Low-frequency repetitive transcranial magnetic stimulation for seizure suppression in patients with extratemporal lobe epilepsy—A pilot study

SummaryWe evaluated the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on seizure frequency in adult patients with medically intractable extratemporal lobe epilepsy (ETLE). Seven patients with medically intractable ETLE received low-frequency rTMS at 0.9Hz, basically two sets of 15min stimulation per day for five days in a week, with the stimulus intensity of 90% of resting motor threshold (RMT). The number of seizures during two weeks before and after the stimulation of one week was compared. Furthermore, RMT and active motor threshold (AMT) were measured before and after rTMS for each daily session. After low-frequency rTMS of one week, the frequency of all seizure types, complex partial seizures (CPSs) and simple partial seizures was reduced by 19.1, 35.9 and 7.4%, respectively. The patients with smaller difference between RMT and AMT before rTMS had higher reduction rate of CPSs. A favorable tendency of seizure reduction, though not statistically significant, during two weeks after low-frequency rTMS was demonstrated in medically intractable ETLE patients. As far as CPSs are concerned, smaller decrease of motor threshold by voluntary muscle contraction was associated with better response to rTMS

Detection and Localization of Traffic Signals with GPS Floating Car Data and Random Forest

As Floating Car Data are becoming increasingly available, in recent years many research works focused on leveraging them to infer road map geometry, topology and attributes. In this paper, we present an algorithm, relying on supervised learning to detect and localize traffic signals based on the spatial distribution of vehicle stop points. Our main contribution is to provide a single framework to address both problems. The proposed method has been experimented with a one-month dataset of real-world GPS traces, collected on the road network of Mitaka (Japan). The results show that this method provides accurate results in terms of localization and performs advantageously compared to the OpenStreetMap database in exhaustivity. Among many potential applications, the output predictions may be used as a prior map and/or combined with other sources of data to guide autonomous vehicles

Imaging Spectroscopy on Preflare Coronal Nonthermal Sources Associated with the 2002 July 23 Flare

We present a detailed examination on the coronal nonthermal emissions during the preflare phase of the X4.8 flare that occurred on 2002 July 23. The microwave (17 GHz and 34 GHz) data obtained with Nobeyama Radioheliograph, at Nobeyama Solar Radio Observatory and the hard X-ray (HXR) data taken with {\it Reuven Ramaty High Energy Solar Spectroscopic Imager} obviously showed nonthermal sources that are located above the flare loops during the preflare phase. We performed imaging spectroscopic analyses on the nonthermal emission sources both in microwaves and in HXRs, and confirmed that electrons are accelerated from several tens of keV to more than 1 MeV even in this phase. If we assume the thin-target model for the HXR emission source, the derived electron spectral indices ($\sim 4.7$) is the same value as that from microwaves ($\sim 4.7$) within the observational uncertainties, which implies that the distribution of the accelerated electrons follows a single power-law. The number density of the microwave-emitting electrons is, however, larger than that of the HXR-emitting electrons, unless we assume low ambient plasma density of about $1.0 \times 10^9$ cm$^{-3}$ for the HXR-emitting region. If we adopt the thick-target model for the HXR emission source, on the other hand, the electron spectral index ($\sim 6.7$) is much different, while the gap of the number density of the accelerated electrons is somewhat reduced.Comment: 21 pages, 6 figures, ApJ accepte

A Case of Funnel Chest Performed Sternal Turnover with Rectus Abdominis Muscle Pedicle

There are two types of surgical procedures for funnel chest: sternal turnover and sternocostal elevation. Both procedures have some merits and some demerits respectively,so the uniformed operative techniques for funnel chest are not concluded. However, it is most important that correction of excavation and prevention of postoperative repiratory dysfunction have completely performed. A 12- year-old boy with severe excavation in the anterior thorax admitted to our hospital was diagnosed as funnel chest.We underwent sternal turnover with rectus abdominis muscle pedicle.Some of reports ordinarily recommended overlap of only sternum to firm plastron and prevent postoperative flail chest. However, we respectively performed conjugation and overlap of both sternum and costal cartilages for more firm fixation of plastron (so-called Ravitch\u27s method),because the overlap of only sternum is not enough to fix plastron firmly.The patient was successfully treated without flail chest postoperative course.The postoperative appearance was satisfactory and respiratory symptom has improved

Pathophysiology of unilateral asterixis due to thalamic lesion.

[Objective]:Unilateral asterixis has been reported in patients with thalamic lesion. This study aims at elucidating the pathophysiology of the thalamic asterixis. [Methods]:Two cases with unilateral asterixis caused by an infarction in the lateral thalamus were studied by analysing the asterixis-related cortical activities, transcranial magnetic stimulation (TMS) for motor cortex excitability and probabilistic diffusion tractography for the thalamo-cortical connectivity. [Results]:Averaging of electroencephalogram (EEG) time-locked to the asterixis revealed rhythmic oscillations of a beta band at the central area contralateral to the affected hand. TMS revealed a decrease in the motor evoked potential (MEP) amplitude and a prolongation of the silent period (SP). The anatomical mapping of connections between the thalamus and cortical areas using a diffusion-weighted image (DWI) showed that the lateral thalamus involved by the infarction was connected to the premotor cortex, the primary motor cortex (M1) and the primary somatosensory cortex (S1) of the corresponding hemisphere. [Conclusions]:The thalamic asterixis is mediated by the sensorimotor cortex, which is subjected to excessive inhibition as a result of the thalamic lesion involving the ventral lateral nucleus. [Significance]:This is the first demonstration of participation of the sensorimotor cortex in the generation of asterixis due to the lateral thalamic lesion

Nomenclature of Genetically Determined Myoclonus Syndromes:Recommendations of the International Parkinson and Movement Disorder Society Task Force

Genetically determined myoclonus disorders are a result of a large number of genes. They have wide clinical variation and no systematic nomenclature. With next-generation sequencing, genetic diagnostics require stringent criteria to associate genes and phenotype. To improve (future) classification and recognition of genetically determined movement disorders, the Movement Disorder Society Task Force for Nomenclature of Genetic Movement Disorders (2012) advocates and renews the naming system of locus symbols. Here, we propose a nomenclature for myoclonus syndromes and related disorders with myoclonic jerks (hyperekplexia and myoclonic epileptic encephalopathies) to guide clinicians in their diagnostic approach to patients with these disorders. Sixty-seven genes were included in the nomenclature. They were divided into 3 subgroups: prominent myoclonus syndromes, 35 genes; prominent myoclonus syndromes combined with another prominent movement disorder, 9 genes; disorders that present usually with other phenotypes but can manifest as a prominent myoclonus syndrome, 23 genes. An additional movement disorder is seen in nearly all myoclonus syndromes: ataxia (n = 41), ataxia and dystonia (n = 6), and dystonia (n = 5). However, no additional movement disorders were seen in related disorders. Cognitive decline and epilepsy are present in the vast majority. The anatomical origin of myoclonus is known in 64% of genetic disorders: cortical (n = 34), noncortical areas (n = 8), and both (n = 1). Cortical myoclonus is commonly seen in association with ataxia, and noncortical myoclonus is often seen with myoclonus-dystonia. This new nomenclature of myoclonus will guide diagnostic testing and phenotype classification. (c) 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society

Low-Intensity Resistance Training with Moderate Blood Flow Restriction Appears Safe and Increases Skeletal Muscle Strength and Size in Cardiovascular Surgery Patients:A Pilot Study

We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 +/- 12.6 years, n = 21, M = 18) were randomly assigned to the control (n = 10) and the KAATSU RT group (n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5-7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.</p

Type of Operation does not Affect Survival after Non-curative Resection for Adenocarcinoma of the Rectum at or below the Peritoneal Reflection: a Multivariate Analysis

Purpose. The purpose of this study was to determine whether the type of operation [sphincter-saving resection (SSR) or abdominoperineal resection (APR)] for primary adenocarcinoma of the rectum at or below the peritoneal reflection affects survival after non-curative surgery. Methods. This retrospective study included 42 patients who underwent non-curative surgery by the following two types of operation between 1989 and 1998: (1) SSR (n=19 patients) included low anterior resection with either double-stapling technique (n=16) or transanal coloanal anastomosis (n=3); (2) APR (n=23). \u27Non-curative\u27 resection implied \u27Curability B\u27 and \u27Curability C\u27 defined by the Japanese Classification of Colorectal Carcinoma. Outcome measure was diseasespecific survival. Univariate and multivariate Cox\u27s regression analyses were used to evaluate data. Median follow-up was 17.2 months at study conclusion. Results. Disease-specific survival after non-curative surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-specific survival after surgery. One variable - \u27Curability\u27 - was significant predictor of outcome after surgery. Conclusions. The type of operation (SSR or APR) did not affect survival after non-curative resection for adenocarcinoma of the rectum at or below the peritoneal reflection

Pyridoxal in the Cerebrospinal Fluid May Be a Better Indicator of Vitamin B6–dependent Epilepsy Than Pyridoxal 5′-Phosphate

Background We aimed to demonstrate the biochemical characteristics of vitamin B6–dependent epilepsy, with a particular focus on pyridoxal 5′-phosphate and pyridoxal in the cerebrospinal fluid. Methods Using our laboratory database, we identified patients with vitamin B6–dependent epilepsy and extracted their data on the concentrations of pyridoxal 5′-phosphate, pyridoxal, pipecolic acid, α-aminoadipic semialdehyde, and monoamine neurotransmitters. We compared the biochemical characteristics of these patients with those of other epilepsy patients with low pyridoxal 5′-phosphate concentrations. Results We identified seven patients with pyridoxine-dependent epilepsy caused by an ALDH7A1 gene abnormality, two patients with pyridoxal 5′-phosphate homeostasis protein deficiency, and 28 patients with other epilepsies with low cerebrospinal fluid pyridoxal 5′-phosphate concentrations. Cerebrospinal fluid pyridoxal and pyridoxal 5′-phosphate concentrations were low in patients with vitamin B6–dependent epilepsy but cerebrospinal fluid pyridoxal concentrations were not reduced in most patients with other epilepsies with low cerebrospinal fluid pyridoxal 5′-phosphate concentrations. Increase in 3-O-methyldopa and 5-hydroxytryptophan was demonstrated in some patients with vitamin B6–dependent epilepsy, suggestive of pyridoxal 5′-phosphate deficiency in the brain. Conclusions Low cerebrospinal fluid pyridoxal concentrations may be a better indicator of pyridoxal 5′-phosphate deficiency in the brain in vitamin B6–dependent epilepsy than low cerebrospinal fluid pyridoxal 5′-phosphate concentrations. This finding is especially helpful in individuals with suspected pyridoxal 5′-phosphate homeostasis protein deficiency, which does not have known biomarkers