Delay-induced amplitude death in multiplex oscillator network with frequency-mismatched layers

The present paper analytically investigates the stability of amplitude death in a multiplex Stuart-Landau oscillator network with a delayed interlayer connection. The network consists of two frequency-mismatched layers, and all oscillators in each layer have identical frequencies. We show that, if the matrices describing the network topologies of each layer commute, then the characteristic equation governing the stability can be reduced to a simple form. This form reveals that the stability of amplitude death in the multiplex network is equally or more conservative than that in a pair of frequency-mismatched oscillators coupled by a delayed connection. In addition, we provide a procedure for designing the delayed interlayer connection such that amplitude death is stable for any commuting matrices and for any intralayer coupling strength. These analytical results are verified through numerical examples. Moreover, we numerically discuss the results for the case in which the commutative property does not hold.

A dense ring of the trans-Neptunian object Quaoar outside its Roche limit

Planetary rings are observed not only around giant planets1, but also around small bodies such as the Centaur Chariklo2 and the dwarf planet Haumea3. Up to now, all known dense rings were located close enough to their parent bodies, being inside the Roche limit, where tidal forces prevent material with reasonable densities from aggregating into a satellite. Here we report observations of an inhomogeneous ring around the trans-Neptunian body (50000) Quaoar. This trans-Neptunian object has an estimated radius4 of 555 km and possesses a roughly 80-km satellite5 (Weywot) that orbits at 24 Quaoar radii6,7. The detected ring orbits at 7.4 radii from the central body, which is well outside Quaoar's classical Roche limit, thus indicating that this limit does not always determine where ring material can survive. Our local collisional simulations show that elastic collisions, based on laboratory experiments8, can maintain a ring far away from the body. Moreover, Quaoar's ring orbits close to the 1/3 spin-orbit resonance9 with Quaoar, a property shared by Chariklo's2,10,11 and Haumea's3 rings, suggesting that this resonance plays a key role in ring confinement for small bodies.

PD-L1 Expression in Cytological and Histological Lung Cancer Specimens

Introduction/Objective

Several studies have explored the feasibility of measuring PD-L1 in cell block cytology and indicated cytological materials could be a reliable source for PD-L1 evaluation in non-small cell lung carcinoma patients. A few studies have investigated the compatibility and performance of PD-L1 clone SP263 testing between cytology and histology specimens. The study was pursued to evaluate PD-L1 expression in cell blocks from EBUS- TBNA compared to that in biopsied tissues from patients with lung carcinoma in our institution to evaluate a feasibility of PD-L1 clone SP263 in cell blocks and histology samples.

Methods/Case Report

A total of 57 specimens cytologically diagnosed lung carcinoma using endobronchial ultrasound guided transbronchial needle aspiraton (EBUS-TBNA) from Jan 1st, 2020, to Dec 31st, 2021 were screened for enrollment. Among them, 24 patients diagnosed with lung carcinoma using EBUS-TBNA and matched transbronchial biopsy (TBB) specimens were reviewed for study. After careful selection, 13 paired formalin-fixed tissues from lung carcinoma patients, including cell blocks and matched histology samples, were included. PD-L1 expression was assessed using the SP263 assay, and the tumor proportion score (TPS) was evaluated. PD-L1 expression was finally divided into three categories according to the TPS: < 1% (negative), 1–49% (low expression) and ≥ 50% (high expression).

Results (if a Case Study enter NA)

Of the 13 matched pairs, 12 (92.3%) showed concordant PD-L1 expression. On cytology, 3 cases were positive (2 high expressors and 1 low- expressors) of which 2 were concordant and 1 discordant with matched histology specimens. Ten cytology samples were negative for PD-L1 expression, and they were concordant to histology samples. The correlation coefficient for TPS was 0.75 considered as having good value. Conclusion: With an overall concordance rate of 92.3% between cytology and histology specimen, this study demonstrates the feasibility of PD-L1 IHC with SP263 clone on limited quality and quantity of cytology samples from lung carcinoma in our institute. It is required for further evaluation with additional specimens to conclude that the usefulness of cytology cell blocks for PD-L1 expression analysis.

472 Accuracy of Documentation and Handover of Surgical Operation Details in Cardiac Surgery

Introduction

GMC Good Medical Practice Guideline states that documentation must be clear, accurate and legible. Accurate documentation of operation notes ensures proper postoperative care and forms important legal documents. This audit aims to assess the accurateness and consistency of recorded operation names throughout patients’ hospital stay following cardiac surgery, as well as the effect of standardisation of operation names to improve the accuracy of documentation.

Method

Patients undergoing cardiac surgery at St. Bartholomew's Hospital from November 29 to December 10, 2021, had data prospectively collected from their electronic patient records, which were compared to the standardised operation name. After the first audit cycle, junior medical staff were educated on the standardisation of operation names. Electronic patient records were reviewed again for patients undergoing cardiac surgery from January 10 to January 20, 2022.

Results

Following intervention, there were significant improvements in the accuracy of documented operation details. Initially, 65% of operation notes were accurately documented, whereas 96% of operation notes were completed to the ideal standard post-intervention. There was a 37% increase in the number of accurate discharge summaries, while inaccuracies and missing operation names were reduced to 0% from the initial 12%.

Conclusions

Accurate documentation of operation details is expected by GMC standards. Poor documentation can hinder the quality-of-care patients receive postoperatively. We have shown variation in descriptions of standard operations and multiple inaccuracies throughout patients’ hospital stay. We suggest agreed standardisation of operation details and education of junior medical staff regarding accuracy of documentation to enhance compliance with the GMC standard.

Generation of ozone during irradiation using medical linear accelerators: an experimental study

Background

Some patients have noted a foul odor during radiation therapy sessions, but the cause of the odor remains unknown. Since we suspected that this phenomenon is due to ozone generated by ionizing radiation, this experimental study measured ozone concentrations in the treatment room and in a coiled polyvinyl chloride (PVC) tube placed within the radiation field.

Methods

We measured ozone concentrations using an ultraviolet absorption method and an ozone monitor. A PVC tube (inner diameter 7 mm, outer diameter 10 mm) was used to mimic the environment of the nasal cavity. The tube (790 cm) was coiled and set between two 4-cm-thick (for X-rays) or 2-cm-thick (for electron beams) water-equivalent solid phantoms. The sampling tube of the ozone monitor was inserted into the PVC tube, and the joint was sealed to prevent environmental air contamination. To measure ozone concentrations in the atmosphere, the sampling tube supplied with the unit was used. A linac was used on a full-sized treatment field (40 cm × 40 cm at a source-to-axis distance of 100 cm). The effect of an electron beam on ozone concentrations was also evaluated with a full-sized treatment field (40 cm × 40 cm at a source-to-surface distance of 100 cm).

Results

Ozone levels in the treatment room were undetectable before the start of daily treatment but reached 0.008 parts per million (ppm) or more at 1 h after the start of treatment. Concentrations then remained nearly constant at 0.010–0.015 ppm throughout the day. The maximum ozone concentration in the PVC tube was only 0.006 ppm, even when it was irradiated at 2400 monitor units/min. Depending on the X-ray dose rate, the concentration increased to a maximum of 0.010 ppm with oxygen flowing into the other end of the tube at 1.5 L/min. Ozone concentrations in the PVC tube did not differ significantly between X-ray and electron-beam irradiation.

Conclusions

Only traces of ozone were found in the PVC tube that was used to mimic the nasal passages during radiation, these concentrations were too low for human perception. However, ozone concentrations did reach potentially detectable levels in the treatment room.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13014-022-02005-6.

Amyloid Beta Is Internalized via Macropinocytosis, an HSPG- and Lipid Raft-Dependent and Rac1-Mediated Process

Intracellular amyloid β peptide (Aβ) accumulation has drawn attention in relation to the pathophysiology of Alzheimer’s disease in addition to its extracellular deposition as senile plaque. Cellular uptake of extracellular Aβ is one of the possible mechanisms by which intracellular Aβ deposits form. Given the relevance of Aβ inside cells, it is important to understand the mechanism by which it is taken up by them. In this study, we elucidated that Neuro2A and SH-SY5Y cells internalize specifically oligomerized Aβ in a time- and dose-dependent manner. The depletion of plasma membrane cholesterol with methyl-β-cyclodextrin or treatment with trypsin diminished the internalization of oAβ, suggesting that the oAβ uptake might be both a lipid raft-dependent and heparan sulfate proteoglycan-mediated process. Treatment with a macropinocytosis inhibitor (ethylisopropyl amiloride and wortmannin) also drastically reduced the uptake of oligomer-Aβ (oAβ). oAβ-treated cells exhibited an increase in Rac1 activity, indicating that macropinocytosis induced by oAβ is regulated by these small GTPases. These findings suggest that macropinocytosis is a major endocytic route through which oAβ42 enters cells.

Investigating charge-up and fragmentation dynamics of oxygen molecules after interaction with strong X-ray free-electron laser pulses

The X-ray-induced charge-up and fragmentation process of a small molecule is examined in great detail by measuring the molecular-frame photoelectron interference pattern in conjunction with other observables in coincidence.

Effects of frequency mismatch on amplitude death in delay-coupled oscillators

The present paper analytically reveals the effects of frequency mismatch on the stability of an equilibrium point within a pair of Stuart-Landau oscillators coupled by a delay connection. By analyzing the roots of the characteristic function governing the stability, we find that there exist four types of boundary curves of stability in a coupling parameters space. These four types depend only on the frequency mismatch. The analytical results allow us to design coupling parameters and frequency mismatch such that the equilibrium point is locally stable. We show that, if we choose appropriate frequency mismatches and delay times, then it is possible to induce amplitude death with strong stability, even by weak coupling. In addition, we show that parts of these analytical results are valid for oscillator networks with complete bipartite topologies.

Drug-coated balloon versus drug-eluting stent following orbital atherectomy for calcified coronary artery: one-year outcomes of a retrospective cohort study

Background

Percutaneous coronary intervention (PCI) for calcified coronary artery remains challenging in the drug-eluting stent (DES) era. The effectiveness of drug-coated balloons (DCBs) and orbital atherectomy system (OAS) is unknown.

Methods

In this retrospective, single-center study, we compared the use of DCBs with second- and third-generation DESs following orbital atherectomy (OA) for calcified de novo coronary lesions. All patients underwent PCI with intravascular imaging. The primary endpoint was major cardiac event, that was a composite of cardiac death, death for unknown cause, non-fatal myocardial infarction, or target lesion revascularization at 1 year.

Results

Between June 2018 and December 2019, 107 patients with coronary lesions were enrolled in this study and divided into two groups: 23 patients in DCB group and 84 patients in DES group. The post-procedure segment percentage diameter stenosis was 23.1% (interquartile range [IQR], 17.7 to 32.5) with DCB versus 14.4% (IQR, 10.0 to 21.2) with DES (P<0.001). Overall adverse event rate for PCI procedure was low: one dissection with DES group, no persistent slow/no-flow, and no perforation with both group. The primary endpoint was not significantly different between 2 groups [DES: 6.0% (5/84), DCB: 0.0% (0/23), log-rank P=0.24].

Conclusions

In calcified coronary artery disease, using DCB following OA is as safe and effective as using DES following OA with respect to 1-year clinical outcomes.

Funding Acknowledgement

Type of funding sources: None.

Unusual visual and olfactory perceptions during radiotherapy sessions: an investigation of the organs responsible

During radiotherapy sessions to treat brain tumors or head-and-neck cancers, some patients experience unusual visual and/or olfactory perceptions. This prospective study sought to answer two questions: (i) what proportion of patients experience these unpleasant sensations?, and (ii) which organs are responsible? Eligible patients had brain or near-orbital tumors treated by helical tomotherapy. All were aged 10 years or older, able to communicate, and interviewed by a radiation oncologist at least once weekly during radiation therapy. If they had experienced such sensations, they were encouraged to join the second phase of the study. The patients were asked to indicate, using a button, when a sensation commenced and ended. The recorded data were collated with the treatment log. Thirty-eight consecutive patients were eligible. Twenty-six experienced visual and 13 olfactory sensations. The radiation doses to the organs related to the visual or olfactory sensations did not differ between patients who reported sensations and those who did not. Seventeen patients were enrolled in the second phase of the study. All 14 with visual sensations reported that the sensations occurred when the X-rays passed at eye level. Olfactory sensations were reported by eight out of nine patients when the X-rays passed through the olfactory epithelium and/or ethmoid sinus level. In conclusion, 68% of patients experienced visual sensations caused by X-rays passing through the level of the eyes, and 34% complained of olfactory sensations. With the exception of one patient, olfactory sensations occurred when the X-rays passed through the levels of the olfactory epithelium and/or ethmoid sinus.

Study of the K_{L}→π^{0}νν[over ¯] Decay at the J-PARC KOTO Experiment

The rare decay K_{L}→π^{0}νν[over ¯] was studied with the dataset taken at the J-PARC KOTO experiment in 2016, 2017, and 2018. With a single event sensitivity of (7.20±0.05_{stat}±0.66_{syst})×10^{-10}, three candidate events were observed in the signal region. After unveiling them, contaminations from K^{±} and scattered K_{L} decays were studied, and the total number of background events was estimated to be 1.22±0.26. We conclude that the number of observed events is statistically consistent with the background expectation. For this dataset, we set an upper limit of 4.9×10^{-9} on the branching fraction of K_{L}→π^{0}νν[over ¯] at the 90% confidence level.

Zonisamide can ameliorate the voltage-dependence alteration of the T-type calcium channel CaV3.1 caused by a mutation responsible for spinocerebellar ataxia

Spinocerebellar ataxia (SCA) 42 is caused by a mutation in CACNA1G, which encodes the low voltage-gated calcium channel Ca_V3.1 (T-type). Patients with SCA42 exhibit a pure form of cerebellar ataxia. We encountered a patient with the p.Arg1715His mutation, suffering from intractable resting tremor, particularly head tremor. This symptom improved with the administration of low-dose of zonisamide (ZNS), a T-type calcium channel blocker effective for treating Parkinson’s disease and epilepsy. Previous electrophysiological studies showed that the voltage dependence of this mutant Ca_V3.1 was shifted toward the positive potential. This abnormal shift was considered a factor related to disease onset and symptoms. In this study, we performed whole-cell recordings of GFP-expressing HEK293T cells that expressed wild-type or mutant Ca_V3.1 and investigated the changes in the abnormal shift of voltage dependence of the mutant Ca_V3.1. The results showed that ZNS in an amount equivalent to the patient’s internal dose significantly ameliorated the abnormal shift in the mutant Ca_V3.1, giving values close to those in the wild-type. On the other hand, ZNS did not affect the voltage dependence of wild-type Ca_V3.1. Because Ca_V3.1 is known to be involved in tremogenesis, modulation of the voltage dependence of mutant Ca_V3.1 by ZNS might have contributed to improvement in the intractable tremor of our patient with SCA42. Moreover, efonidipine, another T-type calcium channel blocker, had no effect on tremors in our patient with SCA42 and did not improve the abnormal shift in the voltage dependence of the mutant Ca_V3.1. This indicates that ZNS is distinct from other T-type calcium channel blockers in terms of modulation of the voltage dependence of the mutant Ca_V3.1.

Amplitude suppression of oscillators with delay connections and slow switching topology

The present paper shows that the amplitudes of oscillators in delay-coupled oscillator networks can be suppressed by switching the network topology at a rate much lower than the oscillator frequencies. The mechanism of suppression was clarified numerically, and a procedure for determining the connection parameters to induce suppression is presented. The analytical and numerical results were obtained with Stuart-Landau oscillators and were experimentally validated using double-scroll chaotic circuits.

Search for K_{L}→π^{0}νν[over ¯] and K_{L}→π^{0}X^{0} Decays at the J-PARC KOTO Experiment

A search for the rare decay K_{L}→π^{0}νν[over ¯] was performed. With the data collected in 2015, corresponding to 2.2×10^{19} protons on target, a single event sensitivity of (1.30±0.01_{stat}±0.14_{syst})×10^{-9} was achieved and no candidate events were observed. We set an upper limit of 3.0×10^{-9} for the branching fraction of K_{L}→π^{0}νν[over ¯] at the 90% confidence level (C.L.), which improved the previous limit by almost an order of magnitude. An upper limit for K_{L}→π^{0}X^{0} was also set as 2.4×10^{-9} at the 90% C.L., where X^{0} is an invisible boson with a mass of 135  MeV/c^{2}.

Identification and functional characterization of novel mutations including frameshift mutation in exon 4 of CSF1R in patients with adult-onset leukoencephalopathy with axonal spheroids and pigmented glia

Objective

Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is caused by mutations in CSF1R. Pathogenic mutations in exons 12–22 including coding sequence of the tyrosine kinase domain (TKD) of CSF1R were previously identified. We aimed to identify CSF1R mutations in patients who were clinically suspected of having ALSP and to determine the pathogenicity of novel CSF1R variants.

Methods

Sixty-one patients who fulfilled the diagnostic criteria of ALSP were included in this study. Genetic analysis of CSF1R was performed for all the coding exons. The haploinsufficiency of CSF1R was examined for frameshift mutations by RT-PCR. Ligand-dependent autophosphorylation of CSF1R was examined in cells expressing CSF1R mutants.

Results

We identified ten variants in CSF1R including two novel frameshift, five novel missense, and two known missense mutations as well as one known missense variant. Eight mutations were located in TKD. One frameshift mutation (p.Pro104LeufsTer8) and one missense variant (p.His362Arg) were located in the extracellular domain. RT-PCR analysis revealed that the frameshift mutation of p.Pro104LeufsTer8 caused nonsense-mediated mRNA decay. Functional assay revealed that none of the mutations within TKD showed autophosphorylation of CSF1R. The p.His362Arg variant located in the extracellular domain showed comparable autophosphorylation of CSF1R to the wild type, suggesting that this variant is not likely pathogenic.

Conclusions

The detection of the CSF1R mutation outside of the region-encoding TKD may extend the genetic spectrum of ALSP with CSF1R mutations. Mutational analysis of all the coding exons of CSF1R should be considered for patients clinically suspected of having ALSP.

Electronic supplementary material

The online version of this article (10.1007/s00415-018-9017-2) contains supplementary material, which is available to authorized users.

[Reversible cerebral vasoconstriction syndrome: a clinical study of 11 cases]

This study reports eleven cases of reversible cerebral vasospasm syndrome (RCVS). Of the 11 patients, two were males and nine were females, with the average age of 47.9 ± 14.1 years. Many of these patients were young. The rates of severe, intractable and pulsative headache, generalized convulsions, and motor hemiparesis were 64%, 27%, and 36%, respectively. As complications of intracerebral lesions in the early stage of disease onset, convexal subarachnoid hemorrhage, lobar intracerebral hemorrhage, and posterior reversible encephalopathy syndrome were observed in 63%, 9%, and 45% of cases, respectively. Cerebral infarction occurred in 45% of cases at around 1-3 weeks after onset. Improvement of cerebral vasoconstriction was recognized in several cases from about the first month of onset. The post-partum period, migraine, transfusion, rapid amelioration for anemia, renal failure, bathing, and cerebrovascular dissection were suspected as disease triggers. Abnormally high blood pressure at onset was confirmed in 55% of cases. It is important to analyze the pathophysiology of RCVS associated with these triggers from the viewpoint of the breakdown of the blood-brain barrier.

Stabilization of a spatially uniform steady state in two systems exhibiting Turing patterns

This paper deals with the stabilization of a spatially uniform steady state in two coupled one-dimensional reaction-diffusion systems with Turing instability. This stabilization corresponds to amplitude death that occurs in a coupled system with Turing instability. Stability analysis of the steady state shows that stabilization does not occur if the two reaction-diffusion systems are identical. We derive a sufficient condition for the steady state to be stable for any length of system and any boundary conditions. Our analytical results are supported with numerical examples.

System identification of propagating wave segments in excitable media and its application to advanced control

The present paper proposes a scheme for controlling wave segments in excitable media. This scheme consists of two phases: in the first phase, a simple mathematical model for wave segments is derived using only the time series data of input and output signals for the media; in the second phase, the model derived in the first phase is used in an advanced control technique. We demonstrate with numerical simulations of the Oregonator model that this scheme performs better than a conventional control scheme.

[Trigeminal Herpes Zoster Presenting with High-intensity Signals for the Spinal Trigeminal Nucleus and Tract on Diffusion-weighted Image: A Case Report of Stroke Mimic]

A 50-year-old woman was admitted to our hospital with dysesthesia on the right upper portion of her face and a headache. Diffusion-weighted brain magnetic resonance imaging (MRI) revealed high-intensity signals in the dorsolateral portion of the medulla oblongata. She was diagnosed with lateral medullary infarction and was intravenously treated with sodium ozagrel. On the second day of hospitalization, she had nausea and vomiting and showed nystagmus to all directions, suggesting damage to the vestibular nucleus. These manifestations coincided with partial symptoms of lateral medullary syndrome. On the third day of hospitalization, a rash appeared on the region of skin innervated by the first and second branches of the right trigeminal nerve. A reevaluation of the MRI findings indicated the presence of a lesion of the right spinal trigeminal nucleus and tract. She was treated with acyclovir for 14 days, and was discharged without any residual symptoms. Varicella zoster virus-DNA was detected in her cerebrospinal fluid. This disease mimics the presentation of a stroke and is important for differential diagnosis. (Received August 1, 2017; Accepted September 14, 2017; Published February 1, 2018).

Rituximab for the treatment of type B insulin resistance syndrome: a case report and review of the literature

BACKGROUND

Type B insulin resistance syndrome is a rare disease characterized by refractory transient hyperglycaemia and severe insulin resistance associated with circulating anti-insulin receptor antibodies. A standardized treatment regimen for type B insulin resistance syndrome has yet to be established.

CASE REPORT

We report the case of a 64-year-old man undergoing haemodialysis for antineutrophil cytoplasmic antibody-associated vasculitis and diabetic nephropathy, who developed rapid onset of hyperglycaemia (glycated albumin 52.1%). Type B insulin resistance syndrome was diagnosed, on the basis of positivity for anti-insulin receptor antibodies and the man's autoimmune history of antineutrophil cytoplasmic antibody-associated vasculitis and idiopathic thrombocytopenic purpura. Although severe hyperglycaemia persisted in spite of corticosteroids and high-dose insulin therapy, rituximab treatment resulted in remarkable improvement of the man's severe insulin resistance and disappearance of anti-insulin receptor antibodies without any adverse effects.

CONCLUSIONS

According to a literature review of 11 cases in addition to the present case, rituximab appears to be a safe and effective strategy for the treatment of corticosteroid-resistant type B insulin resistance syndrome.

Amplitude death in a pair of one-dimensional complex Ginzburg-Landau systems coupled by diffusive connections

This paper shows that, in a pair of one-dimensional complex Ginzburg-Landau (CGL) systems, diffusive connections can induce amplitude death. Stability analysis of a spatially uniform steady state in coupled CGL systems reveals that amplitude death never occurs in a pair of identical CGL systems coupled by no-delay connection, but can occur in the case of delay connection. Moreover, amplitude death never occurs in coupled identical CGL systems with zero nominal frequency. Based on these analytical results, we propose a procedure for designing the connection delay time and the coupling strength to induce spatial-robust stabilization, that is, a stabilization of the steady state for any system size and any boundary condition. Numerical simulations are performed to confirm the analytical results.

[Acute encephalopathy due to angel's trumpet intoxication: A case report and literature review]

We report two cases (a married couple) of intoxication due to angel's trumpet ingestion. Case 1: A 71-year-old woman was found lying unconscious on the sofa at home and was brought to our hospital by ambulance. She showed mydriatic anisocoria, and an intracerebral lesion was suspected. However, the brain magnetic resonance imaging showed no abnormal lesion and acute encephalopathy of unknown cause was diagnosed. Case 2: A 68-year-old man (husband of the patient of Case 1) showed alteration of consciousness with agitation and was admitted to our hospital on the next day. He also had slight mydriasis. As his manifestations were similar to those of his wife, we studied their medical history again. We found that they mistook the roots of angel's trumpet for burdock and cooked and ate them. This intoxication causes characteristic encephalopathy with altered consciousness and mydriasis. In the case of anisocoria or mild mydriasis, the diagnosis is difficult sometimes. The intoxication occurred within a family; this was a clue to the correct diagnosis. Severe cases exhibit pyramidal signs and symptoms or convulsion, and deaths have been reported. Angel's trumpet intoxication is an important neurological emergency.

Proportional-integral control of propagating wave segments in excitable media

Numerical simulations are performed to demonstrate that proportional-integral control, one of the most commonly used feedback schemes in control engineering, can stabilize propagating wave segments in excitable media to a desired size. The proportional-integral controller measures the size of a wave segment and applies a spatially uniform signal to the medium. This controller has the following features: difficult trial-and-error adjustment is not necessary, wave segments can be stabilized to different sizes without readjusting the controller, and the wave segment size can be maintained even in media having position-dependent parameters.

Ability of the Ankle Brachial Index and Brachial-Ankle Pulse Wave Velocity to Predict the 3-Month Outcome in Patients with Non-Cardioembolic Stroke

Aim: Both the ankle brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are surrogates for atherosclerosis. In this study, we aimed to evaluate the ability of ABI and baPWV to predict stroke outcome in patients with first-ever non-cardioembolic stroke.

Methods: This study included consecutive patients with first-ever non-cardioembolic stroke admitted within 1 week after onset to Ota Memorial Hospital between January 2011 and December 2013. Baseline characteristics and National Institutes of Health stroke scale scores at admission were noted. ABI and baPWV were evaluated within 5 days of admission. The patients were categorized according to ABI (cut-off 0.9) and baPWV (cut-off 1870 cm/s) determined using the receiver operation curve for poor outcome. Clinical outcomes were defined based on the modified Rankin scale (mRS) scores 3 months after stroke onset as good (0 and 1) or poor (2–6).

Results: A total of 861 patients were available for evaluation. ABI < 0.9 and baPWV > 1870 cm/s were associated with poor outcome in the univariate analysis (p < 0.001 and p < 0.001, respectively). After adjusting for factors that showed differences between groups, ABI < 0.9 was associated with poor outcome. Among patients with ABI ≥ 0.9, higher baPWV showed a slight association with poor outcome after adjustment [odds ratio 1.46 (95% CI 0.95–2.27)].

Conclusion: Our study suggests that the stroke outcome can be predicted using ABI and to an extent using baPWV when ABI ≥ 0.9 in patients with non-cardioembolic stroke.

Carotid Artery Dissection and Ischemic Stroke Originating from Localized Aortic Arch Dissection

Aortic dissection is an infrequent but important cause of acute ischemic stroke (AIS), and must not be overlooked because of a possible worse outcome, especially with the use of an intravenous recombinant tissue plasminogen activator. We report a case of left carotid artery dissection and AIS originating from localized aortic arch dissection, pathologically caused by cystic medial necrosis in the tunica media.

[Pneumococcal meningitis with accompanying severe hearing loss: 3D-FLAIR imaging of the inner ear and treatment]

A 66-year-old man was admitted to our hospital because of unconsciousness. He was diagnosed with pneumococcal meningitis and treated with a combination of antibiotics (meropenem hydrate), dexamethasone, and intravenous immunoglobulin. Although he gradually regained consciousness, he started showing signs of hearing disturbance. Measurement of auditory brainstem response revealed severe sensorineural hearing loss. The patient then underwent three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging, which revealed increased signals in the cochlea and the vestibuum, and their enhancement after gadolinium administration. This enhancement was still observed on images of the inner ear acquired on the 52nd hospital day. These findings suggested that the change of content in the lymph and the damage to the blood-labyrinth barrier was caused and aggravated by an immune response. Recent studies have shown that an MyD88-dependent immune response contributes to hearing loss in an experimental mouse model of pneumococcal meningitis. The patient was administered steroid pulse and hyperbaric oxygen therapies for improving the hearing deficit, but these therapies were discontinued because of the aggravation of hepatitis B and diabetes mellitus, which he had developed previously.

Brain Natriuretic Peptide and Particular Left Ventricle Segment Asynergy Associated with Cardioembolic Stroke from Old Myocardial Infarction

BACKGROUND

It is important to determine the usage of anticoagulants by defining the actual risk of cardioembolic stroke in patients with old myocardial infarction. In the present study, we aimed to more precisely evaluate the risks of each segment associated with cardioembolic stroke using a 16-segment model. The usage of the plasma brain natriuretic peptide (BNP) associated with cardioembolic stroke was also evaluated in comparison with a left ventricle ejection fraction less than 40%.

METHODS

There were a total of 190 ischemic stroke patients who had premorbid myocardial infarction. The study included a total of 143 ischemic stroke patients with old myocardial infarction who were available for evaluation and excluded patients with atrial fibrillation or acute myocardial infarction. Their left ventricle wall motion abnormality and the level of plasma BNP at their admission were analyzed.

RESULTS

Hypertension and a plasma BNP level of 206.9 pg/mL or higher, determined from the receiver operating characteristic curve, were independently associated with cardioembolic stroke (χ(2) = 35.6, R(2) = .30, P < .001). Adjusting for these factors, statistically independent high risk was observed at the basal-inferior, basal-inferolateral, mid-anterior, mid-anteroseptal, apical-anterior, and apical-septal left ventricles.

CONCLUSION

High plasma BNP levels and left ventricular wall motion abnormalities in the segments perfused with left anterior descending coronary artery or right coronary artery show a high risk for cardioembolic stroke in patients with old myocardial infarction. Considering these factors, it could be possible to more precisely define the risk of cardioembolic stroke and to perform appropriate antithrombotic treatments in old myocardial infarction patients.

Dynamical behavior and peak power reduction in a pair of energy storage oscillators coupled by delayed power price

This paper investigates dynamics of a management system for controlling a pair of energy storages. The system involves the following two characteristics: each storage behaves in a manner that reduces the number of charge noncharge cycles and begins to be charged when the price of power is lower than a particular price threshold. The price is proportional to the past total power flow from a power grid to all storages. A peak of the total power flow occurs when these storages are charged simultaneously. From the viewpoint of nonlinear dynamics, the energy storages can be considered as relaxation oscillators coupled by a delay connection. Our analytical results suggest that the peak can be reduced by inducing an antiphase synchronization in coupled oscillators. We confirm these analytical results through numerical simulations. In addition, we numerically investigate the dynamical behavior in 10 storages and find that time delay in the connection is important in reducing the peak.

[A Clinical and Radiological Comparison of Adult- and Childhood-onset Tuberous Sclerosis Complex]

In this study, we assessed 11 patients who were definitively diagnosed with tuberous sclerosis complex (TSC) based on the accepted clinical diagnostic criteria (Roach, 1998). We compared the clinical and radiological findings of six adult-onset TSC cases (group A) and five child-onset TSC cases (group B). The prevalence rates of generalized tonic-clonic convulsions at onset, mental retardation, facial angiofibroma, and epilepsy were lower in group A than in B group. The number of cortical tubers and subependymal nodules on brain magnetic resonance (MR) and computed tomography (CT) images were also lower in group A. The number of cerebral white matter radial migration lines was similar in both groups. Cortical tubers were most frequently observed in the frontal lobe in both groups. The number of cortical tubers and subependymal nodules did not correlate with the presence of epilepsy or mental retardation. Extra-brain lesions in lung, kidney, and bone were recognized in both groups, and no specific lesions were noted in group A.

Delay- and topology-independent design for inducing amplitude death on networks with time-varying delay connections

We present a procedure to systematically design the connection parameters that will induce amplitude death in oscillator networks with time-varying delay connections. The parameters designed by the procedure are valid in oscillator networks with any network topology and with any connection delay. The validity of the design procedure is confirmed by numerical simulation. We also consider a partial time-varying delay connection, which has both time-invariant and time-varying delays. The effectiveness of the partial connection is shown theoretically and numerically.

Insulin and the Brain: A Sweet Relationship With Intensive Care

BACKGROUND

Insulin receptors (IRs) in the brain have unique molecular features and a characteristic pattern of distribution. Their possible functions extend beyond glucose utilization. In this systematic review, we explore the interactions between insulin and the brain and its implications for anesthesiologists, critical care physicians, and other medical disciplines.

METHODS

A literature search of published preclinical and clinical studies between 1978 and 2014 was conducted, yielding 5996 articles. After applying inclusion and exclusion criteria, 92 studies were selected for this systematic review.

RESULTS

The IRs have unique molecular features, pattern of distribution, and mechanism of action. It has effects on neuronal function, metabolism, and neurotransmission. The IRs are involved in neuronal apoptosis and neurodegenerative processes.

CONCLUSION

In this systematic review, we present a close relationship between insulin and the brain, with discernible effects on memory, learning abilities, and motor functions. The potential therapeutic effects extend from acute brain insults such as traumatic brain injury, brain ischemia, and hemorrhage, to chronic neurodegenerative diseases such as Alzheimer and Parkinson disease. An understanding of the wider effects of insulin conveyed in this review will prompt anaesthesiologists and critical care physicians to consider its therapeutic potential and guide future studies.

[Anti-amphiphysin antibody-positive paraneoplastic neurological syndrome with a longitudinally extensive spinal cord lesion of the dorsal column]

A 53-year-old woman was admitted to our hospital because of gait disturbance and paresthesia of the lower extremities. She also had marked deep sense impairment in her lower limbs. Cervical MRI showed a longitudinally extensive spinal cord lesion of the dorsal column at levels C1-T11. The findings of cerebrospinal fluid examination, including the IgG index (0.65), were normal. Serum anti-AQP4 antibody was negative, but anti-amphiphysin antibody was positive. Electrophysiological examinations suggested the presence of lesions in the dorsal column of the spinal cord and dorsal root ganglion (DRG). Enlargement of and fluorodeoxyglucose accumulation in her left parasternal lymph node was observed on contrast-enhanced CT and PET-CT, respectively. The lymph node biopsy was underwent by using thoracoscopy. The metastasis of carcinoma was pathologically confirmed. Although the primary tumor was not detected on PET-CT re-examination, immunostaining of the biopsied lymph node specimen was positive for both the progesterone receptor and estrogen receptor. On the basis of these findings, the patient was diagnosed with paraneoplastic neurological syndrome due to potential breast cancer. The disorder is an immunological subacute sensory neuropathy with a longitudinally extensive spinal cord lesion of the dorsal column and a DRG lesion.

[Cerebral venous thrombosis as a complication of nephrotic syndrome--a case report and literature review]

We report two cases of cerebral venous thrombosis as a complication of nephrotic syndrome. No urine protein or kidney disease was noted in either case. The patients were diagnosed with nephrotic syndrome after admission to our hospital. Case 1: The patient was a 46-year-old man. He experienced headache and vomiting the day after he drank heavily. Contrast brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed a defect in the transverse sinus, straight sinus, and superior sagittal sinus. His blood was hemo-concentrated, and blood test results indicated high D-dimer and fibrinogen levels and decrease of antithrombin III. Case 2: The patient was an 89-year-old woman. After the diarrhea lasted suffering from ischemic colitis, she developed left hemiplegia and headache. Brain CT revealed hematoma in the subcortical region of the right frontal lobe and a high signal in the straight sinus. The superior sagittal sinus showed high-signal intensity on T1-weighted MRI and mild high-signal intensity on T2-weighted MRI. High fibrinogen levels were detected in the blood. Patients with nephrotic syndrome have a thrombotic tendency; both venous thrombosis and arterial thrombosis may occur. In the literature, the number of published cases of cerebral venous thrombosis was 10-fold that of cerebral artery thrombosis as a complication of nephrotic syndrome in individuals aged <20 years. In adults, however, the number of cerebral venous thrombosis was 2-fold that of cerebral artery thrombosis cases were reported. Nephrotic syndrome shows a thrombotic tendency, but cerebral venous thrombosis may develop as a result of another thrombotic factor. Management of life along with the conventional treatment of nephrotic syndrome is important.

Molecular and functional characterization of choline transporter in the human trophoblastic cell line JEG-3 cells

INTRODUCTION

Choline is essential for the synthesis of the major membrane phospholipid phosphatidylcholine (PC), the methyl donor betaine and the neurotransmitter acetylcholine (ACh), which is involved in several vital biological functions that play key roles in fetal development. In this study, we examined the molecular and functional characteristics of choline uptake in the human trophoblastic cell line JEG-3.

METHODS

We examined [(3)H]choline uptake in the human trophoblastic cell line JEG-3. The expression of CTL1 and CTL2 was evaluated by quantitative real-time PCR, western blotting and immunocytochemistry.

RESULTS

We demonstrated that JEG-3 cells take up [(3)H] choline by a saturable process that is mediated by a Na(+)-independent and pH-dependent transport system. The cells have two different [(3)H] choline transport systems, high- and low-affinity, with Km values of 28.4 ± 5.0 μM and 210.6 ± 55.1 μM, respectively. Cationic compounds and hemicholinium-3 (HC-3) inhibited choline uptake. Choline transporter-like protein 1 (CTL1) and CTL2 mRNA and protein were highly expressed in JEG-3 cells and were localized to the plasma membrane.

DISCUSSION

The present results suggest that choline is mainly transported via a high-affinity choline transport system (CTL1) and a low-affinity choline transport system (CTL2) in human trophoblastic JEG-3 cells. These transporters play an important role in the growth of the fetus.

Dynamics of dc bus networks and their stabilization by decentralized delayed feedback

The present paper deals with the dynamics of bus networks, which consist of several identical dc bus systems connected by resistors. It is analytically guaranteed that the stability of a stand-alone dc bus system is equivalent to that of the networks, independent of the number of bus systems and the network topology. In addition, we show that a decentralized delayed-feedback control can stabilize an unstable operating point embedded within the networks. Moreover, this stabilization does not depend on the number of bus systems or the network topology. A systematic procedure for designing the controller is presented. Finally, the validity of the analytical results is confirmed through numerical examples.

Design of time-delayed connection parameters for inducing amplitude death in high-dimensional oscillator networks

The present paper studies time-delayed-connection induced amplitude death in high-dimensional oscillator networks. We provide two procedures for design of a coupling strength and a transmission delay: these procedures do not depend on the topology of oscillator networks (i.e., network structure and number of oscillators). A graphical procedure based on the Nyquist criterion is proposed and then is numerically confirmed for the case of five-dimensional oscillators, called generalized Rössler oscillators, which have two pairs of complex conjugate unstable roots. In addition, for the case of high-dimensional oscillators having two unstable roots, the procedure can be systematically carried out using only a simple algebraic calculation. This systematic procedure is numerically confirmed for the case of three-dimensional oscillators, called Moore-Spiegel oscillators, which have two positive real unstable roots.

[Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma -stroke mimic and pitfalls for diagnosis]

Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma were presented. We examined the point similar to that of stroke. During the initial visit of our hospital, the patients showed the hemiplegia in 10 cases (62.5%), Horner syndrome in 4 cases (25%), the painless onset in 1 case (6.3%). And one case showed the impairment of consciousness due to vagal reflex in severe pain onset, which was similar to those of subarachnoid hemorrhage. MRI images are useful to confirm the diagnosis. The frequent site of hematoma was the lower cervical spinal cord. The oval shaped hematomas shifted to the left or right in spinal canals, compressed spinal cords in axial image, which was a cause of hemiplegia. Many cases developed during active periods, and the hemorrhage might be relevant to oral antithrombotic agent, C hepatitis, and chronic renal failure. Rapidly progressive cases were indications for emergency surgery, but conservative therapy is also possible and was better prognosis.

Genes associated with the progression of neurofibrillary tangles in Alzheimer's disease

The spreading of neurofibrillary tangles (NFTs), intraneuronal aggregates of highly phosphorylated microtubule-associated protein tau, across the human brain is correlated with the cognitive severity of Alzheimer's disease (AD). To identify genes relevant to NFT expansion defined by the Braak stage, we conducted whole-genome exon array analysis with an exploratory sample set consisting of 213 human post-mortem brain tissue specimens from the entorinal, temporal and frontal cortices of 71 brain-donor subjects: Braak NFT stages 0 (N=13), I-II (N=20), III-IV (N=19) and V-VI (N=19). We identified eight genes, RELN, PTGS2, MYO5C, TRIL, DCHS2, GRB14, NPAS4 and PHYHD1, associated with the Braak stage. The expression levels of three genes, PHYHD1, MYO5C and GRB14, exhibited reproducible association on real-time quantitative PCR analysis. In another sample set, including control subjects (N=30), and in patients with late-onset AD (N=37), dementia with Lewy bodies (N=17) and Parkinson disease (N=36), the expression levels of two genes, PHYHD1 and MYO5C, were obviously associated with late-onset AD. Protein-protein interaction network analysis with a public database revealed that PHYHD1 interacts with MYO5C via POT1, and PHYHD1 directly interacts with amyloid beta-peptide 42. It is thus likely that functional failure of PHYHD1 and MYO5C could lead to AD development.

Analysis of a dc bus system with a nonlinear constant power load and its delayed feedback control

This paper tackles a destabilizing problem of a direct-current (dc) bus system with constant power loads, which can be considered a fundamental problem of dc power grid networks. The present paper clarifies scenarios of the destabilization and applies the well-known delayed-feedback control to the stabilization of the destabilized bus system on the basis of nonlinear science. Further, we propose a systematic procedure for designing the delayed feedback controller. This controller can converge the bus voltage exactly on an unstable operating point without accurate information and can track it using tiny control energy even when a system parameter, such as the power consumption of the load, is slowly varied. These features demonstrate that delayed feedback control can be considered a strong candidate for solving the destabilizing problem.

Abstract W P142: Can Peripheral Arterial Disease Markers Predict the Outcome of Non-cardioembolic Stroke Patients?

Introduction: In acute stroke patients, ankle-brachial index (ABI)>0.9 is a clear predictor of increased stroke recurrence risk. However, it has not been defined whether clinical markers of peripheral arterial disease could predict the outcome of non-cardioembolic stroke.

Hypothesis: We assessed the hypothesis that clinical markers (e.g. ABI and pulse wave velocity [PWV]) of peripheral arterial disease could predict the outcome of non-cardioembolic stroke.

Methods: In our Brain Attack Center, 5432 acute ischemic stroke patients were admitted in January 2007 to December 2012. Among them, 686 lacunar or atherothrombotic stroke (TOAST criteria) patients (248 female and 438 male, median age 70.0 (range 35 to 96)) who admitted within 7 days after their onset and evaluated ABI and PWV during hospitalization were retrospectively examined in this study. Baseline characteristics and NIHSS scores at admission were noted, and modified Rankin scale (mRS) scores 3 months after stroke were evaluated. The patients were categorized into normal (≥0.9) and decreased (<0.9) ABI groups, and into good-outcome (mRS score, 0,1) and poor-outcome (mRS score, 2_6) groups.

Results: ABI was decreased in 28 (5.7%) of 496 good-outcome patients and 22 (11.6%) of 190 poor-outcome patients (p=0.008). PWV was increased in the patients with poor-outcome (2116.6±477.5 cm/s) compared with the patients with good-outcome (1934.9±415.6 cm/s, p<0.001). The patients were categorized into low- or high-PWV with a cutoff (2163 cm/s) determined from a receiver operating characteristics curve against the patients’ outcome. The poor-outcome of patients were predicted with high-age (≥75years), NIHSS score at admission, low-ABI, and high-PWV, independently (overall Χ 2 =86.7, R 2 =0.107, n=686, p<0.001; low-ABI: odds ratio 2.13 [95% confidence interval 1.12 to 4.01], p=0.022; high-PWV: odds ratio 2.36 [95% confidence interval 1.61 to 3.45]).

Conclusion: Our results showed that the poor-outcome of patients were predicted with ABI and PWV even after controlling age and NIHSS score. It is important to evaluate clinical markers (ABI and PWV) of peripheral arterial disease in the non-cardioembolic stroke patients.