Opalski Syndrome Treated with Intravenous Recombinant Tissue Type Plasminogen Activator-Case Report and Review of Literature.

A 65-year-old man with a history of Wallenberg syndrome caused by vertebral artery dissection at 62 years old was admitted to our hospital with nausea, vertigo, right facial dysesthesia, right hemiplegia, crossed sensory disturbance (sensory loss and numbness in the right face and left body below the neck), and right limb ataxia. Magnetic resonance imaging (MRI) performed 80 minutes after onset revealed no acute ischemic stroke lesions, but magnetic resonance angiography (MRA) demonstrated complete occlusion of the right vertebral artery. Based on these neurological and MRA findings, atypical lateral medullary infarction was suggested, and intravenous tissue plasminogen activator (IV-tPA) was started 178 minutes after onset. Right hemiplegia improved immediately after IV-tPA administration. MRI performed on hospital day 2 showed an acute ischemic lesion on the right side of the medulla oblongata, resulting in a diagnosis of Opalski syndrome. Opalski syndrome is a rare subtype of Wallenberg syndrome accompanied by hemiplegia of the side ipsilateral to the lesion, and expansion of the stroke lesion to the corticospinal tract below the pyramidal decussation is considered to cause ipsilateral hemiplegia. Based on this case and previous reports, Opalski syndrome should be considered when limb ataxia and crossed sensory deficit are observed among patients with hyperacute-onset hemiplegia, and IV t-PA therapy should be considered even in the absence of neurological findings such as dysphagia, dysarthria, and Horner's signs and radiological evidence of acute ischemic stroke.

A Case of Subacute Combined Degeneration of Spinal Cord Diagnosed by Vitamin B12 Administration Lowering Methylmalonic Acid.

Subacute combined degeneration of the spinal cord (SCDS) is a neurodegenerative disease characterized by subacute progression in the central and peripheral nervous systems mainly caused by vitamin B12 deficiency. It is known that typical SCDS is frequently accompanied by megaloblastic anemia and increased serum methylmalonic acid (MMA) or homocysteine (Hcy) levels on laboratory findings, and marked abnormalities on spinal cord magnetic resonance imaging (MRI). A 45-year-old woman was admitted to our hospital with a 2-year history of worsening mild weakness, numbness in bilateral lower limbs, and gait disturbance. On admission, as laboratory findings, blood count showed macrocytosis without anemia, and biochemical tests showed mild reduction in total serum vitamin B12 level and no increase of MMA and Hcy levels; there were no abnormal findings on spinal cord MRI. After administration of vitamin B12, her sensorimotor symptoms were improved and laboratory examination showed that macrocytosis was improved, serum vitamin B12 was increased, and serum MMA levels were decreased. This improved clinical course and the laboratory findings following vitamin B12 administration confirmed the diagnosis of SCDS due to vitamin B12 deficiency. SCDS presents with highly variable symptoms and laboratory findings, and observation of MMA levels and neurologic symptoms before and after vitamin B12 administration may be useful for diagnosing SCDS.

KBDeX: A Platform for Exploring Discourse in Collaborative Learning.

Knowledge building as defined in this study is emergent collaborative learning on ill-structured tasks. Although discourses in collaborative learning have been analyzed with traditional qualitative approaches in the learning sciences field, it is difficult to capture the group dynamics. Hence, we are trying to establish a methodology for discourse analysis in collaborative learning from the perspective of complex network science. In order to conduct this study effectively, we are currently developing an application platform, called Knowledge Building Discourse Explorer (KBDeX). The goal of this project is not only to facilitate productive communication between researchers who are concerned with research on knowledge building or emergent collaborative learning, but also to encourage students to explore their own group dynamics by themselves. KBDeX is an analysis platform to visualize network structures of discourse based on the bipartite graph of words × discourse units. KBDeX can visualize them into three different network structures of: (1) students, (2) discourse units, and (3) selected words. The users can explore these three networks with its coefficients and analyze the discourse across phases or in a and stepwise way. Using discourse which has been already analyzed with a traditional qualitative approach, we will demonstrate the beneficial attributes of the KBDeX platform.

Repetitive self-mutilation among Japanese eating disorder patients with drug use disorder: comparison with patients with methamphetamine use disorder.

Repetitive self-mutilation and drug use disorder are less prevalent in Japan, although the prevalence of eating disorder is comparable with rates in Western countries. However, repetitive self-mutilation has not previously been described in relation to eating disorder and drug use disorder in Japan. Subjects consisted of 19 patients with eating disorders and drug use disorders (ED+DUD) and 12 patients with methamphetamine use disorders (MAP). Subjects were drawn from 180 patients who were referred because of eating disorders and 22 patients who were referred because of methamphetamine-related problems. All subjects underwent a semistructured interview. Repetitive self-mutilation tended to be more prevalent among ED+DUD patients than MAP patients. Conversely, history of oppositional defiant disorder and antisocial personality disorder tended to be more prevalent in MAP patients than in ED+DUD patients. The low prevalence of repetitive self-mutilation appears to be due to low risk factors in Japan, even though the pathogenesis of these behaviors seems to be universal.

Temperament and character of Japanese eating disorder patients.

Previous studies consistently reported a link between bulimic behaviors and high Novelty Seeking (NS), as measured by the Temperament and Character Inventory (TCI). However, it remains unclear whether this relationship is universal and occurs in different environments. Subjects of the present study consisted of 66 patients with anorexia nervosa restricting type (AN-R), 59 patients with anorexia nervosa binge eating/ purging type (AN-BP), 101 patients with bulimia nervosa purging type (BN), and 75 controls. NS score in AN-R patients was significantly lower than that in controls, although NS in BN patients did not differ from that in controls. The temperament of AN-R patients seems to be universal, even in different environments. Conversely, something other than temperament might be important in the development of bulimia nervosa in Japan.