Thoracic endovascular aortic repair for hemolysis 17 years after insertion of classical elephant trunk: a case report.

BACKGROUND: The classical elephant trunk (ET) technique is a very useful surgical procedure; however, haemolysis in the aorta associated with ET has been previously reported. It normally occurs within several years after the surgery, and it is a rare case of rapidly progressing haemolysis 10 or more years after aortic arch replacement with ET. CASE PRESENTATION: A 53-year-old man with a history of Stanford type A aortic dissection (DeBakey type Is), who was treated with total arch aortic replacement and aorto-femoral bypass using a prosthetic graft 17 years ago, developed severe progressive haemolytic anaemia. The ET used for the initial surgery was narrowed, and mechanical haemolysis was suspected. We assumed that progressive mechanical haemolysis occurred because of degeneration of the prosthetic graft. Thoracic endovascular aortic repair was performed, and haemolysis and anaemia were mitigated postoperatively. CONCLUSIONS: Haemolysis occurred 17 years after the initial surgery with ET. When haemolysis is suspected in a patient with ET, it must be identified as a cause of haemolysis even if 10 years or more have passed since the ET was inserted. To prevent this complication, attention should be paid to an appropriate ET length and diameter to avoid folding of the ET, particularly when the true cavity diameter is small.

Tactile information affects alternating visual percepts during binocular rivalry using naturalistic objects.

INTRODUCTION: Past studies have provided evidence that the effects of tactile stimulation on binocular rivalry are mediated by primitive features (orientation and spatial frequency) common in vision and touch. In this study, we examined whether such effects on binocular rivalry can be obtained through the roughness of naturalistic objects. In three experiments, the total dominant time of visual percepts of two objects was measured under binocular rivalry when participants touched one of the objects. RESULT: In Experiment 1, the total dominant time for the image of artificial turf and bathmat was prolonged by congruent tactile stimulation and shortened by incongruent tactile stimulation. In Experiment 2, we used the same stimuli but rotated their visual images in opposite directions. The dominant time for either image was prolonged by congruent tactile stimulation. In Experiment 3, we used different types of stimuli, smooth marble and rough fabric, and noted significant effects of the congruent and incongruent tactile stimulation on the dominant time of visual percepts. CONCLUSION: These three experiments demonstrated that visuo-tactile interaction on binocular rivalry can be mediated by roughness.

Multi-modal imaging of the auditory-larynx motor network for voicing perception.

Voicing is one of the most important characteristics of phonetic speech sounds. Despite its importance, voicing perception mechanisms remain largely unknown. To explore auditory-motor networks associated with voicing perception, we firstly examined the brain regions that showed common activities for voicing production and perception using functional magnetic resonance imaging. Results indicated that the auditory and speech motor areas were activated with the operculum parietale 4 (OP4) during both voicing production and perception. Secondly, we used a magnetoencephalography and examined the dynamical functional connectivity of the auditory-motor networks during a perceptual categorization task of /da/-/ta/ continuum stimuli varying in voice onset time (VOT) from 0 to 40 ms in 10 ms steps. Significant functional connectivities from the auditory cortical regions to the larynx motor area via OP4 were observed only when perceiving the stimulus with VOT 30 ms. In addition, regional activity analysis showed that the neural representation of VOT in the auditory cortical regions was mostly correlated with categorical perception of voicing but did not reflect the perception of stimulus with VOT 30 ms. We suggest that the larynx motor area, which is considered to play a crucial role in voicing production, contributes to categorical perception of voicing by complementing the temporal processing in the auditory cortical regions.

Successful management of aortoesophageal fistula caused by esophageal cancer using thoracic endovascular aortic repair.

Aortoesophageal fistula (AEF) is a highly life-threatening condition, even when treated promptly. However, little is known about the treatment for AEF in patients with advanced esophageal cancer. We report the case of a 69-year-old man diagnosed with esophageal squamous cell carcinoma (ESCC) that was admitted to our hospital for ESCC treatment. On diagnosis of unresectable ESCC invading the thoracic aorta, chemotherapy was administered. The response to treatment after two courses was evaluated as stable disease. We performed radiation therapy followed by bypass operation for esophageal stenosis. After radiation therapy, AEF was detected. His condition improved after hemostasis using thoracic endovascular aortic repair (TEVAR). He was discharged from our care after treatment with antibiotics; he died due to cancer progression 7 months after TEVAR. AEF with ESCC is a lethal condition that may occur during cancer treatment; however, TEVAR might help improve the patient's condition.

Intraoperative Transesophageal Echocardiography for Coronary Artery Assessment.

Background: In surgical aortic valve replacement (SAVR), coronary arteries are routinely assessed by transesophageal echocardiography (TEE) to prevent undesirable complications. This study evaluated the capabilities and pitfalls of TEE assessment. Methods and Results: Of 147 consecutive SAVR patients undergoing aortic stenosis, the TEE records for 130 patients, in which the procedures were conducted by a single examiner, were analyzed retrospectively regarding data acquisition and the accuracy of detecting an anomalous origin, high or low takeoff, ostial diameter, and short left main truncus (LMT). The left and right coronary arteries could be visualized in every patient. A left coronary ostium >5 mm was found in 33 patients (25.4%). TEE revealed an anomalous origin in 2 patients (1.5%) that had not been diagnosed, but missed it in another patient. High takeoff was noted in 11 patients (8.3%), often associated with aortic disease necessitating aortic repair. In one such patient, occlusion of the right coronary artery was detected, necessitating coronary revascularization. Short LMT was found in 15 patients (11.8%) but misdiagnosed due to artifact in 1. During selective cardioplegia, malperfusion of the left anterior descending artery due to deep cannula placement was detected. Conclusions: TEE provides fairly accurate assessment in SAVR, including detection of undiagnosed pathologies or pitfalls related to coronary arteries, although misdiagnosis due to artifacts should be kept in mind.

Precision of voicing perceptual identification is altered in association with voice-onset time production changes.

There is ample evidence that motor learning changes the function of perceptual systems. Previous studies examining the interactions between speech production and perception have shown that the discrimination of phonetic contrasts characterized by the difference in articulatory place features is altered following their production changes caused by the perturbation of auditory feedback. The present study focused on a voiced-voiceless contrast in stop consonants, which is characterized by a temporal articulatory parameter, voice-onset time (VOT). In the experiment, we manipulated the participants' motor functions concerning VOT using a cross-categorical auditory feedback (CAF) paradigm (Mitsuya et al. in J Acoust Soc Am 135:2986-2994, 2014), in which a pre-recorded syllable sound starting with a voiced stop consonant (/da/) was fed back simultaneously with the participant's utterance of a voiceless stop consonant (/ta/), and vice versa. The VOT difference between /da/ and /ta/ productions was increased by the CAF, which is consistent with the result of Mitsuya's study. In addition, we conducted perceptual identification tasks of /da/-/ta/ continuum stimuli varying in VOT before and after the CAF task, and found that the identification function became sharper after as compared to before the CAF task. A significant positive correlation between such production and perception changes was also found. On the basis of these results, we consider that the change in motor function concerning VOT affected voiced-voiceless perceptual processing. The present study is the first to show the involvement of the speech production system in the perception of phonetic contrasts characterized by articulatory temporal features.

Effects of Manipulating the Amplitude of Consonant Noise Portion on Subcortical Representation of Voice Onset Time and Voicing Perception in Stop Consonants.

Purpose The purpose of this study was to investigate whether speech perception would reflect small latency changes in subcortical speech representation. Method Twelve native Japanese listeners participated in the experiment. Those listeners participated in speech identification task and auditory brainstem response (ABR) measurement using /d/-/t/ continuum stimuli varying in voice onset time (VOT) with manipulation of the amplitude of initial noise (consonant) portion, the duration of which corresponded to VOT. Results Increasing the noise portion amplitude lengthened subcortical representation of VOT, which is the latency difference between ABRs synchronizing to the onsets of initial noise and following periodic (vowel) portions (VOTABR) and made listeners likely to perceive the stimuli with ambiguous VOT as a voiceless stop /t/. In addition, the amount of VOTABR lengthening was close to that of the VOT boundary shortening. Conclusion A few milliseconds of difference in subcortical speech representation are important for the perception of speech sounds with ambiguous acoustic cues. Supplemental Material https://doi.org/10.23641/asha.7728695.

A Case of Thoracic Endovascular Aortic Repair Using Carotid Access with Axillary-Carotid Bypass for Descending Aortic Aneurysm in a Patient with Aortoiliac Occlusive Disease.

The authors report a 71-year-old male with descending thoracic aortic aneurysm and multiple risk factors (aortoiliac occlusive disease, obesity, ascending aorta dilatation, and history of left ventriculoperitoneal shunt for hydrocephalus) who was treated with thoracic endovascular aortic repair (TEVAR) via left common carotid artery (LCCA) access and left axillary-carotid artery (Ax-CA) bypass; this approach shortened the LCCA clamp time during the procedure. The patient was discharged without any complications. TEVAR via LCCA access with left Ax-CA bypass is a useful and safe procedure for patients in whom conventional femoral artery access is not feasible.

Auditory gap detection: psychometric functions and insights into the underlying neural activity.

The detection of a silent interval or gap provides important insight into temporal processing by the auditory system. Previous research has uncovered a multitude of empirical findings leaving the mechanism of gap detection poorly understood and key issues unresolved. Here, we expand the findings by measuring psychometric functions for a number of conditions including both across-frequency and across-intensity gap detection as a first study of its kind. A model is presented which not only accounts for our findings in a quantitative manner, but also helps frame the body of work on auditory gap research. The model is based on the peripheral response and postulates that the identification of gap requires the detection of activity associated with silence.

Psychophysical Boundary for Categorization of Voiced-Voiceless Stop Consonants in Native Japanese Speakers.

Purpose: The purpose of this study was to investigate the psychophysical boundary used for categorization of voiced-voiceless stop consonants in native Japanese speakers. Method: Twelve native Japanese speakers participated in the experiment. The stimuli were synthetic stop consonant-vowel stimuli varying in voice onset time (VOT) with manipulation of the amplitude of the initial noise portion and the first formant (F1) frequency of the periodic portion. There were 3 tasks, namely, speech identification to either /d/ or /t/, detection of the noise portion, and simultaneity judgment of onsets of the noise and periodic portions. Results: The VOT boundaries of /d/-/t/ were close to the shortest VOT values that allowed for detection of the noise portion but not to those for perceived nonsimultaneity of the noise and periodic portions. The slopes of noise detection functions along VOT were as sharp as those of voiced-voiceless identification functions. In addition, the effects of manipulating the amplitude of the noise portion and the F1 frequency of the periodic portion on the detection of the noise portion were similar to those on voiced-voiceless identification. Conclusion: The psychophysical boundary of perception of the initial noise portion masked by the following periodic portion may be used for voiced-voiceless categorization by Japanese speakers.

Advantages of Transesophageal Echocardiography during Stent Grafting for Aortic Dissection: A Report of Three Cases.

We report the cases of three patients who underwent thoracic endovascular aortic repair for type B aortic dissection in which transesophageal echocardiography (TEE) was used to guide the procedure in addition to fluoroscopy. TEE was found to be advantageous because it can visualize vascular structures along with the guidewire and devices. Furthermore, it provides real-time hemodynamic and hematological information without the need for contrast injection or radiation exposure. Although TEE assessment requires expertise, the efficient use of TEE appears to be helpful for further improving the outcomes of endovascular surgery for aortic dissection.

[Ascending Aortic Thrombus Recognized by Acute Brachial Arterial Occlusion].

We report a case of ascending aortic thrombus with acute arterial occlusion of the brachial artery. A 49-year-old woman had sudden pain in her right arm due to acute occlusion of the right brachial artery. Contrast-enhanced computed tomography and echocardiography revealed a large mobile thrombus in the ascending aorta, which prompted surgical intervention. The thrombi were removed via aortotomy under circulatory arrest. Trans-esophageal echocardiography was useful for watching a potential detachment of the thrombus in the aorta during surgical manipulations or systemic perfusion. Despite no evidence of either inherited or acquired thrombotic predisposition, thrombosis in the right atrium and deep veins of the lower extremities was found postoperatively. Since antiplatelet and anticoagulant therapy was started, she has suffered from no thrombotic event.

Avoidance of Coronary Sinus Injury During Retrograde Cardioplegia.

Coronary sinus injury is a rare but critical complication of retrograde cardioplegia. Even after detection, successful repair with a pericardial patch is not always attained. Malalignment of the infusion cannula relative to the coronary sinus is likely to be partially responsible for the injury. Monitoring the location of the cannula tip can help prevent injury. Transesophageal echocardiography can indicate the vascular structure within which the cannula is located. This finding may be useful in preventing injury to the coronary sinus or middle cardiac vein.

Between-Frequency and Between-Ear Gap Detections and Their Relation to Perception of Stop Consonants.

OBJECTIVES: The objective of this study was to examine the hypothesis that between-channel gap detection, which includes between-frequency and between-ear gap detection, and perception of stop consonants, which is mediated by the length of voice-onset time (VOT), share common mechanisms, namely relative-timing operation in monitoring separate perceptual channels. DESIGN: The authors measured gap detection thresholds and identification functions of /ba/ and /pa/ along VOT in 49 native young adult Japanese listeners. There were three gap detection tasks. In the between-frequency task, the leading and trailing markers differed in terms of center frequency (Fc). The leading marker was a broadband noise of 10 to 20,000 Hz. The trailing marker was a 0.5-octave band-passed noise of 1000-, 2000-, 4000-, or 8000-Hz Fc. In the between-ear task, the two markers were spectrally identical but presented to separate ears. In the within-frequency task, the two spectrally identical markers were presented to the same ear. The /ba/-/pa/ identification functions were obtained in a task in which the listeners were presented synthesized speech stimuli of varying VOTs from 10 to 46 msec and asked to identify them as /ba/ or /pa/. RESULTS: The between-ear gap thresholds were significantly positively correlated with the between-frequency gap thresholds (except those obtained with the trailing marker of 4000-Hz Fc). The between-ear gap thresholds were not significantly correlated with the within-frequency gap thresholds, which were significantly correlated with all the between-frequency gap thresholds. The VOT boundaries and slopes of /ba/-/pa/ identification functions were not significantly correlated with any of these gap thresholds. CONCLUSIONS: There was a close relation between the between-ear and between-frequency gap detection, supporting the view that these two types of gap detection share common mechanisms of between-channel gap detection. However, there was no evidence for a relation between the perception of stop consonants and the between-frequency/ear gap detection in native Japanese speakers.

[Effects of advance visual cue utilization on anticipation of ball direction].

We examined skill-based differences in the anticipation of ball direction during the catching of a grounder in baseball. In Experiment 1, we used film stimuli which included a sequence of pitching and hitting action from the shortstop's customary perspective, and participants judged the ball's direction (left or right). Also, we used white-circle stimuli, and participants reported whether the circle was displaced to the left or to the right. Baseball players responded faster than non-players in the film task, but there was no significant difference between the two groups in the white-circle task. In Experiment 2, we used film stimuli which were cut off at four different temporal occlusion periods to examine the time of extraction of important visual cues. Accuracy exceeded the chance level prior to the bat-ball contact in both groups, but was earlier for players than for non-players. Our results suggest that players may extract anticipatory visual cues more effectively and earlier than non-players.

[A case of pulmonary tuberculosis complicated with severe thrombocytopenia during treatment].

A 58-year-old man was hospitalized with dyspnea. His sputum tested positive for acid-fast bacilli, and PCR analysis revealed Mycobacterium tuberculosis. After the initiation of treatment with isoniazid, rifampicin, ethambutol, and pyrazinamide, the patient developed severe thrombocytopenia. The thrombocytopenia persisted even after the discontinuation of all antituberculosis drugs, and hence, the patient was given blood transfusion. Later, it was found that the patient's platelet-associated IgG level was high, and bone marrow aspiration revealed the presence of megakaryocytes with lesser degree of platelet adhesion. Considering that the patient's thrombocytopenia was induced by an immunological mechanism, he was administered prednisolone; this resulted in the resolution of thrombocytopenia. The patient successfully completed the tuberculosis treatment. Clinicians should remember that antituberculosis drugs may induce autoimmune thrombocytopenia, and if they experience such a case, they should report it to share information, including the names of possible offending drugs.

Dissociable neural activations of conscious visibility and attention.

Recent neuroimaging evidence indicates that visual consciousness of objects is reflected by the activation in the lateral occipital cortex as well as in the frontal and parietal cortex. However, most previous studies used behavioral paradigms in which attention raised or enhanced visual consciousness (visibility or recognition performance). This co-occurrence made it difficult to reveal whether an observed cortical activation is related to visual consciousness or attention. The present fMRI study investigated the dissociability of neural activations underlying these two cognitive phenomena. Toward this aim, we used a visual backward masking paradigm in which directing attention could either enhance or reduce the object visibility. The participants' task was to report the level of subjective visibility for a briefly presented target object. The target was presented in the center with four flankers, which was followed by the same number of masks. Behavioral results showed that attention to the flankers enhanced the target visibility, whereas attention to the masks attenuated it. The fMRI results showed that the occipito-temporal sulcus increased activation in the attend flankers condition compared with the attend masks condition, and occipito-temporal sulcus activation levels positively correlated with the target visibility in both attentional conditions. On the other hand, the inferior frontal gyrus and the intraparietal sulcus increased activation in both the attend flankers and attend masks compared with an attend neither condition, and these activation levels were independent of target visibility. Taken together, present results showed a clear dissociation in neural activities between conscious visibility and attention.

[Evaluation of TB-beads assay utilizing the technique of magnetic beads--an innovative assay method for detection of acid fast bacilli].

The centrifuge method with the use of Semi-Alkalin Proteinase (SAP) and NALC-NaOH, recommended by the "2007 edition of the assay guideline for detection of Mycobacterium tuberculosis," has significantly contributed to improving the sensitivities and specificities of both smear and culture tests for detection of acid fast bacilli (AFB). However, this method poses some challenges in terms of its cumbersome and time-consuming assay protocol. "TB-beads (Kyokuto Pharmaceutical Industrial Co., Ltd.)" is a newly-developed method for detection of AFB utilizing magnetic beads. We evaluated the quality of this method in comparison with the centrifuge method, focusing on the results of smear and culture tests. This evaluation study was conducted using both 5 positive and 5 negative sputum samples. The sensitivity of TB-beads for fluorescent smear tests, conducted using "Acri-stain," was almost the same as that of the centrifuge method. One advantage of TB-beads, however, was that it was very convenient to practice microscopic observation due to the clear background of the smeared glass slides. The comparison of the contamination rates between the two methods showed that TB-beads suggested significantly lower contamination rates. The centrifuge method resulted in 50% and 60% of contamination rates for HK Semisolid Isolation Medium and BacT/ALERT MP, respectively. On the other hand, the contamination rates of TB-beads for both of the culture methods were only 10%. With regard to the 5 positive sputum samples, the comparison of the detection rates between the centrifuge and TB-Beads method was made utilizing Myco Acid, Ogawa K, and BacT/ALERT MP. The TB-Beads method suggested higher detection rates for Myco Acid and Ogawa K, while there were no significant differences between the two methods for BacT/ALERT MP (16-23 days). TB-beads is an easy method that allows to simplify the process of smear tests, and contributes to significantly reducing the contamination rate of culture tests. It also contributes to improving the sensitivity and detection rate of AFB testing. Furthermore, it does not require centrifugation. Ultimately, TB-beads is an innovative, safe, and convenient testing method for detection of AFB, which enables laboratory technicians to save time for routine work.

Differential contributions of the intraparietal sulcus and the inferior parietal lobe to attentional blink: evidence from transcranial magnetic stimulation.

When two targets (T1 and T2) are to be identified in rapid serial visual presentation, the response to T1 induces impairment of T2 report if T2 appears within 500 msec after T1 (attentional blink: AB). AB is thought to reflect temporal limitations of attention which affect target perception. Recent research suggests that the intraparietal sulcus (IPS) contributes to an attentional set associated with task goals, whereas the inferior parietal lobe (IPL) is associated with the disengagement and reorienting of attention to a relevant stimulus presented outside the current focus of attention. We investigated respective involvement of the IPS and the IPL in AB using transcranial magnetic stimulation (TMS). The results of Experiment 1 showed that the magnitude of AB deficit decreased TMS disrupted activity of the IPS after T1 onset. In addition, an increased AB deficit occurred when TMS was delivered over the IPS or IPL after T2 onset. In Experiment 2, where participants were instructed to ignore T1, they showed an AB-like T2 deficit only when TMS was delivered to the IPS after a T2 onset. Findings are discussed in terms of hypotheses about the respective roles of the IPS, in realizing an attentional set, and the IPL, in contributing to a disengagement of attention (from T1 to T2) during an AB period.