In recent years, new procedures for fourth ventricular surgeries have been developed with good results. In particular, the trans-cerebellomedullary fissure approach, which exposes the fourth ventricle without splitting the inferior vermis, has proven successful. For optimum results, specialized techniques should be employed in order to effectively open the roof of the fourth ventricle and obtain a wide exposure of its interior. These techniques include the following steps:(1) placement of an incision over the teania extending from the foramen of Magendie to the ventricular entrance of the lateral recess;(2) lateral extension of the incision to the roof of the lateral recess to facilitate its exposure;(3) implementation of the same procedure on the contralateral side. Upon completion of these steps, the bilateral cerebellar tonsils can be easily retracted superolaterally; this eventually exposes a wide interior of the ventricle. In order to ensure successful surgeries, explicit and accurate descriptions of technique are vital. In this article, we employ detailed illustrations to precisely demonstrate the operative procedures and techniques for fourth ventricular surgeries.

Objectives: We evaluated the validity of the urine dipstick test for identifying reduced glomerular filtration rate (GFR) in male workers. Methods: This study was conducted in male workers aged ≥ 40 years. Reduced GFR was categorized as either estimated GFR (eGFR)< 60 ml/min/1.73 m(2)(eGFR < 60) or eGFR < 50 ml/min/1.73 m(2)(eGFR < 50). Four sets of criteria were used to evaluate the GFR on the basis of proteinuria excretion, as measured using the urine dipstick test. Receiver operating characteristic curves were created based on the sensitivity and specificity and used to calculate the area under the curve (AUC) and the 95% confidence intervals (CI). Results: A total of 5,799 workers were included in this study. Use of an abnormal proteinuria criterion of 1+-3+ and a reduced GFR criterion of eGFR < 60 resulted in a sensitivity and specificity of 7.8% and 97.4%, respectively, while a reduced GFR criterion of eGFR < 50 resulted in a sensitivity and specificity of 37.8% and 97.4%, respectively. The AUC was 0.52 (95% CI, 0.48-0.55) for eGFR < 60 and 0.70 (95% CI, 0.59-0.80) for eGFR < 50. Conclusions: In this study, 92.2% of participants with an eGFR < 60 and 62.2% of participants with an eGFR < 50 were overlooked in the urine dipstick test. These results suggest that the urine dipstick test only is not sufficient enough to identify reduced GFR and that both a urine dipstick test and other measures of GFR are required to reliably identify reduced GFR.

Background Long-term persistence of immune response and safety of two doses of an A/California/07/2009 H1N1 pandemic influenza vaccine adjuvanted with AS03 (an α-tocopherol oil-in-water emulsion-based Adjuvant System) administered 21 d apart was evaluated in Japanese adults [NCT00989612]. Methods One-hundred healthy subjects aged 20-64 y (stratified [1:1] into two age strata 20-40 y and 41-64 y) received 21 d apart, two doses of AS03-adjuvanted 3.75µg haemagglutinin (HA) H1N1 2009 vaccine. Immunogenicity data by haemagglutination inhibition (HI) assay six months after the first vaccine dose (Day 182) and microneutralization assay following each of the two vaccine doses (Days 21 and 42) and at Day 182 are reported here. Results Persistence of strong HI immune response was observed at Day 182 that met the US and European regulatory thresholds for pandemic influenza vaccines (seroprotection rate: 95%; seroconversion rate: 93%; geometric mean fold-rise: 20). The neutralizing antibody response against the A/Netherlands/602/2009 strain (antigenically similar to vaccine-strain) persisted for at least up to Day 182 (vaccine response rate: 76%; geometric mean titer: 114.4) and paralleled the HI immune response at all time points. No marked difference was observed in HI antibody persistence and neutralising antibody response between the two age strata. The vaccine had a clinically-acceptable safety profile. Conclusion Two priming doses of H1N1 2009 pandemic influenza vaccine induced an immune response persisting for at least six months after the first vaccine dose. This could be beneficial in evaluating the importance and effect of vaccination with this AS03-adjuvanted pandemic influenza vaccine.

BACKGROUND In the early stages of Pandemic (H1N1) 2009, border control measures were taken by quarantine stations to block the entry of infected individuals into Japan and community containment measures were implemented to prevent the spreading. The objectives of this study were to describe these measures and the characteristics of infected individuals, and to assess the measures' effectiveness. METHODOLOGY/PRINCIPAL FINDINGS BORDER CONTROL AND COMMUNITY CONTAINMENT MEASURES IMPLEMENTED FROM APRIL TO JUNE (PERIOD I: April 28-May 21, Period II: May 22-June 18) 2009 were described. Number of individuals identified and disease characteristics were analyzed. For entry screening, a health declaration form and an infrared thermoscanner were used to detect symptomatic passengers. Passengers indicated for the rapid influenza test underwent the test followed by RT-PCR. Patients positive for H1N1 were isolated, and close contacts were quarantined. Entry cards were handed out to all asymptomatic passengers informing them about how to contact a health center in case they developed symptoms. Nine individuals were identified by entry screening and 1 during quarantine to have Pandemic (H1N1) 2009. Health monitoring by health centers was performed in period I for passengers arriving from affected countries and in period II for those who had come into contact with the individuals identified by entry screening. Health monitoring identified 3 infected individuals among 129,546 in Period I and 5 among 746 in Period II. Enhanced surveillance, which included mandatory reporting of details of the infected individuals, identified 812 individuals, 141 (18%) of whom had a history of international travel. Twenty-four of these 141 passengers picked up by enhanced surveillance had been developing symptoms on entry and were missed at screening. CONCLUSION/SIGNIFICANCE Symptomatic passengers were detected by the various entry screening measures put in place. Enhanced surveillance provided data for the improvement of public health measures in future pandemics.

A 26-year-old Japanese female presented to us with a 2-year history of multiple arc-shaped erythematous lesions on her scalp and the right side of her forehead. Histopathological examination of two of the lesions showed lobular and septal panniculitis with deposits of IgG in the basement membrane zone. We diagnosed the case as lupus erythematosus profundus, and successfully treated her with 20 mg/day prednisolone. To our knowledge, there has been only one previously reported case of lupus erythematosus profundus with annular-shaped erythematous lesions and six cases with linear configuration.

Flow coefficients v_{n} for n=2, 3, 4, characterizing the anisotropic collective flow in Au+Au collisions at sqrt[s_{NN}]=200  GeV, are measured relative to event planes Ψ_{n}, determined at large rapidity. We report v_{n} as a function of transverse momentum and collision centrality, and study the correlations among the event planes of different order n. The v_{n} are well described by hydrodynamic models which employ a Glauber Monte Carlo initial state geometry with fluctuations, providing additional constraining power on the interplay between initial conditions and the effects of viscosity as the system evolves. This new constraint can serve to improve the precision of the extracted shear viscosity to entropy density ratio η/s.

We conducted a randomized controlled trial in patients with acne vulgaris with moderate to severe inflammatory lesions. The patients were assigned to the following three treatment groups: group A received monotherapy with 0.1% topical adapalene gel for 4 weeks; group B received combination therapy with 0.1% topical adapalene gel and 600 mg oral faropenem for 2 weeks followed by 0.1% topical adapalene gel alone for 2 weeks; and group C received combination therapy with 0.1% topical adapalene gel and 600 mg oral faropenem for 4 weeks. The result of the analysis indicated that the percentage reduction in inflammatory lesion counts after 2 weeks of treatment was significantly higher in groups B and C than in group A (P < 0.05). After 4 weeks of treatment, group C showed significantly higher percentage reduction in inflammatory lesion counts than in groups A and B (P < 0.05), whereas no significant difference was noted between the latter two groups. Adverse reactions included dryness and irritation at the adapalene application sites that were observed in 10.1% of cases (16/158 patients) and diarrhea and loose stool because of oral faropenem that were observed in 7.5% of cases (8/106 patients). Taken together, our results suggest that combination therapy with oral antibiotics and adapalene results in earlier improvement in patients with moderate to severe inflammatory acne compared to the application of adapalene alone, and that 4 weeks of the combination therapy is preferable to 2 weeks of treatment.