Comparison of Fractional Anisotropy from Tract-Based Spatial Statistics with and without Lesion Masking in Patients with Intracerebral Hemorrhage: A Technical Note

BACKGROUND

Diffusion-tensor fractional anisotropy (FA) is an index of neural-fiber damage in patients following stroke. To better characterize FA, tract-based spatial statistics (TBSS) is frequently used, which involves spatial transformation into the standard brain space. Despite its utility, this technique is susceptible to space-occupying hematoma in patients with intracerebral hemorrhage. To correct this, "lesion making" has been proposed. Here, FA values from TBSS without lesion masking and TBSS with lesion masking were compared, and the clinical utility was evaluated.

METHODS

Forty patients from our previously published work were entered into the study. Diffusion-tensor imagings were acquired 14-21 days after onset and FA maps were generated. Lesion masks were produced in reference with nondiffusion (b = 0) brain images. Two types (with or without lesion masking) of TBSS were then performed. For both types, using individual data we extracted mean FA values within for the corticospinal tract (CST) and the superior longitudinal fasciculus (SLF). FA ratio (rFA) between the lesioned hemisphere and the unaffected hemisphere was then calculated. The two sets of the data were then compared by assessing residuals of mean root sum square error (RMSE).

RESULTS

Although rFA obtained from TBSS with lesion masking tended to be slightly smaller, the estimated RMSE was .025 for both the CST and the SLF.

CONCLUSIONS

The estimated FA differences between the two sets of TBSS were very small. Considering the time for manual labor for producing lesion masks, regular TBSS without lesion masking may be sufficient in terms of clinical utility.

Endoscopic Ultrasonography-guided Fine-needle Aspiration Revealed Metastasis-induced Acute Pancreatitis in a Patient with Adrenocortical Carcinoma

A 26-year-old woman complained of upper abdominal pain. Computed tomography (CT) showed acute pancreatitis, a left adrenal tumor and solitary right pulmonary metastasis. She underwent left adrenalectomy; the adrenal tumor was diagnosed as adrenocortical carcinoma (ACC). When preparing to resect the pulmonary metastasis, she suffered a second acute pancreatic attack. Magnetic resonance cholangiopancreatography (MRCP) showed that the proximal main pancreatic duct (MPD) was dilated, and the distal MPD was diminished; however, no pancreatic tumor was observed on CT or MRCP. Endoscopic ultrasonography revealed a solitary pancreatic mass, which was diagnosed as pancreatic metastasis from ACC by endoscopic ultrasonography-guided fine-needle aspiration.

Anomalous Temperature Behavior of the Chiral Spin Helix in CrNb_{3}S_{6} Thin Lamellae

Using Lorentz transmission electron microscopy and small-angle electron scattering techniques, we investigate the temperature-dependent evolution of a magnetic stripe pattern period in thin-film lamellae of the prototype monoaxial chiral helimagnet CrNb_{3}S_{6}. The sinusoidal stripe pattern appears due to formation of a chiral helimagnetic order (CHM) in this material. We found that as the temperature increases, the CHM period is initially independent of temperature and then starts to shrink above the temperature of about 90 K, which is far below the magnetic phase transition temperature for the bulk material T_{c} (123 K). The stripe order disappears at around 140 K, far above T_{c}. We argue that this cascade of transitions reflects a three-stage hierarchical behavior of melting in two dimensions.

Relationship between the administration of nicardipine hydrochloride and the development of delirium in patients on mechanical ventilation

A history of hypertension is a known risk factor for delirium in patients in intensive care units, but the effect of antihypertensive agents on delirium development is unclear. Nicardipine, a calcium channel blocker, is widely used in ICU as a treatment agent for hypertensive emergency. This study investigated the relationship between the administration of nicardipine hydrochloride and delirium development in patients under mechanical ventilation. We conducted a medical chart review of 103 patients, who were divided into two groups according to the use of nicardipine hydrochloride. The prevalence of delirium was compared with respect to factors such as age, sex, laboratory data, and medical history, by multivariate analysis. 21 patients (20.4 %) were treated with nicardipine hydrochloride in 103 patients. The treatment and non-treatment groups differed significantly in age (72 vs. 65 years) and history of high blood pressure (57% vs. 11%). Multivariate analysis revealed that patients in the treatment group developed delirium significantly less often than those in the non-treatment group (19% vs. 48%). These results suggested that treatment of high blood pressure with nicardipine hydrochloride is a possible method for preventing the development of delirium.

Preparation of Functional Monomers as Precursors of Bioprobes from a Common Styrene Derivative and Polymer Synthesis

CM-Str (4-(Chloromethyl)styrene) was used as a useful starting material for the construction of a series of functional monomers. Substitution of the chlorine to the corresponding azide was performed, and the reduction of the azide proceeded smoothly to afford an aminostyrene, which was used as a common precursor for the preparation of functional monomers. Condensation of the amine with a fluorophore, biotin and carbohydrate was accomplished. Among the monomers, a carbohydrate monomer was polymerized with or without acrylamide as a model polymerization to yield the corresponding water-soluble glycopolymers, and biological evaluations of the glycopolymers for a lectin, and wheat germ agglutinin (WGA), were carried out on the basis of the fluorescence change of tryptophan in the WGA.

Long-Term Outcomes of FIM Motor Items Predicted From Acute Stage NIHSS of Patients With Middle Cerebral Artery Infarct

Objective

To outline the association between the National Institutes of Health Stroke Scale (NIHSS) in the acute stage and the Functional Independence Measure (FIM) of motor items several months later.

Methods

Seventy-nine infarct cases with middle-cerebral-artery region transferred to long-term rehabilitation facilities were analyzed. Patients were allocated to either the model-development group or the confirmatory group at a 2:1 ratio. Independent variables were based on the NIHSS during the acute care and on demographic factors such as age and modified Rankin Scale (mRS) before onset. Multivariate logistic analyses were performed to predict the independence of each FIM motor item. These models were evaluated in the confirmatory group.

Results

Multivariate logistic analyses in the model-development group (n=53) indicated that at least one NIHSS item was statistically significantly associated with the functional independence of a single FIM motor item. Of the NIHSS items, the affected lower extremity item was the most widely associated with 11 of the FIM motor items, except for eating and shower transfer. The affected upper extremity function was the second widely involved factor associated with 7 of the FIM motor items including eating, grooming, bathing, toileting, bed transfer, toilet transfer, and shower transfer. Age and mRS were also statistically significant contributing factors. The obtained predictive models were assessed in the confirmatory group (n=26); these were successful except for the stairs climb item.

Conclusion

In combination with age and pre-stroke status, the NIHSS items (especially the affected extremity items) may be useful for the prediction of long-term outcome in terms of activities in daily living.

Synthetic construction of sugar-amino acid hybrid polymers involving globotriaose or lactose and evaluation of their biological activities against Shiga toxins produced by Escherichia coli O157:H7

Synthetic assembly of sugar moieties and amino acids in order to create "sugar-amino acid hybrid polymers" was accomplished by means of simple radical polymerization of carbohydrate monomers having an amino acid-modified polymerizable aglycon. Amines derived from globotriaoside and lactoside as glycoepitopes were condensed with known carbobenzyloxy derivatives, including Z-Gly, Z-l-Ala and Z-β-Ala, which had appropriate spacer ability and a chiral center to afford fully protected sugar-amino acid hybrid compounds in good yields. After deprotection followed by acryloylation, the water-soluble glycomonomers were polymerized with or without acrylamide in the presence of a radical initiator in water to give corresponding copolymers and homopolymers, which were shown by SEC analysis to have high molecular weights. Evaluation of the biological activities of the glycopolymers against Shiga toxins (Stxs) was carried out, and the results suggested that glycopolymers having highly clustered globotriaosyl residues had high affinity against Stx2 (K_D = 2.7∼4.0 µM) even though other glycopolymers did not show any affinity or showed very weak binding affinity. When Stx1 was used for the same assay, all of the glycopolymers having globotriaosyl residues showed high affinity (K_D = 0.30∼1.74 µM). Interestingly, couple of glycopolymers having lactosyl moieties had weaker binding affinity against Stx1. In addition, when cytotoxicity assays were carried out for both Stxs, glycopolymers having highly clustered globotriaosyl residues showed higher affinity than that of the copolymers, and only highly clustered-type glycopolymers displayed neutralization potency against Stx2.

Associations of Diffusion-Tensor Fractional Anisotropy and FIM Outcome Assessments After Intracerebral Hemorrhage

AIM

This study aimed to clarify the associations between fiber tract degeneration evaluated by diffusion-tensor imaging (DTI) and outcomes following intracerebral hemorrhage (ICH).

METHODS

In total, data of 40 patients from our previously published reports were assessed. Acquisition of fractional anisotropy (FA) maps was performed using DTI 14-21 days after onset; tract-based spatial statistics (TBSS) was used for the analysis. Mean FA values within the corticospinal tract (CST), the superior longitudinal fasciculus (SLF), the inferior longitudinal fasciculus, and the uncinate fasciculus were extracted from individual TBSS data. By using multivariate regression analysis, ratios of FA between lesioned and nonlesioned hemispheres were modeled to fit outcomes assessed by Brunnstrom stage (BRS) shoulder/elbow/forearm, hand/finger, and lower extremity functions and Functional Independence Measure (FIM) motor and cognition scores.

RESULTS

Multivariate regression analyses only took the CST data into the final models for FIM-motor (adjusted R² = .145), BRS shoulder/elbow/forearm, hand/finger, and lower extremity outcomes (adjusted R² = .485, .503, and .425, respectively). In contrast, only the SLF data were taken into the final model for the FIM-cognition outcomes (adjusted R² = .177).

CONCLUSIONS

Fiber tract degeneration in the CST mainly affected motor-related outcomes such as FIM-motor and affected extremity functions assessed by using BRS, whereas that in the SLF associated with poorer cognition-related outcomes. These findings imply that, by using DTI, outcomes of patients after ICH may be predictable by assessing fiber tract degeneration in the CST and the SLF.

Element Selectivity in Second-Harmonic Generation of GaFeO_{3} by a Soft-X-Ray Free-Electron Laser

Nonlinear optical frequency conversion has been challenged to move down to the extreme ultraviolet and x-ray region. However, the extremely low signals have allowed researchers to only perform transmission experiments of the gas phase or ultrathin films. Here, we report second harmonic generation (SHG) of the reflected beam of a soft x-ray free-electron laser from a solid, which is enhanced by the resonant effect. The observation revealed that the double resonance condition can be met by absorption edges for transition metal oxides in the soft x-ray range, and this suggests that the resonant SHG technique can be applicable to a wide range of materials. We discuss the possibility of element-selective SHG spectroscopy measurements in the soft x-ray range.

Microscopic Investigation into the Electric Field Effect on Proximity-Induced Magnetism in Pt

Electric field effects on magnetism in metals have attracted widespread attention, but the microscopic mechanism is still controversial. We experimentally show the relevancy between the electric field effect on magnetism and on the electronic structure in Pt in a ferromagnetic state using element-specific measurements: x-ray magnetic circular dichroism (XMCD) and x-ray absorption spectroscopy (XAS). Electric fields are applied to the surface of ultrathin metallic Pt, in which a magnetic moment is induced by the ferromagnetic proximity effect resulting from a Co underlayer. XMCD and XAS measurements performed under the application of electric fields reveal that both the spin and orbital magnetic moments of Pt atoms are electrically modulated, which can be explained not only by the electric-field-induced shift of the Fermi level but also by the change in the orbital hybridizations.

Botulinum Toxin Type A Treatment Combined with Intensive Rehabilitation for Gait Poststroke: A Preliminary Study

GOAL

To examine the effects of botulinum toxin type A (BoNT-A) treatment combined with intensive rehabilitation for gait compared with intensive rehabilitation alone in patients with chronic stroke.

MATERIALS AND METHODS

A comparative case series design was used. Subjects were 19 patients with chronic stroke and spastic hemiplegia. In 9 patients (group I), BoNT-A was injected into spastic muscles of the affected lower limbs, followed by a 4-week inpatient intensive rehabilitation program. In the other 10 patients (group II), a 4-week inpatient intensive rehabilitation program alone was first provided (control period) followed by the same treatment protocol in group I. The Modified Ashworth Scale (MAS) scores, range of motion (ROM), gait speed in the 10-Meter Walking Test, 6-Minute Walking Distance Test (6MD) scores, Timed Up and Go Test (TUG) scores, and Berg Balance Scale scores were evaluated every 4 weeks following baseline assessments.

RESULTS

All results except for the MAS score of knee flexor and the ROM of knee flexion improved in group I and the gait speed, 6MD, and TUG scores improved in group II. Intergroup comparisons at week 4 showed significantly greater improvements in the MAS score of ankle plantar flexor, ROM of ankle dorsiflexion, and 6MD in group I than in group II (P = .016, .011, and .009, respectively).

CONCLUSIONS

BoNT-A treatment for lower-limb spasticity, combined with intensive rehabilitation, was effective in improving spasticity and the 6MD compared with intensive rehabilitation alone in patients with chronic stroke.

Utility of Fractional Anisotropy in Cerebral Peduncle for Stroke Outcome Prediction: Comparison of Hemorrhagic and Ischemic Strokes

BACKGROUND

Diffusion-tensor fractional anisotropy (FA) has been used for predicting stroke outcome. However, most previous studies focused on patients with either hemorrhagic or ischemic stroke. The aim of this study was to assess the correlation between FA and outcome for patients with hemorrhagic stroke and those with ischemic stroke, and then compare their correlation patterns.

METHODS

This study sampled 40 hemorrhagic and 40 ischemic stroke patients from our previously published reports. Diffusion-tensor images were obtained on days 14-21, and FA images were generated, after which the ratio of FA within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated. Outcome was assessed using Brunnstrom stage (BRS), motor component of the functional independence measure (FIM-motor), and total length of hospital stay (LOS) at discharge from our affiliated rehabilitation hospital. The data were then compared between the hemorrhage and the infarct groups. Correlation analyses between rFA and outcome assessments were performed separately for both groups and then were compared between the groups.

RESULTS

The hemorrhage group exhibited significantly more severe BRS, longer LOS, and lower rFA than the infarct group. The correlations between rFA and outcome measures were all statistically significant for both the hemorrhage and the infarct groups. The correlation patterns for BRS and LOS were very similar between the hemorrhage and the infarct groups. However, such similarity was not evident for FIM-motor.

CONCLUSIONS

FA in the cerebral peduncles may be used to predict extremity functions and LOS for both types of stroke.

Iodoacetyl-functionalized pullulan: A supplemental enhancer for single-domain antibody-polyclonal antibody sandwich enzyme-linked immunosorbent assay for detection of survivin

Survivin, an inhibitor of the apoptosis protein family, is a potent tumor marker for diagnosis and prognosis. The enzyme-linked immunosorbent assay (ELISA) is one of the methods that has been used for detection of survivin. However, ELISA has several disadvantages caused by the use of conventional antibodies, and we have therefore been trying to develop a novel ELISA system using camelid single-domain antibodies (VHHs) as advantageous replacements. Here we report a supplemental approach to improve the VHH-polyclonal antibody sandwich ELISA for survivin detection. Iodoacetyl-functionalized pullulan was synthesized, and its thiol reactivity was characterized by a model reaction with l-cysteine. The thiophilic pullulan was applied to an immunoassay asan additive upon coating of standard assay plates with an anti-survivin VHH fusion protein with C-terminal cysteine. The results showed that the mole ratio of the additive to VHH had a significant effect on the consequent response. Mole ratios of 0.07, 0.7, and 7 led to 90% lower, 15% higher, and 69% lower responses, respectively, than the response of a positive control in which no additive was used. The background levels observed in any additive conditions were as low as that of a negative control lacking both VHH and the additive. These results indicate the applicability of the thiol-reactive pullulan as a response enhancer to VHH-based ELISA.