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Systemic amyloidosis is a diseased condition where misfolded proteins deposit in various organs in the form of amyloids, and transthyretin deposition, termed ATTR amyloidosis, can be either an age-related amyloid formation from misfolded wild-type TTR (ATTRwt) or by hereditary TTR malfunction due to mutation in the TTR gene (ATTRv). Although ATTRwt amyloidosis can cause various diseases, such as cardiac failure, conduction disturbances, arrhythmias and carpal tunnel syndrome, it is still under-recognised considering its clinical significance. Here the authors report a case of ATTRwt amyloidosis leading to carotid stenosis requiring surgical intervention. To the best of our knowledge, the current report is the first that described histopathological evidence of amyloid deposition in the carotid artery due to ATTRwt amyloidosis.

Surgical treatment of idiopathic normal pressure hydrocephalus (iNPH) by ventriculoperitoneal (VP) or lumboperitoneal (LP) shunting can achieve long-term recovery of activities of daily living; however, in a subset of patients, maintenance of independence lasted for6 months. This study examined positive preoperative predictive factors of short-term outcome for shunted iNPH patients.Over a 9-year period, consecutive patients from multiple centers diagnosed with probable iNPH underwent either VP or LP shunt surgery. Preoperative variables of age, symptom duration, iNPH severity, tap test response, and magnetic resonance imaging findings of disproportionately enlarged subarachnoid space hydrocephalus (DESH) or incomplete DESH were retrospectively evaluated in relation to 1-year postoperative outcome.Outcome for 154 shunt patients (12 VP, 142 LP) as measured by postoperative disability modified Rankin Scale (mRS) and iNPH-gait disturbance (GD) was the same regardless of age. Symptom duration was inversely correlated with both iNPH severity (P0.0001) and postoperative improvement at 1 year (P = 0.0015). Severity also correlated inversely with postoperative improvement at 1 year (P0.0001). Age was not significantly correlated with the degree of postoperative improvement (mRS: P = 0.487; iNPH grading scale [GD]: P = 0.725). Outcome at 1 year (mRS, gait domain, and activities of daily living significantly improved in patients with a good response to the tap test (P0.0001) Preoperative DESH correlated with improvement in mRS and GD (P0.0001).Mild preoperative iNPH severity, shorter preoperative symptom duration, good tap test response, and complete DESH were associated with good short-term postoperative outcome at 1 year. These positive factors may be useful for prediction of short-term surgical outcome in iNPH patients.

The present research reports thermoset nanocomposites reinforced with cotton fibres extracted from textile waste called as ‘shoddy’ and graphite oxide nanoparticles as filler. The oriented fibre web of shoddy was produced by using the carding machine and it was used as reinforcement. The thermoset epoxy composites with four different fibre volume fraction values namely 0.1, 0.2, 0.3 and 0.4 were developed. These composites were characterized by mechanical properties to optimize the fibre volume fraction. Further, thermoset epoxy nanocomposites were developed by incorporating graphite oxide nanoparticles as filler in four different weight percentages, namely 0.1, 0.3, 0.5 and 1%. All the composites were characterized for mechanical properties, dynamic mechanical properties, thermal degradation behaviour and water absorption behaviour. It has been found that the developed composites can be used in items of furniture materials and to develop some visible and non-visible automotive components.

Objectives There is no clear evidence regarding when to initiate oral anticoagulants (OACs) for secondary prevention of recurrent stroke in patients with atrial fibrillation (AF). Therefore, this study aimed to evaluate the safety and efficacy of a novel OAC initiation protocol for secondary prevention of acute ischemic stroke associated with AF. Materials and methods In this multicenter prospective study 597 consecutive Japanese patients with acute ischemic stroke associated with nonvalvular AF received post-stroke OACs according to a protocol based on severity (clinical (NIHSS) and radiological (ASPECTS + W)), rt-PA use, reperfusion, and hemorrhagic transformation (HT). Primary outcomes of safety and efficacy, including symptomatic hemorrhage, cerebral stroke, and disability were evaluated at 14 and 90 days. Results Mean OAC initiation time was 2.60±2.14 days from onset. The shortest and longest mean initiation times were 0.47±0.50 and 6.16±0.72 days, respectively. Following OAC administration, no ICH was observed within 90 days. A significantly higher incidence of acute recurrent ischemic events occurred 14 days prior to OAC (4.7%) compared with chronic recurrence within 90 days (0.8%) (P = 0.00013, McNemar's test) . Recurrence prior to OAC use was significantly correlated with days to treatment (P = 0.00224), severity (NIHSS, ASPECTS+W: P = 0.0223, P = 0.0393, respectively), and HAS-BLED (P = 0.0395) and there were no correlations with CHADS2 (P = 0.277) or CHA2DS2-VASc (P = 0.246) (Wilcoxon rank sum-test). Conclusions This comprehensive OAC initiation protocol was relatively safe and effective for secondary prevention of stroke in patients with AF. Risk of acute recurrence was high, indicating that OACs should be started as early as possible. (clinical trial registration number: 15B 128)

OBJECTIVE “Join,” an imaging technology–based telemedicine system, allows simultaneous radiological information sharing between physically remote institutions, virtually connecting advanced medical institutions and rural hospitals. This study aimed to elucidate the health economics effect of Join for neurological telemedicine in rural areas in Hokkaido, Japan. METHODS Information concerning 189 requests for patient transfer from Furano Kyokai Hospital, a regional rural hospital, to Asahikawa Medical University Hospital (AMUH), an advanced academic medical institution, was retrospectively collected. The Join system was established between Furano Kyokai Hospital and AMUH in February 2019. Data collected from patients between April 2017 and December 2018 were included in the non-Join group, and those collected between February 2019 and October 2020 were included in the Join group. Clinical variables, reasons for patient transfer requests, duration of hospital stay, and medical costs per patient were analyzed between these two groups. Furthermore, clinical characteristics were compared between patients who were transferred and not transferred based on Join. RESULTS More patients were discharged < 7 days after transfer to AMUH in the non-Join group compared with the Join group (p = 0.02). When focusing on the Join group, more patients who were not transferred were discharged < 1 week (p < 0.01). On the other hand, more patients required surgery (p = 0.01) when transferred. The ratio of patients whose medical cost was < USD5000 substantially decreased, from 33% for the non-Join group to 13% for the Join group. CONCLUSIONS An imaging technology–based telemedicine system, Join, contributed to reducing unnecessary neuro-emergency patient transfer in a remote rural area, and telemedicine with an integrated smartphone system allowed medical personnel to effectively triage at a distance neuro-emergency patients requiring advanced tertiary care.

Introduction Our previous community-based study demonstrated that some individuals with AVIM [asymptomatic ventriculomegaly with features of idiopathic normal pressure hydrocephalus (iNPH) on magnetic resonance imaging (MRI)] progressed to iNPH in several years. In this hospital-based study, we investigated the progression rate from AVIM to iNPH and its possible predictors. Methods We conducted a prospective study of participants with AVIM from several medical institutions/hospitals in Japan. AVIM is defined as “asymptomatic ventriculomegaly with features of iNPH on MRI”; in the present study, asymptomatic was defined as “0 (no symptoms) or 1 (presence of only subjective, but not objective, symptoms) on the iNPH Grading Scale (iNPH-GS).” We also measured possible predicting factors for AVIM-to-iNPH progression, including age, sex, body weight, blood pressure, diabetes mellitus, dyslipidemia, history of mental disease/head injury/sinusitis/smoking/alcohol-intake, Evans index, and the presence of DESH (disproportionately enlarged subarachnoid-space hydrocephalus) findings on brain MRI, and analyzed these potential predictive values. Results In 2012, 93 participants with AVIM were registered and enrolled in the study. Of these, 52 participants were able to be tracked for three years (until 2015). Of the 52 participants, 27 (52%) developed iNPH during the follow-up period (11 definite, 6 probable, and 10 possible iNPH), whereas 25 participants remained asymptomatic in 2015. Among the possible predictive factors examined, the baseline scores of iNPH-GS predicted the AVIM-to-iNPH progression. Conclusions The multicenter prospective study demonstrated that the progression rate from AVIM to iNPH was ~17% per year, and the baseline scores of iNPH-GS predicted the AVIM-to-iNPH progression.

Currently, shortage of trainers for visually impaired people with professional knowledge is a big problem in Japan (Japan Ministry of Health in Labour and Welfare: Annual Report on Government Measures for Persons with Disabilities, 2014; Fukui in Nippon Hojyoken Kagaku Kenkyu 2(1), 22–25, 2008) [1, 2]. In addition, children with congenital blindness are so difficult to learn to walk by themselves, because they cannot get the visual image. In this research, the authors aim to develop a new support device for walking training that can rise for visual impairment and visually impaired children’s spatial perception. The method involves three stages of training, hand cart type stage, wearable type stage, and final stage. The authors focus on developing a safe, lightweight walking support system that can be worn in children’s waist belt at the second and the third stage. In this paper, the authors proposed the wearable type walking support system that consists of infrared sensor and ultrasonic wave sensor. In addition, the equipment is used at each stage so that it can finally walk independently.

In this paper, our research group examines obstacle avoidance by sound to support visually impaired children, because it is estimated that there are 1.4 million visually impaired children in the world. For that reason, we have developed a walking training device for these children. This paper demonstrates obstacle avoidance by sound as an elemental technology of the device. An obstacle transmission element outputs different sounds depending on the position of the obstacle. In particular, the element calculates the distance from the child to the obstacle by values from another elemental technology. After that, the element selects a sound using the distance and obstacle coordinates, and outputs the sound. For an evaluation of the elemental technology, we conducted an evaluation experiment to confirm that the sound correctly corresponds with the distance to the obstacle. As a result, we confirmed that the device could calculate distance and output different sounds correctly.

OBJECTIVEThe study aim was to assess the influence of presurgical clinical symptom severity and disease duration on outcomes of shunt surgery in patients with idiopathic normal-pressure hydrocephalus (iNPH). The authors also evaluated the cerebrospinal fluid tap test as a predictor of improvements following shunt surgery.METHODSEighty-three patients (45 men and 38 women, mean age 76.4 years) underwent lumboperitoneal shunt surgery, and outcomes were evaluated until 12 months following surgery. Risks for poor quality of life (Score 3 or 4 on the modified Rankin Scale [mRS]) and severe gait disturbance were evaluated at 3 and 12 months following shunt surgery, and the tap test was also conducted. Age-adjusted and multivariate relative risks were calculated using Cox proportional-hazards regression.RESULTSOf 83 patients with iNPH, 45 (54%) improved by 1 point on the mRS and 6 patients (7%) improved by ≥ 2 points at 3 months following surgery. At 12 months after surgery, 39 patients (47%) improved by 1 point on the mRS and 13 patients (16%) improved by ≥ 2 points. On the gait domain of the iNPH grading scale (iNPHGS), 36 patients (43%) improved by 1 point and 13 patients (16%) improved by ≥ 2 points at 3 months following surgery. Additionally, 32 patients (38%) improved by 1 point and 14 patients (17%) by ≥ 2 points at 12 months following surgery. In contrast, 3 patients (4%) and 2 patients (2%) had worse symptoms according to the mRS or the gait domain of the iNPHGS, respectively, at 3 months following surgery, and 5 patients (6%) and 3 patients (4%) had worse mRS scores and gait domain scores, respectively, at 12 months after surgery. Patients with severe preoperative mRS scores had a 4.7 times higher multivariate relative risk (RR) for severe mRS scores at 12 months following surgery. Moreover, patients with severe gait disturbance prior to shunt surgery had a 46.5 times greater multivariate RR for severe gait disturbance at the 12-month follow-up. Patients without improved gait following the tap test had multivariate RRs for unimproved gait disturbance of 7.54 and 11.2 at 3 and 12 months following surgery, respectively. Disease duration from onset to shunt surgery was not significantly associated with postoperative symptom severity or unimproved symptoms.CONCLUSIONSPatients with iNPH should receive treatment before their symptoms become severe in order to achieve an improved quality of life. However, the progression of symptoms varies between patients so specific timeframes are not meaningful. The authors also found that tap test scores accurately predicted shunt efficacy. Therefore, indications for shunt surgery should be carefully assessed in each patient with iNPH, considering the relative risks and benefits for that person, including healthy life expectancy.

Background:The 3-meter Timed Up and Go test (TUG) is a reliable quantitative test for assessment of gait and balance. We aimed to establish an optimal threshold of TUG at the tap test for predicting outcomes 12 months after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).Methods:The TUG was measured in a total of 151 patients with possible iNPH before and after a tap test and 12 months after shunt surgery. Among them, 81 patients underwent ventriculoperitoneal shunt implantation (SINPHONI) and 70 underwent lumboperitoneal shunt implantation (SINPHONI-2). The areas under the curve (AUCs), sensitivities, and specificities for predicting shunt effectiveness were assessed.Results:The simple differences of time on TUG at the tap test were significantly more accurate for predicting shunt effectiveness than percent improvement of time. The highest AUC for the synchronized moving cutoff point of TUG time was 0.81 (sensitivity 81.0%; specificity 81.6%) at the threshold of 5 seconds in the SINPHONI-2. For predicting improvements of ≥10 seconds 12 months after lumboperitoneal shunt implantation, the AUC was 0.90, and the sensitivity and specificity at the threshold of 5.6 seconds were 83.3% and 81.0%. Only for patients with a Conclusions:An improvement of 5 seconds was a useful threshold of TUG time at the tap test for predicting a ≥10-second improvement 12 months after shunt surgery, rather than the percent improvement of TUG time.

The dynamic mixing power required for mulling process of green mold sands was measured by using various types of kneaders and binding materials. A series of tensile tests for the green mold sands were carried out. The surface structures of the sands were also observed by a scanning electron microscope. The state of mulling of the sands was found to be successfully correlated with the tensile strength, the tensile breakup energy and the compression characteristics of the sands. It was also found that the completeness of mulling process could be assessed by observing the steadiness of the power for mulling, and that it could be evaluated in terms of the tensile breakup energy. The more the power for mulling was required, the better the state of mulling was.

We showed that ventriculoperitoneal (VP) shunt and lumboperitoneal (LP) shunt surgeries are beneficial for patients with idiopathic normal pressure hydrocephalus (iNPH) in the Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement (SINPHONI; a multicenter prospective cohort study) and in SINPHONI-2 (a multicenter randomized trial). Although therapeutic efficacy is important, cost-effectiveness analysis is equally valuable. Using both a set of assumptions and using the data from SINPHONI and SINPHONI-2, we estimated the total cost of treatment for iNPH, which consists of medical expenses (e.g., operation fees) and costs to the long-term care insurance system (LCIS) in Japan. Regarding the natural course of iNPH patients, 10% or 20% of patients on each modified Rankin Scale (mRS) show aggravation (aggravation rate: 10% or 20%) every 3 months if the patients do not undergo shunt surgery, as described in a previous report. We performed cost-effectiveness analyses for the various scenarios, calculating the quality-adjusted life year (QALY) and the incremental cost-effective ratio (ICER). Then, based on the definition provided by a previous report, we assessed the cost-effectiveness of shunt surgery for iNPH. In the first year after shunt surgery, the ICER of VP shunt varies from 29,934 to 40,742 USD (aggravation rate 10% and 20%, respectively) and the ICER of LP shunt varies from 58,346 to 80,392 USD (aggravation rate 10% and 20%, respectively), which indicates that the shunt surgery for iNPH is a cost-effective treatment. In the 2nd postoperative year, the cost to the LCIS will continue to decrease because of the lasting improvement of the symptoms due to the surgery. The total cost for iNPH patients will show a positive return on investment in as soon as 18 months (VP) and 21 months (LP), indicating that shunt surgery for iNPH is a cost-effective treatment. Because the total cost for iNPH patients will show a positive return on investment within 2 years, shunt surgery for iNPH is a cost-effective treatment and therefore recommended. The SINPHONI-2 study was registered with the University Hospital Medical Information Network Clinical Trials registry: UMIN000002730) SINPHONI was registered with ClinicalTrials.gov, no. NCT00221091.

Background and Purpose: The optimal use of antiplatelet therapy for intracranial branch atheromatous disease (BAD) is not known. Methods: We conducted a prospective multicenter, single-group trial of 144 consecutive patients diagnosed with probable BAD. All patients were treated within 12 h of symptom onset to prevent clinical progression using dual antiplatelet therapy with cilostazol plus one oral antiplatelet drug (aspirin or clopidogrel). Endpoints of progressive BAD in the dual therapy group at 2 weeks were compared with a matched historical control group of 142 patients treated with single oral antiplatelet therapy using either cilostazol, aspirin, or clopidogrel. Results: Progressive motor paresis occurred in 14 patients (9.7%) in the aggressive antiplatelet group, compared with 48 (33.8%) in the matched single antiplatelet group. Multivariate logistic regression analysis revealed the following variables to be associated with a better prognosis for BAD: baseline modified Rankin Scale score, dual oral antiplatelet therapy with cilostazol, and dyslipidemia (odds ratios of 0.616, 0.445, and 0.297, respectively). Hypertension was associated with a worse prognosis for BAD (odds ratio of 1.955). Conclusions: Our trial showed that clinical progression of BAD was significantly reduced with the administration of ultra-early aggressive combination therapy using cilostazol compared to treatment with antiplatelet monotherapy.

Objectives The cerebrospinal fluid tap test for idiopathic normal pressure hydrocephalus (iNPH) is one of the good predictors of the shunt treatment, although this test has a low sensitivity. We aimed to identify key parameters that could be used to improve this sensitivity. Materials & methods During 2010–2011, we recruited and then followed 93 patients with possible iNPH for 12 months after shunt. Among them, 82 patients were finally enrolled in this study. The modified Rankin Scale, iNPH grading scale, and several quantitative measurements were evaluated at entry, after the tap test, before and after shunt. Area under the receiver-operating characteristic curves (AUCs), sensitivities, and specificities of the tap test for predicting shunt effectiveness were calculated for each measurement. They were additionally assessed after stratification by disease duration since the initial presentation of iNPH symptoms. Results The gait disturbance on the iNPH grading scale had the highest accurate scale at the tap test for predicting effectiveness 12 months after shunt: AUC 0.74, sensitivity 56.5%, specificity 91.7%. This AUC increased to 0.76, 0.91 and 0.94 in the subgroup of disease duration

Natural fibers, such as baggase and bamboo were the focus of this work in producing a new high performance paper. In this work, bagasse pith with a porous structure, which is helpful for the attachment of a functional material, was used to produce a high performance composite paper. Powdered bamboo leaf particles were attached as the functional material to the bagasse pith using a variety of conditions involving treatment times, bamboo leaf concentrations and pith length. The smaller particles (less than 45 μm) which were classified by sieve showed a higher degree of attachment than the bamboo leaf particles which were of a size greater than 45 μm. It was found that a degassing process increased the amount of attached bamboo particles, by about 3 times. Moreover decreasing the volume of water necessary for particle flow resulted in a higher adhesion ratio of bamboo particles by about 50%. This was achieved without any chemical processing. Most bamboo particles around the inlet of the pith pores w...

LactoSorb fixation plates are made of a bioabsorbable polymer (82% poly-L-lactic acid and 18% polyglycolic acid), and the strength is not inferior to titanium plates. LactoSorb has been used in the fields of pediatric neurosurgery and facial plastic surgery. Cranial fixation in craniotomy is mostly performed using titanium plates and clamps, but there are issues with esthetics and artifacts on postoperative radiographic images. Absorbable plates solve these problems, but are slightly thicker and more expensive. Here, we describe a technique to solve these disadvantages by inserting absorbable plates into the diploe. The present method was employed in 46 patients, and esthetically favorable results were obtained without intraoperative and postoperative complications. Absorbable plates may replace titanium plates as the main device for cranial fixation. The present method is particularly useful for cranial fixation in adults with a thin scalp.