Abstract
An 18-year-old woman gradually developed speech and gait disturbance for seven months. On admission, she presented with cerebellar ataxia and tetraparesis. Magnetic resonance images showed ...diffuse hyperintense lesions around the fourth ventricle in FLAIR, in addition to lesions of nodular diffusion restriction with enhancement. Heavily T2-weighted images revealed small cystic appearance within this lesion. We diagnosed her as classical medulloblastoma by open brain biopsy. We should consider medulloblastoma as a differential diagnosis of these characteristics around the fourth ventricle, even if magnetic resonance findings are atypical in point of no mass effect and heterogeneous enhancement.
Human monkeypox, an infectious disease caused by monkeypox virus (MPXV), is endemic to western and central Africa. A LightCycler quantitative PCR (LC-qPCR) system was developed for the diagnosis of ...this disease, targeting the A-type inclusion body gene (ATI gene) of MPXV. One naïve monkey was infected with MPXV Zr-599 (Congo Basin strain) and one with MPXV Liberia (West African strain). Another three monkeys were immunized with smallpox vaccine on 0, 3, or 7 days, respectively, before infection with MPXV Zr-599. Peripheral blood cell (PBC) and throat swab (TS) specimens were serially collected. The LC-qPCR was validated for the diagnosis of monkeypox using virus isolation. Sequencing of the partial ATI gene revealed the insertion of a unique 453-nucleotide residue in the West African strains but not in the Congo Basin strains. Specific reverse primers for Congo Basin and West African strains were designed based on the unique sequence insertion. The LC-qPCR detected the MPXV genome, but not those of the other orthopoxviruses tested nor the varicella-zoster virus. Both the sensitivity and specificity of the LC-qPCR were over 90% in comparison to virus isolation when TS specimens were tested. Fourteen of the 15 virus isolation-positive PBC specimens showed positive reactions in the assay. Further, most PBC specimens collected from symptomatic monkeys in the later stage of illness showed positive reactions in the assay but negative reaction in virus isolation. It was possible to differentiate between these two groups with the LC-qPCR. Thus, the newly developed LC-qPCR is a useful and reliable diagnostic tool for MPXV infection.
BACKGROUND Identifying characteristics of patients at high risk of poor adherence before transplantation would be advantageous. However, the optimal approach for characterizing such patients remains ...unknown. We aimed to evaluate the association between factors for hemodialysis nonadherence and post-transplant renal prognosis. We hypothesized that these factors would influence post-transplantation adherence and worsen renal prognosis. MATERIAL AND METHODS We reviewed patients on hemodialysis who underwent kidney transplantation at our hospital between 2000 and 2017 to identify risk factors associated with poor prognosis. The patients' background and pre-transplantation data, known hemodialysis nonadherence factors, serum phosphate and potassium levels, and interdialytic weight gains were evaluated. The primary endpoint was renal death. We also evaluated the fluctuation of calcineurin inhibitor concentration and weight gain after transplantation. RESULTS Seventy-seven patients were eligible, and the mean observational period was 83.2 months (standard deviation, 50.5). Thirteen patients reached the endpoint. Cox proportional hazards regression analysis showed that pre-transplantation serum phosphate level was a risk factor for renal death (p<0.05), while serum potassium levels and weight gain were not. In addition, fluctuation of calcineurin inhibitor concentration was observed in patients with higher phosphate levels before transplantation (p=0.03). Weight gain after transplantation was not associated with the hemodialysis nonadherence factors. CONCLUSIONS High pre-transplantation serum phosphate levels are considered to represent poor drug adherence and/or an unhealthy lifestyle. Patient education that conveys the importance of adhering to medications and provides nutritional guidance is crucial for improving post-transplantation renal prognosis.
The pathogenesis of severe human monkeypox, which causes systemic and fulminant infections, is not clear. This study presents a case repot of fulminant monkeypox with bacterial sepsis after ...experimental infection with monkeypox virus in a cynomolgus monkey (Macaca fascicularis). In our previous study (Saijo et al., 2009, J Gen Virol), two cynomolgus monkeys became moribund after experimental infection with monkeypox virus Liberia strain, West African strain. One exhibited typical monkeypox-related papulovesicular lesions. The other monkey presented fulminant clinical symptoms with a characteristic flat red rash similar to that found in smallpox, which is associated with extremely high fatality rates. In this study, we found that the monkey with flat red rash had high levels of viremia and neutropenia, as well as high plasma levels of pro-inflammatory cytokines and chemokines compared with the other monkey. Monkeypox virus replicates in epithelial cells and macrophages in various organs. Sepsis due to Gram-positive cocci was confirmed histopathologically in the monkey with flat red rash. The lack of inflammatory response in the lesion suggested that the monkey with sepsis experienced strong immune suppression during the viral infection. The neutropenia and excessive inflammatory cytokine responses indicate that neutrophils play key roles in the pathogenesis of systemic and fulminant human monkeypox virus infections with sepsis.
Laser-arc hybrid welding is divided into laser-based and arc-based welding. In the arc-based welding, the laser beam irradiation provides the guiding effect of the arc plasma. Some studies have ...reported that an unstable arc plasma becomes stable due to this guiding effect. This is considered as the influence of metal vapor generation by laser beam irradiation, however, there are few reports on the measurement of metal vapor and arc plasma state during the guiding process. Therefore, the mechanism has been still not fully understood. In this study, the fundamental study of the guiding arc phenomenon was conducted in TIG arc welding (60A) with laser beam irradiation (170W) under relatively low power condition. When the base metal was stainless steel, the guiding arc by the laser beam irradiation was observed unlike the mild steel. Spectroscopic measurement for the guiding arc phenomenon in stainless steel showed that the metal vapor was composed of manganese and chromium, and was widely distributed near the irradiation point, but not concentrated. We also observed the decrement of plasma temperature, which is considered to be caused by distributed metal vapor and the resultant decrement of the current density.
Categories subclassified according to the number of operations performed Category Number of operations performed General thoracic surgery 0 6 1–24 28 25–49 72 50–99 167 100–149 129 150–199 100 ≥ 200 ...176 Total 678 Number of operations performed Esophageal surgery 0 76 1–4 114 5–9 96 10–19 98 20–29 47 30–39 26 40–49 21 ≥ 50 45 Total 523 Incidence of hospital mortality was included in the survey to determine nationwide status, which has contributed to Japanese surgeons’ understanding of the present status of thoracic surgery in Japan, while helping to effect progress for improving operative results by enabling them to compare their work with that of others. Hospital-to-hospital transfer in the category of esophageal surgery is not considered a form of discharge; transfer to a nursing home or a rehabilitation unit is considered hospital discharge, unless the patient subsequently dies because of complications from surgery. The reason for this was that NCD information regarding esophageal surgery does not include non-surgical cases (i.e., patients with adjuvant chemotherapy or radiation only). Because of changes in data collection related to cardiovascular surgery (initially self-reported using questionnaire sheets in each participating institution up to 2014, then by downloading an automatic package from the Japanese Cardiovascular Surgery Database (JCVSD), a cardiovascular sub-section of the NCD), the response rate is not available and is, therefore, not indicated in the cardiovascular surgery category (Table 1). When compared with data for 2016 1 and 2007 2, the number of surgeries in 2017 for congenital heart disease increased by 7.1% (9368 vs. 8744) and 0.2%, respectively; procedures for valvular heart disease increased by 0.2% (23,312 vs. 23,254) and 53.2%, respectively; surgery for thoracic aortic aneurysm increased by 8.7% (20,746 vs. 19,078) and 114.6%, respectively; ischemic heart procedures decreased by 6.6% (13,898 vs. 14,874) and 23.6%, respectively.
This paper presents the second data release of the Hyper Suprime-Cam Subaru Strategic Program, a wide-field optical imaging survey using the 8.2 m Subaru Telescope. We report the release includes ...data from 174 nights of observation through 2018 January. The Wide layer data cover about 300 deg$^2$ in all five broad-band filters ($grizy$) to the nominal survey exposure (10 min in $gr$ and 20 min in $izy$). Partially observed areas are also included in the release; about 1100 deg$^2$ is observed in at least one filter and one exposure. The median seeing in the i-band is ${0_{.}^{\prime \prime }6}$, demonstrating the superb image quality of the survey. The Deep (26 deg$^2$) and UltraDeep (4 deg$^2$) data are jointly processed and the UltraDeep-COSMOS field reaches an unprecedented depth of $i\sim 28$ at $5 \, \sigma$ for point sources. In addition to the broad-band data, narrow-band data are also available in the Deep and UltraDeep fields. This release includes a major update to the processing pipeline, including improved sky subtraction, PSF modeling, object detection, and artifact rejection. The overall data quality has been improved, but this release is not without problems; there is a persistent deblender problem as well as new issues with masks around bright stars. The user is encouraged to review the issue list before utilizing the data for scientific explorations. All the image products as well as catalog products are available for download. The catalogs are also loaded into a database, which provides an easy interface for users to retrieve data for objects of interest. In addition to these main data products, detailed galaxy shape measurements withheld from Public Data Release 1 (PDR1) are now available to the community. The shape catalog is drawn from the S16A internal release, which has a larger area than PDR1 (160 deg$^2$). All products are available at the data release site, https://hsc-release.mtk.nao.ac.jp/.
A positive resection margin is one of the most significant risk factors for local breast cancer recurrence following breast-conserving surgery (BCS). Intraoperative specimen mammography (SMMG) is ...routinely used to evaluate the surgical margin at our institution. The aim of the present study was to assess the adequacy of SMMG for margin assessment. The patient cohort included 174 women who underwent BCS in 2006. The sensitivity and specificity of SMMG were assessed by comparing the margins assessed by histological and radiological methods. It was also examined whether the rate of positive histological margins was decreased by re-excision following SMMG evaluation. A total of 23 false-negatives and 6 false-positives were determined by SMMG. The sensitivity and specificity of SMMG margin assessment for patients with primary breast cancer were 20.6 and 94.6%, respectively. The positive predictive value was 50% and the negative predictive value was 82.2%. A subgroup analysis revealed that the sensitivity and specificity of SMMG in cases with ductal carcinoma in situ (DCIS) were higher compared with those in invasive ductal carcinoma. Furthermore, the positive histological margin rate was not affected by re-excision. Although the general usefulness of intraoperative SMMG was not proven, this procedure may be useful in specific cases, particularly those with DCIS and those diagnosed by stereotactic biopsy. A prospective study with exact criteria and a standard procedure is required.
We performed transcranial magnetic stimulation (TMS) to elucidate the D- and I-wave components comprising the motor evoked potentials (MEPs) elicited from the leg motor area, especially at ...near-threshold intensity. Recordings were made from the tibialis anterior muscle using needle electrodes. A figure-of-eight coil was placed so as to induce current in the brain in eight different directions, starting from the posterior-to-anterior direction and rotating it in 45° steps. The latencies were compared with those evoked by transcranial electrical stimulation (TES) and TMS using a double cone coil. Although the latencies of MEPs ranged from D to I3 waves, the most prominent component evoked by TMS at near-threshold intensity represented the I1 wave. With the double cone coil, the elicited peaks always represented I1 waves, and D waves were evoked only at very high stimulus intensities, suggesting a high effectiveness of this coil in inducing I1 waves. Using the figure-of-eight coil, current flowing anteriorly or toward the hemisphere contralateral to the recorded muscle was more effective in eliciting large responses than current flowing posteriorly or toward the ipsilateral hemisphere. The effective directions induced I1 waves with the lowest threshold, whereas the less effective directions elicited I1 and I2 waves with a similar frequency. Higher stimulus intensities resulted in concomitant activation of D through I3 waves with increasing amount of D waves, but still the predominance of I1 waves was apparent. The amount of I waves, especially of I1 waves, was greater than predicted by the hypothesis that TMS over the leg motor area activates the output cells directly, but rather suggests predominant transsynaptic activation. The results accord with those of recent human epidural recordings.
PDF
