[Three dysuria adults without continuous medical treatment after surgery for spina bifida in infancy].

We encountered three patients with dysuria who had undergone spinal surgery for spina bifida during infancy. The patients presented with mental disability and dysbasia. Difficulty in urination, urinary incontinence, and a residual sensation of urine were resolved through intermittent self-catheterization in all patients. It was speculated that treatment for dysuria in these patients was delayed because they were not aware of its association with their condition during infancy, dysuria was relatively mild, and they had no history of febrile urinary tract infection. It is important for attending physicians to explain to parents of such infants the possible association of spina bifida with the future risk of dysuria, and to consider long-term follow-up to monitor their outcome.

Fluctuation in Serum Sodium Levels Related to Ipragliflozin Administration in a Patient with Diabetic Nephropathy and Sequela of Traumatic Brain Injury.

A 46-year-old diabetic man underwent the removal of a hematoma caused by traumatic brain injury. After surgery, severe hyponatremia occurred. The subsequent administration of NaCl and fludrocortisone improved his laboratory findings. The patient was transferred to our hospital, and his insulin therapy was replaced by teneligliptin. One week later, ipragliflozin treatment was initiated and induced an immediate increase in the serum sodium levels. NaCl and fludrocortisone were therefore discontinued. However, hyponatremia recurred after ipragliflozin withdrawal due to a urinary tract infection. NaCl and fludrocortisone were initiated again, and the laboratory data improved. We herein report a case of serum sodium fluctuation related to ipragliflozin administration.

[Thalamus and Attention].

Attention is the process by which information and selection occurs, the thalamus plays an important role in the selective attention of visual and auditory information. Selective attention is a conscious effort; however, it occurs subconsciously, as well. The lateral geniculate body (LGB) filters visual information before it reaches the cortex (bottom-up attention). The thalamic reticular nucleus (TRN) provides a strong inhibitory input to both the LGB and pulvinar. This regulation involves focusing a spotlight on important information, as well as inhibiting unnecessary background information. Behavioral contexts more strongly modulate activity of the TRN and pulvinar influencing feedforward and feedback information transmission between the frontal, temporal, parietal and occipital cortical areas (top-down attention). The medial geniculate body (MGB) filters auditory information the TRN inhibits the MGB. Attentional modulation occurring in the auditory pathway among the cochlea, cochlear nucleus, superior olivary complex, and inferior colliculus is more important than that of the MGB and TRN. We also discuss the attentional consequence of thalamic hemorrhage.

[Reflex sympathetic dystrophy induced by shunt malfunction: a case report].

A 60-year-old male presented with normal pressure hydrocephalus following subarachnoid hemorrhage and underwent a shunt operation. However, a shunt effective range was so narrow that he repeated a sign of overdrainage and underdrainage of CSF. At the result, reflex sympathetic dystrophy (RSD) as a complication of overdrainage was demonstrated. We could prescribe appropriate shunt flow rate by using siphon control system instead of antisiphon device (ASD) and then avoid shunt malfunction. In addition, medication of Neurotropin for pain control of RSD was so effective. We report a case of RDS as a complication of shunt malfunction.

Chemical profiling and gene expression profiling during the manufacturing process of Taiwan oolong tea "Oriental Beauty".

Oriental Beauty, which is made from tea leaves infested by the tea green leafhopper (Jacobiasca formosana) in Taiwan, has a unique aroma like ripe fruits and honey. To determine what occurs in the tea leaves during the oolong tea manufacturing process, the gene expression profiles and the chemical profiles were investigated. Tea samples were prepared from Camellia sinensis var. sinensis cv. Chin-shin Dah-pang while the tea leaves were attacked by the insect. The main volatile compounds, such as linalool-oxides, benzyl alcohol, 2-phenylethanol, and 2,6-dimethylocta-3,7-diene-2,6-diol, increased during manufacture. The gene expression profiles during manufacture were analyzed by differential screening between fresh leaves and tea leaves of the first turn over. Many up-regulated transcripts were found to encode various proteins homologous to stress response proteins. Accordingly, the endogenous contents of abscisic acid and raffinose increased during manufacture. Thus the traditional manufacturing method is a unique process that utilizes plant defense responses to elevate the production of volatile compounds and other metabolites.

Shunt assistant valve: bench test investigations and clinical performance.

BACKGROUND: We tested the flow characteristics of a new siphon-reducing device, the Shunt Assistant Valve trade mark (SAV) combined with a Codman-Hakim trade mark (CH) programmable valve and studied 4 clinical cases. We discussed the efficacy of the SAV at preventing low pressure syndrome secondary to overdrainage. MATERIALS AND METHODS: In the horizontal position the closing pressure (CP) of the SAV was 0. The SAV was available in five different pressure ranges for the vertical position: 15, 20, 25, 30, and 35 cmH(2)O. A bench test was performed in order to obtain pressure-flow curves for the SAV under various conditions. We investigated the simulation of the postural change of the flow performance of the new device. We implanted an SAV in 4 patients who already had an implanted CH valve. Postural changes of the shunt flow and intracranial pressure (ICP) were measured before and after the addition of the SAV. RESULTS: Bench test: in the horizontal position the flow increased in proportion to the pressure difference. For all SAVs it reached 14 to 16 mL/min when the pressure difference was 50 cmH(2)O. A tantalum sphere determined the CP of the SAV with a maximum in the vertical position. The flow in the vertical position was significantly decreased in comparison with the horizontal position. The external pressures did not influence the flow. Simulation: in adults shunt flow in the supine position was sufficient at both the low and the high ICP stages. When the SAV 20 and the CH valve (CP=8 cmH(2)O) was used in the sitting position we found a reduction of the flow 70-80% compared with the flow-rate found for the CH valve alone. When the CP of the CH valve was adjusted up to 20 cmH(2)O, we found a further reduction of the flow of 27-50% in the sitting position and overdrainage was effectively prevented. With this combination the flow in the sitting position significantly decreased in paediatric hydrocephalus and became zero, indicating the possibility of underdrainage in children. CLINICAL RESULTS: in 4 patients with overdrainage symptoms we found that these subsided after the additional implantation of the SAV. The ICP increased and the shunt flow decreased in both the supine and the sitting positions. CONCLUSION: The SAV effectively decreased the shunt flow in the erect position. Combined use of the SAV with the CH valve is an alternative treatment for patients with overdrainage, especially in patients in whom the increase of the CP of the CH valve alone had failed to control overdrainage.