Dual-layer dual-energy computed tomography for the assessment of hypovascular hepatic metastases: impact of closing k-edge on image quality and lesion detectability.

OBJECTIVES: To evaluate the image quality of virtual-monoenergetic-imaging (VMI) from dual-layer dual-energy CT (DLCT) for the assessment of hypovascular liver metastases and its effect on lesion detectability. METHODS: Eighty-one patients with hypovascular-liver-metastases undergoing portal-venous-phase abdominal DLCT were included. Polyenergetic-images (PEI) and VMI at 40-200 keV (VMI40-200, 10-keV interval) were reconstructed. Image noise, tumor-to-liver contrast, and contrast-to-noise ratio (CNR) of hepatic parenchyma and metastatic nodules (n = 288) were measured to determine the optimal monoenergetic levels. Two radiologists independently and subjectively assessed the image quality (image contrast, image noise, and diagnostic confidence) of PEI and optimal VMI on 5-point scales to determine the best energy. For 38 patients having up to 10 metastases each with diameters < 25 mm (153 lesions), we compared blindly assessed lesion detectability and conspicuity between PEI and VMI at the best energy. RESULTS: Image noise of VMI40-200 was consistently lower than that of PEI (p < 0.01). Tumor-to-liver contrast and CNR increased as the energy decreased with CNR at VMI40-70 being higher than that observed on PEI (p < 0.01). The highest subjective score for diagnostic confidence was assigned at VMI40 followed by VMI50-70, all of which were significantly better than that of PEI (p < 0.01, kappa = 0.75). Lesion detectability at VMI40 was significantly superior to PEI, especially for lesions with diameters of < 10 mm (p < 0.01, kappa ≥ 0.6). CONCLUSIONS: VMI40-70 provided a better subjective and objective image quality for the evaluation of hypovascular liver metastases, and the lesion detectability was improved with use of VMI40 compared with conventional PEI. KEY POINTS: • DLCT-VMI at 40-70 keV provides a superior subjective and objective image quality compared with conventional PEI for the assessment of hypovascular hepatic metastases during portal venous phase. • Tumor-to-liver contrast and CNR of hypovascular hepatic metastases was maximized at 40 keV without a relevant increase in the image noise. • VMI at 40 keV yields a superior lesion detectability, especially for small (< 1 cm) metastatic nodules compared with conventional PEI.

[Primary diaphragmatic schwannoma which needed to be distinguished from a liver tumor].

A 55-year-old woman was admitted because of a tumor located in the ventral region of S4 of the liver, just beneath the diaphragm. A CT scan revealed the round tumor to be delineated as a 33 mm in size, with an outer capsule. The tumor was visualized as concentric circles which presented high-, low-, and high- signal patterns on T2-weighted MRI. It also presented a triphasic pattern in which the border and the central part were not contrasted as a low signal pattern, while the middle part was contrasted as a high signal pattern by T1-weighted enhanced imaging with Gd-DTPA. Angiography revealed that the tumor did not originate from the liver but from the diaphragm, so it was surgically resected as a primary diaphragmatic tumor. We report a schwannoma which originated from the diaphragm, that showed characteristic imaging findings and required to be distinguished from a liver tumor.

Clinical validity of the Japanese version of WAIS-III short forms: Adaptation for patients with mild neurocognitive disorder and dementia.

We investigated the Japanese WAIS-III short form utility in mild neurocognitive disorder and dementia. Our sample consisted of 108 old patients (ages: 65-89; mean age = 78.3). Fifteen short forms (SFs) and full-scale (FS) IQs were compared. The SFs included Dyads (SF1, SF2), Triads (SF3), Tetrads (SF4, SF5, SF6, SF7), Pentad (SF8), Six-subtest (SF9), Seven-subtests (SF10(a)(b), SF11(a)(b), SF12), and Nine-subtest (SF13). Correlations between SFIQs and FSIQ were all significant. Significant differences also were found in paired t-test between FSIQ and 5 SFIQs (SF2: t = -4.16, SF5: t = -7.06, SF7; t = 2.59, SF10(a): t = 2.56, SF12: t = -4.82; p < .05). On the point of clinical accuracy, two SFs led to an appropriate estimated IQ (SF11(a): 84.3%, SF13: 91.7%; within 95% confidence interval and 2 standard error of measurements of FSIQ). However, SF13 was considered to still have a long administration time. The present results suggest that SF11(a) could be the most useful to estimate IQ for Japanese speaking patients with mild neurocognitive disorder and dementia. SF11(a) consists of seven subtests of Similarities, Arithmetic, Digit Span, Information, Picture Completion, Digit Symbol-Coding, and Matrix Reasoning (Ryan & Ward, 1999), and the formula (Axelrod et al., 2001) should be adopted to convert scaled scores into estimated IQ scores.

Reducing artifacts of gadoxetate disodium-enhanced MRI with oxygen inhalation in patients with prior episode of arterial phase motion: intra-individual comparison.

PURPOSE: To determine whether oxygen inhalation reducing artifacts in patients with previous transient severe motion (TSM) on gadoxetate-disodium-enhanced MRI. MATERIALS AND METHODS: Fifty-one patients with TSM on previous gadoxetate-disodium-enhanced MRI (Baseline examination) were evaluated. Image quality in the examination with oxygen inhalation (Oxygen examination) and that in Baseline examination and the examination before Baseline examination without oxygen inhalation (Past examination) were qualitatively compared in dynamic study. RESULTS: Image quality was significantly higher in Oxygen examination than Baseline examination in arterial phase, but there was no statistical difference between Baseline and Past examinations. CONCLUSION: Oxygen inhalation improved image quality in patients with a prior episode of arterial phase TSM.

Reticulocyte hemoglobin equivalent as a potential marker for diagnosis of iron deficiency.

Evaluation of parameters relating to serum ferritin and iron is critically important in the diagnosis of iron deficiency anemia (IDA). The recent development of automated systems for hematology analysis has made it possible to measure reticulocyte hemoglobin equivalent (RET-He), which is thought to reflect iron content in reticulocytes, in the same sample used for complete blood count tests. If RET-He is, indeed, capable of evaluating iron deficiency (ID), it would be useful for immediate diagnosis of IDA. In the present study, we examined the usefulness of RET-He for diagnosis of ID. Blood samples were obtained from 211 patients. Anemia was defined as hemoglobin (Hb) level of <12 g/dL. Iron deficiency was defined as serum ferritin level of <12 ng/mL. Patients were classified into four groups: IDA, ID, control, and non-ID with anemia. Patients in the IDA group had significantly lower RET-He levels than those in the control group. RET-He correlated with serum ferritin in the IDA and ID groups. The area under the curve for RET-He was 0.902, indicating that RET-He facilitates the diagnosis of ID with high accuracy. RET-He changed in parallel with changes in Hb during iron administration for 21 IDA patients. Our results indicate that RET-He may be a clinically useful marker for determining ID in the general population.

Seroprevalence of Toxoplasma gondii in American free-ranging or captive pumas (Felis concolor) and bobcats (Lynx rufus).

Toxoplasma gondii is a major zoonotic agent infecting a wide range of mammals, including wild felids. Like domestic cats, wild felids are involved in the complete infective cycle of T. gondii, as they can host in their gastrointestinal tract sexually mature parasites and shed infective oocysts in their feces. In order to evaluate the importance of this wildlife reservoir, 438 serum samples collected between 1984 and 1999 from 438 pumas (Felis concolor) and from 58 bobcats (Lynx rufus) from North America, Central America and South America were screened for antibodies to T. gondii. The overall prevalence of T. gondii antibodies was 22.4% in pumas and 51.7% in bobcats, with regional variations. Adults were more likely to be seropositive than juveniles and kittens (prevalence ratio (PR) = 2.61; confidence interval (CI) = 1.15, 4.04). In the US, pumas from the southwestern states (Arizona, California and New Mexico) were more likely to be seropositive for T. gondii ( PR = 2.61; 95% CI = 1.32-5.18 ) than pumas from the northwestern and mountain states (Colorado, Idaho, Oregon, Utah and Wyoming). Male pumas from the US were more likely to be seropositive than females (PR = 2.08; 95% CI = 1.11-3.92), whereas female pumas from Mexico, Central America and South America were more likely to be seropositive than female pumas from Canada and the US (PR = 2.49; 95% CI = 1.09-5.69). Captive pumas were also more likely to be seropositive (21.7%, 29/92) for T. gondii than free-ranging animals (19.9%, 69/346) (PR = 1.85; 95% CI = 1.06, 3.17).

Relationship between depressive state, job stress, and sense of coherence among female nurses.

BACKGROUND: People with a strong sense of coherence (SOC) have a high ability to cope with stress and maintain good physical and mental health. AIMS: The aim of this study was to investigate the relationship between depressive state, job stress, and SOC among nurses in a Japanese general hospital. MATERIALS AND METHODS: A self-reporting survey was conducted among 348 female nurses in a general hospital. Job stress was measured using the Japanese version of the effort-reward imbalance (ERI) scale. Depressive state was assessed by the K6 scale. SOC was assessed with the SOC scale, which includes 29 items. Stepwise multiple regression analysis was conducted to examine factors that significantly affect depressive state. RESULTS: SOC, over-commitment, effort-esteem ratio, and age were significantly correlated with the depressive state (ß = -0.46, P < 0.001; ß = 0.27, P < 0.001; ß = 0.16, P < 0.001; ß = -0.10, P < 0.001, respectively). CONCLUSIONS: SOC may have a major influence on the depressive state among female nurses in a Japanese general hospital. From a practical perspective, health care professionals should try to enhance the SOC of nurses.

Relationship between job stress, temperament and depressive symptoms in female nurses.

OBJECTIVES: A casual relationship between temperament, job stress and depressive symptoms has not been established yet. The purpose of this study was to assess the relationships between job stress, temperament and depressive symptoms in female nurses at a Japanese general hospital. MATERIAL AND METHODS: A self-report survey was conducted among 706 nurses. We measured job stress, temperament, and depressive symptoms using the Brief-Job Stress Questionnaire, the TEMPS-A and a screening scale of items from the Ministry of Health, Labour and Welfare of Japan. In order to examine the causal relationship between the measures the stepwise multiple regression and path analyses were used. RESULTS: Depressive symptoms were modestly correlated with job stress (γ = -0.23-0.30). Except for hyperthymic temperament measures, the correlations between depressive symptoms and temperament types were significant and moderate (γ = 0.36-0.50). Overtime, job control as well as depressive and cyclothymic types of temperament were significantly correlated with depressive symptoms (ß = 0.15, p < 0.05; ß = 0.19, p < 0.01; ß = 0.26, p < 0.001; ß = 0.32, p < 0.001, respectively). Path-analysis revealed that depressive and cyclothymic types of temperament influenced depressive symptoms both directly (ß = 0.67, p < 0.001) and indirectly via job stress (ß = 0.35, p < 0.001 from temperament to job stress; ß = 0.20, p < 0.05 from job stress to depressive symptoms). Irritable and anxious types of temperament and quantitative job overload did not contribute to the path-analytic model. CONCLUSIONS: Health care professionals should consider temperament, especially depressive and cyclothymic types, in order to help employees cope better with job stress factors. We need further research about the effective intervention to help employees better cope with their job stress.

Sense of coherence and personality traits related to depressive state.

Aims. The current study aims to examine the influence of job stress, SOC, and personality traits on depressive state. Methods. A self-reported survey was conducted among 347 female nurses in a general hospital. Job stress was measured using the Japanese version of the Brief-Job Stress Questionnaire scale. Depressive state was assessed by the K6 scale. We used 13-item SOC scale. Personality traits were assessed by the Japanese version of Ten-Item Personality Inventory. Multiple liner regression analyses were conducted to examine predictors that significantly affect depressive state. Results. Job and life satisfaction and SOC negatively related to the depressive state (ß = -0.76, P < 0.01; ß = -0.18, P < 0.001, resp.) while neuroticism was positively correlated (ß = 0.49, P < 0.001). Also, intrinsic rewards tended to negatively relate (ß = -0.80, P < 0.1). Conclusions. From a practical perspective, the possible influence of SOC and neurotic personality on depressive state should be considered for health care professionals.

Sleep duration and its association with sleepiness and depression in "ronin-sei" preparatory school students.

PURPOSES: The Japanese word "ronin-sei" refers to a student who has failed their university entrance examination and is preparing to re-take the examination in the following year. We aimed to determine how sleep duration is associated with daytime sleepiness or depression in ronin-sei because impaired daytime performance is known to result from sleep deprivation. METHODS: The participants in this cross-sectional study were 1075 ronin-sei and 285 university students. Sleepiness and depressive symptoms were assessed using the Epworth Sleepiness Scale (ESS) and the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. RESULTS: Ronin-sei had significantly shorter sleep duration and earlier bed- and rise-times than university students. There was no significant difference in CES-D between the groups; however, the ESS score of university students was significantly higher than that of ronin-sei. Ronin-sei who slept for 5 to <6h had higher ESS scores than those who slept for 6 to <7h. The mean CES-D score in ronin-sei who slept <5h was significantly higher than in those who slept for 5 to <6h, from 6 to <7h, and from 7 to <8h. Ronin-sei who slept for more than 8h also had higher depression scores. CONCLUSIONS: Sleep deprivation appears to be common among ronin-sei. Furthermore, a U-shaped relationship was found between sleep duration and depressive symptoms, revealing that ronin-sei who had too little or too much sleep were more likely to exhibit an increase in depressive symptoms.

[Examination of analytical method for triphenyltin (TPT) and tributyltin (TBT) to revise the official methods based on "Act on the Control of Household Products Containing Harmful Substances"].

The use of triphenyltin (TPT) and tributyltin (TBT) in some household products is banned by "Act on the Control of Household Products Containing Harmful Substances" in Japan. To revise the official analytical method, the method for detecting these organotin compounds was examined in six laboratories using a textile product, water-based adhesive, oil-based paint, which contained known amounts of TPT and TBT (0.1, 1.0, 10 µg/g). TPT and TBT were measured by GC-MS after ethyl-derivation with sodium tetraethylborate. The TBT recoveries in the samples were 70-120%. The TPT recoveries in the water-based adhesive samples were 80-110%, while its concentrations in the textile product and oil-based paint samples decreased because of dephenylation during storage. However, the precision of the method examined was satisfactory because most coefficients of variation for TPT and TBT in the samples were less than 10%. Furthermore, the revised method was able to detect concentrations lower than the officially regulated value. However, the sample matrix and the condition of analytical instrument might affect the estimated TPT and TBT concentrations. Therefore, the revised method may not be suitable for quantitative tests; rather, it can be employed to judge the acceptable levels of these organotin compounds by comparing the values of control sample containing regulated amounts of TPT and TBT with those for an unknown sample, with deuterated TPT and TBT as surrogate substances. It is desirable that TPT in textile and oil-based paint samples are analyzed immediately after the samples obtained because of the decomposition of TPT.

Functional assessment of pathogenic IgG subclasses in chronic autoimmune urticaria.

BACKGROUND: Chronic urticaria is caused by a complement fixing, IgG antibody directed to the alpha-subunit of the IgE receptor, which is present in 35% to 45% of patients. This autoimmune subgroup can be identified by an autologous skin test or histamine release from human basophils or cutaneous mast cells. However, binding assays do not correlate with these functional assays. We considered the possibility that pathogenic antibody may be present within particular IgG subclasses, which might facilitate development of a binding method that can reliably screen patients. OBJECTIVE: To determine the subclass distribution of IgG antireceptor antibodies on the basis of histamine release, and to assess the possibility that a subclass specific ELISA binding method could be used to screen patients. METHODS: We isolated patient IgG by protein G affinity chromatography and then isolated patient IgG subclasses 1, 2, 3, and 4 by a combination of antibody affinity chromatography and protein A affinity chromatography. The ability of each subclass to activate basophils was assayed by histamine release. RESULTS: Patient IgG subclasses IgG 1 , IgG 3 , and to a lesser degree IgG 4 have antibody capable of activating basophils to release histamine, whereas IgG 2 is inactive. Immunoblot or RAST assay that is subclass-specific does not correlate with histamine release as a result of nonfunctional but binding antibody within IgG subclasses 1, 3, or 4, and complement activation by IgG 1 and IgG 3 . CONCLUSION: Purification of IgG subclasses from patients with chronic urticaria demonstrates functional antibody in IgG 1 and IgG 3 and occasionally IgG 4 . Nonfunctional antibody within IgG 2 plus nonfunctional antibody mixed with functional antibody within IgG 1 , IgG 3 , and IgG 4 and effects of complement are responsible for a lack of correlation of histamine release with binding assays even if subclass-specific.

A role for C5a in augmenting IgG-dependent histamine release from basophils in chronic urticaria.

BACKGROUND: Histamine release in chronic urticaria is initiated by cross-linking of the alpha subunit of FcepsilonRI by means of IgG antibody, followed by complement activation. OBJECTIVE: We sought to further elucidate the mechanism by which complement augments histamine release and to assess the role of C5a. METHODS: We first quantitated the ability of purified C5a to initiate basophil histamine release and to be inhibited by antibody directed to the C5a receptor. Using this antibody, we quantitated its ability to inhibit histamine release induced by sera from patients with chronic urticaria. We also compared the ability of normal serum, C5-depleted serum, and C5-depleted serum after reconstitution with C5 to augment histamine release by IgG isolated from patients with chronic urticaria. RESULTS: As the concentration of C5a was increased up to 50 ng/mL, the percentage of histamine release increased and reached a plateau of 40% to 50%; this was inhibited by antibody to the C5a receptor. Preincubation of basophils with antibody to the C5a receptor inhibited basophil histamine release from 15 sera tested, with a range of 4% to 39%. Histamine release caused by patient IgG was augmented when normal serum was added but not when C5-depleted serum was substituted for normal serum. Augmentation of histamine release by patient IgG was again obtained when C5-depleted serum was reconstituted with C5. CONCLUSION: Our conclusion is that pathogenic IgG cross-links the IgE receptor directly to cause histamine release, and activation is augmented by complement. C5a is the complement agonist that is responsible for the augmented histamine release.

TH1/TH2 cytokines and inflammatory cells in skin biopsy specimens from patients with chronic idiopathic urticaria: comparison with the allergen-induced late-phase cutaneous reaction.

BACKGROUND: Previous studies have demonstrated infiltration of eosinophils, neutrophils, monocytes, and T cells in the skin of patients with chronic idiopathic urticaria (CIU), suggesting a possible T(H)2-type cytokine pathology analogous to the allergen-induced skin late-phase reaction (LPR). OBJECTIVE: We sought to compare skin biopsy specimens from patients with CIU and the allergen-induced skin LPR for mRNA(+) cells for IL-4, IL-5, and IFN-gamma and inflammatory cell infiltration. METHODS: Skin biopsy specimens were obtained from 13 patients with CIU (6 had positive results for FcepsilonRI autoantibodies), 6 nonatopic control subjects, and 6 atopic subjects (before and after cutaneous allergen challenge). Cryostat sections were processed for immunohistochemistry and in situ hybridization by using the (35)S-riboprobes. RESULTS: There were significant increases in the numbers of intradermal CD3(+) (P =.007), CD4(+) (P =.004), CD8(+) (P =.012), and CD25(+) (P =.018) T cells, as well as eosinophils (P =.02), neutrophils (P =.01), basophils (P =.004), and macro-phages (P =.0014) in patients with CIU compared with numbers in nonatopic control subjects. There were lower numbers of tryptase-positive mast cells (P =.048). In the epidermis of patients with CIU, but not in that of normal subjects or in allergen-challenged biopsy specimens, there were increased numbers of CD3(+) T cells (P =.039). The profile of inflammatory cell infiltration in the allergen-induced skin LPR was similar to that in patients with CIU. In patients with CIU there was a T(H)0 cytokine profile, with significant increases in IL-4 (P =.0029), IL-5 (P =.0025), and IFN-gamma (P =.037) mRNA(+) cells. As expected, in the skin LPR there was an increase in IL-4 (P =.0082) and IL-5 (P =.0051), but not IFN-gamma, mRNA(+) cells. There were no significant differences in either the numbers of inflammatory cells or the cytokine pattern between patients with and without autoantibody. CONCLUSION: The molecular immunopathology of CIU is that of an eosinophil and basophil cell-mediated hypersensitivity reaction. Thus it is similar to the allergic skin LPR but has a T(H)0 rather than a T(H)2 cytokine profile.

Seroprevalence of Bartonella infection in American free-ranging and captive pumas (Felis concolor) and bobcats (Lynx rufus).

Bartonella henselae is the main agent of cat scratch disease in humans and domestic cats are the main reservoir of this bacterium. We conducted a serosurvey to investigate the role of American wild felids as a potential reservoir of Bartonella species. A total of 479 samples (439 serum samples and 40 Nobuto strips) collected between 1984 and 1999 from pumas (Felis concolor) and 91 samples (58 serum samples and 33 Nobuto strips) collected from bobcats (Lynx rufus) in North America, Central America and South America were screened for B. henselae antibodies. The overall prevalence of B. henselae antibodies was respectively 19.4% in pumas and 23.1% in bobcats, with regional variations. In the USA, pumas from the southwestern states were more likely to be seropositive for B. henselae (prevalence ratio (PR) = 2.82, 95% confidence interval (CI) = 1.55, 5.11) than pumas from the Northwest and Mountain states. Similarly, adults were more likely to be B. henselae seropositive than juveniles and kittens (PR = 1.77, 95% CI = 1.07, 2.93). Adult pumas were more likely to have higher B. henselae antibody titers than juveniles and kittens (p = 0.026). B. henselae antibody prevalence was 22.4% (19/85) in bobcats from the USA and 33.3% (2/6) in the Mexican bobcats. In the USA, antibody prevalence varied depending on the geographical origin of the bobcats. In California, the highest prevalence was in bobcats from the coastal range (37.5%). These results suggest a potential role of wild felids in the epidemiological cycle of Bartonella henselae or closely related Bartonella species.