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Intravascular lymphoma is a rare disease that progresses to multiple organ dysfunction caused primarily by tumor cell proliferation in small blood vessels. Few studies have investigated critical care management of intravascular lymphoma. We describe a rare case of multiple organ failure due to intravascular lymphoma with severe lactic acidosis in a patient who survived. A 64-year-old man with impaired consciousness was diagnosed as having intravascular large B-cell lymphoma by means of a random skin biopsy. The patient arrived at our hospital's intensive care unit (ICU) with impaired consciousness, respiratory failure that required mechanical ventilation, and lactic acidosis that required renal replacement therapy. Mechanical ventilation and renal replacement therapy were continued in the ICU, and his respiratory status and circulatory dynamics eventually stabilized. However, his impaired consciousness and hyperlactatemia did not improve until after the start of chemotherapy with doxorubicin, cyclophosphamide, vincristine, prednisolone, and rituximab. Although he developed tumor lysis syndrome immediately after chemotherapy, his systemic condition was gradually stabilized by continued critical care management primarily comprising renal replacement therapy. He was weaned from ventilator support after a tracheotomy and moved to the general ward. Hematopoietic malignancy with hyperlactatemia has a very poor prognosis; however, hyperlactatemia and impaired consciousness were dramatically improved in this patient by critical care management and chemotherapy.

The prevalence of glucose intolerance in chronic liver disease patients is high, but glucose intolerance may be overlooked in a single blood test. The purpose of this study is to evaluate blood glucose variability in patients with chronic liver disease by a continuous glucose monitoring system (CGMS) and to examine the discrepancy between hemoglobin A1c (HbA1c) levels estimated from average blood glucose levels and HbA1c.This study included 335 patients with chronic liver disease associated with glucose intolerance. A fasting blood test and 72-h CGMS were performed. The estimated HbA1c was calculated from the average blood glucose level, and the correlation between hepatic functional reserve and blood glucose-related parameters was analyzed. From the obtained data, we created a new formula to calculate HbA1c without using CGMS.As hepatic functional reserve decreased, average blood glucose and insulin resistance increased while HbA1c decreased (P 0.0001). The discrepancy between the estimated HbA1c calculated from the mean blood glucose level and the serum HbA1c (ΔHbA1c) increased as the liver reserve decreased. Using multiple regression analysis, a formula based on fasting blood glucose, HbA1c, body mass index, albumin, and liver function was constructed, and its validity was demonstrated in a study using a different control group.Hemoglobin A1c may be underestimated because of decreased hepatic functional reserve. CGMS was useful in assessing accurate glycemic control of blood glucose and in detecting postprandial hyperglycemia and nocturnal hypoglycemia. Patients with chronic hepatic impairment should be corrected for hepatic functional reserve before glycemic control.

Background Patients with hepatocellular carcinoma (HCC) and macrovascular invasion (MVI) who receive systemic chemotherapy have a poor prognosis. This study aimed to determine if one-shot cisplatin (CDDP) chemotherapy via hepatic arterial infusion (HAI) combined with radiation therapy (RT) prior to systemic chemotherapy could improve the outcomes of these patients. Methods This study consisted of 32 HCC patients with the following eligibility criteria: (i) portal vein invasion 3/4 and/or hepatic vein invasion 2/3; (ii) received one-shot CDDP via HAI; (iii) received RT for MVI, (iv) a Child–Pugh score ≤ 7; and (v) an Eastern Clinical Oncology Group Performance Status score of 0 or 1. To determine the therapeutic effect, we collected information on patient characteristics and took contrast-enhanced computed tomography at the start of the therapy and every 2 to 4 months after the start of therapy. We evaluated the overall response of the tumor and tumor thrombosis according to modified Response Evaluation Criteria in Solid Tumors. We assessed patient data using the Mann–Whitney U and Fisher exact tests and evaluated overall survival and progression-free survival using the log-rank test. Results The overall response rate at the first evaluation performed a median of 1.4 weeks after HAI was 16% for the main intrahepatic tumor and 59% for the MVI. The best responses were the same as those of the first-time responses. The duration of median survival was 8.6 months, and progression-free survival of the main intrahepatic tumor was 3.2 months. Predictive factors for overall survival were the relative tumor volume in the liver and the first therapeutic response of MVI. There were no severe adverse events or radiation-induced hepatic complications. Conclusions One-shot CDDP via HAI and RT were well tolerated and showed immediate and favorable control of MVI. Thus, this combination shows potential as a bridging therapy to systemic chemotherapy.

This report presents an unusual case of multiple paraovarian cysts that required emergency surgery due to a paraovarian cyst being entrapped by another paraovarian cyst. Laparoscopic surgery is considered useful for diagnostic and therapeutic purposes and is therefore recommended owing to difficulty in differentiating paraovarian cysts from ovarian cysts.

We investigated the effect of interfacial nitrogen (N) defects on tunnel magnetoresistance (TMR) in Fe/MgO/Fe magnetic tunnel junctions (MTJs) which are the basic building block of magnetoresistive random access memory. The N atoms are predicted to originate from the SiN covering for antioxidation. It was found from first-principles quantum-transport calculations that the N defects significantly worsen the TMR. This is particularly evident in the MTJ models with an additional N atom at the MgO/Fe interface, because a conduction channel appears in the antiparallel magnetization configuration due to the N defects. The TMR is directly related to the read error rate of data and the scaling of the memory cell. Therefore, the prevention of nitrogen contamination during the manufacturing processes is a prerequisite for maintaining high performance.

This clinical image presents an unusual report of simultaneous laparoscopic resection of a hydrocele of the canal of Nuck and an ovarian tumor. Laparoscopic treatment with a proper approach is a useful technique in some cases.

Cold forceps polypectomy is simple and widely used in clinical practice. However, there are concerns about the risk of incomplete resection using this technique. In recent years, it has been reported that polypectomy with jumbo forceps (JF) is an effective treatment modality for diminutive polyps (DPs) because JF are able to remove large tissue samples with the combined advantage of a higher complete histological resection rate for DPs than standard forceps. To our knowledge, no studies have evaluated the risk factors for incomplete resection when polypectomy with JF is performed for DPs. From among 1129 DPs resected using JF at Hiroshima City Asa Citizens Hospital between November 2015 and December 2016, we retrospectively evaluated the clinical outcomes of 999 tumors with known histopathology and investigated the relationship between incomplete resection and clinicopathological factors. Most lesions [985 (87%)] were low-grade dysplasia and 14 (1%) were high-grade dysplasia. The en bloc resection rate was 92% (918/999) and the histological en bloc resection rate was 78% (777/999). Multivariate analysis showed that the significant independent predictors of incomplete resection were tumor size ≥ 4 mm [odds ratio (OR) 3.8; 95% confidence interval (CI) 2.65–5.37; p

A woman in her 60s underwent lower endoscopy due to a positive fecal occult blood test. A type 2 tumor was found in the cecum, and a biopsy resulted in the diagnosis of adenocarcinoma(tub2). Contrast-enhanced CT showed an enlarged paracolonic lymph node but no distant metastasis, so the patient underwent a laparoscopic-assisted ileocolic resection and D3 lymph node dissection for cecum cancer. The pathology was pT3, pN2b, pM0, pStage Ⅲc, and 12 courses of FOLFOX were administered as adjuvant chemotherapy. Twenty-four months after the completion of adjuvant chemotherapy, an elevated CEA was observed, and a PET-CT was performed, which showed multiple peritoneal disseminated nodules with FDG accumulation. Based on this finding, CAPOX/bevacizumab therapy was introduced, and on completion of 4 courses, the PET-CT showed a decrease in the size of the nodules and the disappearance of FDG accumulation. Based on this, the patient underwent resection. A peritoneal dissemination resection and bilateral ovariectomy were laparoscopically performed, and the patient is currently under observation. In patients with metastatic recurrence of peritoneal dissemination who underwent complete resection, treatment with CAPOX/bevacizumab may allow for disease control and provide a long-term prognosis.

Time-delayed interactions between DNA, mRNA, and proteins play an important role in the periodic somite segmentation of vertebrates. A mathematical model of the segmentation clock in zebrafish that illustrates the dynamics between proteins and mRNA has recently been proposed; however, the complexity of the model makes solving it analytically unrealistic. In this study, we derived a first-order delay-differential equation (DDE) model by following two heuristic reduction approaches: simplifying protein–mRNA interactions and protein dimerization. Then, we calculated the eigenvalues of the model and found that the maximum eigenvalue and the oscillatory dynamics are qualitatively equivalent when some parameters are varied. This result enabled us to illustrate the effectiveness of using eigenvalues to assess the dynamics of the reduced model. Further, we extended the reduction methods to a complete model of somite segmentation considering the interaction of four genes, and derived a reduced model with four variables and four delay terms. Although the oscillation period of our reduced model decreased by ∼10% compared to the original model, the amplitude differed by less than 10%. The dynamic features for genetic conditions are also qualitatively reproduced by the reduced model. Our model demonstrates that it is possible to identify key parameters and to reveal the interactions among the parameters. © 2017 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.

A man in his 40s with no remarkable past medical history was referred to our hospital with acute exacerbation of nonspecific epigastric pain by another hospital on the morning of the day of presentation. Though vital signs were stable, tenderness and guarding were observed over the entire abdomen. Contrast-enhanced computed tomography (CT) revealed a giant retroperitoneal hematoma due to a ruptured aneurysm close to the superior mesenteric artery. Emergency angiography of the superior mesenteric artery detected a ruptured 2-mm pseudoaneurysm of the posterior superior pancreaticoduodenal artery, for which embolization was immediately performed. The postoperative course was good, with the patient complaining only of transient abdominal pain due to exclusion of the hematoma on hospital day 6. His clinical symptoms disappeared with conservative treatment, and the patient was discharged on hospital day 18. Complete occlusion of the aneurysm and reduction of the hematoma was confirmed on follow-up CT. Pancreaticoduodenal artery aneurysm is an uncommon visceral artery aneurysm, and ruptured aneurysms typically result in fatal hemorrhage and high mortality. We herein report a case of ruptured aneurysm of the posterior pancreaticoduodenal artery where emergency transcatheter arterial embolization was able to save the patient's life. We also review 116 cases of pancreaticoduodenal artery aneurysm reported in Japanese literature.

We consider suppression of macroscopic synchronized oscillations in mixed populations of active and inactive oscillators with local diffusive coupling, described by a lattice complex Ginzburg-Landau model with discrete Laplacian in general dimensions. Approximate expression for the stability of the non-oscillatory stationary state is derived on the basis of the generalized free energy of the system. We show that an effective wavenumber of the system determined by the spatial arrangement of the active and inactive oscillators is an decisive factor in the suppression, in addition to the ratio of active population to inactive population and relative intensity of each population. The effectiveness of the proposed theory is illustrated with a cortico-thalamic model of epileptic seizures, where active and inactive oscillators correspond to epileptic foci and healthy cerebral cortex tissue, respectively., Comment: 20 pages, 5 figures

The anti-hypertensive effect of processed rice bran (PRB) was recently reported, for which the novel peptide Leu-Arg-Ala (LRA) was identified as the functional substance. The purpose of this study was to assess the anti-hypertensive effects of a rice bran supplement containing PRB in individuals with high-normal blood pressure (systolic blood pressure (SBP): 130&ndash, 139 mmHg and/or diastolic blood pressure (DBP): 85&ndash, 89 mmHg) or grade 1 hypertension (SBP: 140&ndash, 159 mmHg and/or DBP: 90&ndash, 99 mmHg). One hundred individuals with high-normal blood pressure or grade 1 hypertension were recruited to participate in this double-blind, randomized, placebo-controlled study. Participants were randomly allocated to the placebo group (n = 50) or the test group (n = 50). Each group took four test tablets (43 &mu, g LRA/day) or four placebo tablets daily. The decrease in blood pressure in the test group compared with the placebo group was the primary outcome. Adverse events were recorded and hematological/urinary parameters measured to determine the safety of the supplement, which was the secondary outcome. In total, 87 participants completed the study. The SBP of the test group at 12 weeks was significantly lower than that of the placebo group (p = 0.0497). No serious adverse events were observed. Daily consumption of a rice bran supplement containing PRB can safely improve mildly elevated blood pressure.

We recently identified a novel, potent antihypertensive peptide, Leu-Arg-Ala (LRA; minimum effective dose = 0.25 mg/kg), from rice bran protein. In this study, we found that LRA potently relaxed mesenteric arteries isolated from spontaneously hypertensive rats (SHRs) (EC50 = 0.1 μM). In contrast, the vasorelaxant activity of each amino acid that constitutes the LRA tripeptide was remarkably attenuated. The LRA-induced vasorelaxant activity was inhibited by N(G)-nitro-l-arginine methyl ester (L-NAME; NO synthase [NOS] inhibitor) but not by an antagonist of bradykinin B2 and Mas receptors or by a phosphoinositide 3-kinase inhibitor. The antihypertensive effect induced after the oral administration of LRA was inhibited by L-NAME. LRA also induced the phosphorylation of endothelial NOS in human umbilical vein endothelial cells. Taken together, LRA may exhibit antihypertensive effects via NO-mediated vasorelaxation. LRA is the first example of a NO-dependent vasorelaxant peptide identified from rice bran protein.

Gamma oscillations are thought to play an important role in brain function. Interneuron gamma (ING) and pyramidal interneuron gamma (PING) mechanisms have been proposed as generation mechanisms for these oscillations. However, the relation between the generation mechanisms and the dynamical properties of the gamma oscillation are still unclear. Among the dynamical properties of the gamma oscillation, the phase response function (PRF) is important because it encodes the response of the oscillation to inputs. Recently, the PRF for an inhibitory population of modified theta neurons that generate an ING rhythm was computed by the adjoint method applied to the associated Fokker-Planck equation (FPE) for the model. The modified theta model incorporates conductance-based synapses as well as the voltage and current dynamics. Here, we extended this previous work by creating an excitatory-inhibitory (E-I) network using the modified theta model and described the population dynamics with the corresponding FPE. We conducted a bifurcation analysis of the FPE to find parameter regions which generate gamma oscillations. In order to label the oscillatory parameter regions by their generation mechanisms, we defined ING- and PING-type gamma oscillation in a mathematically plausible way based on the driver of the inhibitory population. We labeled the oscillatory parameter regions by these generation mechanisms and derived PRFs via the adjoint method on the FPE in order to investigate the differences in the responses of each type of oscillation to inputs. PRFs for PING and ING mechanisms are derived and compared. We found the amplitude of the PRF for the excitatory population is larger in the PING case than in the ING case. Finally, the E-I population of the modified theta neuron enabled us to analyze the PRFs of PING-type gamma oscillation and the entrainment ability of E and I populations. We found a parameter region in which PRFs of E and I are both purely positive in the case of PING oscillations. The different entrainment abilities of E and I stimulation as governed by the respective PRFs was compared to direct simulations of finite populations of model neurons. We find that it is easier to entrain the gamma rhythm by stimulating the inhibitory population than by stimulating the excitatory population as has been found experimentally.

SUMMARY Brain–computer interfaces (BCI) have been studied to allow handicapped people to communicate and control their environments. However, conventional BCIs require a determination of what objects are displayed as targets in advance. BCI combined with augmented reality (AR) can display suitable choices with consideration of real space and can allow users to control devices intuitively. However, little is known about how AR systems affect the accuracy of BCIs; significant factors that may be affected include the background of AR-BCI derived from scenery and the change of the number of target choices. In this research, uwe confirm these two effects and develop a new method using a nontarget object when there is a small number of possible targets. The results show that the background has no effect, and that changing the target decreases the accuracy. However, the proposed method improves the accuracy of AR-BCI.

Scope Hypertension is a risk factor for arteriosclerosis. In this study, we investigate the antihypertensive effect of protease-digested rice bran in a spontaneously hypertension rat (SHR) model. We also purify a novel antihypertensive peptide from the digest. Methods and results Thermolysin-digested rice bran (TRB) is administered to SHRs for 4 weeks, and systolic blood pressure (SBP) was measured weekly using the tail-cuff method. TRB shows an antihypertensive effect in a dose-dependent manner. TRB also reduces angiotensin I-converting enzyme (ACE) activity in lung tissue and serum troponin I levels. TRB is fractionated by HPLC and ACE-inhibitory activity in the HPLC fractions is measured. Peptides LRA and YY are identified from the two fractions with the strongest ACE-inhibitory activity. Amino acid sequence of these peptides are found in a vicilin-like seed storage protein, and identified in rice bran protein using the peptide mass fingerprint method. We confirm that LRA and YY are cleaved by thermolysin digestion of a model synthetic peptide. Orally administered LRA (0.25 mg kg-1 ) or YY (0.5 mg kg-1 ) lowers the SBP of SHRs at 4 h after administration. Conclusion We identify a novel, orally active antihypertensive peptide, LRA from the digest of rice bran protein.

Background Working memory (WM) is a key function for various cognitive processes. Near-infrared spectroscopy (NIRS) is a powerful technique for noninvasive functional imaging. However, a study has yet to be published on the application of NIRS for evaluating WM performance. The objective was to evaluate NIRS for measuring WM performance. Methods Subjects were trained to perform a visuospatial WM task. Eight channels on the lateral prefrontal cortex were analyzed. We asked the following three questions: (1) Does WM performance correlate with NIRS signal amplitudes? (2) What are the differences in NIRS amplitudes between correct- and incorrect-WM tasks? (3) Is there a correlation between WM performance and NIRS amplitudes in only correct-WM tasks? Results NIRS activation in all channels correlated with WM performance (P

SUMMARY The autonomic nervous system is important in maintaining homeostasis by mediating the opposing effects of sympathetic and parasympathetic nervous activity on organs. Although it is known that the amplitude of RSA (respiratory sinus arrhythmia) is an index of parasympathetic nervous activity, it is difficult to estimate that activity in real time in everyday situations. This is in part because of body motion and extrasystole. Further, automatic recognition of the R wave on an electrocardiogram is required for a real-time analysis of the RSA amplitude, and there is an unresolved problem of false recognition of the R wave. In this paper we propose a method of evaluating the amplitude of RSA accurately by statistical processing with probabilistic models. We then estimate parasympathetic nervous activity during body motion and isometric exercise to examine the validity of the method. As a result, using the proposed method we demonstrate that the amplitude of RSA can be extracted in the presence of false recognition of the R wave. An appropriate threshold for the estimate is 1 or 5% because the waveforms of the RSA amplitude do not follow the abrupt changes of parasympathetic nervous activity induced by isometric exercise with the threshold at 10%. Furthermore, the method using the normal distribution is found to be more appropriate than that of the chi-square distribution for statistical processing. Therefore, we expect that the proposed method can be used to evaluate parasympathetic nervous activity with high accuracy in everyday situations. © 2013 Wiley Periodicals, Inc. Electron Comm Jpn, 96(9): 23–32, 2013; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/ecj.11441

Cognitive functions such as sensory processing and memory processes lead to phase synchronization in the electroencephalogram or local field potential between different brain regions. There are a lot of computational researches deriving phase locking values (PLVs), which are an index of phase synchronization intensity, from neural models. However, these researches derive PLVs numerically. To the best of our knowledge, there have been no reports on the derivation of a theoretical PLV. In this study, we propose an analytical method for deriving theoretical PLVs from a cortico-thalamic neural mass model described by a delay differential equation. First, the model for generating neural signals is transformed into a normal form of the Hopf bifurcation using center manifold reduction. Second, the normal form is transformed into a phase model that is suitable for analyzing synchronization phenomena. Third, the Fokker---Planck equation of the phase model is derived and the phase difference distribution is obtained. Finally, the PLVs are calculated from the stationary distribution of the phase difference. The validity of the proposed method is confirmed via numerical simulations. Furthermore, we apply the proposed method to a working memory process, and discuss the neurophysiological basis behind the phase synchronization phenomenon. The results demonstrate the importance of decreasing the intensity of independent noise during the working memory process. The proposed method will be of great use in various experimental studies and simulations relevant to phase synchronization, because it enables the effect of neurophysiological changes on PLVs to be analyzed from a mathematical perspective.

The event-related potential (ERP) of brain EEG (electroencephalogram) activity plays an important role in EEG phase synchronization and/or hemodynamic responses measured by fMRI (functional magnetic resonance imaging). However, the specific mechanism of ERP generation is still unclear. In this study, pulse and noise-type visual stimuli were administered to subjects. Then the phase response of the EEG in α-waves was analyzed. The magnitudes of the phase response were found to vary with the stimulus administered phase and no power increase was observed. These results indicate that the ERP in α-waves is generated by phase resetting of brain activity. © 2012 Wiley Periodicals, Inc. Electron Comm Jpn, 95(7): 58–64, 2012; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/ecj.11368

SUMMARY The autonomic nervous system is important in maintaining homeostasis by mediating the opposing effects of sympathetic and parasympathetic nervous activity on organs. Although it is known that the amplitude of RSA (respiratory sinus arrhythmia) is an index of parasympathetic nervous activity, it is difficult to estimate that activity in real time in everyday situations. This is in part because of body motion and extrasystole. Further, automatic recognition of the R wave on an electrocardiogram is required for a real-time analysis of the RSA amplitude, and there is an unresolved problem of false recognition of the R wave. In this paper we propose a method of evaluating the amplitude of RSA accurately by statistical processing with probabilistic models. We then estimate parasympathetic nervous activity during body motion and isometric exercise to examine the validity of the method. As a result, using the proposed method we demonstrate that the amplitude of RSA can be extracted in the presence of false recognition of the R wave. An appropriate threshold for the estimate is 1 or 5% because the waveforms of the RSA amplitude do not follow the abrupt changes of parasympathetic nervous activity induced by isometric exercise with the threshold at 10%. Furthermore, the method using the normal distribution is found to be more appropriate than that of the chi-square distribution for statistical processing. Therefore, we expect that the proposed method can be used to evaluate parasympathetic nervous activity with high accuracy in everyday situations. © 2013 Wiley Periodicals, Inc. Electron Comm Jpn, 96(9): 23–32, 2013; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/ecj.11441

Summary The corticothalamic Compact Model with time delay proposed by Kim and Robinson is analyzed focusing on the resting EEG, which can be described by the linear version of the model with white-noise input, under the assumption of spatial homogeneity and temporal steadiness. After discussing the availability and restriction of the model by comparing to the original Pre-Compact Model, a data analysis method for the resting EEG using the model is presented. The experimental results analyzed by the method suggest that the eye-closed state compared to the eye-open state would be characterized by enhanced corticothalamic feedback and depressed cortical excitation. The validity of the Reduced Equations derived in our previous paper is also investigated for the resting EEG, concluding that the Reduced Equations would be available with some restriction for the resting EEG, although the center manifold theory on which the Reduced Equations are based is justified at the edge of linear stability in principle.

Event Related Potential (ERP) of brain EEG (Electroencephalogram) activity plays an important role in EEG phase synchronization and/or hemodynamic responses measured by fMRI (functional Magnetic Resonance Imaging). However, the specific mechanism of ERP generation is still unclear. In this study, pulse and noise type visual stimuli are administered to subjects. Then the phase response of the EEG in α-waves is analyzed. As a result, the magnitudes of the phase response are varied by the stimulus administered phase and no power increase is observed. These results indicate that the ERP in α-waves is generated by the phase resetting of brain activity.