Topological defects in nematic liquid crystals are ubiquitous. The defects are important in understanding the fundamental properties of the systems, as well as in practical applications, such as colloidal self-assembly, optical vortex generation and templates for molecular self-assembly. Usually, spatially and temporally stable defects require geometrical frustration imposed by surfaces; otherwise, the system relaxes because of the high cost of the elastic energy. So far, multiple defects are kept in bulk nematic liquid crystals by top-down lithographic techniques. In this work, we stabilize a large number of umbilical defects by doping with an ionic impurity. This method does not require pre-patterned surfaces. We demonstrate that molecular reorientation controlled by an AC voltage induces periodic density modulation of ions accumulated at an electrically insulating polymer interface, resulting in self-organization of a two-dimensional square array of umbilical defects that is reconfigurable and tunable.
Summary: Purpose:We describe a patient with complex partial seizure with unidirectional olfactory aura associated with ipsilateral unruptured aneurysm. Methods and Results:The patient felt a sweet pleasant smell coming from behind her right side every time before the attack. Cranial magnetic resonance imaging (MRI) and threedimensional computed tomography (CT) angiography revealed a large aneurysm at the bifurcation of the right middle cerebral artery and compression of the right orbitofrontal cortex. Small spikes were recorded from the right orbitofrontal and superior temporal gyri and from the uncus by the cortical electrodes during clipping of the aneurysm.Conclusions: The orbitofrontal cortex may have a function related to the ipsilateral directional olfactory sensation. Key Words: Complex partial seizure-Unilateral olfactory auraUnmptured aneurysm-Orbitofrontal cortex.Unruptured intracranial aneurysm is one of rare causes of epilepsy. Daly ( 1 ) reported one in 55 patients with epilepsy with uncinate fits, and Currie et al. (2) had only one in 666 patients with temporal lobe epilepsy. Several other patients (3-7) associated with intracranial aneurysm were reported. Seizure types of most of the patients consisted of complex partial seizures and a few patients noticed a sensory aura.Olfactory aura was produced by Penfield and Jasper (8) on stimulation of the uncus and amygdala. Although functions of the secondary olfactory center are not"ful1y understood, olfactory aura may result from epileptic discharges in the secondary olfactory center.We report a patient with unilateral olfactory aura associated with unruptured cerebral aneurysm located in the ipsilateral orbitofrontal lobe. CASE REPORTA 49-year-old woman complaining of attacks of impaired consciousness was admitted to our hospital. In the past 6 months, she felt a sweet pleasant smell like flowers or sweet fruits as an aura, which she had not previously experienced. She clearly identified the direction of Accepted October I?, 1998. Address correspondence and reprint requests to Dr. M. Mizobuchi at Department of Neurology, Nakamura Memorial Hospital, Minami I , Nishi 14, Chuo-ku, Sapporo 060-8570, Japan. the smell, which always came from behind her right side, and never the left side or front, and never spread to left side or front. After a few seconds, she became confused. During the attack, she could respond verbally but could not remember recent events. After the attack, she could not recall what she had done. The longest attack lasted -20 min without generalized seizures. Automatism, visual or gustatory hallucinations, and d6ja vu were not present. There was no neurologic abnormality including olfaction. Interictal EEG showed paroxysmal discharges over the right temporal region.Cranial magnetic resonance imaging (MRI) showed a round flow-void lesion -I cm in diameter between the tip of the right temporal lobe and the orbitofrontal gyrus (Fig. 1). Three-dimensional computed tomography (CT) angiography revealed a large aneurysm at the bifurcation of th...
The period following heart failure hospitalization (HFH) is a vulnerable time with high rates of death or recurrent HFH.OBJECTIVE To evaluate clinical characteristics, outcomes, and treatment response to vericiguat according to prespecified index event subgroups and time from index HFH in the Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) trial. DESIGN, SETTING, AND PARTICIPANTSAnalysis of an international, randomized, placebo-controlled trial. All VICTORIA patients had recent (<6 months) worsening HF (ejection fraction <45%). Index event subgroups were less than 3 months after HFH (n = 3378), 3 to 6 months after HFH (n = 871), and those requiring outpatient intravenous diuretic therapy only for worsening HF (without HFH) in the previous 3 months (n = 801). Data were analyzed between May 2, 2020, and May 9, 2020.INTERVENTION Vericiguat titrated to 10 mg daily vs placebo. MAIN OUTCOMES AND MEASURESThe primary outcome was time to a composite of HFH or cardiovascular death; secondary outcomes were time to HFH, cardiovascular death, a composite of all-cause mortality or HFH, all-cause death, and total HFH. RESULTS Among 5050 patients in the VICTORIA trial, mean age was 67 years, 24% were women, 64% were White, 22% were Asian, and 5% were Black. Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow-up of 10.8 months, the primary event rates were 40.9, 29.6, and 23.4 events per 100 patient-years in the HFH at less than 3 months, HFH 3 to 6 months, and outpatient worsening subgroups, respectively. Compared with the outpatient worsening subgroup, the multivariable-adjusted relative risk of the primary outcome was higher in HFH less than 3 months (adjusted hazard ratio, 1.48; 95% CI, 1.27-1.73), with a time-dependent gradient of risk demonstrating that patients closest to their index HFH had the highest risk. Vericiguat was associated with reduced risk of the primary outcome overall and in all subgroups, without evidence of treatment heterogeneity. Similar results were evident for all-cause death and HFH. Addtionally, a continuous association between time from HFH and vericiguat treatment showed a trend toward greater benefit with longer duration since HFH. Safety events (symptomatic hypotension and syncope) were infrequent in all subgroups, with no difference between treatment arms.CONCLUSIONS AND RELEVANCE Among patients with worsening chronic HF, those in closest proximity to their index HFH had the highest risk of cardiovascular death or HFH, irrespective of age or clinical risk factors. The benefit of vericiguat did not differ significantly across the spectrum of risk in worsening HF.
The purpose of this study was to analyze tumor control and possible complications of gamma knife radiosurgery (GKRS) in patients with vestibular schwannomas using low marginal doses and conformal multiple shots to fit irregular tumor shapes. The authors evaluated 152 patients with more than 5 years of follow-up. Marginal doses were 9-15 Gy (median 12 Gy), with corresponding treatment volumes ranging from 0.1 to 18.7 cm3 (median 2.0 cm3). The number of isocenters varied from 2 to 24 shots (median 9 shots). The actuarial tumor control rates were 94% at 5 years and 92.4% at 8 years. Larger tumors (p < 0.0001) and those in younger patients (p = 0.018) tended to recur significantly more often. Useful hearing, facial and trigeminal functions were preserved at 71, 100 and 97.4%, respectively. Seventeen percent of all patients developed transient dizziness, with dizziness persisting in 2% of the total. Fifty-six other patients not included in the long-term evaluation consecutively underwent caloric testing and static stabilometry as well as neurological examinations to evaluate vestibular function in detail, both before and after GKRS. The results revealed 90% of the patients to have already developed vestibular dysfunction prior to the treatment despite reported symptoms of dizziness. GKRS did not significantly affect vestibular function. Hydrocephalus was recognized in 5.3% of all patients, and tended to occur in cases with larger tumors (p = 0.0024). GKRS provides a safe and effective therapy for small to medium-sized tumors. However, indications for larger tumors must be carefully considered, as they are more difficult to control and liable to produce ataxia due to transient expansion.
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