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Introduction/Aims Due to muscular weakness and cardiopulmonary dysfunction, patients with muscular dystrophy (MD) have an increased risk of serious complications from coronavirus disease 2019 (COVID-19). Although vaccination is recommended, COVID-19 vaccination safety and immunogenicity in these patients are unknown. We investigated reaction frequency, post-vaccine antibody titers after two mRNA COVID-19 vaccine doses, and clinical predictors of antibody response among patients with MD.We recruited 171 inpatients with MD receiving two BNT162b2 mRNA COVID-19 vaccine doses from seven hospitals. Blood samples were obtained from 53 inpatients before the first dose and 28-30 days after the second dose, and antibody titers were measured.Overall, 104 (60.8%) and 115 (67.6%) patients experienced side effects after the first and second doses, respectively. These were generally mild and self-limited. Multiple logistic regression analysis showed that a bedridden state was associated with reduced side effects (OR: 0.29, 95% CI: 0.12-0.71). The antibody titers of all participants changed from negative to positive after two vaccine doses. The geometric mean titer (GMT) of the inpatients was 239 (95% CI: 159.3-358.7). Older age (RR=0.97, 95% CI: 0.95-0.99) and bedridden state (RR=0.27, 95% CI: 0.14-0.51) were associated with a lower antibody titer. Patients with myotonic dystrophy type 1 (DM1) had a lower GMT than patients with other MDs (RR=0.42, 95% CI: 0.21-0.85).COVID-19 vaccination is safe and immunogenic in inpatients with MD. Patients with DM1 appear to have a poorer COVID-19 antibody response than those with other MDs. This article is protected by copyright. All rights reserved.

To reveal current status of medical practice, we made a nationwide self-questionnaire survey to Japanese certified Neurologists and Child Neurologists. Most specialists seeing patients with myotonic dystrophy (DM) were aware that genetic analysis is approved in health insurance. The ratio of pre-explanation about genetic analysis was also high however written informed consent was not always obtained. Over 60% of specialists regarded motor dysfunction, conduction block/arrhythmia, heart failure, dysphagia, hypoventilation as important complications, while no more than 35% of specialists regarded hypoxia/apnea, multi-organ complications, which are feature of myotonic dystrophy, as important. Over half specialists did not check Holter electrocardiogram, sleep respiratory examination, or swallowing function regularly. This fact implied that cumbersome examinations tended to be refrained from regular assessment. Child neurologists were more aggressive in respiratory care and consultation of cardiovascular specialists. A few neurologists hesitated to introduce mechanical ventilation and tube feeding.

We conducted a comprehensive anonymous questionnaire survey on medical care and treatment for patients with myotonic dystrophy, who registered in the Japanese national registry (Remudy) or were undergoing care in seven hospitals specializing neuromuscular diseases. The questionnaire consisted of 49 questions were distributed to 813 patients, and 342 valid responses were collected. Most prevalent symptoms or complaints were dysfunction of fingers and fatigue. One-third of the adult patients left the job, half of which was due to the disease. Twelve percent of the patients did not visit the specialist regularly, the main reason being distance. The most common reason that the patients did not follow the advice of using a ventilator by medical professionals was lack of feeling the need. One-fourth of the adult female patients had infertility treatment, 80% of which was before a diagnosis of this disorder. This first-time nationwide survey revealed the actual condition of Japanese patients with myotonic dystrophy and raised various care-related issues.

Introduction The Myotonic Dystrophy Health Index (MDHI) is a disease-specific, patient-reported outcome measure. The objective of this study was to translate, evaluate, and validate a Japanese version of the MDHI (MDHI-J). Methods We utilized forward and backward translations and qualitative interviews with 11 myotonic dystrophy type 1 (DM1) participants. We subsequently tested the internal consistency, test-retest reliability, concurrent validity against muscle strength, and 3 quality-of-life measures, and the known-groups validity of the MDHI-J with 60 adult patients. Results The MDHI-J was found to be culturally appropriate, comprehensive, and clinically relevant. The MDHI-J and its subscales had high internal consistency (mean Cronbach's α = 0.91), test-retest reliability (intraclass coefficient 0.678-0.915), and concurrent validity (Spearman's ρ - 0.869 to 0.904). MDHI-J scores were strongly associated with employment, duration of symptoms, and modified Rankin Scale. Discussion The MDHI-J is suitable and valid to measure patient-reported disease burden in adult Japanese patients with DM1. Muscle Nerve 59:577-577, 2019.

To clarify the influence of coronavirus disease-19 (COVID-19) on the care of muscular dystrophy patients, we performed a questionnaire survey that was posted on the internet on May 11, 2020. By the end of July 2020, 542 responses had been collected. Approximately 30% of patients postponed regular consultations, and one-quarter of patients who received consultation more than once a month used telephone consultations. Two of 84 patients with Duchenne muscular dystrophy had reduced their steroid doses. A shortage of ventilator accessories and infection protection equipment occurred following the onset of COVID-19, and this shortage had a serious impact on medical care and infection prevention measures. Reductions in rehabilitation and other services, and avoidance of outings, led to a decrease in exercise and an increase in caregiver burden. Inpatients were restricted from going out and visiting family members. More than 20% of patients reported physical or mental complaints; however, few required treatment. COVID-19 has seriously affected the activities and quality of life of patients with muscular dystrophy. We will continue this survey and analyze the longitudinal changes.

Myotonic dystrophies (DM) are inherited autosomal dominant disorders affecting multiple organs. Currently available therapeutics for DM are limited; therefore, a patient registry is essential for therapeutic development and success of clinical trials targeting the diseases. We have developed a nationwide DM registry in Japan under the Registry of Muscular Dystrophy (Remudy). The registration process was patient-initiated; however, physicians certified the clinical information. The dataset includes all Naarden and TREAT-NMD core datasets and additional items covering major DM clinical features. As of March 2020, we enrolled 976 patients with genetically confirmed DM. The majority (99.9%) of these patients had DM1, with 11.4% having the congenital form. However, 1 patient had DM2. Upon classifying 969 symptomatic DM1 patients based on their age at onset, an earlier onset was associated with a longer CTG repeat length. Myotonia was the most frequent symptom, followed by hand disability, fatigue, and daytime sleepiness. The frequency of hand disabilities, constipation, and visual disturbances was higher for patients with congenital DM. According to a multiple regression analysis of objective clinical measurements related to prognosis and activities of daily living, CTG repeat length strongly influenced the grip strength, forced vital capacity, and QRS time in an electrocardiogram. However, the grip strength was only modestly related to disease duration. This report will shed light on the Japanese national DM registry, which has recruited a significant number of patients. The registry will provide invaluable data for planning clinical trials and improving the standard of care for patients.

Background Cerebral ventriculomegaly is an abnormal feature characteristic of myotonic dystrophy type 1 (DM1). This retrospective study investigated the morphologic changes accompanied by ventriculomegaly in DM1 on brain MRI. Methods One hundred and twelve adult patients with DM1 and 50 sex- and age-matched controls were assessed. The imaging characteristics for evaluations included the z-Evans Index (ventriculomegaly), callosal angle (CA), enlarged perivascular spaces in the centrum semiovale (CS-EPVS), temporo-polar white matter lesion (WML) on 3D fluid-attenuated inversion recovery (FLAIR), disproportionately enlarged subarachnoid-space hydrocephalus (DESH), and pathological brain atrophy. The “z-Evans Index” was defined as the maximum z-axial length of the frontal horns to the maximum cranial z-axial length. To determine the imaging characteristics and genetic information (CTG repeat numbers) that were associated with the z-Evans Index, we used binominal logistic regression analyses. Results The z-Evans Index was significantly larger in the patients than in the controls (0.30 ± 0.05 vs. 0.24 ± 0.02; p Conclusions Our MRI study revealed a normal pressure hydrocephalus (NPH)-like appearance as a morphologic finding accompanied by ventriculomegaly in DM1 that tends to occur in elderly patients.

Myotonic dystrophy type 1 (DM1) is the most common form of muscular dystrophy in adults, affecting multiple organs, including the eyes, heart, endocrine system, and central nervous system. The broad spectrum of DM1 symptoms has been attributed to the aberrant pre-mRNA splicing of various genes due to an abnormal expansion of the CTG repeat in the 3' untranslated region of the DMPK gene. The current challenge in the clinical care of DM1 is the lack of well-established protocols for the management of each organ disorder or symptom. Moreover, the current status of clinical management has not been adequately explored. Metabolic disturbance in DM1 has been less explored among the DM1 manifestations, even though impaired glucose tolerance is a widely known metabolic disorder associated with DM1. We investigated the metabolic disturbance related to DM1 using the national registry of neuromuscular diseases in Japan, Registry of Muscular Dystrophy (Remudy), and assessed the metabolic complications in DM1 and the current treatments. We obtained comprehensive information on the current status of liver dysfunction and dyslipidemia in a sizeable DM1 cohort (~300). We confirmed that the incidence of liver dysfunction and dyslipidemia, particularly hypertriglyceridemia, as well as impaired glucose tolerance, were significantly higher in DM1 patients. Furthermore, the majority of DM1 patients with dyslipidemia were not receiving pharmacotherapy. Our data highlight the current status of DM1 patients in Japan, which can guide the establishment of the standard of care for metabolic issues consequent to DM1.

BackgroundMyotonic dystrophy type 1 involves cardiac conduction disorders. Cardiac conduction disease can cause fatal arrhythmias or sudden death in patients with myotonic dystrophy type 1.Methods and ResultsThis study enrolled 506 patients with myotonic dystrophy type 1 (aged ≥15 years; >50 cytosine‐thymine‐guanine repeats) and was treated in 9 Japanese hospitals for neuromuscular diseases from January 2006 to August 2016. We investigated genetic and clinical backgrounds including health care, activities of daily living, dietary intake, cardiac involvement, and respiratory involvement during follow‐up. The cause of death or the occurrence of composite cardiac events (ie, ventricular arrhythmias, advanced atrioventricular blocks, and device implantations) were evaluated as significant outcomes. During a median follow‐up period of 87 months (Q1–Q3, 37–138 months), 71 patients expired. In the univariate analysis, pacemaker implantations (hazard ratio [HR], 4.35; 95% CI, 1.22–15.50) were associated with sudden death. In contrast, PQ interval ≥240 ms, QRS duration ≥120 ms, nutrition, or respiratory failure were not associated with the incidence of sudden death. The multivariable analysis revealed that a PQ interval ≥240 ms (HR, 2.79; 95% CI, 1.9–7.19,PP< 0.01) were independent factors associated with a higher occurrence of cardiac events than those observed with a PQ interval ConclusionsCardiac conduction disorders are independent markers associated with cardiac events. Further investigation on the prediction of occurrence of sudden death is warranted.

INTRODUCTION The Individualized Neuromuscular Quality of Life (INQoL) is used to measure the quality of life (QoL) of patients with neuromuscular disease. We conducted this study to translate and validate the Japanese version of the INQoL in patients with myotonic dystrophy. METHODS Forward and backward translation, patient testing, and psychometric validation were performed. We used the 36-Item Short Form Health Survey (SF-36) and the modified Rankin scale for concurrent validation. RESULTS The Japanese INQoL was administered to 90 adult patients. The coefficients for internal consistency and test-retest reliability were adequately high in most domains (Cronbach α 0.88-0.96 and intraclass coefficient 0.64-0.99). INQoL domains were moderately to strongly associated with relevant SF-36 subscales (Spearman's ρ -0.23 to -0.74). Symptom severity, disease duration, employment status, and use of a ventilator influenced overall QoL. DISCUSSION The INQoL is a reliable and validated measure of QoL for Japanese patients with myotonic dystrophy. Muscle Nerve, 2018.

Background Multi-systemic symptoms of varying severity in myotonic dystrophy type 1 (DM1) may pose difficulties in caregiving. However, the factors which affect their care burden are yet to be sufficiently understood. Objective We investigated care burden and its correlates among caregivers of patients with DM1. Methods General demographic information was obtained from patients with DM1, as well as Barthel index (ADL), body mass index, and genetic information. Patients completed SF-36v2 (health-related quality of life), CES-D (depressive symptoms), and ESS (daytime sleepiness) questionnaires. Caregivers reported their perception of patient's status through these questionnaires, and completed Zarit Caregiver Burden Interview (ZBI). Correlation analysis of these variables were performed, and regression analysis was utilized to assess the relationship between caregiver burden and other variables. Results Forty-three patient-caregiver dyads participated. Mean ZBI score was 20.7±17.4, and 32.6% reported a significant care burden. ZBI correlated with caregiver-reported CES-D, but not with patient-reported CES-D. Both patient-reported and caregiver-reported physical QoL of patients correlated with patient ADL. Multiple regression analysis revealed that the combination of caregiver-reported CES-D, caregiver-reported mental QoL, and genetic characteristics predicted caregiver burden. Conclusions Caregiver burden was felt although patients were relatively well-functioning. Patients' and caregivers' assessment of patients' physical condition were similar. However, they did not agree on the evaluation of the patients' psychological state. Cognitive characteristic of the patients and the caregivers' perception of the patients' state may have affected the results. Future DM1 care strategies need to work on improvement of patient-caregiver communication and provide support for the caregiver's psychological health.

Makiko Endo,1 Kaori Odaira,2 Ryohei Ono,3 Go Kurauchi,4 Atsushi Koseki,5 Momoko Goto,3 Yumi Sato,4 Seiko Kon,6 Norio Watanabe,7 Norio Sugawara,8 Hiroto Takada,6 En Kimura9 1Clinical Research Unit, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan; 2Regional Medical Liaison Office, National Hospital Organization, Aomori Hospital, Namioka, Aomori 038-1331, Japan; 3Section for Development and Disability Training, National Hospital Organization, Aomori Hospital, Namioka, Aomori 038-1331, Japan; 4Department of Rehabilitation, National Hospital Organization, Aomori Hospital, Namioka, Aomori 038-1331, Japan; 5Section for Development and Disability Training, National Hospital Organization, Hanamaki Hospital, Hanamaki, Iwate 025-0033, Japan; 6Department of Neurology, National Hospital Organization, Aomori Hospital, Namioka, Aomori 038-1331, Japan; 7School of Public Health, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan; 8Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan; 9Department of Clinical Research Support, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8551, Japan Purpose: Myotonic dystrophy type 1 (DM1) is a common form of muscular dystrophy that presents with a variety of symptoms that can affect patients’ quality of life (QoL). Despite the importance of clarifying patients’ subjective experience in both physical and psychosocial aspects for improved symptom management, there is lack of evidence concerning QoL of patients with DM1 in Japan.Patients and methods: A cross-sectional study was performed with 51 DM1 patients who completed questionnaires that measured health-related QoL (HRQoL), depression, and daytime sleepiness. Activities of daily living, body mass index (BMI), and genetic information were also collected, together with general demographic information. Correlation analyses using these variables were performed. Furthermore, regression analysis was utilized to assess the relationship that HRQoL, depression, and daytime sleepiness scores have with other variables.Results: Physical component summary (PCS) score was affected by the disease more than the mental component summary (MCS) score among study participants. Moderate correlation was observed between PCS and depression, PCS and Barthel index, and depression and daytime sleepiness. Regression analysis revealed that age, sex, cytosine–thymine–guanine repeats, and BMI did not predict the aforementioned dependent variables.Conclusion: DM1 symptoms influenced physical component scores more than mental component scores, although the state of physical wellness seemed to affect patients’ mood. Explaining the QoL of these patients only using biologic and genetic characteristics was not sufficient. We conclude that social and psychological aspects of these patients’ lives and the nature of adjustments made by patients due to DM1 to require further examination in order to improve the standard of care. Keywords: depression, excessive daytime sleepiness, chronic illness, psychosocial perspective&nbsp

Background: Although functional impairment in patients with myotonic dystrophy is an important determinant of quality of life (QoL), it is possible that QoL could further be influenced by the subjective evaluation of symptoms. The aim of this study was to investigate the subjective symptom impact on the QoL, after controlling for functional impairment. Methods: Eligible patients with myotonic dystrophy type 1 (DM1) were recruited from four hospitals in Japan. Subjective symptom impact across four domains (muscle weakness, fatigue, pain, and myotonia) and overall QoL were evaluated using the Individualized Neuromuscular Quality of Life (INQoL) questionnaire. Functional impairment was assessed using the modified Rankin scale. Results: Eighty-six patients with DM1 were included in this study. On multiple regression analysis, a portion of the variance in the overall QoL was significantly accounted for by demographic variables and functional impairment (adjusted R2 = 0.32). In addition to these variables, subjective symptom impact (muscular weakness, fatigue, and myotonia) explained additional variance in the overall QoL (adjusted R2 = 0.80). Difficulties in activities of daily living and participation caused by each symptom consistently predicted overall QoL across three symptom domains (muscular weakness, fatigue, and myotonia). Conclusions: Subjective symptom impact needs to be considered, in addition to functional impairment, when evaluating the QoL of patients with DM1.

Lipid metabolism abnormality in myotonic dystrophy (DM) was reviewed. Dyslipidemia is frequently seen in patients with DM. Hypertriglyceridemia, low HDL cholesterolemia, high LDL cholesterolemia, and exceeded visceral fat accumulation are common as abnormal lipid metabolism findings in DM. Dyslipidemia is one of risk factors for metabolic syndrome or nonalcoholic fatty liver disease and is closely relevant to insulin resistance. Careful follow-up for dyslipidemia in DM, especially complicated with glucose intolerance, should be required.

The Individualized Neuromuscular Quality of Life (INQoL) is used to measure the quality of life (QoL) of patients with neuromuscular disease. We conducted this study to translate and validate the Japanese version of the INQoL in patients with myotonic dystrophy.Forward and backward translation, patient testing, and psychometric validation were performed. We used the 36-Item Short Form Health Survey (SF-36) and the modified Rankin scale for concurrent validation.The Japanese INQoL was administered to 90 adult patients. The coefficients for internal consistency and test-retest reliability were adequately high in most domains (Cronbach α 0.88-0.96 and intraclass coefficient 0.64-0.99). INQoL domains were moderately to strongly associated with relevant SF-36 subscales (Spearman's ρ -0.23 to -0.74). Symptom severity, disease duration, employment status, and use of a ventilator influenced overall QoL.The INQoL is a reliable and validated measure of QoL for Japanese patients with myotonic dystrophy. Muscle Nerve, 2018.

We have investigated the high-pressure behavior of cristobalite in helium by powder X-ray diffraction. Cristobalite transformed to a new phase at about 8 GPa. This phase is supposed to have a molar volume of about 30 % larger than cristobalite, suggesting the dissolution of helium atoms in its interstitial voids. On further compression, the new phase transformed to a different phase which showed an X-ray diffraction pattern similar to cristobalite X-I at about 21 GPa. On the other hand, when the new phase was decompressed, it transformed to another new phase at about 7 GPa, which is also supposed to have a molar volume of about 25 % larger than cristobalite. On further decompression, the second new phase transformed to cristobalite II at about 2 GPa. In contrast to cristobalite, quartz did not show anomalous behavior in helium. The behavior of cristobalite in helium was also consistent with that in other mediums up to about 8 GPa, where the volume of cristobalite became close to that of quartz. These results suggest that dissolution of helium may be controlled not only by the density (amount of voids) but also by the network structure of SiO4 tetrahedra (topology of voids).

We demonstrate nanohole fabrication on silicon surface by femtosecond laser pulse irradiation mediated by gold nanoparticles. Gold spheres with diameters of 40, 80 or 200 nm are placed on the silicon substrate surface by a spin-coating method. The laser pulse with duration of 150 fs and wavelength of 820 nm is used to irradiate the Si substrate. Laser fluences applied are in the range of 140–300 mJ/cm2, i.e. below or near the ablation threshold fluence of the bulk silicon substrate without gold particles. The morphological changes of the laser-irradiated areas are investigated by scanning electron microscope (SEM) and atomic force microscope (AFM). Their dependence on the particle diameter, shape and laser fluence is investigated. The ablated surface morphologies are found to strongly depend on the polarization and the energy of the laser pulse. Nanoholes with diameters of about 150 nm and depths in the range of 30 nm are produced in the case of 200 nm diameter particles at fluences below the threshold for Si without Au particles. At fixed laser fluence the diameter and depth of the holes increase with the particle sizes. The optical field enhancement factor on the Si surface is calculated using an FDTD simulation code. A maximal value of about 26 is obtained for 200 nm Au particles. The comparison between the theoretical results for the electromagnetic field enhancement factor achieved and the experimental results is made in order to explain the physics of the nanomachining process.

Nanostructure fabrication on a silicon substrate using a near-field electromagnetic enhancement in the vicinity of gold nanoparticles is studied. Experimental and theoretical investigations are made in order to clarify the properties of the nanoholes produced. The obtained results show that this nanofabrication technique is a flexible method for precise surface nanostructuring. Gold particles with diameters of 40, 80, or 200 nm are placed on the silicon substrate by a spin-coating method, and a 100 fs laser pulse (λ=820 nm) is used to irradiate the samples. A theoretical treatment of the results obtained is made by FDTD (finite difference time domain) simulation and calculations of the near field scattering cross section based on Mie’s theory. The effect of the laser fluence, polarization, and particle size and arrangement on the nanohole properties is studied. The nanohole profiles correspond to the field distributions on the substrate in the low laser fluence region. By using a lower laser fluence than the ablation threshold of bulk silicon, a hole with a diameter of about 40 nm can be produced using a 200 nm gold particle. Furthermore, the gold particles exhibit a considerable field enchantment even at gold particle sizes of a few tens of nanometers, which offers a good opportunity for further decreases in the size of the produced structures. A highest electric field enhancement factor of about 26 is obtained for particles with a diameter of 200 nm. With the decrease of the particle size the field enhancement also decreases. Particle arrangement on the substrate surface strongly affects both the electric field distribution and the enhancement effect of the particles. The highest enhancement for a particle pair is obtained when the polarization of the incident radiation is parallel to the pair axis (longitudinal mode). A good correlation is obtained between the near-field distribution predicted by FDTD simulation and the parameters of the experimentally produced nanoholes.

To compare central conduction in ulnar and median nerve somatosensory evoked potentials (SEPs), we recorded SEPs from the neck and scalp elicited by median and ulnar nerve stimulation in 46 normal young adults.We determined the central conduction time (CCT) in each subject from peak-to-peak and onset-to-onset measurements. The mean value of the onset CCT for the ulnar nerve SEP was 6.2 +/- 0.3 msec, and for the median nerve SEP, 5.9 +/- 0.3 msec. Onset CCT was significantly longer for the ulnar nerve SEP, and there was a significant correlation between onset CCT in both median and ulnar nerve SEPs and subject height. In contrast, the mean value of the "conventional" peak CCT for the ulnar nerve SEP was 5.6 +/- 0.6 msec, and for the median nerve SEP, 5.8 +/- 0.5 msec, with no significant difference between them. In addition, the peak CCT was not correlated with subject height in the ulnar or median nerve SEPs. Our findings suggest that onset CCT measurement is superior to the conventional peak CCT measurement for ulnar as well as median nerve SEPs, and confirm that the central conduction pathway for the ulnar nerve SEP is slightly longer than that for the median nerve SEP.NEUROLOGY 1996;47: 1299-1304

Insulin resistance is a characteristic feature of glucose intolerance in myotonic dystrophy type 1 (DM1). DM1 patients with dysglycaemia have liver insulin resistance as well as muscle insulin resistance, and also abnormality of insulin secretion. Insulin resistance in DM1 might result in multiple metabolic defects. Low level of fasting plasma glucose is a characteristic feature in the early stage of glucose intolerance in DM1, Early intervention against insulin resistance in DM1 is suggested because glucose intolerance could deteriorate in a certain degree of cases. Metformin treatment is useful to improve insulin resistance in DM1. Diabetic patients with DM1 usually show mild hyperglycemia. However, poorly controlled patients with hyperglycemic pattern tending to rise from morning to evening exist. Intensive insulin therapy might be necessary in such cases. We should pay attention to hypoglycemia due to hyperinsulinemia, pseudo improvement of glucose control according to exacerbated dysphagia, and acute aggravation caused by infections, at a bedside.

✓ Epidermal growth factor (EGF) content in urine from patients with glial tumors was examined by radioimmunoassay techniques with labeled human EGF and its rabbit EGF polyclonal antibody. There was no cross-reaction with transforming growth factor-α, which has a common receptor with EGF. Forty glial tumors were divided into three groups according to the clinical stage: Samples from Group A patients were obtained before therapy and/or after biopsy; in these patients a large volume of tumor was apparent on computerized tomography (CT). Group B samples were obtained after gross total removal of the tumor and/or chemo- and radiation therapy; these patients showed a small volume of residual tumor on CT. Samples from Group C patients were obtained after gross tumor total removal and/or chemo- and radiation therapy; no tumor was detected on CT scans in these patients. Urinary EGF levels in Group A samples were statistically significantly higher than in samples from healthy individuals (p < 0.001), Group B patients (p < 0.10), and Group C patients (p < 0.02). In addition, high-grade glial tumors in Group A cases showed a significantly higher level of urinary EGF than low-grade tumors in Group A patients (p < 0.05), or patients with meningioma (p < 0.02), metastatic brain tumor (p < 0.05), and cerebral infarction (p < 0.001). Longitudinal changes of urinary EGF levels in glioma patients mostly synchronized with the clinical course and therapeutic interventions. Therefore, urinary EGF, as a glial tumor marker, may be of practical value for diagnosing a malignant glioma and evaluating for the efficacy of chemo- and radiation therapy.

Using positron emission tomography (PET), cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMR02) were measured in 32 healthy volunteers aged from 27 to 67 years. In bilateral putamen, left supratemporal\ left infrafrontal and left parietal cortices, CMR02 showed a significant decline during aging. The age-related decline of CBF was seen only at the left superior temporal cortex. The mean CMR02 was significantly lower in the elder group (over 51 years old) than in the younger group (under 50 years old), whereas no significant difference in mean CBF between the two groups. The poor correlation of CBF to the age could be explained partly by the fact that CBF is easily influenced by the physiological, psychological and/or environmental factors. The age-related changes of CMR02 were more marked in the association cortices of the left hemisphere than in that of the right hemisphere.

Background Magnetic resonance–guided PLDD has been performed for patients with single-level contained focal disk herniation. We investigated the clinical results of our PLDD practice in reference to the site of the needle tip. Methods Thirty-two patients (24 male patients and 8 female patients; mean age, 35 years) who presented with low back pain and signs of monoradiculopathy underwent MR-guided PLDD. The final location of the needle tip was plotted on a T 1 -weighted axial plane of the targeted disk. An axial image of the targeted disk was divided into 4 quadrants in a cruciform fashion and into 3 zones in a concentric circle. The clinical results as evaluated by MacNab's criteria 6 months after PLDD were investigated in each subdivided area where the needle tip was located. Results The overall success rate of our PLDD practice was 68.8%. The success rate in the 27 patients who had the needle tip in the DL quadrant of the targeted disk was 70.4%. Among them, 14 patients who had the needle tip in the middle zone showed a favorable outcome (77.8%). Conclusions The final location of the needle tip was demonstrated in all cases. Although our MR imaging study was not sufficient to determine the exact position of the needle tip because of MR image distortion, such error seems to be acceptable in the results of our study obtained from the relative positioning of the needle tip in the disk space. This study suggests that the middle zone in the DL quadrant of the targeted disk space seems to be a favorable target to obtain better clinical outcomes.

Nanohole processing of silicon substrate using surface plasmon polaritons of nano gold excited by femtosecond laser is described in comparison with the nanohole processing with transparent polystyrene (PS) nanoparticle template. Gold particles with diameters of 40, 80, or 200 nm are spin coated on the substrate, and a 100 fs, 820 nm laser pulse is used to irradiate the samples. The produced holes are analyzed by scanning electron microscopy and atomic force microscopy. A theoretical analysis of the experimental results is conducted by FDTD (Finite Difference Time Domain) simulation. The dependence of the laser fluence and particle size on the nanohole properties is studied. The nanohole profiles correspond to the field distributions on the Si substrate at low fluence region. A highest electric field enhancement factor of about 26 is obtained for gold particles with a diameter of 200 nm.

We have demonstrated the nanostructure fabrication on the Si surface by a 150 fs, 800 nm femtosecond laser pulse. The nanohole size of about 100 nm can be formed presumably by a near-field optical enhancement effect induced by the particle illumination. The nanohole size is nearly independent of the irradiated pulse number. It is found that the optical enhancement factor was about 7 in this experiment. The hexagonally arrayed nanoholes were fabricated. The diameter of the fabricated nanohole was about 90 nm and the depth was about 9 nm. In addition, using the double pulse fs laser, we demonstrated a low-loss waveguide fabrication in fused silica. A low-optical-loss waveguide is fabricated under the conditions that the first pulse energy and teh second pulse energy in the double pulse mode are 30 jJ and 160 jJ, respectively, nad the pulse time interval is 3 ps. The weak first pulse would act as a pre-conditioner of the fused silica and then the second subsequent pulse effectively induces the uniform refractive index change. This new femtosecond double pulse fabrication technique will be very promising for low-loss photonic device fabrication for photonic networks.© (2005) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

We report a nanohole array fabrication with a particle light enhancement effect using a femtosecond laser pulse. Two-dimensional (2-D) arrayed polystyrene (PS) nanoparticles are deposited on silicon (Si) substrates. Polystyrene spherical particles with diameters of 200, 450, and 820 nm are used. We investigated the fabricated nanohole profiles in terms of the particles diameter and irradiated laser fluence. The morphology of the nanoholes is characterized by scanning electron microscopy (SEM) and atomic force microscopy (AFM). The nanohole diameter and depth became larger and deeper as the diameter of used particle or the irradiated laser fluence is increased. The intensity enhancement factor is obtained from the experimental data by comparing the nanohole depths to the ablation rate of the Si surface without particles. The enhanced light intensity between a PS particle and a Si substrate is calculated by the finite difference time domain (FDTD) method. The calculated optical enhancement factor is consistent with the experimental value.

We will report on nanostructure fabrication on silicon (Si) substrate by 800 nm femtosecond laser pulses. Spherical alumina particles were placed on the substrate surface. After femtosecond laser irradiation at below-ablation-threshold fluences, we have successfully observed the nanoholes formation with around 100 nm in diameter using scanning electron microscope (SEM) and atomic force microscope (AFM). The dependence of nanohole formation on the laser fluence and laser pulse number was investigated. The mechanism for the nanohole drilling is the near-field optical enhancement effect induced by interaction between local surface plasmon on the particles surface and surface plasmon polariton on the Si substrate surface.

We present nanohole array fabrication on a silicon substrate using a femtosecond laser pulse at 820 nm and 100 fs, and a subwavelength polystyrene (PS) particle array as a template. Nanohole array fabrication uses a particle field enhancement effect and two-dimensional (2-D) arrayed PS nanoparticles deposited on a (100) silicon (Si) substrate. PS spheres 200, 450, and 820 nm in diameter are used. The fabricated nanohole profiles in terms of the particle diameter and irradiated laser fluence are investigated. The nanohole diameter and depth become larger and deeper, respectively, as the diameter of the particles used or the irradiated laser fluence is increased. Light intensity enhancement by the particles is obtained experimentally by comparing ablation rates of the Si substrate with and without particles. The enhanced light intensity between a PS particle and a Si substrate is also calculated by the finite difference time domain (FDTD) method. The calculated optical enhancement factor is consistent with the experimental value.

To study the correlation between somatosensory central conduction time (CCT) and the subject's height, we recorded somatosensory evoked potentials (SEPs) from the neck and scalp elicited by median nerve stimulation in 72 normal young adults. We determined the CCT in each subject from peak-to-peak and onset-to-onset measurements. The mean value for the onset CCT was 6.2 +/- 0.4 msec and for the peak CCT, 5.7 +/- 0.5 msec. The peak CCT was significantly shorter but showed a wide range. There was a significant correlation between the onset CCT, but not the peak CCT, and height. Our findings confirm that the length of the central somatosensory pathway is proportional to the subject's height and indicate that the "conventional" peak CCT measurement of median nerve SEPs is inadequate.