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Objective To describe primary paraganglioma in the facial nerve canal and discuss the characteristics of facial nerve paraganglioma in contrast with other tumors. Case report A 23-year-old man developed gradually progressive right facial palsy as the initial symptom. One year later, he exhibited hearing loss without tinnitus in his right ear. CT demonstrated an enlarged facial nerve canal with irregular bony erosion of the circumference. MRI showed a well-enhanced heterogeneous mass with hypo-intensity spots inside it. During surgery, a blood-rich tumor was observed along the facial nerve: however, extensive bleeding interfered with tumor removal. The surgical specimen demonstrated paraganglioma. The tumor was completely removed in the second surgery in combination with arterial embolization. Facial nerve function was reconstructed with a free muscle flap more than one year following resection. Conclusion Because paraganglioma is a blood-rich tumor, it is important to perform angiography and embolization. If preoperative facial nerve palsy is demonstrated, careful management of facial nerve function is needed. Paraganglioma must be considered in the differential diagnosis of a facial nerve tumor.

Tonotopy is an essential functional organization in the mammalian auditory cortex, and its source in the primary auditory cortex (A1) is the incoming frequency-related topographical projections from the ventral division of the medial geniculate body (MGv). However, circuits that relay this functional organization to higher-order regions such as the secondary auditory field (A2) have yet to be identified. Here, we discovered a new pathway that projects directly from MGv to A2 in mice. Tonotopy was established in A2 even when primary fields including A1 were removed, which indicates that tonotopy in A2 can be established solely by thalamic input. Moreover, the structural nature of differing thalamocortical connections was consistent with the functional organization of the target regions in the auditory cortex. Retrograde tracing revealed that the region of MGv input to a local area in A2 was broader than the region of MGv input to A1. Consistent with this anatomy, two-photon calcium imaging revealed that neuronal responses in the thalamocortical recipient layer of A2 showed wider bandwidth and greater heterogeneity of the best frequency distribution than those of A1. The current study demonstrates a new thalamocortical pathway that relays frequency information to A2 on the basis of the MGv compartmentalization.

The pathogenesis of secondary acquired cholesteatoma with a tympanic membrane (TM) perforation is very different from that of other types of cholesteatoma. This disease should be clearly categorized as a different type of cholesteatoma.Primary cholesteatoma generally arises from retraction of the squamous epithelium of the TM. However, in rare cases, epithelial invasion occurs from the edge of the TM perforation and migrates to the medial surface of the TM and middle ear cavity. The aim of this study was to evaluate the clinical features of secondary acquired cholesteatoma with a TM perforation.We investigated 13 ears that underwent surgical treatment after the diagnosis of secondary acquired cholesteatoma with a TM perforation. Patient backgrounds, the preoperative appearances of TM, intraoperative findings, and histopathological findings were investigated.The average age was much higher than that of patients with other types of cholesteatoma, suggesting that it must require long periods of time to establish the disease. The common area of the epithelial invasion was on the superior part of the TM perforation around the tip of the malleus handle. The tendon of the tensor tympani muscle plays an important role as an extension route for this disease.

Background Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) provides high diagnostic accuracy with a low incidence of procedural complications. However, it occasionally causes serious complications, and factors that increase the susceptibility to such adverse events remain unknown. Aims We aimed to examine post-procedural events and determine risk factors associated with EUS-FNA of pancreatic solid lesions. Methods This single-center retrospective study included 316 consecutive patients with pancreatic solid lesions who underwent 327 EUS-FNA procedures from April 2003 to September 2011. We registered all patients undergoing EUS-FNA in the database and retrospectively ascertained the presence/absence of post-procedural adverse events. Results The incidence of post-procedural adverse events, including moderate to mild pancreatitis, mild abdominal pain, and mild bleeding, was 3.4 %. Univariate analysis showed that the incidence of post-procedural events was significantly increased in patients with tumors less than or equal to 20 mm in diameter (P

Our previous study revealed the efficacy and safety of the large balloon dilation (LBD) technique. However, there is insufficient objective data about the recurrence rate. The aim of this study was to compare the recurrence rate of common bile duct (CBD) stones between patients treated with and without LBD. Patients with recurrent CBD stones treated between April 2006 and August 2010, and who had a history of endoscopic sphincterotomy (ES), were enrolled. Patients were excluded if they had a CBD diameter of less than 10 mm or if the diameter of their largest CBD stone was

Although temporal information processing is important in auditory perception, the mechanisms for coding tonal offsets are unknown. We investigated cortical responses elicited at the offset of tonal stimuli using flavoprotein fluorescence imaging in mice. Off-responses were clearly observed at the offset of tonal stimuli lasting for 7 s, but not after stimuli lasting for 1 s. Off-responses to the short stimuli appeared in a similar cortical region, when conditioning tonal stimuli lasting for 5–20 s preceded the stimuli. MK-801, an inhibitor of NMDA receptors, suppressed the two types of off-responses, suggesting that disinhibition produced by NMDA receptor-dependent synaptic depression might be involved in the off-responses. The peak off-responses were localized in a small region adjacent to the primary auditory cortex and no frequency-dependent shift of the response peaks was found. Frequency matching of preceding tonal stimuli with short test stimuli was not required for inducing off-responses to short stimuli. Two-photon calcium imaging demonstrated significantly larger neuronal off-responses to stimuli lasting for 7 s in this field, compared with off-responses to stimuli lasting for 1 s. The present results indicate the presence of an auditory cortical field responding to long-lasting tonal offsets, possibly for temporal information processing.

Amid recent amendment of delineation of a mouse auditory cortical map, a caudal auditory field, originally defined as the primary auditory cortex (AI), was divided into the AI and dorsomedial field (DM), based on distinct high frequency areas. A low frequency area was not previously established in the DM because responses to low frequency tones were weak in this area. This may lead to the misconception that the DM is an atypical region that lacks a low frequency band. In the current study, we confirmed that the DM has a low frequency area that is completely independent from the AI. First, we conducted flavoprotein fluorescence imaging with improved signal to noise ratio and revealed the presence of two separated low frequency areas in the AI and DM. Next, we injected a retrograde neural tracer along the tonotopic axis of the AI or DM to reveal the thalamic origins in the ventral division of the medial geniculate body (MGv). We found that neurons projecting to low frequency areas of the AI and DM occupied different locations within the MGv and mutually independent topographic organizations consisting of thalamic neurons projecting to the AI or DM. These results indicate that the AI and DM have distinct low frequency areas with distinct thalamic projections from the MGv. Our findings reaffirm that the AI and DM should be regarded as independent regions in the mouse auditory cortex.

We propose a method of tool use considering the transition process of a body model from not grasping to grasping a tool using a single model. In our previous research, we proposed a tool-body assimilation model in which a robot autonomously learns tool functions using a deep neural network (DNN) and recurrent neural network (RNN) through experiences of motor babbling. However, the robot started its motion already holding the tools. In real-life situations, the robot would make decisions regarding grasping (handling) or not grasping (manipulating) a tool. To achieve this, the robot performs motor babbling without the tool pre-attached to the hand with the same motion twice, in which the robot handles the tool or manipulates without graping it. To evaluate the model, we have the robot generate motions with showing the initial and target states. As a result, the robot could generate the correct motions with grasping decisions.

We report a case of the patient who underwent endoscopic ultrasound-guided biliary drainage (EUS-BD) for refractory bile duct stenosis due to chronic pancreatitis. The patient had repeatedly undergone endoscopic biliary stenting for bile duct stenosis due to chronic pancreatitis. Because of repeated relapses of cholangitis and jaundice, transpapillary treatment was judged to have reached its limits. Surgical bypass was attempted but had to be abandoned due to adhesions. Thus, EUS-BD was performed. The procedure was successful, and placement of a covered expandable metallic stent (C-EMS) relieved cholangitis. Two months after placement, the C-EMS was removed, and the patient became stent-free but closure of the fistula subsequently occurred.

Endoscopic ultrasound (EUS) is useful in obtaining not only high-resolution images of organs and surrounding tissue but also the tissue itself for histopathological diagnosis using fine needle aspiration. Currently, there are two types of EUS available for use: radial and convex arrayed EUS. Each type of EUS has its own advantages and disadvantages. Because radial arrayed EUS can obtain 360 degree images, it is easy to see surrounding organs and vessels. In addition, a single longitudinal image of the pancreas, gallbladder and bile duct is easy to obtain. For this reason, radial arrayed EUS is highly effective in diagnostic examinations. In contrast, while scanning range of convex arrayed EUS limited to 180 degrees, it has the advantage of being able to obtain tissue samples. Additionally while using convex arrayed EUS, the upper part of the bile duct and neck of the pancreas are easily seen beyond the portal vein. It is important to understand the characteristics of each EUS in order to select the most suitable EUS technique for diagnostic assessment.

To clarify the clinical features and the natural history of serous cystic neoplasm (SCN) of the pancreas.We retrospectively analyzed data from 30 patients affected by SCN. SCNs were classified as (1) microcystic type, (2) micro- and macrocystic type, and (3) macrocystic type according to the modified WHO classification. Eighteen patients who underwent serial radiographic imaging were identified, and tumor growth rate in these patients was evaluated.The median age was 62 years, and the female:male ratio was 2:1. Twenty-five patients (83%) were asymptomatic and 5 (17%) were symptomatic. The median tumor size was 2.6 cm. Fifteen cases (50%) had the microcystic type, 7 (23%) the micro- and macrocystic type, and 8 (27%) the macrocystic type. Age, gender, symptoms, location or tumor size did not differ significantly among the three subtypes. Eighteen patients were followed up for a median of 58 months. Morphological changes were observed in 3 patients (17%) and enlargement of tumor size in 9 patients (50%) during the follow-up. The growth rate was 0.29 cm per year and doubling time was 3.5 years; these rates did not differ among morphological subtypes or size of tumors.In asymptomatic patients with a clear imaging diagnosis of SCN, nonoperative management with a careful follow-up should be recommended. Surgery should be suggested in only symptomatic patients, those with giant tumors (10 cm), rapid growing or when the presence of a potentially malignant tumor cannot be excluded. and IAP.

Background Although experience with diagnostic and therapeutic ERCP in children is growing, little is known about the safety and technical outcomes of endoscopic papillary balloon dilation (EPBD) in pediatric patients with bile duct stones (BDSs). Objective To assess the safety and long-term outcomes of EPBD in pediatric patients with BDSs. Design Case study. Setting Tertiary referral center. Patients and Interventions This study involved 5 children who had BDSs combined with gallstones who underwent EPBD. Main Outcome Measurements Successful EPBD, successful stone removal, procedure-related complications, and long-term outcomes. Results ERCP was successful in all cases, with cannulation and subsequent EPBD. Stone removal was performed in 1 session in all patients. No EPBD-related complications were observed in any patient. After EPBD, 1 patient subsequently underwent laparoscopic cholecystectomy for gallstones. The remaining 4 were followed without surgery. In 2 patients, gallstones were spontaneously passed from the bile duct into the duodenum. During the follow-up period, over a mean of 7.1 years (range 3.7-9.3 years), no recurrence of BDSs was observed in any patient. Limitations Small number of patients. Conclusions Although BDSs are rare in pediatric patients, EPBD may be a safe and effective technique for the management of such stones in some children.

The aim of this study was to elucidate the clinicopathological features and prognosis of mucinous cystic neoplasms (MCNs).We performed a multi-institutional, retrospective study on a collected series of patients with MCN pathologically defined by ovarian-type stroma. Clinicopathological features and prognosis were investigated.Mucinous cystic neoplasm was confirmed in 156 cases, including 129 adenomas (82.7%) and 21 noninvasive (13.4%) and 6 invasive carcinomas (3.9%). Patients with MCN were exclusively women (98.1%) with the mean age of 48.1 years. All but 1 MCN were in the pancreatic body/tail region with a mean size of 65.3 mm. Communication between the cyst and the pancreatic duct was found in 18.1%. The 3-, 5-, and 10-year survival rates were 97.6%, 96.6%, and 96.6%, respectively. A significant difference in the survival rates was observed between adenomas and carcinomas and between minimally invasive carcinomas and invasive carcinomas. Cyst diameter and presence of mural nodule were predictive of malignant MCN.Mucinous cystic neoplasm is a rare but distinctive pancreatic cystic neoplasm with a favorable overall prognosis. All MCNs should be resected to prevent malignant changes but can be observed for an appropriate time when the lesion is small without the presence of mural nodules.

The efficacy of the endoscopic management of laparoscopic cholecystectomy (LC)-associated bile duct injuries is unclear because few studies on the issue report methods matched to injury type or long-term follow-up data.Records from our institution's 11-year experience with the endoscopic management of LC-associated bile duct injuries were reviewed. Leakage was managed with a 5- to 7F endoscopic nasobiliary drainage (ENBD) tube for 1 week without endoscopic sphincterotomy (EST). Stricture was managed with the placement of a single 7F plastic stent for 1-2 months without EST.Fifteen cases were experienced. Of the 11 cases (77.8%) of leakage, 7 improved clinically and on imaging after ENBD, 2 did not resolve until after the placement of a single plastic 7F stent for several more days, and 2 others with leakage and high risk for accidental ENBD removal improved after the placement of a single 7F stent. All 4 cases of stricture resolved completely after the placement of a single 7F stent. There were no severe complications of the endoscopic procedure. At long-term follow-up, no patient had recurrence of symptoms or complications on imaging.ENBD for leakage and biliary stenting for strictures are safe and effective treatments for these LC-associated injuries.

Recent developments in treatment devices and advancements in technology have made endoscopic treatment the first choice for bile duct stones. In endoscopic treatment, the stones are removed after expanding the papilla with endoscopic sphincterotomy or endoscopic papillary balloon dilatation. The devices used to remove bile duct stones include basket catheters, balloon catheters and mechanical lithotripters, and their employment varies depending on the clinical situation. Stone removal by endoscopy is superior to other options, although treatment can be difficult in some cases. The reasons are mainly large stones, a history of gastric surgery, and Mirizzi syndrome. For such difficult cases, various adjuvant treatments such as extracorporeal shock wave lithotripsy, electrohydraulic lithotripsy and lasers are recommended rather than using just a mechanical lithotripter. Recently, large-diameter biliary orifice balloon dilation, a method in which the papilla is expanded using a large-diameter balloon, allowing the stones to be removed, has been reported and is attracting increasing attention.

Gallbladder cancer occurs frequently in patients with pancreaticobiliary maljunction due to pancreatobiliary reflux. Pancreatobiliary reflux is also detected in some patients with a relatively long common channel. This study aimed to clarify the correlation between pancreatobiliary reflux and the length of a common channel.Two hundred and three patients, in whom both the length of a common channel and amylase level in the bile were measured, were enrolled from nine centers.Bile amylase level was correlated with the length of a common channel (P0.01). The minimum length of a common channel that could induce a markedly elevated amylase level in the bile (1,000 mg/dl) was determined as 5 mm. We redefined high confluence of pancreatobiliary ducts (HCPBD) as cases with a common channelor = 5 mm, in which the communication between the pancreatic and bile ducts was occluded with the sphincter contraction. Gallbladder cancer was found in 20% of 56 redefined HCPBD patients. Bile amylase level1,000 mg/dl and biliopancreatic reflux were detected in 79 and 95% of the patients, respectively.Patients with a common channelor = 5 mm (redefined HCPBD) should be monitored for the development of gallbladder cancer, as they frequently showed significant pancreatobiliary reflux.

臨床の場で遭遇する膵腫瘍の診断名の数は限られ，各腫瘍の病理と画像所見の特徴を把握しておくことで鑑別診断の多くが可能となる．膵腫瘍は大きく充実性と嚢胞性に分けられる．充実性には，通常型膵癌，内分泌腫瘍，Solid-pseudopapillary neoplasm（SPN），特殊型膵癌（腺扁平上皮癌，退形成性癌など），腺房細胞癌があり，嚢胞性では，漿液性嚢胞腫瘍（serous cystic neoplasm: SCN），粘液性嚢胞腫瘍（mucinous cystic neoplasm: MCN），膵管内乳頭粘液性腫瘍（intraductal papillary mucinous neoplasm: IPMN）の鑑別を行うことになる．但し，充実性腫瘍の嚢胞化あるいは充実性腫瘍の周囲に貯留嚢胞や仮性嚢胞を形成する場合には充実と嚢胞の混在する病態を呈するため鑑別診断に際し注意する必要がある．充実性腫瘍の鑑別診断で問題となるのは，特殊型膵癌（腺扁平上皮癌，退形成性癌など）と腺房細胞癌，非典型的所見を呈する内分泌腫瘍である．特に，内分泌腫瘍は内部の嚢胞化や主膵管内腫瘍栓など，種々の所見を呈するため注意を要する．嚢胞性腫瘍では，SCNにおいてmicro cystとmacro cystの混在，あるいはmacro cyst主体の例が少なくないことを認識しておく必要がある．MCNとIPMNでは，共通の被膜の有無，嚢胞の構造が内に向かうか外に向かうかが鑑別ポイントとなる．膵腫瘍の鑑別診断において体外式US，EUS，IDUSなど超音波診断の果す役割は大きい．

Background: EUS-guided pancreaticogastrostomy is described as an alternative to surgery for ductal decompression when endoscopic transpapillary access is impossible. We report a case where EUS-guided pancreaticogastrostomy of the pancreatic duct was effective for dilatation of the pancreatic duct caused from occlusion of gastro-pancreatic anastomosis constructed after resection of pancreaticoduodenectomy. Patients and methods: The patient was a 79-year-old woman who had undergone operation for IPMN in the pancreatic head in 1998. Nine years after the operation, she visited us for back pain, and conspicuous dilatation of the main pancreatic duct was found. By observing curved liner array EUS scope, we successfully punctured the main pancreatic duct and placed a plastic stent. Results: After the treatment, the subjective symptom was alleviated and reduction of the dilatation of pancreatic duct was observed in image findings. Conclusion: Endoscopic ultrasonography guided pancreaticogastrostomy appears to be an effective treatment for a case of occlusion of gastro-pancreatic anastomosis after pancreaticoduodenectomy.

Isolated sphenoid sinusitis is rare and difficult to diagnose. The difficulty arises because it is located in the deepest part of the nasal sinuses and the associated inflammation does not lead to typical symptoms of sinusitis. There are many important structures in the vicinity of the sphenoid sinus: the internal carotid artery, cavernous sinus and cranial nerves. Therefore, sphenoid sinusitis causes severe complications. From January 2003 to December 2007, we encountered 15 patients with isolated sphenoid sinusitis. Its incidence in all sinus diseases is 2.2%. Many patients complain of headaches, and they often visit neurologists or neurosurgeons. The pathological spectrum included 10 cases of bacterial sinusitis (5 acute sinusitis, 3 chronic sinusitis and 2 asymptomatic sinusitis), 3 fungal sinusitis, 1 mucocele and 1 retention cyst. When we diagnose isolated sphenoid sinusitis, CT and endoscopy are essential. CT becomes a more useful tool for performing a differential diagnosis when we independently change the window height and width. The endoscopic findings regarding draining from the sphenoethmoidal recess may indicate the severity of inflammation. A detailed observation with CT and endoscopy is the most important to accurately diagnose the pathology of isolated sphenoid sinusitis.

The aim of this study was to identify factors that predict treatment outcome in patients with metastatic pancreatic cancer treated with gemcitabine, and then to use these factors to develop a practical prognostic index.A retrospective study was performed on 66 consecutive patients with histologically confirmed pancreatic adenocarcinoma who were treated with gemcitabine. Factors that predicted treatment outcome were identified by univariate and multivariate analyses using the Cox proportional hazards model.Multivariate analysis identified Eastern Cooperative Oncology Group performance status, primary tumor location, and C-reactive protein as important independent predictive factors. Prognostic score was calculated using the following formula: score = (1 if performance status is 0 or 1; 2 if performance status is 2; and 5 if performance status is 3) + (1 if primary site is body or tail, 3 if primary site is head) + (1 if C-reactive protein is1 mg/dL, 3 if C-reactive protein is 1-3 mg/dL, 6 if C-reactive protein is3 mg/dL). Patients were accordingly divided into three groups: good (prognostic index = 3 or 4), fair (prognostic index = 5-7), and poor (prognostic index = 8). Median survival was 265, 155, and 65 days for each group, respectively (P0.0001). The internally validated c-index (receiver operating characteristics area under the curve) of this model was 0.711. Applied to another data set, the externally validated c-index was 0.692. Prognosis was favorable in the good prognosis group, patients in the fair prognosis group were likely to benefit from gemcitabine, and those in the poor prognosis group were unlikely to benefit.This index improved predictive ability in patients with metastatic pancreatic cancer treated with gemcitabine, which may be helpful in counseling patients and making first treatment decisions.

Flavoprotein fluorescence in the brain is intimately coupled with neuronal aerobic energy metabolism. If flavoproteins are photobleached, neural activities may be affected owing to dysfunction in aerobic energy metabolism in mitochondria. We tested this possibility in cortical slices from mice, and found that exposure to blue light ( λ = 475 nm) derived from a 20 mW diode laser for 50 min suppresses trans-synaptic components of field potentials. This finding formed the basis of a transcranial photo-inactivation technique, that was used to investigate auditory signal transmission between the anterior auditory field (AAF) and the primary auditory cortex (AI) in anesthetized mice. Cortical responses in AAF and AI, elicited by 5 kHz tonal stimuli, were visualized using transcranial flavoprotein fluorescence imaging. After determining responsive areas in AAF and AI, the auditory cortex was exposed to the blue diode laser via the intact skull, while either AAF or AI was protected with a piece of carbon paper. Although the photo-inactivation of AI had no significant effect on the fluorescence responses in AAF, the photo-inactivation of AAF significantly reduced the fluorescence responses in AI, indicating the presence of auditory signal transmission from AAF to AI.

Hilar cholangiocarcinomas grow slowly, and metastases occur late in the natural history. Surgical cure and long-term survival have been demonstrated, when resection margins are clear. Preoperative biliary drainage has been proposed as a way to improve liver function before surgery, and to reduce post-surgical complications. Percutaneous transhepatic biliary drainage (PTBD) with multiple drains was previously the preferred method for the preoperative relief of obstructive jaundice. However, the introduction of percutaneous transhepatic portal vein embolization (PTPE) and wider resection has changed preoperative drainage strategies. Drainage is currently performed only for liver lobes that will remain after resection, and for areas of segmental cholangitis. Endoscopic biliary drainage (EBD) is less invasive than PTBD. Among EBD techniques, endoscopic nasobiliary drainage (ENBD) is preferable to endoscopic biliary stenting (EBS), because secondary cholangitis (due to the retrograde flow of duodenal fluid into the biliary tree) does not occur. ENBD needs to be converted to PTBD in patients with segmental cholangitis, those with a prolonged need for drainage, or when the extent of longitudinal tumor extension is not sufficiently well characterized.

Endoscopic papillary balloon dilatation (EPBD) was reported as a less invasive treatment for bile duct stone. It has advantages of reduced risk of bleeding and preserved papillary function, compared with endoscopic sphincterotomy (EST). However, recurrence of stone has not been elucidated as yet. The problem of EPBD is the high incidence of post-procedure pancreatitis. Reported as risk factors of the pancreatitis are pancreatography, past history of pancreatitis, difficult bile duct cannulation, excessive pressure to the papilla etc. Appropriate measures to prevent post-EPBD pancreatitis are therefore indispensable.

A case of subarachnoid hemorrhage due to vertebral artery dissection after direct laryngoscopy is reported. The patient, a healthy 61-year-old man with hoarseness, was treated for vocal cord polyp with laryngomicrosurgery. After surgery, he complained of nape pain without neurological symptoms. Six days after the onset of nape pain, he suddenly lost consciousness. CT showed subarachnoid hemorrhage and CT angiography demonstrated enlargement of the right vertebral artery which was suspected to be dissecting aneurysm. The right vertebral artery was occluded proximal to the aneurysmal dilation using detachable coils. Most vertebral artery dissections have been described as showing spontaneous onset. Recently, some cases were associated with minor neck trauma like extension and/or rotation. Direct laryngoscopy is a widely used technique in otolaryngological surgery, but it requires that the patient's neck be placed in hyperextension. This is the first report of vertebral artery dissection as a complication of otolaryngological surgery. Physicians should recognize that a hyperextended neck position during surgery may induce vertebral artery injury.

Optical imaging studies have recently revealed the presence of multiple auditory cortical regions in the mouse brain. We have previously demonstrated, using flavoprotein fluorescence imaging, at least six regions in the mouse auditory cortex, including the anterior auditory field (AAF), primary auditory cortex (AI), the secondary auditory field (AII), dorsoanterior field (DA), dorsomedial field (DM) and dorsoposterior field (DP). While multiple regions in the visual cortex and somatosensory cortex have been annotated and consolidated in recent brain atlases, the multiple auditory cortical regions have not yet been presented from a coronal view. In the current study, we obtained regional coordinates of the six auditory cortical regions of the C57BL/6 mouse brain and illustrated these regions on template coronal brain slices. These results should reinforce the existing mouse brain atlases and support future studies in the auditory cortex.

In this study, we propose a neural network based model for learning a robot's drawing sequences in an unsupervised manner. We focus on the ability to learn visual-motor relationships, which can work as a reusable memory in association of drawing motion from a picture image. Assuming that a humanoid robot can draw a shape on a pen tablet, the proposed model learns drawing sequences, which comprises drawing motion and drawn picture image frames. To learn raw pixel data without any given specific features, we utilized a deep neural network for compressing large dimensional picture images and a continuous time recurrent neural network for integration of motion and picture images. To confirm the ability of the proposed model, we performed an experiment for learning 15 sequences comprising three types of shapes. The model successfully learns all the sequences and can associate a drawing motion from a not trained picture image and a trained picture with similar success. We also show that the proposed model self-organizes its behavior according to types shapes.

We propose a method for realizing effective dynamic motion learning in a flexible-joint robot using motor babbling. Flexible-joint robots have recently attracted attention because of their adaptiveness, safety, and, in particular, dynamic motions. It is difficult to control robots that require dynamic motion. In past studies, attractors and oscillators were designed as motion primitives of an assumed task in advance. However, it is difficult to adapt to unintended environmental changes using such methods. To overcome this problem, we use a recurrent neural network (RNN) that does not require predetermined parameters. In this research, we propose a method for facilitating effective learning. First, a robot learns simple motions via motor babbling, acquiring body dynamics using a recurrent neural network (RNN). Motor babbling is the process of movement that infants use to acquire their own body dynamics during their early days. Next, the robot learns additional motions required for a target task using the acquired body dynamics. For acquiring these body dynamics, the robot uses motor babbling with its redundant flexible joints to learn motion primitives. This redundancy implies that there are numerous possible motion patterns. In comparison to a basic learning task, the motion primitives are simply modified to adjust to the task. Next, we focus on the types of motions used in motor babbling. We classify the motions into two motion types, passive motion and active motion. Passive motion involves inertia without any torque input, whereas active motion involves a torque input. The robot acquires body dynamics from the passive motion and a means of torque generation from the active motion. As a result, we demonstrate the importance of performing prior learning via motor babbling before learning a task. In addition, task learning is made more efficient by dividing the motion into two types of motor babbling patterns.

Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) using the slow pull technique (SP-FNA) has recently attracted attention as an effective tissue acquisition technique. However, efficacy of SP-FNA with a 22-gauge conventional needle remains unclear. The aim of this study is to evaluate the diagnostic ability of SP-FNA with a 22-gauge needle.Patients with a pancreatic solid lesion were prospectively enrolled in this study. SP-FNA was performed at two needle passes with a 22-gauge needle. One dedicated pathologist evaluated the obtained samples in terms of quantity (Grade 0: scant; Grade 1: inadequate; Grade 2: adequate), quality (Grade 0: poor; Grade 1: moderate; Grade 2: good), and blood contamination (Grade 0: significant; Grade 1: moderate; Grade 2: low), and provided a pathological diagnosis. Additional EUS-FNA was performed by applying suction (SA-FNA). The evaluation points were as follows: diagnostic accuracy of SP-FNA compared with that of SA-FNA, and the quantity, quality, and blood contamination level of SP-FNA-obtained samples.We enrolled 40 cases. The diagnostic accuracy of SP-FNA was 90% (36/40). There was no significant difference in the accuracy between SP-FNA and SA-FNA (90% vs. 90%, p = 1.000). The samples obtained using SP-FNA were assessed as Grade 2 for quantity in 29 cases (73%), quality in 31 (78%), and blood contamination in 25 (63%).Adequate, high-quality, and unsubstantially blood-contaminated samples could be obtained using SP-FNA. The diagnostic ability of SP-FNA was 90%, which appeared to be similar to that of SA-FNA.

Objective To describe a case of lateral sinus insufficiency, presumably occurring just prior to lateral sinus thrombosis (LST), and to discuss the importance of early surgical intervention and the pathophysiology of full-blown LST. Case report A 4-year-old boy developed headaches and vomiting after exhibiting typical symptoms of acute otitis media. Contrast-enhanced CT revealed narrowing of the sigmoid sinus medially by gas and low-density material. We diagnosed the patient with suspected LST and consequently performed mastoidectomy. A large amount of bloody pus was found in the mastoid cavity and below the bony sinus plate. Sigmoid sinus blood flow was completely restored after drainage of the hemorrhagic and purulent material, and the patient recovered fully. Conclusion Because of the anatomical features of the dural venous sinus, hemorrhage per diapedesis may be strongly associated with the development of LST. In the patient with suspected LST, early diagnosis and surgery prior to the development of intravenous thrombus are key for full recovery from this condition.

Background Adequate needle size and tissue acquisition techniques for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) need further elucidation. Moreover, the actual negative pressure and suction forces of FNA needles remain unknown. We evaluated the suction forces of 19-gauge, 22-gauge, and 25-gauge conventional FNA needles and side hole aspiration needles using conventional negative pressure and the slow pull technique. Methods Using a manometer, we determined the mean (SD) negative pressure and suction force for needle gauge, aspiration volume, and aspiration technique. We also evaluated the time to reach the maximum negative pressure. Results Suction force was comparatively higher in the 19-gauge needle when 50 ml of negative pressure was applied. Suction force using the slow pull method was very weak at 5% of pressure found with conventional methods. With the use of a 20-ml syringe, the time to reach the maximum negative pressure was 4 s in the 19-gauge needle, 11 s in the 22-gauge needle, and 80 s in the 25-gauge needle. Conclusions Bench-top testing showed that suction force increases with a larger gauge needle and larger aspiration volume. The slow pull method produces a very weak suction force. The time to reach the maximum negative pressure was longest in the 25-gauge needle.

We propose the new method of tool use with a tool-body assimilation model based on body babbling and a neurodynamical system for robots to use tools. Almost all existing studies for robots to use tools require predetermined motions and tool features; the motion patterns are limited and the robots cannot use novel tools. Other studies fully search for all available parameters for novel tools, but this leads to massive amounts of calculations. To solve these problems, we took the following approach: we used a humanoid robot model to generate random motions based on human body babbling. These rich motion experiences were used to train recurrent and deep neural networks for modeling a body image. Tool features were self-organized in parametric bias, modulating the body image according to the tool in use. Finally, we designed a neural network for the robot to generate motion only from the target image. Experiments were conducted with multiple tools for manipulating a cylindrical target object. The results show that the tool-body assimilation model is capable of motion generation.

We propose an exploratory form of motor babbling that uses variance predictions from a recurrent neural network as a method to acquire the body dynamics of a robot with flexible joints. In conventional research methods, it is difficult to construct real robots because of the large number of motor babbling motions required. In motor babbling, different motions may be easy or difficult to predict. The variance is large in difficult-to-predict motions, whereas the variance is small in easy-to-predict motions. We use a Stochastic Continuous Timescale Recurrent Neural Network to predict the accuracy and variance of motions. Using the proposed method, a robot can explore motions based on variance. To evaluate the proposed method, experiments were conducted in which the robot learns crank turning and door opening/closing tasks after exploring its body dynamics. The results show that the proposed method is capable of efficient motion generation for any given motion tasks.

Biliary stenting is used as a standard procedure for the relief of jaundice in patients with non-resectable malignant stricture of the bile duct. The stents available in the market are variously characterized, and surgeons must select an appropriate one for each disease status. For the stricture of the middle and/or lower part of the bile duct, covered metallic stent is superior to plastic stent in the patency period, however, there are questions as to the use of metallic stents in light of cost-effectiveness and development of complications of stenting. And, the stent selection for the stricture of the hilar part of the bile duct has not been fully studied, which remains a problem yet to be resolved. In the use of metallic stent, it is difficult to manage when stent occlusion or complication occurs, and it holds the risk of developing a very serious complication. In the use of plastic stent, however, long-term patency cannot be expected, which is also a problem yet to be resolved.