Objective There were some identical T cell clonotypes expanded and accumulated in different organs in aged diseased (NZB?NZW)F1 and MRL/lpr mice. The amino acid motifs in the third complementarity determining region (CDR3) from the T cell receptor (TCR) V? chain was analyzed to demonstrate the antigenic specificity of these identical clones. Methods The TCR V?6 gene in kidneys and brains from different individuals of aged diseased lupus mice were amplified by reverse transcriptase polymerase chain reaction (RT-PCR) respectively. The amino acid motifs in CDR3 loops of TCR V?6 chain were demonstrated by DNA cloning and DNA sequence analysis. The amino acid motifs from the identical T cell clones accumulated in different organs were identified by single-strand conformation polymorphism (SSCP). Results Some conserved amino acid motifs such as isoleucine (I) and aspartic acid (D) were observed in CDR3 loops of TCR V?6 from these identical T cell clones in different individuals of aged diseased (NZB?NZW)F1 mice. Likewise, I, glycine (G) and D or glutamic acid (E) were also found in MRL/lpr mice. Conclusion These identical T cell clones may recognize restricted T cell epitopes on autoantigens and are involved in specific immune responses in SLE.

Objective CD4+ T lymphocytes have been shown to play an important role in the pathogenesis of systemic lupus erythematosus (SLE). To identify the commonly accumulated T cell clones and to investigate its role in murine lupus models, it was analyzed that the T cell clonality infiltrating in different tissues derived from (NZB?NZW)F1 as well as MRL/lpr mice. Methods The expressions of T cell receptor (TCR) V? gene were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) combined with single-strand conformation polymorphism (SSCP) study. The phenotype of T cells expanded in different organs was determined by magnetic cell sorting (MACS). Results RT-PCR and SSCP study of TCR V? chain demonstrated that there were some identical T cell clonotypes expanded and accumulated in different organs in aged diseased mice. Most of these identical clonotypes were CD4+ T cells in both of the two strains. In contrast, young mice exhibited little accumulation of common clone in different organs. The TCR V? usage of these identical clonotypes was limited in V?2, V?6, V?8.1, V?10, V?16, V?18 in MRL/lpr mice and V?6, V?7 in (NZB?NZW)F1 mice respectively. Conclusion The results suggest that activated and clonally expanded CD4+ T cells commonly accumulated in different tissues in aged murine lupus models. These CD4+ T cell clonotypes may be involved in specific immune responses of SLE, thus playing a pathogenic role in these lupus mice.

STUDY DESIGN: The strength effects of a pedicle screw-rod system supplemented with a novel cross-link configuration were biomechanically evaluated in porcine spines. PURPOSE: To assess the biomechanical differences between a conventional cross-link pedicle screw-rod system versus a novel cross-link instrumentation, and to determine the effect of the cross-links. OVERVIEW OF LITERATURE: Transverse cross-link systems affect torsional rigidity, but are thought to have little impact on the sagittal motion of spinal constructs. We tested the strength effects in pullout and flexion-compression tests of novel cross-link pedicle screw constructs using porcine thoracic and lumbar vertebrae. METHODS: Five matched thoracic and lumbar vertebral segments from 15 porcine spines were instrumented with 5.0-mm pedicle screws, which were then connected with 6.0-mm rods after partial corpectomy in the middle vertebral body. The forces required for construct failure in pullout and flexion-compression tests were examined in a randomized manner for three different cross-link configurations: un-cross-link control, conventional cross-link, and cross-link passing through the base of the spinous process. Statistical comparisons of strength data were analyzed using Student's t-tests. RESULTS: The spinous process group required a significantly greater pullout force for construct failure than the control group (p=0.036). No difference was found between the control and cross-link groups, or the cross-link and spinous process groups in pullout testing. In flexion-compression testing, the spinous processes group required significantly greater forces for construct failure than the control and cross-link groups (p<0.001 and p=0.003, respectively). However, there was no difference between the control and cross-link groups. CONCLUSIONS: A novel cross-link configuration that features cross-link devices passing through the base of the spinous processes increased the mechanical resistance in pullout and flexion-compression testing compared to un-cross-link constructs. This configuration provided more resistance to middle-column damage under flexion-compression testing than conventional cross-link configuration.
Lumbar Vertebrae ; Pedicle Screws ; Spinal Fusion ; Spine

Purpose: Re-irradiation is a treatment option for recurrent esophageal cancer patients with a history of radiotherapy, but there is a risk of severe late adverse effects. This study focused on the efficacy and safety of re-irradiation using hyperfractionated radiotherapy. Materials and Methods: Twenty-six patients who underwent re-irradiation by the hyperfraction technique using twice-daily irradiation of 1.2 Gy per fraction for recurrent esophageal cancer were retrospectively included in this study. The overall survival period after the start of secondary radiotherapy and the occurrence of late adverse effects were investigated. Results: Of 26 patients, 21 (81%) received re-irradiation with definitive intention and 21 (81%) underwent concurrent chemotherapy. The median re-irradiation dose was 60 Gy in 50 fractions in 25 treatment days, and the median accumulated irradiation dose in equivalent dose in 2 Gy per fraction was 85.4 Gy with an α/β value of 3. The median interval between two courses of radiotherapy was 21.0 months. The median overall survival period was 15.8 months and the 1-year and 3-year overall survival rates were 64.3% and 28.3%, respectively. Higher dose of re-irradiation and concurrent chemotherapy significantly improved survival (p < 0.001 and p = 0.019, respectively). Severe late adverse effects with the Common Terminology Criteria for Adverse Events grade 3 or higher were observed in 5 (19.2%) patients, and 2 (7.7%) of them developed a grade 5 late adverse effect. Conclusion High-dose re-irradiation using a hyperfractionated schedule with concurrent chemotherapy might be related to good prognosis, while the rate of late severe adverse effects is not high compared with the rates in past reports.

Major bleeding associated with sagittal split ramus osteotomy (SSRO) involves vessels such as the inferior alveolar, facial, and maxillary arteries and veins, and the retromandibular vein (RMV). The present study aimed to clarify and classify the three-dimensional variations in RMV position and course direction in relation to the mandible. Specimens comprised a total of 15 scientific cadavers, and the relationship between RMV and the mandible lateral and posterior views was observed.We identified 3 patterns on the lateral view, the mean distance between the RMV and the posterior border of the ramus was 3.9 mm at the height of the lingula. A total of five course patterns were identified on the posterior view. In no course pattern, the RMV inferior to the lingula was lateral to its position superior to the lingual. The present findings suggest that it may be possible to predict correlations with intraoperative bleeding risk. Further study is planned using contrast computed tomography in patients with jaw deformity for skeletal classification.

Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.

Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.

Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.

Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.