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Background: The superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery requires an anastomosis of the STA to an MCA with diminished blood flow. However, identifying the precise location of the MCA with reduced flow preoperatively is challenging as it often remains nonvisualized. To address this issue, we developed a novel technique, the area target bypass (ATB) method, to infer the location of the responsible vessel for low-flow areas. Objective: The cornerstone of the ATB method lies in the utilization of the vascular fusion map (VFM). The VFM integrates 3D perfusion and 3D vascular images, enabling simultaneous evaluation of cerebral surface vessels and regions with reduced blood flow. This study aimed to assess the efficacy of the STA-MCA bypass surgery adopting the ATB method. Methods: Between August 2022 and March 2023, we conducted eight STA-MCA bypass surgeries using the ATB method. For each case, the VFM was generated using the MTT and DLY parameters, and blood flow improvement was evaluated based on the VFM score, determined by an average score from seven experts. Results: In all cases, the target vessel was identified either preoperatively or during craniotomy, with postoperative patency of the STA-MCA bypass confirmed. Out of the eight cases, seven demonstrated improved blood flow with a VFM score exceeding 1. No complications were reported. Conclusion: The introduction of the ATB method has proven its potential in accurately pinpointing optimal anastomosis sites. Keywords: 3D-image, bypass, diagnosis, surgery, Author(s): Riki Tanaka (corresponding author) [1]; Dragan Jankovic [1,2]; Tomoko Katayama [3]; Mai Okubo [3]; Kento Sasaki [1]; Takamitsu Tamura [1]; Yasuhiro Yamada [1]; Fuminari Komatsu [1]; Yoko Kato [1] [...]

Aneurysm arising from the A1 segment of the anterior cerebral artery is rare. Aneurysm of the A1 segment even being small tend to rupture early. They tend to develop along the with various vascular anomalies of the vessels arising from the A1 segment. Use of computational fluid dynamics and hemodynamic consideration is of importance in this aneurysm. In this report we describe a 57-year-old woman with a small, unruptured A1 segment aneurysm arising from the proximal segment of the posterior surface of A1, and pointing posterior-inferiorly with multiple perforators entangling around for which microsurgical clipping was done. Intraoperative clipping of the aneurysm and salvaging the multiple perforators were challenging. We report a rare case of an A1 segment aneurysm arising from the posterior surface facing with multiple perforators. It is of significance to understand that a small, unruptured A1 aneurysm can arise from the posterior surface of the A1 segment with projection posterior-inferiorly making it deeper in location with multiple perforators entangling it; hence, it is challenging to treat without causing neurological deficits. [ABSTRACT FROM AUTHOR]

Introduction Job satisfaction is a professional aspect that contributes to the achievement of objectives in general and in the health sector; it is a golden standard for having quality care. The satisfaction of nurses is a path toward humanized nursing. This article aims to evaluate the job satisfaction among nurses of the neurosurgery department at Bantane Hospital. Materials and Methods We conducted a cross-sectional study including 74 nurses at Bantane Hospital in Nagoya Japan in August 2023. Nurses responded to a questionnaire relating to job satisfaction. Univariate analysis was supported by bivariate analyses at the 95% significance level. Results The survey revealed that nurses aged between 18 and 29 were mostly represented (62.2%). Drip-injection medication was the most preferred activity (15 times) by Bantane nurses. The satisfaction rate was 63.5% and the fact of considering nurses point of view, good interpersonal relationships, and a considerable lunchtime period was statistically significant (p < 0.05). Conclusion Transcendental motivation is a priority in the approach to humanize nursing by considering both monetary and nonmonetary incentives to motivate nurses. [ABSTRACT FROM AUTHOR]

Trigeminal neuralgia is a nerve disorder that causes unilateral severe facial pain. The clinical features of trigeminal neuralgia are agonizing, paroxysmal, anticipated in one or more divisions of the trigeminal nerve, with repetitive bursts of a few seconds, exacerbated by cutaneous stimuli. Microvascular decompression is proven effective, resulting in a positive outcome. Here, we report two cases of trigeminal neuralgia associated with the vertebral artery, who underwent endoscopic microvascular decompression. This case report aims to show the benefit of computational fluid dynamics evaluation of the neurovascular contact and its effect on change in wall shear stress magnitude of the offending vertebral artery after surgical management with microvascular decompression. [ABSTRACT FROM AUTHOR]

The article discusses the potential of nurse practitioners (NPs) to address the shortage of primary care physicians and meet the increasing demand for healthcare services, particularly among the elderly population. NPs are registered nurses with advanced training and clinical competencies who can provide a wide scope of care. The article highlights the global growth of the NP workforce and the different titles used in various countries. It also explores the role of NPs in primary care and acute care settings, as well as their potential to increase access to healthcare services and reduce costs. The article mentions the history of NPs in Japan and their expanding role. Overall, the article suggests that utilizing NPs effectively can strengthen the healthcare workforce and meet the growing healthcare demands in both developed and underserved areas. [Extracted from the article]

Objectives To investigate metabolite alterations in the plasma of SLE patients to identify novel biomarkers and provide insight into SLE pathogenesis. Methods Patients with SLE (n  = 41, discovery cohort and n  = 37, replication cohort), healthy controls (n  = 30 and n  = 29) and patients with RA (n  = 19, disease control) were recruited. Metabolic profiles of the plasma samples were analysed using liquid chromatography-time-of-flight mass spectrometry and capillary electrophoresis-time-of-flight mass spectrometry. Transcriptome data was analysed using RNA-sequencing for 18 immune cell subsets. The importance of histidine (His) in plasmablast differentiation was investigated by using mouse splenic B cells. Results We demonstrate that a specific amino acid combination including His can effectively distinguish between SLE patients and healthy controls. Random forest and partial least squares-discriminant analysis identified His as an effective classifier for SLE patients. A decrease in His plasma levels correlated with damage accrual independent of prednisolone dosage and type I IFN signature. The oxidative phosphorylation signature in plasmablasts negatively correlated with His levels. We also showed that plasmablast differentiation induced by innate immune signals was dependent on His. Conclusions Plasma His levels are a potential biomarker for SLE patients and are associated with damage accrual. Our data suggest the importance of His as a pathogenic metabolite in SLE pathogenesis. [ABSTRACT FROM AUTHOR]

Background: Careful evaluation of the preoperative imaging for extracranial-intracranial bypass performed for conditions like intracranial stenosis and Moya disease is important. The traditional use of 2D imaging has a significant limitation for neurosurgeons, primarily to determine the optimal location of the recipient artery for performing the surgical bypass. Therefore, many neurosurgeons use 3D angiograms more frequently to overcome these shortcomings.Materials And Methods: We performed the preoperative evaluation of the possibility of performing an anastomosis between the superficial temporal artery and the middle cerebral artery (STA-MCA) bypass by synthesizing images of computerized tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) using Amira® of 3D visualization analysis software (Thermo Scientific Co.).Results: The 3D images prepared before surgery using this software showed good agreement with the intraoperative findings.Conclusion: Preoperative image processing using tools like Amira provide optimal information for good planning and communication for performing STA-MCA bypass and may become a helpful tool. [ABSTRACT FROM AUTHOR]

Background: Careful evaluation of the preoperative imaging for extracranial-intracranial bypass performed for conditions like intracranial stenosis and Moya disease is important. The traditional use of 2D imaging has a significant limitation for neurosurgeons, primarily to determine the optimal location of the recipient artery for performing the surgical bypass. Therefore, many neurosurgeons use 3D angiograms more frequently to overcome these shortcomings.Materials And Methods: We performed the preoperative evaluation of the possibility of performing an anastomosis between the superficial temporal artery and the middle cerebral artery (STA-MCA) bypass by synthesizing images of computerized tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) using Amira® of 3D visualization analysis software (Thermo Scientific Co.).Results: The 3D images prepared before surgery using this software showed good agreement with the intraoperative findings.Conclusion: Preoperative image processing using tools like Amira provide optimal information for good planning and communication for performing STA-MCA bypass and may become a helpful tool. [ABSTRACT FROM AUTHOR]

Objectives: To describe the long-term clinical course of each manifestation of Behçet's disease (BD) and clarify factors involved in oral ulcer (OU) remission using clinical information of BD patients., Methods: We retrospectively studied 155 BD patients visiting our hospital (1989-2020). We defined remission criteria for each manifestation and examined long-term clinical changes. Classification and regression trees and multivariable analyses were performed to investigate OU prognostic factors; hazard ratios were used to assign scores to prognostic factors deemed significant [OU prognosis score (OuP score)]. Risk stratification was examined by dividing the OuP scores into four stages., Results: OUs appeared earliest, with the slowest decline in prevalence observed post-BD diagnosis. OU presence was the most common factor inhibiting complete remission. Young age at OU onset, never smoker, presence of genital ulcers, positive pathergy test, no usage of tumour necrosis factor inhibitors or of immunosuppressants, and long-term non-treatment or symptomatic treatment for OUs were poor OU prognostic factors. Based on multivariable analysis, the area under the curve of the OuP score to predict OU prognosis was 0.678., Conclusions: Remission criteria for each symptom clarified that OU had the greatest impact on complete BD remission. Faster OU remission was associated with earlier OU therapeutic intervention other than symptomatic treatment., (© Japan College of Rheumatology 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)