Assessment of the cut-off value of quantitative liver-portal vein contrast ratio in the hepatobiliary phase of liver MRI.

AIM: To calculate the quantitative liver-portal vein contrast ratio (Q-LPC) cut-off value based on tumour detectability by using receiver operating characteristic (ROC) curves. MATERIALS AND METHODS: Seventy-four patients with tumours (46 men and 28 women; age, 71 ± 8.1 years), who underwent liver magnetic resonance imaging (MRI) using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) were enrolled. Some patients were found to have multiple tumours. In total, 102 tumour images were evaluated for quantitative liver-spleen contrast ratio (Q-LSC) and Q-LPC 10 minutes after the administration of Gd-EOB-DTPA. Q-LPC and Q-LSC were compared to assess the cut-off values and usefulness. The ROC curve was evaluated using the method for continuously distributed test results, with a free scale of 50 mm. A score of ≥30 out of 50 points was considered good. Cut-off values of Q-LPC and Q-LSC were then calculated. The areas under the ROC curve (AUCs) were also examined and compared. RESULTS: The AUC-ROC for Q-LPC was 0.858 (95% confidence interval [CI], 0.783-0.933). The cut-off value was determined to be at 1.462. Sensitivity was 0.747, and specificity was 0.852 at the cut-off value. The AUC-ROC for Q-LSC was 0.710 (95% CI, 0.597-0.822). The cut-off value was at 1.543, the sensitivity was 0.560, and the specificity was 0.778 at the cut-off value. A significant difference was noted between the AUCs (p=0.0016). CONCLUSION: Q-LPC can be used for hepatobiliary phase MRI evaluation.

Chemical composition of South American Burseraceae non-volatile oleoresins and preliminary solubility assessment of their commercial blend.

INTRODUCTION: Non-volatile oleoresins from neotropical Burseraceae are traditionally used for craft, technological and medicinal purposes. The crude resin is usually sold in popular markets of the forest communities. Adding value to this rainforest raw material requires establishing its composition. OBJECTIVE: To analyse the resin composition from different Burseraceae species and establish a minimally reproducible profile by gas chromatography, in order to parameterise its quality control. METHODOLOGY: Crude oleoresin samples of 10 Protium and Trattinnickia species and a commercial blend were subjected to hydrodistillation to remove volatile compounds. The chloroform-soluble residues were methylated, analysed by GC-FID (flame ionisation detection), and individual components were identified by analysing their mass fragmentation pattern in GC-MS and comparison with data from the literature. The blend solubility was assayed in 30 non-chlorinated solvents at three different proportions. RESULTS: The resins consisted exclusively of triterpenes, showing a common predominance of four major compounds in all the samples, corresponding to α-amyrin, ß-amyrin, α-amyrenone and ß-amyrenone. This profile was complemented with minor amounts of the tetracyclic ß-elemolic and α-elemolic acids, maniladiol, brein and other oxidised trace compounds. The better solvents for the resin were those chemically bearing more than four carbon atoms, as n-butyl acetate, 2-ethoxyethanol and isopropanol. The crude resin blend sold contained around 10% of insoluble material that was constituted by up to 70% inorganic residues mixed with humic acid derivatives, as attested by ash analysis and IR spectroscopy, respectively. CONCLUSION: The experimental results, complemented by a general inspection of the literature, demonstrated a systematically reproducible triterpene profile in Protium and Trattinnickia species.

3D morphological assessment of occlusal treatment by measuring dental casts with a micro-focus X-ray CT.

The analysis of occlusal relationship is important for the success of dental treatment. Three-dimensional (3D) computer models of upper and lower dental casts can play a significant role. In this study, we proposed and applied a new method in actual clinical assessment to measure dental casts with occlusal relationship by using a micro-focus X-ray CT system. We examined the modelling accuracy by comparing multiple 3D images taken by shifting the dental cast position. Modelling accuracy was confirmed as 0.03 mm. One occlusal treatment in clinical practice was selected as a case example. The dental casts and bite impression, taken before treatment, were scanned and the occlusal contacts and distance distribution between the upper and lower casts were visualized by a coloured map and overlaid on the computer models. Distances between the upper and lower casts of selected points were compared before and after the treatment. Initially, the subject had early contact on the anterior teeth, where distance was measured as 0.04 mm, and only one area measured less than 0.15 mm. After treatment, five areas measured less than 0.15 mm. Also, by comparing the dental cast models taken before and after occlusal adjustment of the tooth, the position and amount of adjustment were visualized. We successfully demonstrated the quantitative clinical assessment of occlusal treatment.

Near-infrared spectrophotoscopy of finger venules in assessment of autonomic dysfunction.

The authors evaluated morphologic changes in the venules of the finger using near-infrared spectrophotoscopy in patients with autonomic dysfunction, such as familial amyloidotic polyneuropathy and multiple-system atrophy. Abnormalities of the venules, such as tortuosity, irregular venous caliber, and microaneurysm-like change, and a linear negative correlation between the degree of orthostatic hypotension and the degree of vasoconstriction of the venules were observed.

Haemodynamic assessment in patients with dural arteriovenous fistulae: dynamic susceptibility contrast-enhanced MRI.

Cerebral haemodynamics in patients with dural arteriovenous fistulae (DAVF) have not been fully investigated and their effects are not clear. Our purpose was to assess impaired haemodynamics in patients with DAVF using dynamic susceptibility contrast-enhanced MRI (DSC-MRI). We used this technique in eight control subjects (group I) and 17 patients with DAVF who were scheduled to undergo or had already undergone endovascular embolisation and/or surgical excision. There were seven patients with cavernous sinus DAVF (CSDAVF) and the other ten had unilateral transverse/sigmoid sinus DAVF. All patients with CSDAVF underwent DSC-MRI preoperatively (group II) and those with transverse/sigmoid sinus DAVF underwent preoperative DSC-MRI (group III) and postoperative (group IV) assessment. The ratios of relative cerebral blood volume (rCBV), cerebral blood flow (rCBF) and mean transit time (rMTT) were calculated relative to contralateral values. Patients in group II had no significant haemodynamic impairment in grey (GM) or white matter (WM), but cerebellar rMTT were significantly prolonged ( P<0.05). Group III showed haemodynamic impairment characterised by significant increase in rCBV, prolongation of rMTT and decrease in rCBF in GM ( P<0.05). Significantly increased rCBV and prolonged rMTT in the GM ( P<0.05) were obvious in group III patients irrespective of retrograde leptomeningeal venous drainage (RLVD). In group IV, rCBV and rCBF returned to normal values, whereas rMTT was still significantly prolonged in GM ( P<0.05). Our study indicates that patients with CSDAVF may have impaired cerebellar perfusion, and that those with transverse/sigmoid sinus DVAF can have disturbed cerebral haemodynamics, even in the absence of RLVD.

[Analysis of inquiries about prescriptions at the pharmacy of Gifu Pharmaceutical University].

The Ministry of Health, Labour and Welfare explains the objectives of promotion of separation of the pharmacy and clinics as the elimination of duplicated prescription of similar drugs and drug interactions caused by treatment at several departments or hospitals, and sufficient guidance in the use of drugs by pharmacists. The Pharmacy of Gifu Pharmaceutical University has dispensed prescriptions by outside medical organizations as its routine activity. In this study, the contents of question inquiries handled in routine activities were compiled and analyzed, and their meaning was evaluated. The contents of question inquiries were accumulated using data cards. The data obtained during 2 and a half years (562 cases) were analyzed. The percentage of the number of inquiries relative to the number of prescriptions was highest at 1.86% during the first 3 months and was 1.05-1.71% per 3 months thereafter. The inquiries were most frequently about "the dosage/regimen" (153 cases), followed by "discrepancy between the contents of prescription and understanding of the patient" (88 cases) and "problems about insurance coverage" (80 cases). There were also 16 inquiries about "the possibility of contraindications and adverse reactions" and 15 inquiries about "duplicated prescription", which may have exerted serious effects on the patients. Eighty nine % of the inquiries have led to changes in the prescriptions, and about half of these cases were discovered by consultation with the patients or a review of the drug history. Proper and positive execution of these operations in routine pharmacy work is considered to lead to appropriate inquiries about problems with prescriptions and, thus, contribute to the proper use of drugs and prevention of malpractice.

Markov process amplitude EEG model for spontaneous background activity.

The Markov process amplitude (MPA) EEG model effectively representing spontaneous brain activity of the EEG was introduced. The relationship between the electrical mechanism for EEG generation and the proposed model was also investigated. The MPA EEG model was described by the sinusoidal waves with the randomly fluctuating amplitude of the first-order Markov process. The parameters of the MPA EEG model were determined optimally based on the real EEG records. The results of model outputs in the frequency domain demonstrated an excellent fit with the power spectrum of the corresponding EEG. The simulated model signal in the time domain also showed good agreement with the EEG time series. The satisfactory results from the MPA EEG model suggest its possible applicability in clinical practice. Furthermore, from the high goodness of fit, the authors think that the neurons oscillate at fixed frequencies and are modulated by synaptic interactions in accordance with the first-order Markov process.

Simple and low-cost tele-nuclear medicine conference system with the e-mail protocol.

PURPOSE: Because of the recent innovative growth in computer technology, digital imaging, and the Internet, we can take advantage of these facilities for education and clinical work in nuclear medicine. We developed a tele-nuclear medicine conference system with electronic mail (e-mail) on the Internet. METHODS: Twenty-one physicians (20 radiologists, 1 neurologist), 6 technologists and 2 medical students in six university hospitals (Japan 5, Canada 1), 5 local hospitals in Japan participated in this project. We used digital still cameras (330 k pixels) equipped with a floppy disk drive and 10 x optical zoom to digitize images with JPEG compression (640 x 480 matrix). The images were attached to e-mail messages (containing a brief description of each case). The mail was sent simultaneously to all members on the mailing list. Scintigram and SPECT images as well as other radiological images were sent by e-mail. Reply mails about each case were sent to all members via the mailing list. RESULTS: During a period of 6 months, 18 cases (tumor/infection: 7, bone: 6, cardiovascular: 1, neurology; 3, endocrine: 1) with 144 e-mails (average 5.6/case) were submitted to the conference. The average period of discussion was 15.6 days. The number of attached images was 1 to 9 (average, 4.2/e-mails). JPEG compression rate was 1/10 to 1/20. The quality of the images was good enough for discussion. Some cases required additional images for further discussion. CONCLUSION: Our tele-nuclear medicine conference with an electronic mailing list and digital camera was simple and low-cost. The conference system was useful for education and clinical work.

Nonlinear Markov process amplitude EEG model for nonlinear coupling interaction of spontaneous EEG.

To develop an appropriate model for representing spontaneous electroencephalography (EEG) is an important and necessary work in the field of neuroscience. The Markov process amplitude (MPA) EEG model has been proposed in our previous work for representing the features of the EEG in terms of a few parameters. However, being a linear model, the linear MPA EEG model cannot perfectly describe the spontaneous EEG that displays nonlinear phenomena. In this paper, the nonlinear Markov process amplitude (nonlinear MPA) EEG model that includes nonlinear components is introduced. The consistent consideration of the nonlinear features of the EEG investigated by N. Wiener and P. L. Nunez can be seen from the nonlinear MPA EEG model. The similarity in the time domain and the goodness of fitting in the frequency domain with respect to the ongoing EEG are shown. As a result, the EEG power spectrum can be decomposed into the spontaneous components and the nonlinearly coupled components by use of the nonlinear MPA EEG model, which is useful for a better understanding the mechanism of the EEG generation.

[Assessment on intermittent intravenous cyclophosphamide pulse therapy in diffuse proliferative lupus nephritis].

OBJECTIVE: To determine whether intravenous cyclophosphamide pulse therapy (IVCY) is effective for treating patients with diffuse proliferative lupus nephritis (DPLN) who were 1) refractory to methylprednisolone pulse therapy (MP) or 2) could not be treated with MP because of severe diabetes or steroid induced psychosis. METHODS: Seven patients with biopsy proven DPLN were studied after informed consent. Five of them received IVCY after a failure to achieve renal remission with at least 2 cycles of MP therapy. Of the other 2 patients, one had severe diabetes and the other a history of steroid induced psychosis. Bolus therapy with cyclophosphamide (0.5 g/m2 body surface area) was given once a month for 6 consecutive months and then once every 3 months for a total treatment period of 1 year. All patients were given oral prednisone, 0.5 mg/kg per day. The prednisone dose was tapered to the minimal dose required for controlling the disease. After 1 year, the renal status of the patients were evaluated. RESULTS: At 1 year, 4 of the 7 patients achieved substantial improvement. Although the other 3 patients did not satisfy the definition of substantial improvement, none of them had progressive disease. Adverse events were mild and did not require any treatment, with 2 cases of leukocytopenia without fever or major infection. No cases of hemorrhagic cystitis or amenorrhea were observed. CONCLUSIONS: IVCY was 1) effective in the treatment of DPLN which was refractory to MP and 2) relatively safe with minimal side effects.

Automatic detection of open and closed eye states in the electroencephalographic (EEG) record for background EEG interpretation by the trigger method.

Automatic detection of open and closed eye states in electroencephalographic (EEG) records was investigated in this study as a part of procedures for the precise interpretation of the background EEG to achieve a comprehensive automatic EEG interpretation system. The features of eye open and closure were extracted from the EEG using a Markov process amplitude (MPA) EEG model, which could efficiently express the features of the EEG using a small number of parameters. A new technique, named the trigger method, was also developed to overcome the difficulty resulting from large differences in the EEG features among different subjects, because an accurate detection could not be obtained by using the conventional threshold method. The proposed method gave satisfactory results which conformed with those of visual inspection by a qualified EEGer and could be clinically used as a preprocessing method for the automatic interpretation of the awake background EEG.

Assessment of between-instrument variations in a HPLC method for serum lipoproteins and its traceability to reference methods for total cholesterol and HDL-cholesterol.

BACKGROUND: The main purpose of this study was to evaluate the between-instrument variation of the HPLC method for the measurement of total cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), VLDL-cholesterol (VLDL-C), chylomicron cholesterol (CM-C), LDL size, and HDL size. Furthermore, the accuracy of the HPLC was assessed for the determination of TC and HDL-C, compared with CDC reference methods. METHODS: We used four HPLC instruments with different column-load numbers from 250 to 5000. For accuracy assessment of TC and HDL-C, we used the reference methods recommended by the CDC. RESULTS: The values measured by the four instruments were highly correlated with each other (mean r = 0.965), and the absolute mean differences were 4-43 mg/L for TC, 4-30 mg/L for HDL-C, 0-48 mg/L for LDL-C, 7-66 mg/L for VLDL-C, 0-7 mg/L for CM-C, 0.1-0.3 nm for LDL size, and 0-0.1 nm for HDL size. For TC, the HPLC instruments showed high correlation and good agreement with the reference method: r = 0.997; total error <6.6%; absolute mean bias <1.2%. For HDL-C, the results from the HPLC method were significantly higher (10.8% absolute mean bias) than those of the CDC reference method, in spite of good correlation between the two methods (r = 0.998). CONCLUSIONS: The between-instrument variation in serum lipoprotein analysis by HPLC was confirmed to be very small. This method met the US National Cholesterol Education Program's performance criteria for TC but not for HDL-C.

The available period and kind of exercise for increasing osteo sono assessment index in women.

PURPOSE: The purpose of this study is to determine the optimum period and kind of exercise which are more effective for increasing the calcaneus osteo sono assessment index (OSI) in adolescent women. METHODS: The subjects consisted of 600 female students aged from 19 to 21 studying at the Department of Food and Nutrition at Nakamura Gakuen University. The calcaneus OSI was measured by ultrasonic bone absorptiometry. The factors associated with an increased OSI were determined using piecewise linear regression analyses. RESULTS: Experience in performing impact-loading exercise either in junior high school or high school was found to be a significant predictive factor for increased calcaneus OSI after adjusting for age and weight. Regarding other exercise-related factors such as subjective intensity, frequency, hours at a time, and total duration of exercise, a piecewise liner regression analysis showed that a total duration of over 7 yr and a high subjective intensity of the impact-loading exercise during high school and junior high school periods caused a significant increase in the calcaneus OSI. However, the OSI decreased when the subjective intensity of the impact-loading exercise during the high school period was reported to be "very strenuous." CONCLUSIONS: Impact-loading exercise in junior high school and high school is important for increasing calcaneus OSI; however, impact-loading exercise in high school with a "very strenuous" subjective intensity was also found to possibly decrease the calcaneus OSI.

Observational assessment of patient's sleep complaints in the coronary care unit.

Sleep-wake disorders are common in patients who are treated in coronary care units (CCU). We report a clinical trial aimed at developing an observational assessment of patients sleep complaints in a CCU. Thirty-four inpatients with coronary heart diseases in the CCU (Tokyo Metropolitan Hiroo General Hospital) participated in the study. The patient's sleep state was assessed by nursing staff and classified as wakefulness, drowsy and asleep according to a semi-structured observation. Subjective sleep feelings upon rising was also investigated. Sleep disruptions during the latter half of the night was found to be an important determining factor of sleep feeling upon rising.

MCI-154, a Ca2+ sensitizer, decreases the oxygen cost of contractility in isolated canine hearts.

An increase in the responsiveness of the contractile machinery to Ca2+ could theoretically enhance the mechanoenergetics of the heart. To clarify this unresolved issue, we studied the effects of MCI-154, a Ca2+ sensitizer, on the mechanoenergetics in terms of the left ventricular contractility index [slope of end-systolic pressure-volume relationship (Emax)] and the relationship between myocardial oxygen consumption (VO2) and left ventricular pressure-volume area in excised cross-circulated canine hearts. MCI-154 increased Emax by 42 +/- 31% (SD), although the slope of the VO2-PVA relationship (an indicator of contractile efficiency) was unchanged by MCI-154. Despite equal increases in Emax, the relative increase in unloaded VO2 (delta VO2/delta Emax) during infusion of MCI-154 was, however, significantly less than that during CaCl2 infusion (0.0016 +/- 0.0018 vs. 0.0059 +/- 0.0054; P < 0.05). By contrast, delta VO2/delta Emax for milrinone was the same as that for CaCl2 (0.0043 +/- 0.0041 vs. 0.0039 +/- 0.0045; P > 0.05). Basal metabolism in KCl-arrested hearts was unchanged by MCI-154, indicating that MCI-154 consumes less energy than CaCl2 for excitation-contraction coupling. These findings suggest that MCI-154 acts energetically as a Ca2+ sensitizer in beating canine whole hearts.

Decrease in oxygen cost of contractility during hypocapnic alkalosis in canine hearts.

Ca2+ sensitization of contractile machinery could theoretically enhance the mechanoenergetics of the heart. We studied the effects of alkalosis with Ca2+ sensitization on mechanoenergetics within the framework of the relationships of left ventricular pressure-volume area (PVA; a measure of the total mechanical energy), myocardial oxygen consumption per beat (VO2), and the contractility index [E(max) (slope of end-systolic pressure-volume relation)] in 10 excised, cross-circulated canine hearts. Alkalosis was stably maintained without hypoxia (mean pH 7.66). Alkalosis increased E(max) without changing the slope of the VO2-PVA relation, a reflected contractile efficiency. The incremental ratio of unloaded VO2 to E(max) in alkalosis was significantly lower than that in Ca2+ sensitization (0.0012 +/- 0.0010 vs. 0.0062 +/- 0.0030 ml O2 . mmHg-1 . ml . beat-1 . 100 g LV-2; P < 0.01). Basal metabolism under KCl arrest was unchanged by alkalosis, indicating the decreased energy cost of the excitation-contraction coupling by alkalosis. Compared with the control, alkalosis increased E(max) during the Ca2+ infusion of various concentrations without any further increase in unloaded VO2. Thus we demonstrated a decreased oxygen cost of contractility during alkalosis, presumably due to Ca2+ sensitization.

In vivo assessment of prevention of white-noise-induced seizure in magnesium-deficient rats by N-methyl-D-aspartate receptor blockers.

The behavioral changes associated with seizures induced by auditory stimulation in magnesium (Mg)-deficient rats originate in deep brain structures and secondarily project to neocortex. In the present study, we examined the roles of N-methyl-D-aspartate (NMDA) receptors in this seizure model. The intraperitoneal administration of the competitive NMDA receptor blocker DL-2-amino-7-phosphonoheptanoic acid (36 and 72 mg/kg) and the non-competitive NMDA receptor blocker MK-801 (1.35 and 2.7 mg/kg), completely prevented the induction of seizure and bradyarrhythmia or sudden death resulting from seizure. Therefore, the white-noise-induced seizures in Mg-deficient rats are linked to increased neuronal excitability via the NMDA receptor.

Assessment of preload reserve in myocardial ischemia--the relation between preload reserve and ischemic size differs between anterior descending and circumflex coronary artery occlusions in a canine model.

The role of changes in preload in maintaining stable hemodynamics during coronary obstruction was assessed in the presence of myocardial ischemia due to occlusions of the left anterior descending (LAD) and left circumflex (LCX) coronary arteries. Changes in preload (mean left atrial pressure) to maintain a constant stroke volume after coronary occlusion were examined in 18 anesthetized dogs (LAD occlusion in 9 dogs, LCX occlusion in 9 dogs). The level of ischemia was assessed sonomicrometrically. Ventricular function curves relating left atrial pressure to stroke volume were assessed during a control state and after 1 min of coronary occlusion. The extent of preload reserve after coronary occlusion was examined on the ventricular function curves and was defined as the change in mean left atrial pressure required to maintain stroke volume at the level of the control state under conditions of regional ischemia. Ischemic size was determined by a stereo-angiogram after the animals were sacrificed. The extent of preload reserve (X) was linearly related to the ischemic size (Y) in both LAD (Y = 0.90 + 0.16X, r = 0.76, p < 0.001) and LCX (Y = -1.79 + 0.19X, r = 0.79, p < 0.001) occlusions. The slopes of the regression lines in LAD and LCX occlusions were the same. The X intercepts of these lines were -5.6% and 9.4% of the left ventricular weight in LAD and LCX ischemia (p < 0.001), respectively. Thus, the presence of systolic wall motion abnormalities due to coronary occlusion can be compensated for hemodynamically by changes in the preload reserve.(ABSTRACT TRUNCATED AT 250 WORDS)

Increasing FP access in Brazil.

PIP: A 1979 survey of women aged 15-45 years from Sao Paulo, Brazil, concerning their contraception use demonstrates the impact of family planning, even without an official family planning program. 23% of the women were using the pill and 16% were sterilized. Very few used diaphragms, condoms, or IUDs. Although there is now an official family planning program in Brazil, only middle and upper class women have access to sophisticated means of birth control. Poor women are limited to tubal ligation which is often disguised as a cesarean section (the rate at some hospitals for this operation is 90%). Since the Integrated Project was introduced in 2 pilot areas in 1983, 12 branches, where community representatives run monthly discussion meetings and classes are held on family planning methods, have been established in the city. Nurses coordinate volunteer efforts. The program began in slum areas by utilizing the nurses and nurseries already in place to care for children of working women. New expansion will require integrating the family planning program into other established, nongovernmental organizations and working with municipal and state governments.^ieng