Evaluation of image quality in portal imaging using a combination of a storage phosphor plate and diagnostic cassette.

It is useful to utilise a computed radiography system with a combination of storage phosphor plates and therapy cassettes for portal images. However, the therapy cassette has some disadvantages. The objective of the present study was to determine whether the disadvantages of a diagnostic cassette could be overcome to obtain clinically useful portal images. A storage phosphor plate has 0.3 mm of lead foil on the distal surface to reduce backscattered radiation. When the plate is reversed, the lead foil acts as a front intensifying screen, similar to the metal plate of a therapy cassette. We reversed a combination of the diagnostic cassette and storage phosphor plate and obtained portal images of the contrast-detail phantom and the Rando phantom (The Phantom Laboratory, Salem, NY) using three types of cassettes: a reversed diagnostic cassette, a therapy cassette and a diagnostic cassette. The image quality was subjectively evaluated. The Friedman and Wilcoxon tests were applied for statistical analyses. Evaluation of images for the contrast-detail phantom revealed that the reversed diagnostic cassette was inferior to the therapy cassette and superior to the diagnostic cassette, and that the differences were significant (p<0.017). There was no significant difference between the reversed diagnostic cassette and therapy cassette (p>0.05) for the Rando phantom. Portal images obtained using the reversed diagnostic cassette were of sufficiently high quality for clinical use as determined by Rando phantom studies.

Promotion of medial collateral ligament healing using a high-voltage electrical field.

PURPOSE: To assess the biomechanical and histological effects of a high-voltage electrical field on ligament healing. METHODS: 54 male Wistar rats were used. The medial collateral ligaments (MCLs) of 6 rats were measured for normal biomechanical failure load and stiffness. MCLs of the remaining 48 rats were transected and randomly assigned; half were subjected to a high-voltage electrical field for 8 hours a day (experimental group), and the other half were kept under normal conditions (control group). Eight rats from each group were killed 2, 4, and 6 weeks after the transection and their MCLs were tested biomechanically and histologically. RESULTS: Failure load and stiffness of the MCLs in the experimental group were significantly higher than those in the control group 2 weeks after transection, but not thereafter. At week 2, the granulation tissue completely occupied the space between the cut ends of the MCL in the experimental group, whereas some gaps remained in the control group. CONCLUSION: A high-voltage electrical field appear to accelerate ligament healing in the initial 2 weeks. Earlier initial healing may allow earlier start of the rehabilitation.

High-dose rabeprazole-amoxicillin versus rabeprazole-amoxicillin-metronidazole as second-line treatment after failure of the Japanese standard regimen for Helicobacter pylori infection.

BACKGROUND: There is currently no optimal second-line treatment after failure of Helicobacter pylori triple therapy. AIM: To determine effective salvage therapy after failure of lansoprazole-amoxicillin-clarithromycin. METHODS: After failure of lansoprazole-amoxicillin-clarithromycin 123 out-patients were randomized to receive either 2-week rabeprazole (20 mg b.d.) + amoxicillin (1000 mg b.d.) (RA group) or 1-week rabeprazole (10 mg b.d.) + amoxicillin (750 mg twice b.d.) + metronidazole (250 mg b.d.) (RAM group). Eradication was assessed by the 13C-urea breath test. We also evaluated cytochrome p450 (CYP) 2C19 genotype status, determined by polymerase chain reaction - restriction fragment length polymorphism, and susceptibility to clarithromycin and metronidazole. RESULTS: On an intention-to-treat basis, H. pylori infection cure was achieved in 37 of 63 (59%) patients in the RA group and in 49 of 60 (82%) patients in the RAM group. Per protocol-based eradication rates in the RA and RAM groups were 66% (37/56) and 88% (49/56), respectively. In both analytic sets there were significant differences between the treatment groups (P < 0.01 in each). Mild adverse events were observed in eight and five patients from the RA and RAM groups, respectively. Genetic predisposition of CYP2C19 and antibiotic resistance did not influence the treatment outcome either regimen. CONCLUSIONS: The rabeprazole + amoxicillin + metronidazole therapy yielded satisfactory results. In contrast, the cure rate in high-dose rabeprazole + amoxicillin was below an acceptable level.

Micronutrient status and glutathione peroxidase in bedridden patients on tube feeding.

Deficiency of micronutrients, especially selenium, is common in critically ill patients. We investigated the micronutrient status (selenium, zinc, copper and manganese) and glutathione peroxidase (GSH-Px) activity in 30 tube-fed patients and 21 hospitalized non-tube-fed control patients. Serum levels of selenium, copper and manganese in tube-fed patients were significantly lower than in control patients (selenium: 4.85+/-1.38 microg/dl versus 8.67+/-1.45 pg/dl; copper: 44.7+/-36.9 microg/dl versus 92.1+/-21.2 microg/dl; manganese 0.59+/-0.41 microg/dl versus 1.52+/-0.59 microg/dl). However, zinc and log GSH-Px in the serum were similar in the two groups. Serum selenium concentration correlated with the daily intake of selenium in tube-fed patients, but zinc, copper and manganese concentrations did not correlate with the daily intake of the respective trace elements in tube-fed patients. Blood GSH-Px activity correlated positively with serum selenium concentrations in the control patients, but not in tube-fed patients. These results demonstrate that selenium content of enteral feed appears to be insufficient to maintain normal serum levels in elderly bedridden patients. Our findings emphasize the importance of monitoring micronutrient status in patients on enteral feeding to avoid trace element deficiencies.

Effect of soymilk consumption on serum estrogen and androgen concentrations in Japanese men.

Soy consumption has been associated with a reduced risk of prostate cancer. The mechanism for this association may involve the effect of soy on the endocrine system. We conducted a randomized dietary intervention study to determine the effects of soy consumption on serum levels of steroid hormones in men. Thirty-five men were randomly assigned to either a soymilk-supplemented group or a control group. The men in the soy-supplemented group were asked to consume 400 ml of soymilk daily for 8 weeks. The men in the control group maintained their usual diet. Blood samples were obtained just before the initiation of the dietary period and thereafter every two weeks for 12 weeks. Changes in hormone concentrations were analyzed and compared between the two groups using the mixed linear regression model against weeks from the start of the dietary period. The mean (SD) soymilk intake estimated from dietary records during the dietary study period was 342.9 (SD, 74.2) ml in the soymilk-supplemented group. There was a significant difference between the two groups in terms of changes in serum estrone concentrations, which tended to decrease in the soy-supplemented group and increase in the control group over time. None of the other hormones measured (estradiol, total and free-testosterone, or sex hormone-binding globulin) showed any statistical difference between the two groups in terms of patterns of change. The results of the study indicate that soymilk consumption may modify circulating estrone concentrations in men.

Ascorbic acid improves postischemic vasodilatation impaired by infusion of soybean oil into canine iliac artery.

This study was conducted to (a) assess postischemic vasodilatation by changes in the vascular cross-sectional area using simultaneous intravascular two-dimensional and Doppler ultrasound before and after the infusion of Intralipid (Pharmacia & Upjohn, Peapack, NJ, U.S.A.); (b) evaluate how antioxidant ascorbic acid modifies the effects of Intralipid on postischemic vasodilatation: and (c) clarify the changes in plasma nitrite and nitrate (NOx-) levels after the infusion of Intralipid with and without ascorbic acid. Twenty-eight mongrel dogs were used to measure for vascular cross-sectional area and average instantaneous peak velocity in the iliac arteries after the 5-min occlusion of the arteries. Postischemic vasodilatation was impaired after the infusion of Intralipid (20%, 2 ml/kg) and this impaired response was reversed by the co-administration of ascorbic acid (30 mg/kg). NG-monomethyl-L-arginine completely abolished postischemic vasodilatation. Plasma NOx levels were significantly reduced after the infusion of Intralipid compared with baseline (11.6+/-0.4 vs. 12.9+/-0.3 microM, p = 0.025) and after infusion of Intralipid with ascorbic acid compared with baseline (11.8+/-0.5 vs. 13.1+/-0.4 microM, p = 0.047). We concluded that ascorbic acid reverses the endothelial dysfunction induced by Intralipid without increasing plasma NOx- levels and that deactivation of nitric oxide by oxidative stress is a primary contributor to Intralipid-induced impaired vasodilation.

Diffuse noxious inhibitory controls in anti-nociception produced by acupuncture and moxibustion on trigeminal caudalis neurons in rats.

Numerous studies have demonstrated that acupuncture and moxibustion induce analgesic effects. This study examined whether diffuse noxious inhibitory controls (DNIC) participated in acupuncture and moxibustion induced-analgesia. Single unit extracellular recordings from neurons in the trigeminal nucleus caudalis of urethane-anesthetized Wistar rats were obtained with a glass micropipette. A total of 52 single units, including 36 wide dynamic range (WDR), 5 nociceptive specific (NS) and 11 low-threshold mechanoreceptive (LTM) units were examined. During noxious test stimulation (cutaneous pinch or electrical stimulation), acupuncture, moxibustion or pinch stimulation was applied as the conditioning stimulus to the remote area of the receptive fields. When the conditioning stimulation induced rapid suppression of noxious receptive field stimulation response, examination revealed that various areas of the entire body were affected and suppression increased in an intensity-dependent manner. These features resemble DNIC phenomena. The suppression was observed on both WDR and NS neurons but not on LTM neurons. Eight of 16 WDR neurons examined were inhibited by acupuncture, five of 14 by moxibustion, and seventeen of 21 by pinching stimulation. Of the NS neurons, one of 2 units examined was suppressed by acupuncture, one of 2 by moxibustion, and two of 3 by pinch stimulation. Pinch stimulation induced the most profound suppression followed by manual acupuncture. Moxibustion induced moderate suppression with a long induction time. These results suggest that DNIC may be involved in the analgesic mechanism of acupuncture and moxibustion.

Effect of intrarectal prostaglandin E2 analogue (enprostil) on trinitrobenzenesulphonic acid-induced colitis in rats.

Prostaglandins exert a protective effect on colonic mucosa in experimentally induced colitis. This study investigated the effect of enprostil, a prostaglandin E2 (PGE2) analogue, on trinitrobenzenesulphonic acid (TNBS)-induced colitis in rats. Each rat received a rectal enema containing TNBS (30 mg), followed 24 h later by intrarectal once-daily enprostil (200 microg). Enprostil-treated and control rats were killed on day 3 (enprostil group, n = 5; control, n = 6) or day 10 (enprostil group, n = 5; control, n = 5) after TNBS treatment. The area of damaged mucosa of the colon was measured relative to the total colonic area. We also determined the macroscopic score of mucosal damage, and measured PGE2, 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha) and thromboxane B2 (TXB2) concentration in portal vein blood samples. Enprostil significantly reduced both the area of damaged mucosa (including the ulcer area) and the macroscopic score after 3 days' treatment compared with control. Similarly, enprostil significantly reduced plasma concentration of PGE2, 6-keto-PGF1alpha and TXB2 during the acute phase at day 3 of treatment compared with control, but not at day 10. These results suggest that PGE2 enema may have therapeutic potential for treating patients with proctitis or left-sided colitis.

Response characteristics of nucleus submedius neurons to colo-rectal distension in the rat.

The effects of colorectal distension (CRD) were examined on neurons located in and around the nucleus submedius (Sm) in the medial thalamus of urethane-anesthetized rats. A total of 66 units (49 in the Sm and 17 in immediately surrounding regions) responding to cutaneous pinch were tested to examine their responsiveness to the CRD. All the neurons that responded to cutaneous stimulation were nociceptive specific (NS) neurons. Based on their responses to the CRD the Sm neurons were classified into three types as follows: 23 (47%) of 49 neurons in the Sm and three (18%) of 17 neurons near the Sm had tonic excitatory responses with long-lasting after-discharges (type I); nine (18%) Sm neurons and four (24%) peri-Sm neurons were tonically excited but had no after-discharge (type II); and seven (14%) Sm neurons were inhibited (type III). Ten (20%) Sm neurons and 10 (59%) peri-Sm neurons did not respond to CRD. All the excitatory and inhibitory responses to CRD increased with increasing CRD pressure. Simultaneous application of CRD and cutaneous pinch did not produce a reduced response (nocigenic inhibition). These results demonstrate that most of the Sm neurons receive convergent viscerosomatic inputs from the colon and/or rectum and from the skin, suggesting that the Sm may participate in visceral nociception.

Sequential alterations of [3H]rolipram and [3H]cyclic adenosine monophosphate binding in the gerbil brain following transient cerebral ischemia.

We examined the sequential alterations in the binding of selective cyclic adenosine monophosphate (cAMP)-phosphodiesterase (PDE) and cAMP-dependent protein kinase (cAMP-DPK) in the gerbil brain following transient cerebral ischemia using in vitro quantitative autoradiography. [3H]Rolipram, a cAMP-PDE inhibitor, and [3H]cAMP were used to label cAMP-PDE and cAMP-DPK, respectively. Gerbils were subjected to 2-min or 6-min ischemia. Two-minute ischemia, which caused no morphological neuronal damage, produced no significant changes in either [3H]rolipram or [3H]cAMP binding throughout the recirculation period. The reduction of [3H]rolipram binding in the CA1 subfield of the hippocampus began 6 h after 6-min ischemia. Seventy percent of [3H]rolipram binding was preserved at 4 days, at which time almost all CA1 pyramidal cells had been destroyed. On the other hand, the reduction of [3H]cAMP-binding sites in the CA1 subfield began 1 day after 6-min ischemia. At 4 days, 47% of [3H]cAMP-binding sites in the CA1 subfield were preserved. Furthermore, we observed a transient reduction of [3H]cAMP binding in the dentate gyrus, which is resistant to ischemia, at 1 day and 4 days. These results indicate that marked alterations of cAMP-PDE and cAMP-DPK precede neuronal death in the hippocampal CA1 subfield, and the dentate gyrus also showed a transient alteration of cAMP-DPK.

[Clinical studies of long acting amoxicillin in oral surgery].

Clinical studies with long acting amoxicillin (L-AMPC) have been carried out and the following results were obtained. 1. Forty-two patients with acute bacterial infections in the oral region were administrated orally L-AMPC at a daily dose of 1 gram. The clinical results obtained were classified as excellent in 3 cases, good in 28 cases, and the overall efficacy was 75.6%. 2. The antibacterial activity of AMPC was determined for 66 strains isolated from patients with oral infections. Of the strains tested, Gram positive cocci showed high sensitivity with MIC's less than 1.56 mcg/ml, while the sensitivity of PC resistance strains of S. aureus, K. pneumoniae and P. vulgaris was lower. 3. There was 1 case of transaminase elevation in the laboratory finding. 4. Five patients reported the following side effects, eruption 3, diarrhea 2, nausea 1, anorexia 1 and malaise 1. From the results of the present study, it is considered that L-AMPC is a useful antibiotic in the treatment of acute bacterial infections in oral region.