Objective Human Lyme arthritis caused by Borrelia burgdorferi is characterized by an inflammatory infiltrate that consists mainly of neutrophils and T cells. This study was undertaken to evaluate the role of the innate and acquired immune responses elicited by the neutrophil‐activating protein A (NapA) of B burgdorferi in patients with Lyme arthritis. Methods Serum anti‐NapA antibodies were measured in 27 patients with Lyme arthritis and 30 healthy control subjects. The cytokine profile of synovial fluid T cells specific for NapA was investigated in 5 patients with Lyme arthritis. The cytokine profile induced by NapA in neutrophils and monocytes was also investigated. Results Serum anti‐NapA antibodies were found in 48% of the patients with Lyme arthritis but were undetectable in the healthy controls. T cells from the synovial fluid of patients with Lyme arthritis produced interleukin‐17 (IL‐17) in response to NapA. Moreover, NapA was able to induce the expression of IL‐23 in neutrophils and monocytes, as well as the expression of IL‐6, IL‐1β, and transforming growth factor β (TGFβ) in monocytes, via Toll‐like receptor 2. Conclusion These findings indicate that NapA of B burgdorferi is able to drive the expression of IL‐6, IL‐1β, IL‐23, and TGFβ by cells of the innate immune system and to elicit a synovial fluid Th17 cell response that might play a crucial role in the pathogenesis of Lyme arthritis.

BACKGROUND The objective of this prospective cohort study was to determine the efficacy of stereotactic radiosurgery (SRS) as a salvage treatment in patients with recurrent malignant gliomas. METHODS Between January 2000 and December 2006, 114 consecutive patients were treated with SRS as a salvage treatment for recurrent malignant gliomas at a single institution. Clinical outcome and its prognostic factors were analyzed and compared with the historical control group who were treated at the same institution between 1995 and 1999. RESULTS The median overall survival from the time of diagnosis was 37.5 months (95% confidence interval [95% CI], 11.7–63.2 months) for patients with grade 3 gliomas (according to World Health Organization criteria) and was 23months (95% CI, 16.2–29.3 months) for patients with glioblastomas. The median progression‐free survival after SRS was 8.6 months (95% CI, 1.1–16.2 months) for patients with grade 3 gliomas and 4.6 months for patients with glioblastomas (95% CI, 4.0–5.2 months). With regard to treatment‐related complications, radiation‐induced necrosis was observed in 22 of 114 patients (24.4%). Compared with this historic control group, SRS significantly prolonged survival as a salvage treatment in patients with recurrent glioblastomas (23 months vs 12 months; P < .0001), but it was not found to provide a significant surgical benefit in patients with recurrent grade 3 gliomas (37.5 months vs 26 months; P = .789). On univariate analysis of prognostic factors, tumor volume (<10 mL) and low histologic grade were found to significantly influence better survival (P = .009 and P = .041, respectively). CONCLUSIONS SRS is a safe and effective modality in selected patients with recurrent small‐sized glioblastomas. However, the efficacy of SRS for recurrent grade 3 gliomas needs to be further evaluated in well‐designed clinical studies. Cancer 2008. © 2008 American Cancer Society.

The authors critically analyzed a large series of patients with hemifacial spasm (HFS) and who underwent microvascular decompression (MVD) under a prospective protocol. We describe several "lessons learned" that are required for achieving successful surgery and proper postoperative management. The purpose of this study is to report on our experience during the previous 10 years with this procedure and we also discuss various related topics. From April 1997 to June 2009, over 1,200 consecutive patients underwent MVD for HFS. Among them, 1,174 patients who underwent MVD for HFS with a minimum 1 year follow-up were enrolled in the study. The median follow-up period was 3.5 years (range, 1-9.3 years). Based on the operative and medical records, the intraoperative findings and the postoperative outcomes were obtained and then analyzed. At the 1-year follow-up examination, 1,105 (94.1%) patients of the total 1,174 patients exhibited a "cured" state, and 69 (5.9%) patients had residual spasms. In all the patients, the major postoperative complications included transient hearing loss in 31 (2.6%), permanent hearing loss in 13 (1.1%), transient facial weakness in 86 (7.3%), permanent facial weakness in 9 (0.7%), cerebrospinal fluid leak in three (0.25%) and cerebellar infarction or hemorrhage in two (0.17%). There were no operative deaths. Microvascular decompression is a very effective, safe modality of treatment for hemifacial spasm. MVD is not sophisticated surgery, but having a basic understanding of the surgical procedures is required to achieve successful surgery.

Facial EMG monitoring of the LSR is an effective tool to use when performing complete decompression, and it may be helpful in predicting outcomes.

The postoperative course of microvascular decompression (MVD) for hemifacial spasm (HFS) is variable, and the optimal time for assessing the results is unclear. From April 1997 to October 2007, MVD for HFS was performed in 801 patients. Patients were divided into two groups (cured or failed) according to subjective patient assessments over a 3-year period. We analyzed patient characteristics and surgical findings to determine prognostic factors. Medical records were analyzed retrospectively over the 3-year follow-up period. Of the 801 patients who underwent surgery, 743 (92.8 %) appeared to be cured, 70 (8.7 %) had residual or recurrent spasms more than 1 year after surgery, 11 (1.3 %) had gradual improvement over 3 years, and 1 (0.1 %) had delayed improvement more than 3 years after surgery. Fifty-eight patients (7.2 %) had residual or recurrent spasms more than 3 years after surgery, of which 19 (2.4 %) had recurrence after initial relief. The mean time to spasm recurrence was 18.9 months. Intraoperative resolution of the lateral spread response (LSR) after decompression (p = 0.048) and severe indentation (p = 0.038) were significant predictors of good long-term outcome after MVD for HFS. In our series, 70 patients (8.7 %) had residual or recurrent spasms more than 1 year after surgery, of which 12 (17.1 %) improved gradually after 1 year. If the surgeon can confirm intraoperative resolution of the LSR and severe indentation, reoperation can be delayed until 3 years after MVD.

Polydimethylsiloxanevi–poly(vinylidene fluoride) (PDMSvi–PVDF) composite membranes were prepared using asymmetric PVDF hollow‐fiber membranes as the substrate where a very thin layer of silicone‐based coating material was deposited via a developed dip coating method. The preparation of the composite membranes under various conditions were investigated. In the optimal coating procedure, homogenous and stable oligo‐PDMSvi coating layers as thin as 1–2 μm were successfully deposited on the surface of PVDF membranes. The developed PDMSvi–PVDF composite membranes were applied for separation of a wide variety of volatile organic compounds (benzene, chloroform, acetone, ethyl acetate, and toluene). The results showed that the PDMSvi–PVDF hollow‐fiber composite membranes that had been developed exhibited very high removal efficiency (>96%) for all the VOCs examined under favorable operating conditions. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci, 2006

Our objective is to present surgical techniques used for the prevention of cerebrospinal fluid leakage after microvascular decompression (MVD). From January 1996 to February 2006, microvascular decompression for hemifacial spasm or trigeminal neuralgia was performed in 678 consecutive patients. In order to achieve watertight dural closure, several pieces of muscle were interposed between the dura when the dura was sutured; the dura was stitched with the addition of muscle pieces to plug the dural defect. In cases where the mastoid air cell system was opened, bone wax was used to seal the opened surface of the cavity, and a muscle patch was applied for the secondary sealing. The cranioplasty was performed using polymethylmethacrylate (PMMA) bone cement. Only 2 (0.29%) of 678 patients, who underwent MVD followed by dural closure using several muscle pieces to plug the potential dural defect, suffered from CSF leaks. Both were treated with lumbar subarachnoid drainage; neither patient required a lumbar peritoneal shunt or a revision operation. A watertight dural closure with the addition of muscle pieces in a "plugging" fashion, along with sealing the opened surface of the mastoid cavity using bone wax and cranioplasty using bone cement, provides a simple and effective technique for the prevention of CSF leakage after MVD.

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