A growing aneurysm of the posterior inferior cerebellar artery complicated with cerebellar infarction: A case report.

INTRODUCTION AND IMPORTANCE: Hereby we describe an instructive patient with cerebellar infarction and a growing aneurysm at the posterior inferior cerebellar artery (PICA), which was not a true cause of infarction. CASE PRESENTATION: A 50-year-old female presented with dizziness and posterior neck pain at our hospital (Mitaka city, Tokyo, Japan). Diffusion weighted magnetic resonance (MR) images showed cerebellar infarction in the left PICA territory and MR angiography study showed an aneurysm at the origin of the left PICA, which grew in 2 weeks. Since we considered cerebellar infarction was caused by thrombosis from the aneurysm, trapping of the PICA and occipital artery-PICA bypass was performed to prevent recurrent cerebellar infarction and rupture of the aneurysm by neurosurgeons. During the operation, dissection was observed at the distal PICA, which was diagnosed to be the true cause of cerebellar infarction. By the follow-up for 12 months at an outpatient, there was no recurrence of cerebral infarction. CLINICAL DISCUSSION: A specimen of the artery showing the findings of dissection was not obtained, and the pathological diagnosis could not be made. It would be controversial whether a surgical procedure presented here was the most optimal. CONCLUSION: This is a first reported case of growing aneurysms and cerebral infarction due to arterial dissection. Even if cerebral infarction is accompanied by growing aneurysms, arterial dissection should be included in the differential diagnoses of a cause of infarction. Posterior cervical pain can be a clue for early appropriate diagnosis in such a case.

Is using intracerebral hemorrhage scoring systems valid for mortality prediction in surgically treated patients?

While intracerebral hemorrhage (ICH) scoring systems provide mortality and morbidity prediction, the actual mortality rates seem to be lower than those predicted by scoring systems in our clinical impression. To assess the validity of the ICH score and the Surgical Swedish ICH (SwICH) score, we retrospectively reviewed surgically treated ICH patients between 2012 and 2019. Uni- and multivariate analyses were performed to identify variables in predicting 30-day mortality. We identified 203 patients (mean ICH score 2.7; mean SwICH score 2.0). The actual 30-day mortality was 7%, which was significantly lower than those predicted by the ICH and the SwICH scores (55% and 16%, respectively; p < 0.001). Both scores were strongly correlated with the modified Rankin scale (mRS) at discharge (correlation coefficient 0.97 and 0.98; critical value 0.81). The only significant prognostic factors for the 30-day mortality by multivariate analysis were anisocoria (p = 0.03) and preoperative Glasgow Coma Scale (p = 0.03). These two factors also predicted mRS at discharge (p < 0.001). After discharge, 15% of patients improved regarding mRS and 29% of wheelchair-bound patients gained the ability to ambulate. No significant relationship existed between the degree of recovery after discharge and preoperative ICH score (p = 0.25). The ICH and SwICH scores were more valid in predicting morbidity, rather than mortality after surgical intervention for ICH. Anisocoria and Glasgow Coma Scale < 7 were the only two factors that predicted 30-day mortality and morbidity at discharge.

Frontotemporal dermoid cyst with incomplete dermal sinus tract in an adult: A case report.

BACKGROUND: Non-midline supratentorial dermoid cyst with dermal sinus tract has been rarely reported especially in adults. We recently experienced a noteworthy patient with frontotemporal dermoid cyst with incomplete dermal sinus tract. CASE DESCRIPTION: A 43-year-old female presented with recurrent subcutaneous mass in the left superolateral orbital region. She had a history of active bronchial asthma, which precluded her from contrast-enhanced imaging studies. Plain imaging studies showed a subcutaneous mass which was continuous with an intrasylvian fissure mass by a tract in the sphenoid ridge and the lesser wing of the sphenoid bone. Frontotemporal craniotomy was performed to reset the mass and the tract. Intraoperative finding showed no intradural tumor components. Extradural component was carefully removed focusing attention on the frontal branch of the facial nerve. The pathology was consistent with dermoid cyst and dermal sinus tract. Postoperatively, she had mild facial palsy of the corrugator supercilii (House and Brackmann Grade II). She was discharged home with modified Rankin scale 1. CONCLUSION: Dermoid cyst needs to be included in the differential diagnosis of adult-onset subcutaneous mass in the frontotemporal regions. After thorough imaging studies for the presence and extent of the sinus tract, the symptomatic lesion should be excised completely once and for all.

Usefulness of N-vinyl-2-pyrrolidone Embalming for Endoscopic Transnasal Skull Base Approach in Cadaver Dissection.

Formalin or formaldehyde is commonly used for cadaver fixation, which is, however, not suitable for endoscopic transnasal skull base approach because of consequent hardening of the soft tissue. Several alternatives have been reported, but each of them also has some limitations. We applied a novel fixation method using N-vinyl-2-pyrrolidone (NVP), a precursor of the water-soluble macromolecular polymer, for endoscopic transnasal skull base approach in six donated cadaver specimens. In four cadavers, elasticity of the soft tissue in the nasal cavity was almost similar to that of living tissue, and a surgical approach similar to the real surgical field was possible. However, the soft tissue was moderately stiffer than living tissue in two specimens so that surgical manipulation was hindered to some extent while NVP concentration was 10% in all the cadavers. Since the brain tissue was too soft and pliable for surgical manipulation in NVP, more careful surgical manipulation than real surgical field was mandatory in order to prevent damage in the brain tissue. Therefore, this concentration of NVP was considered to be appropriate. In conclusion, NVP embalming was effective for endoscopic transnasal skull base approach in cadaver dissection, providing environment similar to the real surgical field.

Detailed standardized protocol to prevent cerebrospinal fluid shunt infection.

OBJECTIVE: While cerebrospinal fluid (CSF) shunt surgery plays an essential role in the treatment of hydrocephalus, postoperative infection due to the implantation of foreign materials is still one of the most common and potentially serious complications of this procedure. Because no previously reported protocol has been proven to prevent postoperative infection after CSF shunt surgeries in adults, the authors investigated the effectiveness of a protocol introduced in their institution. METHODS: A detailed standardized surgical protocol to prevent infection in patients undergoing CSF shunt surgeries was introduced in the authors' institution in December 2011. The protocol included a series of detailed rules regarding the surgical procedure, the surgical environment to minimize contamination from air, double gloving, local injection of antibiotics, and postoperative management. The rate of CSF shunt infection during the 3 years after surgery before and after implementation of the protocol was compared in patients undergoing their first CSF shunt surgeries. The inclusion periods were from January 2006 to November 2011 for the preprotocol group and from December 2011 to December 2014 for the postprotocol group. RESULTS: The study included 124 preprotocol patients and 52 postprotocol patients. The mean patient age was 59 years in both groups, ranging from 40 days to 88 years. Comparison of patient background factors, including known risk factors for surgical site infections, showed no significant difference between the patient groups before and after implementation of the protocol. While 9 patients (7.3%) developed shunt infections before protocol implementation, no shunt infections (0%) were observed in patients who underwent surgery after protocol implementation. The difference was statistically significant (p = 0.047). CONCLUSIONS: The authors' detailed protocol for CSF shunt surgeries was effective in preventing postoperative infection regardless of patient age.

[Detection of DNA in Highly Processed Foods].

Highly processed foods, including soy sauce, cornflakes, starch sugar, beet sugar and vegetable oil, are not currently subject to genetically modified (GM) food labeling, because DNA could not be detected in these food products. Here we re-examined the method of DNA extraction from starch syrup, beet sugar and vegetable oil using commercially available DNA extraction kits. We found that DNA was not stably detected by PCR targeting a species-specific endogenous plant gene. The reason for this may have been that the DNA yield was below the detection limit, because PCR inhibition was not observed.

Development and evaluation of rapid screening detection methods for genetically modified crops using loop-mediated isothermal amplification.

We developed new loop-mediated isothermal amplification (LAMP)-based detection methods for the screening of genetically modified (GM) maize and soybean events. The LAMP methods developed targeted seven sequences: cauliflower mosaic virus 35S promoter; 5-enolpyruvylshikimate-3-phosphate synthase gene from Agrobacterium tumefaciens strain CP4 (cp4epsps); phosphinothricin acetyltransferase (pat) gene; mannose-6-phosphate isomerase gene; Pisum sativum ribulose 1, 5-bisphosphate carboxylase terminator; a common sequence between Cry1Ab and Cry1Ac genes; and a GA21 construct-specific sequence. We designed new specific primer sets for each target, and the limit of detection (LOD) was evaluated using authorized GM maize and soybean events. LODs for each target were ≤ 0.5%. To make the DNA extraction process simple and rapid, we also developed a direct LAMP detection scheme using crude cell lysates. The entire process, including pretreatments and detection, could be completed within 1 h.

Smart Glasses for Neurosurgical Navigation by Augmented Reality.

BACKGROUND: Wearable devices with heads-up displays or smart glasses can overlay images onto the sight of the wearer. This technology has never been applied to surgical navigation. OBJECTIVE: To assess the applicability and accuracy of smart glasses for augmented reality (AR)-based neurosurgical navigation. METHODS: Smart glasses were applied to AR-based neurosurgical navigation. Three-dimensional computer graphics were created based on preoperative magnetic resonance images and visualized in see-through smart glasses. Optical markers were attached to the smart glasses and the patient's head for accurate navigation. Two motion capture cameras were used for registration and continuous monitoring of the location of the smart glasses in relation to the patient's head. After the accuracy was assessed with a phantom, this technique was applied in 2 patients with brain tumors located in the brain surface. RESULTS: A stereoscopic view by image overlay through the smart glasses was successful in the phantom and in both patients. Hands-free neuronavigation inside the operative field was available from any angles and distances. The targeting error in the phantom measured in 75 points ranged from 0.2 to 8.1 mm (mean 3.1 ± 1.9 mm, median 2.7 mm). The intraoperative targeting error between the visualized and real locations in the 2 patients (measured in 40 points) ranged from 0.6 to 4.9 mm (mean 2.1 ± 1.1 mm, median 1.8 mm). CONCLUSION: Smart glasses enabled AR-based neurosurgical navigation in a hands-free fashion. Stereoscopic computer graphics of targeted brain tumors corresponding to the surgical field were clearly visualized during surgery.

Molecular phylogenetic analysis of new Entoloma rhodopolium-related species in Japan and its identification method using PCR-RFLP.

Poisonous Entoloma rhodopolium and other similar species including edible E. sarcopum are morphologically diverse. People mistake poisonous species for edible species. Classification and the detection method of these species need to be defined. The morphological and phylogenetic studies have been reported in northern Europe. In Japan, the genetic study remains unsolved. Thus, phylogenetic analysis of E. rhodopolium was conducted using ITS and RPB2 sequences, and the result was compared with that of European species. Japanese E. rhodopolium was classified into three clades, none of which belonged to the true European E. rhodopolium and other known species. Three species were defined as new species. Entoloma rhodopolium clade-I (named E. lacus) was genetically close to but morphologically separated from E. majaloides. Clade-II (E. subrhodopolium) was classified to the same group as E. sinuatum and E. subsinuatum, but distinct from these species. Clade-III was segregated from known Entoloma species including E. lupinum, and named E. pseudorhodopolium. Based on the classification, a simple identification method PCR-RFLP was developed to discriminate between poisonous species and edible E. sarcopum, which is very similar in morphology. The study can help to clarify the taxonomy of complex E. rhodopolium-related species, and to prevent food poisoning.

Rapid Identification Method of Omphalotus japonicus by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP).

Omphalotus japonicus is a poisonous mushroom that grows in Japan. It can be mistaken for edible mushrooms (Shiitake, Hiratake and Mukitake), and if ingested, it causes food poisoning within 30 min to 1 hr. We established a rapid detection method using PCR-RFLP to identify O. japonicus by restriction digestion of the amplified ITS region. By using Sau96I, Bpu10I, SfcI or DrdI/HincII as a restriction enzyme, it was possible to rapidly identify and discriminate O. japonicus based on the fragment length. This study also provided a short PCR-RFLP system comprising amplification and digestion of a short 200-bp DNA fragment within the ITS region. The system could identify and discriminate O. japonicus after in vitro gastric digestion of native and heated mushroom samples as a model of food poisoning. In addition, a confirmatory assay using real-time PCR was developed to achieve more sensitive detection of O. japonicus.

Quantification of DNA fragmentation in processed foods using real-time PCR.

DNA analysis of processed foods is performed widely to detect various targets, such as genetically modified organisms (GMOs). Food processing often causes DNA fragmentation, which consequently affects the results of PCR analysis. In order to assess the effects of DNA fragmentation on the reliability of PCR analysis, we investigated a novel methodology to quantify the degree of DNA fragmentation. We designed four real-time PCR assays that amplified 18S ribosomal RNA gene sequences common to various plants at lengths of approximately 100, 200, 400, and 800 base pairs (bp). Then, we created an indicator value, "DNA fragmentation index (DFI)", which is calculated from the Cq values derived from the real-time PCR assays. Finally, we demonstrated the efficacy of this method for the quality control of GMO detection in processed foods by evaluating the relationship between the DFI and the limit of detection.

Outcomes of chronic subdural hematoma with preexisting comorbidities causing disturbed consciousness.

OBJECTIVE Chronic subdural hematoma (CSDH) is widely treated by drainage through a bur hole opening. However, whether and how preexisting comorbidities causing disturbance of consciousness affect patient outcomes remains unclear. METHODS The authors analyzed 188 consecutive patients with CSDH who were surgically treated at the Neurosurgery Institute of the Kyorin University School of Medicine between 2010 and 2012 and followed them for more than 90 days. The mean patient age was 77.0 years (range 33-101 years) and 56 were women. Patient outcomes including modified Rankin Scale (mRS) score, postoperative morbidity and mortality, and recurrence 90 days after initial surgery were analyzed according to preexisting comorbidities causing disturbance of consciousness. The comorbidities observed in 46 patients (24%) included dementia (30 patients), history of ischemic stroke (10 patients), psychiatric disorders (3 patients), and others (3 patients). RESULTS Background characteristics of patients with comorbidities showed older patient age (p < 0.001), lower preoperative Glasgow Coma Scale score (p < 0.001), and higher preoperative mRS score (p < 0.001). The mean mRS score 90 days after the neurosurgical procedure was 1.2 in all 188 patients, which was significantly higher in those with comorbidities (p < 0.001). By 1-way ANOVA with repeated measures, interaction existed between the presence of comorbidities and mRS score, and improvement of mRS score was observed in smaller proportions of patients with comorbidities (p = 0.002). By multivariate logistic regression analysis, the presence of comorbidities, patient age, reoperation for recurrence, and preoperative mRS score were significantly related to poor outcomes, defined as mRS score of 3 or more at 90 days after surgery. Postoperative morbidity (p < 0.01) and mortality (p < 0.01) were significantly higher in those with comorbidities, whereas the rate of recurrence of CSDH was not significantly different. CONCLUSIONS The preexistence of comorbidities causing disturbance of consciousness affected severity and outcomes 90 days after surgical treatment of CSDH, and comorbidities were also correlated with aging.

Development and Evaluation of Event-Specific Quantitative PCR Method for Genetically Modified Soybean MON87701.

A real-time PCR-based analytical method was developed for the event-specific quantification of a genetically modified (GM) soybean event, MON87701. First, a standard plasmid for MON87701 quantification was constructed. The conversion factor (Cf) required to calculate the amount of genetically modified organism (GMO) was experimentally determined for a real-time PCR instrument. The determined Cf for the real-time PCR instrument was 1.24. For the evaluation of the developed method, a blind test was carried out in an inter-laboratory trial. The trueness and precision were evaluated as the bias and reproducibility of relative standard deviation (RSDr), respectively. The determined biases and the RSDr values were less than 30 and 13%, respectively, at all evaluated concentrations. The limit of quantitation of the method was 0.5%, and the developed method would thus be applicable for practical analyses for the detection and quantification of MON87701.

Interlaboratory validation data on real-time polymerase chain reaction detection for unauthorized genetically modified papaya line PRSV-YK.

This article is referred to research article entitled "Whole genome sequence analysis of unidentified genetically modified papaya for development of a specific detection method" (Nakamura et al., 2016) [1]. Real-time polymerase chain reaction (PCR) detection method for unauthorized genetically modified (GM) papaya (Carica papaya L.) line PRSV-YK (PRSV-YK detection method) was developed using whole genome sequence data (DDBJ Sequenced Read Archive under accession No. PRJDB3976). Interlaboratory validation datasets for PRSV-YK detection method were provided. Data indicating homogeneity of samples prepared for interlaboratory validation were included. Specificity and sensitivity test data for PRSV-YK detection method were also provided.

Whole genome sequence analysis of unidentified genetically modified papaya for development of a specific detection method.

Identification of transgenic sequences in an unknown genetically modified (GM) papaya (Carica papaya L.) by whole genome sequence analysis was demonstrated. Whole genome sequence data were generated for a GM-positive fresh papaya fruit commodity detected in monitoring using real-time polymerase chain reaction (PCR). The sequences obtained were mapped against an open database for papaya genome sequence. Transgenic construct- and event-specific sequences were identified as a GM papaya developed to resist infection from a Papaya ringspot virus. Based on the transgenic sequences, a specific real-time PCR detection method for GM papaya applicable to various food commodities was developed. Whole genome sequence analysis enabled identifying unknown transgenic construct- and event-specific sequences in GM papaya and development of a reliable method for detecting them in papaya food commodities.

Development and Interlaboratory Validation of a Simple Screening Method for Genetically Modified Maize Using a ΔΔC(q)-Based Multiplex Real-Time PCR Assay.

A number of genetically modified (GM) maize events have been developed and approved worldwide for commercial cultivation. A screening method is needed to monitor GM maize approved for commercialization in countries that mandate the labeling of foods containing a specified threshold level of GM crops. In Japan, a screening method has been implemented to monitor approved GM maize since 2001. However, the screening method currently used in Japan is time-consuming and requires generation of a calibration curve and experimental conversion factor (C(f)) value. We developed a simple screening method that avoids the need for a calibration curve and C(f) value. In this method, ΔC(q) values between the target sequences and the endogenous gene are calculated using multiplex real-time PCR, and the ΔΔC(q) value between the analytical and control samples is used as the criterion for determining analytical samples in which the GM organism content is below the threshold level for labeling of GM crops. An interlaboratory study indicated that the method is applicable independently with at least two models of PCR instruments used in this study.

Selection of Suitable DNA Extraction Methods for Genetically Modified Maize 3272, and Development and Evaluation of an Event-Specific Quantitative PCR Method for 3272.

A novel real-time PCR-based analytical method was developed for the event-specific quantification of a genetically modified (GM) maize, 3272. We first attempted to obtain genome DNA from this maize using a DNeasy Plant Maxi kit and a DNeasy Plant Mini kit, which have been widely utilized in our previous studies, but DNA extraction yields from 3272 were markedly lower than those from non-GM maize seeds. However, lowering of DNA extraction yields was not observed with GM quicker or Genomic-tip 20/G. We chose GM quicker for evaluation of the quantitative method. We prepared a standard plasmid for 3272 quantification. The conversion factor (Cf), which is required to calculate the amount of a genetically modified organism (GMO), was experimentally determined for two real-time PCR instruments, the Applied Biosystems 7900HT (the ABI 7900) and the Applied Biosystems 7500 (the ABI7500). The determined Cf values were 0.60 and 0.59 for the ABI 7900 and the ABI 7500, respectively. To evaluate the developed method, a blind test was conducted as part of an interlaboratory study. The trueness and precision were evaluated as the bias and reproducibility of the relative standard deviation (RSDr). The determined values were similar to those in our previous validation studies. The limit of quantitation for the method was estimated to be 0.5% or less, and we concluded that the developed method would be suitable and practical for detection and quantification of 3272.

Volumetric analyses of cerebral white matter hyperintensity lesions on magnetic resonance imaging in a Japanese population undergoing medical check-up.

AIM: To clarify growth patterns, spatial distribution and risk factors of cerebral white matter hyperintensity (WMH) lesions on magnetic resonance imaging. METHODS: We analyzed volumes of cerebral WMH lesions in those who underwent brain magnetic resonance imaging as a hospital-based health check-up in 2012 and 2013 by using a computational quantitative image analysis software (Software for NeuroImage Processing in Experimental Research). After excluding subjects not suitable for volumetric analyses because of pathological brain conditions, a total of 1047 healthy participants (mean age 56.6 years) were included for the analyses. First, the relationship of computational volumetry and conventional qualitative visual evaluation by Shinohara grading was evaluated. Volumes of WMH lesions were analyzed according to age and the different cerebral lobes. Finally, clinical risk factors associated with WMH lesions were assessed. RESULTS: Volumes of WMH lesions were significantly correlated with Shinohara grading (P < 0.001). WMH lesions significantly enlarged with aging (P < 0.001) except for the occipital lobe, especially in participants aged 50 years or older. Age and systolic blood pressure were significantly related to volumes of WMH lesions in all the lobes, whereas diastolic blood pressure was not related only in the occipital lobe. CONCLUSION: Based on computational quantitative volumetric analyses, cerebral WMH lesions increased with age, and were associated with blood pressure. However, the occipital lobe was the only exception to these findings.

Identification of a Highly Specific Isoflavone 7-O-glucosyltransferase in the soybean (Glycine max (L.) Merr.).

Isoflavone conjugates [7-O-ß-D-glucosides and 7-O-(6″-malonyl-ß-D-glucosides) of daidzein and genistein] accumulate in soybean roots and serve as the stored precursors of isoflavones (aglycons), which play very important roles in the rhizobia-mediated nodulation of this plant. Thus far, the isoflavone 7-O-glucosyltransferase (GmIF7GT or GmUGT1) has been biochemically characterized and is believed to be involved in isoflavone conjugate biosynthesis. The soybean genome encodes many other glycosyltransferase homologs (GmUGTs) that are related to GmUGT1; however, their catalytic properties, substrate specificities, and role(s) in isoflavone conjugation are unknown. In this study, nine different GmUGT1-related GmUGT cDNAs were isolated; six of these cDNAs belonged to two distinct phylogenetic subgroups (A and B), and these six were functionally characterized. The results showed that GmUGT4, a representative of subgroup A, encoded a UGT that was highly specific for isoflavones showing kcat and kcat/Km values for daidzein of 5.89 ± 0.65 s(-1) and 2.91 × 10(5) s(-1)M(-1), respectively. Moreover, GmUGT4 was expressed in the roots (mainly in lateral roots) of the 7-day-old seedlings and seeds, both of which contained abundant amounts of isoflavone conjugates. By contrast, GmUGT1 and GmUGT7, which were subgroup B members, encoded enzymes with broad glucosyl-acceptor specificities and were mainly expressed in the aerial portions (cotyledons and hypocotyls) of the seedlings. In the present study, we proposed that the role of isoflavone glucosylation in a soybean plant is assigned to different GmUGT members in an organ/tissue-dependent manner. We also established the functional importance of GmUGT4 in the biosynthesis of isoflavone conjugates in lateral roots that make a major contribution to overall N2 fixation.

Neurosurgical simulation by interactive computer graphics on iPad.

PURPOSE: Presurgical simulation before complicated neurosurgery is a state-of-the-art technique, and its usefulness has recently become well known. However, simulation requires complex image processing, which hinders its widespread application. We explored handling the results of interactive computer graphics on the iPad tablet, which can easily be controlled anywhere. METHODS: Data from preneurosurgical simulations from 12 patients (4 men, 8 women) who underwent complex brain surgery were loaded onto an iPad. First, DICOM data were loaded using Amira visualization software to create interactive computer graphics, and ParaView, another free visualization software package, was used to convert the results of the simulation to be loaded using the free iPad software KiwiViewer. RESULTS: The interactive computer graphics created prior to neurosurgery were successfully displayed and smoothly controlled on the iPad in all patients. The number of elements ranged from 3 to 13 (mean 7). The mean original data size was 233 MB, which was reduced to 10.4 MB (4.4% of original size) after image processing by ParaView. This was increased to 46.6 MB (19.9%) after decompression in KiwiViewer. Controlling the magnification, transfer, rotation, and selection of translucence in 10 levels of each element were smoothly and easily performed using one or two fingers. The requisite skill to smoothly control the iPad software was acquired within 1.8 trials on average in 12 medical students and 6 neurosurgical residents. CONCLUSIONS: Using an iPad to handle the result of preneurosurgical simulation was extremely useful because it could easily be handled anywhere.