Cs and Br tuning to achieve ultralow-hysteresis and high-performance indoor triple cation perovskite solar cell with low-cost carbon-based electrode

With high efficacy for electron-photon conversion under low light, perovskite materials show great potential for indoor solar cell applications to power small electronics for internet of things (IoTs). To match the spectrum of an indoor LED light source, triple cation perovskite composition was varied to adjust band gap values via Cs and Br tuning. However, increased band gaps lead to morphology, phase instability, and defect issues. 10% Cs and 30% Br strike the right balance, leading to low-cost carbon-based devices with the highest power conversion efficiency (PCE) of 31.94% and good stability under low light cycles. With further improvement in device stack and size, functional solar cells with the ultralow hysteresis index (HI) of 0.1 and the highest PCE of 30.09% with an active area of 1 cm2 can be achieved. A module from connecting two such cells in series can simultaneously power humidity and temperature sensors under 1000 lux.

Natural history of asymptomatic cervical internal carotid artery stenosis in diabetes mellitus patients

INTRODUCTION

Diabetes mellitus (DM) is known to be a cause of cervical internal carotid artery stenosis (ICS). In this study, we investigated the natural history of asymptomatic ICS in DM patients without surgical intervention.

METHODS

We conducted a retrospective study of 148 DM patients with asymptomatic ICS treated medically at the Kansai Electric Power Hospital from April 2013 to March 2023, inclusive. We examined the incidence of ischemic stroke with ICS and evaluated the patients' clinical characteristics and imaging findings.

RESULTS

Ischemic stroke with ICS occurred in 7 patients (4.7 %), and only smoking history was significantly correlated with the incidence of ischemic stroke (p = 0.04).

DISCUSSION

The incidence rate of ischemic stroke with ICS in this study (4.7%) was comparable to the previous report. The result that, the correlated factors of the incidence of ischemic stroke in DM patients with ICS was only smoking history, seemed acceptable. However, prospective studies with a larger number of cases may be needed in the future to determine the correlated factors more eligibly.

Acute-Phase Plasma Pigment Epithelium-Derived Factor Predicting Outcomes after Aneurysmal Subarachnoid Hemorrhage in the Elderly

Aneurysmal subarachnoid hemorrhage (SAH) has increased with the aging of the population, but the outcome for elderly SAH patients is very poor. Therefore, predicting the outcome is important for determining whether to pursue aggressive treatment. Pigment epithelium-derived factor (PEDF) is a matricellular protein that is induced in the brain, and the plasma levels could be used as a biomarker for the severity of metabolic diseases. This study investigated whether acute-phase plasma PEDF levels could predict outcomes after aneurysmal SAH in the elderly. Plasma samples and clinical variables were collected over 1-3 days, post-SAH, from 56 consecutive elderly SAH patients ≥75 years of age registered in nine regional stroke centers in Japan between September 2013 and December 2016. The samples and variables were analyzed in terms of 3-month outcomes. Acute-phase plasma PEDF levels were significantly elevated in patients with ultimately poor outcomes, and the cutoff value of 12.6 µg/mL differentiated 3-month outcomes with high sensitivity (75.6%) and specificity (80.0%). Acute-phase plasma PEDF levels of ≥12.6 µg/mL were an independent and possibly better predictor of poor outcome than previously reported clinical variables. Acute-phase plasma PEDF levels may serve as the first biomarker to predict 3-month outcomes and to select elderly SAH patients who should be actively treated.

Prompt Electronic Discrimination of Gas Molecules by Self-Heating Temperature Modulation

Though considerable progress has been achieved on gas molecule recognition by electronic nose (e-nose) comprised of nonselective (metal oxide) semiconductor chemiresistors, extracting adequate molecular features within short time (<1 s) remains a big obstacle, which hinders the emerging e-nose applications in lethal or explosive gas warning. Herein, by virtue of the ultrafast (∼20 μs) thermal relaxation time of self-heated WO3-based chemiresistors fabricated via oblique angle deposition, instead of external heating, self-heating temperature modulation has been proposed to generate sufficient electrical response features. Accurate discrimination of 12 gases (including 3 xylene isomers with the same function group and molecular weight) has been readily achieved within 0.5-1 s, which is one order faster than the state-of-the-art e-noses. A smart wireless e-nose, capable of instantaneously discriminating target gas in ambient air background, has been developed, paving the way for the practical applications of e-nose in the area of homeland security and public health.

Real-time kinetic analysis and detection of glycated hemoglobin A1c using a quartz crystal microbalance-based aptasensor

Glycated hemoglobin (HbA1c) has been an important biomarker for long-term diagnosis and monitoring of diabetes mellitus. The development of a rapid, reliable, and less sophisticated device to measure HbA1c is imperative to facilitate efficient early-care diabetes management. To date, no existing aptamer-based biosensor (aptasensor) for detecting HbA1c has been developed using a quartz crystal microbalance (QCM). In this study, the aptamer specific to HbA1c as a novel biosensing receptor was covalently functionalized onto a QCM substrate via mixed self-assembled monolayers (SAMs). A portable QCM equipped with a liquid-flow module was used to investigate the biospecificity, sensitivity, and interaction dynamics of the aptamer functionalized surfaces. The real-time kinetic analysis of HbA1c binding to the surface-functionalized aptamers revealed "on" and "off" binding rates of 4.19 × 104 M-1 s-1 and 2.43 × 10-3 s-1, respectively. These kinetic parameters imply that the QCM-based aptasensor specifically recognizes HbA1c with an equilibrium dissociation constant as low as 57.99 nM. The linear detection of HbA1c spanned from 13 to 108 nM, with a limit of detection (LOD) of 26.29 nM. Moreover, the spiked plasma sample analysis offered compelling evidence that this aptasensor is a promising technique for developing a point-of-care device for diabetes mellitus.

Twig-like middle cerebral artery as a variety of isolated middle cerebral artery disease with new vessel formation: illustrative case

BACKGROUND

Twig-like middle cerebral artery (T-MCA) is reported as a rare vascular anomaly characterized by reconstitution of the M1 segment of the middle cerebral artery (MCA) by a plexiform network of small vessels. Although it is generally believed that the etiology of T-MCA is an embryological persistence, some investigators have suggested that T-MCA may be a secondary consequence. Here, the authors report a second case of de novo T-MCA formation and reconsider the concept of T-MCA in connection with isolated MCA disease.

OBSERVATIONS

A 40-year-old man's brain magnetic resonance imaging (MRI) checkup showed moderate stenosis of the M1 segment of the left MCA. Annual MRI follow-up was planned, and when performed 1 year later, it showed occlusion of the M1 segment of the left MCA. Cerebral angiography revealed occlusion of that M1 segment with abnormal arterial networks. This case was diagnosed as de novo T-MCA. The patient has remained asymptomatic for 2 years.

LESSONS

The reports of de novo T-MCA indicate that acquired factors may be involved in the pathogenesis of T-MCA. We suggest that T-MCA should be defined as a variety of isolated MCA disease with new vessel formation.

Cilostazol May Improve Outcomes Even in Patients with Aneurysmal Subarachnoid Hemorrhage Aged 75 Years and Older: Multicenter Cohort Study and Propensity Score-Matched Analyses

BACKGROUND

The opportunities to treat elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) are increasing globally, but the outcome remains poor. This study seeks to investigate treatment-related factors that can modify functional outcomes in patients with aSAH aged ≥75 years.

METHODS

A total of 202 patients with aSAH aged ≥75 years prospectively enrolled in 9 primary stroke centers from 2013 to 2021 were retrospectively analyzed. Clinical variables including treatments for hydrocephalus, angiographic vasospasm, and delayed cerebral ischemia were compared between patients with good (modified Rankin Scale [mRS] score 0-2) and poor (mRS score 3-6) outcomes at 90 days from onset, followed by multivariate analyses to find independent outcome determinants. A modifiable treatment-related variable was evaluated after propensity score matching with adjustments for age, sex, pre-onset mRS score, aSAH severity, and treatment modality.

RESULTS

More than half of patients showed World Federation of Neurological Societies grades IV-V on admission. Univariate analyses showed that advanced age, worse pre-onset mRS score, more severe neurologic status on admission, higher modified Fisher grade on admission computed tomography scans, and acute and chronic hydrocephalus were associated with poor outcomes. In contrast, administration of a phosphodiesterase type III inhibitor, cilostazol, was associated with good outcomes in both univariate (P = 0.036) and multivariate analyses (adjusted odds ratio, 0.305; 95% confidence interval, 0.097-0.955; P = 0.042). Propensity score matching analyses showed that patients treated with cilostazol had better outcomes (P = 0.016) with fewer incidences of delayed cerebral infarction (P = 0.008).

CONCLUSIONS

Even in patients with aSAH aged ≥75 years, cilostazol administration may lead to better outcomes by suppressing the development of delayed cerebral infarction.

Moyamoya disease presenting with symptomatic ischemic stroke during new-generation tyrosine kinase inhibitor treatment: two illustrative cases

Tyrosine kinase inhibitors (TKIs) have been widely used to treat chronic myeloid leukemia. Nilotinib and ponatinib, which are second- and third-generation TKIs, have been reported to cause cerebrovascular arterial complications. Here, we present two cases of moyamoya disease presenting with symptomatic ischemic stroke during new-generation TKI treatment. We judged that new-generation TKI treatment was a factor in symptomatic ischemic stroke of unknown moyamoya disease in both cases. Noninvasive examinations using magnetic resonance imaging or carotid ultrasonography should be performed before and during new-generation TKI treatment in order to prevent symptomatic ischemic stroke.

Effect of Exercise Therapy on Incident Admission in Patients with Type 2 Diabetes Mellitus Undergoing Inpatient Diabetes Self-management Education and Support Tokyo Metropolitan Toshima Hospital, Tokyo Metropolitan Hospital Organization, Japan

BACKGROUND

Exercise therapy is the key to preventing admission of patients with type 2 diabetes mellitus (T2DM). However, a few studies have examined the effects of exercise therapy on patients with T2DM undergoing inpatient diabetes self-management education and support (IDSMES).

OBJECTIVE

This study investigated whether exercise therapy influenced the incidence of admission after discharge in patients with T2DM undergoing IDSMES.

METHODS

This retrospective cohort study included patients with T2DM who underwent IDSMES between June 2011 and May 2015. Overall, 258 patients were included in this study. The exercise therapy program was implemented in June 2013. Accordingly, patients diagnosed between June 2011 and May 2013 were categorized as the non-exercise therapy program group, while those diagnosed between June 2013 and May 2015 were categorized as the exercise therapy program group. Outcomes were incident diabetes-related and all-cause admissions within 1 year of discharge. Multiple logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the exercise therapy program's impact on the outcomes.

RESULTS

Within 1 year of discharge, 27 (10.5%) patients underwent diabetes-related admissions and 62 (24.0%) underwent all-cause admissions. Multiple logistic regression analyses showed a significant association of the exercise therapy program with incident diabetes-related and allcause admissions [OR: 0.22 (95% CI: 0.08-0.59) and 0.44 (95% CI: 0.22-0.86), respectively].

CONCLUSION

Exercise therapy programs significantly lowered the incidences of diabetes-related and all-cause admissions. This indicates that implementing exercise therapy during hospitalization may be important for preventing admissions of patients with T2DM receiving IDSMES.

Using computed tomography fusion imaging as learning data for sonographer training in identification of left ventricular endocardial boundaries

BACKGROUND

We hypothesized that if computed tomography (CT) images were used as learning data, we could overcome volume underestimation by echocardiography, improving the accuracy of left ventricular (LV) volume measurements.

METHODS

We utilized a fusion imaging modality consisting of echocardiography with superimposed CT images for 37 consecutive patients to identify the endocardial boundary. We compared LV volumes obtained with and without CT learning trace-lines (TLs). Furthermore, 3D echocardiography was used to compare LV volumes obtained with and without CT learning for endocardial identification. The mean difference between the echocardiography and CT-derived LV volumes and the coefficient of variation were compared pre- and post-learning. Bland-Altman analysis was used to assess the differences in LV volume (mL) obtained from the 2D pre-learning TL and 3D post-learning TL.

RESULTS

The post-learning TL was located closer to the epicardium than the pre-learning TL. This trend was particularly pronounced in the lateral and the anterior wall. The post-learning TL was along the inner side of the high echoic layer in the basal-lateral wall in the four-chamber view. CT fusion imaging determined that the difference in LV volume between 2D echocardiography and CT was small (-25.6 ± 14.4 mL before learning, -6.9 ± 11.5 mL after learning) and that CT learning improved the coefficient of variation (10.9 % before learning, 7.8 % after learning). Significant improvements were observed during 3D echocardiography; the difference in LV volume between 3D echocardiography and CT was slight (-20.5 ± 15.1 mL before learning, 3.8 ± 15.7 mL after learning), and the coefficient of variation improved (11.5 % before learning, 9.3 % after learning).

CONCLUSIONS

Differences between the LV volumes obtained using CT and echocardiography either disappeared or were reduced after CT fusion imaging. Fusion imaging is useful in training regimens for accurate LV volume quantification using echocardiography and may contribute to quality control.

Unraveling the Adsorption Behavior of Thymol on Carbon and Silica Nanospheres for Prolonged Antibacterial Activity: Experimental and DFT Studies

Functionalization of thymol (Thy) on nanocarriers is a key step in achieving prolonged antimicrobial activity. This requires nanomaterials with uniform particle diameters and suitable thymol sorption. Herein, hollow carbon (HC) and SiO2-carbon core-shell (SiO2@C) were investigated due to their diverse morphologies and ease of surface modification. HC (14 ± 1 nm size) and SiO2@C (10 ± 1.5 nm size) were synthesized by the Stöber method before thymol was loaded by incipient wetness impregnation. Nanoparticle physicochemical properties were characterized by advanced techniques, including X-ray photoelectron spectroscopy (XPS) and near-edge X-ray absorption fine structure (NEXAFS). Adsorption energies of thymol on the carbon and SiO2 surfaces were elucidated by density functional theory (DFT) simulations. Moreover, the in vitro thymol release profiles and antibacterial activity were evaluated. The experimental results indicated that the oxy-carbon surface species of HC led to longer thymol release profiles than the -OH group of SiO2@C. The DFT calculations revealed that the weaker physical interaction of thymol on HC was better for drug release than that on SiO2@C. Thus, a longer thymol release profile of HC with hollow structures showed better antibacterial performance against Gram-positive bacteria Staphylococcus aureus than that of SiO2@C with core-shell structures. This work confirms the important role of carbon morphology and specific functional groups in thymol release profiles for the further development of inhibition products.

Influence of metal salts (Al, Ca, and Mg) on the work function and hole extraction at carbon counter electrodes in perovskite solar cells

Hole transport material-free carbon-based perovskite solar cells (HTM-free C-PSCs) are recognized as a cost-effective and stable alternative to conventional perovskite solar cells. However, the significant energy level misalignment between the perovskite layer and the carbon counter electrode (CE) results in ineffective hole extraction and unfavorable charge recombination, which decreases the power conversion efficiency (PCE). Here, we report the introduction of metal salts (Al, Ca, and Mg) into graphite/carbon black (Gr/CB) CEs to modify the work function and enhance the hole selectivity of the CE. This modification leads to improved energy level alignment, efficient hole extraction, and reduced charge recombination. The PCE of the HTM-free C-PSC based on Al-modified Gr/CB as the CE material reached 9.91%, which is approximately 12% higher than that of devices employing unmodified Gr/CB CEs. This work demonstrates that by directly incorporating metal salts into the Gr/CB CE, the energy level alignment and hole extraction at the perovskite/carbon interface can be improved. This presents a viable method for enhancing the PCE of HTM-free C-PSCs.

Unrevealing tunable resonant excitons and correlated plasmons and their coupling in new amorphous carbon-like for highly efficient photovoltaic devices

An understanding on roles of excitons and plasmons is important in excitonic solar cells and photovoltaic (PV) technologies. Here, we produce new amorphous carbon (a-C) like films on Indium Tin Oxide (ITO) generating PV cells with efficiency three order of magnitude higher than the existing biomass-derived a-C. The amorphous carbon films are prepared from the bioproduct of palmyra sap with a simple, environmentally friendly, and highly reproducible method. Using spectroscopic ellipsometry, we measure simultaneously complex dielectric function, loss function as well as reflectivity and reveal coexistence of many-body resonant excitons and correlated-plasmons occurring due to strong electronic correlations. X-ray absorption and photoemission spectroscopies show the nature of electron and hole in defining the energy of the excitons and plasmons as a function of N or B doping. Our result shows new a-C like films and the importance of the coupling of resonant excitons and correlated plasmons in determining efficiency of photovoltaic devices.

Plasma SPARC Elevation in Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Matricellular proteins have been implicated in pathologies after subarachnoid hemorrhage (SAH). To find a new therapeutic molecular target, the present study aimed to clarify the relationships between serially measured plasma levels of a matricellular protein, secreted protein acidic and rich in cysteine (SPARC), and delayed cerebral ischemia (DCI) in 117 consecutive aneurysmal SAH patients with admission World Federation of Neurological Surgeons (WFNS) grades I-III. DCI developed in 25 patients with higher incidences of past history of hypertension and dyslipidemia, preoperative WFNS grade III, modified Fisher grade 4, spinal drainage, and angiographic vasospasm. Plasma SPARC levels were increased after SAH, and significantly higher in patients with than without DCI at days 7-9, and in patients with VASOGRADE-Yellow compared with VASOGRADE-Green at days 1-3 and 7-9. However, there were no relationships between plasma SPARC levels and angiographic vasospasm. Receiver-operating characteristic curves differentiating DCI from no DCI determined the cut-off value of plasma SPARC ≥ 82.1 ng/ml at days 7 - 9 (sensitivity, 0.800; specificity, 0.533; and area under the curve, 0.708), which was found to be an independent determinant of DCI development in multivariate analyses. This is the first study to show that SPARC is upregulated in peripheral blood after SAH, and that SPARC may be involved in the development of DCI without angiographic vasospasm in a clinical setting.

Controlling the Photocatalytic Activity and Benzylamine Photooxidation Selectivity of Bi2WO6 via Ion Substitution: Effects of Electronegativity

Doping or ion substitution is often used as an effective strategy to improve photocatalytic activities of several semiconductors. Most frequently, the dopants provide extra states to increase light absorption, alter the electronic structure, or lower the carrier recombination. This work focuses on ion substitution in Bi₂WO₆, where the dopants modify band-edge potentials of the catalysts. Specifically, we investigate how the electronegativity (EN) of the dopant could be used to tune the band-edge potentials and how such changes influence the photocatalytic mechanism. Compared to Te that has a lower EN, I lowers the band-edge potentials. While substitutions with both ions enhance Rh B photodegradation and benzylamine photooxidation, the modified band potentials of I-doped Bi₂WO₆ influence the benzylamine photooxidation pathway, resulting in higher selectivity. Additionally, substitution of I⁷⁺ in the Bi₂WO₆ lattice improves the morphologies, decreases the band-gap energy, and reduces the carrier recombination. As a result, I-doped Bi₂WO₆ shows almost 3 times higher %conversion while maintaining 100% selectivity in the oxidative coupling of benzylamine. The findings here signify the importance of the choices of dopants on the photocatalytic reactions and would benefit the design of other related materials for such applications.

Denileukin diftitox-induced systemic capillary leak syndrome with acute kidney injury

Systemic capillary leak syndrome is a rare and life-threatening disorder, characterized by recurrent episodes of unexplained hypotension, hemoconcentration, and hypoalbuminemia. This condition is caused by leakage of plasma and proteins into the extravascular space and can be classified as either idiopathic or secondary. Secondary systemic capillary leak syndrome can result from cancer, infections, medications, or surgery. Systemic capillary leak syndrome frequently develops as a side effect of denileukin diftitox treatment of refractory cutaneous T-cell lymphoma. However, the pathophysiology of this disease is not well understood. Herein, we report a case of denileukin diftitox-induced systemic capillary leak syndrome.

Angiomatous meningioma associated with rapidly aggravated peritumoral leptomeningitis: A case report

Background

A special type of meningioma is known to have infiltrated inflammatory cells within the tumor, associated with peritumoral inflammation. However, there have been no reports of meningioma with inflammatory response only around the tumor, without inflammatory cells within the tumor itself.

Case Description

A 70-year-old woman presented with transient right hemiparesis due to an extra-axial tumor on the left frontal convexity. The tumor appeared hypointense on T1-weighted magnetic resonance images and hyperintense on T2-weighted images without peritumoral edema, and was homogenously enhanced associated with the peritumoral leptomeningeal enhancement. Cerebrospinal fluid examination showed an increase in the number of inflammatory cells with a predominance of mononuclear cells. During the following 1 month, the tumor size was unchanged, but the peritumoral leptomeningeal enhancement was remarkably enlarged with uncontrolled focal seizures. The tumor was subtotally removed and semisolid substances in the subarachnoid space were biopsied. Pathological examination with immunostaining revealed angiomatous meningioma: the tumor had no inflammatory cell infiltration within it, but was associated with the infiltration of immunoglobulin G4-negative lymphocytes into the border zone between the tumor and the dura mater, as well as numerous neutrophils and fibrinous exudates in the peritumoral subarachnoid space. The tumor removal rapidly improved the leptomeningeal enhancement and inflammatory reactions.

Conclusion

The authors reported the first case of angiomatous meningioma associated with massive peritumoral inflammation without inflammatory infiltrates within the tumor itself.

Advantages of Extradural Anterior Clinoidectomy and Extradural Approach with Dural Incision for Blood Blister Aneurysm or Pseudoaneurysm in the Internal Carotid Artery: Two Case Reports

Blood blister aneurysms (BBAs) or pseudoaneurysms (PAs) in the internal carotid artery (ICA) have fragile necks; therefore, conventional neck clipping is difficult. The standard treatment for BBAs or PAs is trapping with high or low flow bypass. However, there is no consensus on whether or not anterior clinoidectomy should be performed together. Two patients with ruptured ICA PA (anterior protrusion) or BBA (posterior protrusion) were presented to our hospital. Complete trapping was safely performed for both types of aneurysms via extradural anterior clinoidectomy and the extradural approach with dural incision. The advantages of the procedure are 1) safe proximal clipping, 2) early identification of the ICA C3 portion, 3) minimized frontal lobe retraction, 4) optic canal opening to allow mobility of the optic nerve, and 5) dural ring incision to allow mobility of the ICA.

Plasma Fibulin-5 Levels as an Independent Predictor of a Poor Outcome after an Aneurysmal Subarachnoid Hemorrhage

Aneurysmal subarachnoid hemorrhage (SAH) is a poor-outcome disease with a delayed neurological exacerbation. Fibulin-5 (FBLN5) is one of matricellular proteins, some of which have been involved in SAH pathologies. However, no study has investigated FBLN5's roles in SAH. This study was aimed at examining the relationships between serially measured plasma FBLN5 levels and neurovascular events or outcomes in 204 consecutive aneurysmal SAH patients, including 77 patients (37.7%) with poor outcomes (90-day modified Rankin Scale 3-6). Plasma FBLN5 levels were not related to angiographic vasospasm, delayed cerebral ischemia, and delayed cerebral infarction, but elevated levels were associated with severe admission clinical grades, any neurological exacerbation and poor outcomes. Receiver-operating characteristic curves indicated that the most reasonable cut-off values of plasma FBLN5, in order to differentiate 90-day poor from good outcomes, were obtained from analyses at days 4-6 for all patients (487.2 ng/mL; specificity, 61.4%; and sensitivity, 62.3%) and from analyses at days 7-9 for only non-severe patient (476.8 ng/mL; specificity, 66.0%; and sensitivity, 77.8%). Multivariate analyses revealed that the plasma FBLN5 levels were independent determinants of the 90-day poor outcomes in both all patients' and non-severe patients' analyses. These findings suggest that the delayed elevation of plasma FBLN5 is related to poor outcomes, and that FBLN5 may be a new molecular target to reveal a post-SAH pathophysiology.

Passive dual-probe near-field microscopy

Accurate and simultaneous multiposition near-field measurements are essential to study the time-dependent local dynamics, including heat and carrier transfer. The existing passive long-wavelength infrared (LWIR) scattering-type scanning near-field optical microscopy (s-SNOM) systems with a single probe cannot perform precise near-field measurements of the heat or carrier transporting process at the nanoscale level. Therefore, in this study, we developed a passive LWIR s-SNOM system with two probes. To test the effectiveness of the proposed passive LWIR dual-probe s-SNOM system, each probe was precisely controlled using a shear-force feedback system, and the mechanical interference between the probes was used to monitor the distance between the probes. We achieved simultaneous near-field measurements at two different positions 500 nm apart using the proposed passive LWIR dual-probe s-SNOM system. The simultaneously detected near-field signals from two different points were extracted individually, making this technique an effective nanoscale analysis tool for local carrier dynamics.

Roles of glutamate in brain injuries after subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage (SAH) is a stroke type with a high rate of mortality and morbidity. Post-SAH brain injury as a determinant of poor outcome is classified into the following two types: early brain injury (EBI) and delayed cerebral ischemia (DCI). EBI consists of various acute brain pathophysiologies that occur within the first 72 hours of SAH in a clinical setting. The underlying mechanisms of DCI are considered to be cerebral vasospasm or microcirculatory disturbance, which develops mostly 4 to 14 days after clinical SAH. Glutamate is the principal neurotransmitter in the central nervous system, but excessive glutamate is known to induce neurotoxicity. Experimental and clinical studies have revealed that excessive glutamates are released after SAH. In addition, many studies have reported the relationships between excessive glutamate release or overactivation of glutamate receptors and excitotoxicity, cortical spreading depolarization, seizure, increased blood-brain barrier permeability, neuroinflammation, microthrombosis formation, microvasospasm, cerebral vasospasm, impairments of brain metabolic supply and demand, impaired neurovascular coupling, and so on, all of which potentially contribute to the development of EBI or DCI. As glutamates always exert their functions through one or more of 4 major receptors of glutamates, it would be valuable to know the mechanisms as to how glutamates cause these pathologies, and the possibility that a glutamate receptor antagonist may block the pathologies. To prevent the mechanistic steps leading to glutamate-mediated neurotoxicity may ameliorate SAH-induced brain injuries and improve the outcomes. This review addresses the current knowledge of glutamate-mediated neurotoxicity, focusing on EBI and DCI after SAH.

Endovascular therapy for cardiocerebral infarction associated with atrial fibrillation: A case report and literature review

Background:

Cardiocerebral infarction (CCI) is a rare entity that refers to the simultaneous occurrence of acute myocardial infarction and acute ischemic stroke. The management of CCI patients remains unclear.

Case Description:

An 86-year-old woman with a medical history of paroxysmal atrial fibrillation presented with a sudden onset of consciousness disturbance and right hemiplegia. Computed tomography of the head revealed no intracranial hemorrhage but the left hyperdense middle cerebral artery sign, associated with ST-segment elevation in II, III, and aVF noted on a routine 12-lead electrocardiogram at admission. The patient was immediately brought to the catheterization laboratory and percutaneous coronary intervention (PCI) was performed first, followed by mechanical thrombectomy, resulting in successful revascularization of the both diseases.

Conclusion:

Although the treatment strategy of CCI may depend on the condition of coronary and cerebral ischemia, it may be appropriate to prioritize coronary angiography and PCI if not acute ischemic stroke is critical.

Safety, efficacy, and drug survival of the infliximab biosimilar CT-P13 in post-marketing surveillance of Japanese patients with psoriasis

Based on extrapolation of similar clinical outcomes in rheumatoid arthritis to the originator infliximab (IFX) in randomized clinical trials, the first biosimilar antibody CT-P13 was approved for the treatment of psoriasis. To evaluate the safety, efficacy, and drug survival of CT-P13 for psoriasis in real-world clinical practice, prospective post-marketing surveillance was conducted in 165 Japanese psoriasis patients. During a 1-year follow-up period, adverse drug reactions (ADRs) occurred in 29 patients (17.6%). Infusion reaction was the most frequent ADR (6.7%), and mild pneumonia was reported as the only case of infection. Serious ADRs were reported in two patients (1.2%): acute cholecystitis and interstitial pneumonia. The interstitial pneumonia developed after a single infusion of CT-P13 and the patient died of respiratory failure. In naive patients to biologic therapy (n = 44), the Psoriasis Area Severity Index (PASI) decreased rapidly after the start of CT-P13 treatment, and response rate achieving an absolute PASI score <1 was 55% at 30 weeks. The response rate was high (78%) in patients with psoriatic arthritis, and 40% and 20% in those in plaque psoriasis and pustular psoriasis, respectively. Of patients switched from IFX to CT-P13 mainly for nonmedical reasons (n = 105), 57% had already reached PASI <1 by pretreatment with IFX and CT-P13 maintained this status. The incidence of ADRs in this patient group was low and the drug survival rate was as high as 74%, even at 1 year, which was significantly higher than that in the naïve patient group (47%). Patients switched from other biologics for medical reasons (n = 16) responded similarly to biologic-naïve patients, but drug survival was lower (24%). In conclusion, CT-P13 showed excellent effectiveness as a first-line therapy, no clinical difficulties in switching from IFX, and usefulness in patients who failed other biologics. CT-P13 could be a cost-effective alternative to IFX for the treatment of psoriasis.

A case of traumatic acute interhemispheric subdural hematoma due to injured dural branch of anterior cerebral artery

Background:

The precise causes of traumatic acute interhemispheric subdural hematoma (AISDH) are unclear in most cases, and there are few cases, where the sources of bleeding are directly confirmed intraoperatively. We report a rare case of traumatic AISDH, in which a damaged dural branch of anterior cerebral artery (ACA) to the cerebral falx was identified as the cause of bleeding during hematoma removal.

Case Description:

A 61-year-old man with a history of craniotomy for the left putaminal hemorrhage at the age of 50 fell from a bed, bruised his head, and lost consciousness. Computed tomography of the head showed AISDH of 2.5cm in thickness, which was removed through a parietal parasagittal craniotomy under the microscope. Intraoperatively, the bleeding source was revealed to be a damaged dural branch from ACA to the cerebral falx. There was no rebleeding during his stay in our hospital.

Conclusion:

In this case, intraoperative findings revealed that the cause of bleeding was a damage to the dural branch of ACA. A vascular study is mandatory to rule out a vascular malformation in similar cases.

Graphite/Carbon Black Counter Electrode Deposition Methods to Improve the Efficiency and Stability of Hole-Transport-Layer-Free Perovskite Solar Cells

The interfacial compatibility between the graphite/carbon black composite counter electrode (Gr/CB CE) and the perovskite layer is a crucial determinant of the performance of the hole-transport-layer-free carbon-based perovskite solar cells, and judicious selection of the Gr/CB CE application method is essential for achieving an optimum contact. In this work, three different types of Gr/CB CEs application methods are investigated: (1) deposition of Gr/CB on the fluorine-doped tin oxide (FTO) substrate, followed by clamping to the perovskite layer, (2) direct deposition of Gr/CB onto the perovskite layer, and (3) deposition of Gr/CB onto the PbI₂ precursor layer, followed by immersion in methylammonium iodide solution for the in situ conversion of PbI₂ to perovskite. The results revealed that Method 3 produced superior Gr/CB-perovskite contacts, resulting in up to 8.81% power conversion efficiency. The devices prepared using Method 3 also exhibited the best stability in the air, retaining 71.1% of their original efficiency after 1600 h of continuous testing. These results demonstrate that Gr/CB CEs can be considered excellent alternatives to the costly noble metals often employed in perovskite solar cells (PSCs) when deposited using a suitable technique.

ADC Level is Related to DWI Reversal in Patients Undergoing Mechanical Thrombectomy: A Retrospective Cohort Study

BACKGROUND AND PURPOSE

In patients with ischemic stroke, DWI lesions can occasionally be reversed by reperfusion therapy. This study aimed to ascertain the relationship between ADC levels and DWI reversal in patients with acute ischemic stroke who underwent recanalization treatment.

MATERIALS AND METHODS

We conducted a retrospective cohort study in patients with acute ischemic stroke who underwent endovascular mechanical thrombectomy with successful recanalization between April 2017 and March 2021. DWI reversal was assessed through follow-up MR imaging approximately 24 hours after treatment.

RESULTS

In total, 118 patients were included. DWI reversal was confirmed in 42 patients. The ADC level in patients with reversal was significantly higher than that in patients without reversal. Eighty-three percent of patients with DWI reversal areas had mean ADC levels of ≥520 × 10^-6 mm²/s, and 71% of patients without DWI reversal areas had mean ADC levels of <520 × 10^-6 mm²/s. The mean ADC threshold was 520 × 10^-6 mm²/s with a sensitivity and specificity of 71% and 83%, respectively. In multivariate analysis, the mean ADC level (OR, 1.023; 95% CI, 1.013-1.033; P < .0001) was independently associated with DWI reversal. Patients with DWI reversal areas had earlier neurologic improvement (NIHSS at 7 days) than patients without reversal areas (P < .0001).

CONCLUSIONS

In acute ischemic stroke, the ADC value is independently associated with DWI reversal. Lesions with a mean ADC of ≥520 × 10^-6 mm²/s are salvageable by mechanical thrombectomy, and DWI reversal areas regain neurologic function. The ADC value is easily assessed and is a useful tool to predict viable lesions.

A familial case of periodontal Ehlers-Danlos syndrome lacking skin extensibility and joint hypermobility with a missense mutation in C1R

Periodontal Ehlers-Danlos syndrome (pEDS) is an autosomal-dominant disorder first described by Stewart in 1977 that is characterized by severe gingival recession and periodontitis that triggers premature loss of permanent teeth and alveolar bone absorption. It was recently shown that pEDS is caused by a heterozygous missense mutation in C1R or C1S, which encode complement 1 proteases. Here, we report a familial case of pEDS with a novel heterozygous missense mutation, c.674G>C (p.R225P), in C1R (NM_001733.4). The case exhibited pretibial hyperpigmentation and extended periodontitis but neither skin extensibility nor joint hypermobility, suggesting that this mutation will expand the definition of pEDS.

Echocardiography image quality of global longitudinal strain in cardio-oncology: a prospective real-world investigation

BACKGROUND

Left-ventricular (LV) global longitudinal strain (GLS) has been reported to be a robust and sensitive marker of chemotherapy-induced cardiac damage. Image quality is paramount for accurate GLS measurements. In real-world cardio-oncology settings, the incidence of suboptimal echocardiography quality and its significance in clinical decision-making have not been well investigated. This prospective study examined the incidence and impact of suboptimal echocardiographic image quality on detecting subtle myocardial damage by chemotherapy.

METHODS

Seventy-seven consecutive patients with breast cancer (age, 52 ± 12 years, 76 women, 33 with left-sided breast cancer) were included in this study. Echocardiography was performed at 3-month intervals 1 year before and after chemotherapy initiation. We classified the image quality of each echocardiographic acquisition into three groups: optimal, suboptimal, or inadequate for speckle tracking.

RESULTS

Among the 376 examinations obtained during the cardiac monitoring, the image quality in 194 (52%) was optimal, suboptimal in 159 (42%), and inadequate in 23 (6%). The interobserver reproducibility was 0.91 in the optimal and 0.21 in the suboptimal group. In contrast, the optimal group showed progressive impairment in both GLS (p = 0.001) and LV ejection fraction (LVEF) (p < 0.001) during follow-up, and the suboptimal group showed a progressive decrease in LVEF (p = 0.006), but not in GLS (p = 0.13). Left-sided mammotomy and/or reconstruction surgery and high body mass index were significant determinants of suboptimal image quality.

CONCLUSIONS

Even in cases of minor image quality impairment, the physician should assess GLS carefully to avoid errors in crucial clinical decision-making.

Mesostructural study on graphenic-based carbon prepared from coconut shells by heat treatment and liquid exfoliation

In this study, the effect of heating temperature on the structure of graphenic-based carbon (GC) has been successfully investigated. A series of GC materials was prepared from coconut shells by a green synthesis method. The process includes heating at four temperatures (T = 400, 600, 800 and 1000 °C) followed by an exfoliation process assisted by hydrochloric acid (HCl). These materials were characterized by wide- and small-angle x-ray scattering (WAXS and SAXS), Fourier-transform infrared spectroscopy (FTIR), x-ray photoemission spectroscopy (XPS) and transmission electron microscopy (TEM). The WAXS analysis shows Braggs peaks corresponding to the reduced graphene oxide (rGO)-like phase. Investigations by FTIR and XPS methods show the presence of carbon-oxygen functional groups such as C=C (carbon with sp² hybridization), C–C (carbon with sp³ hybridization), and C=O bonds. The sp² bonds form a 2-dimensional (2D) network in hexagonal lattice, while carbon with sp³ bonds tends to form a 3-dimensional (3D) tetrahedral structure. The BET analysis revealed meso- and micro-pore structures in GC. Heating process reduces the specific surface area and increases pore size of GC. Moreover, increasing the heating temperature induces a decrease in radius of gyration (R_g) and an increase in the formation of 2D structures in GC. The fitting results of SAXS profiles, proved by TEM and XPS, yielded the structure of GC containing the mixture of 2D and 3D structures. Thus, it is suggested that the GC has a mesostructure.

A rare intracranial fusiform thrombosed aneurysm of the distal middle cerebral artery: A case report

Background:

Intracranial aneurysms of the distal middle cerebral artery are rare, and most etiologies are infection or dissection. We present an extremely rare intracranial fusiform thrombosed aneurysm of the distal middle cerebral artery with histopathological confirmation of a pseudoaneurysm.

Case Description:

Our patient, a 68-year-old female, was previously healthy and had no history of infection or trauma. A fusiform thrombosed aneurysm of the distal middle cerebral artery was detected incidentally. The patient was treated successfully with trapping and resection of the aneurysm followed by superficial temporal artery to middle cerebral artery anastomosis. Xanthochromic and hypertrophic arachnoid membranes around the aneurysm were noticed, and a thrombus was detected inside the lesion. The aneurysmal wall had hyalinized connective tissue incompletely surrounded with intima, with no media or adventitia. Pathologically, it was a pseudoaneurysm.

Conclusion:

We report an extremely rare case of a pseudoaneurysm of the distal middle cerebral artery. We discuss the etiology of the lesion, with a literature review, and propose that the appearance and increase of the pseudoaneurysm was followed by microbleed of an aneurysm unrelated to the branching zone.

Effects of Oxygen Partial Pressure and Substrate Temperature on the Structure and Morphology of Sc and Y Co-Doped ZrO2 Solid Electrolyte Thin Films Prepared via Pulsed Laser Deposition

Scandium (Sc) and yttrium (Y) co-doped ZrO₂ (ScYSZ) thin films were prepared on a SiO₂-Si substrate via pulsed laser deposition (PLD) method. In order to obtain good quality thin films with the desired microstructure, various oxygen partial pressures (PO2) from 0.01 Pa to 10 Pa and substrate temperatures (T_s) from 25 °C to 800 °C were investigated. X-ray diffraction (XRD) patterns results showed that amorphous ScYSZ thin films were formed at room substrate temperature while cubic polycrystalline thin films were obtained at higher substrate temperatures (T_s = 200 °C, 400 °C, 600 °C, 800 °C). Raman spectra revealed a distinct Raman shift at around 600 cm⁻¹ supporting a cubic phase. However, a transition from cubic to tetragonal phase can be observed with increasing oxygen partial pressure. Photoemission spectroscopy (PES) spectra suggested supporting analysis that more oxygen vacancies in the lattice can be observed for samples deposited at lower oxygen partial pressures resulting in a cubic structure with higher dopant cation binding energies as compared to the tetragonal structure observed at higher oxygen partial pressure. On the other hand, dense morphologies can be obtained at lower  PO2 (0.01 Pa and 0.1 Pa) while more porous morphologies can be obtained at higher PO2 (1.0 Pa and 10 Pa).

MNG-2 Meningioma with aseptic meningitis

The patient, a woman in her seventies, visited the Department of Neurology at our hospital one month ago with transient right hemiparesis, and was referred to our department because a CT scan showed a 4cm extramedullary lesion in the left convexity. She was judged to have symptomatic epilepsy associated with the lesion and was started on antiepileptic drugs. The lesion showed low signal on T1WI, equal signal on T2WI, and homogeneous contrast on Gd contrast T1WI, suggesting a meningioma, but the surrounding left frontal lobe subarachnoid space was also contrasted, suggesting the possibility of seeding or other diseases. After that, the contrast area of the subarachnoid space increased in a short period of time, and the control of epileptic seizures was poor. Preoperative spinal fluid examination showed an elevated cell count and findings of aseptic meningitis. A left parietal craniotomy was performed to remove the extramedullary tumor as much as possible. The subarachnoid space of the left frontal lobe adjacent to the tumor was covered with extensive pale yellow apparently abscess-like tissue. The pathological diagnosis of the extramedullary tumor was angiomatous meningioma (WHO Grade 1), and the pale yellow tissue that filled the subarachnoid space was necrotic tissue containing neutrophils and no tumor component. IgG4 was positive in about 10% of the tumor. The postoperative course of the patient was good, the contrast area of the left frontal lobe subarachnoid space was reduced on MRI, aseptic meningitis was improved, and she was discharged home with no neurological deficits. The patient has been under outpatient observation for 2 years without recurrence of aseptic meningitis or appearance of contrast-enhancing lesions in the subarachnoid space. This case is thought to be a possible IgG4-related disease, and we report it with a discussion of the literature.

Contrast extravasation from basilar artery without aneurysm formation on digital subtraction angiography in computed tomography angiogram-negative subarachnoid hemorrhage: A case report

Background:

The causes of angiogram-negative subarachnoid hemorrhage (SAH) on initial angiography, which accounts for 10–30% of spontaneous SAH, are heterogeneous and still unclear. We report a case of nonaneurysmal SAH, in which initial computed tomographic angiography (CTA) showed no source of bleeding, but the subsequent digital subtraction angiography (DSA) revealed contrast extravasation from the basilar artery without aneurysms.

Case Description:

A 67-year-old woman with a medical history of hypertension presented as SAH of World Federation of Neurological Surgeons Grade II. CTA on admission did not show any cause of bleeding and DSA was subsequently performed to show contrast extravasation from a perforator of the middle third of the basilar artery without aneurysms during the subsequent DSA, resulting in profound deterioration SAH and neurological status. The patient was conservatively treated. Follow-up DSAs on days 2 and 16 showed no source of bleeding as well.

Conclusion:

Although the precise cause of bleeding in this case is uncertain, SAH might be caused by local dissection of the basilar artery perforator, and the bleeding site might heal spontaneously without forming of a pseudoaneurysm.

Experimental data of four-point probe, scanning electron microscopy, and near-edge X-ray fine structure of titanium (IV) isopropoxide and zirconium (IV) dioxide binders incorporated carbon-based counter electrode for dye-sensitized solar cells

In this article, we present the data collected from the fabricated carbon black-graphite counter electrode for dye-sensitized solar cells (DSSC) by incorporating binders such as titanium (IV) isopropoxide (TTIP), and zirconium (IV) dioxide (ZrO₂). The addition of binders to the carbon black-graphite composite (CB/Gr) can drastically improve the adherence between the counter electrodes and the fluorine-doped tin oxide (FTO) substrate, surface area and the interparticle connection between the carbon materials. These data are presented which comprise of the resistivity measurements, scanning electron microscopy (SEM) with energy dispersive X-ray (EDX), and near-edge X-ray absorption fine structure (NEXAFS). The collection of this data was performed at room temperature. Detailed analysis of the data can be found in [1].

Safety and efficacy of bexarotene for Japanese patients with cutaneous T-cell lymphoma: Real-world experience from post-marketing surveillance

To establish real-world evidence about the safety and efficacy of bexarotene for Japanese patients with cutaneous T-cell lymphoma, we conducted a nationwide cohort study using data from post-marketing surveillance for bexarotene treatment. In total, 294 patients with cutaneous T-cell lymphoma were identified between June 2016 and June 2018. Of these, 267 patients were included as the safety analysis set. Of the 267 patients, 175 were included in the efficacy analysis set. Of these, 139 patients had mycosis fungoides, including 46 with early stage disease and 93 with advanced stage disease. Among the 139 patients with mycosis fungoides, the objective response rate was 46.8%. A significant difference in objective response rate was detected between patients who started with bexarotene at 300 mg/m² (61.6%) and patients who started with bexarotene at less than 300 mg/m² (22.6%, p < 0.001). Of the 139 patients with mycosis fungoides, 92 were treated with a combination of bexarotene plus photo(chemo)therapy. A significant difference in objective response rate was seen between bexarotene with a combination of photo(chemo)therapy (57.6%) and bexarotene without a combination of photo(chemo)therapy (25.5%, p < 0.001). Starting bexarotene at 300 mg/m² and combination with photo(chemo)therapy were detected as independent factors influencing response. Common treatment-related adverse events included hypothyroidism (85.8%), hypertriglyceridemia (68.5%), hypercholesterolemia (43.8%), and neutropenia (21.3%). Hypertriglyceridemia, hypercholesterolemia, and neutropenia occurred more frequently in patients who started with bexarotene at 300 mg/m² than patients who started with bexarotene at less than 300 mg/m² (hypertriglyceridemia, 76.4% vs. 57.0%, p = 0.001; hypercholesterolemia, 49.0% vs. 36.4%, p = 0.045; neutropenia, 28.0% vs. 12.1%, p = 0.002; respectively). The present study indicates that starting bexarotene at 300 mg/m² and combination of photo(chemo)therapy offer a promising efficacy for the treatment of patients with mycosis fungoides. Efficacy of low-dose bexarotene plus photo(chemo)therapy should be evaluated in future.

Anti-LGI1 Encephalitis Developing Immunoglobulin Responsive Orthostatic Hypotension after Remission

Anti-leucine-rich glioma-inactivated 1 (LGI1) antibody is associated with limbic encephalitis. We herein report a patient with anti-LGI1 encephalitis who developed severe orthostatic hypotension (OH) responsive to immunoglobulin therapy five years after developing symptoms of encephalitis. A 71-year-old man presented with amnesia caused by limbic encephalitis. The symptoms of encephalitis improved partially without any immunotherapy. Five years later, he developed severe OH, and anti-LGI1 antibody was positive. The catecholamine dynamics indicated that the central autonomic nervous system was the lesion of his OH. Intravenous immunoglobulin therapy improved the OH. This case suggests that anti-LGI1 antibody can be associated with severe OH.