Predictors of Diagnostic Contributions and Spontaneous Remission of Symptoms Associated with Positron Emission Tomography with Fluorine-18-Fluorodeoxy Glucose Combined with Computed Tomography in Classic Fever or Inflammation of Unknown Origin:a Retrospective Study

Background@#In patients with fever or inflammation of unknown origin (fever of unknown origin [FUO] or inflammation of unknown origin [IUO], respectively), expert consensus recommends the use of positron emission tomography with fluorine-18-fluorodeoxy glucose combined with computed tomography (FDG-PET/CT) when standard work-up fails to identify diagnostic clues. However, the clinical variables associated with successful localization of the cause by FDG-PET/CT remain uncertain. Moreover, the long-term outcomes of patients with unexplained FUO or IUO after negative FDG-PET/CT results are unknown. Therefore, we assessed predictors of successful diagnosis of FUO or IUO caused by FDG-PET/CT and associations of spontaneous remission of symptoms with FDG-PET/CT results. @*Methods@#All patients with FUO or IUO, who underwent FDG-PET/CT from 2013 to 2019 because diagnostic work-up failed to identify a cause, were retrospectively included. We calculated the diagnostic yield and performed multivariable logistic regression to assess characteristics previously proposed to be associated with successful localization of FUO or IUO causes. We also assessed whether the FDG-PET/CT results were associated with spontaneous remissions. @*Results@#In total, 50 patients with diagnostically challenging FUO or IUO (35 with FUO and 15 with IUO) were assessed. Other than one case of infection, all the identified causes were either malignancy or non-infectious inflammatory diseases (each with 18 patients), and FDG-PET/ CT correctly localized the cause in 29 patients (diagnostic yield = 58%). None of the proposed variables was associated with successful localization. All 13 patients with sustained unexplained cause remained alive (median follow-up, 190 days). Spontaneous remission was observed in 4 of 5 patients with a negative FDG-PET/CT, and 1 of 8 with a positive result (P = 0.018). @*Conclusion@#In the current cohort, the proposed variables were not predictive for successful localization by FDG-PET/CT. A negative FDG-PET/CT scan may be prognostic for spontaneous remission in patients with sustained FUO or IUO.

Predictors of Diagnostic Contributions and Spontaneous Remission of Symptoms Associated with Positron Emission Tomography with Fluorine-18-Fluorodeoxy Glucose Combined with Computed Tomography in Classic Fever or Inflammation of Unknown Origin:a Retrospective Study

Background@#In patients with fever or inflammation of unknown origin (fever of unknown origin [FUO] or inflammation of unknown origin [IUO], respectively), expert consensus recommends the use of positron emission tomography with fluorine-18-fluorodeoxy glucose combined with computed tomography (FDG-PET/CT) when standard work-up fails to identify diagnostic clues. However, the clinical variables associated with successful localization of the cause by FDG-PET/CT remain uncertain. Moreover, the long-term outcomes of patients with unexplained FUO or IUO after negative FDG-PET/CT results are unknown. Therefore, we assessed predictors of successful diagnosis of FUO or IUO caused by FDG-PET/CT and associations of spontaneous remission of symptoms with FDG-PET/CT results. @*Methods@#All patients with FUO or IUO, who underwent FDG-PET/CT from 2013 to 2019 because diagnostic work-up failed to identify a cause, were retrospectively included. We calculated the diagnostic yield and performed multivariable logistic regression to assess characteristics previously proposed to be associated with successful localization of FUO or IUO causes. We also assessed whether the FDG-PET/CT results were associated with spontaneous remissions. @*Results@#In total, 50 patients with diagnostically challenging FUO or IUO (35 with FUO and 15 with IUO) were assessed. Other than one case of infection, all the identified causes were either malignancy or non-infectious inflammatory diseases (each with 18 patients), and FDG-PET/ CT correctly localized the cause in 29 patients (diagnostic yield = 58%). None of the proposed variables was associated with successful localization. All 13 patients with sustained unexplained cause remained alive (median follow-up, 190 days). Spontaneous remission was observed in 4 of 5 patients with a negative FDG-PET/CT, and 1 of 8 with a positive result (P = 0.018). @*Conclusion@#In the current cohort, the proposed variables were not predictive for successful localization by FDG-PET/CT. A negative FDG-PET/CT scan may be prognostic for spontaneous remission in patients with sustained FUO or IUO.

[99m]Tc-MIBI washout rate to evaluate the effects of steroid therapy in cardiac sarcoidosis

We sought to determine the usefulness of the [99m]Tc-MIBI [MIBI] washout rate for the evaluation of steroid therapy in cardiac sarcoidosis [CS]. Eleven CS patients underwent MIBI myocardial SPECT both before and 6 months after initiating steroid therapy. The washout rate [WOR] of MIBI was calculated using early and delayed polar map images. The washout score [WOS] of MIBI was derived from the difference between the early and delayed total defect scores [TDS]. Serum ACE and BNP exhibited significant improvement after the therapy [p = 0.004, p = 0.045]. In the LV function, EDV and E/A ratio exhibited significant improvement after the therapy [p = 0.041, p = 0.007], while there were no significant differences between before and after therapy in EF or ESV. Early and delayed TDS showed no significant differences between before and after the therapy. In contrast, WOR differed significantly [p < .0001], while WOS did not differ significantly between before and after the therapy. The washout rate of MIBI is suitable for assessment of cardiac function in CS with steroid therapy, being especially better than the washout score of MIBI for assessment of disease activity of mild myocardial damage in CS with steroid therapy

Role of ¹²³I-BMIPP and serum B-type natriuretic peptide for the evaluation of patients with heart failure

<p><b>INTRODUCTION</b>Myocardial scintigraphy with ¹²³I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (¹²³I-BMIPP) is used to evaluate impaired fatty acid metabolism. B-type natriuretic peptide (BNP), which is secreted by the ventricular myocardium on stretching and/or pressure overload, is a useful cardiac biomarker. This study aimed to evaluate the usefulness of ¹²³I-BMIPP imaging and serum BNP levels in patients with heart failure (HF).</p><p><b>METHODS</b>113 patients with HF were enrolled. There were 68 patients with ischaemic heart disease (IHD) and 22 with overt HF. Cardiac scintigraphy was performed 7 ± 3 days after admission, and heart-to-mediastinum (H/M) count ratios on early and delayed images and washout rates (WR) of ¹²³I-BMIPP were recorded. Serum BNP levels were recorded on the day of ¹²³I-BMIPP imaging. The ejection fraction (EF) was calculated just before cardiac scintigraphy using conventional echocardiography.</p><p><b>RESULTS</b>The mean BNP level and EF were 282 pg/mL and 47%, respectively, with significant correlation between them. The mean H/M count ratios on early and delayed images were 2.29 and 1.93, respectively, showing significant positive correlations with EF (r = 0.31, p = 0.0006). The WR was significantly correlated with EF (r = -0.36, p < 0.0001) and BNP levels (r = 0.33, p = 0.003), and mean WR was significantly higher in patients with overt HF compared to those without (p < 0.001). Patients with IHD had significantly higher EFs than those with non-IHD (p = 0.03).</p><p><b>CONCLUSION</b>The evaluation of impaired myocardial metabolism using ¹²³I-BMIPP scintigraphy and serum BNP levels appears to be useful for the evaluation of severity of HF.</p>

Establishment of "Fujita–style" problem–based learning with an emphasis on the use of a monitoring room to support tutors / 医学教育

1)We reproduced a problem–based learning (PBL) tutorial at our school and developed our own PBL tutorial, which we call "Fujita–style PBL." This is a clinical problem-solving type of PBL, in which both a monitoring room and small–group learning rooms are used.<br>2)To maintain the present number of PBL lessons despite the limited number of tutors, one tutor supervises several groups simultaneously. Coordinators observe the progress of PBL from a monitoring room and support the tutors.<br>3)Students learn the given scenario and identify their learning issues. After they study the learning issues by themselves, the students return to tutorials to explain their learning issues. Thereafter, each group's findings are presented to the groups supervised by one tutor.

The influence of motor learning on automatized levels of upper and lower limbs. A comparison between soccer and basketball players / 体力科学

A study was conducted to investigate the influence of motor learning on functional specialization of the upper and lower limbs by comparing automatized levels in upper and lower limb movements between 17 soccer (S group) and 14 basketball (B group) players at a university. They carried out transitory palmar flexion of both hands while stepping and performing alternate flexion-extension movements of both ankle joints, and transitory plantar flexion of both feet while performing alternate flexion-extension movement of both shoulder joints and both wrist joints. The automatized levels of the upper and lower limb movements were evaluated by the degree of interference between the upper and lower limb movements.<BR>It was shown that automatization of lower limb movements was more advanced than that of upper limb movements in both groups. The automatized levels of stepping in the S and B groups showed no significant difference, and were similar to those of university students in general obtained in our previous study. However, the automatized levels of ankle joint movements in both groups were higher than those for university students in general.<BR>In both groups, the insertion of transitory palmar flexion was restricted to within the phase where the degree of interference was small during the stepping and ankle joint movement. However, this tendency was not clear in the trial where transitory plantar flexion was superimposed on shoulder joint and wrist joint movements.<BR>As for the difference between the groups, the S group showed a higher automatized level of ankle joint movement than the B group. On the other hand, the B group showed higher automatized levels of both upper limb movements than the S group, and this tendency was especially evident for shoulder joint movement.<BR>These results suggest that the change in the automatized level of upper and lower limb movements by specific motor learning is added to the functional specialization of the upper and lower limbs acquired by daily basic motor learning in an upright position.

Effects of a sagittal position of the body gravity center and manual weight-load on postural control during rapid arm-lifting / 体力科学

A study was conducted to investigate the effects of a sagittal position of the body gravity center (GCP) and manual weight-load on postural control during rapid arm-lifting. The subjects were five males aged 21 to 36 years. They stood on a force plate while maintaining the GCP at 30%, 45% and 60% from the heel, regarding the fool length as 100%, and anteriorly lifted both arms spontaneously as rapidly as possible. These trials were carried out ten times under a 5 kg weight or no weight. EMGs of the biceps femoris muscle (BFM) and anterior deltoid muscle (ADM), the fluctuation of the center of foot pressure (CFP) and body motion were analyzed by focusing on their time sequences.<BR>At 45% and 60% GCP the BFM action started prior to the ADM action, whereas at 30% GCP it tended to lag behind. The lag times under no weight were 13.9±12.75 ms (mean±SD) at 30% GCP, -32.7±18.18 ms at 45% GCP and -46.0±19.40 ms at 60% GCP. Those under 5 kg weight were 15.0±11.40 ms at 30% GCP, -22.0±6.74 ms at 45% GCP and -28.9±7.63 ms at 60% GCP. These results indicate that the anticipatory action of the muscle related to postural control arises only at specific GCPs.<BR>The difference of starting points for BFM action to ADM action showed no significant difference between 45% and 60% GCP for either as 5 kg or no weight. The CFP position moving in a forward direction during arm-lifting showed a marked difference between 45% and 60% GCP. The time for arm-lifting showed a marked difference between 5 kg and no weight. These results suggest that the starting point of anticipatory muscle action related to postural control does not change according to the magnitude and time course of the distance to the body equilibrium as a result of arm-lifting.

Interference of upper limbs exercise to the periodic lower limbs exercise with different automatized levels / 体力科学

The voluntary exercises consist of different automatized levels and are mostly a combination of the upper limbs and the lower limbs exercises.<BR>This study was to examine the interference of the upper limbs exercise to the periodic lower limbs exercise with different automatized levels. Seven male university students, aged 19 and 20 yrs., served as subjects. The periodic lower limbs exercises were the stepping (walking on the place) and the alternate plantar-flexion of the right and left foot while standing. The frequencies of the lower limbs exercises were 120, 160 and 200 times/min, The stepping, which is similar to the motion of the lower limbs in walking or running, may be performed more frequently in daily life than the plantar-flexion in which only the ankle angle was changed. Therefore, we assume that the stepping is a higly automatized exercise compared with the plantar-flexion. Upper limbs exercise, which was combined with the lower limbs exercise, was the simultaneous tapping of one time by both hand. The interference degree was evaluated by the change of step intervals of the lower limbs exercise. The results were:<BR>1) The fluctuation of step intervals on the plantar-flexion was greater than the fluctuation on the stepping and the smallest in the frequency 120 compared with that in the other frequencies.<BR>2) When the tapping was combined with the lower limbs exercises, one step interval at that time was lengthened and one step interval immediately before the tapping was shortened. This change of step intervals was greater in the plantar-flexion than that in the stepping. The change in the plantar-flexion was the smallest in the frequency 120 compared with that in the other frequencies.<BR>The above mentioned findings suggest that the automatized level of the lower limbs exercise can be clearly evaluated by the interference degree of the upper limbs exercise to the periodic lower limbs exercise.

Effects of salt intake on the body in exercise / 体力科学

This study was to examine the effects of quantity of taking salt diet on the body during exercise. The subjects were made to do endurance exercise on each after intake of the moderate-salt diet, the much-salt diet and a little-salt diet in a fixed duration.<BR>The results were obtained as follows:<BR>1) Under the much-salt diet intake, responce of systolic blood pressure and heart rate showed small increment during the exercise.<BR>2) Under a little-salt diet intake, the CK-MB/CK ratio showed large increment during exercise.<BR>3) Under the much-salt diet intake, serum BUN values were decreased compared with under the other diets. Under a little-salt diet intake, serum BUN, Uric Acid and Triglycerides values were increased, on the contrary serum Glucose values were decreased in resting condition. Especially, under a little-salt diet intake, serum BUN values were increased during the exercise.<BR>4) The value of urinary sodium excretion was varied in response to the intake of salt. The value of urinary potassium excretion showed no change under the much-salt diet intake. But it showed decrease under a little-salt diet intake.<BR>5) Under a little-salt diet intake, the creatinine clearance values were decreaced during and after the exercise.<BR>The above mentioned findings suggested that the change of salt intake itself may become a stressor to the body and it is necessary to pay much attention when we exercise under these condition.

A basic study for establishing a suitable exercise prescription with long distance walking. II / 体力科学

The present study was performed to investigate the effects of 120 km walking, 40 km a day for 3 successive days on the condition that taking rest and foods freely, upon physical functions for healthy male and female subjects. All measurements were enforced at postabsorptive state early in the morning for the 10 successive days including the days of walking. Blood pressure, heart rate, and body weight were measured every morning. Blood samplings enforced, too. Urine collections were enforced from first day to 7 th day. The results obtained were as follows;<BR>1) There were no changes in heart rate, blood pressure, and body weight, which were measured early in the morning, before and after 120 km walking.<BR>2) Serum GOT and GPT activities had little changes, while serum LDH, α-HBDH, and CK activities increased gradually after walking.<BR>3) Serum CK-MB activities, which indicate myocardial injury, increased after walking, on the contrary CK-MB/CK ratio decreased. It was suggested that effects of 120km walking to myocardium were rather than slight ones.<BR>4) In spite of the same sorce in which serum CK-MB and LDH-1 were resulted, both did'nt exhibit same patterns in serum.<BR>5) Serum lipids decreased gradually after walking.<BR>6) Urinary excretion of creatinine and uric acid increased after 120km walking especially.<BR>7) If it is allowed to take sufficient foods and rest, 120km walking, 40km a day for 3 successive days, would not result in such a physical stress over the following days.

EFFECTS OF TAURINE ON THE METABOLISM WITH EXERCISE (III) THREE KILOMETER RUNNING IN MIDDLE AGED MALES AND FEMALES / 体力科学

Effects of taurine on the functions of the body and metabolism with 3km running upon taking a diet, which is constituted of lowest possible amount of carbohydrate and highest possible amount of fat and protein, were investigated in 25 male and female subjects of age thirties by double blind test method. The results were as follows<BR>1) Taurine administration (T. A.) proved to inhibit the degree of increase in heart rate and increase the maximal degree of pulse pressure in response to 3 km running.<BR>2) T. A. proved to inhibit the degree of increase in serum creatine kinase isozyme MB (CK-MB) activities and CK-MB/CK ratio.<BR>3) T. A. proved to inhibit the decrease of serum total protein values immediately before running and in the following morning. Similar trends in terms of the particuler times were observed, too, in the case of the degree of decrease of serum triglycerides values.<BR>4) T. A. seemed to accelerate the utilization of saturated fatty acids especially.<BR>5) Three kilometer running seemed to increase in serum taurine concentrations from several hours after running to the morning immediately after running.

EFFECT OF TAURINE ON THE METABOLISM WITH EXERCISE (II) / 体力科学

Effects of 5 km running upon taking a low-carbohydrate, high-fat and protein diet on the body, in fourteen healthy young males and three healthy young females, all being affected by taurine inducement, were investigated by double blind test method. The results obtained were as follows ;<BR>1) As to the degree of in heart rate upon 5 km running, in males, there were no differences between taurine administration group (M-group) and placebo administration group (P-group) . But in females, recordings in P-group were much larger than those of M-group.<BR>2) As to the degree of increase in systolic blood pressure upon 5 km running, in males, no differences between both groups were observed, but in females, recordings in P-group were larger than those of M-group.<BR>3) Both serum creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) activities did not recover to pre-exercise levels during 3 days after 5 km running in both groups of both sexes.<BR>4) In the rate of CK-MB against CK, not only P-group of females had extraordinary high levels immediately after 5 km running, but also P-group of both sexes had higher levels on 3rd and 5th day after 5 km runnning than M-group.<BR>5) In both sexes P-group was larger than M-group in the degree of increase in blood lactate and serum triglyceride levels.<BR>6) As to the changes in serum total protein levels, in males, no differences between both groups were observed, but in females, P-group had extraordinary low levels on 1st day after 5 km running and maintained low levels during 5 days recovery.<BR>7) As to the changes in both serum total fatty acids levels and the rate of unsaturated fatty acids against total fatty acids, no differences were observed between both groups of both sexes.<BR>8) As to the degree of increase in plasma noradrenalin and adrenalin levels, in males, no differences between both groups were observed, but in females, recordings in M-group were larger than those of P-group.