Nonconvulsive Status Epilepticus Associated with Cerebral Hyperperfusion Syndrome after Carotid Endarterectomy: A Case Report.

We report a case of a 73-year-old man who developed nonconvulsive status epilepticus as a complication of cerebral hyperperfusion syndrome after carotid endarterectomy for carotid artery stenosis. On postoperative day 1, the patient experienced headaches and vomiting. Resting N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography showed increased cerebral blood flow to the entire right hemisphere, and the patient was diagnosed with cerebral hyperperfusion syndrome. He was treated with antihypertensive and antiseizure medications, sedated using propofol, intubated, and placed under mechanical ventilation. On postoperative day 3, computed tomography perfusion imaging showed a reduction in hyperperfusion, and propofol sedation was terminated on postoperative day 4. However, the patient exhibited prolonged impaired awareness and roving eye movements, and long-term video electroencephalographic monitoring revealed electrographic seizures. The patient was diagnosed with nonconvulsive status epilepticus. Propofol sedation was resumed, and the antiseizure medication dose was increased. Subsequently, the state of hyperperfusion in the right hemisphere diminished, and electroencephalographic findings improved, allowing sedation to be terminated on postoperative day 7. The findings from this case suggest that when clinical subtle symptoms, such as impaired awareness and roving eye movements, are observed during treatment of cerebral hyperperfusion syndrome, video electroencephalography should be performed to detect electrographic seizures.

Initial medical protocol efforts using both CT and MRI/MRA for acute cerebral infarction.

BACKGROUND: Earlier administration of intravenous recombinant tissue-type plasminogen activator (rtPA) and mechanical thrombectomy (MT) improves the neurological prognosis of patients with acute ischemic stroke (AIS). We introduced a new protocol that includes head and chest computed tomography (CT) and magnetic resonance imaging (MRI)/ magnetic resonance angiography (MRA) for all patients, which is quite different from previously evaluated protocols. This study aimed to examine whether this protocol could contribute to the prompt therapeutic intervention of AIS. METHODS: This is a retrospective observational study analyzing patients with AIS who were transported to our hospital by ambulance between January 2015 and November 2021. An AIS initial treatment protocol was introduced in April 2020, under which, CT and MRI/MRA imaging were performed in all patients, and the indication for rtPA and MT were determined. The participants were divided into those who were treated before and after the protocol introduction (conventional treatment and protocol groups, respectively). The time from hospital arrival to the start of rtPA administration (door-to-needle time: DNT) and the time from hospital arrival to the start of endovascular treatment (door-to-puncture time: DPT) were compared between the groups. RESULT: A total of 121 patients were analyzed, wherein 63 patients received rtPA (18 in the conventional treatment group and 45 in the protocol group) and 98 patients received MT (32 in the conventional treatment group and 66 in the protocol group). The median DNT was 97.0 (IQR 49.0-138.0) min vs. 56.5 (IQR 41.0-72.0) min (p < 0.001) for the conventional treatment and the protocol groups, respectively. The median DPT was 129.0 (IQR 62.0-196.0) min vs. 55.0 (IQR 40.5-69.5) min (p < 0.001), respectively. Moreover, DNT was achieved within 60 min in 5.6% vs. 69.9% (p < 0.001) and DPT within 90 min in 25.0% vs. 85.7% (p < 0.001), respectively. CONCLUSION: The introduction of a protocol, including CT/MRI imaging, significantly shortened DNT and DPT.

Experimental Validation of Pullout Resistance for Stent Retrievers and Aspiration Catheters.

Objective: Stretching or avulsion of a small perforating artery caused by mechanical traction contributes to intracranial hemorrhagic complications in mechanical thrombectomy, especially for medium and small-vessel occlusions. This study aimed to measure the pullout resistance during stent retriever (SR) traction and aspiration catheter (AC) traction with or without thrombi and characterize the mechanical properties of each device. Methods: We placed the thrombectomy device in the area corresponding to the insular segment of the middle cerebral artery of a silicon carotid artery model. The thrombectomy device was automatically pulled out at a constant velocity using a horizontal motorized test stand, and pullout resistance was continuously measured 2000 times per second using a digital force gauge. Five types of SRs and two types of ACs with or without thrombus were evaluated. The data were divided into four groups for analysis: SR without clot, SR with clot, AC without clot, and AC with clot. Results: The line graph was a jagged waveform during SR traction, and it was a gentle curve during AC traction. The maximum pullout resistance was higher in the SR with clot group than the other groups. The coefficient of variation was higher in the SR group than the AC group, with or without clot. Conclusion: The pullout resistance during SR traction was more fluctuated than that during AC traction. In the presence of a thrombus, pullout resistance for SR was substantially increased, whereas AC resistance was less susceptible to thrombi. The differences in characteristics may reflect differences in the frequency of mechanical traction injury between the devices during clinical use.

[A Rebleeding Case of Carotid Blowout Syndrome after Endovascular Treatment with Covered Stent].

We present a case of a patient who survived carotid blowout syndrome(CBS)due to covered stent placement, but bled again 34 days later. A 67-year-old man with laryngeal cancer experienced cardiac arrest due to carotid blowout a day after he underwent the balloon occlusion test and abnormal feeder embolization of the tumor. After quick resuscitation, he was treated with endovascular therapy using a covered stent, since he had insufficient cerebral ischemic tolerance. We succeeded in stent placement and the bleeding stopped without any procedural complications. The patient survived after the procedure. However, bleeding recurred when a nasal endoscope was inserted 34 days later. The rupture point was immediately distal of the stent. We performed carotid artery occlusion with coils and n-butyl-cyanoacrylate. The patient survived, but his condition gradually weakened and died 97 days after stenting. Emergency hemostasis for carotid blowout using a covered stent is the only available treatment for patients who do not have sufficient cerebral ischemic tolerance. However, this procedure has a higher rate of re-bleeding than carotid artery occlusion. Moreover, it is an off-label treatment in Japan. Therefore, possible treatments for CBS including use of covered stent or treatments for non-ruptured CBS should be analyzed in the future.

Differences in the Mechanisms of MnO2 Oxidation between Lignin Model Compounds with the p-Hydroxyphenyl, Guaiacyl, and Syringyl Nuclei.

The purpose of this study was to examine how the rate and mechanism of MnO2 oxidation differ between the p-hydroxyphenyl (H), guaiacyl (G), and syringyl (S) types of simple nonphenolic lignin model compounds as well as the p-ethylphenyl (E) type compounds. The oxidation was conducted using an excess amount of MnO2 in a sulfate buffer solution at a pH value of 1.5 at room temperature. MnO2 oxidized at least the G and S nuclei, although it commonly oxidizes alcohols present at the benzyl position. The oxidation rates of the benzyl alcohol derivatives were in the order of G- > S- ≫ H- > E-type, which suggests that the rates are determined by the electronic effects of their methoxy and ethyl functional groups on not only their benzyl positions but also their aromatic π-electron systems. The kinetic isotope effect was observed in the MnO2 oxidations of the same derivatives deuterated at their benzyl hydroxymethyl groups. The observed magnitudes were in the order of E- ≫ H- > G- ≫ S-type, suggesting that the contribution of oxidation of their aromatic nuclei, which is another reaction mode of the oxidation of their benzyl positions, increases in the reverse order.

Arterial spin labeling imaging correlates with the angiographic and clinical vascularity of vestibular schwannomas.

PURPOSE: Hypervascular vestibular schwannomas (HVSs) are a type of the vestibular schwannomas (VSs) that are extremely difficult to remove. We examined whether HVSs can be predicted by using arterial spin labeling (ASL) imaging. METHODS: A total of 103 patients with VSs underwent ASL imaging and digital subtraction angiography (DSA) before surgery. Regional cerebral blood flow (CBF) of gray matter and regional tumor blood flow (TBF) were calculated from ASL imaging, and we defined the ratio of TBF to CBF as the relative TBF (rTBF = TBF/CBF). Angiographic vascularity was evaluated by DSA, and clinical vascularity was evaluated by the degree of intraoperative tumor bleeding. Based on the angiographic and clinical vascularity, the VSs were divided into two categories: HVS and non-HVS. We compared rTBF with angiographic and clinical vascularities, retrospectively. RESULTS: The mean rTBFs of angiographic non-HVSs and HVSs were 1.29 and 2.58, respectively (p < 0.0001). At a cutoff value of 1.55, the sensitivity and specificity were 93.9% and 72.9%, respectively. The mean rTBFs of clinical non-HVS and HVSs were 1.45 and 2.22, respectively (p = 0.0002). At a cutoff value of 1.55, the sensitivity and specificity were 79.4% and 66.7%, respectively. CONCLUSION: The rTBF calculated from ASL imaging correlates well with tumor vascularity and may be useful for predicting HVSs before surgery.

T929I and K1774N mutation pair and M918L single mutation identified in the voltage-gated sodium channel gene of pyrethroid-resistant Thrips tabaci (Thysanoptera: Thripidae) in Japan.

Pyrethroid-resistance in onion thrips, Thrips tabaci, has been reported in many countries including Japan. Identifying factors of the resistance is important to correctly monitoring the resistance in field populations. To identify pyrethroid-resistance related genes in T. tabaci in Japan, we performed RNA-Seq analysis of seven T. tabaci strains including two pyrethroid-resistant and five pyrethroid-susceptible strains. We identified a pair of single point mutations, T929I and K1774N, introducing two amino acid mutations, in the voltage-gated sodium channel gene, a pyrethroid target gene, in the two resistant strains. The K1774N is a newly identified mutation located in the fourth repeat domain of the sodium channel. Genotyping analysis of field-collected populations showed that most of the T. tabaci individuals in resistant populations carried the mutation pair, indicating that the mutation pair is closely associated with pyrethroid-resistance in Japan. Another resistance-related mutation, M918L, was also identified in part of the resistant populations. Most of the individuals with the mutation pair were arrhenotokous while all individuals with the M918L single mutation were thelytokous. The result of differentially expressed gene analysis revealed a small number of up-regulated detoxification genes in each resistant strain which might be involved in resistance to pyrethroid. However, no up-regulated detoxification genes common to the two resistant strains were detected. Our results indicate that the mutation pair in the sodium channel gene is the most important target for monitoring pyrethroid-resistance in T. tabaci, and that pyrethroid-resistant arrhenotokous individuals with the mutation pair are likely to be widely distributed in Japan.

Stereoselective Formation of ß-O-4 Structures Mimicking Softwood Lignin Biosynthesis: Effects of Solvent and the Structures of Quinone Methide Lignin Models.

p-Quinone methide (QM) is formed as an intermediate during lignin biosynthesis. The aromatization of the QM by the attack of a nucleophile at the α-position of its side chain generates a phenolic hydroxy group in a growing polymer and creates stereoisomeric forms in the side chain. A series of ß-O-4-aryl ether QMs was reacted with water at 25 °C to replicate the formation of p-hydroxyphenyl (H) and guaiacyl (G) ß-O-4 structures in plant cell walls. Water addition occurred in 3-methoxy-substituted QMs (G-type QMs) with half-lives ( t1/2) between 13 and 15 min, at pH 7, in 50% water solution (dioxane-water, 1:1). The rate increased as the water concentration increased to 99% ( t1/2, 1.2-1.4 min). Similar solvent effects were observed for more reactive nonsubstituted QMs (H-type QMs with t1/2 of <1 min). Consequently, t1/2 of the H-type QMs was shorter than that of the G-type QMs under every solvent condition. Upon increasing the water concentration, the variation in the erythro/ threo ratios of the four dimeric ß-O-4 products increased. Interestingly, the effect of pH on the stereopreference, which was observed in 50% water solution, was small and became imperceptible as the water concentration increased to 99%, suggesting that the effect of the solvent, as well as the effect of the pH, plays an important role in understanding the reaction conditions in cell walls during lignin biosynthesis. The threo isomer was preferentially formed in the four dimeric ß-O-4 structures, which is inconsistent with the structural features of compression wood lignin rich in H-units. However, the erythro-selective formation was attained in an H-type QM at every pH studied (pH 3.5-7) by introducing a biphenyl structure into the ß-etherified ring moiety.

Lignin-Biosynthetic Study: Reactivity of Quinone Methides in the Diastereopreferential Formation of p-Hydroxyphenyl- and Guaiacyl-Type ß- O-4 Structures.

p-Quinone methides are involved in lignin biosynthesis as transient intermediates, and the aromatization step has a great impact on the chemical structure of the resulting lignin. A series of quinone methides (QMs) were synthesized and allowed to react with water in pH 3-7 buffers at 25 °C to mimic the formation of p-hydroxyphenyl- and guaiacyl-type (H- and G-type, respectively) ß- O-4 structures in gymnosperm-plant cell walls. Water addition occurred in 3-methoxy-substituted QMs (G-type QMs) with half-lives of 1.4-15 min. In contrast, nonsubstituted QMs (H-type QMs) were very labile; they were aromatized to ß- O-4 products with half-lives of only 10-40 s. The rapid aromatization in H-type QMs may provide an advantage over G-type species for efficiently driving the lignin-polymerization cycle, which possibly contributes to the development of highly lignified compression wood. In the water-addition reaction, the threo isomers of the ß- O-4 products were stereopreferentially formed more than the erythro isomers from both G- and H-type QMs ( erythro/ threo ratios of 24:76 and 50:50, respectively). The proportion of erythro isomers was higher at lower-pH conditions. This pH-dependent trend agrees with findings from a previous study on 3,5-dimethoxy-substituted (syringyl-type, S-type) QMs; thus, this pH-dependent trend is common in H-, G-, and S-type lignin-related QMs. Higher threo-selectivity was obtained by changing the ß-etherified aromatic rings from G- to H-type. A similar but weaker effect was also observed by changing the QM moiety from G- to H-type.

NMR Assignment for Diaryl Ether Structures (4-O-5 Structures) in Pine Wood Lignin.

A 4-O-5-tetramer lignin model compound carrying ß-O-4 linkages on each of the side-chain moieties was synthesized, as well as 4-O-5-coupled dehydrodiconiferyl alcohol. By comparison with their NMR data, two cross-signals in the HSQC spectrum of pine milled wood lignin recorded in DMSO-d6 were assigned to H2/C2 and H6/C6 correlations on the aromatic rings of 4-O-5-linked units. Although the H2/C2 correlation peak appeared in the same region as syringyl units, nitrobenzene oxidation of the pine lignin did not yield any syringyl-type product, but did release a 4-O-5-type product.

Direct participation of counter anion in acid hydrolysis of glycoside.

The mechanism of acid hydrolysis of glycoside has been investigated since the end of the 19th century accompanied by lots of literatures published on the mechanism, although little attention has surprisingly been paid to the action of counter anion of acid. In this paper, it was investigated whether or not counter anion of acid directly participates in acid hydrolysis of glycosides, methyl α- and ß-D-glucopyranosides (MGP) in water, aqueous 74%, and 82% 1,4-dioxane systems. Because proton activity of a reaction system is the important rate-determining parameter in the universally acknowledged mechanism, it was carefully estimated in this study. The results suggested that bromide anion directly participates in the acid hydrolysis reaction of MGP in a water solvent system and the participation of bromide anion is further pronounced in aqueous 74% and 82% 1,4-dioxane solvent systems. It was also suggested that chloride anion directly participates in these dioxane solvent systems.

Reactivity of lignin with different composition of aromatic syringyl/guaiacyl structures and erythro/threo side chain structures in ß-O-4 type during alkaline delignification: as a basis for the different degradability of hardwood and softwood lignin.

The reactivity of lignin during alkaline delignification was quantitatively investigated focusing on the effect of the structural differences between syringyl and guaiacyl aromatic nuclei and between erythro and threo in the side chain of ß-O-4 type lignin substructure on the ß-O-4 bond cleavage rate. It was known that the ratio of this reaction rate of the erythro to threo isomers of the dimeric ß-O-4 type lignin model compound with two guaiacyl aromatic nuclei was ca. 4. However, the presence of a syringyl nucleus strongly influenced the rate, and the ratio of the syringyl type analogue was in the range between 2.7 and 8.0 depending on the reaction temperature. The effect of syringyl nucleus on the enhancement of the reaction rate appeared to be greater when the syringyl nucleus consists of the cleaving ether bond rather than being a member of the carbon framework.

Penasins A-E, long-chain cytotoxic sphingoid bases, from a marine sponge Penares sp.

Five sphingoid bases, penasin A (1), penasin B (2), and a mixture of penasins C-E (3-5), were identified from a marine sponge Penares sp. as cytotoxic constituents. The structure of the common polar head part was assigned by analysis of the NMR data, whereas the structures of the long aliphatic chains including the locations of double bond(s) and a branched methyl group were determined by analysis of tandem FABMS and (13)C NMR data together with the GC-MS analysis of ozonolysis products. The absolute configuration of the headgroup was defined for the mixture of 3-5 by the modified Mosher method. Penasins exhibit moderate cytotoxicity against HeLa and P388 cells.

Dissolution of beech and spruce milled woods in LiCl/DMSO.

A novel solvent system, lithium chloride/dimethyl sulfoxide (LiCl/DMSO), was developed for dissolving milled wood. This system completely dissolved beech and spruce milled woods prepared from the Wiley woods (coarse wood meals prepared by a Wiley mill) by 2 h planetary ball-milling under the milling conditions employed. The dependence of the structural change of lignin on the degree of milling was examined to evaluate the correlation between the dissolution and lignin structure. The nitrobenzene oxidation analyses showed that the 2 h milling caused almost no structural change in the aromatic part of lignin in the milled woods. The ozonation analyses suggested that the decrease of the erythro ratio [erythro/(erythro + threo)] obtained from beta-O-4 structure in lignin is only 0.35% after the 2 h milling. Although the yield decrease of the ozonation products was 9.8% after the 2 h milling, this value was fairly smaller than that after a longer time milling. When it is taken into consideration that the other solvent systems for dissolution of wood meal, which are proposed by Lu and Ralph, require 5 h of milling under the same milling conditions to dissolve the milled woods, it is safely stated that the LiCl/DMSO solvent system completely dissolves milled wood, the lignin of which is structurally less altered and, thus, is expected to provide an improved method for structural analysis of the entire lignin fraction in wood cell wall.

Significant lability of guaiacylglycerol beta-phenacyl ether under alkaline conditions.

It was observed that the beta-O-4 bond cleavage of a dimeric phenolic lignin model compound with an alpha-carbonyl group at the B-ring, 2-(2-ethoxy-4-formylphenoxy)-1-(4-hydroxy-3-methoxyphenyl)propane-1,3-diol (I), is extremely fast in a mild anaerobic alkaline treatment (0.45 mol/L NaOH, 95 degrees C, 0.8 MPa of N2). This phenomenon significantly contrasts with the case of a common dimeric phenolic lignin model compound without any specific functional group, 1-(4-hydroxy-3-methoxyphenyl)-2-(2-methoxyphenoxy)propane-1,3-diol (II). The most plausible mechanism is the migration of the B-ring from the beta- to the alpha-position following the SNAr mechanism. Because this migration affords the alkaline labile phenolic alpha-O-4-type compound (XI), the formation of the quinone methide as well as the cleavage of the originally alkaline very stable alkyl-aryl ether bond is promoted. This promotion of the quinone methide formation explains why a relatively large amount of 4-hydroxy-3-methoxybenzaldehyde (IV) is produced from I in an oxygen-alkali treatment.

Detailed examination of the degradation of phenol derivatives under oxygen delignification conditions.

Several phenolic compounds were subjected to oxygen-alkali oxidations under oxygen delignification conditions, and their degradations were examined in detail by applying a novel formula. The formula was established on the basis of the two following considerations. The degradation of the phenolic compounds should be expressed by the sum of two types, each of which is caused by molecular oxygen and by highly reactive active oxygen species (HAOS). The degradation should be described by a mathematical equation to which a rate function, k(t), dependent on reaction time t, is applied instead of a rate constant. By rearrangements, the following formula was obtained: k(t) = A/(t + B) (A, B are constants). This is hyperbola, and the illustration of k(t) visualized the contribution of HAOS to the degradation of the phenolic compounds. HAOS did not contribute so much to the degradation, especially at 70 degrees C, which suggests the low energy supply for the HAOS generation at 70 degrees C. The extrapolation of k(t) to the beginning of the reaction gives its initial value, k(initial), which is the rate constant of the reaction between the phenolic compounds and molecular oxygen. As expected, k(initial) was dependent on the electronic property of their substituents. Quantification of the phenolic compounds degraded by HAOS showed that the contribution of HAOS to the degradation is not great. The maximum contribution was observed in the oxidation of 2,6-dimethylphenol at 85 degrees C. In this case, 5 and 95% of the compound were degraded by HAOS and molecular oxygen, respectively.

Pinkus tumor may originate from intraepidermal eccrine ducts and proliferate in the dermis.

To clarify the histopathogenesis of Pinkus tumor (fibroepithelial basal cell carcinoma, FEBCC), we have studied cytokeratin (CK) expression in FEBCC using ten different anti-keratin antibodies against CK 1, 7, 8, 10, 14, 15, 16, 17, 18 and 19. Tumor nests consisted of two epithelial components: duct-like structures and basaloid cells of anastomosing strands. In duct-like structure, CK 1, 10, 14, 16, 17 and 19 were detected. CK expression of duct-like structure showed the hyperproliferative state of eccrine intraepidermal ducts. In basaloid cells of anastomosing strands, CK 14 and 17 were detectable. These results suggested that duct-like structure originates from the intraepidermal duct and proliferates to spread in the dermis.

Phosphorylation by Cdk1 induces Plk1-mediated vimentin phosphorylation during mitosis.

Several kinases phosphorylate vimentin, the most common intermediate filament protein, in mitosis. Aurora-B and Rho-kinase regulate vimentin filament separation through the cleavage furrow-specific vimentin phosphorylation. Cdk1 also phosphorylates vimentin from prometaphase to metaphase, but its significance has remained unknown. Here we demonstrated a direct interaction between Plk1 and vimentin-Ser55 phosphorylated by Cdk1, an event that led to Plk1 activation and further vimentin phosphorylation. Plk1 phosphorylated vimentin at approximately 1 mol phosphate/mol substrate, which partly inhibited its filament forming ability, in vitro. Plk1 induced the phosphorylation of vimentin-Ser82, which was elevated from metaphase and maintained until the end of mitosis. This elevation followed the Cdk1-induced vimentin-Ser55 phosphorylation, and was impaired by Plk1 depletion. Mutational analyses revealed that Plk1-induced vimentin-Ser82 phosphorylation plays an important role in vimentin filaments segregation, coordinately with Rho-kinase and Aurora-B. Taken together, these results indicated a novel mechanism that Cdk1 regulated mitotic vimentin phosphorylation via not only a direct enzyme reaction but also Plk1 recruitment to vimentin.