Multiple encephalopathy syndrome: a case of a novel radiological subtype of acute encephalopathy in childhood.

INTRODUCTION: This report presents the case of a novel subtype of acute encephalopathy syndrome in childhood found in a patient with influenza type A infection; the patient exhibited evident magnetic resonance imaging (MRI) findings. CASE REPORT: A 4-year-old boy was transferred to our hospital for prolonged (lasting 60 min) status epilepticus with influenza encephalopathy. Mild brain hypothermia therapy was applied for 72 h, followed by targeted temperature management for 96 h with mechanical ventilation in the intensive care unit. Moreover, methylprednisolone pulse therapy and immunoglobulin therapy were administered. One month after the treatment, his physical status recovered such that he was able to run, take food orally, communicate verbally, and successfully return to kindergarten. Interestingly, serial MRI studies revealed findings that were compatible with 1) acute necrotizing encephalopathy (ANE), 2) mild encephalitis/encephalopathy with a reversible splenial lesion (MERS type II), 3) acute cerebellitis, and 4) acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) on days 2, 4, 7, and 16, respectively. CONCLUSIONS: To the best of our knowledge, these significant MRI findings associated with acute encephalopathy have never been reported. Thus, herein, we propose the new term radiological "multiple encephalopathy syndrome (MES)" based on our case of acute encephalopathy in childhood.

What is the origin of macroscopic friction?

What is the origin of molecular friction, and how can macroscopic friction be explained in terms of molecular friction? To elucidate the origins of molecular and macroscopic friction, we conducted density functional theory calculations and double-direct shear tests at normal stresses ranging from 5 to 60 MPa for mica surfaces. Frictional forces between mica surfaces were theoretically predicted to oscillate periodically every 30° of sliding direction, in agreement with previous experimental findings. This result affirms that the potential energy roughness of mica under sliding is the origin of molecular friction, which depends on the normal stress and sliding direction. The discovered mechanism of molecular friction can quantitatively explain experimentally observed macroscopic friction of mica when the presence of wear particles is taken into consideration.

Lymphatic tract reconstruction using a pedicled deep inferior epigastric perforator flap.

We encountered a case in which we used a pedicled deep inferior epigastric perforator(DIEP) flap to repair a lymphatic leak. This case shows that such repairs can lead to the reconstruction of the lymphatic tract and prevent lymphatic leak recurrences. The present report describes a 45-year-old woman with ovarian cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy, and omentectomy. She presented with a pelvic lymphocele with lower-extremity swelling. Lymphovenous anastomosis was performed and swelling of the lower extremity abated. However, because of the occurrence of deep vein thrombosis and the recurrence of swelling, we used a 6-cm-long and 14-cm-wideDIEP flap after lymphocele fenestration. The flap was de-epithelialized and fixed into the peritoneum, with the cutis side facing the leakage point. The postoperative course was uneventful, and no recurrence was observed. We obtained good results by providing abundant blood flow to abundant lymph tissue at the fenestration point. It is known that lymphatic vessels can spontaneously connect with each other. We hypothesize that the DIEP flap improved the edema in this case by regenerating the lymphatic network and improving flow into the bridging flap.

Percutaneous drainage of pancreatic fistula following pancreatectomy with CT-fluoroscopic guidance.

PURPOSE: To evaluate the clinical utility of percutaneous drainage of pancreatic fistula following pancreatectomy with real-time CT-fluoroscopic guidance. MATERIAL AND METHODS: During January 2007 through March 2013, of 295 patients who underwent pancreatectomy, 20 patients received percutaneous drainage of pancreatic fistula with real-time CT-fluoroscopic guidance. The mean diameter of pancreatic fluid collections was 8.1±2.7 (SD)cm (range: 3.5-15.0cm). Feasibility, safety, and clinical success were evaluated. Primary and secondary clinical successes were defined respectively as the resolution of pancreatic fistula by initial drainage alone, and after additional intervention. Factors affecting primary clinical success and the drainage period were also evaluated. RESULTS: Drainage catheters were placed in planned sites in all patients. No major complication occurred except in 1/20 patient (5%) who experienced endotoxin shock. Primary and secondary clinical success rates were, respectively, 50% (10/20) and 90% (18/20). An amylase level greater than 30,000IU/L in the fluid collection was a significant factor lowering the primary clinical success rate (P<0.02) and prolonging the drainage period (>30 days) (P<0.02). CONCLUSION: Real-time CT-fluoroscopic guided drainage is a feasible, safe, and useful therapeutic option for the management of pancreatic fistula after pancreatectomy. The fluid amylase level is a useful indicator to predict refractory pancreatic fistula.

Modelling how incorporation of divalent cations affects calcite wettability-implications for biomineralisation and oil recovery.

Using density functional theory and geochemical speciation modelling, we predicted how solid-fluid interfacial energy is changed, when divalent cations substitute into a calcite surface. The effect on wettability can be dramatic. Trace metal uptake can impact organic compound adsorption, with effects for example, on the ability of organisms to control crystal growth and our ability to predict the wettability of pore surfaces. Wettability influences how easily an organic phase can be removed from a surface, either organic compounds from contaminated soil or crude oil from a reservoir. In our simulations, transition metals substituted exothermically into calcite and more favourably into sites at the surface than in the bulk, meaning that surface properties are more strongly affected than results from bulk experiments imply. As a result of divalent cation substitution, calcite-fluid interfacial energy is significantly altered, enough to change macroscopic contact angle by tens of degrees. Substitution of Sr, Ba and Pb makes surfaces more hydrophobic. With substitution of Mg and the transition metals, calcite becomes more hydrophilic, weakening organic compound adsorption. For biomineralisation, this provides a switch for turning on and off the activity of organic crystal growth inhibitors, thereby controlling the shape of the associated mineral phase.

Associations between abdominal visceral fat and surrogate measures of obesity in Japanese men with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: There are ethnic differences in the distribution of abdominal obesity associated with metabolic disorders. In Japan, the appropriate reference values for abdominal obesity have not been established in individuals with spinal cord injury (SCI), although there are a number of studies in Western countries. This study evaluates the associations between visceral fat area (VFA), waist circumference (WC) and body mass index (BMI), to examine cutoffs and estimate the error for WC and BMI equivalent to 100 cm(2) VFA in Japanese men with SCI. SETTING: National Rehabilitation Center for Persons with Disabilities, Japan. METHODS: Seventy-four men (aged 45.6 (s.d. 14.3) years) participated in the study. VFA was quantified using computed tomography at the level of the umbilicus, and associations were determined using nonlinear regression analysis. The error of the estimates from the regression equation was assessed using a Bland-Altman plot. RESULTS: The mean VFA was 101.2 (s.d. 53.0) cm(2) and 32 subjects had a VFA ⩾100 cm(2). The cutoffs for a VFA of 100 cm(2) were WC, 81.3 cm and BMI, 22.5 kg m(-2). The relationship between the estimated and actual values showed that the error increased as VFA increased, which resulted in a negative proportional bias. CONCLUSION: The suggested cutoff for Japanese men with SCI is a VFA of 100 cm(2), which is lower than that in the healthy able-bodied population for both WC and BMI. Further investigation is needed to determine the reference value for estimating SCI-specific VF accumulation.

Comprehensive data on ionising radiation from Fukushima Daiichi nuclear power plant in the town of Miharu, Fukushima Prefecture: The Misho Project.

Data related to radioactivity released from the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident on 15 March 2011 gathered by residents of Miharu, Fukushima Prefecture, and by Tohoku University are presented. These data sets consist of (1) the earliest radiation monitoring by a Geiger counter in the town, (2) ratios of radioactivity between (132)Te and (137)Cs for a wide area between Fukushima and Tokyo, (3) radiation measurement of soil samples collected from 18 school grounds, and (4) external radiation exposure of 1400 students using OSL badges. By combining and analysing these various data sets, a curve for the cumulative total external exposure as a function of time, with 16 : 00 h on 15 March 2011 being time zero, is obtained. The average cumulative external dosage is estimated to be 10 mSv (σ = 4.2 mSv) over 10 years. In addition, the initiative that the residents of Miharu took in response to the FDNPP accident, which became known as The Misho Project (MP), is documented; in particular, the time at which the municipality instructed the immediate ingestion of iodine tablets by those under the age of 40, 13 : 00 h on 15 March 2011, is assessed.

Strontium, nickel, cadmium, and lead substitution into calcite, studied by density functional theory.

We have used density functional theory to predict the ion exchange energies for divalent cations Ni(2+), Sr(2+), Cd(2+), and Pb(2+) into a calcite {10.4} surface in equilibrium with water. Exchange energies were calculated for substitution into the topmost surface layer, at the mineral-fluid interface, and into the second layer of the solid. This information can be used as an indicator for cation substitution in the bulk phase, such as for the uptake of toxic metals from the environment and the growth of secondary phases. In both the surface and in the second layer, Ni(2+), Cd(2+), and Pb(2+) substitute exothermically and Sr(2+) substitutes endothermically. Our results agree with published experimental data that demonstrate trace metal coprecipitation with calcite as a sink for Ni(2+), Cd(2+), and Pb(2+), whereas Sr(2+) has a distribution constant significantly smaller than 1. Ni(2+) substitution is favored at the mineral-fluid interface compared with bulk substitution, which also agrees with experimental data. Our results predict that Ni(2+), Cd(2+), and Pb(2+) form a stable solid solution with calcite. Successful prediction of the experimental results gives us confidence in our ability to predict the divalent cation preference for surfaces rather than for sites within the bulk crystal structure, which cannot be directly derived from experiment.

Risk of surgical glove perforation in oral and maxillofacial surgery.

Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects.

Changes in beef sensory traits as somatic-cell-cloned Japanese black steers increased in age from 20 to 30 months.

Changes in sensory traits of longissimus muscle (LM) from 20-30-month-old cattle were investigated using somatic cell clones of Japanese black steers slaughtered at 20-, 25- and 30-months-old (n=3, 4 and 4 respectively). The fat content of LM samples at 20, 25 and 30 months were 23.7, 38.7 and 41.1%, respectively. Soluble collagen content and collagen solubility at 20 months was greater than at 25 and 30 months. In terms of sensory traits, initial tenderness and juiciness at 25 months was greater than at 20 months, and fattiness at 25 and 30 months was greater than at 20 months. These results demonstrate that the changes in physicochemical traits of beef accompanying the differences in slaughter age affect the sensory traits although the desirable effects of the sensory traits do not continue throughout the entire fattening period.

Chlamydophila pneumoniae Infection Induced Nodular Vasculitis.

We present the case history of a 48-year-old male patient with Chlamydophila (Chlamydia) pneumoniae who developed a nodular vasculitis. He developed a cutaneous vasculitis with the onset of respiratory symptoms. The diagnosis of Chlamydophila pneumoniae infection was based on serology. Since this infection is very common in our population, although often asymptomatic, it should be systematically considered as a causative agent of nodular vasculitis.

Analysis of VH gene rearrangement and somatic hypermutation in Sjogren's syndrome and IgG4-related sclerosing sialadenitis.

IgG4-related sclerosing sialadenitis is currently considered as an autoimmune disease distinct from Sjogren's syndrome (SS) and responds extremely well to steroid therapy. To further elucidate the characteristics of IgG4-related sclerosing sialadenitis, we analysed VH fragments of IgH genes and their somatic hypermutation in SS (n = 3) and IgG4-related sclerosing sialadenitis (n = 3), using sialolithiasis (n = 3) as a non-autoimmune control. DNA was extracted from the affected inflammatory lesions. After PCR amplification of rearranged IgH genes, at least 50 clones per case (more than 500 clones in total) were sequenced for VH fragments. Monoclonal IgH rearrangement was not detected in any cases examined. When compared with sialolithiasis, there was no VH family or VH fragment specific to SS or IgG4-related sclerosing sialadenitis. However, rates of unmutated VH fragments in SS (30%) and IgG4-related sclerosing sialadenitis (39%) were higher than that in sialolithiasis (14%) with statistical significance (P = 0.0005 and P < 0.0001, respectively). This finding suggests that some autoantibodies encoded by germline or less mutated VH genes may fail to be eliminated and could play a role in the development of SS and IgG4-related sclerosing sialadenitis.

Analysis of reoperations and their impact on the results of pancreas transplantation.

BACKGROUND: Many factors, including the advances in surgical techniques and immunosuppression, have been brought significant improvement to graft and patient survivals of patients undergoing pancreatic transplantations. However, one third of these patients require reoperations (ReOps). PURPOSE: We sought to evaluate the distribution of ReOps in the early or late postoperative period and analyze their impact on patient and graft survivals. PATIENTS AND METHODS: This unicenter, retrospective study was performed using data from 182 patient charts after pancreas transplantation from January 2000 through December 2007. RESULTS: We performed 88 ReOps on 73 patients; 43 early and 41 late operations. The simultaneous pancreas-kidney transplantation group showed a greater incidence of premature ReOps. The group undergoing early ReOp showed a lower survival rate (87.2%) compared with the nonoperated group, but a similar survival rate (97.5%) to the late ReOp group. In relation to the survival of pancreatic grafts after 1 year, the early ReOp group showed inferior survival to the late ReOp group, both of which were significantly worse results then those of the group without ReOp. CONCLUSION: ReOps were related to the success of the procedure. When they were performed in the first 3 months they had a negative impact on patient and graft survival.

Acute encephalitis with refractory, repetitive partial seizures (AERRPS): a peculiar form of childhood encephalitis.

OBJECTIVE: We conducted a nationwide multicenter study in Japan to elucidate the clinical and laboratory characteristics of acute encephalitis with refractory, repetitive partial seizures (AERRPS). MATERIALS AND METHODS: Clinical and laboratory features, treatment, and outcome were assessed using a structured questionnaire. RESULTS: Twenty-nine children were enrolled in the study. Refractory and repetitive partial seizures accompanied by fever were the cardinal clinical features. Partial seizures consisted principally of eye deviation or facial twitching, being periodically repeated during the acute phase. These seizures were refractory to conventional anticonvulsants and were only suppressed by high-dose intravenous barbiturate administration. Rhythmic activities on electroencephalography and non-specific cerebral atrophy on neuroimaging were common. Serum or cerebrospinal antibodies against GluRepsilon2 were positive in six patients. General prognosis was unfavorable due to intractable epilepsy and cognitive deficits. CONCLUSION: Based on the peculiar and homogenous features, AERRPS can be regarded as a distinct clinical entity.

Study on the performance of anaerobic ammonium oxidation treatment using PVA gel as a carrier.

A continuous experiment was carried out to study the performance of anaerobic ammonium oxidation (anammox), a novel and low cost nitrogen removal treatment process with an energy-saving characteristic. A complete mixing reactor was used with polyvinyl alcohol (PVA) gel as the carrier. In particular, performances of nitrogen removal and attachment characteristics of anammox bacteria on the PVA carrier surface were investigated. The results indicted that high concentration of anammox bacteria, up to 27,000 mg/L-carrier, had attached on the PVA carrier surface. A high nitrogen removal rate of up to 5.5 kg/m(3)-reactor/d was obtained during this continuous experiment. Furthermore, it was also confirmed that there was no generation of N(2)O gas in the anammox reaction.

Apparent diffusion coefficient of pituitary macroadenoma evaluated with line-scan diffusion-weighted imaging.

OBJECTIVE: The goal of this study was to evaluate the consistency of pituitary macroadenoma using apparent diffusion coefficient (ADC) with line-scan diffusion-weighted imaging (LSDWI). METHODS: Patients with pituitary macroadenoma (n=19) were studied prospectively. The LSDWI was performed using a maximum b factor of 1000 s/mm2. The consistency of macroadenoma was rated as soft, intermediate or hard at transsphenoidal surgery. The ADC values of tumors were compared with the tumor-consistency ratings. RESULTS: A soft consistency was found at surgery in 13 patients (mean ADC: 0.84+/-0.1x10(-3) mm2/s); an intermediate consistency was observed in six patients (mean ADC: 0.81+/-0.16x10(-3) mm2/s). No tumors of hard consistency were found. There was no significant difference in ADC values between tumors of soft consistency compared with tumors of intermediate consistency (P=0.37). CONCLUSIONS: A relationship between tumor consistency and the ADCs of soft and intermediate macroadenomas was not shown in this study using LSDWI.

Intramuscular fat deposition in principal muscles from twenty-four to thirty months of age using identical twins of Japanese Black steers.

The changes in i.m. fat deposition in the principal muscles [M. semitendinosus, M. semimembranosus, M. psoas major, M. latissimus dorsi, LM (7th to 8th and 10th to 11th thoracic vertebrae), and M. supraspinatus] from 24 to 30 mo of age were investigated using identical twins of Japanese Black steers. Four sets of identical twins of Japanese Black steers were used in this study. Animals were fattened from 10 to 24 or 30 mo of age for each pair of identical twins. Body weights of twin steers slaughtered at 24 and at 30 mo of age were similar at 10 mo of age and thereafter up to 24 mo of age. The changes in serum concentration of vitamin A, glucose, total cholesterol, albumin, and total protein were similar in each pair of twins during the first fattening stage (10 to 24 mo). Fat contents of LM (7th to 8th thoracic vertebrae) at 24 and 30 mo of age were 37.0 and 42.4%, respectively (P < 0.05). Moreover, in the principal muscles, except M. semimembranosus and M. supraspinatus, fat content at 30 mo of age was greater than at 24 mo of age (P < 0.05). The proportional increase in fat content from 24 to 30 mo of age was greatest in M. semitendinosus (+58.7%) and least in M. supraspinatus (+6.1%). These results demonstrate that i.m. fat continues to increase after 24 mo of age, and the rates of i.m. fat deposition and the ages when i.m. fat is deposited are different for every muscle.