Clinical characteristics of patients with ischemic stroke after the 2016 Kumamoto earthquake,a multi-center study

Objective

To investigate the clinical characteristics of patients with ischemic stroke following the 2016 Kumamoto earthquake.

Methods

We retrospectively studied patients with ischemic stroke admitted to 5 stroke centers for 1 year after the earthquake. We compared clinical characteristics in these patients (the post-earthquake group) to those in the patients with ischemic stroke admitted during the same period from the previous 3 years (the pre-earthquake group). Additionally, we analyzed the trend of the incidence rate of stroke before and after the earthquake.

Results

A total of 1979 patients were admitted after the earthquake; 5670 (1,890/year on average) patients were admitted before the earthquake. A first-ever ischemic stroke (71 vs. 75%) and premorbid modified Rankin Scale > 1 (26 vs. 29%) were found significantly more frequently in patients after the earthquake. National Institutes of Health Stroke Scale score ≤ 2 at discharge (60 vs. 65%) was found more frequently in patients after the earthquake, although non-discharge to home (65 vs. 70%) was more frequent in patients after the earthquake. Trend analysis revealed a decrease of small vessel occlusion and large artery atherosclerosis in the month after the earthquake.

Conclusions

The 2016 Kumamoto earthquake may have affected the characteristics of stroke during the early phase of the earthquake and increased the difficulty in returning home.

     

Direct visualization of cortical peritubular capillary of transplanted human kidney with reperfusion injury using a magnifying endoscopy

BACKGROUND: We developed a direct imaging system of renal microcirculation by a magnifying-endoscopy that enables visualization of the movement of erythrocyte in glomerular and cortical peritubular capillary (CPC). We investigated the microcirculation of CPC in the early phase of both living- and cadaveric-donor transplant kidneys. METHODS: Erythrocyte velocity in CPC were monitored and measured in 20 renal transplants at 20, 60, 90, and 120 minutes after reperfusion. The kidney grafts came from 11 living donors and 9 non-heart-beating cadaveric donors. RESULTS: In living-donor transplants, erythrocyte velocity in CPC at 20 minutes after revascularization declined to one third of baseline value just before nephrectomy and recovered to the prenephrectomy value 120 minutes after reperfusion. In contrast, it continued to be disturbed for 90 minutes in cadaveric-donor transplants. Erythrocyte velocity in CPC more significantly deteriorated in cadaveric transplants than in those of living transplants at 20 through 60 minutes after the revascularization. In living-donor transplants, erythrocyte velocity did not correlate with donor age, both warm (WIT) and cold ischemic time (CIT), time to the initial urination, and best creatine clearance. In the cadaveric transplants, ischemic time, both WIT and CIT, did not correlate with the erythrocyte velocity. However, donor age, duration of acute tubular necrosis, and best creatine clearance after transplantation significantly correlated with the erythrocyte velocity. CONCLUSION: The measurement of erythrocyte velocity in CPC is a reliable method for predicting the recovery of renal function and reserved renal function of kidney allografts undergoing prolonged ischemia.     

A comparison of changes in cardiac preload variables during graded hypovolemia and hypervolemia in mechanically ventilated dogs

We developed an online monitoring system to measure systolic blood pressure variation (SPV) and its down (dDown) and up components, along with pulse pressure variation (dPP). Using the system, we compared different cardiac preload indicators-such as stroke volume variation (SVV) and corrected flow time (FTc)-along with central venous pressure and pulmonary artery occlusion pressure in mechanically-ventilated dogs during normovolemia, graded hypovolemia (-200 and -350 mL), and hypervolemia (+200 and +350 mL). We simultaneously measured these preload indicators along with global hemodynamic variables and investigated their validity and limitations to access preload changes. SPV increased from 4.8 +/- 1.4 mm Hg at baseline to 11.2 +/- 1.8 mm Hg during hypovolemia (-350 mL), but it did not change significantly during hypervolemia. Similar changes were observed with dDown, dPP, and SVV. FTc, conversely, increased during hypervolemia but remained unchanged during hypovolemia. The results of this study indicate that SPV, dDown, dPP, and SVV are useful indicators of hypovolemia, but not of hypervolemia. Conversely, hypovolemia could not be detected reliably by FTc, but it does reflect blood volume changes during hypervolemia. Although SPV, dDown, and dPP measurements require no additional invasion and cost beyond arterial cannulation, their limits must be kept in mind for the monitoring of blood volume status in mechanically-ventilated patients.     

Lack of association of interleukin-18 gene polymorphisms with susceptibility of Japanese populations to Graves' disease or Graves' ophthalmopathy.

OBJECTIVE: To investigate whether polymorphisms of interleukin (IL)-18 gene confer susceptibility to Graves' disease (GD) and Graves' ophthalmopathy (GO). DESIGN: We performed a case control study on polymorphisms of IL-18 gene in Japanese patients with GD (n = 435), and healthy control subjects without antithyroid autoantibodies or family history of autoimmune disorders (n = 255). The C-4675G, C-607A, and G-137C polymorphisms in the promoter region and A105C (exon 5) polymorphism were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using restriction enzymes, sequence-specific PCR, and PCR-direct sequencing methods. RESULTS: None of the polymorphisms in the IL-18 gene were associated with development of Graves' disease. The CC genotype and C allele frequencies of IL-18 gene G-137C polymorphism tended to be greater in patients with ophthalmopathy than in patients without evident ophthalmopathy. However, the differences were not statistically significant. Although there were three major haplotypes, none of the haplotypes were statistically associated with susceptibility to GD or ophthalmopathy. CONCLUSIONS: These results suggest that IL-18 gene polymorphisms are not major genetic factors for susceptibility to GD in a Japanese population. Further studies with adequate sized data set in the subset analyses for GO are needed.     

Histopathological investigation of the 1p/19q-codeleted gliomas resected following alkylating agent chemotherapy

Journal of Neuro-Oncology - Lower grade gliomas with 1p/19q codeletion are often responsive to chemotherapy, and several of these have been treated using upfront chemotherapy and subsequent...     

Computed diffusion-weighted imaging using 3-T magnetic resonance imaging for prostate cancer diagnosis

Objective

To assess the efficacy of computed diffusion-weighted images (cDWIs) of b?=?2000 s/mm² (cDWI₂₀₀₀) generated from DWIs of b?=?0 and 1000 for prostate cancer (PCa) diagnosis in comparison with that of measured original DWIs of b?=?1000 (mDWI₁₀₀₀) and b?=?2000(mDWI₂₀₀₀) using 3-T MRI.

Methods

Eighty patients who underwent a preoperative MRI examination, including T2WI and DWI (b?=?0, 1000, 2000 s/mm²), were enrolled in this study. Four combinations of images, protocol A (T2WI alone), B (T2WI + mDWI₁₀₀₀), C (T2WI + mDWI₂₀₀₀) and D (T2WI + cDWI₂₀₀₀), were assessed for their diagnostic capability. Areas under the receiver operating characteristic curve (Az) and diagnostic performance were evaluated, as well as contrast ratios (CR) between cancerous and non-cancerous lesions for each DWI.

Results

The highest CR was obtained with cDWI₂₀₀₀ (0.29?±?0.16). Sensitivity, specificity, accuracy, and Az of the protocols were: A: 66.3 %, 59.4 %, 63.0 %, 0.67; B: 82.6 %, 62.0 %, 72.5 %, 0.80; C: 84.1 %, 66.5 %, 75.5 %, 0.86; D: 83.2 %, 70.0 %, 76.6 %, and 0.84, respectively The specificities and accuracies of protocol C and D were significantly higher than those of protocol B (P?<?0.05).

Conclusion

cDWI₂₀₀₀ appears to be more effective than mDWI₁₀₀₀, and at least as effective as mDWI₂₀₀₀ for PCa diagnosis.

Key Points

? Computed diffusion-weighted MRI with over b1000s/mm ² is useful for prostate cancer detection. ? Computed DWI produces any b-value images with two different b-value images. ? DWI with computed b2000s/mm ² is as valuable as DWI with measured b2000 s/mm ² .     

Bone Marrow‐Derived Cells Implanted into Freeze‐Injured Urinary Bladders Reconstruct Functional Smooth Muscle Layers

Regenerative medicine offers great hope for lower urinary tract dysfunctions due to irreversibly damaged urinary bladders and urethras. Our aim is the utilization of bone marrow‐derived cells to reconstruct smooth muscle layers for the treatments of irreversibly damaged lower urinary tracts. In our mouse model system for urinary bladder regeneration, the majority of smooth muscle layers in about one‐third of the bladder are destroyed by brief freezing. Three days after wounding, we implant cultured cells derived from bone marrow. The implanted bone marrow‐derived cells survive and differentiate into layered smooth muscle structures that remediate urinary dysfunction. However, bone marrow‐derived cells implanted into the intact normal urinary bladders do not exhibit these behaviors. The presence of large pores in the walls of the freeze‐injured urinary bladders is likely to be helpful for a high rate of survival of the implanted cells. The pores could also serve as scaffolding for the reconstruction of tissue structures. The surviving host cells upregulate several growth factor mRNAs that, if translated, can promote differentiation of smooth muscle and other cell types. We conclude that the multipotency of the bone marrow‐derived cells and the provision of scaffolding and suitable growth factors by the microenvironment enable successful tissue engineering in our model system for urinary bladder regeneration. In this review, we suggest that the development of regenerative medicine needs not only a greater understanding of the requirements for undifferentiated cell proliferation and targeted differentiation, but also further knowledge of each unique microenvironment within recipient tissues.