Bottle neck sign of the proximal portion of the internal carotid artery in moyamoya disease.

OBJECTIVE: We investigated morphologic features of the extracranial internal carotid artery (ICA) by carotid ultrasonography in patients with moyamoya disease. METHODS: We performed conventional carotid ultrasonography and transoral carotid ultrasonography on 19 ICAs in 10 patients with moyamoya disease (moyamoya group) and 28 ICAs in 14 control subjects (control group). We evaluated whether the diameter was greatly reduced at the proximal portion of the ICA above the bulbus, like a champagne bottle neck, to be less than half that of the common carotid artery and whether the diameter of the ICA was smaller than that of the external carotid artery (diameter reversal) on conventional carotid ultrasonography. We then measured the internal diameter of the extracranial distal ICA by transoral carotid ultrasonography. We compared the incidence of a "bottle neck" appearance, diameter reversal, and the ICA diameter between the 2 groups. RESULTS: The bottle neck and diameter reversal were shown in 14 (74%) and 16 (84%) of the 19 ICAs in the moyamoya group, respectively (chi2 test, P<.0001). However, neither of them was shown in the control group. The diameter of the distal ICA in the moyamoya group was significantly smaller than that in the control group (mean+/-SD, 2.4+/-0.60 versus 4.1+/-0.52 mm; unpaired t test, P<.0001). CONCLUSIONS: These results suggest that rapid internal diameter reduction at the proximal portion of the ICA, characterized by a bottle neck appearance or diameter reversal, is an important morphologic feature of moyamoya disease.     

Factors associated with occurrence of the intraleft atrial nonsmoke spontaneous individual contrast phenomenon after a Valsalva maneuver during transesophageal echocardiography

Nonsmoke spontaneous individual contrast (NSSIC) is a phenomenon that is a contrast effect appearing from the right pulmonary vein to the left atrium just after a Valsalva maneuver in a transesophageal echocardiography study without administration of any contrast medium. The goal of this study was to characterize factors associated with occurrence of NSSIC. Transesophageal echocardiography was performed in 228 consecutive patients to determine the presence or absence of the patent foramen ovale and valvular disease and various patient characteristics and laboratory data. NSSIC was demonstrated in 109 (47.8%) of 228 patients. Factors associated with occurrence of NSSIC included younger age, male gender, smoking habit, taller height, heavier weight, higher hematocrit, higher plasma level of fibrinogen, lower D-dimer levels and presence of mitral valve strand. Multiple logistic regression analysis indicated that higher hematocrit and plasma levels of fibrinogen were most closely associated with the presence of NSSIC. Thus, NSSIC may occur secondary to specific blood rheologic factors during the Valsalva maneuver.     

Increase in the number of admissions to psychiatric hospitals immediately after the Great East Japan Earthquake

Introduction

Major natural disasters have a significant impact on the mental health of survivors in affected communities. Although it has been speculated that the number of survivors requiring admission to psychiatric hospital increases immediately after a major disaster, few studies have examined the issue.

Methods

On March 11, 2011, the Great East Japan Earthquake and subsequent tsunami devastated the relatively isolated city of Kesennuma. We therefore compared the weekly number of patients admitted to 2 psychiatric hospitals in Kesennuma in the 4 weeks immediately after the earthquake with those in the 4 weeks immediately preceding the earthquake. We also made comparisons between this 8‐week period and the corresponding 8‐week periods in 2009, 2010, and 2012.

Results

The number of patients admitted to the 2 psychiatric hospitals increased in 4 weeks after the disaster in 2011, with a weekly median (range) of 13 (9‐16), compared with 6 (5‐9) in the preceding 4 weeks in 2011. The corresponding figures were 5.5 (2‐10) in 2009, 6.5 (5‐9) in 2010, and 4 (3‐7) in 2012 (P = .01, H = 13.05). By diagnostic category, admissions for schizophrenia spectrum disorder and neurotic stress‐related disorder increased significantly following the disaster.

Discussion

Demands for inpatient psychiatric treatment increased immediately after the Great East Japan Earthquake. Government officials and mental health professionals must strengthen support for survivors with mental illness, especially those with schizophrenia spectrum disorder. This should include support for mental health authorities and medical staff in the affected community.     

The serine racemase mRNA is expressed in both neurons and glial cells of the rat retina

D-Serine, an endogenous and obligatory coagonist for the glycine site of the N-methyl-D-aspartate receptor in mammals, is synthesized from L-serine by serine racemase. Serine racemase and D-serine have long been believed to occur predominantly in astrocytes, according to immunohistochemical studies. Recent studies have demonstrated, however, that both the mRNA and protein levels of serine racemase are considerably higher in neurons than in astrocytes in primary cultures of the rat brain and that the mRNA level of serine racemase predominates in neurons of the adult rat brain. Here we report the application of in situ hybridization based on tyramide signal amplification for the detection of serine racemase mRNA in sections of the adult rat retina and optic nerve head. The localization of serine racemase mRNA could be demonstrated in ganglion cells, amacrine cells, bipolar cells, horizontal cells, and Müller cells of the retina as well as in the astrocytes of the optic nerve head and the lamina cribrosa. This is the first study to demonstrate the exact localization of serine racemase mRNA at the cellular or tissue level in the retina and the optic nerve head. These results suggest that both the neuron- and glia-derived D-serine could modulate neurotransmission via the glycine site of the N-methyl-D-aspartate receptors in the retina.     

Replication of the association between a chromosome 9p21 polymorphism and coronary artery disease in Japanese and Korean populations

Coronary artery disease (CAD) has become a major health problem in many countries. Recent genome-wide association studies have identified the association between rs1333049 on chromosome 9p21 and susceptibility to CAD in Caucasoid populations. In this study, we evaluated the associations of rs1333049 with CAD in Japanese (604 patients and 1,151 controls) and Koreans (679 patients and 706 controls). We found a significant association in both Japanese [odds ratio (OR) = 1.30, 95% confidence interval (CI); 1.13–1.49, p = 0.00027, allele count model] and Koreans (OR = 1.19, 95% CI; 1.02–1.38, p = 0.025, allele count model). These observations demonstrated that chromosome 9p21 was the susceptibility locus for CAD also in East Asians.     

Methylation and protein expression of DNA repair genes: association with chemotherapy exposure and survival in sporadic ovarian and peritoneal carcinomas

Background  

DNA repair genes critically regulate the cellular response to chemotherapy and epigenetic regulation of these genes may be influenced by chemotherapy exposure. Restoration of BRCA1 and BRCA2 mediates resistance to platinum chemotherapy in recurrent BRCA1 and BRCA2 mutated hereditary ovarian carcinomas. We evaluated BRCA1, BRCA2, and MLH1 protein expression in 115 sporadic primary ovarian carcinomas, of which 31 had paired recurrent neoplasms collected after chemotherapy. Additionally, we assessed whether promoter methylation of BRCA1, MLH1 or FANCF influenced response to chemotherapy or explained alterations in protein expression after chemotherapy exposure.     

A Retrospective Analysis of R-MPV Plus Response-adapted Whole-brain Radiotherapy for Elderly Patients with Primary Central Nervous System Lymphoma

Objective Few reports have described the real-world outcomes of rituximab, methotrexate (MTX), procarbazine, and vincristine (R-MPV) plus response-adapted whole-brain radiotherapy (WBRT) for elderly patients with primary central nervous system lymphoma (PCNSL). We evaluated the outcome of this regimen. Methods We evaluated >60-year-old patients with newly diagnosed PCNSL who received R-MPV plus WBRT from January 2010 to December 2019 at Toyohashi Municipal Hospital. The patients'' characteristics, regimen enforcement, response rate, survival, and toxicity were analyzed. Patients Ten patients were consecutively enrolled. Their median age was 69 years old, and 60% had a performance status of 3 or 4 before induction therapy. Results Seven patients achieved a complete response after induction, and all 10 patients achieved a complete response after consolidation. Seven received reduced-dose WBRT at 23.4 Gy, and 2 received WBRT at 45 Gy. The median follow-up was 44.4 months; the 3-year progression-free survival and overall survival rates were 60% and 80%, respectively; and the cumulative incidence of relapse was 40%. The incidence of symptomatic delayed neurotoxicity was 70%. Of the 7 patients who received reduced-dose WBRT, 4 (57%) developed delayed neurotoxicity, including 1 severely affected patient. Only one patient survived without relapse and delayed neurotoxicity. The ratio of patients who developed relapse or delayed neurotoxicity that impaired daily life was 33% and 100% in the MTX high- and low-intensity groups, respectively. Conclusion This regimen in elderly patients is unsatisfactory because of delayed neurotoxicity. We should consider maintaining an adequate MTX intensity, postponing or minimizing WBRT, and choosing high-dose consolidation therapy for select patients.     

Objective assessment of reduced invasiveness in MED

Microendoscopic discectomy (MED) has been accepted as a minimally invasive procedure for lumbar discectomy because of the small skin incision and short hospital stay required for this surgery. However, there are few objective laboratory data to confirm the reduced systemic responses in the early phase after this procedure. In order to substantiate the reduced invasiveness of MED compared to microdiscectomy (MD) or procedures involved in one-level unilateral laminotomy, the invasiveness of each surgical procedure was evaluated by measuring serum levels of biochemical parameters reflective of a post-operative inflammatory reaction and damage to the paravertebral muscles. Thirty-three patients who underwent lumbar discectomy or one-level unilateral laminotomy (MED in 15 cases, MD in 11 cases and one-level unilateral laminotomy in 7 cases with lumbar spinal canal stenosis) were included in this study. The serum levels of C-reactive protein (CRP) and creatine phosphokinase (CPK) were measured at 24 h after operation. Interleukin-6 (IL-6) and Interleukin-10 (IL-10) were measured at 2, 4, 8 and –24 h following the surgery to monitor the inflammatory response to the respective surgery. The post-operative serum CRP levels from both the MD and MED groups were significantly lower than those from the open laminotomy group. However, there was no significant difference in these serum levels between the MED and MD groups. The levels of IL-6 and IL-10 in the MED group during0 the first post-operative day were also significantly lower than those in the laminotomy group. When the MED and MD groups were compared, the IL-6 levels in the MED group were lower than in MD group at 2, 4 and 8 h after surgery, but the differences were not statistically significant. However, the level was significantly lower in the MED group at 24 h after surgery. In terms of IL-10, no significant difference was noted between the MED and MD groups over the study period. The changes in serum levels of post-operative inflammatory: markers (CRP, IL-6 and IL-10) in the early phase indicated reduced inflammatory reactions in MED as well as in MD when compared with classical open unilateral laminotomy. These data draw a direct link between the lower level of the inflammatory response and reduced invasiveness of MED. However, an indicator for muscle damage (CPK) appeared not to be affected by the type of surgical procedure used to correct disc herniation.