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✓ The authors describe two occurrences of idiopathic spinal cord herniation, an entity that has been reported previously in only 11 cases. The patients described in this report presented in midlife with Brown—Séquard syndrome. Computerized tomography myelography and magnetic resonance (MR) imaging showed ventral displacement of the spinal cord with no apparent dorsal mass. Intraspinal cerebrospinal fluid (CSF) flow studies in which phase-contrast pulse sequence cine MR imaging was used displayed a normal pattern dorsal to the spinal cord. Percutaneous intrathecal endoscopic observation did not disclose dorsal intradural cysts, but ventral adhesions were seen between the spinal cord and the dura. Microsurgical intradural exploration revealed ventrolateral herniation of the cord and a ventral root through a dural defect into an epidural arachnoid cyst. The adhesions were released, the cord was repositioned intradurally, and the dural defect was patched. The patients showed gradual improvement postsurgery, as did most of the patients in the previously reported cases. The CSF flow and endoscopic studies were found to be particularly informative, and dural patching with surgical membrane is recommended.

The formation of syringomyelia is caused by some mechanical factors. In Chiari type I malformation, it is observed that the flow of cerebrospinal fluid is blocked by a herniated cerebellar tonsil. However, the influence of the blockade by the hernia on the spinal cord is not clarified. In this study, we examine the stress state in the spinal cord when it is deformed in certain bending modes:one state is that caused by a certain load and the other state is that of free vibration. Through numerical examples by FEM (finite element method), we consider the relationship among the impediment in the flaw of cerebrospinal fluid, the stress distribution and the location of syringomyelia.

OBJECTIVE AND IMPORTANCE: Two patients with dural arteriovenous fistulas involving the transverse sinus and superior sagittal sinus are described, with a focus on the unique type of venous drainage of the fistula. CLINICAL PRESENTATION: Both patients presented with papilledema and progressive visual disturbance. Angiography and magnetic resonance imaging showed that the fistulas involving the superior sagittal sinus had a dilated venous channel, separate from the sinus lumen, located within the wall of the sinus. INTERVENTION: Transvenous embolization of the venous channel of the fistula, proximal to its drainage into the superior sagittal sinus, resulted in closure of the fistula and restoration of the superior sagittal sinus function. The clinical symptoms were reversed; the symptoms are believed to have reflected venous hypertension in the superior sagittal sinus, resulting from the shunted flow and interfering with normal venous drainage. CONCLUSION: This unique type of dural arteriovenous fistula may be a variant, occurring in the developmental process of the fistula. It is significant clinically because transvenous embolization can be used to close the fistula and restore sinus function.

The subject of analysis in this study is a human brain exhibiting edema. The cells of an edematous brain contain an overabundance of cerebrospinal fluid (CSF). Brain edema appears as a white region in magnetic resonance images of the brain. However, such images show only that an excess of CSF is present in the cells ; they give us no information on the direction or quantity of CSF flux. Therefore, we studied the flow of CSF in brain through computer simulation. First, we constructed a two-dimensional model of a brain using FEM based on Poisson's equation and a diffusion equation and simulated the CSF flow in the brain tissue in order to determine the quantity of CSF present. Second, we simulated a case in which colored-albumin is poured into the brain tissue at the site of edema and compared the distribution of CSF in this case with that in a CT image which exhibits edema. The results on CSF flow obtained in the simulation are similar to those obtained by pathological observation. Moreover, we believe that these simulations help us to develop new medical treatments for brain disease such as edema.

OBJECTIVE AND IMPORTANCE : Hajdu-Cheney syndrome is a rare idiopathic bone disease based on a generalized bone dysplasia accompanied by acro-osteolysis. We describe a surgical case of this syndrome that was accompanied by neurological signs associated with cervical syringomyelia. CLINICAL PRESENTATION : A 41-year-old woman was referred to our hospital with mild quadriparesis and sensory disturbance resulting from a car accident. There was a neck injury. She showed almost all of the major characteristic clinical features and roentgenographic findings of Hajdu-Cheney syndrome with syringomyelia. INTERVENTION : Surgical treatment was indicated because of the progressive neurological deficits. Foramen magnum decompression and C1 laminectomy were performed, and the dura was exposed. The dura was opened at the area of the foramen magnum and C1. The occipitocervical posterior fusion was carried out with an iliac bone graft and titanium wires. CONCLUSION : Postoperatively, quadriparesis and sensory disturbance improved and the patient showed improved ambulation. Magnetic resonance imaging disclosed the well-decompressed foramen magnum. The syringomyelia disappeared in the segmental area of C2 and was decreased in the segmental areas of C5-T6. The treatment of this syndrome is symptomatic. In this patient, magnetic resonance imaging disclosed compression of the brain stem by basilar invagination and platybasia, disturbance of cerebrospinal fluid flow at the level of the foramen magnum, and syringomyelia. It was suspected that the obstruction of cerebrospinal fluid flow at the level of foramen magnum caused the cervical syringomyelia. However, the long-term prognosis remains uncertain. Follow-up is necessary to assess the final result of the treatment.

Results from simulations performed for the Atmospheric Chemistry and Climate Modeling Intercomparison Project (ACCMIP) are analysed to examine how OH and methane lifetime may change from present day to the future, under different climate and emissions scenarios. Present day (2000) mean tropospheric chemical lifetime derived from the ACCMIP multi-model mean is 9.8 ± 1.6 yr (9.3 ± 0.9 yr when only including selected models), lower than a recent observationally-based estimate, but with a similar range to previous multi-model estimates. Future model projections are based on the four Representative Concentration Pathways (RCPs), and the results also exhibit a large range. Decreases in global methane lifetime of 4.5 ± 9.1% are simulated for the scenario with lowest radiative forcing by 2100 (RCP 2.6), while increases of 8.5 ± 10.4% are simulated for the scenario with highest radiative forcing (RCP 8.5). In this scenario, the key driver of the evolution of OH and methane lifetime is methane itself, since its concentration more than doubles by 2100 and it consumes much of the OH that exists in the troposphere. Stratospheric ozone recovery, which drives tropospheric OH decreases through photolysis modifications, also plays a partial role. In the other scenarios, where methane changes are less drastic, the interplay between various competing drivers leads to smaller and more diverse OH and methane lifetime responses, which are difficult to attribute. For all scenarios, regional OH changes are even more variable, with the most robust feature being the large decreases over the remote oceans in RCP8.5. Through a regression analysis, we suggest that differences in emissions of non-methane volatile organic compounds and in the simulation of photolysis rates may be the main factors causing the differences in simulated present day OH and methane lifetime. Diversity in predicted changes between present day and future OH was found to be associated more strongly with differences in modelled temperature and stratospheric ozone changes. Finally, through perturbation experiments we calculated an OH feedback factor (F) of 1.24 from present day conditions (1.50 from 2100 RCP8.5 conditions) and a climate feedback on methane lifetime of 0.33 ± 0.13 yr K−1, on average. Models that did not include interactive stratospheric ozone effects on photolysis showed a stronger sensitivity to climate, as they did not account for negative effects of climate-driven stratospheric ozone recovery on tropospheric OH, which would have partly offset the overall OH/methane lifetime response to climate change.

Since the 1980s several spaceborne sensors have been used to retrieve the aerosol optical depth (AOD) over the Mediterranean region. In parallel, AOD climatologies coming from different numerical model simulations are now also available, permitting to distinguish the contribution of several aerosol types to the total AOD. In this work, we perform a comparative analysis of this unique multi-year database in terms of total AOD and of its apportionment by the five main aerosol types (soil dust, sea-salt, sulfate, black and organic carbon). We use 9 different satellite-derived monthly AOD products: NOAA/AVHRR, SeaWiFS (2 products), TERRA/MISR, TERRA/MODIS, AQUA/MODIS, ENVISAT/MERIS, PARASOL/POLDER and MSG/SEVIRI, as well as 3 more historical datasets: NIMBUS7/CZCS, TOMS (onboard NIMBUS7 and Earth-Probe) and METEOSAT/MVIRI. Monthly model datasets include the aerosol climatology from Tegen et al. (1997), the climate-chemistry models LMDz-OR-INCA and RegCM-4, the multi-model mean coming from the ACCMIP exercise, and the reanalyses GEMS and MACC. Ground-based Level-2 AERONET AOD observations from 47 stations around the basin are used here to evaluate the model and satellite data. The sensor MODIS (on AQUA and TERRA) has the best average AOD scores over this region, showing a relevant spatio-temporal variability and highlighting high dust loads over Northern Africa and the sea (spring and summer), and sulfate aerosols over continental Europe (summer). The comparison also shows limitations of certain datasets (especially MERIS and SeaWiFS standard products). Models reproduce the main patterns of the AOD variability over the basin. The MACC reanalysis is the closest to AERONET data, but appears to underestimate dust over Northern Africa, where RegCM-4 is found closer to MODIS thanks to its interactive scheme for dust emissions. The vertical dimension is also investigated using the CALIOP instrument. This study confirms differences of vertical distribution between dust aerosols showing a large vertical spread, and other continental and marine aerosols which are confined in the boundary layer. From this compilation, we propose a 4-D blended product from model and satellite data, consisting in monthly time series of 3-D aerosol distribution at a 50 km horizontal resolution over the Euro-Mediterranean marine and continental region for the 2003–2009 period. The product is based on the total AOD from AQUA/MODIS, apportioned into sulfates, black and organic carbon from the MACC reanalysis, and into dust and sea-salt aerosols from RegCM-4 simulations, which are distributed vertically based on CALIOP climatology. We extend the 2003–2009 reconstruction to the past up to 1979 using the 2003–2009 average and applying the decreasing trend in sulfate aerosols from LMDz-OR-INCA, whose AOD trends over Europe and the Mediterranean are median among the ACCMIP models. Finally optical properties of the different aerosol types in this region are proposed from Mie calculations so that this reconstruction can be included in regional climate models for aerosol radiative forcing and aerosol-climate studies.

Ozone (O3) from 17 atmospheric chemistry models taking part in the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP) has been used to calculate tropospheric ozone radiative forcings (RFs). All models applied a common set of anthropogenic emissions, which are better constrained for the present-day than the past. Future anthropogenic emissions follow the four Representative Concentration Pathway (RCP) scenarios, which define a relatively narrow range of possible air pollution emissions. We calculate a value for the pre-industrial (1750) to present-day (2010) tropospheric ozone RF of 410 mW m−2. The model range of pre-industrial to present-day changes in O3 produces a spread (±1 standard deviation) in RFs of ±17%. Three different radiation schemes were used – we find differences in RFs between schemes (for the same ozone fields) of ±10%. Applying two different tropopause definitions gives differences in RFs of ±3%. Given additional (unquantified) uncertainties associated with emissions, climate-chemistry interactions and land-use change, we estimate an overall uncertainty of ±30% for the tropospheric ozone RF. Experiments carried out by a subset of six models attribute tropospheric ozone RF to increased emissions of methane (44±12%), nitrogen oxides (31 ± 9%), carbon monoxide (15 ± 3%) and non-methane volatile organic compounds (9 ± 2%); earlier studies attributed more of the tropospheric ozone RF to methane and less to nitrogen oxides. Normalising RFs to changes in tropospheric column ozone, we find a global mean normalised RF of 42 mW m−2 DU−1, a value similar to previous work. Using normalised RFs and future tropospheric column ozone projections we calculate future tropospheric ozone RFs (mW m−2; relative to 1750) for the four future scenarios (RCP2.6, RCP4.5, RCP6.0 and RCP8.5) of 350, 420, 370 and 460 (in 2030), and 200, 300, 280 and 600 (in 2100). Models show some coherent responses of ozone to climate change: decreases in the tropical lower troposphere, associated with increases in water vapour; and increases in the sub-tropical to mid-latitude upper troposphere, associated with increases in lightning and stratosphere-to-troposphere transport. Climate change has relatively small impacts on global mean tropospheric ozone RF.

As part of the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP), we evaluate the historical black carbon (BC) aerosols simulated by 8 ACCMIP models against observations including 12 ice core records, long-term surface mass concentrations, and recent Arctic BC snowpack measurements. We also estimate BC albedo forcing by performing additional simulations using offline models with prescribed meteorology from 1996–2000. We evaluate the vertical profile of BC snow concentrations from these offline simulations using the recent BC snowpack measurements. Despite using the same BC emissions, the global BC burden differs by approximately a factor of 3 among models due to differences in aerosol removal parameterizations and simulated meteorology: 34 Gg to 103 Gg in 1850 and 82 Gg to 315 Gg in 2000. However, the global BC burden from preindustrial to present-day increases by 2.5–3 times with little variation among models, roughly matching the 2.5-fold increase in total BC emissions during the same period. We find a large divergence among models at both Northern Hemisphere (NH) and Southern Hemisphere (SH) high latitude regions for BC burden and at SH high latitude regions for deposition fluxes. The ACCMIP simulations match the observed BC surface mass concentrations well in Europe and North America except at Ispra. However, the models fail to predict the Arctic BC seasonality due to severe underestimations during winter and spring. The simulated vertically resolved BC snow concentrations are, on average, within a factor of 2–3 of the BC snowpack measurements except for Greenland and the Arctic Ocean. For the ice core evaluation, models tend to adequately capture both the observed temporal trends and the magnitudes at Greenland sites. However, models fail to predict the decreasing trend of BC depositions/ice core concentrations from the 1950s to the 1970s in most Tibetan Plateau ice cores. The distinct temporal trend at the Tibetan Plateau ice cores indicates a strong influence from Western Europe, but the modeled BC increases in that period are consistent with the emission changes in Eastern Europe, the Middle East, South and East Asia. At the Alps site, the simulated BC suggests a strong influence from Europe, which agrees with the Alps ice core observations. At Zuoqiupu on the Tibetan Plateau, models successfully simulate the higher BC concentrations observed during the non-monsoon season compared to the monsoon season but overpredict BC in both seasons. Despite a large divergence in BC deposition at two Antarctic ice core sites, some models with a BC lifetime of less than 7 days are able to capture the observed concentrations. In 2000 relative to 1850, globally and annually averaged BC surface albedo forcing from the offline simulations ranges from 0.014 to 0.019 W m−2 among the ACCMIP models. Comparing offline and online BC albedo forcings computed by some of the same models, we find that the global annual mean can vary by up to a factor of two because of different aerosol models or different BC-snow parameterizations and snow cover. The spatial distributions of the offline BC albedo forcing in 2000 show especially high BC forcing (i.e., over 0.1 W m−2) over Manchuria, Karakoram, and most of the Former USSR. Models predict the highest global annual mean BC forcing in 1980 rather than 2000, mostly driven by the high fossil fuel and biofuel emissions in the Former USSR in 1980.

We have analysed time-slice simulations from 17 global models, participating in the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP), to explore changes in present-day (2000) hydroxyl radical (OH) concentration and methane (CH4) lifetime relative to preindustrial times (1850) and to 1980. A comparison of modeled and observation-derived methane and methyl chloroform lifetimes suggests that the present-day global multi-model mean OH concentration is overestimated by 5 to 10% but is within the range of uncertainties. The models consistently simulate higher OH concentrations in the Northern Hemisphere (NH) compared with the Southern Hemisphere (SH) for the present-day (2000; inter-hemispheric ratios of 1.13 to 1.42), in contrast to observation-based approaches which generally indicate higher OH in the SH although uncertainties are large. Evaluation of simulated carbon monoxide (CO) concentrations, the primary sink for OH, against ground-based and satellite observations suggests low biases in the NH that may contribute to the high north–south OH asymmetry in the models. The models vary widely in their regional distribution of present-day OH concentrations (up to 34%). Despite large regional changes, the multi-model global mean (mass-weighted) OH concentration changes little over the past 150 yr, due to concurrent increases in factors that enhance OH (humidity, tropospheric ozone, nitrogen oxide (NOx) emissions, and UV radiation due to decreases in stratospheric ozone), compensated by increases in OH sinks (methane abundance, carbon monoxide and non-methane volatile organic carbon (NMVOC) emissions). The large inter-model diversity in the sign and magnitude of preindustrial to present-day OH changes (ranging from a decrease of 12.7% to an increase of 14.6%) indicate that uncertainty remains in our understanding of the long-term trends in OH and methane lifetime. We show that this diversity is largely explained by the different ratio of the change in global mean tropospheric CO and NOx burdens (ΔCO/ΔNOx, approximately represents changes in OH sinks versus changes in OH sources) in the models, pointing to a need for better constraints on natural precursor emissions and on the chemical mechanisms in the current generation of chemistry-climate models. For the 1980 to 2000 period, we find that climate warming and a slight increase in mean OH (3.5 ± 2.2%) leads to a 4.3 ± 1.9% decrease in the methane lifetime. Analysing sensitivity simulations performed by 10 models, we find that preindustrial to present-day climate change decreased the methane lifetime by about four months, representing a negative feedback on the climate system. Further, we analysed attribution experiments performed by a subset of models relative to 2000 conditions with only one precursor at a time set to 1860 levels. We find that global mean OH increased by 46.4 ± 12.2% in response to preindustrial to present-day anthropogenic NOx emission increases, and decreased by 17.3 ± 2.3%, 7.6 ± 1.5%, and 3.1 ± 3.0% due to methane burden, and anthropogenic CO, and NMVOC emissions increases, respectively.

Intradural spinal lipomas that are not associated with spinal dysraphism are rare. We report four cases of adult patients with intradural spinal lipomas. All of the patients were young adults, three women and one man, who ranged in age from 22 to 37 years (mean, 30.3 yr). The clinical presentation of these lesions varied, depending upon the size and location of each lipoma. It is interesting that the symptoms in the women gradually deteriorated during pregnancy or after delivery. Magnetic resonance imaging was very useful in determining the exact location of lipoma. In three of four patients, neurological improvement was obtained after decompressive laminectomy and partial removal of the lipoma.

We use simultaneous observations of ozone and outgoing longwave radiation (OLR) from the Tropospheric Emission Spectrometer (TES) to evaluate ozone distributions and radiative forcing simulated by a suite of chemistry-climate models that participated in the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP). The ensemble mean of ACCMIP models show a persistent but modest tropospheric ozone low bias (5–20 ppb) in the Southern Hemisphere (SH) and modest high bias (5–10 ppb) in the Northern Hemisphere (NH) relative to TES for 2005–2010. These biases lead to substantial differences in ozone instantaneous radiative forcing between TES and the ACCMIP simulations. Using TES instantaneous radiative kernels (IRK), we show that the ACCMIP ensemble mean has a low bias in the SH tropics of up to 100 m W m−2 locally and a global low bias of 35 ± 44 m W m−2 relative to TES. Combining ACCMIP preindustrial ozone and the TES present-day ozone, we calculate an observationally constrained estimate of tropospheric ozone radiative forcing (RF) of 399 ± 70 m W m−2, which is about 7% higher than using the ACCMIP models alone but with the same standard deviation (Stevenson et al., 2012). In addition, we explore an alternate approach to constraining radiative forcing estimates by choosing a subset of models that best match TES ozone, which leads to an ozone RF of 369 ± 42 m W m−2. This estimate is closer to the ACCMIP ensemble mean RF but about a 40% reduction in standard deviation. These results point towards a profitable direction of combining observations and chemistry-climate model simulations to reduce uncertainty in ozone radiative forcing.

We report two cases of ependymoma which showed prominent "granular cell" changes of the cytoplasm. The patients were a 7-year-old boy with a tumor in the cerebellum (case 1) and a 70-year-old man with a tumor in the frontal lobe (case 2). The tumor of case 1 showed a histopathological appearance of ependymoma containing many focal aggregates of large polygonal cells in which the cytoplasm was stuffed with numerous eosinophilic granules. The tumor of case 2 predominantly showed the features of papillary ependymoma, and some tumor cells were swollen and contained similar eosinophilic granules. Intracytoplasmic granules in both tumors were immunoreactive for GFAP and ubiquitin, but not for epithelial membrane antigen, CD68 or mitochondria. Ultrastructurally, they were found as aggregates of membrane-bound, electron-dense, globular structures. Karyotypic analysis of the tumor in case 1 demonstrated 2, 11 and 12 trisomies. Intracytoplasmic eosinophilic granules occasionally occur in astrocytic and oligodendroglial neoplasms, but an appearance of similar granules is very rare in ependymoma. The two cases presented here may represent a new histopathological variant of ependymoma, and the term "granular cell ependymoma" is appropriate for them.

Intraorbital schwannoma is a rare tumor that constitutes approximately 1%-8% of all orbital tumors. The authors report a case of orbital schwannoma in a 5-year-old boy who was admitted to their institute with exophthalmos and ptosis of the right eye. Computed tomography scanning and MR imaging revealed a retroocular mass in the right orbit. The tumor was successfully removed via a transcranial approach. The pathological diagnosis was schwannoma that appeared to originate from the superior branch of the oculomotor nerve. Despite the rarity of these intraorbital extraocular tumors in children, schwannomas should be differentiated from other intraorbital tumors.

Emissions of air pollutants and their precursors determine regional air quality and can alter climate. Climate change can perturb the long-range transport, chemical processing, and local meteorology that influence air pollution. We review the implications of projected changes in methane (CH(4)), ozone precursors (O(3)), and aerosols for climate (expressed in terms of the radiative forcing metric or changes in global surface temperature) and hemispheric-to-continental scale air quality. Reducing the O(3) precursor CH(4) would slow near-term warming by decreasing both CH(4) and tropospheric O(3). Uncertainty remains as to the net climate forcing from anthropogenic nitrogen oxide (NO(x)) emissions, which increase tropospheric O(3) (warming) but also increase aerosols and decrease CH(4) (both cooling). Anthropogenic emissions of carbon monoxide (CO) and non-CH(4) volatile organic compounds (NMVOC) warm by increasing both O(3) and CH(4). Radiative impacts from secondary organic aerosols (SOA) are poorly understood. Black carbon emission controls, by reducing the absorption of sunlight in the atmosphere and on snow and ice, have the potential to slow near-term warming, but uncertainties in coincident emissions of reflective (cooling) aerosols and poorly constrained cloud indirect effects confound robust estimates of net climate impacts. Reducing sulfate and nitrate aerosols would improve air quality and lessen interference with the hydrologic cycle, but lead to warming. A holistic and balanced view is thus needed to assess how air pollution controls influence climate; a first step towards this goal involves estimating net climate impacts from individual emission sectors. Modeling and observational analyses suggest a warming climate degrades air quality (increasing surface O(3) and particulate matter) in many populated regions, including during pollution episodes. Prior Intergovernmental Panel on Climate Change (IPCC) scenarios (SRES) allowed unconstrained growth, whereas the Representative Concentration Pathway (RCP) scenarios assume uniformly an aggressive reduction, of air pollutant emissions. New estimates from the current generation of chemistry-climate models with RCP emissions thus project improved air quality over the next century relative to those using the IPCC SRES scenarios. These two sets of projections likely bracket possible futures. We find that uncertainty in emission-driven changes in air quality is generally greater than uncertainty in climate-driven changes. Confidence in air quality projections is limited by the reliability of anthropogenic emission trajectories and the uncertainties in regional climate responses, feedbacks with the terrestrial biosphere, and oxidation pathways affecting O(3) and SOA.

The purpose of this study was to quantify the changes of blood-brain barrier glucose transporter kinetics following cerebral ischemia using an in situ brain perfusion technique. Sixty-four adult male Sprague-Dawley rats were divided into control and ischemia groups, and a four-vessel occlusion model was used to provide an ischemic insult. To obtain regional capillary permeability area products of glucose and regional perfusion fluid flow rates, the perfusion fluid was dually labeled with 2-deoxy[14C]glucose and [3H]diazepam, and the brain was perfused at a constant rate via the external carotid artery. After sampling tissues from the brain, dual scintillation counting was performed and both regional perfusion fluid flow rates and regional capillary permeability area products were calculated. We determined kinetic parameters, including Vmax, Km and Kd as described in the Michaelis-Menten equation, by the non-linear least squares method. In the ischemia group, a decrease in Vmax and an increase in Km were recognized, which mean decreases in the affinity and the number of functioning glucose transporters. These results suggest that cerebral ischemia downregulates the blood-brain barrier glucose transporters.

The brain consists of brain tissue, blood and extracellular fluid. We can thus consider that brain tissue has multi-phasic properties. There is a very important interrelation between the tissue and the fluid. Thus, we consider that the respective factors on brain neurosurgery, the distribution of brain tissue pressure and extracellular fluid flow are very important, and we cannot neglect those factors closely related to metabolism of the brain tissue. This study constructs a two-dimensional consolidation model of the brain using the finite element method (FEM) and simulates the flow and distribution of cerebrospinal fluid (CSF). The two dominant equations on the consolidation theory are approximated numerically in time by the finite difference method and in space by the FEM. The results obtained by computer simulation regarding brain edema using the FEM are compared with the pathological observation with regrad to the flux distribution and flow direction of CSF, and we conclude that they are much the same as those from the view point of the pathological and clinical surgery. We furthermore propose that we should take the boundary conditions of pressure of the subarchanoid space and ventricle into consideration in the simulation of brain edema.

[1] Results of comprehensive long-term simulations of surface all-sky and clear-sky ultraviolet (UV) radiation through 1960–2100 are presented. A new earth system model, MIROC-ESM-CHEM, is used for the simulation, which considers key processes that change the surface UV radiation: atmospheric dynamics and chemistry affecting ozone in the stratosphere and troposphere, aerosols and clouds in the troposphere, and changes in surface albedo with sea ice and snow cover. In contrast to previous assessments considering only the effect of long-term change in stratospheric ozone, the simulated long-term behavior of UV radiation in this study is strongly affected by other processes. In one of two simulations, all-sky UV radiation in the northern midlatitudes is projected to increase in the 21st century despite the expected recovery of the stratospheric ozone layer. Reductions in aerosols and clouds are expected to overcompensate for the effect of ozone recovery. The results are sensitive to the future socioeconomic scenario, describing GHG concentrations and emissions of aerosol and ozone precursors in the troposphere. The interannual variability of UV radiation associated with the 11 year solar cycle and local processes is also discussed.

A 5-month-old boy presented with a rare case of intramedullary teratoma extending from T1 to S5 and associated with a lumbosacral lipoma. Magnetic resonance imaging showed the tumor extended over the lipoma. Since the tumor could not be clearly demarcated from the spinal cord, surgery was performed under a preoperative diagnosis of spinal glioma. The lack of demarcation made safe resection of the tumor difficult to perform, so that the tumor was only partially removed by decompressing the spinal cord. The histological diagnosis was mature teratoma. This case was likely the result of some dysembryogenetic mechanism and the tumor was not neoplastic. The long-term outcome cannot yet be determined, but no recurrence of the symptoms has been observed for 3 years. Spinal intramedullary teratoma is rare and tends to be located in the lumbosacral region. Surgical intervention is crucial and total removal may be achievable, but is likely to be partial with tight adhesion to the spinal cord, so that aggressive approaches should be avoided in such cases.

[1] We consider future changes in tropospheric ozone based on the Representative Concentration Pathways (RCPs), which are new emission and concentration scenarios for the 5th coupled model intercomparison project. In contrast to the SRES scenarios, all the RCP scenarios assume an emission reduction of NOx by the late 21st Century that has the potential to achieve tropospheric ozone reduction. However, increasing radiative forcing (RF) due to greenhouse gases and changes in CH4 concentration also contribute to differences in the tropospheric ozone distribution among RCP scenarios. In the RCP4.5 and RCP6.0, assuming the stabilization of RF, the increase in tropospheric ozone due to enhanced residual circulation is cancelled out by the ozone reduction due to ozone precursor reductions. In contrast, in the RCP8.5, assuming increasing RF even after 2100, further enhanced residual circulation and significant increase in CH4 cause a dramatic increase in tropospheric ozone.

The treatment of spinal abnormalities with cloacal exstrophy is controversial. Ten cases of this complex treated at Hyogo Prefectural Kobe Children's Hospital between 1991 and 2010 are presented. In our series, all 10 patients had tethered spinal cords. In addition, there were 3 terminal myelocystoceles, 2 meningoceles, 7 lipomas, 5 thickened filums and 3 syrinxes. Eight of 10 patients underwent surgery, and no patient deteriorated. All 3 patients with terminal myelocystocele had lower extremity weakness, but motor functions in two patients improved after surgery. All 4 patients with lipoma and/or thickened filum were asymptomatic. Two of them were conservatively treated, and they remain asymptomatic. Terminal myelocystocele and symptomatic syrinx should be surgically treated.

A case of intraorbital arteriovenous malformation presenting with visual loss, exophthalmos, and chemosis of the right eye is reported. Enhanced computer tomography and magnetic resonance imaging showed extraocular muscle enlargement and vascular abnormality in the right retrobulbar space. Angiography revealed an abnormal intraorbital vascular stain with an extremely dilated right ophthalmic artery. Total removal of the intraorbital contents was performed after unsuccessful endovascular and surgical treatment of arteriovenous malformation (AVM). Histopathological examination disclosed an AVM in the retrobulbar fatty tissue with extension into the extraocular muscles and optic nerve.

[1] The results from a three-dimensional chemistry climate model (CCM) of the Center for Climate System Research/National Institute for Environmental Studies (CCSR/NIES) were analyzed for 1980–2000 to detect variations due to the 11 year solar cycle. Multiple regression analysis, including the constant, linear trend, solar, quasi-biennial oscillation, volcanic, and sea surface temperature (SST) terms, was applied for ozone and temperature of the CCM for the REF1 scenario of CCM Validation. Using observed SST as a lower boundary condition, the results suggest that the contribution of solar cycle forcing in the CCSR/NIES CCM is about 1% in ozone volume mixing ratio and 0.2 K in temperature per 100 units of 10.7 cm solar microwave flux in the tropical lower stratosphere for the period 1980–2000. A change in ozone transport may be the main factor for the solar signal of ozone concentration in the lower stratosphere. Another sensitivity experiment excluding solar cycle forcing shows a small solar response in the lower stratosphere, suggesting that the interannual variability of the SST could contribute to the solar term in the lower stratosphere through troposphere-stratosphere processes and/or have an effect as an artifact of interference due to the insufficient period for analysis.

International audience; Temperature results from multi-decadal simulations of coupled chemistry climate models for the recent past are analyzed using multi-linear regression including a trend, solar cycle, lower stratospheric tropical wind, and volcanic aerosol terms. The climatology of the models for recent years is in good agreement with observations for the troposphere but the model results diverge from each other and from observations in the stratosphere. Overall, the models agree better with observations than in previous assessments, primarily because of corrections in the observed temperatures. The annually averaged global and polar temperature trends simulated by the models are generally in agreement with revised satellite observations and radiosonde data over much of their altitude range. In the global average, the model trends underpredict the radiosonde data slightly at the top of the observed range. Over the Antarctic some models underpredict the temperature trend in the lower stratosphere, while others overpredict the trends.

We describe the treatment of patients having syndromic craniosynostosis with severe craniofacial abnormality. One patient had Cruzon's syndrome, one had Beare-Stevenson cutis gyrata syndrome, and four had Pfeiffers syndrome. Anterior cranial deformity in all patients was treated using fronto-orbital advancement (FOA) by gradual distraction. Initially, the frontal and supraorbital bones were removed and remodeled. Next, the frontal bones were fixed loosely to the supraorbital bones with absorbable threads. Then, the supraorbital and temporal bones were connected using distraction devices on both sides. The temporal bones were thereafter reinforced with titanium plates. Distraction was started one week postoperation, and the mean amount of elongation was 28.9 mm. Distraction devices were removed one to five months after the operation. One case required FOA by the traditional method ten months after the initial operation. Local infection was observed in three cases, but there were no majors complications. Posterior cranial remodelings were performed in five cases, with one requiring a second operation. We chose the appropriate procedure according to the degree of cranial deformity and operative findings. We performed decompression of the foramen magnum in five cases and laminectomy of the atlas in two cases. Ventriculoperitoneal shunt for hydrocephalus and tracheotomy for airway obstruction were performed in all cases. Cranial remodeling for treating severe craniofacial abnormality requires careful inspection of abnormalities, proper timing, close attention to the procedure and adequate perioperative care. Multidisciplinary therapy is essential for treating severe syndromic craniosynostosis due to systematic osseocartilaginous aplasia.

In some patients with severe syndromic craniosynostosis, bony orbits are so small and shallow that the eyeballs dislocate. Dry cornitis and conjunctivitis can be seen often. When conventional fronto-orbital advancement is attempted in these cases, side walls of the orbit cannot go forward, because the width of bony orbit is smaller than the eyeball. To expand bony orbits and cranial volume, supralateral rim of the orbit was expanded laterally at the time of operation and gradually advanced foward postoperatively. With a coronal skin incision approach, frontal bone was taken off. Supralateral orbital rim bone was detached and cut at the centers of the orbits. Lateral expansion, 5 to 10 mm, was made and fixed with polylactate plates. A pair of distraction devices was fixed between the orbital rim and the temporal bone. Frontal bone was let floating on the dura mater and tied loosely with the orbital rim. Advancement of 1 to 1.5 mm/d was carried out, and the devices were taken off after 1-month consolidation period. Five patients with Pfeiffer syndrome, 1 with Crouzon, and 1 with Beare-Stevenson cutis gyrata syndrome were treated with this method. Procedure, outcomes, and complications are discussed.

The 11-year solar cycles in ozone and temperature are examined using new simulations of coupled chemistry climate models. The results show a secondary maximum in stratospheric tropical ozone, in agreement with satellite observations and in contrast with most previously published simulations. The mean model response varies by up to about 2.5% in ozone and 0.8 K in temperature during a typical solar cycle, at the lower end of the observed ranges of peak responses. Neither the upper atmospheric effects of energetic particles nor the presence of the quasi biennial oscillation is necessary to simulate the lower stratospheric response in the observed low latitude ozone concentration. Comparisons are also made between model simulations and observed total column ozone. As in previous studies, the model simulations agree well with observations. For those models which cover the full temporal range 1960-2005, the ozone solar signal below 50 hPa changes substantially from the first two solar cycles to the last two solar cycles. Further investigation suggests that this difference is due to an aliasing between the sea surface temperatures and the solar cycle during the first part of the period. The relationship between these results and the overall structure in the tropical solar ozone response is discussed. Further understanding of solar processes requires improvement in the observations of the vertically varying and column integrated ozone. Copyright 2008 by the American Geophysical Union.

The authors constructed a two-dimensional model of vasogenic brain edema, using the finite element method (FEM). The model incorporates the following physical parameters: cerebrovascular hydraulic conductivity, metabolic water production, tissue hydraulic conductivity and compliance, tissue and plasma osmotic and hydrostatic pressures, cerebrospinal fluid hydrostatic pressure and absorption, intracerebral stress, and shift of brain tissue. These parameters, related by partial differential equations, were approximated numerically in time and space by the FEM. The results of computer simulation of brain edema by the FEM were compared with experimental data obtained in a feline cold injury brain edema model. Computer simulation predicted the changes observed in interstitial pressure, extent of edema, intracerebral stress distribution, and shift of brain tissue. The results indicate that the FEM, applied to a model of vasogenic brain edema, can be used to predict the time course and regional distribution of fluid accumulation and the accompanying regional stress and deformation of brain tissue.

Radical resection of chiasmatic-hypothalamic glioma (CHG) carries a significant risk of morbidity and the optimum treatment remains undecided. The authors reported 9 children with CHG, who were treated with surgical resection with or without postoperative chemotherapy. Age at the time of diagnosis ranged from 4 months to 7.7 years (mean 3.1 years), and no patient had evidence of neurofibromatosis type 1. Surgical resections of the tumors were performed in all patients because of severe visual impairment or intracranial hypertension caused by large tumors. All of the surgical interventions resulted in partial resections. Pathological examination revealed pilocytic astrocytomas in 7 patients, low grade astrocytoma in 1 and anaplastic astrocytoma in 1. Seven patients with residual tumors received postoperative chemotherapy consisting of cisplatin, cyclophosphamide, etoposide and vincristine. Reduction in tumor size was noticed in 5 patients, although 2 patients had no response and switched to local radiotherapy. Although minor complications of chemotherapy were noticed in 5 patients, severe sequelae such as neuropsychological deficits or endocrinopathies did not occur, and all patients completed chemotherapy programs. Additional treatments are recommended in case of incomplete tumor resections, because our experience demonstrates that the majority of the residual tumors have potential to progress. Our present data suggests that the chemotherapy of the aforementioned regimen is effective in controlling CHGs after partial resections and is relatively well tolerated even in young children who are vulnerable to radiotherapy.

Simulations from eleven coupled chemistry-climate models (CCMs) employing nearly identical forcings have been used to project the evolution of stratospheric ozone throughout the 21st century. The model-to-model agreement in projected temperature trends is good, and all CCMs predict continued, global mean cooling of the stratosphere over the next 5 decades, increasing from around 0.25 K/decade at 50 hPa to around 1 K/ decade at 1 hPa under the Intergovernmental Panel on Climate Change (IPCC) Special Report on Emissions Scenarios (SRES) A1B scenario. In general, the simulated ozone evolution is mainly determined by decreases in halogen concentrations and continued cooling of the global stratosphere due to increases in greenhouse gases (GHGs). Column ozone is projected to increase as stratospheric halogen concentrations return to 1980s levels. Because of ozone increases in the middle and upper stratosphere due to GHGinduced cooling, total ozone averaged over midlatitudes, outside the polar regions, and globally, is projected to increase to 1980 values between 2035 and 2050 and before lower stratospheric halogen amounts decrease to 1980 values. In the polar regions the CCMs simulate small temperature trends in the first and second half of the 21st century in midwinter. Differences in stratospheric inorganic chlorine (Cly) among the CCMs are key to diagnosing the intermodel differences in simulated ozone recovery, in particular in the Antarctic. It is found that there are substantial quantitative differences in the simulated Cly, with the October mean Antarctic Cly peak value varying from less than 2 ppb to over 3.5 ppb in the CCMs, and the date at which the Cly returns to 1980 values varying from before 2030 to after 2050. There is a similar variation in the timing of recovery of Antarctic springtime column ozone back to 1980 values. As most models underestimate peak Cly near 2000, ozone recovery in the Antarctic could occur even later, between 2060 and 2070. In the Arctic the column ozone increase in spring does not follow halogen decreases as closely as in the Antarctic, reaching 1980 values before Arctic halogen amounts decrease to 1980 values and before the Antarctic. None of the CCMs predict future large decreases in the Arctic column ozone. By 2100, total column ozone is projected to be substantially above 1980 values in all regions except in the tropics.

Intracranial capillary hemangiomas are very rare, though several spinal capillary hemangiomas have recently been reported. We report here a case of intracranial capillary hemangioma with multiple cysts and review the current literature of similar cases. A 4-month-old girl was referred to our hospital for treatment of hydrocephalus and a cerebellar mass lesion. She presented with hemangiomas distributed widely over the body, as well as disseminated hemangiomas in the pleura, liver, spleen, pancreas, kidneys and vagina. Pathological examination of the specimen from the vagina confirmed the diagnosis of a capillary hemangioma made at another hospital. Radiological examination of the brain revealed a cystic mass lesion in the left cerebellar hemisphere with subsequent obstructive hydrocephalus. The cysts extended upward into the bilateral ventricle. Following neuroendoscopic fenestration of the cysts, resection of the left cerebellar mass was performed. Histological examination of the lesion demonstrated similarly sized capillaries, and the pathological diagnosis was confirmed as capillary hemangioma. There was no recurrence postoperatively. Our patient was treated successfully by surgical resection and neuroendoscopic procedures. Surgical intervention may therefore be indicated in intracranial capillary hemangiomas.

In the recent past, the emerging India economy is highly dependent on conventional as well as renewable energy to deal with energy security. Keeping the potential of biomass and its plentiful availability, the Indian government has been encouraging various industrial sectors to generate their own energy from it. The Indian sugar industry has adopted and made impressive growth in bagasse (a renewable biomass, i.e. left after sugercane is crushed) based cogeneration power to fulfil their energy need, as well as to export a big chunk of energy to grid power. Like fossil fuel, bagasse combustion also generates various critical pollutants. This article provides the first ever estimation, current status and overview of magnitude of air pollutant emissions from rapidly growing bagasse based cogeneration technology in Indian sugar mills. The estimated emission from the world's second largest sugar industry in India for particulate matter, NOX, SO2, CO and CO2 is estimated to be 444 ± 225 Gg yr−1, 188 ± 95 Gg yr−1, 43 ± 22 Gg yr−1, 463 ± 240 Gg yr−1 and 47.4 ± 9 Tg yr−1, respectively in 2014. The studies also analyze and identify potential hot spot regions across the country and explore the possible further potential growth for this sector. This first ever estimation not only improves the existing national emission inventory, but is also useful in chemical transport modeling studies, as well as for policy makers.

The authors present a pediatric case of ganglioglioma occurring in the medulla oblongata. A 7-year-old boy was referred to our hospital with complaints of ataxia, seizure and sleep apnea. MRI of the brain disclosed a large tumor occupying the medulla oblongata, and the upper portion of the cervical spinal cord was also involved. The patient underwent midline suboccipital craniotomy and laminectomy of C1 to attempt radical resection of the tumor, which resulted only in partial removal of the tumor due to severe bradycardia during the operation. The histological diagnosis was ganglioglioma, WHO grade 2. Although both radiotherapy and chemotherapy were performed following the operation, the tumor remained unchanged. The patient died of respiratory arrest five months after the operation. Gangliogliomas usually occur in the supratentorial region, which permits easy surgical access and good prognosis. Only 3% of gangliogliomas occur in the brain stem, and its management can be challenging because of the difficulty of radical resection and poor response to both radiotherapy and chemotherapy.

Simulations of the stratosphere from thirteen coupled chemistry-climate models (CCMs) are evaluated to provide guidance for the interpretation of ozone predictions made by the same CCMs. The focus of the evaluation is on how well the fields and processes that are important for determining the ozone distribution are represented in the simulations of the recent past. The core period of the evaluation is from 1980 to 1999 but long-term trends are compared for an extended period (1960–2004). Comparisons of polar high-latitude temperatures show that most CCMs have only small biases in the Northern Hemisphere in winter and spring, but still have cold biases in the Southern Hemisphere spring below 10 hPa. Most CCMs display the correct stratospheric response of polar temperatures to wave forcing in the Northern, but not in the Southern Hemisphere. Global long-term stratospheric temperature trends are in reasonable agreement with satellite and radiosonde observations. Comparisons of simulations of methane, mean age of air, and propagation of the annual cycle in water vapor show a wide spread in the results, indicating differences in transport. However, for around half the models there is reasonable agreement with observations. In these models the mean age of air and the water vapor tape recorder signal are generally better than reported in previous model intercomparisons. Comparisons of the water vapor and inorganic chlorine (Cly) fields also show a large intermodel spread. Differences in tropical water vapor mixing ratios in the lower stratosphere are primarily related to biases in the simulated tropical tropopause temperatures and not transport. The spread in Cly, which is largest in the polar lower stratosphere, appears to be primarily related to transport differences. In general the amplitude and phase of the annual cycle in total ozone is well simulated apart from the southern high latitudes. Most CCMs show reasonable agreement with observed total ozone trends and variability on a global scale, but a greater spread in the ozone trends in polar regions in spring, especially in the Arctic. In conclusion, despite the wide range of skills in representing different processes assessed here, there is sufficient agreement between the majority of the CCMs and the observations that some confidence can be placed in their predictions.

[1] Time series of the instantaneous radiative forcings for main anthropogenic and natural forcing agents from the year 1850 to 2000 are evaluated at the Earth's surface as well as at the tropopause with an atmospheric general circulation model. This evaluation corresponds to a simulation of 20th century climate with a synthetic coupled atmosphere-ocean general circulation model. The evaluation indicates that the positive radiative forcing at the tropopause rapidly increases from 1910 to 1950 and after 1970 principally due to long-lived greenhouse gases, while the negative radiative forcing at the surface sharply increases between 1955 and 1965 mainly due to the aerosol direct and indirect effects. This study suggests that a simultaneous analysis of changing rates of the radiative forcing both at the tropopause and surface can explain tendencies of changes in the surface air temperature.

Eleven patients with syndromic craniosynostosis were treated with gradual distraction fronto-orbital advancement using "floating forehead." The frontal and supraorbital area was cut and remolded. Bony orbits were widened in three patients. Frontal bone was let floating on the dura and fixed loosely with absorbable threads to remolded supraorbital bone. A pair of distracters with hinge plates (A.V.D. system, Bear Medic Corp, Tokyo, Japan) was fixed between the temporal area and supraorbital bone. Distraction was begun 5 to 7 days after the surgery, and 1.8 to 3.2 cm advancement was obtained. Distracters were taken off after 3 to 7 weeks of consolidation periods. Although no major complication was encountered, some minor complications related to the devices were experienced.

[1] Causes of the global surface air temperature warming in the early half of the 20th century are examined using a climate model and an optimal detection/attribution methodology. While the anthropogenic response seems to be underestimated in our model, our previous study detected the influence due to natural external forcing, including the combined effects of solar irradiance changes and the recovery from large volcanic activity. We further partition the responses between these two natural external factors, detecting both the solar and the volcanic signal in the observed early warming. A diagnosis of the sensitivity to solar forcing and a volcanic super-eruption simulation suggest that our model possesses larger climate sensitivities to solar forcing and longer relaxation times to volcanic forcing than HadCM3, enabling us to detect both the solar and volcanic forcing responses.