[Attempt to Evaluate the Influence of Morphology, Blood Flow, and Hardness in Mammary Gland Malignant Disease].

It is important to make an appropriate diagnosis category by evaluating the morphology, blood flow, and hardness of mammary gland disease in breast ultrasound, such as screening and detailed examination. Therefore, understanding the characteristics and effects of B-mode (BM), color Doppler (CD), and elastography (EG) in ultrasonography is considered to lead to improvement in examination accuracy. In this study, we clarified the impact of each function on qualitative diagnosis, with the aim of assisting technologists with high-accuracy breast ultrasound. The subjects were 531 malignant tumor cases. The final evaluation of ultrasonography was classified into 5 levels, BM was classified into 5 levels, CD was classified into 4 levels based on blood flow evaluation, and EG was classified into 9 levels based on the Tsukuba elasticity score. The contribution rates of BM, CD, and EG were 70.4%, 15.0%, and 14.6% in all cases (correlation ratio 0.87). BM was most important at the time of breast ultrasound. No difference was observed between CD and EG. In the evaluation by malignant tumor, each characteristic was seen in the degree of influence. It became clear that comprehensive evaluation is important for benign/malignant evaluation and histological-type estimation.

[Relationship between Clostridium difficile ITS-PCR Type and Pathogenicity].

Clostridium difficile (C. difficile) causes antibiotic-associated diarrhea and nosocomial infection. The PCR of internal transcribed spacer regions (ITS) is easily conductible in a relatively short time. The purpose of the current study is to classify C. difficile by PCR electrophoresis pattern of ITS (ITS-PCR type) and estimate the relationship of the ITS-PCR type of C. difficile with its pathogenicity. We examined 77 strains which were obtained in our hospital from March 2012 to August 2013. Toxin genes were detected by PCR using toxin gene specific primers. Antimicrobial sensitivities were measured by E-test. Pseudomembrane formation and severity of the illness in clinical patients were investigated based on the medical records. The strains were classified into the 33 ITS-PCR types. Among them, most of strains in 18 PCR types were not associated with any toxin genes. Strains with toxin A(+)/B(+)genes were classified into 14PCR types. The 3 strains with toxin B (+) strains and the two strains with toxin A(+)/B(+)/binary toxin(+) genes were classified into 1 PCR type, type 17, and type 16, respectively. 6 strains in 13 strains of type 33, and 5 strains in 11 strains of type 2 were detected from the same ward, presuming nosocomial infection. Minimum inhibitory concentrations (MICs) of vancomycin and metronidazole were ≤ 2 µg/mL, distribution of MICs were not correlated with ITS-PCR type. The pseudomembrane forming and severity of the illness were not obviously related to ITS-PCR pattern. Thus, the typing of C. difficile by ITS-PCR pattern is considered to be useful for early detection of nosocomial infection, and assessment of toxigenicity.

Impact of kidney function and urinary protein excretion on intima-media thickness in Japanese patients with type 2 diabetes.

BACKGROUND: Carotid echo indexes [intima-media thickness (IMT)] are commonly used surrogate markers for cardiovascular disease; however, the impacts of chronic kidney disease (CKD) on changes in IMT are unclear. We examined associations between CKD and IMT in participants with and without type 2 diabetes through longitudinal analysis. METHODS: In total, 424 subjects were enrolled in this study. IMT was measured as per carotid echo indexes. Relationships between IMT and risk factors were analyzed using multiple linear regression analysis, in which we defined IMT as the dependent variable and atherosclerosis-related factors (age, sex, systolic pressure, total cholesterol, body mass index, estimated glomerular filtration rate (eGFR), uric acid, smoking index, number of antihypertensive drugs, statin use, urinary protein levels, past cardiovascular event, glycated hemoglobin, and diabetes duration) as independent variables. RESULTS: The study population was composed of 70.3 % male subjects. Participants with diabetes accounted for 64.4 % of the total population. The mean follow-up duration was 2.2 ± 1.5 years. Alterations in IMT tended to be associated with systolic blood pressure (+10 mmHg) (ß = -0.0084, p = 0.09) and eGFR (+10 mL/min/1.73 m(2)) (ß = -0.0049, p = 0.06) in all participants. In participants without diabetes, alterations in IMT were associated with eGFR (+10 mL/min/1.73 m(2)) (ß = -0.0104, p = 0.03) and tended to be associated with systolic blood pressure (+10 mmHg) (ß = 0.0094, p = 0.06). No significant relationships were found in participants with diabetes. CONCLUSION: Low eGFR was associated with progression of carotid thickness independent of common cardiovascular risk factors in non-diabetic participants.

[Trends for the etiology of infective endocarditis at our hospital these 5 years].

The aim of this study is to evaluate characteristics of infective endocarditis for 5 years at Kanazawa University Hospital. Retrospectively, we investigated 39 patients diagnosed as infective endocarditis at our hospital from 2006 to 2010 based on blood culture and/or rejected cardiac specimens. Of 39 patients with infective endocarditis, 27 were male and 12 were female. Mean age was 55.4 years and 69% patients were older than 50 years. The frequent underlying presumed diseases were cardiac diseases. Vegetation was mainly observed at mitral valve and aortic valve. Streptococcus species [14 cases (36%)] and Staphylococcus species [12 cases (31%)] were common pathogens. In Streptococcus species, the critical cause was mostly presumed to be associated with dental procedure and oral cavity. In Staphylococcus species, intravascular device and soft tissue infection were also frequently presumed. Frequency of chronic kidney disease and infection around valve were higher in Staphylococcus species than those observed in Streptococcus species [12 cases (100%) vs. 7 cases (50%); p < 0.05, 6 cases (50%) vs. 1 case (7%); p < 0.05]. Our results suggested that the etiology of patients with Staphylococcus species infection increased in number among patients suffering from infective endocarditis at our hospital.

Impact of kidney function and urinary protein excretion on pulmonary function in Japanese patients with chronic kidney disease.

BACKGROUND: Although the cardiorenal relationship in chronic kidney disease has been investigated, information about the lung-kidney relationship is limited. Here, we investigated the impact of kidney function and urinary protein excretion on pulmonary dysfunction. METHODS: The data from pulmonary function tests and kidney function (estimated glomerular filtration rate [eGFR] and urinary protein) between 1 April 2005 and 30 June 2010 were selected from our laboratory database. Data were classified into 4 categories according to eGFR and proteinuria. Category 1, eGFR ≥60 ml/min/1.73 m(2) and urinary protein <0.3 g/gCr; category 2, eGFR <60 ml/min/1.73 m(2) and urinary protein <0.3 g/gCr; category 3, eGFR ≥60 ml/min/1.73 m(2) and urinary protein ≥0.3 g/gCr; and category 4, eGFR <60 ml/min/1.73 m(2) and urinary protein ≥0.3 g/gCr. Pulmonary function data were evaluated according to these 4 categories. RESULTS: A total of 133 participants without major respiratory disease, abnormal computed tomography and smoking history were enrolled. Hemoglobin (Hb)-adjusted percentage carbon monoxide diffusing capacity (%DLCO) in category 4 (46.2 ± 7.5) and category 2 (63.6 ± 17.8) were significantly lower than in category 1 (75.8 ± 18.9) (P < 0.05). In addition, Hb-adjusted %DLCO was weakly correlated with eGFR in participants with urinary protein <0.3 g/gCr (R = 0.30, P = 0.001). Hb-adjusted %DLCO was strongly correlated with eGFR in participants with urinary protein ≥0.3 g/gCr (R = 0.81, P < 0.001). Other pulmonary function test markers (percentage (%) vital capacity, % forced expiratory volume in one second (FEV1), FEV1/forced vital capacity, % total lung capacity, and % residual volume) were not significantly different between categories. CONCLUSION: This study suggests that decreased eGFR is associated with decreased %DLCO in proteinuric patients.

Reversibility of the pulmonary function based on the partial flow-volume curve predicts the efficacy of bronchodilator therapy for treating chronic cough.

OBJECTIVE: Partial expiratory flow-volume curves have the potential to detect mild bronchoconstriction because they are not affected by the modulatory effects of deep inspiration. The aim of this study was to investigate the relationship between the efficacy of bronchodilator therapy (BDT) in treating the cough and to assess the increase in the expiratory flow of the partial flow-volume curve at 40% above the residual volume level (PEF40) caused by treatment with a short-acting beta-2 agonist (SABA) in patients with chronic nonproductive cough. METHODS: We measured the reversibility of PEF40 caused by a SABA in 42 patients with chronic nonproductive cough at visit 1 (day 0). The patients received BDT for six days. The visual analogue scale (VAS) was used to assess the efficacy of BDT in treating coughing at visit 2 (day 7) (0 mm, 'no cough;' 100 mm, 'no change in coughing'). RESULTS: Reversibility of the PEF40 was correlated (r=0.690, p<0.001) with the VAS score determined at visit 2 and was higher in the patients with cough variant asthma (CVA) (44.9 ± 18.3%) than in those with atopic cough (13.4 ± 10.4%) (p<0.01). CONCLUSION: Reversibility of the PEF40 predicted the efficacy of BDT in patients with chronic nonproductive cough and helped to identify patients with CVA.

Prediction formula for interrupter respiratory resistance in healthy Japanese adults.

Interrupter respiratory resistance (Rint) measurement is useful for evaluating lung function in patients who cannot perform traditional pulmonary function tests. However, data on the prediction formulas for Rint in healthy Japanese adults are lacking. Our aims were to examine the relationship between Rint and sex, age, height, and weight, to establish prediction formulas, and to evaluate our new prediction formula (%Rint) in patients with asthma. Rint measurement was performed in 1,536 healthy adult subjects aged 21-80 years. This study was conducted according to ATS guidelines, which recommend obtaining 10 measurements to ensure a minimum of 5 technically acceptable interruptions (Am J Respir Crit Care Med 2007). Stepwise multiple linear regression analysis indicated that height was the most significant variable independently correlating with Rint. The Rint prediction formulas for our cohort based on height were: RintE = -0.03168 x height + 8.204084 and Rinti = -0.02985 x height + 7.920835. Both %RintE and %Rinti were significantly higher in patients with asthma than in normal subjects (%RintE; 135.2 +/- 26.4 vs. 98.6 +/- 25.5, %RintI; 142.4 +/- 30.4 vs. 98.6 +/- 27.4; p < 0.0001). We established prediction formulas of Rint for healthy Japanese adults. %Rint is useful in screening for asthma.

Comparison of feeding systems: feed cost, palatability and environmental impact among hay-fattened beef, consistent grass-only-fed beef and conventional marbled beef in Wagyu (Japanese Black cattle).

The objective of this article is to compare feed cost, palatability and environmental impacts among feeding systems of high concentrate (HC), high hay (HH) and grass-only-fed (Gof) groups. Feed cost was the sum of costs paid for feed intake times the price of feed per kilogram. Palatability was measured by a panel taste test using HH and Gof beef and analyzed for differences. Environmental impacts were calculated based on 1 kg of Japanese beef yield of CO(2) equivalents (eq) and animal end weights at each feeding stage. Results showed that the HH and Gof feeding systems could significantly reduce feed costs by approximately 60% and 78%, respectively, from the HC. In the panel taste test, 50% and 47.50% of panelists indicated that HH beef was 'extremely delicious' and 'acceptable,' respectively, while 15% indicated that Gof beef was 'extremely delicious'; 62.50% indicated that Gof beef was 'acceptable.' Environmental impacts of each feeding system in terms of CO(2) equivalents (eq) were 9.32, 6.10 and 2.04 tonnes of eq for the HC, HH and Gof, respectively. The HH was an economical system that produced moderate impacts on the environment and had impressive taste.

[Investigation of quality control and average glandular dose and image quality in digital mammography in Hokkaido].

A questionnaire survey about mammography in Hokkaido was mailed to 121 facilities from August to September 2009. We surveyed the conditions of digital mammography with regard to quality control (QC) and average glandular dose at 79 facilities in Hokkaido in 2009, and the results of the survey were compared with those of 2004. We found that digital mammography techniques were widely used across Hokkaido and that computed radiography (CR) systems were quite widespread, with 70% of facilities having them. The average glandular dose ranged from 1.04 to 2.3 mGy (mean: 1.73 mGy) for digital equipment. The results revealed several problems. Although the use of 1-, 2-, and 3-megapixel (MP) liquid crystal displays (LCDs) was not uncommon, 5-MP LCDs were used in most cases when reading digital mammograms. Facilities that have mammography equipment are unlikely to have quality control instruments for mammography. Although daily QC is performed in most facilities, further quality control for digital mammography should be developed, including that for monitors. In a second study, we evaluated the 1 Shot Phantom M Plus (1 Shot Phantom), which enables objective evaluation by providing for one physical measurement rather than a subjective visual analysis. The results indicated that the 1 Shot Phantom was very useful for digital mammography systems in daily QC testing because it enabled objectivity.

[Circulatory function test for the diagnosis of diabetic complications].

Diabetic patients suffer from systemic complications, which are generally characterized by a lack of early symptoms. In the management of diabetes, early diagnosis of complications and preventing progression are of importance. Vascular complications of diabetes are divided into microvascular and macrovascular complications. Circulatory function tests play a major role in diagnosing the presence and severity of macrovascular complications in clinical settings. In this review, we outlined the significance and precautions of each test in the diagnosis of diabetic macrovascular disease. 1) Echocardiography: Diabetic patients are often associated with ischemic heart disease, and some patients present with diffuse wall motion abnormalities due to multivessel disease. Patients with diabetic cardiomyopathy may have signs of left ventricular diastolic dysfunction with normal systolic function. 2) Carotid ultrasonography: Increase in intima-media thickness is associated with the onset of cardiovascular and cerebrovascular disease. Hypoechoic plaque and the thrombus formation have been reported to be closely related with cerebral infarction. 3) Assessment of lower extremity artery: Patients with diabetes are at a higher risk of developing peripheral artery diseases (PAD), which lead to disability. Doppler ultrasonography is widely used for noninvasive diagnosis of PAD. Information of real-time physiological blood flow is useful for disease monitoring. 4) Ankle-brachial index (ABI): ABI is a simple method recommended for screening and evaluating PAD of lower limbs. The limitation of this measurement is that pseudonormalization may occur with severe calcification of artery walls. 5) Pulse wave velocity (PWV), flow-mediated dilatation (FMD): PWV and FMD provide information for the function of blood vessels. Functional changes in peripheral arteries may precede structural changes. In this regard, these tests may play an important role in early diagnosis.

Relationships of serum haptoglobin concentration with HbA1c and glycated albumin concentrations in Japanese type 2 diabetic patients.

BACKGROUND: The stable fractions of glycated hemoglobin (Hb), particularly HbA(1c), and glycated albumin (GA) were measured to monitor chronic glycemic control. Haptoglobin (Hp) is a Hb-binding protein, which plays a major role in preventing free Hb-induced tissue oxidative damage. The aim of this study was to clarify the relationships of serum Hp concentration with HbA(1c) and GA concentrations. METHODS: A cross-sectional study to determine the relationship of serum Hp concentration with GA and HbA(1c) concentrations was conducted. The subjects were 125 Japanese type 2 diabetic patients with stable HbA(1c) levels for more than 3 consecutive months. Patients with altered albumin and red blood cell turnover, which are observed in those with chronic renal failure, liver cirrhosis, and anemia among others, were excluded from the study. RESULTS: Serum Hp concentration positively correlated with HbA(1c) concentration (r=0.30, p<0.001), but not with GA concentration (r=0.15, p=0.10). There was a weak inverse correlation between serum Hp concentration and GA/HbA(1c) ratio (r=-0.19, p=0.03). Moreover, GA /HbA(1c) ratio inversely correlated with body mass index (BMI) (r=-0.31, p<0.001). In contrast, there was no significant correlation between Hb concentration and HbA(1c) (r=0.01, p=0.88) or GA (r=0.12, p=0.21) concentrations. We also analyzed the correlation of serum Hp concentration with GA and HbA(1c) concentrations in patients with the Hp 2-1 and Hp 2-2 genotypes, separately. Hp concentration positively correlated with HbA(1c) concentration in patients with the Hp 2-1 (r=0.32, p=0.03) and Hp 2-2 (r=0.29, p=0.02) phenotypes. Multiple regression analysis revealed that the observed correlation between Hp and HbA(1c) concentrations was significant after adjustment for age, gender, and BMI. In contrast, there was no significant correlation between GA and Hp concentrations in patients with either phenotype. Then, we analyzed how Hp concentration affects GA/HbA(1c) ratio in patients with these Hp phenotypes. There was an inverse correlation between Hp concentration and GA/HbA(1c) ratio in patients with Hp 2-1 (r=-0.44, p=0.003), but not in those with Hp 2-2 (r=-0.03, p=0.75). Multiple regression analysis revealed that the inverse correlation between Hp concentration and GA/HbA(1c) ratio in patients with Hp 2-1 was independent of age, gender, and BMI. CONCLUSIONS: Hp phenotype and concentration should be considered in interpreting HbA(1c) and GA levels as glycemic control indicators in diabetic patients. We suggest that in type 2 diabetic patients with Hp 2-1 and high Hp concentrations, HbA(1c) level may be overestimated relative to GA level.

Application of inorganic element ratios to chemometrics for determination of the geographic origin of welsh onions.

The composition of concentration ratios of 19 inorganic elements to Mg (hereinafter referred to as 19-element/Mg composition) was applied to chemometric techniques to determine the geographic origin (Japan or China) of Welsh onions (Allium fistulosum L.). Using a composition of element ratios has the advantage of simplified sample preparation, and it was possible to determine the geographic origin of a Welsh onion within 2 days. The classical technique based on 20 element concentrations was also used along with the new simpler one based on 19 elements/Mg in order to validate the new technique. Twenty elements, Na, P, K, Ca, Mg, Mn, Fe, Cu, Zn, Sr, Ba, Co, Ni, Rb, Mo, Cd, Cs, La, Ce, and Tl, in 244 Welsh onion samples were analyzed by flame atomic absorption spectroscopy, inductively coupled plasma atomic emission spectrometry, and inductively coupled plasma mass spectrometry. Linear discriminant analysis (LDA) on 20-element concentrations and 19-element/Mg composition was applied to these analytical data, and soft independent modeling of class analogy (SIMCA) on 19-element/Mg composition was applied to these analytical data. The results showed that techniques based on 19-element/Mg composition were effective. LDA, based on 19-element/Mg composition for classification of samples from Japan and from Shandong, Shanghai, and Fujian in China, classified 101 samples used for modeling 97% correctly and predicted another 119 samples excluding 24 nonauthentic samples 93% correctly. In discriminations by 10 times of SIMCA based on 19-element/Mg composition modeled using 101 samples, 220 samples from known production areas including samples used for modeling and excluding 24 nonauthentic samples were predicted 92% correctly.

Chemometric techniques on inorganic elements composition for the determination of the geographic origin of Welsh onions.

Techniques to determine the producing country of Welsh onions (Allium fistulosum L.) were developed by using 216 samples from Japan and from Anchu Shandgon, Shanghai and Amoy Fjian in China. Twelve elements (Na, P, K, Ca, Mg. Mn, Fe, Cu, Zn, Sr, Ba, Al, Co, Ni, Rb, Mo, Cd, Cs, La, Ce, Tl and Pb) contained in Welsh onions were determined. In order to determining whether Welsh onions originate in Japan or in China, linear discriminant analysis (LDA) and soft independent modeling of class analogy (SIMCA) were performed, using concentrations of 20 elements excluding Al and Pb in 22 elements. In LDA for two-group discrimination modeled on Welsh onions from Japan and China, 103 samples used for modeling were classified 95% correctly, and 89 other samples were predicted 94% correctly. As the average of predictions by SIMCA modeled on samples selected by 10 times of random selections, 192 samples, including the 103 samples used for modeling, were predicted 96% correctly. In discriminations by combined LDA and SIMCA, all 81 samples produced in Japan were correctly judged to be Japanese ones, and only 8 samples out of 111 samples produced in China were not correctly judged to be Chinese ones.