Team-based Learning Impact: A Comparative Study of Student and Faculty Facilitators.

BACKGROUND: Team-based learning (TBL) refers to the application of an active-learning method that has gained popularity across all health-care disciplines. This study aimed to assess nutrition students' perceptions of the roles of student versus faculty facilitators. METHODS: Participants in the study included, 117 2nd-year nutrition students registered in the "Introduction to Medicine" course in the 2022 academic year at a Japanese university. The first TBL session was faculty-led, whereas three students served as facilitators in the second. Upon completion of the course, learners and student facilitators completed a questionnaire on the student-led TBL. Responses to close-ended questions were analyzed using descriptive statistics, and those to open-ended questions were categorized into common themes. RESULTS: A total of 114 learners and 3 student facilitators responded to the questions. Learners found student-led TBL to be just as or more effective than faculty-led TBL in three respects: comprehension (93.0%), active participation (96.5%), and expectation of academic performance improvement (93.9%). According to student facilitators, it improved their knowledge, confidence, communication skills, and leadership abilities. Learners and facilitators indicated that student-led TBL was significantly more effective than faculty-led TBL. Thus, student-led TBL can enhance the ability of all students at different academic levels. DISCUSSION: Student-led TBL appears to be an effective learning strategy in higher education and further shifts toward student-centered learning in the course curriculum.

T2 and Apparent Diffusion Coefficient of MRI Reflect Maturation of Tissue-Engineered Auricular Cartilage Subcutaneously Transplanted in Rats.

In cartilage regenerative medicine, autologous chondrocyte implantation (ACI) has been applied clinically for partial defects of joint cartilage or nasal augmentation. To make treatment with ACI more effective and prevalent, modalities to evaluate the quality of transplanted constructs noninvasively are necessary. In this study, we compared the efficacy of several noninvasive modalities for evaluating the maturation of tissue-engineered auricular cartilage containing a biodegradable polymer scaffold. We first transplanted tissue-engineered cartilage consisting of human auricular chondrocytes, atelocollagen gel, and a poly-l-lactic acid (PLLA) porous scaffold subcutaneously into the back of athymic nude rats. Eight weeks after transplantation, the rats were examined by magnetic resonance imaging (MRI), X-ray, and ultrasound as noninvasive modalities. Then, the excised constructs were examined by histological and biochemical analysis including toluidine blue (TB) staining, glycosaminoglycans content, and enzyme-linked immunosorbent assay of type II collagen. Among the modalities examined, transverse relaxation time (T2) and apparent diffusion coefficient of MRI showed quite a high correlation with histological and biochemical results, suggesting that these can effectively detect the maturation of tissue-engineered auricular cartilage. Since these noninvasive modalities would realize time-course analysis of the maturation of tissue-engineered auricular cartilage, this study provides a substantial insight for improving the quality of tissue-engineered cartilage, leading to improvement of the quality and technique in cartilage regenerative medicine.

Hepatic Relaxation Times from Postmortem MR Imaging of Adult Humans.

PURPOSE: To measure T1 and T2 values of hepatic postmortem magnetic resonance (PMMR) imaging. MATERIALS AND METHODS: We performed hepatic PMMR imaging of 22 deceased adults (16 men, 6 women; mean age, 56.3 years) whose deaths were for reasons other than liver injury or disease at a mean of 27.7 hours after death. Before imaging, the bodies were kept in cold storage at 4°C (mean rectal temperature, 17.6°C). We measured T1 and T2 values in the liver at two sites (the anterior segment of the right lobe and the lateral segment of the left lobe). We also investigated the influence of the body temperature and postmortem interval on T1 and T2 values. RESULTS: In the anterior segment of the right lobe and the lateral segment of the left lobe, T1 values of PMMR imaging were 524 ± 112 ms and 472 ± 104 ms (mean ± standard deviation), respectively; while T2 values were 42 ± 6 ms and 43 ± 8 ms, respectively. T1 and T2 values did not differ significantly between the two sites (P ≧ 0.05). Regarding temperature, the T2 values of hepatic PMMR imaging were linearly correlated with the body temperature, but the T1 values were not. The T1 and T2 values of the two sites in the liver did not correlate with the postmortem interval. CONCLUSION: Reduction in body temperature after death is considered to induce T1 and T2 value changes in the liver on PMMR imaging.

Characteristic X-ray absorptiometry applied to the assessment of tissue-engineered cartilage development.

BACKGROUND: Transmission and tomographic X-ray measurements are useful in assessing bone structures, but only a few studies have examined cartilage growth because of the poor contrast in conventional X-ray imaging. OBJECTIVE: In this study, we attempted to use the linear attenuation coefficient (LAC) as a metric of tissue-engineered cartilage development, which would be useful in high-throughput screening of cartilage products. METHODS: Assuming that the LAC is related to the amount of extracellular matrix (ECM) in terms of the density and its atomic components, we measured X-ray absorption through tissue-engineered cartilage constructs. Characteristic X-ray beams from a molybdenum microfocus X-ray tube were employed to avoid beam hardening. The correlation of the LAC with mechanical properties was analyzed for verification. RESULTS: The LAC was higher for chondrocyte constructs and lower for fibroblast-dominant constructs and was consistent with the quantification of toluidine blue staining, which is a proof of ECM production. The LAC was positively correlated with the bending modulus but negatively correlated with the dynamic elastic modulus and stiffness, possibly because of the remaining scaffold. CONCLUSIONS: The LAC has the potential to be used as a metric of development of tissue-engineered cartilage. However, the calcified regions should be excluded from analysis to avoid decreasing the correlation between the LAC and the amount of ECM.

Optimization of Inversion Time for Postmortem Fluid-attenuated Inversion Recovery (FLAIR) MR Imaging at 1.5T: Temperature-based Suppression of Cerebrospinal Fluid.

PURPOSE: Signal intensity (SI) and image contrast on postmortem magnetic resonance (MR) imaging are different from those of imaging of living bodies. We sought to suppress the SI of cerebrospinal fluid (CSF) sufficiently for fluid-attenuated inversion recovery (FLAIR) sequence in postmortem MR (PMMR) imaging by optimizing inversion time (TI). MATERIALS AND METHODS: We subject 28 deceased patients to PMMR imaging 3 to 113 hours after confirmation of death (mean, 27.4 hrs.). PMMR imaging was performed at 1.5 tesla, and T1 values of CSF were measured with maps of relaxation time. Rectal temperatures (RT) measured immediately after PMMR imaging ranged from 6 to 32°C (mean, 15.4°C). We analyzed the relationship between T1 and RT statistically using Pearson's correlation coefficient. We obtained FLAIR images from one cadaver using both a TI routinely used for living bodies and an optimized TI calculated from the RT. RESULTS: T1 values of CSF ranged from 2159 to 4063 ms (mean 2962.4), and there was a significantly positive correlation between T1 and RT (r = 0.96, P < 0.0001). The regression expression for the relationship was T1 = 74.4 * RT + 1813 for a magnetic field strength of 1.5T. The SI of CSF was effectively suppressed with the optimized TI (0.693 * T1), namely, TI = 0.693 * (77.4 * RT + 1813). CONCLUSION: Use of the TI calculated from the linear regression of the T1 and RT optimizes the FLAIR sequence of PMMR imaging.

A simple method for MR elastography: a gradient-echo type multi-echo sequence.

To demonstrate the feasibility of a novel MR elastography (MRE) technique based on a conventional gradient-echo type multi-echo MR sequence which does not need additional bipolar magnetic field gradients (motion encoding gradient: MEG), yet is sensitive to vibration. In a gradient-echo type multi-echo MR sequence, several images are produced from each echo of the train with different echo times (TEs). If these echoes are synchronized with the vibration, each readout's gradient lobes achieve a MEG-like effect, and the later generated echo causes a greater MEG-like effect. The sequence was tested for the tissue-mimicking agarose gel phantoms and the psoas major muscles of healthy volunteers. It was confirmed that the readout gradient lobes caused an MEG-like effect and the later TE images had higher sensitivity to vibrations. The magnitude image of later generated echo suffered the T2 decay and the susceptibility artifacts, but the wave image and elastogram of later generated echo were unaffected by these effects. In in vivo experiments, this method was able to measure the mean shear modulus of the psoas major muscle. From the results of phantom experiments and volunteer studies, it was shown that this method has clinical application potential.

Optimization of inversion time for postmortem short-tau inversion recovery (STIR) MR imaging.

PURPOSE: Signal intensity and image contrast differ between postmortem magnetic resonance (PMMR) images and images acquired from the living body. We sought to achieve sufficient fat suppression with short-tau inversion recovery (STIR) PMMR imaging by optimizing inversion time (TI). MATERIAL AND METHODS: We subjected 37 deceased adult patients to PMMR imaging at 1.5 tesla 8 to 60 hours after confirmation of death and measured T1 values of areas of subcutaneous fat with relaxation time maps. Rectal temperature (RT) measured immediately after PMMR ranged from 6 to 31°C. We used Pearson's correlation coefficient to analyze the relationship between T1 and relaxation time (RT). We compared STIR images from 4 cadavers acquired with a TI commonly used in the living body and another TI calculated from the linear regression of T1 and RT. RESULTS: T1 values of subcutaneous fat ranged from 89.4 to 182.2 ms. There was a strong, positive, and significant correlation between T1 and RT (r = 0.91, P < 0.0001). The regression expression for the relationship was T1 = 2.6*RT + 90 at a field strength of 1.5T. The subcutaneous fat signal was suppressed more effectively with the optimized TI. CONCLUSION: The T1 value of subcutaneous fat in PMMR correlates linearly with body temperature. Using this correlation to determine TI, fat suppression with PMMR STIR imaging can be easily improved.

Magnetic resonance elastography using an air ball-actuator.

The purpose of this study was to develop a new technique for a powerful compact MR elastography (MRE) actuator based on a pneumatic ball-vibrator. This is a compact actuator that generates powerful centrifugal force vibrations via high speed revolutions of an internal ball using compressed air. This equipment is easy to handle due to its simple principles and structure. Vibration frequency and centrifugal force are freely adjustable via air pressure changes (air flow volume), and replacement of the internal ball. In order to achieve MRI compatibility, all parts were constructed from non-ferromagnetic materials. Vibration amplitudes (displacements) were measured optically by a laser displacement sensor. From a bench test of displacement, even though the vibration frequency increased, the amount of displacement did not decrease. An essential step in MRE is the generation of mechanical waves within tissue via an actuator, and MRE sequences are synchronized to several phase offsets of vibration. In this system, the phase offset was detected by a four-channel optical-fiber sensor, and it was used as an MRI trigger signal. In an agarose gel phantom experiment, this actuator was used to make an MR elastogram. This study shows that the use of a ball actuator for MRE is feasible.

Illusory Reversal of Causality between Touch and Vision has No Effect on Prism Adaptation Rate.

Learning, according to Oxford Dictionary, is "to gain knowledge or skill by studying, from experience, from being taught, etc." In order to learn from experience, the central nervous system has to decide what action leads to what consequence, and temporal perception plays a critical role in determining the causality between actions and consequences. In motor adaptation, causality between action and consequence is implicitly assumed so that a subject adapts to a new environment based on the consequence caused by her action. Adaptation to visual displacement induced by prisms is a prime example; the visual error signal associated with the motor output contributes to the recovery of accurate reaching, and a delayed feedback of visual error can decrease the adaptation rate. Subjective feeling of temporal order of action and consequence, however, can be modified or even reversed when her sense of simultaneity is manipulated with an artificially delayed feedback. Our previous study (Tanaka et al., 2011; Exp. Brain Res.) demonstrated that the rate of prism adaptation was unaffected when the subjective delay of visual feedback was shortened. This study asked whether subjects could adapt to prism adaptation and whether the rate of prism adaptation was affected when the subjective temporal order was illusory reversed. Adapting to additional 100 ms delay and its sudden removal caused a positive shift of point of simultaneity in a temporal order judgment experiment, indicating an illusory reversal of action and consequence. We found that, even in this case, the subjects were able to adapt to prism displacement with the learning rate that was statistically indistinguishable to that without temporal adaptation. This result provides further evidence to the dissociation between conscious temporal perception and motor adaptation.

Roughened glass slides and a spectrophotometer for the detection of the wavelength-dependent refractive index of transparent liquids.

We describe a method to determine the wavelength-dependent refractive index of liquids by measurement of light transmittance with a spectrophotometer. The method is based on using roughened glass slides with different a priori known refractive indices and immersing the slides into the transparent liquid with unknown refractive index. Using the dispersion data on the glass material it is possible to find the index match between the liquid and the glass slide, and hence the refractive index of the liquid.

Modeling shear modulus distribution in magnetic resonance elastography with piecewise constant level sets.

Magnetic resonance elastography (MRE) is designed for imaging the mechanical properties of soft tissues. However, the interpretation of shear modulus distribution is often confusing and cumbersome. For reliable evaluation, a common practice is to specify the regions of interest and consider regional elasticity. Such an experience-dependent protocol is susceptible to intrapersonal and interpersonal variability. In this study we propose to remodel shear modulus distribution with piecewise constant level sets by referring to the corresponding magnitude image. Optimal segmentation and registration are achieved by a new hybrid level set model comprised of alternating global and local region competitions. Experimental results on the simulated MRE data sets show that the mean error of elasticity reconstruction is 11.33% for local frequency estimation and 18.87% for algebraic inversion of differential equation. Piecewise constant level set modeling is effective to improve the quality of shear modulus distribution, and facilitates MRE analysis and interpretation.

Abnormal brain MRI signal in 18q-syndrome not due to dysmyelination.

BACKGROUND: 18q-Syndrome is a chromosomal disorder exhibiting various symptoms arising from the central nervous system. Brain magnetic resonance imaging (MRI) of patients with this syndrome usually demonstrates abnormal white matter intensities. This is widely believed to be due to impaired myelin formation because this syndrome involves the deletion of the myelin basic protein (MBP) gene in 18q23. However, this hypothesis has not been confirmed by actual pathology because early death is unusual and autopsy rarely performed. PATIENT: A 6-year-old boy with ring chromosome 18 syndrome was examined by genetic analysis for the MBP gene, brain MRI, and autopsy. RESULTS: Haploinsufficiency of the MBP gene was confirmed. T(2)-weighted MRI revealed diffuse high intensities throughout the cerebral white matter. Pathological examination showed the cerebral white matter to be uniformly stained by Klüver-Barrera and MBP immunohistochemical staining. Oligodendrocytes were immunoreactive for proteolipid protein and ferritin but not MBP. Electron microscopy revealed clusters of axons wrapped in compact myelin sheaths with distinct major dense lines. Holzer and immunohistochemical staining for glial fibrillary acidic protein showed extensive staining of the white matter and an increased number of glial filaments. CONCLUSIONS: This pathological study demonstrated that in this disorder, the brain was well myelinated, contrary to established hypotheses about this disorder. The MRI signal abnormalities in 18q-syndrome could be attributed to gliosis and not to dysmyelination.

Physical delay but not subjective delay determines learning rate in prism adaptation.

Timing is critical in determining the causal relationship between two events. Motor adaptation relies on the timing of actions and their results for determining which preceding control signals were responsible for subsequent error in the resulting movements. An artificially induced temporal delay in error feedback as short as 50 ms has been found to slow the learning rate of prism adaptation. Recent studies have demonstrated that our sense of simultaneity is flexibly adaptive when a persistent delay is inserted into visual feedback timing of one's own action. Therefore, judgments of "subjective simultaneity" (i.e. whether two events are simultaneous on a subjective basis) do not necessarily correspond to the actual simultaneity of physical events. We evaluated the effects of adaptation to a temporal shift of subjective simultaneity on prism adaptation by examining whether prism adaptation depends on physical timing or subjective timing. We found that after persistently experiencing an additional 100-ms delay in a pointing experiment, psychometric curves of the timing of judgments about the temporal order of touching and visual feedback were shifted by 40 ms, indicating that subjective simultaneity adapted. Next, while maintaining temporal adaptation, participants adapted to spatial displacement caused by a prism with and without an additional temporal delay in feedback. Learning speed was reliably predicted by physical timing but not by subjective timing. These results indicate that prism adaptation occurs independently of awareness of subjective timing and may be processed in primary motor areas that are thought to have fidelity with temporal relations.

Postmortem magnetic resonance imaging dealing with low temperature objects.

In Japan, the medical examiner system is not widespread, the rate of autopsy is low, and many medical institutions therefore perform postmortem imaging using clinical equipment. Postmortem imaging is performed to clarify cause of death, select candidates for autopsy, make a guide map for autopsy, or provide additional information for autopsy. Findings are classified into 3 categories: cause of death and associated changes, changes induced by cardiopulmonary resuscitation, and postmortem changes. Postmortem magnetic resonance imaging shows characteristic changes in signal intensity related to low body temperature after death; they are low temperature images.

Evaluation of negative fixed-charge density in tissue-engineered cartilage by quantitative MRI and relationship with biomechanical properties.

Applying tissue-engineered cartilage in a clinical setting requires noninvasive evaluation to detect the maturity of the cartilage. Magnetic resonance imaging (MRI) of articular cartilage has been widely accepted and applied clinically in recent years. In this study, we evaluated the negative fixed-charge density (nFCD) of tissue-engineered cartilage using gadolinium-enhanced MRI and determined the relationship between nFCD and biomechanical properties. To reconstruct cartilage tissue, articular chondrocytes from bovine humeral heads were embedded in agarose gel and cultured in vitro for up to 4 weeks. The nFCD of the cartilage was determined using the MRI gadolinium exclusion method. The equilibrium modulus was determined using a compressive stress relaxation test, and the dynamic modulus was determined by a dynamic compression test. The equilibrium compressive modulus and dynamic modulus of the tissue-engineered cartilage increased with an increase in culture time. The nFCD value--as determined with the [Gd-DTPA(2-)] measurement using the MRI technique--increased with culture time. In the regression analysis, nFCD showed significant correlations with equilibrium compressive modulus and dynamic modulus. From these results, gadolinium-enhanced MRI measurements can serve as a useful predictor of the biomechanical properties of tissue-engineered cartilage.

Characteristic signal intensity changes on postmortem magnetic resonance imaging of the brain.

PURPOSE: We investigated and identified postmortem changes on magnetic resonance imaging (MRI) of the brain to provide accurate diagnostic guidelines. MATERIALS AND METHODS: Our subjects were 16 deceased patients (mean age 57 years) who underwent postmortem computed tomography (CT), MRI, and autopsy, the latter of which showed no abnormalities in the brain. The subjects underwent CT and MRI 6-73 h after confirmation of death (mean 26 h), after being kept in cold storage at 4 degrees C. Postmortem MRI of the brain was performed using T1-weighted imaging (T1WI), T2WI, fluid attenuated inversion recovery (FLAIR) imaging, and diffusion weighted imaging (DWI) with parameters identical to those used for living persons. RESULTS: In all cases, postmortem CT showed brain edema and swelling. Postmortem MRI showed characteristic common signal intensity (SI) changes, including (1) high SI of the basal ganglia and thalamus on T1WI; (2) suppression of fat SI on T2WI; (3) insufficient SI suppression of cerebrospinal fluid on FLAIR imaging; (4) high SI rims along the cerebral cortices and the ventricular wall on DWI; and (5) an apparent diffusion coefficient decrease to less than half the normal value. CONCLUSION: Postmortem MRI of the brain in all cases showed characteristic common SI changes. Global cerebral ischemia without following reperfusion and low body temperature explain these changes.

Validation of the Friedewald Equation for Evaluation of Plasma LDL-Cholesterol.

In most clinical laboratories, low density lipoprotein (LDL) cholesterol is usually estimated indirectly with the Friedewald equation or directly with the N-geneous assay. We assessed LDL-cholesterol values obtained by both methods to find an appropriate fasting period and to assess the influence of the energy content of the last meal. Blood samples were taken from 28 healthy volunteers who had consumed a standard meal (107 g of carbohydrate, 658 kcal) followed by a fasting period of 12 and 18 h, or a high-energy meal (190 g of carbohydrate, 1011 kcal) with a fasting period of 12 h. Prolongation of the fasting period from 12 h to 18 h decreased glucose level, but did not decrease triacylglycerol, total cholesterol, or high density lipoprotein (HDL) cholesterol. LDL-cholesterol levels measured with the N-geneous assay did not change (94.0 +/- 21.5 to 96.3 +/- 19.1 mg/dl). LDL-cholesterol levels calculated with the Friedewald equation were also similar after fasting periods of 12 h (98.5 +/- 21.4 mg/dl) and 18 h (99.7 +/- 20.2 mg/dl). The high-energy meal did not change the level of LDL-cholesterol measured with the N-geneous assay (96.1 +/- 21.2 mg/dl), or the glucose, triacylglycerol, total cholesterol, or HDL-cholesterol level, but LDL-cholesterol levels evaluated from the Friedewald equation (92.6 +/- 20.3 mg/dl) became significantly lower. A fasting time longer than 12 h is not necessary to obtain reasonable blood lipid levels. The Friedewald equation gave higher LDL-cholesterol levels than N-geneous assay in young Japanese females who had eaten a low-energy meal, and lower values when they had eaten a high-energy meal. Thus, it may be necessary to pay attention to energy of nigh meal prior to blood withdrawal.

Volumetric q-space imaging by 3D diffusion-weighted MRI.

High b-value diffusion magnetic resonance imaging (MRI) enables us to detect far smaller architectures, by using q-space analysis, than the resolution in conventional MRI. Average displacement, one of the q-space parameters, quantitatively reflects architecture size and is very useful in observing small changes in microstructures in vivo (e.g., neurodegeneration, tumor heterogeneity, and others). Diffusion-weighted imaging (DWI) is performed by a two-dimensional (2D) multislice method; however, due to finite slice thickness and slice gap, there is a partial-volume effect that makes it difficult to detect the net q-space signal. On the other hand, three-dimensional (3D) MRI, having the advantages of very thin slice thickness and no slice gap (contiguous slices), allows volumetric evaluation acquired in a small isotropic voxel, as compared to 2D multislice imaging. Little is known about the isotropic high-resolution 3D DWI application to q-space analysis. In this study, we have developed and implemented a high b-value 3D DWI sequence, applied q-space analysis to study the reliability of high b-value 3D DWI and obtained a microscopic analytical map with isotropic high resolution and less contamination.

Feasibility of noninvasive evaluation of biophysical properties of tissue-engineered cartilage by using quantitative MRI.

The application of tissue-engineered cartilage in a clinical setting requires a noninvasive method to assess the biophysical and biochemical properties of the engineered cartilage. Since articular cartilage is composed of 70-80% water and has dense extracellular matrixes (ECM), it is considered that the condition of the water molecules in the tissue is correlated with its biomechanical property. Therefore, magnetic resonance imaging (MRI) represents a potential approach to assess the biophysical property of the engineered cartilage. In this study, we test the hypothesis that quantitative MRI can be used as a noninvasive assessment method to assess the biophysical property of the engineered cartilage. To reconstruct a model of cartilaginous tissue, chondrocytes harvested from the humeral head of calves were embedded in an agarose gel and cultured in vitro up to 4 weeks. Equilibrium Young's moduli were determined from the stress relaxation tests. After mechanical testing, MRI-derived parameters (longitudinal relaxation time T1, transverse relaxation time T2, and water self-diffusion coefficient D) were measured. The equilibrium Young's modulus of the engineered cartilage showed a tendency to increase with an increase in the culture time, whereas T1 and D decreased. Based on a regression analysis, T1 and D showed a strong correlation with the equilibrium Young's modulus. The results showed that T1 and D values derived from the MRI measurements could be used to noninvasively monitor the biophysical properties of the engineered cartilage.

First detection of IgA against norovirus in breast milk.

Breast milk samples (n = 239) collected from 1994-1997 from mothers at Chiba City, Japan, were tested for antinorovirus antibody by ELISA and western blot methods. It was found that 31 breast milk samples contained IgA against norovirus and this represented 13%. Breast milk could react with a diversity of norovirus genotypes. The highest number of samples containing IgA against norovirus was found in genotype GII/6 (11.3%) and the lowest in GI/8, GII/8 and GII/12 (each of 0.8%). Of note, twenty-eight samples showed reactivity to more than one different norovirus genotypes. Interestingly, three samples demonstrated cross-reaction with both norovirus genogroups I and II. This report is noteworthy because it is the first, to the best of our knowledge, demonstrating the presence of antibody against norovirus in breast milk.