C-reactive Protein is A Predictor of Deterioration of Acute Internal Carotid Artery M1 Qcclusion Following Recanalization.

INTRODUCTION: Administration of intravenous recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy (MT) have become standard therapeutic approaches for acute internal carotid artery and middle cerebral artery M1 segment occlusion (ICA/M1O). However, clinical deterioration of the condition is still observed in some cases. OBJECTIVE: We aimed to identify patients' factors associated with exacerbation. This was a single-center, retrospective study of 35 consecutive patients with acute ICA/M1O who underwent rt-PA/rt-PA and MT at our hospital between January 2016 and September 2019. We divided patients into two groups based on the total NIHSS score at discharge: the "improvement" and "exacerbation" groups. Clinical characteristics, laboratory data, and imaging findings were compared between the groups. RESULTS: The improvement group (13 patients [37%]) had a lower mean age (70 vs. 81 years, p = 0.02), National Institutes of Health Stroke Scale score (NIHSS, 13 vs. 19, p = 0.02), and C-reactive protein (CRP) levels (0.24 vs. 0.92 mg/dl, p < 0.01) than the exacerbation group (22 patients [63%]). Receiver operating characteristic curve analysis revealed the cut-off age to be 79 (sensitivity 76.9%, specificity 72.7%), NIHSS score to be 20 (sensitivity 92.3%, specificity 63.6%), and CRP to be 0.14 mg/dl (sensitivity 69.2%, specificity 81.8%). Multivariate analysis confirmed a CRP level of >0.14 mg/dl (odds ratio, 10.16; 95% confidence interval 1.38-75.13; p = 0.01) to be independently associated with clinical deterioration at discharge. CONCLUSIONS: A CRP level of >0.14 mg/dl is a strong predictor of clinical deterioration at discharge in patients with acute ICA/M1O undergoing recanalization therapy.

Atom-resolved analysis of an ionic KBr(001) crystal surface covered with a thin water layer by frequency modulation atomic force microscopy.

An ionic KBr(001) crystal surface covered with a thin water layer was observed with a frequency modulation atomic force microscope (FM-AFM) with atomic resolution. By immersing only the tip apex of the AFM cantilever in the thin water layer, the Q-factor of the cantilever in probing the solid-liquid interface can be maintained as high as that of FM-AFM operation in air, leading to improvement of the minimum detection of a differential force determined by the noise. Two types of images with atom-resolved contrast were observed, possibly owing to the different types of ions (K(+) or Br(-)) adsorbed on the tip apex that incorporated into the hydration layers on the tip and on the sample surface. The force-distance characteristics at the solid-water interface were analyzed by taking spatial variation maps of the resonant frequency shift of the AFM cantilever with the high Q-factor. The oscillatory frequency shift-distance curves exhibited atomic site dependence. The roles of hydration and the ions on the tip and on the sample surface in the measurements were discussed.

Practical removal of radioactivity from sediment mud in a swimming pool in Fukushima, Japan by immobilized photosynthetic bacteria.

About 90% of the radioactive Cs in the sediment mud of a school's swimming pool in Fukushima, Japan was removed by treatment for 3 d using the alginate immobilized photosynthetic bacterium Rhodobcater sphaeroides SSI. Even though batch treatment was carried out 3 times repeatedly, the activity of immobilized cells in removing Cs was maintained at levels of about 84% (second batch) and 78% (third batch). Cs was strongly attached to the sediment mud because, even with HNO(3) treatment at pH of 2.00-1.60 for 24 h, it was not eluted into the water. Furthermore, more than 75% of the Cs could be removed without solubilization with HNO(3). This suggests that the Cs attached to the sediment mud was transformed into immobilized cells via the Cs(+) ion by the negative charge of the immobilized cell surface and/or the potassium transport system of the photosynthetic bacterium.

Practical removal of radioactivity from soil in Fukushima using immobilized photosynthetic bacteria combined with anaerobic digestion and lactic acid fermentation as pre-treatment.

Practical removal of radioactivity from polluted soil in Fukushima, Japan was done using a photosynthetic bacterium, Rhodobacter sphaeroides SSI, immobilized in alginate beads. The beads were put in a mesh bag and soaked in which soil was suspended (5 kg of soil/10 L of tap water). The radioactivity of the broth decreased by 31% after 15 d of aerobic treatment. When lactic acid bacterial culture broth was added to the suspend broth, about 50% of the radioactivity was transferred to a suspend broth fraction consisting of small particles from the soil after 3 d of fermentation and 20 s of sedimentation. The results suggest that organic matter in the soil was decomposed by anaerobic digestion and lactic acid fermentation simultaneously, and was then transferred into the liquid as small particles. With combined treatment by anaerobic digestion and lactic acid fermentation for 5 d and immobilized bead aerobic treatment for an additional 19 d, the radioactivity of suspend broth decreased by 66%. The radioactivity of the original soil (10.56 µSv/h) ultimately decreased by 67% (3.52 µSv/h) after the combined treatment.

Erythrocyte zinc concentration as an indicator to distinguish painless thyroiditis-associated transient hypothyroidism from permanent hypothyroidism.

Red blood cell (RBC) zinc (Zn) concentration reflects a patient's mean thyroid hormone level over the preceding several months. The aim of this study was to examine whether RBC Zn level can be used as an indicator to distinguish painless thyroiditis-associated transient hypothyroidism (TH) from permanent hypothyroidism (PH). RBC Zn level was measured in 30 untreated PH patients with Hashimoto's thyroiditis and 7 untreated TH patients with painless thyroiditis in whom preceding transient thyrotoxicosis had been confirmed. RBC Zn concentration was significantly lower in TH patients than that in PH patients. There was a positive correlation between RBC Zn and serum TSH, and the latter was clearly lower in TH patients than that in PH patients. However, RBC Zn level was again significantly lower in TH patients than PH patients despite of the comparable serum TSH levels in both groups when RBC Zn was evaluated in patients with serum TSH levels of less than 50 mU/L. Thus TH patients could be identified with RBC Zn measurement, allowing us avoidance of unnecessarily prolonged T4 administration to them.

Effects of benidipine, a long-acting T-type calcium channel blocker, on home blood pressure and renal function in patients with essential hypertension: a retrospective, 'real-world' comparison with amlodipine.

BACKGROUND AND OBJECTIVE: Calcium channel antagonists (calcium channel blockers [CCBs]) are often used in the treatment of patients with hypertension to achieve strict blood pressure (BP) targets. In the present study, we compared the antihypertensive effects (determined by home BP [HBP] measurements) and the effects on renal function of benidipine (hydrochloride) and amlodipine (mesylate), a commonly used CCB. METHODS: Changes in HBP and urinary albumin excretion (UAE) were investigated in 47 benidipine and 37 amlodipine recipients with essential hypertension and albuminuria between January 2007 and December 2007. Both benidipine and amlodipine significantly reduced morning and evening HBP over a 12-month period. RESULTS: Both medications also significantly reduced UAE compared with pretreatment values; however, the reduction in UAE observed in the benidipine group occurred independent of the drug's antihypertensive effects, whereas a positive correlation was shown between the reduction in morning systolic BP and UAE in the amlodipine group. CONCLUSIONS: These results demonstrate that benidipine favourably affects renal function in patients with essential hypertension compared with amlodipine, suggesting that the clinical benefits of benidipine as an antihypertensive drug include a renoprotective effect.

Colonoscopic stigmata of 1 mm or deeper submucosal invasion in colorectal cancer.

PURPOSE: This study was designed to identify colonoscopic stigmata, indicating substantial invasion into the submucosa by T1 colorectal cancer with sessile morphology, including both flat and protruded types. METHODS: A total of 111 Tis or T1 colorectal cancers were studied retrospectively. The lesions were divided into two groups: Group A (n = 83), Tis or T1 cancers with <1 mm submucosal invasion; and Group B (n = 28), T1 cancers with a >/=1 mm submucosal invasion. Printed photographs of the lesions were reviewed by five experienced colonoscopists who were blinded to histology. Deep depression, irregular surface, ulceration or erosion, fold convergence, and spontaneous bleeding were independently evaluated. Findings considered present by three or more reviewers were defined as positive. Kappa analysis was used to measure inter/intraobserver variability. RESULTS: Positive rates of four findings but not fold convergence were significantly higher in Group B than in Group A. Irregular surface and spontaneous bleeding were significant independent predictors of >/=1 mm submucosal invasion, with diagnostic accuracies of 85.6 and 76.6 percent, respectively. Kappa analysis demonstrated fair-to-good inter/intraobserver agreement for spontaneous bleeding and fair-to-good intraobserver agreement for irregular surface. CONCLUSIONS: Irregular surface and spontaneous bleeding were colonoscopic stigmata, indicating >/=1 mm submucosal invasion in T1 colorectal cancer.

Electrophysiological and Morphological Properties of α and γ Motoneurons in the Rat Trigeminal Motor Nucleus.

The muscle contraction during voluntary movement is regulated by activities of α- and γ-motoneurons (αMNs and γMNs, respectively). The tension of jaw-closing muscles can be finely tuned over a wide range. This excellent function is likely to be achieved by the specific populations of αMNs innervating jaw-closing muscles. Indeed, we have recently demonstrated that in the rat dorsolateral trigeminal motor nucleus (dl-TMN), the size distribution of αMNs was bimodal and the population of smaller αMNs showed a size distribution similar to that of γMNs, by immunohistochemically identifying αMNs and γMNs based on the expressions of estrogen-related receptor gamma (Err3) and neuronal DNA binding protein NeuN together with ChAT. This finding suggests the presence of αMNs as small as γMNs. However, differences in the electrophysiological membrane properties between αMNs and γMNs remain unknown also in the dl-TMN. Therefore, in the present study, we studied the electrophysiological membrane properties of MNs in the dl-TMN of infant rats at postnatal days 7-12 together with their morphological properties using whole-cell current-clamp recordings followed by immunohistochemical staining with an anti-NeuN and anti-ChAT antibodies. We found that the ChAT-positive and NeuN-positive αMNs were divided into two subclasses: the first one had a larger cell body and displayed a 4-aminopyridine (4-AP)-sensitive current while the second one had a smaller cell body and displayed a less prominent 4-AP-sensitive current and a low-threshold spike, suitable for their orderly recruitment. We finally found that γMNs showing ChAT-positive and NeuN-negative immunoreactivities had smaller cell bodies and displayed an afterdepolarization mediated by flufenamate-sensitive cation current. It is suggested that these electrophysiological and morphological features of MNs in the dl-TMN are well correlated with the precise control of occlusion.

Monocyte chemoattractant protein-1 expression correlates with macrophage infiltration and tumor vascularity in human gastric carcinomas.

The purpose of this study was to investigate the role of interactions between tumor cells and macrophages during angiogenesis in human gastric carcinomas. Macrophage infiltration into tumors and monocyte chemoattractant protein-1 (MCP-1) expression was assessed in 72 archival specimens of gastric carcinoma for comparison with tumor vascularity. The mRNA expression of MCP-1 was examined by RT-PCR in 6 gastric carcinoma cell lines and in fresh biopsy specimens from 18 patients. Immunolocalization of representative angiogenic factors, vascular endothelial growth factor (VEGF), and platelet-derived endothelial cell growth factor (PD-ECGF) was also done. MCP-1 expression in tumor cells increased with the depth of tumor invasion (Tis 9.5%, T1 19.4%, T2-4 60.0%), as did microvessel density and macrophage infiltration. Macrophage counts correlated with vessel counts, and both were significantly higher in MCP-1-positive than in negative tumors. Of the 6 gastric carcinoma cell lines, 2 constitutively expressed MCP-1 mRNA. In 6 (33.3%) of 18 biopsy samples, MCP-1 mRNA was expressed at higher levels in tumor tissues than in normal mucosa. VEGF protein was expressed by gastric carcinoma cells, whereas PD-ECGF protein was expressed mainly by stromal mononuclear cells. MCP-1 expression correlated significantly with VEGF but not PD-ECGF expression in gastric carcinomas. These results suggest that MCP-1 produced by human gastric carcinoma cells plays a role in angiogenesis via macrophage recruitment and activation.

[A surgical case of tectal cavernous malformation presented by hydrocephalus].

We report a surgical case of tectal cavernous malformation presented by hydrocephalus. This 30-year-old man suffered from headache and nausea due to an obstructive hydrocephalus caused by a cavernous malformation in the tectum. Magnetic resonance (MR) images on admission showed a small lesion depicted as isointensity on the T1-weighted image, hyperintensity on the T2-weighted image, and accompanied with peripheral low-signal intensity rim, suggesting a tectal cavernous malformation. After admission, ventricular drainage was performed and the patient's symptoms improved immediately. He underwent a ventriculoperitoneal shunt ten days after the ventricular drainage. Postoperative CT scan showed an enlargement of the tectal mass with hemorrhagic change, but there was no deterioration in his neurological status. Cerebral angiography demonstrated no vascular stain or venous malformation. Microsurgical removal of the tectal mass was then performed via an occipital transtentorial approach. Histopathology proved a cavernous malformation and MR images at follow-up demonstrated total excision. Postoperatively, an upward gaze palsy appeared, but gradually improved within a month. Management strategy of brain stem cavernous malformation is controversial. Occasionally, brain stem hemorrhage may become critical. Therefore, we recommend aggressive surgical extirpation of symptomatic brain stem cavernous malformation, if it is accessible, if hemorrhage is present, and if the patient's condition permits it.

[Currarino triad: a case report].

The authors report a case of Currarino triad with a combination of anterior sacral meningocele and mature teratoma, sacral body deformity, anorectal stenosis, and tethered cord. A newborn girl suffered from vomiting, abdominal distension and constipation. Initially, a diverting colostomy was performed at the age of one month. 7 months later, at the age of 8 months, we performed posterior sagittal anorectoplasty (PSARP): As a result, extirpation of teratoma, excision of meningocele, untethering of the spinal cord, and anorectoplasty were achieved simultaneously without complication. We suggest the use of an MRI to specify the presence of anosacral and spinal cord anomalies in patients with intractable constipation and we recommend combined pediatric and neurosurgical assessment and management for all cases of Currarino triad.

Kelvin probe force microscopy study of a Pt/TiO2 catalyst model placed in an atmospheric pressure of N2 environment.

A catalyst model comprising platinum nanoparticles deposited on a TiO(2)(110) wafer was prepared in a vacuum, transferred in air, and characterized with a Kelvin probe force microscope placed in a N(2) environment. The topography and local work function of individual nanoparticles were observed with single-nanometer resolution in the N(2) environment of one atmosphere pressure. Some nanoparticle presented positive shifts of work function relative to that of the TiO(2) surface, while the others showed negative shifts. This finding suggests heterogeneous properties of the nanoparticles exposed to air and then N(2). The ability of the advanced microscope was demonstrated in observing the work function of metal nanoparticles on a metal oxide support even in the presence of vapor environments.

Entropy-controlled 2D supramolecular structures of N,N'-bis(n-alkyl)naphthalenediimides on a HOPG surface.

The two-dimensional supramolecular structures of a series of N,N'-bis(n-alkyl)naphthalenediimides (NDIs), whose chain lengths span from C3 to C18, at a liquid-HOPG surface interface, studied by STM and FM-AFM, are assigned with the help of molecular dynamics/molecular mechanics calculations to demonstrate that the C3- and C4-NDIs show lamellar structures, the C4- to C12-NDIs show honeycomb (KAGOME) structures, and the C14- to C18-NDIs show lamellar structures again. The change in supramolecular structure depending on chain length can be explained semiquantitatively by the balance of entropy and enthalpy terms to show the importance of "self-avoiding walk" of the alkyl chain in entropy terms.

Sporadic adult-onset hypophosphatemic osteomalacia caused by excessive action of fibroblast growth factor 23.

A 50-year-old man without family history of metabolic bone disease was referred to our hospital with a 5-year history of progressively worsening spinal and bilateral diffuse leg pain and proximal muscle weakness. Two years before admission, he was diagnosed as ankylosing spondylitis by a rheumatologist and was maintained on low-dose prednisone therapy without benefit. He developed progressive spinal and thoracic deformities, resulting in a 10 cm loss in height in the preceding 2 years. On physical examination, marked thoracic kyphosis and pectus carinatum was noted. Plain radiograph revealed pseudofracture in the right femoral neck. Laboratory findings showed a normal level of serum calcium, elevated level of serum alkaline phosphatase and inappropriately increased urinary phosphate excretion despite extreme hypophosphatemia. He was diagnosed as adult-onset hypophosphatemic osteomalacia caused by renal phosphate wasting. Serum fibroblast growth factor 23 was the upper limit of normal despite extreme hypophosphatemia and no neoplastic lesion potentially inducing hypophosphatemic osteomalacia could be identified in a thorough search including imaging studies of his entire body. Oral administration of phosphate and activated vitamin D together with dipyridamole relieved the persistent pain and weakness, and he became fully ambulatory.

Preliminary study comparing diffuse gastric FDG uptake and gastritis.

Diffuse high FDG uptake in the stomach is occasionally observed on positron emission tomography (PET) images. Some PET oncologists believe this to be physiologic uptake, but the exact cause is undetermined. We retrospectively compared PET images and endoscopic findings to examine the relation between diffuse gastric FDG uptake and gastritis. From September to December 2005, 113 individuals (68 men and 45 women), aged 52 ± 12 years, underwent both gastrofiberscopy and PET/computed tomography on the same day as part of a cancer screening program. Gastric FDG uptake was visually evaluated on PET images and classified as low, moderate, or high. Gastritis was classified as mild, moderate, or severe. For each screenee, the degree of FDG uptake was compared with the severity of gastritis. FDG uptake was low, moderate, and high in 64, 31, and 18 screenees, respectively. Gastritis was mild, moderate, and severe in 59, 44, and 10 screenees, respectively. A significant relation was observed between the degree of FDG uptake and the degree of gastritis (p＜0.0001). High FDG uptake was observed significantly more often in the upper half of the stomach than in the lower half (p＜0.0001). Similarly, gastritis was observed significantly more often in the upper half of the stomach (p=0.005). A significant relation was observed between the degree of FDG uptake and the severity of gastritis in both the upper (p＜0.0001) and lower (p=0.01) portions. In conclusion, the significant relation we found between the degree of FDG uptake and the severity of gastritis suggests that gastritis is a major cause of diffuse FDG uptake in the stomach.

Septic cavernous sinus thrombosis complicated by narrowing of the internal carotid artery, subarachnoid abscess and multiple pulmonary septic emboli.

A 56-year-old woman was admitted because of a high fever, right ptosis, chemosis, proptosis and ocular muscle palsy. Cranial MRI revealed a cavernous sinus thrombosis and a subarachnoid abscess. Carotid angio-gram demonstrated marked stenosis as well as aneurismal formation of the right internal carotid artery at the intracavernous portion. Chest radiograph showed bilateral multiple pulmonary nodules, some of which contained a cavity. Blood culture was positive for Streptococcus constellatus. She was diagnosed with septic cavernous sinus thrombosis complicated by narrowing of the internal carotid artery, subarachnoid abscess and multiple pulmonary septic emboli. She recovered with partial ocular sequelae as a result of seven weeks of intravenous antimicrobial therapy.

Community-acquired Staphylococcus aureus pneumonia accompanied by rapidly progressive glomerulonephritis and hemophagocytic syndrome.

A 59-year-old woman without underlying disease was admitted to a local hospital because of lung abscess, cytopenias and renal failure. 3 days before admission, she was diagnosed as influenza infection and was under antiviral therapy. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus (MSSA). She was transferred to our hospital on the 15th day at the local hospital because the clinical manifestations could not improve even though she was treated with multiple intravenous antibiotics directed against MSSA. Sputum cultures yielded methicillin-resistant S. aureus (MRSA) producing toxic shock syndrome toxin-1 (TSST-1) and serologic test indicated hypercytokinemia. She was diagnosed as rapidly progressive glomerulonephritis and hemophagocytic syndrome associated with staphylococcal infection. The pulmonary lesions, cytopenias and renal dysfunction improved as a result of long-term antimicrobial treatment including vancomycin, hemodialysis, short-term administration of corticosteroid and other supportive cares. She was finally weaned from hemodialysis on the 73rd hospital day. In recent years, the number of cases of S. aureus producing TSST-1 and enterotoxin has been increasing and in cases of staphylococcal infections, close attention should be given to toxin-mediated as well as non-toxin-mediated clinical manifestations.

Is apoptosis in antral mucosa correlated with serum nitrite concentration in Japanese Helicobacter pylori-infected patients?

BACKGROUND AND AIM: Helicobacter pylori infection in gastric mucosa is a form of chronic active gastritis that leads to expression of inducible nitric oxide synthase in host macrophages and polymorphonuclear leukocytes. Nitric oxide produced by these cells infiltrating the gastric mucosa could damage DNA. We correlated apoptosis in H. pylori-infected antral tissue from peptic ulcer patients with serum nitrate-plus-nitrite. METHODS: Biopsy specimens were obtained endoscopically from antrum and fundus in 17 peptic ulcer patients before and after H. pylori eradication. Tissue samples were subjected to rapid urease testing and histopathological scoring (updated Sydney system), as well as immunohistochemical detection of single-stranded DNA indicating apoptotic cells. Fasting serum samples were analyzed for combined nitrate and nitrite content. RESULTS: In all cases atrophy was absent to mild in antral mucosa and H. pylori was eradicated successfully. A strong positive correlation was present between apoptosis and both inflammation and activity scores in infected antral mucosa. A significant positive correlation also was noted between apoptosis and H. pylori density. Serum nitrite concentrations were decreased significantly by successful eradication of H. pylori, and showed a strong positive correlation with H. pylori density. Serum nitrite concentrations showed a significant positive correlation with numbers of single-stranded DNA-positive cells. CONCLUSIONS: High H. pylori density was associated with elevated serum nitrate-plus-nitrite (a marker of nitric oxide production in gastric mucosa). Increased apoptosis and abnormal gastric cell turnover are likely results.

Rupture of the anterolateral papillary muscle caused by a single diagonal branch obstruction.

This report presents the first case of anterolateral papillary muscle rupture caused by a diagonal branch occlusion only. Although the patient was in shock on admission, he was successfully treated by emergency surgery after hemodynamic stabilization by a percutaneous cardiopulmonary support system. This case implies that the anterolateral papillary muscle has a single blood supply and that it can rupture by an occlusion of only one diagonal branch even after balloon angioplasty.