Guillain-Barré syndrome (GBS), Fisher syndrome (FS) and Bickerstaff brainstem encephalitis represent a spectrum of acute post-infectious immune-mediated diseases. GBS can present as acute infl ammatory demyelinating neuropathy or acute motor axonal neuropathy (AMAN). The epidemiological association of Campylobacter jejuni infection and antiganglioside antibodies with AMAN and FS is well established. Gangliosides GM1 and GD1a, target molecules in AMAN, are identical to the terminal carbohydrate residues of C jejuni lipo-oligosaccharides. AMAN can be reproduced in rabbits sensitized with the gangliosides and lipo-oligosaccharides, thus verifying GBS as the fi rst example of molecular mimicry in autoimmune diseases. Immunohistochemical studies on AMAN rabbit models demonstrated autoantibody binding at the nodes of Ranvier, triggering complement activation followed by formation of membrane attack complexes. This leads to the disappearance of sodium channel clusters, causing muscle weakness and axonal degeneration. Like AMAN, FS also displays molecular mimicry but between GQ1b and C jejuni lipo-oligosaccharides. The development of either AMAN or FS following C jejuni infection depends on which ganglioside-like lipo-oligosaccharides are expressed by C jejuni strains as a result of the bacterial genetic polymorphism. Bickerstaff brainstem encephalitis share common fi ndings of anti-GQ1b antibodies with FS making the two disorders related, thus extending the spectrum of the GBS phenotype.

Purpose: Bone is one of the most common sites of metastases in patients with advanced lung cancer. Skeletal complications may cause significant morbidity and decrease performance status (PS). Such complications, referred to as skeletal related events (SREs), include severe bone pain, pathological fractures, spinal cord compression, and hypercalcemia of malignancy. We assessed the clinical impact of SREs in non-small lung cancer (NSCLC) patients with bone metastases. Methods: We retrospectively investigated the clinical records of all 120 patients who were diagnosed advanced NSCLC with bone metastases between June 1998 and March 2009. Results: A total of 23 patients (26.7%) were found to have SREs at the time of initial diagnosis. The median survival time (MST) was 123 days for patients with SREs, while it increased to 276 days for those without SREs. The MST of the patients with SREs were significantly shorter than that of the patients without SREs (p<0.001). We also studied the SREs during clinical courses of 89 patients whose records were available over 3 months. A total of 39 patients (43.8%) were found to have SREs during clinical courses. Conclusion: The patients in NSCLC with bone metastases were often found to have SREs. SREs cause significant morbidity and deterioration of PS. Systemic chemotherapy could not decrease SREs during their clinical courses. Further studies evaluating bisphosphonates in combination with chemotherapy are warranted. Palliat Care Res 2010; 5(2): 145-151

Background: Common regional anesthesia approaches for video-assisted thoracoscopic surgery (VATS) include paravertebral block (PVB) and erector spinae plane block (ESPB). PVB is considered a deep nerve block which is contraindicated in antithrombotic therapy. ESPB is effective when administered as a bolus, as well as continuously. However, the recently proposed intertransverse process block (ITPB) ensures more effective diffusion of the local anesthetic into the paravertebral space.Case: We report cases of three patients who received bolus ITPB (costotransverse foramen block and mid-point transverse process-to-pleura block in one and two cases, respectively) combined with continuous ESPB when a deep nerve block could not be administered. Opioids were not required postoperatively, and all postoperative numerical rating scale scores (0–10) at rest were maintained below 4. Conclusions The combination of bolus ITPB and continuous ESPB may be an alternative analgesic method when deep nerve blocks are contraindicated in VATS.

OBJECTIVETo examine the effectiveness of a drug abuse prevention program focusing on social influences for drug education classes in high school.

METHODSThe social influence program in the experimental group used role-playing led by a pharmacist, a police officer and a teacher. The intervention evaluation used a quasi-experimental design. The subjects were first-year students from 10 high schools assigned to the experimental group (6 schools, 828 students) and the control group (4 schools, 408 students). In the control group, a pharmacist used a conventional information program in a lecture format.

RESULTSRegarding knowledge about drug abuse, in both the experimental and control groups, and for both males and females, a long-term effect was observed immediately after the program and lasted up to 15 months. For three other measures, attitudes toward drug abuse problem, self-efficacy regarding drug abuse prevention, and perception of social support for preventing drug abuse, a short-term effect was generally observed in the experimental group beginning immediately after the program and lasting for 3 months. A long-term effect was evident in high-risk students with positive opinions regarding drugs. In the control group and for both males and females, although an effect was generally evident immediately after the program, neither a short-nor a long-term effect was observed in males, suggesting the difficulty in achieving lasting effects.

CONCLUSIONSThe social influence program in the experimental group showed remarkable effectiveness. Thus, the program may be useful for preventing drug abuse among high school students in Japan.

Purpose: The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods: Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results: Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy.

Purpose: The purpose of the study was to determine the effect of cartilage degeneration at the patellofemoral joint on clinical outcomes after open wedge high tibial osteotomy and to investigate the predisposing factors for progressive patellofemoral cartilage degeneration. Methods: Seventy-two knees were evaluated on second-look arthroscopy in patients who opted for plate and screw removal at an average of 20.1 months after osteotomy. Cartilage degeneration at the patellofemoral joint was evaluated using the International Cartilage Repair Society grading system, with cases divided into progression and nonprogression groups. Radiographic parameters of the patellofemoral anatomy, knee range of motion, and clinical outcomes were evaluated from the preoperative baseline to the final follow up, on average 50 months after osteotomy. A contracture > 5° was considered a flexion contracture. Results: Cartilage degeneration progressed in 31 knees, and preoperative knee flexion contracture was significantly associated with progressive degeneration (P < 0.01). The Lysholm and Kujala scores were significantly lower in the progression group (87.9 and 85.3, respectively) than in the nonprogression group (91.6 and 93.6, respectively) (P < 0.05). The odds ratio of the flexion contracture resulting in progression of patellofemoral cartilage degeneration was 4.63 (95% confidence interval, 1.77–12.1). No association was detected between progressive degeneration and age, sex, body mass index, Kellgren-Lawrence grade, or radiographic parameters. Conclusions Flexion contracture may be associated with progression of cartilage degeneration at the patellofemoral joint and may negatively affect the clinical outcomes after open wedge, high tibial osteotomy.

Gastric adenocarcinoma of the fundic gland mucosa type (GA-FGM) was proposed as a new variant of gastric adenocarcinoma of the fundic gland type (GA-FG). However, at present, the influence of Helicobacter pylori and the speed of progression and degree of malignancy in GA-FGM remain unclear. Herein, we report the first case of intramucosal GA-FGM that was endoscopically observed before and after H. pylori eradication over 15 years. The lesion showed the same tumor size with no submucosal invasion and a low MIB-1 labeling index 15 years after its detection using endoscopy. The endoscopic morphology changed from 0-IIa before H. pylori eradication to 0-IIa+IIc and then 0-I after H. pylori eradication. These findings suggest that the unaltered tumor size reflects low-grade malignancy and slow growth, and that the endoscopic morphology is influenced by H. pylori eradication.