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A new species Polacanthoderes shiraseae sp. nov. from three Antarctic regions (off Cape Darnley, off Totten Glacier, and in Lützow-Holm Bay) is described. In addition, type species of Polacanthoderes, Polacanthoderes martinezi, is redescribed. The new species is distinguished from P. martinezi by the presence of conspicuously thick lateroventral acicular spines on segments 8 and 9 and the presence of sublateral small acicular spines on segment 7. Both P. martinezi and P. shiraseae sp. nov. occasionally show intraspecific morphological variations in the position of some small acicular spines. The K2P genetic distances based on the mitochondrial cytochrome c oxidase subunit 1 gene sequences in P. shiraseae sp. nov. are 0–1.5%, equivalent to those in other echinoderid species. Phylogenetic analyses of Polacanthoderes based on the nuclear 18S rRNA and 28S rRNA gene sequences support the inclusion of the genus in Echinorhagata/Echinoderidae and suggest that the genus represents the most basal group of this order/family.

Cerebrovascular malformations comprise abnormal development of cerebral vasculature. They can result in hemorrhagic stroke due to rupture of lesions as well as seizures and neurological defects. The most common forms of cerebrovascular malformations are brain arteriovenous malformations (bAVMs) and cerebral cavernous malformations (CCMs). They occur in both sporadic and inherited forms. Rapidly evolving molecular genetic methodologies have helped to identify causative or associated genes involved in genesis of bAVMs and CCMs. In this review, we highlight the current knowledge regarding the genetic basis of these malformations.

Rotational vertebral artery occlusion is a rare cause of ischemic stroke in the vertebrobasilar arteries. While computed tomography angiography (CTA) is less invasive for the diagnosis of rational vertebral artery occlusion than digital subtraction angiography and more useful for elucidating the correlation between vertebrobasilar arteries and the surrounding structure, carotid ultrasound is noninvasive and more beneficial for the real-time evaluation of the hemodynamic change with neck rotation compared to CTA. Here, we reported 2 cases of rotational vertebral artery occlusion in patients aged 81 and 38 years and proposed a novel technique for its diagnosis using ultrasound-guided CTA. We suggest that the combination of ultrasound and CTA is useful for diagnosing rotational vertebral artery occlusion, which would compensate for the disadvantages of CTA alone.

The reliability and validity of measurements in questionnaire surveys are affected by the survey design. Previous studies have discussed whether the items on a multidimensional scale should be grouped by subscale or randomized to increase the reliability and validity of the measurement. However, it is not clear what effect item order has on the true reliability and validity and whether the order causes bias in these estimates. Furthermore, it is not clear whether there are sequential dependencies of responses, which refers to the effect of past responses on current responses and, if so, what effects that they have on reliability, coefficient α, and validity. Study 1 empirically revealed that each respondent's previous response had a positive effect on his or her current response. In Study 2, we conducted a theoretical investigation and found that the first-order positive sequential dependencies of responses reduced the reliability, coefficient α, and validity of the subscales. In addition, sequential dependencies were found to render these indicators higher when the items were grouped than when they were randomized and caused an overestimation of reliability by coefficient α. Study 3 confirmed the effects of sequential dependencies and item order on coefficient α using real data. Thus, this study showed the potential impact of sequential dependencies of responses on psychological measurements.

We report the first mermithid nematode found to be parasitic in a marine tanaidacean crustacean. Ten host tanaidaceans were collected from a depth of 52 m in Otsuchi Bay, Iwate, Japan, north-western Pacific, and identified as a species in the tanaidid genus Zeuxo Templeton, 1840. Nematodes occurred in the host's body cavity; in one case, at least two individuals inhabited a single host. We provide a brief description and illustrations of the morphology of the nematode. In a phylogenetic reconstruction based on the 18S ribosomal RNA gene, the nematode nested in a clade otherwise containing mermithids from terrestrial or freshwater hosts, showing an expansion in host utilization in Mermithidae Braun, 1883 from terrestrial/freshwater hosts to a marine organism.

We describe three free-living marine nematode species from Sagami Bay, Japan. Wiesoncholaimus jambio sp. nov. is the second species of this genus. It differs from the type species, Wiesoncholaimus mawsonae Inglis, 1966, by its dorsal tooth, which is as long as the other two teeth; its conicocylindrical tail, which is as long as 4.6–4.8 cloacal body diameters; and the absence of the gubernaculum. Thalassironus cf. britannicus de Man, 1889 agrees well with a redescription of Thalassironus britannicus de Man, 1889 based on specimens collected near the type locality. However, as it is possible that T. britannicus sensu lato includes two or more species, our species may not be conspecific to T. britannicus sensu stricto. Vasostoma cf. longispicula Huang and Wu, 2010 closely resembles Vasostoma longispicula Huang and Wu, 2010 originally described from China, but minor differentiations are observed in body diameter, body cuticle thickness, and type of precloacal supplements.

This case is the first document to describe a patient receiving anti-programmed cell death 1 (PD-1) antibodies which showed cranial dura matter involvement. According to the increasing use of anti-PD-1 monoclonal antibodies, adverse effects can occur in several organs since its ligand PD-L1 and PD-L2 are expressed in a wide variety of tissues. The estimated rate of neurological complications is 1–4.2% of patients, and neuromuscular disorders are the most common. Adverse effects on the central nervous system including encephalitis are less frequent. Here, a patient receiving anti-PD-1 antibodies showed cranial dura matter involvement, and the dura enhancement on MRI was resolved by withdrawal of the treatment with anti-PD-1 antibodies only.

The relationship between RNF213 c.14429G > A (p.Arg4810Lys) heterozygous variants and clinical manifestation in patients with Moyamoya disease (MMD) remains unclear. We performed a retrospective cohort analysis to clarify the genotype-phenotype correlation of this RNF213 hotspot variant in MMD patients, especially between wild-type (GG) and heterozygous (GA) genotypes. Clinical and genetic data were obtained from patients diagnosed with MMD in our institutions between October 2011 and November 2020. Clinical data included age, sex, neurological status at diagnosis, medical history, smoking history, alcohol intake, and family history. Of the 225 enrolled patients, 160 (71.1%) were symptomatic, 3 (1.3%) had the homozygous variant, and 149 (66.2%) had the heterozygous variant (GA). Analysis of all enrolled patients showed that the GA group was prone to present bilateral symptoms (p = 0.008) and progressive status (Suzuki grade ≥ 4; p = 0.017). Analysis limited to symptomatic patients revealed that the GA group had bilateral symptoms (p = 0.017), younger age at onset (p = 0.043), and, in particular, a higher proportion of onset before 25 years of age (p = 0.021). Multivariate logistic regression analysis of overall patients revealed that earlier age at diagnosis (p

We describe three free-living marine nematode species from Sagami Bay, Japan.

Nectonema, the only horsehair worm (Nematomorpha) genus found in marine environments, was previously known to be parasitic only in decapod crustaceans. We report Nectonema sp. as the first record of a marine nematomorph parasitic in isopod crustaceans. This is also the third record of marine nematomorphs from the North Pacific. Six infected isopods (Natatolana japonensis) collected from 1425 m of depth in the Sea of Japan each contained one to seven (mean 2.33) nematomorphs in the body cavity in the pereon. There was no correlation between the host body length and number of parasites. For Nectonema sp., we describe and illustrate morphological features of the parasitic juvenile stage and present nucleotide sequences for the cytochrome c oxidase subunit I gene (COI or cox1; 451 nt), 18S rRNA gene (1777 nt), and region spanning the internal transcribed spacer 1 (ITS1) and the 28S rRNA gene including the 5.8S rRNA gene and ITS2 (1218 nt in total). In an 18S maximum-likelihood tree that included 24 nematomorph species, Nectonema sp. grouped with N. agile from the northwestern Atlantic; the 18S gene from these two taxa was divergent by 11.8% K2P distance, suggesting that they are different species. Nectonema species may have a broader range of host groups than previously suspected, but may have been previously misidentified as nematode parasites., 謎多き海のハリガネムシの予想外の宿主を発見. 京都大学プレスリリース. 2021-06-29.

Three new species of free-living marine nematodes, Phanodermopsis dordi sp. nov., Halalaimus shinkai sp. nov., and Oxystomina hakureiae sp. nov. are described from the abyssal sediments of the Clarion-Clipperton Fracture Zone, North Pacific. Phanodermopsis dordi sp. nov. differs from the congeners by having papilliform anterior sensilla and a long conical tail with an acute tip. Halalaimus shinkai sp. nov., belonging to Keppner’s group 2 based on the presence of caudal alae and the absence of precloacal sensillum or pore, can be distinguished from all of the members of this group by the presence of lateral pieces of gubernacula. Oxystomina hakureiae sp. nov. differs from the congeners by the short setiform anterior sensilla, the amphid located posterior to cephalic sensilla, the conico-cylindrical tail in both sexes, the spicules with a velum and a capitulum, the presence of the gubernacula and the precloacal setae, and the diorchic and monodelphic reproductive systems. The amended dichotomous keys to the species of Phanodermopsis, Halalaimus group 2, and Oxystomina are provided. A new combination Nemanema arenaria (Bussau, 1990) comb. nov. transferred from Oxystomina is also provided.

A 55-year-old man presented with recurrent brain infarction which had increased multifocally mainly in the cerebral white matter over the course of one year. Antibodies associated with antiphospholipid syndrome (APS) were initially negative. The patient was admitted to our department because of the thickened meninges shown on gadolinium enhanced brain MRI, mimicking hypertrophic pachymeningitis. However, blood and cerebrospinal fluid analysis revealed no significant inflammatory changes. On histopathological examination of the biopsied meninges, the arachnoid membrane was thickened with fibrosis, and arachnoidal microvessels were enlarged without significant inflammatory changes. The dura mater was not thickened, and no inflammation or microvessel enlargement were revealed. Finally, serum IgG anticardiolipin antibody testing was positive twice at an interval of more than 12 weeks, confirming the diagnosis of APS. Since initiating antithrombotic therapy with warfarin, brain infarction has not recurred. Without inflammation in the arachnoid membrane, the congestion of blood flow caused by thrombosis of microvessels in the arachnoid membrane might have increased the thickness of the arachnoid membrane.

A new species of free-living marine nematode, Oncholaimus langhovdensis sp. nov., is described from the intertidal zone of Langhovde (near Syowa Station), Dronning Maud Land, East Antarctica. It closely resembles 11 congeners in the conico-cylindrical tail shape present in males and amphid and excretory pore positions, short spicules, and Demanian system structure present in females. However, it mainly differs from these congeners in body size, de Man's ratios, tail length and shape, and Demanian system structure present in females. Oncholaimus langhovdensis sp. nov. also resembles four congeners known only by females, but it can be distinguished from them based on the tail length and uvette position. In addition to O. langhovdensis sp. nov., two undescribed species (Tripyloididae gen. sp. and Axonolaimidae gen. sp.) and four unidentified species (Sphaerolaimus sp., Oncholaimidae gen. sp., Comesomatidae gen. sp., and Chromadorida fam. gen. sp.) were found from the same locality.

INTRODUCTION Cerebellar glioblastoma (cGBM) is extremely rare, accounting for 0.7–0.9% of all gliomas. Few studies have reported on clinical course, histopathology, and prognosis. In this report, we discussed cases which were diagnosed as cGBM, and were treated in our institute. Materials and Methods We retrospectively analyzed 9 cGBMs (age ranged 41 to 85 years, median 69), operated at our institute after 2010 January, and evaluated their promoter methylation, mutation, and Copy Number Variation status detected by methylation-specific PCR (MSP), DNA sequencing or immunohistochemistry, and Multiplex Ligation-dependent Probe Amplification (MLPA), respectively. RESULTS All patients underwent resection; 3 gross total resections (GTRs, 33%), 2 subtotal resections, 4 partial resections, with relatively low achievement of GTR. The tumor location predominated in the cerebellar hemisphere (7 patients, 78%) over vermis (2). One patient had brain stem invasion. After surgery, 8 patients received temozolomide (TMZ) and radiotherapy (RT), while did only one RT alone. After recurrence, three patients were treated with bevacizumab monotherapy, and other three received either TMZ and RT, TMZ and ACNU, or TMZ monotherapy. The median progression-free survival (PFS) was 12.0 months, and the median overall survival (OS) was 17.1 months. Five patients (56%) were methylated, whereas all were wild-type. deletion was negative in all patients. amplification and combined amplification and deletion were found in one patient each. DISCUSSION Despite the lower rate of GTR, there was a tendency of longer PFS compared to supratentorial GBM (sGBM). The clinical course after recurrence was unfavorable, and OS thereafter was similar to that of sGBM. cGBMs appeared to lack the typical genetic mutations occurred in sGBM, suggesting that cGBMs might be stimulated with different regulatory cellular signals.

BACKGROUND Preoperative accurate evaluation of arteries and veins can help avoid ischemic complication of brain tumor surgery. The latest ultra-high-resolution CT (UHRCT) angiography (Aquilion PrecisionTM; Canon Medical Systems) has recently become available for clinical testing of the main arteries and critical perforating arteries by brain CTA, compared to conventional CT. METHODS UHRCT provides slice collimation of 0.25 mm x 160 and matrix size of 1024 x 1024 or 2048 x 2048. Major features of this CT scanner include an improved detector system (the minimal slice thickness, 0.25 mm; the maximal channel number, 1792) and a small x-ray focus (the smallest size, 0.4 x 0.5 mm) compared to a standard multi-detector CT (MDCT) scanner (the minimal slice thickness, 0.5 mm; the maximal channel number, 896; the smallest x-ray focus size, 0.8 x 0.9 mm). RESULTS Until July 2019, 168 patients with brain tumor underwent UHRCT angiography. As high resolution image could visualize cortical arteries and cortical veins clearly, it helped to decide approach route to the tumor and achieve accurate biopsy of even small lesion. Identification of tumor feeders and passing arteries allowed for efficient feeder coagulation and preservation of passing artery, avoiding the ischemic change of surrounding brain. Improved image reconstruction could visualize perforating arteries, which helped to preserve perforator by predicting the location during tumor removal. CONCLUSION UHRCT angiography can visualize even tiny arteries and veins around the tumor, and contributes to avoid the risk of ischemic complication.

BACKGROUND Maximum safe resection is a primary goal of glioma surgery. Ultrasonic aspiration is commonly used technique in neurosurgery, as it allows for safely debulking of tumors without damaging the adjacent brain tissue. CUSA Clarity helps to avoid damage to blood vessels and nerve fibers due to its original function, ‘Tissue Select’. Here we introduce glioma surgery using CUSA Clarity. METHODS We used CUSA Clarity in three cases with glioma at Kyorin University Hospital. According to fragility of the tissues and hardness of the tumor, we adjusted power, irrigation, and Tissue Select level of CUSA Clarity. We also introduce subpial aspiration technique in glioma surgery using normal CUSA. RESULTS Histological diagnoses of the three patients were WHO grade IV glioblastoma, grade III anaplastic astrocytoma, and grade II oligodendroglioma. All patients underwent successful maximum safe resection without ischemic complication. CUSA Clarity allowed for safe subpial dissection and preservation of pia and small vessels more perfectly than surgery using normal CUSA. CUSA Clarity also contributed to bloodless dissection of the tumor margin due to avoidance of feeder injury. When using Tissue Select mode, the power of the CUSA was elevated by 10 or 20 to aspirate the tumor effectively. CONCLUSION CUSA Clarity contributes to safe resection of glioma due to selective tumor aspiration by Tissue Select.

Two new and one known species of free-living marine nematode belonging to the family Phanodermatidae are described. They were collected during the 12th Japanese Association for Marine Biology (JAMBIO) Coastal Organism Joint Survey off Jogashima, Japan in Sagami Bay, North Pacific Ocean. Phanodermopsis kohtsukai sp. nov. differs from the congeners by the shape of the tail, the longer spicules, and the absence of the gubernaculum. Micoletzkyia nakanoi sp. nov. differs from the congeners by the absence of a circle of cervical setae, the proportion of the tail, the cylindrical gubernaculum without projection, and the position of the vulva. Crenopharynx caudata (Filipjev, 1927) comb. nov. is transferred from the genus Phanodermopsis based on the presence of the long spicules. The morphological characters of the newly collected specimens of C. caudata comb. nov. are in excellent agreement with those shown in the original description of the specimens from Arctic Russia and the previous redescription of the specimens from Skagerrak. The new diagnoses and species lists for these three genera and two dichotomous keys to the males of Micoletzkyia and Crenopharynx are provided.

BACKGROUNDS: Standard of care for patients with primary CNS lymphoma (PCNSL) has been high-dose methotrexate (HD-MTX)-based multiagent immunochemotherapy, particularly with R-MPV-A with or without whole-brain radiotherapy (WBRT), however, the optimal treatment for relapsed/refractory (r/r)PCNSL has not been established yet. Approval of a second-generation BTK inhibitor, tirabrutinib, for r/rPCNSL in Japan in March 2020, prompted us to evaluate retrospectively efficacy of R-MPV-A for r/rPCNSL to compare their activities. PATIENTS: Histologically proven PCNSL patients treated at relapse in our institution from April 2000 to November 2019 were analyzed. Outcomes were compared between those treated with RMPVA or other regimens. RESULTS: Among 148 PCNSL patients identified, 73 had at least one relapse, of whom 47 received salvage chemotherapy including 23 treated with RMPVA, 14 with HD-MTX monotherapy, and 11 with DeVIC (DEX, etoposide, ifosfamide, CDBCA). Median age/KPS were 69 yo (20–87)/ 80 (40–100), 27 patients had received prior WBRT. RMPVA was given at the first relapse in 11 patients, median number of RMPV cycles was 8 (1–4 cycles: 10; 8 cycles 13). CR/CRu were achieved in 19 (83%), response rate was 87%, while there were two PDs (9%). After median follow-up of 21.9 months, the median PFS after salvage RMPVA was 13.0 m (95%CI: 9.1–16.9), 1-year overall survival (OS) was 82%, median OS was 70.0 m (95%CI: 12.9–127.1), which were longer than those in 24 patients with salvage treatment other than RMPVA (mPFS 4.4 m, P=0.054; mOS 13.6 m, P=0.009). Median PFS and OS for HD-MTX monotherapy were 5.1m and 36.6 m, while those for DeVIC were 4.4 m and 9.1 m, respectively. Treatment was generally well-tolerated but there was one treatment-related death. CONCLUSIONS: Salvage RMPVA at relapses was active and associated with longer survival compared with other regimens, necessitating further development of salvage regimens incorporating tirabrutinib in the future studies.

BACKGROUND: The frontal aslant tract (FAT) is a white matter fiber connecting the superior frontal gyrus to the lateral inferior frontal gyrus. Damage to FAT in dominant hemisphere can lead to speech deficits which, in most cases, resolve within weeks to months. However, little is known about mechanisms of recovery and factors for predicting permanent language deficits. METHODS: Eighteen patients with glioma (age ranged 24 to 78, 10 glioblastomas and 8 lower grade gliomas) located in the medial frontal lobe in the dominant hemisphere involving the supplementary motor area (SMA) and FAT were included. FAT was visualized using diffusion tensor imaging tractography in pre- and postoperative MRI. Postoperative language deficit, resected area of FAT and surrounding brain regions including the cingulate gyrus and corpus callosum (CC) were retrospectively reviewed. RESULTS: In 17 of 18 cases, postoperative language deficits were observed. Speech deficits resolved within a month in 12 cases, while recovery was incomplete in five cases. In two patients without complete recovery, CC located beneath SMA was removed because of tumor infiltration. Other two patients had substantial injury of middle third portion of FAT. The last case had preceding infarction in the contralateral frontal white matter including FAT. In cases with complete language recovery, transcallosal fibers connecting the contralateral SMA to the ipsilateral inferior frontal gyrus were detected by postoperative DTI-tractography. These fibers were damaged anywhere along its length in patients without complete language recovery, indicating that they may play an important role in recovery after FAT injury. CONCLUSION: Injury to CC or middle third portion of FAT can cause permanent language disorder. Transcallosal fibers from contralateral SMA seems to be involved in the recovery from language deficit after injury to FAT. In glioma surgery involving dominant SMA or FAT, these fibers should be preserved to avoid permanent speech deficit.

BACKGROUNDS Standard of care for patients with primary CNS lymphoma (PCNSL) has been high-dose methotrexate (HD-MTX)-based multiagent immunochemotherapy including an induction R-MPV with consolidation whole-brain radiotherapy (WBRT) and HD-cytarabine to achieve complete remission, however, the optimal treatment for relapsed/refractory (r/r) PCNSL has not been established yet, besides the recent approval of a BTK inhibitor, tirabrutinib, in Japan. We evaluated retrospectively efficacy of R-MPV-A for r/rPCNSL. PATIENTS Histologically proven PCNSL patients treated at relapse in our institution from April 2000 to November 2019 were analyzed. Outcomes were compared between those treated with RMPVA or other regimens. RESULTS Among 148 PCNSL patients identified, 73 had at least one relapse, of whom 47 received salvage chemotherapy including 23 treated with RMPVA either at the first relapse (11) or at the second or later relapse (12). Median age/KPS of this salvage RMPVA group were 71 (42–87)/80 (40–100). Nine patients were pretreated with the first-line RMPVA. HD-cytarabine was given to 13 patients. Median number of RMPV cycles was 8 (1–4 cycles: 10; 8 cycles 13). CR/CRu were achieved in 19 (83%), response rate was 87%, while there were two PDs (9%). After median follow-up of 21.9 months, the median PFS after salvage RMPVA was 13.0 m (95%CI: 9.1–16.9), 1-year overall survival (OS) was 82%, median OS was 70.0 m (95%CI: 12.9–127.1), which were longer than those in 24 patients with salvage treatment other than RMPVA (mPFS 4.4 m, P=0.054; mOS 13.6 m, P=0.009). Among patients with salvage RMPVA, HD-cytarabine was associated with better PFS (P=0.066), and complete responses were significantly correlated with longer OS. Treatment was generally well-tolerated but there was one treatment-related death. CONCLUSIONS Salvage RMPVA at relapses was active and associated with longer survival compared with other regimens, necessitating further development of salvage regimens incorporating tirabrutinib in the future studies.

BACKGROUND A maximal safe resection has been shown as an independent prognosis factor for high grade glioma (HGG). Intraoperative photo dynamics diagnosis (PDD) facilitates an increased rate of tumor resection, thereby taking an important role in accomplishment of “ maximal safe resection “ along with neuro-navigation and monitoring of motor nerve function. Since the approval of aminolevulinic acid (5-ALA) for PDD in 2013 in Japan, we have been utilizing the PDD when HGG is suspected by preoperative assessments. Here we retrospectively analyze clinical findings in PDD-mediated tumor resection. METHODS From February 2014 to March 2019, 285 consecutive patients (132 females) with suspected HGG underwent total of 302 PDD-mediated resection. Median age was 61 yo (13–90). A single oral dose of 5-ALA 20 mg/kg was given within three hours before microsurgery. Positivity of excited fluorescence was assessed qualitatively under surgical microscope. RESULTS Among 195 gliomas, the fluorescence positivity rates were 89.6% (120/134) for glioblastoma, 40.5% (15/37) for grade III, and 13.6% (3/22) for grade II. The positive rates for other histologies were 30.2% (13/43) for malignant lymphoma, 32.1% (9/28) for metastatic brain tumor, 0% (0/7) for meningioma (include atypical), and 4.5% (1/22) for other types. In gliomas the high positivity correlated with histological grades, while all fluorescence-positive grade II gliomas were recurrent tumors. Serious adverse events were not observed. CONCLUSIONS The qualitative PDD showed a clinical utility to aid accurate resection in glioblastoma, whereas its positivity was inconsistent in lower grade gliomas as well as other malignant brain tumors. This unreliability might attribute, at least in part, to fluorescent intensity heterogeneity in situ, a reduced excitation by an inappropriate radiation angle of the light source, and the qualitative fluorescence detection. Impacts of introducing quantitative detection system as well as molecular and histopathological features on better discrimination will be discussed.

BACKGROUNDS Primary central nervous system lymphoma (PCNSL) frequently causes severe damage of activities of daily living (ADL) and neurocognitive function (NCF) due to extensive brain infiltration, necessitating their appropriate assessment and measures even in clinical practice. Since few studies have focused on the changes in the level of ADL and NCF in the course of PCNSL treatment, we retrospectively analyzed the effect of initial treatment of PCNSL in view of ADL and NCF. METHODS Among 55 patients (13 male/9 female) with newly-diagnosed PCNSL treated in our institution from January 2014 to June 2019, 22 were evaluated with both ADL and NCF. Remission induction therapies consisted of high-dose methotrexate alone (two patients), R-MPV (rituximab, methotrexate, procarbazine, and vincristine)(17 patients), and R-MPV+radiaotherapy (three patients), according to the patients’ conditions. Rehabilitation staffs intervened from the beginning, providing specific exercises and periodically evaluating scores of Karnofsky Performance Status (KPS) and Mini Mental State Examination (MMSE). RESULTS Mean age was 68.4 yo (range 34 to 85). After induction therapies, there were 11 complete responses (CRs), eight partial responses (PRs), and three progressive diseases (PDs). Both KPS and MMSE scores improved after induction therapy, from median 70 (40–90) to 80 (50–90), and from 24 (0–30) to 27(0–30), respectively. Among three patients who underwent RT, MMSE declined in two (one CR/one PR). CONCLUSIONS Case-adjusted induction therapies resulted in significant radiographical responses, and the longitudinal evaluation of ADL and NCF by rehabilitation staffs could validate their maintenance or improvement over time through effective treatments and early rehabilitation intervention. However, three was difficulty in assessing patients with higher brain dysfunction such as aphasia and social adjustment disorder. Further study is needed to include more patients and to explore more appropriate evaluation batteries and timings during and after completion of induction therapy for PCNSL.

BACKGROUNDS Current standard of care for glioblastoma, consists of postoperative temozolomide (TMZ) concomitant with radiotherapy, followed by adjuvant TMZ monotherapy. Recently, an international phase 3 trial (EF-14) demonstrated that addition of tumor-treating fields (TTF) to adjuvant TMZ after completion of chemoradiotherapy extended median progression-free survival and overall survival by 2.7 months and 4.8 months, respectively, compared with TMZ alone in patients with newly diagnosed glioblastoma. TTF is now considered as a part of its initial treatment in the guideline in Japan (recommendation grade B). However,distinct from anticancer drugs,little is known or experienced using TTF as a therapeutic device so far, especially in management and handling. METHODS First six patients with newly diagnosed glioblastoma who underwent TTF were analyzed with special interest in medical and social supports to execute TTF at home. RESULTS TTF was first introduced in our institution in May 2016, but no patients were treated because of no coverage by medical insurance until December 2017. We further needed to wait to initiate TTF treatment until January 2019 when the contract to use TTF systems was finally made between the company and institution. Since then six patients were registered in five months. For its introduction to clinical practice,it is essential to establish new in-house environment with medical professions division in the facility including documentations of calculating instruction fees and usage guidance for home care application of TTF. It is also important to initiate providing information of TTF such as timing of visit by specific practitioners and potential medical and psychologic burdens to patients and their families during and after chemoradiotherapy to better understand this new modality leading to the consent acquisition. CONCLUSIONS Introducing TTF into clinical practice should accompany improvement of management in not only medical equipment and documentations but also patient care in hospital and home.

BACKGROUND Higher extent of resection contributes to better prognosis of the patients with glioma. However, resection of deep-seated glioma represents a surgical challenge not only because of the depth but because of adjacent eloquent structures such as pyramidal tract, deep venous system, and brainstem. METHODS We performed a retrospective review of patients with deep-seated glioma around thalamus who underwent surgery between March 2014 and February 2019. The tumors were removed with use of neuronavigation, DTI tractography, electrophysiological monitoring and photo dynamics diagnosis using aminolevulinic acid via interhemispheric or transcortical approach. Volumetric analysis of preoperative tumor volume as well as postoperative residual volumes was performed. RESULTS A total of 17 patients, ages ranged from 13–79 years (median; 51) were eligible. Twelve patients underwent radical resection and 5 underwent biopsy (2 with craniotomy, 2 with endoscopy, and 1 stereotactic biopsy). Pathological diagnosis consisted of glioblastoma (GBM) in 10, diffuse midline glioma (DMG) in 3, anaplastic astrocytoma in 3, and diffuse astrocytoma in 1. Extent of resection of the patients attempted radical resection was 96.7%±6.4%. Postoperatively, 12 patients developed hemianopsia, 2 had hemiparesis because of corticospinal tract injury, 2 sensory disturbance, and 3 cognitive dysfunction. At 1 month after surgery, Karnofsky performance status (KPS) worsened in 5 GBM patients and 1 DMG patient, while improved or stable in the rest 11 patients. CONCLUSION Resection of deep-seated glioma around thalamus accompanies a high risk of neurological deficits. Nevertheless, radical resection without KPS decline can be achieved by preserving the corticospinal tract, deep venous system, and brainstem and minimizing damages of surrounding brain.

OBJECTIVE Maximal safe resection is a standard of care (SOC) for treatment of malignant glioma in light of quality of life (QOL) maintenance and better outcomes. This strategy is especially important when vital perforating arteries such as lateral striate arteries (LSA) and anterior choroidal arteries,are involved in tumor and its periphery,as their damage causes serious deterioration in the activities of daily life. Here we report a utility of preoperative cerebral angiography in glioma surgery. METHODS Six cases of perforator-involving malignant gliomas, consisting of five glioblastomas and one anaplastic ganglioma, operated from December 2018 to July 2019 were evaluated with preoperative imaging using sophisticated cerebral angiographic techniques and fusion imaging with MRI. RESULTS In all six cases, perforating arteries passed through or around the tumors. The cerebral angiography revealed the origin of LSA in all patients; one at M1,two at M1-M1 junction, and three at the superior trunk of M2. Anterior choroidal arteries and Heubner’s recurrent arteries were also identified preoperatively. By knowing the precise locations of these perforators,intraoperative resection of vascular-rich malignant gliomas could be performed with precaution of avoiding their unnecessary injury. No symptomatic complications occurred after angiography. Postoperative MRI disclosed a potential embolic infarction in the perforator territory in one patient,which resolved in a few days. CONCLUSIONS Visualization of perforators by angiography was helpful in detailed evaluation of surgical strategy and facilitated safe resection also leading to shortening of operating time. Compared to another modalities,angiography provided the best special resolution for visualization of vital perforating arteries involved in malignant gliomas.

BACKGROUNDS The patients with malignant brain tumors frequently show the hypercoagulability state and a decrease in fibrinolysis ability with an elevation in D-dimer. This is partially due to tumor-related hemiparesis or surgical stress including long-term bed-ridden positioning during and after operation,which could lead to development and extension of deep venous thrombosis (DVT) in lower extremities and eventually fatal pulmonary embolism. METHODS We retrospectively examined the pre- and postoperative serum D-dimer levels and DVT state in 75 consecutive patients with malignant brain tumors (i.e. glioma,malignant lymphoma; mean age 64 yo,28 females) operated at our hospital from January 2015 to April 2017. Serial D-dimer levels were measured with the latex agglutination method (Roche) at 2 days before and right after operation,postoperative day (POD) 1,3,and 7. Lower limb venous ultrasound (LVUS) or contrast CT was performed if preoperative D-dimer was 0.5μg/ml or higher. RESULTS Average BMI was 21.3,nine patients with diabetes mellitus,10 had recurrent diseases after chemotherapy,and 10 presented paresis in the lower extremities preoperatively while two developed transient paresis postoperatively. While two patients had prior DVT history,central and calf DVTs were identified preoperatively in one and 12 (15%) patients,respectively. Among four patients with re-elevation of D-dimer after POD 7,infection (2 patients),new DVT (2),and hemorrhagic events (gastrointestinal 2,including 1 death; epistaxis 2) developed,where a cut-off value D-dimer > 1.69 yielded sensitivity 100% and specificity 80%. Intraoperative intermittent calf compression prevented perioperative pulmonary embolism in those with calf DVT. CONCLUSIONS Appropriate perioperative DVT managements could prevent development of pulmonary embolisms in all patients with”high-risk” malignant brain tumors. Not only D-dimer > 1.5,but age of 80 or older,high preoperative D-dimer levels with calf DVT and taking DOAC may be risk factors for postoperative venous thromboembolism.

We reviewed reports about the postoperative course of hemifacial spasm (HFS) after microvascular decompression (MVD), including in our own patients, and investigated treatment for delayed resolution or recurrence of HFS. Symptoms of HFS disappear after surgery in many patients, but spasm persists postoperatively in about 10–40%. Residual spasm also gradually decreases, with rates of 1–13% at 1 year postoperatively. However, because delayed resolution is uncommon after 1 year postoperatively, the following is advised: (1) In patients with residual spasms after 1 year postoperatively (incomplete cure) or who again experience spasm ≥ 1 year postoperatively (recurrence), re-operation is recommended if the spasms are worse than before MVD. (2) When re-operation is considered, preoperative magnetic resonance imaging (MRI) findings and intraoperative videos should be reviewed to ensure that no compression due to a small artery or vein was missed, and to confirm that adhesions with the prosthesis are not causing compression. If any suspicious findings are identified, the cause must be eliminated. Moreover, because of the risk of nerve injury, decompression of the distal portion of the facial nerve should be performed only in patients in whom distal compression is strongly suspected to be the cause of symptoms. (3) Cure rates after re-operation are high, but complications such as hearing impairment and facial weakness have been reported in 10–20% of cases, so surgery must be performed with great care.

本稿は、戦前期日本における回教政策に関して、大日本回教協会を中心に実証・分析を加えたものである。従来の研究では、一次史料の収集・比較分析は不十分であり、必ずしも実態が明らかではなかった。第一に、あまり分析されてこなかった四王天延孝会長期も含めて、回教協会の組織運営・諸活動の実態を通史的に明らかにした。第二に、日本政府からの補助金・事業指示の分析をもとにして、大日本回教協会を、外務省の回教政策を実行するために設立された、外務省の外郭団体だと明らかにした。第三に、陸軍の回教政策とは異なった観点に立つ、外務省の回教政策の内実を明らかにした。外務省の回教政策とはすなわち、中東を中心に全イスラーム世界を対象とし、手法として文化工作を最重視することであった。極東占領地内に回教政策を局限した陸軍との間にはある種の棲み分けがなされていた。ただし、戦局の悪化、回教協会に対する大東亜省の影響力増の結果、以上の図式は崩されることになった。, This article focuses on the Islamic policy in prewar Japan. First, it traces the activities and organizational management of the Dai Nippon Kaikyo Kyokai (DNKK), from beginning to end. Secondly, by analyzing the business instructions and subsidies for the DNKK from the Japanese government, it becomes clear that the DNKK was established in order to execute the Islamic policy of the Ministry of Foreign Affairs (MFA). Thirdly, it makes clear the Islamic policy of the MFA, which takes a different point of view from the Army. The Islamic policy of the MFA targeted the entire Islamic world centering on the Middle East, and gave paramount weight to cultural activities. At first, segregation of the Islamic policy had been made between the MFA and the Army, because the Army confined its Islamic policy only in the occupied territories in the Far East. However, such segregation was collapsed later, as a result of the deterioration of the war situation and increased influence of the Ministry of Greater East Asia for the DNKK．

X-ray powder diffraction, magnetization and electrical resistivity measurements were carried out for polycrystalline Heusler alloys Mn2-xNi1+xSb ( 0 ≤ x ≤ 1) in 4.2-720 K and in magnetic fields up to 16 T. The lattice parameter a was determined to be 0.5974 nm for Mn2NiSb (x = 0) and 0.6021 nm for MnNi2Sb (x = 1) at room temperature. The parameter a shrinks for 0.4 ≤ x ≤ 0.75. The Curie temperatures TC for x = 0 and 1 were determined to be 623 K and 353 K, respectively. For, TC was enhanced up to 663 K (x = 0.5). Obtained results showed the unique behaviors on the structural, magnetic and electrical properties for the intermediate Mn-Ni composition.