Image Quality of the Coronary Angiography with Noise Reduction Technology to Decrease the Radiation Dose.

We examined the effects of a reduced exposure dose on the quality of images from an angiography device augmented with a noise reduction algorithm. Before its clinical application, we compared the diameter of the discrimination limit of the hole with that in the conventional method by a visual evaluation with a contrast-detail (C-D) phantom imaged using the target dose. Based on the results, a reducible dose was determined and applied clinically. The sample population consisted of patients being followed up after percutaneous coronary intervention (PCI) for coronary artery disease; we evaluated the effects of the exposure reduction on image quality. A significant dose reduction was observed by the noise-reduction method compared to the conventional method; the radiation dose to the flat panel detector (FPD) could be reduced to 70 nGy per frame. Clinically, a dose reduction of approx. 40% was obtained while maintaining image quality almost equal to that of the conventional method.

Azathioprine is essential following cyclosporine for patients with steroid-refractory ulcerative colitis.

AIM: To evaluate long-term prognosis following cyclosporine treatment by examining the rate of surgery avoidance among cyclosporine responders. METHODS: We retrospectively reviewed clinical records for 29 patients diagnosed with severe steroid-refractory ulcerative colitis in our hospital from August 1997 to August 2008 and treated with cyclosporine by continuous intravenous infusion. All patients were treated with intravenous corticosteroids for more than 5 d prior to cyclosporine therapy. Administration was continued for up to 21 d under serum monitoring to maintain cyclosporine levels between 400 and 600 ng/mL. Clinical activity was assessed before and after cyclosporine therapy using the clinical activity index score, with a reduction of ≥ 5 considered to indicate a response. Among responders, we defined cases not requiring surgery for more than 5 years as exhibiting long-term efficacy of cyclosporine. Factors considered to be possibly predictive of long-term efficacy of cyclosporine were sex, age, disease duration, clinical activity index score, C-reactive protein level, hemoglobin level, disease extent, endoscopic findings, and clinical course. RESULTS: Cyclosporine was not discontinued due to side effects in any patient. Nineteen (65.5%) of 29 patients were considered responders. A statistically significant (P = 0.004) inverse association was observed between an endoscopic finding of "mucosal bleeding" and responsive cases. Fifteen (9 males, 6 females) of these 19 patients were followed for 5 years or more, of whom 9 (60%) exhibited long-term efficacy of cyclosporine. Of the 10 non-responders, 9 (90%) underwent surgery within 6 mo of cyclosporine therapy. None of the following factors had a significant impact on the long-term efficacy of cyclosporine: sex, age, duration of disease, clinical activity index score, C-reactive protein level, hemoglobin level, extent of disease, endoscopic findings, or clinical course. In contrast, a significant association was observed for maintenance therapy with azathioprine after cyclosporine therapy (P = 0.0014). CONCLUSION: Maintenance therapy with azathioprine might improve the long-term efficacy of continuously infused cyclosporine for severe steroid-refractory ulcerative colitis patients.

Images of colonic real-time tissue sonoelastography correlate with those of colonoscopy and may predict response to therapy in patients with ulcerative colitis.

BACKGROUND: Real-time tissue sonoelastography (EG) is a new non-invasive technique that visualizes differences in tissue strain. We evaluated the usefulness of EG in patients with ulcerative colitis (UC) by investigating the association between EG and colonoscopic findings and disease activity. METHODS: Thirty-seven UC patients undergoing EG and colonoscopy were invited to enroll. EG findings were classified as normal, homogeneous, random, or hard, and colonoscopic findings as normal, mucosal edema and erosion, punched-out ulcer, and extensive mucosal abrasion. Clinical findings were evaluated using clinical activity index (CAI) scores for each patient at colonoscopy. RESULTS: On EG, 10 cases were classified as normal, 11 as homogeneous, 6 as random, and 10 as hard. EG findings showed a significant correlation those of colonoscopy (p < 0.001). Seven of 10 (70%) normal-type patients were in the remission phase, while all 6 random-type patients were in the active phase. Among active-phase patients, 4 of 7 (57%) homogeneous-type patients responded to steroid or leukocytapheresis therapy, while 3 of 6 (50%) random-type patients required treatment with cyclosporine. Three of 10 (30%) hard-type patients required colectomy. CONCLUSIONS: In this small series, EG findings reflected colonoscopic findings and correlated with disease activity among patients with UC.

Clinicopathological study of colorectal cancer occurring in patients with ulcerative colitis: results from a single hospital in Japan.

BACKGROUND/AIMS: Colorectal cancer (CRC) was first recognized as a complication of ulcerative colitis (UC) in 1925, and the increased risk has since been confirmed in a multitude of epidemiological studies. To our knowledge, however, all of these studies have been conducted in Western countries. The aim of this study was to identify the clinicopathological features of ulcerative colitis-related CRC in a consecutive series of patients at a single hospital in central Japan. METHODOLOGY: 314 (170 males, 144 females, mean age 30) consecutive patients diagnosed with ulcerative colitis were enrolled and investigated for the development of CRC. 240 patients had relapsing-remitting disease, 54 had chronic continuous disease, 16 had experienced one attack only, 2 had the acute fulminating type, and 2 were unknown. With regard to disease extension, 181 cases were of the pan-colitis type, 84 were left-sided colitis, and 42 were proctitis. Two patients (1%) had a family history of colorectal cancer and 45 (14%) were past or current smokers. RESULTS: Colorectal cancer developed in seven patients (male to female ratio of 1:6), which was 2.2% of the total. Average age at the onset of ulcerative colitis was 28 years. Average age at the onset of cancer was 44 years, and average duration of UC at cancer onset was 192 months. Ulcerative colitis was of the pancolitis type in all cases. Three patients (43%) showed the relapse-remitting type and four (57%) the chronic continuing type. Three patients (43%) had a family history of cancer, in particular colorectal cancer in one patient (14%). None of the patients had a history of smoking. The histological type of cancer was well differentiated tubular adenocarcinoma in three patients (43%) and poorly differentiated adenocarcinoma in three patients (43%) each, and endocrine cell carcinoma in one (14%). CONCLUSIONS: In this group of Japanese patients, development of colorectal cancer was more likely to occur in patients with ulcerative colitis that was long-standing, and more extensive than left-sided colitis, particularly in those with a family history of colorectal cancer, inflammatory polyps, or dysplasia. CRCs in our patients with UC were often poorly differentiated and had a poor prognosis.

Enteral nutrition decreases hospitalization rate in patients with Crohn's disease.

BACKGROUND AND AIMS: Crohn's disease (CD) is a chronic inflammatory bowel disease with relapse and remission. CD patients are admitted to hospital when bowel inflammation flares up severely, which lowers their quality of life. Enteral nutrition (EN) with an elemental diet plays an important role in the treatment for CD patients in Japan, because of its few adverse effects, and it is thought to be effective in maintaining remission. We investigated the effectiveness of EN with an elemental diet with regard to the avoidance of hospitalization. METHODS: A total of 268 patients with CD who visited hospital from 2003-2008 were enrolled. The relationship between the caloric content of an elemental diet and hospitalization as an end-point was examined retrospectively using Cox regression analysis. Cumulative non-hospitalization rates were calculated by the Kaplan-Meier method. RESULTS: Of the 268 patients, 155 received an elemental diet providing 900 kcal/day or more. Among 237 patients with ileal involvement, 135 patients receiving an elemental diet providing 900 kcal/day or more showed a statistically significant improvement in cumulative non-hospitalization rate. Among 31 patients without ileal involvement, in contrast, the cumulative non-hospitalization rate did not differ among those receiving an elemental diet of less or more than 900 kcal/day. CONCLUSION: The use of an elemental diet of 900 kcal/day may be effective in avoiding hospitalization in CD patients with ileal lesions. This diet may be useful in improving the long-term convalescence of these patients.

Restriction-modification systems may be associated with Helicobacter pylori virulence.

Restriction-modification (R-M) systems are exclusive to unicellular organisms and ubiquitous in the bacterial world. Bacteria use R-M systems as a defense against invasion by foreign DNA. Analysis of the genome sequences of Helicobacter pylori strains 26 695 and J99 identified an extraordinary number of genes with homology to R-M genes in other bacterial species. All H. pylori strains possess their own unique complement of active R-M systems. All of the methylases that have been studied so far were present in all major human population groupings, suggesting that their horizontal acquisition pre-dated the separation of these populations. The two most strongly conserved methylase genes of H. pylori, hpy IM and hpy IIIM, are both preceded by alternative genes that compete for presence at their loci, and furthermore these genes may be associated with H. pylori pathogenicity. Further study should investigate the roles of H. pylori R-M systems.

Potential role for matrix metalloproteinase-3 in gastric ulcer healing.

BACKGROUND/AIMS: Matrix metalloproteinases (MMPs) are endopeptidases which perform important functions in extracellular matrix remodeling, cell proliferation, and inflammatory processes. Here, we compared MMP-3 levels with those of tissue inhibitor of metalloproteinases (TIMP)-1 and several inflammatory cytokines in gastric ulcer (GU) patients. METHODS: This study enrolled 50 patients with GU and 6 with functional dyspepsia (FD). Samples of gastric mucosa from the antrum and the ulcer site were harvested from GU patients and of antral mucosa alone from FD patients during upper gastrointestinal endoscopy. Mucosal biopsy tissues were cultured for 24 h, and the culture supernatant was measured for levels of MMP-3, TIMP-1, IL-1beta, IL-6, and IL-8. RESULTS: All GU patients were positive for Helicobacter pylori, while all FD patients were negative. Antral levels of TIMP-1, IL-1beta, IL-6, and IL-8 were significantly higher in GU than FD patients. Further, MMP-3 levels were significantly higher in GU patients at the ulcer site than in the antrum, and had a significantly positive correlation with TIMP-1, IL-1beta, IL-6, and IL-8. CONCLUSION: MMP-3 levels were significantly higher at the ulcer site than in the antrum, suggesting that MMP-3 may perform an important function in gastric ulcer healing.

[A case of hepatosplenic cat scratch disease].

A 43-year-old man was admitted with idiopathic fever. Abdominal ultrasonogram demonstrated multiple hypoechoic lesions in the spleen. Abdominal CT scan showed multiple hypodense lesions in the liver and spleen. The patient had a cat in his house, and the presence of a very high serous antibody titer for Bartonella henselae led to the diagnosis of hepatosplenic cat scratch disease. It is important to consider this disease in the differential diagnosis of idiopathic fever when multiple lesions are detected in the liver and spleen.

[Effects of visual optical stimuli for accommodation-convergence system on asthenopia].

PURPOSE: We investigated the effect on eyestrain of optical stimuli that we designed for accommodation and convergence systems. METHODS: Eight female students were given optical stimuli for accommodation and convergence systems for 1.5 min immediately after 20 min of a sustained task on a 3-D display. Before and after the trial, their ocular functions were measured and their symptoms were assessed. The optical stimuli were applied by moving targets of scenery images far and near around the far point position of both eyes on a horizonal place, which induced divergence in the direction of the eye position of rest. In a control group, subjects rested with closed eyes for 1.5 min instead of applying the optical stimuli. RESULTS: There were significant changes in the accommodative contraction time (from far to near) and the accommodative relaxation time (from near to far) and the lag of accommodation at near target, from 1.26 s to 1.62 s and from 1.49 s to 1.63 s and from 0.5 D to 0.65 D, respectively, and in the symptoms in the control group after the duration of closed-eye rest. In the stimulus group, however, the changes of those functions were smaller than in the control group. CONCLUSION: From these results, we suggest that our designed optical stimuli for accommodation and convergence systems are effective on asthenopia following accommodative dysfunction.

Reduction of asthenopia related to accommodative relaxation by means of far point stimuli.

PURPOSE: To conduct an experimental investigation of the effect of accommodative relaxation using far point shift stimuli for the reduction of asthenopia. METHODS: Twenty-two female students accommodated to a far point shift stimuli during a 2-min period immediately after a 15-min sustained task on a three-dimensional display. Before and after the trial, their accommodative step response and symptoms were assessed. The far point shift stimuli in the optical system, which were presented on a refractometer, were created by moving the target scenery images from far to near, lineally centred about the far point position of each eye. During 2 min of fixating on the far point shift stimuli, changes in refraction were recorded in the same eye. RESULTS: While looking at the far point shift stimuli, 10 of 22 subjects had changes in refraction that showed a hypermetropic shift, and the other 12 subjects had changes in refraction that showed a myopic shift. The time taken for the accommodative step response from far to near post-trial in the myopic shift group was markedly prolonged, and the accommodative lag at the far target in the optometer was significantly increased. In the myopic shift group, the symptoms of "eye fatigue", "eye pain", "eye heaviness", and "eye dryness" also increased after the trial. In the hyperopic shift group, however, only the symptom of "eye dryness" increased, with no reduction of accommodation function. CONCLUSIONS: We suggest that accommodative relaxation by accommodative far point shift stimuli is effective in the reduction of asthenopia.

[Reduction of asthenopia-related to accommodative relaxation].

PURPOSE: We investigated experimentally the effect of accommodative relaxation by outward shift stimuli for accommodation on asthenopia. METHODS: Twenty female students fixed on optical outward-shift stimuli at accommodation for 2 min immediately after 15 min of a sustained task on a 3-D display. Before and after the trial task and the outward shift stimuli, their accommodative step response was measured and their subjective symptoms were assessed. The outward shift stimuli in the optical system, which was set on a refractometer, were presented by moving the target scenery images from far to near and near to far repetitively a round both eyes' far point position. At the same time as the accommodation measurements, the changes of refraction were recorded from the same eye. RESULTS: While looking at the outward shift stimuli, the refraction of 9 out of 20 subjects showed an outward shift and that of the other 11 subjects shifted inward. The post-trial value of contraction (from far to near) time of accommodative step response in the inward-shift group was markedly prolonged, from 0.86 s to 0.97 s (p = 0.043), and the post-trial accommodative power at the far target was shifted outward; from +1.21 D to +1.13 D(p = 0.048). The subjective symptoms of "ocular fatigue", "eye heaviness" and "eye dryness" also increased after the is(p = 0.0035, p = 0.0038, p = 0.0162, respectively). In the outward-shift group, however, no statistical changes were found. CONCLUSION: From these results, we suggested that accommodative relaxation produced by outward shift stimuli at accommodation is effective in reducing of asthenopia following the deterioration of accommodative functions.

Dihydrochalcones: evaluation as novel radical scavenging antioxidants.

Dihydrochalcones are a family of bicyclic flavonoids, defined by the presence of two benzene rings joined by a saturated three carbon bridge. In the present study, we systematically examined the antioxidant activities of dihydrochalcones against the stable free radical (1,1-diphenyl-2-picrylhydrazyl) and lipid peroxidation in the erythrocyte membrane. All dihydrochalcones exhibited higher antioxidant activities than the corresponding flavanones. The (1)H NMR analysis indicated that the active dihydrochalcone has a time-averaged conformation in which the aromatic A ring is orthogonal to the carbonyl group, while the inactive dihydrochalcone such as 2'-O-methyl-phloretin has a strongly hydrogen-bonded phenolic hydroxyl group, suggestive of a coplanar conformation. A hydroxyl group at the 2'-position of the dihydrochalcone A ring, newly formed by reduction of the flavanone C ring, is an essential pharmacophore for its radical scavenging potential.

[Effects on eyestrain of outward stimuli for accommodation].

PURPOSE: We investigated experimentally the effect on eyestrain of outward-shift stimuli for accommodation. METHODS: Six female students fixed optical outward-shift stimuli for accommodation during 2 min immediately after 15 min of a sustained task on a 3-D display. Before and after the trial, their ocular functions were measured and their subjective symptoms were assessed. The outward-shift stimuli were applied by moving the targets of scenery images from far to near and near to far repetitively at around both eyes' far point position. As a control, stationary targets at the position of 0 D were used instead of moving targets. The same experiment was repeated twice for each subject. RESULTS: In the first experiment, there were significant changes in the accommodative contraction time, the accommodation lag, and the myopic shift, and the subjective symptoms of "eyestrain" and "eye dryness" in the control group, but in the stimulus group there were only increases of the complaint of "eyestrain". In the second experiment, the changed items were the contraction time and the complaints of "eyestrain" and "eye dryness" in both groups. The outward-shift stimuli caused a tendency in the far point to shift outward in the first experiment, and there was a statistically significant inward shift in the second experiment. CONCLUSION: From these results, it is suggested that the outward-shift stimuli for accommodation are effective in relieving eyestrain following the deterioration of ocular functions except when the far point is shifted inward.

Expression of the Krüppel-type zinc finger gene, ZK7, in head and neck squamous cell carcinoma and normal mucosa.

ZK7 is thought to be involved in the inhibitory effect of vascular endothelial growth factor on apoptotic cell death in human hematopoietic cells. In the present study, we examined the effects of ZK7 on human head and neck squamous cell carcinomas (HNSCC). The expression levels of messenger RNA for ZK7 in HNSCC clinical specimens exposed to platinum drugs and/or ionizing radiation were found to be higher than those in non-exposed specimens (P=0.0116). Cell lines examination showed that ZK7 over-expressing cells had low sensitivity to the chemotherapeutic agent cisplatin and ionizing radiation. These results suggest that ZK7 may inhibit apoptotic cell death in HNSCC.