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A 66-year-old woman was diagnosed with stage IVb sigmoid colon cancer. Modified FOLFOX-6 (mFOLFOX-6; levofolinate‒fluorouracil‒oxaliplatin) plus panitumumab was selected as the chemotherapeutic regimen, but she was administered a regimen without oxaliplatin (L-OHP) or bolus 5-fluorouracil (5-FU) because of her general condition and concern about adverse effects. The patient had impaired consciousness on day 3 of chemotherapy. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain showed no findings of hemorrhage, infarction, brain metastasis, and leukoencephalopathy. Except for high blood ammonia concentration (353 µg/dL), there were no other findings that could have caused her condition. Impaired consciousness due to hyperammonemia was diagnosed. We started an intravenous drip supplemented with branched chain amino acids for liver protection. Approximately 6 hours later, blood ammonia level improved to 88 µg/dL, which approached the reference value. Consciousness level improved over time, reaching a level of alertness on day 5 after starting chemotherapy. 5-FU was suspected to be the cause of impaired consciousness due to hyperammonemia, but the exact cause could not be identified because most of the previously reported cases were given L-OHP, bolus 5-FU, and other concomitant medications. In this case, since there were no other concomitant medications, it is highly probable that continuous infusion of 5-FU alone caused impaired consciousness due to hyperammonemia. This is an important case that indicates the need to monitor carefully for the occurrence of hyperammonemia when 5-FU is administered continuously; it also proposes future issues for investigation.

This paper proposes Value-Aware solid-state drive (SSD) with fast access speed and low power consumption by eliminating error-correcting code (ECC). Value-Aware SSD utilizes the error tolerance of image recognition application using a deep neural network (DNN) to enhance reliability. In a previous paper, which proposes Value-Aware SSD, fast ECC decoder is implemented and SSD is evaluated with the 32-bit floating-point data format. On the other hand, in this paper, the proposed Value-Aware SSD is analyzed with 32-bit and 8-bit fixed-point data format and achieves the higher reliability even without ECC by newly proposed two techniques, Critical Bit Error Reduction (CBER) and Middle & Lower Page Error Reduction (M&L-PER). CBER and M&L-PER are proposed for 32-bit and 8-bit data format of application, respectively. These techniques modulate the threshold voltage ( $V_{\mathrm {TH}}$ ) distribution of memory cells by recognizing the importance of each stored bit. By proposed CBER, as much as 15% bit error rate (BER) of NAND flash is allowed while the application provides high image recognition accuracy. Even if bit precision is truncated to 8 bit, 3.9% BER is accepted by M&L-PER. The fast read access and low power consumption are realized because ECC is not required. Finally, this paper analyzes the Value-Aware techniques with 3-D multi-level cell (MLC) NAND flash to compare the effects for 3D-MLC and triple-level cell (TLC) NAND flash.

A 33-year-old man presented with slowly progressive weakness in the lower extremities over 8 years. At the age of 16 years, the elevation of serum creatine kinase level was detected. Physical examination revealed scapular winging, exaggerated lumbar lordosis and tendoachilles contracture. Gowers sign was positive and proximal dominant limb weakness was noted. Hypertrophy was observed in the upper limbs such as the biceps brachii and forearm flexor muscles. Muscle biopsy showed distinct differences in size of muscle fibers and regenerating and necrotic muscle fibers. A histological study revealed decreased calpain3 expression. Gene analysis of CAPN3 revealed two known gene mutations, leading to a diagnosis of calpainopathy (limb girdle muscular dystrophy 2A; LGMD2A). We here report our patient to discuss findings of upper limb hypertrophy, which are frequently missed compared to the lower limb, but important clinical findings.

A 68-year-old woman was referred to our hospital for progressive dizziness, gait disturbances and weight loss for 18 months. The patient was alert and showed dysphagia and a marked tendency to fall backward. Electronystagmography showed bilateral vestibular dysfunction and audiometry showed right sensorineural hearing disturbance. Cerebrospinal fluid exam showed mononuclear pleocytosis and elevated protein levels. On 18F-FDG PET/CT, abnormal uptake was observed in the mediastinal lymph nodes, from which biopsy specimens were obtained. Histological findings showed non-caseous granuloma and a diagnosis of bilateral vestibulocochlear, glossopharyngeal and vagal nerve palsies due to neurosarcoidosis was made. Steroid therapy resulted in improvement in her clinical symptoms. Neurosarcoidosis should be included in the differential diagnosis of patients showing progressive easy falling and dysphagia.

Influenza encephalopathy is characterized by high fever, disturbance of consciousness following influenza virus infection. We encountered 2 adult patients with influenza-associated acute necrotizing encephalopathy (Case 1, a 70-year-old woman with diabetes; Case 2, a 49-year-old woman with multiple myeloma), showing hemorrhagic lesions in the bilateral thalamus. Case 1 presented with fever and disturbance of consciousness followed by status epilepticus, and Case 2 developed fever and drowsiness as initial manifestation. Influenza type A was positive in Case 1 and influenza type B was positive in Case 2. In the acute phase, 2 patients required respiratory ventilation and were treated with anti-influenza drug, steroid and immunoglobulin. Cognitive impairment remained in the both patients in the chronic phase. When acute necrotizing encephalopathy is suspected, intensive treatment should be started as early as possible to improve clinical outcome of patients.

This paper proposes Privacy-aware Data-Lifetime Control NAND Flash System (PDLCS), which changes the data-lifetime flexibly for the right to be forgotten. This system realizes both short and long term data-lifetime by In-3D Vertical Cell Processing. Furthermore, data-lifetime can be extended or shortened at any time. This system secures privacy data and thus is a universal solution for future secure storage, which is not resolved by software techniques.

Background Hypothalamic lesions, such as tumors and demyelinating diseases, reportedly cause abnormal sleepiness. However, stroke involving the hypothalamus has rarely been described. Here, we report a patient with infarction restricted to the hypothalamus who presented with sudden onset of sleep. Case presentation A 42-year-old woman with a history of migraine without aura presented with irresistible sleepiness and developed several episodes of sudden onset of sleep. Neurological examinations were unremarkable except for partial left Horner syndrome. Brain magnetic resonance imaging (MRI) revealed a high-intensity lesion restricted to the left hypothalamus on diffusion-weighted and fluid-attenuated inversion recovery MRI images. Cerebrospinal fluid (CSF) orexin-A levels obtained on hospital day 3 after her sleepiness had resolved were normal (337 pg/mL; normal > 200 pg/mL). Serum anti-nuclear and anti-aquaporin 4 (AQP4) antibodies and CSF myelin basic protein and oligoclonal band were negative. A small hypothalamic infarction was suspected, and the patient was treated with intravenous edaravone and argatroban, as well as oral clopidogrel. Three months later, there had been no clinical relapse, and the hypothalamic lesion had almost disappeared on follow-up MRI. No new lesion suggestive of demyelinating disease or tumor was observed. Conclusion Hypothalamic stroke should be considered a cause of sudden onset of sleep.

Scene text magnifier aims to magnify text in natural scene images without recognition. It could help the special groups, who have myopia or dyslexia to better understand the scene. In this paper, we design the scene text magnifier through interacted four CNN-based networks: character erasing, character extraction, character magnify, and image synthesis. The architecture of the networks are extended based on the hourglass encoder-decoders. It inputs the original scene text image and outputs the text magnified image while keeps the background unchange. Intermediately, we can get the side-output results of text erasing and text extraction. The four sub-networks are first trained independently and fine-tuned in end-to-end mode. The training samples for each stage are processed through a flow with original image and text annotation in ICDAR2013 and Flickr dataset as input, and corresponding text erased image, magnified text annotation, and text magnified scene image as output. To evaluate the performance of text magnifier, the Structural Similarity is used to measure the regional changes in each character region. The experimental results demonstrate our method can magnify scene text effectively without effecting the background., to appear at the International Conference on Document Analysis and Recognition (ICDAR) 2019

This paper proposes 2 neural network (NN) techniques for 3D-TLC (Triple-Level Cell) NAND flash memory. 1) Predict data-retention/read-disturb lifetime for chip sorting during preshipment test. 2) Detect and correct errors in aftermarket. First, in pre-shipment test, Neural Network-based Lifetime Prediction (NNLP) predicts ECC decoding fail rate (EDFR) and estimates data-retention/read-disturb lifetime. Based on predicted lifetime, NNLP sorts NAND flash. Second, in aftermarket, Neural Network-based Error Detection (NNED) detects and corrects errors. NNED decreases bit-error rate (BER) by 81.4%.

Read-disturb Modeled Artificial Neural Network Coupled LDPC ECC (RDNN-LDPC) is proposed to correct errors of read-hot data for 3D-TLC NAND flash. Conventional ANN-LDPC is optimized to correct errors of read-cold data. However, ANN-LDPC does not correct errors of read-hot data. To correct errors of read-hot data, this paper analyzes how input parameter and model change. As a result, measured results of proposed RDNN-LDPC extend acceptable read cycle of 3D-TLC NAND flash by 10-times.

This paper proposes fine-grained ECC optimized by Neural Network (NN) for 3D-TLC NAND flash memories. Among 48 combinations of 8 reliability enhancement techniques (RETs) and 6 BCH ECCs, proposed NN automatically selects the optimal combination of RET and BCH ECC. Errors with complicated data pattern dependence and memory variations are adaptively compensated. In addition, the design trade-off between the high reliability and parity overhead (cost) is resolved. As a result, both high reliability and small parity overhead are realized simultaneously. The acceptable data-retention time increases by 2.0-times and the data overhead decreases by 30%.

A 70-year-old woman noticed difficulty in speech and weakness of the left upper and lower limb upon awakening. Neurological examination showed dysarthria and left hemiparesis. No sensory disturbance was observed. Brain MRI revealed acute infarction in the right posterior limb of the internal capsule. On the hospital day 1, she developed the abnormal sensations restricted to the bilateral shoulders, resulting in difficulty initiating sleep. On laboratory data, renal function and serum hemoglobin and ferritin levels were normal. When four essential features of restless legs syndrome (RLS) were applied to her shoulders, the patient met RLS criteria. Following low dose pramipexole treatment, the abnormal sensation of the shoulders and insomnia significantly improved. We should be aware of the possibility of RLS or its variant, including "restless shoulder" of our patient, for the cause of insomnia following acute ischemic infarction.

A 57-year-old man developed rapidly progressive dementia and a gait disturbance over 4 months. The patient had a slowly progressive executive dysfunction and speech problems for 4 years and was previously monitored in our outpatient clinic following a diagnosis of frontotemporal dementia. Diffusion-weighted MRI revealed high signal intensities in the right caudate nucleus and the bilateral cortices. Cerebrospinal fluid analysis showed increased levels of the 14-3-3 and total tau proteins. Periodic synchronous discharge was not evident on an electroencephalogram. Prion protein gene analysis identified a glutamate-to-lysine substitution at codon 219 (E219K) in the presence of the E200K mutation, leading to a genetic diagnosis of genetic Creutzfeldt-Jakob disease (CJD). The E219K polymorphism found on the allele of the E200K mutation may have influenced the characteristic clinical course of our patient that differed from that of typical E200K genetic CJD.

A 57-year-old woman had been suffered from insomnia due to restlessness and abnormal sensation of the left side of the body for 33 years. Since the preceding year of the first visit frequency of the symptoms increased, and the abnormal sensation was spread to the right leg. Her daughter had restless legs syndrome (RLS) since age 20. Neurological examination showed no abnormality. Laboratory test results showed normal ferritin levels. There was no renal dysfunction or anemia. A diagnosis of RLS was made, and her symptoms responded well to pramipexole treatment. However, the patient developed right shoulder pain and right-hand tremor one year and one and a half year after the first visit, respectively. Based on clinical findings and the findings of dopamine transporter scan and cardiac 123I-MIBG scintigraphy, the patient was diagnosed with Parkinson's disease (PD). Careful observation of changes in RLS symptoms is required as an increased frequency and spread of symptoms of RLS could be the early manifestation of PD.

Lateral charge migration and vertical charge detrap degrade the reliability of 3D-Triple-Level Cell (TLC) NAND flash. Lateral charge migration is dominant at the low write/erase (W/E) endurance and vertical charge de-trap is dominant at the high endurance. Conventional techniques address only one of these problems. This paper proposes Endurance-based Dynamic V TH Distribution Shaping (DVDS) to suppress both errors at a wide range of the endurance. At low (1) and high (2k) endurance, measured errors decrease by 27% and 20% and measured acceptable data-retention time increases by 1.7x and 2.7x, respectively.

Layer-by-layer Adaptively Optimized Error Correcting Code (ECC) is proposed to improve the reliability of triple-level cell (TLC) NAND flash-based SSD for the scene recognition using convolutional neural network (CNN) of IoT edge devices. Layer-by-layer Adaptively Optimized ECC is composed of Layer-by-layer Iteration-Optimized Low Density Parity-Check (LBL-LDPC) and Layer-by-layer Code-length Adjusted Asymmetric Coding (LBL-AC). The conventional techniques like LDPC ECC and Asymmetric Coding (AC) improve the reliability. However, they require large overheads of the ECC decoding time and the flag/parity cell. Proposed LBL-LDPC and LBL-AC decrease the ECC decoding time by 14% and the data overhead by 26%, respectively, without recognition accuracy degradation. In addition, the data-retention time extends by 230%.

A 69-year-old woman with a previous history of migraine without aura developed throbbing headache in the right frontal region accompanied by nausea, lasting more than 4 hours a day. The headache intensity was more severe than that of usual her migraine headaches. Administration of eletriptan in the previous hospital improved her headaches. However, one month later the patient experienced more intense headaches in the same region and then was referred to our hospital. MR angiography showed abnormal signal intensities in the cavernous sinus. Cerebral angiography revealed blood reflux to the cavernous sinus, leading to diagnosis of cavernous sinus dural arteriovenous fistula. Transvenous embolization of cavernous sinus dural arteriovenous fistula was performed, which resulted in resolution of the patient's headache. We should be aware that patients with cavernous sinus dural arteriovenous fistula can manifest migraine-like headaches without being accompanied by cranial nerve palsies.

In posterior reversible encephalopathy syndrome, isolated involvement of the brainstem is rare. In addition, there have been a few reports describing a concomitant occurrence of stroke and a brainstem variant of posterior reversible encephalopathy syndrome. We here report a patient with isolated pontine involvement of posterior reversible encephalopathy syndrome accompanied by fresh ischemic cerebral infarction in the left corona radiata detected by brain magnetic resonance imaging. Follow-up brain magnetic resonance imaging on hospital day 14 showed a marked improvement of signal changes in the pons; however, cerebral infarction in the left corona radiata enlarged despite medical treatment. Although rare, clinicians should be aware of the co-occurrence of posterior reversible encephalopathy syndrome and ischemic infarctions, especially in patients with untreated/uncontrolled hypertension and chronic kidney disease. We discuss the possible mechanism related to brainstem posterior reversible encephalopathy syndrome and stroke, reviewing the previous case reports.

In this paper, we find conditions that reconstruction of temperature distribution gets worse when the ultrasonic transceivers (transmitter and receiver) are arranged flexibly. We discovered the minimum number of the ultrasonic transceivers required for successful reconstruction and proved that the number is correct. Moreover, we proposed arrangement of the number in accordance with parity of pixel division. As a result of simulation with these arrangements, the reconstruction succeeded.

To improve the reliability of Triple-Level Cell (TLC) NAND flash memory, Advanced Error Prediction (AEP) low-density parity-check (LDPC) ECC with Error Dispersion Coding is proposed. In the conventional LDPC, error-correction capability is degraded due to burst errors [1]. To reduce burst errors and improve the error-correction capabilities of LDPC, this paper proposes Error Dispersion Coding (EDC) which reduces burst errors, decreases the worst bit-error rate (BER) of Upper/Middle/Lower pages, and finally extends the data-retention time of TLC NAND flash memory. By applying proposed EDC, in 3D-TLC NAND flash memory, the burst errors and the worst BER are decreased by 87% and 40%, respectively. As a result, the acceptable data-retention time is extended by 1.8 and 2.6 times in 2D and 3D-TLC NAND flash memory, respectively.

A 26-year-old, otherwise healthy man presented with visual abnormality followed by loss of consciousness and convulsion. The patient then developed headache and fever 14 days later. Brain MRI showed hyperintensities in the left cingulate cortex. The cerrebrospinal fluid examinations showed mononuclear pleocytosis and positive PCR results for human herpesvirus 6 (HHV-6). A diagnosis of HHV-6 encephalitis and symptomatic epilepsy was made. The patient's clinical symptoms improved promptly following acyclovir treatment. However, 3 months later the patient noticed dysesthesia in the trunk, the left upper limb and the right lower limb. Brain and spine MRI showed multiple brain white matter lesions, the middle cerebellar peduncle and cervical spinal lesions. The symptoms resolved following methylprednisolone pulse therapy only. We report an adult patient with HHV-6 encephalitis followed by acute disseminated encephalomyelitis whose initial presentation was epilepsy. HHV-6 encephalitis should be included in the differential diagnosis of encephalitis of unknown etiology in an immunocompetent adult.

Value-Aware SSD with Vertical 3D-TLC (Triple-Level Cell) NAND flash for the image recognition is proposed to increase the acceptable bit-error rate (BER) by 12-times and extend the data-retention time by 300-times. In addition to the reliability improvement, the read time reduces by 26%. The proposed SSD combines new data-aware techniques with deep neural network's error tolerance. 10% BER of NAND flash is allowed while providing the accurate and fast image recognition. The design overhead in the SSD controller is negligibly small.

•We report 2 patients with pontine infarcts showing transient conjugate eye deviation.•Conjugate eye deviation resolved within a few days in both patients.•Small restricted dorsomedial pontine lesions can produce conjugate eye deviation.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited., Background: It has been reported that the function of the labrum is to ensure that an increased surface area encountered the femoral head and spares the cartilage from excessive strain. The purpose of this study was to determine whether early deformation of the hip articular cartilage occurs under high-load conditions in the presence/absence of the labrum. Methods: The hip joints of 4 beagle dogs were retrieved. A continuous static load of 80 Kg was applied for 2.5 hours. Magnetic resonance imaging (MRI) was performed immediately after the loading and at 30, 60, 90, 120, and 150 minutes after the loading. The load was then removed, and the specimens were stored for 14 h to allow the cartilage to recover. The labrum was then carefully removed, and the experiment was performed again. Results: The maximum percentage change in cartilage thickness was 35.3 ± 17.4% when the labrum was intact and 55.7± 7.5% after the labrum had been excised (p=0.060). Labral excision resulted in a reduction in cartilage thickness. Cartilage thickness was significantly decreased in the normal and labral excision models immediately after loading (p=0.003 and p=0.022, respectively). Conclusion: The labrum plays a role in dispersing loads equally across the joint cartilage and reduces the load placed on the maximum weight-bearing region of cartilage. Early articular cartilage deformation occurred under high-load conditions both before and after the excision of the labrum.

The character information in natural scene images contains various personal information, such as telephone numbers, home addresses, etc. It is a high risk of leakage the information if they are published. In this paper, we proposed a scene text erasing method to properly hide the information via an inpainting convolutional neural network (CNN) model. The input is a scene text image, and the output is expected to be text erased image with all the character regions filled up the colors of the surrounding background pixels. This work is accomplished by a CNN model through convolution to deconvolution with interconnection process. The training samples and the corresponding inpainting images are considered as teaching signals for training. To evaluate the text erasing performance, the output images are detected by a novel scene text detection method. Subsequently, the same measurement on text detection is utilized for testing the images in benchmark dataset ICDAR2013. Compared with direct text detection way, the scene text erasing process demonstrates a drastically decrease on the precision, recall and f-score. That proves the effectiveness of proposed method for erasing the text in natural scene images.

A 50-year-old woman presented with constriction sensation in the lower part of the chest, paresthesia in the right forearm and hypesthesia in the right thigh. One month later, she noticed a loss of sense of smell. The normal findings of the nasal mucosa and the impaired results of standard olfactory acuity test (T&T olfactometry) and intravenous olfactory test (Alinamin test) suggested a lesion proximal to the nasal mucosa. Sensory disturbances in the segmental areas of cervical, thoracic and lumbar regions were clinically and electrophysiologically attributed to polyradiculopathy. MRI of the brain and whole spine revealed no abnormalities. Cerebrospinal fluid examination showed lymphocytic pleocytosis. Sarcoidosis was diagnosed based on the findings including an elevated serum angiotensin-converting enzyme level, bilateral hilar lymphadenopathy on the chest CT and histological evidence of noncaseating granulomas. Methylprednisolone pulse therapy improved the olfactory and sensory disturbances. Neurosarcoidosis should be considered in the differential diagnosis of olfactory impairment.

We present the case of a 31-year-old woman who developed N-methyl-d-aspartate (NMDA) receptor encephalitis during the course of relapsing and remitting multiple brain lesions. The patient developed a tingling sensation in the left upper and lower extremities, and was first admitted to our hospital at age 27. She was tentatively diagnosed with multiple sclerosis on the basis of multiple lesions with Gd-enhancement in the brainstem, and 2 separate clinical relapses by age 28. At age 31, she developed a headache and pyrexia, followed by confusion and abnormal behavior. Her symptoms acutely progressed to stupor, and subsequently, she developed oral dyskinesia and athetosis-like involuntary movement of the left arm. The stupor state continued over 2 months. However, she had completely recovered by 3 months after the onset of psychiatric symptoms. Her serum and CSF samples tested positive for anti-NMDA receptor antibodies, and she was diagnosed with NMDA receptor encephalitis. Her serum was negative for anti-AQP4 antibody, but showed weak positivity for antinuclear antibody. Between ages 32 and 34, she experienced 2 clinical relapses, including right-hand clumsiness, confusion, aphasia, and dysphagia. FLAIR images showed a high-intensity area in the brain stem, thalamus, and subcortical white matter. No tumors were found throughout the course. A clinical entity of NMDA receptor encephalitis can include various neurologic disorders, such as the development of recurrent demyelinating brain lesions. Further investigation is required to clarify the pathophysiological role of anti-NMDA receptor antibody in our patient.

A 74-year-old man was referred to our department for dizziness and progressive unsteady gait over 6 years. His family history was unremarkable. Neurological examination showed dysarthria, saccadic eye movement, palatal tremor (1.7 Hz)-synchronous with rotational ocular movement, and truncal ataxia. T2-weighted magnetic resonance imaging (MRI) of the brain revealed hyperintense and hypertrophic bilateral inferior olivary nuclei at the medulla and mild cerebellar atrophy. On the basis of neurological findings of oculopalatal tremor and cerebellar ataxia with brain MRI findings, the diagnosis of progressive ataxia and palatal tremor (PAPT) was made. PAPT should be included in differential diagnosis of dizziness observed in elderly individuals.

We have previously described the mid- to long-term results of conventional simple varus intertrochanteric osteotomy for osteonecrosis of the femoral head, showing that 19 of the 26 hips had good or excellent results. We extended the follow-up to a mean of 18.1 years (10.5 to 26) including a total of 34 hips in 28 patients, with a mean age at surgery of 33 years (19 to 53). There were 18 men and ten women and 25 hips (74%) had a satisfactory result with a Harris hip score ≥ 80. In all, six hips needed total hip replacement (THR) or hemiarthroplasty. The collapse of the femoral head or narrowing of the joint space was found to have progressed in nine hips (26%). Leg shortening after osteotomy was a mean of 19 mm (8 to 36). With conversion to THR or hemiarthroplasty as the endpoint, the ten-year survival rate was 88.2% (95% confidence interval (CI) 82.7 to 93.7) and the 20-year survival rate was 79.7% (95% CI 72.1 to 87.3); four hips were converted at ten years and other two hips were converted at 20 years.Shortening of the leg after osteotomy remains a concern; however, the conventional varus half-wedge osteotomy provides favourable long-term results in hips with less than two-thirds of the medial part of the femoral head affected by necrotic bone and with normal bone superolaterally.

Author, A 4-U hybrid total hip arthroplasty (THA) system was specifically designed for patients with developmental dysplasia of the hip (DDH). Straight stem with an appropriate offset and various size variations are advantages. We followed 128 hips in 124 patients, 13 men and 111 women, for a mean of 6.5years (range, 5.0-7.5years). Two acetabular and femoral components in two patients had been revised for infection, one acetabular component had been revised for recurrent dislocation, and one femoral component had been revised for periprosthetic femoral fracture. None of the acetabular or femoral components were revised for loosening or were found to be loose at follow-up. The Harris hip score increased from a preoperative average of 42 points to 88 points at the most recent follow-up. Primary THA using the 4-U system had a good mid-term result in patients with DDH. This system could be applied for all patients including those with the narrowest and deformed femurs

© 2011 British Editorial Society of Bone and Joint Surgery, We report the mid- to long-term (mean 20.3 years, 10 to 32.5) results of the Chiari pelvic osteotomy in patients with pre- to advanced stage osteoarthritis in dysplastic hips. We followed 163 Japanese patients (173 hips) with a mean age at surgery of 20 years (9 to 54). Overall, 124 hips (72%) had satisfactory results, with Harris hip scores ≥ 80. Satisfactory results were seen in 105 of 134 hips with pre- or early osteoarthritis (78%) and 19 of 39 hips with advanced osteoarthritis (49%). A total of 15 hips (9%) underwent a total hip replacement (THR) with a mean interval between osteotomy and THR of 16.4 years. With conversion to THR as the endpoint, the 30-year survival rate was 85.9% (95% confidence interval 82.3 to 89.5). It was 91.8% for patients with pre- or early osteoarthritis and 43.6% for those with advanced osteoarthritis (p < 0.001). We now perform the Chiari osteotomy for patients with dysplastic hips showing poor joint congruency and who prefer a joint-conserving procedure to THR.

http://dx.doi.org/10.1016/j.arth.2010.02.014, We evaluated intermediate-term to long-term survival of cemented calcar replacement femoral components in hybrid revision total hip arthroplasty. We followed up 52 hips in 50 patients for a mean of 11.4 years. Six (12%) femoral components had been revised: 2 for aseptic loosening, 2 for periprosthetic fracture, and 2 for deep infection. One additional femoral component was definitely loose. The number of previous revision operations (P = .004), preoperatively poorer femoral bone stock (P = .005), and postoperative poor cement mantle grading (P = .003) were significant factors for failure. Kaplan-Meier analysis revealed that the 15-year survival rate was 90% with mechanical failure as the end point. This technique remains a reasonable option for the first-time revision, especially for older and less active patients.

Approximately 70% of wheat endosperm consists of starch, and variations in the quality and quantity of starch affect the processing characteristics of wheat flour. Amylose content in particular has a major effect on Asian noodle quality, and selection of wheat lines with slightly lower amylose levels is an important goal in Japanese wheat breeding programs. Accurately measuring amylose content by direct methods such as colorimetric assays was found to be problematic, suggesting there was a need for a more efficient and accurate method of screening for reduced amylose content. Therefore, we characterized mutations in the wheat waxy genes, which control amylose synthesis, and developed DNA markers for the identification of null waxy alleles. In this review, we describe the development of these markers and outline their utility for wheat breeding programs.

Background Meningeal carcinomatosis and hypercoagulability associated with malignancy are typical late stage complications in cancer patients. The co-occurrence of meningeal carcinomatosis and cerebral infarction related to hypercoagulability associated with malignancy in an individual as the initial manifestation of malignancy has not been previously reported. Case presentation Herein, we report the case of an 80-year-old patient who presented with meningeal carcinomatosis and hypercoagulability related to malignancy as the initial manifestation of occult gastric cancer. The patient displayed consciousness disturbance, mild left facial paralysis, and bilateral positive Babinski’s sign. Using brain magnetic resonance imaging, the patient was diagnosed as having acute multiple cerebral infarctions. Cerebrospinal fluid (CSF) cytology showed adenocarcinoma and upper gastrointestinal endoscopy disclosed scirrhous gastric cancer. The patient presented with headache, fever, and meningeal irritation with a subacute course. Tuberculous or fungal meningitis was initially suspected; however, cytological evidence of adenocarcinoma in the CSF led to the diagnosis of meningeal carcinomatosis. Conclusion The comorbidity of hypercoagulability associated with malignancy and meningeal carcinomatosis should be considered in a patient presenting with multiple cerebral infarctions, progressive disturbance of consciousness, fever, and meningeal irritation.

A 31-year-old man with pontine infarction was referred to our hospital for further evaluation and treatment. At admission, his neurological examination was unremarkable. No lymphadenopathy or skin lesions were found. The Treponema pallidum haemagglutination test, rapid plasma regain test and fluorescent treponemal antibody absorption test of immunoglobulin G were positive in both serum and cerebrospinal fluid (CSF). CSF analysis showed lymphocytic pleocytosis. The patient had male-to-male sexual contact and was found to be HIV positive. Physicians should be aware that acute ischaemic stroke may be the first manifestation of neurosyphilis in a young adult, especially with HIV infection.

Acute hemicerebellitis, marked by headache with or without cerebellar signs, is a rare clinical entity involving a unilateral cerebellar hemisphere. The pathogenesis of acute hemicerebellitis remains unclear, and the disease rarely occurs in adults. Here, we report an 18-year-old woman who presented with a lack of coordination of the right hand and leg lasting longer than one week, following a pulsatile headache. A neurological examination disclosed ocular dysmetria, right-sided limb ataxia and slight truncal ataxia. Cerebrospinal fluid analysis showed mononuclear pleocytosis. The serology and autoimmune studies were unremarkable. Brain magnetic resonance imaging (MRI) revealed a focal signal change in the right cerebellar hemisphere and vermis. Acute hemicerebellitis was diagnosed, and the patient was treated with intravenous methylprednisolone sodium succinate and acyclovir. Subsequently, the headache resolved, and the cerebellar signs were markedly improved. Twenty days after admission, she became asymptomatic and brain MRI showed resolution of cerebellar hyperintensity on the right side. In conclusion, we identified only 6 additional patients with adult-onset acute hemicerebellitis from previous reports, highlighting the importance of recognizing this rare clinical entity. Its clinical outcome is usually favorable, but in the acute phase, attention should be directed toward clinical symptoms that are suggestive of increased intracranial pressure.

Objective To describe a patient positive for the anti–aquaporin 4 antibody with hypothalamic lesions showing hypothermia, hypotension, hypersomnia, and obesity. Design Case report. Setting University hospital. Patient We describe a 21-year-old woman who was positive for anti–aquaporin 4 antibody and presented with hypothermia, hypotension, and hypersomnia owing to bilateral hypothalamic lesions as the only abnormal clinical finding. Results Immediate steroid administration resulted in significant improvement of the patient's vital signs and imaging findings; however, her cognitive impairment and sleepiness persisted, and she subsequently developed obesity. Decreased cerebrospinal fluid orexin levels and sleep studies confirmed the diagnosis of narcolepsy due to medical condition. Physicians should be aware that neuromyelitis optica spectrum disorders can initially involve the hypothalamus. Conclusions We emphasize that measurement of anti–aquaporin 4 antibody is of clinical importance in the differential diagnosis of hypothalamic lesions.

Background Kikuchi Fujimoto disease (KFD), or histiocytic necrotising lymphadenitis, is a benign and self-limiting condition characterised by primarily affecting the cervical lymph nodes. Recurrent aseptic meningitis in association with KFD is extremely rare and remains a diagnostic challenge. Case presentation We report a 28-year-old man who presented 7 episodes of aseptic meningitis associated with KFD over the course of 7 years. Histopathological findings of enlarged lymph nodes led to the diagnosis of KFD. The patient’s headache and lymphadenopathy spontaneously resolved without any sequelae. Conclusions A diagnosis of KFD should be considered when enlarged cervical lymph nodes are observed in patients with recurrent aseptic meningitis. A long-term prognosis remains uncertain, and careful follow-up is preferred.

A 72-year-old man with diabetes mellitus and hypertension was admitted to our hospital with lightheadedness. The patient showed lateropulsion to the right side, but his neurological findings were otherwise normal. Brain magnetic resonance images showed a fresh ischemic infarct in the left dorsal part of the lower pons. Body lateropulsion is characterized by an irresistible falling to one side and has been reported in lesions in several brain regions. However, it has rarely been reported in pontine lesions. We suggest that physicians should be aware that pontine lesions can cause isolated body lateropulsion without other neurological deficits.

A 56-year-old woman had been experiencing episodic left eye pain followed within 3 days by double vision and adduction of the left eye since the age of 30. The episodes occurred once per month, and her symptoms spontaneously resolved within 3 days. The patient was diagnosed with ophthalmoplegic migraine (OM) with left abducens nerve palsy at the age of 53 years. In May 2011, she developed bilateral retro-orbital pain followed by double vision and limitation of abduction of the right eye. She recalled having a cold and high fever 10 days before the onset of the headache. MRI showed no thickening or enhancement of the right abducens nerve. Constructive interference in steady-state (CISS) MRI showed neurovascular contact between the right abducens nerve and anterior inferior cerebellar artery. Right abducens nerve palsy accompanied by OM was diagnosed after other diseases that can cause ophthalmoplegia were excluded. The patient's eye symptoms gradually improved following steroid treatment. There have been a few similar case reports of adult patients with OM showing left and right abducens nerve palsy at different time points. In this case report, we discuss the possible mechanisms related to OM.

A 66-year-old man was admitted to our hospital with muscle pain, fatigue and appetite loss that had lasted for a month. The patient was somnolent and had nuchal stiffness with a high fever. Cerebrospinal fluid (CSF) tests demonstrated lymphocytic pleocytosis with a decreased CSF-blood glucose ratio. The tests for tuberculous, fungal and carcinomatous meningitis and herpetic meningoencephalitis were negative. Endocrinological exams showed hypopituitarism and diabetes insipidus. A pituitary MRI showed an enlargement of the pituitary stalk. A diagnosis of lymphocytic hypophysitis with aseptic meningitis was made after the exclusion of secondary hypophysitis. Lymphocytic hypophysitis with aseptic meningitis can mimic subacute meningoencephalitis.

A 57-year-old woman presented with weakness of the right leg over one and a half years. She had visited several clinics but her symptom had been attributed to lumbar spondylosis or aging itself. Motor examination revealed 4/5 strength in the distal right lower limb without muscle atrophy. Hyperreflexia of the right upper and lower limbs with right-sided ankle pseudoclonus, right positive Babinski’s sign and sensory impairment in her right leg below the knee were also noted. Brain magnetic resonance imaging revealed a left parasagittal parietal meningioma with homogeneous contrast enhancement (Picture). Monoparesis of the leg is commonly caused by a lower motor neuron lesion; however, it could be attributable to a central lesion such as meningioma (1, 2). Here, we report a rare case of pure motor monoparesis of the leg due to parasagittal meningioma and emphasize that detecting upper motor neuron signs such as hyperreflexia, clonus or positive Babinski’s sign in an affected limb is crucial to reach the correct diagnosis of localization.

A 24-year-old woman presented subdural empyema developing from sinusitis caused by Porphyromonas and Fusobacterium infection. She experienced fever and progressive headache with gradually worsening symptoms. Neurological examination revealed drowsiness and neck stiffness. A CSF examination detected pleocytosis and a low glucose level. Gadolinium-enhanced T1-weighted images from brain MRI showed thickening enhancement at the leptomeninges in the left frontal to temporal lobes and interhemispheric fissure with edema. Based on the diagnosis of bacterial meningoencephalitis and subdural empyema developing from sinusitis primary to odontogenic infection, she received antibacterial chemotherapy with meropenem hydrate and vancomycin hydrochloride, after which motor aphasia and consciousness disturbance occurred. No bacteria were isolated from a trans-sphenoidal biopsy specimen and CSF culture. Molecular typing also was performed by sequencing the 16S ribosomal RNA intergenic spacer region, and Porphyromonas and Fusobacterium were identified. She was given cephalosporin and metronidazol, after which her neurological symptoms and signs gradually lessened. Physicians need to be aware that patients may develop subdural empyema subsequent to sinusitis associated with Porphyromonas and Fusobacterium infection and that amplification and sequence analysis of partial bacterial 16S ribosomal RNA gene should be examined when no bacteria is identified by culture.

As the result of developments in computer technology in recent years, the calculation, simulation and analysis of the stress environment for the artificial hip prosthesis and the femur have been made possible. In order to perform an exact calculation, three-dimensional modeling with the hip prosthesis and femur is required. The modeling of a femur is done by reconstructing the femoral outline data from CT images using three-dimensional CAD. The outline extraction work is performed by the experience and subjectivity of the operator, and the reliability of the data and working efficiency is low. In this paper, algorithms that extract the femur outline from CT images automatically are proposed.