Abstract BACKGROUND Preoperative accurate evaluation of arteries and veins can help avoid ischemic complication of brain tumor surgery. The latest ultra-high-resolution CT (UHRCT) angiography (Aquilion PrecisionTM; Canon Medical Systems) has recently become available for clinical testing of the main arteries and critical perforating arteries by brain CTA, compared to conventional CT. METHODS UHRCT provides slice collimation of 0.25 mm x 160 and matrix size of 1024 x 1024 or 2048 x 2048. Major features of this CT scanner include an improved detector system (the minimal slice thickness, 0.25 mm; the maximal channel number, 1792) and a small x-ray focus (the smallest size, 0.4 x 0.5 mm) compared to a standard multi-detector CT (MDCT) scanner (the minimal slice thickness, 0.5 mm; the maximal channel number, 896; the smallest x-ray focus size, 0.8 x 0.9 mm). RESULTS Until July 2019, 168 patients with brain tumor underwent UHRCT angiography. As high resolution image could visualize cortical arteries and cortical veins clearly, it helped to decide approach route to the tumor and achieve accurate biopsy of even small lesion. Identification of tumor feeders and passing arteries allowed for efficient feeder coagulation and preservation of passing artery, avoiding the ischemic change of surrounding brain. Improved image reconstruction could visualize perforating arteries, which helped to preserve perforator by predicting the location during tumor removal. CONCLUSION UHRCT angiography can visualize even tiny arteries and veins around the tumor, and contributes to avoid the risk of ischemic complication.
Abstract Despite the repeatedly raised criticism that findings in economic games are specific to situations involving trivial incentives, most studies that have examined the stake-size effect have failed to find a strong effect. Using three prisoner’s dilemma experiments, involving 479 non-student residents of suburban Tokyo and 162 students, we show here that stake size strongly affects a player’s cooperation choices in prisoner’s dilemma games when stake size is manipulated within each individual such that each player faces different stake sizes. Participants cooperated at a higher rate when stakes were lower than when they were higher, regardless of the absolute stake size. These findings suggest that participants were ‘moral bargain hunters’ who purchased moral righteousness at a low price when they were provided with a ‘price list’ of prosocial behaviours. In addition, the moral bargain hunters who cooperated at a lower stake but not at a higher stake did not cooperate in a single-stake one-shot game.
Syphilis is an infectious disease caused by the spirochete bacterium Treponema pallidum . Neurosyphilis results from the infection of the nervous system with Treponema pallidum , which can occur at any stage of syphilis. Neurosyphilis is often overlooked because of its rarity. Early‐stage neurosyphilis with brain mass formation is rare. We present a case of early‐stage neurosyphilis with prominent Epstein–Barr virus (EBV)‐positive monoclonal lymphoplasmacytic proliferation in an immunocompetent patient. A 36‐year‐old man presented with a chief complaint of a progressively worsening headache, a newly developed skin rash, and a fever. Magnetic resonance imaging showed a mass lesion, which measured 18 mm in diameter, in the left frontal lobe of the cerebrum. The patient underwent an emergency operation to remove the abscess. A pathological investigation revealed complex findings. There was an abscess in the cerebrum. Lymphoplasmacytic meningitis was also noted. In addition, a vaguely nodular lesion, which was composed of plasmacytoid and lymphoid cells, was observed around the abscess. Immunohistochemically, an anti‐Treponema pallidum antibody revealed numerous Treponemas around the abscess. In situ hybridization revealed that the plasmacytoid and lymphoid cells were Epstein–Barr encoding region (EBER)‐positive; κ‐positive cells were significantly more prevalent than λ‐positive cells, suggesting light‐chain restriction. Postoperatively, parenteral antibiotics were administered for four weeks. The patient has been free of recurrence for two years since the surgery. No association between neurosyphilis and EBV‐positive lymphoplasmacytic proliferation has ever been reported. Mass formation in early‐stage neurosyphilis is an exceptionally rare event. The present case indicates that in syphilis patients, lymphoproliferative disorders that lead to mass formation may be caused by concomitant EBV reactivation. Furthermore, when treating patients with mass lesions of the central nervous system, it is important to check their medical history and perform laboratory screening for infectious diseases to avoid overlooking syphilis infections.
Altruistic punishment following social norm violations promotes human cooperation. However, experimental evidence indicates that some forms of punishment are spiteful rather than altruistic. Using two types of punishment games and seven non-strategic games, we identified strong behavioural differences between altruistic and spiteful punishers. Altruistic punishers who rejected unfair offers in the ultimatum game and punished norm violators in the third-party punishment game behaved pro-socially in various non-strategic games. Spiteful punishers who rejected unfair offers in the ultimatum game but did not punish norm violators in the third-party punishment game behaved selfishly in non-strategic games. In addition, the left caudate nucleus was larger in spiteful punishers than in altruistic punishers. These findings are in contrast to the previous assumption that altruistic punishers derive pleasure from enforcement of fairness norms, and suggest that spiteful punishers derive pleasure from seeing the target experience negative consequences.
Abstract BACKGROUNDS: Standard of care for patients with primary CNS lymphoma (PCNSL) has been high-dose methotrexate (HD-MTX)-based multiagent immunochemotherapy, particularly with R-MPV-A with or without whole-brain radiotherapy (WBRT), however, the optimal treatment for relapsed/refractory (r/r)PCNSL has not been established yet. Approval of a second-generation BTK inhibitor, tirabrutinib, for r/rPCNSL in Japan in March 2020, prompted us to evaluate retrospectively efficacy of R-MPV-A for r/rPCNSL to compare their activities. PATIENTS: Histologically proven PCNSL patients treated at relapse in our institution from April 2000 to November 2019 were analyzed. Outcomes were compared between those treated with RMPVA or other regimens. RESULTS: Among 148 PCNSL patients identified, 73 had at least one relapse, of whom 47 received salvage chemotherapy including 23 treated with RMPVA, 14 with HD-MTX monotherapy, and 11 with DeVIC (DEX, etoposide, ifosfamide, CDBCA). Median age/KPS were 69 yo (20–87)/ 80 (40–100), 27 patients had received prior WBRT. RMPVA was given at the first relapse in 11 patients, median number of RMPV cycles was 8 (1–4 cycles: 10; 8 cycles 13). CR/CRu were achieved in 19 (83%), response rate was 87%, while there were two PDs (9%). After median follow-up of 21.9 months, the median PFS after salvage RMPVA was 13.0 m (95%CI: 9.1–16.9), 1-year overall survival (OS) was 82%, median OS was 70.0 m (95%CI: 12.9–127.1), which were longer than those in 24 patients with salvage treatment other than RMPVA (mPFS 4.4 m, P=0.054; mOS 13.6 m, P=0.009). Median PFS and OS for HD-MTX monotherapy were 5.1m and 36.6 m, while those for DeVIC were 4.4 m and 9.1 m, respectively. Treatment was generally well-tolerated but there was one treatment-related death. CONCLUSIONS: Salvage RMPVA at relapses was active and associated with longer survival compared with other regimens, necessitating further development of salvage regimens incorporating tirabrutinib in the future studies.
