Revascularization procedure mainly by suction thrombectomy for acute cervical carotid occlusion.

SUMMARY: In many cases, the prognosis for acute cervical carotid artery occlusion is poor. However, a standard treatment for the acute stage is not yet established. We report here the results of eight consecutive patients (mean age 71.5 years old) in which revascularization mainly by suction thrombectomy was performed under proximal protection during the acute phase. The occlusion sites were the intracranial internal carotid artery in five patients, tandem lesions of the internal carotid origin and intracranial vessel in two patients, and the common carotid artery in one patient. In addition, the subjects who received the treatment had an extent of infarction in MRI/DWI that was 1/3 or less of the internal carotid artery territory. The mean time from the onset to treatment commencement was 7.25 hours (2-28 hours). For the endovascular treatment, a guiding catheter with a balloon was used for proximal protection of the carotid artery. Revascularization was performed mainly by suction thrombectomy, and if a stenosed lesion was observed, PTA/stenting was added. Local fibrinolysis was not performed in combination with the above procedure. The treatment results were complete recanalization in three patients and partial recanalization in three patients. However, recanalization was not achieved in two patients. No hyperfusion syndrome or hemorrhagic infarction was observed postoperatively. All four patients in whom thrombi were successfully aspirated had occlusions proximal to the ophthalmic artery branch. In three of these four patients, complete recanalization was achieved. The revascularization procedure using suction thrombectomy under proximal protection was considered effective against the acute cervical carotid occlusions, in particular, those proximal to the ophthalmic artery branch.

Raman microspectroscopic study on polymerization and degradation processes of a diacetylene derivative at surface enhanced Raman scattering active substrates. 1. Reaction kinetics.

Raman microspectroscopy was applied to study the polymerization kinetics of the Langmuir-Blodgett (LB) films of 10,12-pentacosadiynoic acid (DA) adsorbed on surface enhanced Raman scattering (SERS) active Ag island films. A two-dimensional (2D) Raman microscopic image measured at 1520 cm(-1) exhibits bright and dim spots with the diameter of several hundred nanometers. Raman microscopic spectra, measured by defocusing the excitation laser light (532 nm, diameter of ca. 10 mum) on the samples at room temperature, proved the occurrence of the surface processes consisting of the formation of polydiacetylene (PDA) in the blue phase, its conversion to the red phase, and subsequent bleaching. These reactions were negligible under the same condition for the DA-LB films prepared on a smooth (i.e., SERS-inactive) Ag film, indicating that the 532-nm-induced polymerization and the bleaching process are enhanced by the SERS-active substrates. At low temperatures below -50 degrees C, the Raman microscopic measurements proved the formation of the blue phase and its conversion to the red phase with much lower reaction rates compared to the corresponding rates at room temperature. The bleaching, however, was much suppressed at the low temperatures. The kinetic analyses of the formation of the blue phase and its conversion to the red phase were performed by using the intensity changes of the Raman bands due to the blue (1477 cm(-1)) and red (1517 cm(-1)) phases as a function of the irradiation time. The results strongly suggested the existence of at least two processes taking place simultaneously on the SERS-active substrates; that is, one of the processes is a sequential reaction, DA-monomers --> PDA in the blue phase --> PDA in the red phase, and the other is another sequential reaction, DA-monomers --> PDA in the red phase --> degradation species (probably amorphous carbon). Thus, even at the low temperatures, there occurs the surface reaction consisting of the formation of PDA and its degradation. The reaction can be ascribed to a process taking place at the highly SERS-active site, which gives the bright spot (so-called "hot spot") on the 2D Raman image, as proved by the confocal Raman microscopic measurement in the following paper.

Raman microspectroscopic study on polymerization and degradation processes of a diacetylene derivative at surface enhanced Raman scattering active substrates. 2. Confocal Raman microscopic observation of polydiacetylene adsorbed on active sites.

Confocal Raman microscopic measurements were performed at room temperature on the Langmuir-Blodgett (LB) monolayer of 10,12-pentacosadiynoic acid (DA) prepared on surface enhanced Raman scattering (SERS) active Ag island films, two-dimensional (2D) Raman images of which exhibit bright and dim spots on a dark background. The measurements performed by focusing the excitation laser light (488 nm) on the dark background indicate the prompt appearance of the Raman bands (1515 and 2115 cm(-1)) due to polydiacetylene (PDA) in the red phase and subsequent diminution of the Raman bands. On the other hand, the spectra observed by focusing the excitation laser spot on the dim and bright spots exhibit almost random fluctuations, giving rather narrow Raman bands in the 1620-1000 cm(-1) region, which appear and disappear temporarily with varying intensities under the continuous irradiation at 488 nm. Broad Raman bands appear around 1580 and 1360 cm(-1), which are ascribable to amorphous carbon, at a later stage of the observation, the intensities from the bright spot being more than 100 times stronger than those from the dim spot. The narrow bands are ascribed to a series of carbonaceous intermediates such as polyenes, graphite sheets with various sizes, and folded or reorganized forms of the sheets including carbon nanotubes and fullerenes, which are formed during the conversion of PDA to amorphous carbon. The random spectral fluctuation was interpreted by considering that the intermediates undergo thermally activated diffusion and get temporarily in contact with the SERS-active site, resulting in the enhancement of their Raman bands and the fluctuation.

Inefficient visual search for second-order motion.

Visual search rate was used to assess attentional resources required for detection of opposing motions defined either by luminance or by modulations of texture contrast, flicker, or size. Though luminance-based targets were detected quickly, search through second-order motion was slow. Control experiments ruled out stimuli visibility, complexity, eccentricity sensitivity, and attributes of the carrier as possible accounts. Results suggest separate processing of the two types of stimuli: Luminance-based motion is detected by spatiotemporal filters, whereas second-order motion is likely processed by a capacity-limited, later stage. Rate-reducing effects of increased contrast and speed mirrored previous research suggesting that effortful feature tracking may be the mechanism.

Eye movement control in reading unspaced text: the case of the Japanese script.

The present study examines the landing-site distributions of the eyes during natural reading of Japanese script: a script that mixes three different writing systems (Kanji, Hiragana, and Katakana) and that misses regular spacing between words. The results show a clear preference of the eyes to land at the beginning rather than the center of the word. In addition, it was found that the eyes land on Kanji characters more frequently than on Hiragana or Katakana characters. Further analysis for two- and three-character words indicated that the eye's landing-site distribution differs depending on type of the characters in the word: the eyes prefer to land at the word beginning only when the initial character of the word is a Kanji character. For pure Hiragana words, the proportion of initial fixations did not differ between character positions. Thus, as already indicated by Kambe (National Institute of Japanese Language Report 85 (1986) 29), the visual distinctiveness of the three Japanese scripts plays a role in guiding eye movements in reading Japanese.

Perception of relation of stimuli locations successively flashed before saccade.

Based on localization error for a single perisaccadic flash, eye position signal is supposed to change more slowly than physical eye position. Nevertheless, a flicker is not perceived as moving in accordance with localization error for a single flash. We carried out two experiments to investigate this problem. Experiment 1 examined how a single flash or a flicker presented before saccade was perceived. The results showed that the flicker was not perceived as moving, although mislocalization for the single flash increases gradually before saccade. Experiment 2 was a vernier test of two stimuli successively flashed before the saccade. The results showed that the point of subjective equality shifted in accordance with the mislocalization for a single perisaccadic flash when the interstimulus interval (ISI) was about 2 s; however, it did not shift when the ISI was 78 ms. Comparison between these results and previous studies suggests that the relation of the locations of successive flashes before saccade is perceived exocentrically when the ISI and stimulus onset asynchrony between flashes was short.

[Effect of concreteness of target words on verbal working memory: an evaluation using Japanese version of reading span test].

Effects of concreteness and representation mode (kanji/hiragana) of target words on working memory during reading was tested using Japanese version of reading span test (RST), developed by Osaka and Osaka (1994). Concreteness and familiarity of target words and difficulty of sentences were carefully controlled. The words with high concreteness resulted in significantly higher RST scores, which suggests the high efficiency of working memory in processing these words. The results suggest that high concrete noun-words associated with visual clues consume less working memory capacity during reading. The effect of representation mode is different between subjects with high-RST and low-RST scores. Characteristic of the high concrete words that may be responsible for the effectiveness of processing are discussed.

Cortical activity related to cue-invariant shape perception in humans.

We used magnetoencephalography to search spatio-temporally for cortical activity related to the perception of shape defined by various visual cues in humans. The visual stimuli were three kinds of two-dimensional figures: two had fixed shapes (Diamond and Cross), the other did not (Noise). These figures were defined by three visual cues: difference of flicker, texture or luminance between the foreground and the background in the random dot pattern. Using this stimulus, we recorded the magnetic responses from the temporo-occipital regions of nine healthy subjects. Additionally, we measured the reaction time for the subjects to detect the figure by button-pressing. A magnetic component was identified in the responses. The properties of the first magnetic component differed for stimulus condition. The peak latency of the first magnetic component was different for the cues (270 ms for flicker, 360 ms for texture and 250 ms for luminance), but not for the figures. In contrast, the peak amplitude of the first magnetic component was different for the figures (96-144 fT for Diamond or Cross and 52-80 fT for Noise), but not for the cues. The signal source of the first magnetic component was estimated to lie on the ventral side of the extrastriate cortex: In the posterior part of the inferior temporal cortex, probably in the fusiform gyrus in four subjects, and in the lateral part of the occipital cortex which was outside of the primary visual cortex (visual area 1) in one subject. The signal source location was different inter-individually, but almost the same within each subject. Reaction time was 471 ms for flicker, 569 ms for texture and 426 ms for luminance, but the interval between the reaction time and the peak latency was constant (about 200 ms) for each cue. The first magnetic component was more clearly recorded from the right hemisphere than from the left.We found that the shape defined by the different visual cues activates the same localized site in the lateral extrastriate cortex. This spatial convergence suggests that there is a restricted locus that processes the visual shape regardless of the difference of the visual cue. The correspondence between the peak latency and the reaction time suggests that the activity of the area is responsible for the perception of visual shape. The inter-hemispheric difference suggests a dominance of the right hemisphere in visual shape processing.

Asymmetry of the human visual field in magnetic response to apparent motion.

Predominance of the lower visual field has been shown in various visual tasks, but whether the upper visual field is involved in a specific neural process is unknown. We used magnetoencephalography to study the effect of orientation and direction on the responses of five subjects to apparent motion from the human extrastriate cortex. The first magnetic response always was the largest, and the peak latency of about 200 ms did not change with the stimulus conditions. Amplitudes of the first responses were highest when motions were oriented at the horizontal meridian, decreasing with the degree of the angle between motion orientation and the horizontal meridian. There was no difference in amplitude between the two directions in the lower visual field, whereas the value of the response to downward motion in the upper visual field was significantly larger than that to upward motion. These amplitude changes are not due to differences in the anatomical distribution of neural activities because the estimated origins for the first responses always were in the same cortical area (around the occipito-parieto-temporal region) and the directions of the current vectors did not change with the stimulus conditions, and the estimated current strength changed with the stimulus conditions as did the response amplitude. These findings suggest that the human extrastriate cortex has a directional preference for downward versus upward motion in the upper visual field.

Optimal viewing position in vertically and horizontally presented Japanese words.

In the present study, the optimal viewing position (OVP) phenomenon in Japanese Hiragana was investigated, with special reference to a comparison between the vertical and the horizontal meridians in the visual field. In the first experiment, word recognition scores were determined while the eyes were fixating predetermined locations in vertically and horizontally displayed words. Similar to what has been reported for Roman scripts, OVP curves, which were asymmetric with respect to the beginning of words, were observed in both conditions. However, this asymmetry was less pronounced for vertically than for horizontally displayed words. In the second experiment, the visibility of individual characters within strings was examined for the vertical and horizontal meridians. As for Roman characters, letter identification scores were better in the right than in the left visual field. However, identification scores did not differ between the upper and the lower sides of fixation along the vertical meridian. The results showed that the model proposed by Nazir, O'Regan, and Jacobs (1991) cannot entirely account for the OVP phenomenon. A model in which visual and lexical factors are combined is proposed instead.

Individual differences in working memory and the peak alpha frequency shift on magnetoencephalography.

The effect of the working memory demands on the peak alpha frequency of the power spectrum of magnetoencephalography (MEG) was investigated. There were one control condition and four listening span test (LST) conditions demanding the use of working memory. The results showed that the peak alpha frequency of the averaged MEG power shifted to the higher frequency region in the LST condition dominantly in the fronto-temporal region. Individual differences in working memory capacities were observed in the shift of peak alpha frequency of MEG.

[A study of association between lean body mass and serum insulin-like growth factor-1 in continuous ambulatory peritoneal dialysis patients].

Malnutrition is one of the major issues associated with high mortality and morbidity in chronic dialysis patients. Several methods to evaluate the nutritional status of these patients have been attempted for example anthropometric measurement and biochemical parameters. Recently, it was reported that insulin-like growth factor-1 (IGF-1) has been valuable for estimating nutritional status. In this study, we measured lean body mass (LBM) by dual energy X-ray absorptiometry (DXA), IGF-1 and other biochemical parameters in 35 patients on CAPD. Two years later, the second measurement of LBM was performed, and we assessed the percent changes of LBM and biochemical parameters. There was negative correlation between the percent changes of LBM and the duration of CAPD. In patients treated with CAPD for less than 36 months (group I) LBM increased, however, it decreased significantly in those treated for more than 36 months (group II). On the other hand, in group I there was a positive correlation between the percent changes of LBM and IGF-1. In group II there was no correlation between the percent changes of LBM and any other biochemical parameters. It could be concluded that IGF-1 is one of the predisposing factors for improving LBM of patients on CAPD for a limited duration.

Circulatory arrest with profound hypothermia during the surgical treatment of large internal carotid artery aneurysm--case report.

A 43-year-old male presented with a cerebral aneurysm manifesting as right facial paresthesia, without neurological deficit. Angiography revealed a large aneurysm (22 mm) of the left internal carotid artery. Intravascular treatment using placement of a detachable coil was attempted, but the coil did not stay in the aneurysmal cavity and the procedure was abandoned. The patient did not tolerate the transient balloon occlusion test of the left internal carotid artery. Therefore, the aneurysm was clipped through an open craniotomy with profound hypothermia (20 degrees C) with cardiac arrest (24 minutes). The aneurysmal dome was collapsed, allowing easy dissection of the posterior communicating artery. The closed chest method was used during the extracorporeal cardiopulmonary bypass. Postoperative angiography revealed complete neck clipping with preservation of carotid blood flow. The patient recovered well and resumed his employment. Circulatory arrest with hypothermia provides several benefits for the surgical treatment of large and giant aneurysms.

Immunohistochemical detection of advanced glycosylation end-products in the peritoneum and its possible pathophysiological role in CAPD.

It has recently been suggested that advanced glycosylation end-products (AGEs) are formed in the peritoneum in patients on CAPD. However, the exact location of AGE accumulation, the relation with the duration of CAPD and its pathophysiological role in CAPD remain unclear. If the peritoneum is glycosylated, it could bring about altered peritoneal function. Therefore, the aim of this study is to clarify the localization of AGEs in the peritoneum in accordance with the duration of CAPD and to examine its relation to the peritoneal permeability. Fifteen non-diabetic patients were divided into three groups (each 5 patients) on the basis of the mean duration (D) of CAPD (Group 1, D = 0 month; Group II, D = 34 months; Group III, D = 84 months). The AGE staining by monoclonal anti-AGE antibody in the peritoneum and the four-hour peritoneal equilibration test (PET) were compared among these groups. AGE was absent or found only weakly in Group I. However, in groups II and III, AGE was moderately or strongly positive especially in the vascular walls and it was dominant in group III. PET revealed that peritoneal permeability for glucose, creatinine, beta2-microglobulin and albumin was increased in Group II as compared to Group I, and it was further increased in Group III. The results of this study indicate that AGEs become dominantly accumulated in the vascular wall in accordance with the prolongation of CAPD treatment, and this might play some roles for the increased permeability of the peritoneal membrane in CAPD.

[Evaluation of nutritional status of patients on continuous ambulatory peritoneal dialysis (CAPD) by dual photon energy X-ray absorptiometry (DEXA)].

Malnutrition is a serious complication in patients on long-term CAPD treatment. Accordingly, quantitative evaluation of nutritional status is a critical issue. This study aimed to assess nutritional status by dual photon energy x-ray absorptiometry (DEXA) in CAPD patients. Total lean body mass (D-TBM), right arm lean mass (D-RAM) and body fat percent (D-% FAT) measured by DEXA were compared with mid-arm muscle circumference (MAMC) and body fat percent (AP-% FAT) measured by anthropometrics (AP) in 51 CAPD patients. The subjects were stratified into groups by gender, age, duration on CAPD, and diabetes mellitus or non-diabetes. There was significant correlation between D-TBM, D-RAM and MAMC (r = 0.519, p = 0.001, r = 0.545, p = 0.001) or D-% FAT and AP-% FAT (r = 0.763, p = 0.0001). However, in the groups of females with over 50 years and over 48 months of dialysis duration, there was no correlation between D-TBM, D-RAM and MAMC. The DEXA method is useful in the quantitative evaluation of nutritional status of dialysis patients serially.

Re-evaluation of local adaptation for motion aftereffect.

A motion aftereffect (MAE) can be induced by stimuli moving in surrounding areas. This suggests the relevance of mechanisms for relative motion, rather than early-level motion detectors, which are considered to work locally. Experiments are reported in which the role of local adaptation in the MAE with a stimulus configuration comprising relative motion has been discussed. Sinusoidal gratings were presented in three rectangular windows: a centre window, and two windows one above and one below the central one. The surrounding top and bottom windows, which were divided into left and right halves, had gratings presented in only one of the two halves. The MAE duration was measured after adaptation to motion either in the central or in the surrounding windows, by controlling the regions with the gratings. From this, the regions of surrounding gratings were found not to have a significant effect with adaptation in the centre window. With adaptation in the surrounds, however, these regions did affect the MAE; the MAE duration was reduced when the adapted region had no gratings in the test phase. Thus, for an MAE it is necessary for the adapted area to be covered with stimuli in the test phase, which indicates the dominance of local adaptation for the MAE even when relative motion is relevant in producing the MAE.