Comparison of proton density fat fraction, simultaneous R2*, and apparent diffusion coefficient for assessment of focal vertebral bone marrow lesions.

AIM: To investigate the diagnostic performance of proton density fat fraction (PDFF) and simultaneous R2* for focal vertebral bone marrow lesion (VBML) assessment, compared with the apparent diffusion coefficient (ADC). MATERIALS AND METHODS: One hundred and ninety-two spinal magnetic resonance imaging (MRI) examinations performed in 126 patients with focal VBMLs from March 2016 to November 2018 were reviewed retrospectively. The lesions were divided into metastases and benign VBMLs. The protocol consisted of routine morphological MRI sequences, followed by complex-based chemical shift imaging (CSE)-MRI and diffusion-weighted (DW)-MRI with a 1.5 T system. PDFF, R2*, and the ADC values were compared using the Mann-Whitney U-test. Receiver operating characteristic curve analysis was carried out to assess the diagnostic performance for differentiating metastases from focal benign VBMLs. RESULTS: PDFF, R2*, and mean ADC values in metastases were significantly lower than those in benign VBMLs (p<0.05). The PDFF (area under the curve [AUC]= 0.968; 95% confidence interval [CI]=0.932-0.988) showed a significantly larger AUC compared with R2* (AUC=0.670; 95% CI=0.599-0.736) and ADC (AUC=0.801; 95% CI=0.738-0.855). The optimal cut-off value of the PDFF for predicting metastases was 9%; this threshold corresponded to a sensitivity of 96.67%, specificity of 90.28%, and accuracy of 94.27%. CONCLUSION: PDFF is significantly more accurate than ADC and R2* for differentiating focal benign VMBLs from metastases.

Case report: electrical automated massage chair use can induce osteoporotic vertebral compression fracture.

This case report describes a case of an elderly woman diagnosed with acute osteoporotic vertebral compression fracture (OVCF) at thoracic spine after using an electrical automated massage chair (EAMC). Care should be taken when using an EAMC, especially by those with or at risk of developing osteoporosis. Osteoporotic vertebral compression fracture (OVCF) is a common problem among elderly population and presents a high burden to society. Osteoporotic fractures may occur after a minimal trauma of the vertebrae. Electrical automated massage chair (EAMC) is a device that uses a programmed algorithm to perform automated massage. The massage chair, a popular device among elderly with back pain, relies on friction and rhythmic tapping created by a motorized roller. However, research regarding the safety of this device is lacking, especially in the perspective of OVCF. We present a case of an elderly woman diagnosed with acute OVCF of the thoracic spine after using an EAMC. The patient had no risk factor for fragility fracture and experienced an abrupt onset of severe upper back pain while using EAMC. Imaging studies revealed an isolated acute compression fracture at T8 vertebra (AO classification type A1) while dual-energy X-Ray absorptiometry scan confirmed osteoporosis. The patient was treated with a plastic orthosis and oral medications for osteoporosis. After 6-months follow-up, the patient showed union of the fractured T8 vertebra and no remaining symptoms. This case highlights that OVCF can be induced by EAMC. Therefore, patients with or at risk for osteoporosis should be cautious while opting for deep tissue massage using EAMC.

Effects of beta-blockers for congestive heart failure in pediatric and congenital heart disease patients: a meta-analysis of published studies.

AIM: The effects of beta-blockers in pediatric and congenital heart disease (CHD) patients suffering from heart failure are controversial. We performed a meta-analysis to determine whether beta-blockers are effective for heart failure in pediatric and CHD patients. METHODS: We searched for clinical trials focusing on clinical on clinical and ventricular functional/dimensional changes after beta-blocker therapy in PubMed (from its inception to August 2013) and bibliographies of identified studies. Studies investigating any of three beta blockers (carvedilol, bisoprolol, and extended release metoprolol succinate) which are known to be effective in adult patients with heart failure were included. RESULTS: Of the 158 screened, 17 (N.=476) fulfilled the study criteria and were analyzed. Beta-blockers were associated with significant improvements in left ventricular (LV) ejection fraction (EF) (12.47%; 95% CI, 10.36 to 14.61), fraction shortening (5.75%; 95% CI, 4.42 to 7.08), LV end-diastolic dimension (-2.91 mm; 95% CI, -5.46 to -0.36), and LV systolic dimension (-4.03 mm; 95% CI, -6.81 to -1.25). No significant change in the pooled mean difference of the right ventricular (RV) EF (3.50%; P=0.08) was observed. However, the RV EF in the untreated group showed a deteriorating trend (-3%), which was different from the trend in the treatment group. There was a significant reduction in the incidence of clinical worsening (odds ratio, 2.15; 95% CI, 1.27 to 3.66). CONCLUSION: Beta-blocker therapy was associated with a significant improvement of echocardiographic parameters in patients with systemic LV failure. However, the use of beta-blockers did not provide significant benefits in terms of improving the EF in patients with RV failure. Nonetheless, beta-blockers may be effective to prevent the clinical deterioration of pediatric and CHD patients with heart failure.

Analysis of flicker noise for improved data retention characteristics in silicon-oxide-high-k-oxide-silicon flash memory using N2 implantation.

In this paper, we fabricate planar-type Silicon-Oxide-High-k-Oxide-Silicon (SOHOS) and the planar-type SOHOS devices with N2 implantation of 3 x 10(15) dose in a tunneling oxide to determine the impact of N2 implantation in the tunneling oxide of a memory device. The N2 implantation device has better retention characteristics than the device with no implantation. In order establish the correlation between N2 implantation and retention characteristic improvement, the low frequency noise (1/f noise) characteristic is investigated. The normalized drain current noise (S(ID)/I(D)2) level of the N2 implantation device is higher than that of the device with no implantation, which means that N2 implantation causes more trap formation near the interface. Considering that N2 implantation does not affect the DC transfer characteristics, such as mobility and sub-threshold slope, this finding indicates that the increase in the 1/f noise level is due to oxide traps rather than to interface traps. Therefore, the retention characteristic improvement in the N2 implantation device can be explained by the generation of higher number of oxide traps and an increase in the potential barrier blocking the leakage path in the tunneling oxide.

Fall mechanisms, bone strength, and hip fractures in elderly men and women in Taiwan.

UNLABELLED: Three modifiable factors of fall direction, poor bone strength, and depression were associated with an increased risk of hip fractures for elderly men and women; fall direction was a much stronger predictor than the other two. When a fall occurs, changing fall direction may be most effective to prevent hip fractures. INTRODUCTION: A matched case-control study was conducted to identify risk factors for hip fractures in elderly men and women in Taiwan. METHODS: Cases were defined as persons who visited the emergency room due to a fall and were diagnosed with a first hip fracture. For each case, a control was matched by gender and time of falling, selected from persons who sought care at the same emergency room due to a fall resulting in injury other than a hip fracture. In total, 85 paired men and 221 paired women were included. RESULTS: For men, backward, straight-down, and sideways falls were associated with 10.8-, 13.6-, and 15.2-fold increased risks of hip fractures, respectively, compared with forward falls. Poor bone strength and depression were associated with 2.27- and 2.85-fold increased risks of hip fractures, respectively, while dependence in ≥3 activities of daily living was associated with a fivefold lower risk. For women, compared with forward falls, backward, straight-down, and sideways falls were associated with 10.2-, 9.86-, and 12.8-fold increased risks of hip fractures, respectively. Living in a rented house, poor bone strength, depression, and use of antidiabetics were associated with 1.65-, 2.78-, 1.89-, and 1.92-fold increased risks of hip fractures, respectively. Hormone replacement therapy was associated with a fivefold lower risk of hip fractures. CONCLUSIONS: While bone strength and depression can be risk factors for hip fractures in elderly people, the direction of the fall was the strongest predictor. Some risk factors differed between elderly men and women.

Intraoperative examination of sentinel lymph nodes by immunohistochemical staining in patients with breast cancer.

AIM: To performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (CK-IHC) staining of the SLN removed during the operation of breast cancer patients. STUDY DESIGN: Between December 2002 and March 2004, 62 patients with T1 and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. Eighty-nine sentinel lymph nodes (mean number, 1.44) were biopsied and first examined by hematoxylin-eosin (H&E) stained frozen section. All the tumour free sentinel lymph nodes by H&E stained frozen section were immunostained for cytokeratin using a rapid immunohistochemical assay (Cytokeratin (PAN), 1:50, Novocastra Lab., Newcastle, UK) during the operations. RESULTS: Rapid IHC staining revealed seven positive sentinel lymph nodes that were negative for metastasis by H&E staining. This study showed a sensitivity of 92.86%, a specificity of 100%, an accuracy of 98.9%, and a negative predictive value of 98.7%. CONCLUSIONS: The intraoperative examination of sentinel lymph nodes is an accurate and effective way of predicting the axillary lymph node status of patients with breast cancers.

Does a thoracic epidural confer any additional benefit following video-assisted thoracoscopic pleurectomy for primary spontaneous pneumothorax?

OBJECTIVE: Video-assisted thoracoscopic (VATS) bullectomy and apical pleurectomy has become the preferred procedure for recurrent or complicated primary spontaneous pneumothorax (SPN). Although thoracic epidural analgesia is the gold standard after open thoracic surgical procedures, its use in the management of minimally invasive procedures in this young population has not been extensively studied. METHODS: From 1997 to 2003, a single surgeon performed 118 consecutive VATS pleurectomies for primary SPN. The perioperative course, analgesic requirements, hospital stay and long-term complications were compared for 22 (18%) patients in whom a patient-controlled thoracic epidural was used for analgesia and 96 (82%) patients who did not receive an epidural (parenteral opioids). A four-point verbal pain score (0-3) was recorded hourly in every patient at rest and on coughing following surgery. RESULTS: One patient required additional surgery for evacuation of haemothorax. There were no mortalities or other major complications in the series. Overall median hospital stay was 3 (range 1-10) days, the incidence of long-term pain at 3 months was 6%, and the long-term recurrence rate was 3%. Despite parenteral opioids being discontinued significantly earlier than epidurals, pain scores were similar in both groups. There were no significant differences in the duration of air-leaks, length of drainage, hospital stay, long-term pain and long-term paraesthesias between the two groups. CONCLUSIONS: Thoracic epidural analgesia does not contribute significantly to minimize neither perioperative nor long-term pain after VATS pleurectomy for primary SPN. The additional resource requirement in these patients is not justified.

Prediction of corrosion rates of water distribution pipelines according to aggressive corrosive water in Korea.

The drinking water network serving Korea has been used for almost 100 years. Therefore, pipelines have suffered various degrees of deterioration due to aggressive environments. The pipe breaks were caused by in-external corrosion, water hammer, surface loading, etc. In this paper, we focused on describing corrosion status in water distribution pipes in Korea and reviewing some methods to predict corrosion rates. Results indicate that corrosive water of lakes was more aggressive than river water and the winter was more aggressive compared to other seasons. The roughness growth rates of Dongbok lake showed 0.23 mm/year. The high variation of corrosion rates is controlled by the aging pipes and smaller diameter. Also the phenolphthalein test on a cementitious core of cement mortar lined ductile cast iron pipe indicated the pipes over 15 years old had lost 50-100% of their lime active cross sectional area.

Ganglioneuroblastoma presenting as dilated cardiomyopathy.

We report an unusual presentation of ganglioneuroblastoma with features of dilated cardiomyopathy in a 22 month old girl. She was admitted with cardiomegaly; during echocardiography a suspicious abdominal mass was detected by chance. Further imaging studies, including abdominal ultrasonography and spiral computed tomography, revealed a solid mass originating in the right adrenal gland. Metabolic studies and pathological findings were compatible with ganglioneuroblastoma. Following tumour removal and supportive therapy for cardiomyopathy, her clinical condition and laboratory findings improved. Although ganglioneuroblastoma with features of dilated cardiomyopathy is rare, because neurogenic tumours may be involved in its development, measurement of catecholamines in children with dilated cardiomyopathy is strongly recommended.

Analysis of the in vivo dendritic cell response to the bacterial superantigen staphylococcal enterotoxin B in the mouse spleen.

To investigate the in vivo effects of Staphylococcal enterotoxin B (SEB) on dendritic cells (DCs) in the spleen, a single dose of SEB (50 microg/kg) was administered to BALB/c mice by intraperitoneal injection. Afterwards, the mice were sacrificed at 2, 6 and 24 hr, 2, 4, 7 and 15 days, and the spleens were removed. The immunocytochemical characterization of the cells was carried out using various monoclonal antibodies in cryostat-cut sections. The distribution patterns of DCs and their major costimulatory molecules, CD80, CD86 and CD40 in the spleen were identified, and the evidence for maturation of DCs in vivo in response to SEB was obtained. It was found that systemic administration of SEB induced the migration of most of the immature, splenic DCs from the marginal zone to the periarterial lymphatic sheath within 6 hr. This movement paralleled a maturation process, as assessed by upregulation of CD40, CD80 and CD86 expression in the interdigitating dendritic cells (IDCs). The upregulation of costimulatory molecule expression was conspicuous only in DCs in contrast to other antigen-presenting cells (APCs) such as macrophages and B cells which did not show any significant alterations in their costimulatory molecule expression. We also demonstrated the temporal expression pattern of these costimulatory molecules on the activated DCs. The upregulation of costimulatory molecules on DCs reached a peak level 6 hr after SEB injection, while the increase in number of T cells expressing T cell receptor V138 reached a peak level on day 2 after SEB treatment. In conclusion, we demonstrated the in vivo DC response to SEB in the mouse spleen, especially a potent stimulative effect of SEB on DCs in vivo, a temporal distribution pattern of DCs as well as T cells including TCR Vbeta8+ T cells, and a differential expression pattern of costimulatory molecules on the activated DCs. The results of the present study indicate that DCs are the principal type of APCs which mediate T cell activation by SAg in vivo, and that each costimulatory molecule may have different role in the activation of DCs by SAg. Thus, it is plausible to speculate that DCs play a critical role in the T cell clonal expansion by SAgs and other SAg-induced immune responses in vivo.

Effects of cyclic changes in muscle length on force production in in-situ cat soleus.

Muscle shortening and stretch are associated with force depression and force enhancement, respectively. Previously, we have investigated the effect of combined dynamic contractions (i.e. a single shortening-stretch and stretch-shortening cycle) on force production (Herzog and Leonard, 2000). In order to investigate the relationship between force depression and force enhancement systematically, we studied the effects of a single as well as multiple stretch-shortening and shortening-stretch cycles on the ascending limb of the force-length relationship. Furthermore, by systematically varying the speed and magnitude of stretch preceding shortening and the speed and magnitude of shortening preceding stretch, we investigated the influence of these varying contractile conditions on force depression and force enhancement, respectively. Test contractions were performed on cat soleus (n=6) by electrical stimulation using four conceptually different protocols containing a single or repeated stretch-shortening and shortening-stretch cycles. The results of this study showed that: (1) force depression was not influenced by stretch preceding shortening independent of the speed and amount of stretch; (2) force enhancement was influenced in a dose-dependent manner by the amount of shortening preceding stretch but was not affected by the speed of shortening; (3) repeated stretch-shortening (shortening-stretch) cycles showed cumulative effects; (4) the number of shortening steps over a given distance did not influence the amount of force depression. The findings of this study support the idea that the mechanism of force depression associated with muscle shortening is different from that of force enhancement associated with muscle stretch. Furthermore, they support and extend our previous findings that stretch-shortening and shortening-stretch cycles are not commutative.

Expression of cyclins in ductal hyperplasia, atypical ductal hyperplasia and ductal carcinoma in situ of the breast.

Cyclin/cdc complexes are known to function in cell-cycle regulation. Cyclin D1/cdk4 and -6 complexes, which functions as a G1-S checkpoint and cyclin B1/cdc2 complexes, a G2-M checkpoint are essential for DNA synthesis and mitosis, respectively. Thus, dysregulated overexpression of cyclins appears to be involved in uncontrollable cell proliferation and early tumor development. We investigated the expression and proliferative index of cyclin D1 (PIcyclin D1), cyclin B1 (PIcyclin B1) and Ki-67 (PIKi-67) using immunohistochemical staining on 15 cases of ductal hyperplasia (DH), 26 cases of atypical ductal hyperplasia (ADH) and 43 cases of ductal carcinoma in situ (DCIS) of the breast in order to evaluate whether these cyclins are associated with abnormal cell proliferation and play a role in tumor development from ADH to carcinoma. Furthermore, we investigated whether the expression and proliferative index of the cyclins and Ki-67 are correlated with the histologic grade according to the Van Nuys classification and with the histologic subtype according to traditional classification. Finally, we estimated the correlation coefficient among PIcyclin D1, PIcyclin B1, PIKi-67 and estrogen receptor in ADH and DCIS. The expression of cyclin D1 was detected in 39.5% of DCIS and 7.7% of ADH cases. In the DH cases, expression of cyclin D1 was not found. Expression of cyclin B1 was also detected in 69.7% of DCIS, 50.0% of ADH and 93.3% of the DH cases. The PIcyclin D1 was significantly different among these three groups. Moreover, the PIcyclin D1 and PIKi-67 were differed significantly between the low grade DCIS and ADH cases. However, PIcyclin B1 only appeared to be significantly different between the total DCIS and ADH. Results of the correlation coefficient among PIcyclin D1, PIcyclin B1 and PIKi-67 were positively correlated with each other. No significant correlation was found between the expression of ER and cyclin D1 in ADH and DCIS. In summary, our results support the hypothesis that a cyclin D1 and cyclin B1 protein aberration, along with Ki-67, may act as a relatively early event in the tumor development from ADH to carcinoma.

Effects of speed and distance of muscle shortening on force depression during voluntary contractions.

The purpose of this study was to determine the influence of speed and distance of muscle shortening on the amount of force depression for voluntary contractions. Two experimental tests were performed. In the first test, subjects performed isometric knee extensor contractions following muscle shortening produced by isokinetic knee extensions over the range 25-50 degrees. In the second test, subjects performed isometric knee extensor contractions following muscle shortening produced by isokinetic knee extensions at two speeds: 20 and 240 degrees /s. Knee extensor moments, surface electromyographical (EMG) signals of quadriceps femoris, and interpolated twitch moments were measured during all contractions and were compared with the corresponding values obtained during purely isometric contractions. Force depression following muscle shortening for the voluntary contractions tested in this study did not depend on the distance or the speed of muscle shortening. These results are in contrast to the corresponding results in the literature obtained using artificial electrical stimulation in which force depression was always found to be directly related to the distance of shortening and inversely related to the speed of shortening. The difference in force depression as a function of the distance and speed of muscle shortening between voluntary and artificial electrical stimulation may be associated with changes in activation following the voluntary shortening contractions, whereas activation is controlled and constant in all artificial stimulation protocols.

Lobular carcinoma in situ in sclerosing adenosis.

The initial presentation of breast malignancy as noninvasive carcinoma in an area of sclerosing adenosis is unusual. Especially, lobular carcinoma in situ in sclerosing adenosis sometimes can be a potential source of confusion with invasive lobular carcinoma. We report a case of lobular carcinoma in situ presenting in adenosis exhibiting patterns akin to invasive lobular carcinoma, thus leading to potential misdiagnosis. Overall architecture of the lesion as seen at lower power and immunohistochemistry can be useful to distinguish between sclerosing adenosis with lobular carcinoma in situ and infiltrating lobular carcinoma.

De novo direct duplication of 15q15-->q24 in a newborn boy with mild manifestations.

Duplication of distal 15q results in a recognizable clinical phenotype. We report here on a 25-day-old boy with a de novo interstitial duplication of chromosome region 15q15-q24. The manifestations in this patient are milder than those of previously described patients and include minor facial anomalies, velopharyngeal insufficiency, branchial cleft cyst, and hydronephrosis. Fluorescence in situ hybridization (FISH) using a chromosome 15 painting probe confirmed that the extra material is of chromosome 15 origin. Further analysis with the SNRPN probe demonstrated that the duplication is telomeric to the Prader-Willi/Angelman syndrome critical region. This case delineates a broader spectrum for patients with duplication 15q syndrome.

Force depression in human quadriceps femoris following voluntary shortening contractions.

The purpose of this study was to investigate whether the isometric muscle force, redeveloped following maximal-effort voluntary shortening contractions in human skeletal muscle, is smaller than the purely isometric muscle force at the corresponding length. Isometric knee extensor moments, surface electromyographic (EMG) signals of quadriceps femoris, and interpolated twitch moments (ITMs) were measured while 10 subjects performed purely isometric knee extensor contractions at a 60 degrees knee angle and isometric knee extensor contractions at a 60 degrees knee angle preceded by maximal-effort voluntary shortening of the quadriceps muscles. It was found that the knee extensor moments were significantly decreased for the isometric-shortening-isometric contractions compared with the isometric contractions for the group as a whole, whereas the corresponding EMG and ITM values were the same. This study is the first to demonstrate force depression following muscle shortening for voluntary contractions. We concluded that force depression following muscle shortening is an actual property of skeletal muscle rather than a stimulation artifact and that force depression during voluntary contraction is not accompanied by systematic changes in muscle activation as evaluated by EMG and ITM.

Early rehabilitation program in postmastectomy patients: a prospective clinical trial.

The purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only. Data were obtained at preoperatively, three days after operation, at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint, upper extremity circumferential measurements, as well as 10 elements of shoulder function. Postoperatively, both groups showed an increased range of motion of the shoulder joint and improved functional activities, but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment. This study also showed that an early rehabilitation program did not increase postoperative complications. We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion, and significantly better in a rehabilitation group.

PTC and PROP behave differently in tests of discrimination from their solvents.

Better discrimination was possible between phenylthiocarbamide (PTC) solutions and the pure solvent when the solvent was a tasteless low-concentration NaCl solution to which the subject had adapted than when the solvent was purified water. The reverse was true for 6-n-propylthiouracil (PROP). The differences in discrimination for PROP and PTC in the different solvents were caused by differences in the intensity and persistence of aftertastes, rather than a more intense perception of the PTC and PROP tastes per se. This has consequences for traditional approaches to measuring taste sensitivity, as well as indicating that PTC and PROP are not necessarily equivalent indicators of 'taster' versus 'non-taster' status.