Unveiling new quantum phases in the Shastry-Sutherland compound SrCu2(BO3)2 up to the saturation magnetic field.

Under magnetic fields, quantum magnets often undergo exotic phase transitions with various kinds of order. The discovery of a sequence of fractional magnetization plateaus in the Shastry-Sutherland compound SrCu2(BO3)2 has played a central role in the high-field research on quantum materials, but so far this system could only be probed up to half the saturation value of the magnetization. Here, we report the first experimental and theoretical investigation of this compound up to the saturation magnetic field of 140 T and beyond. Using ultrasound and magnetostriction techniques combined with extensive tensor-network calculations (iPEPS), several spin-supersolid phases are revealed between the 1/2 plateau and saturation (1/1 plateau). Quite remarkably, the sound velocity of the 1/2 plateau exhibits a drastic decrease of -50%, related to the tetragonal-to-orthorhombic instability of the checkerboard-type magnon crystal. The unveiled nature of this paradigmatic quantum system is a new milestone for exploring exotic quantum states of matter emerging in extreme conditions.

Ultrasound measurement technique for the single-turn-coil magnets.

Ultrasound is a powerful means to study numerous phenomena of condensed-matter physics as acoustic waves couple strongly to structural, magnetic, orbital, and charge degrees of freedom. In this paper, we present such a technique combined with single-turn coils (STCs) that generate magnetic fields beyond 100 T with the typical pulse duration of 6 µs. As a benchmark of this technique, the ultrasound results for MnCr2S4, Cu6[Si6O18]·6H2O, and liquid oxygen are shown. The resolution for the relative sound-velocity change in the STC is estimated as Δv/v ∼ 10-3, which is sufficient to study various field-induced phase transitions and critical phenomena.

Liver stiffness measurement using acoustic radiation force impulse elastography in hepatitis C virus-infected patients with a sustained virological response.

BACKGROUND: Acoustic radiation force impulse (ARFI) elastography is a non-invasive method for measuring liver stiffness. However, there are no reports evaluating the value of ARFI elastography for liver fibrosis in chronic hepatitis C patients with a sustained virological response (SVR). AIM: To investigate the diagnostic performance of ARFI elastography for the assessment of liver fibrosis in hepatitis C virus (HCV) infected patients with an SVR. METHODS: In this prospective study, we enrolled 336 patients: 121 HCV patients with an SVR (44.6% women) and 215 patients with HCV (47.9% women). ARFI elastography measurements of all patients were performed on the same day of liver biopsy. RESULTS: The diagnostic accuracies, expressed as areas under the receiver operating characteristic curves for ARFI elastography, in HCV patients with an SVR and those in patients with HCV were 0.818 and 0.875 for the diagnosis of significant fibrosis (≥F2), 0.909 and 0.888 for the diagnosis of severe fibrosis (≥F3), and 0.981 and 0.890 for the diagnosis of liver cirrhosis (F4), respectively. The optimum cut-off values for ARFI elastography were 1.26 m/s for ≥F2, 1.31 m/s for ≥F3 and 1.49 m/s for F4 in HCV patients with an SVR. The liver stiffness values were lower in patients with SVR compared with those in patients with HCV at the same stage of fibrosis. The liver stiffness values were affected by the necroinflammatory activity and the time after SVR. CONCLUSION: Acoustic radiation force impulse elastography is an acceptable method for predicting the severity of fibrosis in patients with hepatitis C virus and a sustained viral response.

Delayed L-DOPA-induced hyperalgesia.

Previously we reported on L-DOPA's antinociceptive effect on substance P-induced nociceptive behaviors in mice [Shimizu T, Iwata S, Morioka H, Masuyama T, Fukuda T, Nomoto M. Antinociceptive mechanism of L-DOPA. Pain 2004;110;246-9.]. Since significant hyperalgesia was noted following antinociception, our study was designed to investigate the mechanism of this hyperalgesia. Nociceptive behaviors were enhanced 2 h after L-DOPA administration. L-DOPA induced hyperalgesia occurred after conversion to dopamine because co-administration of benserazide, a DOPA decarboxylase inhibitor, completely abolished the L-DOPA-induced hyperalgesia. The D2 receptor agonist, quinpirole, depressed these behaviors entirely, while the D1 antagonist, SCH23390, inhibited the enhancement of these behaviors by L-DOPA. The D2 receptor antagonist, sulpiride, which induced hyperalgesia of the substance P-induced behaviors in naive mice, did not have any effects on L-DOPA-induced hyperalgesia. Spinal cord dopamine content increased rapidly after L-DOPA administration, exhibiting levels 100 times greater than baseline, and then returned to control after 1 h. These results suggested that the dopaminergic inhibitory system for pain sensation was temporarily impaired by excess amounts of exogenous dopamine that were derived from L-DOPA and both D1 and D2 receptors were involved in L-DOPA-induced hyperalgesia.

Management of severe subarachnoid hemorrhage; significance of assessment of both neurological and systemic insults at acute stage.

In order to elucidate mutual interrelationship between neurological and systemic dysfunctions in patients with subarachnoid hemorrhage (SAH) at acute stage, neurological condition, systemic complications and plasma catecholamine (CA) level were studied in 1431 consecutive cases admitted within 72 hours after the onset. Five hundred and twenty-four cases with Glasgow Coma Scale (GCS) score 8 or less were assigned to the group of severely ill cases (G-ill), 907 cases with GCS score 9 or more to that of the less ill group (G-well). Plasma CA level was extremely high at super-acute stage within an hour after bleeding and lowered fairly quickly within 24 hours to the normal range. Assuming the value obtained from a formula of [blood sugar level (mg/dl)/serum potassium concentration (mEq/L)] as stress index (SI), SI correlates well (r = 0.4-0.6) with serum catecholamine level at acute stage. Thus, sympathetic hyperactivity after SAH can be grossly estimated with SI. SI over 40 means that patients might have considerable neurological insults as well as systemic ones. For patients in G-well, SI over 50 means that there may be risks for systemic complications even in cases with good neurological condition.

Medico-financial Environment on Treatment for Acutely Ruptured Cerebral Aneurysms. GDC Embolization vs Neck Clipping.

SUMMARY: We have been using the Guglielmi detachable coils (GDC) since 1997 as one choice of cerebral aneurysm treatment.We have, at the present time, two effective radical treatment methods for acutely ruptured cerebral aneurysms, GDC embolization and conventional surgical aneurysmal neck clipping. There ensued questions about the cost and efficacy of the two strategies. Retrospective analysis was done on a GDC group and a clipping group, with each twenty consecutive patients. The features of the GDC group patients were higher age, and poorer Hunt and Kosnik grades than the other group. All MCA aneurysms were treated with surgical neck clipping, while all the posterior circulation aneurysms were embolized with GDC. Based on the Japanese Medical Insurance and Payment System, 477,890 points (1 point = yen 10) as a mean was required with the GDC group, and 456,084 points with the neck clipping group, showing no significant difference between the two groups. In the GDC group, the cost of the implanted medical device seemed to raise the total medical expense. At present, the GDC embolization is the preferred choice of strategies in acutely ruptured cerebral aneurysms, and its preference increases in the surgically difficult cases, very old, or poor grade patients, and in various complicated cases. And, the GDC embolization seems to be satisfactory from the medico-financial viewpoint.

Endovascular Treatment for Ruptured VA Dissecting Aneurysm Involving the Origin of PICA.

SUMMARY: Ruptured vertebral artery dissecting aneurysms (VADA) re-bleed frequently especially during first 24 hours, which makes the prognosis of the patients with this disease poor. Recently endovascular trapping with detachable platinum coils at an acute stage has been done for preventing re-bleeding. However, for the cases with dissecting aneurysm involving the origin of the posterior inferior cerebellar artery (PICA), these methods are hardly indicated because of the risk of ischemic complication in the PICA territory. We proposed a simple and effective therapeutic method for these cases. We occluded the affected vertebral artery (VA) near its root intending to introduce collateral blood flow from the deep cervical artery into the VA trunk. The controlled antegrade VA flow and retrograde flow from the contralateral VA make a watershed at the dissecting aneurysm, which promotes thrombosis of pseudolumen with preserving the antegrade blood flow of PICA.We treated two cases with ruptured VADA involving PICA, and in both cases thrombosis of aneurysm was obtained without any ischemic complication. This method would be considered as a treatment of choice to the cases with VADA involving PICA.

Obsessive-compulsive disorder with poor insight.

Although a diagnosis of obsessive-compulsive disorder (OCD) can be made with the specification "poor insight" (PI), this subtype remains understudied. To investigate the subtype, 78 OCD patients were characterized by degree of insight, reevaluated after treatment, and compared with 20 schizophrenics with OCD (OCD+S). At the pretreatment assessments in OCD patients, 28 subjects with poor or delusional insight (PI; 36%) were distinguished from 50 subjects with fair or good insight (GI; 64%) using the insight question of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Compared to the OCD+S group, OCD patients were less likely to have PI, whereas OCD PI patients showed a similar degree of functional impairment as that observed in the OCD+S. After a 6-month combination of clomipramine with cognitive-behavioral treatment, 14 of 25 OCD PI patients no longer fell in the PI category, which was associated with reduced OCD severity and depressive status. Schizotypal personality disorder (SPD) was more common in patients whose insight remained poor even after the treatment. OCD patients demonstrate a range of insight with PI accompanied by significant dysfunction. Comorbid SPD in PI patients may be associated with worse prognosis.

Expression of pituitary adenylate cyclase-activating polypeptide mRNA in the cochlea of rats.

Expression of mRNA for pituitary adenylate cyclase-activating polypeptide (PACAP) was detected in the cochlea of rats using a reverse transcription-polymerase chain reaction and in situ hybridization. Examination of in situ hybridization demonstrated that cells in the spiral ganglion, and marginal cells in the stria vascularis expressed mRNA for PACAP. These findings suggest that PACAP may play an important role in regulating cochlear functions.

[Effect of arbekacin on the production of toxic shock syndrome toxin 1 by methicillin-resistant Staphylococcus aureus].

The effect of arbekacin (ABK), vancokmycin (VCM) and teicoplanin (TEIC) on the production of toxic shock syndrome toxin-1 (TSST-1) by methicillin-resistant Staphylococcus aureus was examined. In logarithmic-phase cultures, ABK, VCM and TEIC inhibited TSST-1 production by 85, 10 and 25%, respectively, at the concentration of one-fourth the each MIC. In stationary-phase cultures, ABK inhibited TSST-1 production by 50% or 90% compared with the control at the concentration of 4.0 micrograms/ml or 5.0 micrograms/ml respectively. VCM and TEIC did not inhibit TSST-1 production at the concentration of 8.0 micrograms/ml or lower. In human blood cultures, TSST-1 production was inhibited by ABK by 50% at 0.04 microgram/ml (1/256 of Cmax), but not inhibited by VCM and TEIC at the concentration of 1/16 of Cmax or lower. It has been already known that ABK has higher bactericidal activity than VCM and TEIC. ABK combined the inhibition of TSST-1 production with high bactericidal activity in both bacterial growth phases, and therefore ABK should be considered for the treatment of TSST-1-mediated MRSA-infection.

[Comparisons of factors affecting voiding disorders between patients with benign prostate hyperplasia and volunteers].

PURPOSE: The prostate size and motivation to visit clinics were investigated in patients with prostate hyperplasia. OBJECTS AND METHODS: One hundred ninety-five patients who had urinary symptoms and visited our outpatient clinic between September 1994 and October 1999 and 268 age-matched volunteers in Mitaka City who underwent a medical examination of the prostate in June 1997 were compared. International Prostate Symptom Score (IPSS), Quality Of Life Score (QOL score), residual urine volume, prostate volume and urinary flow rate were measured. RESULTS: The prostate volume of the volunteers was 20-25 cm3 irrespective of the age. The prostate size of the outpatients was larger than that of the volunteers for every age group. IPSS and QOL score were significantly higher in the outpatients than in the volunteers. Diurnal urinary frequency and sense of residual urine contributed to the discrimination index of the two groups more significantly than the other scores. There was a significant correlation between prostate volume and residual urine volume. The score of weak urinary steam was inversely and significantly correlated with peak urinary flow rate. CONCLUSIONS: There was no age-related enlargement of the prostate gland. The prostate gland was significantly larger in the patients than in the volunteers even in those in their fifties. Urinary frequency and sense of residual urine are important factors for men to seek and receive medical care.

[Combination effect of arbekacin and cefepime on mixed culture of MRSA and P. aeruginosa].

We investigated the in vitro combination effects of arbekacin (ABK), vancomycin (VCM) or teicoplanin (TEIC) and cefepime (CFPM) on methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa isolated from various clinical specimens. Using checkerboard titration technique by agar dilution, combinations of ABK, VCM or TEIC and CFPM exhibited synergistic effects on 25 MRSA strains. The similar effects were also observed on ABK-resistant MRSA. Combination of ABK and CFPM exhibited a good effect on P. aeruginosa, but combinations of VCM or TEIC and CFPM exhibited no synergistic effect on P. aeruginosa. In vitro bactericidal activities of ABK, VCM or TEIC and CFPM against mixed cultures of MRSA with P. aeruginosa were examined at concentration of each drug that corresponds to the serum concentration at 3 hours after the usual therapeutic dosage. VCM or TEIC alone showed bacteriostatic effects against MRSA, and no enhancements were observed when combined with CFPM. ABK alone showed good bactericidal activity against MRSA and combination with CFPM enhanced the bactericidal activity. Against P. aeruginosa, ABK or CFPM alone showed the bactericidal activity, and strong bactericidal activity was induced by the combination of ABK and CFPM. VCM and TEIC showed no bactericidal activities against P. aeruginosa. When CFPM combined with VCM or TEIC, the bactericidal activity of CFPM was not enhanced against P. aeruginosa.

T wave alternans for predicting adverse effects of amiodarone in a patient with dilated cardiomyopathy.

An implantable cardioverter defibrillator (ICD) was used in a 62-year-old man with dilated cardiomyopathy (DCM) because of hemodynamically intolerable ventricular tachycardia (VT). Amiodarone was administered after a second episode of ICD discharge. Three weeks later, incessant VT appeared, and DC discharge failed to terminate it. Microvolt T wave alternans (TWA), measured by a spectral method, was observed in this patient with and without amiodarone administration. The onset heart rate with TWA was lower and the alternans voltage was higher with amiodarone than without it. The effects of amiodarone appeared to be related to the exacerbation of VT and an increased defibrillation threshold. TWA might be useful in predicting the proarrhythmic effects of amiodarone in similar cases.

Concurrent Hodgkin's disease (mixed cellularity type) and T-cell chronic lymphocytic leukemia/prolymphocytic leukemia.

We describe a patient with leukopenic T-cell chronic lymphocytic leukemia/prolymphocytic leukemia (T-CLL/PLL), according to the Revised European-American Classification of Lymphoid Neoplasms. This patient simultaneously developed classic Hodgkin's disease (HD), a combination previously unreported. The leukemic cells were small and mature, did not have cytoplasmic granulation, and appeared similar to B-cell chronic lymphocytic leukemia. Immunophenotyping of the bone marrow-infiltrating cells revealed a postthymic suppressor/cytotoxic phenotype of CD2+, CD3+, CD4, CD5+, CD8+, CD25-, TCR-alpha beta. A lymph node biopsy showed the histological features of HD (mixed cellularity) with infiltrating CD8+ lymphocytes, and immunohistochemical examination revealed the following phenotype of Reed-Sternberg cells: LeuM1/CD15+, BerH2/CD30+, L26/PanB-, UCHL-1/CD45RO-, cyCD3-, CD4, CD8-, CD20-, CD79a-, EMA-, EBER-1+, LMP-1+. Southern blot analysis of the bone marrow and lymph node revealed the same rearrangement of bands of T-cell-receptor genes. Although the HD was treated with chemotherapy that resulted in complete remission, the T-PLL/CLL took an indolent course. This case may suggest the existence of a subtype of T-CLL/PLL with leukopenia and an indolent clinical course. Both diseases were believed to be independent and not a transformation of one to the other.

[T-cell prolymphocytic leukemia complicated by diffuse large B-cell lymphoma of the stomach].

We describe a case of T-cell prolymphocytic leukemia (T-PLL) in a 76-year-old man, who developed diffuse large B-cell lymphoma (DLBL) of the stomach, a previously unreported occurrence. The patient was referred to our hospital because of marked leukocytosis (40,000/microliter) without clinical symptoms. He was diagnosed as having T-PLL on the basis of the characteristic cell morphology and immunophenotype (CD2+, CD3+, CD4+, CD5+, CD7+, CD8-, CD25-, TCR alpha/beta+), but cytogenetic analysis showed no abnormalities. Fifteen months later, he developed a gastric tumor. Biopsy of the tumor revealed DLBL without features of MALT lymphoma; Helicobacter pylori was not detected. Chemotherapy eradicated the tumor, whereas the T-PLL was resistant to the therapy. The disease showed an indolent course for about 2 years thereafter. Immunological derangement due to T-PLL might have potentiated the development of DLBL in this case.

[The significance of early detection for prostate cancer in mass screening].

PURPOSE: In Mitaka city, mass screening for prostate cancer was conducted for 3 years from 1995 to 1997. Clinical stages were compared between patients found by screening and those diagnosed at our clinic during the same time. The significance of serum-free prostate specific antigen (PSA) in mass screening for prostate cancer was examined. MATERIAL AND METHODS: A prospective clinical trial was conducted on men aged 50 years or older. The primary examination consisted of taking the international prostate symptom score, quality of life score, PSA (Tandem-R) and digital rectal examination (DRE). If PSA was greater than 4.0 ng./ml and/or if DRE suggested cancer, transrectal ultrasound-guided sextant prostate biopsies were indicated. RESULTS: Of the men screened, 23.2% (320/1375) had serum PSA greater than 4.0 ng./ml. and/or suspicious findings on DRE. Biopsy was performed in 199 of 320 (62.1%). Cancer was detected in 21 (1.5%, 21/1375). Prostate cancer was found in one case among 154 males (0.65%, 1/154) who were screened twice or more. The cancer stage found by screening was significantly earlier than that diagnosed at the outpatient clinic (Wilcoxon's rank-sum test: p = 0.0047). Receiver operating characteristics analysis showed that the optimal free PSA-to-PSA ratio was 12%. Positive predictive value increased from 18% to 50% when free PSA-to-PSA ratio was combined with PSA. CONCLUSION: 1. Cancer detection rate was 1.5% in the mass screening in Mitaka City. 2. Cancer stage found by screening was significantly earlier than that diagnosed at the outpatient clinic. 3. Free PSA determination might eliminate unnecessary biopsies in men with PSA above 4.0 ng./ml with minimal loss of cancer detection.

Clinical and experimental observation of glistening in acrylic intraocular lenses.

PURPOSE: To determine whether or not glistening particles in implanted acrylic intraocular lenses (IOL) increase with the passage of time. METHODS: Prospective clinical study: Glistenings were evaluated in 31 patients (49 eyes) with implanted acrylic IOL, the emphasis being on when glistening first became evident and subsequent changes in the number of glistening particles. EXPERIMENT: IOLs were monitored for any changes that occurred with the passage of time as they were immersed first in a 50 degrees C saline solution and then in another saline solution with a temperature of 35 degrees C. RESULTS: Prospective clinical study: Glistening phenomenon was observed in 28 IOLs (57%) 2 to 16 months after implantation (mean = 6.6 months). Glistenings reached their peak in number within a few months of formation in all cases, showing no further increase thereafter. EXPERIMENT: Glistening particles first appeared on the 10th day of the experiment in sizes ranging from 3 to 10 microm in diameter. They remained at the same level for the next 60 days without showing any increase. CONCLUSIONS: Glistening formation in acrylic IOLs was found to stabilize within a few months after appearance. The method of our experiment proved reliable in producing, in a relatively short period of time, glistening similar to that found in patients.

[Bactericidal activity of biapenem against various bacteria].

The bactericidal activity of biapenem (BIPM), a new carbapenem agent, against Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Serratia marcescens was compared with those of imipenem (IPM), panipenem (PAPM), meropenem (MEPM) and ceftazidime (CAZ). The bactericidal activity of BIPM against S. aureus was equal to those of IPM, PAPM and MEPM. Against E. coli and K. pneumoniae, BIPM showed higher bactericidal activity than IPM and PAPM. Against P. aeruginosa, BIPM showed excellent bactericidal activity campared with IPM. The killing speeds of BIPM and IPM were obviously the most rapid among four carbapenems. BIPM showed a strong bactericidal activity against 5 species of bacteria including P. aeruginosa.

Clearance of Subarachnoid Clots after GDC Embolization for Acutely Ruptured Cerebral Aneurysm. Comparison with Early Direct Surgery.

SUMMARY: It is apparent that subarachnoid clots play an important role in the development of delayed vasospasm that is one of the major causes of mortality and morbidity in patients with acutely ruptured cerebral aneurysm. The purpose of this study is to compare the clearance of subarachnoid clots in the acute stage after the treatment with Guglielmi detachable coils (GDC) and after treatment with direct surgery. Forty-nine patients were treated by GDC embolization within four days of the ictus. After GDC embolization, adjunctive therapies, such as ventricular and/or spinal drainage (67%), intrathecal administration of urokinase (41%), continuous cisternal irrigation (16%), and external decompression (16%), were performed. Seventy-four surgically treated patients were subsequently treated by continuous cisternal irrigation with mock-CSF containing ascorbic acid for ten days. The clearance of subarachnoid clots was assessed by the Hounsfield number serial changes on the CT scans taken on days 0, 4, 7, 10 after subarachnoid hemorrhage. The incidence of symptomatic vasospasm was lower in the GDC group (6%) than in the surgery group (12%). The clearance of subarachnoid clots from both the basal cistern and the Sylvian fissure was more rapid in the GDC cases than in the surgery cases in the first four days. Intrathecal administration of urokinase accelerated the clearance significantly. GDC embolization followed by intrathecal administration of thrombolytic agents accelerates the reduction of subarachnoid clots and favorably acts to prevent delayed vasospasm.