Sheehanjohnson2409

The 4th edition of the Guidelines for Treatment and Management of Head Injury by the Japan Society of Neurotraumatology newly published a three-step evaluation method for CT, indications for repeat CT, cancer risk associated with radiation exposure, and preparation of examination guidelines for reduction of radiation exposure. This manuscript describes how to proceed with diagnostic imaging of head injuries and the new items. The important points are as follows •CT is the first-step diagnostic imaging method in the acute phase. •Initial CT assesses the presence or absence of intracranial hemorrhage requiring emergency craniotomy. •It is necessary to perform repeat CT to assess secondary injury. •For minor head injuries, the indication for CT should be determined by confirming neurological concomitant symptoms considering radiation exposure.To avoid preventable trauma death(PTD), initial management, including resuscitation, is crucial in traumatic brain injury(TBI)care. PTD is defined as a case in which the percentage of probability of survival exceeds 50%, but the patient unfortunately dies without appropriate treatment. To diminish cases of PTD, a standardized approach has been established with several training courses and guidelines. However, 20% of all patients with TBI experience PTD. In our study, PTD cases accounted for 26.2% of all cases of so-called "talk and deterioration." Additionally, anti-coagulation/anti-platelet users comprised 26.8% of all PTD cases. Thus, to eliminate PTD, measures against anti-coagulants are important. Moreover, quick decision making regarding treatments preceding the rapid-changing pathophysiology is also essential in TBI care. In addition to securing airway management, providing oxygen support, and stabilizing circulation, timely administration of a neutralizer for anti-coagulative drugs and use of tranexamic acid(a drug for anti-fibrinolysis)is crucial. In this chapter, the pearls of initial TBI management are mentioned, with focus on the "first hour" of treatment.We present an extremely rare case of an extracranial saccular aneurysm arising from the proximal end of a distal fenestration in the posterior inferior cerebellar artery (PICA), with the PICA originating extra-cranially from the vertebral artery (VA). [Case] A 71-year-old woman with hypertension, was referred to our hospital for hearing disturbance. After the incidental discovery of an unruptured aneurysm on magnetic resonance imaging, an angiography showed the aneurysm arising from the proximal end of the right distal fenestrated PICA. Both the aneurysm and the origin of the PICA were extracranial. The patient was treated conservatively because of the size and shape of the aneurysm. [Conclusion] A literature review revealed nine reported cases of fenestrated PICAs, two of which were aneurysms with fenestrated PICAs. Meclofenamate Sodium This present case repot is the first to describe an extracranial aneurysm in a fenestrated PICA of extracranial origin. Embryologically, PICA fenestrations may represent remnants of a plexiform arterial channel between the primitive VA and a vertebrobasilar anastomosis.Somatic Symptom Disorder is a specific disorder that is extensively defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). Although the diagnostic criteria for somatic symptom disorder has archived breakaway from mind-body dualism and simplification for physicians, it remains vague and universally unapplicable. link2 Moreover, despite the DSM-5 removing etiology in diagnosis, there is still a need to determine the etiology for individualized patient treatment. In particular, patients with somatic symptom disorder and relative disorders have psychological pathologies, such as somatization and anxiety about illness, all of which require psychiatric treatment. However, these patients initially visit physicians, not psychiatrists, since their symptoms are somatic, and they are anxious about the possibility of a physical disease. As such, supportive attitude and continuous treatment are important, as they can be performed even without a psychiatric consultation. Furthermore, while the effectiveness of pharmacotherapy is limited for these disorders, psychotherapy has the possibility to bring about a fundamental resolution. Particularly, cognitive behavior therapy or psychoanalytic psychotherapy has been found to be effective; however, they require high motivation and take up much time from the patients. link3 Fortunately, the Morita therapy is especially effective for patients who pay excessive attention to somatic symptoms or are hypochondriacal, which is applicable for outpatients using a comparatively short interview that can even be performed in nonpsychiatric clinical settings.State-of-the-art tissue-clearing methods provide cellular resolution information of intact tissues in individual mammalian organs and the entire body. Combining these tissue-clearing methods with high-speed imaging and automated image analysis using light-sheet microscopy can reduce the cost and speed up tissue examination by several orders of magnitude. Moreover, the chemical nature of these methods enable antibody labeling of entire organs, which can be applied to thick human tissues. By combining powerful tissue clearing, labeling, imaging, and data analysis, scientists are able to extract structural and functional cellular information from complex mammalian bodies and large human specimens. Furthermore, the rapid generation of terabytes of imaging data calls for efficient computational approaches to address the challenges of large data set analysis and management. In this review, we described how tissue-clearing methods can provide an unbiased overview of mammalian bodies and human specimens at the system level, and discussed the current challenges and future possibilities in applying tissue-clearing methods to human neuroscience.Management of primary central nervous system lymphoma (PCNSL) includes induction and consolidation therapies in newly diagnosed patients, as well as second-line therapy in relapsed or refractory patients. The current standard-of-care induction therapy involves methotrexate (MTX)-based multi-agent immunochemotherapy with rituximab, methotrexate, procarbazine, and vincristine. Deferral or dose reduction of radiation therapy is considered in consolidation therapy, especially in elderly patients who carry a high risk of radiation-induced delayed neurotoxicity. Since elderly patients comprise the main population of PCNSL, minimally toxic treatments that are effective and feasible for them are strongly needed. For second-line therapy, rechallenge using MTX-based chemotherapy (in patients with a prior durable response to MTX-based chemotherapy) or radiation therapy is considered. Bruton's tyrosine kinase inhibitor tirabrutinib (for relapsed and refractory PCNSL) and high-dose chemotherapy with autologous stem cell transplantation support using thiotepa and busulfan (BuTT) were approved by the Japanese Ministry of Health and Welfare in March 2020 and has recently become available for clinical practice. While these novel treatments seem promising, the optimal use of these treatments along with the standard-of-care therapy of PCNSL should be defined and investigated in clinical trials.The 2016 revision of the WHO classification of lymphoid neoplasms has been published. Although pathological analysis is necessary for the diagnosis of malignant lymphoma, genetic analysis has become increasingly important in recent years. The diagnosis of malignant lymphoma in the peripheral nerves and skeletal muscles is challenging; hence, diagnosis based on genetic profiles is desirable. In this article, previous studies on malignant lymphoma in the peripheral nerves and skeletal muscles are summarized. Common clinical findings, radiological characteristics, and genetic tests were reviewed.Intravascular large B-cell lymphoma is an extranodal large B-cell lymphoma characterized by the selective growth of tumor cells in small vessels. It is often difficult to diagnose because of its various and non-specific manifestations. A key to diagnosis is an understanding of how to suspect this disease and performing tissue diagnoses including random skin biopsy. Due to advances in treatment, the importance of early diagnosis is increasing. However, as the pathogenesis and manifestations of the disease are still unclear, additional knowledge is needed.Primary central nervous system lymphoma (PCNSL) consists of 1%-5% of brain tumors, and the lesions can be identified using conventional techniques such as CT and MRI. However, differential diagnosis is still challenging when the lesions show atypical findings similar to other diseases such as glioma, infectious diseases (progressive multifocal leukoencephalopathy, toxoplasmosis), and demyelinating diseases (multiple sclerosis). In this review, we have presented imaging findings of conventional and advanced neuroimaging techniques to help differentiate PCNSL from other diseases and detect further characteristics such as prognostic factors, treatment effects, and gene mutations.Neurologists have a significant role in cancer treatment. Neuro-oncology is a novel discipline that involves the study of primary tumors and specific neurological symptoms associated with cancer and cancer treatments. Thus, neurologists must be involved in the treatment of cancer patients in Japan. In addition, it is necessary to educate and train neurologists as neuro-oncologists. With the increase in the number of cancer patients, its importance seems to increase further.What are desirable roles of general neurologists in the diagnosis and treatment of primary central nervous system lymphoma (PCNSL)? These issues were discussed 7 years back in the special feature articles of this journal. In the last 7 years genome analyses using liquid biopsy specimens have progressed and are becoming popular in the management of PCNSL, thereby enabling neurosurgeons to avoid invasive brain biopsy. The role of general neurologists in this country is not to be directly engaged in the PCNSL management, but to make an early diagnosis of PCNSL and to refer patients with PCNSL to specialists for a combination of chemotherapy and irradiation therapy.

Volleyball players have shown to be at an increased risk of developing scapular dyskinesis. The kinetic chain exercise approach has gained a lot of attention because of its claims to provide an improved motor control and scapular kinematics. A form of cross exercise, known as mirror therapy, may enhance the effects of a kinetic chain exercise approach in throwing performance.

To examine the effects of mirror cross exercise (MCE), based on a kinetic chain exercise approach in the throwing performance of volleyball athletes with scapular dyskinesis.

Randomized controlled trial.

Biomechanics laboratory.

39 volleyball players with scapular dyskinesis were randomly allocated into 3 groups. The first group completed a 6-week kinetic chain approach (KCA group), the second group completed a kinetic chain exercise approach program in addition to MCE group, and the control group followed only their regular training program. Before and after delivering both interventions, throwing accuracy, speed, and force were determined while measuring the ground reaction forces of the drive leg during throwing.