Developing an Educational Program for Ultrasound Hip Screening during Newborn and Infant Home Visits: A Protocol Paper.

Ultrasound hip screening is suitable for the early identification of developmental dysplasia of the hip (DDH). Newborn and infant home visits are good opportunities for hip screening in the community, but studies focusing on nurse-led screenings are lacking. Based on a pre-post design, this study aims to develop and evaluate an ultrasound training program to improve nurses' assessment skills in detecting DDH cases during newborn and infant home visits. Said educational program will include e-learning, hands-on seminars, and clinical training. The primary outcome will be the success rate of imaging standard planes (standardized images for hip assessment) in clinical training. The secondary outcomes will include knowledge test results, objective structured clinical examination scores, time required for imaging, and inter-rater reliability between nurses and physicians. The educational program will address the issue of missed and late detection of DDH cases in resource-limited communities. This study will demonstrate the feasibility of procedures and the effectiveness of the educational program in 2024. The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry before starting the study (no. UMIN000051929, 16 August 2023).

[Measured X-ray Spectra and Absorbed Dose Conversion Factors in a Water Equivalent Phantom Irradiated with Diagnostic X-rays].

The diagnostic X-ray spectra in a water equivalent phantom have been measured. From these measured spectra, the absorbed dose conversion factors of water were derived. The primary X-ray spectra were also measured and the scattered X-ray spectra were calculated by subtraction. The measurements were made at the depths of 0, 5, 10, 15, and 20 cm in a 20 cm-thick phantom and at the X-ray tube voltages 60, 90, and 120 kV by using a small silicon diode detector. The radiation field size was 30×30 cm2 at the phantom surface. In the obtained spectra, the fraction of the scattered photon number is increased with the depth. The X-ray qualities of the spectra in the phantom were near the qualities of primary X-rays when the depth is 0 cm, and became near the qualities of scattered X-rays as the depth increases. The changes of the X-ray qualities due to the depth change were small; photon mean-energy changes were within 4.6 keV. The changes in the absorbed dose conversion factors were also small (within 0.68%). These conversion factors were 0.4-2.3% larger than those obtained from the effective energy of incident X-rays and only -0.3 to 0.5% larger than those obtained from the X-ray spectra calculated from the aluminum half value layer and the tube voltage of incident X-rays. This study shows experimentally that the absorbed dose in a water-like phantom can be calculated with good accuracy by using the absorbed dose conversion factor obtained from the incident X-rays.

Residual Femoral Deformity and Femoroacetabular Impingement after Intertrochanteric Osteotomy for Slipped Capital Femoral Epiphysis.

We retrospectively reviewed 29 hips in which intertrochanteric osteotomies were performed for severe slipped capital femoral epiphyses. Mean age at surgery: 12.6 years. Mean follow-up period: 6 years. At the final follow-up evaluation, one patient had coxalgia, and six hips showed a limited range of motion. A pistol-grip deformity was observed in 13 hips, osteoarthritis in two hips, and a bump existed in 19 hips on the latest radiographs. Gradual remodeling of the bumps was observed post-operatively in 22 hips. The mean α and ß angles and offset α and ß improved over time. The remodeling proceeded rapidly for 1 year post-surgery. We compared hips classified as ß angles of ≥ 63° to < 63° at the final follow-up evaluation, the mean ß angle 1 year post-surgery, and the mean ratio of improvement of the ß angle per year from 1 year post-surgery to the final follow up, which differed significantly. Nearly all of the patients who underwent intertrochanteric osteotomies had residual morphologic abnormalities, but few had clinical symptoms. The ß angle 1 year post-surgery and the ratio of remodeling of the bump from 1 year post-surgery to the final follow-up can be regarded as a potential predictor of morphologic results after intertrochanteric osteotomy.

Design and synthesis of biotin analogues reversibly binding with streptavidin.

Two new biotin analogues, biotin carbonate 5 and biotin carbamate 6, have been synthesized. These molecules were designed to reversibly bind with streptavidin by replacing the hydrogen-bond donor NH group(s) of biotin's cyclic urea moiety with oxygen. Biotin carbonate 5 was synthesized from L-arabinose (7), which furnishes the desired stereochemistry at the 3,4-cis-dihydroxy groups, in 11% overall yield (over 10 steps). Synthesis of biotin carbamate 6 was accomplished from L-cysteine-derived chiral aldehyde 33 in 11% overall yield (over 7 steps). Surface plasmon resonance analysis of water-soluble biotin carbonate analogue 46 and biotin carbamate analogue 47 revealed that KD values of these compounds for binding to streptavidin were 6.7×10(-6) M and 1.7×10(-10) M, respectively. These values were remarkably greater than that of biotin (KD =10(-15) M), and thus indicate the importance of the nitrogen atoms for the strong binding between biotin and streptavidin.

[Breast dose reduction in female CT screening for lung cancer using various metallic shields].

We evaluated the effectiveness of metallic shields that were used for reduction of the breast dose in thoracic computed tomography(CT). For the evaluation, we measured breast surface dose and image standard deviation(SD)in the lung area. The metallic shields were made from bismuth, zinc, copper, and iron. The bismuth shield has been marketed and used for dose reduction. The other three metallic shields were chosen because they have lower atomic numbers and a lower yield of characteristic X-rays. As a result, use of the metallic shields showed a lower breast dose than the decrement of the tube current in the same image SD. The insertion of a thin aluminum sheet between the shield and a phantom was also effective in reducing breast surface dose. We calculated the dose reduction rate to evaluate the effectiveness of these metallic shields. This dose reduction rate was defined as the ratio of the decrease in breast surface dose by metallic shields to the breast surface dose measured with the tube current decrement in the same image SD. The maximum dose reduction rate was 6.4% for the bismuth shield, and 12.0-13.3% for the other shields. These results indicate that the shields made from zinc, copper, and iron are more effective for dose reduction than the shield made form bismuth. The best dose reduction rate, 13.3%, has been achieved when the zinc shield placed 20 mm apart from a phantom with 0.2 mm aluminum was used.

[Absorbed dose conversion factors obtained from X-ray spectra measured at water phantom surface].

The absorbed dose conversion factor for X-rays at the water phantom surface has been obtained from the measured spectra. These measurements have been made at tube voltages of 60 kV to 120 kV and field sizes ranging from 5 x 5 cm(2) to 30 x 30 cm(2) with and without additional 2 mm aluminium filtration. A small silicon diode detector with little angular dependence was used for this measurement. The absorbed dose conversion factor obtained was 0.03-0.43% smaller than that obtained from the primary X-ray spectrum. The difference was large for high-voltage and heavily filtered X-rays. As field size increases, the conversion factor decreases, but the decrease is slight when field size exceeds 20 x 20 cm(2). The absorbed dose conversion factor obtained from the primary or surface X-ray spectrum is 0.4-1.8% larger than that obtained from the effective energy of primary X-rays. The difference is large in high-voltage X-rays and decreases slightly with increases in field size.

Significance of preoperative position of the femoral head in failed closed reduction in developmental dislocation of the hip: surgical results.

Long-term follow-up results of open reduction for developmental dislocation of 83 hips via the extensive anterolateral approach were retrospectively analyzed. Open reduction was performed in infancy, and the follow-up period ranged from 12 to 24 years. This procedure is a complete circumferential dissection of the joint capsule and produces sufficient concentric reduction of the femoral head in the acetabulum immediately after the surgery. A lateral arthrographic classification of interposed limbus and the preoperative position of the unreduced femoral head is introduced, and is related to operative findings and surgical results, including Severin's classification. The results at the final follow-up were: Severin's group I in 35 hips, group II in 19 hips, group III in 10 hips, and group IV in four hips. According to the classification of the preoperative position of the femoral head, there were 31 hips of the intracapsular type and 37 hips of the extracapsular type. Thirty-four of the 37 hips of the extracapsular type were classified in Severin's group I or II (92%). Twenty of the 31 hips of the intracapsular type were classified in Severin's group I or II (65%). A very significantly greater number of hips with good radiological outcome were in the extracapsular type than in the intracapsular type.

Expression of connective tissue growth factor/hypertrophic chondrocyte-specific gene product 24 (CTGF/Hcs24/CCN2) during distraction osteogenesis.

To investigate the localization and expression of connective tissue growth factor/hypertrophic chondrocyte-specific gene product 24/CCN family member 2 (CTGF/Hcs24/CCN2) during distraction osteogenesis in the rat femur, we studied a total of 54 male rats (11 weeks old). We performed osteotomy in the midshaft of the right femur. After 7 days (lag phase), distraction was started, at the rate of 0.25 mm/12 h for 21 days (distraction phase) by using a small external fixator, and this was followed by a 7-day consolidation phase. Localization and expression of CTGF/Hcs24 during distraction osteogenesis in the femur were examined by immunostaining, in situ hybridization, and reverse transcriptase polymerase chain reaction (RT-PCR). Immunostaining showed the localization of CTGF/Hcs24 in various cells located in the bone-forming area around the osteotomy site. During the distraction phase, in situ hybridization showed that CTGF/Hcs24 mRNA was expressed not only in hypertrophic chondrocytes and osteoblasts but also in fibroblast-like cells and mesenchymal cells at sites of end-ochondral ossification, and not only in osteoblasts but also in pre-osteoblasts and fibroblast-like cells at sites of intramembranous ossification. RT-PCR showed higher level expression of CTGF/Hcs24 mRNA in the distracted group than in the nondistracted group. These results revealed an elevated pattern of CTGF/Hcs24 mRNA expression during distraction osteogenesis, and suggest that CTGF/Hcs24 may play some roles in the endochondral and intramembranous ossification processes that occur during distraction osteogenesis.

Intrinsic and synaptic properties of the dorsomedial nucleus of the intercollicular complex, an area known to be involved in distance call production in Bengalese finches.

The dorsomedial nucleus of the intercollicular complex (DM) of the midbrain in the Bengalese finch is essential for the vocal production of distance calls that have sexually-dimorphic acoustic structures in the adult. Anatomical tracing of the vocal control system shows that DM neurons of adult males receive axonal inputs from the robust nucleus of the archistriatum (RA), and the inputs are considered to be crucial for the male-typical features of distance calls. In order to investigate the neural mechanisms underlying distance call patterns of male finches in DM, we characterized neurons in DM and examined their synaptic responses to RA inputs in brain slice preparations. By using whole-cell recording techniques, we could classify at least three types of neurons based on electrophysiological and morphological characteristics. Type I neurons exhibited regular and high-frequency trains of action potentials in response to depolarizing current pulses. Type II neurons had large somata and action potential trains accommodating during depolarization. Type III neurons were characterized by a few spikes followed by a slow depolarization during current injection. Their somata were markedly small and their axons often projected toward the contralateral DM or the thalamic nucleus uvaeformis (Uva). In all these cell types, electrical stimulation of an area including DM-projecting RA axons often elicited both excitatory postsynaptic currents (EPSCs) mediated mainly by non-NMDA glutamate receptors and inhibitory postsynaptic currents (IPSCs) mediated by GABA(A) receptors. These intrinsic properties of DM neurons and their excitatory and inhibitory synaptic inputs may play important roles in generating the acoustic patterns of distance calls in male finches.

Developmental difference of neural functions in the song and call control system in Bengalese finches.

In Bengalese finches, the maturation of distance calls and the stabilization of their song are obtained through developmental learning stages. In this study, whole cell patch clamp recordings were made from neurons in the robust nucleus of the archistriatum (RA), which is a motor control nucleus of male-specific vocalization in male birds of different developmental stages. The neurons in the RA were categorized into three types according to their electrophysiological properties under voltage clamp recordings. Distribution ratios of the neuron types changed during development. The firing pattern of these neurons was highly co-related with the expression of slow-inactivated (SI) type outward current. In this study, we first showed that the developmental change of the neural circuit in the RA was induced by the expression of the SI-type outward current.

Neural function of the mesencephalic dorsomedial nucleus (DM) on distance call production in Bengalese finches.

In sexually mature Bengalese finches, acoustic structures of distance calls show sexual difference. The dorsomedial nucleus (DM) of intercollicular complex is known as the midbrain vocal center of distance calls. Neural input from the robust nucleus of archistriatum (RA) was observed in the DM of sexually mature males, but not observed in that of sexually mature females. The purpose of this study is to clarify somo more details of physiological function of the neural system in the DM in distance call production. Electrical stimulation to the DM of both sexes induced a call acoustically similar to distance calls, whose duration depended on the number of the pulses/train of electrical stimulation; electrical stimulation in relatively large (or small) numbers of pulses/train induced calls with relatively long (or short) duration, respectively. Multi-unit spikes were recorded from neurons in the DM. The increment of the frequency of recorded spikos was large when the bird vocalized distance calls, and the number of the frequency decreased when the bird vocalized calls whose duration was shorter than that of distance calls. These results suggest that the neural system in the DM controls duration of distance calls in sexually mature males and females. Electrical stimulation to the DM under different pulse frequencies induced calls with different patterns of time-frequency characteristics. The relation between the pulse frequencies and time-frequency characteristics showed sexual difference. The relation between them in RA-lesioned males was similar to that in females. These results suggest that the neural circuit in the DM of sexually mature males is consisted of sexually common neural circuit controlled by the neural input from the RA, and that these sexually different neural system produce sexually different acoustic structures of distance calls.

Measurement of backscattered x-ray spectra at the water surface in the energy range 60 kV to 120 kV.

Backscattered x-ray spectra at the water surface have been measured by using a small silicon diode detector. The measurements have been made at tube voltages 60 kV to 120 kV (HVL 2.4-6.1 mm Al) and field sizes 5 x 5 cm2 to 30 x 30 cm2. The measured spectra are corrected for detector distortion and for the angular dependence of detector efficiency. The obtained backscattered spectrum has a lower mean energy and a narrower shape than the primary spectrum. The ratio of the mean energy of the backscattered spectrum to that of the primary spectrum is between 0.83 and 0.94. The ratio of the spectrum width at 10% of the continuous spectrum maximum is between 0.65 and 0.78. The change of spectral shape due to the field size is slight. In the high-voltage spectra, the peak due to the Compton scattering of tungsten Kalpha x-rays is observed. The backscatter factors (BSFs) calculated from the obtained spectra show a satisfactory agreement with other studies. The difference between the BSF defined as the ratio of air kerma and the BSF defined as the ratio of water kerma is also calculated; the maximum difference is 0.43%. The empirical equation showing the relation between the two BSFs is presented.

Three-dimensional assessment of the hip joint by two-directional arthrography.

This retrospective study involved assessment of the three-dimensional bony and cartilaginous cover of the hip acetabular shelf of the hip joint using arthrograms. The extent of lateral and anteroposterior cover, the time course of the changes of cover in each direction, and the relationship between lateral and anteroposterior cover were investigated. It was found that the final extent of acetabular cover could be predicted sooner from the cartilaginous cover than from the bony cover on both the contralateral side and the affected side. There was no significant correlation between lateral and anteroposterior cover on the contralateral side, suggesting the need for assessment of anteroposterior cover to avoid a late diagnosis of anterior acetabular dysplasia.

Scale Arrangement Pattern in a Lepidopteran Wing. 1. Periodic Cellular Pattern in the Pupal Wing of Pieris rapae: (scale/cellular pattern/regular spacing/wing epidermis/Pieris rapae).

In most species of lepidopteran insects, anteroposterior rows formed by scales are arranged at regular intervals in the adult wing; within each row two kinds of scales are alternately arranged. To investigate the cellular basis for the scale arrangement pattern, we examined cell arrangement in the epidermal monolayer of the pupal wing of a small white cabbage butterfly, Pieris rapae, by scanning electron microscopy and light microscopy. The arrangement of scale precursor cells, closely resembling that of scales in the adult wing, was observed in the wing epidermis of the early pupa. Scale precursor cells are proximodistally elongated and form anteroposterior rows. Within a row two kinds of scale precursor cells are nearly alternately arranged, which is not so precise as the alternation of scales in the adult wing. Individual rows of scale precursor cells are separated by rows of single or double undifferentiated general epidermal cells. Occasionally, arrangement abnormalities occur both in the adult and the pupal wing. The cellular basis for the regular spacing of scale rows is discussed.