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As headache is known as one of the most common symptoms in the patients with Chiari malformation type 1 (CM1), it is difficult to find out CM1-related headache among the symptoms because headache itself is commonly seen. Herein, we retrospectively review the cases of six CM1 patients complaining only of headache by which they complained of deterioration in daily life activities. The symptom of headache worsened during anteflexion (n = 2; 33%), retroflexion (n = 1; 17%), jumping (n = 3; 50%), going up the stairs (n = 1; 17%), and running (n = 1; 17%). Mean age at the onset was 15.7 years old (ranging 11–18) and four out of six were female. These inductive factors were clearly different from “Valsalva-like maneuvers,” although the mechanism might originate from dynamic tonsil changes. We named these headaches as “motion-specific.” These headaches radiated to the posterior side. MRI revealed that the extent of tonsillar ectopia was 11.3 mm, while syringomyelia was observed in three out of six patients (50%). All patients underwent surgical treatment, with the “motion-specific headache” completely disappearing 12.5 days thereafter. Although headaches are common, “motion-specific headache” may be a good candidate symptom to distinguish CM1 patients, especially among teenagers with headaches, and a good predictor for favorable outcomes after surgical treatment.

Spinal arteriovenous (AV) shunts are rare conditions that sometimes present with myelopathy symptoms. The progression of the symptoms is usually gradual; however, some cases show rapid deterioration. We retrospectively investigated the factors that induced the rapid deterioration of myelopathy symptoms in patients with spinal AV shunts. We treated 33 patients with myelopathy with spinal AV shunts at our institutions, eight of whom experienced rapid deterioration (within 24 hours: 24.2%). Of these, three were related to the body movement or particular postures associated with playing golf, 30 minutes of Japanese straight sitting, and massage care. One patient showed deterioration after embolization for a tracheal aneurysm. The remaining four patients received steroid pulse therapy (high-dose steroid infusion) shortly before the rapid deterioration. These symptoms stopped progressing after cessation of steroid use. While positional or physical factors contributing to myelopathy deterioration might exist, we could not identify specific factors in this study. Nevertheless, rapid deterioration was frequently observed after high-dose steroid use. We must take care not to administer high-dose steroids for myelopathy caused by spinal AV shunt disease.

Background: Lumbar ligamentum flavum hematomas (LFHs) are rare. However, when they occur and contribute to epidural cauda equina compression, timely surgical intervention is frequently warranted. Case Description: A 69-year-old female presented with the left lower extremity sciatica and gait disturbance of 2 weeks’ duration that ultimately evolved into a paraparesis/cauda equina syndrome. When the lumbar MRI revealed left-sided L4-L5 epidural compression attributed to a hemorrhage into the hypertrophied ligamentum flavum (HLF), she successfully underwent a bilateral fenestration/decompressive procedure. Pathologically, neovascularization and rupture of the ventral layers of the degenerated and thickened HLF contributed to the LFH. Conclusion: Arterial neovascularization (i.e., arterial feeding vessels from paramuscular/prelaminar lumbar branches) contributed to a left-sided L4-L5 LFH that resulted in epidural cauda equina compression in a 69-year-old female. Following surgical focal fenestration/decompression, the patient’s symptoms/signs resolved.

A sulfonated polybenzophenone/polyimide block copolymer membrane exhibited high proton conductivity, good dimensional and mechanical stabilities, and low gas permeability, which are attractive for fuel cell applications.

We present a case of spontaneous regression of multicentric pilocytic astrocytoma with cerebrospinal fluid (CSF) dissemination without neurofibromatosis type 1 (NF1) in an adult, the first such case reported. Magnetic resonance imaging (MRI) showed multiple low signal intensity lesions on T1-weighted images and high signal intensity areas on T2-weighted images in the bilateral thalamus, basal ganglia and midbrain. Contrast-enhanced MRI revealed that small, enhanced lesions were seen in the basal ganglia and the pineal region. Neuroendoscopic biopsy and third ventriculostomy were performed. Intraoperative findings demonstrated CSF dissemination. Histologically, the specimens showed pilocytic astrocytoma. Serial MRIs showed regression of the tumor without any additional treatment. The clinical features of spontaneous regression of pilocytic astrocytoma are discussed.

A 45-year-old woman presented with a rare case of metastatic cauda equina tumor from breast cancer without spinal column or brain metastasis. She had undergone resection of breast cancer 4 years previously. She presented with a 2-month history of severe low back pain. Magnetic resonance imaging showed a well-enhanced intradural extramedullary mass at the L1 level without other intradural lesions. At surgery, the tumor was partially removed to preserve the nerve root function under electrophysiological monitoring. The histological diagnosis was adenocarcinoma. The tumor was located in the subarachnoid space, suggesting hematogenous metastasis from the breast cancer. Postoperatively the pain subsided and no neurological deficit occurred. She underwent adjuvant therapy and rehabilitation. Cauda equina tumors may be relatively progressive regardless of imaging findings and clinical symptoms, so preoperative systemic investigation should be conducted, considering the possibility of metastatic tumor. A comprehensive therapeutic strategy involving adjuvant therapy after surgery is important to establish, considering the preservation of postoperative nerve function.

Background: Ultrasonic surgical aspirators have been used mainly for removing brain tumors. Because of their longitudinal and torsional tip, they are used for cutting the bone structures in spinal surgery installing a scalpel-type tip. The purpose of this report is to describe the effectiveness and surgical pitfalls of an ultrasonic bone curette in laminoplastic laminotomy and hemilaminotomy. Methods: We present 12 patients who underwent laminoplastic laminotomy and hemilaminotomy. We used a SONOPET UST-2001 ultrasonic bone curette with HB-05S handpieces (M and M Co, Ltd, Tokyo, Japan). After a tumor was removed, titanium plates were used for the laminoplastic laminotomy and hemilaminotomy. The technical advantage of an ultrasonic bone curette and procedure-related complication were examined. Results: There were no major procedure-related complications such as cord injury. Wound infection and subcutaneous fluid collection caused by cerebrospinal fluid leakage did not occur for reconstruction of posterior bony structure. In 1 patient with calcified dura mater associated with tumor, dural tear occurred. The width of the tip was narrow enough for resected laminae to be fused postoperatively, and spinal instability did not occur in all cases. Conclusion: The scalpel-type ultrasonic bone curette is useful for cutting bone and effective for reconstruction of the laminae. Laminotomy with an ultrasonic bone curette is safe and minimally invasive. To prevent dural tear, we recommend drilling laminae to make the bone thin as the first step, followed by cutting the remaining laminae using a bone curette especially in cases with calcified or tense dura mater., Article, SURGICAL NEUROLOGY. 72(5):470-475 (2009)

Gold hydride is a rare transition-metal species. Despite the fact that gold hydrides may be key intermediates in several gold-catalyzed reactions, their chemical properties are not well understood. We report the synthesis, characterization, and catalytic properties of the gold(I) hydride species that play an important role in a gold(I)-catalyzed dehydrogenative alcohol silylation. Tricoordinated complexes AuCl(xantphos) (1a) and AuCl(xy-xantphos) (1b) were prepared and characterized by 1H and 31P{1H} NMR measurements and X-ray crystallography. Gold(I) hydride species 6b generated from the reaction between 1b and PhMe2SiH (4b) in CDCl3 was characterized by 1H and 31P NMR measurements and ESI-MS spectrometry. NMR and kinetic studies revealed that the reaction mechanism involves the gold(I) hydride species as a key intermediate. The high catalytic activities of 1a and 1b in dehydrogenative alcohol silylation are explained by the stability of the tricoordinated chelating structure and the activation of the Au...

OBJECTIVE: Burn injuries associated with excessive heating of medical metallic devices have been reported, but a definite mechanism for magnetic resonance imaging-induced heating remains unresolved. The aim of this study is to evaluate temperature elevation of metallic wires, aneurysm clips, and clips attached to metallic wires under 3.0-T magnetic resonance imaging. METHODS: The temperature of the metallic wires, the aneurysm clips, and the clips attached to the metallic wires was measured with a fiber optic thermometer sensor system. RESULTS: Although the specific absorption rate was less than that observed during standard use, the temperature rapidly increased in the metallic wire. Furthermore, temperature elevation was observed when the clips were attached to metallic wires. On the other hand, not all clips showed obvious temperature elevation when they were placed alone in a 3.0-T magnetic resonance imaging environment. CONCLUSION: Aneurysm clips, when placed alone in a 3.0-T magnetic resonance imaging environment, are confirmed to be safe during temperature elevation.

This study was designed to clarify the various factors associated with the poor prognosis of the dorsal aneurysm of the internal carotid artery. Three hundred sixty-five aneurysms diagnosed by angiography were registered from 171 institutes in Japan by questionnaire between January 2001 and December 2003. The average age at diagnosis was 53.8 years among 105 men and 233 women patients. Sixty-eight aneurysms were located in C1, 74 in C1-2 and 213 in C2. Three hundred thirty-nine aneurysms obtained Glasgow outcome score (GOS) of all 365 aneurysms were extracted and classified into group A (Good Recovery (GR), Moderate Disability (MD)) and group B (Severe Disability (SD), Vegetative State (VS), Dead (D)) for analysing various factors. Poor prognostic factors were assessed by single variate analysis. Significant prognostic factors are rupture as onset (Odds ratio [OR] 9.9850), intraoperative bleeding (OR 6.3979), postoperative regrowth of the aneurysm (OR 5.8586), preoperative rebleeding (OR 5.1278), postoperative bleeding (OR 4.6397), Hunt-Kosnik grade greater than 3 (OR 4.5247), suspicion of dissecting aneurysm on angiogram (OR 3.5023), World Federation of Neurosurgical Societies (WFNS) grade greater than 3 (OR 3.2734), diagnosis as dissection in the operative field (OR 3.2296), thin aneurysm neck (OR 3.0252), thin aneurysm dome (OR 2.8794), temporary occlusion of the cervical carotid artery (OR 2.8667), and Fisher group greater than 3 (OR 2.3564). No significant differences were observed in the history, including hypertension, age, sex, size of an aneurysm dome and neck, presence of other aneurysms for the poor outcome. Observation therapy, i.e., no treatment, was correlated with poor outcome. Any perioperative bleedings strongly correlated with poor outcome. We should pay more attention to patients with a regrowing, thin walled aneurysm than to those with a larger aneurysm. Since the conservative treatment does not result in the good outcome, we need to treat those patients in the early stage.

We investigated the crystal structure, physical properties and ferroelectric performance of bulk material obtained by mixing and sintering Bi 3.25 La 0.75 Ti 3 O 12 and Bi 4 Si 3 O 12 or Bi 2 SiO 5 for use as a novel ferroelectric material for ferroelectric memory. The resulting material was identified as a structure whereby, all of the peaks, as determined by powder X-ray and neutron diffraction, were the same as Bi 3.25 La 0.75 Ti 3 O 12 , and thus a single phase was obtained. Moreover, we investigated the crystal structure of the material by neutron diffraction, and the obtained results suggested that Si is substituted on Ti sites. The resulting material was investigated by SEM, and grains grown relative to Bi 3.25 La 0.75 Ti 3 O 12 were observed. Based on P–E hysteresis measurements, this sample has a high remanent polarization ( P r ) and a low coercive field ( E c ) relative to Bi 3.25 La 0.75 Ti 3 O 12 , as well as improved overall ferroelectric characteristics.

The durability of a novel proton-conducting polymer electrolyte membrane, sulfonated polybenzophenone/poly (arylene ether) (SPK) block copolymer, was evaluated at middle temperature (80 °C), low humidity (53% RH), and a low current density, 0.02 Acm−2, in a polymer electrolyte fuel cell for 980 h. The electrochemical properties and drain water collected from the anode and cathode were monitored during the test, followed by post-test analyses of the membrane. The nuclear magnetic resonance (NMR) spectra and ion exchange capacity (IEC) value of the post-test membrane showed very minor changes compared to those of the pristine one. The post-test membrane retained 94% of its original weight-averaged molecular weight (Mw)org. There was no remarkable change in Qoxide (oxide formation charge of the cathode catalyst) after the test, which indicates that the specific adsorption of decomposition products of the SPK membrane on the cathode catalyst was not significant. Keywords: Polymer electrolyte fuel cell, Sulfonated aromatic polymer, Block copolymer membranes, Durability

International audience; Proton conductive spots on the membrane surface of sulfonated poly(arylene ketone) multiblock copolymer were investigated by current-sensing atomic force microscopy (CS-AFM) under the hydrogen atmosphere with changing relative humidity, temperature, and bias voltage. The bright spots, where the hydrophilic clusters should be effectively connected inside the membrane, were distributed rather inhomogeneously on the surface at low temperature and humidity but became more homogeneous at higher temperature and humidity. The average diameter of the spots was approximately 10 nm at 40% RH, which increased to 13 nm at 70% RH. The total area of the proton conducting spots, as well as current at each spot, on the membrane surface increased at high humidity and temperature. In addition, the diameter of the proton-conductive spots and the ratio of proton-conductive area on the membrane surface continuously increased with increasing the bias voltage. This increase of the conducting area and the current should be related to the change of the bulk ionic conductivity.

SUMMARY: We generated 196 expressed sequence tags (EST) from a Japanese eel Anguilla japonica spleen cDNA library. Of these, 90 EST (46%) showed no homology to known genes, while 106 EST (54%) showed homology to known genes and transcripts. Of the 106 homologous EST, 13 were homologous to 12 different immune-related genes, 46 were homologous to 33 different ribosomal proteins, three were homologous to the 28S rRNA gene, 10 were homologous to eight different mitochondrial genes and the remaining 34 encoded 28 different identified genes. Six identified EST are similar to previously reported EST of Japanese flounder Paralichthys olivaceus spleen cDNA. These analyses demonstrate the utility of EST and sequence-tagged clones in comparative studies of gene expression in the fish spleen.

In this paper an integrateds tudy is discusseda iming to developt he methodology utilizing simulation system analysis based on the newly developedm athematical model analysis of multi-project planning and scheduling problem in the largescale regional development of localcity, where systematic methodology is for evaluating effectiveness and efficiency of the multi-project plan obtained by the simulation system analysis is also discussed from the social, economical and administrativev iewpoints.The methodology developed through above study is applied to the actual large-scale comprehensive regional development at Maihara-choin Shiga-prefectur, e a nd it is confirmedth at the methodologyd eveloped. in thiss tudy works well to obtain reasonable and desirable multi-project planning and scheduling

Sulfonated polybenzophenone/poly(arylene ether) block copolymers were designed and synthesized via Ni-mediated coupling polymerization. The block copolymers were obtained as high-molecular-weight (Mn = 70–110 kDa, Mw = 150–230 kDa) with low polydispersity index (Mw/Mn = 2.0–2.3). The block copolymer membranes showed well-developed hydrophilic/hydrophobic phase separation and high proton conductivity and low gas permeability. The membrane showed better fuel cell performance and durability compared with those with Nafion, state-of-the-art proton conducting membrane.

NeuRobot, a micromanipulator system with a rigid neuroendoscope and three micromanipulators, was developed for less invasive and telecontrolled neurosurgery. This system can be used to perform sophisticated surgical procedures through a small, 10-mm-diameter, window. The present study was performed to evaluate the feasibility of using NeuRobot in neuroendoscopy. Four different intraventricular neurosurgical procedures were simulated in three fixed cadaver heads using NeuRobot: (1) fenestration of the floor of the third ventricle; (2) fenestration of the septum pellucidum; (3) biopsy of the thalamus; and (4) biopsy of the choroid plexus of the lateral ventricle. Each procedure required less than 2 min, and all procedures were performed accurately. After these surgical simulations, a third ventriculostomy was carried out safely and adequately in a patient with obstructive hydrocephalus due to a midbrain venous angioma. Our results confirmed that NeuRobot is applicable to lesions in which conventional endoscopic neurosurgery is indicated. Furthermore, NeuRobot can perform more complex surgical procedures than a conventional neuroendoscope because of its maneuverability and stability. NeuRobot will become a useful neurosurgical tool for dealing with lesions that are difficult to treat by conventional neuroendoscopic surgery., Article, JOURNAL OF CLINICAL NEUROSCIENCE. 19(11):1553-1557 (2012)

A 45-year-old woman presented with a rare case of metastatic cauda equina tumor from breast cancer without spinal column or brain metastasis. She had undergone resection of breast cancer 4 years previously. She presented with a 2-month history of severe low back pain. Magnetic resonance imaging showed a well-enhanced intradural extramedullary mass at the L1 level without other intradural lesions. At surgery, the tumor was partially removed to preserve the nerve root function under electrophysiological monitoring. The histological diagnosis was adenocarcinoma. The tumor was located in the subarachnoid space, suggesting hematogenous metastasis from the breast cancer. Postoperatively the pain subsided and no neurological deficit occurred. She underwent adjuvant therapy and rehabilitation. Cauda equina tumors may be relatively progressive regardless of imaging findings and clinical symptoms, so preoperative systemic investigation should be conducted, considering the possibility of metastatic tumor. A comprehensive therapeutic strategy involving adjuvant therapy after surgery is important to establish, considering the preservation of postoperative nerve function.

In order to improve QOL in patients with craniopharyngioma, retrospective analysis was performed to discover factors for influencing functional outcome and the best treatment strategy. 56 patients were treated between 1978 and 2005. They were initially treated with surgery and surgical cure was obtained in 29 patients (Group A). Subtotal tumor resection with prophylactic radiation was performed in 8 patients (Group D). Tumor recurrence was noted in 19 patients and stereotactic radiation or 2nd operation was performed in 11 patients (Group B). 2nd operation and fractionated radiation were undertaken in 8 patients (Group C). Endocrine, vision and recognition were scored from 2 to 0, respectively; 2 indicates normal, 1 partially disturbed, 0 fully disturbed. The mean score before treatment was 4.7 and the final score was 3.9. Factors leading to poor outcome included extrasellar origin, solid tumor, bad score before treatment, 2nd surgery for recurrence. The change of scores after the treatment was -0.1 in group A, -0.7 in Group B, -0.9 in Group C and 0.3 in Group D. Maximum tumor removal should be attempted with functional preservation. Subtotal removal with prophylactic radiation is recommended if the patient has normal hypothalamic function.

A series of silicon-constrained monodentate trialkylphosphines SMAPs bearing a Si substituent with diverse electronic natures were synthesized. DFT calculations and NMR measurements indicated that ...

[reaction: see text] A gold(I) complex of Xantphos AuCl(xantphos) catalyzes the dehydrogenative silylation of alcohols with high chemoselectivity and solvent tolerance. It is selective for the silylation of hydroxyl groups in the presence of alkenes, alkynes, alkyl halides (RCl, RBr), ketones, aldehydes, conjugated enones, esters, and carbamates.

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Object Robotic surgery can be applied as a novel technology. Our master-slave microscopic-micromanipulator system (NeuRobot), which has a rigid endoscope and three robot-arms, has been developed to perform neurosurgical procedures, and employed successfully in some clinical cases. Although the master and slave parts of NeuRobot are directly connected by wire, it is possible to separate each part and to apply it to telesurgery with some modifications. To evaluate feasibility of NeuRobot in telesurgery, some basic experiments were performed. Methods The quality of telemedicine network system between Shinshu University and one of the affiliated hospitals, which was completely separated from other public network systems, was investigated. The communication delay was calculated from the transmitting and the receiving records in the computers set in each hospital. The relationship between the change in communication delay from the master part to the slave part of NeuRobot (0, 100, 300, 500 and 700 ms) respectively and feasibility of NeuRobot was investigated. The task performance time in each time changing group was compared. Feasibility of NeuRobot in telesurgical usage was evaluated. The master part and the slave part of NeuRobot placed in each hospital were connected through private network system. Interhospitally connected NeuRobot was compared with directly connected one in terms of task performance time. Results Less than 1 ms was required for corresponding the data in a steady transmitting state. Within 2 seconds after connection, relative time delay (maximum 40 ms) and packet loss were sometimes observed. The mean task performance time was significantly longer in over 500 ms delayed group compared with directly connected NeuRobot. There was no significant difference in the task performance time between directly connected NeuRobot and interhospitally connected NeuRobot. Conclusion Our results proved that telesurgical usage of NeuRobot was feasible. Telesurgical usage of telecontrolled manipulator system is recommended for application in a private network system in order to reduce technical and ethical problems. Some technical innovations will bring breakthrough to the telemedicine field.