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Herein, we present the case of a 76-year-old man diagnosed with an iliopsoas abscess 3 months prior and consequently administered metronidazole. The patient visited our facility complaining of difficulty in speaking and feeling unsteady when walking. Neurological findings showed dysarthria, nystagmus, and bilateral cerebellar ataxia. Head MRI-FLAIR demonstrated symmetrical hyperintensities in the bilateral cerebellar dentate nuclei, red nucleus, periaqueductal of the midbrain, periventricular third ventricle, and the corpus callosum. Although Wernicke's encephalopathy was among the differential diagnoses based on the imaging findings, the thiamine level was normal and improvement in symptoms and hyperintensity on FLAIR within 5 days of discontinuing metronidazole led to the diagnosis of metronidazole-induced encephalopathy. Although there were many similarities in the imaging findings of metronidazole-induced encephalopathy and Wernicke's encephalopathy, Metronidazole-induced encephalopathy should be initially considered when midbrain red nucleus lesions are observed.
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Overexpression of human dynactin-associated protein (dynAP) transforms NIH3T3 cells. DynAP is a single-pass transmembrane protein with a carboxy-terminal region (amino acids 135-210) exposed to the outside of the cell possessing one potential N-glycosylation site (position 143) and a distal C-terminal region (residues 173-210) harboring a Thr/Ser-rich (T/S) cluster that may be O-glycosylated. In SDS-PAGE, dynAP migrates anomalously at ~ 45 kDa, much larger than expected (22.5 kDa) based on the amino acid composition. Using dynAP mutants, we herein showed that the T/S cluster region is responsible for the anomalous migration. The T/S cluster region is required for transport to the cytoplasmic membrane and cell transformation. We produced and purified the extracellular fragment (dynAP135-210) in secreted form and analyzed the attached glycans. Asn143 displayed complex-type glycosylation, suggesting that oligosaccharide transferase may recognize the NXT/S sequon in the secretory form, but not clearly in full-length dynAP. Core I-type O-glycosylation (Gal-GalNAc) was observed, but the mass spectrometry signal was weak, clearly indicating that further studies are needed to elucidate modifications in this region.
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Aminoácidos , Polisacáridos , Animales , Complejo Dinactina , Glicosilación , Humanos , Ratones , Células 3T3 NIH , Polisacáridos/químicaRESUMEN
Language tasks must be based on perioperative neuropsychological evaluation during intraoperative language area mapping for the resection of brain tumor near the language cortex under awake craniotomy. However, flexibility is needed during surgery, because actions during surgery must change based on neurological symptoms and the presence or absence of aphasia. Here, we developed software to assess patients' ability to complete language tasks during surgery by using a tablet device; these language tasks serve as indicators of changes in patient status. We examined its effectiveness through the use of the software. In this case, the patient was a 68-year-old female. Before the surgery, the patient exhibited transcortical sensory aphasia. However, 1 day before the surgery, she exhibited worsening of language symptoms. We prepared a language task on the tablet device based on the patient's ability to complete the task before the surgery. The patient's wakefulness baseline was different from that predicted before the surgery. However, we were able to modify the surgical plan by using the results of the language task on the tablet device. In addition, we were able to finish mapping in approximately 90 minutes.
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Neoplasias Encefálicas , Lenguaje , Anciano , Mapeo Encefálico , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/cirugía , Computadoras de Mano , Craneotomía , Femenino , Humanos , Monitoreo Intraoperatorio , VigiliaRESUMEN
A palatal augmentation prosthesis (PAP) is used to facilitate improvement in the speech and swallowing functions of patients with tongue resection or tongue movement disorders. However, a PAP's effect is limited in cases where articulation disorder is severe due to wide glossectomy and/or segmental mandibulectomy. In this paper, we describe speech outcomes of a patient with an articulation disorder following glossectomy and segmental mandibulectomy. We used a palatal plate (PP) based on a PAP, along with an artificial tongue (KAT). Speech improvement was evaluated by a standardized speech intelligibility test consisting of 100 syllables. The speech intelligibility score was significantly higher when the patient wore both the PP and KAT than when he wore neither (pï¼0.013). The conversational intelligibility score was significantly improved with the PP and KAT than without PP and KAT (pï¼0.024). These results suggest that speech function can be improved in patients with hard tissue defects with segmental mandibulectomy using both a PP and a KAT. The nature of the design of the PP and that of the KAT will allow these prostheses to address a wide range of tissue defects.
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We report a case of consciousness disorder following the fourth course of chemotherapy with cisplatin (CDDP) and 5- fluorouracil (5-FU) in a patient with esophageal cancer. A 74-year-old man was admitted to our hospital to receive chemotherapy for esophageal cancer. Six days after chemotherapy, the patient showed impaired consciousness and his serum sodium concentration was found to be 125 mEq/L, but no edema or dehydration was noted. This hyponatremic state was diagnosed as CDDP-induced syndrome of inappropriate secretion of antidiuretic hormone (SIADH) on the basis of serum and urine hypo-osmolality. Accordingly, fluid intake was restricted and sodium supplements were administered, resulting in an appropriate increase in the serum sodium concentration to 132 mEq/L in 4 days.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Trastornos de la Conciencia/etiología , Neoplasias Esofágicas/tratamiento farmacológico , Síndrome de Secreción Inadecuada de ADH/inducido químicamente , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Trastornos de la Conciencia/tratamiento farmacológico , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Síndrome de Secreción Inadecuada de ADH/diagnóstico , Síndrome de Secreción Inadecuada de ADH/tratamiento farmacológico , Masculino , Sodio/uso terapéuticoRESUMEN
OBJECTIVES: The measurement of language development in hearing-impaired children is an important step in assessing the appropriateness of an intervention. We proposed a set of language tests (the Assessment Package for Language Development in Japanese Hearing-Impaired Children [ALADJIN]) to evaluate the development of practical communication skills. This package consisted of communication skills (TQAID), comprehensive (PVT-R and SCTAW) and productive vocabulary (WFT), comprehensive and productive syntax (STA), and the STRAW. METHODS: A total of 638 children with greater than 70-dB hearing impairment were subjected to this set of language tests. Additional tests, including the PARS, the RCPM, and parental questionnaires, were administered to assess the backgrounds of the children. RESULTS: A trimodal distribution was observed among hearing-impaired children by the histogram-based analysis of each test. CONCLUSIONS: The ALADJIN is a useful Japanese-language evaluation kit for hearing-impaired children.
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Trastornos de la Comunicación/diagnóstico , Pérdida Auditiva/diagnóstico , Desarrollo del Lenguaje , Pruebas del Lenguaje , Conducta Verbal/fisiología , Vocabulario , Niño , Preescolar , Trastornos de la Comunicación/etiología , Trastornos de la Comunicación/terapia , Evaluación de la Discapacidad , Intervención Educativa Precoz/normas , Familia , Femenino , Audífonos/normas , Pérdida Auditiva/complicaciones , Pérdida Auditiva/psicología , Pérdida Auditiva/terapia , Humanos , Japón , Pruebas del Lenguaje/normas , Pruebas del Lenguaje/estadística & datos numéricos , MasculinoRESUMEN
OBJECTIVES: Japanese-speaking children in a standard sample were subjected to a test battery (ALADJIN: Assessment Package for Language Development in Japanese Hearing-Impaired Children) to evaluate the effect of language development on both interpersonal communication skills and academic achievement. METHODS: A total of 414 preschool and school-age children without hearing impairment were included in this study. The following tests make up the ALADJIN: the Test of Question-Answer Interaction Development (TQAID), the Japanese Language by Criterion Referenced Test-II (CRT-II) for measuring academic achievement, the Picture Vocabulary Test-Revised (PVT-R), the Standardized Comprehension Test of Abstract Words (SCTAW), both parts of the Syntactic Processing Test for Aphasia (STA), and the Word Fluency Test (WFT). Means and standard deviations at each academic grade level were calculated, and a multiple regression analysis was performed. RESULTS: A ceiling effect was observed for the TQAID and the STA in children in grade 3 of elementary school, and the scores for the PVT-R, SCTAW, and WFT increased incrementally according to grade level. Multiple regression analysis revealed that the PVT-R, WFT, and STA (production) have predictive power for the results of the TQAID (R = 0.59; R2 = 0.58; p <0.0001), whereas the SCTAW and STA (comprehension) have predictive power for the results of the CRT-II. CONCLUSIONS: Both vocabulary and syntax are important in communication development among children. The results of our multiple regression analysis suggest that different language domains may play different roles in the development of interpersonal communication skills and in academic achievement. The development of interpersonal communication skills is largely based on productive vocabulary and syntax abilities, whereas academic achievement is largely based on comprehensive vocabulary and syntax abilities. Children who have difficulties in either area should be evaluated with detailed language assessment tools such as the ALADJIN in an effort to aid in the selection of appropriate intervention.
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Escolaridad , Desarrollo del Lenguaje , Pruebas del Lenguaje , Pruebas de Asociación de Palabras , Niño , Preescolar , Comunicación , Familia , Femenino , Humanos , Relaciones Interpersonales , Japón , Pruebas del Lenguaje/normas , Pruebas del Lenguaje/estadística & datos numéricos , Masculino , Valor Predictivo de las Pruebas , Análisis de Regresión , Vocabulario , Pruebas de Asociación de Palabras/normas , Pruebas de Asociación de Palabras/estadística & datos numéricosRESUMEN
OBJECTIVES: This study examined syntactic development of auditory comprehension of sentences in Japanese-speaking school-age children with and without hearing impairment. METHODS: In total, 592 preschool and school-age children (421 normal-hearing and 171 hearing-impaired) were included in this cross-sectional observation study conducted using the Syntactic Processing Test for Aphasia for Japanese language users. Linear regression analysis was used to determine the estimated age at which each syntactic structure was acquired. RESULTS: Acquisition of syntactic structures was observed in hearing-impaired and normal-hearing children. Basic word order sentences of agent-object-verb and the goal benefactive construction were acquired at preschool age (earlier group), whereas reverse word order sentences of object-agent-verb, source benefactive construction, passive voice, and relative clauses were acquired at school age (later group). The results showed that many hearing-impaired children may not acquire Japanese grammatical structures until the age of 12 years. CONCLUSIONS: Adequate screening for language development for school-age hearing-impaired children is required for an effective intervention.
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Comprensión/fisiología , Pérdida Auditiva , Desarrollo del Lenguaje , Trastornos del Lenguaje , Inteligibilidad del Habla/fisiología , Niño , Preescolar , Intervención Educativa Precoz , Femenino , Pérdida Auditiva/complicaciones , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/psicología , Humanos , Japón , Trastornos del Lenguaje/etiología , Trastornos del Lenguaje/psicología , Trastornos del Lenguaje/terapia , Pruebas del Lenguaje/normas , Pruebas del Lenguaje/estadística & datos numéricos , Masculino , Tamizaje Masivo/métodos , Vocabulario , Pruebas de Asociación de Palabras/normas , Pruebas de Asociación de Palabras/estadística & datos numéricosRESUMEN
Kawasaki disease is an acute febrile disease predominantly seen in young children. We report a case of Kawasaki disease in a 32-year-old pregnant woman. She developed a generalized erythematous skin rash accompanied by high fever. Bilateral conjunctival congestion, tender cervical lymphadenopathy, an edematous lower lip and peripheral edema followed by desquamation were observed. She was successfully treated with aspirin and intravenous gammaglobulin (1 g/kg/day). Her course was not complicated by coronary artery aneurysm and she delivered a healthy baby. To the best of our knowledge, this is the first case of Kawasaki disease in a pregnant woman. We suggest that Kawasaki disease should be included in the differential diagnosis of a generalized, erythematous skin rash accompanied by high fever in adults.