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Purpose Diffusion tensor image analysis along the perivascular space (DTI-ALPS) index is intended to reflect the glymphatic function of the brain; however, head rotation may reduce reproducibility and reliability. This study aimed to evaluate whether reorientation of DTI data improves the reproducibility of the ALPS index using the OASIS-3 dataset. Materials and methods 234 cognitively normal subjects from the OASIS-3 dataset were included. Original and reoriented ALPS indices were calculated using a technique that registered vector information of DTI to another space and created reoriented diffusivity maps. The F test was used to compare variances of the original and reoriented ALPS indices. Subsequently, subjects with head rotation around the z- (inferior-superior; n = 43) or x axis (right-left; n = 25) and matched subjects with neutral head position were selected for evaluation of intra- and inter-rater reliability. Intraclass correlation coefficients (ICCs) of the original and reoriented ALPS indices for participants with head rotation and neutral head position were calculated separately. The Bland–Altman plot comparing the original and reoriented ALPS indices was also evaluated. Results The reoriented ALPS index exhibited a significantly smaller variance than the original ALPS index (p 0.85). A wider range of the 95% limit of agreement of the Bland–Altman plot for subjects with x axis rotation was identified, indicating that x axis rotation may remarkably affect calculation of the ALPS index. Conclusion The technique used in this study enabled the creation of reoriented diffusivity maps and improved reproducibility in calculating the ALPS index.

Postmortem computed tomography (PMCT) has been recently reported to be useful for detecting causes of death in the emergency department. In this study, the incidence and causes of death of type A acute aortic dissection (AAD) were investigated in patients who experienced out-of-hospital cardiopulmonary arrest (OHCPA) using PMCT. PMCT or enhanced computed tomography was performed in 311 of 528 consecutive patients experiencing OHCPA. A total of 23 (7%) of 311 patients were diagnosed with type A AAD based on clinical courses and CT findings. Eighteen consecutive patients who did not experience OHCPA were diagnosed with type A AAD during the same period. Pre-hospital death was observed in 21 (51%) of 41 patients with type A AAD. Bloody pericardial effusion was observed more frequently in patients who experienced OHCPA with type A AAD than in those who did not experience OHCPA with type A AAD (91% vs 28%, respectively; p

要旨 【目的】外傷患者に対する病院前輸液が生命予後に与える影響は議論が分かれている。今回我々はショックを呈した外傷症例に対し，病院前輸液が来院時のfibrinogen値に与える影響と，ショックに対する改善効果を検討した。【対象】2010年4月から2014年10月までに当院へ搬送された18歳以上の外傷患者で現場にて出血性ショックであったものを対象とし後方視的に診療録調査を行い，病院前輸液施行群と非輸液群に分けて比較検討した。【結果】91例中，非輸液群が50例，輸液群が41例であった。fibrinogen値が200mg/dL未満となる予測因子を求めて多重ロジスティック回帰分析を施行したところ，病院前輸液の調整オッズ比が3.16（95%信頼区間:1.15–8.68）であった。一方，輸液群においては来院時収縮期血圧が有意に高く（非輸液群100.6±26.2mmHg vs 輸液群113.0±27.1mmHg），Base Deficitが有意に低かった（非輸液群4.4 [1.6–9.3] mmol/L vs 輸液群2.6 [0.6–4.7] mmol/L）。院内死亡率に有意差はなかったが，輸液群で低い傾向があった。【結語】病院前輸液はfibrinogen値を低下させる要因であったが，ショックとそれに伴う代謝性アシドーシスを抑制し，少なくとも生命予後を悪化させなかった。 ABSTRACT Background: The survival effect of prehospital intravenous fluid (IVF) administration for severely injured patients remains controversial. This study focuses on the impact of prehospital IVF on the fibrinogen level on admission to the emergency department and also analyzes the beneficial effect of prehospital IVF for fluid resuscitation in shock. Object and Methods: The medical charts of trauma patients aged 18 years or older who presented to the hospital between April 2010 and October 2014 were retrospectively reviewed; patients with hemorrhagic shock at the scene of arrival were identified and classified into two groups depending on whether or not prehospital IVF was administered. Results: Of the 91 patients who met the inclusion criteria, 41 of them received prehospital IVF and 50 did not. Multiple logistic regression analysis showed that the only prognostic factor for a fibrinogen level lower than 200mg/dL included prehospital IVF with an adjusted odds ratio: 3.16 (95% confidence interval: 1.15–8.68). On the other hand, in the IVF group, systolic blood pressure on arrival was significantly higher (no IVF: 100.6±26.2mmHg vs IVF: 113±27.1mmHg), and base deficit was significantly lower (no IVF: 4.4 [1.6–9.3] mmol/L vs IVF: 2.6 [0.6–4.7] mmol/L). In–hospital mortality of the IVF group was 9.8%, which was slightly lower than the no IVF group (14%), but the difference was not significant. Conclusion: Prehospital IVF decreased fibrinogen level in trauma patients, but it also reduced the metabolic acidosis during hemorrhagic shock and did not worsen survival.

非連続性に多発性脊椎損傷を認めた9例に対して,その臨床的な特徴や診断上の問題点について検討した。年齢は17～50(平均26.4)歳,男性7例,女性2例で受傷原因は交通外傷6例,転落3例,来院時の神経学的重症度は完全損傷(Frankel A)3例,不全損傷6(Frankel B: 1, C: 3, E: 2)例であった。6例で合併損傷を認め,その内訳は頭部外傷2例,胸部外傷4例,腹部外傷1例,四肢骨折2例,骨盤骨折1例であった。全例で頸椎損傷を伴っており,8例で損傷部位は2か所で,その組み合わせは,上位頸椎+下位頸椎:1例,上位頸椎+胸椎:1例,中下位頸椎+胸椎:6例であった。また,1例は3か所に損傷(頸椎に2か所と胸椎)を認めた。これらの結果から,脊椎・脊髄損傷例では多発性に脊椎損傷を有している可能性があり,全身の評価および全脊椎の検索が必要である。

We succeeded in achieving visible-light responsiveness on a tubular TiO(2) sample through the treatment of a tubular TiO(2) that has a large surface area with an aqueous solution of ammonia or triethylamine at room temperature and subsequent calcination at 623 K, which produced a nitrided tubular TiO(2) sample. It was found that the ease of nitridation is dependent on the surface states; washing the tubular TiO(2) sample with an aqueous acidic solution is very effective and indispensable. This treatment causes the appearance of acidic sites on the tubular TiO(2), which was proved by the following experiments: NH(3) temperature-programmed desorption and two types of organic reactions exploiting the acid properties. The prepared samples, TiO(2-δ)N(δ), efficiently absorb light in the visible region, and they exhibit a prominent feature for the decomposition of methylene blue in an aqueous solution at 300 K under irradiation with visible light, indicating the achievement of visible-light responsiveness on the tubular TiO(2) sample. This type of tubular TiO(2-δ)N(δ) sample has merit in the sense that it has a large surface area and a characteristic high transparency for enabling photocatalytic reactions because it has a tubular structure and is composed of thin walls.

An 86-year-old woman with end-stage renal disease (etiology unknown) presented with left flank pain for ten hours. She was hypotensive and had a firm, exquisitely tender left flank mass. Computed tomography (CT) scan of the abdomen revealed a 20 cm left renal mass with extensive fatty tissue and associated retroperitoneal hemorrhage (Fig. 1). The patient died from hemorrhagic shock. Based on the large peri-renal fatty masses and the presence of a vessel extending into the renal parenchyma (Fig. 2), we concluded this was a kidney angiomyolipoma.1 Figure 1 CT scan of the abdomen showing retroperitoneal hemorrhage (short arrows) and areas of fatty tissue (arrow heads). Figure 2 CT scan of the abdomen showing the vessel extending to the renal parenchyma (arrow). Kidney angiomyolipomas are benign renal neoplasms, usually detected incidentally on imaging. Approximately 80 % occur spontaneously as in this case, while 20 % occur in association with tuberous sclerosis complex.2 As the lesions increase in size, the vascular supply becomes aneurysmal and hemorrhage risk increases. In one study, the risk of hemorrhage in lesions larger than eight cm was 25–50 %.3 Management is based on the size of the lesion and the presence of symptoms, with a shift toward less invasive treatments. Arterial embolization is used to reduce the size of angiomyolipomas,4 and regrowth does not occur after successful embolization. Some authors suggest arterial embolization if the tumor is symptomatic or greater than four cm.5

The purpose of this study was to determine the incidence of mismanaged injury of the cervical spinal cord, to identify factors contributing to a failure to recognize such injury. Thirty-three patients with cervical spinal cord injury were transported to emergency department during the period from October, 1999 to March, 2001. Seven patients (21%) of them were transferred without cervical spine immobilization. Mechanism of injury in 7 patients was fall in 4, motor vehicle crash in 2, unknown in one. Clinical signs on admission revealed neck pain and/or back pain in 4 patients, altered mental status in 4 patients, numbness of extremities in 2 patients, paradoxical respiration in 2 patients, respiratory arrest in one. Neurological classification of Frankel grade was A in 2, B in 1, C in 2, D in 1 and E in 1. All trauma patients with a cervical spine injury or with a mechanism of injury having the potential to cause cervical spine injury should be immobilized at the scene, during transport and at the emergency room by using one of several available methods.

Two types of angular contact ball bearings for machine tools having steel rings and silicon nitride balls were tested and the temperature rise was compared with that of conventional steel ball bearings with grease lubrication and oil-air lubrication as well. Experimental results indicated that the temperature rise of silicon nitride ball bearings was much lower than that of steel ball bearings at high speeds. Calculations made using a computer demonstrated that the reduction of gyroscopic moments and centrifugal forces acting on balls because of the low density of silicon nitride resulted in about 30 to 50 percent less frictional loss at high speeds even with low-cost lubrication such as grease or oil-air.