Junichi Kamizono

Survivin-responsive conditionally replicating adenovirus exhibits cancer-specific and efficient viral replication.

Although a conditionally replicating adenovirus (CRA) exhibiting cancer-selective replication and induction of cell death is an innovative potential anticancer agent, current imperfections in cancer specificity and efficient viral replication limit the usefulness of this technique. Here, we constructed survivin-responsive CRAs (Surv.CRAs), in which expression of the wild-type or mutant adenoviral early region 1A (E1A) gene is regulated by the promoter of survivin, a new member of the inhibitor of apoptosis gene family. We explored the cancer specificity and effectiveness of viral replication of Surv.CRAs, evaluating their potential as a treatment for cancer. The survivin promoter was strongly activated in all cancers examined at levels similar to or even higher than those seen for representative strong promoters; in contrast, low activity was observed in normal cells. Surv.CRAs efficiently replicated and potently induced cell death in most types of cancer. In contrast, minimal viral replication in normal cells did not induce any detectable cytotoxicity. A single injection of Surv.CRAs into a preestablished tumor expressing survivin, even at relatively low levels, induced significant tumor death and inhibition of tumor growth. Furthermore, Surv.CRAs were superior to telomerase-dependent CRAs, one of the most effective CRAs that have been examined to date, both in terms of cancer specificity and efficiency. Thus, Surv.CRAs are an attractive potential anticancer agent that could effectively and specifically treat a variety of cancers.

Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249

Analysis of surgical site infection after musculoskeletal tumor surgery: risk assessment using a new scoring system.

Surgical site infection (SSI) has not been extensively studied in musculoskeletal tumors (MST) owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases) treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery (P = 0.0002) and intraoperative blood loss (P = 0.0005) was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI) index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials). The MOSI index (0–4 points) score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points). The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI.

Occupational recovery after open-door type laminoplasty for patients with ossification of the posterior longitudinal ligament.

Study Design. A cross-sectional survey of occupational recovery after surgery with patients who had ossification of the posterior longitudinal ligament. Objectives. To evaluate occupational recovery after open-door type laminoplasty for patients with ossification of the posterior longitudinal ligament. Summary of Background Data. The literature contains numerous reports on the surgical results of laminoplasty for ossification of the posterior longitudinal ligament, but very few reports are available on postoperative quality of life, and even fewer on occupational recovery after laminoplasty. Methods. A cross-sectional survey was conducted of 301 patients with ossification of the posterior longitudinal ligament in the cervical spine who were employed before open-door type laminoplasty. Presurgical occupations were classified into three categories: light sedentary labor, light standing labor, and heavy labor. High-rise workers and professional drivers were analyzed separately. The subjects were rated by occupational category for determining the occupational recovery ratio. Factors analyzed for impact on recovery were pre- and postsurgery severity of myelopathy, duration of myelopathy, age at surgery, gender, and type of ossification of the posterior longitudinal ligament. Results. Of the 301 patients studied, 160 (53%) returned to work. Poor recovery rates were observed for heavy labor, high-rise workers, and professional drivers. The period required for return to work did not significantly differ among occupational categories. Occupation, presurgery severity of myelopathy, and postsurgery severity of myelopathy were significantly correlated with occupational recovery. Conclusion. Patients’ occupations should be carefully considered when designing postsurgery occupational rehabilitation programs, and patients should receive postoperative advice regarding the suitability of occupation.

Clinical Outcome of Arthroscopic Partial Resection of Hip Acetabular Labrum Tear: A Case Report

51歳男性．1年程前より，誘因なく右股関節痛が出現し，平成18年10月当科紹介受診．股関節内外旋での疼痛認めるも，単純レントゲンにて明らかな異常を認めなかった．腰椎を含め，他部位に異常を認めず，臨床所見より股関節唇損傷を疑い，MRI，CT arthrographyを行った．その結果，いずれにおいても関節唇の一部に関節唇損傷を疑う所見を認めた．また，関節内局麻注入にて一時的な症状改善を認め，症状，画像を総合的に判断し，最終的に関節唇損傷と診断し，関節鏡を行った．鏡視にて前外側の関節唇損傷を認め，鏡視下関節唇切除術を行った．術後早期より，歩行時の疼痛などの症状の改善を認め，経過良好である．股関節唇損傷は症状やCT arthrography，MRI，関節内局麻注入などで診断されることが多いが，画像上明らかな異常所見がない例も少なくない．原因が明らかでない股関節痛が持続する症例では，関節唇損傷も考慮に入れて，関節鏡を用いた．診断治療を行うことは有効な方法であると考える．

Paraspinal Penetrating Injury Caused by Wooden Chopstick.

Injury in the oral cavity is common in infants, but injury penetrating into the deep tissue in the oral cavity is rare. We reported a rare injury penetrating into the paraspinal canal from the mouth by a wooden chopstick. A three-year-old boy fell on his face during dinner, and the wooden chopstick he was using pierced his mouth. The broken chopstick could not be found by X-ray examination, but continuous examination to detect the broken chopstick was necessary to determine penetrating injury into the cavity. On CT examination, the broken chopstick was found in his paraspinal canal, and it was removed by posterior cervical spinal approach. He was discharged without any complications.