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Although the carotid artery stump as an embolic source for ischemic stroke has been well described, there have been few systematic reports of a similar syndrome in the posterior circulation (PC) after vertebral artery (VA) origin occlusion. The aim of this study was to identify the incidence and characteristics of acute ischemic stroke with VA stump syndrome. Of 3463 consecutive patients who were admitted within 7 days after onset, 865 patients with acute ischemic stroke in the PC were enrolled. The diagnostic criteria of VA stump syndrome included: (1) acute ischemic stroke in the posterior circulation; (2) the VA origin occlusion identified on MRA, duplex ultrasound, CT angiography, and/or conventional angiography; (3) presence of distal antegrade flow in the ipsilateral VA; and (4) absence of other causes of ischemic stroke. Of the 865 patients with PC stroke, 12 (1.4%) were diagnosed as having VA stump syndrome. The ischemic lesions included the cerebellum in all patients. Nine patients had multiple ischemic lesions in the brain stem, thalamus, or posterior lobe other than cerebellum. On duplex ultrasound, a to-and-fro flow pattern was observed in the culprit VA in 10 patients. Three patients had recurrences of ischemic stroke in the PC during the acute phase. VA stump syndrome was not a rare mechanism of PC stroke, and there was a high rate of stroke recurrence during the acute phase. Vascular assessment by a multimodality approach can be used to promptly detect VA stump syndrome., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background and Purpose: Diffusion-weighted imaging can depict secondary signal change of the substantia nigra of patients with ipsilateral striatal infarction via a decrease in the apparent diffusion coefficient (ADC). Clinical predictors of this phenomenon remain unclear., Methods: We assessed 98 stroke patients with acute ischemic lesions in the hemilateral basal ganglia, external capsule, or internal capsule. The ADC values of the bilateral substantia nigra obtained from a follow-up MRI, various clinical factors, and patients' outcome were analyzed. Nineteen patients who underwent a follow-up MRI within 3 days were excluded from analysis because none of them demonstrated a significant ADC change of substantia nigra., Results: Of 79 patients, 21 (26.6%) revealed a decreased ADC in the substantia nigra. Ischemic lesions in the globus pallidus (odds ratio 12.90) and the presence of emboligenic diseases (odds ratio 6.95) were independent predictors for an ADC decrease in the substantia nigra. The clinical outcome 3 months after stroke onset was not different between patients with an ADC decrease and patients without., Conclusions: A reduction of ADC in the substantia nigra after acute striatal infarction was more frequently observed when the globus pallidus was affected or when the patient had emboligenic diseases, however, did not necessarily relate to the patient's clinical outcome.

Objective: A single-center, observational study was performed to identify the predictors for oral intake 3 months after onset in stroke patients with severe dysphagia., Methods: Of 4972 consecutive acute stroke patients, 723 could not eat orally on day 10. Three months after onset, a questionnaire was sent to all patients. Those who survived and replied to the questionnaire were divided into 2 groups, and the clinical factors that predicted their acquisition of oral intake were analyzed., Results: Of the 586 dysphagic patients who responded, 141 (24.2%) achieved oral intake after 3 months. On logistic-regression model analysis, age ≤ 80 years, hyperlipidemia, non-cardioembolic stroke, modified Rankin Scale score 0 before onset, and National Institutes of Health Stroke Scale (NIHSS) score were independently related to oral intake 3 months after onset. From two different model analyses, NIHSS score ≤ 17 on day 10 (OR 3.58, 95% CI, 2.35-5.54) was found to be a stronger predictor for oral intake than NIHSS score ≤ 17 on admission (OR 2.17, 95% CI, 1.40-3.39)., Conclusion: In severely dysphagic acute stroke patients, functional independence at baseline, younger age, absence of hyperlipidemia, non-cardioembolic stroke, and a milder NIHSS score on day 10 are useful predictors of the resumption of oral intake., (Copyright © 2012 Elsevier B.V. All rights reserved.)

We develop a theory and the method of its application for chemical dynamics in systems, in which the adiabatic potential energy hyper-surfaces (PES) are densely quasi-degenerate to each other in a wide range of molecular geometry. Such adiabatic electronic states tend to couple each other through strong nonadiabatic interactions. Technically, therefore, it is often extremely hard to accurately single out the individual PES in those systems. Moreover, due to the mutual nonadiabatic couplings that may spread wide in space and due to the energy-time uncertainty relation, the notion of the isolated and well-defined potential energy surface should lose the sense. On the other hand, such dense electronic states should offer a very interesting molecular field in which chemical reactions to proceed in characteristic manners. However, to treat these systems, the standard theoretical framework of chemical reaction dynamics, which starts from the Born-Oppenheimer approximation and ends up with quantum nuclear wavepacket dynamics, is not very useful. We here explore this problem with our developed nonadiabatic electron wavepacket theory, which we call the phase-space averaging and natural branching (PSANB) method [T. Yonehara and K. Takatsuka, J. Chem. Phys. 129, 134109 (2008)], or branching-path representation, in which the packets are propagated in time along the non-Born-Oppenheimer branching paths. In this paper, after outlining the basic theory, we examine using a one-dimensional model how well the PSANB method works with such densely quasi-degenerate nonadiabatic systems. To do so, we compare the performance of PSANB with the full quantum mechanical results and those given by the fewest switches surface hopping (FSSH) method, which is known to be one of the most reliable and flexible methods to date. It turns out that the PSANB electron wavepacket approach actually yields very good results with far fewer initial sampling paths. Then we apply the electron wavepacket dynamics in path-branching representation and the so-called semiclassical Ehrenfest theory to a hydrogen molecule embedded in twelve membered boron cluster (B(12)) in excited states, which are densely quasi-degenerate due to the vacancy in 2p orbitals of boron atom [1s(2)2s(2)2p(1)]. Bond dissociation of the hydrogen molecule quickly takes place in the cluster and the resultant hydrogen atoms are squeezed out to the surface of the cluster. We further study collision dynamics between H(2) and B(12), which also gives interesting phenomena. The present study suggests an interesting functionality of the boron clusters.

A 57-year-old man was admitted because of left hemiparesis. A magnetic resonance imaging scan of the brain revealed a recent infarct from the dorsal side of the right putamen to the corona radiata. Three hours after onset, he complained of rotational vertigo. Truncal ataxia was also found on standing a few days later, which persisted until the chronic phase. Repeat magnetic resonance imaging scans on days 2 and 11 revealed no additional lesions. The present case indicates that rotational vertigo might result from a small, supratentorial, subcortical lesion., (Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

We hypothesized that extensive early ischemic changes increase subsequent intracranial hemorrhage (ICH) in patients within 3 h of onset regardless of intravenous tPA (IV-tPA). We have established a modified scoring method, ASPECTS+W, including deep white matter lesions on DWI (DWI-W) in addition to the original ASPECTS regions. We aimed to elucidate whether CT-ASPECTS, DWI-ASPECTS, and ASPECTS+W could be useful tools in helping to predict subsequent ICH in acute ischemic stroke. One-hundred sixty-four consecutive patients with anterior circulation ischemic stroke were enrolled. All patients underwent both MRI and CT within 3 h of onset. ASPECTS+W was defined as an 11-point method combining the ten ASPECTS regions and DWI-W. The relationships of CT-ASPECTS, DWI-ASPECTS, and ASPECTS+W with ICH within the initial 36 h were assessed. Thirty-six patients (22%) were treated with IV-tPA. Follow-up CT was obtained in 159 patients, and 19 (12%) developed ICH. Patients with ICH had higher baseline NIHSS scores (median, 25 vs. 13, p = 0.010), a higher rate of IV-tPA (42 vs. 20%, p = 0.041), lower CT-ASPECTS (median, 7 vs. 10, p = 0.008), lower DWI-ASPECTS (6 vs. 9, p = 0.001), lower ASPECTS+W (6 vs. 9, p = 0.001), and higher DWI-W lesions (74 vs. 47%, p = 0.048) than those without ICH. ICA or M1 proximal occlusion was more frequently seen in patients with ICH (68 vs. 32%, p = 0.004) than in those without ICH. On multivariate regression analysis, lower ASPECTS+W (OR 0.75, 95% CI 0.58-0.96, p = 0.027) and administration of IV-tPA (OR 9.13, 95% CI 2.15-46.21, p = 0.004) independently predicted ICH development. In conclusion, ASPECTS+W is a useful tool for predicting ICH development independent of IV-tPA.

This study investigated environmental distributions and production mechanisms of chlorinated polycyclic aromatic hydrocarbons (Cl-PAHs) in the sediments from some tidal flats located in Asia. Cl-PAHs were found in sediments taken from Arao tidal flat, Kikuchigawa River and Shirakawa River. The range of ∑Cl-PAHs was from 25.5 to 483 pg g(-1) for Kikuchigawa River and Arao tidal flat, respectively. Concentrations of PAHs and Cl-PAHs showed no significant correlations (r=0.134). This result suggests that the origins of these compounds differ. In the identified Cl-PAH isomers, the most abundant Cl-PAH isomer was 9,10-dichloroanthracene (9,10-di-Cl-ANT) in the three sites. In general, concentrations of Cl-ANTs in the coastal environment are about 3-5 orders of magnitude lower than those of anthracene (ANT). However, concentration ratios between Cl-ANTs and ANT (Cl-ANTs/ANT) in the sediments ranged from 4.1% to 24.6%. This result indicated that Cl-PAHs were not generated under industrial processes but the high concentration ratios have resulted from the contribution of photochemical production of Cl-ANTs in the sediments because ANT is known to have high photochemical reactivity. For examining this phenomenon, ANT adsorbed onto glass beads was irradiated with UV under the mimicked field conditions of tidal flats. As a result, it was noticed that, while chlorinated derivatives were negligible in a light-controlled group, production of 2-Cl-ANT, 9-Cl-ANT and 9,10-diCl-ANT on the irradiated surface were found in this study. These results suggest that photochemical reaction of PAHs can be a potential source of the occurrence of Cl-PAHs in the coastal environment., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

A 74-year-old man complained of near loss of consciousness when he rotated his head to the left side. The symptom was reversed by returning his head to a neutral position. Transcranial Doppler studies with the patient's neck rotated into the left side revealed reduction of flow in his left vertebral artery. Vertebral angiography revealed a hypoplastic right vertebral artery and occlusion of the left vertebral artery at the C6 level on head rotation. We diagnosed him bow hunter's syndrome and treated him conservatively. Six months later, he was symptom-free on head rotation. Transcranial Doppler and vertebral angiography demonstrated the disappearance of the vertebral artery occlusion at the neck rotation. Some patient without any definite cause can be treated conservatively, and surgical interventions for bow hunter's syndrome should be carefully decided.

Continuous fermentation by retaining cells with a membrane-integrated fermentation reactor (MFR) system was found to reduce the amount of supplied sub-raw material. If the amount of sub-raw material can be reduced, continuous fermentation with the MFR system should become a more attractive process for industrialization, due to decreased material costs and loads during the refinement process. Our findings indicate that the production rate decreased when the amount of the sub-raw material was reduced in batch fermentation, but did not decrease during continuous fermentation with Sporolactobacillus laevolacticus. Moreover, continuous fermentation with a reduced amount of sub-raw material resulted in a productivity of 11.2 g/L/h over 800 h. In addition, the index of industrial process applicability used in the MFR system increased by 6.3-fold as compared with the conventional membrane-based fermentation reactor previously reported, suggesting a potential for the industrialization of this D-lactic acid continuous fermentation process.

Objective: It remains unclear which patients with acute stroke need percutaneous endoscopic gastrostomy (PEG) placement and when it should be performed. The aim of this study was to identify the predictors for oral intake 6 months after onset in stroke patients., Methods: Data were obtained from a prospectively registered database of 738 acute ischemic stroke patients both with and without a history of stroke. Patients who survived for 6 months and replied to a questionnaire were divided into two groups: those with oral intake 6 months after onset and those without. Predictors for oral intake 6 months after onset were analyzed., Results: Forty-five patients died during their hospital stay, 145 did not reply to the questionnaire, and 23 died during follow-up. Of the residual 525 patients, 485 (92.4%) had oral intake after 6 months. On multivariate analysis, modified Rankin Scale score 0 before admission (OR 2.70, 95% CI 1.10-6.61) and National Institutes of Health Stroke Scale (NIHSS) score ≤9 on day 10 (OR 21.12, 95% CI 5.04-88.39) were independent predictors for oral intake after 6 months, while NIHSS score on admission was not., Conclusion: Clinicians should be cautious about PEG placement for stroke patients who were independent prior to their stroke and whose stroke severity decreases 10 days after admission, because their swallowing dysfunction may improve within a brief period.

This paper describes the performance of a novel bio-reactor system, the membrane-integrated fermentation reactor (MFR), for efficient continuous fermentation. The MFR, equipped with an autoclavable polyvinylidene difluoride membrane, has normally been used for biological wastewater treatment. The productivity of the MFR system, applied to the continuous production of pyruvic acid by the yeast Torulopsis glabrata, was remarkably high. The volumetric productivity of pyruvic acid increased up to 4.2 g/l/h, about four times higher than that of batch fermentation. Moreover, the membrane was able to filter fermentation broth for more than 300 h without fouling even though the cell density of the fermentation broth reached 600 as OD(660). Transmembrane pressure, used as an indicator of membrane fouling, remained below 5 kPa throughout the continuous fermentation. These results clearly indicate that the MFR system is a simple and highly efficient system that is applicable to the fermentative production of a range of biochemicals.

Chemical theory and its application to dynamical electrons in molecules under intense electromagnetic fields is explored, in which we take an explicit account of nuclear nonadiabatic (kinematic) interactions along with simultaneous coupling with intense optical interactions. All the electronic wavefunctions studied here are necessarily time-dependent, and thereby beyond stationary state quantum chemistry based on the Born-Oppenheimer framework. As a general and tractable alternative framework with which to track the electronic and nuclear simultaneous dynamics, we propose an on-the-fly method to calculate the electron and nuclear wavepackets coupled along the branching non-Born-Oppenheimer paths, through which their bifurcations, strong quantum entanglement between nuclear electronic motions, and coherence and decoherence among the phases associated with them are properly represented. Some illustrative numerical examples are also reported, which are aimed at our final goals; real time tracking of nonadiabatic electronic states, chemical dynamics in densely degenerate electronic states coupled with nuclear motions and manipulation and/or creation of new electronic states in terms of intense lasers, and so on. Other examples are also presented as to how the electron wavepacket dynamics can be used to analyze chemical reactions, shedding a new light on some typical and conventional chemical reactions such as proton transfer followed by tautomerization.

This report describes the production of highly optically pure D-lactic acid by the continuous fermentation of Sporolactobacillus laevolacticus and S. inulinus, using a membrane-integrated fermentation (MFR) system. The optical purity of D-lactic acid produced by the continuous fermentation system was greater than that produced by batch fermentation; the maximum value for the optical purity of D-lactic acid reached 99.8% enantiomeric excess by continuous fermentation when S. leavolacticus was used. The volumetric productivity of the optically pure D-lactic acid was about 12 g/L/h, this being approximately 11-fold higher than that obtained by batch fermentation. An enzymatic analysis indicated that both S. laevolacticus and S. inulinus could convert L-lactic acid to D-lactic acid by isomerization after the late-log phase. These results provide evidence for an effective bio-process to produce D-lactic acid of greater optical purity than has conventionally been achieved to date.

We report a case of torsion of ovarian carcinoma pedicle during chemotherapy with bevacizumab and FOLFIRI. A 47-year-old-female who had undergone laparoscopic-assisted sigmoidectomy for sigmoid cancer with multiple metastatic liver tumors, was treated with 3 courses of FOLFOX4 and 9 courses of FOLFIRI. Bevacizumab (BV) was started to administer with FOLFIRI since a CT scan had revealed that metastatic liver tumors had enlarged . Four days after final administration of BV (13th course), she presented lower abdominal pain. CT scan showed an enlarged right ovary sized 20 cm, but no findings suggesting bowel perforation; therefore we assumed her pain was due to enlarged ovarian tumor, which might be metastasis from sigmoid cancer. Increased oral morphine could not relieve her pain. Then, along with sufficient information about the risks of the operation caused by BV, we proposed an operation to remove her enlarged ovary. Day 16 after final administration of BV, we undertook a laparotomy by lower median incision, and found a twisted right adnex with large necrotic ovarian tumor. Pathologists diagnosed the ovarian tumor as primary ovarian cancer. No complication related to BV occurred, and she was moved to the ward for internal medicine 13 days after operation.

There are very few reports describing the presence of a stump embolism after vertebral artery occlusion. We describe three patients who presented with posterior circulation ischemic strokes after vertebral artery occlusion. These patients were successfully treated with anticoagulation therapy without surgical or endovascular treatment., (Copyright (c) 2010 Elsevier B.V. All rights reserved.)

A 16-year-old woman was admitted to our hospital because of the motorbike accident On admission, her consciousness was alert, and she had lower lip laceration and left femur open wound. Brain CT showed no abnormality, but chest CT revealed slight left lungs sprain and her left femur was fractured in the radiograph. Debridement and the art of the steel wire pulling of the left femur fracture part were enforced under general anesthesia about two hours coming to a hospital later. Her awaking from anesthetizing after the operation was delayed, and the consciousness level gradually decreased. Head MRI diffusion weighted image (DWI) after about 36 hours coming to a hospital showed diffuse high signal region centering on the cerebral white matter. We diagnosed her as having cerebral fat embolism based on clinical course and MRI findings. DWI abnormal signals disappeared in three weeks and the symptoms had improved gradually. It is thought that head MRI-DWI is useful to diagnose and evaluate the pathophysiology of cerebral fat embolism.

Background: The impact of deep white matter lesions observed at the corona radiata on diffusion-weighted MRI (DWI-W lesions) on the clinical recovery of patients after tissue plasminogen activator (tPA) therapy is unclear. Our goal was to elucidate whether DWI findings before tPA could predict clinical recovery., Methods: A total of 83 consecutive patients with hyperacute anterior circulation ischemic stroke were enrolled. All patients underwent MRI within 3 h and received intravenous tPA. The relationships among the Alberta Stroke Program Early CT Score (ASPECTS) on DWI (DWI-ASPECTS), DWI-W lesions, early dramatic improvement (> or =10-point reduction in the total National Institutes of Health Stroke Scale, NIHSS, score or a total NIHSS score of 0-2 after 24 h), early improvement (> or =4-point reduction in the total NIHSS score after 24 h) and worsening (> or =4-point increase in the total NIHSS score after 24 h) were assessed., Results: The median of the baseline DWI-ASPECTS value was 9 (range: 5-10), and DWI-W lesions were found in 36 patients (43%). Patients with early dramatic improvement had a shorter time from onset to tPA (116.1 +/- 34.9 vs. 133.2 +/- 33.1 min; p = 0.0281) and higher DWI-ASPECTS (medians: 9 vs. 9; p = 0.0568). DWI-W lesions were seen less frequently in patients with than without early dramatic improvement (26 vs. 54%; p = 0.0213). Multivariate logistic regression analysis demonstrated that absence of DWI-W lesions (OR: 1.80; 95% CI: 1.08-3.13; p = 0.0279), higher ASPECTS (OR: 1.56; 95% CI: 1.06-2.46; p = 0.0346) and shorter time from onset to tPA (OR: 0.98; 95% CI: 0.97-0.99; p = 0.0429) were independent predictors of early dramatic improvement., Conclusions: DWI-ASPECTS and DWI-W lesions appear to be useful tools for predicting early dramatic improvement., (Copyright 2010 S. Karger AG, Basel.)

In order to determine predictive factors of stroke recurrence during anticoagulant therapy and to estimate prognosis, we retrospectively examined clinical data of 197 consecutive patients with acute ischemic stroke. The subjects were divided into two groups, within the therapeutic range group and below therapeutic range group, based on Japanese guidelines for the management of stroke 2004. Univariate analysis revealed that cardioembolic stroke patients were less frequent in the therapeutic range group (61% vs 77%; p = 0.03), while more lacunar stroke patients were experienced (17% vs 6%; p = 0.01). In patients with past history of cardioembolic stroke, significant favorable outcomes as of Barthel index (54 vs 33; p = 0.03) and modified Rankin Scale (3 vs 4; p = 0.04) were found within the therapeutic range group. There is a possibility that adequate anticoagulation prevents thrombogenesis or lead to early recanalization, especially in patients with past history of cardioembolic stroke.

We extend our formerly proposed theory for non-Born-Oppenheimer electronic and nuclear wavepacket dynamics within on-the-fly scheme [T. Yonehara, S. Takahashi, and K. Takatsuka, J. Chem. Phys. 130, 214113 (2009)] to a case of nonadiabatic dynamics under an intense laser field: electron wavepacket in a molecule is propagated in attosecond time-scale along non-Born-Oppenheimer nuclear paths that smoothly branch due to nonadiabatic coupling and/or optical interactions. Such branching paths are determined consistently with the motion of the electron wavepackets. Furthermore, these nuclear paths are quantized in terms of Gaussian wavepackets (action decomposed function), which can be applied to nonclassical paths. Both electronic wavepacket dynamics and quantization of non-Born-Oppenheimer paths are generalized so as to include the direct effects of the classical vector potential of electromagnetic fields. In the second half of this paper, we perform numerical studies to explore nonadiabatic dynamics in a laser field by examining two cases: one is a two-state model system having an avoided crossing, and the other is two-state dynamics in HF molecule on the two low lying ab initio potential curves. Both are placed in laser fields. With the former system, we survey some basic properties of the coupling of nonadiabatic dynamics and laser interaction varying the relevant coupling parameters such as the laser timing with respect to the incident of nonadiabatic transition. This investigation will set a foundation for the future studies of control of electronic states in realistic multidimensional molecular systems. Application to the latter system shows that non-Born-Oppenheimer quantum chemistry in laser fields is indeed useful in the study of dynamics in ab initio level. Through the comparison with full quantum data, we verify that the formalism and methodology developed here work accurately. Furthermore, we attain some basic insight about the characteristics of molecules in laser fields.

In the present study, we analyze and characterize the levels of PCBs and OH-PCBs in serum and breast adipose tissue, and measure TH (total 3,5,5'-triiodothyronine (tT3) and total l-thyroxine (tT4)) levels in serum of Japanese women diagnosed with breast cancer (n = 51) to know how PCBs affect thyroid hormone homeostasis. Concentrations of Sigma(90)OH-PCBs in serum and adipose tissues were 630 pg g(-1) serum wet wt. and 140 pg/ g(-1) lipid wt., respectively, and the levels of OH-PCBs in adipose tissues were 4-5 times lower than in serum. The tT3 and tT4 concentrations in serum (n = 20) were 1.3 ng g(-1) serum wet wt. and 62 ng g(-1) serum wet wt., respectively. Among all the OH-PCBs, 4'-OH-CB101/120, 4-OH-CB107/4'-OH-CB108, 3'-OH-CB138, 4-OH-CB146, 3-OH-CB153, 4'-OH-CB172, and 4-OH-CB187 were the dominant isomers in serum. No significant correlation between the concentrations of the TH and OH-PCBs in serum was observed (p > 0.05). The results indicated that the relationship between the OH-PCB levels and the thyroid hormone markers was rare. From analysis of two kinds of human biological samples, it was estimated that OH-PCBs have little effect on thyroid hormone homeostasis.

We present a 70-year-old man who suffered two attacks of possible incomplete infarction. At the first attack, the responsible lesion was unclear on MRI including DWI, but demonstrated a high uptake of (99m)Tc-ECD SPECT during the acute phase; thereafter the lesion became atrophic with a low uptake on SPECT during the chronic phase. At the second attack, the responsible lesion revealed weakly hyperintense changes on DWI without marked changes on conventional modalities, but had a high uptake on SPECT and capillary blush on angiography during the acute phase. It is suggested that incomplete infarction can solely result in a massive and clinically critical lesion without an accompanying complete infarction.

A practical quantum theory for unifying electronic and nuclear dynamics, which were separated by the Born-Oppenheimer approximation, is proposed. The theory consists of two processes. Nonadiabatic (quantum) electron wavepacket dynamics on branching (non-Born-Oppenheimer) nuclear paths are first constructed. Since these paths are not the classical trajectories, most of the existing semiclassical theories to generate quantum wavepacket do not work. Therefore, we apply our own developed semiclassical wavepacket theory to these generated non-Born-Oppenheimer paths. This wavepacket is generated based on what we call the action decomposed function, which does not require the information of the so-called stability matrix. Thus, the motion of nuclei is also quantized, and consequently the total wave function is represented as a series of entanglement between the electronic and nuclear wavepackets. In the last half of the article, we show the practice to demonstrate how these independent theories can be unified to give electron-nuclear wavepackets in a two-state model. The wavepackets up to the phases and resultant transition probabilities are compared to the full quantum-mechanical counterparts. It turns out that the lowest level approximation to the wavepacket approach already shows a good agreement with the full quantum quantities. Thus, the present theoretical framework gives a basic method with which to study non-Born-Oppenheimer electronic and nuclear wavepacket states relevant to ultrafast chemical events.

Case Report: A 50-year-old woman with primary serous papillary carcinoma (PSPC) of peritoneal origin located in the posterior uterine serosa and cul-de-sac without peritoneal dissemination. No peritoneal dissemination was detected but the tumor metastasized to para-aortic and supraclavicular lymph nodes. After first chemotherapy course, pericardial effusion occurred. A pericardiectomy was performed to prevent cardiac failure. Subsequent chemotherapy with paclitaxel and carboplatin was effective against this tumor, Conclusion: In general, a typical type of PSPC usually develops distant metastasis with diffuse peritoneal dissemination; the present case shows unusual clinical behavior.

Objective: Some patients report the absence of a typical headache at the onset of subarachnoid hemorrhage (SAH). We investigated the clinical backgrounds and characteristics of patients with SAH without headache and compared the findings with those of patients with SAH and headache., Methods: We examined 224 patients retrospectively who underwent intracranial aneurysmal clipping. Patient's characteristics, Fisher's computed tomography grade, situation at onset, site of ruptured aneurysm, and symptoms were compared. Subjects were categorized into two groups: headache group and nonheadache group., Results: Eighteen patients (8.0%) did not present with headache. There were no significant differences in terms of age, sex, Fisher's computed tomography grade, onset time, or site of ruptured aneurysm., Conclusions: The patients without headache have no specific clinical characteristics over patients with common SAH.

We propose a simple and tractable method to treat quantum electron wavepacket dynamics that nonadiabatically couples with "classical" nuclear motions in mixed quantum-classical representation. The electron wavepacket is propagated inducing electronic-state mixing along our proposed paths. It has been shown in our previous studies that classical force working on nuclei in a nonadiabatic region is represented in a matrix form (called the force matrix), and the solutions of the Hamilton canonical equations of motion for nuclei based on this force matrix give rise to a cascade of infinitely many branching paths when solved simultaneously with electronic-state mixing. As a tractable approximation to these rigorous solutions, we here devise a method to provide much simpler nonadiabatic paths: (i) extract one or a few number of representative paths by taking an average over the paths in phase space (not averaging over the forces) that should be otherwise undergo the fine branching. (ii) After the nonadiabatic coupling becomes sufficiently small, let these paths naturally branch by running them with their own individual eigenforces (the eigenvalues of the force matrix). Since the eigenforces coincide with the forces of adiabatic potential energy surfaces in the limit of zero nonadiabatic coupling, these branching paths eventually run on one of possible adiabatic potential energy surfaces, converging to a classical path (Born-Oppenheimer path). The paths thus created are theoretically satisfactory in that they realize the coherent mixing of electronic states in the manner of quantum entanglement and yet eventually become consistent with the Born-Oppenheimer classical trajectories. We test the present method numerically with the use of two- and three-state systems that are extracted from ab initio calculations for the excited states of LiH molecule.

In this study we investigated the factors associated with pre-hospital delay to treat acute ischemic stroke and transient attack with intravenous recombinant tissue-plasminogen activator (rt-PA) in Japan. In 625 patients, we investigated the pathways and times of their arrival to our hospital, and the significant and independent factors in the patients' clinical backgrounds associated with delayed arrival (>2 h after notice). In total, 287 patients arrived at our hospital directly via EMS, 113 came by themselves, and 225 transferred from other institutes. Delayed arrivals occurred in 423 patients (68%). Multivariate analyses showed that staying in another hospital at notice, a worsened course, and referral from other institutes were positively related, and evening onset, having a witness at onset, loss of consciousness, and using EMS were negatively related to delayed arrival; a worsened course was positively related, and staying in other hospital at notice, having a witness at onset, loss of consciousness, and a high NIHSS on admission were negatively related to delayed alert; hypercholesterolemia and onset in a nursing home were positively related, and staying in other hospital at notice, loss of consciousness, and a high NIHSS on admission were negatively related to not using EMS. A lack of knowledge concerning stroke emergency by medical staff as well as the general public may be responsible for some stroke patients losing the chance for rt-PA treatment.

A 53-year-old man was admitted to our hospital after suffering four attacks with loss of consciousness and/or topographic agnosia. Three months after the first attack, the cerebrospinal fluid analysis showed no abnormal findings. IgG-autoantibodies and IgM-autoantibodies against glutamate receptor epsilon2 (GluRepsilon2) were detected in cerebrospinal fluid and serum respectively. At that time, we diagnosed him as having limbic encephalopathy. Brain MRI revealed a high intensity lesion on T2-weighted and FLAIR images in the medial regions of the bilateral temporal lobes and splenium. A diffusion-weighted image revealed high intensity lesions which were also weakly enhanced by Gd-DTPA in the deep white matter beside the posterior horns. The patient then developed numbness in the right hand. The cerebralspinal fluid analysis, four months after the onset of the disease, exhibited slight pleocytosis and elevated protein. IgG-autoantibodies against GluRepsilon2 were detected in the serum. The lesions beside the posterior horns were ring-like enhanced more strongly. Brain biopsy led to a diagnosis of glioblastoma. We suggest that patients with autoantibodies against GluRepsilon2 should be carefully diagnosed with limbic encephalopathy associated with autoimmune mechanisms even if radiological findings are typical of the disease.

The clinical significance of white matter changes including periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) on MRI in patients with normal pressure hydrocephalus is unclear. We investigated the correlation between ventricular size and white matter changes in healthy individuals. We performed MRI in 683 (mean age 59; 55% men) neurologically normal adults without a history or radiological findings of brain disease or trauma, who were undergoing brain health screening. The correlation between Evans' index and severity of white matter changes was analyzed. Multiple linear regression analysis was used to identify the main clinical factors influencing ventricular enlargement and white matter changes. Evans' index was 0.248+/-0.026 (mean+/-SD). Incidence of PVH was 40% and DWMH was 29%. Evans' index was weakly correlated with PVH grading (rho=0.24; P<.01) and DWMH grading (rho=0.24; P<.01). Multiple linear regression analysis showed that age (beta=0.034; SE=0.003) diastolic blood pressure (0.004; 0.002), Evans' index (0.019; 0.009), and a history of hypertension (0.173; 0.053) had a significant impact on PVH grade, whereas age (0.030; 0.003) and history of hypertension (0.224; 0.049) were related to DWMH grade. It was suggested that there is an independent correlation between ventricular enlargement and PVH in normal adults. This finding in a normal population could be due to the presence of preclinical disease, but its bearing on the changes that occur in normal pressure hydrocephalus remain uncertain at the present time.

A 64-year-old woman presented with a partial seizure on the left side of her face. Although diffusion weighted images and magnetic resonance angiography 3 h after the onset did not show any signs of ischemic stroke, a susceptibility vessel sign (SVS) on T2*-weighted gradient echo imaging (GRE) and a hyperintense vessel sign (HVS) on fluid attenuated inversion recovery images at the distal branch of the right middle cerebral artery were revealed. One day later, these GRE SVS and HVS signs disappeared and a new infarct lesion in the right insular cortex was found on magnetic resonance images (MRI). It is suggested that occlusive vessel signs on MRI, including GRE SVS and HVS, are sometimes the only findings of ischemic stroke at the hyperacute phase.

A theory of quantum electron wavepacket dynamics that nonadiabatically couples with classical nuclear motions in intense optical fields is studied. The formalism is intended to track the laser-driven electron wavepackets in terms of the linear combination of configuration-state functions generated with ab initio molecular orbitals. Beginning with the total quantum Hamiltonian for electrons and nuclei in the vector potential of classical electromagnetic field, we reduce the Hamiltonian into a mixed quantum-classical representation by replacing the quantum nuclear momentum operators with the classical counterparts. This framework gives equations of motion for electron wavepackets in an intense laser field through the time dependent variational principle. On the other hand, a generalization of the Newtonian equations provides a matrix form of forces acting on the nuclei for nonadiabatic dynamics. A mean-field approximation to the force matrix reduces this higher order formalism to the semiclassical Ehrenfest theory in intense optical fields. To bring these theories into a practical quantum chemical package for general molecules, we have implemented the relevant ab initio algorithms in it. Some numerical results in the level of the semiclassical Ehrenfest-type theory with explicit use of the nuclear kinematic (derivative) coupling and the velocity form for the optical interaction are presented.

Case 1: A-35-year-old woman was diagnosed as cervical cancer Stage IIIb. When admitted to the hospital, her tumor marker SCC level was 50 ng/mL. Concurrent chemoradiation therapy was started on November, 2005. The SCC level was reduced by 0.9 ng/mL in February, 2006. In April, tumor recurrence was found by PET, and chemotherapy was restarted, but the SCC level was increased. In September, paclitaxel/S-1 therapy was performed, and the tumor markers were again reduced remarkably (SCC 9.8--> 1.3 ng/mL). Case 2: A-78-year-old woman was diagnosed as cervical cancer Stage IIIb. In August, 2004, concurrent chemoradiation therapy was started, and tumor markers were reduced (SCC 25.4--> 1.8 ng/mL). However, tumor markers were increased soon after the therapy. Chemotherapy was started, but it could not be maintained because of the side effects. In April, 2006, paclitaxel/S-1 therapy was performed, and the tumor markers were reduced remarkably (SCC 120--> 10 ng/mL). However, that therapy could also not be maintained because of the side effect. In July, she died of the cancer.

Solid/liquid interfaces are important locations for various chemical reactions, such as electrode chemical reactions and metal corrosions. Conventional surface analytical methods, such as XPS and SEM-EDS, have been applied to solid materials after being removed from the liquid phase. These methods do not involve direct observation, although useful information is available. It is important to directly observe surface reactions on solid materials in the liquid phase in order to understand the details of these reactions. One feasible method of doing this is 3D micro-XRF analysis. The confocal 3D micro XRF method enables nondestructive x-ray elemental analysis of localized microspace. We have applied a confocal 3D micro-XRF instrument for solid/liquid interface analysis. This technique was applied for direct observation of the chemical deposition of Cu on an Fe plate and the dissolution of Fe in a CuSO4 solution.

We demonstrate extremely efficient germanium-on-silicon metal-semiconductor-metal photodetectors with responsivities (R) as high as 0.85 A/W at 1.55 microm and 2V reverse bias. Ge was directly grown on Si by using a novel heteroepitaxial growth technique, which uses multisteps of growth and hydrogen annealing to reduce surface roughness and threading dislocations that form due to the 4.2% lattice mismatch. Photodiodes on such layers exhibit reverse dark currents of 100 mA/cm2 and external quantum efficiency up to 68%. This technology is promising to realize monolithically integrated optoelectronics.

A 68-year-old man was admitted to our hospital with left hemiparesis, unilateral spatial neglect, and anosognosia at nine hours after blunt neck trauma. Carotid ultrasonography and angiography revealed occlusion of the right common carotid artery. A second ultrasonographic examination detected a double lumen, intimal flap, and a movable thrombus at the occlusion site, with reversed flow in the external cerebral artery and antegrade flow in the internal cerebral artery. Magnetic resonance angiography showed occlusion of the M1 distal section of the right middle cerebral artery. We diagnosed dissection of the right common carotid artery and artery-to-artery embolism from the thrombus in the dissecting common carotid artery. We started anticoagulation on the second hospital day. The patient was able to walk independently at discharge. The finding of carotid dissection on ultrasonography varied during the acute phase. We observed a mural thrombus in the true lumen and vessel recanalization. Treated only by anticoagulants without surgical therapy, the patient had a good outcome without reattack or hyperperfusion syndrome.

We study quantum dynamics of the multichannel reactions of H(2)CO including the molecular and radical dissociation channels as well as the isomerization ones, H(2)CO-->trans-HCOH and trans-HCOH-->cis-HCOH. For this purpose, the previously developed potential energy function [T. Yonehara and S. Kato, J. Chem. Phys. 117, 11131 (2002)] is refined to give accurate transition state energies and to describe the radical dissociation channel. The cumulative reaction probabilities for the molecular dissociation and two isomerization channels are calculated by using the full Watson Hamiltonian. We also carry out wave packet dynamics calculations starting from the transition state region for the molecular dissociation. A contracted basis set for the angular coordinates is constructed to reduce the size of dynamics calculations. The intramolecular vibrational relaxation dynamics is found to be fast and almost complete within 300 fs. Using the energy filtered wave functions, the time propagation of HCOH population is obtained in the energy range from 81 to 94 kcal/mol. The branching ratio of the radical product is estimated by calculating the time dependent reactive fluxes to the molecular and radical dissociation products.

A 65-year-old woman experienced sudden positional vertigo with rightward, horizontal nystagmus that resolved within days. MRI revealed a left parietal lobe infarction involving the supramarginal gyrus. The patient experienced a transient recurrence of vertigo after 7 days but MRI failed to reveal the presence of any new lesions; furthermore, the patient's EEG was normal. We suggest that this patient's vertigo was due to her parietal cortical infarction.

We report 2 cases with cavernous sinus dural arteriovenous fistula (C-dAVF) presenting with headache as an initial symptom. A 70-year-old woman complained of acute persistent headache in the right temporal region. Another 74-year-old woman suffered from sudden and severe headache, developing from right-sided temporal throbbing to bilateral headache. Her condition was also complicated with cranial nerve deficits. These two patients were finally diagnosed as having C-dAVF based on the results of magnetic resonance angiography and cerebral angiography. It was difficult to make rapid diagnosis of C-dAVF in our patients, because they presented with headache alone but no typical symptoms of C-dAVF, such as proptosis, conjunctival injection or orbital bruit. C-dAVF should be considered as an important differential diagnosis in patients with headache.

In order to determine predictive factors of early seizures (ES) after acute stroke and to estimate prognosis, we retrospectively examined clinical data of 1,743 consecutive patients with acute ischemic stroke. The subjects were divided into two groups; an ES group (19 patients) and a non-ES group (1,724 patients). Multivariate statistical analysis revealed that the NIH-Stroke Scale score on admission (/10, OR, 1.1: 95% CI 1.04 to 1.13) and positive past history of cerebrovascular disease or brain injury (OR, 3.85: 95% CI 1.49 to 9.95) are significant factors to predict ES. There was no significant difference in the outcome between the two groups. A recurrence of seizures, after follow up for 4 to 40 months, was observed only in one patient with a history of ES.

We analysed retrospectively 15 consecutive patients with cerebral infarction undergoing decompressive craniectomy. Ninety-three percent of patients survived, and 53% of them were partially dependent (Barthel Index > 0). We defined the partially dependent patients as good outcome group, and totally dependent as poor outcome group. In good outcome group, compared with poor outcome group, there are more frequent left hemispheric lesion (50%: 0%, p = 0.029), and pre-operative JCS < or = II-30 (62.5%: 14.3%, p = 0.057). Although many patients were severely disabled, 79% of the patients and their family answered that having operation was correct choice. All the patients in good outcome group acquired the ability of oral feeding and communication skill. 87.5% of the patient in good outcome group was satisfied with the outcome. Based on these results, we emphasized that comprehensive evaluations, including satisfaction scale and QOL assessment necessary to decide the indication of decompressive craniectomy for ischemic stroke.

A 75-year-old man was admitted to our hospital because of high fever and disturbance of consciousness 4 days after dental treatment including scaling, irrigation, and oral antibiotic for dental caries without gingivitis. A lumber puncture revealed cloudy cerebrospinal fluid (CSF): it contained 984 leukocytes/mm3, 680 mg/dl of protein, 5 mg/dl of glucose (blood sugar 233 mg/dl), and Streptococcus oralis, one of common microorganisms on the gingival, was isolated from the CSF. He was successfully treated with intravenous antibiotics. The authors believe this patient's meningitis developed as a result of bacteremia after the dental scaling in the present case.

Objective: We investigated the efficacy of edaravone in patients with cardioembolic stroke., Methods: Cardioembolic stroke patients were treated with drip intravenous infusion of edaravone (ED group, n=141) for 7 days, and were retrospectively compared with a historical-controlled cohort of similar patients (control group, n=114)., Results: Early improvement (between day 0 and day 10), defined as change in National Institutes of Health Stroke Scale (NIHSS), was seen more frequently in mild patients (NIHSS on admission < or = 7) among the ED group than in the control group (change in NIHSS +2 vs. -2, respectively, p=0.013). Similar efficacy was not seen in the moderate to severe (NIHSS >7) patients. Independent patients (modified Rankin Scale < or = 2) 6 months after the onset were likely to be less frequent in the ED than the control group (28% versus 41%; p=0.066). Other clinical outcomes in the ED group were not significantly different from those in the control group., Conclusion: The results suggest that edaravone may only be effective in mild patients with cardioembolic stroke.

Clinical characteristics of mobile thrombus in the cervical carotid artery were investigated. In the 1,528 patients with acute ischemic stroke, mobile thrombi were detected by carotid echography in 14 patients (0.9%; mean 77 years-old; 8 women). Mean National Institutes of Health Stroke Scale was 19 on admission, and 24 on day 10. Mean modified Rankin Scale was 4.6 (dead in 2 patients) at discharge. MR angiography disclosed occlusion of the internal carotid artery in 11 of 14 patients. Mobile thrombi were divided into 3 subtypes: floating thrombus in 5 patients; mobile mural thrombus in 5; oscillating thrombus in 4. Followed echography showed occlusion of the internal carotid artery in 4 of 7 patients. Floating thrombus disappeared in one of 5 patients without clinical recurrence. Although surgical treatment including carotid endarterectomy was not performed in all of the present cases, clinical recurrence during admission was seen in only one patient with embolic stroke in the contralateral internal carotid artery of the mobile thrombus.

The purpose of this study was to determine factors that extend the length of hospital stay in patients with ischemic stroke in acute hospital. Clinical data of 462 consecutive patients with acute ischemic stroke were retrospectively researched. These subjects were divided into two groups; short stay group (length of hospital stay < or = 14 days, 238 patients) and long stay group (length of hospital stay > 14 days, 224 patients). Using multivariate statistical methods, the independent factors associated with prolonged hospital stay were investigated. Independent and significant factors associated with prolonged hospital stay were National Institutes of Health Stroke Scale score on admission (OR, 1.072: 95% CI, 1.021 to 1.125), transient ischemic attack (OR, 0.142: 95% CI, 0.021 to 0.966), any complications during hospital stay (OR, 7.975: 95% CI, 3.539 to 17.971) and interval between offer to discharge (OR, 1.441: 95% CI, 1.294 to 1.605). It was suggested that control of complication could decrease length of hospital stay in patients with ischemic stroke in acute hospitals.