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Misaki, Koichi ; Uchiyama, Naoyuki ; Inaki, Anri ; Kinuya, Seigo ; Nambu, Iku ; Kamide, Tomoya ; Mohri, Masanao ; Hayashi, Yasuhiko ; Nakada, Mitsutoshi ; 見崎, 孝一 ; 内山, 尚之 ; 稲木, 杏吏 ; 絹谷, 清剛 ; 林, 康彦 ; 中田, 光俊
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金沢大学附属病院脳神経外科<br />Background and purpose: Hemodynamic impairments are considered risk factors of cerebral hyperperfusio
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n after carotid artery stenting (CAS); measurement by Single-photon emission computed tomography (SPECT) using a subjective region of interest (ROI) method lacks consistency and reproducibility. Materials and methods: The present study compared objective perfusion analysis (stereotactic extraction estimation [SEE] method) with the ROI method for preoperative SPECT to predict the hyperperfusion phenomenon (HPP) after CAS. Preoperative resting asymmetry index (cerebral blood flow [CBF] ratio from the affected to unaffected hemisphere) and cerebrovascular reactivity (CVR) to acetazolamide were measured by N-isopropyl-p-[123I]-iodoamphetamine SPECT using the SEE and ROI method in 84 patients. CBF was also measured the day after CAS. Perfusion data with the highest area under the curve (AUC) by receiver-operating characteristic (ROC) analysis was considered a perfusion risk factor of HPP. Multivariate analyses for clinical characteristics and perfusion risk factors were performed to determine predictors of HPP. Results: The HPP was observed in 10 patients (11.9%). Female sex, contralateral stenosis, and degree of stenosis were significantly associated with HPP development on univariate analysis, and symptomatic stenosis was not found to be a significant factor. On SPECT analysis, CVR in the MCA area by SEE method had the highest AUC (0.981). Multivariate analysis showed that CVR in the MCA area was a significant predictor of HPP (P = 0.041). To predict hyperperfusion, the ROC curve of the CVR showed a cutoff value of –0.60%, sensitivity of 94.6%, and specificity of 100% (P < 0.001). Conclusions: Objective SEE method had better a predictive capability than ROI method to identify risk of hyperperfusion after CAS. © 2018 Elsevier Masson SAS<br />Embargo Period 12 months
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2. Vascular RAGE transports oxytocin into the brain to elicit its maternal bonding behaviour in mice
Yamamoto, Yasuhiko ; Liang, Mingkun ; Munesue, Seiichi ; Deguchi, Kisaburo ; Harashima, Ai ; Furuhara, Kazumi ; Yuhi, Teruko ; Zhong, Jing ; Akther, Shirin ; Goto, Hisanori ; Eguchi, Yuya ; Kitao, Yasuko ; Hori, Osamu ; Shiraishi, Yoshitake ; Ozaki, Noriyuki ; Shimizu, Yu ; Kamide, Tomoya ; Yoshikawa, Akifumi ; Hayashi, Yasuhiko ; Nakada, Mitsutoshi ; Lopatina, Olga ; Gerasimenko, Maria ; Komleva, Yulia ; Malinovskaya, Natalia ; Salmina, Alla B. ; Asano, Masahide ; Nishimori, Katsuhiko ; Shoelson, Steven E. ; Yamamoto, Hiroshi ; Higashida, Haruhiro ; 山本, 靖彦 ; 棟居, 聖一 ; 古原, 和美 ; 堀, 修 ; 白石, 昌武 ; 尾﨑, 紀之 ; 吉川, 陽文 ; 中田, 光俊 ; 東田, 陽博
概要:
金沢大学医薬保健研究域医学系<br />Oxytocin sets the stage for childbirth by initiating uterine contractions, lactation and maternal bo
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nding behaviours. Mice lacking secreted oxcytocin (Oxt -/-, Cd38 -/-) or its receptor (Oxtr -/-) fail to nurture. Normal maternal behaviour is restored by peripheral oxcytocin replacement in Oxt -/- and Cd38 -/-, but not Oxtr -/- mice, implying that circulating oxcytocin crosses the blood-brain barrier. Exogenous oxcytocin also has behavioural effects in humans. However, circulating polypeptides are typically excluded from the brain. We show that oxcytocin is transported into the brain by receptor for advanced glycation end-products (RAGE) on brain capillary endothelial cells. The increases in oxcytocin in the brain which follow exogenous administration are lost in Ager -/- male mice lacking RAGE, and behaviours characteristic to abnormalities in oxcytocin signalling are recapitulated in Ager -/- mice, including deficits in maternal bonding and hyperactivity. Our findings show that RAGE-mediated transport is critical to the behavioural actions of oxcytocin associated with parenting and social bonding.<br />30820471
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Hayashi, Yasuhiko ; Sasagawa, Yasuo ; Kita, Daisuke ; Fukui, Issei ; Oishi, Masahiro ; Tachibana, Osamu ; Ueda, Fumiaki ; Nakada, Mitsutoshi
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Purpose: Although hemorrhage within pituitary adenomas frequently exacerbates the symptoms, there are many grades of sev
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erity. Moreover, the contributing factors for symptom severity are still controversial. Methods: This retrospective study included 82 patients who underwent transsphenoidal surgery for pituitary adenomas with intratumoral hemorrhage. The grades of preoperative symptoms were classified into group A, asymptomatic or minor symptoms; group B, moderate symptoms sufficient for complain; and group C, severe symptoms disturbing daily life. Results: The hemorrhage volume within an adenoma was significantly higher in group C (92.6%) than in groups A (48.6%) and B (58.7%). Both headache and diplopia were dominant in group C, occurring in 72.2% and 27.8% of the patients, respectively. In group C, there was no significant difference in frequency between adenoma extensions into the sphenoid sinus (0%) and involvement of the cavernous sinus of Knosp grade 4 (0%), and extensions into the suprasellar region were not common (38.9%). The most distinctive feature was that “no extrasellar extension” was found only in group C (41.2%), and “multidirectional extension” was not detected in this group (0%). Multiple regression analysis revealed that the most powerful determining factors were the high frequencies of intratumoral hemorrhage and lack of extrasellar and multidirectional extensions. Conclusion: Rapid volume expansion of a hematoma and lack of extension or unidirectional extension might lead to significant compression of the sellar and surrounding structures. Of note, the integrity of the sellar dura might contribute to the acute onset of symptom manifestations caused by hemorrhage in pituitary adenomas. © 2017 Springer Science+Business Media, LLC<br />Embargo Period 12 months
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Chinbe, Hiroyuki ; Yoneyama, Takeshi ; Watanabe, Tetsuyou ; Miyashita, Katsuyoshi ; Nakada, Mitsutoshi
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Purpose: Development and evaluation of an effective attachment device for a bilateral brain tumor resection robotic surg
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ery system based on the sensory performance of the human index finger in order to precisely detect gripping- and pulling-force feedback. Methods: First, a basic test was conducted to investigate the performance of the human index finger in the gripping- and pulling-force feedback system. Based on the test result, a new finger-attachment device was designed and constructed. Then, discrimination tests were conducted to assess the pulling force and the feedback on the hardness of the gripped material. Results: The results of the basic test show the application of pulling force on the side surface of the finger has an advantage to distinguish the pulling force when the gripping force is applied on the finger-touching surface. Based on this result, a finger-attachment device that applies a gripping force on the finger surface and pulling force on the side surface of the finger was developed. By conducting a discrimination test to assess the hardness of the gripped material, an operator can distinguish whether the gripped material is harder or softer than a normal brain tissue. This will help in confirming whether the gripped material is a tumor. By conducting a discrimination test to assess the pulling force, an operator can distinguish the pulling-force resistance when attempting to pull off the soft material. Pulling-force feedback may help avoid the breaking of blood pipes when they are trapped in the gripper or attached to the gripped tissue. Conclusion: The finger-attachment device that was developed for detecting gripping- and pulling-force feedback may play an important role in the development of future neurosurgery robotic systems for precise and safe resection of brain tumors. © 2017 CARS<br />Embargo Period 12 months
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Yoneyama, Takeshi ; Watanabe, Tetsuyou ; Kagawa, Hiroyuki ; Hamada, Jun-ichiro ; Hayashi, Yutaka ; Nakada, Mitsutoshi
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Purpose For the application of less invasive robotic neurosurgery to the resection of deep-seated tumors, a prototype sy
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stem of a force-detecting gripper with a flexible micromanipulator and force feedback to the operating unit will be developed. Methods Gripping force applied on the gripper is detected by strain gauges attached to the gripper clip. The signal is transmitted to the amplifier by wires running through the inner tube of the manipulator. Proportional force is applied on the finger lever of the operating unit by the surgeon using a bilateral control program. A pulling force experienced by the gripper is also detected at the gripper clip. The signal for the pulling force is transmitted in a manner identical to that mentioned previously, and the proportional torque is applied on the touching roller of the finger lever of the operating unit. The surgeon can feel the gripping force as the resistance of the operating force of the finger and can feel the pulling force as the friction at the finger surface. Results A basic operation test showed that both the gripping force and pulling force were clearly detected in the gripping of soft material and that the operator could feel the gripping force and pulling force at the finger lever of the operating unit. Conclusions A prototype of the force feedback in the microgripping manipulator system has been developed. The system will be useful for removing deep-seated brain tumors in future master-slave-type robotic neurosurgery. © 2013 CARS.
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Misaki, Kouichi ; Nakada, Mitsutoshi ; Mohri, Masanao ; Hayashi, Yutaka ; Hamada, Jun-ichiro
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Choroid plexus carcinoma (CPC) is a malignant tumor with a strong tendency to spread along the cerebrospinal fluid pathw
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ay. There is no standardized chemotherapy protocol for this rare tumor. We report a 38-year-old man with CPC in the lateral ventricle with obstructive hydrocephalus. Because of the poor demarcation between thalamus and fornix, subtotal tumor resection was performed. Postoperative spine magnetic resonance (MR) image revealed whole spinal axis dissemination. After diagnosis of CPC, the patient was treated with whole ventricular and spine radiation concomitant with temozolomide chemotherapy, although the O 6-methylguanine-DNA methyltransferase (MGMT) promoter was found to be unmethylated. Although MR images revealed transient stable disease during adjuvant therapy, tumor progression was depicted after four cycles of temozolomide therapy. We discuss the ineffectiveness of adjuvant temozolomide therapy for CPC in connection with O 6-methylguanine-DNA methyltransferase promoter methylation. © 2011 The Japan Society of Brain Tumor Pathology.
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Yoneyama, Takeshi ; Watanabe, Tetsuyo ; Kagawa, Hiroyuki ; Hamada, Jun-ichiro ; Hayashi, Yasuhiko ; Nakada, Mitsutoshi
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In order to realize a less invasive robotic neurosurgery for the deeply seated tumor, a force detecting gripper with a f
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lexible micro manipulator has been developed. Gripping force applied on the gripper is detected by strain gages fit on the gripper clip. Signal is conducted to the amplifier by the cables through the inner pipe of the manipulator. In order to approach to the deeply seated tumor through a narrow hole, a micro manipulator which can flex at the end part to face the gripper for the target and can rotate the closing direction of the gripper at the end of the manipulator has been developed. Some operation test showed that the developed manipulator can approach flexibly to the target, and the taking out force of a target on the soft material was detected clearly. © 2011 IEEE.
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Yoneyama, Takeshi ; Watanabe, Tetsuyou ; Kagawa, Hiroyuki ; Hamada, Jun-ichiro ; Hayashi, Yutaka ; Nakada, Mitsutoshi
概要:
In order to realize a less invasive robotic neurosurgery for the deeply seated tumor, a force detecting gripper with a flexible micro manipulator has been developed. Gripping force applied on the gripper is detected by strain gages fit
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on the gripper clip. Signal is conducted to the amplifier by the cables through the inner pipe of the manipulator. In order to approach to the deeply seated tumor through a narrow hole, a micro manipulator which can flex at the end part to face the gripper for the target and can rotate the closing direction of the gripper at the end of the manipulator has been developed. Some operation test showed that the developed manipulator can approach flexibly to the target, and the taking out force of a target on the soft material was detected clearly.
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Chinbe, Hiroyuki ; Yoneyama, Takeshi ; Watanabe, Tetsuyou ; Nakada, Mitsutoshi
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The human fingertip has very high density of the receptor to accept sense of touch stimulation. The corresponding somati
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c sensory area in a brain is very large, and considered to be a specialized part for palpation. A lot of haptic display system then have been developed with the investigation of human haptic perception. However, the researches about the human perception for pulling force at grasping, namely static frictional force are limited. This paper investigated it, aiming at a future development of pulling and grasping force feedback system for neurosurgical robotic systems. For the purpose, this paper explored the possibility of displaying pulling force to an index finger during grasping. The absolute and difference thresholds for pulling sense were the targets. The results showed that grasping disturbs the pulling sense, and the sides of index fingertip can be used to display pulling sense, relatively large force, namely scaled force feedback is required for the perception. The results provide an important insight at a hardware and controller design of force feedback systems. © 2016 IEEE.<br />42nd Conference of the Industrial Electronics Society, IECON 2016; Palazzo dei CongressiFlorence; Italy; 24 October 2016 through 27 October 2016; Category numberCFP16IEC-ART; Code 125546
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Yoneyama, Takeshi ; Watanabe, Tetsuyo ; Kagawa, Hiroyuki ; Hayashi, Yutaka ; Nakada, Mitsutoshi
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Background In photodynamic diagnosis using 5-aminolevulinic acid (5-ALA), discrimination between the tumor and normal ti
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ssue is very important for a precise resection. However, it is difficult to distinguish between infiltrating tumor and normal regions in the boundary area. In this study, fluorescent intensity and bright spot analyses using a confocal microscope is proposed for the precise discrimination between infiltrating tumor and normal regions. Methods From the 5-ALA-resected brain tumor tissue, the red fluorescent and marginal regions were sliced for observation under a confocal microscope. Hematoxylin and eosin (H&E) staining were performed on serial slices of the same tissue. According to the pathological inspection of the H&E slides, the tumor and infiltrating and normal regions on confocal microscopy images were investigated. From the fluorescent intensity of the image pixels, a histogram of pixel number with the same fluorescent intensity was obtained. The fluorescent bright spot sizes and total number were compared between the marginal and normal regions. Results The fluorescence intensity distribution and average intensity in the tumor were different from those in the normal region. The probability of a difference from the dark enhanced the difference between the tumor and the normal region. The bright spot size and number in the infiltrating tumor were different from those in the normal region. Conclusions Fluorescence intensity analysis is useful to distinguish a tumor region, and a bright spot analysis is useful to distinguish between infiltrating tumor and normal regions. These methods will be important for the precise resection or photodynamic therapy of brain tumors. © 2016 Elsevier B.V.<br />Embargo Period 12 months
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