Decomposed Multilateral Filtering for Accelerating Filtering with Multiple Guidance Images.

This paper proposes an efficient algorithm for edge-preserving filtering with multiple guidance images, so-called multilateral filtering. Multimodal signal processing for sensor fusion is increasingly important in image sensing. Edge-preserving filtering is available for various sensor fusion applications, such as estimating scene properties and refining inverse-rendered images. The main application is joint edge-preserving filtering, which can preferably reflect the edge information of a guidance image from an additional sensor. The drawback of edge-preserving filtering lies in its long computational time; thus, many acceleration methods have been proposed. However, most accelerated filtering cannot handle multiple guidance information well, although the multiple guidance information provides us with various benefits. Therefore, we extend the efficient edge-preserving filters so that they can use additional multiple guidance images. Our algorithm, named decomposes multilateral filtering (DMF), can extend the efficient filtering methods to the multilateral filtering method, which decomposes the filter into a set of constant-time filtering. Experimental results show that our algorithm performs efficiently and is sufficient for various applications.

Multispectral near-infrared imaging for wetness estimation.

Estimation of the wetness of objects is an important technique for recognizing states in the real world. In this paper, we propose a non-contact method for estimating the wetness of objects using multispectral near-infrared (NIR) imaging. In contrast with a previous method that requires hyperspectral (110-band) images taken with fine spectral resolution (5 nm intervals) to estimate the degree of wetness, our method enables accurate wetness estimation using few-band NIR images with coarse spectral resolution (40 nm intervals). In general, water absorbs a substantial amount of incident light at wavelengths around 1000 nm and a smaller amount at wavelengths around 900 nm. This phenomenon indicates that the light absorption coefficient of water particularly varies over the NIR spectral band. These differences in the light absorption coefficients of water in the NIR bands are exploited in the model we derived for the appearance of a wet object surface, facilitating accurate wetness estimation. The effectiveness of the proposed method is demonstrated experimentally.

Does cognitive behavioral therapy for anxiety disorders assist the discontinuation of benzodiazepines among patients with anxiety disorders? A systematic review and meta-analysis.

Long-term use of benzodiazepines (BZD) is not recommended for the treatment of anxiety disorders. Cognitive behavioral therapy (CBT) is an effective treatment option for discontinuation of BZD in patients with anxiety disorders. This systematic review and meta-analysis sought to clarify whether CBT is effective for discontinuing BZD anxiolytics in patients with anxiety disorders. This study was preregistered with PROSPERO (registration number: CRD42019125263). A literature search of major electronic databases was conducted in December 2018. Three randomized controlled trials were included in this review, and meta-analyses were performed. The proportion of discontinuing BZD anxiolytics was significantly higher in the CBT plus gradual tapering group than in the gradual tapering alone group, both in the short term (3 months after allocation; number needed to treat: 3.2, 95% confidence interval [CI]: 2.1 to 7.1; risk ratio: 1.96, 95%CI: 1.29 to 2.98, P = 0.002, three studies) and long term (6 to 12 months after allocation; number needed to treat: 2.8, 95%CI: 1.9 to 5.3; risk ratio: 2.16, 95%CI: 1.41 to 3.32, P = 0.0004, three studies). CBT may be effective for discontinuing BZD anxiolytics, both in the short term and in the long term after the allocation. Further studies with larger sample sizes are necessary to draw definitive conclusions regarding the efficacy and safety of CBT for discontinuing BZD anxiolytics in patients with anxiety disorders.

Investigation of appropriate semi-quantitative index for assessment of esophageal and breast cancer treatment response in Japanese patients using 18F-FDG PET/CT findings.

OBJECTIVE: To examine the correlation of the quantitative indexes standardized uptake value (SUV), SUV corrected for lean body mass (SUL) and SUV corrected for Japanese lean body mass (SULj) with body weight to develop an appropriate quantitative index independent of body weight fluctuation for assessment of response to cancer treatment in Japanese patients. SUBJECTS AND METHODS: Fifty-six males with esophageal cancer and 30 females with breast cancer underwent fluorine-18-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scans, once before and once after, receiving neoadjuvant chemotherapy prior to planned surgical resection. The maximum value, peak value, and average value of SUV, SUL and SULj were calculated by setting a spherical volume of interest (3cm diameter) in a normal area of the liver. The correlation between each index and body weight was obtained from the correlation coefficient (r) and the significance of the correlation was tested. RESULTS: Analyses were conducted with all patients (P<0.01), as well as after dividing into those with only esophageal (P<0.05) or breast (P<0.01) cancer. Regarding the correlation coefficient between each index and body weight, a significant difference was seen for SUVmax, SUVpeak and SUVmean. In contrast, there was no correlation with body weight for SULmax, SULpeak, SULmean, SULjmax, SULjpeak, or SULjmean in any of the 3 groups. CONCLUSION: Based on the correlation with body weight, we concluded that both SUL and SULj (SUL corrected for Japanese lean body mass) is useful for assessment of cancer treatment response in Japanese patients.

[Simulation at Incomplete Acquisition on Stress-rest Cerebral Blood Flow Quantitative Values One Day Method].

The QSPECT dual table autoradiography (DTARG) method can be used for quantitative determination of cerebral blood flow. We verified the influence on quantitative values obtained for cerebral blood flow in the case when usual acquisition was impossible and evaluated those values. Results obtained with an acquisition time of 30 min were considered to be true values, and the correlation and consistency with results of other times were evaluated. Values obtained with a shortened acquisition time showed a high correlation with the true value. As for consistency, there were differences among the various data collection intervals. Nevertheless, regardless of the use of a shortened acquisition time and the data acquisition interval, values obtained with the QSPECT program showed a high correlation with the true value. Based on our findings showing a high correlation, a quantitative evaluation of cerebral blood flow can be performed with the QSPECT DTARG method, even with complications, such as examination interruption, thus, it is considered to be a flexible method.

Automatic measurement of the Cobb angle for adolescent idiopathic scoliosis using convolutional neural network.

This study proposes a convolutional neural network method for automatic vertebrae detection and Cobb angle (CA) measurement on X-ray images for scoliosis. 1021 full-length X-ray images of the whole spine of patients with adolescent idiopathic scoliosis (AIS) were used for training and segmentation. The proposed AI algorithm's results were compared with those of the manual method by six doctors using the intraclass correlation coefficient (ICC). The ICCs recorded by six doctors and AI were excellent or good, with a value of 0.973 for the major curve in the standing position. The mean error between AI and doctors was not affected by the angle size, with AI tending to measure 1.7°-2.2° smaller than that measured by the doctors. The proposed method showed a high correlation with the doctors' measurements, regardless of the CA size, doctors' experience, and patient posture. The proposed method showed excellent reliability, indicating that it is a promising automated method for measuring CA in patients with AIS.

Upper End Vertebra of Proximal Thoracic Curve At T1 is a Novel Risk Factor of Postoperative Shoulder Imbalance in Lenke Type 2 Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Retrospective single-center study. OBJECTIVE: We investigated the risk factors of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) including the position of preoperative upper end vertebra (UEV). METHODS: Seventy-five patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries from 2008 to 2018 were included. We included only patients whose upper instrumented vertebrae were at T2. The patients were divided into 2 groups based on radiographic shoulder height (RSH) at final follow-up, namely PSI group and non-PSI group, and PSI was defined as RSH > 10 mm. UEV, RSH, Cobb angle, curve flexibility, T1 and T2 tilt, correction rate, Risser grade, Scoliosis Research Society-22 scores, and demographic data were compared between the groups using independent t-tests or chi-square tests. Variables with P value < 0.20 in univariate analysis were assessed in logistic regression analysis. RESULTS: Thirty-four patients in the PSI group and 37 patients in the non-PSI group were analyzed. Univariate analysis revealed that there were more patients with UEV at T1 (PSI: 85%, non-PSI: 54%, P < 0.01) and Risser grade ≥ 3 (PSI: 88%, non-PSI: 62%; P < 0.05) in the PSI group than in the non-PSI group. Logistic regression analysis revealed that UEV at T1 (odds ratio [OR] = 4.1 [1.2-14.4], P < 0.05) and Risser grade ≥ 3 (OR = 3.9 [1.1-14.5], P < 0.05) are significantly associated with PSI. CONCLUSIONS: UEV at T1 and Risser grade ≥ 3 at the time of surgery are significant risk factors of PSI.

Two identical nonylphenol monooxygenase genes linked to IS6100 and some putative insertion sequence elements in Sphingomonas sp. NP5.

Sphingomonas sp. NP5 can degrade a wide range of nonylphenol (NP) isomers that have widely contaminated aquatic environments as major endocrine-disrupting chemicals. To understand the biochemical and genetic backgrounds of NP degradation, a gene library of strain NP5 was constructed using a broad-host-range vector pBBR1MCS-2 and introduced into Sphingobium japonicum UT26. Several transformants accumulated reddish brown metabolites on agar plates dispersed with a mixture of NP isomers. Two different DNA fragments (7.6 and 9.3 kb) involved in the phenotype were isolated from the transformants. Sequence analysis revealed that both fragments contained an identical 1593 bp monooxygenase gene (nmoA), the predicted protein sequence of which showed 83 % identity to the octylphenol-4-monooxygenase of Sphingomonas sp. PWE1. The nmoA gene in the 7.6 kb fragment was surrounded by an IS21-type insertion sequence (IS) and IS6100, while another in the 9.3 kb fragment was adjacent to an IS66-type IS, suggesting that they have been acquired through multiple transposition events. A fast-growing recombinant Pseudomonas putida strain harbouring nmoA was constructed and used for degradation of a chemically synthesized NP isomer, 4-(1-ethyl-1-methylhexyl)phenol. This strain converted the isomer into hydroquinone stoichiometrically. 3-Methyl-3-octanol, probably originating from the alkyl side chain, was also detected as the metabolite. These results indicate that these two nmoA genes are involved in the NP degradation ability of strain NP5.

Isolation and characterization of a novel Enterococcus faecalis bacteriophage phiEF24C as a therapeutic candidate.

Vancomycin-resistant Enterococcus faecalis (VRE) has become a significant threat in nosocomial settings. Bacteriophage (phage) therapy is frequently proposed as a potential alternative therapy for infections caused by this bacterium. To search for candidate therapeutic phages against Enterococcus faecalis infections, 30 Enterococcus faecalis phages were isolated from the environment. One of these, virulent phage phiEF24C, which has a broad host range, was selected for analysis. The plaque-forming ability of phiEF24C was virtually unaffected by differences in the clinical host strains. Furthermore, the phage had a shorter latent period and a larger burst size than ordinary tailed phages, indicating that phiEF24C has effective lytic activity against many Enterococcus faecalis strains, including VRE. Morphological and genomic analyses revealed that phiEF24C is a large myovirus (classified as family Myoviridae morphotype A1) with a linear double-stranded DNA genome of c. 143 kbp. Analyses of the N-terminal amino acid sequences of the virion proteins, together with the morphology and the genome size, speculated that phiEF24C is closely related to other myoviruses of Gram-positive bacteria that have been used experimentally or practically for therapy or prophylaxis. Considering these results, phiEF24C may be a potential candidate therapeutic phage against Enterococcus faecalis infections.

Change in acetylcholine release from rat bladder with partial outlet obstruction.

OBJECTIVE: To investigate changes in acetylcholine release from the bladder of rats with partial bladder outlet obstruction (BOO), as partial BOO leads to hypertrophy and an alteration in the contractions of the detrusor smooth muscle, and acetylcholine plays an important role in urinary bladder contractions but there is little available information on acetylcholine release after BOO. MATERIAL AND METHODS: Partial BOO was induced in adult female rats by ligating the proximal urethra over a 1 mm angiocatheter; sham-operated rats served as controls. The rats were killed 2 weeks, 3 and 6 months after induction of BOO. We investigated the contractions induced by carbachol, KCl (80 mm), ATP and electrical-field stimulation (EFS, 2.5-40 Hz), and collected the dialysate obtained from a microdialysis probe inserted into the muscle strips during EFS, and measured the amount of acetylcholine in the dialysate fraction by high-performance liquid chromatography with electro-chemical detection. S-100 immunohistochemical staining of the bladder preparations was used for histological examination in BOO and control rats. RESULTS: The bladder weight gradually increased after BOO. There were no significant changes in KCl-induced contractions throughout the experimental period in either group. There were no significant changes in carbachol-induced contractions until 3 months after BOO but there was a significant reduction at 6 months. ATP-induced contractions were significantly increased 2 weeks and 3 months after BOO. EFS-induced contractions were gradually reduced after BOO. Acetylcholine release from the bladder strips was not significantly different between the groups until 2 weeks after BOO. However, acetylcholine release in BOO rats was significantly decreased 3-6 months after BOO, being significantly lower than that of the control rats. In the histological study, the number of nerve fibres in the BOO rats was significantly lower than in the control rats. CONCLUSIONS: We suggest that the prolonged BOO caused a decrease in EFS-induced acetylcholine release and the number of nerves in the rat urinary bladder, which might contribute to bladder underactivity in BOO.

Pharmacological effects of solifenacin on human isolated urinary bladder.

To investigate the effects of solifenacin on human detrusor smooth muscles, we evaluate the effects of solifenacin on the contractions induced by carbachol, KCl, CaCl2 and electrical field stimulation (EFS), and the EFS-induced acetylcholine release from detrusor smooth muscle strips by using the muscle bath and microdialysis technique. The effects of solifenacin were also compared with effects of other antimuscarinic agents (atropine, oxybutynin and propiverine). Pretreatment with various antimuscarinic agents caused parallel shifts to the right of the concentration-response curves to carbachol. The pA2 value of the Schild plots for solifenacin was similar to that for oxybutynin. Atropine did not inhibit the KCl- and CaCl2-induced contractions, while solifenacin, oxybutynin and propiverine significantly inhibited these contractions. EFS-induced contractions were inhibited by various antimuscarinic drugs in a concentration-dependent manner. In the presence of atropine, solifenacin tended to inhibit the residual atropine-resistant contractions induced by EFS, but it was not significant. However, oxybutynin and propiverine inhibited them under the same conditions. Although pretreatment with atropine and propiverine did not cause significant changes in EFS-induced acetylcholine release, solifenacin and oxybutynin caused significant decreases in acetylcholine release. The present results suggest that solifenacin inhibits contractions of human detrusor smooth muscles mainly by the antimuscarinic action and that the high concentration of solifenacin has Ca2+ channel antagonist action. Moreover, solifenacin may block not only postjunctional receptors, but also prejunctional receptors to modulate acetylcholine releases in cholinergic nerve endings in human detrusor smooth muscles. The findings support that muscarinic-receptor-inhibitory actions in human bladder mainly contribute to the usefulness of solifenacin as a therapeutic drug for overactive bladder.

Pharmacological effects of propiverine and its active metabolite, M-1, on isolated human urinary bladder smooth muscle, and on bladder contraction in rats.

OBJECTIVE: To investigate the effects of M-1, a major active metabolite of propiverine on the bladder. METHODS: We have evaluated the effects of M-1 on the contractions induced by carbachol, KCl, CaCl(2), and electrical field stimulation (EFS) in human detrusor smooth muscles, and pelvic nerve stimulation-induced bladder contractions in rats. The effects of M-1 were also compared with the effects of propiverine and tolterodine. RESULTS: Pretreatment with propiverine and tolterodine caused parallel shifts to the right of the concentration-response curves to carbachol. M-1 caused concentration-dependent reduction in the maximum contractile responses induced by carbachol. Although tolterodine did not inhibit the KCl- and CaCl(2)-induced contractions, M-1 and propiverine significantly inhibited these contractions. In the presence of atropine, M-1 and propiverine significantly inhibited the atropine resistant part of the contraction induced by EFS. On the other hand, tolterodine did not have significant inhibitory effects on atropine resistant contractions. Pelvic nerve stimulation induced bimodal phasic and tonic contractions in the rat bladder. M-1 mainly inhibited the phasic contraction. Tolterodine caused a significant inhibition in the tonic contraction, and propiverine had inhibitory effects on both contractions. CONCLUSIONS: The present results suggest that M-1 has inhibitory effects on the bladder smooth muscles through calcium antagonistic action. It is possible that the clinical effects of propiverine on the human bladder are based not only on the action of propiverine itself but also on one of its active metabolites, M-1.

A new retainer using magnetic attachment.

PATIENT: A 58-year-old man with a complaint of masticatory disturbance presented. His mandibular left premolars and molars were missing, and the mandibular left canine, which was neighboring to the missing part, showed marked labial tipping. A cobalt-chromium removable partial denture was fabricated using a new magnetic attachment retainer because it seemed difficult to apply a conventional clasp for this case. This retainer is constructed from the buccal hook arm sliding bucco-lingually and the magnetic attachment which works to lock the movable part when it was closed. Six years after the delivery of this denture, both the abutment tooth and the periodontal tissue are healthy, and the denture is functioning well. DISCUSSION: As this retainer does not use the elasticity of clasp arms, block out area can be minimized, and the maximum area of the contacting surface of the hook arm brings about very positive retention and bracing. The function of attractive force is to resist the splitting force and not to become directly involved in the retention of the denture. Therefore, the attractive force for this system does not need to be very strong. This system also provides the advantages of a sectional denture, allowing protection of the abutment tooth and the use of the abutment tooth in its original form. CONCLUSION: The retainer described in this report has many advantages including, no hazardous lateral force, adequate retentive force, and application to natural teeth or tipped teeth.

[Bilateral pheochromocytomas with von Hippel-Lindau disease: a case report].

A case of bilateral pheochromocytomas with von Hippel Lindau disease (VHL) is reported. A 32-year-old man visited Kumamoto Red Cross Hospital for further examination of hypertension. Computed tomography revealed bilateral adrenal tumors and noradrenalin levels in serum and urine were elevated. Suspecting bilateral pheochromocytoma, he was reffered to our hospital for further examination and treatment. 131I-MIBG scintigraphy showed accumulation in bilateral adrenal glands. Moreover, he had cerebellar and spinal hemangioblastomas. Bilateral adrenalectomies and left nephrectomy were performed because tumor thrombus extended into the left renal vein, and pathological diagnosis was pheochromocytoma. His sister had been diagnosed as VHL disease. We diagnosed the patient as VHL disease because of the existence of cerebellar and spinal hemangioblastomas, bilateral pheochromocytomas, missense mutation and his family history. This is the eleventh case of bilateral pheochromocytomas with VHL disease reported in Japanese literatures.

C5a receptor expression is associated with poor prognosis in urothelial cell carcinoma patients treated with radical cystectomy or nephroureterectomy.

Patients with aggressive urothelial cell carcinoma (UCC) that undergo radical cystectomy or nephroureterectomy exhibit markedly high rates of disease recurrence and mortality. To select appropriate adjuvant thxerapies in addition to radical surgery, the identification of predictive prognostic markers for UCC patients is required. The aim of the present study was to identify such markers, by evaluating the association of UCC complement component 5 (C5) fragment a (C5a)receptor (C5aR) expression, detected using immunohistochemistry, with clinicopathological parameters and survival outcomes of UCC patients. The results revealed that C5aR was expressed in cancer cells, particularly at the invasive front, but not in noncancerous urothelial cells or adjacent cells. The UCC C5aR-positive rate of patients treated with radical surgeries was 73% (38/52) and the rate was 83% (20/24) at stages I-II of disease. No correlation between C5aR expression and any of clinicopathological parameters, which included gender, tumor location, World Health Organization grade, T stage, vessel invasion and stage of disease, was identified. However, univariate and multivariate analyses revealed that C5aR-positive UCC patients exhibited significantly lower overall survival rates [hazard ratio (HR), 3.14; 95% confidence interval (CI), 1.03-9.60; P=0.035 and HR, 3.92; 95% CI, 1.15-13.4; P=0.029, respectively] and 5-year survival rates (0.42 vs. 0.83) compared with C5aR-negative UCC patients. Furthermore, 5-year survival and disease-specific survival rates were lower in patients with C5aR-positive UCC (0.51; 95% CI, 0.30-0.71) than patients with C5aR-negative UCC (0.83; 95% CI, 0.62-1.00). These results indicate that UCC C5aR expression is predictive of poor patient outcomes and thus may lead to the appropriate selection of adjuvant therapies at earlier UCC stages, which could improve patient prognosis.

C5aR is frequently expressed in metastatic renal cell carcinoma and plays a crucial role in cell invasion via the ERK and PI3 kinase pathways.

The anaphylatoxin C5a is a chemoattractant for leukocyte migration via the C5a receptor (C5aR). We recently reported that C5aR was aberrantly expressed in a wide variety of human related cancers, while it also promotes cancer cell invasion by C5a stimulation. However, the biological significance of C5aR expression in renal cell carcinoma (RCC) has not yet been clarified. In the present study, we aimed to elucidate the biological role of C5aR in RCC progression. Clinical RCC specimens were analyzed for C5aR expression and its relationship with baseline demographic data and clinicopathological parameters was analyzed. Moreover, renal carcinoma Renca cells stably expressing C5aR were generated and used to assess the effects of C5a-C5aR axis activation on various cellular phenomena in culture. Immunohistochemistry revealed that 96.7% of the metastatic RCCs (mRCCs) showed C5aR expression, whereas only 50.5% of the non-metastatic RCCs expressed C5aR (P<0.001). Although C5a stimulation did not significantly alter anoikis of C5aR­expressing Renca cells, C5a elicited cell morphological change and scattering of those cells accompanied with dynamic actin rearrangement, which was not observed in the Renca cells harboring the empty vector only. Moreover, C5a triggered ERK and PI3K­dependent invasion of the C5aR-expressing renal carcinoma cells. These results are consistent with the idea that the C5a-C5aR axis plays a crucial role in renal carcinoma cell invasion, which may be one of the key steps for RCC metastasis. The present study provides proof­of­concept that the C5a-C5aR axis may be a useful therapeutic target for preventing RCC progression.

Sorafenib enhances the antitumor effects of anti-CTLA-4 antibody in a murine cancer model by inhibiting myeloid-derived suppressor cells.

This antitumor effect of sorafenib is considered to be dependent not only on its direct cytotoxicity to cancer cells but also due to the inhibition of myeloid-derived suppressor cells (MDSCs). Recently, a novel antibody against cytotoxic T-lymphocyte antigen 4 (CTLA-4), which activates lymphocytes, is currently in clinical applications. The aim of the present study was to investigate the synergistic antitumor effects of anti-CTLA-4 antibody (Ab) and sorafenib in a murine cancer model. RENCA cells were subcutaneously inoculated into mice, which were randomly divided into 4 treatment groups: sorafenib plus anti-CTLA-4 Ab, sorafenib plus control Ab, vehicle plus anti-CTLA-4 Ab, and vehicle plus control Ab. Single therapy using anti-CTLA-4 Ab suppressed tumor growth, but no difference was noted when compared with the single therapy group using sorafenib. Notably, the greatest decrease in tumor size was noted with sorafenib plus anti-CTLA-4 Ab (combination therapy), and the highest rate of tumor rejection was observed in the combination therapy group. The number of infiltrating CD4- or CD8-positive lymphocytes was strongly increased in the combination therapy group. These in vivo data indicate that sorafenib increased the immunostimulatory effect of anti-CTLA-4 Ab even when sorafenib was used at a low dose. An in vitro study using MDSCs and CD8(+) T cells showed that the inhibitory effect of MDSCs on CD8(+) T cells was significantly abrogated by the combined use of sorafenib and anti-CTLA-4 Ab. Sorafenib suppressed the expression of immunosuppressive factors in MDSCs. These data indicate that combination therapy of sorafenib and anti-CTLA-4 Ab may be effective in advanced kidney cancer patients.

Microvascular decompression for hemifacial spasm caused by the vertebral artery: a simple and effective transposition method using surgical glue.

BACKGROUND: Microvascular decompression for the treatment of trigeminal neuralgia and hemifacial spasm (HFS) has been established and has brought about excellent results. However, recurrence or lack of relief from the symptoms was experienced in some cases in which the nerve root or root exit zone were compressed by the vertebral (VA) and basilar arteries. We experienced a severe HFS case, mainly caused by a compression with the tortuous VA. A more simple transposition technique of the offending VA using surgical glue is reported. METHODS: A 64-year-old male had been suffering from HFS for six years. The tortuous right VA with anterior inferior cerebellar arteries (AICA) was considered to be responsible for his vascular compression syndrome. The VA was carefully and slowly dislocated away from the pontomedullary junction toward the cranial base. Then the arteriosclerotic portion of the VA wall was chosen, where a small piece of Surgicel (ETHICON, Inc., Somerville, NJ) is placed beforehand so as to use a minimum amount of glue (Biobond; Mitsubishi Pharma Corp., Osaka, Japan). Until the glue is hardened, the VA is held away from the brain stem. After this procedure, the ordinary transposition of AICA branches was added. RESULTS: The annoying HFS completely disappeared immediately after the operation. CONCLUSION: The advantage of our method is the simplicity of the procedure. It requires less space and time while the other methods using tapes, strips, and clips need a greater working space and more time.

Familial hypercholesterolemia: a family who suffered cerebral infarction over three successive generations.

A certain family with a history of familial hypercholesterolemia (FH) in which several members suffered cerebral infarction (CI) for 3 successive generations is reported. The first case is a 54-year-old female who suffered from medial longitudinal fasciculus syndrome caused by a lesion on the pons. The second case is the son of the first case and is a 28-year-old male who suffered from left hemiparesis by a lesion on the corona radiata. The third case is the mother of the first case and is a 77-year-old female who suffered from dizziness as a result of cerebellar lacunae. All 3 patients showed a marked elevation of their serum cholesterol level without any apparent history of coronary heart disease (CHD). Our cases are peculiar and unique because the patients are of 3 successive generations who suffer from CI without any apparent history of CHD. Moreover, the latter generations are having CI at younger ages. The mechanism of CI was thought to be the occlusion of the arteriole by the increased viscosity associated with other risk factors rather than the apparent arteriosclerosis in our cases. Although FH is often associated with a high incidence of CHD, the information about the occurrence of CI has not always been available. The patients may suffer from CI more frequently than was previously thought. We hope to point out the need for such FH patients to be carefully monitored and to be treated as a high-risk group for CI as well as CHD.