Axonal remodeling in the corticospinal tract after stroke： how does rehabilitative training modulate it？

Stroke causes long-term disability, and rehabilitative training is commonly used to improve the consecutive functional recovery. Following brain damage, surviving neurons undergo morphological alterations to reconstruct the remaining neural network. In the motor system, such neural network remodeling is observed as a motor map reorganization. Because of its significant correlation with functional recovery, motor map reorganization has been regarded as a key phenomenon for functional recovery after stroke. Although the mechanism underlying motor map reorganization remains unclear, increasing evidence has shown a critical role for axonal remodeling in the corticospinal tract. In this study, we review previous studies investigating axonal remodeling in the corticospinal tract after stroke and discuss which mechanisms may underlie the stimulatory effect of rehabilitative training. Axonal remodeling in the corticospinal tract can be classified into three types based on the location and the original targets of corticospinal neurons, and it seems that all the surviving corticospinal neurons in both ipsilesional and contralesional hemisphere can participate in axonal remodeling and motor map reorganization. Through axonal remodeling, corticospinal neurons alter their output selectivity from a single to multiple areas to compensate for the lost function. The remodeling of the corticospinal axon is influenced by the extent of tissue destruction and promoted by various therapeutic interventions, including rehabilitative training. Although the precise molecular mechanism underlying rehabilitation-promoted axonal remodeling remains elusive, previous data suggest that rehabilitative training promotes axonal remodeling by upregulating growth-promoting and downregulating growth-inhibiting signals.

前列腺癌活检术后出血和MR诊断时肿瘤可检出性的相关性研究

目的以组织病理学结果为参照标准，回顾性评价前列腺癌活检术后出血对MRT2WI、动态增强MRI和DWI对肿瘤检出准确性的影响。方法本研究经伦理委员会同意并免除知情同意书。40例男性前列腺癌病人，年龄62～84岁（平均71岁），超声（US）引导系统下前列腺的12针活检术后行前列腺MRI检查。活检和MRI检查间隔平均24d（6-54d）。在1．5TMR设备上行T1WI、T2WI、动态增强与DWI检查。依据活检部位，于MR影像上将前列腺分为8个区域。3位医师共同分析每个区域是否有出血及有无前列腺癌，

内镜下静脉曲张结扎术联合部分脾脏栓塞术:可明显改善伴有食管静脉曲张与血小板减少的肝硬化患者预后

The aim of this study was to assess the efficacy of the combination of endoscopic variceal ligation(EVL)and partial splenic embolization(PSE)compared with EVL alone in cirrhosis patients with thrombocytopenia.In a prospective study,84 cirrhosis patients with esophageal varices and thrombocytopenia(platelet count < 50,000/mm3)underwent EVL plus PSE(N = 42)or EVL alone(N = 42).Primary end points assessed during the follow-up period included the recurrence of varices,progression to variceal bleeding,and death.Comparison between combined treatment and variceal ligation alone by multivariate analysis showed a hazard ratio of 0.44 for the recurrence of varices(P = 0.02),0.19 for progression to variceal bleeding(P = 0.01),and 0.31 for death(P = 0.04).These results suggest that the combination of EVL plus PSE can prevent the recurrence of varices,progression to variceal bleeding,and death in cirrhosis patients with esophageal varices and thrombocytopenia.

Pulmonary <i>Mycobacterium kansasii</i>Disease with Solitary Nodule

We recently encountered two patients with pulmonary Mycobacterium kansasii disease showing a solitary nodule. The patients were 53 and 66 years old and both were male. One patient had underlying diseases. The diagnosis was based on the clinical symptom in one patient and an abnormal chest shadow in the other. The final diagnosis was obtained by bronchoscopy and CT-guided lung biopsy. Antituberculous drugs were administered to one patient. We emphasize the importance of the positive identification of causative microorganisms in patients who present with a solitary nodule including surgical methods to differentiate the infection from lung cancer.

组织多普勒超声测得的左室充盈压指数(E/E')预测非瓣膜性房颤患者的生存率

目的:探讨舒张早期经二尖瓣血流速度(E)与舒张早期二尖瓣环速度(E’)的比值能否预测非瓣膜性房颤患者的预后。方法:230例非瓣膜性房颤患者被纳入研究。根据E/E’值将患者分为低E/E’组(A组:E/E’≤15)和高E/E’组(B组:E/E’】15)。

多西紫杉醇和卡铂联合治疗晚期或复发宫颈癌:一项初步研究

Objectives. This is a pilot study for a future trial to assess the efficacy and safety of combination chemotherapy with docetaxel and carboplatin in advanced or recurrent uterine cervix cancer. Methods. The patients eligible for this study had histologically confirmed, advanced (stage IB2- IV) or recurrent uterine cervix cancer. Eligible patients had measurable lesions and must have sufficient bone marrow, renal, and liver functions. Docetaxel was administered intravenously (IV) at 60 mg/m2 followed by IV carboplatin administration based on AUC = 6. Chemotherapy was repeated in 1- 6 courses depending on the purpose of the therapy. The response was evaluated based on RECIST criteria. The toxicity grade was determined by NCI- CTC version 2. Results. During January 2001 and April 2004, 17 patients were entered in this study. The distribution of stage was IB2, 3; IIB, 8; IIIB, 3; IVB, 1; recurrent, 2. There were 9 squamous cell carcinomas, 6 adenocarcinomas, 1 adenosquamous cell carcinoma, and 1 small cell carcinoma. The overall response rate was 76% (2 CR, 11 PR, and 4 SD). No progression of disease was observed. All 5 adenocarcinoma patients in the neoadjuvant chemotherapy group responded including 1 pathological CR. The incidences of grade 3/4 toxicities were 76% for neutrocytopenia, 12% for thrombocytopenia, and 6% for anemia. No grade 3/4 neurotoxicity was observed. Conclusions. The combination of docetaxel and carboplatin is an effective and safe treatment for uterine cervix cancer. Further evaluation particularly targeted on cervical adenocarcinoma is warranted.

Immunological Effects of Silica and Asbestos

Silicosis patients （SILs） and patients who have been exposed to asbestos develop not only respiratory diseases but also certain immunological disorders. In particular, SIL sometimes complicates autoimmune diseases such as systemic scleroderma, rheumatoid arthritis （known as Caplan syndrome）, and systemic lupus erythematoses. In addition, malignant complications such as lung cancer and malignant mesothelioma often occurr in patients exposed to asbestos, and may be involved in the reduction of tumor immunity. Although silica-induced disorders of autoimmunity have been explained as adjuvant-type effects of silica, more precise analyses are needed and should reflect the recent progress in immunomolecular findings. A brief summary of our investigations related to the immunological effects of silica/asbestos is presented. Recent advances in immunomolecular studies led to detailed analyses of the immunological effects of asbestos and silica. Both affect immuno-competent cells and these effects may be associated with the pathophysiological development of complications in silicosis and asbestos-exposed patients such as the occurrence of autoimmune disorders and malignant tumors, respectively. In addition, immunological analyses may lead to the development of new clinical tools for the modification of the pathophysiological aspects of diseases such as the regulation of autoimmunity or tumor immunity using cellmediated therapies, various cytokines, and molecule-targeting therapies. In particular, as the incidence of asbestosrelated malignancies is increasing and such malignancies have been a medical and social problem since the summer of 2005 in Japan, efforts should be focused on developing a cure for these diseases to eliminate nationwide anxiety.

Boron neutron capture therapy for vulvar melanoma and genital extramammary Paget’s disease with curative responses

Background:Although the most commonly recommended treatment for melanoma and extramammary Paget’s disease(EMPD)of the genital region is wide surgical excision of the lesion,the procedure is highly invasive and can lead to functional and sexual problems.Alternative treatments have been used for local control when wide local exci-sion was not feasible.Here,we describe four patients with genital malignancies who were treated with boron neutron capture therapy(BNCT).Methods:The four patients included one patient with vulvar melanoma(VM)and three with genital EMPD.They underwent BNCT at the Kyoto University Research Reactor between 2005 and 2014 using para-boronophenylalanine as the boron delivery agent.They were irradiated with an epithermal neutron beam between the curative tumor dose and the tolerable skin/mucosal doses.Results:All patients showed similar tumor and normal tissue responses following BNCT and achieved complete responses within 6 months.The most severe normal tissue response was moderate skin erosion during the first 2 months,which diminished gradually thereafter.Dysuria or contact pain persisted for 2 months and resolved com-pletely by 4 months.Conclusions:Treating VM and EMPD with BNCT resulted in complete local tumor control.Based on our clinical expe-rience,we conclude that BNCT is a promising treatment for primary VM and EMPD of the genital region.