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OBJECTIVE There have been no accurate surveillance data regarding the incidence rate of spinal arteriovenous shunts (SAVSs). Here, the authors investigate the epidemiology and clinical characteristics of SAVSs. METHODS The authors conducted multicenter hospital-based surveillance as an inventory survey at 8 core hospitals in Okayama Prefecture between April 1, 2009, and March 31, 2019. Consecutive patients who lived in Okayama and were diagnosed with SAVSs on angiographic studies were enrolled. The clinical characteristics and the incidence rates of each form of SAVS and the differences between SAVSs at different spinal levels were analyzed. RESULTS The authors identified a total of 45 patients with SAVSs, including 2 cases of spinal arteriovenous malformation, 5 cases of perimedullary arteriovenous fistula (AVF), 31 cases of spinal dural AVF (SDAVF), and 7 cases of spinal epidural AVF (SEAVF). The crude incidence rate was 0.234 per 100,000 person-years for all SAVSs including those at the craniocervical junction (CCJ) level. The incidence rate of SDAVF and SEAVF combined increased with advancing age in men only. In a comparative analysis between upper and lower spinal SDAVF/SEAVF, hemorrhage occurred in 7/14 cases (50%) at the CCJ/cervical level and in 0/24 cases (0%) at the thoracolumbar level (p = 0.0003). Venous congestion appeared in 1/14 cases (7%) at the CCJ/cervical level and in 23/24 cases (96%) at the thoracolumbar level (p < 0.0001). CONCLUSIONS The authors reported detailed incidence rates of SAVSs in Japan. There were some differences in clinical characteristics of SAVSs in the upper spinal levels and those in the lower spinal levels.

Microvascular decompression (MVD) is the gold standard in the treatment of hemifacial spasm (HFS), and endovascular surgery has been described as a treatment only for aneurysm-induced HFS in several previous cases. We describe symptomatic HFS caused by a normal vertebral artery (VA) trunk adjacent to the ipsilateral dissecting VA aneurysm completely cured after stent-assisted coil embolization. A 52-year-old man presented with a 2-month history of gradually worsening left HFS. Magnetic resonance imaging (MRI) and cerebral angiography revealed a dissecting VA aneurysm on the left side. Based on the findings from preoperative MRI, not the aneurysmal dome itself, but the VA trunk just distal to the aneurysmal dome was considered likely to be compressing the root exit zone (REZ) of the facial nerve. Stent-assisted coil embolization was conducted for the VA aneurysm, and the stent was deployed to cover the wide neck of the aneurysm and offending zone of the VA trunk simultaneously. HFS started to show improvement just after the procedure and complete disappearance within 1 year. HFS was completely resolved by stenting of the offending artery. Stents may show efficacy for “intra-arterial decompression” by reducing pulsatility against the REZ of the facial nerve due to the thickness and rigidity of the stent metal and delayed endothelialization.

Background and AimsInterspecific difference in pollinators (pollinator isolation) is important for reproductive isolation in flowering plants. Species-specific pollination by fungus gnats has been discovered in several plant taxa, suggesting that they can contribute to reproductive isolation. Nevertheless, their contribution has not been studied in detail, partly because they are too small for field observations during flower visitation. To quantify their flower visitation, we used the genus Arisaema (Araceae) because the pitcher-like spathe of Arisaema can trap all floral visitors.MethodsWe evaluated floral visitor assemblage in an altitudinal gradient including five Arisaema species. We also examined interspecific differences in altitudinal distribution (geographic isolation) and flowering phenology (phenological isolation). To exclude the effect of interspecific differences in altitudinal distribution on floral visitor assemblage, we established ten experimental plots including the five Arisaema species in high- and low-altitude areas and collected floral visitors. We also collected floral visitors in three additional sites. Finally, we estimated the strength and contribution of these three reproductive barriers using a unified formula for reproductive isolation.Key ResultsEach Arisaema species selectively attracted different fungus gnats in the altitudinal gradient, experimental plots and additional sites. Altitudinal distribution and flowering phenology differed among the five Arisaema species, whereas the strength of geographic and phenological isolations were distinctly weaker than those in pollinator isolation. Nevertheless, the absolute contribution of pollinator isolation to total reproductive isolation was weaker than geographic and phenological isolations, because pollinator isolation functions after the two early-acting barriers in plant life history.ConclusionsOur results suggest that selective pollination by fungus gnats potentially contributes to reproductive isolation. Since geographic and phenological isolations can be disrupted by habitat disturbance and interannual climate change, the strong and stable pollinator isolation might compensate for the weakened early-acting barriers as an alternative reproductive isolation among the five Arisaema species.

Global climate change increases uncertainty in sustained functioning of forest ecosystems. Forest canopies are a key link between terrestrial ecosystems, the atmosphere, and climate. Here, we introduce research presented at the 66th meeting of the Ecological Society of Japan in the symposium "Structure and function of forest canopies under climate change." Old-growth forest carbon stores are the largest and may be the most vulnerable to climate change as the balance between sequestration and emission could easily be tipped. Detailed structural analysis of individual large, old trees shows they are allocating wood to the trunk and crown in patterns that cannot be deduced from ground, thus can be used to more accurately quantify total forest carbon and sequestration. Slowly migrating species sensitive to novel climatic conditions will have to acclimate at the individual level. Accounting for physiological responses of trees to climate change will improve predictions of future species distributions and subsequent functioning of forest ecosystems. Field experiments manipulating temperature and precipitation show how trees compensate physiologically to mitigate for higher temperatures and drought. However, it is difficult to measure acclimation responses over long timeframes. Intraindividual trait variation is proposed as an indicator of acclimation potential of trees to future conditions and suggests that acclimation potential may vary among regional populations within a species. Integrating whole-tree structural data with physiological data offers a promising avenue for understanding how trees will respond to climatic shifts.

Postoperative rebleeding (PR) is one of the most severe complications of endoscopic surgery, often performed to remove spontaneous intracerebral hemorrhage (sICH). However, the risk factors for PR remain unclear. This study retrospectively investigated whether increased preoperative plasma plasmin-α2-plasmin inhibitor complex (PIC) levels, indicating activation of fibrinolysis, are associated with PR. A total of 101 patients underwent endoscopic surgery to evacuate sICH at our institution from January 2010 to June 2019, and 79 patients who underwent examinations of plasma PIC levels at admission with available radiographical data were included. Correlations between PR and increased plasma PIC levels were retrospectively evaluated. PR occurred in eight patients (10.1%), and high PIC levels (≥ 4 or 6 μg/ml) were significantly associated with PR. The sensitivities employing high PIC levels of ≥ 4 μg/ml and ≥ 6 μg/ml were both 0.63, and the specificities using the same PIC levels were 0.86 and 0.92, respectively. Multivariable analyses showed that high plasma PIC levels of ≥ 4 μg/ml (odds ratio (OR), 12.77; 95% confidence interval (CI), 1.65–98.77; p = 0.02) or ≥ 6 μg/ml (OR, 18.33; 95% CI, 2.32–144.82; p = 0.006) were independent predictors of PR. This study found that increased plasma PIC levels were associated with PR following the endoscopic evacuation of sICHs, indicating that increased plasma PIC levels could be potentially used to predict PR. Further studies are needed to establish new surgical strategies and adjuvant treatments to improve surgical outcomes in patients with sICH prone to PR.

Premise The genus Arisaema (Araceae) has rapidly diversified in Japan, and multiple species often coexist in the field. Although Japanese Arisaema species hybridize from artificial crossing, hybrid individuals are rare in mixed populations; suggesting the presence of effective pre-pollination barriers. We examined the following reproductive barriers between A. sikokianum and A. tosaense: habitat, phenology, and pollinator isolations. Methods Habitat isolation was examined by interspecific comparisons of microhabitat conditions at a mixed site and of altitude at the sampling site of herbarium specimens. Phenological isolation was evaluated by comparing seasonal transition in apparent spathe condition and frequency of insect visitation. Pollinator isolation was examined by comparing floral visitor assemblages between the two Arisaema species. To avoid overestimation of pollinator isolation due to seasonal changes in insect assemblages, we also compared visitor assemblages between natural and late-flowering A. sikokianum, where the latter was experimentally introduced and blooming with a natural A. tosaense population. Results Microhabitat conditions and sampling elevations of herbarium specimens overlapped between the two Arisaema species. At the population level, A. sikokianum and A. tosaense flowered for 39 and 52 days, respectively, with 13 days overlap. Insect visitation in A. sikokianum decreased before the seasonal overlap. Floral visitor assemblages differed between the two Arisaema species, while the difference between natural and late-flowering A. sikokianum was less distinct. Conclusions Phenological and pollinator isolation contribute to reproductive isolation between the two Arisaema species and should enable the two species to coexist in this area.

Commelina communis f. ciliata (Commelinaceae), a newly distinguished taxon, is an annual andromonoecious herb exhibiting a mixed mating system, the details of which remain unclear. We developed microsatellite markers for use in exploring the evolution of andromonoecy and mixed mating in the species. Fifteen microsatellite loci were developed using next-generation sequencing. The primer sets were used to evaluate 65 C. communis f. ciliata individuals from three populations in Japan; we found 1-13 alleles per locus and the expected heterozygosity ranged from 0.00 to 0.76. The markers are potentially useful to examine intra- and interspecies genetic structure and the mixed mating strategy of Commelina species via paternity analysis.

Background: Craniocervical junction arteriovenous fistulas (CCJAVFs) are known to be rare, but variations and clinical behaviors remain controversial. Methods: A total of 11 CCJAVF patients (M: F=9:2, age 54–77 years) were investigated. Based on the radiological and intraoperative findings, they were categorized into three types: dural AVF (DAVF), radicular AVF (RAVF), and epidural AVF (EDAVF). Results: There were four symptomatic patients (subarachnoid hemorrhage in two, myelopathy in one, and tinnitus in one) and seven asymptomatic patients in whom coincidental CCJAVFs were discovered on imaging studies for other vascular diseases (arteriovenous malformation in one, intracranial DAVF in two, ruptured cerebral aneurysm in two, and carotid artery stenosis in two). Of these 11 patients, 2 (18.2%) had multiple CCJAVFs. Of 14 lesions, the diagnoses were DAVF in 5, RAVF in 3, and EDAVF in 6 (C1–C2 level ratio =5:0, 2:1, 3:3). Patients with DAVF/RAVF in four lesions with intradural venous reflux underwent surgery, although an RAVF remained in one lesion after embolization/radiation. Since all six EDAVFs, two DAVFs, and one RAVF had neither feeder aneurysms nor significant symptoms, no treatment was provided; of these nine lesions, one DAVF and one RAVF remained unchanged, whereas six EDAVFs showed spontaneous obliteration within a year. Unfortunately, however, one DAVF bled before elective surgery. Conclusion: CCJAVFs have many variations of shunting site, angioarchitecture, and multiplicity, and they were frequently associated with coincidental vascular lesions. For symptomatic DAVF/RAVF lesions with intradural drainage, surgery is preferred, whereas asymptomatic EDAVFs without dangerous drainage may obliterate during their natural course.

Background and Purpose: To date, the incidence of intracranial and spinal arteriovenous shunts has not been thoroughly investigated. We aimed to clarify recent trends in the rates of intracranial and spinal arteriovenous shunts in Japan. Methods: We conducted multicenter hospital-based surveillance at 8 core hospitals in Okayama Prefecture between April 1, 2009 and March 31, 2019. Patients who lived in Okayama and were diagnosed with cerebral arteriovenous malformations, dural arteriovenous fistulas (DAVFs), or spinal arteriovenous shunts (SAVSs) were enrolled. The incidence and temporal trends of each disease were calculated. Results: Among a total of 393 cranial and spinal arteriovenous shunts, 201 (51.1%) cases of DAVF, 155 (39.4%) cases of cerebral arteriovenous malformation, and 34 (8.7%) cases of SAVS were identified. The crude incidence rates between 2009 and 2019 were 2.040 per 100 000 person-years for all arteriovenous shunts, 0.805 for cerebral arteriovenous malformation, 1.044 for DAVF, and 0.177 for SAVS. The incidence of all types tended to increase over the decade, with a notable increase in incidence starting in 2012. Even after adjusting for population aging, the incidence of nonaggressive DAVF increased 6.0-fold while that of SAVS increased 4.4-fold from 2010 to 2018. Conclusions: In contrast to previous studies, we found that the incidence of DAVF is higher than that of cerebral arteriovenous malformation. Even after adjusting for population aging, all of the disease types tended to increase in incidence over the last decade, with an especially prominent increase in SAVSs and nonaggressive DAVFs. Various factors including population aging may affect an increase in DAVF and SAVS.

Table 1 on p. 135 should be replaced with the corrected Table 1 shown bellow.

General decline of understory cover can result from increased abundance of and foraging pressure by deer. But population size and degree of aggregation can increase for unpalatable understory plants that escape foraging pressure. Clonal reproduction can enable unpalatable plant species to increase their population sizes while trending toward spatially aggregated distributions. However, the details of the relationship between clonal reproduction in unpalatable plants and their dynamics under intensive deer herbivory are not clear. We compared the population structures and spatial patterns of two coexisting unpalatable plant species, Arisaema ovale (with clonal reproduction) and A. peninsulae (without clonal reproduction) in a riparian forest intensively grazed by Sika deer, and examined the null hypothesis that the extent of spatial aggregation and local population size would not differ between the clonal and non-clonal Arisaema species. In a 0.36-ha plot, A. ovale had a larger population size (1087 individuals) with a higher abundance ratio of small plants (p

The seedling stage is critical in the life cycle of trees, and performance is controlled by both abiotic and biotic factors, which are spatially heterogeneous. We investigated the relationships between the seedling survival or growth of Fagus crenata and seven potentially influencing factors (culm density of dwarf bamboo, slope angle, topographic convexity, distance from the nearest conspecific adult, and local density of F. crenata seedlings, and seedling size and age), under consideration of the changes in direction and strength of the microtopographic effects across space. In 2011, we identified all F. crenata seedlings (maximum stem length

Estimating the timing of flower bud formation in plants is essential to identify environmental factors that regulate floral transition. The presence of winter dormancy between the initiation of flowers and anthesis, characteristic of most trees in the temperate forests, hampers accurate estimation of the timing of floral transition. To overcome this difficulty, expression levels of flowering-time genes could be used as indicators of the timing of floral transition. Here, we evaluated the usefulness of molecular markers in estimating the timing of floral transition in Fagus crenata, a deciduous tree that shows intermittent and synchronized flowering at the population level. We selected FLOWERING LOCUS T (FT) as a candidate molecular marker and quantified the expression levels of its ortholog in F. crenata (FcFT). Subsequently, we analyzed the relationship between morphogenetic changes that occur between the vegetative state of the buds and the initiation of floral organs, and compared the FcFT expression levels in reproductive and vegetative buds, collected from spring to autumn. FcFT expression in leaves peaked at least two weeks before the morphological changes associated with flowering were visible in the buds in late July. FcFT expression levels were significantly higher in the reproductive buds than in the vegetative buds in July. These results suggest that the FcFT expression in July is a reliable indicator of the timing and occurrence of floral transition. This study highlights the utility of molecular tools in unraveling reproductive dynamics in plants, in combination with ecological and physiological approaches.

Seedling genotype is one of the major factors affecting seedling survival when the rate of damage by natural enemies depends on a host genotype. However, to our knowledge, no previous study has examined the mortality of seedlings adjacent to conspecific adults, considering intraspecific variation in seedling genotypes. On the basis of the assumption that natural enemies adapt to adult trees having a unique genotype, we tested the hypothesis that seedling survival decreases when they are more closely genetically related to neighboring adults, by measuring the mortality rate of seedlings of Fagus crenata growing in a cool-temperate forest in Japan. We estimated the genetic relatedness of seedlings (2 and 6 years old) to the neighboring adult F. crenata using microsatellite analysis and measured seedling survival. We determined that there was a non-significant negative correlation between seedling survival and genetic relatedness in the 2-year-old seedling cohort, and a non-significant but positive correlation in the 6-year-old seedlings. Our results call for further studies on the potential relationship between seedling survival and genetic relatedness to neighboring adults.

Dendrochronological approaches enable us to understand forest stand dynamics by estimation of disturbance history and age structure. The present study was conducted in an old-growth beech forest in a forest reserve in western Japan. Increment cores were taken for tree ring analysis from all canopy trees in a 50 m × 130 m study plot. Radial growth release criteria were developed to identify significant growth releases in each tree ring series and to characterize the disturbance history of the study site. The age structure of the forest was indicative of continuous establishment by Fagus crenata and simultaneous establishment by Magnolia obovata. A variety of low-intensity disturbances were identified in each decade, especially after the 1900s, but the occurrence of high-intensity catastrophic disturbance was rare, and likely played an important role in maintaining species diversity in the existing forest canopy. The results also suggest that F. crenata regenerates gradually before and after both large- and small-scale disturbances, whereas M. obovata and Betula grossa regenerate only after large-scale catastrophic disturbances.

Objective While a certain fraction of endometriomas can develop de novo epithelial ovarian cancer (EOC) such as clear cell carcinoma (OCCC), there is currently no useful biomarker available for early detection of OCCC from endometriomas. The aim of this study was to describe the diagnostic utility of a novel biomarker for EOC especially for OCCC to distinguish from endometrioma. Methods More than 100,000 glycan structures of serum glycoproteins obtained from 134 pretreatment all stage EOC patients (including 45 OCCCs) and 159 non-cancer control women (including 36 endometriomas) were explored for a mass spectrum approach. Diagnostic accuracy of identified biomarker was compared to the one of CA-125 by comparing area under curve (AUC) and positive/negative predictive values (PPV and NPV). Results A2160, a fully-sialylated alpha-chain of complement 4-binding protein, was identified as a candidate target marker. A2160 was significantly elevated in all stages of OCCC compared to with endometriomas. Diagnostic accuracy of A2160 (cutoff 1.6U/mL) to distinguish early stage OCCC from endometrioma is significantly higher than that of CA-125 (cutoff 35IU/L): AUC for A2160 versus CA-125, 0.92 versus 0.67; PPV 95% versus 64%; and NPV 85% versus 58%. In addition, fully-sialylated glycans had a higher accuracy for diagnosing EOC as compared to partially-sialylated glycans of alpha-chain of complement 4-binding protein. Conclusion Our study suggested that A2160 may be a useful biomarker to distinguish early-stage OCCC from endometrioma. This new biomarker can be potentially applied for the monitoring of endometrioma patients, making possible the early diagnosis of OCCC.

Malignant oral cancers do not commonly occur in pregnant women. But when they do, the presence of a foetus and maternal physiological changes complicate and limit the treatment options. Risk benefit assessment and balancing of them are always important. A 33-year-old woman, who was 25 weeks pregnant, presented with a squamous cell carcinoma on her tongue. She was clinically staged II (T2, N0 and M0). Discussions between the patient, surgical teams and obstetricians agreed to continue her pregnancy while managing the tumour. Hemi-glossectomy and ipsilateral neck dissection was performed. Free antero-lateral thigh flap was transferred to reconstruct the tongue defect, successfully. The patient gave birth to a healthy baby afterward. She is tumour free for 6 years. Free flap reconstruction can be an option, even if the patient is pregnant.

A Japanese male patient presented with an enormously disfigured penis and scrotum. The penis was swollen and distorted rightward, and the skin was hard and lumpy. The patient had had a subdermal abscess for 6 years. The current condition was considered secondary lymphoedema of the penis and scrotum resulting from chronic skin infection. Wide excision of the affected area with bilateral inguinal lymph node dissection were performed. The degloved penile shaft and scrotum were covered with skin grafts, and a satisfactory result was obtained.

Several proximate factors of masting have been provided. Here, I focus on the role of internal factors, especially the relationship between internal carbon resources and modular structures in trees. I summarize various studies of carbon resource allocation for reproduction during masting events in terms of the proximate factors of masting and discuss the modular structure in which trees accumulate and consume carbon resources as well as the timing when internal carbon resources affect masting since trees have complex resource dynamics among organs. The resource budget model, which provides a simple mechanistic explanation of the masting mechanism, is supported by various study lines. This model assumes decreasing levels of stored photosynthate after flowering and fruiting. According to several studies, however, carbon reserves do not decrease after fruiting in species in which the modules autonomously allocate current photosynthate for fruiting. In addition, it is important to elucidate when carbon resources affect masting events because during their long developmental processes, trees pass through various stages until they produce maturing fruits to create successful masting events. To explore the mechanisms of masting in future studies, it would be important to figure out how and when candidate factors (including nutrients other than carbon) may influence the entire reproduction process, for example, using field manipulation experiments.

Hepatitis B virus (HBV) reactivation during anticancer chemotherapy or immunosuppressive therapy in chronic carriers can lead to fatal liver failure. We report a rare case of severe HBV reactivation during postoperative radiotherapy with concomitant and adjuvant temozolomide (TMZ) for malignant glioma. A 49-year-old Japanese woman with a history of HBV carrier status with positive results for hepatitis B surface antigen presented with persistent headache due to a tumor in the left frontal lobe. The tumor was partially resected and anaplastic astrocytoma was diagnosed. Postoperative liver function was normal and radiotherapy plus concomitant and adjuvant TMZ was started. Impaired liver function became apparent just before administration of adjuvant TMZ, and acute liver failure developed. Antiviral therapy including entecavir, a nucleoside analog, led to a successful outcome and the patient survived. This case underlines the possibility of HBV reactivation due to TMZ and suggests the utility of HBV screening and antiviral prophylaxis before administration of TMZ to patients with malignant glioma.

Airborne pollen of Cryptomeria japonica causes severe pollinosis, and the number of people suffering from pollinosis has increased rapidly during recent decades. Male flower production in C. japonica shows annual variability; thus, predicting male flower production for the following spring could be a countermeasure against pollinosis. We analyzed factors that explain fluctuations in male flower production of C. japonica according to parameters reflecting internal resource dynamics based on field observations. In addition, we carried out experiments to regulate available resource levels using artificial shading to test the effect of internal resource levels on the number of male flowers produced. We found that temperature and precipitation in the previous summer and a relative increase in male flower production in the previous year were negatively related, whereas sunshine duration in the previous summer and diameter at breast height were positively related to the current year increase in male flower production. The number of male flowers was significantly reduced by the shading treatment and was positively correlated with the amount of total non-structural carbohydrates in the root. These results suggest that understanding the parameters controlling internal resource levels could lead to more accurate predictions of male flower production.

We studied the expression of peripheral myelin protein 22 (PMP22) gene in the human central nervous system (CNS). Northern blot analysis was performed with polyA+ RNA blots containing several parts of the human brain and the spinal cord using human PMP22 cDNA as a probe. As two alternative PMP22 transcripts have been reported and since exon 1A-containing transcripts are associated with myelin formation, the exon 1A fragment was also used to examine this transcript. Total PMP22 mRNA was significantly detected in most parts of brain and spinal cord, while exon 1A-containing transcripts were detected in the medulla, spinal cord and corpus callosum. PMP22-like immunoreactivity was identified in motor neurons and preganglionic sympathetic neurons in the spinal cord. PMP22 was also detected in pia mater of the spinal cord. These results suggest that PMP22 might play an important role in human CNS.

Palladium-catalyzed aryl amination of 2,6-dibromopyridine with 2,6-bis(methylamino)pyridine or 2-bromo-6-(methylamino)pyridine gave new azacalix[ n ](2,6)pyridines ( n =4 and 6). Molecular structure, conformation, and complexation of the macrocycles toward zinc ion were characterized by NMR spectroscopy and X-ray crystallography.

An analysis is presented of three possible pathways of reproductive allocation, namely, allocation of resources to reproductive organs from reproductive shoots, from non‐reproductive shoots and from the main trunk. These pathways were examined by comparing the amount of storage starch in reproductive shoots, non‐reproductive shoots and the main trunk in Styrax obassia, a typical masting tree species, during a year of little flowering (1999) and in a mass‐flowering year (2000). In addition, we measured rates of light‐saturated photosynthesis in leaves of reproductive and non‐reproductive shoots to examine the contribution of photosynthetic production to reproductive costs. In both the main trunk and non‐reproductive shoots the pattern of seasonal variation in the amount of starch did not differ between 1999 and 2000. However, in the mass‐flowering year, the amount of starch in the reproductive shoots was less than that in non‐reproductive shoots during the growing season. Thus, reproductive shoots bore most of the cost of reproduction, although non‐reproductive shoots and the main trunk also bore some of the cost. Mass‐based rates of light‐saturated photosynthesis of the leaves of reproductive shoots were significantly higher than those of non‐reproductive shoots during both the flowering and the fruiting period. However, leaves of reproductive shoots had a significantly smaller area, a lower mass per area, and lower concentrations of nitrogen than leaves of non‐reproductive shoots, although the number of leaves did not differ between the two types of shoots. Therefore, the amount of photosynthate per shoot was significantly lower in reproductive shoots than in non‐reproductive shoots. These results suggest that the cost of reproduction depends predominantly on storage starch in reproductive shoots, although it is still unclear how much photosynthate is allocated to reproductive organs from non‐reproductive shoots.

We analyzed the first audiological assessment and latest pure tone audiometry (PTA) in 29 hearing-impaired children (58 ears) visiting Osaka University for their first audiological assessment at the ages of 0, 1, and 2. We evaluated their hearing thresholds with PTA during follow-up and compared them to their first assessments. We combined auditory brain-stem response (ABR), behavioral audiometry, and conditioned orientation reflex (COR) for audiological evaluation of infants. Hearing thresholds assessed by 2 or 3 of these methods were sufficiently precise for hearing aid fitting. Thresholds of recorded ABR waves in 14 ears at loud sound pressure correlated well with later pure tone thresholds at high frequencies. Pure tone thresholds of those in whom no ABR waves were observed at 100 dB, were often out of scale at high frequencies--14% at 4000 Hz and 73% at 8000 Hz. Because of residual hearing at low frequencies, 4-frequency-averaged hearing at 500 Hz, 2 x 1000 Hz, 2000 Hz was better than 100 dB in 7 of 44 ears (16%), and 4 of 22 children (18%) did not fit the severest rank, 2, of the Disabled Persons, Welfare Law in Japan.

Type 2 diabetes is known to be associated with cognitive dysfunction and an increased risk of dementia in the elderly. Although it is one of the most efficacious therapies in diabetic patients, insulin therapy requires that patients learn to inject themselves with insulin. We studied the association between brain atrophy detected on magnetic resonance imaging (MRI) of the head and the ability of type 2 diabetic patients to learn self-injection. MRI of the head was performed in 41 type 2 diabetic patients aged 60-80 years old. The area of the cerebrum relative to the intracranial area (the brain parenchymal fraction: BPF) was calculated with the WinROOF software program. Learning ability was assessed by counting the number of training sessions needed to acquire the ability to self-inject. Patients were divided into a failure group and success group. The average age was significantly higher (P < 0.001) and the BPF was significantly lower (P < 0.001) in the failure group (patients requiring 14 or more training sessions) than the success group (the remaining patients). A binary logistic regression analysis revealed that both age and BPF were independent predictors of success/failure in acquiring self-injection ability (P = 0.005 and P = 0.031, respectively). We conclude that brain atrophy on MRI is an important determinant of the ability of patients to learn insulin self-injection.

The parapharyngeal space is a complex area where a variety of both primary and metastatic neoplasms can originate. Metastatic lymph nodes in this region are common in pharyngeal squamous cell carcinoma. However it is a rare clinical occurrence that a metastatic thyroid carcinoma occupies the parapharyngeal space. We reported a 58-year-old male who had been operated upon for a thyroid carcinoma at 44 years of age and had a large metastatic lymph node in the right parapharyngeal space. We removed the metastatic lymph node by the mandibular swing-transcervical approach. Rouviere described a direct lymphatic pathway from the posterior surface of the superior thyroid lobe to lateral retropharyngeal lymph nodes. The possibility must be considered that thyroid carcinoma existing in that particular region can metastasize to the parapharyngeal space.

Clinical findings in 14 ears of 12 patients (7 females and 5 males) with inner ear damage due to acute otitis media were studied. The patients' ages ranged between 27 and 77 years (average 45 years). The patiens complained of otalgia, hearing loss, tinnitis, and vertigo at the time of their initial presentations. They were treated with antibiotics combined with steroids, vasodilators, and vitamins. Complete recovery of hearing was obtained in 6 ears. We recommend early auditory and vestibular testing for patients who were suspected to have sensorineural hearing loss, tinnitis or vertigo due to inner ear damage.

Sasa senanensis is a dwarf bamboo species distributed on the floors of cool temperate forests in Japan and adjacent regions. We isolated eight polymorphic microsatellite loci from this species. The number of alleles ranged from two to eight and the observed heterozygosity per locus from 0.13 to 0.74. Seven of the eight loci were also polymorphic in Sasa nipponica. Most of these markers were successfully amplified in other dwarf bamboo species. These markers will be useful for investigating clonal structure and population genetics in some dwarf bamboo species.

The role of resource availability in determining the incidence of masting has been widely studied, but how floral transition and initiation are regulated by the resource level is unclear. We tested the hypothesis that floral transition is stimulated by high resource availabiltiy in Fagus crenata based on a new technique, the expression analyses of flowering genes. We isolated F. crenata orthologues of FLOWERING LOCUS T, LEAFY and APETALA1, and confirmed their functions using transgenic Arabidopsis thaliana. We monitored the gene expression levels for 5 years and detected a cycle of on and off years, which was correlated with fluctuations of the shoot-nitrogen concentration. Nitrogen fertilisation resulted in the significantly higher expression of flowering genes than the control, where all of the fertilised trees flowered, whereas the control did not. Our findings identified nitrogen as a key regulator of mast flowering, thereby providing new empirical evidence to support the resource budget model.

Air embolism is a rare, but occasionally fatal complication of peripheral and central venous catheterization. We present a case of an 89-year-old female, who had a central venous catheter placed in her right jugular vein during the perioperative period for right femoral subtrochanteric fracture. On the day following her operation, level of consciousness worsened a few minutes after the catheter was removed. CT scan showed air bubbles in bilateral cavernous sinuses and brachiocephalic vein. Administration of 100% oxygen was started, and she regained consciousness a few hours later, finally air bubbles disappeared on a CT scan performed 10 hours after onset. Air embolism should be taken into consideration when treating venous catheters, and appropriate O₂ administration and radiological examinations must be performed immediately if level of consciousness or vital signs deteriorate.

A 46-year-old woman was admitted to our hospital for examination of her amnesia. Psychiatric examinations revealed that her recent memory was moderately disturbed despite well-preserved general cognitive function. Brain MRI and I-IMP SPECT (eZIS) revealed mild brain atrophy and hypoperfusion localized to the hippocampus, superior parietal lobule, and posterior cingulate gyrus. She was diagnosed with amnestic MCI at that time. However, five years later, she developed personality changes, parkinsonism and dementia. Investigation of her family medical history revealed that the patient's two sisters are demented and under the medical care. DNA analysis revealed an intronic mutation IVS10 C>T in the MAPT gene. Although her two sisters also have the same mutation, her elder sister has typical FTD without parkinsonism. Approximately 10% of patients with amnestic MCI develop Alzheimer's disease each year. Thus, amnestic MCI has been usually considered to be an early stage of Alzheimer's disease. Interestingly our patient having a MAPT gene mutation started to develop amnestic MCI as an initial symptom. Therefore because of the diversity in early clinical features of FTDP-17, aggressive DNA analysis is necessary for accurate diagnosis.

Dwarf bamboos in the genus Sasa are believed to be long-lived, synchronously flowering, and monocarpic plants. However, the monocarpy of dwarf bamboo has not been confirmed, because whether all ramets within one genet flower at the same time cannot be determined without differentiating the genetic structure among ramets. This study aims to evaluate the reproductive traits of Sasa pubiculmis by verifying the monocarpy and physiological integration between flowering ramets and non-flowering ramets during a 4-year flowering period. One genotypically identified genet, which covered an area of approximately 3 ha, had both flowering and non-flowering patches of ramets during the 4-year flowering period (2004-2007). A fraction of the flowering genet remained non-flowering during the 4 years of observation, and did not die after mass flowering. Flowering ramets were physically connected to non-flowering ramets via rhizomes, and assimilated (13)C was allocated from non-flowering ramets to flowering ramets. Consequently, we clarified that this dwarf bamboo potentially has polycarpic reproductive traits rather than monocarpic, and a genet can keep rhizomes and non-flowering patches alive to sustain the organism after mass flowering.

595 Background: CEA and CA19-9 are measured widely in daily practice for colorectal cancer to monitor the condition of treatment, though its specificity and sensitivity is not satisfied enough. While, the innovation of mass spectrometry in this decade is dramatically. The revolutionized approach for the screening of glycomarkers provides a chance to discover more desirable tumor markers. We focused on glycan alterations of serum glycoproteins and tried to find new markers which are more specific and sensitive than the current markers. Methods: Sera of 80 CRC patients and 50 healthy volunteers were analyzed in this study. Glycopeptides were prepared from serum proteins by trypsin digestion, enriched by filtration and aleuria aurantia lectin(AAL), and then applied to liquid chromatography time-of flight mass spectrometry* (*LC-TOF-MS). Data was analyzed with our newly developed software, which calculates all of peak intensities and positions (m/z and elution time), aligns all peaks for all samples, and finally screens markers from a million of candidates. Results: Leucine-rich alpha-2-glycoprotein-1 with fucosylated triantennary N-glycan (LRG-FTG) was discovered as a new CRC marker from over 100,000 candidate glycopeptide peaks. The level of LRG-FTG in CRC patients (1.25 ± 0.973 U/ml) was much higher than that of healthy parsons (0.496 ± 0.433 U/ml, p < 10-10). Its sensitivity and specificity exceeded those of CA19-9. CEA and LRG-FTG levels were moderately correlated (r = 0.61), however their relation was independent and complementary. Combination marker of LRG-FTG and CEA showed 84% of sensitivity, 90% of specificity and 0.91 of AUC (ROC analysis), and responded well to the efficacy of chemotherapy. Conclusions: Serum LRG-FTG was significantly elevated in CRC patients compared to healthy volunteers. The combination with CEA is expected to be an alternative diagnostic marker which distinguishes CRC from healthy persons and a sensitive monitoring marker for evaluation of efficacy during chemotherapy. Further validation study is warranted to evaluate serum LRG-FTG combination test compared with conventional tumor markers.