Can the ‘Head-Turning Sign’ Be a Clinical Marker of Alzheimer's Disease?

Aims: To investigate the incidence and severity of the ‘head-turning sign’ (HTS), i.e. turning the head back to the caregiver(s) for help, in patients with various dementias and discuss its clinical specificity in Alzheimer’s disease (AD). Methods: We investigated the incidence and severity of HTS while administering a short cognitive test (the revised Hasegawa Dementia Rating Scale: HDSR) in outpatients with AD [125 patients, including 4 with AD + vascular dementia (VaD)], 8 with amnestic mild cognitive impairment (aMCI), 34 with dementia with Lewy bodies (DLB), 8 with progressive supranuclear palsy (PSP) and 6 with VaD. Results: Significant differences were found among the 5 disease groups in the incidence and severity of HTS, and HDSR scores. Given the significant differences between AD and DLB in post hoc analyses, patients were dichotomized into AD-related (AD and aMCI) and AD-nonrelated (PSP, DLB and VaD) groups. Both incidence (41 vs. 17%, p = 0.002) and severity of HTS (0.80 ± 1.13 vs. 0.21 ± 0.60, p = 0.001) were significantly higher in the AD-related group, while average age and HDSR scores were comparable between both groups. AD-related disease, female gender and low HDSR score contributed significantly to the occurrence and severity of HTS. Conclusions: HTS can be a clinical marker of AD and aMCI, and may represent a type of excuse behavior as well as a sign of dependency on and trust in the caregivers

Unilateral Abducens Nerve Palsy as an Early Feature of Multiple Mononeuropathy Associated with Anti-GQ1b Antibody

Patients with anti-GQ1b antibody syndrome show various combinations of ophthalmoplegia, ataxia, areflexia, or altered sensorium as clinical features. We describe herein a unique case with unilateral abducens nerve palsy as an early feature of multiple mononeuropathy involving dysfunctions of the inferior dental plexus and the ulnar nerve, which was thought to be associated with anti-GQ1b antibody. A 27-year-old man presented with acute-onset diplopia. He subsequently experienced numbness not only in the right lower teeth and gums but also on the ulnar side of the left hand. Neurological examinations revealed dysfunctions of the right abducens nerve, the right inferior dental plexus, and the left ulnar nerve, suggesting multiple mononeuropathy. Serum anti-GQ1b antibody was positive. This is a rare case report of a patient with unilateral abducens nerve palsy as an early feature of multiple mononeuropathy associated with anti-GQ1b antibody. We suggest that anti-GQ1b antibody syndrome should be taken into consideration as a differential diagnosis of acute multiple mononeuropathy if ophthalmoplegia is present unilaterally

岡山大学における核燃料物質の安全管理のための劣化ウランと天然ウランの鑑別について

In Japan, the Law for the Regulation of Nuclear Source Materials, Nuclear Fuel Materials and Reactors (Regulation Law) controls the nuclear fuel materials such as thorium (Th), uranium (U) and plutonium (Pu). Under the Regulation Law, all related materials and reactors are needed to register to the Government. In Okayama University, many nuclear fuel materials, mainly uranium compounds, are registered and stored in 11 departments, separately. Discrimination between depleted uranium and natural uranium is important for the observance of the Regulation Law and the safety management of the nuclear fuel materials in the Okayama University. However, the discrimination of the two kind of uranium has poorly analyzed. In this study, we analyzed several uranium compounds by using γ-ray spectrometry to determine whether the depleted uranium or not

Case report: Recovery from refractory myasthenic crisis to minimal symptom expression after add-on treatment with efgartigimod

Myasthenic crisis, a life-threatening exacerbation of myasthenia gravis, is a significant clinical challenge, particularly when refractory to standard therapies. Here, we described a case of myasthenic crisis in which the patient transitioned from refractory myasthenic crisis to minimal symptom expression after receiving add-on treatment with efgartigimod, a novel neonatal Fc receptor antagonist. A 54 years-old woman who was diagnosed with anti-acetylcholine receptor antibody-positive myasthenia gravis experienced respiratory failure necessitating mechanical ventilation. Despite aggressive treatment with plasmapheresis, intravenous immunoglobulins, and high-dose corticosteroids, her condition continued to deteriorate, culminating in persistent myasthenic crisis. Efgartigimod was administered as salvage therapy. Remarkable improvement in neuromuscular function was observed within days, allowing for successful weaning from mechanical ventilation. Over the subsequent weeks, the patient’s symptoms continued to ameliorate, ultimately reaching a state of minimal symptom expression. Serial assessments of her serum anti-acetylcholine receptor antibody titer showed a consistent decline in parallel with this clinical improvement. This case highlights efgartigimod’s potential as an effective therapeutic option for refractory myasthenic crisis, offering new hope for patients facing this life-threatening condition

Modified Hatch Score Predicts 6-Month Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation: Data from the University Of Massachusetts Atrial Fibrillation Registry

AIMS: Pre-procedural identification of patients with atrial fibrillation (AF) who will benefit most from pulmonary vein isolation remains challenging. The HATCH score [Hypertension x1 + Age≥75 x1 + Thrombo-embolic event x2, COPD x1, Heart failure x2] has been associated with progression of AF and recently with adverse outcomes after catheter ablation. However, data regarding the HATCH score are limited. This study aimed to evaluate the performance of a modified HATCH scoring system, including pre-procedural obstructive sleep apnea as an additional risk element, compared to the CHADS risk score as a predictor of AF recurrence after an index pulmonary vein isolation procedure for AF. METHODS AND RESULTS: Seventy eight patients (48 men, mean age 60 ± 1.1 years) with paroxysmal or persistent AF underwent an index pulmonary vein isolation procedure between 2010 and 2014 using either radiofrequency (n=64) or cryoballoon (n = 14). Over a 6-month follow-up period, 35 patients had recurrence (44.9%) when monitored using Holter monitoring and in-office ECGs. The modified HATCH score was associated on univariate testing with AF recurrence. In multivariate logistic regression analyses including factors known to be associated with AF recurrence, the modified HATCH score (p: 0.03) was independently associated with AF recurrence and showed superior test characteristics using ROC curve analysis (C statistic = 0.64 for modified HATCH vs. 0.55 for CHADS2). The difference between the modified HATCH and the CHADS2 scores in predicting recurrence was not statistically significant (p = 0.8). CONCLUSIONS: AF recurred in 44% of patients over a 6-month follow-up. A modified HATCH including OSA successfully identified individuals at risk for 6-month recurrence. Further research is needed including larger cohorts of patients undergoing ablation and followed for more extended periods to further validate the performance of the modified HATCH score

Cortisol-Induced Masculinization: Does Thermal Stress Affect Gonadal Fate in Pejerrey, a Teleost Fish with Temperature-Dependent Sex Determination?

BACKGROUND: Gonadal fate in many reptiles, fish, and amphibians is modulated by the temperature experienced during a critical period early in life (temperature-dependent sex determination; TSD). Several molecular processes involved in TSD have been described but how the animals "sense" environmental temperature remains unknown. We examined whether the stress-related hormone cortisol mediates between temperature and sex differentiation of pejerrey, a gonochoristic teleost fish with marked TSD, and the possibility that it involves glucocorticoid receptor- and/or steroid biosynthesis-modulation. METHODOLOGY/PRINCIPAL FINDINGS: Larvae maintained during the period of gonadal sex differentiation at a masculinizing temperature (29 degrees C; 100% males) consistently had higher cortisol, 11-ketotestoterone (11-KT), and testosterone (T) titres than those at a feminizing temperature (17 degrees C; 100% females). Cortisol-treated animals had elevated 11-KT and T, and showed a typical molecular signature of masculinization including amh upregulation, cyp19a1a downregulation, and higher incidence of gonadal apoptosis during sex differentiation. Administration of cortisol and a non-metabolizable glucocorticoid receptor (GR) agonist (Dexamethasone) to larvae at a "sexually neutral" temperature (24 degrees C) caused significant increases in the proportion of males. CONCLUSIONS/SIGNIFICANCE: Our results suggest a role of cortisol in the masculinization of pejerrey and provide a possible link between stress and testicular differentiation in this gonochoristic TSD species. Cortisol role or roles during TSD of pejerrey seem(s) to involve both androgen biosynthesis- and GR-mediated processes. These findings and recent reports of cortisol effects on sex determination of sequential hermaphroditic fishes, TSD reptiles, and birds provide support to the notion that stress responses might be involved in various forms of environmental sex determination