[A Case of Aphasia after Neck Clipping of a Ruptured Aneurysm at the Origin of the Duplicated Middle Cerebral Artery].

We report a case of aphasia after neck clipping of a ruptured aneurysm at the origin of the duplicated middle cerebral artery(DMCA). A 60-year-old woman had a sudden onset of headache and nausea. A computed tomography(CT)scan revealed diffuse subarachnoid hemorrhage. Head three-dimensional CT angiography(3D-CTA)showed a left DMCA with a saccular aneurysm at the origin. She became aphasic on the third day after aneurysmal neck clipping. A CT scan revealed a low-density area in the anterior portion of the left temporal lobe, which is perfused by the DMCA. The DMCA was patent on 3D-CTA, but the angle between the ICA and the DMCA changed steep. It is suspected that the clip changed the branching angle at the DMCA origin, which may have led to decreased blood flow in the DMCA. She received linguistic rehabilitation for dysnomia and was discharged with slight difficulty in naming objects. Six months later, she recovered from the aphasia. One year later, the DMCA was patent on 3D-CTA. We should pay attention to ischemic complications in clipping because DMCAs are easily deformed.

[Quantitative Evaluation of Metal Artifacts on CT Images on the Basis of Statistics of Extremes].

It is well-known that metal artifacts have a harmful effect on the image quality of computed tomography (CT) images. However, the physical property remains still unknown. In this study, we investigated the relationship between metal artifacts and tube currents using statistics of extremes. A commercially available phantom for measuring CT dose index 160 mm in diameter was prepared and a brass rod 13 mm in diameter was placed at the centerline of the phantom. This phantom was used as a target object to evaluate metal artifacts and was scanned using an area detector CT scanner with various tube currents under a constant tube voltage of 120 kV. Sixty parallel line segments with a length of 100 pixels were placed to cross metal artifacts on CT images and the largest difference between two adjacent CT values in each of 60 CT value profiles of these line segments was employed as a feature variable for measuring metal artifacts; these feature variables were analyzed on the basis of extreme value theory. The CT value variation induced by metal artifacts was statistically characterized by Gumbel distribution, which was one of the extreme value distributions; namely, metal artifacts have the same statistical characteristic as streak artifacts. Therefore, Gumbel evaluation method makes it possible to analyze not only streak artifacts but also metal artifacts. Furthermore, the location parameter in Gumbel distribution was shown to be in inverse proportion to the square root of a tube current. This result suggested that metal artifacts have the same dose dependence as image noises.

Carotid arterial intraplaque hemorrhage and calcification influences cerebral hemodynamics.

We evaluated associations between cerebral blood flow (CBF) and histopathological features in atherosclerotic lesions of the internal carotid artery. Cerebrovascular reactivity (CVR) and CBF were measured in 72 patients with unilateral carotid artery stenosis who underwent Xe-CT before carotid endarterectomy. Collateral blood flow was estimated as stump pressure. Proportions of fibrous tissue, intraplaque hemorrhage (IPH), and calcification were pathologically compared with the entire plaque body. The Spearman's rank test and stepwise multiple linear regression analysis revealed that the IPH rate significantly and negatively correlated with CBF, whereas the calcification rate positively correlated with CVR. One-way analysis of variance showed that IPH and the absence of calcification might confer a risk for CBF and CVR reduction. Thus, not only the stenosis rate but also the degree of IPH and calcification in carotid arterial plaque are notable risk factors for ischemic stroke.

Using a combined working memory - Semantic feature analysis approach to treat anomia in aphasia: A Pilot Study.

INTRODUCTION: The purpose of the study was to pilot a working memory (WM) - and modified Semantic Feature Analysis (SFA) approach to treat word finding deficits in a group of people with aphasia (PwA). Two research questions were posed: 1. Will the group of PwA be able to complete the WM tasks used in the approach? 2. Will the approach improve naming performance in PwA? METHOD: Three individuals with mild - moderate aphasia participated in this singlesubject multiple baseline treatment design. Pre-treatment assessments of language, and pre- to post-treatment assessments of WM abilities were carried out. The treatment protocol incorporated WM and linguistic tasks in order to improve naming accuracy across two treatment lists. Probes were carried out prior to treatment on each list, and at one-month following completion of treatment. Two outcome measures were obtained: Percent accuracy in completing the WM steps, and treatment effect sizes (Beeson & Robey, 2006). Additionally, modified t-tests (Crawford & Garthwaite, 2012; Crawford & Howell, 1998), were calculated in which post-treatment WM measures were compared against neurotypical control groups to detect any improvements in WM functions. RESULTS: All three participants completed the WM steps with a high degree of accuracy. A range of small to large ESs were obtained for all three participants across the two treated lists, while no meaningful ESs were obtained for the control (untreated) list. All three participants demonstrated improved scores across most of the WM measures with significant improvements noted on certain WM assessments. CONCLUSIONS: The findings revealed that the WM - SFA approach can be used successfully in individuals with mild - moderate aphasia. The proposed approach holds promise as feasible intervention designed to remediate anomia in PwA.

The use of semantic- and phonological-based feature approaches to treat naming deficits in aphasia.

The aim of the study was to compare approaches highlighting either semantic or phonological features to treat naming deficits in aphasia. Treatment focused on improving picture naming. An alternating treatments design was used with a multiple baseline design across stimuli to examine effects of both approaches in two participants with varying degrees of anomia. The features approaches were modified in that three, rather than six, features were used. Significant differential effects were found across participants; this appeared to be a function of each participant's strengths or preferences over the course of treatment. Modest generalization effects were obtained for one participant. Naming error analyses revealed patterns suggestive of increased lexical access for both participants. These findings provide evidence that using a modified features-based protocol can improve naming when incorporating both semantic and phonological feature cues. Naming error patterns can provide additional evidence of improved naming during treatment.

Utility of U-Net for the objective segmentation of the fibroglandular tissue region on clinical digital mammograms.

This study investigates the equivalence or compatibility between U-Net and visual segmentations of fibroglandular tissue regions by mammography experts for calculating the breast density and mean glandular dose (MGD). A total of 703 mediolateral oblique-view mammograms were used for segmentation. Two region types were set as the ground truth (determined visually): (1) one type included only the region where fibroglandular tissue was identifiable (called the 'dense region'); (2) the other type included the region where the fibroglandular tissue may have existed in the past, provided that apparent adipose-only parts, such as the retromammary space, are excluded (the 'diffuse region'). U-Net was trained to segment the fibroglandular tissue region with an adaptive moment estimation optimiser, five-fold cross-validated with 400 training and 100 validation mammograms, and tested with 203 mammograms. The breast density and MGD were calculated using the van Engeland and Dance formulas, respectively, and compared between U-Net and the ground truth with the Dice similarity coefficient and Bland-Altman analysis. Dice similarity coefficients between U-Net and the ground truth were 0.895 and 0.939 for the dense and diffuse regions, respectively. In the Bland-Altman analysis, no proportional or fixed errors were discovered in either the dense or diffuse region for breast density, whereas a slight proportional error was discovered in both regions for the MGD (the slopes of the regression lines were -0.0299 and -0.0443 for the dense and diffuse regions, respectively). Consequently, the U-Net and ground truth were deemed equivalent (interchangeable) for breast density and compatible (interchangeable following four simple arithmetic operations) for MGD. U-Net-based segmentation of the fibroglandular tissue region was satisfactory for both regions, providing reliable segmentation for breast density and MGD calculations. U-Net will be useful in developing a reliable individualised screening-mammography programme, instead of relying on the visual judgement of mammography experts.

The effect of breast density on the missed lesion rate in screening digital mammography determined using an adjustable-density breast phantom tailored to Japanese women.

OBJECTIVE: Despite the high risk of missing lesions in mammography, the missed lesion rate is yet to be clinically established. Further, no breast phantoms with adjustable breast density currently exist. We developed a novel, adjustable-density breast phantom with a composition identical to that of actual breasts, and determined the quantitative relationship between breast density and the missed lesion rate in mammography. METHODS: An original breast phantom consisting of adipose- and fibroglandular-equivalent materials was developed, and a receiver operating characteristic (ROC) study was performed. Breast density, which is the fraction by weight of fibroglandular to total tissue, was adjusted to 25%, 50%, and 75% by arbitrarily mixing the two materials. Microcalcification, mass lesions, and spiculated lesions, each with unique characteristics, were inserted into the phantom. For the above-mentioned fibroglandular densities, 50 positive and 50 negative images for each lesion type were used as case samples for the ROC study. Five certified radiological technologists participated in lesion detection. RESULTS: The mass-lesion detection rate, according to the area under the curve, decreased by 18.0% (p = 0.0001, 95% Confidence intervals [CI] = 0.1258 to 0.1822) and 37.8% (p = 0.0003, 95% CI = 0.2453 to 0.4031) for breast densities of 50% and 75%, respectively, compared to that for a 25% breast density. A similar tendency was observed with microcalcification; however, spiculated lesions did not follow this tendency. CONCLUSIONS: We quantified the missed lesion rate in different densities of breast tissue using a novel breast phantom, which is imperative for advancing individualized screening mammography.

[A case of dural arteriovenous fistula associated with subcortical and subdural hemorrhage].

We encountered a case of dural arteriovenous fistula (AVF) in which a cortical venous drainage was successfully treated by direct surgery. A 68-year-old man complained of headache and visual disturbance. CT on admission revealed intracerebral hematoma in the left occipital lobe and subdural hemorrhage in the left temporooccipital region. Angiography showed dural AVF in the left occipital region, which was type IV classified by Cognard and a varix of the draining vein. We performed direct surgery to remove the hematoma and obliteration of the draining vein was observed 10 days after onset. Intraoperative angiography via the middle meningeal artery which fed the dural AVF was very useful in the identification of the dural AVF and the varix and also to certify the obliteration of the fistula. Postoperative angiography showed disappearance of dural AVF. The patient had a good clinical course. Early direct surgery in this type of dural AVF is necessary in order to prevent another hemorrhage from the varix.

The Use of Written Naming and Repetition to Treat Naming Deficits in Aphasia.

Purpose The purpose of the study was to examine the use of a combined written naming + repetition (WN + REP) approach and an REP-only approach to treat naming deficits in a group of individuals with aphasia. Method Six individuals participated in the study. A multiple-baseline design across behaviors was used. A WN + REP approach, an REP approach, and an untreated condition were presented. Three 10-item treatment lists and one 10-item untreated list were created. Each 10-item treatment list was evenly divided so that 5 items were treated using the WN + REP approach and 5 items were treated using the REP approach. Results Visual analyses of treatment data revealed improvements in 4 of the 6 participants. Meaningful treatment effect sizes were obtained for 5 of the 6 participants in at least 1 of the approaches across the treatment lists. Slightly more participants obtained meaningful effect sizes in the WN + REP approach than in the REP approach. Use of writing as a strategy to help with naming the pictures verbally increased over the duration of treatment in 5 of the 6 participants. Conclusions The findings revealed that both approaches improved spoken naming accuracy in aphasia. Although the WN + REP approach resulted in more meaningful effect sizes than the REP approach, there was no overwhelming advantage in using 1 or the other approach. However, the WN + REP approach promoted writing as a functional strategy that could be used when naming the picture verbally was not successful.

Bovine insulin filaments induced by reducing disulfide bonds show a different morphology, secondary structure, and cell toxicity from intact insulin amyloid fibrils.

Amyloid fibrils are associated with more than 20 diseases, including Alzheimer's disease and type II diabetes. Insulin is a 51-residue polypeptide hormone, with its two polypeptide chains linked by one intrachain and two interchain disulfide bonds, and has long been known to self-assemble in vitro into amyloid fibrils. We demonstrate here that bovine insulin forms flexible filaments in the presence of a reducing agent, Tris (2-carboxyethyl) phosphine. The insulin filaments, possibly formed due to partial reduction of S-S bonds in insulin molecules, differ from intact insulin fibrils in terms of their secondary structure. The insulin filaments were determined to have an antiparallel beta-sheet structure, whereas the insulin fibrils have a parallel beta-sheet structure. Of importance, the cell toxicity of the insulin filaments was remarkably lower than that of the insulin fibrils. This finding supports the idea that cell toxicity of amyloids correlates with their morphology. The remarkably low toxicity of the filamentous structure should shed new light on possible pharmacological approaches to the various diseases caused by amyloid fibrils.

Structural determination and functional analysis of a soluble matrix protein associated with calcification of the exoskeleton of the crayfish, Procambarus clarkii.

A novel matrix protein named calcification-associated soluble protein-2 (Casp-2) was isolated from the acetic acid-soluble fraction of the exoskeleton of the crayfish Procambarus clarkii, and its primary structure was determined by a combination of peptide sequencing, mass spectral analysis, and cDNA cloning. Casp-2 consists of 117 amino acid residues and has a chitin-binding consensus sequence, the so-called Rebers-Riddiford (R-R) consensus sequence. Casp-2 exhibited an inhibitory activity on calcium carbonate precipitation from its supersaturated solution in vitro, suggesting association with calcification of the exoskeleton. Reverse transcription PCR and Northern blot analyses indicated that the Casp-2 gene was expressed only at the epidermis throughout the molting stages, and most strongly at the late pre-molt stage. Recombinant Casp-2 showed weak affinity to chitin in spite of having the R-R consensus sequence. These results indicate that Casp-2 interacts loosely with chitin fibrils and regulates calcification in the cuticle.

Conceptual organization at 6 and 8 years of age: evidence from the semantic priming of object decisions.

PURPOSE: The purpose of this study was to examine children's knowledge of semantic relations. METHOD: In Experiment 1, the 6-year-olds, 8-year-olds, and adults participated in an object decision task. Participants in the primed group made object decisions in response to primes that were related taxonomically, thematically, or perceptually to the target objects. Those in the unprimed group made decisions about the same stimuli without the benefit of primes. In Experiment 2, the children in the primed group explained the taxonomic and thematic relations between the prime-target pairs used in Experiment 1. RESULTS: In Experiment 1, the strength of semantic relations did not vary with type or age, as taxonomic priming was as strong as thematic priming and the degree of priming did not reliably differentiate the 3 age groups. Differential priming effects between taxonomic and perceptual conditions, the former hastening and the latter slowing responses, suggested that the relation binding object concepts into taxonomies was not reducible to common physical features. In Experiment 2, the 6-year-olds had more difficulty describing taxonomic than thematic relations, whereas the 8-year-olds described both with ease. CONCLUSIONS: Contrary to the shift hypothesis, taxonomic and thematic relationsstructure concepts in children as young as 6 and into adulthood. In accord with the performance hypothesis, 6-year-olds' representations of taxonomic relations are fragile and vulnerable to high task demands.

The Use of One or Three Semantic Associative Primes in Treating Anomia in Aphasia.

Purpose: The aims of the study were to investigate the use of semantic associative relationships as primes in treating naming deficits, or anomia, in aphasia and to determine if differential treatment effects would be found if 1 or 3 primes were presented. Method: Ten individuals with varying degrees of anomia participated in the study. A single-subject, A-B treatment design with a cross-over component was used. A 1-PRIME condition (use of 1 prime) was compared with a 3-PRIMES condition (use of 3 primes) for each participant. Results: Visual analyses of treatment data revealed improvements in 8 of 10 participants. Meaningful effect sizes were obtained in at least 1 of the conditions for 6 of the 10 participants. Slightly more participants demonstrated meaningful effect sizes in the 3-PRIMES condition than in the 1-PRIME condition. Correlation analyses revealed a positive correlation between the number of teaching episodes and 3-PRIMES probe performance. Conclusions: The results support a protocol that uses semantic associative primes to increase naming accuracy in aphasia. The 3-PRIMES condition was slightly more beneficial than the 1-PRIME condition in terms of improving naming abilities in these participants, but there was no overwhelming advantage in using one or the other condition.

The effects of thematic relations on picture naming abilities across the lifespan.

A picture-word interference paradigm tracked patterns of activation during picture naming in 87 individuals (age range 17-80 years old). Distractor words were presented at stimulus onset asynchronies (SOAs) of -200, -100, and 0 ms bearing a has a-, location, or no relationship to the picture. Analyses of group naming reaction times revealed significant facilitation effects for both semantic relation types for all age groups. Analyses of temporal patterns of activation revealed significant effects primarily at SOAs of -200 and -100 ms. These findings provide evidence that both thematic relations are particularly salient in how semantic knowledge is organized, and that the patterns of effects from these semantic relations remain the same as one ages.

Factors affecting serum albumin in the perioperative period of colorectal surgery: a retrospective study.

BACKGROUND: Albumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. Hypoalbuminemia is a risk factor for mortality, postoperative complications, and prolonged hospital stay. The magnitude of the systemic inflammatory response during the perioperative period, as indicated by the acute-phase proteins-C-reactive protein (CRP) in particular-, may help identify the risk of postoperative infectious complication. The correlation between serum albumin and CRP with gastrointestinal cancer has been reported. However, it is unclear whether antecedent CRP could be utilized to predict future hypoalbuminemia in the perioperative period in colorectal surgery. The primary endpoint of this study was to reveal that antecedent CRP could be utilized to predict future hypoalbuminemia in the perioperative period of colorectal surgery. METHODS: Thirty-seven patients who underwent elective open colorectal surgery were included in this study. Correlations between preoperative CRP and serum albumin on postoperative day (POD) 3, between preoperative CRP and serum albumin on POD 7 and between CRP on POD 3 and serum albumin on POD 7 were examined. Relationships between preoperative CRP and hypoalbuminemia on POD 3, between preoperative CRP and hypoalbuminemia on POD 7 and between CRP on POD 3 and hypoalbuminemia on POD 7 were examined by receiver operating characteristic analysis. RESULTS: Three-quarters of patients were older than 65 years of age. Significant correlations were observed between preoperative CRP and serum albumin on POD 3 (p = 0.023), between preoperative CRP and serum albumin on POD 7 (p = 0.023) and between CRP on POD 3 and serum albumin on POD 7 (p < 0.001). The area under the receiver operating characteristic curve of CRP on POD 3 to development of hypoalbuminemia on POD 7 was 0.833 (95 % CI 0.679-0.987) with an optimal threshold of 12.43 mg/dL, sensitivity 75 % and specificity 80 %. CONCLUSIONS: The present study revealed that antecedent CRP was associated with future serum albumin. Additionally, CRP on POD 3 could be useful in predicting the development of hypoalbuminemia on POD 7. This result suggests that CRP on POD 3 may be a valuable indicator for early nutritional intervention.

De novo distal posterior cerebral artery aneurysm.

BACKGROUND: De novo aneurysms in the posterior circulation are very rare. The authors describe a first case of ruptured de novo posterior cerebral artery (PCA) aneurysm in the P3 portion. CASE DESCRIPTION: A 52-year-old woman with ruptured de novo P3 aneurysm was treated by early endovascular obliteration using Guglielmi Detachable Coils (GDC). To prevent vasospasm, she received postoperative treatment with a hypertensive hypervolemia dilution and a calcium antagonist. She was discharged without neurologic deficits. CONCLUSIONS: Aneuryms arising from peripheral segment of PCA are rare, and delayed surgical clipping has been recommended for these lesions. This is the first report of a de novo P3 ruptured aneurysm treated by endovascular embolization using GDC in the acute stage of subarachnoid hemorrhage. The characteristics of de novo posterior circulation aneurysms and the strategy for the distal PCA aneurysms are discussed.

The use of a modified semantic features analysis approach in aphasia.

Several studies have reported improved naming using the semantic feature analysis (SFA) approach in individuals with aphasia. Whether the SFA can be modified and still produce naming improvements in aphasia is unknown. The present study was designed to address this question by using a modified version of the SFA approach. Three, rather than the typical six, features were used, and written along with verbal responses were allowed in an individual with both aphasia and apraxia of speech. A single-subject multiple-baseline design across behaviors was used to treat naming of single objects across three different semantic categories in a 72-year-old individual with aphasia and apraxia of speech. Stimulus generalization of training was measured by using photographs of trained items presented in natural contexts. Training of the three different categories resulted in improved naming. At a 6-week follow-up session, naming remained above pre-treatment levels but declines were noted compared to treatment levels. Generalization to the same trained items presented in different contexts was also demonstrated although declines in performance were also noted over time. Results of the study provide qualified support for the use of three features in promoting long-term improvement of naming in an individual with both aphasia and apraxia of speech. Future SFA studies should focus on whether it is the number or types of features used, aphasia severity, or length of treatment that are critical factors in rehabilitating naming deficits in aphasia.

The use of the picture-word interference paradigm to examine naming abilities in aphasic individuals.

BACKGROUND: Although naming deficits are well documented in aphasia, on-line measures of naming processes have been little investigated. The use of on-line measures may offer further insight into the nature of aphasic naming deficits that would otherwise be difficult to interpret when using off-line measures. AIMS: The temporal activation of semantic and phonological processes was tracked in older normal control and aphasic individuals using a picture-word interference paradigm. The purpose of the study was to examine how word interference results can augment and/or corroborate standard language testing in the aphasic group, as well as to examine temporal patterns of activation in the aphasic group when compared to a normal control group. METHODS & PROCEDURES: A total of 20 older normal individuals and 11 aphasic individuals participated. Detailed measures of each aphasic individual's language and naming skills were obtained. A visual picture-word interference paradigm was used in which the words bore either a semantic, phonological, or no relationship to 25 pictures. These competitor words were presented at stimulus onset asynchronies of -300 ms, +300 ms, and 0 ms. OUTCOMES & RESULTS: Analyses of naming RTs in both groups revealed significant early semantic interference effects, mid-semantic interference effects, and mid-phonological facilitation effects. A matched control-aphasic group comparison revealed no differences in the temporal activation of effects during the course of naming. Partial support for this RT pattern was found in the aphasic naming error pattern. The aphasic group also demonstrated greater SIEs and PFEs compared to the matched control group, which indicated disruptions of the phonological processing stage. Analyses of behavioural performances of the aphasic group corroborated this finding. CONCLUSIONS: The aphasic naming RTs results were unexpected given the results from the priming literature, which has supported the idea of slowed or reduced patterns of activation in aphasic individuals. However, analyses of naming RTs also confirmed the behavioural finding of a disruption surrounding phonological processes; thus, the analyses of naming latencies offers another potential means of pinpointing breakdowns of lexical access in individuals with aphasia.