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Systemic amyloidosis is a diseased condition where misfolded proteins deposit in various organs in the form of amyloids, and transthyretin deposition, termed ATTR amyloidosis, can be either an age-related amyloid formation from misfolded wild-type TTR (ATTRwt) or by hereditary TTR malfunction due to mutation in the TTR gene (ATTRv). Although ATTRwt amyloidosis can cause various diseases, such as cardiac failure, conduction disturbances, arrhythmias and carpal tunnel syndrome, it is still under-recognised considering its clinical significance. Here the authors report a case of ATTRwt amyloidosis leading to carotid stenosis requiring surgical intervention. To the best of our knowledge, the current report is the first that described histopathological evidence of amyloid deposition in the carotid artery due to ATTRwt amyloidosis.

OBJECTIVE “Join,” an imaging technology–based telemedicine system, allows simultaneous radiological information sharing between physically remote institutions, virtually connecting advanced medical institutions and rural hospitals. This study aimed to elucidate the health economics effect of Join for neurological telemedicine in rural areas in Hokkaido, Japan. METHODS Information concerning 189 requests for patient transfer from Furano Kyokai Hospital, a regional rural hospital, to Asahikawa Medical University Hospital (AMUH), an advanced academic medical institution, was retrospectively collected. The Join system was established between Furano Kyokai Hospital and AMUH in February 2019. Data collected from patients between April 2017 and December 2018 were included in the non-Join group, and those collected between February 2019 and October 2020 were included in the Join group. Clinical variables, reasons for patient transfer requests, duration of hospital stay, and medical costs per patient were analyzed between these two groups. Furthermore, clinical characteristics were compared between patients who were transferred and not transferred based on Join. RESULTS More patients were discharged < 7 days after transfer to AMUH in the non-Join group compared with the Join group (p = 0.02). When focusing on the Join group, more patients who were not transferred were discharged < 1 week (p < 0.01). On the other hand, more patients required surgery (p = 0.01) when transferred. The ratio of patients whose medical cost was < USD5000 substantially decreased, from 33% for the non-Join group to 13% for the Join group. CONCLUSIONS An imaging technology–based telemedicine system, Join, contributed to reducing unnecessary neuro-emergency patient transfer in a remote rural area, and telemedicine with an integrated smartphone system allowed medical personnel to effectively triage at a distance neuro-emergency patients requiring advanced tertiary care.

Background:The 3-meter Timed Up and Go test (TUG) is a reliable quantitative test for assessment of gait and balance. We aimed to establish an optimal threshold of TUG at the tap test for predicting outcomes 12 months after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).Methods:The TUG was measured in a total of 151 patients with possible iNPH before and after a tap test and 12 months after shunt surgery. Among them, 81 patients underwent ventriculoperitoneal shunt implantation (SINPHONI) and 70 underwent lumboperitoneal shunt implantation (SINPHONI-2). The areas under the curve (AUCs), sensitivities, and specificities for predicting shunt effectiveness were assessed.Results:The simple differences of time on TUG at the tap test were significantly more accurate for predicting shunt effectiveness than percent improvement of time. The highest AUC for the synchronized moving cutoff point of TUG time was 0.81 (sensitivity 81.0%; specificity 81.6%) at the threshold of 5 seconds in the SINPHONI-2. For predicting improvements of ≥10 seconds 12 months after lumboperitoneal shunt implantation, the AUC was 0.90, and the sensitivity and specificity at the threshold of 5.6 seconds were 83.3% and 81.0%. Only for patients with a Conclusions:An improvement of 5 seconds was a useful threshold of TUG time at the tap test for predicting a ≥10-second improvement 12 months after shunt surgery, rather than the percent improvement of TUG time.

The dynamic mixing power required for mulling process of green mold sands was measured by using various types of kneaders and binding materials. A series of tensile tests for the green mold sands were carried out. The surface structures of the sands were also observed by a scanning electron microscope. The state of mulling of the sands was found to be successfully correlated with the tensile strength, the tensile breakup energy and the compression characteristics of the sands. It was also found that the completeness of mulling process could be assessed by observing the steadiness of the power for mulling, and that it could be evaluated in terms of the tensile breakup energy. The more the power for mulling was required, the better the state of mulling was.

We showed that ventriculoperitoneal (VP) shunt and lumboperitoneal (LP) shunt surgeries are beneficial for patients with idiopathic normal pressure hydrocephalus (iNPH) in the Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement (SINPHONI; a multicenter prospective cohort study) and in SINPHONI-2 (a multicenter randomized trial). Although therapeutic efficacy is important, cost-effectiveness analysis is equally valuable. Using both a set of assumptions and using the data from SINPHONI and SINPHONI-2, we estimated the total cost of treatment for iNPH, which consists of medical expenses (e.g., operation fees) and costs to the long-term care insurance system (LCIS) in Japan. Regarding the natural course of iNPH patients, 10% or 20% of patients on each modified Rankin Scale (mRS) show aggravation (aggravation rate: 10% or 20%) every 3 months if the patients do not undergo shunt surgery, as described in a previous report. We performed cost-effectiveness analyses for the various scenarios, calculating the quality-adjusted life year (QALY) and the incremental cost-effective ratio (ICER). Then, based on the definition provided by a previous report, we assessed the cost-effectiveness of shunt surgery for iNPH. In the first year after shunt surgery, the ICER of VP shunt varies from 29,934 to 40,742 USD (aggravation rate 10% and 20%, respectively) and the ICER of LP shunt varies from 58,346 to 80,392 USD (aggravation rate 10% and 20%, respectively), which indicates that the shunt surgery for iNPH is a cost-effective treatment. In the 2nd postoperative year, the cost to the LCIS will continue to decrease because of the lasting improvement of the symptoms due to the surgery. The total cost for iNPH patients will show a positive return on investment in as soon as 18 months (VP) and 21 months (LP), indicating that shunt surgery for iNPH is a cost-effective treatment. Because the total cost for iNPH patients will show a positive return on investment within 2 years, shunt surgery for iNPH is a cost-effective treatment and therefore recommended. The SINPHONI-2 study was registered with the University Hospital Medical Information Network Clinical Trials registry: UMIN000002730) SINPHONI was registered with ClinicalTrials.gov, no. NCT00221091.

Background and Purpose: The optimal use of antiplatelet therapy for intracranial branch atheromatous disease (BAD) is not known. Methods: We conducted a prospective multicenter, single-group trial of 144 consecutive patients diagnosed with probable BAD. All patients were treated within 12 h of symptom onset to prevent clinical progression using dual antiplatelet therapy with cilostazol plus one oral antiplatelet drug (aspirin or clopidogrel). Endpoints of progressive BAD in the dual therapy group at 2 weeks were compared with a matched historical control group of 142 patients treated with single oral antiplatelet therapy using either cilostazol, aspirin, or clopidogrel. Results: Progressive motor paresis occurred in 14 patients (9.7%) in the aggressive antiplatelet group, compared with 48 (33.8%) in the matched single antiplatelet group. Multivariate logistic regression analysis revealed the following variables to be associated with a better prognosis for BAD: baseline modified Rankin Scale score, dual oral antiplatelet therapy with cilostazol, and dyslipidemia (odds ratios of 0.616, 0.445, and 0.297, respectively). Hypertension was associated with a worse prognosis for BAD (odds ratio of 1.955). Conclusions: Our trial showed that clinical progression of BAD was significantly reduced with the administration of ultra-early aggressive combination therapy using cilostazol compared to treatment with antiplatelet monotherapy.

LactoSorb fixation plates are made of a bioabsorbable polymer (82% poly-L-lactic acid and 18% polyglycolic acid), and the strength is not inferior to titanium plates. LactoSorb has been used in the fields of pediatric neurosurgery and facial plastic surgery. Cranial fixation in craniotomy is mostly performed using titanium plates and clamps, but there are issues with esthetics and artifacts on postoperative radiographic images. Absorbable plates solve these problems, but are slightly thicker and more expensive. Here, we describe a technique to solve these disadvantages by inserting absorbable plates into the diploe. The present method was employed in 46 patients, and esthetically favorable results were obtained without intraoperative and postoperative complications. Absorbable plates may replace titanium plates as the main device for cranial fixation. The present method is particularly useful for cranial fixation in adults with a thin scalp.

Carbon nanotubes (CNT) have remarkable mechanical properties with very high elastic modulus and electrical conductivity. Shape memory polymer (SMP) as one of smart materials is characterized with its remarkable recoverability and shape memory effect, but its mechanical properties such as strength and elastic modulus is not high enough. In this study, CNT/SMP nanocomposites were developed with the typical CNTs of the vapor growth carbon fibers (VGCFs). A fine and homogeneous dispersion of VGCF throughout the SMP matrix is obtained. The specimens with different VGCF weight fraction, such as SMP bulk, 1.7 wt.%, 3.3 wt.% and 5.0 wt.%, were prepared, and their dynamic mechanical properties and shape recovery behavior were investigated. It was found that storage elastic modulus is improved obviously with increment of VGCF weight fraction, and the CNT/SMP nanocomposites showed a good shape memory effect. It is indicated that the recovery stress of CNT/SMP nanocomposites with only 3.3% weight fraction of carbon nanotubes will reach almost twice of that in SMP bulk.

The establishment of recycling systems and the reduction of various fiber wastes are strongly required to create a truly recycling society. In recent years, antibacterial functionality in products such as household articles have become widely used because of the rising demand for cleanliness and comfort in our lives. Therefore the amount of antibacterial waste fibers is expected to increase in the near future. With this trend in mind, this paper focuses on the use of PET fiber waste containing antibacterial agents in producing useful PET fiber reinforced PP thermoplastic composites.The PET waste fibers containing antibacterial agents were cut into 50mm lengths and mixed with a PP web by using a carding machine to make PET/PP webs with 0-70 weight percent of PET fiber (Wf). Samples were compression molded at a molding temperature between 180∼250°C. The antibacterial and the mechanical properties of the PET/PP composites were evaluated.The results of antibacterial tests showed that the antibacterial activity of the composites increased with increasing Wf. The composites with large Wf showed high antibacterial activity at short times. The bending strength of composites with Wf=10∼40% was larger than that of the neat PP matrix, and showed a maximum value at Wf=40% of about 1.6 times that of the neat PP matrix. The Izod impact value also increased notably with increasing Wf. It was concluded that the molding system devised here was an effective method for the recycle of PET fiber waste containing antibacterial agents in composite materials.

The purpose of this study is to investigate the spinnability, biodegradability and antibacterial properties of biodegradable polymers containing a silver-based antibacterial agent. The biodegradable polymers used were polybutyrene succinate (PBS) and polylactic acid (PLA). Two types of silver-based antibacterial agents, silver-based zeolite (AgZL) and silver-based zirconium phosphate (AgZR), were used. The experimental results show that the value of the weight-average molecular weight (Mw), which greatly affects the spinnability of the fiber sample, decreases with the increase in the contents of AgZL and AgZR for both PLA and PBS. The degree of the decrease in the Mw for AgZL was greater than that for AgZR because of the higher content of crystal water for AgZL. The value of antibacterial activity (R) for PLA was higher than that for PBS because of the lactic acid of PLA. AgZL was more effective in terms of antibacterial activity than AgZR in PLA and PBS fiber samples because the elution concentration of silver ions of AgZL is higher than that of AgZR from the initial stage of elution. The biodegradability of PLA and PBS increases with the increase in the content of the antibacterial agent. Especially, the hydrolysis of PLA is accelerated by the silver-based antibacterial agent. Finally, the value of R decreases as the number of washing cycles increases because the antibacterial agent falls of from the polymer surface.

PET fiber reinforced PE thermoplastic composites were molded by using industrial wastes of PET/PE core/sheath non-woven fabrics. The waste fabrics were fed directly into the injection molding machine without prior pelletizing to simplify the molding process. The composition of the fabrics used was 50% PET and 50% PE. By controlling the molding temperature, the PE portion of the fabric could be melted while keeping the PET fibers intact during the injection molding process. At a molding temperature of 200°C, the tensile, bending and impact behavior of the molded composites were much higher than those of the neat PE matrix. Reasonably high Izod impact values were also obtained for the molded composites. However, both the strength and modulus decreased with increasing molding temperature because of the thermal damage to the PET fibers at higher temperatures. The molding system discussed in this paper shows promise for contributing toward the material recycle of core/sheath fiber wastes as a raw material of thermoplastic composites.

Shrinkproof and reinforcing effects of duck feather hydrolysate on the treatment of archaeological waterlogged wood were investigated. The bulking effect, i.e. the shrinkproof index was enhanced through the impregnation of cell walls with duck feather hydrolysate and sodium acetate derived from neutralization process in the preparation of pH 7 duck feather hydrolysate solution. The reinforcement of cell walls seems to be brought about through the structural modification of duck feather hydrolysate to Beta sheet form by acetic acid in the treatment bath. The good affinity between lignin, maincomponent of biodegraded waterlogged wood, and duck feather keratin is also effective for the reinforcement of cell walls.