Reinforcement of pedicle screws using PMMA augmentation may be a feasible surgical technique for osteoporotic spines.

Objective: N-(2-hydroxyethyl)-nicotinamide nitrate (nicorandil) is a unique anti-anginal agent, reported to act as both an ATP-sensitive K þ channel opener (PCO) and a nitric oxide donor. It also has an anti-oxidant action. We examined the effects of nicorandil on streptozotocin (STZ)-induced islet b-cell damage both in vivo and in vitro. Design and methods: STZ-induced diabetic Brown Norway rats (STZ-DM) were fed with nicorandil-containing chow from day 2 (STZ-DM-N48), 3 (STZ-DM-N72), and 4 (STZ-DM-N96) to day 30. Body weight, blood glucose, and plasma insulin were measured every week. For the in vitro assay, neonatal rat islet-rich cultures were performed and cells were treated with nicorandil from 1 h before to 2 h after exposure to STZ for 30 min. Insulin secretion from islet cells was assayed after an additional 24 h of culture. We also observed the effect of nicorandil on the generation of reactive oxygen species (ROS) from rat inslinoma cells (RINm5F). Results: Body weight loss and blood glucose levels of STZ-DM-N48 rats were significantly lower than those of STZ-DM rats. Immunohistochemical staining of insulin showed preservation of insulin-secreting islet b-cells in STZ-DM-N48 rats. Nicorandil also dose-dependently recovered the insulin release from neonatal rat islet cells treated with STZ in in vitro experiments. Nicorandil did not act as a PCO on neonatal rat islet b-cells or RINm5F cells, and did not show an inhibitory effect on poly( ADP-ribose) polymerase-1. However, the drug inhibited the production of ROS stimulated by high glucose (22.0 mmol/l) in RINm5F cells. Conclusions: These results suggested that nicorandil improves diabetes and rat islet b-cell damage induced by STZ in vivo and in vitro. It protects islet b-cells, at least partly, via a radical scavenging effect.European Journal of Endocrinology 151 277-285

Shoot population dynamics of Carex kobomugi Ohwi, a rhizomatous perennial sedge with a guerilla-type growth form, dominating on Japanese coastal dunes, were examined to detect factors generating the zonal distribution pattern of the plant species. Relative growth rate of shoot (RGRS) and number of branching shoots formed by a mother shoot in a year (NBr) were measured in three populations occurring at three different distances from the shoreline. In 1992, Carex kobomugi shoots at the most inland site (90 m from the shoreline), where Imperata cylindrica var. koenigii dominated and soil-water salinity is always low, showed the lowest RGRS (0.0172 g g-1 day-1 from April to June and 0.00079 g g-1 day-1 in July) and the smallest NBr (1.3 shoots shoot-1 year–1 averaged for 3 years). Shoots of the species at the most seaward site (40 m from the shoreline), where the soil-water salinity is always higher than that of more inland sites, showed the highest RGRS (0.0228 g g-1 day-1 from April to June and 0.0093 g g-1 day-1 in July) and the largest NBr (2.5 shoots-1). However, Carex kobomugi population at the 40 m site had a high fraction of injured shoots (46% of total shoots sampled), which were recorded as shoots without any greenish above-ground part, and high mortality (0.34) due to temporal flooding of sea water caused by storms. In the intermediate site (70 m from the shoreline), Carex kobomugi had intermediateRGRS and NBr with low injury rate. The NBr value, however, showed a decreasing trend over the 3 years of observation, suggesting deteriorating effects of intraspecific competition on population dynamics. In the spring of the fourth year, shoots of Carex kobomugi at 70 m and 90 m from the shoreline produced 1.2 to 2.0 times higher number of buds per shoot than the 3-year-averaged NBrs. This suggests that some fractions of the buds were terminated or became dormant through intra- and/or inter-specific competition. The sparse distribution of Carex kobomugi at the 90 m site may be dictated by its competitive inferiority to Imperata cylindrica which has a denser root system and an aggressive growth form of a phalanx type.

OBJECTIVE Teriparatide (TPTD) is a potent promoter of early-stage osteogenesis and may be a useful adjuvant therapy to reduce complications related to bone fragility in spinal surgery patients with osteoporosis. However, effective neoadjuvant TPTD therapy regimens remain poorly understood. This study aimed to examine the effect of preoperative TPTD administration on cancellous bone with bone histomorphometry and to clarify the timing of preoperative TPTD administration for patients with spinal fusion and osteoporosis. METHODS In this longitudinal multicenter study, 57 patients with spinal fusion and osteoporosis, who consented to undergo iliac biopsy, were allocated to the following treatment groups: neoadjuvant TPTD therapy group (n = 42) and no neoadjuvant therapy (NTC) group (n = 15). Patients in the TPTD group were categorized into subgroups on the basis of duration of preoperative TPTD administration, as follows: 1 month (n = 9), 2 months (n = 8), 3 months (n = 9), 4 months (n = 7), and 6 months (n = 9). All patient samples were preoperatively double labeled with tetracycline, and iliac biopsies were performed during spinal fusion surgery. Histomorphometric analyses were performed on nondecalcified, thin-sliced specimens. Specimens were classified on the basis of TPTD administration duration and subsequently compared with those of the NTC group. Postoperative complications and Oswestry Disability Index scores were evaluated at 1 and 2 years after surgery. RESULTS There were no demographic differences between groups. Mineralizing surface/bone surface, a key parameter of dynamic bone formation, started to increase after 1 month of TPTD administration; this increase became significant after 3 months of administration and peaked at 4 months, with a 6-fold increase relative to that of the NTC group. The patients who received preoperative TPTD for 3 months or more had superior clinical results in terms of the osteoporotic complication rate and Oswestry Disability Index scores, except for bisphosphonate-pretreated patients. CONCLUSIONS When considering neoadjuvant TPTD therapy, the authors recommend at least 3 months of preoperative administration to provide a more substantial anabolic effect from the early postoperative stage.

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Study Design. Retrospective multi-center study. Objective. To identify the morphological features of costovertebral joints and ribs in surgically managed cervical injury patients with diffuse idiopathic skeletal hyperostosis (DISH) and to examine its impact on their vital prognosis. Summary of Background Data. Several reports have indicated that DISH is an independent risk factor for mortality after spinal fracture. The reason for the high mortality in cervical injury patients with DISH is unclear, although some reports have suggested a possible association between pulmonary complications and mortality. Methods. From 1999 to 2017, a total of 50 DISH patients (44 males) with cervical spine injuries who underwent spinal surgery were enrolled (average age 74 yrs). Prognosis and clinical risk factor data were collected; the morphological features of the patients’ costovertebral joints and ribs were evaluated with computed tomography. The influence of each proposed risk factor and thoracic morphological feature on mortality was tested with univariate and multivariate analyses. Results. The survival rate at 5 years after surgery was 52.3%. Nineteen (38%) patients died, and the most common cause of death was pneumonia (68%). Costovertebral bone excrescences and rib hyperostosis were found to be thoracic pathognomonic signs; their frequencies were 94% and 82%, respectively, and these conditions occurred in an average of 7.0 joints and 4.7 bones, respectively. The results of the log-rank test showed a significant difference in age, injury severity score (ISS), costovertebral bone excrescences, and rib hyperostosis. The results of age-adjusted multivariate analysis indicated that age (hazard ratio [HR] = 8.65, 95% confidence interval [CI] = 1.10–68.28, P = 0.041) and rib hyperostosis (HR = 3.82, 95% CI = 1.38–10.57, P = 0.010) were associated with mortality. Conclusion. Reduced chest wall mobility associated with rib hyperostosis in cervical spine injury patients with DISH leads to a poor prognosis. Level of Evidence: 3

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