Imbalance in multiple sclerosis and neuromyelitis optica: association with deep sensation disturbance.

Abnormality in balance is one of the most important causes of gait disturbance which has a direct impact to disability and medical cost in multiple sclerosis (MS) and neuromyelitis optica (NMO). However, characteristics of imbalance in these two diseases have not been fully elucidated. The aim of this study was to evaluate the degree and features of imbalance using stabilography, the degree of deep sensation disturbance using tibial nerve somatosensory evoked potentials (SEP), and their association with clinical impairment, in patients with MS and NMO. Seven NMO patients and seven MS patients with balance disturbance were examined. The relationship among stabilography measurements representing the degree and features of imbalance, height-adjusted P38 peak latency of SEP, and neurological functional disability, were analyzed. Stabilography evaluation showed a significantly severer degree of imbalance in NMO than in MS. Romberg quotient of the patients with brainstem lesions was significantly larger than those without them. In all patients, length of excursion per second significantly correlated positively with anterio-posterior-axis power spectra at intermediate frequency band. In all patients and in NMO, P38 peak latency adjusted by height significantly correlated positively with anterio-posterior-axis power spectra at intermediate frequency band. These findings suggest that the degree of imbalance of MS and NMO possibly correlate with deep sensation disturbance, which could be evaluated by anterio-posterior-axis power spectra at intermediate frequency band by stabilography. Severer imbalance in NMO than MS may be associated with the severe longitudinally extensive spinal cord lesions.

[A Case of Juvenile Cerebral Infarction due to Reversible Cerebral Vasoconstriction Syndrome].

A 19-year-old woman had a thunderclap headache, followed by left hemiparesis and left homonymous hemianopsia. Laboratory tests showed no signs of infection and immunological test results were unremarkable. MRI revealed a cerebral infarction in the right posterior cerebral artery territory, and digital subtraction angiography(DSA)showed right posterior cerebral artery stenosis on day 2. The first follow-up DSA demonstrated an irregular, bead-like appearance on day 9, but the stenotic lesion returned to normal on day 21. Reversible cerebral vasoconstriction syndrome should be suspected in cases of rapid resolution of symptoms.

[Acute Subdural Hematoma in Snowboarders:A Multivariate Analysis of 79 Cases].

Snowboarding-related head injuries have become less common as the number of snowboarders has decreased;however, severe head injuries, such as acute subdural hematomas, occur every snowboarding season. We investigated the characteristics of cases of snowboarding-related acute subdural hematoma treated at our hospital. A total of 3,632 patients with snowboarding-related head injuries seen at our hospital between the 1995/96 and 2012/13 snowboarding seasons were enrolled in this study. Seventy-nine(2.2%)patients were diagnosed with acute subdural hematomas using computed tomography. We statistically analyzed the patient questionnaire responses, clinical records, and radiological findings. We compared the findings of the acute subdural hematoma(ASDH)group with those of the non-ASDH group. Among beginners, falling on a slope, incidents involving gentle slopes, and injuries of unknown origin were significantly more common in the ASDH group. On the other hand, among the intermediate snowboarders, incidents involving jumps, jump failure, and collisions with other snowboarders were more common in the non-ASDH group. Secondly, in an analysis involving subjects who had an ASDH, we compared the beginner group with the intermediate/advanced group. Falling on a slope, incidents involving gentle slopes, pure ASDH, diffuse brain swelling, and death were more common in the beginner group, and ASDH combined with contusions or subarachnoid hemorrhaging and incidents involving a jump were more common in the intermediate/advanced group. Finally, we summarized the cases of 10 subjects with an ASDH as well as diffuse brain swelling. Nine of the 10 patients died, 8 were first-timers or beginners, 6 had incidents involving flat or gentle slopes, and 5 had fallen on a slope. Snowboarding is a recreational sport;therefore, snowboarders must take responsibility for their actions. However, snowboarders, especially beginners, could decrease their risk of ASDH if they are informed about ASDH and take precautions to reduce their risk of falling on gentle slopes. Educational activities related to this topic should continue.

[Multiple and simultaneous intracranical hemorrhages with homocysteinemia].

A decreased intake of brightly colored vegetables results in increased levels of serum homocysteine, and homocysteinemia is associated with the progression of arteriosclerosis. Moreover, homocysteinemia is a known risk factor for cerebral infarction. Here, we report three cases wherein multiple simultaneous intracranial hemorrhages developed in the presence of homocysteinemia. The dietary habits of the patients involved indicated that decreased intake of brightly colored vegetables and the consequent progression of arteriosclerosis caused intracranial hemorrhage. Thus, in daily medical care, the measurement of serum homocysteine levels is useful for managing dietary habits and progression of arteriosclerosis.

Quantification of caffeine in coffee cans using electrochemical measurements, machine learning, and boron-doped diamond electrodes.

Electrochemical measurements, which exhibit high accuracy and sensitivity under low contamination, controlled electrolyte concentration, and pH conditions, have been used in determining various compounds. The electrochemical quantification capability decreases with an increase in the complexity of the measurement object. Therefore, solvent pretreatment and electrolyte addition are crucial in performing electrochemical measurements of specific compounds directly from beverages owing to the poor measurement quality caused by unspecified noise signals from foreign substances and unstable electrolyte concentrations. To prevent such signal disturbances from affecting quantitative analysis, spectral data of voltage-current values from electrochemical measurements must be used for principal component analysis (PCA). Moreover, this method enables highly accurate quantification even though numerical data alone are challenging to analyze. This study utilized boron-doped diamond (BDD) single-chip electrochemical detection to quantify caffeine content in commercial beverages without dilution. By applying PCA, we integrated electrochemical signals with known caffeine contents and subsequently utilized principal component regression to predict the caffeine content in unknown beverages. Consequently, we addressed existing research problems, such as the high quantification cost and the long measurement time required to obtain results after quantification. The average prediction accuracy was 93.8% compared to the actual content values. Electrochemical measurements are helpful in medical care and indirectly support our lives.

A simple and useful coma scale for patients with neurologic emergencies: the Emergency Coma Scale.

OBJECTIVES: The Emergency Coma Scale (ECS) was developed in Japan in 2003. We planned a multicenter study to evaluate the utility of the ECS by comparison of the ECS and the Glasgow Coma Scale (GCS). METHODS: Ten medical facilities, including 4 university hospitals in Japan, participated in this study. We evaluated and recorded the level of consciousness, using the ECS and GCS, of all patients transported to these medical facilities by ambulance. We then performed a statistical analysis of the level of rater agreement of each scale using the average weighted κ coefficient according to the types of diagnosis at time of discharge and the occupations of the raters. We then evaluated the relationship between outcome of patients and their scores on the ECS and GCS by logistic regression analysis. RESULTS: The ECS showed the greater agreement among raters in patient scoring (0.802). In patients with traumatic brain injury and cerebrovascular disease, the ECS also yielded the higher agreement (0.846 and 0.779, respectively). The ECS score appears to be more strongly related than the GCS to patient outcome as measured by the Glasgow Outcome Scale (GOS). CONCLUSIONS: Our results showed that the ECS is a simple and readily understandable coma scale for a wide range of professionals in the field of neurologic emergencies. Furthermore, ECS appears to be suitable for evaluating patients in neurologic emergency settings.

[Cerebral infarction suspected due to dissection of intracranial carotid artery in 2 children].

Intracranial cerebral artery dissection in children is very rare. We report 2 children who were diagnosed as having cerebral infarction which was suspected to be due to dissection of intracranial cerebral artery. Case 1: An 11-year-old girl presented with conscious disturbance and hemiparesis after seizure. Computed tomography (CT) showed cerebral infarction in the right frontal lobe. Her symptoms did not change, but angiography demonstrated reversible change. She received conservative therapy. Case 2: A 10-year-old boy complained of headache, and presented nausea and monoparesis of the left upper extremity. CT showed cerebral infarction in the right frontal lobe. He received superficial temporal artery-middle cerebral artery anastomosis because his symptoms fluctuated. In both cases, cerebral angiography showed string sign from the supraclinoid portion of the internal carotid artery to the middle and the anterior cerebral artery. Follow-up angiography showed improvement of stenosis. In pediatric cases of cerebral artery dissection, improvement with conservative therapy is frequently reported. It is necessary to follow-up such patients closely using magnetic resonance angiography or conventional angiography to determine whether or not surgery is indicated.

Surface EMG Pattern Recognition Using Long Short-Term Memory Combined with Multilayer Perceptron.

Motion classification based on pattern recognition of surface EMG (sEMG) signals is a promising approach for prosthetic control. We present a pattern recognition model that combines long short-term memory (LSTM) network with multiplayer perceptron (MLP) for sEMG signals feature learning and classification. The LSTM network captures temporal dependencies of the sEMG signals while the MLP has no inherent temporal dynamics but focuses on the static characteristics. The combination of the two networks would learn a feature space that contains both the dynamic and static information of the sEMG signals, which helps to improve the motion classification accuracy. The architecture of the proposed network was optimized by investigating the appropriate width and depth of the neural network as well as the dropout to achieve the best classification results. The performance of the proposed pattern recognition model was evaluated using Ninapro database. The results show that the proposed model can produce better classification accuracy than most of the well-known recognition techniques.

Recurrent intracranial solitary fibrous tumor initially diagnosed as hemangiopericytoma.

We describe a case of an intracranial solitary fibrous tumor that recurred three times consecutively in an 11-year period. A 72-year-old man presented with a headache and gait disturbance. Magnetic resonance imaging (MRI) revealed a dumbbell tumor at the left tentorium. The tumor was removed but recurred. The first diagnosis was hemangiopericytoma, but all specimens showed a "patternless pattern" and few reticulin fibers, which features were not compatible with hemangiopericytoma. All tumors showed immunoreactivity for CD34 and bcl-2. These results point to a solitary fibrous tumor (SFT) and not to hemangiopericytoma. We present here a hypercellular spindle-cell tumor that was very similar to hemangiopericytoma but is better diagnosed as SFT.

Clinical investigation of acute spontaneous subdural hematoma cases.

BACKGROUND: Acute spontaneous subdural hematomas of arterial origin without any traumatic history or vascular anomaly are rarely reported. Here, we report our series of 6 patients with acute spontaneous subdural hematoma. METHODS: All patients with acute spontaneous subdural hematoma were surgically treated at our hospital between January 1994 and December 2003. Each patient's constitution, medical history, clinical findings, intraoperative findings, complications, and outcomes were reviewed. RESULTS: The patients were 5 men and 1 woman with a mean age of 53.0 years (range 32-82). Two of the 6 patients had histories of head injury with onset more than 10 years earlier. Other medical histories included hepatitis C, dementia, alcoholism, and hypertension in one patient each. Initial symptoms were rapidly progressive disturbance of consciousness in 5 patients. Surgical operation was performed in all patients, and the bleeding points were identified as ruptures of cortical arteries located near the sylvian fissure. One patient completely recovered, one had a moderate deficit, two had severe deficits, one fell into a vegetative state, and one died (mortality was 16.7%). CONCLUSION: In many cases, the patients suddenly fell into a serious disturbance of consciousness at the onset, and the outcomes were poor. We emphasize that a very early operation is required for a good outcome.

Characteristics of helmet or knit cap use in head injury of snowboarders.

The rate of head injury is 1.86-6 times higher for snowboarding than for skiing. Detailed data about the usefulness of a helmet or knit cap for protecting against serious head injuries have not been reported. The present study evaluated the use of a helmet or knit cap for preventing head injuries. Questionnaire data were collected from 1,190 consecutive patients in a hospital during the 1999/2000-2002/2003 winter seasons at Uonuma ski resort, Niigata, Japan. Patients were divided into the helmet, knit cap, and no cap groups. Upper technical level was highest and jumping as the cause of injury was most frequent in the helmet group. After adjustment for other confounders, there was a significant negative association between the occurrence of serious head injury during snowboarding and female sex (adjusted odds ratio 0.55, 95% confidence interval 0.421-0.718, p < 0.0001) and a significant positive association between serious head injury and jumping (adjusted odds ratio 2.25, 95% confidence interval 1.48-3.43, p = 0.0001). Among snowboarding maneuvers, only jumping showed a significant negative association between wearing of a helmet or knit cap and the occurrence of serious head injury (p = 0.036). Snowboarders who wear helmets might attempt dangerous maneuvers causing injuries. Wearing of a helmet or knit cap protected against serious head injuries on jumping. Every snowboarder should wear a helmet or knit cap on jumping to prevent head injury.

Molecular characterisation of equine group A rotavirus, Nasuno, isolated in Tochigi Prefecture, Japan.

In this study, equine group A rotavirus (RV-A), Nasuno, isolated from foal diarrhoea in Tochigi Prefecture, Japan was characterised genetically by sequence analysis of the genome segments encoding VP4 and VP7. The nucleotide and deduced amino acid sequences revealed high homology with P[12] RV-As (94.0-99.3% and 94.9-99.4%) and G3 RV-As (86.9-99.5% and 91.1-99.4%). Nasuno was also classified into P[12] and G3 in the phylogenetic analysis of the nucleotide sequences of the genome segments encoding VP4 and VP7.

[A case of infundibular dilatation developed into an aneurysm and rupturing after the rupture of an aneurysm 10 years ago].

A 44-year-old female with subarachnoid hemorrhage caused by the left internal carotid-posterior communicating artery aneurysm rupture was presented. At that time, carotid angiography showed the left internal carotid-posterior communicating artery aneurysm and the right internal carotid-posterior communicating artery portion infundibular dilatation. Neck clipping for left internal carotid-posterior communicating artery aneurysm was done and she was discharged from our hospital without neurological deficit. After 10 years, she suffered a second subarachnoid hemorrhage. Carotid angiography demonstrated the right internal carotid-posterior communicating artery aneurysm developed from the opposite infundibular dilatation. Emergency clipping was performed with three Sugita fenestration clips, because that aneurysm had a very wide neck. We should examine the internal carotid-posterior communicating artery infundibular dilatation with opposite side aneurysms in young females carefully and serially.

An outbreak of systemic granulomatous disease in cows with high milk yields.

Seven of 92 lactating Holstein cows on a dairy farm developed urticaria with alopecia and decreased milk production, and three of the seven died over the course of 7 to 18 days. Pathologic examination of the three cows, including the two dead and one euthanized cow, revealed that the skin, liver, spleen, kidneys, heart, salivary glands, pancreas, adrenal glands, mammary glands, lymph nodes, and trigeminal ganglia had lymphocytic to lymphogranulomatous inflammation. Inflammation predominated by lymphocytic infiltration was prominent in the heart, pancreas, mammary glands, adrenal gland, and trigeminal ganglia. Severe granulomatous inflammation with multinucleated giant cells was present in the spleen and kidneys. These lesions and their distributions were most similar to those seen in suspected cases of citrus pulp toxicosis and hairy vetch toxicosis. The outbreak of this disease resolved with the elimination of Citrus pulp from the feed. Immunohistochemical detection of lymphocytes and macrophage markers confirmed dramatic hyperplasia of CD3-positive T lymphocytes in these lesions. This strongly suggested that a type 4 hypersensitivity reaction played a role in the development of the lesions.

Use of a perfusion co-culture system consisting of Caco-2 and Hep G2 cell compartments for the kinetic analysis of benzo[a]pyrene toxicity.

Conventional cytotoxicity tests cannot usually include various metabolic processes in humans. We therefore developed a physiologically based, multi-compartment perfusion co-culture system, using a Caco-2 cell monolayer on a semi-permeable membrane and a microcarrier-based, three-dimensional culture of Hep G2 cells to mimic permeation across the small intestine and biotransformation of the small intestine and the liver. Stable operations allowed us to maintain various activities of both cells for at least 4 days. Cocultivation improved the growth of Hep G2 cells and enhanced the cytochrome P450 1A1/2 capacities of both Hep G2 and Caco-2 cells. When benzo[a]pyrene (BaP) was loaded on the apical side of the Caco-2 cell layer, the enhanced P450 capacities produced a higher amount of BaP-7,8-hydrodiol, a precursor of the ultimate carcinogen of BaP, BaP-7,8-dihydrodiol-9,10-epoxide (BPDE). These phenomena led to the initially retarded, but later stronger, expression of BaP toxicity in the co-culture system than in pure cultures, which agreed with the actual load of BaP-7.8-hydrodiol to the Hep G2 cells. Because this kind of system can reproduce such complicated phenomena, including those influenced by organ-organ interactions, it is useful as a new in vitro experimental system, for understanding the unknown mechanisms involved in final toxicity in humans and thereby improving physiologically based pharmacokinetic (PBPK) simulation models.

Prediction of the muscle strength by the muscle thickness and hardness using ultrasound muscle hardness meter.

PURPOSES: The present study investigated whether a combination of the thickness and hardness of muscles without muscle tension can be used to estimate muscle strength during knee extension in adult males and females. METHODS: Seventy-two males and thirty-three females, whose ages ranged from 18 to 35 years, participated in this study. We measured muscle thickness and hardness in the right anterior region of the thigh (rectus femoris muscle and vastus intermedius muscle) without muscle tension using an ultrasound muscle hardness meter, and the maximal voluntary isometric contraction of right knee extension (MVIC). The changing ratios (%) of the tissue thickness before compression to those during compression (compression ratio) are calculated as an index of the hardness. Higher ratio indicates a harder muscle compared with that of other individuals showing the same muscle thickness. RESULTS: In male group, although the MVIC had significantly positive correlation to both muscle thickness (r=0.412, p<0.01) and compression ratio (r=0.233, p<0.05), their variables also had correlation mutually. In the female group, the MVIC has significantly positive correlation to only compression ratio (r=0.499, p<0.01), not muscle thickness (r=0.225, n.s.). On multiple linear regression analysis, the combination of two parameters (muscle thickness and compression ratio) allowed more accurate estimation of MVIC (r=0.573, p<0.01) in the female group. CONCLUSION: These findings suggested that the combination of muscle thickness and hardness is capable of effectively estimating muscle strength especially in females.

Development of a flexible system for measuring muscle area using ultrasonography.

Muscular strength can be estimated by quantification of muscle area. For this purpose, we developed a flexible measuring system for muscle area using ultrasonography. This method is completely safe and is particularly suitable for elderly people because the subjects are not required to perform any muscular contraction during measurement. The ultrasound probe is installed on a mechanical arm, and continuously scans fragmental images along the body surface. A wide-area cross-sectional image is then constructed using the measured images. The link mechanism is very flexible, enabling the operator to measure images for any body posture and body site. Use of the spatial compounding method reduces speckle and artifact noise in the resultant cross-sectional images. The operator can observe individual muscles (extensor, flexor muscle, etc.) in detail. We conducted experiments to evaluate the performance of the system. In the experiments, the position of the ultrasound probe was calculated with high accuracy according to the link posture. In addition, a high degree of correlation was verified between MR images and those of the developed system. We observed a reduction in noise due to use of the spatial compounding method, and propose a new calibration method for correcting the measured muscle area, which were slightly deformed by the contact pressure of the ultrasound probe. Finally, we examined the relation between muscular area and muscular strength in young and middle-aged subjects. The results of these experiments confirm that the developed system can estimate muscular strength based on muscular area.

Differences in clinical characteristics of head injuries to snowboarders by skill level.

BACKGROUND: Many reports have compared head injuries between snowboarding and skiing. However, detailed studies comparing snowboarding head injuries between beginners and intermediates/experts have been lacking. PURPOSE: The authors investigated differences in clinical characteristics of head injuries to snowboarders between beginners (group B) and intermediates/experts (group IE). STUDY DESIGN: Descriptive epidemiology study. METHODS: The study population included 2367 patients treated at Saito Memorial Hospital and Yuzawa Community Health Medical Center, Niigata Prefecture, Japan, during 9 seasons from 1999-2000 to 2007-2008. RESULTS: Group B comprised 959 patients (mean age, 23.0 years; 52% males). Group IE comprised 1408 patients (mean age, 24.8 years; 72% males). Accidents in group B predominantly occurred as falls on gentle slopes (37%) and intermediate slopes (33%), whereas accidents in group IE occurred mostly during jumping (48%). The impact point on the head was predominantly occipital in both groups, but group IE showed a significantly higher frequency of trauma to the frontal region. The ratio of neurologic abnormalities was significantly higher in group IE. However, the ratio of surgical cases was significantly higher in group B (n = 10, 1.04%) than in group IE (n = 5, 0.36%). More acute subdural hematomas were seen in group B, but more fractures, contusions, and acute epidural hematomas were seen in group IE. Four moderate disabilities, 2 comatose patients, and 2 deaths were seen in group B, and 1 moderate disability, 2 severe disabilities, and 1 death were seen in group IE during this study. CONCLUSION: The data suggest significant differences in clinical states between beginners and intermediates/experts. Preventive methods for severe head injuries among snowboarders need to be devised based on differences in skill levels.

Direct visualization of ultrasonic power distribution using mechanoluminescent film.

In this research, a technique for measuring ultrasonic power with a mechanoluminescent (ML) sensing film was developed. A linear relationship was observed between the ultrasonic power and the ML intensity induced by ultrasonic vibration, indicating that ultrasonic power can be evaluated by measuring ML intensity. In addition, the ultrasonic power distribution on the surface of a transducer was visualized by recording ML images with a charge-coupled device camera.

Calibration of cross-sectional images measured by an ultrasound-based muscle evaluation system.

The quantification of muscle volume can be used to estimate muscular strength. Therefore, we developed a flexible measuring system for muscle volume using ultrasonog-raphy. In the measuring process, subjects are not required to perform any muscular contraction, so it is completely safe and particularly suitable for elderly people. The ultrasound probe is installed on a mechanical arm, and continuously scans fragmental images along the body surface. The measured images are then composed into a wide area cross-sectional image. However, the muscle area measured by our system was slightly smaller than that measured by MRI. because the ultrasound probe contacted the body surface with a little pressure during the measurement. The strain then decreases the total image size and its circumference. This paper introduces our developed system and proposes a new calibration method for the muscle area in the thigh based on its circumference.