Recently, non-specific low back pain without clear diagnosis has been changed of the diagnosis and treatment. I showed the data of Yamaguchi Low Back Pain study in the article. It has been shown that we can select appropriate treatment based on the clear diagnosis. I described the current status and issues of low back pain treatment and outlined the classification and differentiation of non-specific low back pain.

We used the Fogarty 2Fr IMAG Kit^® on 14 patients who underwent aorto-coronary bypass grafting. The free flow of the left internal thoracic artery (LITA) after dilatation using Fogarty balloon catheter was 7.4 times greater than before dilatation. There was no statistical differences in catecholamines used postoperatively and postoperative cardiac output in the groups of cases with and without dilatation. String sign was appeared in 4 patients with dilatation of LITA. Fogarty balloon catheter save effective dilatation of LITA in certain selected cases.

A 64-year-old man was admitted with intermittent high fever of 4 months duration and with three episodes of arterial embolism in the previous 2 months. Several investigations revealed evidence that those episodes involving bilateral popliteal arteries and the left external iliac artery originated from mycotic emboli. Severe mitral insufficiency due to infective endocarditis was also recognized. The ischemic symptoms improved after medical treatment. Despite antibiotic therapy for 4 weeks, inflammatory signs did not subside. Since aneurysm formation of the left external iliac artery at the embolized portion was detected on CT, mitral valve replacement and aneurysmectomy with femoro-femoral grafting were done concomitantly. Inflammatory signs disappeared immediately after the operation. Pathological findings indicated organization of the mitral vegetation and evidence of active infection in the aneurysm wall. Though aneurysmal change of a symptomatic embolized site is not common, the preoperative evaluation of possible associated mycotic aneurysm is important to decide on surgical strategy for infective endocarditis complicated by embolism.

This study aimed to evaluate dynamic balance capability, bathyesthesia, and the composite compensation of bathyesthesia and visual sense for dynamic balance assessed by use of force plates and to examine their correlation to age in a cross-sectorial manner. Participants of this study were 147 healthy people (55 men, 92 women). To evaluate dynamic balance capability, we evaluated the index of postural stability (IPS), which is the logarithmic value of the ratio of the area of stability limits to the area of postural sway, with participants standing on a hard surface with eyes opened. To measure bathyesthesia, we evaluated the modified index of postural stability (MIPS), i.e., the IPS with participants standing on a soft surface with eyes closed. As for the composite compensation index of bathyesthesia and visual sense for dynamic balance, we calculated the rubber IPS Romberg ratio (MIPS/IPS). The correlation coefficients (Spearman’s rho) of IPS, MIPS and MIPS/IPS to age were −0.666 (p < 0.001), −0.697 (p < 0.001) and −0.600 (p < 0.001), respectively. These results suggest that dynamic balance capability and bathyesthesia decline with advancing age, and the composite compensation of bathyesthesia and visual sense for dynamic balance strengthens with advancing age.

There is no report that describes in detail the radiological and intraoperative findings of rickets with symptomatic cervical ossification of the posterior longitudinal ligament. Here, we describe a case of X-linked hypophosphatemic rickets with cervical ossification of the posterior longitudinal ligament presenting unique radiological and intraoperative findings. The patient presented progressive tetraparesis. Magnetic resonance imaging studies revealed severe cervical spinal cord compression caused by ossification of the posterior longitudinal ligament. Computed tomography scans revealed homogeneously increased vertebral bone density. An expansive laminoplasty was performed. At surgery, homogeneously hard lamina bone was burdened in drilling and opening of the laminae. The patient's neurological symptoms were improved postoperatively. Bony fusion of the hinges occurred postoperatively. Therefore, expansive laminoplasty could be performed for symptomatic cervical ossification of the posterior longitudinal ligament with X-linked hypophosphatemic rickets. However, unusual bone characters should be taken into consideration for careful operation during surgery.
Bone Density* ; Familial Hypophosphatemic Rickets* ; Humans ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Ossification of Posterior Longitudinal Ligament* ; Rickets ; Spinal Cord Compression

STUDY DESIGN: Multicenter prospective study with a crossover design. PURPOSE: The objective of this study is to compare the efficacy of limaprost alfadex (LP) and elcatonin (EL) for lumbar spinal stenosis (LSS) patients with concurrent osteoporosis. OVERVIEW OF LITERATURE: It has been increasingly important to improve quality of life by establishing appropriate conservative treatments for LSS patients with concurrent osteoporosis who will presumably continue to increase due to the percentage of the aging elevations, however there is no prospective study. METHODS: A total of 19 patients with LSS and concurrent osteoporosis were enrolled in this study. The patients were divided into two groups and compared using a crossover design. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and short-form (SF)-8 health survey scale were used for clinical evaluations. RESULTS: There was a significant improvement of buttock-leg pain and numbness in the EL group. A significant improvement of impaired walking function was noted for the LP group according to the JOABPEQ while the rest of the items in the JOABPEQ showed no significant differences. The SF-8 health survey revealed that somatic pains and physical summary scores in the EL group and physical functioning and physical summary scores in the LP group tended to improve but not to any statistically significant extents. CONCLUSIONS: Concomitant uses of EL may be useful in patients who do not respond satisfactorily to the treatments of LP for 6-8 weeks.
Aging ; Asian Continental Ancestry Group ; Back Pain ; Cross-Over Studies* ; Drug Therapy ; Health Surveys ; Humans ; Hypesthesia ; Nociceptive Pain ; Osteoporosis* ; Prospective Studies ; Quality of Life ; Spinal Stenosis* ; Walking ; Surveys and Questionnaires

STUDY DESIGN: Prospective study. PURPOSE: We evaluated the usefulness of diffusion tensor imaging (DTI) in diagnosing patients with cervical myelopathy by determining the accuracy of normal DTI parameter values. OVERVIEW OF LITERATURE: DTI can visualize white matter tracts in vivo and quantify anisotropy. DTI is known to be more sensitive than conventional magnetic resonance imaging (MRI) in detecting subtle pathological changes of the spinal cord. METHODS: A total of 31 normal subjects (13 men and 18 women; age, 23-87 years; mean age, 46.0 years) were included in this study. The patients had no symptoms of myelopathy or radiculopathy. A Philips Achieva 3-Tesla MRI with SE-type Single Shot EPI was used to obtain diffusion tensor images. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured as DTI parameters on axial sections of several cervical levels. Subjects were divided into two groups: >40 years (n=16) and < or =40 years (n=15). A paired t-test was used to compare significant differences between the groups. ADC and FA values were most stable on axial sections. RESULTS: For all subjects, mean ADC and FA values were 1.06+/-0.09x10-3 mm2/sec and 0.68+/-0.05, respectively. ADC was significantly higher in subjects >40 years of age than in those < or =40 years. There was no significant difference in FA values between the two groups. The mean ADC value was significantly higher in normal subjects >40 years of age than in those < or =40 years. CONCLUSIONS: It is important to consider age when evaluating cervical myelopathy by DTI.
Anisotropy ; Diffusion Tensor Imaging ; Diffusion* ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Prospective Studies ; Radiculopathy ; Reference Values* ; Spinal Cord Diseases ; Spinal Cord*

Folic acid contained in potato (Solanum tuberosum L.) tubers is concentrated in potato chips by dehydration during frying. It is a vitamin recommended to young women which helps protect fetus from congenital disease. Additionally, folic acid can lower plasma homocysteine concentrations, a known independent risk factor for cardiovascular disease. This study was designed to determine whether the dietary consumption of potato chips affect serum folic acid concentration and plasma homocysteine concentration in human subjects. Results showed a significant increase in serum concentrations of folate 1, 3, and 6 hours after ingestion. Vitamin B₆, on the other hand, increased significantly after 3 hours of intake. In contrast, plasma homocysteine concentration decreased significantly 6 hours after ingestion. These results suggest that potato chips would be a good dietary source of folic acid for humans.

The purpose of this study was to determine whether improved physical fitness through a new exercise program intervention including elements of Tai Chi Chuan and Kung Fu gymnastics among elderly people who have lower physical. Eighty older adults with less physical strength aged 71-89 (mean age±SD=77.3±3.9), recruited from Tsurugaya area of Sendai, participated in a 3-month randomized controlled trial, with allocation to a new exercise program or well-accepted exercise program control. Physical performance measures included the timed up and go test (TUGT), the functional reach test, a 6 min continuous walking test, and the sit-and-reach test were conducted before and after the intervention. Data were analyzed through on-treatment-analysis of variance. After training, although no significant between-groups differences were observed for all the measures, TUGT, which is recommended as a simple screening tool to identify those at risk of falling was improved in both groups following the intervention (P<0.05). The findings revealed that the new exercise program including Tai Chi Chuan and Kung Fu gymnastics element could improve physical fitness to a similar level as the well-accepted exercise program.

The purpose of this study was to confirm the causal structure model of muscle, motor and living functions utilizing structural equation modeling (SEM) . As subjects, 103 community-dwelling older men and women, aged 65.7±6.9years of age, participated in the study to measure muscle cross-sectional area, maximum voluntary contractions, muscle power, 4 physical performance tests, and 16 questionnaires regarding ability of activities of daily living. The causal structure model of muscle, motor and living functions was hypothesized to be a hierarchical causal structure. The causal structure model of muscle function was hypothesized to be a hierarchical causal structure consisting of 3 sub-domains of muscle mass, muscle strength, and muscle power. Data analysis procedures were as follows : a) testing of construct validity of muscle function variables using confirmatory factor analysis (CFA) in SEM ; b) testing of causal structure using SEM ; c) testing of factor invariance using multi-group analysis for gender. The highest goodness of fit indices was obtained in the causal structure model of muscle, motor and living functions (NFI= .928, CFI= .978, RMSEA =.061) . The causal coefficient of muscle function to motor function was .98 (p<.05), followed by.34 for motor function to living function. From the results of multi-group analysis, the measurement invariance model indicated the highest goodness of fit indices (TLI=.968, CFI .977) . It was concluded that the hierarchical causal relation was among muscle, motor and living functions, and in which muscle function was consisted of 3 sub-domains.