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A 61-year-old woman presented with acute intense lower back pain and weakness in her left leg. She also presented with throbbing headache on the same day. On admission, muscle weakness in her left leg, lower left quadrantanopia and left lower extremity deep sensory disturbance were observed. Laboratory data showed no coagulopathy and autoimmune antibody was negative. Cerebrospinal fluid examination showed bloody and inflammatory findings. Brain MRI revealed cerebral infarction with multiple intracranial arterial stenosis and convexal subarachnoid hemorrhage. Spinal MRI revealed spinal hemorrhage in the cervical, thoracic, and part of the lumbar spine. Because these lesions occurred simultaneously, we made a diagnosis of vasculitis. After high dose corticosteroids therapy was undertaken, the multiple arterial stenosis improved. Primary angiitis of the central nervous system is sometimes difficult to distinguish from reversible cerebral vasoconstriction syndrome in its initial stage; although symptoms, examination findings and treatment differ in both.

In this study, we systematically investigated microstructures and tensile properties of an Al&ndash, 12mass%Si alloy additive-manufactured by laser powder bed fusion (LPBF) process and subsequently annealed at various temperatures. Microstructure of the as-fabricated sample was characterized by a number of melt pools consisting of &alpha, Al phases surrounded by Si eutectic phases. Fine Si precipitates were observed in the &alpha, Al phase in the sample annealed at 200 &deg, C. The eutectic Si phase appears to agglutinate, resulting in a coarsened Si phase formed at high temperatures above 300 &deg, C. The initial cellular microstructure completely disappears and a number of coarsened Si phases and plate-shaped intermetallic phases (&beta, AlFeSi) were formed in the sample annealed at 530 &deg, C. However, the grain morphology of the &alpha, Al matrix slightly changed after the annealing at high temperatures. The as-fabricated specimen showed a high strength above 400 MPa and a low ductility of below 10% in total elongation. The tensile ductility varied depending on the tensile direction. The annealed specimens exhibited a lower tensile strength and larger elongation, whereas the direction dependence of the tensile properties was less pronounced in the specimens annealed at higher temperatures. The anisotropic tensile ductility can be rationalized by preferential fractures occurred around melt pool boundaries.

Objective The objective of the study is to demonstrate the utility of near-infrared spectroscopy (NIRS) in evaluating chest compression (CC) quality in cardiac arrest (CA) patients as well as determine its prognosis predictive value. Methods We present a nonconsecutive case series of adult patients with CA whose cardiopulmonary resuscitation (CPR) was monitored with NIRS and collected the total hemoglobin concentration change ( Δ cHb), the tissue oxygen index (TOI), and the Δ TOI to assess CC quality in a noninvasive fashion. Results During CPR, Δ cHb displayed waveforms monitor, which we regarded as a surrogate for CC quality. Total hemoglobin concentration change waveforms responded accurately to variations or cessations of CCs. In addition, a TOI greater than 40% measured upon admission appears to be significant in predicting patient's outcome. Of 15 patients, 6 had a TOI greater than 40% measured upon admission, and 67% of the latter were in return of spontaneous circulation after CPR and were found to be significantly different between return of spontaneous circulation and death ( P = .047; P Conclusion Near-infrared spectroscopy reliably assesses the quality of CCs in patients with CA demonstrated by synchronous waveforms during CPR and possible prognostic predictive value, although further investigation is warranted.

This report describes the case of a 47-year-old man who shot himself in the left side of the chest in an attempted suicide, and was transferred to the hospital. Two gunshot wounds were found in the left side of the chest and the back. CT scans revealed left hemopneumothorax, the accumulation of pericardial blood, and lacerations of the heart and the spleen. Emergency thoracotomy and laparotomy were performed. There was a contusion of the left lung and lacerations of the left ventricular free wall, the diaphragm, and the spleen. The laceration of the heart was repaired by 3 pairs of mattress sutures with felt strips, and covered with fibrin glue and a TachoComb(®) tissue sealing sheet without the use of cardiopulmonary bypass. The patient was discharged on foot on the 18th postoperative day. Such patients can only be saved with an efficient emergency medical-care system including quick transportation, and close cooperation of the hospital staff.

Purpose: Tissue dysoxia is thought to be a fundamental cause of the organ failure that occurs as a result of shock. Plasma lactate has been frequently measured as an indicator of the state of systemic tissue metabolism. On the other hand, tissue lactate levels can directly indicate a disorder in the state of cytological tissue metabolism. The continuous monitoring of lactate levels in subcutaneous tissue will reflect the state of tissue dysoxia more precisely than levels of lactate in the plasma lactate. We have investigated the differences in the levels of plasma and tissue lactate using a microdialysis (MD) technique in an animal septic shock model. Method: Male 8-week-old Wistar/ST rats were used. We prepared an animal model by injection of lipopolysaccharide (LPS) into the abdominal cavity. LPS was given to 9 animals in the experimental group while physiological saline was given to 6 animals in the control group. A MD probe was used to quantify the lactate levels in the subcutaneous tissue. The mean arterial pressure, blood gas content and lactate levels were measured every 50 min up to 400 min after injection and compared between both groups. Result: The MAP of both groups showed similar changes after injection. Plasma lactate levels in the LPS group showed a significant increase after 100 min and reached a plateau from 150 min to 250 min. Subcutaneous lactate in the LPS group showed a significant increase after 150 min. Subcutaneous pyruvate in the LPS group showed a significant increase after 100 min. The lactate/pyruvate (L/P) ratio in the subcutaneous tissue showed a sustained increase from 300 min in the LPS group. Conclusion: Monitoring plasma lactate levels is useful for the early assessment of anaerobic metabolism before hypotension. Plasma lactate levels did not increase during some periods. This phenomenon was due to the balance between production and utilization. However, tissue lactate showed a chronological increase. These results suggest that the measurement of tissue lactate levels is reliable for assessing local energy metabolic disturbances. Under conditions of septic shock, an increase in lactate levels was found to be a sensitive marker of tissue metabolism disorder.

The present experiments were carried out to investigate the usefulness of measuring peripheral tissue metabolism for the clinical assessment of shock. Male Wistar/ST rats (8 weeks-old) were used. All rats were placed in a supine position while anesthetized. A tube for measuring arterial pressure and collecting blood samples was cannulated into the femoral artery. For microdialysis, the introducer was inserted into the subcutaneous tissue in the abdominal wall. Blood was exsanguinated to maintain the mean arterial pressure at 40 +/- 5 mmHg. Mean arterial pressure, arterial blood gas and serum lactate levels were measured. Microdialysis was performed to quantify the levels of lactate and pyruvate in the subcutaneous tissue. Six rats died due to hemorrhagic shock by 350 min (Group D) while six rats had survived for the 350 min period after exsanguination (Group A). These data was obtained at intervals of 50 min after exsanguination up to a period of 250 min and compared between Groups A and D. In Group A, serum lactate levels did not increase throughout the entire period of observation. Serum lactate levels in Group D transiently increased, but did not show a dramatic increase during the blood pressure maintenance period. In particular, serum lactate levels increased again after a period of more than 150 min following exsanguination. Lactate levels in the subcutaneous tissue gradually increased and were significantly higher in Group D than that in Group A after 150 min. The L/P ratio in Group A remained fairly constant during the period of observation. In contrast, the L/P ratio in Group D increased gradually, and was significantly higher than that in Group A after 100 min. It was concluded that the continuous increase in the L/P ratio in the subcutaneous tissue in Group D was indicative of tissue circulatory failure and of an abnormality in tissue oxygen metabolism prior to the detection of the collapse of compensatory mechanisms appearing in the vital signs. These findings suggest that measuring the L/P ratio is useful for the clinical assessment and monitoring of shock.

A 15-year-old boy with a neck injury transferred to our emergency room was alert and cooperative. During surgical closure of the wound, he vomited and became somnolent. A piece of brain tissue was found in vomit. Computed tomography (CT) showed pneumocephalus and a small hemorrhage in the left frontal lobe. Surgery undertaken found an irregular bone defect in the plamun sphenoidale and a dural laceration in the frontal base. The dura of the left frontal convexity was also lacerated. These findings suggested that an unknown foreign body penetrated the right lateral neck and the skull base through the nasopharynx, then reached up to the frontal bone. Postoperative course was uneventful. He witnessed later that he hit his neck on to an iron rod protruding from concrete blocks when he fell. He had known that this rod had penetrated his neck. Orbitocranial stab wounds may associate penetrating brain injuries, but it seems quite rare that a cervical stab wound complicated a penetrating brain injury. It should be stressed that physicians and paramedics must glean information about the modality of penetrating injuries.

CdF2/CaF2 resonant tunneling diode (RTD) structures of 100 nm diameter were fabricated in SiO2 hole arrays formed on Si(100) substrates. RTD structures were grown by molecular beam epitaxy (MBE) in SiO2 hole arrays. After the growth of the initial CaF2 layer at a substrate temperature of 120 °C, in situ annealing at 500 °C was carried out to reduce the density of defects or pinholes in the barrier layer. In the measurement of current–voltage (I–V) characteristics, negative differential resistance (NDR) was clearly demonstrated at room temperature. The peak-to-valley current ratio (PVCR) was 106. The valley current was significantly suppressed. Results obtained here strongly indicates that the RTD structures proposed in this study are promising for high-quality NDR elements compatible with Si LSI technology based on Si(100) substrates.

It is generally believed that TCD is not helpful in detecting intracranial aneurysms smaller than 15mm in diameter, to despite great improvement in technology of transcranial Doppler (TCD) in transcranial Doppler angiography (TCDA), three dimentional transcranial Doppler (3D-TCD) and transcranial color flow image (TCFI) . So far there haven't been any reports to challenge this theory. In this study, we examined a 50-yearold female with diffuse subarachnoid hemorrhage. We were able to detect four aneurysms in this patient. The size of aneurysms ranged from 2mm to 9mm in diameter using TCFI under the following criteria before cerebral angiography. We conducted the experiment as follow:1) Set up sample volume from 1.5 × 1.0mm to 3.0 × 1.0mm.2) Carefully scanned the captured artery.3) Detected an appendage structure with pathological blood flow near the normal cerebral artery using axial and coronal view in B-mode scan.4) Detected a pathlogical color-flow image with Doppler sonogram, which indicates a turbulent flow.5) Found normal flow pattern at the proximal and distal portions of the turbulent flow region.This is the first report showing the turbulent flow of small cerebral aneurysms using B-mode scan and Doppler son ogram.We believe that our report indicates the reliability of TCFI for screening unruptured cerebral aneurysms.

The authors have demonstrated the crystal growth of CaF2∕CdF2∕CaF2 multilayered heterostructures on Si(100) substrates as double-barrier resonant tunneling diode structures by a low-temperature growth technique. Current-voltage characteristics were investigated and the authors observed negative differential resistance (NDR) characteristics at room temperature. The peak-to-valley current ratio was 2–8, and 13 at maximum, and peak current density was 80–90A∕cm2. The quantum-well layer thickness dependence of NDR peak voltages is also discussed on the basis of qualitative analytical model using the Esaki-Tsu formula.