Hiroshi Baba

Early intervention to promote oral feeding in patients with intracerebral hemorrhage: a retrospective cohort study

BackgroundStroke is a major cause of dysphagia, but little is known about when and how dysphagic patients should be fed and treated after an acute stroke. The purpose of this study is to establish the feasibility, risks and clinical outcomes of early intensive oral care and a new speech and language therapist/nurse led structured policy for oral feeding in patients with an acute intracerebral hemorrhage (ICH).MethodsA total of 219 patients with spontaneous ICH who were admitted to our institution from 2004 to 2007 were retrospectively analyzed. An early intervention program for oral feeding, which consisted of intensive oral care and early behavioral interventions, was introduced from April 2005 and fully operational by January 2006. Outcomes were compared between an early intervention group of 129 patients recruited after January 2006 and a historical control group of 90 patients recruited between January 2004 and March 2005. A logistic regression technique was used to adjust for baseline differences between the groups. To analyze time to attain oral feeding, the Kaplan-Meier method and Cox proportional hazard model were used.ResultsThe proportion of patients who could tolerate oral feeding was significantly higher in the early intervention group compared with the control group (112/129 (86.8%) vs. 61/90 (67.8%); odds ratio 3.13, 95% CI, 1.59-6.15; P < 0.001). After adjusting for baseline imbalances, the odds ratio was 4.42 (95% CI, 1.81-10.8; P = 0.001). The incidence of chest infection was lower in the early intervention group compared with the control group (27/129 (20.9%) vs. 32/90 (35.6%); odds ratio 0.48, 95% CI, 0.26-0.88; P = 0.016). A log-rank test found a significant difference in nutritional supplementation-free survival between the two groups (hazard ratio 1.94, 95% CI, 1.46-2.71; P < 0.001).ConclusionsOur data suggest that the techniques can be used safely and possibly with enough benefit to justify a randomized controlled trial. Further investigation is needed to solve the eating problems that are associated with patients recovering from a severe stroke.

Brain surface spindle cell glioma in a patient with medically intractable partial epilepsy : A variant of monomorphous angiocentric glioma?

We report a case of brain surface angiocentric glioma in a 6‐year‐old Japanese boy with medically intractable partial epilepsy. MRI showed somewhat ill‐defined high‐signal lesions on fluid‐attenuated inversion recovery and T2‐weighted imagings of the right occipitoparietal cortex. At surgery, a yellowish tumor was localized in the superficial cortex. Histologically, the tumor was predominantly composed of elongated astrocytic cells forming rings around blood vessels. Tumor cells circumferential to vessels predominanted in low cellurarity areas, whereas radial alignment with perivascular pseudorosettes was observed in more cellular regions. These perivascular pseudorosettes closely resembled those of ependymoma. The tumor cells showed variable cytoplasmic immunoreactivity with GFAP. These findings were more likely monomorphous angiocentric glioma, which was first described by Wang etu2003al. in 2005. However, in our case the tumor had a small foci of polymorphous appearance and a comparatively high MIB‐1 labeling index (8%). Therefore, the present case may be an atypical form of monomorphous angiocentric glioma. However, no de novo anaplastic monomorphous angiocentric glioma similar to our case has yet been reported in the literature. It remains to be determined whether the behavior of monomorphous angiocentric glioma is an example of benign biological characteristics or whether it more closely resembles a low‐grade malignant tumor.

Callosotomy and subsequent surgery for children with refractory epilepsy

Callosotomy has been considered as a palliative therapy for refractory epilepsy patients with non-focal onset seizures. Residual partial seizures and unilateral epileptiform discharges on electroencephalography (EEG) are sometimes observed after callosotomy. These findings suggest that some patients may be candidates for subsequent resective surgery. Of 149 children who received a callosotomy, resective/disconnective surgery was subsequently performed in 19 patients. Most patients had generalized seizures and epileptiform discharges on EEG before callosotomy. Two-third had normal neuroimaging studies at initial presurgical evaluation. After callosotomy, ictal symptoms evolved into asymmetric features suggesting partial onset seizures. Post-callosotomy EEG showed completely lateralized or localized epileptiform discharges responsible for residual partial seizures in 16 of 19 patients. Fifteen patients underwent resective surgery of the unilateral frontal lobe, and the remaining received hemispherotomy or posterior quadrantectomy. After subsequent surgery, favorable seizure outcomes were obtained in 11 patients (57.9%). Favorable seizure outcomes may be achieved with callosotomy and subsequent surgery in selected patients who are not candidates for a conventional resective surgery at initial presurgical evaluation.

Nuclear excitation in 189 Os with synchrotron radiation

Abstract The 6 h radioactivity of 189m Os was observed after irradiation of 189 Os with white synchrotron radiation produced at a superconducting wiggler installed in a 2.5 GeV electron storage ring. It was considered that production of the activity resulted mainly from the excitation of the 70 keV nuclear level in 189 Os through a process referred to as nuclear excitation by electron transition (NEET). The NEET probability was deduced to be (5.7 ± 1.7) × 10 −9 per created K-hole, which was smaller by a factor of thirty than the previous result obtained with electron bombardment.

Pediatric moyamoya disease presenting with intracerebral hemorrhage—Report of three cases and review of the literature

Intracerebral hemorrhage in patients with moyamoya disease is rare in children. We report three unique cases of pediatric moyamoya disease with hemorrhagic onset. Two 7-year-old girls and a 9-year-old girl were admitted to our hospital because of intracerebral hemorrhage associated with angiographically verified moyamoya disease. Two of them did not demonstrate either an ischemic episode or cerebral infarct on the magnetic resonance images. A decreased regional cerebral blood flow was revealed on single photon emission computed tomography in two patients, who developed cerebral infarction in the acute stage following hemorrhage. They underwent superficial temporal artery-middle cerebral artery anastomoses combined with encephalo-myo-synangiosis, and have not experienced any further ischemic episodes thereafter. Hemodynamic insufficiency associated with moyamoya disease could cause intracerebral hemorrhage even in children. Adequate management in the acute stage of hemorrhage and revascularization surgery are recommended to prevent cerebral infarction, which may easily occur in pediatric patients with moyamoya disease.

Specific Fission J-Window and Angular Momentum Dependence of the Fission Barrier

A method to determine a unique J-window in the fission process was devised and the fissioning nuclide associated with thus extracted J-window was identified for each of the heavy-ion reaction systems. Obtained fission barriers at the resulting J-window were compared with the calculated values by the rotating finite range model (RFRM). The deduced barriers for individual nuclides were compared with the RFRM barriers to reproduce more or less the angular momentum dependence the RFRM prediction. The deduced systematic behavior of the fission barrier indicates no even-odd and shell corrections are necessary. The nuclear dissipation effect based on Kramers model revealed substantial reduction of the statistically deduced barrier heights and brought a fairly large scattering from the RFRM J-dependence. However, introduction of the temperaturedependent friction coefficient (γ = 2 for T ≥ 1.0 MeV and 0.5 for T < 1.0 MeV) was found to bring about satisfactory agreement with both RFRM fission barriers and the pre-fission neutron multiplicity systematics.

Determination of the formation cross section by γ spectrometry: Derivation of universal correction formulas for ingrowth during irradiation

Abstract We have derived generalized correction formulas for the effect of ingrowth from the precursor during irradiation in the determination of the formation cross section by γ spectrometry. The correction formulas enabled one to carry out the correction quite easily. They require no detailed decay schemes of involved nuclides, except for the half-lives and, in the case where nuclear isomers exist, the fraction of transition between any pair of nuclides, and thus make it possible to get rid of the tedious derivation of individual correction formulas. The whole procedure is easily programmed in a personal computer and one can instantaneously judge whether a correction is necessary for a relevant nuclide. Further, it supplies correction factors to deduce both the independent and cumulative yields of a nuclide from the extrapolated yield to the end-of-bombardment (EOB) in the decay analysis, on the one hand, and also those to be applied to the chemically separated activities at EOB on the other. The latter set of correction factors are applicable to physically separated activities in ISOL or gas-jet transport experiments as well, provided that the effective retention duration of the product nuclides in the reaction chamber is known.

Solvent Extraction Behavior of Astatine and Radioiodine at Tracer Concentrations

The solvent extraction behavior of radioioine and astatine has been investigated under various conditions in order to compare the extraction behavior of astatine with radioiodine at tracer concentration. In this study, basic tracer solutions of astatine and radioiodine were extracted into the CS2 solution under various conditions. Astatine existed as a pure species in the tracer solution and formed cationic compound in the acidic solution which was also extracted into the organic solvent instantaneously. On the other hand, radioiodine existed as a complex in the tracer solution and was partly extracted into the organic solvent at tracer concentration. The observed different extraction behavior of astatine and radioiodine were consistently explained by the respective proposed extraction reaction schemes.

Surgical versus medical treatment for children with epileptic encephalopathy in infancy and early childhood: Results of an international multicenter cohort study in Far-East Asia (the FACE study)

OBJECTIVEnTo compare the seizure and developmental outcomes in infants and young children with epileptic encephalopathy who have undergone surgical and medical treatments.nnnMETHODSnAn international, multicenter, observational cohort study was undertaken. A total of 317 children aged <6 years, who had frequent disabling seizures despite intensive medical treatments, were registered. Among the enrolled children, 250 were treated medically (medical group), 31 underwent resective surgery (resective group), and 36 underwent palliative surgery [callosotomy (n=30) or vagal nerve stimulation (n=6); palliative group] on admission. Seizure and developmental outcomes were obtained for 230 children during the 3-year follow-up period. Cox proportional hazard model was used to adjust for clinical backgrounds among treatment groups when comparing the seizure-free survival rates.nnnRESULTSnAt the 3-year follow-up, seizure-free survival was 15.7%, 32.1%, and 52.4% in the medical, palliative, and resective groups, respectively. The adjusted hazard ratios for seizure recurrence in the resective and palliative groups versus the medical group were 0.43 (95% CI, 0.21-0.87, P=0.019) and 0.82 (95% CI, 0.46-1.46, P=0.50), respectively; the former was statistically significant. Regarding the developmental outcome, the mean DQs in the resective group increased significantly compared to those in the medical group during the follow-up (P<0.01). As for subgroup analysis, better seizure and development outcomes were demonstrated in the resective group compared to the medical group in children with nonsyndromic epilepsies (those to which no known epilepsy syndromes were applicable).nnnSIGNIFICANCEnThese results suggest that surgical treatments, particularly resective surgeries, are associated with better seizure and developmental outcomes compared with successive medical treatment. The present observations may facilitate the identification of infants and young children with epileptic encephalopathy who could benefit from surgery.

Distribution behavior of astatine: Solvent extraction and back extraction

The distribution behavior of astatine was studied at tracer concentrations and over a wide range of carrier iodide concentration in both solvent extraction and back extraction processes. Astatine compounds were extracted instantly into the organic solvent, CS2 from the carrier free and carrier iodide containing solutions. Back extraction of astatine with various NaOH solutions followed by solvent extraction caused the hydrolysis of astatine. The distribution behavior of astatine was explained by the extraction reaction schemes.