Successful transcatheter arterial embolization for a massive hemothorax caused by acupuncture.

Acupuncture is an alternative treatment for a variety of diseases, and serious complications are rare. We report a case of transcatheter arterial embolization performed in a patient with a massive hemothorax after acupuncture treatment. A 36-year-old woman with no previous medical history was admitted to our hospital with left back pain and respiratory distress after acupuncture treatment. Contrast-enhanced computed tomography showed a left hemothorax and leakage of contrast medium, which was considered to result from an injury to the second intercostal artery, caused by acupuncture treatment. Transcatheter arterial embolization successfully stopped the bleeding, and the hematoma was thoracoscopically removed. No rebleeding was observed 6 months after treatment.

Impact of Green Tea Catechin Ingestion on the Pharmacokinetics of Lisinopril in Healthy Volunteers.

Lisinopril, a highly hydrophilic long-acting angiotensin-converting enzyme inhibitor, is frequently prescribed for the treatment of hypertension and congestive heart failure. Green tea consumption may reduce the risk of cardiovascular outcomes and total mortality, whereas green tea or its catechin components has been reported to decrease plasma concentrations of a hydrophilic ß blocker, nadolol, in humans. The aim of this study was to evaluate possible effects of green tea extract (GTE) on the lisinopril pharmacokinetics. In an open-label, randomized, single-center, 2-phase crossover study, 10 healthy subjects ingested 200 mL of an aqueous solution of GTE containing ~ 300 mg of (-)-epigallocatechin gallate, a major catechin component in green tea, or water (control) when receiving 10 mg of lisinopril after overnight fasting. The geometric mean ratio (GTE/control) for maximum plasma concentration and the area under the plasma concentration-time curve of lisinopril were 0.289 (90% confidence interval (CI) 0.226-0.352) and 0.337 (90% CI 0.269-0.405), respectively. In contrast, there were no significant differences in time to reach maximum lisinopril concentration (6 hours in both phases) and renal clearance of lisinopril (57.7 mL/minute in control vs. 56.9 mL/minute in GTE). These results suggest that the extent of intestinal absorption of lisinopril was significantly impaired in the presence of GTE, whereas it had no major effect on the absorption rate and renal excretion of lisinopril. Concomitant use of lisinopril and green tea may decrease oral exposure to lisinopril, and therefore result in reduced therapeutic efficacy.

Effects of single green tea ingestion on pharmacokinetics of nadolol in healthy volunteers.

AIMS: The aim of this study was to investigate the effects of a single green tea (GT), administered concomitantly or 1 hour before nadolol intake on nadolol pharmacokinetics. METHODS: In a randomized 3-phase crossover study, 11 healthy volunteers received an oral administration of nadolol with, or 1 hour after preingestion of brewed GT, or with water in a volume of 150 mL. RESULTS: Geometric mean ratio with 90% confidence interval for nadolol AUC0-48 was 0.371 (0.303-0.439) with concomitant GT. In addition, ingestion of GT 1 hour before nadolol administration resulted in a significant reduction of nadolol AUC0-48 with geometric mean ratio of 0.536 (0.406-0.665). There were no differences in time to maximal plasma concentration and renal clearance of nadolol among groups. CONCLUSION: These results suggest that single concomitant ingestion of GT substantially decreases plasma concentrations of nadolol. Moreover, the reduction in nadolol bioavailability could persist for at least 1 hour after drinking a cup of GT.

Factors associated with the size of the adhesio interthalamica based on 3.0-T magnetic resonance images.

BACKGROUND: Adhesio interthalamica (AI) is a small structure connecting bilateral thalami. PURPOSE: To evaluate the effects of patient age, sex, and lateral diameter of the third ventricle on the long diameter of the AI using multivariate analyses based on magnetic resonance (MR) images obtained with 3.0-T scanners. MATERIAL AND METHODS: This clinical retrospective study included images of 153 patients who underwent MR examination using 3.0-T scanners. The long diameter of the AI and lateral diameter of the third ventricle were measured on images in the mid-sagittal plane and axial plane at the anterior commissure, respectively. Univariate and multivariate analyses were performed. RESULTS: AI was observed in 138 patients (70 men, 68 women; mean age = 63.7 ± 13.7 years; mean AI size =5.34 ± 1.63 mm). By univariate analyses, patient age (r = -0.262, P = 0.002), sex ( P = 0.010), and lateral diameter of the third ventricle (r = -0.642, P < 0.001) were significantly associated with the long diameter of the AI. With multiple linear regression analyses with a stepwise selection of parameters, only the lateral diameter of the third ventricle (estimate = -0.432, P < 0.001) was significantly associated with the long diameter of the AI. The lateral diameter of the third ventricle was longer in patients without AI (15 patients) than in those with AI ( P = 0.006). CONCLUSION: The lateral diameter of the third ventricle was a major factor negatively associated with the long diameter of the AI.

Role of (-)-epigallocatechin gallate in the pharmacokinetic interaction between nadolol and green tea in healthy volunteers.

PURPOSE: The aim of the present study is to investigate a possible role of a single dose of (-)-epigallocatechin gallate (EGCG), the major catechin in green tea, for the pharmacokinetic interaction between green tea and nadolol in humans. METHODS: In a randomized three-phase crossover study, 13 healthy volunteers received single doses of 30 mg nadolol orally with water (control), or an aqueous solution of EGCG-concentrated green tea extract (GTE) at low or high dose. Plasma concentrations and urinary excretion of nadolol were determined up to 48 h. In addition, blood pressure and pulse rate were monitored. In vitro transport kinetic experiments were performed using human embryonic kidney 293 cells stably expressing organic anion transporting polypeptide (OATP)1A2 to evaluate the inhibitory effect of EGCG on OATP1A2-mediated substrate transport. RESULTS: Single coadministration of low and high dose GTE significantly reduced the plasma concentrations of nadolol. The geometric mean ratios with 90% CI for area under the plasma concentration-time curves from 0 to infinity of nadolol were 0.72 (0.56-0.87) for the low and 0.60 (0.51-0.69) for the high dose. There were no significant differences in Tmax, elimination half-life, and renal clearance between GTE and water phases. No significant changes were observed for blood pressure and pulse rate between phases. EGCG competitively inhibited OATP1A2-mediated uptake of sulphobromophthalein and nadolol with Ki values of 21.6 and 19.4 µM, respectively. CONCLUSIONS: EGCG is suggested to be a key contributor to the interaction of green tea with nadolol. Moreover, even a single coadministration of green tea may significantly affect nadolol pharmacokinetics.

Lack of pharmacokinetic interaction between fluvastatin and green tea in healthy volunteers.

PURPOSE: The objective of this study is to assess the effects of green tea and its major catechin component, (-)-epigallocatechin gallate (EGCG), on CYP2C9-mediated substrate metabolism in vitro, and the pharmacokinetics of fluvastatin in healthy volunteers. METHODS: The metabolism of diclofenac and fluvastatin in human recombinant CYP2C9 was investigated in the presence of EGCG. In a randomized three-phase crossover study, 11 healthy volunteers ingested a single 20-mg dose of fluvastatin with green tea extract (GTE), containing 150 mg of EGCG, along with water (300 mL), brewed green tea (300 mL), or water (300 mL) after overnight fasting. Plasma concentrations of fluvastatin and EGCG were measured by ultra-performance liquid chromatography with fluorescence detection and a single mass spectrometer. RESULTS: EGCG inhibited diclofenac 4'-hydroxylation and fluvastatin degradation with IC50 of 2.23 and 48.04 µM, respectively. Brewed green tea used in the clinical study also dose-dependently inhibited the metabolism of diclofenac and fluvastatin in vitro. However, no significant effects of GTE and brewed green tea were observed in plasma concentrations of fluvastatin. The geometric mean ratios with 90% CI for area under the plasma concentration-time curve (AUC0-∞) of fluvastatin were 0.993 (0.963-1.024, vs. brewed green tea) and 0.977 (0.935-1.020, vs. GTE). CONCLUSIONS: Although in vitro studies indicated that EGCG and brewed green tea produce significant inhibitory effects on CYP2C9 activity, the concomitant administration of green tea and fluvastatin in healthy volunteers did not influence the pharmacokinetics of fluvastatin.

PEG-poly(L-lysine)-based polymeric micelle MRI contrast agent: Feasibility study of a Gd-micelle contrast agent for MR lymphography.

PURPOSE: To investigate the feasibility of polymeric micelle of poly(ethyleneglycol) (PEG)-b-poly(L-lysine-DOTA) (Gd-micelle) as a contrast agent for magnetic resonance lymphography (MRL). MATERIALS AND METHODS: Twenty-four female BALB/c mice were randomly divided into four groups of six mice each. Among them, mice of two groups were injected of complete Freund's adjuvant to obtain inflamed lymph nodes. We subcutaneously injected 0.5 µmol Gd per mouse of Gd-micelle or gadofluorine P in the right rear footpad. Identical 3D T1 -weighted gradient-echo imaging (1T MRI system) were subsequently obtained to create time-intensity curves of the right popliteal, sacral, and lumbar-aortic lymph nodes and to measure the contrast ratios (CRs). The peak CR, area under the curve (AUC), and elimination half-life (T1/2 ) of CR of the popliteal lymph node were assessed by two-way factorial analysis of variance. We also performed a qualitative assessment of normal and inflamed lymph node at three timepoints. RESULTS: The mean peak CR of Gd-micelle was 2.64 and 1.89 for gadofluorine P in normal mice, and 3.48 and 2.73 in the inflamed lymph node. Statistically, peak CR was higher for Gd-micelle (P = 0.004). In addition, the AUC was larger (P < 0.001) and T1/2 was longer (P < 0.001) for Gd-micelle. In qualitative assessment, Gd-micelle demonstrated the same or higher scores in every lymph node, and demonstrated a higher score in lumbar-aortic lymph node of a 360-minute image (P = 0.006) and in inflamed lymph node of a 360-minute image (P = 0.009). CONCLUSION: Compared to gadofluorine P, Gd-micelle showed higher and more prolonged enhancement in MRL imaging in normal and inflamed lymph nodes. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:238-245.

Group cognitive-behavioral intervention for patients with burning mouth syndrome.

This study was conducted to assess the psychological characteristics of, and determine the effectiveness of group cognitive-behavioral (CB) treatment for, patients with burning mouth syndrome (BMS). The baseline characteristics of 24 female patients (age 69.7 ± 5.9 years) and an identical number of healthy female control subjects (age 69.2 ± 5.5 years) were compared. The patient group had significantly higher anxiety scores (P < 0.05) at baseline. A brief group CB intervention was delivered in a small-group format. Two sessions were planned 6 months apart. A numeric rating scale (NRS) was used to assess pain intensity. Anxiety was evaluated using a state and trait anxiety inventories. Present pain intensity decreased after both the first and second sessions. The session effect was significant (P = 0.02), but no repeat effect was found (P = 0.19). The state anxiety inventory score also decreased after the second session. The session effect was significant (P < 0.01), as was the repeat effect (P < 0.01). The trait anxiety inventory score decreased after the second session, and the session effect was significant (P = 0.013), but the repeat effect was not (P = 0.93). The results suggest that a brief group CB intervention reduces pain intensity and anxiety in patients with BMS.

Association between iron content and gray matter missegmentation with voxel-based morphometry in basal ganglia.

PURPOSE: To show an association between T2-weighted signal intensity (T2-SI) variation and missegmentation in the putamen of healthy adults, using 3.0-tesla magnetic resonance scanner and voxel-based morphomery (VBM). MATERIALS AND METHODS: Contiguous sagittal T1-weighted images and axial T2-weighted images of the brain were obtained from 1380 healthy participants using a 3.0 Tesla (T) MR scanner. After image preprocessing with Statistical Parametric Mapping 5, the association between T2-SI ratio (= A/B, where A is the mean of the T2-SI in the putamen, and B is that in the thalamus) variation and gray matter missegmentation was assessed using VBM. RESULTS: A significant positive correlation was revealed between T2-SI ratio and bilateral putamen volume on the gray matter images. In addition, we found a significant negative correlation between T2-SI ratio and bilateral putamen volume on the white matter images. We consider that these results show the influence of missegmentation. CONCLUSION: To the best of our knowledge, this is the first VBM study to demonstrate an association between T2-SI variation and gray matter missegmentation. These results indicate the possibility that VBM may be more affected by individual differences in iron content levels than by individual differences in tissue volumes if detected-regions with VBM contained substantial iron deposition.

Electrophysiological characteristics of idiopathic ventricular tachycardia in children.

BACKGROUND: Idiopathic ventricular tachycardia (VT) has been reported to have a good prognosis, but there still might be the potential risk of sudden death. METHODS AND RESULTS: The 46 consecutive children (mean age 11.7 ± 3.4 years) with idiopathic VT were enrolled in this study. Monomorphic VT was detected in 39 patients and polymorphic VT in 7 patients. The VT originated from the right ventricle (RV) in 22 patients, and left ventricle (LV) in 17 patients. The VT was induced by exercise in 68% of the RVVT, 41% of the LVVT, and 100% of the polymorphic VT. The VT was induced by programmed ventricular stimulation in 41% of the RVVT, 35% of the LVVT, and none of the polymorphic VT. Adenosine tri-phosphate terminated the VT in 9 of 15 patients (60%). The mechanism of the VT was suspected to be triggered by activity in 36.4%, automaticity in 40.9%, and re-entry in 22.7% of the RVVT, whereas it was 52.9%, 5.9%, and 41.2% of the LVVT, respectively. CONCLUSIONS: The exercise inducibility was higher in polymorphic VT than the RVVT and LVVT, but no difference in the programmed stimulation. The sensitivity to adenosine tri-phosphate was not different between the RVVT and LVVT. In some patients with idiopathic VT, a non-verapamil sensitive re-entry was documented, which was more common in patients with ischemic heart disease or cardiomyopathy.

Tract-specific analysis of the superior occipitofrontal fasciculus in schizophrenia.

Diffusion tensor imaging has been highlighted as a non-invasive tool to explore neural connectivity in vivo. Several studies have suggested disorganization of the neural network (circuitry) including the thalamo-prefrontal connection in schizophrenia. Recent research using post-mortem brains showed that the superior occipitofrontal fasciculus (SOFF) fibers extended to the thalamus. We postulated that the SOFF has some relationship with the anatomical structural components of the thalamo-prefrontal circuitry. We quantitatively assessed the diffusion abnormalities of the SOFF using diffusion tensor tractography (DTT) in schizophrenia. Nineteen male patients with schizophrenia and 20 age-matched normal controls were studied. DTT of the SOFF (DTT-SOFF) was visualized using free software (dTV II/VOLUME-ONE), and we performed tract-specific measurement of the fractional anisotropy (FA), then calculated the apparent diffusion coefficient (ADC) of the DTT-SOFF. Tractography and tract-specific analysis of the SOFF were successfully performed in all subjects. All tracts appeared to be connecting the prefrontal area to the thalamus. The mean FA value of patients with schizophrenia [0.376 (S.D. 0.030)] was significantly lower than that of controls [0.432 (S.D. 0.032)], and the ADC value of patients with schizophrenia [0.771 (x10(-3) mm(2)/s) (S.D. 0.041)] was significantly higher than that of controls [0.726 (x10(-3) mm(2)/s) (S.D. 0.027)]. Our results suggest that the so-called SOFF may be a structural component connecting the prefrontal area to the thalamus and that it is deteriorated in schizophrenia.

Diffusion-tensor neuronal fiber tractography and manganese-enhanced MR imaging of primate visual pathway in the common marmoset: preliminary results.

PURPOSE: To investigate whether diffusion-tensor tractography (DTT) of neuronal fibers is useful for delineating the configuration of the neuronal fiber trajectories in the primate visual pathway, including the well-developed optic chiasm, in comparison with tract tracing at manganese-enhanced magnetic resonance (MR) imaging. MATERIALS AND METHODS: The handling methods used for all the animals in this study were approved by the institutional committee for animal experiments. Diffusion-tensor MR imaging was performed in four healthy common marmosets, and in two of these animals, manganese-enhanced MR imaging tract tracing was performed by using a 7.0-T MR imaging unit. The visual pathways were quantitatively investigated in terms of the manganese distribution observed on the manganese-enhanced MR images. The images obtained with DTT and manganese-enhanced MR imaging tract tracing were qualitatively compared, and the features of the visual pathway were verified through fusion of the reconstructed images obtained by using these two modalities. RESULTS: DTT provided information regarding the neuroanatomic features of the marmoset visual pathway and revealed the bilateral branching patterns of the typical primate retinogeniculate pathways, although several incorrectly tracked fibers were noted. The distribution of manganese on the manganese-enhanced MR images revealed bilateral innervation of the retinal projections and depicted the layered internal structure of the lateral geniculate nuclei bilaterally, depending on the ocularity of each layer. These morphologic findings were consistent with those of previous histopathologic studies. CONCLUSION: The findings of this preliminary study raise the possibility that DTT is useful for visualizing the neuronal fiber trajectories in primate visual pathways. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/249/3/855/DC1.

Delayed automatic detection of change in speech sounds in adults with autism: a magnetoencephalographic study.

OBJECTIVE: Autism is a form of pervasive developmental disorder in which dysfunction in interpersonal relationships and communication is fundamental. This study evaluated neurophysiological abnormalities at the basic level of language processing, i.e. automatic change detection of speech and non-speech sounds, using magnetoencephalographic recording of mismatch response elicited by change in vowels and tones. METHODS: The auditory magnetic mismatch field (MMF) was evaluated in 9 adults with autism and 19 control subjects using whole-head magnetoencephalography. The MMF in response to the duration change of a pure tone or vowel /a/ and that in response to across-phoneme change between vowels /a/ and /o/, were recorded. RESULTS: The groups were not significantly different in MMF power under any conditions. However, the autism group showed a left-biased latency prolongation of the MMF particularly under the across-phoneme change condition, and this latency delay was significantly associated with greater symptom severity. CONCLUSIONS: These results suggest that adults with autism are associated with delayed processing for automatic change detection of speech sounds. These electrophysiological abnormalities at the earliest level of information processing may contribute to the basis for language deficits observed in autism. SIGNIFICANCE: These results provide the first evidence for delayed latency of phonetic MMF in adults with autism.

Do high or low doses of anxiolytics and hypnotics affect mismatch negativity in schizophrenic subjects? An EEG and MEG study.

OBJECTIVE: Many studies have demonstrated mismatch negativity (MMN) attenuation in schizophrenia. Recently, investigators have shown that GABAergic inhibitory neurons may regulate MMN generation. Considering that a substantial proportion of schizophrenic patients receive anxiolytics and hypnotics that have affinity to GABA(A) receptors to reduce their comorbid symptoms of anxiety and sleep disturbances, we need to assess whether anxiolytics/hypnotics might affect their MMN generation. The aim of this study is to assess the possibility that high or low doses of anxiolytics/hypnotics received by schizophrenic subjects affect their mismatch negativity (MMN), using event-related potentials (ERPs) and magnetoencephalography (MEG). METHODS: Twenty-three and 16 patients with schizophrenia participated in the ERP and MEG studies, respectively. Three types of MMN (MMN in response to a duration change of pure-tone stimuli, within-category vowel change (Japanese vowel /a/ with short versus long duration), and across-category vowel change (vowel /a/ versus /o/)) were recorded. RESULTS: High or low doses of benzodiazepine had no significant effects on MMN amplitude/magnetic MMN power, topography/laterality, or latency under any conditions of the ERP or MEG study. CONCLUSIONS: These results suggest that chronic administration of anxiolytics/hypnotics does not significantly affect MMN in schizophrenia.