Suzuki (Japan)

BACKGROUNDHypoglossal neurinomas are rare tumors that pose management challenges, particularly when they contain cystic components. While total removal remains the standard treatment, resection can be excessively invasive for older adults. This report describes a case of cystic hypoglossal neurinoma successfully treated through a partial resection with cyst aspiration followed by Gamma Knife radiosurgery (GKRS).OBSERVATIONSA male aged 81 years presented with progressive dysarthria and dysphagia secondary to left hypoglossal nerve palsy. MRI revealed a cystic lesion compressing the medulla and a solid component within the left hypoglossal canal. Cyst aspiration was performed to alleviate potentially life-threatening lower cranial nerve palsy, followed by GKRS. At 21 months, marked cyst shrinkage was observed after a transient post-GKRS expansion, with no further interventions required.LESSONSA treatment strategy combining cyst aspiration and GKRS was useful for managing cystic hypoglossal neurinoma in an older adult. Minimally invasive management should be considered for older adults with comorbidities who are at increased risk for postoperative complications.https://thejns.org/doi/10.3171/CASE25821

Endogenous and exogenous enzymes influence the sensory properties of cooked rice by acting on starch during gelatinization. This study elucidated the distinct spatial distributions of endogenous α-glucosidase (E-AG) and an exogenous version derived from Aspergillus niger (A-AG) during cooking. The E-AG, A-AG, and water distributions in rice grains were visualized. E-AG was distributed throughout the raw grain, whereas A-AG was localized around starch granules, amyloplasts, and cell walls, penetrating the grain and existing along cell walls during soaking. With A-AG, the cooking time was prolonged by approximately 1min, and the temperature rise from 85 to 100°C became more gradual. This may result from enzyme-added rice's enhanced starch hydrolysis and gelatinization, which increases endothermic reactions. The modified outer area obtained at 85-100°C reached 58±7% with A-AG and 52±5% without. Moreover, the enzyme's preservation effect appears to be related to its localization.

Background: Major depressive disorder (MDD) is often accompanied by generalized anxiety disorder (GAD), a comorbidity linked to greater illness burden and potentially poorer outcomes. Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are established treatments for MDD, yet the impact of comorbid GAD and concomitant medications remains unclear. This study aimed to compare rTMS/iTBS treatment outcomes between patients with MDD with and without comorbid GAD, and to examine the association between concomitant psychotropic medication use, stimulation protocol, and treatment response in a real-world clinical setting. Methods: We conducted a retrospective observational analysis using registry data from 108 patients (MDD + GAD: n = 36; MDD only: n = 72). Patients received either Left-iTBS or Right-rTMS. Baseline severity, percentage change in Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HAMD-17) scores, response, and remission were assessed. Logistic and linear regression models adjusted for age, sex, and baseline severity were applied. Sensitivity analyses stratified by stimulation protocol and benzodiazepine (BDZ) use were performed. Results: Baseline severity did not differ between groups. MADRS reduction was numerically lower in the comorbid GAD group (48.3% vs. 52.7%, p = 0.09), whereas HAMD-17 reduction was comparable. Response and remission rates did not differ significantly. Medication use and stimulation protocol did not show statistically significant independent associations with outcomes. Sensitivity analyses confirmed equivalent outcomes between Left-iTBS and Right-rTMS. BDZ users showed a non-significant trend toward lower MADRS improvement and remission. Conclusions: rTMS/iTBS produced substantial clinical improvement and was well tolerated in both patients with MDD and those with MDD comorbid with GAD. Although comorbid anxiety showed a modest tendency to attenuate MADRS score reduction, overall response and remission rates were comparable between groups. Neither concomitant medications nor stimulation protocol significantly affected treatment outcomes, while the potential influence of BDZ exposure warrants further investigation.

BackgroundThe surgical efficacy of mitral valve repair (MVR) in dogs with advanced myxomatous mitral valve disease (MMVD) and atrial fibrillation (AF) remains unclear.Hypothesis/ObjectivesTo explore risk factors for the persistence of AF and to evaluate survival after MVR.AnimalsTwenty-eight dogs with preoperative AF selected from a cohort of 2733 dogs with MMVD that underwent MVR between January 2015 and April 2024.MethodsThis retrospective study evaluated whether AF persisted at 30 days postoperatively. Risk factors for postoperative persistent atrial fibrillation (pAF) were assessed using preoperative variables. Survival was analyzed using landmark analysis over 2 postoperative intervals: 0-30 days and 30-1000 days.ResultsFour dogs died within the first 30 days. Ten dogs were assigned to the pAF group, whereas 14 dogs that returned to sinus rhythm (SR) comprised the SR group. During the initial 30-day postoperative period, the survival probability at 30 days was 86% (95% confidence interval [CI], 74-100). Body weight (per 1.0 kg; risk ratio, 1.07; 95% CI, 1.01-1.12) and preoperative fractional shortening (per 1.0%; risk ratio, 0.95; 95% CI, 0.90-0.99) were predictive of postoperative pAF at 30 days. From 30 to 1000 days, the survival probability at 1000 days was 45% (95% CI, 20-100) in the pAF group and 90% (95% CI, 73-100) in the SR group (P = .030).Conclusions and clinical importanceGreater body weight and systolic dysfunction might be associated with postoperative pAF, which might negatively affect long-term survival after MVR.

Abstract It becomes essential to improve electromagnetic interference (EMI) shielding for high-speed, sensitive RF electronic devices when packaged in a shielding metal enclosure. The shielding effect by transmission (SET) was evaluated for 13 metal plates, which were considered as shielding unwanted EM waves. Most of the $$\mathrm S_{21}$$ measurements for metals showed a similar high reflection performance at 6 GHz. However, when a 6-GHz low-noise-amplifier (LNA) was packaged in an aluminum die-casting (ADC) mold and covered with a high-SET metal lid, a sharp peak in $$\mathrm S_{21}$$ at 5.2 GHz was observed. It was confirmed that the internal output signal radiated from the output signal pin between the PCB and the ADC, caused by impedance mismatch, was reflected at the bottom of the lid, propagated, and changed the total phase by 5 $$\pi$$ , and was incident on the input stage of the LNA, causing resonant oscillation at 5.2 GHz. When the iron-based EM wave shielding (EMWS) sheet was attached to the metal lid bottom, the shielding effect by absorption (SEA) was increased by about 10 dB, and the sharp peak on the $$\mathrm S_{21}$$ curve disappeared. This phenomenon was also investigated during the EVM evaluation for 64-QAM-OFDM transmission. When the LNA package was covered with an ADC lid, the EVM increased by approximately 10 dB due to increased quadrature error (Quad-Err). When the LNA package was covered with an ADC/EMWS lid, the EVM and Quad-Err were substantially suppressed. It is essential to shield electronic devices from both external and internal EMI by using high-SEA and SET materials to achieve high-quality QAM-OFDM transmission.

The insulation layers of submarine cables can be damaged by harsh marine condition and anthropic factor, leading to faults. Due to complex undersea environment, it is difficult to sense high-impedance faults in submarine cables. This paper proposes a method for detecting and locating high-impedance faults. Based on the distributed-parameter model of three-core submarine cable in modal domain, the modal voltage along the cable is firstly computed. Then, the fault detection criterion is established by using the selected modal voltage signal which effectively reflects fault occurrence. Finally, based on amplitude distribution characteristics of the modal voltage, the faulty cable section is identified. A fault distance estimation algorithm is constructed by using the section identification result as a boundary condition and iterative solution to estimate precise fault location. The simulation model of a submarine cable fed by offshore wind power is constructed by PSCAD/EMTDC. Various high impedance fault simulations results validate the effectiveness of the method. The calculation time of this method is only 0.06 s with a maximum fault distance estimation error not exceeding 0.608 km.

Carboplatin, pemetrexed, and pembrolizumab are established as a key first-line regimen for metastatic non-small cell lung cancer, although selecting the optimal therapy for each patient remains challenging in real-world clinical practice. This retrospective multicenter study compared the efficacy and safety of two atezolizumab-based combination regimens, ACnP (carboplatin, nab-paclitaxel, atezolizumab) and ABCP (carboplatin, paclitaxel, bevacizumab, atezolizumab), in patients with non-small cell lung cancer in real-world clinical practice. A total of 91 patients treated between May 2018 and December 2023 at six Japanese hospitals were analyzed: 40 received ACnP and 51 received ABCP. Patient characteristics, treatment outcomes, and adverse events were compared, with subgroup analyses adjusted by inverse probability of treatment weighting using propensity scores. The objective response rates were 55.0% with ACnP and 45.1% with ABCP. Median progression-free survival was 5.5 months for ACnP and 6.9 months for ABCP, while median overall survival was 16.2 and 18.3 months, respectively. Subgroup analyses showed significantly improved progression-free survival with ABCP in patients with brain metastases, liver metastases, EGFR-positive tumors, PD-L1-positive tumors, and impaired renal function (CCr < 45 mL/min). ABCP also conferred overall survival benefits in patients with brain and liver metastases. However, ACnP was associated with a lower incidence of neutropenia, peripheral neuropathy, and skin rash. These findings suggest that ABCP may offer superior efficacy in specific non-small cell lung cancer subgroups, while ACnP remains a valuable option for patients requiring a more tolerable safety profile.