Reliability of personality and values tests: The effects of "high stakes" selection conditions, and of four years in medical school.

This study investigated if scores on tests of personal qualities are affected by whether they will determine selection decisions ("high stakes") or not; and whether they are stable for individuals and groups across a four-year medical course. Two tests, one assessing values and one assessing components of personality, were administered either at the same time as a medical university entrance exam (first cohort; N = 216), or after entry was confirmed (second cohort; N = 142). Both cohorts took the tests again after four years of medical school. Analysis of variance was used to compare group mean scores and interactions, and correlation coefficients to measure temporal reliability. The high stakes cohort initially presented themselves in a significantly more positive light on the personality test. After four years of medical school scores on both tests changed significantly, towards more communitarian values and less empathic attitudes. Thus, personality scores were affected by both the conditions under which the initial tests were conducted and by the passage of time, but values only by the passage of time. Before and after scores were significantly correlated.

Trial use of the Personal Qualities Assessment (PQA) in the entrance examination of a Japanese medical university: similarities to the results in western countries.

BACKGROUND: The Personal Qualities Assessment (PQA), developed by the University of Newcastle, Australia to assess the aptitude of future medical professionals, has been used in Western countries. PURPOSES: The objective was to investigate whether the PQA is appropriate for Japanese medical school applicants. METHODS: Two of the PQA tests, Libertarian-Dual-Communitarian moral orientations (Mojac) and Narcissism, Aloofness, Confidence, and Empathy (NACE), were translated into Japanese, and administered at the Tokyo Women's Medical University entrance examinations from 2007 to 2009. RESULTS: The distributions of the applicants' Mojac and NACE scores were close to the normal distribution, and the mean scores did not exhibit a large difference from those in Western countries. The only significant difference was that the mean score of the NACE test was slightly lower than the Western norm. CONCLUSIONS: The translated PQA tests may be appropriate for use with Japanese applicants, though further research considering cultural differences is required.

Identification of ventrolateral intramedullary intervertebral disc herniation in a dog.

A 10-year-old male cross-breed dog was brought to Nihon University Animal Hospital with a history of acute onset of paralysis in the pelvic limbs 13 days previously. Magnetic resonance imaging revealed an intramedullary linear tract in the spinal cord at the thoracic vertebrae 12-13 region, which appeared hyperintense on T2-weighted images, but was hypointense and isointense on T1-weighted images when compared with normal parenchyma of the spinal cord. A hemilaminectomy was performed and a blob of what appeared to be fibrous tissue was found adhering to the surface of the dura mater. The diameter of the blob was about 4 mm. A durotomy was performed over the affected area and chondroid material was found within the spinal cord. Material from the nucleus pulposus penetrated the dura mater from the ventral aspect of the spinal cord in previously reported intramedullary intervertebral disc herniation cases, but, in this case, penetration occurred from the left ventrolateral aspect and progressed through to the right lateral aspect, forming a visible blob of what appeared to be fibrous tissue on the surface of the dura mater at the exit point. To the best of our knowledge, this was the first case report of an intramedullary intervertebral disc herniation originating from the ventrolateral aspect of the spinal cord in a dog.

Magnetic resonance imaging features and clinical signs associated with presumptive and confirmed progressive myelomalacia in dogs: 12 cases (1997-2008).

OBJECTIVE: To characterize clinical signs and findings from magnetic resonance imaging (MRI) and CSF analysis for dogs with progressive myelomalacia (PM) diagnosed on the basis of clinical and histologic features. DESIGN: Retrospective case series. ANIMALS: 5 dogs with confirmed PM and 7 with presumptive PM evaluated from 1997 through 2008. PROCEDURES: Medical records of study dogs were reviewed, and clinical signs and MRI and CSF findings were evaluated. A clinical diagnosis of PM was made on the basis of detection of disk-associated spinal cord compression via MRI and progression of clinical signs from initial paraparesis or paraplegia to thoracic limb lower motor neuron paresis to tetraplegia associated with cranial migration of the extent of cutaneous trunci reflex extinction and analgesia, terminating in death due to respiratory paralysis. RESULTS: All dogs were paraplegic and had signs of lower motor neuron lesions. As revealed by MRI of the vertebral column, the length of abnormal signal intensity was more than 6-fold, compared with the body length of L2. In some dogs, these abnormal MRI findings were observed before PM was clinically diagnosed. The CSF examination revealed hemorrhagic xanthochromia. CONCLUSIONS AND CLINICAL RELEVANCE: A hyperintense region of the spinal cord > 6 times the length of L2 on T2-weighted imaging might be a characteristic MRI finding of PM. In some dogs, such MRI findings were observed before PM was clinically diagnosed. Progressive myelomalacia may thus be diagnosable at the early stage through MRI and CSF examination before signs of PM develop.

Symptomatic tongue atrophy due to atypical polymyositis in a Pembroke Welsh Corgi.

A three-year-old, 7.3-kg, female Pembroke Welsh Corgi exhibited symptomatic tongue atrophy, crinkling of the tip of the tongue, dysphagia and excessive salivation. Neurological examination suggested multiple cranial neuropathy, but polymyositis was diagnosed by magnetic resonance imaging and muscle biopsy. The dog did not respond to prednisolone treatment and died from aspiration pneumonia 22 months after the first presentation. Post-mortem histopathological examination of the tongue revealed marked myofiber loss and fibrosis with multifocal infiltration of mixed mononuclear cells. Similar findings were also observed in the masticatory muscles and quadriceps without abnormality of peripheral nerves or evidence of infection. Symptomatic tongue atrophy occurring in the course of polymyositis has not been reported previously in dogs.

MRI of secondary cervical syringomyelia in four cats.

This report describes the use of magnetic resonance imaging (MRI) to diagnose cervical syringomyelia in 4 cats. MRI revealed enlargement of the lateral ventricle in all the cats. Of the 4 cases, MRI revealed herniation of the cerebellum in 3 cats, an isolated fourth ventricle in 1 cat, severe hydrocephalus in 2 cats and brain masses in 1 cat. In this report, the cervical syringomyelia in these cats may have been due to formation of a secondary syrinx (enlargement of the central canal) as a result of blockage of flow in the outlet of the fourth ventricle caused by FIP encephalomyelitis or secondary cerebellar tonsillar herniation caused by increased intracranial pressure due to intracranial masses or may have been due to caudal compression of the cerebellum caused by increased intracranial pressure due to hydrocephalus.

Magnetic resonance imaging and computed tomography findings of vertebral osteosarcoma in a cat.

An 8-year-old female Persian cat with a gait disorder was brought to our hospital. Pelvic limb mobility had gradually reduced over the preceding 3 months, then rapidly deteriorated 2 weeks before consultation. Signs also occurred in the thoracic limbs. With a tentative diagnosis of neural disease, magnetic resonance imaging and computed tomography were performed. T1-weighted imaging showed isointensity in the seventh cervical vertebra, while T2-weighted imaging revealed hypointensity. Contrast-enhanced T1-weighted imaging revealed a uniformly enhancing mass. Extirpation of the mass relieved the clinical signs, leading to disappearance of the neurological signs. The histopathological examination suggested osteosarcoma.

Ocular granulomatous meningoencephalomyelitis in a dog: magnetic resonance images and clinical findings.

A 4-year-old female miniature dachshund presented with a history of progressive decrease in vision, neck pain, and ataxia for which an MRI was performed 21 days after the initial consultation. The optic nerves showed isointensities on T1- (T1W) and T2-weighted (T2W) images that were enhanced by the contrast medium. The optic chiasm was swollen. Other parts of the cerebral parenchyma, not only the visual pathway, showed symmetrical hyperintensities on T2W images. Cerebrospinal fluid showed increased anti-GFAP autoantibodies. The dog received corticosteroid therapy despite which she exhibited anorexia, vomiting, and lethargy. Hence, a follow-up MRI was repeated 30 days after the initial consultation in which T2W images showed enlargement of the hyperintense area. The dog died 45 days after the initial consultation. Postmortem pathological examination confirmed a diagnosis of granulomatous meningoencephalomyelitis (GME).

A canine case of necrotizing meningoencephalitis for long-term observation: clinical and MRI findings.

A 3-year-old female pug presented with general seizure following a partial seizure. During the remaining 48 months till death, the dog showed various neurological signs such as disturbance of consciousness, myoclonus and various types of partial seizure after each occurrence of the seizure clusters, and the dog eventually exhibited inability to stand and dementia. Magnetic resonance imaging findings revealed atrophy of the brain over the course of the disease. On histopathological analysis, the dog was diagnosed with necrotizing meningoencephalitis. This case of a canine necrotizing meningoencephalitis observed over the long term is valuable.

A feline case of isolated fourth ventricle with syringomyelia suspected to be related with feline infectious peritonitis.

A one-year-old female cat was unable to stand. Magnetic resonance imaging was performed, and an enlargement of the lateral, third, and fourth ventricles and syringomyelia were detected. The cat was diagnosed with an isolated fourth ventricle (IFV) with syringomyelia. The serum isoantibody test for the feline infectious peritonitis (FIP) virus was 1:3,200. After the cat died, a pathological examination revealed nonsuppurative encephalomyelitis. We suspected that the IFV, detected in the cat, was associated with FIP encephalomyelitis. To our knowledge, there has been no report on IFV in veterinary medicine.

Malignant peripheral nerve sheath tumor arising from the spinal canal in a cat.

A 10-year-old female mongrel cat with back pain was brought to the Nihon University Animal Medical Center. Palpation demonstrated a mass in the back region. Radiography revealed partial destruction of the processus spinosus and the arch of the T8 and T9 vertebrae. On magnetic resonance imaging, the mass was found to have compressed the spinal cord and extended to the outside of the spinal canal. We performed extirpation of the mass, and confirmed that it arose from the spinal canal. Histopathologically, the mass was a malignant peripheral nerve sheath tumor.

Traumatic intracerebral hematoma in a dog: MR images and clinical findings.

A nine-year-old, male, mongrel dog was unsteady after falling down a set of stairs. The dog exhibited a mildly abnormal gait 2 days after injury, and was not able to stand, with spasticity of the right limbs, 4 days after injury. MR imaging revealed a clearly demarcated mass on the top of the left lateral ventricle that showed mild hyperintensity on T1-weighted images and hyperintensity on T2-weighted images. The authors diagnosed the dog as having a traumatic intracerebral hematoma. This type of case, in which the clinical signs deteriorated due to edema associated with hematoma, is extremely rare.

Left atrial volume and the risk of paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy.

Paroxysmal atrial fibrillation (PAF) is a common complication of patients with hypertrophic cardiomyopathy, often leading to acute or progressive heart failure and cerebral infarction. We assessed the echocardiographic data of 141 consecutive patients with hypertrophic cardiomyopathy, with and without PAF. In all, 31 patients (22%) had a history of PAF with spontaneous conversion to in sinus rhythm. Left atrial volume and left atrial volume indexed to body surface area were significantly increased for patients with PAF compared with those without PAF. Maximum left atrial volume was the most sensitive and specific parameter for the occurrence of PAF in patients with hypertrophic cardiomyopathy.

[Validation of a new hand-carried ultrasound device equipped with directional color power Doppler and continuous wave Doppler].

OBJECTIVES: This study evaluated the accuracy of the directional color power Doppler (DCPD) and continuous wave Doppler (CWD) methods incorporated in the new hand-carried SonoSite 180PLUS ultrasound device. METHODS: The hand-held ultrasound system with 2.5 MHz transducer and SONOS 5500 was used as a standard ultrasound system with a 2 to 4 MHz wideband transducer. The experimental study used a Doppler wire phantom to evaluate the influence of target wire speed and angle of transducer on DCPD imaging. The clinical study included 48 consecutive patients. DCPD assessment of valvular regurgitation measured the distances of DCPD signals of mitral, aortic and tricuspid valve regurgitation using the apical four-chamber view for comparison with standard echocardiography. CWD assessment measured the peak velocities of the aortic flow and tricuspid valve regurgitant flow for comparison with standard echocardiography. RESULTS: In the experimental study, DCPD signals were not influenced by target wire speed changes and transducer incident angles. In the clinical study, agreements for mitral, aortic and tricuspid regurgitation between the two methods were 89.6%, 81.8% and 78.7%, respectively. The distances of DCPD valve regurgitant signals by the hand-carried ultrasound device showed good correlation (mitral regurgitation: y = 0.84x + 0.55; r = 0.93, aortic regurgitation: y = 0.95x + 0.27; r = 0.94, tricuspid regurgitation: y = 0.86x + 0.61; r = 0.90) with those by standard echocardiography. Evaluation of CWD velocity measurements showed good agreement for the lower flow velocities (< 2.0 m/sec). However, underestimation occurred for the high flow velocities (> 2.0 m/sec) compared with those by standard echocardiography (aortic flow: y = 0.80x + 0.11; r = 0.95, tricuspid regurgitation: y = 1.00x - 0.23; r = 0.90). CONCLUSIONS: The new hand-carried ultrasound device (SonoSite 180PLUS equipped with DCPD and CWD) is clinically useful for evaluating valvular regurgitations and flow velocities. Further studies are needed to determine the mechanism of the underestimation of high flow velocities by CWD.

Single-beat determination of Doppler-derived aortic flow measurement in patients with atrial fibrillation.

The clinical assessment of left ventricular systolic function in patients with atrial fibrillation is unreliable and difficult because of beat-to-beat variation. We initially evaluated an index that is on the basis of the ratio of preceding R-R (RR1) to pre-preceding R-R (RR2) intervals (RR1/RR2) for the measurement of Doppler aortic flow (peak flow velocity [Vp] and time-velocity integral [TVI] proportional to stroke volume) in 20 patients (aged 65 +/- 9.6 years) with atrial fibrillation. We obtained each parameter for >13 cardiac cycles, and the relationship between each parameter at a given cardiac beat and the RR1/RR2 ratio were evaluated by linear regression analysis. The value of each parameter at RR1/RR2 = 1 was calculated from the equation of linear regression line and compared with measured average value over all cardiac cycles. Both parameters showed a significant positive correlation with the RR1/RR2 ratio (Vp, r = 0.98, y = 1.01x + 0.61; TVI, r = 0.99, y = 1.01x + 0.26). The calculated value of each parameter at RR1/RR2 = 1 was quite similar to the average value (Vp, 97.4 +/- 30.8 vs 95.7 +/- 29.8 cm/s; TVI, 17.7 +/- 6.8 vs 17.3 +/- 6.7 cm, respectively). In the additional 20 patients (aged 77.4 +/- 15.2 years), Doppler aortic flow parameters of a single beat with identical RR1 and RR2 intervals were compared with measured average value over all cardiac cycles and showed similar results (Vp, r = 0.99, y = 0.99x + 3.4, P <.0001, bias -0.5 cm/s; TVI, r = 0.99, y = 0.92x + 1.5, P <.0001, bias 0.1 cm). In conclusion, the Doppler aortic flow at RR1/RR2 = 1 allows the left ventricular systolic parameters to be accurately evaluated during atrial fibrillation and obviates the less reliable process of averaging multiple irregular beats.

[Assessment of the clinical feasibility of OptiGo for hand-held echocardiography].

OBJECTIVES: Hand-held ultrasound devices are becoming available for clinical examination, but the accuracy and precision of such devices are unclear. This study compared the accuracy of a hand-held echo device to a standard echo system. METHODS: Twenty-two patients were examined with the OptiGo (Phillips Medial Systems) hand-held ultrasound system with a 2.5 MHz transducer and SONOS 5500 (Phillips Medial Systems) standard ultrasound system with a 2 to 4 MHz wideband transducer. Patients with cardiac arrhythmia and tachycardia were excluded. Image quality, chamber size (left ventricle, left atrium), global and regional left ventricular function, valve morphology and severity of valve regurgitation were assessed. RESULTS: There was good agreement between the two imaging devices for image quality (77.3%), left ventricular ejection fraction (90.5%), regional wall motion score (> 90%), valve morphology (> 90%), severity of valve regurgitation (> 81.0%) and there was good correlation and agreement for left ventricular and left atrial size. CONCLUSIONS: Although the OptiGo has limitations, the hand-held examination appropriately estimates global and regional left ventricular function, valve morphology, valve regurgitation and chamber size.

A canine case of gliosis with cyst formation in the posterior fossa.

A 5-month-old male Great Pyrenees with symptoms of convulsions, circling, and a head tilt was referred to the Animal Medical Center of Nihon University. On a magnetic resonance image (MRI), a cyst in the posterior fossa was noted and a part of the cyst enhanced by gadoteridol. Based on MRI and clinical findings, the patient was tentatively diagnosed with a cyst formation tumor, and an operation to open the cyst and remove the part enhanced by contrast was performed. Postoperatively, the clinical course was good. Pathologically, the removed tissue was diagnosed as a gliosis with cyst formation.

Production of hydroxyl radicals and alpha-dicarbonyl compounds associated with Amadori compound-Cu2+ complex degradation.

The chemical properties of Amadori compounds in the presence of transition metal ions were studied, using the analogs 1-deoxy-1-n-butylamino-D-fructose (DBF) and N(alpha)-formyl-fructoselysine (fFL). The following characteristics were revealed: (a) DBF combined easily with Cu2+ (but no other transition metal ions) to form a DBF-Cu2+ complex in phosphate buffer, pH 7.4; (b) the complex was unstable, and degraded with the release of Cu+ during incubation at 37 degrees C; (c) degradation of the complex was associated with the production of hydroxyl radicals by the Fenton reaction and alpha-dicarbonyl compounds by non-autoxidative degradation; and (d) properties of DBF were similar to those of fFL. The above properties were additionally observed in glycated poly-Lys (GPL). Our findings indicate a novel mechanism for the generation of hydroxyl radicals and a-dicarbonyl compounds from Amadori adducts in the presence of Cu2+.