Utility of computed tomography and 18 F-fluorodeoxyglucose with positron emission tomography/computed tomography for distinguishing appendiceal mucocele caused by mucinous adenocarcinoma from other pathologies.

AIM: Differentiating appendiceal mucocele with mucinous adenocarcinoma from other pathologies before surgery is difficult. The objective of this study was to evaluate the utility of CT and 18 F-fluorodeoxyglucose (FDG) with positron emission tomography (PET)/CT for differentiating mucinous adenocarcinoma of appendiceal mucocele from other pathologies. METHOD: The study included 25 patients who underwent surgery for clinically diagnosed appendiceal mucoceles detected on CT at the University of Tokyo Hospital. Among these patients, 19 underwent FDG-PET/CT preoperatively. We compared features of the CT imaging findings and maximum standard uptake values (SUVmax ) detected by FDG-PET/CT between mucocele with mucinous adenocarcinoma and other pathologies. RESULTS: A total of 13 men (52%) and 12 women (48%) were included in this study, with a median age of 65 years (range 34-83). There were six patients (24%) with pathologically confirmed mucinous adenocarcinoma, 15 patients (60%) with appendiceal mucinous neoplasm and four patients (16%) with simple mucocele caused by chronic inflammation. On the CT findings, wall irregularity was the only significant feature for the two groups in this study (83.3% vs 0.0%, P < 0.01). There was a significant difference in the SUVmax levels on PET/CT between the two groups (100.0% vs 20.0%, P < 0.01). CONCLUSION: Distinguishing between mucocele with mucinous adenocarcinoma and other pathologies using imaging modalities is challenging. Our results suggest that wall irregularity on CT and elevated SUVmax on PET/CT are useful factors that can be employed for such discrimination.

Oxytocin's neurochemical effects in the medial prefrontal cortex underlie recovery of task-specific brain activity in autism: a randomized controlled trial.

The neuropeptide oxytocin may be an effective therapeutic strategy for the currently untreatable social and communication deficits associated with autism. Our recent paper reported that oxytocin mitigated autistic behavioral deficits through the restoration of activity in the ventromedial prefrontal cortex (vmPFC), as demonstrated with functional magnetic resonance imaging (fMRI) during a socio-communication task. However, it is unknown whether oxytocin exhibited effects at the neuronal level, which was outside of the specific task examined. In the same randomized, double-blind, placebo-controlled, within-subject cross-over clinical trial in which a single dose of intranasal oxytocin (24 IU) was administered to 40 men with high-functioning autism spectrum disorder (UMIN000002241/000004393), we measured N-acetylaspartate (NAA) levels, a marker for neuronal energy demand, in the vmPFC using (1)H-magnetic resonance spectroscopy ((1)H-MRS). The differences in the NAA levels between the oxytocin and placebo sessions were associated with oxytocin-induced fMRI signal changes in the vmPFC. The oxytocin-induced increases in the fMRI signal could be predicted by the NAA differences between the oxytocin and placebo sessions (P=0.002), an effect that remained after controlling for variability in the time between the fMRI and (1)H-MRS scans (P=0.006) and the order of administration of oxytocin and placebo (P=0.001). Furthermore, path analysis showed that the NAA differences in the vmPFC triggered increases in the task-dependent fMRI signals in the vmPFC, which consequently led to improvements in the socio-communication difficulties associated with autism. The present study suggests that the beneficial effects of oxytocin are not limited to the autistic behavior elicited by our psychological task, but may generalize to other autistic behavioral problems associated with the vmPFC.

Propose a wall shear stress divergence to estimate the risks of intracranial aneurysm rupture.

Although wall shear stress (WSS) has long been considered a critical indicator of intracranial aneurysm rupture, there is still no definite conclusion as to whether a high or a low WSS results in aneurysm rupture. The reason may be that the effect of WSS direction has not been fully considered. The objectives of this study are to investigate the magnitude of WSS (|WSS|) and its divergence on the aneurysm surface and to test the significance of both in relation to the aneurysm rupture. Patient-specific computational fluid dynamics (CFD) was used to compute WSS and wall shear stress divergence (WSSD) on the aneurysm surface for nineteen patients. Our results revealed that if high |WSS| is stretching aneurysm luminal surface, and the stretching region is concentrated, the aneurysm is under a high risk of rupture. It seems that, by considering both direction and magnitude of WSS, WSSD may be a better indicator for the risk estimation of aneurysm rupture (154).

Comparison of hemodynamic parameters that can predict an aneurysmal rupture: 20 patient-specific models experiment.

Hemodynamic analysis of cerebral aneurysms is widely performed to understand the mechanism of aneurysmal rupture. Computational fluid dynamics (CFD) studies have suggested that several hemodynamic parameters are associated with such ruptures. However, a number of factors remain to be addressed to correlate these parameters with aneurysmal ruptures, especially under analytical conditions. Specifically, CFD analysis is often performed with rigid wall models due to computational cost limitations. Here, to evaluate the effects of the deformation of the aneurysmal wall, experimental flow measurement with elastic models under pulsating conditions was conducted using three-dimensional particle image velocimetry (3D PIV). By analyzing 20 patient-specific, elastic, silicone aneurysm models, the hemodynamic parameters of ruptured and unruptured aneurysms were statistically compared to identify the variables that can effectively predict an aneurysmal rupture. Our analyses yielded three parameters (average wall shear stress ratio, in-phase deviation ratio, and pressure difference) which could effectively predict an aneurysmal rupture. These results suggested that measurement of wall shear stress (WSS) at both the aneurysm dome and parent artery is important and that pressure difference can also be a potential indicator of aneurysmal rupture.

The relationship of waist circumference and body mass index to grey matter volume in community dwelling adults with mild obesity.

Objective: Previous work has shown that high body mass index (BMI) is associated with low grey matter volume. However, evidence on the relationship between waist circumference (WC) and brain volume is relatively scarce. Moreover, the influence of mild obesity (as indexed by WC and BMI) on brain volume remains unclear. This study explored the relationships between WC and BMI and grey matter volume in a large sample of Japanese adults. Methods: The participants were 792 community-dwelling adults (523 men and 269 women). Brain magnetic resonance images were collected, and the correlation between WC or BMI and global grey matter volume were analysed. The relationships between WC or BMI and regional grey matter volume were also investigated using voxel-based morphometry. Results: Global grey matter volume was not correlated with WC or BMI. Voxel-based morphometry analysis revealed significant negative correlations between both WC and BMI and regional grey matter volume. The areas correlated with each index were more widespread in men than in women. In women, the total area of the regions significantly correlated with WC was slightly greater than that of the regions significantly correlated with BMI. Conclusions: Results show that both WC and BMI were inversely related to regional grey matter volume, even in Japanese adults with somewhat mild obesity. Especially in populations with less obesity, such as the female participants in current study, WC may be more sensitive than BMI as a marker of grey matter volume differences associated with obesity.

The impact of deformation of an aneurysm model under pulsatile flow on hemodynamic analysis.

Hemodynamic analysis of cerebral aneurysms has been widely carried out to clarify the mechanisms of their growth and rupture. In several cases, patient-specific aneurysm models made of transparent polymers have been used. Even though periodic changes in aneurysms due to the pulsation of blood flow could be important, the deformation of the model geometry and its effect on hemodynamic evaluation has not been fully investigated. In addition, the fabrication accuracy of aneurysm models has not been evaluated even though it may affect the hemodynamic parameters to be analyzed. In this study, the fabrication accuracy of a silicone aneurysm model was investigated. Additionally, the deformation of the model under pulsatile flow as well as its correlation with flow behavior was evaluated. Consequently, a fabrication method for an aneurysm model with high accuracy was established and the importance of the wall thickness of the model was also specified.

High-Resolution C-Arm CT and Metal Artifact Reduction Software: A Novel Imaging Modality for Analyzing Aneurysms Treated with Stent-Assisted Coil Embolization.

BACKGROUND AND PURPOSE: Combination of high-resolution C-arm CT and novel metal artifact reduction software may contribute to the assessment of aneurysms treated with stent-assisted coil embolization. This study aimed to evaluate the efficacy of a novel Metal Artifact Reduction prototype software combined with the currently available high spatial-resolution C-arm CT prototype implementation by using an experimental aneurysm model treated with stent-assisted coil embolization. MATERIALS AND METHODS: Eight experimental aneurysms were created in 6 swine. Coil embolization of each aneurysm was performed by using a stent-assisted technique. High-resolution C-arm CT with intra-arterial contrast injection was performed immediately after the treatment. The obtained images were processed with Metal Artifact Reduction. Five neurointerventional specialists reviewed the image quality before and after Metal Artifact Reduction. Observational and quantitative analyses (via image analysis software) were performed. RESULTS: Every aneurysm was successfully created and treated with stent-assisted coil embolization. Before Metal Artifact Reduction, coil loops protruding through the stent lumen were not visualized due to the prominent metal artifacts produced by the coils. These became visible after Metal Artifact Reduction processing. Contrast filling in the residual aneurysm was also visualized after Metal Artifact Reduction in every aneurysm. Both the observational (P < .0001) and quantitative (P < .001) analyses showed significant reduction of the metal artifacts after application of the Metal Artifact Reduction prototype software. CONCLUSIONS: The combination of high-resolution C-arm CT and Metal Artifact Reduction enables differentiation of the coil mass, stent, and contrast material on the same image by significantly reducing the metal artifacts produced by the platinum coils. This novel image technique may improve the assessment of aneurysms treated with stent-assisted coil embolization.

Brain diffusivity pattern is individual-specific information.

The human brain is composed of complex networks of 100 billion neurons that underlie its higher functions. The set of neural connections in the brain has recently attracted growing interest from the scientific community. It is important to identify individual differences in these neural connections to study the background of individual differences in brain function and performance. In the present study, we investigated whether the pattern of brain diffusion, reflecting neural connections, is discernibly different among individuals; i.e., whether brain diffusivity is personally identifiable information. Using diffusion tensor imaging data from 224 healthy subjects scanned twice at an interval of about 1year, we performed brain recognition by spatial normalization of fractional anisotropy maps, feature extraction based on Principal Component Analysis, and calculation of the Euclidean distances between image pairs projected into the subspace. Even with only 16 dimensions used for projection, the rank-one identification rate was 99.1%. The rank-one identification rate was 100% with ⩾32 dimensions used for projection. The genuine accept rates were 95.1% and 100% at a false accept rate of 0.001%, with 16 and ⩾32 dimensions used for projection, respectively. There were no large differences in the Euclidean distance among different combinations of scanners used or between image pairs with and without scanner upgrade. The results indicate that brain diffusivity can identify a specific individual; i.e., the pattern of brain diffusion is personally identifiable information. Individual differences in brain diffusivity will form the basis of individual differences in personality and brain function.

Influence of parameter settings in voxel-based morphometry 8. Using DARTEL and region-of-interest on reproducibility in gray matter volumetry.

OBJECTIVES: To investigate whether reproducibility of gray matter volumetry is influenced by parameter settings for VBM 8 using Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL) with region-of-interest (ROI) analyses. METHODS: We prepared three-dimensional T1-weighted magnetic resonance images (3D-T1WIs) of 21 healthy subjects. All subjects were imaged with each of five MRI systems. Voxel-based morphometry 8 (VBM 8) and WFU PickAtlas software were used for gray matter volumetry. The bilateral ROI labels used were those provided as default settings with the software: Frontal Lobe, Hippocampus, Occipital Lobe, Orbital Gyrus, Parietal Lobe, Putamen, and Temporal Lobe. All 3D-T1WIs were segmented to gray matter with six parameters of VBM 8, with each parameter having between three and eight selectable levels. Reproducibility was evaluated as the standard deviation (mm³) of measured values for the five MRI systems. RESULTS: Reproducibility was influenced by 'Bias regularization (BiasR)', 'Bias FWHM', and 'De-noising filter' settings, but not by 'MRF weighting', 'Sampling distance', or 'Warping regularization' settings. Reproducibility in BiasR was influenced by ROI. Superior reproducibility was observed in Frontal Lobe with the BiasR1 setting, and in Hippocampus, Parietal Lobe, and Putamen with the BiasR3*, BiasR1, and BiasR5 settings, respectively. CONCLUSION: Reproducibility of gray matter volumetry was influenced by parameter settings in VBM 8 using DARTEL and ROI. In multi-center studies, the use of appropriate settings in VBM 8 with DARTEL results in reduced scanner effect.

The C-ring problem of sterol biosynthesis: TiCl(4)-induced rearrangement into the anti-Markovnikov cation corresponding to the C-ring.

[reaction: see text] Cation 9, generated by the reaction of diol 8 and BF(3).Et(2)O, SnCl(4), Sc(OTf)(3), FeCl(3), TiF(4), or CF(3)SO(3)H, leads to a hydride shift, providing cation 11, which corresponds to the initiation of backbone rearrangement. On the other hand, TiCl(4) selectively induces rearrangement to secondary cation 13 by ring expansion, which corresponds to the C-ring formation of sterol biosynthesis. AlCl(3) and ZrCl(4) induce further rearrangement into six-membered ring tert-cation 16.

Synthesis of cyclopentadienones catalyzed by methylidynetricobalt nonacarbonyl.

Easily prepared and air-stable methylidynetricobalt nonacarbonyl could be used as a catalyst for the intramolecular [2 + 2 + 1]-cocyclization of diynes and carbon monoxide producing cyclopentadienones.

Intrahepatic cholangiocarcinoma arising 10 years after the excision of congenital extrahepatic biliary dilation.

A 52-year-old woman was found to have a liver tumor during treatment for a liver abscess. The tumor was diagnosed as intrahepatic cholangiocarcinoma by closer examinations, including a percutaneous needle biopsy. Ten years previously, she had undergone excision of a choledochal cyst, with reconstruction by Roux-en-Y hepaticojejunostomy, as treatment for Todani's type Ia congenital biliary dilation, which had been confined only to the extrahepatic bile duct. The significant association between congenital biliary dilation and hepatobiliary malignancies is well known. Some patients have been reported to develop biliary cancer long after the excision of the entire extrahepatic bile duct and hepaticoenterostomy. However, in these patients, the development mostly took place in the remnant choledochal cyst, the anastomotic site, or in the dilated intrahepatic bile duct of Todani's type IV-A congenital biliary dilation. The development of intrahepatic cholangiocarcinoma after operation has not been reported previously in a patient with Todani's type I congenital biliary dilation. This case suggests that the entire biliary tree may have a high risk of field cancerization, even in extrahepatic congenital biliary dilation.

Usefulness of MR imaging in the postsurgical monitoring of gallbladder cancer in a patient with bile duct cancer that developed 7 years after resection of mucinous adenocarcinoma of the gallbladder.

We encountered a case of left hepatic duct cancer that developed 7 years after surgical resection of early-stage adenocarcinoma of the gallbladder. A 65-year-old woman was hospitalized with high fever and general fatigue. She also had elevated serum levels of alkaline phosphatase, gamma-glutamyltranspeptidase, and carbohydrate antigen 19-9. Seven years earlier, she had undergone extended cholecystectomy and resection of the extrahepatic bile duct for early-stage mucinous adenocarcinoma of the gallbladder. Conventional examinations did not reveal any responsible lesions. Magnetic resonance (MR) cholangiography, however, showed a tumor obstructing the left hepatic duct, and dynamic MR images revealed multiple foci of bacterial abscess in the liver. Surgically resected tissue again revealed mucinous adenocarcinoma. The present case is rare in that metachronous mucinous adenocarcinoma of the biliary system occurred after a long interval. This case suggests the usefulness of MR imaging in the postsurgical monitoring of patients with gallbladder carcinoma.

Serum creatine kinase isoenzymes in Duchenne muscular dystrophy.

Creatine kinase isoenzymes in sera of 51 patients with Duchenne muscular dystrophy were separated on a micro-column of DEAE Sephadex A-50. MB isoenzyme was detected in the sera of 32 cases (63%). MB percentage of total creatine kinase activity correlated significantly with urinary creatine/creatinine ratio in the early stages of the disease. No close relationship between MB levels and ECG findings was observed. The origin of serum MB in Duchenne dystrophy is discussed.

Estimation of normal heart weight in Japanese subjects: development of a simplified normal heart weight scale.

To estimate cardiac workload from total heart weight (HW) in persons who have died suddenly, standards of normal HW must be established. We present standards of normal HW for Japanese subjects and propose a simplified scale for calculating normal HW from body height (BH) and body weight (BW). A total of 830 persons (506 male and 324 female) who had died suddenly of unnatural causes were selected for analysis from among persons examined at forensic autopsy at the Jikei University School of Medicine. The HW, BH and BW of each subject were measured. Body surface area (BSA) in square meters was calculated from BH in centimeters and BW in kilograms with Takahira's equation. We found allometric relations between HW and BSA represented by these equations: HW=BSA(1.441) x 168.200 for males and HW=BSA(1.367) x 161.970 for females. For practical use, we developed a simplified scale with which normal HW can be easily and quickly calculated from BH and BW. Our simple technique can be used to estimate normal HW in routine autopsy practice.

Evaluation of angiographically assisted spiral CT in surgical cases of hepatocellular carcinoma considering recurrent cases.

Between June 1993 and July 1996, computed tomography during arterial portgraphy (CTAP) was performed on 22 patients with hepatocellular carcinoma (HCC) and liver cirrhosis before surgery. In 17 out of 22 patients, CT hepatic arteriography (CTA) was combined with CTAP. All 22 patients underwent definitive surgery. In 16 patients in which CTA was successfully performed, 20 HCC nodules and 28 pseudolesions were detected. The pseudolesions were depicted larger in size with CTA than with CTAP, formed a variety of shapes, and were enhanced homogeneously, while HCC nodules were depicted larger with CTAP than with CTA, formed a round or wedge shape, and were sometimes enhanced heterogeneously. Recurrence was diagnosed in 9 of 22 patients. Five recurrent lesions in 4 patients were already revealed by pre-operative CTAP. CTA was performed in only 1 of 5 lesions. The diagnostic accuracy for HCC significantly improves by recognizing by recognizing pseudolesions with CTA and CTAP.

[Asynchronus rejection of intrathoracic heart-lung transplantation rats].

We have reported intrathoracic heart-lung transplantation in rats could be made easily by using Internal Shunt Method as described elsewhere. In this study, we examined the rejection of intrathoracic heart-lung allografts in this model to determine whether acute pulmonary rejection precedes cardiac rejection following heart-lung transplantation or not. Ten heart-lung allografts (no immunosuppressive agent was given) and four isografts were examined pathologically. There was no pathologic change except perivascular or peribronchiolar edema in isografts, which was attributed to operative damage. Acute pulmonary rejection apparent pathologically 3 days after transplantation and lung allografts lost its function 6 days after transplantation. Otherwise, acute cardiac rejection first became apparent pathologically 5 days after transplantation. And their pulsation appeared well 6 days after it. It is concluded that pulmonary rejection precedes cardiac rejection following heart-lung transplantation.

[Total removal of infected pacemaker lead under cardiopulmonary bypass in a case of endocarditis, bacteremia and lung abscess].

A 60-year-old man, who had undergone implantation of a transvenous pacemaker system on the left chest wall for sick sinus syndrome 19 years ago, was admitted because of endocarditis with septicemia and lung abscess 2 months after reimplantation of the generator. His blood culture revealed Staphylococcus aureus. Following debridement of the infected pacemaker pocket and antibiotics therapy, we tried to remove the pacemaker system under cardiopulmonary bypass 1 month after admission. In intraoperative inspection, the electrodes had become firmly encased with fibrous tissue within the tricuspid valve and the right ventricle. After the operation, antibiotic therapy was performed for 4 weeks. His postoperative course was uneventful. Patients with pacemaker infection should undergo aggressive total removal of the pacemaker system, particularly incase with endocarditis and bacteremia.

[Studies on adoptive immunotherapy using recombinant interleukin 2].

Lymphokine activated killer (LAK) cells derived from normal subjects were examined as to the following points: 1) monoclonal analysis of LAK, 2) cytotoxic ability of LAK, 3) effect on LAK cytotoxic ability of the presence in the medium of either serum obtained from gastric cancer patients or nonspecific immunosuppressive factors (ferritin, IAP, AFP), 4) effect, on induction of their cytotoxicity, of the presence in the medium during culture of sera from gastric cancer patients, simulating the conditions of in vivo administration and 5) augmentation of cytotoxic ability of LAK by simultaneous IL2 administration. The following results were obtained. 1) Monoclonal marker analysis of LAK revealed that the ratios of OKT3+, OKT4+, OKT8+ and OKIa1+ lymphocytes were all significantly higher than those in peripheral blood lymphocytes (PBL). 2) Cytotoxic ability of LAK against various tumor cell lines (MKN-28, MKN-45, KATOIII, PC-10 and K562) was found to be higher than that of PBL. 3) Addition to medium of ferritin, IAP or AFP significantly reduced the cytotoxic ability of both PBL and LAK against various tumor cell lines. However, the degree of reduction was significantly milder in the case of LAK than in PBL. 4) The cytotoxicity-suppressing effects of gastric cancer sera (untreated, at stages III and IV) were significantly milder in the case of LAK than in PBL. 5) When gastric cancer serum was added to medium, instead of normal AB serum during induction of LAK, its cytotoxic ability against various tumor cell lines was significantly reduced. Its cytotoxic ability was nevertheless significantly higher than that of PBL. 6) When IL2 was added to medium during cytotoxicity assay, cytotoxic ability of LAK was augmented. When LAK was cultured for 1 hour before assay in fresh medium containing 1,000 U/ml IL2, its cytotoxic ability was further augmented.