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Cerebral rheumatoid vasculitis (CRV) is a rare, fatal, and diagnostically challenging disorder. We herein report an 81-year-old woman with a 4-year history of rheumatoid arthritis who presented with a fever, progressive disturbance of consciousness, high level of rheumatoid factor, and hypocomplementemia. The enhancement of the perforating branches in the left middle cerebral artery led us to suspect CRV. A brain biopsy could not be performed. After we intensified steroid therapy, the size of the cerebral lesions temporarily decreased. However, recurrence in the left frontal lobe occurred one month later, and the patient subsequently died. Early intensive treatments may be needed for CRV.

A 73-year-old man with a 5-day history of continuous hiccup, fever, and rapidly progressing paraplegia was admitted to our hospital. On admission, he exhibited dysarthria, complete paraplegia, and insentience of both lower limbs. Head and spine MRI showed abnormal, asymmetric lesions in the white matter, basal ganglia, and brainstem, and multiple spinal cord lesions. Test for serum anti-AQP4 antibody was negative. Evaluation of human leukocyte antigen (HLA)-B51 was negative; however, HLA-B54 was positive. Although skin lesions were absent, we considered neuro-Sweet disease and high-dose steroid therapy was initiated. The hiccup disappeared gradually, and he regained the ability to walk with a cane 30 days after the onset. Subsequently, the patient tested positive for serum anti-myelin oligodendrocyte glycoprotein (MOG) antibody. It is important to consider MOG antibody-related disease as potential diagnosis in patients exhibiting clinical features of neuro-Sweet disease except for the absence of skin lesions.

A 76-year-old woman with a 7-year history of dementia presented to our hospital with generalized convulsive seizure for the first time. Contrast-enhanced brain magnetic resonance imaging revealed leptomeningeal enhancement mainly in the right occipital lobe and multiple lobar microbleeds in the bilateral cerebral and cerebellar subcortex. No white matter lesions were observed. A brain biopsy of the right parieto-occipital lobe revealed cerebral amyloid angiopathy (CAA). White matter lesions appeared in the right parieto-occipital lobe three days after the biopsy, and we considered inflammatory CAA. Three courses of methylprednisolone pulse followed by oral prednisolone therapy gradually reduced leptomeningeal and white matter lesions. An apolipoprotein E genotype investigation identified the e2/e3 genotype. In patients with inflammatory CAA, a risk of exacerbation should be considered after brain biopsy, in which the e2 allele might play a role.

Introduction Some reports revealed that hidden blood loss (HBL) during surgery for traumatic thoracolumbar fracture cannot be ignored, even when using a percutaneous approach. Using percutaneous pedicle screws (PPS) for traumatic thoracolumbar fracture, this study aimed to compare estimate blood loss (EBL), including HBL, between early and late fixation. Methods This investigation was a retrospective study. In the present study, data from 39 patients who underwent posterior spinal stabilization using PPS for single-level thoracolumbar fracture have been included. We divided the patients into an early group (group E) (n=20) in whom surgery was conducted within 3 days of fracture and a late group (group L) (n=19) in whom surgery was conducted more than 3 days after fracture. We evaluated hemoglobin (Hb) on the day of injury, and 1, 3 or 4, and 7 days after surgery, EBL, HBL, and transfusion requirement. Results Hb on day 1 (group E: 12.2±1.7 g/dL, group L: 12.3±1.6 g/dL) was significantly less than that on the injured day (group E: 14.2±1.7 g/dL, group L: 13.9±1.7 g/dL) in both groups. The values of Hb and EBL were not significantly different at any time between the two groups. HBL (group E: 487±266 mL, group L: 386±305 mL) was not significantly different between the two groups. No patients required transfusion in either group. Conclusions EBL in early fixation using PPS for traumatic thoracolumbar fracture is not significantly different compared with that in late surgery from days 1 to 7 postoperatively. Early fixation using PPS for traumatic thoracolumbar fracture does not result in negative outcomes any more than those in late surgery in terms of blood loss.

Attenuation of the secondary injury of spinal cord injury (SCI) can suppress the spread of spinal cord tissue damage, possibly resulting in spinal cord sparing that can improve functional prognoses. Granulocyte colony-stimulating factor (G-CSF) is a haematological cytokine commonly used to treat neutropenia. Previous reports have shown that G-CSF promotes functional recovery in rodent models of SCI. Based on preclinical results, we conducted early phase clinical trials, showing safety/feasibility and suggestive efficacy. These lines of evidence demonstrate that G-CSF might have therapeutic benefits for acute SCI in humans. To confirm this efficacy and to obtain strong evidence for pharmaceutical approval of G-CSF therapy for SCI, we conducted a phase 3 clinical trial designed as a prospective, randomized, double-blinded and placebo-controlled comparative trial. The current trial included cervical SCI [severity of American Spinal Injury Association (ASIA) Impairment Scale (AIS) B or C] within 48 h after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group was administered 400 μg/m2/day × 5 days of G-CSF in normal saline via intravenous infusion for five consecutive days. The placebo group was similarly administered a placebo. Allocation was concealed between blinded evaluators of efficacy/safety and those for laboratory data, as G-CSF markedly increases white blood cell counts that can reveal patient treatment. Efficacy and safety were evaluated by blinded observer. Our primary end point was changes in ASIA motor scores from baseline to 3 months after drug administration. Each group includes 44 patients (88 total patients). Our protocol was approved by the Pharmaceuticals and Medical Device Agency in Japan and this trial is funded by the Center for Clinical Trials, Japan Medical Association. There was no significant difference in the primary end point between the G-CSF and the placebo control groups. In contrast, one of the secondary end points showed that the ASIA motor score 6 months (P = 0.062) and 1 year (P = 0.073) after drug administration tend to be higher in the G-CSF group compared with the placebo control group. Moreover, in patients aged over 65 years old, motor recovery 6 months after drug administration showed a strong trend towards a better recovery in the G-CSF treated group (P = 0.056) compared with the control group. The present trial failed to show a significant effect of G-CSF in primary end point although the subanalyses of the present trial suggested potential G-CSF benefits for specific population., Koda et al. present the results of a randomized phase 3 trial comparing granulocyte colony-stimulating factor versus placebo in patients with acute spinal cord injury. While the primary endpoint was not met, a sub-analysis revealed a trend towards superior efficacy of G-CSF versus placebo in an elderly population.

A 48-year-old woman with a right-sided headache beginning a month prior to admission presented with sudden-onset right hemiparesis. On admission, she had weakness of the right lower extremity, which disappeared 3 hours after onset. Contrast enhanced brain MRI revealed no parenchymal lesion, while indicated thrombi in the superior sagittal sinus and the right side of the transverse sinus, sigmoid sinus, and internal jugular vein, leading to the diagnosis of cerebral venous sinus thrombosis. Brain perfusion single photon emission computed tomography presented slightly decreased blood flow in the bilateral frontal lobes (left-sided dominant) and the right occipitotemporal lobe. Electroencephalogram showed no abnormal finding. After anticoagulant therapy, thrombi in the venous sinuses decreased and brain blood flow improved. We should consider cerebral venous sinus thrombosis in the case of a patient presenting with symptoms of a transient ischemic attack accompanied with headache. Moreover, the etiology of transient neurological deficits remains controversial.

Background Trousseau syndrome is a poor prognosis. We report a case of Trousseau syndrome treated by radical resection after endovascular treatment. Case A 59‐year‐old woman presented to our department reporting spontaneous dizziness and pain of the upper abdomen. Magnetic resolution imaging (MRI) showed shower embolization of Brain. Contrast‐enhanced computer tomography (CT) showed renal infarction and splenic infarction, and a tumor was observed in the retrohepatic area. On day 9, sudden right side joint prejudice, neglect of left half space, and left hemiplegia were observed. MRI revealed obstruction of the right middle cerebral artery (MCA) perfusion zone. On the same day, endovascular treatment was performed and reperfusion was obtained. We decided on a radical surgery policy because there were a primary lesion and a high risk of new embolism, and no metastasis was seen. Discussion Trousseau syndrome generally has a poor prognosis, but active treatment should be considered as an option when we can expect the recovery of function., Image diagnosis of the case. (a) Contrast‐enhanced CT showed evidence of bilateral renal infarction. (b) Contrast‐enhanced CT showed splenic infarction (pointed by arrow head). (c) Contrast‐enhanced CT showed a tumor in the retrohepatic area(pointed by arrows heads).

A 60-year-old woman with a 3-day history of ataxic gait, blurred vision, and upper extremity paresthesia was admitted to our hospital. She presented with severe visual disturbances (finger counting), ophthalmoplegia, neck weakness, and sensory ataxia. Serum anti-GQ1b antibody, anti-GM3 antibody, and anti-GD3 antibody were strongly positive, which might contribute to the pathogenesis. Since we suspected Guillain-Barre syndrome (GBS), intravenous immunoglobulin therapy (IVIg) and high-dose steroid therapy were administered; however, improvements in her visual acuity were minimal. Additional IVIg and high-dose steroid therapy resulted in limited visual acuity improvements. Therapeutic strategies for patients with GBS and refractory optic neuropathy remain controversial.

Little is known in mechanism and clinical features of transient focal neurological episodes (TFNEs) in patients with both hereditary transthyretin (ATTR) type and Aβ-type cerebral amyloid angiopath...

A 23-year-woman was presented for sudden-onset monocular blindness. Branch retinal artery occlusion in the right eye and multiple brain embolism were detected. Trousseau syndrome due to bilateral ovarian cancer was diagnosed; no embolic events were observed after anticoagulant therapy and surgical resection.

Summary We assessed the safety and feasibility of a unified conservative treatment protocol for osteoporotic vertebral fractures in the elderly patients with a 24-week follow-up. Our results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible in managing patients. Purpose The purpose of this study was to prove the safety and feasibility of a unified conservative treatment protocol, which included initial hospitalization with rigorous bed rest followed by a rehabilitation program with Jewett brace for osteoporotic vertebral fractures (OVFs) in the elderly patients with a 24-week follow-up. Methods Between April 2012 and Mach 2015, one hundred fifty-four patients met the eligibility for this study. Radiological findings at the 3-week, 6~8-week, 24-week assessment were evaluated. Among these, 11 patients underwent early surgery within the first 2 weeks after admission and 19 patients lost follow-up. Therefore, 124 patients were assessed at the final follow-up visit. Results The average vertebral instability in all the present series was 4.9 ± 4.8° at 3-week, 2.9 ± 3.5° at 6~8-week, and 1.8 ± 3.0° at 24-week follow-up visit. Delayed union was observed in 16 patients on the 24-week follow-up visit. Therefore, the present conservative treatment protocol resulted in bony union in 98 out of 124 patients (79.0%, per protocol set analysis) and 98 out of 154 patients including drop-out (63.6%, intention-to-treat analysis). There was no severe adverse event related to initial bed rest. The vertebral instability at 3-week assessment was significantly higher in the delayed union group when compared with that in the union group. Univariate analyses followed by multivariate logistic regression analysis revealed that T2-weighted image of confined high intensity on MRI and having more than 5° of vertebral instability on dynamic X-ray at 3-week assessment are the independent risk factors for delayed union of conservative treatment in the present series. Conclusions Our results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible. Therefore, the present conservative treatment protocol can be one of the acceptable treatment options in managing OVF patients.

Background: The interpretation of thoracic spine X-rays is difficult because these images cannot clearly visualize the thoracic spine because of the overlap with soft tissues, such as the heart and pulmonary blood vessels. Thus, to improve the clarity of thoracic spine radiographs using existing radiograph equipment, we have investigated a one-shot energy subtraction method to visualize thoracic spine radiographs. Our objective was to evaluate whether the thoracic spine radiographs generated using this method could visualize the spine more clearly than the corresponding original thoracic spine radiographs. Methods: This study included 29 patients who underwent thoracic spine radiographs. We used a one-shot energy subtraction method to improve the clarity of thoracic spine radiographs. Image definition was evaluated using vertebrae sampled from each region of the thoracic spine. Specifically, these were: Th1, Th5, Th9, and Th12. Image definition was assessed using a three-point grading system. The conventional and processed computed radiographs (both frontal and lateral views) of all 29 study patients were evaluated by 5 spine surgeons. Results: In all thoracic regions on both frontal and lateral views, the processed images showed statistically significantly better clarity than the corresponding conventional images, especially at all sampling sites on the frontal view and T5 and 9 on the lateral view. Conclusions: Thoracic spine radiographs generated using this method visualized the spine more clearly than the corresponding original thoracic spine radiographs. The greatest advantages of this image processing technique were its ability to clearly depict the whole thoracic spine on frontal views and the middle thoracic spine on lateral views. © 2012 The Japanese Orthopaedic Association.

Introduction Granulocyte colony-stimulating factor (G-CSF) is generally used for neutropaenia. Previous experimental studies revealed that G-CSF promoted neurological recovery after spinal cord injury (SCI). Next, we moved to early phase of clinical trials. In a phase I/IIa trial, no adverse events were observed. Next, we conducted a non-randomised, non-blinded, comparative trial, which suggested the efficacy of G-CSF for promoting neurological recovery. Based on those results, we are now performing a phase III trial. Methods and analysis The objective of this study is to evaluate the efficacy of G-CSF for acute SCI. The study design is a prospective, multicentre, randomised, double-blinded, placebo-controlled comparative study. The current trial includes cervical SCI (severity of American Spinal Injury Association (ASIA) Impairment Scale B/C) within 48 hours after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group is administered 400 µg/m 2 /day×5 days of G-CSF in normal saline via intravenous infusion for 5 consecutive days. The placebo group is similarly administered a placebo. Our primary endpoint is changes in ASIA motor scores from baseline to 3 months. Each group includes 44 patients (88 total patients). Ethics and dissemination The study will be conducted according to the principles of the World Medical Association Declaration of Helsinki and in accordance with the Japanese Medical Research Involving Human Subjects Act and other guidelines, regulations and Acts. Results of the clinical study will be submitted to the head of the respective clinical study site as a report after conclusion of the clinical study by the sponsor-investigator. Even if the results are not favourable despite conducting the clinical study properly, the data will be published as a paper. Trial registration number UMIN000018752.

The characteristics of leakage current observed in the pixels of pinned photodiode CMOS image sensor with negative transfer-gate bias operation are investigated, taking metal contamination into account. Simulation results show that interface states between insulator and the pinned layer in the vicinity of transfer gate, acting as hole traps, are responsible for negative transfer-gate bias dependence of the dark current.

舌全摘出例の中には術後の誤嚥を防止するために喉頭全摘出術を併施せざるをえない症例がある。今回, 舌全摘出例における喉頭保存の限界について舌周囲の合併切除範囲との関係から検討した。舌全摘出例における喉頭保存の条件としては, 心肺機能が良好で, 喉頭保存に対するモチベーションが高いことに加え, 上喉頭神経が温存され, 下顎骨の連続性が確保あるいは再獲得され, 中咽頭切除が一側壁までに限局することが挙げられた。また喉頭保存例では喉頭挙上術, 喉頭形成術, 輪状咽頭筋切断術等の誤嚥防止策が有効であるが, 甲状舌骨筋神経の温存は喉頭挙上術を補完する上からも重要と考えられた。

上顎部の扁平上皮癌に対する術前CBDCA同時併用加速多分割照射療法の有用性について検討した。本法による28例の臨床効果はCR率17.9%, good PR・CR率32.1%であり, 組織学的効果は Grade III・IV率28.6%であった。また上顎切除後の一次局所制御率は85.7%であった。本法の治療成績もほぼ満足しうるものであり, かつ組織学的効果も確保されていたことから, 本術前療法は201Tl SPECTなどの応用による厳密な術前治療効果の評価によりCR例や good PR例では縮小手術の可能性をもたらし, 術後の形態・機能温存に有用と考えられた。

1994年5月から1995年3月までに18例の頭頸部進行癌に対し, 1回1.6Gy 1日2回, 6時間間隔で総照射線量70.4Gyの加速多分副照射およびCBDCA 1日30mg静注の同時併用療法をおこなった。上顎洞癌, 下咽頭癌各5例, 舌癌4例, 喉頭癌2例, 扁桃癌, 頬粘膜癌各1例であった。平均年齢は60.5歳 (38～70)。全例生検により扁平上皮癌と診断されている。TNM分類ではT3N0: 5例, T4N0: 7例, T3N1: 1例, T3N2: 2例, T4N2: 1例, T4N3: 2例であった。経過観察期間は平均6.7力月 (2～12) であった。18例中9例 (50%) でCRが得られ, 8例 (45%) でPRとなり, 奏効率95%であった。上顎洞癌の1例のみNCであった。主な副作用は口内炎と骨髄抑制であったがRTOG Criteria で Grade 2-3の口内炎が17例に Grade 4が1例にみられた。Grade 3-4の血小板減少が22%にみられたが, いずれも特に処置を要することはなかった。

優れた腫瘍親和性薬剤である塩化タリウムを用い, 上咽頭腫瘍の放射線・化学療法の前後に201T1 SPECTを行い, 病巣の viability の評価に201T1 SPECTが有用か否か検討した。組織学的に確診の得られた11例の上咽頭腫瘍患者 (放射線治療単独3例化学療法併用8例) を対象とし, 治療前後に43回の201T1 SPECTを行った。3検出器回転型ガンマカメラを使用し, 塩化タリウム111MBq (3mCi) 静注後5分からデータ収集を開始した。治療効果判定はMRI所見に基づきCR, PR, NCに分類した。治療前においては, 全例病巣に一致した高度の201T1集積を認めた。CR1例, PR10例では, いずれも治療終了時に201T1集積が減弱 (4例) または消失 (7例) していた。このうち, 治療直後にMRIで腫瘤が残存し, その後経過を追って201T1 SPECTとMRIを行ったPR4例では, まず201T1集積が消失し, その後MRI上の腫瘤の縮小を認めた。201T1 SPECTは上咽頭腫瘍の放射線治療効果の判定に極めて有用である。

Computed radiography (CR) has many advantages compared with conventional radiographs, especially in image processing. Although CR is being used in chest radiography and mammography, it has not been applied to spine imaging. The purposes of this study were to formulate a set of new CR processing parameters and to test whether the resultant whole-spine radiographs visualized the spine more clearly than conventional images. This study included 29 patients who underwent whole-spine radiographs. We used 3 image processing methods to improve the clarity of whole-spine radiographs: gradation processing, dynamic range control processing, and multi-objective frequency processing. Radiograph definition was evaluated using vertebrae sampled from each region of the whole spine, specifically C4, C7, T8, T12, and L3; evaluation of the lateral view also included the sacral spine and femoral head. Image definition was assessed using a 3-point grading system. The conventional and processed CR images (both frontal and lateral views) were evaluated by 5 spine surgeons. In all spinal regions on both frontal and lateral views, the processed images showed statistically significantly better clarity than the corresponding conventional images, especially at T12, L3, the sacral spine, and the femoral head on the lateral view. Our set of new CR processing parameters can improve the clarity of whole-spine radiographs compared with conventional images. The greatest advantage of image processing was that it enabled clear depiction of the thoracolumbar junction, lumbar vertebrae, sacrum, and femoral head in the lateral view.

This paper presents a novel automated microwave filter tuning method based on successive optimization of zeros of return loss characteristics. The proposed method consists of two stages; coarse and fine tuning stages. In the first stage, called coarse tuning, the phase response error of the target filter is minimized. Then in the second stage, called fine tuning, we optimize the position of zeros of return loss characteristics. Performance of the proposed tuning procedure is evaluated through some experiments of actual filter tuning.

Objective: To determine the incidence of thrombosis and change in caliber of the internal jugular vein after neck dissection. Patients and methods: Between September 1999 and December 2000, we studied 68 patients who underwent 76 neck dissection that spared the internal jugular vein. Thrombosis of the internal jugular vein was determined using duplex Doppler scans. The examination was performed about 10 days after the operation. Preoperative and postoperative imaging was available for 28 patients who underwent 32 neck dissections after April 2000. These 28 patients were divided into three groups. Group 1 consisted of 5 internal jugular veins which were treated with supraomohyoid neck dissection. Group 2 included 17 internal jugular veins which were treated with functional neck dissection. For group 3, ten patients underwent simultaneous bilateral neck dissections that spared the ipsilateral internal jugular vein with concurrent contralateral radical neck dissection. For each group, the mean ratio of the post- to pre-operative caliber of the internal jugular vein was calculated. Measurements were planned for 7 days, 1 month, and 3 months postoperatively. Results: The overall patency of the 76 internal jugular veins after neck dissection was 100%. In all groups, the mean ratio of the post- to pre-operative caliber of the internal jugular vein was lowest during the early postoperative period, and gradually increased within 3 months after surgery. Conclusion: The caliber of the internal jugular veins decreased the most during the early postoperative period; however, internal jugular vein thrombosis is uncommon.

The effects of plasma and precursors during low-temperature silicon nitride (LT-SiN) film deposition on the magnetic properties of a CoFeB alloy layer, which is one magnetic material in a magnetic tunnel junction (MTJ) in magnetoresistive random access memory (MRAM), were investigated. The NH3 plasma exposure was found to nitride the CoFeB alloy layer, resulting in degradation of the magnetic properties of the CoFeB alloy layer. To suppress this degradation, NH3-free LT-SiN films deposited using silane and nitrogen source gases with helium or argon dilution in a conventional plasma enhanced chemical vapor deposition (PECVD) apparatus were evaluated. The LT-SiN film deposited under conditions of a highly dilute helium flow in the SiH4–N2–He gas mixture exhibited high density, sufficient moisture-blocking ability, and low leakage current. On the other hand, the film deposited at the SiH4–N2–Ar gas mixture exhibited poor film qualities. It is revealed that helium gas has enhanced the generation of N2 radicals and the decomposition of silane gas during the deposition of the SiH4–N2–He gas mixture. Finally, we demonstrated that the electrical properties of 8-kbit MRAM arrays have been improved by using the optimized NH3-free LT-SiN film for the MTJ-protection layer.

We fabricated of a feedback loop phase conjugate mirror (RING-SPPCM) using photorefractive Rh:BaTiO3 crystal, and measured the reflectivity of this mirror with nanosecond pulses at 1064nm. The reflectivity of about 33% was obtained. A demonstration of the correction of phase distortions was made with this arrangement.

Photorefractive effect with Rh-doped BaTiO3 crystals are more sensitive to near infared light, compared with nominally non-doped crystals. The reflectivity of photorefractive phaseconjugate mirrors was measured for several wavelengths in the nearinfrared. The reflectivity of about 25% was obtained at the wavelength of 780nm in a ring configuration.

Since 1982, we had used the Jackson-Ono's direct bronchoscope with Tanaka's adapter for HFJV. This device was attached to the proximal end of the bronchoscope, and had a short channel for HFJV. However, this method resulted in high PaCO2 (mean 63.9±20.5mmHg) during long surgical procedure. Therefore, controlled respiration was intermittently required to increase the ventilatory flow per minute.Recently, a bronchoscope with a long built-in channel has been devised at our department, in which spouting orifice of the oxygen is located inside the scope approxymately 6cm proximal from the tip. Since 1986, this device has been applied to 9 patients with bronchial foreign bodies and relatively lower PaCO2 (mean 29.3±11.3mmHg) has been observed during the surgical procedure.Several basic experiments were performed to clarify the mechanism of better clinical results in blood gas analysis using a model of lung and bronchus complex. Following results were obtained: (1) the pressure at the distal end of the newly devised bronchoscope was significantly higher; (2) the ventilatory flow rate per minute was significantly higher than that of conventional bronchoscope with Tanaka's adapter; (3) there was no significant difference in airway pressure between these two instruments. From these results we concluded that the reason why low PaCO2 could be maintained with newly developed bronchoscope during long manipulation was due to high ventilatory flow rate in spite of the similar airway pressure inside the bronchus.