Well-Differentiated Liposarcoma That Increased in Size after Menopause: A Case Report and a Review of the Literature.

This study reports a case of uterine liposarcoma together with a literature review. At 52 years old, our patient was diagnosed with lipoleiomyoma by MRI. A mass (39 × 32 × 41 mm3) protruding from the anterior wall of the uterine body was observed. When the patient was 58, her previous doctor found that the tumor had grown, and she was referred to the gynecology department of our hospital. On MRI, the major diameter was 1.23-fold longer and the volume was 1.85-fold higher compared with the prior imaging findings. Diffusion-weighted images revealed no significant anomalous signals. Thus, malignant tumors were included in the differential diagnosis. The patient consented to total abdominal hysterectomy and bilateral salpingo-oophorectomy. The mass on the anterior wall remained completely in the myometrium. No implantation was found in the abdominal cavity, and ascites was not detected. No bleeding or necrosis was observed on the cut surface. Histopathologically, differences in the sizes of adipocytes and stromal cells were identified. There were irregularities in the nuclear findings. The immunohistochemical findings were as follows: CDK4 (+), desmin (+), S100p (-), and Ki - 67 = 1%. Therefore, a diagnosis of well-differentiated liposarcoma was rendered. The lesion was localized in the uterus, and it was completely removed during surgery. Well-differentiated liposarcoma of uterine primary has no possibility of recurrence following complete resection, and thus, the patient underwent follow-up without additional treatment. No metastasis or recurrence has been observed for 10 months after surgery.

Long-term wheel-running prevents reduction of grip strength in type 2 diabetic rats.

Diabetic skeletal muscles show reduced contractile force and increased fatigability. Hands are a target for several diabetes-induced complications. Therefore, reduced handgrip strength often occurs as a consequence of diabetes. The aim of this study was to examine whether long-term exercise can prevent reduction of grip strength in type 2 diabetes mellitus (T2DM) model OLETF rats, and to explore the mechanisms underlying diabetes-induced grip strength reduction. Ten 5-week-old OLETF rats were used as experimental animals, and five non-diabetic LETO rats as controls of OLETF rats. Half OLETF rats performed daily voluntary wheel-running for 17 months (OLETF + EXE), and the rest of OLETF and LETO rats were sedentary. Grip strength was higher in OLETF + EXE and LETO groups than in OLETF group. OLETF group with hyperglycemia showed an increase in HbA1c, serum TNF-α, and muscle SERCA activity, but a decrease in circulating insulin. Each fiber area, total fiber area, and % total fiber area in type IIb fibers of extensor digitorum longus muscles were larger in OLETF + EXE and LETO groups than in OLETF group. There was a positive correlation between grip strength and the above three parameters concerning type IIb fiber area. Therefore, type IIb fiber atrophy may be the major direct cause of grip strength reduction in OLETF group, although there seems multiple etiological mechanisms. Long-term wheel-running may have blocked the diabetes-induced reduction of grip strength by preventing type IIb fiber atrophy. Regular exercise may be a potent modality for preventing not only the progression of diabetes but muscle dysfunction in T2DM patients.

Correlation Between Lactic Acid Bacteria Beverage Intake and Stress Resilience.

We investigated the effect of lactic acid bacteria-containing beverage intake on the level of resilience against stress in male university students. Forty male university students were recruited into the study and randomly assigned into two groups. They were instructed to consume lactic acid bacteria-containing beverage or water twice a day for 28 days. The level of stress resilience, stress reaction, and anxiety were evaluated by a series of questionnaires conducted at three time points (T1: day 0, T2: day 14, and T3: day 28). The stress response was also assessed by measuring their salivary amylase levels. The variance analysis of each group showed a significant increase in stress resilience at T3 compared with T1 in the group of participants who consumed the lactic acid bacteria-containing beverage. Our results suggest that lactic acid bacteria-containing beverage intake could affect resilience against stress positively.

Delayed appearance of transient hyperintensity foci on T1-weighted magnetic resonance imaging in acute disseminated encephalomyelitis.

PURPOSE: To evaluate the frequency, characteristics, and clinical significance of transient hyperintensity foci on T1-weighted images (T1WI) in acute disseminated encephalomyelitis (ADEM). MATERIALS AND METHODS: Patients diagnosed with ADEM underwent MR studies at the time of disease onset and every 3 months or more often thereafter. The frequency and appearance timing of abnormal signals including T1WI and their morphological characteristics were evaluated. Relations between patient symptoms and abnormal signals on MRI were also evaluated. RESULTS: Five ADEM patients were included in this study. Linear (n = 2) or nodular (n = 1) T1-hyperintensity foci appeared in 3 patients (60%, 3/5). Locations of T1-hyperintensity foci were both cortical/subcortical region and basal ganglia (n = 1), subcortical region alone (n = 1), and internal capsule (n = 1). Those T1-hyperintensity foci were located within the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity foci on initial MRI. Some T1-hyperintensity foci also showed hyperintensity on diffusion-weighted image (DWI) and contrast enhancement. T1-hyperintensity appeared at 14-43 days (median, 28 days), and disappeared in 2 patients at 91 days and 627 days after disease onset. There were no neurological sequelae remained in any patients. CONCLUSION: T1-hyperintensity foci is not a rare finding (60%) and it can be observed after improvement in symptoms in ADEM.

Coil Embolization for Cerebral Aneurysms Using a Semi-Jailing Technique and Open-Cell Stent.

BACKGROUND: Numerous reports have described the semi-jailing technique (SJT) using a closed-cell stent for stent-assisted coil embolization, revealing issues including poor expansion and thrombotic complications in curved vessels. This paper reports preliminary experience with SJT using an open-cell stent, a novel type of stent allowing stent placement from a microcatheter. METHODS: First, this research investigated differences between open- and closed-cell types in SJT using silicone vessel models. Next, 43 patients who underwent SJT for the internal carotid artery were divided into 2 groups to investigate treatment outcomes: 24 patients with placement of an open-cell stent (open-cell group) and 19 patients with closed-cell stents (closed-cell group). RESULTS: In the silicone vessel model, coils could be placed with the open-cell stent deployed with a shorter length than the closed-cell stent. No significant differences were found between groups in terms of maximum diameter of the aneurysm or dome-neck ratio. The open-cell group showed a trend toward higher complete embolization immediately after surgery (54.2% vs. 26.3%, P = 0.06), with few cases of stent malapposition (0% vs. 31.6%, P < 0.01). However, 1 case of ischemic complication in the closed-cell group and 1 case of hemorrhagic complication in open-cell group occurred. All cases of modified Rankin Scale scores at discharge were 0-1. CONCLUSIONS: Although the open-cell stent carries the disadvantage of an unresheathable design, coil placement with a shorter stent deployment length may be advantageous during SJT for internal carotid artery aneurysm embolization with favorable consequences for excellent vessel wall apposition.

Transfer of cyanobacterial carbon to a higher trophic-level fish community in a eutrophic lake food web: fatty acid and stable isotope analyses.

The dietary utilization of cyanobacterial carbon by fish communities is poorly understood. We examined the transfer of cyanobacterial carbon to fish in a eutrophic lake using fatty acid biomarkers and measuring the stable carbon isotope ratios of fatty acid and bulk nitrogen. We collected five species of fish (Hypomesus nipponensis, Carassius sp., Cyprinus carpio, Tridentiger brevispinis, and Gymnogobius castaneus) as well as the seston from June to November 2016 from Lake Hachiro, Japan. Cyanobacterial blooms were observed from August to October. From June to August, cyanobacterial fatty acid biomarkers (18:2ω6 and 18:3ω3) accounted for only 1.4-4.3% of total fatty acids in these fish species, indicating a low contribution of cyanobacteria to fish diets during this period. However, the contribution of the cyanobacterial fatty acid biomarkers in these fish species increased sharply in September (10.5-17.1%), except in second-year H. nipponensis. In September, the stable carbon isotope ratios of 18:3ω3 in these fish species were almost equivalent to those in the seston, which was primarily composed of cyanobacteria. The trophic positions of the collected fish species ranged from 1.6 to 3.4, based on their stable nitrogen isotope values, indicating that some fish ingested cyanobacteria directly, while others acquired cyanobacteria indirectly, through the food chain. These findings indicate that cyanobacterial carbon is transferred up the food chain in eutrophic lake ecosystems with cyanobacterial blooms.

Relationship between Hemorrhagic Complications and Target Vessels in Acute Thrombectomy.

PURPOSE: Intracranial hemorrhage after thrombectomy using a catheter to treat acute major cerebral artery occlusion is known to exacerbate patient outcomes. This study was performed to determine the relationship between middle cerebral artery (MCA) tortuosity and postoperative hemorrhage. METHODS: We examined 111 consecutive patients who underwent acute thrombectomy for major intracranial artery occlusion in the anterior circulation at our hospital between September 2013 and June 2016. Patients in whom intracranial hemorrhage or subarachnoid hemorrhage was seen on head computed tomography 12-24 hours after surgery were assigned to the hemorrhagic group, whereas all the other patients were assigned to the nonhemorrhagic group. The groups were compared for tortuosity of the MCA, which was evaluated by finding the top-to-bottom (TB) distance of the M1 segment on anterior-posterior view angiograms. A modified Rankin scale score of 0-2 at 3 months after onset was considered a favorable prognosis. RESULTS: The hemorrhagic group comprised 28 patients (25.2%) and the nonhemorrhagic group comprised 83 patients (74.8%). No significant difference in patient characteristics was seen between the groups. The hemorrhagic group displayed significantly fewer patients with a favorable prognosis (17.9% versus 43.4%, P = .016). The TB distance was significantly greater in the hemorrhagic group (hemorrhagic group, 9.7 mm; nonhemorrhagic group, 7.6 mm; P = .002); multivariate analysis also identified a TB distance over 8.8 mm as a factor independently associated with postoperative intracranial hemorrhage (P = .001). CONCLUSIONS: Post-thrombectomy hemorrhage was significantly correlated with TB distance. A solution is needed for selecting and combining devices used in patients with a TB distance over 8.8 mm.

Femoral bone structure in Otsuka Long-Evans Tokushima Fatty rats.

OBJECTIVES: Type 2 diabetes mellitus (T2DM) increases fracture risk despite normal to high levels of bone mineral density. Bone quality is known to affect bone fragility in T2DM. The aim of this study was to clarify the trabecular bone microstructure and cortical bone geometry of the femur in T2DM model rats. METHODS: Five-week-old Otsuka Long-Evans Tokushima Fatty (OLETF; n = 5) and Long-Evans Tokushima Otsuka (LETO; n = 5) rats were used. At the age of 18 months, femurs were scanned with micro-computed tomography, and trabecular bone microstructure and cortical bone geometry were analyzed. RESULTS: Trabecular bone microstructure and cortical bone geometry deteriorated in the femur in OLETF rats. Compared with in LETO rats, in OLETF rats, bone volume fraction, trabecular number and connectivity density decreased, and trabecular space significantly increased. Moreover, in OLETF rats, cortical bone volume and section area decreased, and medullary volume significantly increased. CONCLUSIONS: Long-term T2DM leaded to deterioration in trabecular and cortical bone structure. Therefore, OLETF rats may serve as a useful animal model for investigating the relationship between T2DM and bone quality.

[Quantitative evaluation of airway involvement in a patient with relapsing polychondritis using computed tomography].

A 63-year-old woman was admitted to our hospital because of auricular chondritis, conjunctivitis, polyarthralgia, productive cough and dyspnea. On admission, pulmonary function test demonstrated an obstructive pattern, and flow-volume curve (FVC) revealed a constrictive upper airway flow pattern. Chest CT showed a thickened tracheal wall and narrowing of the airway. The laboratory findings revealed an elevation of CRP and high titer of anti-type II collagen antibody. She was diagnosed as relapsing polychondritis (RP) according to Damiani's criteria. After the initiation of the therapy with 32 mg/day of methylprednisolone, her symptoms, pulmonary function, FVC and CT findings ameliorated promptly, and the titer of anti-type II collagen antibody became normalized. Moreover, we measured the airway wall thickness, percentage wall area (WA%) and percentage wall thickness (WT%), by CT and HRCT, and also evaluated the airway involvement quantitatively. Both WA% and WT% were inversely correlated with FEV1.0%. The airway inlolvement is most important prognostic factor in patients with RP, and sequential evaluation of airway manifestation are necessary. We suggest that a quantitative evaluation of bronchial structures by sequential CT is useful for the evaluation of RP as well as pulmonary function tests.

MRI tight posterior fossa sign for prenatal diagnosis of Chiari type II malformation.

INTRODUCTION: Chiari type II malformation (CMII) is one of three hindbrain malformations that display hydrocephalus. We have observed that cerebrospinal fluid (CSF) signal in the posterior fossa, which is always apparent on normal fetal MR images, is not visible in a fetus with CMII. We use the term 'tight posterior fossa' for this MR imaging finding, and evaluate the diagnostic value of this finding on fetal MR images. METHODS: Included in the study were 21 fetuses which underwent brain MR imaging at 1.5 T using two-dimensional balanced turbo-field-echo (2-D balanced-TFE) in the axial and sagittal planes. Postnatal diagnoses were CMII (n=5), CNS abnormalities other than CMII (n=8), and no abnormality (n=8). A tight posterior fossa was defined as an absent or slit-like water signal space around the hindbrain in the posterior fossa on both sagittal and axial MR images. RESULTS: All CMII fetuses displayed a tight posterior fossa on MR images. Hydrocephalus was visualized in all CMII fetuses and myelomeningocele in four fetuses, but hindbrain herniation was visualized only in two of five fetuses. The CSF signal surrounding the hindbrain was clearly visible in all the other 16 fetuses, including five with hydrocephalus not associated with CMII, although it was slightly narrower in a fetus with a cloverleaf skull than in the normal fetuses. CONCLUSION: Tight posterior fossa in the presence of hydrocephalus is a useful and characteristic finding of CMII on fetal MRI.

Pitching biomechanics as a pitcher approaches muscular fatigue during a simulated baseball game.

BACKGROUND: The effects of approaching muscular fatigue on pitching biomechanics are currently unknown. As a pitcher fatigues, pitching mechanics may change, leading to a decrease in performance and an increased risk of injury. HYPOTHESIS: As a pitcher approaches muscular fatigue, select pitching biomechanical variables will be significantly different than they were before muscular fatigue. STUDY DESIGN: Controlled laboratory study. METHODS: Ten collegiate baseball pitchers threw 15 pitches per inning for 7 to 9 innings off an indoor throwing mound during a simulated baseball game. A pitching session ended when each pitcher felt he could no longer continue owing to a subjective perception of muscular fatigue. A 6-camera 3D automatic digitizing system collected 200-Hz video data. Twenty kinematic and 11 kinetic variables were calculated throughout 4 phases of the pitch. A repeated-measure analysis of variance (P < .01) was used to compare biomechanical variables between innings. RESULTS: Compared with the initial 2 innings, as a pitcher approached muscular fatigue during the final 2 innings he was able to pitch, there was a significant decrease in ball velocity, and the trunk was significantly closer to a vertical position. There were no other significant differences in kinematics or kinetics variables. CONCLUSION: The relatively few differences observed imply that pitching biomechanics remained remarkably similar between collegiate starting pitchers who threw between 105 and 135 pitches for 7 to 9 innings and approached muscular fatigue. CLINICAL RELEVANCE: This study did not support the idea that there is an increase in shoulder and elbow forces and torques as muscular fatigue is approached. It is possible that if a pitcher remained in a fatigued state for a longer period of time, additional changes in pitching mechanics may occur and the risk of injury may increase.

Clinicoradiological factors influencing the reversibility of posterior reversible encephalopathy syndrome: a multicenter study.

PURPOSE: The aim of this retrospective study was to clarify the relation between the reversibility of posterior reversible encephalopathy syndrome (PRES) with three factors: the anatomical region of the brain involved, the background clinical cause, and the diffusion weighted image (DWI) intensity of PRES lesions. MATERIAL AND METHODS: This multicenter study, conducted by the PRES Study Group of the Neuroradiology Workshop, involved 52 cases from 28 institutions. Initial and follow-up magnetic resonance imaging were compared regarding the reversibility of PRES lesions according to anatomical location and clinical background. Initial DWI and apparent diffusion coefficient (ADC) maps were reviewed in 20 cases. RESULTS: Reversibility was significantly lower (P < 0.01) in the brain stem (44%) and deep white matter (47%) compared to the other cortical and subcortical areas (76%-91%). The reversibility was greater in the eclampsia subgroup followed by the hypertension and chemotherapy subgroups. DWI, even with ADC maps, had limitations in predicting the outcome of PRES lesions. CONCLUSION: The typical cortical and subcortical PRES lesions showed reversibility, whereas the brain stem and deep white matter lesions showed less reversibility. PRES due to eclampsia showed maximum reversibility compared to hypertension- and drug-related PRES. DWI, even with ADC maps, had limitations in predicting the course of PRES.

[A case of extrapontine myelinolysis precipitated by correction of a hyper-osmolar state].

We report a case of extrapontine myelinolysis (EPM) precipitated by correction of a hyper-osmolar state. A 7-year-old boy presented with disturbed consciousness. Serum BUN and Na level were 48 mg/dl and 196 mmol/L, respectively. T2-weighted images and FLAIR images of MRI visualized symmetrical bilateral high signal intensity areas in the external capsule and in the thalamus. In addition, the splenium of the corpus callosum showed high signal intensity. All these lesions showed high signal intensity on diffusion-weighted images. Extrapontine myelinolysis is precipitated not only by the rapid correction of a hypo-osmolar state but also by that of a hyper-osmolar state.

[Visualization of brain perfusion by contrast-enhanced ultrasonography: preliminary study in rabbits].

PURPOSE: We evaluated the usefulness of an agent for contrast-enhanced ultrasonography (galactose parmitine acid: Levovist) in visualizing brain perfusion in rabbits. MATERIALS AND METHODS: Six rabbits were involved in this study. A hole in the skull bone was made under anesthesia and used as an acoustic window. An ischemic model (3 of 6 rabbits) was made by surgically occluding the M1 portion of the middle cerebral artery. Power Doppler images (PDI) and B-mode Harmonic images (HI) before and after intravenous injections of the contrast medium (150 mg/body) were obtained using the HDI5000 (ATL) equipped with a linear-type 5-12 Mhz probe. RESULTS: Smaller arteries were clearly visualized by contrast-enhanced PDI. However, enhancement of brain parenchyma was not clear on PDI. Enhancement of brain parenchyma was observed clearly on contrast-enhanced HI. Enhancement was strong during the first pass and then diminished quickly. In ischemic models, hypoperfusion in the right cerebral hemisphere (the occluded side) were clearly observed on contrast-enhanced HI. CONCLUSION: Brain perfusion in rabbits can be observed on contrast-enhanced Harmonic ultrasonographic imaging. It is suggested to be useful for human clinical cases, including hypoxic ischemic brain injury in infants.

[Usefulness of Cho/Cr ratio in proton MR spectroscopy for differentiating residual/recurrent glioma from non-neoplastic lesions].

PURPOSE: We evaluated the clinical usefulness of the Cho/Cr ratio of proton MR spectroscopy(1H-MRS) to differentiate residual/recurrent glioma from non-neoplastic lesions. PATIENTS AND METHODS: 20 cases of glioma were involved in this study(astrocytoma grade I-II: 7, oligodendroglioma: 1, astrocytoma grade III: 2, glioblastoma: 10). Seven of the patients underwent surgical resection only, 4 underwent surgical resection and radiotherapy(40-60 Gy), and 9 underwent surgical resection and radiotherapy with concurrent chemotherapy(14-60 Gy). 1H-MRS was performed on a 1.5 Tesla clinical MR unit using a 3D-chemical shift imaging sequence(1500 msec/270 msec/1 (TR/TE/excitations), and the Cho/Cr ratio was calculated in the voxel where neoplastic lesion was most suspected on MRI. The presence of lactate + lipid peak was also evaluated. All spectra were obtained after the contrast enhanced study. RESULTS: Cho/Cr ratios were significantly higher in cases of residual/recurrent tumors(mean +/- SD = 1.70 +/- 0.96) than in non-neoplastic lesions(mean +/- SD = 1.04 +/- 1.16) (Mann-Whitney U-test p = 0.047). If a Cho/Cr ratio of more than 1.5 was used as a marker of tumor presence, its sensitivity was 64%, specificity 83%, and accuracy 70%. One false-positive case that of radiation necrosis whose spectrum showed a high Cho/Cr ratio with markedly elevated lactate + lipid peak. CONCLUSION: The Cho/Cr ratio of 1H-MRS provides additional information to MRI in differentiating residual/recurrent gliomas from non-neoplastic lesions.

Statistics of spectra for critical quantum chaos in one-dimensional quasiperiodic systems.

We study spectral statistics of one-dimensional quasiperiodic systems at the metal-insulator transition. Several types of spectral statistics are observed at the critical points, lines, and region. On the critical lines, we find the bandwidth distribution P(B) (w) around the origin (in the tail) to have the form of P(B) (w) approximately w(alpha) [P(B) (w) approximately e(-beta w(gamma) ) ] (alpha,beta,gamma >0) , while in the critical region P(B) (w) approximately w(- alpha') (alpha' >0) . We also find the level spacing distribution to follow an inverse power law P(G) (s) approximately s(-delta) (delta>0) .

[A case of intravascular lymphomatosis with sinus thrombosis].

We report a rare case of intravascular lymphomatosis with massive tumor in the superior sagittal sinus (SSS), which caused sinus thrombosis. A 63-year-old man was incidentally found to have an enhancing mass in the superior sagittal sinus on MRI. The tumor manifested spontaneous regression during with 4 month's follow-up. Five months after the initial MR examination, T2-weighted MR images revealed a area of hyperintensity in the right occipital lobe. The area showed hypointensity on diffusion-weighted image and showed hyperintensity on ADC mapping, findings that are compatible with vasogenic edema.

[Imaging findings of elongated styloid process syndrome (Eagle's syndrome): report of two cases].

Elongated styloid process syndrome, which is synonymous with Eagle's syndrome, is a rare disease. Although an elongated styloid process is not always symptomatic, if it compresses the cranial nerves and/or carotid artery, a patient can present with sore throat, dysphasia, or dysphoria of the throat. We present two cases of elongated styloid process syndrome, focusing on the imaging findings. The elongated styloid processes were visualized by panoramic photograms. However, CT images, especially 3DCT images, were useful in visualizing the elongated styloid process itself as well as the relationship between the styloid process and surrounding soft tissue.