Successful outcome after resection of pancreatic cancer with a solitary hepatic metastasis

The presence of hepatic metastasis in pancreatic cancer has generally been considered to be a contraindication for surgery. However, the present case survived seven years after concomitant resection of pancreatic cancer and hepatic metastasis. This shows that hepatic metastasis may be a strong predictor of poor survival, but not a determinant of noncurability. Surgical resection may be an option for highly selected patients with pancreatic cancer complicated with hepatic metastasis.     

MR diffusion tensor imaging documented arcuate fasciculus lesion in a patient with normal repetition performance

Background: The pathophysiology of the syndrome of conduction aphasia has been thought to involve a disconnection between posterior and anterior language areas. The arcuate fasciculus has been one of the principal candidates for an anatomical link between Wernicke's and Broca's area, but direct evidence for its involvement in conduction aphasia has been difficult to obtain. Aims: The purpose of this study was to examine white matter tract integrity, using the novel magnetic resonance imaging technique of diffusion tensor imaging, in a patient with transcortical aphasia. Methods & Procedures: A case study of a 55-year-old, right-handed man with aphasia following a left hemisphere stroke is reported. The patient's language performance was assessed with the Boston Diagnostic Aphasia Examination twice: at 10 days and at 2 years after his stroke. An MR diffusion tensor imaging study was obtained approximately 2 years after his stroke using the 1.5 T Phillips Gyroscan NT system. White matter fibre tracts maps were reconstructed using the “FACT” algorithm. Outcomes and Results: Ten days after his stroke, the patient had a non-fluent aphasia with marked impairment of both auditory comprehension and spontaneous speech. However, repetition was relatively intact. By 2 years, when the MR diffusion tensor imaging study was performed, repetition was completely normal and the patient had only subtle deficits in areas of naming and auditory comprehension. The MR diffusion tensor imaging study revealed a lesion of the dominant hemisphere arcuate fasciculus. Conclusions: This study documents normal repetition performance in a patient who on subsequent MR diffusion tensor imaging was found to have a lesion involving the dominant hemisphere arcuate fasciculus lesion. This case adds to previously published cases of normal repetition performance despite a documented lesion of the arcuate fasciculus, and thus further challenges the traditional model of conduction aphasia invoking a critical role of this white matter tract. Our case also suggests that MR diffusion tensor imaging may be a potentially useful technique to evaluate regional involvement of specific white matter tract projections in patients with aphasia.     

Social isolation perturbs experience‐driven synaptic glutamate receptor subunit 4 delivery in the developing rat barrel cortex

In neonates, the stress of social isolation can alter developing neural circuits and cause mental illness. However, the molecular and cellular bases for these effects are poorly understood. Experience‐driven synaptic AMPA receptor delivery is crucial for circuit organisation during development. In the rat, whisker experience drives the delivery of glutamate receptor subunit 4 (GluA4) but not glutamate receptor subunit 1 (GluA1) to layer 4–2/3 pyramidal synapses in the barrel cortex during postnatal day (P)8–10, whereas GluA1 but not GluA4 is delivered to these synapses during P12–14. We recently reported that early social isolation disrupts experience‐driven GluA1 delivery to layer 4–2/3 pyramidal synapses during P12–14. Here, we report that neonatal isolation affects even earlier stages of development by preventing experience‐dependent synaptic GluA4 delivery. Thus, social isolation severely affects synaptic maturation throughout early postnatal development.     

Conditioned enhancement of firing rates and synchrony of hippocampal neurons and firing rates of motor cortical neurons in rats

The aim of this study was to examine the potential ability of neuronal groups to enhance their activities by conditioning without behaviors. We employed a method of neuronal operant conditioning in which increments in the firing rates and synchrony of closely neighboring neurons in the motor cortex and hippocampus were rewarded in the absence of behaviors. Rats were trained to engage in a free‐operant task in which nose‐poke behaviors were rewarded in session 1, and firing rates and synchrony above preset criteria were rewarded in sessions 2 and 3, respectively. The firing rates of motor cortical and hippocampal neuron groups were found to increase rapidly in session 2 similarly to the nose‐poke behavior in session 1. Placing contingency of reward on firing synchrony resulted in selective enhancement of firing synchrony of only hippocampal neurons in session 3. Control experiments revealed that the enhancement of neuronal firing was not attributable to increments of superstitious behaviors or excitation caused by reward delivery. Analysis of the firing rates and synchrony of individual neurons and neuron pairs in each group revealed that the firing rates and synchrony of some but not all neurons and neuron pairs increased in each group. No enhancement was observed in any neurons and neuron pairs recorded by neighboring electrodes not used for conditioning. These results suggest that neuronal operant conditioning enhances the firing rates and synchrony of only some neurons in small restricted areas. The present findings are expected to contribute to further research into neurorehabilitation and neuroprosthesis.     

Discrepancy in polysomnography scoring for a patient with obstructive sleep apnea hypopnea syndrome

Overnight polysomnography (PSG) is indispensable for diagnosis of obstructive sleep apnea hypopnea syndrome. However, studies on interscorer agreement on PSG scoring between laboratories are few. The purpose of this study was to examine the reliability of interscorer agreement on PSG scoring among 16 sleep laboratories in Japan. We found a relatively moderate interscorer reliability of the index of oxygen desaturation and arousal during sleep, but a relatively low reliability of the index of transient reduction in and complete cessation of breathing (apnea hypopnea index). The median rate of interscorer coincidence of sleep staging was the lowest for slow wave (deep) sleep (23.5%), followed by those for Stage 1 (59.8%), Wake (73.2%) and Stage 2 (74.2%) in this order, and rapid eye movement was the most reliably identified stage (91.3%). The median rate of interscorer coincidence for all stages was 71.8%. The present study demonstrates that scorers tend to analyze PSG data according to a relatively empirical decision as opposed to a rule-dependent decision. Further detailed scoring manuals are required to decrease the interscorer discrepancy in PSG scoring.     

Impact of COVID-19 on the Volume of Acute Stroke Admissions: A Nationwide Survey in Japan

This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.