarding the treatment modalities, the effectiveness of both nonsurgical management, such as oral analgesics, needle aspiration, and intra-articular injection of corticosteroid drugs, and surgical management, have been reported. Previous studies have described that the ISC can contain gas, which is derived from the vacuum phenomenon of an adjacent facet joint; however, this clinical condition has never been systematically investigated because of its rarity. In the present report, we describe the case of a 68-year-old male with gas-containing ISC in the lumbar spine who was successfully treated with surgical management; additionally, we performed a literature review to discuss the decision-making process for cases of gas-containing ISC. Based on our findings and previous literature, we recommend that considering the peculiarity of the content of such lesions in addition to the ball-valve effect of a synovial cyst, prompt transition to surgical management would be pertinent when nonsurgical treatment cannot achieve satisfactory outcomes in such cases.
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http://dx.doi.org/10.1016/j.jocn.2020.01.047DOI Listing
February 2020

Health-related quality of life, including marital and reproductive status, of middle-aged Japanese women with posterior spinal fusion using Cotrel-Dubousset instrumentation for adolescent idiopathic scoliosis: Longer than 22-year follow-up.

J Orthop Sci 2020 Sep 24;25(5):820-824. Epub 2019 Dec 24.

Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.

Background: Few studies have examined long-term outcomes after posterior spinal fusion using Cotrel-Dubousset instrumentation (CDI) for adolescent idiopathic scoliosis (AIS). Most patients with AIS are female, and their main concern is how spinal fusion will affect their future life. This study aimed to investigate the long-term health-related quality of life (HRQOL), including marital and reproductive status, of middle-aged Japanese women who underwent posterior spinal fusion using CDI for AIS in its earliest days in Japan.

Methods: Japanese women who were younger than 20 years of age at the time of surgery using CDI, between 1985 and 1995, were targeted. Roland-Morris Disability Questionnaire, Oswestry Disability Index, Scoliosis Research Society-22 questionnaire, and 36-Item Short-Form Survey (SF-36) were used to evaluate HRQOL. Marital and reproductive status were also investigated. These results were compared to those of healthy women controls and Japanese national data for 2015.

Results: Of 87 female patients, 29 (33.3%) were included, with 71 healthy women as controls. The average age of the patient group was 42.7 years (range 37-48 years), and the average follow-up period was 27.5 years (range 22-32 years). HRQOL scores in the patient group were generally lower than that in the healthy control group, although there was no significant difference between the two groups in the role component summary score (RCS) of SF-36. Marital and reproductive status were not significantly different between patient and control groups, and results for the patient group were similar to Japanese national data.

Conclusions: This is the first study of HRQOL in middle-aged patients who underwent posterior spinal fusion using CDI for AIS in Japan. Although HRQOL scores expect RCS of the patient group were lower than those of the healthy control group, the effects of posterior spinal fusion using CDI on women's social life and marital and reproductive statuses were minimal.
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http://dx.doi.org/10.1016/j.jos.2019.11.007DOI Listing
September 2020

Snapshots of PLP-substrate and PLP-product external aldimines as intermediates in two types of cysteine desulfurase enzymes.

FEBS J 2020 03 19;287(6):1138-1154. Epub 2019 Oct 19.

Department of Biochemistry and Molecular Biology, Graduate School of Science and Engineering, Saitama University, Saitama, Japan.

Cysteine desulfurase enzymes catalyze sulfur mobilization from l-cysteine to sulfur-containing biomolecules such as iron-sulfur (Fe-S) clusters and thio-tRNAs. The enzymes utilize the cofactor pyridoxal-5'-phosphate (PLP), which forms the external substrate- and product-aldimines and ketimines during catalysis and are grouped into two types (I and II) based on their different catalytic loops. To clarify the structure-based catalytic mechanisms for each group, we determined the structures of the external substrate- and product-aldimines as catalytic intermediates of NifS (type I) and SufS (type II) that are involved in Fe-S cluster biosynthesis using X-ray crystallographic snapshot analysis. As a common intermediate structure, the thiol group of the PLP-l-cysteine external aldimine is stabilized by the conserved histidine adjacent to PLP through a polar interaction. This interaction makes the thiol group orientated for subsequent nucleophilic attack by a conserved cysteine residue on the catalytic loop in the state of PLP-l-cysteine ketimine, which is formed from the PLP-l-cysteine aldimine. Unlike the intermediates, structural changes of the loops were different between the type I and II enzymes. In the type I enzyme, conformational and topological change of the loop is necessary for nucleophilic attack by the cysteine. In contrast, the loop in type II cysteine desulfurase enzymes showed no large conformational change; rather, it might possibly orient the thiol group of the catalytic cysteine for nucleophilic attack toward PLP-l-cysteine. The present structures allow a revision of the catalytic mechanism and may provide a clue for consideration of enzyme function, structural diversity, and evolution of cysteine desulfurase enzymes. DATABASE: Structural data are available in PDB database under the accession numbers 5WT2, 5WT4, 5ZSP, 5ZST, 5ZS9, 5ZSK, 5ZSO, 6KFZ, 6KG0, and 6KG1.
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http://dx.doi.org/10.1111/febs.15081DOI Listing
March 2020

Activation of the Sphingosine 1 Phosphate-Rho Pathway in Pterygium and in Ultraviolet-Irradiated Normal Conjunctiva.

Int J Mol Sci 2019 Sep 20;20(19). Epub 2019 Sep 20.

Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.

Sphingosine 1 phosphate (S1P) is a bioactive lipid that regulates cellular activity, including proliferation, cytoskeletal organization, migration, and fibrosis. In this study, the potential relevance of S1P-Rho signaling in pterygium formation and the effects of ultraviolet (UV) irradiation on activation of the S1P/S1P receptor axis and fibrotic responses were investigated in vitro. Expressions of the S1P2, S1P4, and S1P5 receptors were significantly higher in pterygium tissue than in normal conjunctiva, and the concentration of S1P was significantly elevated in the lysate of normal conjunctival fibroblast cell (NCFC) irradiated with UV (UV-NCFCs). RhoA activity was significantly upregulated in pterygium fibroblast cells (PFCs) and UV-NCFCs, and myosin phosphatase-Rho interacting protein (MRIP) was upregulated, and myosin phosphatase target subunit 1 (MYPT1) was downregulated in PFCs. Fibrogenic changes were significantly upregulated in both PFCs and UV-NCFCs compared to NCFCs. We found that the activation of the S1P receptor-Rho cascade was observed in pterygium tissue. Additionally, in vitro examination showed S1P-rho activation and fibrogenic changes in PFCs and UV-NCFCs. S1P elevation and the resulting upregulation of the downstream Rho signaling pathway may be important in pterygium formation; this pathway offers a potential therapeutic target for suppressing pterygium generation.
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http://dx.doi.org/10.3390/ijms20194670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801701PMC
September 2019

Identification of IscU residues critical for de novo iron-sulfur cluster assembly.

Mol Microbiol 2019 12 7;112(6):1769-1783. Epub 2019 Oct 7.

Department of Biochemistry and Molecular Biology, Graduate School of Science and Engineering, Saitama University, 255 Shimo-Okubo, Sakura-ku, Saitama, 338-8570, Japan.

IscU is a central component of the ISC machinery and serves as a scaffold for the de novo assembly of iron-sulfur (Fe-S) clusters prior to their delivery to target apo-Fe-S proteins. However, the molecular mechanism is not yet fully understood. In this study, we have conducted mutational analysis of E. coli IscU using the recently developed genetic complementation system of a mutant that can survive without Fe-S clusters. The Fe-S cluster ligands (C37, C63, H105, C106) and the proximal D39 and K103 residues are essential for in vivo function of IscU and could not be substituted with any other amino acids. Furthermore, we found that substitution of Y3, a strictly conserved residue among IscU homologs, abolished in vivo functions. Surprisingly, a second-site suppressor mutation in IscS (A349V) reverted the defect caused by IscU Y3 substitutions. Biochemical analysis revealed that IscU Y3 was crucial for functional interaction with IscS and sulfur transfer between the two proteins. Our findings suggest that the critical role of IscU Y3 is linked to the conformational dynamics of the flexible loop of IscS, which is required for the ingenious sulfur transfer to IscU.
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http://dx.doi.org/10.1111/mmi.14392DOI Listing
December 2019

Opioids and analgesics use after adult spinal deformity surgery correlates with sagittal alignment and preoperative analgesic pattern.

Eur Spine J 2020 01 6;29(1):73-84. Epub 2019 Sep 6.

Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France.

Purpose: To assess pain, health-related quality of life (HRQOL) scores and sagittal parameters of adult spinal deformity (ASD)-operated patients in the context of their analgesic consumption especially opioids (narcotics) over the first year postoperative period.

Methods: In total, 372 patients from a multicenter database were stratified into 3 groups at baseline: 241 patients in the minimal group (no analgesic, or NSAIDs/narcotics weekly or less), 64 in the NSAIDs every day group and 67 in the narcotics every day group. HRQOL and back and leg pain scores were evaluated at 6 months and 1 year postoperatively. Also several sagittal alignment parameters were assessed.

Results: Significant improvements in pain and HRQOL scores were observed across all 3 groups by 1 year (P < 0.05) postoperatively. While the minimal group had the best pre- and postoperative HRQOL scores, the NSAID group demonstrated the best improvement in HRQOL. Only the minimal group displayed continued improvement from 6 months to 1 year. 90%, 65% and 40% of minimal, NSAID and narcotic groups of patients, respectively, no longer took any analgesics at 1 year postoperatively. Alternatively, 36% of patients in the narcotics group continued to take narcotics at 1 year. Residual malalignment increased NSAIDs consumption in different groups at 1 year.

Conclusion: This study evaluated the analgesics use after ASD surgery in relation to the clinical and radiological outcomes. Despite important postoperative opioids consumption in the narcotics group, clinical outcome yet improved. Malalignment parameters demonstrated a predictive value in regard to NSAIDs' usage. These slides can be retrieved under Electronic Supplementary Material.
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http://dx.doi.org/10.1007/s00586-019-06141-8DOI Listing
January 2020

Impact of Multifidus Muscle Swelling on C5 Palsy After Cervical Laminoplasty.

Spine (Phila Pa 1976) 2020 Jan;45(1):E10-E17

Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.

Study Design: Retrospective radiological analysis OBJECTIVE.: The aim of this study was to identify the effects of posterior cervical muscle swelling on C5 palsy (C5P) by evaluating early postoperative magnetic resonance (MR) images.

Summary Of Background Data: Cervical laminoplasty is an established technique, but the risk of C5P after surgery has not been fully resolved. Studies have reported that lateral stretching and postoperative swelling of the multifidus muscle may cause stretching of the medial branches and cervical nerves.

Methods: A total of 214 C5 nerves of 107 consecutive patients who underwent laminoplasty were examined. We reviewed their demographic and surgical data and radiographic and MR images as parameters, including the axial cross-sectional area (CSA) of the posterior muscles. The patients and C5 nerves were divided into C5P and non-C5P groups. The parameters and changes were compared between the two groups to examine correlations with C5P.

Results: In demographic data, age, sex, history of smoking, diabetes mellitus, and preoperative Japanese Orthopedic Association scores were not significantly different between the groups. Only body mass index (BMI) was significantly higher in the C5P group. Regarding the surgical and imaging data, the number of laminoplasty, operative time, decompression trough width, cervical sagittal alignment, preoperative spinal cord rotation, and posterior shift of the spinal cord were not significantly different, but the multifidus CSA change ratio was significantly higher in the C5P group. Multiple logistic regression analyses revealed that the multifidus CSA change ratio and BMI were significant independent factors.

Conclusion: Multifidus swelling is associated with C5P, possibly through traction of the C5 nerve via the medial branches of the cervical dorsal rami. The medial branch is the shortest of the dorsal rami and may have the largest effect by traction force. Therefore, a gentle maneuver of the deep posterior muscles during surgery is a potential countermeasure to prevent C5P.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000003205DOI Listing
January 2020

Carbon-fibre cage reconstruction in anterior cervical corpectomy for multilevel cervical spondylosis: mid-term outcomes.

J Spine Surg 2019 Jun;5(2):251-258

l'Institut de la Colonne Vertébrale, Surgery Unit 1, 7ème étage, CHU Tripode Pellegrin, Bordeaux, France.

Background: Mid-term clinical and radiological evaluation of a carbon-fiber cage in multilevel cervical spondylosis (MCS). Anterior cervical corpectomy and fusion (ACCF) using titanium mesh cages (TMC) has shown satisfactory outcomes, but with subsidence of up to 20%. Conventional long-fiber carbon fiber cages have shown a safe profile in discectomy/fusion (ACDF) but with minimal data in the setting of corpectomy.

Methods: Retrospective review of a single centre multi-surgeon cohort of MCS patients from 2007-2012. Follow-up period was a minimum of 3.5 years, mean 6 years. Outcomes included peri-operative, clinical [Nurick, European Myelopathy, Visual Analogue Scores (VAS), modified Japanese Orthopaedic Association (mJOA) scores and radiographic (C2C7, Cobb & ROM angles)].

Results: A total of 102 consecutive patients were included. Mean length of stay was 5.5 (SD 3.5) days, blood loss 322 (SD 358) mL and operative time 98 (SD 31) min. Corpectomy levels included 72 single-level ACCF and 30 multiple ACCF. Fourteen had peri-operative complications. Three patients required early cage revisions. Mean pain scores improved from VAS neck 4.6 to 2.6 (P<0.01) and VAS arm 5.1 to 2.0 (P<0.01). Mean Nurick score improved from 1.2 to 0.4/4 (P<0.01). Mean follow-up EMS was 15.9/18 and mJOA was 14.0/17. Seventy follow-up radiographs were obtained. Flexion-extension angulation differences of >3 mm across the instrumented level were present in 5 patients, all of which displayed fusion of either grade 1 or 2. 7 had C2C7 kyphosis. Severe subsidence (>3 mm) was seen in 9 cases (13%).

Conclusions: Mid-term outcomes of this carbon-fiber cage indicate that it is safe and durable for the treatment of MCS with a similar radiological profile to that of TMC.
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http://dx.doi.org/10.21037/jss.2019.03.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626739PMC
June 2019

Adult spinal deformity surgical decision-making score. Part 2: development and validation of a scoring system to guide the selection of treatment modalities for patients above 40 years with adult spinal deformity.

Eur Spine J 2020 01 17;29(1):45-53. Epub 2019 Jul 17.

L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France.

Purpose: We aimed to develop and internally validate a scoring system, the adult spinal deformity surgical decision-making (ASD-SDM) score, to guide the decision-making process for ASD patients aged above 40 years.

Methods: A multicentre prospective ASD database was retrospectively reviewed. The scoring system was developed using data from a derivation set and was internally validated in a validation set. The performance of the ASD-SDM score for predicting surgical management was assessed using the area under the receiver operating characteristic curve (AUC).

Results: A total of 702 patients were included for analysis in the present study. The scoring system developed based on 562 patients, ranging from 0 to 12 points, included five parameters: leg pain scored by the numerical rating scale; pain and self-image domains in the Scoliosis Research Society-22 score; coronal Cobb angle; and relative spinopelvic alignment. Surgical indication was graded as low (score 0 to 4), moderate (score 5 to 7), and high (score 8 to 12) groups. In the validation set of 140 patients, the AUC for predicting surgical management according to the ASD-SDM score was 0.797 (standard error = 0.037, P < 0.001, 95% confidence interval = 0.714 to 0.861), and in the low, moderate, and high surgical indication groups, 23.7%, 43.5%, and 80.4% of the patients, respectively, were treated surgically.

Conclusions: The ASD-SDM score demonstrated reliability, with higher scores indicating a higher probability of surgery. This index could aid in the selection of surgery for ASD patients in clinical settings. These slides can be retrieved under Electronic Supplementary Material.
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http://dx.doi.org/10.1007/s00586-019-06068-0DOI Listing
January 2020

Development and characterization of a new rat ocular hypertension model induced by intracameral injection of conjunctival fibroblasts.

Sci Rep 2019 04 29;9(1):6593. Epub 2019 Apr 29.

Department of Ophthalmology, University of Tokyo, 7-3-1, Hongo, Bunkyoku, Tokyo, 113-8655, Japan.

Glaucoma is a chronic optic neuropathy that leads to visual field loss. Elucidating the mechanisms underlying glaucoma is essential for developing new treatments, such as neuroprotective drugs. Various glaucoma models based on the induction of intraocular pressure (IOP) elevation have been established for use in glaucoma studies. However, the time-dependent pathological changes accompanying IOP elevation have not been fully elucidated. In this study, rat conjunctival fibroblasts were injected into the anterior chamber of rat eyes, and IOP elevation was induced for 28 days. Glaucomatous signs such as optic nerve head cupping, retinal thinning, glial activation and apoptotic signaling in the retina were obvious in the cell-injected eyes on the 14th day after injection. The pattern of retinal ganglion cell (RGC) loss differed by the magnitude of IOP elevation. The number of RGCs decreased by 37.5% in eyes with IOP lower than 50 mmHg (Under-50) and by 88.0% in those with IOP higher than 50 mmHg (Over-50) 28 days after cell injection. The RGC counts were correlated with IOP in the Under-50 group but not in the Over-50 group. Our model may contribute to the investigation of pathogenic mechanisms of glaucoma and the development of new glaucoma treatments.
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http://dx.doi.org/10.1038/s41598-019-43048-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488598PMC
April 2019