Longitudinal study of risk factors for decreased cross-sectional area of psoas major and paraspinal muscle in 1849 individuals.

This 10-year retrospective observational study investigated longitudinal losses in psoas major and paraspinal muscle area in 1849 healthy individuals (1690 male, 159 female) screened using computed tomography. Logistic regression analysis revealed significant decreases in psoas major and paraspinal muscle area at 10 years relative to the baseline area regardless of age or sex, starting at 30 years of age. Only aging [≥ 50 s (odds ratio [OR]: 1.72; 95% confidence interval [CI] 1.05-2.84; p = 0.03) and ≥ 60 s (OR: 2.67; 95% CI 1.55-4.60; p < 0.001)] was a risk factor for decreases in psoas major area. Age ≥ 60 years (OR: 2.05; 95% CI 1.24-3.39; p = 0.005), body mass index ≥ 25 kg/m2 (OR: 1.32; 95% CI 1.01-1.73; p = 0.04), and visceral fat ≥ 100 cm2 (OR: 1.61; 95% CI 1.20-2.15; p = 0.001) were risk factors for decreases in paraspinal muscle area. Physical activity ≥ 900 kcal/week (OR: 0.68; 95% CI 0.50-0.94; p = 0.02) attenuated paraspinal muscle area loss in male. Our study demonstrated that walking > 45 min daily (Calories = METs (walking: 3.0) × duration of time (h) × weight (60 kg) × 1.05) can reduce paraspinal muscle loss, which may in turn decrease the risk of falls, low-back pain, and sarcopenia.

Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome.

Although posterior reversible encephalopathy syndrome (PRES) is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blood pressure may trigger atypical PRES, and failure to lower blood pressure may lead to a concomitant aneurysm rupture. In the future treatment of hypertensive urgency with a recurrence of symptoms and mean arterial blood pressure >150 mmHg, it is advisable to immediately hospitalize the patient for aggressive blood pressure management, especially if PRES is suspected based on clinical and radiological features.

An unusual variant of the callosomarginal artery from the A1 segment of the anterior cerebral artery.

BACKGROUND: Although the anatomy of the A1 segment of the anterior cerebral artery (ACA) is highly variable, a callosomarginal artery (CMA) arising from the A1 segment of the ACA is rare. CASE DESCRIPTION: A 27-year-old man presented with severe headache and was admitted to our hospital. Initial computed tomography (CT) showed subarachnoid hemorrhage in the basal cistern. Three-dimensional CT angiography revealed a saccular aneurysm arising from the left internal carotid bifurcation and showed an anomalous cortical branch originating from the left A1 segment of the ACA. The anomalous artery was interpreted as a CMA. CONCLUSIONS: Recognizing this variant preoperatively could be helpful in preventing complications of surgery. Careful follow-up studies are necessary in the present case to monitor the development of another aneurysm at the junction between the left CMA and the left A1 segment of the ACA.

An unusual variant of the common trunk of the fronto-orbital and frontopolar arteries associated with a ruptured aneurysm of the A1 segment of the anterior cerebral artery.

BACKGROUND: The common trunk of the fronto-orbital artery (FOA) and frontopolar artery (FPA) arising from the A1 segment of the anterior cerebral artery (ACA) associated with a ruptured aneurysm (AN), is rare. CASE DESCRIPTION: The patient was a 52-year-old man who suffered from subarachnoid hemorrhage. Three-dimensional computed tomography angiography revealed an elongated and tortuous left A1 segment of the ACA and a saccular AN arising from the left A1 segment of the ACA at the origin of the cortical branch, defining its location just on the midline and behind the anterior communicating artery. This vessel had two branches. One branch ran along the inferior surface of the ipsilateral frontal lobe, and the other branch ran anteriorly and medially along the surface of the left hemisphere toward the frontal pole. The anomalous artery was interpreted as a common trunk of the FOA and FPA. Bifrontal craniotomy was performed. The anomalous artery arose from the A1 segment of the ACA at the origin of the AN, and the recurrent artery of Heubner branched off the anomalous artery. The AN was successfully obliterated, clipping with a bayonet-shaped Yasargil titanium clip. Complete AN occlusion and patency of both the A1 and the common trunk of the FOA and FPA, were confirmed intraoperatively by indocyanine green angiography. CONCLUSIONS: Recognizing this variant preoperatively, could be helpful in preventing the complications of surgery.

Aneurysm of the A1 Segment of the Anterior Cerebral Artery Associated with the Persistent Primitive Olfactory Artery.

BACKGROUND: The persistent primitive artery constitutes the anterior cerebral artery proper. When the persistent primitive artery keeps its embryologic course along the olfactory bulb, it is called the persistent primitive olfactory artery (PPOA). CASE DESCRIPTION: A 69-year-old man presented with an incidentally discovered unruptured aneurysm at the origin of the PPOA. The PPOA originated at the A1 segment of the anterior cerebral artery, coursed anteromedially along the olfactory tract, made a hairpin turn posterosuperior to the midline, and formed the callosomarginal branch of the anterior cerebral artery. The anomalous artery was interpreted as a PPOA (type 3). Type 3 PPOA associated with an unruptured aneurysm is rare. CONCLUSIONS: There is a high incidence of aneurysms associated with a PPOA. Follow-up studies are necessary in the present case to monitor for the development of another aneurysm at the hairpin bend.

Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery.

BACKGROUND: Aneurysms arising from the posterior communicating artery (PCoA) itself are rare in which aneurysms usually located in the proximal portion of the PCoA. The authors report a case of the true PCoA ruptured aneurysm in the distal portion of the PCoA. CASE DESCRIPTION: The patient was an 83-year-old man who suffered subarachnoid hemorrhage. Cerebral angiography revealed a saccular aneurysm arising on the fetal type right PCoA itself in the distal portion of the PCoA. 2 days after the onset of symptoms, the patient underwent right interfascial pterional craniotomy, with anterior temporal approach. The aneurysm was successfully clipped with the preservation of both the PCoA and the thalamoperforating artery. CONCLUSION: We speculated that blood flow into the PCoA gradually increased after occlusion of the left vertebral artery, which induced tortuosity of the PCoA. As a result, hemodynamic stress might increase near the curvature and cause aneurysm formation.

Transition of occupational health issues associated with stabilization and decommissioning of the nuclear reactors in the Fukushima Daiichi Nuclear Power Plant through 2013.

OBJECTIVE: To clarify the occupational health (OH) issues that arose, what actions were taken, and the OH performances during the disaster involving the Fukushima Daiichi Nuclear Power Plant and thus improve the OH management system with respect to long-term decommissioning work and preparation for future disasters. METHODS: We used information in advisory reports to the Tokyo Electric Power Company by an OH expert group, observation through support activities, and data officially released by the Tokyo Electric Power Company. RESULTS: Occupational health issues transitioned as work progressed and seasons changed. They were categorized into OH management system establishment, radiation exposure control, heat illness prevention, infectious disease prevention and control, and fitness for workers' duties. CONCLUSIONS: Occupational health management systems involving OH experts should be implemented to manage multiple health risks with several conflicts and trade-offs after a disaster.

Prediction of malignancy grading using computed tomography perfusion imaging in nonenhancing supratentorial gliomas.

Tumor grade differentiation is often difficult using routine neuroimaging alone. Computed tomography perfusion imaging (CTP) provides quantitative information on tumor vasculature that closely parallels the degree of tumor malignancy. This study examined whether CTP is useful for preoperatively predicting the grade of malignancy in glioma showing no enhancement on contrast-enhanced magnetic resonance imaging (MRI). Subjects comprised 17 patients with supratentorial glioma without enhancement on MRI. CTP was performed preoperatively, and absolute values and normalized ratios of parameters were calculated. Postoperatively, subjects were classified into two groups according to histological diagnosis of grade 3 (G3) glioma or grade 2 (G2) glioma. Absolute values and normalized ratios for each parameter were compared between G3 and G2. Accuracies of normalized ratios for cerebral blood flow (nCBF) and cerebral blood volume (nCBV) in predicting a diagnosis of G3 were assessed. In addition, nCBV was compared between diffuse astrocytoma, G2 oligodendroglial tumor (OT), and G3 OT. Values for nCBF and nCBV differed significantly between G3 and G2. Using nCBV of 1.6 as a cutoff, specificity and sensitivity for distinguishing G3 were 83.3% and 90.9%, respectively. No significant difference in nCBV was seen between diffuse astrocytoma and G2 OT, whereas differences were noted between G2 and G3 OTs, and between diffuse astrocytoma and G3 OT. CTP offers a useful method for differentiating between G3 and G2 in nonenhancing gliomas.

Epigenetic status and aberrant expression of the maspin gene in human hepato-biliary tract carcinomas.

We examined expression of maspin and the epigenetic status of its gene in 40 primary hepato-biliary tract carcinomas and 11 cell lines originating from hepato-pancreatico-biliary tract carcinomas. Aberrant maspin expression was frequently observed immunohistochemically in biliary tract carcinomas (22/25, 88%) but not in hepatocellular carcinomas (HCCs) (0/15, 0%). Aberrant maspin expression by five pancreatico-biliary tract carcinoma cell lines was closely associated with demethylation at the maspin promoter. Five of six HCC cell lines were maspin-negative and exhibited extensive hypomethylation and hypoacetylation at the maspin promoter. Treatment with 5-aza-2'-deoxycytidine did not activate maspin expression in these five maspin-negative HCC cell lines, whereas treatment with Trichostatin A (TSA) activated maspin expression in two of them. Treatment with TSA increased histone acetylation in some HCC cell lines. These results suggest that aberrant maspin expression in biliary tract carcinomas is closely associated with demethylation at the promoter region, but that some HCC cell lines additionally require histone acetylation. In addition, the fact that maspin-negative HCC cell lines remain after treatment with TSA suggests the existence of other repressive factors controlling maspin expression.

[A case report of sphenoidal encephalocele presenting with cerebral spinal fluid rhinorrhea].

Sphenoidal encephalocele is a rare congenital anomaly. We report a case of sphenoidal encephalocele presenting with cerebral spinal fluid rhinorrhea. A 53-years-old man suffered recurrent fever and rhinorrhea. Computed tomography demonstrated a low density area extending from the left middle cranial fossa into the left sphenoidal sinus. Bone defect was identified in the medial surface of the left middle cranial fossa. Magnetic resonance imaging with contrast medium demonstrated peripheral enhancement of the lesion. We diagnosed the lesion as sphenoidal encephalocele. Surgical repair and amputation of the encaphalocele was performed. Sphenoidal encaphalocele should be considered as a possible diagnosis for recurrent fever and rhinorrhea.

A phase II study of radiotherapy after hyperbaric oxygenation combined with interferon-beta and nimustine hydrochloride to treat supratentorial malignant gliomas.

Hypoxic cells play a key role in the radioresistance of malignant glioma. Interferon-beta, ACNU as nimustine hydrochloride and radiotherapy (IAR) is a common therapy for malignant glioma in Japan. Since hyperbaric oxygenation (HBO) increases oxygen pressure in glioma tissue, we applied a modified IAR therapy, radiotherapy after HBO combined with interferon-beta and ACNU (HBO/IAR therapy), for supratentorial malignant gliomas. Daily radiation therapy was completed within 15 min after HBO. We assessed HBO/IAR with respect to toxicity, response rates and the time of tumor progression (TTP). We also examined the incidence of responses by some prognostic factors before HBO/IAR, namely, age, Karnofsky performance scale (KPS), histological type, tumor size, tumor site and operation type. Of 39 patients who participated in this study, 35 underwent a complete schedule of HBO/IAR therapy in which toxicity was permissible. Thirty patients (76.9%) either maintained or increased KPS during HBO/IAR with a mean duration of 68 +/- 14 days. The response rates (CR + PR%) for glioblastoma, anaplastic astrocytoma and overall were 50%, 30% and 43%, respectively. The incidence of therapeutic responses among all prognostic factors before HBO/IAR did not significantly differ. Median TTP for patients with glioblastoma, patients with anaplastic astrocytoma, and overall were 38, 56 and 43 weeks, respectively. The present study suggested that HBO/IAR therapy could be applied to especially patients with poor prognostic factors, because of its short treatment period, its permissible toxicity and identical response to patients with good prognostic factors.