Impairment of bimanual in-phase movement during recovery from frontal lobe tumor surgery: a case report.

The mechanisms underlying bimanual coordination have not yet been fully elucidated. Here, we evaluated the clinical features of bimanual movement impairment in a patient following surgery for a frontal lobe tumor. The patient was an 80-year-old man who had undergone subtotal tumor resection for a tumor in the right superior frontal gyrus. Histological examination of the resected specimen led to the diagnosis of malignant lymphoma of the diffuse large B-cell type, and the patient subsequently received high-dose methotrexate-based chemotherapy. Postoperatively, the patient had difficulty with bimanual movement, and on the 5th postoperative day we found that the impairment could not be attributed to weakness. Temporal changes in the characteristics of manual movements were analyzed. Bimanual diadochokinesis (opening/closing of the hands, pronation/supination of the forearms, and sequential finger movements) was more disturbed than unilateral movements; in-phase movements were more severely impaired than anti-phase movements. Bimanual movement performance was better when cued using an auditory metronome. On the 15th postoperative day, movements improved. The present observations show that in addition to the disturbance of anti-phase bimanual movements, resection of the frontal lobe involving the supplementary motor area (SMA) and premotor cortex (PMC) can cause transient impairment of in-phase bimanual diadochokinesis, which can be more severe than the impairment of anti-phase movements. The effect of auditory cueing on bimanual skills may be useful in the diagnosis of anatomical localization of the superior frontal gyrus and functional localization of the SMA and PMC and in rehabilitation of patients with brain tumors, as in the case of degenerative movement disorders.

Osteogenic Response to Polysaccharide Nanogel Sheets of Human Fibroblasts After Conversion Into Functional Osteoblasts by Direct Phenotypic Cell Reprogramming.

Human dermal fibroblasts (HDFs) were converted into osteoblasts using a ALK inhibitor II (inhibitor of transforming growth factor-ß signal) on freeze-dried nanogel-cross-linked porous (FD-NanoClip) polysaccharide sheets or fibers. Then, the ability of these directly converted osteoblasts (dOBs) to produce calcified substrates and the expression of osteoblast genes were analyzed in comparison with osteoblasts converted by exactly the same procedure but seeded onto a conventional atelocollagen scaffold. dOBs exposed to FD-NanoClip in both sheet and fiber morphologies produced a significantly higher concentration of calcium deposits as compared to a control cell sample (i.e., unconverted fibroblasts), while there was no statistically significant difference in calcification level between dOBs exposed to atelocollagen sheets and the control group. The observed differences in osteogenic behaviors were interpreted according to Raman spectroscopic analyses comparing different polysaccharide scaffolds and Fourier transform infrared spectroscopy analyses of dOB cultures. This study substantiates a possible new path to repair large bone defects through a simplified transplantation procedure using FD-NanoClip sheets with better osteogenic outputs as compared to the existing atelocollagen scaffolding material.

Severe hemodynamic depression after carotid artery stenting: The problem overcome with a transvenous temporary cardiac pacemaker.

BACKGROUND: Carotid angioplasty stenting (CAS) may have adverse events including perioperative hemodynamic depression. A transvenous temporary cardiac pacemaker (TTCP) is an option for preventing devastating sequelae due to circulatory failure. An exploration of the predictors of hemodynamic depression following CAS is valuable for selecting candidates for preoperative TTCP implantation before CAS. CASE DESCRIPTION: An 84-year-old man underwent CAS for asymptomatic left carotid severe stenosis. He had no history of bradycardia arrhythmia. A TTCP was implanted in advance in view of the likelihood of perioperative hemodynamic depression. CAS was accomplished successfully, but severe hypotension and vanishing of self-heartbeat occurred about 90 min after the procedure. By activating the pre-implanted TTCP, spontaneous circulation was readily recovered with vasopressor administration. He was discharged with no additional neurological deficits. A literature review using a random effect model found that smoking (odds ratio [OR] 1.68, 95% confidence interval (CI) 1.13-2.52) and severely calcified plaque (OR 3.70, 95% CI 2.15-6.35) were significant predictors of perioperative hemodynamic depression following CAS. CONCLUSION: TTCP can be recommended for a patient receiving CAS to prevent catastrophic consequences, particularly in cases with a history of smoking or severely calcified plaque.

A case of inferior frontal gyrus infarction manifesting Gerstmann syndrome.

A 48-year-old female suffered from cerebral infarction involving the left inferior frontal gyrus. This was due to ischemic complications of endovascular treatment for subarachnoid hemorrhage. She exhibited severe acalculia, agraphia, finger agnosia, and right-left disorientation (the four features of Gerstmann syndrome), but aphasia was scarcely noticeable. Single-photon emission tomography revealed hypoperfusion in the left inferior frontal area and also in the left parietal area. It is possible that Gerstmann syndrome was caused in the present case by disruption of the association fiber connecting the inferior frontal area with the inferior parietal area.

Surface functionalization of PEEK with silicon nitride.

Surface roughness, bioactivity, and antibacterial properties are desirable in skeletal implants. We hot-pressed a mix of particulate sodium chloride (NaCl) salt and silicon nitride (ß-Si3N4) onto the surface of bulk PEEK. NaCl grains were removed by leaching in water, resulting in a porous PEEK surface embedded with sim15 vol% ß-Si3N4particles. This functionalized surface showed the osteogenic and antibacterial properties previously reported in bulk silicon nitride implants. Surface enhancement of PEEK with ß-Si3N4could improve the performance of spinal fusion cages, by facilitating arthrodesis and resisting bacteria.

Effectiveness of Lee Silverman Voice Treatment® LOUD on Japanese-Speaking Patients with Parkinson's Disease.

Background. Lee Silverman Voice Treatment® LOUD (LSVT®) is an intensive program devised in the United States to train patients with Parkinson's disease (PD) to speak louder, at normal intensity, while keeping a good voice quality. Four weeks of LSVT® has been shown to increase vocal loudness and improve intelligibility among Japanese-speaking PD patients. However, the long-term effects of LSVT® have not been examined in these patients. Objective. This study aimed to investigate the long-term effects of LSVT® on Japanese-speaking PD patients. Methods. Twenty-one Japanese PD patients underwent a standardized course (four sessions over four consecutive days, for four weeks) of LSVT® at our hospital. Vocal loudness and intelligibility were assessed at the following three time-points: pretreatment (baseline), immediately after treatment, and at the end of the 12 month follow-up (12FU). Sound pressure levels (dB SPL) were measured during the following tasks: sustained phonation of /a/, reading a standardized text, and delivery of a monologue. Three experienced speech-language pathologists, who were blinded to patients' identities and assessment points, assessed speech intelligibility based on recorded audio samples of each participant during the reading and monologue tasks. Results. Fourteen patients were evaluated at 12FU. Changes in dB SPL from baseline to immediately after treatment were +6.5 dB, +4.2 dB, and +2.8 dB, and those from baseline until 12FU were +4.7 dB, +3.5 dB, and +2.5 dB in sustained phonation of /a/, reading a passage, and delivery of a monologue, respectively. These changes were significant (p < 0.025) in both the baseline-to-immediately-after-treatment and baseline-to-12FU intervals. Intelligibility relative to baseline was significantly improved immediately after treatment, but not at 12FU. Conclusions. LSVT® had a long-term effect on the vocal loudness of Japanese-speaking PD patients. A short-term effect was seen in intelligibility, however, there was no significant long-term effect.

Metabolic machinery encrypted in the Raman spectrum of influenza A virus-inoculated mammalian cells.

Raman spectroscopy was applied with a high spectral resolution to a structural study of Influenza (type A) virus before and after its inoculation into Madin-Darby canine kidney cells. This study exploits the fact that the major virus and cell constituents, namely DNA/RNA, lipid, and protein molecules, exhibit peculiar fingerprints in the Raman spectrum, which clearly differed between cells and viruses, as well as before and after virus inoculation into cells. These vibrational features, which allowed us to discuss viral assembly, membrane lipid evolution, and nucleoprotein interactions of the virus with the host cells, reflected the ability of the virus to alter host cells' pathways to enhance its replication efficiency. Upon comparing Raman signals from the host cells before and after virus inoculation, we were also able to discuss in detail cell metabolic reactions against the presence of the virus in terms of compositional variations of lipid species, the formation of fatty acids, dephosphorylation of high-energy adenosine triphosphate molecules, and enzymatic hydrolysis of the hemagglutinin glycoprotein.

The role of nitrogen off-stoichiometry in the osteogenic behavior of silicon nitride bioceramics.

The surface chemistry of silicon nitride plays an important role in stimulating osteoblasts to proliferate and produce bone tissue with improved efficiency. This property, which is advantageous in spinal fusion surgery has a chemical origin and is a direct consequence of the cleavage of covalent SN bonds in an aqueous environment. Building upon a wealth of published research on the stimulation of osteoblastic activity by silicon, the aim of this paper is to explore the role of nitrogen and, more specifically, the N/Si atomic ratio on the osteogenic response of Si3N4. The surface stoichiometry of Si3N4 was gradually altered toward a silicon-rich composition by systematically treating the Si3N4 surface with a high-power pulsed laser in an Ar gas atmosphere (i.e., operated at different pulse times, spot sizes, and voltages). Different analytical probes were used to characterize the surface including X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, and energy dispersive X-ray spectroscopy (EDS). Osteoconductivity was tested in vitro using SaOS-2 osteosarcoma cells, and samples with different surface stoichiometry were compared for their osteogenic response. These experiments clearly indicated a fundamental role for nitrogen off-stoichiometry in osteogenesis, and showed that both cell proliferation and growth of bone tissue diminished with decreasing nitrogen content.

In situ molecular vibration insights into the antibacterial behavior of silicon nitride bioceramic versus gram-negative Escherichia coli.

Gram-negative bacteria represent a substantial fraction of pathogens responsible for periprosthetic infections. Given the increasing resistance of such bacteria to antibiotics, significant efforts are nowadays paid in developing new biomaterial surfaces, which offer resistance against bacterial adhesion and/or possess inherent antibacterial effects. Non-oxide silicon nitride (Si3N4) bioceramic in its polycrystalline form is a biomaterial with inherent antibacterial properties. Building upon previous phenomenological findings, the present study focuses on vibrational analyses of the metabolic response of Escherichia coli at the molecular level. A time-lapse study is conducted upon exposing the bacteria in vitro to Si3N4 bioceramic surfaces. A comparison is carried out with the as-cultured bacterial strain and with bacteria exposed to other commercially available biomaterials, namely, Ti-alloy (Ti6Al4V-ELI) and zirconia-toughened alumina (ZTA) oxide bioceramic tested under exactly the same experimental conditions. The metabolic pathways before and after exposure to different substrates were monitored by means of Raman and FTIR spectroscopies. Results indicated the development of significant osmotic stress in the bacterial strain and constant concentration decreases of its cellular compounds markers over time upon exposure to Si3N4. This ultimately led to bacterial lysis (also confirmed by conventional fluorescence microscopy assays). The main antibacterial effect was of chemical origin and driven by the elution of nitrogen ions from the Si3N4 surface, successively converted into ammonia (NH3) or ammonium (NH4)+ in aqueous solution, depending on environmental pH. The presence of these nitrogen species created osmotic stress in the cytoplasmic space. In answer to the osmotic stress, metabolic rates changed rapidly, the bacterial membrane was damaged, and lysis occurred almost completely within 48 h exposure. The antibacterial behavior exerted by the Si3N4 substrate on E. coli was more effective than that observed on the biomedical Ti6Al4V alloy. Conversely, no lysis but bacterial proliferation was recorded for E. coli exposed to ZTA bioceramic oxide substrates.

Osteogenic response of mesenchymal progenitor cells to natural polysaccharide nanogel and atelocollagen scaffolds: A spectroscopic study.

A natural polysaccharide scaffold, referred to as "freeze-dry nanogel-crosslinked-porous" (FD-NanoCliP) gel, was tested in comparison with an atelocollagen scaffold with respect to osteogenesis versus the mouse mesenchymal progenitor cell line KUSA-A1. The amphiphilic polysaccharide network, engineered in its structure to fit chemically crosslinked nanogels as building blocks into a physically crosslinked porous gel, revealed a superior osteointegrative performance as compared to the soluble atelocollagen network and a peculiar c-plane orientation growth of apatite crystallites, which resembled the structure of natural enamel. Besides evaluating osteogenesis in the FD-NanoCliP gel scaffold, an additional purpose of this study was to assess its chemical composition at the nanoscale and, through its knowledge, to interpret the osteogenic response of mesenchymal cells. In addition to conventional (optical and electron) microscopy and biological evaluation kits, the peculiar chemistry of the FD-NanoCliP gel scaffold and the formation of apatite on it were characterized by means of several independent analytical probes at the molecular scale, which included Raman, cathodoluminescence, energy dispersive X-ray, and X-ray fluorescence spectroscopies. This body of information consistently provided evidence for a peculiar chemistry developed in osteogenesis at the polysaccharide scaffold surface. Such chemistry is not available in soluble atelocollagen and it is key in the superior bioactivity found in the polysaccharide network.

Label-Free SERS Discrimination and In Situ Analysis of Life Cycle in Escherichia coli and Staphylococcus epidermidis.

Surface enhanced Raman spectroscopy (SERS) has been proven suitable for identifying and characterizing different bacterial species, and to fully understand the chemically driven metabolic variations that occur during their evolution. In this study, SERS was exploited to identify the cellular composition of Gram-positive and Gram-negative bacteria by using mesoporous silicon-based substrates decorated with silver nanoparticles. The main differences between the investigated bacterial strains reside in the structure of the cell walls and plasmatic membranes, as well as their biofilm matrix, as clearly noticed in the corresponding SERS spectrum. A complete characterization of the spectra was provided in order to understand the contribution of each vibrational signal collected from the bacterial culture at different times, allowing the analysis of the bacterial populations after 12, 24, and 48 h. The results show clear features in terms of vibrational bands in line with the bacterial growth curve, including an increasing intensity of the signals during the first 24 h and their subsequent decrease in the late stationary phase after 48 h of culture. The evolution of the bacterial culture was also confirmed by fluorescence microscope images.

Bioglass functionalization of laser-patterned bioceramic surfaces and their enhanced bioactivity.

The surfaces of silicon nitride (ß-Si3N4) and zirconia toughened alumina (ZTA) were patterned using a high-energy laser source, which operated at a wavelength of 1064 nm. The patterning procedure yielded a series regular, cylindrical cavities 500 and 300 µm in diameter and depth, respectively. These cavities were subsequently filled with bioglass mixed with different fractions of Si3N4 powder (0, 5, and 10 mol.%) to obtain bioactive functionalized bioceramic surfaces. The laser-patterned samples were first characterized using several spectroscopic techniques before and after functionalization, and then tested in vitro with respect to their osteoconductivity using a human osteosarcoma cell line (SaOS-2). After in vitro testing, fluorescence microscopy was used to address the biological response and to estimate osteopontin and osteocalcin protein contents and distributions. The presence of bioglass greatly enhanced the biological response of both ceramic surfaces, but mainly induced production of inorganic apatite. On the other hand, the addition of minor fraction of Si3N4 into the bioglass-filled holes greatly enhanced bio-mineralization and stimulated the SaOS-2 cells to produce higher amounts of bone extracellular matrix (collagen and proteins), thus enhancing the osteopontin to osteocalcin ratio. It was also observed that the presence of a fraction of Si3N4 in the powder mixture filling the holes bestowed more uniform cell colonization on the otherwise bioinert ZTA surface.

Nanogel tectonic porous 3D scaffold for direct reprogramming fibroblasts into osteoblasts and bone regeneration.

Transplantation of engineered three-dimensional (3D) bone tissue may provide therapeutic benefits to patients with various bone diseases. To achieve this goal, appropriate 3D scaffolds and cells are required. In the present study, we devised a novel nanogel tectonic material for artificial 3D scaffold, namely the nanogel-cross-linked porous (NanoCliP)-freeze-dried (FD) gel, and estimated its potential as a 3D scaffold for bone tissue engineering. As the osteoblasts, directly converted osteoblasts (dOBs) were used, because a large number of highly functional osteoblasts could be induced from fibroblasts that can be collected from patients with a minimally invasive procedure. The NanoCliP-FD gel was highly porous, and fibronectin coating of the gel allowed efficient adhesion of the dOBs, so that the cells occupied the almost entire surface of the walls of the pores after culturing for 7 days. The dOBs massively produced calcified bone matrix, and the culture could be continued for at least 28 days. The NanoCliP-FD gel with dOBs remarkably promoted bone regeneration in vivo after having been grafted to bone defect lesions that were artificially created in mice. The present findings suggest that the combination of the NanoCliP-FD gel and dOBs may provide a feasible therapeutic modality for bone diseases.

Raman Imaging of Individual Membrane Lipids and Deoxynucleoside Triphosphates in Living Neuronal Cells during Neurite Outgrowth.

Recent developments in Raman imaging at the microscopic scale were exploited here with the specific purpose of locating spectral fingerprints of individual membrane lipids and deoxynucleoside triphosphates during neuronal cell networking and separation. After carefully screening the Raman spectra of isolated lipid components, we located an in situ mapped specific Raman fingerprints from individual phospholipids at the micrometric level in comparison with the total lipid distribution within single living cells. We concurrently examined silent zones of lipid emissions and exploited those peculiar spectral ranges for mapping both abundance and localization of individual DNA nucleoside triphosphates. This work represents a first step toward label-free/molecular-selective Raman patterning with high spectral resolution of the relevant chemical species involved with the functionality of neuronal cells.

Monitoring metabolic reactions in Staphylococcus epidermidis exposed to silicon nitride using in situ time-lapse Raman spectroscopy.

Staphylococcus epidermidis (S. epidermidis) is one of the leading nosocomial pathogens, particularly associated with periprosthetic infections of biomedical implants. Silicon nitride (Si3N4), a nonoxide biomaterial widely used in spinal implants, has shown bacteriostatic effects against both gram-positive and gram-negative bacteria; however, the physicochemical interactions between Si3N4 and bacteria yet remain conspicuously unexplored. In situ time-lapse Raman spectroscopic experiments were conducted by exposing S. epidermidis for 12, 24, and 48 h to Si3N4 substrates to understand the evolution of bacterial metabolism and to elucidate the ceramics antimicrobial behavior. The Raman probe captured an initial metabolic response of the bacteria to the adverse chemistry of the Si3N4 surface, which included peroxidation of membrane phospholipids and protein structural modifications to adjust for survivorship. However, beyond 24 h of exposure, the Raman signals representing DNA, lipids, proteins, and carbohydrates showed clear fingerprints of bacterial lysis. Bands related to biofilm formation completely disappeared or underwent drastically reduced intensity. Bacterial lysis was confirmed by conventional fluorescence microscopy methods. Spectroscopic experiments suggested that a pH change at the Si3N4's surface induced variations in the membrane structure and D-alanylation of teichoic acids in its peptidoglycan layer. Concurrent stimulation of peptidoglycan hydrolase (i.e., an enzyme involved with autolysis) ultimately led to membrane degradation and cellular death. An additional finding was that modulating the Si3N4 surface by increasing the population of amine groups improved the efficiency of the substrate against S. epidermidis, thus suggesting that optimization of the near-surface (alkaline) conditions may be a viable approach to bacterial reduction.

In vitro antibacterial activity of oxide and non-oxide bioceramics for arthroplastic devices: II. Fourier transform infrared spectroscopy.

The metabolic response of Gram-positive Staphylococcus epidermidis (S. epidermidis) bacteria to bioceramic substrates was probed by means of Fourier transform infrared spectroscopy (FTIR). Oxide zirconia-toughened alumina (ZTA) and non-oxide silicon nitride (Si3N4) substrates were tested. Bacteria exposed to silica glass substrates were used as a control. S. epidermidis, a major cause of periprosthetic infections, was screened to obtain a precise time-lapse knowledge of its molecular composition and to mechanistically understand its interaction with different substrates. At the molecular level, the structure of proteins, lipids, nucleic acid, and aromatic amino acids evolved with time in response to different substrates. In combination with statistical validation and local pH measurements, a chemical lysis mechanism was spectroscopically observed in situ on the Si3N4 substrates. Utilization of FTIR in this study avoided fluorescence noise which occurred while probing the ZTA samples with Raman spectroscopy in a companion paper. The substrate-driven dynamics of polysaccharide and peptide variations in the bacterial cell wall, peculiar to Si3N4 bioceramics, are elucidated.

Japanese Adaptation of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39): Comparative Study among Different Types of Aphasia.

BACKGROUND: We have developed a Japanese version of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39), designated as SAQOL-39-J, and used psychometric methods to examine its acceptability and reliability. METHODS: The acceptability and reliability of SAQOL-39-J, which was developed from the English version using a standard translation and back-translation method, were examined in 54 aphasia patients using standard psychometric methods. The acceptability and reliability of SAQOL-39-J were then compared among patients with different types of aphasia. RESULTS: SAQOL-39-J showed good acceptability, internal consistency (Cronbach's α score = .90), and test-retest reliability (intraclass correlation coefficient = .97). Broca's aphasia patients showed the lowest total scores and communication scores on SAQOL-39-J. CONCLUSIONS: The Japanese version of SAQOL-39, SAQOL-39-J, provides acceptable and reliable data in Japanese stroke patients with aphasia. Among different types of aphasia, Broca's aphasia patients had the lowest total and communication SAQOL-39-J scores. Further studies are needed to assess the effectiveness of health care interventions on health-related quality of life in this population.

Voice features of Parkinson's disease patients with subthalamic nucleus deep brain stimulation.

Voice and speech disorders are one of the most important issues after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease patients; however, their characteristics remain unclear. We performed a comprehensive voice evaluation including the multi-dimensional voice program for acoustic analysis, the GRBAS scale for perceptual analysis, and the evaluation of the voice handicap index (VHI) for psychosocial analysis. In total, 68 patients who had undergone STN-DBS (37 assessed in the on- and off-stimulation conditions) and 40 who had been treated with medical therapy alone were evaluated. Further, we performed laryngoscopic examinations in 13 STN-DBS and 19 medical-therapy-alone patients. The STN-DBS group, especially females, showed widespread impairment of voice parameters and significantly poorer VHI scores than the medical-therapy-alone group. The degree of voiceless (DUV) and strained voice were the most impaired factors in the STN-DBS group; and DUV significantly improved after stopping stimulation. Furthermore strained voice, breathiness, and asthenia improved after stopping stimulation. Laryngoscopic examination showed that abnormal laryngeal muscle contraction and incomplete glottal closure were more prominent in the STN-DBS group than in the medical-therapy-alone group. We demonstrated that (1) more widespread voice impairment in females, (2) poorer voice-related QOL, (3) worse DUV and strained voice, and (4) abnormal laryngeal muscle contraction were the characteristic voice and laryngeal findings in the STN-DBS group compared with those in the medical-therapy-alone group.

Usefulness and pitfall of Narrow band imaging combined with magnifying endoscopy for detecting an unknown head and neck primary site with cervical lymph node metastasis.

OBJECTIVE: Cervical nodal metastasis from clinically undetectable primary squamous cell carcinoma (SCC) accounts for 1-2% of head and neck malignancies. We retrospectively evaluate the ability of Narrow band imaging combined with magnifying endoscopy (NBI-ME) to detect the primary sites of superficial SCC in the head and neck region. METHODS: This was a report of 11 patients. We performed with NBI-ME to detect unknown primary sites in the head and neck. RESULTS: Among 11 patients, primary sites were detected in eight. Primary sites were detected in the head and neck in 6 (54.5%) of 11 patients on NBI-ME, all 6 primary lesions were a flat lesion. Two patients in whom primary lesions could not be detected on NBI-ME, one had submucosal tumor like lesion, the other featured by a detectable primary lesion 19 months after neck dissection. CONCLUSION: NBI-ME can be recommended as an essential procedure for the detection of primary lesions in patients with primary unknown cervical lymph node metastasis.