Atypical Symptoms in Migraine-Related Alice in Wonderland Syndrome: Expansion of the Phenotype and Reflection on the Pathomechanism

We report an 8-year-old girl who experienced daily episodes of visual and somesthetic distortion and was diagnosed with Alice in wonderland syndrome (AIWS). Ophthalmologic assessment revealed best-corrected visual acuity of 0.2 in both eyes, and bilateral constricted tubular or spiral visual fields. Augmented amplitude of visually evoked potentials was revealed, and treatment with lomerizine and valproate showed favorable effect on the visual/somesthetic distortion as well as the visual field and acuity. Psychogenic visual problems can co-exist with the typical sensory distortion in AIWS, similarly to the case of psychogenic pseudo-seizures in subjects with epilepsy. Otherwise, an ambiguous borderline between psychological and physical pathomechanisms in migraine may also be characteristic of the migraine-related AIWS

University Administrators’ Visions for the Recovery of International Student Exchange in a Post–COVID-19 World

Objectives: Little is known about how international functions of higher education, such as exchange programmes, can be resumed during recovery from a disruptive global crisis, such as COVID-19. We collected the opinions of administrators of international exchange programmes regarding their plans to resume their exchange programmes in the recovery phase and identified variations in the responses concerning institution type (public vs. private) and the presence or absence of a medical school. Method: We used multiple-choice survey questions in our study, resulting in 180 valid responses. We examined overall patterns using descriptive statistics and institutional uniqueness using Fisher’s exact test. Results: Governing organisations and domestic university networks are expected to initiate the resumption of student exchange programmes. Respondents indicate that they would rely on infection prevention experts at their institutions as sources of information for their decision-making. Public universities would rely more extensively on their staff’s opinions whilst private universities would consult with external experts. Universities with a medical school indicated a greater likelihood of referring to the opinions of experts at their institutions. Implication for Theory and/or Practice: Higher education systems vary across nations. However, extant studies have shown some shared features, and the findings may have implications for higher education institutions internationally. Policy incentives and support may encourage public universities to participate in the global recovery of international education. During global public health infectious crises, institutions without a medical school may require more government support. Conclusions: Institutional variations should be considered to effectively encourage universities to adapt to changing dynamics in the recovery of international education. Method: The study used multiple-choice survey questions, resulting in 180 valid responses. The study examined overall patterns using descriptive statistics and institutional uniqueness using Fisher\u27s exact test. Results: Governing organisations and domestic university networks are expected to initiate the resumption of student exchange. Respondents indicate that they would rely on infection prevention experts at their institutions as sources of information for their decision-making. Public universities would rely more extensively on their staff’s opinions whilst private universities would consult with external experts. Universities with a medical school indicated a greater likelihood of referring to the opinions of experts at their institutions. Implication for Theory and/or Practice: The higher education systems vary across nations. However, extant studies have shown some shared features, and the findings may have implications for higher education institutions internationally. Policy incentives and support may encourage public universities to participate in the global recovery of international education. During global public health infectious crises, institutions without a medical school may require more government support. Conclusions: Institutional variations should be considered to effectively encourage universities to adapt to changing dynamics in the recovery of international education

Noninvasive quantification of regional ventricular function in rats: Assessment of serial change and spatial distribution using ultrasound strain analysis

Background: The optimal method for quantitative assessment of regional ventricular function in rats remains unclear. The goal of this study was to investigate the use of ultrasonic strain rate (SR) and strain analysis in evaluating the serial change and spatial distribution of regional contractile function in rats. Methods: In all, 22 anesthetized rats underwent incremental dobutamine infusion (protocol 1) for assessment of serial change or underwent coronary ligation (protocol 2) for assessment of spatial distribution. For protocol 1, the serial change of systolic SR and strain during dobutamine was measured in the posterior myocardium on the short-axis view, and the systolic strain was compared with the percent change in wall thickening. For protocol 2, the spatial distribution of strain profile was analyzed in normal, peripheral ischemic, and central ischemic regions that were identified by myocardial contrast echocardiography. Results: In protocol 1, the incremental dobutamine infusion resulted in a gradual increase in peak systolic SR. In contrast, peak systolic strain increased with low-dose dobutamine but tended to decrease for higher doses of dobutamine. Further, the serial change of peak systolic strain corresponded to changes in percent change in wall thickening, but the strain values were always lower than percent change in wall thickening. In protocol 2, the strain profile indicated postsystolic thickening in the peripheral ischemic region and indicated systolic wall thinning in the central ischemic region. Conclusions: Ultrasonic determination of SR and strain is an accurate and noninvasive method of quantitation of the serial change and spatial distribution of regional contractile function in rats. Copyright 2005 by the American Society of Echocardiography.Hirano T, Asanuma T, Azakami R, Okuda K, Ishikura F, Beppu S. Noninvasive quantification of regional ventricular function in rats: assessment of serial change and spatial distribution using ultrasound strain analysis. J Am Soc Echocardiogr. 2005 Sep;18(9):907-12. doi: 10.1016/j.echo.2005.01.009

Assessment of Macular Function by Multifocal Electroretinography and Optical Coherence Tomography before and after Panretinal Photocoagulation in Diabetic Retinopathy

We evaluated macular function before and after panretinal photocoagulation (PRP) in diabetic retinopathy using a multifocal electroretinogram (mfERG) and optical coherence tomogram (OCT). In mfERGs, the 1st positive wave (P1) minus the 1st negative wave (N1) amplitude (P1 ? N1 amplitude), the P1 peak latency and the response density were measured in 7, 19, 37 and 103 hexagonal areas or elements (Areas 1, 2, 3 and 4) within a central radius of 5, 7, 10 and 20 degrees, respectively. The mean retinal thickness was estimated from 9 calculation points at the foveal region within 5 degrees; the central and each of the other 4 points at a distance of 250 ?m and 500 ?m from the central por tion on horizontal and vertical sections on OCT. The P1 peak latencies from the 4 areas were remarkably prolonged in 14 eyes of 9 patients with preproliferative or early proliferative diabetic retinopathy showing no clinically significant macular edema before PRP as compared with those in 15 normal control eyes, without a tendency of recovery throughout the course after PRP except for area 1. The P1-N1 amplitudes and the mean response density levels from the 4 areas were remarkably decreased in the diabetic eyes before PRP as compared with those in the control eyes, followed by a maximum decrease in both parameters at 3 months after PRP. However, remarkable recoveries were detected in both decreased parameters from the 4 areas at 6 months after PRP. The mean foveal retinal thickness on OCT was remarkably increased in the diabetic eyes before PRP as compared with the thickness in 16 normal control eyes. Most remarkably, a transient increase in thickness was detected in diabetic eyes 1 month after PRP, followed by a tendency of recovery 3 to 6 months after PRP. These results indicate that mfERG and OCT examinations are useful in the assessment of macular function before and after PRP in diabetic retinopathy, especially within 5 degrees of the central portion, and that the effects of PRP on macular function in this entity seem to be reversible at the foveal region, although we need to do further investigation in relation to the outcome of visual acuity

Effects of Metoclopramide Hydrochloride, a D2-Selective Dopamine Receptor Antagonist, on the Fast Oscillation of the Electrooculogram

Fast oscillation (FO) of an electrooculogram (EOG) was recorded in both eyes of 10 healthy volunteers before and after administration of metoclopramide hydrochloride (MTCL), a D2-selective dopamine receptor antagonist, paying particular attention to sex concerning sensitivity to dopamine in young subjects. Healthy volunteers were divided into male and female groups; 5 males (10 eyes) aged 21 to 23 years (average, 21.8 years) and 5 females (10 eyes) aged 19 to 25 years (average, 21.8 years). As an FO parameter, the dfFO (the averaged difference in ?V between maximum amplitude in the dark period and minimum amplitude in the light period during FO measurement) was evaluated. The mean level of dfFO significantly increased between phase A (the initial 10 min before intravenous injection of 10 mg of MTCL) and phase B (10 min after the injection) in the male and female groups (P < 0.01 and P < 0.025) and between phase A and phase C (the additional 10 min after the injection) in both groups (P < 0.01 and P < 0.05). The mean level of dfFO in the female group was significantly higher than that of the male group in phase B (P < 0.05). As a control, the experimental procedure was performed with physiological saline administration, and no changes were observed. The data suggest that there exists some difference between young males and females generation concerning sensitivity to dopamine and that young females may show a higher-than-male sensitivity to dopamine in the occurrence of FO potential

Proteinuria during Follow-Up Period and Long-Term Renal Survival of Childhood IgA Nephropathy.

BACKGROUND:Proteinuria is the most important risk factor for IgA nephropathy progression. The purpose of this study is to evaluate the long-term outcome and risk factors for poor prognosis in childhood IgA nephropathy. METHODS:Patients who were diagnosed with IgA nephropathy between 1972 and 1992 at the Tokyo Metropolitan Kiyose Children's Hospital were included. We analyzed risk factors for progression to end-stage kidney disease (ESKD) and chronic renal insufficiency (CRI) using Kaplan-Meier method and multivariate analyses of Cox proportional hazard model. RESULTS:One hundred patients were included and the median observation period was 11.8 years. Twelve and 17 patients progressed to ESKD and CRI, respectively. The survival probabilities were 90.0% at 10 years and 79.8% at 20 years for ESKD, and 86.1% at 10 years and 72.3% at 20 years for CRI. Notably, patients with heavy proteinuria with hypoalbuminemia during follow-up period showed extremely poor prognosis. In this group, the survival rate at 10 years from ESKD and CRI was 40.6% and 20.8%, respectively. By multivariate analysis, proteinuria at diagnosis and proteinuria during follow-up period were risk factors for ESKD, whereas glomeruli showing mesangial proliferation ≥50% and proteinuria during follow-up period were risk factors for CRI. Patients without heavy proteinuria during follow-up period did not develop CRI and 63% of patients with mild proteinuria during follow-up period showed no proteinuria at the last observation. CONCLUSIONS:The degree of proteinuria during follow-up period is the strongest risk factor for ESKD and CRI