Satoshi Kodama

A new pulse height analysis system based on fast ADC digitizing technique

A fast digitizing system was used as a pulse height analysis system in nuclear spectroscopy. Input signals were processed by a computerized data processing system consisting of a fast ADC (analog-to-digital converter) of 200 MHz/10 b and a UNIX workstation without any shaping circuit. Measurements have been made with a HPGe detector and a /sup 60/Co gamma -ray source. An energy resolution of 1.7 keV was obtained in this system whereas it was 2.0 keV in the conventional system with a shaping circuit with a 6- mu s time constant. A digital analysis of the pulse waveform has been performed. The selection of convex waveform gives an improved peak to Compton ratio. This technique has the potential to analyze individual signals with required accuracies and to be used as an advanced signal processing method. >

Tsunami-tendenko and morality in disasters

Disaster planning challenges our morality. Everyday rules of action may need to be suspended during large-scale disasters in favour of maxims that that may make prudential or practical sense and may even be morally preferable but emotionally hard to accept, such as tsunami-tendenko. This maxim dictates that the individual not stay and help others but run and preserve his or her life instead. Tsunami-tendenko became well known after the great East Japan earthquake on 11 March 2011, when almost all the elementary and junior high school students in one city survived the tsunami because they acted on this maxim that had been taught for several years. While tsunami-tendenko has been praised, two criticisms of it merit careful consideration: one, that the maxim is selfish and immoral; and two, that it goes against the natural tendency to try to save others in dire need. In this paper, I will explain the concept of tsunami-tendenko and then respond to these criticisms. Such ethical analysis is essential for dispelling confusion and doubts about evacuation policies in a disaster.

Is Asian bioethics really the solution

Today Asia is attracting attention in the area of bioethics. In fact, the potential of bioethics is beginning to be discussed seriously at academic centers across Asia. In Japan, this discussion began a decade ago with the publication “Japanese and Western Bioethics.” The book is one of the principal explorations of biomedical ethics involving Japan to date. Tom Beauchamp, an author of one of the books chapters, compares Japanese and American standards of informed consent and refutes relativistic positions, concluding that:

Scientific Misconduct in Japan: The Present Paucity of Oversight Policy

Scientific misconduct can jeopardize scientific progress and destroy the credibility and reputation of academic institutions and their faculty and students; ultimately it can compromise scientific integrity and result in a loss of confidence for the entire scientific community. Only recently in Japan has scientific misconduct become a central public topic. This increased attention to the topic, in turn, has highlighted a paucity of ethical standards within the Japanese scientific community and a lack of an apt process for conflict resolution. In this brief report, we first provide an overview of several high-profile cases of scientific misconduct recently uncovered in Japan. Next we consider how a recent rise in competition within the academic and scientific communities is possibly related to a concurrent increase in reported cases of scientific misconduct. Last, after discussing what actions have already been taken, we recommend further actions needed to deal with the problem of scientific misconduct in Japan.

Tacrolimus-Induced Reversible Cerebral Vasoconstriction Syndrome with Delayed Multi-Segmental Vasoconstriction

Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular syndrome characterized by multi-segmental constrictions of the cerebral arteries that resolves spontaneously within 3 months. Although RCVS is considered to be due to transient dysregulation of vascular tone, the exact pathomechanism remains unclear. We describe the case of a 15-year-old girl with RCVS induced by tacrolimus, who developed generalized seizure during the postoperative course of orthotropic heart transplantation. Magnetic resonance imaging at symptom onset showed a few vasoconstrictions accompanying brain edema and convexity subarachnoid hemorrhage. Although her neurological conditions rapidly improved after discontinuing tacrolimus, a repeat magnetic resonance angiogram demonstrated delayed progression of the multi-segmental vasoconstrictions followed by subsequent resolution. Our case demonstrates that cautious observation of the cerebral arteries using magnetic resonance angiography and careful management of vasoconstrictions with vasodilators are necessary for delayed vasoconstrictions even when the clinical symptoms improve.

Key challenges in bringing CRISPR-mediated somatic cell therapy into the clinic

Editorial summaryGenome editing using clustered regularly interspersed short palindromic repeats (CRISPR) and CRISPR-associated proteins offers the potential to facilitate safe and effective treatment of genetic diseases refractory to other types of intervention. Here, we identify some of the major challenges for clinicians, regulators, and human research ethics committees in the clinical translation of CRISPR-mediated somatic cell therapy.

Societal Preferences for Interventions with the Same Efficiency: Assessment and Application to Decision Making

Background and ObjectivesAlthough quality-adjusted life-years (QALYs) may not completely reflect the value of a healthcare technology, it remains unclear how to adjust the cost per QALY threshold. First, the present study compares two survey methods of measuring people’s preferences for a specific healthcare technology when each choice has the same efficiency. The second objective was to consider how this information regarding preferences could be used in decision making.MethodsWe conducted single-attribute (budget allocation) and multi-attribute (discrete-choice) experiments to survey public medical care preferences. Approximately 1000 respondents were sampled for each experiment. Six questions were prepared to address the attributes included in the study: (a) age; (b) objective of care; (c) disease severity; (d) prior medical care; (e) cause of disease; and (f) disease frequency. For the discrete-choice experiment (a) age, (b) objective of care, (c) disease severity, and (d) prior medical care were orthogonally combined. All assumed medical care had the same costs and incremental cost-effectiveness ratio (ICER; cost per life-year or QALY). We also calculated the preference-adjusted threshold (PAT) to reflect people’s preferences in a threshold range.ResultsThe results of both experiments revealed similar preferences: intervention for younger patients was strongly preferred, followed by interventions for treatment and severe disease states being preferred, despite the same cost per life-year or QALY. The single-attribute experiment revealed that many people prefer an option in which resources are equally allocated between two interventions. Marginal PATs were calculated for age, objective of care, disease severity, and prior medical care.ConclusionThe single- and multi-attribute experiments revealed similar preferences. PAT can reflect people’s preferences within the decision-maker’s threshold range in a numerical manner.

Aphasic status epilepticus preceding tumefactive left hemisphere lesion in anti-MOG antibody associated disease

INTRODUCTION Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies have recently been associated with epilepsy with FLAIR hyperintense cortical lesions on MRI. Association between anti-MOG antibodies and epilepsy without detectable structural brain lesion on MRI is unknown. CASE REPORT A 48-year-old right-handed man with a four-and-a-half year history of anti-MOG antibody associated demyelinating disease presented with persistent global aphasia. Brain MRI showed no new lesion or cortical lesion in the left hemisphere. Electroencephalogram, magnetoencephalography, and brain perfusion single-photon emission computed tomography suggested epileptic foci in the left temporal and parietal lobes, and the patients aphasia transiently responded to intravenous diazepam, compatible with aphasic status epilepticus. Cerebrospinal fluid showed mildly elevated cell count and positive oligoclonal bands. The patient only partially responded to antiepileptic drugs but responded to steroid pulse therapy. Six months later, the patient again exhibited global aphasia. Brain MRI showed tumefactive white matter lesion in the left temporo-parietal lobes. CONCLUSION Autoimmune epilepsy without obvious causative lesion on MRI can be seen in the course of anti-MOG antibody associated demyelinating disease. The subsequent emergence of tumefactive lesion closely located to the epileptic foci may suggest some association between autoimmune epilepsy and demyelinating lesions.

S147. Effect of 1 Hz and 5 Hz rTMS over supplementary motor area on motor cortical excitability

Introduction Recent clinical trial of repetitive transcranial magnetic stimulation (rTMS) in Parkinson’s disease (PD) showed that both 1 Hz and 5 Hz rTMS over supplementary motor cortex (SMA) are effective for motor symptoms in PD. Previous studies have also indicated 1 Hz rTMS over primary motor cortex (M1) induces an inhibition whereas 5 Hz rTMS produce facilitation in excitability. Our aim is to clarify why both 1 Hz and 5 Hz rTMS, which have the opposite effects in cortical excitability, show the similar beneficial effects for PD. Recent clinical trial of repe. Methods Subjects are twelve right-handed healthy volunteers (10 men, mean age 30.9 ± 6.5 years). rTMS consists of total 1000 pulses of 1 Hz, 5 Hz rTMS and realistic sham stimulation over SMA at intensity of 110% active motor threshold for the tibialis anterior (TA). We recorded motor-evoked potentials (MEP) from the right first dorsal interosseous (FDI) muscle and measured MEPs, short-intercortical inhibition (SICI) and intercortical facilitation (ICF) before, immediately (0), 15 and 30 min after the end of each condition. Results A two-way repeated measures ANOVA demonstrated a significant main effect of ‘condition’ (1 Hz, 5 Hz and sham) on the mean MEP amplitude (F2,87 = 4.72, P = 0.0113), whereas no significant effect on ‘time’ (T0-T30) (F2,87 = 0.589, P = 0.56) and ‘time’ × ‘condition’ interaction (F2,87=0.79. P = 0.535). Post hoc t tests revealed that decrease in MEP amplitude lasted at least for 15 min after the end of stimulation (0 min P = 0.0048; 15 min P = 0.0047). SICI and ICF did not show significant changes after 1 Hz rTMS. There were no significant changes either in MEP, SICI and ICF after 5 Hz rTMS and sham stimulation. Conclusion 1 Hz SMA-rTMS decreased the amplitude of MEP evoked by a single-pulse TMS, whereas 5 Hz SMA-rTMS did not show significant changes. We suggest that 1 Hz and 5 Hz SMA-rTMS show different physiological after-effects, even though both conditions have a similar therapeutic effect for PD. It is presumable that these two rTMS have different mechanism for improving motor symptoms of PD. Further investigation is required to clarify the precise physiological effects of SMA-rTMS.

T124. Effect of subthreshold paired associative stimulation during voluntary contraction on different forms of motor learning

Introduction Paired associative stimulation can induce long-term potentiation (LTP)-like or long-term depression (LTD)-like synaptic plasticity changes in the human primary motor cortex (M1) by repeated pairing of an electrical stimulus to the median nerve with a suprathreshold transcranial magnetic stimulation (TMS) pulse to M1. The effective interstimulus intervals (ISIs) between electric stimulation and TMS for inducing LTP-like plasticity are approximately 21–25 ms, while ISI of about 10 ms is suitable for inducing LTD-like changes. We previously reported that standard PAS with ISI of 21.5 ms (PAS21.5) and 25 ms (PAS25) differentially modulate two types of motor learning, that is, model-free motor learning was facilitated by PAS21.5 while model-based motor learning was inhibited by PAS25. We argued that standard PAS at different ISIs might involve different inputs to corticospinal neurons, which are sensitive to current direction of TMS applied in PAS. This is because the facilitatory effects of subthreshold PAS during target muscle voluntary contraction (sub-PAS) on motor evoked potentials (MEP) depended on current direction by TMS (i.e. sub-PAS21.5 required posterior-to-anterior (PA) currents, while sub-PAS25 was only effective when applied with anterior-to-posterior (AP) currents). In this study, we examined the effects of sub-PAS on model-free and model-based motor learning. We hypothesized that sub-PAS might be more effective to modulate motor learning than standard PAS, since selective stimulation by sub-PAS would reduce the interindividual variability of PAS effects. In addition to LTP-inducing protocols, we examined whether and how LTD-inducing sub-PAS protocol affects motor learning in this study. Methods Forty healthy volunteers (11 females) participated. We examined changes of performance of model-free learning (i.e. acceleration of repeated rapid thumb abduction) and model-based learning (i.e. visuomotor gain adaptation of pincer grip) after different PAS interventions. ISIs in PAS were adjusted in each subject using the latency of the individual N20 of the right median nerve somatosensory evoked potentials. Results Model-free learning was specifically facilitated by sub-PAS with ISI equaling N20 (sub-PASN20) when applied with PA currents, while this learning was exclusively inhibited by sub-PAS with ISI of N20-8.5 (sub-PASN20−8.5) when applied with AP currents. In contrast, model-based learning was interfered by sub-PAS only when ISI equals N20 + 5 (sub-PASN20+5), irrespective of current direction of TMS. Conclusion These findings showed that model-free and model-based motor learning are mediated in M1 by considerably different procedures, since modulation of model-free learning is likely to depend on specific combination between current direction and ISI adopted in sub-PAS, while model-based motor learning appears to be associated with interneuron circuits dependent only on ISI, but not on current direction applied in sub-PAS.