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A 62-year-old woman was transported to our hospital for management of generalized clonic seizures. Cerebrospinal fluid examination showed an increased monocyte-dominant cell count, high protein concentration, and low glucose concentration that was 17% of the plasma glucose concentration. Contrast-enhanced cranial magnetic resonance imaging revealed diffuse leptomeningeal enhancement with multiple nodular lesions. She underwent examinations that ruled out the following conditions: tuberculous meningitis, systemic sarcoidosis, malignant lymphoma, carcinomatous meningitis, and central nervous system vasculitis. On hospital day 13, dural and brain biopsies revealed neurosarcoidosis, for which steroid therapy was administered. Thereafter, imaging examinations showed marked improvement. Because isolated neurosarcoidosis is difficult to diagnose, early pathologic diagnosis may be essential.

Background and Purpose— We investigated whether administration of edaravone, a free radical scavenger, before or during tissue-type plasminogen activator (tPA) can enhance early recanalization in a major arterial occlusion. Methods— The YAMATO study (Tissue-Type Plasminogen Activator and Edaravone Combination Therapy) is an investigator-initiated, multicenter (17 hospitals in Japan), prospective, randomized, and open-label study. Patients with stroke secondary to occlusion of the M1 or M2 portion of the middle cerebral artery and within 4.5 hours of the onset were studied. The subjects were randomly allocated to the early group (intravenous edaravone [30 mg] was started before or during tPA) and the late group (edaravone was started after tPA and the assessment of early recanalization). Results— One-hundred sixty-five patients (96 men; median age [interquartile range], of 78 [69–85] years) were randomized 1:1 to either the early group (82 patients) or the late group (83 patients). Primary outcome, defined as an early recanalization 1.5 hour after tPA, was observed in 53% of the early group and in 53% of the late group ( P =1.000). About secondary outcomes, the rate of significant recanalization of ≥50% was not different between the 2 groups (28% versus 34%; P =0.393). The symptomatic intracerebral hemorrhage has occurred in 4 patients (5%) in the early group and in 2 patients (2%) in the late group ( P =0.443). The favorable outcome (modified Rankin Scale score of 0–2) at 3 months was also similar between the groups (53% versus 57%; P =0.738). Conclusions— The timing of edaravone infusion does not affect the rate of early recanalization, symptomatic intracerebral hemorrhage, or favorable outcome after tPA therapy. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/index-j.htm . Unique identifier: UMIN000006330.

Background The accessory middle cerebral artery (AMCA) is a middle cerebral artery (MCA) anomaly originating from the anterior cerebral artery. We report our experience of a case in which thrombectomy was undertaken for a patient with hemodynamics that were specific to the AMCA. Case Presentation An 84‐year‐old man with a history of atrial fibrillation developed paralysis of the left upper and lower extremities. Imaging examinations suggested tandem occlusion of the right internal carotid artery and the origin (M2 segment) of the right MCA. An extremely narrow MCA was visualized. Because there was concern regarding development of frontal lobe infarction, thrombectomy was carried out to restore anterograde blood flow, but an AMCA was found. Recanalization of the main MCA in the infarction zone resulted in hemorrhagic infarction, and the patient died of cerebral herniation. Conclusion When a vascular variation like AMCA is suspected, a careful evaluation of hemodynamics is necessary before undertaking endovascular intervention., The accessory middle cerebral artery is a middle cerebral artery anomaly originating from the anterior cerebral artery. A rare case in which thrombectomy was undertaken for a patient with hemodynamics that were specific to an accessory middle cerebral artery is reported.

Background Anticoagulant therapy is used for preventing cerebral infarction in patients with non-valvular atrial fibrillation (NVAF). However, in clinical practice, many patients with NVAF are not prescribed oral anticoagulants (OACs). In this study, we retrospectively investigated the prescription status of OACs at the time of stroke onset and factors associated with drug prescription. Methods We studied patients with cerebral infarction with persistent NVAF who were admitted to our hospital between January 1 2015 and December 31, 2018. A total of 245 patients who had a CHADS2 score of 1 or higher and were receiving outpatient care for any underlying disease were included as subjects in this study. Results Overall, 104 of the 245 (42.4 %) patients received OAC therapy. The percentage of heart failure, percentage of previous cerebral infarction, CHADS2 score before stroke onset, and percentage of specialists (cardiovascular or neurological specialists) were significantly higher in the OAC therapy group than in the non-OAC therapy group. Age was older, and percentages of female sex, dementia, and patients receiving antiplatelet drugs on admission were significantly higher in the non-OAC therapy group than in the OAC therapy group. Multiple logistic regression analysis showed that previous cerebral infarction and specialists were associated with OAC therapy, whereas dementia and antiplatelet drugs on admission were associated with non-OAC therapy [cerebral infarction: odds ratio (OR) 6.926, 95 % confidence interval (CI) 1.742–27.541; specialists: OR 3.209, 95 % CI 1.694–6.080; dementia: OR 0.237, 95 % CI 0.067–0.831; and antiplatelet drug: OR 0.029, 95 % CI 0.007–0.114]. Conclusion Our findings indicate that OAC prescription is affected by a previous history of cerebral infarction, a history of dementia, concurrent use of antiplatelet drugs, and whether the patient visits a specialist.

An 85-year-old woman hospitalized for rehabilitation after cerebral infarction developed persistent bloody diarrhea and was transferred to our hospital (day 1). Contrast-enhanced computed tomography of the abdomen showed edematous thickening extending from the left side of the transverse colon to the rectum, with decreased mucosal enhancement. She was diagnosed with ischemic enteritis. She fasted and was treated with fluids and antibiotics. The bloody diarrhea stopped, and she was restarted on the direct oral anticoagulant (DOAC) edoxaban on day 5. Endoscopy on day 11 showed linear ulceration and severe mucosal edema in the rectum. The diarrhea was persistent, so fasting and fluid therapy were continued. A blood test on day 18 showed significant prolongation of the prothrombin time (≥100 s), International Normalized Ratio (14.03), and activated partial thromboplastin time (87.5 s), as well as a significant increase in protein induced by vitamin K absence-II (12,469 mAU/mL). Her condition was diagnosed as a coagulation abnormality due to vitamin-K deficiency. A vitamin-K preparation was administered immediately, and her coagulation abnormality improved rapidly. In general, DOACs do not require routine monitoring with blood tests. However, frequent monitoring of the coagulation function is required in fasting patients on DOACs because acute coagulation abnormalities can be induced rapidly by vitamin-K deficiency. Given that non-valvular atrial fibrillation and ischemic enteritis are among the most prevalent diseases affecting older people, the likelihood of encountering these diseases in daily clinical practice will increase with the aging of the population. We herein report this instructive case suggesting that a severe coagulation abnormality may develop during treatment for ischemic enteritis in older people taking a DOAC.

AIM As the number of aged stroke patients increases in Japan, the proportion of older patients who receive recombinant tissue plasminogen activator (rt-PA, 0.6 mg/kg) is also rising. However, the Japanese stroke guideline indicates that rt-PA therapy must be administered very carefully in older patients (i.e. ≥81 years of age) because of serious complications after the therapy. We retrospectively assessed the clinical outcomes of rt-PA therapy in older patients. METHODS This study included 321 patients who received rt-PA therapy for acute cerebral infarction at our hospital between April 2007 and April 2017. The outcomes (modified Rankin Scale [mRS] score at 3 months after treatment) and symptomatic intracerebral hemorrhaging (sICH) were compared and analyzed between patients ≥81 years of age (group A) and those

We herein report three ischemic stroke patients who underwent emergency carotid artery stenting after receiving intravenous tissue plasminogen activator (t-PA) treatment. All patients received antiplatelet medications immediately before stent placement for loading as well as dual antiplatelet therapy after stenting. Under high-dose and dual antiplatelet therapy, none of the three patients showed symptomatic intracranial hemorrhaging. However, one case showed reocclusion of the placed stent after acute thrombosis. As a result, new treatment strategies for the use of antiplatelet agents during emergency stent placement must be developed, particularly for patients who have received intravenous t-PA therapy.

Introduction: The mechanism of the unfavorable outcome in diabetic patients treated with intravenous thrombolysis (tPA therapy) is still uncertain. We investigated the relationship of diabetes mellitus with early and delayed recanalization after tPA therapy. Methods: Data on 165 patients from the prospective randomized control study, evaluated the efficacy of combined tPA and Edaravone therapy, were retrospectively analyzed. All patients had the middle cerebral occlusion before t-PA therapy. Based on a history of diabetes mellitus or hemoglobin A1c level of ≥6.5% on admission, all patients were classified into diabetes (D) or non-diabetes (ND) groups. The presence of arterial recanalization was assessed at 2 points: 1) early recanalization, defined as at least partial recanalization Results: Among the 165 (96 men; median age, 78 [69-85] years) patients, 33 (20%) patients were classified into the D group. Age, initial NIHSS score, DWI-ASPECTS, proximal occlusion, and the onset to needle time were not different between the 2 groups (p=0.118, 0.607, 0.586, 0.258, 0.238). Early recanalization was similarly observed in the D and ND groups (61% vs. 51%, p=0.435). However, complete recanalization at 24 h was significantly infrequent in the D group (13% vs. 44%, p=0.002). This tendency was consistent in patients with as well as without early recanalization. Regarding patients with early recanalization, 4 (22%) of the 18 patients in the D group and 34 (58%) of the 59 patients in the ND group had complete recanalization at 24 h (p=0.014). Among those without early recanalization, none (0%) of the 13 patients with the D group had complete recanalization at 24 h, while 18 (30%) of the 60 patients achieved it (p=0.029). By the multivariate regression analysis, diabetes mellitus was the independent negative factor for complete recanalization at 24 h (OR 0.17, 95%CI: 0.05-0.54, p=0.002). At 3 months, there is an increased mortality rate in the D group (19% vs. 6%, p=0.038). Conclusion: Diabetes mellitus was an indicator of no complete recanalization at 24 h regardless of the early recanalization. This may explain the mechanism of the unfavorable outcome in patients with diabetes mellitus.

Objective We previously reported that the antiplatelet action is intensified with combined use of clopidogrel and cilostazol in ischemic stroke patients using the VerifyNow P2Y12 Assay. In this study, the relationship between the cilostazol dose and the platelet function achieved with combination therapy was investigated. Methods The subjects included 231 patients with noncardiogenic ischemic stroke treated at our hospital (18 patients treated with a combination of clopidogrel (75 mg) and cilostazol (100 mg), 52 patients treated with a combination of clopidogrel (75 mg) and cilostazol (200 mg), 126 patients treated with clopidogrel (75 mg) alone and 35 patients treated with cilostazol (200 mg) alone). The platelet function achieved with 20 μM of adenosine diphosphate was measured using the VerifyNow P2Y12 Assay. Clopidogrel resistance was defined as P2Y12 Reaction Units (PRU) >230 and/or % inhibition 230 in 32 patients (25.4%) receiving clopidogrel alone, one patient (5.6%) receiving combination therapy with cilostazol (100 mg) and one patient (1.9%) receiving combination therapy with cilostazol (200 mg). The rate of PRU >230 was significantly lower in both of the cilostazol combination groups than in the clopidogrel alone group. The percent inhibition was

Only a few studies have addressed the optimal start time for oral anticoagulants (OACs) after acute ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). The aim of this retrospective study was to analyze the time of OAC administration after stroke onset.Methods and Results:This study included 300 patients with NVAF who had acute ischemic stroke and were treated with OACs between April 2012 and March 2016. We investigated the time at which OACs were started by anticoagulant type and the relationship between the time of OAC administration and stroke severity (the National Institutes of Health Stroke Scale [NIHSS] score on admission). Of the 300 patients, 114 and 186 patients received warfarin and direct-acting OACs (DOACs), respectively. Patients in the DOAC group had OAC initiated therapy significantly sooner (3 days) than in the warfarin group (7 days; P0.001). With regard to stroke severity (NIHSS score8, mild; 8-16, moderate;16, severe), the median time for starting therapy was 2, 7, and 11 days for mild, moderate, and severe stroke, respectively. Hemorrhagic events occurred in 3 patients in the warfarin group; however, no hemorrhagic events occurred in the DOAC group.Our study revealed that neurologists began OACs earlier in patients with mild acute cerebral infarction. Even in patients with severe stroke, OACs were started earlier than expected.

Objective Decompressive craniectomy (DC) in patients with malignant middle cerebral artery (MCA) infarction is known to decrease the mortality rate. However, the functional outcomes (communication and oral intake) of this procedure remain unclear. Most patients with malignant MCA infarction exhibit a loss of consciousness, which may be principally governed by the thalamus. We herein investigated the functional outcomes of DC at 90 days after the onset of malignant MCA infarction and their association with preoperative thalamus deformation, which can occur due to pressure and edema. Methods Twelve of 2,692 patients with acute cerebral infarction were diagnosed with malignant MCA infarction and underwent DC. We evaluated preoperative thalamus damage using brain computed tomography and its association with communication and oral intake abilities and the modified Rankin Scale (mRS) and Barthel index scores at 90 days after stroke onset. Results The mRS score at 90 days was 0-4 in five patients. Seven patients could communicate immediately after surgery, while five could do so by 90 days. Five patients were able to resume the oral intake of food at 90 days. All patients with preoperative thalamus deformation showed a poor recovery, while those with absent or slight preoperative thalamus deformation showed a good recovery. Conclusion Patients with preoperative thalamus deformation caused by pressure and edema show a poor oral intake and communication abilities after DC, suggesting that preoperative thalamus deformation is a predictor of poor functional outcomes after DC in patients with malignant MCA infarction.

We herein describe the case of an 18-year-old girl who presented with dizziness and headache in 2012. In 2013, brain magnetic resonance imaging revealed multiple intracerebral small lesions and intracerebral hydrocephalus. She was diagnosed with neurosarcoidosis following a brain biopsy. Although prednisolone, methotrexate, and azathioprine were administered, her hydrocephalus worsened and her granulomatous lesions were observed to increase in number on MRI. The patient's hydrocephalus showed no improvement despite her undergoing one ventriculoperitoneal shunt procedure, one septum pellucidum fenestration, and three ventriculoatrial shunt procedures. Infliximab therapy was then initiated, which resulted in a reduction in the size of the granulomatous lesions and the improvement of the patient's clinical symptoms. Infliximab may be a viable therapeutic option for treating intractable neurosarcoidosis.

Background and objective Cervicocephalic arterial dissection can cause both ischemic stroke and hemorrhagic stroke. However, spontaneous cervicocephalic arterial dissection presenting only with headache and neck pain has rarely been reported. The clinical features of patients with spontaneous cervicocephalic arterial dissection presenting only with headache and neck pain were investigated. Methods The subjects were seven patients with spontaneous cervicocephalic arterial dissection with headache and neck pain alone who were admitted to our hospital during the past 3 years. The clinical features of these patients were investigated. The diagnosis of arterial dissection was based on the criteria of the Strategies Against Stroke Study for Young Adults in Japan. Results The age of the patients (3 males, 4 females) ranged from 35 to 79 (mean, 51.0 ± 16.2) years. Six patients had vertebral artery dissection, one had internal carotid artery dissection, and one had an association of vertebral and internal carotid artery dissection. With the exception of one patient, the headache and neck pain were unilateral. All patients with vertebral artery dissection complained of posterior cervical or occipital pain. In the cases of internal carotid artery dissection, one patient complained of temporal pain, and one patient with co-existing vertebral artery dissection complained of posterior cervical pain. The mode of onset was acute in five patients, thunderclap in one, and gradual and progressive in one. The pain was severe in all cases. Five patients complained of continuous pain, while two had intermittent pain. The quality of the pain was described as throbbing by five patients and constrictive by two. The headache and neck pain persisted for 1 week or longer in six of the seven patients. Conclusion Cervicocephalic arterial dissection should be suspected when patients complain of intense unilateral posterior cervical and occipital pain or temporal pain.

Seadike is a coastal structure constructed in the rear region of the foreshore to maximize its usability by preventing direct effect of wave. The expected construction field is determined under the design wave and tidal condition where minor wave overtopping is anticipated. Thus, the location of seadike is generally fixed at the highest site of the surrounding area with seadike crest height controlling the permissible range of wave overtopping volume. But a lot of times, frontal sand beach of the seadike continuously deforms due to incident waves, resulting failure in maintaining its initial slope. The erosion and deposition of the seadike front cause changes in the crest height and volume of wave overtopping and decrease in the setting depth of the seadike, which endangers seadike region as a result. In this study, the relation of local scouring and setting depth of the seadike front in the run-up region is examined by using 2D hydraulic model tests and numerical simulations by modified SBEACH model. As a result, the study learned that if appropriate boundary condition is applied to the modified SBEACH model, it is possible to create practical estimations on the local scouring at the seadike foot when erosive waves flow into the region.

内科的治療で症状の再発を抑えることのできなかった進行性脳卒中に対し，急性期に血管内治療を行い，良好な結果が得られた症例を経験した．患者1は内頸動脈高度狭窄例であり，脳梗塞の発症機序として動脈原性脳塞栓(artery to artery embolism)や血行力学性の2つが考えられた．患者2は脳底動脈の高度狭窄例であり，発症機序として血行力学性が考えられた．通常，頭蓋内あるいは頸部脳主幹動脈の狭窄病変に起因する脳梗塞の急性期治療は抗血栓療法などを用いた内科的治療が一般的であり，外科的治療は待機的に検討される．内科的治療でも症状をコントロールすることができない進行性脳卒中に対しては，急性期に外科的治療を行うことも考慮されるが，待機的な外科的治療とは異なり緊急での外科的治療は，治療行為にともなう合併症発現の危険性がより高まると思われる．したがって個々の患者ごとに正確に病態を把握し，治療適応をみきわめることが重要と考える．

The inhibitory response to clopidogrel considerably varies among individuals and clopidogrel resistance is a risk factor for thrombotic events in patients with cardiovascular disease. Based on the platelet aggregation evaluated by the VerifyNow P2Y12 Assay, the present study investigated clopidogrel resistance and the effect of cilostazol addition.We measured the ability of 20 µM ADP to aggregate platelets using the VerifyNow P2Y12 Assay. Clopidogrel resistance was defined as % inhibition of20% in this assay.We examined 77 patients (53 men and 24 women, aged 65.8 ± 9.9 years) with ischemic stroke or carotid artery stenting who received clopidogrel (75 mg) for7 days at our hospital between October 2009 and March 2010. For 62 patients (42 men and 20 women, aged 65.3 ± 9.9 years) 75 mg clopidogrel alone was administered (clopidogrel only group); the other 15 patients (11 men and 4 women, aged 67.9 ± 9.9 years) received 75 mg of clopidogrel plus 100 or 200 mg of cilostazol (cilostazol combination group).Clopidogrel resistance was identified in 18 (29%) of the 62 patients in the clopidogrel only group. The percent inhibition was significantly higher in the cilostazol combination group than in the clopidogrel only group (41.7 ± 28.0% vs. 64.9 ± 22.7%, p=0.005). None of the patients in the cilostazol combination group had % inhibition of20%.Clopidogrel resistance developed in 29% of patients given clopidogrel alone. The addition of cilostazol to clopidogrel may have intensified platelet inhibition.

2002年8月から2009年10月までの間に埼玉医科大学国際医療センター・埼玉医科大学病院を受診した特発性頸部内頸動脈解離症例10例(年齢は36～70歳，男性8例，女性2例)について臨床的検討を行った．診断にはSASSY-Japan脳動脈解離ワーキンググループの「脳動脈解離の診断基準」をもとに，頭部MRI・MRA，3D-CTA，脳血管撮影，頸動脈超音波検査などの検査を用いて行った．脳虚血発症例は8例，頸部痛のみの症例が1例，無症候性が1例であった．発症時に頭痛または頸部痛を伴った症例は4例(40%)であった．10例中4例で発症後3カ月以内に画像上解離血管の改善が認められた．発症3カ月後のmodified Rankin Scale(mRS)は7例がmRS 1であり，3例がmRS 2と全例で転帰が良好であった．平均観察期間17.2カ月において，全例で脳卒中の再発を認めなかった．本邦においても特発性頸部内頸動脈解離症例は決して稀ではなく，内頸動脈の閉塞または狭窄を来した症例に遭遇した際には，常に本疾患を念頭においた複数の検査を可及的速やかに行う必要がある．

In this study, the authors experimentally investigated the formation of cuspate topography and the effect of the initial topographic perturbation on the alongshore uniform barred beach with a 1/20 slope.The cuspate topographies appeared only in the cases which we generate the accretion-type waves.The perturbation added in the initial topography disappeared gradually and the positive-feedback mechanism was not observed in this study.This result indicates that the formation of cusp with positive feedback mechanism may need other certain wave condition.

The clinical symptoms of Takayasu's arteritis (TA), which mainly affects the aorta and major aortic branches, vary widely depending on the site and degree of arterial lesions. We present herein the case of a young man whose initial symptom was pulmonary artery occlusion and who manifested TA 6 years later as cerebral embolism. Angiography confirmed bilateral common carotid artery (CCA) occlusion and a well-developed collateral circulation. The stump of the occluded CCA has both proximal and distal ends. The possibility of emboli from the occluded CCA (distal stump) seems to be the most probable explanation, as turbulent flow was detected at distal stump on color Doppler sonography. The carotid stump can be a potential source of emboli in TA as well as in atherosclerosis.

Field measurements of bottom topography together with the wave height and water particle velocity in the shallow water region were carried out in September, 2008 and 2009 to investigate the relation between rip channel and rip current. On the relict rip channel, rip current is usually generated provided the wave incident angle does not change significantly or the incident wave height increases largely. The rip channel easily decays when the incident wave angle undergoes great change from normal to oblique. Even in the case where there is not any typical bottom configuration, rip current occurs from the hot spot where longshore currents converge that has a potential for generating rip channel through the interaction between wave and wave-induced current.

The evaluation of wave forces acting on caisson breakwaters with deformed wave-dissipating works is important from the view point of caisson sliding. Wave pressures and wave forces acting on caisson breakwaters were measured to investigate the effect of the deformation of the wave-dissipating works on wave pressures and wave forces. Several cross sections of wave-dissipating works defined based on the previous study. When the crown of wave-dissipating work settles near the still water level, the impulsive wave pressure occurs and leads to increase in wave force. This wave force increases with progress of wave-dissipating works deformation indicated with a settlement of crown and decrease in the width of wave-dissipating works.

The horizontal and vertical components of tsunami force acting on a model bridge beam are measured in two-dimensional experiments. The wave pressure acting on the model bridge beam is also measured at the offshore, upper and lower sides of the model bridge beam. A horizontal plate is used as the model bridge beam in order to investigate the basic characteristics of the tsunami force acting on it. The authors show the measured tsunami force and wave pressure, comparing the tsunami force and wave pressure acting on the model bridge with relatively complicated cross section. In the comparison, the authors mention the role of reducing the vertical tsunami force by air under the model bridge beam.

Barangay Guinsaugon, a village, in southern Leyte Island, Philippines was buried by landslide debris in February, 2006. Geological survey of the landslide area was performed in 2006 and 2007. The cause of the landslide was determined with the survey and laboratory analysis of samples collected during the survey thereon. The most important factor detected was the occurrence of smectite, a kind of clay mineral. Smectite expands or swells at wet conditions, and is already known as the material sharing the resposibility of landslides. Apparently, smectite was formed at the late stage of volcanic activity in the area. The second factor was the fault system of the Philippine Fault Zone. The faults cut the area in many directions, and loosen the volcanic rocks. There were some observations indicating that many landslides occurred prior to the February 2007 landslide. Another factor acting as a trigger is the heavy rainfall; over 700 mm for two weeks prior to the landslide.

Riverbank erosion near river mouth is an increasingly serious problem for social-economic activities and natural environment of Southeast Asia. There are many factors impact on erosion process such as bank materials, mangrove trees, aquatic animal burrows, meteorological and hydrodynamic conditions. In this paper, the authors investigated the critical shear stress for erosion of cohesive riverbanks in the Soai Rap River, southern Vietnam. The results showed that the riverbanks have been moderately eroded with the critical shear stresses range from 0 to 5.731 N/m2 and the erodibility coefficients range from 0.497 to 9.07 cm3/N-s. Simultaneously, the authors applied numerical models to verify the distribution of shear velocities in the study area. In condition with tidal currents, the significant shear velocities mainly appear in the upper part of the Soai Rap River and in the Dong Tranh River (near river mouth). In condition with waves, the significant shear velocities only appear at the river mouth. In conditions with both tidal currents and waves, the significant shear velocities appear in upper part of the Soai Rap River and at the river mouth. The simulation results indicate that the distribution of shear velocities agree quite closely with the field survey data.

It is important to grasp water surface profile when we discuss various phenomena in coastal zone. For example, sediment transport and rip current are determined mainly by the spatial distribution of waves in surf zone. Measurement of waves using Euler's method is a general. However it is difficult to determine spatial distribution of waves. A considerable number of studies have been conducted on the spatial wave distributions by using two video camera images. These studies analyzed azimuth difference of digital images taken by video cameras. In this study, the authors proposed the procedure to measure surface profile by applying stereo matching method of two images of the sea surface without any targets or tracers. The validity of the proposed procedure was examined through the experiment in a wave basin.

Susumu ARAKI, Gou URAI, Hirotoshi MAKINO, Mamoru ARITA and Ichiro DEGUCHI Expected total repair cost of detached breakwaters is estimated in this study. The criterion for repair is based on the reduction of hydraulic performance of the detached breakwaters. The relationship between incident wave height, deformation of the detached breakwater body and transmitted wave height is measured in experiments. The influences of wave group characteristic of incident waves on the transmitted wave height behind the detached breakwater are taken into account. Wave group characteristics have a great influence on the expected total repair cost because the deformation of the detached breakwater and the transmitted wave height are dependent on the wave group characteristics in a certain range of incident wave height.

OBJECTIVE Anticoagulation therapy with warfarin is associated with a favorable prognosis in ischemic stroke. Dabigatran, a new oral anticoagulant, is widely used to prevent ischemic stroke in non-valvular atrial fibrillation (NVAF) patients. However, its association with decreased severity and a favorable prognosis once ischemic stroke has occurred remains unknown. METHODS We retrospectively reviewed all the patients with NVAF-associated ischemic stroke admitted to our hospital from April 2011 to December 2014 and included those who received dabigatran therapy. We assessed whether the patients were under regular use of the drug or discontinuance and classified them into 2 groups, the treatment and discontinuation groups. Clinical data, including the age, sex, ASCOD stroke phenotype, NVAF type, prescribed drug dose, comorbidities, CHADS2 score, renal function, National Institute of Health Stroke Scale (NIHSS) score on admission, modified Rankin scale (mRS) score at discharge, D-dimer, and brain natriuretic peptide, were investigated and compared between the groups. RESULTS Nine patients were under regular dabigatran therapy, and 6 were under discontinuance of the drug. The age, sex, ASCOD stroke phenotype, NVAF type, comorbidities, renal function, and CHADS2 scores did not differ between the 2 groups; however, the NIHSS scores were significantly lower in the treatment group. The mRS scores at discharge were additionally decreased in the treatment group. Moreover, the D-dimer scores were lower in the treatment group, thus suggesting a possible role in the decreased stroke severity. CONCLUSION Dabigatran may therefore decrease the severity of ischemic stroke, even if ischemic stroke occurs.

It is important to grasp water surface profile when we discuss various phenomena in coastal zone. For example, sediment transport and rip current are determined mainly by the spatial distribution of waves in surf zone. Measurement of sea waves using Euler's method is a general. However it is difficult to determine spatial distribution of waves. We had measured wave profile using experimental water tank without tracers or targets. We generated a few kinds of regular waves and took the pictures by two digital cameras and analyzed the azimuth difference in digital images by stereo matching method.