Coexistence of a Classical Nodoventricular Accessory Pathway With a Left-Sided Mahaim Accessory Pathway.

The coexistence of 2 Mahaim pathways represents a diagnostic challenge. We present a case in which the SH/HA intervals were useful for identifying concealed nodoventricular or His-ventricular pathways.

Utility of U-Net for the objective segmentation of the fibroglandular tissue region on clinical digital mammograms.

This study investigates the equivalence or compatibility between U-Net and visual segmentations of fibroglandular tissue regions by mammography experts for calculating the breast density and mean glandular dose (MGD). A total of 703 mediolateral oblique-view mammograms were used for segmentation. Two region types were set as the ground truth (determined visually): (1) one type included only the region where fibroglandular tissue was identifiable (called the 'dense region'); (2) the other type included the region where the fibroglandular tissue may have existed in the past, provided that apparent adipose-only parts, such as the retromammary space, are excluded (the 'diffuse region'). U-Net was trained to segment the fibroglandular tissue region with an adaptive moment estimation optimiser, five-fold cross-validated with 400 training and 100 validation mammograms, and tested with 203 mammograms. The breast density and MGD were calculated using the van Engeland and Dance formulas, respectively, and compared between U-Net and the ground truth with the Dice similarity coefficient and Bland-Altman analysis. Dice similarity coefficients between U-Net and the ground truth were 0.895 and 0.939 for the dense and diffuse regions, respectively. In the Bland-Altman analysis, no proportional or fixed errors were discovered in either the dense or diffuse region for breast density, whereas a slight proportional error was discovered in both regions for the MGD (the slopes of the regression lines were -0.0299 and -0.0443 for the dense and diffuse regions, respectively). Consequently, the U-Net and ground truth were deemed equivalent (interchangeable) for breast density and compatible (interchangeable following four simple arithmetic operations) for MGD. U-Net-based segmentation of the fibroglandular tissue region was satisfactory for both regions, providing reliable segmentation for breast density and MGD calculations. U-Net will be useful in developing a reliable individualised screening-mammography programme, instead of relying on the visual judgement of mammography experts.

The effect of breast density on the missed lesion rate in screening digital mammography determined using an adjustable-density breast phantom tailored to Japanese women.

OBJECTIVE: Despite the high risk of missing lesions in mammography, the missed lesion rate is yet to be clinically established. Further, no breast phantoms with adjustable breast density currently exist. We developed a novel, adjustable-density breast phantom with a composition identical to that of actual breasts, and determined the quantitative relationship between breast density and the missed lesion rate in mammography. METHODS: An original breast phantom consisting of adipose- and fibroglandular-equivalent materials was developed, and a receiver operating characteristic (ROC) study was performed. Breast density, which is the fraction by weight of fibroglandular to total tissue, was adjusted to 25%, 50%, and 75% by arbitrarily mixing the two materials. Microcalcification, mass lesions, and spiculated lesions, each with unique characteristics, were inserted into the phantom. For the above-mentioned fibroglandular densities, 50 positive and 50 negative images for each lesion type were used as case samples for the ROC study. Five certified radiological technologists participated in lesion detection. RESULTS: The mass-lesion detection rate, according to the area under the curve, decreased by 18.0% (p = 0.0001, 95% Confidence intervals [CI] = 0.1258 to 0.1822) and 37.8% (p = 0.0003, 95% CI = 0.2453 to 0.4031) for breast densities of 50% and 75%, respectively, compared to that for a 25% breast density. A similar tendency was observed with microcalcification; however, spiculated lesions did not follow this tendency. CONCLUSIONS: We quantified the missed lesion rate in different densities of breast tissue using a novel breast phantom, which is imperative for advancing individualized screening mammography.

[Intractable Atrial Arrhythmia after Maze Procedure].

Maze procedure has achieved high cure rates and become the surgical golden standard for the treatment of atrial fibrillation. But, atrial arrhythmia after maze procedure is often persistent and drug-resistant. In these cases, diagnosis by electrophysiological study (EPS) and treatment by catheter ablation (ABL) are useful. In our hospital, maze procedure has been actively performed for mitral valve surgery with atrial arrhythmia. We examined the cases that required ABL after maze procedure in our hospital. We reported 2 such typical cases where ablation of cavo-tricuspid isthmus line (CTI) in the right atrium and left superior pulmonary vein-left atrial appendage space( LSPV-LAA ridge) in the left atrium was effective.

Effect of viscosity on the shaking-induced fluidization in a liquid-immersed granular medium.

A liquid-immersed granular medium is shaken vertically under a wide range of accelerations (Γ in dimensionless form) and frequencies (f) and its fluidization process is studied. The granular medium is formed by settling and consists of two size-graded layers (particle diameter d) such that the upper layer is fine grained and is less permeable. When Γ>Γ(c), a liquid-rich layer formed by the accumulated liquid at the two-layer boundary causes a gravitational instability. The upwellings of the instability are separated horizontally by a distance (wavelength) λ, and their amplitude grows exponentially with time [∝exp(pt)] at a growth rate p. We conduct experiments for two liquid viscosity cases such that the particle settling velocity (V(s)) of the same particle differs by a factor of 17. We find that for both cases, Γ(c) is at a minimum in an optimum frequency band centered at f∼100 Hz. However, the high-viscosity (HV) case has a smaller Γ(c), a shorter λ, and a faster dimensionless growth rate [p'=p/(V(s)/d)]. We also measure granular rheology under an oscillatory shear and find that (i) interparticle friction decreases when the strain amplitude becomes large and (ii) friction is smaller for the HV case. From (i), we infer that the shear strain of the shaking experiments becomes largest at around f∼100 Hz. We consider that (ii) is a consequence of liquid lubrication and is a reason for a smaller Γ(c) for the HV case. We show that the low- and high-frequency limits of the optimum frequency band can be explained by introducing critical values of dimensionless jerk (i.e., time derivative of acceleration) J and dimensionless shaking energy S. The low-frequency limit corresponds to the requirement that in order to unjam the particles, the period of shaking (1/f) must be shorter than the time needed for the particles to rearrange by settling (d/V(s)), which also explains why the HV case is fluidized at a lower f compared to the LV case. We apply the results of the linear stability analyses for Rayleigh-Taylor instability. Using the measured λ and p, we infer that (i) only a thin layer beneath the two-layer boundary is mobile and the rest of the lower layer remains jammed and (ii) the effective viscosity of the upper granular layer relative to the liquid is smaller for the HV case as a result of smaller friction.

Syntactic comprehension in patients with amyotrophic lateral sclerosis.

Recent neuropsychological studies of patients with amyotrophic lateral sclerosis (ALS) have demonstrated that some patients have aphasic symptoms, including impaired syntactic comprehension. However, it is not known if syntactic comprehension disorder is related to executive and visuospatial dysfunction. In this study, we evaluated syntactic comprehension using the Syntax Test for Aphasia (STA) auditory comprehension task, frontal executive function using the Frontal Assessment Battery (FAB), visuospatial function using Raven's Coloured Progressive Matrices (RCPM), and dementia using the Hasegawa Dementia Scale-Revised (HDS-R) in 25 patients with ALS. Of the 25 patients, 18 (72%) had syntactic comprehension disorder (STA score < IV), nine (36%) had frontal executive dysfunction (FAB score < 14), six (24%) had visuospatial dysfunction (RCPM score < 24), and none had dementia (HDS-R score < 20). Nine of the 18 patients with syntactic comprehension disorder (50%) passed the FAB and RCPM. Although sample size was small, these patients had a low STA score but normal FAB and RCPM score. All patients with bulbar onset ALS had syntactic comprehension disorder. These results indicate that it might be necessary to assess syntactic comprehension in patients with bulbar onset ALS. The implications of these findings are discussed in relation to the pathological continuum of ALS.

Adaptation by stochastic switching of a monostable genetic circuit in Escherichia coli.

Stochastic switching is considered as a cost-saving strategy for adaptation to environmental challenges. We show here that stochastic switching of a monostable circuit can mediate the adaptation of the engineered OSU12-hisC Escherichia coli strain to histidine starvation. In this strain, the hisC gene was deleted from the His operon and placed under the control of a monostable foreign promoter. In response to histidine depletion, the OSU12-hisC population shifted to a higher HisC expression level, which is beneficial under starving conditions but is not favoured by the monostable circuit. The population shift was accompanied by growth recovery and was reversible upon histidine addition. A weak directionality in stochastic switching of hisC was observed in growing microcolonies under histidine-free conditions. Directionality and fate decision were in part dependent on the initial cellular status. Finally, microarray analysis indicated that OSU12-hisC reorganized its transcriptome to reach the appropriate physiological state upon starvation. These findings suggest that bacteria do not necessarily need to evolve signalling mechanisms to control gene expression appropriately, even for essential genes.