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近年, TRT (Tinnitus Retraining Therapy) が効果をあげており耳鳴と心理的状態との関連も議論されているが, MMPI (Minnesota Multiphasic Personality Inventory) を用いた耳鳴患者の心理的特性に関する研究はまだない。そこで我々はTRTを受けている耳鳴患者23例とMMPI日本版標準化集団についてMMPIの尺度ごとに比較検討した。その結果, 耳鳴患者では男女ともに心気症, 抑うつ尺度が高い値を示した。さらに男性では軽躁病と社会的内向性尺度, 女性ではヒステリー, パラノイア, 統合失調症尺度において有意差を認めた。一方, 耳鳴患者の中でいずれかの尺度においてT得点が70を超えた事例は23例中8例で, その8例中7例は初回THIが58以上であった。よって耳鳴の苦痛を強く訴える患者の治療には心身両面からのアプローチが必要であり, 心理検査等で個々の心理状態を的確にアセスメントすることがより効果的な治療につながると考える。

Tinnitus Retraining Therapy (以下TRTとする) は, 比較的新しい耳鳴治療法で耳鳴を消失させることが目的ではなく, 耳鳴に対して順応 (Habituation) をおこさせることによってその苦痛度を改善させる事が目的であり, その有効性から欧米では急速に普及している。TRTの有効性を向上させる目的で, 認知行動療法的アプローチをTRTに取り入れ, カウンセリングを全例において臨床心理士が行い早期から臨床心理士が介入するTRT (以下強化TRTとする) を施行した。耳鳴りの大きさ, 時間, 気になり方についての Visual analogue scale, Tinnitus Handicap Inventory, Hospital Anxiety and Depression Scale において有意な改善を認めた。この結果は, 強化TRTにおいて耳鳴り苦痛度および症例の耳鳴り以外の一般生活における抑鬱や不安も解消されたことを示唆している。現段階において耳鳴患者のレベルの分類は容易ではなくどのような症例が臨床心理士の介入を要するか明確に判断できる基準がないため, 可能であればカウンセリングを含め早期の臨床心理士の介入が望ましいと考える。

We report two cases of head and neck cancer invading the trachea. Tumor resection and end-toend anastomosis were performed at the same time. One case was a thyroid papillary carcinoma, and the other was metastasis of a paratracheal node that invaded the thyroid, trachea and esophagus. Both patients required long-term intubation because of obstruction of the airway due to laryngeal edema and a tracheostomy was necessary. We can infer from these cases that the causes of severe vocal edema were infection, history of radiotherapy and extensive resection. In addition, it is quite likely that one of the causes of airway obstruction was recurrent laryngeal nerve palsy. Long-term intubation may be considered a cause of laryngeal edema and recurrent nerve palsy. Because it is difficult to estimate the risk of vocal edema, and difficult to know how long intubation will be required, we have to carefully consider the complications related to such procedures.

Treadmill exercise has the specific aftereffect that, in stepping down onto the floor after exercise, a person has the perception of self-motion and sways forward. It has been speculated that treadmill exercise is accompanied by an adaptation process in the postural control system because of a mismatch between the visual and somatosensory input, and thus the aftereffect occurs as re-adaptation to normal postural control. However, nobody has yet succeeded in showing whether the extent of the mismatch between the visual and somatosensory input during treadmill exercise influences the aftereffect. In the present study, we used a video image of sufficient reality to induce self-motion perception, and changed the visual input during treadmill exercise to vary the mismatch level. As a result, the aftereffect was significantly reduced by normally-directed visual stimuli and significantly increased by reverse-directed visual stimuli. In conclusion, a correlation was found between the level of the mismatch and the aftereffect, supporting the view that aftereffects are caused by a mismatch of the visual and somatosensory input during treadmill exercise.

In patients with cervical adenopathy, especially, those of cervical lymph node metastasis with no detectable primary tumor, diagnosis and treatment planning can become confused. We evaluated 36 patients with cervical lymph node metastasis of unknown origin between 1985 and 2002. Primary sites were detected in 20 before treatment. The other 36 patients clearly had no primary lesions when treatment started. Primary sites were 5 cases of oropharynx, 2 of the parotid gland, and 1 each of larynx, nasopharynx, hypopharynx, and malignant lymphoma detected in 11 after treatment for cervical lymph nodes. No primary lesion was found in 28 patients. The neck LN stage was N1 in 11 patients, N2 in 29, N3 in 11, and unknown in 8. To detect the primary site, we conducted "random" biopsy, panendoscopy, and radiographic evaluation including FDG-PET. Biopsy sites were the nasopharynx, palatine and lingual tonsil, and piriform sinus. Some 35 patients (59.3%) underwent random biopsy, and primary sites were found this way in 5 patients (14.3%). The 36 who had no primary lesion were treated for cervical lymph nodes, of whom 24 underwent neck dissection. Chemotherapy and radiotherapy were the treatment of choice in many cases. We analyzed 31 patients for 5 year survival. Overall survival was 63.7%, disease-specific survival 69.2%, and disease-free survival 46.8%. In another analysis a statistically significant difference was seen in survival among patients who had neck surgery or not (85.7% vs. 38.9%, p = 0.029; log rank test). Analysis suggested that primary sites should be studied by CT, MRI, FDG-PET, and panendoscopy, including random biopsy. The primary site cannot be detected, treatment should initially involve cervical adenopathy with combined surgery, chemotherapy, and radiotherapy. After treatment, the patient should be followed up carefully to find the primary lesion.

We analyzed 7 cases of parapharyngeal space tumors and discussed our method of operation. In our department, we managed to resect the tumor without mandibular osteotomy. When this was possible, it meant the most minimally invasive surgery for the patient. This course has advantages in regards to post operation, duration of hospitalization and cosmetic results. In order to obtain operative fields, we dissected some structures from the cervical approach gradually. In the cases of neurogenic tumors, we resected the tumors after tumor reduction using CUSA. There was no recurrence after therapeutic resection, and there were fewer complications. From these results, we concluded that the decision regarding operative methods depends on the histology or the vascularity of the tumor rather than the size or the location.

In order to study the efficacy of surgical intervention, as well as the influence of cigarette smoking on olfaction in clinical states, we examined olfactory ability by means of the University of Pennsylvania Smell Identification Test (UPSIT). We enrolled 37 patients 21 to 60 years of age who underwent surgery for chronic sinusitis. Normosmia was defined as an UPSIT score of 30 or more. Among these patients, 31 had a disturbance in their smelling ability in the preoperative stage, and the improvement rate, defined as a rise in score of 4 or more points after surgery, was 64.5%; 11 were well healed. However, all 7 patients who were more than 40 years old at the time of surgery, and currently smoking cigarettes, had a significant deficit in olfaction in the preoperative stage and even in the postoperative stage. This study demonstrated that cigarette smoking has adverse effects on olfactory ability, especially for older patients.

This study examined whether evoked magnetic fields and intra- and extracellular potentials from longitudinal CA3 slices of guinea-pig can be interpreted within a single theoretical framework that incorporates ligand- and voltage-sensitive conductances in the dendrites and soma of the pyramidal cells. The 1991 CA3 mathematical model of R. D. Traub is modified to take into account the asymmetric branching patterns of the apical and basal dendrites of the pyramidal cells. The revised model accounts for the magnitude and waveform of the bi- and triphasic magnetic fields evoked by somatic and apical stimulations, respectively, in the slice in the absence of fast inhibition (blocked by 0.1 mM picrotoxin). The revised model also accounts for selective effects of 4-aminopyridine (4-AP) and tetraethylammonium (TEA), which block the potassium channels of A and C type, respectively, on the slow wave of the magnetic fields. Furthermore, the model correctly predicts the laminar profiles of field potential as well as intracellular potentials in the pyramidal cells produced by two classes of cells - those directly activated and those indirectly (synaptically) activated by the applied external stimulus. The intracellular potentials in this validated model reveal that the spikes and slow waves of the magnetic fields are generated in or near the soma and apical dendrites, respectively. These results demonstrate that a single theoretical framework couched within the modern concepts of cellular physiology provides a unified account of magnetic fields outside the slice, extracellular potentials within the slice and intracellular potentials of the pyramidal cells for CA3.

Pungent sensation of hot peppers is thought to be mediated by vanilloid receptor subtype-1 (VR1), which can be activated by capsaicin, but there is little information regarding its histological localization in the tongue. We examined the immunohistochemical distribution of VR1 in the rat tongue. Intensely labeled VR1-immunoreactive (VR1-IR) fibers were concentrated in the circumvallate, foliate, and fungiform papillae, while sparse VR1-IR fibers were scattered throughout the tongue. VR1-positive taste-bud cells were not observed. Many VR1-positive nerve fibers surrounded the furrows of the circumvallate and foliate papillae, forming plexuses. Some of these VR1-positive fibers penetrated the apical epithelium and the trench wall epithelium, while a few of them entered taste buds. These VR1 distribution patterns resembled those of substance P (SP) and the calcitonin gene-related peptide (CGRP). Double-labeling experiments revealed that most of the VR1-immunoreactivity coexisted with SP- or CGRP-immunoreactivity in the nerve terminals in the circumvallate and foliate papillae. On the other hand, in the fungiform papillae, most of the VR1-IR fibers were positive for SP, but fewer were also positive for CGRP. Although VR1-immunoreactivity was not observed in taste-bud cells, our findings that a large number of VR1-IR fibers concentrated in the taste papillae suggest that capsaicin easily reaches the VR1 nerve terminals because of its lipophilic nature.

When predicting unsteady flow and pressure fields around a structure in a turbulent boundaryrnlayer by Large Eddy Simulation (LES), velocity fluctuations of turbulence (inflow turbulence), whichrnreproduce statistical characteristics of the turbulent boundary layer, must be given at the inflow boundary.rnHowever, research has just started on development of a method for generating inflow turbulence thatrnsatisfies the prescribed turbulence statistics, and many issues still remain to be resolved. In our previousrnstudy, we proposed a method for generating inflow turbulence and confirmed its applicability by LES ofrnan isotropic turbulence. In this study, the generation method was applied to a turbulent boundary layerrndeveloped over a flat plate, and the reproducibility of turbulence statistics predicted by LES computationrnwas examined. Statistical characteristics of a turbulent boundary layer developed over a flat plate wererninvestigated by a wind tunnel test for modeling the cross-spectral density matrix for use as targets ofrninflow turbulence generation for LES computation. Furthermore, we investigated how the degree ofrncorrespondence of the cross-spectral density matrix of the generated inflow turbulence with the targetrncross-spectral density matrix estimated by the wind tunnel test influenced the LES results for the turbulentrnboundary layer. The results of this study confirmed that the reproduction of cross-spectra of the normalrncomponents of the inflow turbulence generation is very important in reproducing power spectra, spatialrncorrelation and turbulence statistics of wind velocity in LES.

New technologies such as microelectrode arrays and high-resolution optical recording have been yielding microscopic, dynamic, and wide observation-area measurements of membrane-potential behavior. To analyze near-future experimental data, a new potential dynamics theory will inevitably be required. Microscopically speaking, the membrane extends two-dimensionally with various shapes in the three-dimensional world. This paper presents two-dimensional membrane-potential equations to analyze the microscopic spatiotemporal behavior of the membrane potential. The two-dimensional treatment is a good approximation when the curvature of the nonplanar membrane is not so large. Results of numerical calculations predict, as an example, that the signal velocity v on a soma has a dependence of v∝D0.77 on the conductive-layer thickness D, instead of v∝D1/2 in the case of cylinders used in the cable theory. We also present a virtual experimental result which suggests that the temporal coincidence of action-potential pulses has more significant effects when the conductive-layer thickness reduces.

Although Ramsay Hunt syndrome is one of the most important diseases causing peripheral facial palsy, the detailed pathology of the disease in the intratemporal facial nerve remains unclear. The purpose of this study was to increase knowledge of the pathogenesis of the syndrome by means of surgical findings. Between April 1976 and March 1997 we performed subtotal decompression of the facial nerve in 74 patients with severe Ramsay Hunt syndrome. The grade of nerve swelling was assessed using a microscope and recorded in a standardized form. The relationships between nerve swelling, the timing of surgery and the swelling of each segment were analyzed. Pronounced neural swelling, involving the geniculate ganglion and the horizontal segment, was consistent finding in the acute phase. Although the incidence of pronounced swelling of the horizontal segment gradually declined with time after onset, in most cases nerve swelling persisted even beyond the 16th week after onset. These data suggest that diffuse viral neuritis occurs throughout the intratemporal facial nerve. We assume that the viral inflammatory swelling involving the geniculate ganglion and horizontal segment is mostly responsible for the acute facial palsy in the acute phase.

Although transnasal endoscopic medial maxillectomy (TEMM) is effective for the treatment of inverted papilloma (IP) in maxillary sinus (MS), it involves resection of the inferior turbinate (IT). TEMM also involves resection of the nasolacrimal duct (ND) in many cases to gain better access. Therefore, we developed a novel procedure in which the preserved IT and ND are shifted medially for a complete resection of IP in the MS. Incision was made in the mucosa of the lateral wall along the anterior margin of the IT. After removal of the medial maxillary wall except the ND and the lateral nasal mucosa, the anterior lateral mucosa of the nose, including the IT and the ND, was shifted in the medial direction to allow wider access to the MS. The tumor was removed together with the attachment through the anterior side of the ND. This modified TEMM was performed in 10 patients with IP. The IT and ND were preserved in all patients. We have not observed epiphora after this surgery. The advantages of the novel approach presented herein include: 1) preservation of the IT, ND, and lateral nasal mucosa; 2) wide access to the MS by shifting the IT, ND, and lateral nasal mucosa in the medial direction; and 3) direct access to the MS through anterior space of the ND, resulting in easier operation with a straight endoscope and instruments. This approach is a safe and effective method to obtain wide and straight access to the MS and to resect IP in the MS.

Objective The prognosis for facial nerve palsy (FNP) depends on its severity. Currently, many clinicians use the Yanagihara, House–Brackmann, and/or Sunnybrook grading systems to assess FNP. Although these assessments are performed by experts, inter- and intra-observer disagreements have been demonstrated. The quantitative and objective analyses of the degree of FNP would be preferred to monitor functional changes and to plan and evaluate therapeutic interventions in patients with FNP. Numerous two-dimensional (2-D) assessments have been proposed, however, the limitations of 2-D assessment have been reported. The purpose of this study was to introduce a three-dimensional (3-D) image generation system for the analysis of facial nerve palsy (FNP) and to show the correlation between the severity of FNP assessed by this method and two conventional systems. Methods Five independent facial motions, resting, eyebrow raise, gentle eye closure, full smile with lips open and whistling were recorded with our system and the images were then analyzed using our software. The regional and gross facial symmetries were analyzed. The predicted scores were calculated and compared to the Yanagihara and H–B grading scores. We analyzed 15 normal volunteers and 42 patients with FNP. Results The results showed that 3-D analysis could measure mouth movement in the anteroposterior direction, whereas two-dimensional analysis could not. The system results showed good correlation with the clinical results from the Yanagihara ( r 2 = 0.86) and House–Brackmann ( r 2 = 0.81) grading scales. Conclusion This objective method can produce consistent results that align with two conventional systems. Therefore, this method is ideally suited for use in a routine clinical setting.

Bell's palsy is highly associated with diabetes mellitus (DM). Either the reactivation of herpes simplex virus type 1 (HSV-1) or diabetic mononeuropathy has been proposed to cause the facial paralysis observed in DM patients. However, distinguishing whether the facial palsy is caused by herpetic neuritis or diabetic mononeuropathy is difficult. We previously reported that facial paralysis was aggravated in DM mice after HSV-1 inoculation of the murine auricle. In the current study, we induced HSV-1 reactivation by an auricular scratch following DM induction with streptozotocin (STZ).Controlled animal study.Diabetes mellitus was induced with streptozotocin injection in only mice that developed transient facial nerve paralysis with HSV-1. Recurrent facial palsy was induced after HSV-1 reactivation by auricular scratch.After DM induction, the number of cluster of differentiation 3 (CD3)(+) T cells decreased by 70% in the DM mice, and facial nerve palsy recurred in 13% of the DM mice. Herpes simplex virus type 1 deoxyribonucleic acid (DNA) was detected in the facial nerve of all of the DM mice with palsy, and HSV-1 capsids were found in the geniculate ganglion using electron microscopy. Herpes simplex virus type 1 DNA was also found in some of the DM mice without palsy, which suggested the subclinical reactivation of HSV-1.These results suggested that HSV-1 reactivation in the geniculate ganglion may be the main causative factor of the increased incidence of facial paralysis in DM patients.

ObjectivesTo evaluate the effect of continuous positive airway pressure (CPAP) therapy on Ménière's disease patients with concomitant obstructive sleep apnea syndrome (OSAS), since recent reports suggest OSAS may cause dysfunction of the vestibular system.Study designProspective study using CPAP administered to patients diagnosed with "Definite Ménière's disease" according to the guidelines of the American Academy of Otolaryngology--Head and Neck Surgery and combined with OSAS.SettingUniversity hospital.MethodsTwenty consecutive patients, 14 male and 6 female with active, unilateral, cochleovestibular Ménière's disease refractory to medical management who also had concurrent OSAS as defined by International Classification of Sleep Disorders, Second Edition were selected to undergo solitary CPAP therapy. Audiometric testing, caloric testing, and DHI survey were conducted before and after CPAP therapy and compared to assess effectiveness of CPAP therapy as utilized for treatment of Ménière's disease.ResultsAlthough caloric testing did not show significant difference, audiometric testing and results of dizziness handicap inventory were significantly improved (p < 0.05) after CPAP therapy only, without standard treatment for Ménière's disease.ConclusionRecent reports have suggested that OSAS may cause dysfunction of the vestibular system. We investigated whether standard therapy for OSAS would be of benefit in the management of vertigo and hearing loss in Ménière's disease patients. Our study cohort demonstrated significant improvement in both DHI and audiometric testing following solitary CPAP therapy for OSAS. Solitary CPAP therapy may become a new effective treatment strategy for Ménière's disease patients with OSAS, not just only for control of dizziness and vertigo but also for potential benefit of hearing.

Acquired chemoresistance to 5-fluorouracil (5-FU) remains one of the obstacles for the success of 5-FU-based cancer chemotherapy, and some molecular mechanisms of acquired 5-FU resistance are still unknown. The main action of 5-FU is the suppression of DNA replication by inhibiting Thymidylate Synthase (TS).We analyzed 5-FU resistance mechanisms using the head and neck squamous cell carcinoma cell lines, UM-SCC-23, and two different resistant cell lines, UM-SCC-23/WR and UM-SCC-23/MR, which were procured from UM-SCC-23 cells. To acquire resistance, the two cells underwent repeated treatment of 5-FU with different durations and frequency. We determined differences in the cell-cycle distribution and the expression of TS proteins in the three cell lines. Moreover, cell-cycle distribution in cells which acquired resistance after 5-FU treatment, was compared to that of parental cells, using flow cytometric analysis.There was a remarkable increase in TS protein expression levels in UM-SCC-23/WR following 5-FU treatment. S-phase cells of UM-SCC-23 and UM-SCC-23/WR cells were immediately increased after treatment with 5-FU, whereas UM-SCC-23/MR were accumulated to the S-phase slightly later.The cell-cycle perturbation or elevation of TS protein expression may be involved in acquired 5-FU resistance and identifies 5-FU resistance mechanisms in the two different 5-FU treatment regimens.

Bell's palsy is the most common cause of facial paralysis; it has an incidence of 20 to 30 per 100, 000 people. Many events such as viral infection, is chemia and autoimmune reaction have been proposed as causes of Bell's palsy. However, to date there have been no reports of conclusive evidence of the etiological agent responsible for Bell's palsysince Sir Charles Bell described the disease in 1830. Because the etiological agent remains unknown, treatment of this condition is empiric, varying from observation alone to the use of steroids and surgical decompression.Recent advancements in the molecular methods of in situ hybridization and polymerase chain reaction have revealed the existence of HSV-1 genomes in the involved facial nerve as well as the geniculate ganglion. In addition, animal experiments have shown that HSV-1 may induce facial paralysis and the beneficial effect of the antiviral agent of acyclovir for facial function has also been demonstrated. These findings provide the evidence that latently infected HSV-1 causes Bell's palsy when it reactivates and it is controversial whether we should continue using the term “Bell's palsy” to mean “idiopathic facial paralysis” or whether we should now recognize Bell's palsy as “herpetic facial paralysis”. However, currently, we have no reliable, widely available clinical test for the early identification of HSV-1 infection in Bell's patients. Methodological break-through will resolve this problem and data accumulation will datermine the percentage of patients with Bell's palsy in whom HSV-1 is the etiological agent.

BACKGROUND The purpose of this study was to evaluate the results of surgery for small acoustic neurinomas at our institute via the middle cranial fossa and retrosigmoid approaches, and to determine the indications for each approach. METHODS Fifty-three patients with unilateral tumors less than 2 cm in diameter were studied. Surgery was performed via the middle cranial fossa approach in 36 tumors and via the retrosigmoid approach in 17 tumors. RESULTS The hearing preservation rate was 68% (36/53) in all patients, 93% (14/15) in patients with intracanalicular tumors, 79% (15/19) in patients with tumors less than 1 cm in diameter, and 43% (7/19) in patients with tumors between 1 and 2 cm in diameter. The facial nerve function was excellent or good in 80% (42/53), 74% (11/15), 84% (16/19), and 78% (15/19), respectively. Among the 19 patients with tumors between 1 and 2 cm in diameter, the frequencies of hearing preservation and of excellent or good facial nerve function (47% and 87%, respectively) in the 15 patients approached via the retrosigmoid approach were higher than those (0% and 50%, respectively) in the four patients approached via the middle cranial fossa approach. CONCLUSIONS We conclude that tumors smaller than 2 cm should be removed because preservation of hearing as well as facial nerve function may be possible in almost all of these patients. Tumors larger than 1 cm should be surgically treated through the retrosigmoid approach.

Many current studies have suggested that herpes simplex virus is a probable cause of Bell's palsy, and that treatment with antiviral agents such as acyclovir might benefit the patients. In the present study, 69 patients with Bell's palsy were treated with oral administration of acyclovir (2000 mg/day) and prednisolone (60-40 mg/day) at Ehime University Hospital between Oct. 1995 and Dec. 1998. Patients enrolled in this study met the following criteria: 1) severe or complete paralysis with a score lower than 20 by the 40-point Japanese grading system, and 2) treatment started within 7 days of onset. The overall recovery rate was 95.7% (66/69). The rate in patients who started this treatment within 3 days after disease onset was 100%, and this early treatment was highly efficacious in the prevention of nerve degeneration and resulted in a significantly better recovery. By comparison, the recovery rate in patients whose treatment was started 4 days or more after onset was only 84.2%. All patients who were given a diagnosis of zoster sine herpete and treated with acyclovir-prednisolone had a good outcome. These results suggest that early treatment, within 3 days after palsy onset, is necessary for effective acyclovir-prednisolone therapy of Bell's palsy.

Surgical decompression of the intratemporal facial nerve from the geniculate ganglion to the stylomastoid foramen was carried out in 91 patients with Bell's palsy. All of the patients had denervation exceeding 95%, and a suprastapedial lesion. Edematous swelling of the nerve was assessed using the following three grades: + +, nerve swells beyond the bony facial canal; +, nerve swells beyond the nerve sheath, but within the bony canal, and -, no notable swelling observed. Varying degrees of swelling of the nerve were noted in all of the patients from onset to the end of the ninth week. The incidence of + + swelling was highest within 3 weeks of onset and then declined. + + swelling was most often noted in the vicinity of the geniculate ganglion, and was thought to be a manifestation of inflammation due to herpes simplex virus infection. There was a clear time dependency of the swelling in the horizontal and pyramidal segments, but not in the mastoid segment. After the ninth week, the incidence of swelling decreased sharply and no swelling of the nerve was observed in about one-third of the patients. Considering the etiology and the analysis of edematous swelling, we propose that the course of Bell's palsy be differentiated into an acute phase (the first 3 weeks after onset), a subacute phase (from the fourth to ninth weeks) and a chronic phase (after the tenth week).

The recent progress of physiological measurement allows us to observe membrane potential behaviors of extensive regions with higher spatial and temporal resolutions. Accordingly, a new theory has been expected with which we can analyze the spatiotemporal dynamics of the membrane potential with the cell-shape and the spatial distributions of electrical parameters taken into consideration quantitatively. We propose a microscopic analysis theory using the boundary element method. An example of a preliminary numerical calculation is also reported.

Corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) are characterized by their unique clinical features and neuronal pathology. Although astrocytic plaques and tufts of abnormal fibers have been suggested to be specific histopathologic markers, recent studies have revealed significant clinicopathologic overlap between CBD and PSP. Based on the distinctive camera lucida profile of astrocytic inclusions on Gallyas-Braak silver staining, we found that astrocytic plaques and tufts of abnormal fibers did not coexist in the same patient among 30 cases of clinically diagnosed CBD, PSP and atypical Parkinson's disease. Using Tau immunohistochemistry it was difficult to verify the absence of tufts of abnormal fibers. A morphometric analysis revealed that the two groups classified by the presence or absence of astrocytic plaques and tufts of abnormal fibers exhibited significant differences in the density of ballooned neurons and neurofibrillary tangles and degeneration of the subcortical nuclei. Assessment using the NINDS neuropathologic criteria revealed that the cases with astrocytic plaques and tufts of abnormal fibers closely correspond to CBD and typical PSP, respectively. In addition, the cases lacking either of these two astrocytic inclusions had atypical PSP according to the NINDS criteria, and were associated with novel tau-positive astrocytes (spiny astrocytes). We thus conclude that astrocytic plaques and tufts of abnormal fibers are highly characteristic structures for CBD and typical PSP, respectively. We emphasize the importance of strict differentiation between different astrocytic inclusions not only for diagnosis, but also for further studies for elucidation of their role in the disease mechanisms of CBD and PSP.

The immunologic aspects of facial nerve paralysis due to herpes simplex virus type 1 (HSV-1) infection were investigated in a mouse model system. Half of the 4- to 5-week-old mice developed facial nerve paralysis, whereas none of the 6-week-old mice died or developed facial nerve paralysis on inoculation with HSV-1. Six-week-old mice showed significantly higher titers of anti-HS V-1 neutralizing antibody than did 4-week-old animals. Passive transfer of either anti-HSV-1 antibody or HSV-1-immunized splenic T cells into 4-week-old mice 3 hours after HSV-1 inoculation prevented development of facial nerve paralysis and death, whereas such transfers 48 or 96 hours after HSV-1 inoculation did not prevent or exacerbate facial nerve paralysis. These results demonstrate that the age and the immunologic potency of mice are closely related to the pathogenesis of facial nerve paralysis. That facial nerve paralysis developed even in 6-week-old mice whose T-cell function was suppressed with anti-CD3 antibody suggests that virus-induced cellular demyelination is unlikely as a cause of facial nerve paralysis in this animal model.

Velocity of malleus, umbo, and stapes footplate in response to stepwise increases up to +400 mm H2O in hydrostatic pressure of the inner ear was investigated in 10 fresh human temporal bones by using a laser Doppler interferometer. The sound-pressure input was 114 dB SPL, and the frequency range was 0.4 to 5.0 kHz. Static displacement of these sites was also measured by a video measuring system. When the inner ear pressure was increased, the malleus and stapes moved outward. Amplitude of umbo velocity decreased below 1.0 kHz with a slight increase around 2.0 kHz, whereas stapes velocity decreased at all frequencies with the major effect below 1.0 kHz. The phase angle of malleus umbo velocity advanced markedly in response to the increased inner ear pressure between 1.0 and 1.4 kHz. Change in the vibration of the umbo was thought to be primarily caused by an increased stiffness of the middle ear conduction system, and that of the stapes was caused by distention of the annular ligament and increased cochlear impedance produced by the increased inner ear pressure. These changes in TM vibration and its phase angle may help detect indirectly an elevation of inner ear pressure.

The state-of-the-art of utilizing turbulence models in wind engineering is reviewed. It is explained why CFD application to wind engineering problems is difficult. Three types of numerical methods for analyzing turbulent flow (DNS, LES, RANS model) are presented. New models and new techniques of LES are noted. Revisions of the standard k – e model for adopting the bluff body aerodynamics are described. The results of RSM applied to a cubic model are shown and thus the shortcoming of this model is presented.

The advantage of combination therapy using prednisolone and prostaglandin E1 (PGE1) was evaluated in 35 patients with Bell's palsy. Complete recovery was achieved in all 15 patients treated with prednisolone-PGE1. Conversely, complete recovery was achieved in 17 patients out of 20 treated with prednisolone alone. The cumulative cure rate at 4 weeks, 2 months, and 6 months after onset of facial palsy was consistently higher in the prednisolone-PGE1 group than in the prednisolone alone group. Progression of facial palsy after onset was also slower and milder in prednisolonePGE1 group than that of in the prednisolone alone group. These results suggest that administration of PGE1 prevents Waller's degeneration of the facial nerve by increasing blood flow to the nerve, and consequently improving the outcome in cases of Bell's facial palsy. PGE1 was thought to be potentially beneficial for patients in whom the use of steroids is restricted due to underlying diseases such as diabetes mellitus, peptic ulcer, osteoporosis or infection.

The pathogenesis of facial nerve paralysis and vestibulo-cochlear dysfunction of Ramsay Hunt syndrome remains unclear as varicella-zoster virus (VZV) has not been demonstrated in the lesions. Using the polymerase chain reaction, we detected VZV genomes not only in the vesicles on the auricles or oral cavity but also in the facial nerve sheath, middle ear mucosa and cerebrospinal fluid from patients with Ramsay Hunt syndrome. The VZV genome was undetectable in the same kinds of clinical samples obtained from control patients with facial nerve paralysis of other etiologies. The results indicated that VZV spreads widely in the neural components, mucocutaneous tissue and cerebrospinal fluid. The present study will facilitate better understanding of the pathogenesis of facial nerve paralysis, vertigo, hearing impairment and other cranial nerve dysfunction of Ramsay Hunt syndrome.

It is well known that applications of the standard k−e model to flowfields around bluff-shaped bodies, often yield serious errors such as overestimation of turbulence kinetic energy k in the impinging region. Murakami, Mochida and Kondo have proposed a new k−e model which resolves these problems by modifying the expression for eddy viscosity approximation. This paper examines the applicability of this new k−e model (MMK model) to flowfields around three types of bluff bodies, i.e. a 2D square rib, a cube and a low-rise building model with 1 : 1 : 0.5 shape. The first half of the paper investigates the accuracy of the MMK model in reproducing turbulence characteristics around a bluff body. Results of the MMK model are compared precisely with those of the standard k−e model, a revised k−e model proposed by Launder and Kato (LK model) and wind tunnel tests for flow fields around a 2D square rib and a cube. The MMK model is also applied to predicting surface pressures on a low-rise building model with 1 : 1 : 0.5 shape with various wind angles including an oblique one. The accuracy and applicability of the MMK model to wind engineering problems are then discussed by comparing its results with those of the standard k−e model and of the wind tunnel tests.

The effect of graded variations in middle ear pressure on ossicular vibration was measured in 15 normal human temporal bone specimens. The displacement amplitude of the umbo and stapes head was measured at 16 frequencies between 0.2 kHz and 3.5 kHz at a constant sound pressure of 134 dB SPL at the tympanic membrane (TM) using a non-contacting video measuring system. Both negative and positive pressures decreased umbo and stapes vibration at low frequencies and slightly increased the vibration at higher frequencies. The effects were greater for negative pressure than for positive pressure. The change in stapes vibration was less than that of the umbo at low frequencies, but increased at higher frequencies. In some temporal bones, a small positive pressure produced improvement in stapes vibration at all frequencies. These effects were thought to be primarily due to an increased stiffness of the TM and a damping of ossicular vibration, due to stretching of the ossicular suspensory ligaments and the annular ligament of the footplate.

Head and neck squamous cell carcinoma (HNSCC) may be curable with surgery, radiation and chemotherapy in its early stages. However, recurrence and metastasis often prevail following primary treatment in advanced stage cases and are associated with significant morbidity and mortality. In this study we investigated the combination therapy of gemcitabine and cetuximab for HNSCC. The UM-SCC-6 and UM-SCC-23 HNSCC cell lines were analyzed following treatment with gemcitabine and cetuximab. To determine the mechanism of action of this combination treatment, the cell cycle distributions following gemcitabine and/or cetuximab treatment were analyzed by flow cytometry and apoptosis assay. Gemcitabine and cetuximab combination treatment exerted an enhanced cytotoxic effect. The cell cycle analysis demonstrated that cells accumulated in the S phase following gemcitabine treatment and G1 arrest occurred following cetuximab treatment. An increase in sub-G1 phase cells was also observed following treatment with the two drugs. In an apoptosis assay, caspase 3/7 activity was found to be higher when administering a combination of gemcitabine and cetuximab compared to each agent administered alone. Gemcitabine and cetuximab are individually effective against HNSCC and an enhanced growth inhibitory effect may be expected when these agents are used in combination.

Most antiarrhythmic drugs act on ion channels and alter the electrical properties of cardiac ­tissues, which is beneficial for preventing or treating cardiac arrhythmias. This chapter provides a basic understanding of anti-arrhythmic agents, especially on the electrophysiological properties of cardiac excitation.

This paper presents our work in progress on enabling computerized reasoning capability in machine-to-machine communication scenarios for the Networked Society (or Internet of Things). Such reasoning capability is about drawing high-level conclusions on the situation in real time based on raw data streams generated by various sources. There are challenges posed by the dynamic and heterogenous availability of raw data coming from different sources, as well as the stringent time constraints for conclusions to be made. Our goal hence is to make machine-based reasoning processes time-efficient, resource-efficient, and scalable. We present an approach that addresses the challenges by decomposing a reasoning process into two stages: “shallow reasoning” and “deep reasoning”. The former deals with the dynamic and heterogenous availability of raw data from different sources, while the latter executes semantic reasoning with a lightweight workload that has been reduced by the former. We present our prototype implementation of a reasoning system that adopts the proposed approach in a proactive healthcare use case. Performance evaluation is currently ongoing to verify the effectiveness of our approach.

Blood patch is a therapeutic procedure that uses a perilymphatic fistula to repair an inner ear window rupture by filling the tympanic cavity with autologous blood. The experimental study was conducted in 13 guinea pigs. Autologous blood or commercially available fibrin glue was poured into the otic bulla after artificial rupture of the round window. The animals were sacrificed immediately, or 1 to 7 days after the operation. The results showed that the blood or the fibrin glue successfully closed the window rupture by closing directly and by facilitating the formation of granulation at the margin of the rupture. Fibrin glue seemed to be preferable to autologous blood due to its non-toxic nature in the inner ear.

中耳手術や側頭骨内腫瘍, 聴神経腫瘍などで顔面神経が切断され端々吻合できない場合の再建術として, 中枢端が同定できる場合には神経移植術が, 中枢端が同定できない場合は異種神経である舌下神経と顔面神経を吻合する手術が行われる。神経移植, 舌下神経―顔面神経吻合術は強い筋収縮と自然な顔面表情が得られるが, 病的共同運動も必発である。また, 舌下神経―顔面神経吻合術は舌の萎縮を生じ, 症例により構音, 咀嚼, 嚥下障害をきたすことが難点である。これに対して jump graft は神経再生は遅く弱いが, 舌の萎縮が生じず, 病的共同運動も軽いという利点がある。何れの神経再建術も単独で満足な顔面の表情を獲得することはできず, 特に前額部の回復は困難である。吊り上げ術や側頭筋移行術 (Gillius-Andersen 変法) などの補助的な形成手術を併用したり, また神経再生に伴う病的共同運動に対しては選択的筋切除術なども有効である。

Clinical studies were performed on 325 patients with Ramsay Hunt syndrome who were treated in the Facial Nerve Clinic at Ehime University Hospital between 1976 and 1995. The clinical manifestations of Ramsay Hunt syndrome were various. Three major symptoms, auricular vesicles, facial paralysis and vestibulo-cochlear dysfunction, were found in 57.6% of the patients although these symptoms did not always appear simultaneously. Auricular vesicles appeared before (19.3%), during (46.5%), or after (34.2%) the onset of facial paralysis. Hearing loss was observed subjectively in only 20% but objectively in 48.2% of the patients. Hearing loss appeared before (34.3%), during (34.3%), or after (31.3%) the onset of facial paralysis. Complete recovery from facial paralysis was achieved in 52.4% of the patients. Good recovery of the facial nerve function was achieved in patients who had zoster vesicles or vestibulo-cochlear dysfunction preceding the development of facial paralysis. Complete recovery of hearing was also achieved in 45.4% of the patients, and the recovery was better in patients having light hearing loss, less than 35dB. The patients younger than 16 years old showed better recovery from both facial paralysis and hearing loss than the patients older than 60 years. Glossopharyngeal nerve or vagal nerve paralysis concomitant with facial paralysis was found in 8 (2.5%) patients. The outcome of glossopharyngeal nerve paralysis was good but that of the vagal nerve was poor.

To clarify the role and site of herpes simplex virus (HSV) infection in the pathogenesis of facial paralysis, we examined the viral genome by the polymerase chain reaction and the neutralization antibody titer using microplates in an animal model. Following inoculation with HSV type 1 of the KOS strain into mouse auricles, HSV DNA appeared in the ipsilateral facial nerve on the 3rd day, and in bilateral facial nerves and the brain stem on the 10th day only in animals with facial paralysis. In animals without facial paralysis, no HSV DNA was detected in these tissues. The neutralization antibody titer was elevated between 4 and 20 days in all animals, with or without facial paralysis. Facial paralysis developed only on the inoculated side, even though HSV DNA was also present in the contralateral facial nerve. We conclude that HSV infection in the facial nerve and brain stem is prerequisite for facial paralysis, and suggest that an immunologic reaction following viral infection plays a key role in the pathogenesis.

Improvement of information delivery systems in ITS is an important issue to provide more effective guidance and support to drivers and passengers, and use of contextual information with improved granularity is beneficial to this end. The goal of our study is to provide a flexible information delivery system concept that makes use of various contextual data around users to determine target receivers of the information specific to a certain context. This paper focuses on a system concept that uses finer-grained location-based screening of target receivers by integrated use of different access networks and also information of a user's transport mode (e.g., riding on a car, walking). The system is designed to provide necessary capabilities to enable information senders to provide the information by merely specifying the contexts of the information receivers. In this paper, we describe the proposed system architecture and the evaluation results.