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This study evaluated the contrast-to-noise ratio (CNR), spatial resolution, and subjective quality of dual imaging plates (DIP) intraoral radiography.The DIP and conventional single IP (CSIP) methods both used YCR DT-1 imaging plates (Yoshida Co.). The DIP, comprising a front IP (FIP) and back IP (BIP), was constructed. DIP images were synthesized from the FIP and BIP images. An aluminum step phantom was used to measure the CNR. A line pair gauge was used to measure the spatial imaging resolution. A phantom comprising a porcine mandible embedded in acrylic resin was used for subjective evaluation.The CNR of the DIP image was 32% higher than that of the FIP image. The spatial resolution achieved using the FIP, DIP, and CSIP was highly comparable except above 4 line pairs/mm, where that of the CSIP was highest. In subjective evaluation, the noise in the DIP images was significantly lower than in those obtained using the FIP and CSIP.The CNR of the DIP was higher than that of the FIP. The decrease in spatial resolution of the DIP was limited. The subjective image quality of the DIP was higher than that of the FIP.

The Great East Japan Earthquake occurred in Japan on March 11, 2011, with a nuclear accident occurring at the Fukushima Daiichi Nuclear Power Plant afterward. The disaster constrained many evacuees to change their lifestyles. However, the effect of evacuation on the new-onset of hyperuricemia have not been sufficiently elucidated. We aimed to assess the association between evacuation and new-onset hyperuricemia after the earthquake based on the Fukushima Health Management Survey from a lifestyle and socio-psychological perspective. A longitudinal study examined data collected from 18,140 residents (6,961 men and 11,179 women) with non-hyperuricemia who underwent both the Comprehensive Health Check and the Mental Health and Lifestyle Survey between 2011 and 2017. Using a Cox proportional hazards regression model analysis, we estimated associations between new-onset hyperuricemia and lifestyle- and disaster-related factors, including evacuation. We defined hyperuricemia as uric acid levels > 7.0 mg/dL for men and > 6.0 mg/dL for women. A total of 2,996 participants (1,608 men, 23.1%, 1,388 women, 12.4%) newly developed hyperuricemia during a median follow-up of 4.3 years. This study observed significant associations between evacuation and onset of hyperuricemia in women (adjusted hazard ratio 1.18, 95% confidence interval, 1.05–1.32, p = 0.007), but not in men (adjusted hazard ratio 1.11, 95% confidence interval, 0.99–1.24, p = 0.067). Evacuation after a natural disaster is an independent risk factor for the new-onset of hyperuricemia in women.

To investigate the distribution of nurse practitioners (NPs) across Japan and their perceived facilitators and barriers to NP implementation in Japan.NP certification examinations have been conducted in Japan since 2011, and by 2020, there were 487 NPs in the country. The momentum of NP implementation is slower in Japan compared with other countries.A cross-sectional descriptive study, following the STROBE guidelines, was conducted. Web-based survey questionnaires, developed by the authors, were administered to 248 NPs whose email addresses were maintained by the certification management body.Valid responses were obtained from 101 NPs (response rate: 40.7%), of which 34% were male. The respondents had more than 12 years of registered nurse experience on an average before enrolling in the graduate NP program. 53% were employed as NPs from the beginning, while 25% were initially employed as registered nurses and later advanced to NPs, and 11% still worked as RNs. A majority worked in hospitals with beds. Many NPs perceived the lack of NP national licensure and reimbursement benefits as barriers to NP implementation, whereas recognition from superiors and organizations was considered facilitators.Despite their small numbers in Japan, NPs take on crucial tasks and contribute to the appropriate distribution of medical resources. The NP licensure system and recognition from superiors and organizations may be necessary to promote NP roles in Japan.Some certified NPs still work as registered nurses. Recognition from nursing and organization administrators is critical to implementing NPs. To this end, a reimbursement system benefiting the organizations and a legislation facilitating NP employment are required.

Background and aims On March 11, 2011, the Great East Japan Earthquake occurred in Japan, with a nuclear accident subsequently occurring at the Fukushima Daiichi Nuclear Power Plant. The disaster forced many evacuees to change particular aspects of their lifestyles. This study assessed the association between evacuation and hyperuricemia based on the Fukushima Health Management Survey from a lifestyle and socio-psychological perspective. Methods and results This cross-sectional study included 22,812 residents (9391 men and 13,297 women) who underwent both the Comprehensive Health Check and the Mental Health and Lifestyle Survey in fiscal year 2011. Associations between hyperuricemia and lifestyle- and disaster-related factors including evacuation were estimated using a logistic and liner regression analysis. With hyperuricemia defined as uric acid levels >7.0 mg/dL for men and >6.0 mg/dL for women, significant associations were observed between evacuation and hyperuricemia in men (the multivariate-adjusted odds ratio 1.20, 95% confidence interval, 1.05–1.36, p = 0.005), but not in women. In the multivariate-adjusted multiple liner regression analysis, evacuation had significant and positive associations with uric acid levels both in men (β = 0.084, p = 0.002) and women (β = 0.060, p Conclusion Evacuation after a natural disaster is an independent factor associated with hyperuricemia.

Purpose The spatial resolution of cone-beam computed tomography (CBCT) in small fields of view (FOVs) is important for clinical applications. However, it is difficult to measure spatial resolution reliably due to error factors such as noise. The aim of this study was to obtain a modulation transfer function (MTF) more accurately. Methods A CBCT apparatus was used with small FOV. An aluminum pipe slightly tilted at an inclination ratio of 77/3 (25.7) was used as the measurement phantom. The MTF was calculated from the edge image of the phantom. The actual oversampling ratio was determined by regression analysis. The experiment was repeated 16 times and the edge-spread function (ESF) was approximated by the least-square method. Furthermore, a low-pass filter (LPF) was applied to eliminate the component at frequencies above the Nyquist frequency. Finally, the MTF was calculated from the pre-processed ESF. Results Results showed that pre-processing reduced the noise of the ESF. The MTFs at frequencies of 1.0 and 2.0 LP/mm were 0.59 and 0.18, respectively, in air and 0.52 and 0.16, respectively, in water. Conclusion The repeating-edge oversampling method combined with ESF pre-processing improved the accuracy of the MTF under clinically relevant conditions with a phantom.

This study was performed to develop a new rat model of reduced masticatory activity in order to assess the effect of this reduction on the morphology of the temporomandibular joint (TMJ) over time. Female rats were used, and ovariectomy was performed to simulate aged/postmenopausal status. Twenty-four SD rats aged 6 weeks were divided into four groups: ovariectomy/sham procedure (Ov/S); ovariectomy/reduced masticatory activity (Ov/RMA); non-Ov/S (NO/S); and non-Ov/RMA (NO/RMA). The RMA procedure involved grinding down the edges of the upper and mandibular incisors by about 3 mm and supplying the rats with a powdered diet. The bilateral TMJ was examined by micro-computed tomography at 0, 1, 2, 4, 6, and 8 weeks after the start of RMA. Condylar width was greater in the NO/S group than in the Ov/S group after the 2nd week, showing that ovariectomy reduced the width of the condyle. After the 2nd week, significant differences in condylar width were apparent between the NO/S and NO/RMA groups, and between the Ov/S and Ov/RMA groups. This RMA procedure appeared to provide a good model of reduced masticatory activity. The present findings in female rats suggest that reduction of appropriate mastication activity in the growth period results in poor growth of the mandibular condyle and immediately induces atrophy of the mandibular condyle under conditions simulating aged/postmenopausal status.

The present study used an aluminum phantom to calculate accurate vertical magnification values around the mental foramen on panoramic radiography (PR) and compared corrected PR (Cor-PR) thickness measurements of the aluminum phantom and mandibular cortical width (MCW) of the human head with cone-beam computed tomography (CBCT) measurements at two fields of view (FOVs). The calculated vertical magnification value for PR around the mental foramen was 1.37. Measurements of the aluminum phantom significantly differed between Cor-PR and CBCT with an FOV of 100 mm and between CBCT with FOVs of 40 and 100 mm; however, MCW measurements did not significantly differ among the three methods. There was a very strong correlation between Cor-PR and CBCT with an FOV of 40 mm and between CBCT with FOVs of 40 mm and 100 mm, and intraobserver and interobserver agreement was good-to-excellent for all methods. These results suggest that Cor-PR and CBCT with small and large FOVs are acceptable for measuring MCW.

In the field of dentistry, diagnoses based on data obtained using medical imaging modalities such as digital panoramic radiography and cone beam computed tomography (CBCT) have been widely recommended for advanced dental care. In Lao People’s Democratic Republic (Laos), there are place where advanced dental imaging devices are available in only one university dental hospital. The establishment of an information and communication technology (ICT) system has been expected as telemedicine system, for sharing medical imaging data among medical institutions in Laos. Recently, regional medical cooperation using telemedicine has been developed in Japan, and medical imaging data have been provided and shared among medical institutions, by using a mobile tablet terminal application. Therefore, we have carried out the empirical research on the telemedicine system with the university in Laos. The technologies and research results from our project will be presented in this chapter.

Recently, the occurrence of large earthquakes has become a concern in Japan, prompting the need for a numerical method that can accurately predict real phenomena, such as the elastoplastic soil-water coupled finite element method. Because the elastoplastic constitutive model requires many material parameters, various soil tests and specialized knowledge are needed to determine these material parameters. In this study, a new method was proposed to determine the material parameters from the limited ground information obtained by borehole inspections and the method was validated by comparing the numerical results with monitored seismic behavior. One-dimensional seismic analyses were conducted using the material parameters estimated from borehole data near the target sites. It was confirmed that the amplitude and predominant period obtained by numerical simulation were consistent with the monitored data. As a result, it was found that the dynamic numerical result was more consistent with the monitored data when the compression index was set to be larger than that in the static analysis.

Our hospital, located on the mainland, serves as a hub center for nine hospitals on the remote islands of Nagasaki Prefecture, Japan. There are no stroke specialists on these islands. We can transfer emergency patients from these islands to our hospital at any time, using a teleradiology system and three types of helicopter transport. We examined the efficacy of the drip and ship (DS) method for treating patients with acute ischemic stroke (AIS) on these islands, in comparison with patients on the mainland. From 2010 to 2017, we reviewed 98 consecutive patients with AIS who received intravenous recombinant tissue plasminogen activator (IV rt-PA) in our hospital or were transported to our hospital after IV rt-PA. Patients were divided into the Islands group (received IV rt-PA on the islands, DS; 31 cases) and the Mainland group (67 cases). The median transport distance from the islands was 112 km. The rate of patients achieving favorable outcomes was 54.8% in the Islands group and 64.2% in the Mainland group, with no significant differences. Multivariate analysis revealed that patients living on isolated islands did not have increased risks of unfavorable outcomes. Endovascular therapy (EVT), as part of the drip, ship, and retrieve method, was performed in 22.6% of patients in the Islands group and EVT in 38.8% of those in the Mainland group. The DS method seems feasible and safe for patients living on isolated islands with the use of 24-h helicopter transportation and teleradiology., Neurologia medico-chirurgica, 59(12), pp.504-510; 2019

In the wide area of the eastern part of Tokyo, the ground level is less than mean sea level. This area is more vulnerable to disasters than other areas. If large flood damage such as storm surge should occur in this area, the disaster would be a long-term catastrophe. On the coast of Tokyo Bay, countermeasures have been taken by tide embankments and floodgates. However, considering the damage scale when it occurs, an analysis in this area is very important. In this area, ground settlement occurred and groundwater head dropped because groundwater excessively withdrew by the industrial purpose during the period of economic growth. Currently, the groundwater head recovers and the ground settlement has been subsided. However, due to the groundwater head fluctuation, pore water pressure distribution had been different from hydrostatic pressure distribution. Therefore, in the analysis in this area, it is necessary to consider past groundwater head fluctuation. In this research, the ground settlement and the distribution of pore water pressure are simulated from groundwater level fluctuation over the past 100 years. Then, we conducted the seismic analysis by input the distribution of effective stress calculating from the simulated ground water pressure. The sites analyzed in this research are Tokyo Sea Life Park at the mouth of Arakawa River.

We report a rare case of asymptomatic aplastic or twig-like middle cerebral artery (Ap/T-MCA) with small unruptured aneurysms at the origin (A1) of the anomalous collateral artery containing plexiform (twig-like) networks and in the anterior communicating artery. In Ap/T-MCA, other cerebrovascular systems are usually considered to exhibit normal findings not associated with atherosclerosis. At first admission, atherosclerotic M1 occlusion was suspected because of the patient's risk factors and multiple stenoses in major intracranial arteries. Cerebral blood flow (CBF) studies revealed reduction of resting CBF and vascular reserve in the ipsilateral MCA territory. After 5 years, a diagnosis of Ap/T-MCA was reached based on detailed image examination and intraoperative findings during aneurysm clipping in combination with extracranial-intracranial (EC-IC) bypass. It should be noted that atherosclerosis can coexist with Ap/T-MCA, which is considered a congenital anomaly in which bleeding often occurs due to a ruptured aneurysm within the fragile collateral vessels. In previous reports, A1 aneurysms at the origins of the collateral arteries ruptured even when they were small. Aggressive radical surgery using EC-IC bypass can be considered for the treatment of unruptured aneurysms associated with Ap/T-MCA, but further research is needed. (Received September 14, 2020; Accepted November 4, 2020; Published 1 April, 2021).

Herein, we report a rare case of a dissecting aneurysm of the M2 segment of the middle cerebral artery(MCA), presenting with a deep white matter infarction triggered by minor head injury. A 31-year-old woman was admitted to our hospital with headache and vomiting 3 hours after a mild head impact. A magnetic resonance angiogram obtained 10 months earlier, when the patient had complained of sudden headache, showed mild fusiform dilatation of the left M2 segment. On admission, computed tomography angiography(CTA)revealed irregular fusiform dilatation of the superior trunk of the left M2. Magnetic resonance imaging showed an intramural hematoma on the wall of the left M2 and acute infarction in the left deep white matter. Eight days after admission, CTA revealed further dilation of the aneurysm, and it was diagnosed as a dissecting aneurysm. The patient was successfully treated with proximal clipping and superficial temporal artery(STA)-MCA(M4)bypass on day 15. Bypass to a cortical M4 recipient was performed after the efferent M4 was identified using indocyanine green videoangiography. Four weeks postoperatively, the patient was discharged without any neurological deficits. The M2 dissecting aneurysm gradually regressed, and the bypass remained patent for 10 months postoperatively. To our knowledge, this is the first case of a dissecting M2 aneurysm treated by proximal clipping and STA-MCA bypass. This procedure seems a feasible option when the distal portion of the dissected MCA is difficult to expose.

A 58-year-old woman underwent left frontotemporal craniotomy for clipping of an unruptured cerebral aneurysm. A small defect was accidentally created in the orbital roof intraoperatively. The patient developed left eyelid edema and ocular pain after recovery from anesthesia. The following day, the eyelid edema worsened, and she had difficulty opening her eyes. On the 9

Purpose Circadian rhythm is associated with the pathogenesis of systemic disease and bone mineral metabolism. This study aimed to radiographically evaluate morphological characteristics of the interalveolar septum in circadian rhythm deficient animals. Methods Heads of 10 brain and muscle arnt-like protein-1 (BMAL1)-knockout (KO) mice and 10 wild-type mice sacrificed at 36 weeks were imaged using micro-computed tomography. The mean depth from the cementoenamel junction to the alveolar ridge (virtual bone sounding: VBS) of the interalveolar septum between the first and second molars, and the bone mineral density (BMD) of the interalveolar septum and the mandibular inferior cortex region were calculated. Tooth diameter was also measured. Results The VBS of the interalveolar septum in the BMAL1-KO mice was significantly deeper than that in wild-type mice. The BMD in the BMAL1-KO mice was significantly lower than in the wild-type mice in both regions. No significant difference was observed in tooth diameter between BMAL1-KO and wild-type mice. Conclusion These results suggest that low BMD in the interalveolar septum accelerates bone resorption in the interalveolar septum in BMAL1-KO mice.

A 69-year-old woman presented on an emergency basis, with headache and left hemiparesis. Initial head CT at the time of admission revealed a large subcortical hematoma with perihematomal edema extending from the right parietal to the occipital lobe. A small part of the hematoma extended toward the trigone of the right lateral ventricle. CT angiography revealed no vascular abnormalities. Emergency craniotomy was erformed, and the patient's initial postoperative course was unremarkable. However, the patient's neurological symptoms worsened 10 days postoperatively, and CT revealed a new low-density cystic lesion with perifocal edema at the site of hematoma removal, in addition to severe cerebral compression. We performed a reoperation, and intraoperatively we observed hematoma fluid mixed with cerebrospinal fluid without any abnormal blood vessels or neoplastic lesions in the hematoma cavity. We identified the choroid plexus deep within the surgical field, and slight leakage of cerebrospinal fluid was detected from the ventricular aspect, indicating the formation of a small passage between the hematoma cavity and the ventricle. After the second operation, her postoperative course was uneventful without recurrent cyst formation. An early symptomatic expanding porencephalic cyst in the hematoma cavity after removal of an intracerebral hematoma is rare, and only a few cases have been reported in the literature. Based on literature review and considering the likely mechanism of cyst development, we speculated that progressive cyst expansion could be attributed to a check valve mechanism between the ventricle and the cavity from which the hematoma was removed, as observed in the present case.

Cerebral aneurysms and arachnoid cysts are relatively common cerebral malformations and the use of recent modalities has increased their detection rates. However, cerebral aneurysms associated with arachnoid cysts are unusual. We describe two cases of ruptured cerebral aneurysms associated with arachnoid cysts. According to previous reports, clinical presentation may sometimes be unusual, as cysts can prevent subarachnoid hemorrhage. Moreover, in some cases, CT may reveal typical arachnoid cysts without subarachnoid hemorrhage, without intracystic hematoma, or with subdural hematoma alone. These clinical presentations and radiologic findings can lead to delayed diagnosis of subarachnoid hemorrhage. Therefore, we should consider the coexistence of arachnoid cyst in case of a warning sign of aneurysm rupture.

Cervical carotid disease is typical atherosclerosis, which is responsible for ischemic stroke. The effectiveness of carotid endarterectomy (CEA) for advanced carotid stenosis has been established in many large studies, and CEA is the gold standard in surgical treatment. On the other hand, endovascular carotid artery stenting (CAS) has become increasingly popular recently. It is very important to avoid any complications to maintain the effectiveness of CEA. The retractor device is important for the exposure of carotid arteries and for the safe surgical manipulation. We have started to use lone star retractor system (LSRS) to deploy the surgical field. LSRS provides the usability to handle and a shallower surgical field without the disturbance of surgical manipulation. And it can facilitate exposure of the distal internal carotid artery because surgeon can retract freely in whole circumference by towing with moderate strength. LSRS may bring the smoother and easier surgical manipulations in CEA.

Intracranial germinomas are considered one of the most radiosensitive tumors and are curable by radiotherapy alone. Although patients can expect long-term survival, the adverse effects of radiotherapy and late sequelae in survivors are a major concern. Radiation-induced secondary neoplasms are one of those sequelae and are a serious concern because they are often connected directly with life prognosis. We describe a case of radiation-induced glioblastoma after radiotherapy for germinoma. An 11-year-old boy with basal ganglia germinoma was successfully treated with postoperative cranial irradiation. At the age of 40 years, he was admitted to our hospital for aphasia and memory disturbance. CT and MRI revealed a tumor in the left parietal lobe with dissemination. The tumor of the parietal lobe was removed surgically, and pathohistologically, it was diagnosed as glioblastoma. Long-term survivors who receive radiotherapy for germinomas in childhood are at risk for late complications, including radiation-induced neoplasms. Therefore, careful follow-up neurological examinations are recommended in these patients, even 20-30 years after radiotherapy.

Our hospital serves as the main hub for eight remote island hospitals(RIHs)in Nagasaki Prefecture, Japan. The shortage of stroke physicians, which has led to overwork, is a major concern. Several "task-shifting" systems were adopted to avoid physician burnout. First, the emergency department established a hotline system for receiving emergency calls regarding a stroke, and which managed initial care until the stroke physicians arrived(called the Nagasaki Medical Center stroke hotline system: N-SHOT)in 2014. The rt-PA administration rate increased from 3.3% in the Pre-N-SHOT group to 6.7% in the N-SHOT group. Second, the 'isolated islands stroke hotline system(I-SHOT)', with which physicians in RIHs participate in cooperation with N-SHOT, was started in 2017. After I-SHOT was introduced, the number of patients treated with the drip and ship method using teleradiology and 24-h helicopter transportation increased from 20(2010-2016)to 29 cases in 2017-2018. Additionally, new information and communication technology(ICT)using smart devices was introduced into the teleradiology system for task support. Third, on behalf of stroke physicians, nurse practitioners(NP)helped bedridden patients who had been delivered from RIHs and who had received acute treatment, and returned to their islands by helicopter or airplane as transitions of care. N-SHOT is smoothly operated by each hospital department without reducing the quality of the stroke hotline. It has contributed to an increase in rt-PA and mechanical thrombectomy cases; I-SHOT has had the same effect. Task-shifting and task support with N-I-SHOT, the smooth transfer system by NP, and the new ICT are considered to be useful for reducing the overall burden of stroke physicians.

A 59-year-old woman suffering from memory impairment visited our hospital. She was discharged nine years ago without complications after undergoing neck clipping surgery for intracranial aneurysm rupture and a right ventricular peritoneal shunt using the CODMAN

A 68-year-old male with a sudden headache while defecation was transferred to our hospital. He was initially diagnosed with intracerebral hemorrhage in the right occipital lobe and acute subdural hematoma(ASDH)in the right interhemispheric fissure. A CT angiography(CTA)showed stenosis in the superior sagittal sinus(SSS)and the vein of Galen(VG)near the hematoma, which were considered to be due to compression of the hematoma. In the source image of CTA, the enhancement effect of the hematoma part was not clear. MRI revealed a heterogeneous mixed signal intensity in the hematoma area, suggesting a mixture of hematoma components that had bled at different times. Cerebral angiography performed two weeks after onset showed a tumor shadow imaged from the middle meningeal artery. Therefore, the presence of hemorrhagic meningioma was suspected. This was confirmed by contrast-enhanced MRI. One month after the onset, tumor resection was performed after the embolization of the feeding artery. Part of the tumor around the SSS and VG was left due to severe adhesion. Postoperatively, stenosis of the SSS and VG significantly improved. In this case, the increase in venous pressure may be related to the bleeding mechanism. Hemorrhagic onset meningioma with interhemispheric ASDH is extremely rare, and only 4 cases have been reported. It is easy to misdiagnose if only non-contrast CT is used. It should be noted that in cases of intratumoral hemorrhage, CTA may not show an enhancing effect in the acute phase. Since contrast-enhanced MRI may be useful for a definitive diagnosis, it should be performed at the time of initial imaging.

A 17-year-old female in a lethargic state with mild dysarthria was transferred to our hospital after experiencing a generalized tonic seizure immediately after giving birth. Head CT showed a cortical subarachnoid hemorrhage(cSAH)in the left frontoparietal convexity. Three-dimensional rotational angiography(3D-RA)revealed multifocal narrowing of the cortical branches of the left middle cerebral artery(MCA)and severe stenosis of the left M1 segment with plexiform collateral networks, suggesting the presence of reversible vasoconstriction syndrome(RCVS)and aplastic or twig-like MCA(Ap/T-MCA). When 3D-RA was repeated on day 17, the narrowing of the cortical artery had resolved, and a new constriction of more proximal blood vessels was observed. The arterial spasm disappeared within 3 months, confirming the diagnosis of RCVS and Ap/T-MCA. Although non-aneurysmal SAH due to Ap/T-MCA is extremely rare, RCVS often complicates cSAH in the frontal/parietal region. It is suggested that RCVS triggers cSAH in the presence of incidental Ap/T-MCA. Ap/T-MCA is thought to be caused by developmental abnormalities during the embryonic period, but only 11 cases in children or adolescents have been reported. This suggests that there are a considerable number of asymptomatic young patients whose condition has not been detected. The majority of patients with Ap/T-MCA are from East Asia, suggesting that racial and genetic background differences are a factor. As this anomaly is more likely to present as a stroke in adulthood, long-term follow-up is recommended if it is found at a young age. There is no evidence that revascularization is effective in preventing stroke. Further studies are needed on how to manage this condition appropriately.

We report two rare cases of late-onset brain edema after craniotomy for clipping or coating of unruptured intracranial aneurysms, possibly due to an allergic reaction to topically applied fibrin glue or gelatin sponge used for arachnoid plasty to cover the opened sylvian cistern. Both patients were women in their 60s with an allergic predisposition and both followed a similar clinical course. A slight fever and headache persisted during the postoperative period. Five to six weeks after surgery without complications, MR images showed an extensive T2 prolongated region in the white matter around the operative field, indicative of vasogenic edema, with mass effect and meningeal enhancement around the sylvian fissure that had been covered with gelatin sponge and sprayed fibrin glue. Swelling of the cerebral cortex around the sylvian fissure subjected to arachnoid plasty was also observed. Blood tests showed the absence of an inflammatory reaction and cerebrospinal fluid examination showed lymphocytosis that was considered to be due to an aseptic meningeal reaction or meningitis. Clinical symptoms and imaging findings steadily improved with the administration of steroids and antiallergic agents. Delayed brain edema may occur around the arachnoid plasty area despite an uneventful chronic postoperative period, which could be due to an allergic reaction to locally administered fibrin glue or gelatin sponge. Thus, the application of arachnoid plasty using fibrin glue and gelatin sponge in patients with a predisposition to allergies needs to be carefully considered.

We report a rare case of perianeurysmal edema(PAE)around the dome of a usual intracranial aneurysm. A 79-year-old woman who presented with a dull headache that had become stronger from a month before was referred to our hospital for further examination of an aneurysm. MR angiogram had detected the aneurysm, having a dumbbell shape and arising from the M2 bifurcation of the right middle cerebral artery. Initial fluid attenuated inversion recovery and T2 weighed images revealed a slightly high intensity area in the brain around the dome of the aneurysm buried in the right temporal lobe, suggesting the presence of PAE possibly due to a preceding minor leak or partial thrombosis or impending rupture of the aneurysm. A CT angiogram revealed bleb formation of the aneurysm(size:10×6 to 4mm)without definite intraluminal thrombosis. The patient and her family consented to emergency craniotomy. During the microsurgical approach, thickening of the arachnoid membrane on the right sylvian fissure was observed. The subarachnoid space between the right frontal and temporal lobes was turbid/adhesive, and deposition of hemosiderin was observed around the aneurysm, indicating a preceding minor bleeding. The aneurysm was successfully clipped, and the postoperative course was uneventful. The present case showed that PAE could be observed even in a usual aneurysm. This finding might be an indirect sign of a preceding minor leak from the aneurysm, particularly when the dome is buried in brain parenchyma or is in close contact with the surrounding brain surface.

Background: Middle cerebral artery (MCA) has a significantly lower incidence of anatomical variations than other intracranial arteries. We present an extremely rare case of unruptured aneurysms with the segmental duplicated MCA (d-MCA) formed a fenestrated structure at origin. Case Description: A 55-year-old female underwent direct surgery for the unruptured aneurysms at the top of the right internal cerebral artery with d-MCA. The d-MCA branches separated at the right internal cerebral artery top and had comparable with that of the main MCA trunk. Moreover, there was an anastomosis between the d-MCA branches. We diagnosed this anastomosis as segmental d-MCA. Two aneurysmal domes were identified during surgery at the origin of the d-MCA, which the main dome protruding backward was wide necked and another small one was collapsed or thrombosed protruding forward. We used a fenestrated clip for the posterior projecting dome, and the aneurysms were successfully obliterated. Conclusion: Although cerebral aneurysms associated with d-MCA are rare, there are technical difficulties in the surgical management. A fenestrated clip might be most reasonable to obtain patency of the parent arteries for the posterior projecting aneurysms if the perforators can be avoided.

The highly enantioselective Diels-Alder reaction of acetylenic dienophiles is shown to be effectively catalyzed by cationic chiral palladium complexes. Not only the degree but also the sense of enantioselectivity critically depends on the steric demand of ligands. Computational analyses indicate that the steric demand does not affect the endo/exo-selectivity but the enantioface selectivity of dienes.

Highly enantioselective [3+2] cycloaddition of ynones and nitrones has been developed. Very bulky ligand, DTBM-SEGPHOS, was used for an effective asymmetric induction over distal reaction centers on the linear ynone dipolarophile and for prevention of PdII catalyst deactivation by coordination of the nitrones. The reaction has wide scope of substrates in both ynones and nitrones.

Brain and muscle Arnt-like protein-1 (BMAL1) knockout mice exhibit accelerated aging, abnormal glucose metabolism, and impaired adipocyte differentiation, among other phenotypes, which are effects associated with the BMAL1 gene. No study has investigated temporal changes in the deformation of the mandibular condyle and the presence of calcification in areas surrounding the mandibular condyle. In a study of 12 C57/BL strain mice under inhalation anesthesia, we collected images of the mandibular condyle at 6 weeks after birth and then every 5 weeks from 10 to 25 weeks after birth. At 25 weeks, deformation of the mandibular condyle was seen in 8 of 12 joints in BMAL1 knockout mice and in 2 of 12 joints in wild-type mice. At 20 and 25 weeks, deformation in areas surrounding the mandibular condyle, which are known to undergo calcification, was seen in 2 of 12 joints in BMAL1 knockout mice and in 0 of 12 joints in wild-type mice. BMAL1 knockout mice exhibited premature aging of the mandibular condyle, which suggests that circadian rhythms affect mandibular condyle morphology.

We compared the diagnostic reliability of 3.0-T magnetic resonance imaging (MRI) for detection of osseous abnormalities of the temporomandibular joint (TMJ) with that of the gold standard, cone-beam computed tomography (CBCT). Fifty-six TMJs were imaged with CBCT and MRI, and images of condyles and fossae were independently assessed for the presence of osseous abnormalities. The accuracy, sensitivity, and specificity of 3.0-T MRI were 0.88, 1.0, and 0.73, respectively, in condyle evaluation and 0.91, 0.75, and 0.95 in fossa evaluation. The McNemar test showed no significant difference (P > 0.05) between MRI and CBCT in the evaluation of osseous abnormalities in condyles and fossae. The present results indicate that 3.0-T MRI is equal to CBCT in the diagnostic evaluation of osseous abnormalities of the mandibular condyle.

Residual renal function (RRF) is a strong prognostic factor of morbidity and mortality in patients undergoing peritoneal dialysis (PD). We determined predictors of the RRF rate of decline using both baseline values and time-averaged ones. We retrospectively analyzed 94 patients being treated with PD at the Japanese Red Cross Medical Center. The decline rate of RRF was calculated by a diminution in the weekly renal Kt/V between the first and last follow up divided by follow-up years. The mean follow-up period was 2.28 years, and the mean decline rate of weekly renal Kt/V was 0.25 per year. A multivariate analysis using baseline parameters identified dialysis-to-plasma ratios of creatinine at 4 h (P = 0.02), urinary protein (P = 0.02), and mean blood pressure (MBP) (P < 0.01) as being positively associated with the RRF rate of decline, while the use of angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) had a negative correlation (P = 0.03). When using time-averaged values as independent variables, a lower weekly total renal Kt/V (P < 0.0001), higher urinary protein (P < 0.0001), and higher MBP (P = 0.04) independently predicted a faster RRF rate of decline. We demonstrated that PD patients with a lower MBP and lower urinary protein both at baseline and throughout their PD duration had a slower RRF rate of decline. We recommend strict control of blood pressure and anti-proteinuric therapy for PD patients.

We report a case of reactive arthritis (ReA) triggered by Yersinia enterocolitica enteritis. A 24-year-old Japanese man developed polyarthritis in the lower limbs. Two weeks prior to these symptoms, he noted diarrhea, right lower abdominal pain and a fever. Y. enterocolitica was not isolated from a stool culture; however, he was diagnosed with ReA based on the colonoscopic findings of a high anti-Y. enterocolitica antibody titer and HLA-B27 antigen positivity. Following treatment with methotrexate and steroids, his arthritis improved. This is the first reported Japanese case of ReA in the English literature after a gastrointestinal infection caused by Y. enterocolitica.