Disseminated Epidermolytic Acanthoma

A 65-year-old Japanese male suffered from numerous brownish papules on his back for 6 months. Clinical appearance resembled seborrheic keratosis, but light microscopic examination revealed epidermolytic hyperkeratosis. Electron findings were the same as those of epidermolytic hyperkeratosis and systemic nevus verrucosus. It may be concluded that this type of skin disease is an acquired epidermolytic hyperkeratosis.     

Diagnostic Criteria for Moyamoya Disease - 2021 Revised Version

In this report, we, the Research Committee on Moyamoya Disease (Spontaneous Occlusion of the circle of Willis), describe in detail the changes in the new “Diagnostic Criteria 2021” for moyamoya disease and its scientific basis to make it widely known to the world. The revised criteria cover all aspects of the disease, including a definition of the disease concept, diagnostic imaging, and the concept of quasi-moyamoya disease (moyamoya syndrome).     

Longitudinal change in depressive symptoms among healthcare professionals with and without COVID-19 vaccine hesitancy from October 2020 to June 2021 in Japan

This study aimed to compare the longitudinal change in depressive symptoms among healthcare professionals in Japan who are willing to receive novel coronavirus disease (COVID-19) vaccination and those who are unwilling to receive COVID-19 vaccination. The baseline survey was conducted in October 2020 (Survey time 1: T1); respondents in T1 were invited to participate in May 2021 (Survey time 2: T2). Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Group comparisons of the estimated mean of PHQ-9 score at T1 and T2 were estimated by the analysis of covariance. In T1, 597 participants (response rate: 4.4%) completed all questions. In T2, 211 participants (follow up rate: 35.3%) completed all questions. The group and time interaction effect was significant (F(1, 207)=3.9, p=0.049); depressive symptoms were worse among healthcare professionals who were unwilling to receive vaccination than among those who were willing to receive vaccination. This study showed that depressive symptoms were worse among healthcare professionals who were unwilling to receive COVID-19 vaccination than those who are willing to receive COVID-19 vaccination. This suggests that it is important to take care of healthcare professionals who are unwilling to receive vaccination to prevent mental health deterioration.     

Differential Gene Expression in Relation to the Clinical Characteristics of Human Brain Arteriovenous Malformations

Arteriovenous malformations (AVMs) of the central nervous system are considered as congenital disorders. They are composed of abnormally developed dilated arteries and veins and are characterized microscopically by the absence of a capillary network. We previously reported DNA fragmentation and increased expression of apoptosis-related factors in AVM lesions. In this article, we used microarray analysis to examine differential gene expression in relation to clinical manifestations in 11 AVM samples from Japanese patients. We categorized the genes with altered expression into four groups: death-related, neuron-related, inflammation-related, and other. The death-related differentially expressed genes were MMP9, LIF, SOD2, BCL2A1, MMP12, and HSPA6. The neuron-related genes were NPY, S100A9, NeuroD2, S100Abeta, CAMK2A, SYNPR, CHRM2, and CAMKV. The inflammation-related genes were PTX3, IL8, IL6, CXCL10, GBP1, CHRM3, CXCL1, IL1R2, CCL18, and CCL13. In addition, we compared gene expression in those with or without clinical characteristics including deep drainer, embolization, and high-flow nidus. We identified a small number of genes. Using these microarray data we are able to generate and test new hypotheses to explore AVM pathophysiology. Microarray analysis is a useful technique to study clinical specimens from patients with brain vascular malformations.     

Parent Artery Occlusion for Unruptured Cerebral Aneurysms: The Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2

Parent artery occlusion (PAO) is an alternative to surgical clipping or endovascular endosaccular coil embolization for the management of cerebral aneurysms. Most giant and fusiform aneurysms are not amenable to endosaccular coil embolization due to anatomical considerations, such as a broad-neck. However, majority of reports regarding the safety of PAO are based on case series involving a relatively small number of patients. In the present study, a total of 381 consecutive patients with unruptured cerebral aneurysms who were treated with PAO were extracted from the Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and JR-NET2 database, which are nationwide surveys conducted by the Japanese Society of Neuroendovascular Therapy. The mean age of the 381 patients was 58.1 years, and 59.3% were female. The aneurysmal location included the vertebral artery (42%) and the cavernous portion of internal carotid artery (32%). The aneurysm size and shape consisted of fusiform (45%), giant (25%), and large (22%). Symptomatic lesions were present in 59.8% of the population. Technical success was achieved in 98.4%. The 30-day morbidity and mortality rates were 3.1% and 1.0%, respectively. The most frequent procedure-related complication was ischemic stroke, which occurred in 12.9% (distal embolism, 6.0%; branch occlusion, 3.9%). The 30-day morbidity and mortality rates related to ischemic strokes were 2.1% and 0.3%, respectively. PAO for unruptured aneurysms is feasible with a high technical success rate. Peri-procedural management of ischemic stroke is the key to enhance the safety of this treatment option.     

Prurigo pigmentosa successfully treated with minocycline

Five patients with prurigo pigmentosa were treated with 100-200 mg minocycline daily. The eruption and pruritus rapidly resolved within a few days or up to a week. There has been no recurrence after stopping medication and we conclude that minocycline is effective for prurigo pigmentosa and safer than dapsone.     

Risk Factors for Postoperative Cerebrospinal Fluid Leak after Graded Multilayer Cranial Base Repair with Suturing via the Endoscopic Endonasal Approach

This study analyzed risk factors for postoperative cerebrospinal fluid (CSF) leak after graded multilayer cranial base repair method with dural suturing. We performed surgery via the endoscopic endonasal approach (EEA) from 2012.6 to 2018.4, and those consecutive clinical data were prospectively accumulated and retrospectively analyzed. We tailored the repair method according to the intraoperative CSF leak grade. Among 388 surgeries via the EEA, there were 10 (2.6%) cases of postoperative CSF leak after graded repair with suturing. Postoperative CSF leak occurred in two of the 150 cases without intraoperative CSF leak (grade 0), one of the 104 cases with small (grade 1) intraoperative CSF leak, two of the 60 cases with moderate (grade 2) leak, and five of the 74 cases with large (grade 3) leak. Univariate analysis indicated that chordoma (P = 0.023), estimated tumor volume ≥ 7400 mm³ (P = 0.003), and maximum tumor diameter ≥ 32.5 mm (P = 0.001) were significant risk factors for postoperative CSF leak. Additionally, among cases with intraoperative grade 3 CSF leak, chordoma (P = 0.021), estimated tumor volume ≥ 23000 mm³ (P = 0.003), and maximum tumor diameter ≥ 45.5 mm (P = 0.001) were significant risk factors for postoperative CSF leak. Maximum tumor diameter, estimated tumor volume, and chordoma tumor pathology are related to a higher risk of postoperative CSF leak.     

Desmoid tumor in a scar from radical nephrectomy for renal cancer

Desmoid tumor is a fibroblastic proliferation arising in musculoaponeurotic tissues. We report a case of abdominal desmoid tumor discovered 2 years after radical nephrectomy for right renal cell carcinoma. Surgical extirpation was performed and the patient remained well 2 years later with no evidence of disease. The possibility of desmoid tumors developing in the incised abdominal wall should be considered while following patients after surgery.     

Evaluation of transcutaneous CO2 responses following acute changes in PaCO2 in healthy subjects

Background and objective: Transcutaneous blood gas‐monitoring systems with miniaturized SpO₂ (peripheral blood oxygen saturation)/PCO₂ combined sensors (TOSCATM) have been widely used. There are no reports of the inter‐ and intra‐individual variability in transcutaneous measurements of PaCO₂ (PtcCO₂) in response to acute progressive changes in PaCO₂. This study examined inter‐ and intra‐individual variability of PtcCO₂ measurements under semi‐steady‐state conditions, and characterized the behaviour of PtcCO₂ in response to acute progressive changes in PaCO₂. Methods: Subjects breathed mixed gases through a mouthpiece connected to an automatic arterial blood gas controller. Using end‐tidal PCO₂ and PO₂ as guides, PaCO₂ was controlled to increase and/or decrease between baseline and ≥ 60 mm Hg, in a stepwise (n = 9) or progressive fashion (n = 6). Arterial blood was sampled when needed. Results: Intra‐individual correlation coefficients between PtcCO₂ and PaCO₂ were excellent in all subjects (0.971–0.989); however, the slope of the regression line varied among subjects (1.040–1.335). Bias and limits of agreement (± 2 SD from bias) between PtcCO₂ and PaCO₂ were ?1.8 mm Hg and ?7.7 to 4.1 mm Hg. Changes in PtcCO₂ in response to acute progressive changes in PaCO₂ also varied among subjects. Conclusion: The PtcCO₂ measurement system allows reliable estimation of PaCO₂ in a given subject. However, caution is needed when comparing absolute values between subjects or when acute changes in PaCO₂ occur.     

Evaluation of sleep using ambulatory skin potential recording:Differences between morning and evening type

Abstract In order to validate the evaluation of sleep using cassette type ambulatory skin potential measurement system (C-SPA), sleep duration variables extracted from 24 h recordings were compared between two groups (16 of the intermediate type and 16 of the evening type) with different sleep-wake habits rated by Morningness and Eveningness Questionnaires (MEQ). Compared with the intermediate type, the evening type subjects go to bed and get up later, have difficulty in falling asleep and more frequently awaken during sleep. Thus, the sleep variables by C-SPA provide valuable information about duration of sleep and differentiate the Sleep-wake habits.