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A 49-year-old woman presented with abdominal pain. A computed tomography scan revealed a left breast mass with suspected peritoneal dissemination. She had no notable family history of the disease. Following a detailed examination, she was diagnosed with ovarian cancer(Stage ⅢC)and left breast cancer(Stage Ⅰ). After confirming the diagnosis of ovarian cancer with a laparoscopic biopsy, neoadjuvant chemotherapy was scheduled. Due to its efficiency in reducing tumor burden, debulking surgery was also performed. While receiving adjuvant chemotherapy for ovarian cancer, concomitant anastrozole was administered for breast cancer. A pathogenic variant of BRCA2 was subsequently identified. Once adjuvant chemotherapy for ovarian cancer had been completed, a left mastectomy and sentinel lymph node biopsy were performed as management for breast cancer. The patient will continue treatment with anastrozole for breast cancer and olaparib for ovarian cancer and will be followed up appropriately.

Background The rapid and accurate diagnosis of individuals with SARS-CoV-2 infection is an effective way to prevent and control the spread of COVID-19. Although the detection of SARS-CoV‐2 viral RNA by RT‐qPCR is the gold standard for COVID‐19 testing, the use of antigen-detecting rapid diagnostic tests (Ag-RDTs) is emerging as a complementary surveillance tool as Omicron case numbers skyrocket worldwide. However, the results from Ag-RDTs are less accurate for individuals with low viral loads. Methods To develop a more sensitive and accurate Ag-RDT, we screened a total of 90 candidate monoclonal antibodies (mAbs) obtained from guinea pigs immunized with SARS-CoV-2 nucleocapsid protein (CoV-2-NP), and a highly specific epitope-characterized mAb set suitable for detecting the antigen was selected. By applying the mAb set to an automated chemiluminescence flow-through membrane immunoassay device, we developed a highly sensitive and quantitative Ag-RDT, CoV-2-POCube. Results CoV-2-POCube exclusively recognizes a variety of CoV-2-NP variants but not the nucleocapsid proteins of SARS-CoV and other human coronaviruses. CoV-2-POCube achieved a limit of detection sensitivity of 0.20 ~ 0.66 pg/mL of a variety of CoV-2-NP variants, showing over 100 times greater sensitivity than commercially airable SARS-CoV-2 Ag-RDTs. Conclusion CoV-2-POCube is a promising alternative to currently available diagnostic devices for faster clinical decision-making in individuals with suspected COVID-19 in limited-resource settings.

Background Coil embolization of aneurysms of the ophthalmic segment of the internal carotid artery (ICA-OphA ANs) has potential risks of visual complications. We analyzed this risk and focused on the relationship of the ophthalmic artery (OphA) origin with the aneurysm neck. Methods From January 2003 to April 2018, 179 unruptured ICA-OphA ANs were treated with endovascular surgery in our institution. Two ruptured and four aneurysms with missing data were excluded. Finally, 173 unruptured aneurysms were included in this study. The aneurysms were classified into three groups according to the location of the OphA origin: Separate, Shared, and Dome type. We retrospectively assessed visual complications based on the relationship between types of aneurysm and postoperative angiographic findings for the OphA. Results Visual deficits remained permanent in eleven cases (6.4%). In the Dome type, visual complications were significantly more frequent compared to the Separate type. Change in the OphA flow was significantly associated with a higher complication rate of 2.9%, but patients with changed OphA flow had a significant rate of 7.5% ( p = 0.020). We found no significant difference in the incidence of visual complications concerning the use of perioperative antithrombotic therapy. Conclusions The location of OphA origin regarding the aneurysmal neck and postoperative OphA flow were significantly correlated with the visual outcome after coil embolization for ICA-OphA ANs. Post-procedural flow in the OphA was an important factor affecting the rate of ischemic retinal complications. Retinal embolic events occurred with preserved flow in the OphA, albeit at a lower rate.

Background Foramen magnum dural arteriovenous fistula (DAVF) is a rare disease, with some reported cases of successful treatment. We achieved complete obliteration of the foramen magnum DAVF through microsurgery after complications of endovascular embolization. We reviewed the treatment modalities and outcomes, focusing on pathologic and anatomic features from the literature. Case Description A 65-year-old man was admitted to our hospital with sudden diplopia. Magnetic resonance imaging revealed a subarachnoid hemorrhage around the right side of the prepontine cistern, and a foramen magnum DAVF was diagnosed by angiography. Subsequent angiography revealed that the fistula was supplied by the right neuromeningeal trunk of the ascending pharyngeal artery and the right posterior meningeal artery of the vertebral artery (VA), and the veins of the pouch via the fistula were retrogradely draining into the intracranial veins. We aimed to treat complete occlusion endovascularly with balloon-augmented transarterial Onyx injection via the posterior meningeal artery, but Onyx was refluxed to the VA through the anastomosis between the VA and posterior meningeal artery. Onyx subsequently migrated to the top of the basilar artery, causing occlusion, so we urgently removed the Onyx with a stent retriever (Trevo). Several weeks later, we performed complete obliteration of the foramen magnum DAVF via a lateral suboccipital approach with a C1 laminectomy. Conclusions Most foramen magnum DAVFs were obliterated completely with only endovascular treatment. Microsurgery is an effective and reliable treatment for incomplete occlusion and complications.

Objective Risk control of thromboembolic complications (TECs) during stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) is crucial for satisfactory treatment outcomes. We retrospectively evaluated the data from our cohort of SACE for UIAs to analyze the role of anatomical, clinical, and stent type-related factors to determine the optimal preoperative values of light transmission aggregometry (LTA) for TEC prevention. Methods From July 2015 to May 2018, we retrospectively analyzed the data from 132 patients with SACE-treated UIAs at our hospital. Data regarding the aneurysm location, maximum diameter, stent type used, preoperative LTA value, and ischemic and hemorrhagic complications were collected. Aspirin 100 mg and clopidogrel 75 mg were started 7 days before surgery, with a “boost” dose (an additional 75 mg of clopidogrel for an LTA value >60%) added after August 2016 to address clopidogrel resistance. After multivariate analysis, we developed our original combined parameter termed the thromboembolic predictor (TEP). Receiver operating characteristic (ROC) analysis for TEP and each significant variable was performed. Results TECs were confirmed in 5 of the 132 patients (3.8%) and hemorrhagic complications in 9 of the 132 patients (6.8%). From the multivariate analysis results, the LTA value and maximum diameter were chosen as significant variables and included in the TEP. ROC analysis of the LTA value revealed a sensitivity and specificity of 0.866 and 0.600, respectively (area under the curve, 0.747), with a cutoff of 62%. TEP permitted the establishment of an optimal LTA value according to the aneurysm maximum diameter to predict for TECs. The complication rate for the Neuroform EZ, Enterprise, Neuroform Atlas, and LVIS stents was 2.9%, 10.5%, 1.4%, and 14.3%, respectively. Conclusions The preoperative LTA value contributes to the prediction of TECs after SACE for UIAs. The TEP (relating the LTA cutoff to aneurysm size) allows for improved antiplatelet therapy adjustment before SACE to reduce TECs.

Traumatic brain injury (TBI) is increasingly a major cause of disability across the globe. The current methods of diagnosis are inadequate at classifying patients and prognosis. TBI is a diagnostic and therapeutic challenge. There is no Food and Drug Administration (FDA)-approved treatment for TBI yet. It took about 16 years of preclinical research to develop accurate and objective diagnostic measures for TBI. Two brain-specific protein biomarkers, namely, ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein, have been extensively characterized. Recently, the two biomarkers were approved by the FDA as the first blood-based biomarker, Brain Trauma Indicator™ (BTI™), via the Breakthrough Devices Program. This scoping review presents (i) TBI diagnosis challenges, (ii) the process behind the FDA approval of biomarkers, and (iii) known unknowns in TBI biomarker biology. The current lag in TBI incidence and hospitalization can be reduced if digital biomarkers such as hard fall detection are standardized and used as a mechanism to alert paramedics to an unresponsive trauma patient.

Introduction: Cell-based therapies for stroke remain under development and there is a lack of pre-clinical large animal data defining optimal dosing and delivery methods. Whereas safety and efficacy of intra-arterial (IA) mesenchymal stem cells (MSC) have been demonstrated in rodent models, large animal model are lacking, hampering advancement of the field and limiting mechanistic insights. Methods: An endovascular canine reversible Middle Cerebral Artery Occlusion (MCAO) model using a retractable platinum coil for 60-120 min was established. At 48-hour post-MCAO, allogeneic male canine MSCs (10-80 million) were delivered using a microcatheter in the ipsilateral upper cervical internal carotid artery of female canine subjects. Serial MRIs and neurological deficit scoring (NDS) were performed over 30 days. Animals were euthanized at15-30 d post-MCAO and brains were harvested for histology and molecular analyses. Results: There was a dose-dependent reduction of infarct volume on MRI associated with improved neurological scoring and corticospinal tract caliber on Diffusion Tensor Imaging over the range of 10, 20 and 40 million MSCs vs. PBS control. This dose-range was safe and did not result in worsening of stroke volume or behavioral outcomes. In contrast, 80 million IA MSCs led to a worsened neurological score immediately following the injection and an increase in the infarct volume at 4 days post injection. Conclusion: Together these findings establish a successful preclinical canine model of stroke in which dose-dependent efficacy of IA MSC therapy is demonstrated to reduce stroke size and augment DTI. These findings have important clinical implications in designing early-stage trials of IA delivery in humans.

Objective We report the clinical outcomes of stent-assisted coiling for wide-necked intracranial aneurysms using 3 low-profile laser-cut stents and compare the results according to stent type. Methods All patients treated with stent-assisted coiling for their intracranial aneurysms at our hospital between July 2010 and September 2019 were reviewed. We selected patients with Enterprise, Neuroform EZ, or Neuroform Atlas stents who underwent imaging follow-up and investigated aneurysm and stent features, stent-related complications, recanalization, and retreatment rates. We compared the retreatment risk among the patients treated with the 3 stent types using Kaplan-Meier survival analysis and Cox regression analysis. Results We evaluated 364 consecutive cases (103 Enterprise, 105 Neuroform EZ, and 156 Neuroform Atlas stents). Neuroform Atlas was more frequently used in distal vessels: 8 (7.8%) Enterprise, 2 (1.9%) Neuroform EZ, and 41 (26.3%) Neuroform Atlas cases, respectively. The median follow-up durations were 6.49, 4.91, and 1.24 years for the Enterprise, Neuroform EZ, and Neuroform Atlas cases, respectively, and retreatment was performed in 11 (10.1%), 9 (8.6%), and 6 (3.8%) cases. In the first 2 years of follow-up, the estimated retreatment risk ratios for Neuroform EZ and Neuroform Atlas with Enterprise as reference were 0.63 (95% confidence interval, 0.24–1.65; P = 0.35) and 0.54 (95% confidence interval, 0.18–1.59; P = 0.26), respectively. Conclusions Neuroform Atlas stents were more frequently deployed in small-caliber vessels compared with the other 2 types of stents. The complication rate and retreatment risk until at least 1 year after the aneurysm treatment appeared to be similar for the 3 stent types.

Oxidative stress is now recognized to be an important therapeutic target in kidney diseases. However, there are currently no biomarkers that can be used clinically to diagnose renal oxidative stress.A rapid assay system for urinary thioredoxin 1, an oxidative stress-dependent biomarker of acute kidney injury (AKI), was developed as a chemiluminescence enzyme immunoassay and validated analytically and clinically.Analytic evaluation revealed that hemolytic hemoglobin caused measurements to be abnormally high, above the detectable range. However, urine sediment containing red blood cells did not affect the measurements. Assays using our proposed chemiluminescence enzyme immunoassay were completed within as little as 6 min, whereas a conventional ELISA 4 h. AciduriapH 6.0 led to a significant underestimation of thioredoxin 1 concentrations. However, the effects of aciduria were completely reversible with use of a buffer developed for pH adjustment. Urinary thioredoxin 1 was increased in patients with AKI, but was unaffected by extrarenal oxidative stress diseases, including hypoxemia and myocardial infarction, or by chronic kidney disease in which serum creatinine concentrations were comparable.These results suggest that the chemiluminescent enzyme immunoassay system for urinary thioredoxin 1 enables rapid and specific diagnosis of AKI associated with oxidative stress.

Background: Recent preclinical studies of stroke recovery have explored the possibility of utilizing exosomes (ES) instead of complete cells as therapeutic agents. ES are endosomal origin small-membrane vesicles with a size of 40 to 100nm in diameter, secreted from many types of cells including mesenchymal stem cells (MSCs). ES-encapsulated transfer of miRNAs promotes neurite remodeling and functional recovery of stroke in rats. The optimal route of delivery of ES in stroke is not established. While a few studies have shown efficacy of intra-venous exosomes administration for stroke, there is one study exploring intra-arterial exosome therapy (IAX) with single dose of 100ug exosomes. We propose intra-arterial delivery of exosomes in a dose escalation study to establish safety and early efficacy. Methods: Female ovariectomized Sprague-Dawley rats were exposed to MCAo for 90 min. Rats were treated with IAX (10, 50 and 100ug/0.5mL), IAMSCs (1x10 5 cells/0.5mL) or IA phosphate-buffered saline (IAPBS) at 1 day (1D) after MCAo. To test neurological and motor function, the standardized neurobehavioral test battery and the rotarod test were performed. The mean duration (in seconds) on the device was recorded from 3 rotarod measurements. The rats were tested at pre-surgery, 7, 15 and 30 days post-MCAo. Results: There was no neurological worsening or mortality post IA exosome delivery at any dose tier. The Neurological deficit score of IAX 10ug treatment group at POD 7, 15 and 30, and IAX 50ug treatment at POD 15 were significantly improved in comparison to IA PBS. IAX 10ug treatment group showed trend of improvement in motor coordination compared to the IA PBS/MSC/higher doses of exosome treatment groups. Conclusions: The Neurological deficit scores of IAX 10ug treatment group were significantly improved in comparison to IA PBS. Lower dose than previously published might be most effective, and noninferior to IA-MSCs.

Objectives: Long term outcome of large / giant unruptured intracranial aneurysms (LG-UIAs) after endovascular therapy is still unknown. We retrospectively analyzed long-term results of patients with LG-UIAs who were followed up more than 5 years after endovascular therapy. Methods: We included patients from our complete database with UIAs greater than 10mm and treated at our hospital from January 2003 to December 2013. Retreatment rate of targeted aneurysms, rupture rate, and the modified Rankin scale (mRS) at last visit were evaluated till December 2018. Results: From 142 patients treated during the period were excluded 3 patients with perioperative rupture and 38 patients with less than 5 years follow-up period, finally analyzing 101 patients. The median aneurysm size was 12.0 mm (IQR 10.8-15). The median follow-up period was 9.4 years (IQR: 7-11), the longest being 13.3 years. Retreatment was performed on 36 patients (35.6%). Comparing cumulative re-treatment rates in groups with aneurysm sizes 20 mm, it was predominantly higher for aneurysms> 20 mm (P = 0.02, Figure1 ). Rupture of targeted aneurysms was observed in 2 cases (1.98%, Figure2 ), and the longest period from last treatment was up to 12 years. The mRS 0-1 at the first treatment and the final visit were 98% and 93%, respectively, and mRS deterioration remained at 5%. Conclusion: The retreatment rate tended to increase in proportion to the size of the aneurysm, however the final neurological outcome was favorable when considering the natural history of these aneurysms. Since aneurysmal rupture could occur after 12 years of treatment, long-term follow-up should be considered for LG-UIAs.

Background: Control of risks of thromboembolic complications (TEC) during stent assisted coil embolization (SACE) for unruptured intracranial aneurysm (UIA) is crucial for outcome. We evaluated retrospectively our cohort of SACE for UIA, analyzing the role of anatomical, clinical and stent type related factors to determine optimal presurgical values of light transmission aggregometry (LTA) for TEC prevention. Methods: From July 2015 to May 2018 we retrospectively analyzed 132 SACE treated UIA patients at our hospital. Aneurysm location and maximum diameter, preoperative LTA-value, ischemic and hemorrhagic complications, preoperative and discharge Modified Rankin scale (mRS) were collected. Aspirin 100 mg and clopidogrel 75 mg were started 7 days before operation, with “boost” therapy (additional 75mg clopidogrel in LTA-value >60) added after August 2016, addressing clopidogrel resistance. After multivariate analysis we developed our original combined parameter called TEC predictor (TEP). Receiver operating characteristic (ROC) analysis for TEP and each significant variable were performed. Results: TEC were confirmed in five (3.8%, 5/132) and hemorrhagic - in nine patients (6.8%, 9/132), with mRS deterioration post-operatively in five patients (5/132, 3.8%). By multivariate analysis, LTA-value and maximum diameter were chosen as significant variables, and included in TEP. ROC analysis of LTA-value showed sensitivity and specificity of 0.866 and 0.600 respectively (AUC=0.747) with cut-off point of 62. TEP permitted establishing optimal LTA-value according to the aneurysm maximum diameter to predict TEC. Neuroform-EZ, Enterprise, Neuroform-Atlas, and LVIS stents complications were 2.9%, 10.5%, 1.4%, and 14.3%, respectively. Conclusions: Preoperative LTA-value contributes to predicting TEC after SACE of UIA. TEP (relating LTA cutoff value to aneurysm size) provides improved antiplatelet therapy adjustment prior to SACE for TEC reduction.

Author(s): Misaki, Kouichi; Takao, Hiroyuki; Suzuki, Takashi; Nishimura, Kengo; Kan, Issei; Yuki, Ichiro; Ishibashi, Toshihiro; Yamamoto, Makoto; Murayama, Yuichi | Abstract: BACKGROUND:Hemodynamic factors play important roles in aneurysm recurrence after endovascular treatment. OBJECTIVE:Predicting the risk of recurrence by hemodynamic analysis using an untreated aneurysm model is important because such prediction is required before treatment. METHODS:We retrospectively analyzed hemodynamic factors associated with aneurysm recurrence from pretreatment models of five recurrent and five stable posterior communicating artery (Pcom) aneurysms with no significant differences in aneurysm volume, coil packing density, or sizes of the dome, neck, or Pcom. Hemodynamic factors of velocity ratio, flow rate, pressure ratio, and wall shear stress were investigated. RESULTS:Among the hemodynamic factors investigated, velocity ratio and flow rate of the Pcom showed significant differences between the recurrence group and stable group (0.630 ± 0.062 and 0.926 ± 0.051, P= 0.016; 56.4 ± 8.9 and 121.6 ± 6.7, P= 0.008, respectively). CONCLUSIONS:Our results suggest that hemodynamic factors may be associated with aneurysm recurrence among Pcom aneurysms. Velocity and flow rate in the Pcom may be a pretreatment prognostic factor for aneurysm recurrence after endovascular treatment.

Background Surgical treatment of vertebral artery (VA)-thrombosed giant aneurysms requires achieving both obliteration of the parent artery to prevent bleeding and dome thrombectomy to relieve the brain stem from mass effect. To secure both proximal and distal control of complex VA aneurysms, the contralateral approach to the aneurysm might be a useful alternative, as previously described. We successfully treated a case of VA-thrombosed giant aneurysm in a new, original way by combining craniotomy (ipsilateral and contralateral) and the endovascular technique. Case Description A 48-year-old man presented with a thrombosed giant aneurysm of the right VA compressing the brain stem. Treatment consisted of endovascular proximal ligation of the VA followed by 2-staged craniotomy for complete trapping of the aneurysm and intra-aneurysmal thrombectomy. The VA distal to the aneurysm was obliterated via contralateral craniotomy as only that provided adequate working space. Finally, intra-aneurysmal partial thrombectomy was performed through an ipsilateral craniotomy, which also made possible the obliteration of the eventually dangerous remaining vasa vasorum and additional proximal ligation of the VA. Conclusions Based on pathologic and surgical anatomical characteristics, a combination of an endovascular procedure with 2-staged craniotomy for complete trapping, thrombectomy, and vasa vasorum obliteration could be considered a feasible way to treat VA-thrombosed giant aneurysms located ventral to the brain stem and have their distal neck portions/patent vessel beyond the midline toward the contralateral side.

We grew high-quality single crystals of AuAl2, AuGa2, and AuIn2 with the fluorite (CaF2)-type cubic structure and determined the Fermi surface properties by the de Haas-van Alphen (dHvA) experiments using full-potential LAPW bad calculations. The Fermi surface and optical properties for three compounds were once studied from an interest of colors because AuAl2 has a striking bright reddish-purple color, whereas AuGa2 and AuIn2 are, respectively, neutral and bluish. The detected dHvA frequencies in the present study are found to be in a wide range of (0.1–13)×107 Oe. The main dHvA branches for three compounds are in excellent agreement with the theoretical ones, but some dHvA branches with small dHvA frequencies are slightly deviated from the theoretical ones, especially in AuGa2 and AuIn2.

An extremely large magnetoresistance of PtSn4 has been recently observed and discussed from a viewpoint of de Haas-van Alphen (dHvA) oscillations and theoretical small Fermi surfaces. We have studied precisely the Fermi surfaces by measuring angular dependences of dHvA frequencies and have also carried out the full potential LAPW band calculation. Furthermore, small Fermi surfaces have been detected in another Pt-based compound of Pt3In7 with the cubic structure.

We report a very rare case of a ruptured abdominal aortic aneurysm (AAA) with an anomaly of the inferior vena cava (IVC). The AAA was covered with a large hematoma and an expanded vein was on its left side. It was not until we could not locate the IVC on the right side of AAA that we recognized the anomaly during the operation. Although we reviewed the findings on enhanced computed tomography, we were confused whether the case was a duplicated or left-sided IVC. Subsequently, a bifurcated vascular prosthesis was implanted without ligation of the left renal vein to join the left-sided IVC.

This paper describes an effective reinforcement technique for foundation of breakwater in order to provide resiliency to the breakwater against earthquake and tsunami related compound geo-disaster. As reinforcing measures, the technique uses gabions and sheet piles in the foundation of the breakwater. A series of shaking table tests were performed to evaluate the effectiveness of the technique under different earthquake loadings, and comparisons were made between conventional and reinforced foundation. The results of these tests reveal the advantages of the reinforcing foundation technique in terms of reduction in settlement and horizontal displacement of the breakwater during the earthquake loadings. Duration and level of acceleration of earthquake loadings had significant impacts on the settlement and horizontal displacement of the breakwater. It was found that one of the reasons of settlement of the breakwater is lateral flow of foundation soils during earthquake, and the sheet piles could reduce the lateral flow. The excess pore water pressures could be reduced significantly during earthquake due to the reinforcing technique. Numerical analyses were also performed to confirm the effectiveness of the technique, and to determine behavior of the reinforcement-soil-breakwater system during the earthquakes.

We succeeded in growing single crystals of SrTGe 3 (T: transition metal) by the In-flux method and measured the electrical resistivity, specific heat, and de Haas–van Alphen (dHvA) effect. We confirmed superconductivity in SrPdGe 3 and SrPtGe 3 , which was previously observed using polycrystal samples, and also found superconductivity for SrRhGe 3 , SrIrGe 3 , and SrNiGe 3 . Furthermore, from the results of dHvA experiments and energy band calculations, Fermi surfaces of SrIrGe 3 are found to split into two similar Fermi surfaces, reflecting the Rashba-type non-centrosymmetric tetragonal structure. We also grew single crystals of EuTGe 3 by the same In-flux method and studied magnetic properties, especially focusing on magnetism of EuIrGe 3 with a Neel temperature T N =12.2 K and a successive magnetic transition T ' N =7.3 K. The magnetic phase diagram of EuIrGe 3 is found to consist of three antiferromagnetic phases named AF1, AF2, and AF3. A critical field H c reaching a saturated moment of 7 μ B /Eu is determined as H c ≃ 160 kOe from a high-field magnetization curve. We proposed a simple helical magnetic structure based on the Dzyaloshinskii-Moriya interaction.

Deep femoral artery (DFA) aneurysms are rare. DFA is protected by the adductor canal, which may delay the diagnosis. Then, its early diagnosis may be difficult and it is possible to be misdiagnosis with incarcerated inguinal hernia, which occurs more often in elderly people. We report a very rare case of a treatment of an advanced elderly patient with an isolated ruptured DFA aneurysm that was preoperatively confused with an incarcerated inguinal hernia.A 97-year-old man was admitted to a neighboring hospital due to a painful mass of the right groin after transient consciousness loss and the patient was diagnosed with right incarcerated inguinal hernia by a nonenhanced computed tomography (CT). Although he was observed for 3 days, he suddenly lost consciousness again with a decrease in blood pressure. Thus, he was referred to our hospital due to the painful pulsatile inguinal mass after resuscitation from shock. As we diagnosed a ruptured DFA aneurysm by an enhanced CT, we emergently performed an excision of the aneurysm with revascularization of the right DFA. The postoperative course was uneventful without ischemic change of the lower leg.

Uterine sarcomas are rare and aggressive gynecologic tumors with poor prognosis; therefore, early diagnosis is crucial for therapy. However, it is very difficult to distinguish uterine sarcomas from leiomyomas which are common benign uterine tumors. Therefore, the development of a diagnostic method that utilizes reliable biomarkers to distinguish uterine sarcomas from leiomyomas is important so as to identify the rare tumors. The candidate factors as novel biomarkers were searched for in public databases and a pilot study was performed for confirmation. Growth differentiation factor-15 (GDF15), progranulin, and osteopontin were identified as candidate biomarkers for diagnosing uterine sarcoma. Thus, developing a rapid and easy method to measure these factors could help establish a screening system for uterine sarcomas. In this study, we developed a novel measurement system for these factors using a compact chemical luminescence immunological automatic analyzer POCubeTM. This assay system, which is based on the flow-through membrane immunoassay, completes the whole process and generates results within 15 min. Serum concentrations of these factors measured via POCubeTM correlated well with those measured using enzyme-linked immunosorbent assay (r = 0.994 for GDF15, r = 0.992 for progranulin, and r = 0.976 for osteopontin). The POCubeTM system provides rapid and easy measurement of these factors, thereby facilitating uterine sarcoma diagnosis.

PurposeWe used an imaging technique based on 3-dimensional (3D) C-arm CT to assess the apposition of three types of stents after coiling of intracranial aneurysms.MethodsAll patients with intracranial aneurysms were considered who received stent-assisted coiling with Enterprise2, Neuroform EZ, or Neuroform Atlas stents confirmed by C-arm CT imaging at our institution between June 2015 and November 2017. A 3D digital subtraction angiography (DSA) scan for vessel imaging followed by a high-resolution cone beam CT (HR-CBCT) scan for coil and stent imaging was performed. The images were fused to obtain dual volume 3D fusion images. We investigated malapposition of the stent trunk (crescent sign) and of the stent edges (edge malapposition) and used the χ2 statistic to test for an association with stent types. Inter-rater agreement between two raters was estimated using Cohen’s kappa statistics.ResultsWe evaluated 75 consecutive cases. Enterprise2 stents were used in 22 cases, Neuroform EZ in 26, and Neuroform Atlas in 27 cases. By stent type, crescent sign was detected in 27% of Enterprise2, 8% of Neuroform EZ, and none of Neuroform Atlas stents (p=0.007), while edge malapposition was detected in 27% of Enterprise2, 58% of Neuroform EZ, and 30% of Neuroform Atlas stents (p=0.05). Excellent (κ=0.81) and good (κ=0.78) agreement between the raters was found for the detection of edge apposition and crescent sign, respectively.ConclusionStent malapposition was clearly visualized by dual volume 3D imaging. The Neuroform Atlas stents showed good apposition even in vessels with strong curvature.

Background and Purpose Precise stent deployment is important for successful treatment of intracranial aneurysms by stent-assisted coiling (SAC). We evaluated the accuracy of virtual stents generated using commercial stent planning software by comparing the length of virtual and actually deployed intracranial laser cut stents on three-dimensional digital subtraction angiography (3D-DSA) images. Methods We retrospectively analyzed the data of 75 consecutive cases of intracranial wide-necked aneurysms treated with the SAC technique using laser cut stents. Based on 3D-DSA images acquired by C-arm CT, stent sizing and placement were intraoperatively simulated by a commercial software application. The difference in length of the stents was estimated by measuring proximal discrepancies between the end points of the virtual and actually deployed stents on fused pre-procedural and post-procedural 3D-DSA images. Discrepancies between distal stent end points were manually minimized. The Kruskal–Wallis test was applied to test whether stent location, type, and length had an effect on difference in length between virtual and real stent. Results The median difference in length between virtual and real stents was 1.58 mm with interquartile range 1.12–2.12 mm. There was no evidence for an effect of stent location (p = 0.23), stent type (p = 0.33), or stent length (p = 0.53) on difference in length between virtual and real stents. Conclusions Stent planning software allows 3D simulation of laser cut stents overlain on 3D-DSA images of vessels and may thus be useful for stent selection and deployment of laser cut stents during stent-assisted coiling of intracranial aneurysms.

We succeeded in growing single crystals of \(\hbox {Yb}_{4}\hbox {Sb}_{3}\), Ullmannite(NiSbS)-type compounds, \(\hbox {Pd}_{3}\hbox {Bi}_{2}\hbox {Si}_{2}\), EuPtSi, and EuPtGe with the non-centrosymmetric cubic structures by the Bridgman method. Split Fermi surface properties are clarified for \(\hbox {Yb}_{4}\hbox {Sb}_{3}\) and \(\hbox {Pd}_{3}\hbox {Bi}_{2}\hbox {Si}_{2}\). As for EuPtSi and EuPtGe with the cubic chiral structure, we observed the first-order like antiferromagnetic ordering at the Neel temperatures \(T_N=4.0\,{\rm K}\) and 3.4 K, respectively, which are small in magnitude compared with ordering temperatures of 10–100 K in the usual divalent Eu compounds, reflecting the frustration of spins in the chiral structure.

BackgroundStabilization of microcatheters during coiling after their optimal shaping are key factors for successful endovascular coil embolization of cerebral aneurysms. However, stabilization and optimal shaping of microcatheters are sometimes difficult. Our aim was to introduce "tailor-made" microcatheter shapes for coil embolization using three-dimensional (3D) printed vessel models. MethodSince August 2014, we have been investigating the use of 3D printed models of intracranial arterial aneurysms to produce optimally shaped microcatheters for endovascular coil embolization. Using Digital Imaging and Communication in Medicine data obtained from preoperative cerebral angiography, a vessel model was produced with a 3D printer using acrylic resin. Preoperative planning of microcatheter navigation and shaping were performed using the 3D vessel models. Before the procedure, microcatheter mandrels were bent manually to the intended angle, referring to the vessel model, and then sterilized. The 3D vessel models were also sterilized with plasma and used during the procedure. ResultsTwenty-six patients (27 aneurysms) were treated using a total of 48 microcatheters shaped while referring to the 3D printed vessel model. Of the 48 catheters, only 9 (19%) required modification of the initial shape due to inappropriate positioning of the catheter. Only 29% of the catheter placements required repositioning due to catheter kick back. There were no procedure-related complications, including aneurysm rupture. The responses from assistants to a questionnaire administered after the embolizations on the usefulness of the technique were favorable. ConclusionsTailor-made shaping of microcatheters may facilitate easier and safer procedures in coil embolization of intracranial aneurysm. 3D printed aneurysm models are simple and cheap to produce and apply.3D printed models make possible optimal "tailor-made" micro-catheter shapings."Tailor-made" micro-catheters permit easier access to aneurysms for coiling.

BACKGROUND Thin-walled regions (TWRs) of cerebral aneurysms are at high risk of rupture, and careful attention should be paid during surgical procedures. Despite this, an optimal imaging technique to estimate TWRs has not been established. Previously, pressure elevation at TWRs was reported with computational fluid dynamics (CFD) but not fully evaluated. OBJECTIVE To investigate the possibility of predicting aneurysmal TWRs at high-pressure areas with CFD. METHODS Fifty unruptured middle cerebral artery aneurysms were analyzed. Spatial and temporal maximum pressure (Pmax) areas were determined with a fluid-flow formula under pulsatile blood flow conditions. Intraoperatively, TWRs of aneurysm domes were identified as reddish areas relative to the healthy normal middle cerebral arteries; 5 neurosurgeons evaluated and divided these regions according to Pmax area and TWR correspondence. Pressure difference (PD) was defined as the degree of pressure elevation on the aneurysmal wall at Pmax and was calculated by subtracting the average pressure from the Pmax and dividing by the dynamic pressure at the aneurysm inlet side for normalization. RESULTS In 41 of the 50 cases (82.0%), the Pmax areas and TWRs corresponded. PD values were significantly higher in the correspondence group than in the noncorrespondence group (P = .008). A receiver-operating characteristic curve demonstrated that PD accurately predicted TWRs at Pmax areas (area under the curve, 0.764; 95% confidence interval, 0.574-0.955; cutoff value, 0.607; sensitivity, 66.7%; specificity, 82.9%). CONCLUSION A high PD may be a key parameter for predicting TWRs in unruptured cerebral aneurysms. ABBREVIATIONS CFD, computational fluid dynamicsMCA, middle cerebral arteryPave, average pressurePD, pressure differencePmax, maximum pressureTWR, thin-walled regionWSS, wall shear stress.

This paper deals with reinforcing technique for foundation of breakwater which provides resiliency to breakwater against earthquakes. Gabions and sheet piles were used in foundation of breakwater as reinforcing measures against earthquake loadings. Shaking table tests were performed to evaluate the effectiveness of the technique under different earthquake loadings, and comparisons were made between conventional and the reinforced foundation. Numerical analyses were also performed to elucidate the mechanism of the reinforcement–soil–breakwater system during earthquakes. The results of this study reveal the advantages of the technique in reducing settlement and horizontal displacement of the breakwater during different earthquake loadings.

We report a case of direct carotid puncture for endovascular thrombectomy in a 96-year-old patient with acute cerebral infarction. Anatomical difficulties of carotid artery access, including an unfavorable aortic arch type and the tortuosity of carotids, could have resulted in a recanalization delay or failure in patients with acute ischemic stroke. A 96-year-old woman developed sudden right hemiparesis. By initiating thrombectomy, we could not access the common carotid artery;therefore, we performed a direct carotid puncture on the neck and achieved successful recanalization with improvement of hemiparesis. We discuss the limitations and technical aspects of this technique. We conclude that in case of stroke, a direct carotid artery puncture is a feasible alternative to an anatomically difficult transfemoral access.

Purpose Antiplatelet management is essential in neuroendovascular treatment, especially with intracranial stent deployment, for thromboembolic complication reduction. There are few articles which described the use of light transmission aggregometry (LTA) as a platelet function test prior to deployment of intracranial stent. The aim of this study was to evaluate the usefulness of strict antiplatelet management in patients with stent assisted coil embolization. Method A total of 372 patients with intracranial aneurysms were treated with endovascular procedure from July 2015 to March 2018. During the period, 119 patients underwent stent-assisted coil embolization. All patients were measured platelet function test before procedure. Platelet function test was performed using LTA measuring adenosine diphosphate (ADP). We retrospectively analyzed thromboembolic complication based on two protocols (stages) of antiplatelet management for that period. In early stage, the patients were taken regular double antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg, daily) seven days before the procedure. In the late stage, we employed strict antiplatelet management described as follows: if ADP value is less than 60, additional clopidogrel 75 mg was administered in addition to the regular double antiplatelet therapy. Thromboembolic complications occurring from the date of the procedure until discharge were evaluated. Results In the early stage (July 2015 to August 2016), three thromboembolic complications were occurred out of 35 patients (8.6%). Patients with complications had significantly higher average ADP value than those without complication (60.7 versus 45.6; p=0.018). A cut-off value of ADP was 62 (AUC 0.807, Sensitivity 0.67, Specificity 0.93). In the late stage (August 2016 to March 2018), CLP boosting was conducted in nine patients out of 84 patients (10.7%). The rate of thromboembolic complication was significantly lower in late stage than that in the early stage (1.2% versus 8.6%; p=0.04). Conclusion Strict antiplatelet management using platelet aggregation test may reduce thromboembolic complication in patients with stent assisted coil embolization. Disclosures I. Kan: None. T. Ishibashi: None. I. Yuki: None. K. Sakuta: None. T. Kodama: None. S. Kaku: None. N. Kato: None. K. Nishimura: None. K. Aoki: None. Y. Murayama: None.

Purpose: Little is known about the long term clinical outcomes of middle cerebral artery (MCA) stenosis / occlusion patients who are treated with medical therapy. The efficacy and safety of the medical treatment was evaluated by analyzing the clinical outcomes along and imaging analysis using CT Angiography (CTA) with an automatic measurement software. Methods: Patients who were diagnosed with middle artery stenosis or occlusion were prospectively enrolled in the study. Those who were diagnosed with moyamoya disease were excluded. Along with the rigorous medical treatment for atherosclerosis risk factors, Cilostazol 200mg/day was selected as the first line of medication, and switched to either aspirin 100mg/day or clopidogrel 75mg/day if necessary. CT Angiogram (CTA) was performed and a software for the measurement of stenosis on the stretched view was used for evaluating the degree of stenosis. The neurological findings as well as the degree of stenosis during the observation time were analyzed. Results: Of the 186 MCA stenosis / occlusion patients who visited our institution, 62 lesions in 60 patients who completed periodic CTA evaluation were selected for the study. 20 lesions (40.3%) were symptomatic at the time of diagnosis. 45 patients (75.0%) were treated with cilostazol and 22 (36.7%) underwent dual antiplatelet therapy. 7 patients (11.7%) were observed without any antiplatelet therapy. During the median observation time of 75.6 months, 24 patients (40.0%) showed angiographic improvement, and the median % area stenosis improved from 66.0% (IQR: 53.0 - 80.0) to 54.7% (48.6 - 77.5). Of the 29 patients who showed complete occlusion at the initial diagnosis, 17 (58.6%) showed any degree of recanalization. For those with symptomatic lesions, no patient developed major stroke on the ipsilateral side after completing the 3 months of initial treatment. Conclusions: Angiographic improvement of MCA stenosis was observed with successful prevention of major stroke associated with the disease. Majority of the patients who tolerated the complete occlusion at the time of initial treatment showed recanalization during the observation period. Medical treatment can be an effective therapeutic method for the MCA stenosis / occlusion patients.

The compounds of EuNi(Si1−xGex)3 order antiferromagnetically. At the temperature TC below the Ńeel temperature TN, EuNiSi3 (x = 0) shows an additional magnetic transition into ferro-magnetic state. TN decreases monotonously with increasing the Ge composition x. The Curie temperature TC decreases rapidly with increasing x and vanishes at the critical composition x ≈ 0.3. We have measured the electrical resistivity and thermopower of EuNi(Si0.8Ge0.2)3, which is a compound near to the boundary between the ferromagnetic and antiferromagnetic ground states in the phase diagram for EuNi(Si1−xGex)3 system, under pressures up to 1.8 GPa at temperatures from 2 to 300 K. The anomalies in ρ(T) and S(T) curves of EuNi(Si0.8Ge0.2)3 are observed at TC = 16 K and TN = 34 K at ambient pressure. Both TC and TN increase linearly with increasing pressure. The temperature variations of ρ and S of EuNi(Si0.8Ge0.2)3 at P = 1.8 GPa are almost the same as those of EuNi(Si0.9Ge0.1)3 (x=0.1) at ambient pressure, revealing that the effect of pressure on TN and TC is the same as that of the increase of Si concentration. The pressure and atomic composition dependences of the magnetic transition temperatures TN and TC can be expressed by using the Gruneisen parameters. These results indicate that the changes of TN and TC are attributed to the change of atomic volume induced by the applying pressure or the atomic substitution.

Introduction: Prediction of ischemic core during the thrombectomy procedure can contribute to the treatment strategy. To evaluate if the Cone Beam CT CBV (CBCT-CBV) can predict the image findings of post procedure MRI, retrospective analysis was performed. Methods: A total of 14 ischemic stroke cases with major vessel occlusion underwent CBCT-CBV. A 4 French diagnostic catheter, which was placed in the guiding catheter, was positioned at the ascending aorta. Utilizing 6 seconds acquisition (6Sec Dyna PBV Neuro, Siemens Healthcare), 30% diluted contrast was injected with the speed of 6ml/sec. The reconstruction of the images with CBV color mapping was created immediately after the acquisition. The pre and post procedure CBCT-CBV data was compared with the corresponding MRI images and the results were retrospectively analyzed. Results: Of the 14 cases who showed major vessel occlusion, 6 underwent both pre and post CBCT-CBV. Location of the occluded vessels were internal carotid artery (ICA) (4 cases), middle cerebral artery (9 cases) and 1 basilar artery. No case showed increased CBV. Five cases showed a significant reduction of regional CBV (mean reduction; 72.65%) at the end of the procedure. All these cases showed DWI high regions in the post procedure MRI matched with the area of CBCT-CBV reduction (100%). Of the 6 cases who underwent both pre and post procedure CBCT-CBV, 3 showed decreased CBV in the pre-procedure CBV. After the recanalization of the occluded vessels, the regional CBV was normalized to the level of contra lateral side in every case. Conclusions: Intra-operative CBCT-CBV showed recovery of the reduced CBV after the recanalization in some cases. The area of reduced CBV at the end of procedure was matched with the DWI positive region in the post-procedure MRI (100%). Intra-operative CBCT-CBV may contribute to the prediction of post-operative ischemic core.

We introduce a new imaging technique to improve visualisation of stent apposition after endovascular treatment of brain aneurysms employing high-resolution cone beam CT and three-dimensional digital subtraction angiography. After performing a stent-assisted coil embolisation of brain aneurysm, the image datasets were processed with a metal artefact reduction software followed by the automated image fusion programmes. Two patients who underwent aneurysm coiling using a Neuroform stent were evaluated. The reconstructed 3D images showed a detailed structure of the stent struts and identified malappositions of the deployed stents. Case 1 showed good apposition on the outer curvature side of the carotid siphon, while the inner curvature side showed prominent malapposition. Case 2, with multiple aneurysms, showed good apposition on both outer and inner curvature sides, although inward prolapse of the struts was observed. This new imaging technique may help evaluate stent apposition after the endovascular aneurysm treatment.

We grew the single crystals of semimetals YSb, LuSb, YBi, and LuBi with the NaCl-type cubic structure by the Sb(Bi)-self-flux method and studied the Fermi surface properties on the basis of the de ...