A new telestroke network system in northern area of Okayama prefecture

Background Telestroke network can provide rapid access to specialized treatment and improves on‐site management of acute stroke patients through the “hub‐and‐spoke” model. In the northern part of Okayama Prefecture, there has been a regional gap of stroke care due to the shortage of stroke specialists and facilities. In addition, due to the novel coronavirus disease 2019 (COVID‐19), it is required to reduce the unnecessary contact with stroke patients from other hospitals. Aim We organized a novel cost‐free telestroke network with an image and video sharing for neurological diseases in the northern part of Okayama Prefecture to improve the stroke management in the area. Method We prepared the tablet device on which Skype® application was installed for each hospital and recruited the patients who visited or hospitalized in the spoke hospitals and were suspected to have some neurological diseases from April 2019 to May 2020. The patient's clinical data were recorded and analyzed. Results During the study period, 5 patients were recruited including the cases with the initial diagnosis of stroke or brain tumor. Among them, 2 cases were transferred to the hub hospital, 2 cases were transferred to other hospitals, and 1 case was treated on site under specialist's advice. Conclusion The new telestroke network system may be beneficial for acute stroke management and reducing the unnecessary patient's transfer in the rural area, especially under coexistence with COVID‐19

In Vivo Analysis of Extracellular Proteins in Rat Brains with a Newly Developed Intracerebral Microdialysis Probe

Peptides and proteins in the extracellular space in the central nervous system were investigated in vivo using an intracerebral microdialysis probe. The molecular cut-off of the hollow fiber which was used for the probe was approximately 100 kDa. We examined recovery rates of several compounds in vitro. The recovery rates of proteins and peptides were between 7-28%, with the exceptions of substance P and insulin-like growth factor I. The recovery rates of monoamines and their metabolites were 22-40%. In in vivo studies, two major proteins with apparent molecular weights of 62 kDa and 12 kDa, and several minor proteins (28 kDa, 43 kDa, 52 kDa and 70 kDa) were detected by SDS-polyacrylamide gel electrophoresis in the dialysate from a probe implanted in the striatum of anesthetized rats. These results suggest that the newly developed, intracerebral microdialysis probe might be useful for investigating the dynamic changes of peptides and proteins in the central nervous system.</p

Long-lasting effects of ceruletide on L-Dopa-induced dyskinesias in monkey

The long-lasting effects of ceruletide(CLT), a cholecystokinin-8(CCK-8) analogue, on involuntary movements were investigated. Nine monkeys were used. One group(6 monkeys) received unilateral lesions to the ventromedial tegmentum(VMT) of the midbrain. The second group(3 monkeys) served as controls. Hypokinesia was produced after lesioning of the VMT. Administration of a large amount of L-Dopa or direct intracaudate injection of dopamine(DA) relieved the symptoms initially but then induced dyskinesias later. Two monkeys with reproducible dyskinesias were chosen for further study. Systemically administered CLT combined with L-Dopa improved the hypokinesia without inducing dyskinesia. These effects of a single dose of 50 μg/kg CLT continued up to 9 days. Direct combined administration of CLT and DA into the dorsomedial part of the head of the caudate nucleus ipsilateral to the VMT lesion improved the hypokinesia without inducing dyskinesia. The effect of a single direct injection of 20 ng/kg CLT persisted for 3 days. The long-lasting effects of systemically and directly administered CLT were confirmed. These findings suggest that CLT modulates the DA system indirectly through the central CCK system, especially in the dorsomedial part of the head of the caudate nucleus

The effects of total parenteral nutrition on the histological and cytological changes of several organs in rats.

The experiment was carried out to investigate the effects of total parenteral nutrition (TPN) on body weight, nitrogen balance and the histological or cytological changes of main organs in rats. TPN was introduced to 59 female Wistar rats of seven weeks after birth, for ten days. The animals were devided into six groups as follows: Group I Control, fed orally by pellets Group II TPN of amino acid-fat-glucose Group III TPN of amino acid-glucose Group IV Fat and glucose Group V Amino acid exclusively Group VI Starvation 1) The body weight increases in Group II and III were 6.7% and 3.6% of the initial value, respectively. However, the increase in body weight of each group was less than that of control. Nitrogen balance study showed that cumulative nitrogens of Group II and III for seven days were 1.10 and 0.93 grams, respectively. 2) Fatty infiltration in the liver was not due to whether TPN consisted of fat or not. When a Cal/N ratio was increased in TPN, liver showed fatty infiltration at the peripheral regions of the lobules. The fatty infiltration seemed to become more diffuse as caloric excess was greater. Electron microscopy of hepatocytes revealed multiple giant lipid droplets in cytoplasm and glycogen cluster localizing around lipid droplets. This suggests that glycogen may change to fat following TPN. 3) TPN caused an atrophy of exocrine pancreas. The atrophy was much greater in Group IV, which was excluded amino acid. Ultrastructurally, pancreatic acinar cells revealed increased FCD (focal cytoplasmic degradation) of various size, augumented flat mitochondria, increased immature zymogen granules and dilatation of rough surfaced endoplasmic reticulum. These results show that deprivation of amino acid from TPN causes impairment to pancreatic acinar cells, even in short period. 4) Infusion of hypertonic glucose or amino acid caused cloudy swelling and vacuolization of renal tubule epithelial cells, which ultrastructurally coincided with the swelling, deformity and vacuolization of mitochondria, low electron density of cytoplasm and increased lysosomes

Familial Hemophagocytic Lymphohistiocytosis Presenting as Hydrops Fetalis

Abstract Background Familial hemophagocytic lymphohistiocytosis (FLH) is an autosomal recessive disorder of immune regulation that leads to a hyperinflammatory syndrome. Fetal onset FHL is extremely rare and is considered to be the most severe form of FHL. Case We report a preterm case of FHL that presented as hydrops fetalis. The infant was treated with a chemotherapy regimen based on the HLH-2004 protocol from the third day of life. However, he had persistent cytopenia and died on the 18th day of life due to bacteremia. The detection of defective perforin expression in the patient's natural killer cells and mutations in the PRF1 gene resulted in a molecular diagnosis of FHL. Conclusion We suggest that early diagnosis and the development of an appropriate immunosuppressive strategy that can induce and maintain remission until hematopoietic stem cell transplantation can be performed are required to improve the outcomes of fetal onset FHL