Acute subdural hematoma caused by rupture of a mycotic aneurysm due to meningitis associated with infectious endocarditis: comparison of autopsy findings with postmortem computed tomography

Forensic pathologists often encounter cases of acute subdural hematoma (SDH) due to trauma, whereas those attributable to endogenous causes are rare. Here, we report a case of the latter type in a 42-year-old man who was found dead at home after several months of fever and malaise. Postmortem computed tomography (PMCT) and autopsy were undertaken to clarify the cause of death. PMCT images revealed a fatal SDH and a localized hyper-density area in the right parietal lobe; macroscopic and microscopic examinations revealed SDH due to rupture of a mycotic aneurysm (MA) associated with meningitis. The PMCT images also indicated thickening and calcification of the mitral valve, while autopsy demonstrated infective endocarditis (IE). In addition, PMCT demonstrated a low-density area in the spleen, which was shown to be a splenic abscess at autopsy. PMCT also demonstrated tooth cavities. Based on the findings of autopsy, the cause of death was considered to be SDH due to rupture of the MA resulting from meningitis with IE and splenic abscess. Although PMCT was unable to clarify the significance of any individual feature, a retrospective review of the PMCT images might have suggested IE, bacteremia, or ruptured MA leading to SDH. This case suggests that, instead of interpreting individual features demonstrated on PMCT images, integrated interpretation of overall PMCT findings might provide clues for identifying causes of death, despite the fact that PMCT lacks diagnostic accuracy for infectious diseases such as IE and meningitis.

Usefulness of a tissue optical clearing technique for forensic autopsy

Forensic pathologists are required to investigate lethal trauma or disease at autopsy. In addition to massive contusions of various organs, a number of small features with potentially fatal implications also need to be sought. Since such lesions may need microscopic examinations for detailed evaluation, it is important to select suitable anatomic locations for tissue sampling. For practical screening of small lesions, we have developed a tissue optical clearing (TOC) technique for forensic autopsy. The technique involves clearing with a non-toxic organic solvent, ethyl cinnamate, which renders excised organs transparent, while hemorrhages or blood-containing vessels remain opaque. Using this technique, tiny hemorrhages in the spinal cord were able to be identified by gross examination, allowing proper selection of locations for tissue sampling. Subsequent histopathological evaluation was successfully performed with no apparent artifacts related with the TOC procedure. In addition, a combination of TOC and targeted CT angiography allowed feasible examination of the arterial occlusive lesion in the superior mesenteric artery, and when combined with micro-CT scanning it was useful for evaluating the lumen of the coronary artery with stent implantation. The results obtained so far indicated that TOC could complement routine forensic autopsy procedures when detailed evaluation of small lesions is required.

Interplay of spin-orbit coupling and Coulomb interaction in ZnO-based electron system

Spin-orbit coupling (SOC) is pivotal for various fundamental spin-dependent phenomena in solids and their technological applications. In semiconductors, these phenomena have been so far studied in relatively weak electron-electron interaction regimes, where the single electron picture holds. However, SOC can profoundly compete against Coulomb interaction, which could lead to the emergence of unconventional electronic phases. Since SOC depends on the electric field in the crystal including contributions of itinerant electrons, electron-electron interactions can modify this coupling. Here we demonstrate the emergence of the SOC effect in a high-mobility two-dimensional electron system in a simple band structure MgZnO/ZnO semiconductor. This electron system also features strong electron-electron interaction effects. By changing the carrier density with Mg-content, we tune the SOC strength and achieve its interplay with electron-electron interaction. These systems pave a way to emergent spintronic phenomena in strong electron correlation regimes and to the formation of quasiparticles with the electron spin strongly coupled to the density.

Large Variation of Dirac Semimetal State in Perovskite CaIrO_{3} with Pressure-Tuning of Electron Correlation

The impact of electron correlation on the Dirac semimetal state is investigated for perovskite CaIrO_{3} in terms of the magnetotransport properties under varying pressures. The reduction of electron correlation with a pressure of 1 GPa enhances the Fermi velocity as much as 40%, but it reduces the mobility by an order of magnitude by detuning the Dirac node from the Fermi energy. Moreover, the giant magnetoresistance at the quantum limit due to the one-dimensional confinement of Dirac electrons is critically suppressed under pressure. These results indicate that the electron correlation is a crucial knob for controlling the transport of a correlated Dirac semimetal.

P977Selective liner ablation according to the type of tachycardia induced after pulmonary vein isolation in single-procedure for long-standing persistent atrial fibrillation

Background

The most effective approach for long-standing persistent atrial fibrillation (LSPAF) ablation remained undetermined. Here, we hypothesized that selective linear ablation (SLA) according to the type of tachycardia induced by burst atrial pacing (BAP) after pulmonary venous isolation (PVI) in single-procedure reduces the recurrence.

Methods

A cohort of 66 LSPAF patients (Mean age 71.0±8.2 years, AF duration 40.5±58.8 months) who underwent PVI in single-procedure between April 2016 and November 2018 was evaluated.

Results

Any sustained atrial tachycardia (AT) or AF were not inducible by BAP after PVI in 21 patients (Non-inducible group, 31.8%, 71.3±7.9 years, 34.4±54.2 months). These patients underwent cavo-tricuspid isthmus (CTI) ablation after PVI. Forty-one patients underwent selective liner ablation according to the type of tachycardia induced by BAP after PVI (SLA group, 62.1%, 71.2±8.3 years, 39.3±55.6 months). Maccroreentry ATs (6 common atrial flutter, 5 AT originating from left atrial anterior wall, 2 peri-mitral atrial flutter, 1 roof-dependent atrial flutter) were induced by BAP in 14 patients of SLA group (73.2±19.7 years, 51.7±83.5 months). RF applications created the complete linear lesions to terminate maccroreentry ATs. Sustained AF was induced by BAP after PVI in 27 patients of SLA group (70.2±9.2 years, 32.9±31.2 months). These patients underwent posterior wall isolation (PWI) and CTI ablation. Unmappable AT was induced by BAP after PVI in 4 patients (Non-SLA group, 6.1%, 67.0±9.7 years, 84.5±105.6 months). These patients underwent PWI, CTI and mitral isthmus ablation on an empirical basis instead of SLA. Using a 90-day blanking period, the single-procedure Kaplan-Meier estimates of AT or AF event-free survival were 79% at 12 months. During follow-up (14.5±8.0 months), although 19 /21 (90.5%) of Non-inducible group patients and 33/41 (80.5%) of SLA group patients did not experience AT or AF recurrence, all of Non-SLA group patients experienced AF recurrence. There was no difference between Non-inducible group and SLA group in predicting recurrence of AT or AF (p=0.3). However, there was a difference when compared with Non-SLA group (each p<0.001). Non-SLA group was an independent powerful predictor resulting in recurrence of AF after adjusting for potential confounding factors (adjusted hazard ratio = 7.17; 95% confidence interval; 2.2–23.1, p=0.001, Wald χ2=10.9). Furthermore, in Kaplan-Meier survival curves for predicting AT or AF recurrence, Non-SLA group was the significant predictive marker of AT or AF recurrence (Log-Lank χ2=18.0, p<0.001).

Kaplan-Meier survival curves

Conclusions

In LSPAF patients without inducibility of any tachycardia after PVI, sinus rhythm was highly maintained without stepwise ablation other than CTI ablation. SLA reduced recurrence of AF in LSPAF patients with AT and AF induced after PVI. In addition, nonselective liner ablations for unmappable AT after PVI were less effective in LSPAF patients.

P5697J-wave elevation in the inferior leads is a predictor of lethal ventricular arrhythmia initiated by premature ventricular contractions with right bundle branch block and superior axis

Background

Lethal-ventricular-arrhythmia (VA) could be sometimes initiated by idiopathic Premature Ventricular Contractions (PVCs) originated form inferior wall. Furthermore, J-wave elevation in inferior leads was sometimes associated with lethal-VA. However, it was unclear the relationship between these PVCs and J-wave elevation in patients with lethal-VA.

Purpose

The aim of this study was to investigate the relationship between PVCs and J-wave elevation.

Methods and results

We studied 32 patients who underwent radiofrequency (RF) ablation of idiopathic PVCs with RBBB and superior axis. These PVCs were originating from inferior wall of left ventricular. Lethal-VA was defined as ventricular fibrillation (VF) or ventricular tachycardia (VT) with loss of consciousness (LOC). Among 32 patients, 3 had VF and 2 had VT with LOC. Other 27 had non-lethal-VA. Baseline clinical characteristics were not significantly difference between lethal and non-lethal-VA. The ratio of J-wave elevation in lethal-VA was significant higher as compared to those with non-lethal-VA (5/5 (100%) vs. 3/27 (11.1%), p<0.0001). Furthermore, no patients had recurrence of lethal-VA with J wave elevation in inferior leads after RF ablation of these PVCs with RBBB and superior axis,

Conclusions

We speculated that J-wave elevation in inferior leads might be a predictor of lethal-VA initiated by PVCs with RBBB and superior axis. RF ablation of these PVCs were useful method of treating lethal-VA.

Acknowledgement/Funding

None

Strong-correlation induced high-mobility electrons in Dirac semimetal of perovskite oxide

Electrons in conventional metals become less mobile under the influence of electron correlation. Contrary to this empirical knowledge, we report here that electrons with the highest mobility ever found in known bulk oxide semiconductors emerge in the strong-correlation regime of the Dirac semimetal of perovskite CaIrO₃. The transport measurements reveal that the high mobility exceeding 60,000 cm²V⁻¹s⁻¹ originates from the proximity of the Fermi energy to the Dirac node (ΔE < 10 meV). The calculation based on the density functional theory and the dynamical mean field theory reveals that the energy difference becomes smaller as the system approaches the Mott transition, highlighting a crucial role of correlation effects cooperating with the spin-orbit coupling. The correlation-induced self-tuning of Dirac node enables the quantum limit at a modest magnetic field with a giant magnetoresistance, thus providing an ideal platform to study the novel phenomena of correlated Dirac electron.

Electron correlation normally makes electrons less mobile, but it is still not clear when correlation becomes very strong in Dirac semimetals. Here, Fujioka et al. report a very high electron mobility exceeding 60,000 cm²V⁻¹s⁻¹ in correlated Dirac semimetal of perovskite CaIrO3, due to the enhanced electron correlation nearby the Mott transition.

Comparison of Sensitivity of Immunocomplex Capture Fluorescence Analysis for Detecting Donor-specific Anti-HLA Class II Antibodies in Kidney Transplant Patients

BACKGROUND

Immunocomplex capture fluorescence analysis (ICFA) detects donor-specific antihuman leukocyte antigen (HLA) antibodies (DSA), but the detection sensitivity of HLA class II antibodies using conventional ICFA is as low as 57%. The aim of the study was to improve the detection sensitivity of HLA class II antibodies by ICFA, and compare the ICFA results with the Luminex single-antigen bead test.

METHODS

Six DSA-negative kidney transplant donors and recipient pairs and 10 HLA class II DSA-positive pairs were included in the study. The detection sensitivity of modified ICFA was compared with conventional ICFA, and the ICFA results were compared with the Luminex single-antigen bead test.

RESULTS

The index value of modified ICFA was higher than that of conventional ICFA. The cutoff value of conventional ICFA was 30,686 (MFI), which was improved to 19,405 using modified ICFA. Regarding the HLA-DQ antibody, 5 samples found to be positive by Luminex single-antigen bead testing were all negative using modified ICFA. The reason for this discrepancy could be related to: (1) the difference in detection sensitivity; (2) the difference in HLA antigen surface expression between naive lymphocytes and synthetic beads; or (3) the structure of synthetic HLA DQ antigen on the Luminex single-antigen beads.

CONCLUSION

The index value of the modified ICFA was higher than that of conventional ICFA, and the detection sensitivity of HLA class II antibodies was improved by modified ICFA. Further assessment is necessary to clarify the reasons for divergence between ICFA and Luminex single-antigen bead test results.

Advanced capabilities for materials modelling with Quantum ESPRESSO

Quantum EXPRESSO is an integrated suite of open-source computer codes for quantum simulations of materials using state-of-the-art electronic-structure techniques, based on density-functional theory, density-functional perturbation theory, and many-body perturbation theory, within the plane-wave pseudopotential and projector-augmented-wave approaches. Quantum EXPRESSO owes its popularity to the wide variety of properties and processes it allows to simulate, to its performance on an increasingly broad array of hardware architectures, and to a community of researchers that rely on its capabilities as a core open-source development platform to implement their ideas. In this paper we describe recent extensions and improvements, covering new methodologies and property calculators, improved parallelization, code modularization, and extended interoperability both within the distribution and with external software.

A magnetic heterostructure of topological insulators as a candidate for an axion insulator

The axion insulator which may exhibit an exotic quantized magnetoelectric effect is one of the most interesting quantum phases predicted for the three-dimensional topological insulator (TI). The axion insulator state is expected to show up in magnetically doped TIs with magnetizations pointing inwards and outwards from the respective surfaces. Towards the realization of the axion insulator, we here engineered a TI heterostructure in which magnetic ions (Cr) are modulation-doped only in the vicinity of the top and bottom surfaces of the TI ((Bi,Sb)₂Te₃) film. A separation layer between the two magnetic layers weakens interlayer coupling between them, enabling the magnetization reversal of individual layers. We demonstrate the realization of the axion insulator by observing a zero Hall plateau (ZHP) (where both the Hall and longitudinal conductivity become zero) in the electric transport properties, excluding the other possible origins for the ZHP. The manifestation of the axion insulator can lead to a new stage of research on novel magnetoelectric responses in topological matter.

Dynamic Viscoelasticity of Soft Liners and Masticatory Function

Soft denture liners are used for edentulous patients to cushion functional forces. We hypothesized that the application of soft liners having viscoelastic properties would lead to the most marked improvement in masticatory function. The shear storage modulus ( G′), shear loss modulus ( G′′), and loss tangent (tan δ) were determined for 6 materials by means of a dynamic viscoelastometer. Masticatory function of ten subjects was evaluated by measurements of maximum bite forces and chewing times and frequencies for 2 food samples, and by the use of visual analogue scales. The acrylic materials exhibited viscoelastic behavior, while the silicones exhibited elastic behavior. The improvement in masticatory function compared with hard resin was found to be in the order: acrylic permanent materials > silicone > acrylic temporary materials. The results suggest that the use of materials with higher tan δ and G′ provides the most optimum masticatory function for patients requiring the provision of soft liners on their dentures.

Observation of Zeeman effect in topological surface state with distinct material dependence

Manipulating the spins of the topological surface states represents an essential step towards exploring the exotic quantum states emerging from the time reversal symmetry breaking via magnetic doping or external magnetic fields. The latter case relies on the Zeeman effect and thereby we need to estimate the g-factor of the topological surface state precisely. Here, we report the direct observations of the Zeeman effect at the surfaces of Bi₂Se₃ and Sb₂Te₂Se by spectroscopic-imaging scanning tunnelling microscopy. The Zeeman shift of the zero mode Landau level is identified unambiguously by appropriately excluding the extrinsic effects arising from the nonlinearity in the band dispersion of the topological surface state and the spatially varying potential. Surprisingly, the g-factors of the topological surface states in Bi₂Se₃ and Sb₂Te₂Se are very different (+18 and −6, respectively). Such remarkable material dependence opens up a new route to control the spins of the topological surface states.

The knowledge of how electrons behave under magnetic field provides inherent information for exotic quantum states. Here, Fu et al. find different g-factors of topological surface states in Bi₂Se₃ and Sb₂Te₂Se, which suggests possible control of such states in spin-related applications.

P450 oxidoreductase deficiency with maternal virilization during pregnancy

PURPOSE

The authors report on a rare case of maternal virilization during pregnancy caused by autosomal recessive P450 oxidore- ductase (POR) deficiency.

MATERIALS AND METHODS

A 24-year-old primigravida developed a deepening voice and hirsutism in the second trimester. Prenatal ultrasonography failed to detect any fetal abnormality and fetal growth was normal. POR deficiency was suspected, but the mother declined fetal genetic testing. A female neonate was delivered by cesarean section at 41 weeks' gestation.

RESULTS

The neonate had skeletal abnormalities. Mutational analysis of the POR gene demonstrated homozygosity for c.1370 G>A and p.R457H in the patient and heterozygosity in her parents. POR deficiency was confirmed in the neonate.

CONCLUSION

POR deficiency should be suspected in cases of maternal virilization. Maternal urinary estriol, fetal magnetic resonance imaging, and parental genetic testing should be performed. Parental consent for fetal genetic testing should be sought to ensure prompt diagnosis and early treatment.