Introduction：Intracranial hemorrhage after severe coronavirus disease 2019 (COVID-19) is associated with increased mortality and unfavorable patient outcomes.Case：A man in his 60s with independent activities of daily living (ADL) was diagnosed with COVID-19, and placed on a ventilator on Day (D)-3 and VV-ECMO on D-5. On D-23, an emergency craniotomy was performed for a left acute subdural hematoma. The patient was weaned from VV-ECMO on D-27. On D-33, sitting was initiated. On D-36, the patient was weaned from the ventilator and began exercise therapy. The Glasgow coma score (GCS) was E2V1TM4. Basic movement as assessed by the Functional Status Score for ICU (FSS-ICU) and Barthel Index (BI), was 3 and 0 points, respectively. On D-40, wheelchair use commenced. He began standing with a long leg orthosis on D-50, and began walking on D-53.On D-67, the patient transferred to a convalescent hospital. His GCS was E4V4M6. Generalized cognitive decline and motor paralysis were noted. The right upper limb, hand, and lower limb were assessed as Brunnstrom recovery stage IV, V, and V, respectively. The patient's grip strength was 11.9 kg [right] and 18.3 kg [left]. His knee extensor strength was 0.13 kgf/kg [right] and 0.19 kgf/kg [left]. The FSS-ICU, walking speed, and BI were 21 points, 0.17 m/sec, and 40 points, respectively. The patient was discharged on D-240.Discussion：The Early Mobilization and Rehabilitation Expert Consensus reports that early mobilization and active exercise can improve ADL at discharge. Our patient was weaned from VV-ECMO as soon as possible and practiced standing and walking with a long leg orthosis, resulting in a better outcome.

Introduction：Intracranial hemorrhage after severe coronavirus disease 2019 (COVID-19) is associated with increased mortality and unfavorable patient outcomes.Case：A man in his 60s with independent activities of daily living (ADL) was diagnosed with COVID-19, and placed on a ventilator on Day (D)-3 and VV-ECMO on D-5. On D-23, an emergency craniotomy was performed for a left acute subdural hematoma. The patient was weaned from VV-ECMO on D-27. On D-33, sitting was initiated. On D-36, the patient was weaned from the ventilator and began exercise therapy. The Glasgow coma score (GCS) was E2V1TM4. Basic movement as assessed by the Functional Status Score for ICU (FSS-ICU) and Barthel Index (BI), was 3 and 0 points, respectively. On D-40, wheelchair use commenced. He began standing with a long leg orthosis on D-50, and began walking on D-53.On D-67, the patient transferred to a convalescent hospital. His GCS was E4V4M6. Generalized cognitive decline and motor paralysis were noted. The right upper limb, hand, and lower limb were assessed as Brunnstrom recovery stage IV, V, and V, respectively. The patien's grip strength was 11.9 kg [right] and 18.3 kg [left]. His knee extensor strength was 0.13 kgf/kg [right] and 0.19 kgf/kg [left]. The FSS-ICU, walking speed, and BI were 21 points, 0.17 m/sec, and 40 points, respectively. The patient was discharged on D-240.Discussion：The Early Mobilization and Rehabilitation Expert Consensus reports that early mobilization and active exercise can improve ADL at discharge. Our patient was weaned from VV-ECMO as soon as possible and practiced standing and walking with a long leg orthosis, resulting in a better outcome.

Objective: Gut—microbiota—brain axis plays a role in the pathogenesis of Parkinson’s disease (PD). The subdiaphragmatic vagus nerve serves as a major modulatory pathway between the gut microbiota and the brain. However, the role of subdiaphragmatic vagus nerve in PD pathogenesis are unknown. Here, we investigated the effects of subdiaphragmatic vagotomy (SDV) on the neurotoxicity in the mouse striatum and colon after administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Methods: Sham or SVD was performed. Subsequently, saline or MPTP (10 mg/kg × 3, 2-hour interval) was administered to mice. Western blot analysis of tyrosine hydroxylase (TH) and dopamine transporter (DAT) in the striatum and phosphorylated α-synuclein (p-α-Syn) in the colon was performed. Results: Repeated administration of MPTP significantly caused reduction of TH and DAT in the striatum and increase of p-α-Syn in the colon of mice. However, SDV did not affect the reduction of TH and DAT in the striatum and increases in p-α-Syn in the colon after repeated MPTP administration. Conclusion These data suggest that subdiaphragmatic vagus nerve doses not play a role in the MPTP-induced neurotoxicity in the brain and colon.

Objective：Although prediction of functional recovery after lacunar infarction is challenging, quantitative evaluation of brain imaging may be promising. In this article, we investigate association of the amount of corticospinal tract (CST) injury on Computed Tomography (CT) and functional recovery of lacunar infarction in the corona radiata.Methods：In 24 patients with lacunar infarction of the corona radiata, we investigated association of the amount of virtual CST injury with upper and lower limb motor function at 90 days after the stroke onset. The optimal area of the virtual CST to predict motor function was also determined. Finally, we evaluated whether the quantitative CST injury predicted practical motor function regarding activities of daily living.Results：The amount of virtual CST injury, evaluated with Hounsfield unit value of CT, was significantly associated with upper and lower limb function at 90 days after stroke onset. Among them, 6 mm radius CST circle for upper limb had the highest regression coefficient to predict Brunnstrom stage for the upper extremity (R2＝0.69), grip strength (R2＝0.52) and Simple Test for Evaluating Hand function (R2＝0.75). Also, 7 mm radius CST circle for lower limb had the highest regression coefficient to predict Brunnstrom stage for the lower extremity (R2＝0.51), weight bearing index (R2＝0.53) and Berg Balance Scale (R2＝0.52). These virtual CSTs predicted practical function including practical upper limb and ambulation.Conclusion：Quantitative evaluation of CST on CT predicted functional recovery after lacunar infarction of the corona radiata.

Objective：Although prediction of functional recovery after lacunar infarction is challenging, quantitative evaluation of brain imaging may be promising. In this article, we investigate association of the amount of corticospinal tract (CST) injury on Computed Tomography (CT) and functional recovery of lacunar infarction in the corona radiata.Methods：In 24 patients with lacunar infarction of the corona radiata, we investigated association of the amount of virtual CST injury with upper and lower limb motor function at 90 days after the stroke onset. The optimal area of the virtual CST to predict motor function was also determined. Finally, we evaluated whether the quantitative CST injury predicted practical motor function regarding activities of daily living.Results：The amount of virtual CST injury, evaluated with Hounsfield unit value of CT, was significantly associated with upper and lower limb function at 90 days after stroke onset. Among them, 6 mm radius CST circle for upper limb had the highest regression coefficient to predict Brunnstrom stage for the upper extremity (R2＝0.69), grip strength (R2＝0.52) and Simple Test for Evaluating Hand function (R2＝0.75). Also, 7 mm radius CST circle for lower limb had the highest regression coefficient to predict Brunnstrom stage for the lower extremity (R2＝0.51), weight bearing index (R2＝0.53) and Berg Balance Scale (R2＝0.52). These virtual CSTs predicted practical function including practical upper limb and ambulation.Conclusion：Quantitative evaluation of CST on CT predicted functional recovery after lacunar infarction of the corona radiata.

We report a case of a 64-year-old woman with a history of radiation therapy for breast cancer 27 years ago who developed malignant pericardial mesothelioma. Since 3 years ago, the recurrent bloody pericardial effusion was getting worse, which caused general edema and nocturnal dyspnea. She had a thickened pericardium and the right ventricular pressure curve showed a dip-and-plateau pattern. We diagnosed constrictive pericarditis and performed a pericardiectomy and waffle procedure on the thickened epicardium without cardiopulmonary bypass. The post-operative histology confirmed malignant pericardial mesothelioma and she died on the 17th postoperative day. Pericardial malignant mesothelioma is a rare disorder but very aggressive. This fatal disease may be considered in a patient with recurrent bloody pericardial effusion who has a history of thoracic radiation therapy.

We report the case of a 55-year-old man who received a hard blow to his chest from a liquid nitrogen hose that caused traumatic aortic dissection (Stanford type A, DeBakey type II). He did not have any other hemorrhagic injury ; therefore, we decided to perform an emergency surgery. The postoperative course was uneventful, and he was discharged on postoperative day 19. Pathological findings were compatible with traumatic aortic dissection. Blunt thoracic aortic injury is a potentially life-threatening injury ; therefore, it is worth remembering that relatively low-energy blunt trauma can cause aortic injury in patients with severe atherosclerosis. The optimal timing of intervention should be individualized in traumatic aortic injury with consideration of associated injuries.

Objective: Exposure to the herbicide glyphosate during pregnancy and lactation may increase the risk for autism spectrum disorder (ASD) in offspring. Recently, we reported that maternal exposure of formulated glyphosate caused ASD-like behaviors in juvenile offspring. Here, we investigated whether maternal exposure of pure glyphosate could cause ASD-like behaviors in juvenile offspring. Methods: Water or 0.098% glyphosate was administered as drinking water from E5 to P21 (weaning). Behavioral tests such as grooming test and three-chamber social interaction test in male offspring were performed from P28 to P35. Results: Male offspring showed ASD-like behavioral abnormalities (i.e., increasing grooming behavior and social interaction deficit) after maternal exposure of glyphosate. Conclusion The findings suggest that the exposure of glyphosate during pregnancy and lactation may cause ASD-like behavioral abnormalities in male juvenile offspring. It is likely that glyphosate itself, but not the other ingredients, may contribute to ASD-like behavioral abnormalities in juvenile offspring.

Objective: Exposure to the herbicide glyphosate during pregnancy and lactation may increase the risk for autism spectrum disorder (ASD) in offspring. Recently, we reported that maternal exposure of formulated glyphosate caused ASD-like behaviors in juvenile offspring. Here, we investigated whether maternal exposure of pure glyphosate could cause ASD-like behaviors in juvenile offspring. Methods: Water or 0.098% glyphosate was administered as drinking water from E5 to P21 (weaning). Behavioral tests such as grooming test and three-chamber social interaction test in male offspring were performed from P28 to P35. Results: Male offspring showed ASD-like behavioral abnormalities (i.e., increasing grooming behavior and social interaction deficit) after maternal exposure of glyphosate. Conclusion The findings suggest that the exposure of glyphosate during pregnancy and lactation may cause ASD-like behavioral abnormalities in male juvenile offspring. It is likely that glyphosate itself, but not the other ingredients, may contribute to ASD-like behavioral abnormalities in juvenile offspring.

Dopamine supersensitivity psychosis (DSP) is a type of acute exacerbation of recurrent psychosis caused by long-term treatment with antipsychotics in schizophrenic patients. Although DSP is exceedingly troublesome for clinicians, effective treatment has not yet been established. Based on clinical research and our animal study, we hypothesize that aripiprazole, an atypical anti-psychotic, may reduce the exacerbation of recurrent psychotic episodes. We report the case of a 46-year-old female who suffered from schizophrenia with DSP. In this case, sustained treatment with a high dose of aripiprazole gradually reduced the severity of her recurrent psychotic episodes. In conclusion, sustained treatment with aripiprazole may reduce the exacerbation of recurrent psychotic episodes in schizophrenic patients with DSP, and may be an effective treatment of DSP.
Animals ; Antipsychotic Agents ; Aripiprazole* ; Disease Progression ; Dopamine* ; Female ; Humans ; Middle Aged ; Psychotic Disorders ; Receptors, Dopamine D2 ; Recurrence ; Schizophrenia