Methods: This study included 138 patients who underwent PLIF, with a mean age of 67 years and a follow-up period of 12 months. At 12 months postoperatively, lumbar computed tomography (CT) was performed to assess SL, and patients were categorized into SL and nonloosening (NL) groups accordingly. A propensity score-matched model was used to adjust for age, sex, and body mass index (BMI). Propensity score matching was performed to compare outcomes between the SL and NL groups. Results: Among the 138 patients, 29 (21%) developed SL following PLIF. Preliminary analysis revealed that the patients in the SL group were older and exhibited decreased femoral neck bone mineral density, preoperative pelvic retroversion, poor whole spine alignment, and lesser improvement in HRQOL compared with the NL group. Using propensity score matching, 22 patients were selected from each group (mean age, 72 years) (C-statistic=0.78). The propensity score-matched analysis demonstrated significant differences in the preoperative pelvic tilt (25.9° vs. 17.8°, p=0.010) between the matched SL and NL groups. Furthermore, the Oswestry Disability Index scores indicated poorer improvements in the matched SL group than in the matched NL group at 9 months postoperatively (p=0.025). Conclusions After matching, pre- and postoperative pelvic retroversion were significantly associated with SL. Patients with SL experienced significantly poorer improvement in HRQOL at 9 months postoperatively. Therefore, implementing strategies for preventing SL may enhance early postoperative HRQOL.

In C1–C2 posterior fixation, the C1 lateral mass and C2 pedicle/translaminar screw insertion under spine navigation have been used frequently. To avoid the risk of neurovascular damage in atlantoaxial stabilization, we assessed the safety and effectiveness of a preoperative computed tomography (CT) image-based navigation system with intraoperative independent C1 and C2 vertebral registration. It is ideal when a reference frame can be linked directly to the C1 posterior arch for C1-direct-captured navigation, but there is a mechanical challenge. A new spine clamp-tracker system was implemented recently, which allows reliable C1- and C2- direct-captured navigation in nine patients with traumatic C2 fractures. In this way, there was no misalignment of C1–C2 screws. C1 lateral mass screws were used except for one case, and translaminar screws were primarily used as an anchor for C2. The C1 lateral mass screw locations, which are 19 mm laterally from the C1 posterior arch’s center, are taken to be constant. However, there is one unusual circumstance in which using a C1 laminar hook instead of a C1 lateral mass screw appears to be a beneficial substitute. The increase of surgical accuracy for posterior C1–C2 screw fixation without cost constraints is significantly facilitated by intraoperative C1- and C2-direct-captured navigation with preoperative computed CT images.

The abscopal effect refers to the phenomenon in which local radiotherapy is associated with the regression of metastatic cancer that is distantly located from the irradiated site.Here, we present a case of a patient with advanced gastric cancer and brain metastases who was successfully treated with brain radiotherapy and anti-programmed death-1 (PD-1) therapy-induced abscopal effect. Although anti-PD-1 therapy alone could not prevent disease progression, the metastatic lesions in the brain and also in the abdominal lymph node showed a drastic response after brain radiotherapy and anti-PD-1 therapy. To our knowledge, this is the first reported case of successful treatment of advanced gastric cancer with multiple brain and abdominal lymph node metastases, possibly through anti-PD-1 therapy combined with brain radiotherapy-induced abscopal effect. We suggest that the combination of brain radiotherapy and anti-PD-1 therapy may be considered as a therapeutic option for advanced gastric cancer, especially when there is brain metastasis.

OBJECTIVE: The anti-epileptogenic drug levetiracetam has anticonvulsant and anti-epileptogenesis effects. Synergy between cell death and inflammation can lead to increased levels of apoptosis inhibitory factors and brain-derived neurotrophic factor, aberrant neurogenesis and extended axon sprouting. Once hyperexcitation of the neural network occurs, spontaneous seizures or epileptogenesis develops. This study investigated whether the anti-epileptogenic effect of levetiracetam is due to its alternate apoptotic activity. METHODS: Adult male Noda epileptic rats were treated with levetiracetam or vehicle control for two weeks. mRNA quantification of Bax, Bcl-2 and GAPDH expression were performed from prefrontal cortex and hippocampus tissue samples. RESULTS: The levetiracetam-treated group showed a significant increase of Bax/Bcl-2 mRNA expression ratio in the prefrontal cortex than the control group, but no change in the Bax/Bcl-2 mRNA expression ratio in hippocampus. CONCLUSION: Idiopathic generalized epilepsy including childhood absence epilepsy develop at childhood and recover spontaneously during adolescence. The aberrant neural excitable network is pruned by a neural-maturing action. This study suggests the mechanism of acquired anti-epileptogenesis by levetiracetam treatment may be similar to spontaneous recovery of idiopathic generalized epilepsy during adolescence.
Adolescent* ; Adult ; Animals ; Apoptosis ; Axons ; Brain-Derived Neurotrophic Factor ; Cell Death ; Epilepsy, Absence ; Epilepsy, Generalized* ; Hippocampus ; Humans ; Inflammation ; Male ; Neurogenesis ; Prefrontal Cortex ; Rats ; RNA, Messenger ; Seizures

1) We conducted a randomized controlled trial in medical education area and explored practical issues through reflection on the processes.
2) In February 2007, 39 fourth-year medical students in Nippon Medical School listened to the lecture about how to ask key questions for the diagnosis. Shortly after they had medical interview with a standardized patient for measurement purpose. They were randomly allocated to study and control groups. The lecture content for the intervention group corresponded to the interview but the one for the control group did not correspond to the interview.
3) We identified the issues related with ethical review for research, how to mask the information of randomization out of assessors, and equity of educational intervention and assessment offered to both groups.