Effect of cranioplasty on FIM in patients with severe cerebral infarction after cerebral decompression.

Arai N, Abe Y, Metani H, Hiraoka T, Hanayama K. Effect of cranioplasty on FIM in patients with severe cerebral infarction after cerebral decompression. Jpn J Compr Rehabil Sci 2023; 14: 33-38. Objective: The functional effects of cranioplasty were measured in patients with severe cerebral infarction who had undergone cerebral decompression by comparing the functional independence measure (FIM) during convalescent rehabilitation before and after cranioplasty. Methods: The study design was a single-center retrospective cohort study. Results: Fifty-five patients underwent cerebral decompression after cerebral infarction at our hospital, six of whom were included in this study. Two patients who exhibited cranial depression had no changes in FIM one month prior to cranioplasty. However, the FIM increased one month postoperatively. These patients showed a large increase in the scores for movement and transfer. Discussion: Cranioplasty may play a role in improving ability during convalescent rehabilitation in patients with severe cerebral infarction who undergo cerebral decompression, especially in movement and transfer items.

The Pathogenesis of Disinhibition in Patients with Traumatic Brain Injury: A Two Patient Case Report.

Higher brain dysfunction commonly occurs following traumatic brain injury (TBI), and may manifest in a social behavioral impairment which can significantly impede active social participation. We report two cases, one of voyeurism and the second of alcohol abuse, which might have been caused by TBI resulting in disinhibition, a type of social behavioral impairment. We discuss the underlying pathophysiological mechanisms to raise awareness of such cases and aid the development of effective interventions. Patient 1 suffered a TBI at 18 years of age, 2 years after which he presented repeated episodes of sexually deviant behavior (voyeurism). At 28, he committed suicide, since he was unable to control his aberrant behavior. Patient 2 suffered a TBI at the age of 13. He first displayed problematic behavior 7 years later, which included drinking excessive amounts of alcohol and stealing while inebriated. Despite both patients having sound moral judgment, they had irrational and uncontrollable impulses of desire. Imaging findings could explain the possible causes of impulse control impairments. Damage to the basal ganglia and limbic system, which are involved in social behavior, presumably led to desire-dominated behavior, leading to the patients conducting unlawful acts despite intact moral judgment. It is crucial to educate society about the prevalence of these disorders, explain how these disinhibitions start, and develop effective interventions.

Efficacy of soft palatal augmentation prosthesis for oral functional rehabilitation in patients with dysarthria and dysphagia: a protocol for a randomised controlled trial.

INTRODUCTION: Palatal augmentation prosthesis (PAP) is used in patients with articulation and swallowing disorders caused by postoperative loss of tongue tissue due to tongue cancer, cerebrovascular disease sequelae and age-related hypofunction. We have previously reported a newly designed soft PAP fabricated using an thermoplastic material that is particularly appropriate for early intervention. However, the effect of soft PAP on oral function improvement remains to be elucidated. The aim of this study is to investigate whether soft PAP can improve dysarthria and dysphagia occurring as cerebrovascular disease sequelae. METHODS AND ANALYSIS: This prospective, randomised, controlled trial will compare the immediate and training effects of rehabilitation using soft PAP with those of rehabilitation without using it. Primary outcomes are the single-word intelligibility test score and pharyngeal transit time (PTT). Secondary outcomes are tongue function (evaluated based on maximum tongue pressure, repetitions of tongue pressure and endurance of tongue pressure), articulation function (evaluated based on speech intelligibility, oral diadochokinesis, Voice-Related Quality of Life (V-RQOL)) and swallowing function (evaluated using Eating Assessment Tool-10). The study results will help determine the efficacy of Soft PAP in improving functional outcomes of word intelligibility and PTT. We hypothesised that early rehabilitation using Soft PAP would more effectively improve articulation and swallowing function compared with conventional rehabilitation without using soft PAP. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Okayama University Certified Review Board. The study findings will be published in an open access, peer-reviewed journal and presented at relevant conferences and research meetings. TRIAL REGISTRATION NUMBER: jRCTs062200054.

Characteristics of Patients with Trephine Syndrome: A Retrospective Study.

Objectives: This study retrospectively investigated the prevalence and clinical features of trephine syndrome, which is a late complication of craniectom, in patients who underwent craniectomy decompression. Methods: Trephine syndrome was defined as an increase of ≥2 points in the functional independent measure (FIM) score at 7 days after cranioplasty compared with that 3 days before cranioplasty. Patients who underwent craniectomy at Kawasaki Medical School Hospital between January 1, 2010, and March 15, 2020, were included in the study. Results: During the observation period, 102 patients underwent craniectomy decompression; 71 of them later underwent cranioplasty. In total, 12 and 59 patients were assigned to the trephine and non-trephine syndrome groups, respectively. The patients in the trephine syndrome group were significantly younger than those in the non-trephine syndrome group (P<0.05). The mean durations±standard deviations (in days) from craniectomy decompression to cranioplasty were 57.1±38.9 and 83.6±69.3 for the trephine and non-trephine syndrome groups, respectively (P<0.05). Improvements in the FIM motor scores were greater than the improvements in the cognitive scores for all but one case (P<0.05). The frequency with which patients experienced exacerbation (worsened consciousness and sudden anisocoria) after hospitalization was significantly higher in the trephine syndrome group than in the non-trephine syndrome group (P<0.05). Conclusions: Performing cranioplasty as early as possible in young patients may lead to functional improvement. In the trephine syndrome group, the improvement in motor FIM score was greater than that of the cognitive score. Moreover, post-hospitalization exacerbation was more frequent in the trephine syndrome group.

Foundational Study on the Simple Detection of Impairment Resulting in Dangerous Driving in Patients with Higher Brain Dysfunction.

OBJECTIVES: We performed a survey of medical records to reveal the cognitive deficits behind dangerous driving in patients with higher brain dysfunction. METHODS: Thirty-four patients with higher brain dysfunction were included in this study. Patients' basic characteristics, neuropsychological test results, scores on two types of driving aptitude tests, and accident/near miss data from a driving simulator were extracted from medical records. We conducted χ2 tests for independence between comprehensive driving aptitude scores and "traffic accidents" / "being prohibited from driving as defined by the number of traffic accidents and near misses." Backward logistic regression analysis was carried out to assess correlations of "traffic accidents" and "being prohibited from driving as defined by the number of traffic accidents and near misses" with neuropsychological test scores. RESULTS: No significant correlation was observed between the comprehensive driving aptitude score and "traffic accidents" / "being prohibited from driving as defined by the number of traffic accidents and near misses." The score on the Raven's Colored Progressive Matrices test was the only factor identified as a significant predictor of "being prohibited from driving as defined by the number of traffic accidents and near misses." CONCLUSIONS: The results of this study suggest that it is important to focus on the decline in problem-solving ability as a predictor of "being prohibited from driving as defined by the number of traffic accidents and near misses."

Interpretations and applications of the term, "higher brain dysfunction".

Hiraoka T. Interpretations and applications of the term, "higher brain dysfunction." Jpn J Compr Rehabil Sci 2021; 12: 1-3.

Preventive Effects of Repetitive Peripheral Magnetic Stimulation on Muscle Atrophy in the Paretic Lower Limb of Acute Stroke Patients: A Pilot Study.

OBJECTIVE: The aim of this study was to investigate the effect of repetitive peripheral magnetic stimulation (rPMS) on muscle atrophy prevention in the rectus femoris muscle (RF) of the paretic limb in acute stroke patients. METHODS: Twelve acute stroke patients with a National Institute of Health Stroke Scale score >5 and a motor score of the paretic lower limb >2 at admission were divided into an intervention group (rPMS: mean age, 75±6.4 years) and a conventional care group (non-rPMS: mean age, 62±11.8 years). Baseline measurements were performed within 4 days of stroke onset. In the rPMS group, treatment was applied to the paretic thigh only for 2 weeks, 5 days a week, in addition to conventional care. The cross-sectional area (CSA) of the RF was assessed in both limbs using ultrasound at baseline and 2 weeks later. Data on patient characteristics were collected from the clinical records to assess correlations with the CSA rate of change. RESULTS: Patients in the rPMS group were significantly older. Although the CSA of the RF did not change significantly on either side in the rPMS group, there was a significant decrease in the CSA on the paretic side in the non-rPMS group. However, no significant difference was observed in the CSA rate of change in the rPMS and non-rPMS groups. The CSA rate of change on the paretic side correlated negatively with age in the rPMS group. CONCLUSIONS: Our results suggest that rPMS prevents muscle atrophy more effectively in patients in their 60s than in patients more than 70 years old.

Association of late effects of single, severe traumatic brain injury with Alzheimer's disease using amyloid PET.

Traumatic brain injury (TBI) is suggested to be a risk factor for the onset of Alzheimer's disease (AD); however, the data remain controversial. This is the first report on cognitive decline in patients with TBI over 30 years post-injury. The medical significance/key learning points of this report are that (1) Functional Independence Measure (FIM) is useful in clinical settings, such as for higher brain dysfunction and dementia; (2) amyloid PET findings represent an essential biomarker for follow-up after TBI; and (3) cognitive decline can occur in patients with TBI more than 30 years post-injury.

Food transit duration is associated with the number of stage II transport cycles when eating solid food.

OBJECTIVE: When eating solids, stage II transport (St2Tr) propels triturated food into the pharynx for bolus formation and storage before swallowing. Although the existence of St2Tr is acknowledged, the reason for its existence remains unclear. Understanding it may facilitate development of food appropriate for individuals with dysphagia. The purpose of this study was to explore how measures of duration of eating and swallowing affect the number of St2Tr cycles. DESIGN: Videofluorography was performed on 13 healthy subjects eating 6-g squares of banana, tofu, and cookies. Measurements included the number of St2Tr cycles, duration of processing (from food entering the mouth to onset of swallowing), pre-upper esophageal sphincter (UES) transit duration (from onset of swallowing to onset of UES transit), UES transit duration (leading edge to trailing edge passing the UES), and total sequence duration (from onset of swallowing to terminal swallow). Principal component (PC) analysis was used to identify factors affecting the number of St2Tr cycles. Analysis of covariance was performed using the 1st PC as an independent variable for predicting the number of St2Tr cycles. RESULTS: All four duration measures were significantly positively correlated with the number of St2Tr cycles. Analysis revealed two orthogonal PCs with variable loading. The 1st PC was a function of the timing variables. The 2nd PC was a function of the number of swallows. CONCLUSIONS: The number of St2Tr cycles was associated with measures of food transit duration and was greater with harder foods before processing and more viscous foods just before swallowing.

Electromyography of Swallowing with Fine Wire Intramuscular Electrodes in Healthy Human: Amplitude Difference of Selected Hyoid Muscles.

Few studies have examined the intensity of muscle activity during swallowing in healthy humans. We examined selected hyoid muscles using fine wire intramuscular electromyography (EMG) during swallowing of four food consistencies. Thirteen healthy adults were studied using videofluorography and EMG of the anterior belly of digastric (ABD), geniohyoid (GH), sternohyoid (SH), and masseter (MA; surface electrodes) while ingesting thin liquid (three trials) and solid food of three consistencies (banana, tofu, and cookie, three trials each). After rectification, integration, and normalization, peak EMG amplitudes for each muscle in each trial were measured. Hyoid displacements were measured in two dimensions. Data were analyzed using repeated measures ANOVA with Bonferroni correction. GH had the highest adjusted amplitude for both solids and liquid. For MA and ABD, amplitude was highest with triturated cookie. For ABD, amplitude was lowest with liquid. There were no significant food consistency effects for GH or SH. Hyoid displacements were greatest for cookie and the lowest for liquid. EMG amplitude varied with initial food consistency. The high peak EMG amplitude of GH is consistent with its essential role in opening the upper esophageal sphincter. High MA amplitude with hard solid foods is likely due to the higher tongue-palate pressure with triturated solids. The higher ABD amplitude with solid food is associated with greater hyoid displacement. These findings support the existence of a central pattern generator that modifies the level of muscle activity during pharyngeal swallowing in response to input from mechanoreceptors in the oral cavity.

Morphological and genomic comparisons of Hawaiian and Japanese Black-footed Albatrosses (Phoebastria nigripes) using double digest RADseq: implications for conservation.

Evaluating the genetic and demographic independence of populations of threatened species is important for determining appropriate conservation measures, but different technologies can yield different conclusions. Despite multiple studies, the taxonomic status and extent of gene flow between the main breeding populations of Black-footed Albatross (Phoebastria nigripes), a Near-Threatened philopatric seabird, are still controversial. Here, we employ double digest RADseq to quantify the extent of genomewide divergence and gene flow in this species. Our genomewide data set of 9760 loci containing 3455 single nucleotide polymorphisms yielded estimates of genetic diversity and gene flow that were generally robust across seven different filtering and sampling protocols and suggest a low level of genomic variation (θ per site = âˆ¼0.00002-0.00028), with estimates of effective population size (N e = âˆ¼500-15 881) falling far below current census size. Genetic differentiation was small but detectable between Japan and Hawaii (F ST ≈ 0.038-0.049), with no F ST outliers. Additionally, using museum specimens, we found that effect sizes of morphological differences by sex or population rarely exceeded 4%. These patterns suggest that the Hawaiian and Japanese populations exhibit small but significant differences and should be considered separate management units, although the evolutionary and adaptive consequences of this differentiation remain to be identified.

Frequency of stage II oral transport cycles in healthy human.

Stage II transport (St2Tr) is propulsion of triturated food into the pharynx for storage before swallowing via tongue squeeze-back against the palate. To clarify the phenomenology of St2Tr, we examined the effects of food consistency and the number of chewing cycles on the number of St2Tr cycles in a chew-swallow sequence. We recorded chew-swallow sequences in lateral projection with videofluoroscopy of 13 healthy volunteers eating 6 g of hard (shortbread cookie), and soft foods (ripe banana and tofu) with barium. We counted the number of chewing and St2Tr cycles from food intake to terminal swallow. We used the Friedman test for bivariate analyses and negative binomial regression for multivariable analyses. On bivariate analysis, food consistency had a positive association with the number of chewing cycles (P = 0.013), but not with the number of St2Tr cycles (P = 0.27). Multivariable analysis, however, revealed a greater number of St2Tr cycles with hard than soft food (P ≤ 0.01) and a trend toward negative correlation between the numbers of St2Tr and chewing cycles (P = 0.083). The number of chewing cycles needed to clear the mouth differs among food consistencies as demonstrated previously. Greater numbers of both St2Tr and chewing cycles were elicited with the hard than with the soft foods. Given the trend toward negative correlation, the association between the number of St2Tr cycles and that of chewing cycles deserves further study.

Electromyography of swallowing with fine wire intramuscular electrodes in healthy human: activation sequence of selected hyoid muscles.

Few studies have reported the activation sequence of the swallowing muscles in healthy human participants. We examined temporal characteristics of selected hyoid muscles using fine wire intramuscular electromyography (EMG). Thirteen healthy adults were studied using EMG of the anterior belly of digastric (ABD), geniohyoid (GH), sternohyoid (SH), and masseter (MA, with surface electrodes) while ingesting thin liquid, banana, tofu, and cookie (3 trials each). Onset timing was measured from rectified and integrated EMG. Data were analyzed using repeated-measures ANOVA with Bonferroni correction. When drinking thin liquid, MA, GH, and ABD were activated almost simultaneously, but SH was activated later (using GH onset as 0 s, MA -0.07 (-0.20 to 0.17) second [median (interquartile range)]; ABD 0.00 (-0.10 to 0.07) second; SH 0.17 (0.02 to 0.37) second; P < 0.01). With solid foods, MA contraction preceded GH and ABD; SH was last and delayed relative to liquid swallows (GH 0 s; MA -0.17 (-0.27 to 0.07) second; ABD 0.00 (-0.03 to 0.03) second; SH 0.37 (0.23 to 0.50) second; P < 0.01). The role of the MA differs between solids and liquids so the variation in its timing is expected. The synchronous contraction of GH and ABD was consistent with their role in hyolaryngeal elevation. The SH contracted later with solids, perhaps because if the longer duration of the swallow. The consistent pattern among foods supports the concept of a central pattern generator for pharyngeal swallowing.

Human suffering effects of nuclear tests at Semipalatinsk, Kazakhstan: established on the basis of questionnaire surveys.

The main objective of the present paper is to explore the effects of radiation exposure on the inhabitants near the Semipalatinsk Nuclear Tests Site (SNTS), Kazakhstan. Our research team of the Research Institute for Radiation Biology and Medicine, Hiroshima University, started in 2002 to conduct a field research study using questionnaire surveys. The present paper attempts to clarify health effects and mental problems on the inhabitants by using our questionnaire surveys. Among the responses to our survey, the present paper focuses upon responses to the questions concerning their health and mental problems. The data in Semipalatinsk have been compared with the results obtained in a similar survey conducted by Hiroshima and Nagasaki cities. The results show: (1) 33% of the residents replied that they felt bad or had very bad health conditions. (2) 70% of the residents strongly recognized a causal relationship between their bad health conditions and the nuclear tests. (3) The diseases that over 30% of respondents possessed are arthralgia/ lower back pain/ arthritis, high-blood pressure, heart disease and digestive system disease. (4) Acute radiation injuries from 1949 to 1962 that over 20% of respondents experienced were headaches and general malaise. (5) Concerning their mental condition, 22% of respondents felt easily frustrated and agitated and 21% experienced nightmare.

Stable metallic behavior and antiferromagnetic ordering of Fe(III) d spins in (EDO-TTFVO)2.FeCl4.

We report the crystal structure and physical properties of the 2:1 FeCl4- salt of a new donor molecule, EDO-TTFVO. Crystal structure analysis of this salt revealed that the donor molecules formed a beta' '-type two-dimensional conducting layer, and there is a short S...Cl contact between the donor molecules and the FeCl4- ions, which is expected to mediate a strong pi-d interaction. This salt showed a stable metallic conducting behavior down to 0.3 K and an antiferromagnetic ordering at TN approximately 3.0 K, indicating that this salt becomes a new antiferromagnetic molecular metal at ambient pressure. The appearance of the magnetic ordering is considered to originate from the strong pi-d interactions between the donor molecules and the FeCl4- ions because the field dependence of magnetoresistances was remarkably affected below the antiferromagnetic transition temperature.

High pressure Raman study of bromine and iodine: soft phonon in the incommensurate phase.

A new phase of solid bromine was discovered at a pressure region above 80 GPa by Raman scattering experiments with a diamond anvil high-pressure cell. This phase was found to be the same as the iodine phase V with an incommensurate structure [Nature (London) 423, 971 (2003)] which appears between the molecular phase I and the monatomic phase II. In the incommensurate phases of both bromine and iodine, Raman active soft modes were clearly found in the low frequency region. The data suggest that the monoatomic phase II occurs above 30 and 115 GPa for iodine and bromine, respectively.

Caged RNase: photoactivation of the enzyme from perfect off-state by site-specific incorporation of 2-nitrobenzyl moiety.

Photo-triggered activation of semisynthetic Ribonuclease S' from a perfect off-state was successfully carried out by incorporation of photo-labile caged moiety into a proximity to the active site.