Risk of Misdiagnosis in Spinal Hypertrophic Pachymeningitis: A Report of Two Cases.

Hypertrophic pachymeningitis (HP) is a rare inflammatory disease of the central nervous system. It typically manifests in the cranium; cases involving the spinal cord are rare (8.6%). This report includes two cases of spinal HP encountered among 666 spinal operative cases. The purpose of this study is to present the initial imaging findings, final diagnosis, and course of treatment in these two cases of spinal HP and to present the possible risk of misdiagnosis with a literature review. In case 1, a 69-year-old female presented with back pain. The initial radiological diagnosis with magnetic resonance imaging (MRI) was a meningioma. However, her blood test showed a mild elevation of C-reactive protein level (3.16 mg/dL), with positive IgG4 and myeloperoxidase anti-neutrophil cytoplasmic antibody results, suggesting an autoimmune disease. We performed a biopsy of the thickened dura and an expansive duraplasty. Serological and pathological diagnosis suggested IgG4-related HP. In case 2, a 67-year-old male presented with bilateral thigh pain. MRI revealed a mass resembling a disc hernia at the L2/3 intervertebral level. The mass was surgically removed. Pathological examination and cerebrospinal fluid analysis confirmed the diagnosis of HP associated with IgG4-related disease. In both cases, immunosuppressive therapy was administered, and follow-up MRI scans revealed the disappearance of the mass. The study concludes that a spinal HP can potentially be misdiagnosed when its images resemble those of tumors or disc hernias owing to its rarity.

Full-Endoscopic Foraminal Decompression for Foraminal Stenosis Following Osteoporotic Vertebral Fracture in an Elderly Woman Under Local Anesthesia:A Case Report.

Osteoporotic vertebral fracture (OVF) is common in the elderly population. In this report, we describe a case with radiculopathy due to foraminal stenosis caused by OVF in a very elderly patient that was treated successfully by full-endoscopic foraminotomy under local anesthesia. The patient was an 89-year-old woman who presented with a chief complaint of left leg pain for 5 years. She visited a couple of hospitals and finally consulted us to determine the exact cause of the pain. Computed tomography scans were obtained and selective nerve root block at L3 was performed. The diagnosis was radiculopathy at L3 due to foraminal stenosis following OVF. The patient had severe heart disease, so we decided to avoid surgery under general anesthesia and planned full-endoscopic spine surgery under local anesthesia. We performed transforaminal full-endoscopic lumbar foraminotomy at L3-L4 to decompress the L3 nerve root. The leg pain disappeared completely immediately after surgery. Postoperative computed tomography confirmed appropriate bone resection. The leg pain did not recur during a year of postoperative follow-up. OVF may cause lumbar radiculopathy as a result of foraminal stenosis, and transforaminal full-endoscopic lumbar foraminotomy under local anesthesia would be the best option in an elderly patient with poor general condition. J. Med. Invest. 71 : 179-183, February, 2024.

Integrating molecular design and crystal engineering approaches in non-humidified intermediate-temperature proton conductors based on a Dawson-type polyoxometalate and poly(ethylene glycol) derivatives.

Anionic metal-oxygen clusters known as polyoxometalates (POMs) have been widely researched as components of proton conductors. While proton conduction under non-humidified intermediate-temperature (100-250 °C) conditions is advantageous from the viewpoint of kinetics, few solid-state materials, not to mention POM-based crystals, show truly effective proton conduction without the aid of water vapor. In this context, non-volatile proton-conductive polymers have been confined into POM-based frameworks, while fast proton conduction was infeasible. Herein, we demonstrate a new strategy to synthesize POM-polymer composites exhibiting fast proton conduction under non-humidified intermediate-temperature conditions. Specifically, a molecular design approach utilizing poly(ethylene glycol)s (PEGs) of different terminal groups or chain lengths controls the proton carrier density, and a crystal engineering approach using a large Dawson-type POM ([α-P2W18O62]6-) with an anisotropic molecular shape and alkali metal ions as counter cations fine-tunes the mobility of the confined PEGs as proton carriers. By integrating these approaches, proton conductivity over 10-4 S cm-1 at 150 °C, comparable to the well-known highly proton-conductive solid-state materials, is achieved. The proton conduction mechanism is discussed with alternative current impedance spectroscopy jointly with specific heat capacity measurements and solid-state NMR spectroscopy.

Responsive Four-Coordinate Iron(II) Nodes in FePd(CN)4.

Metal node design is crucial for obtaining structurally diverse coordination polymers (CPs) and metal-organic frameworks with desirable properties; however, FeII ions are exclusively six-coordinated. Herein, we present a cyanide-bridged three-dimensional (3D) CP, FePd(CN)4 , bearing four-coordinate FeII ions, which is synthesized by thermal treatment of a two-dimensional (2D) six-coordinate FeII CP, Fe(H2 O)2 Pd(CN)4 ⋅4 H2 O, to remove water molecules. Atomic-resolution transmission electron microscopy and powder X-ray and neutron diffraction measurements revealed that the FePd(CN)4 structure is composed of a two-fold interpenetrated PtS topology network, where the FeII center demonstrates an intermediate geometry between tetrahedral and square-planar coordination. This four-coordinate FeII center with the distorted geometry can act as a thermo-responsive flexible node in the PtS network.

Intramedullary spinal cord germinoma clinically mimicking multiple sclerosis: A case report.

BACKGROUND: It is important to differentiate intramedullary neoplastic lesions from nonneoplastic diseases such as multiple sclerosis (MS) and other demyelinating or inflammatory diseases. CASE DESCRIPTION: A 26-year-old Japanese male presented with a history of intracranial germinomas and obstructive hydrocephalus, treated with endoscopic surgery, and adjuvant chemotherapy and radiation therapy. Three years later, he developed paresthesias involving the right hand and both lower extremities. The cervical MR scan demonstrated a heterogeneously enhancing intramedullary C1-C2 lesion with surrounding edema. On cytological examination of the cerebrospinal fluid (CSF), there were no neoplastic cells. However, the fluid was positive for oligoclonal immunoglobulin G (IgG) bands. The patient received steroid pulse therapy to address the potential MS diagnosis. The follow-up MR showed reduced edema, but no change in the size of the intramedullary lesion. Therefore, the patient underwent a cervical laminectomy for tumor resection. The pathology was consistent with the same cranial germinoma treated 3 years previously. He subsequently received whole spinal radiation and three courses of chemotherapy. CONCLUSION: Some spinal cord tumors may produce oligoclonal IgG bands in CSF. In this case, an intramedullary C1-C2 spinal cord germinoma was originally misdiagnosed as MS due to the presence of oligoclonal IgG bands in CSF. Differentiating this tumor from MS and initiating appropriate treatment were critical into the care of this patient.

An Ising iron(ii) chain exhibits a large finite-size energy barrier and "hard" magnetic behaviour.

One-dimensional spin chains featuring strong axial anisotropic magnetism are promising candidates for isolatable and miniatured information storage materials, the so-called single-chain magnets (SCMs). Here we show a mixed azido/carboxylato bridged metamagnetic iron(ii) chain [Fe(N3)2(4-mpc)]n (4-mpc = N-methylpyridinium-4-carboxylate) with a large energy barrier of 150 K, a large remnant magnetization (1.55Nß) and coercivity (1.7 T at 2 K) for homo-spin SCMs. Heat capacity and Mössbauer spectroscopy studies corroborate the intrinsic nature of SCM behavior regardless of weak interchain magnetic interactions, which lead to the coexistence of metamagnetism but not long-range magnetic ordering. Moreover, detailed magnetic investigations indicate that the system is not only within the "Ising limit" but also in the "finite-size" regime.

Impact of Lanthanoid Substitution on the Structural and Physical Properties of an Infinite-Layer Iron Oxide.

The effect of lanthanoid (Ln = Nd, Sm, Ho) substitution on the structural and physical properties of the infinite-layer iron oxide SrFeO2 was investigated by X-ray diffraction (XRD) at ambient and high pressure, neutron diffraction, and 57Fe Mössbauer spectroscopy. Ln for Sr substituted samples up to ∼30% were synthesized by topochemical reduction using CaH2. While the introduction of the smaller Ln3+ ion reduces the a axis as expected, we found an unusual expansion of the c axis as well as the volume. Rietveld refinements along with pair distribution function analysis revealed the incorporation of oxygen atoms between FeO2 layers with a charge-compensated composition of (Sr1-xLnx)FeO2+x/2, which accounts for the failed electron doping to the FeO2 layer. The incorporated partial apical oxygen or the pyramidal coordination induces incoherent buckling of the FeO2 sheet, leading to a significant reduction of the Néel temperature. High-pressure XRD experiments for (Sr0.75Ho0.25)FeO2.125 suggest a possible stabilization of an intermediate spin state in comparison with SrFeO2, revealing a certain contribution of the in-plane Fe-O distance to the pressure-induced transition.

From Tetrahedral to Octahedral Iron Coordination: Layer Compression in Topochemically Prepared FeLa2Ti3O10.

Synthesis, characterization, and thermal modification of the new layered perovskite FeLa2Ti3O10 have been studied. FeLa2Ti3O10 was prepared by ion exchange of the triple-layered Ruddlesden-Popper phase Li2La2Ti3O10 with FeCl2 at 350 °C under static vacuum. Rietveld refinement on synchrotron X-ray diffraction data indicates that the new phase is isostructural with CoLa2Ti3O10, where FeII cations occupy slightly compressed/flattened interlayer tetrahedral sites. Magnetic measurements on FeLa2Ti3O10 display Curie-Weiss behavior at high temperatures and a spin-glass transition at lower temperatures (<30 K). Thermal treatment in oxygen shows that FeLa2Ti3O10 undergoes a significant cell contraction (Δc ≈ -2.7 Å) with a change in the oxidation state of iron (Fe2+ to Fe3+); structural analysis and Mössbauer studies indicate that upon oxidation the local iron environment goes from tetrahedral to octahedral coordination with some deintercalation of iron as Fe2O3 to produce Fe0.67La2Ti3O10.

Flexible Endoscopic Aspiration for Intraventricular Casting Hematoma.

BACKGROUND: Conventionally, patients suffering a massive intraventricular hemorrhage have undergone external ventricular drainage. However, long-term or repeated drainage increases the risk of complications due to infections or shunt dependency. Neuroendoscopic surgery may offer some advantages over more conventional procedures. METHODS: Thirteen patients suffering intraventricular hematoma associated with intracerebral hemorrhage, treated in our hospital between April 2011 and March 2014, were reviewed retrospectively. Casting hematomas in the ventricles were manually aspirated using a flexible endoscope. The timing of the operation, period of post-endoscopic ventricular drainage, additional internal shunt surgery, 3-month post-surgical outcome, and critical complications were evaluated. RESULTS: Two patients (treated during our earliest use of endoscope) who underwent surgery on the 7th and 16th day post-onset required subsequent cerebrospinal shunt surgery. In contrast, of the 11 patients who underwent endoscopic surgery on the day of onset, only 1 patient required an additional, third ventriculostomy due to a secondary obstruction of the aqueduct by adhesive fibrous membranes. After 3 months, all six patients with mRS scores of 2-3 satisfied all the following criteria: initial Glasgow Coma Scale scores higher than 8, flexible endoscopic surgeries performed on the day of onset, and period of ventricular drainage of less than 4 days. CONCLUSIONS: Early surgical intervention using a flexible endoscope and short period of post-surgical drainage can be highly effective for patients suffering from casting intraventricular hematomas associated with intracerebral hemorrhage. The advantages of this treatment may be a less invasive procedure, ICP control in the acute phase, breaking away from ventricular drainage in the early stage, and prevention of hydrocephalus or intracranial infectious complications in the long term.

Panventriculomegaly with a wide foramen of Magendie and large cisterna magna.

OBJECT The authors' goal in this paper is to provide the first clinical, radiological, and genetic studies of panventriculomegaly (PaVM) defined by a wide foramen of Magendie and large cisterna magna. METHODS Clinical and brain imaging data from 28 PaVM patients (including 10 patients from 5 families) were retrospectively studied. Five children were included. In adult patients, the age at onset was 56.0 ± 16.7 years. Tetraventricular dilation, aqueductal opening with flow void on T2-weighted images, and a wide foramen of Magendie and large cisterna magna (wide cerebrospinal fluid space at the fourth ventricle outlet) were essential MRI findings for PaVM diagnosis. 3D fast asymmetrical spin echo sequences were used for visualization of cistern membranes. Time-spatial labeling inversion pulse examination was performed to analyze cerebrospinal fluid movement. Copy number variations were determined using high-resolution microarray and were validated by quantitative polymerase chain reaction with breakpoint sequencing. RESULTS Adult patients showed gait disturbance, urinary dysfunction, and cognitive dysfunction. Five infant patients exhibited macrocranium. Patients were divided into 2 subcategories, those with or without downward bulging third ventricular floors and membranous structures in the prepontine cistern. Patients with bulging floors were successfully treated with endoscopic third ventriculostomy. Genetic analysis revealed a deletion in DNAH14 that encodes a dynein heavy chain protein associated with motile cilia function, and which co-segregated with patients in a family without a downward bulging third ventricular floor. CONCLUSIONS Panventriculomegaly with a wide foramen of Magendie and a large cisterna magna may belong to a subtype of congenital hydrocephalus with familial accumulation, younger age at onset, and symptoms of normal pressure hydrocephalus. In addition, a family with PaVM has a gene mutation associated with dysfunction of motile cilia.

Recanalization of a large supraclinoid carotid aneurysm via elicited vertebral artery-internal carotid artery anastomosis: a case report.

Proximal ligation of the internal carotid artery (ICA) with high-flow bypass is one of the surgical strategies for treating large, unclippable ICA aneurysms. We encountered a rare case of recanalization of a large ICA aneurysm that disappeared after high-flow bypass surgery, and subsequently reappeared via an elicited vertebral artery (VA)-ICA anastomosis (anastomosis between the anterior meningeal artery branching from the right VA, and the ascending pharyngeal artery branching (APA) from the right ICA). To the best of our knowledge, this is the first case report describing angiographical recurrence of a large ICA aneurysm after the surgery. Periodic long-term follow-up by neuroimaging may be necessary after this surgery, particularly in cases of ICA proximal ligation with the ICA aneurysm, when the APA has not been clearly identified as a branch from the ipsilateral external carotid artery on the preoperative angiogram.

Exploration of new superconductors and functional materials, and fabrication of superconducting tapes and wires of iron pnictides.

This review shows the highlights of a 4-year-long research project supported by the Japanese Government to explore new superconducting materials and relevant functional materials. The project found several tens of new superconductors by examining ∼1000 materials, each of which was chosen by Japanese experts with a background in solid state chemistry. This review summarizes the major achievements of the project in newly found superconducting materials, and the fabrication wires and tapes of iron-based superconductors; it incorporates a list of ∼700 unsuccessful materials examined for superconductivity in the project. In addition, described are new functional materials and functionalities discovered during the project.

Nonsurgical treatment of chronic subdural hematoma with tranexamic acid.

OBJECT: Chronic subdural hematoma (CSDH) is a common condition after head trauma. It can often be successfully treated surgically by inserting a bur hole and draining the liquefied hematoma. However, to the best of the authors' knowledge, for nonemergency cases not requiring surgery, no reports have indicated the best approach for preventing hematoma enlargement or resolving it completely. The authors hypothesized that hyperfibrinolysis plays a major role in liquefaction of the hematoma. Therefore, they evaluated the ability of an antifibrinolytic drug, tranexamic acid, to completely resolve CSDH compared with bur hole surgery alone. METHODS: From 2007 to 2011, a total of 21 patients with CSDH seen consecutively at Kuki General Hospital, Japan, were given 750 mg of tranexamic acid orally every day. Patients were identified by a retrospective records review, which collected data on the volume of the hematoma (based on radiographic measurements) and any complications. Follow-up for each patient consisted of CT or MRI every 21 days from diagnosis to resolution of the CSDH. RESULTS: Of the 21 patients, 3 with early stages of CSDH were treated by bur hole surgery before receiving medical therapy. The median duration of clinical and radiographic follow-up was 58 days (range 28-137 days). Before tranexamic acid therapy was initiated, the median hematoma volume for the 21 patients was 58.5 ml (range 7.5-223.2 ml); for the 18 patients who had not undergone surgery, the median hematoma volume was 55.6 ml (range 7.5-140.5 ml). After therapy, the median volume for all 21 patients was 3.7 ml (range 0-22.1 ml). No hematomas recurred or progressed. CONCLUSIONS: Chronic subdural hematoma can be treated with tranexamic acid without concomitant surgery. Tranexamic acid might simultaneously inhibit the fibrinolytic and inflammatory (kinin-kallikrein) systems, which might consequently resolve CSDH. This medical therapy could prevent the early stages of CSDH that can occur after head trauma and the recurrence of CSDH after surgery.

Carboxylated SiO2-coated α-Fe nanoparticles: towards a versatile platform for biomedical applications.

Carboxylated SiO2-coated α-Fe nanoparticles have been successfully prepared via CaH2-mediated reduction of SiO2-coated Fe3O4 nanoparticles followed by surface carboxylation. These α-Fe-based nanoparticles, which are characterized by ease of coating with additional functional groups, a large magnetization of 154 emu per g-Fe, enhanced corrosion resistivity, excellent aqueous dispersibility, and low cytotoxicity, have potential to be a versatile platform in biomedical applications.

Square planar coordinate iron oxides.

We will provide an overview of the synthesis, structures, chemical and physical properties of novel iron oxides bearing FeO(4) square planar coordination, such as SrFeO(2) and Sr(3)Fe(2)O(5). The preparation of these materials relies on topotactic low-temperature reduction using metal hydrides. For instance, a simple 3D perovskite structure SrFeO(3) converts to a 2D structure SrFeO(2)via SrFeO(2.5). SrFeO(2) shows a remarkable stability against temperature and chemical substitution (for both A- and B-sites) and also tolerates distortions of square planes toward tetrahedra to adapt different A sites. Such structural stability and flexibility arise from strong covalent interactions not only through the in-plane Fe-O-Fe superexchange interactions but also through the out-of-plane Fe-Fe direct exchange interactions, and explains why SrFeO(2) exhibits magnetic order far beyond room temperature. The application of pressure on SrFeO(2) and Sr(3)Fe(2)O(5) further enhances the Fe-Fe direct exchange interactions and eventually induces striking transitions at around 34 GPa: spin-state transition from S = 2 to S = 1, insulator-to-metal transition, and antiferro-to-ferromagnetic transition. The high mobility of oxide ions at relatively low temperatures, during the reduction and reoxidation reaction process would offer an important challenge to tailor and design new solid oxide fuel cells/membranes toward lowering working temperatures.

BaFeO3: a ferromagnetic iron oxide.

Magnetic attraction: The cubic perovskite BaFeO(3) (see picture, Ba blue, Fe brown, O white), which is obtained by a low-temperature reaction using ozone as an oxidant, exhibits ferromagnetism with a fairly large moment of 3.5 µ(B) per Fe ion above a small critical field of approximately 0.3 T. This specific ferromagnetism is attributed to the enhancement of O→Fe charge transfer that arises from deepening of the Fe(4+) d levels.

Anisotropic oxygen diffusion at low temperature in perovskite-structure iron oxides.

Oxygen-ion conduction in transition-metal oxides is exploited in, for example, electrolytes in solid-oxide fuel cells and oxygen-separation membranes, which currently work at high temperatures. Conduction at low temperature is a key to developing further utilization, and an understanding of the structures that enable conduction is also important to gain insight into oxygen-diffusion pathways. Here we report the structural changes observed when single-crystalline, epitaxial CaFeO2.5 thin films were changed into CaFeO2 by low-temperature reductions with CaH2. During the reduction process from the brownmillerite CaFeO2.5 into the infinite-layer structure of CaFeO2, some of the oxygen atoms are released from and others are rearranged within the perovskite-structure framework. We evaluated these changes and the reaction time they required, and found two oxygen diffusion pathways and the related kinetics at low temperature. The results demonstrate that oxygen diffusion in the brownmillerite is highly anisotropic, significantly higher along the lateral direction of the tetrahedral and octahedral layers.

[Diagnostic efficacy and pitfalls of a 64-raw multislice computed tomography scan for mild head injuries in children].

The aim of this study is to analyze the usefulness of 64-raw multislice computed tomography (CT) scans and bone images of three-dimensional CT (3D-CT) scans for evaluation of mild head injuries in children. Thirteen children (9 boys and 4 girls, less than or equal to 15 years old) with mild head injury were included in the study. Head CT scans obtained within 24 hours after injury. All children had no episodes of loss of consciousness, amnesia, epilepsy, vomiting, and no neurological abnormality on arrival at hospital. We detected 9 positive findings on CT scans, which looked like fracture lines at the frontal bone in 7 cases. The bone images of CT axial views revealed a true fracture in one case in which a skull X-ray could not demonstrate a fracture line, but, other positive findings turned out to be a diploic vein surrounded by a thin bone cortex. All false positive findings were detected in the patients under the age of 6. By the 3D-reconstructive CT scan, it is easier to detect not only the intracranial lesions but also the cranial fracture. But, the diploic vein is apt to be misdiagnosed as the fracture line, especially in patients under the age of 6.

CaFeO2: a new type of layered structure with iron in a distorted square planar coordination.

CaFeO(2), a material exhibiting an unprecedented layered structure containing 3d(6) iron in a high-spin distorted square-planar coordination, is reported. The new phase, obtained through a low-temperature reduction procedure using calcium hydride, has been characterized through powder neutron diffraction, synchrotron X-ray diffraction, Mossbauer spectroscopy, XAS experiments as well as first-principles DFT calculations. The XAS spectra near the Fe-K edge for the whole solid solution (Sr(1-x)Ca(x))FeO(2) supports that iron is in a square-planar coordination for 0