External validation of ADNEX MR SCORING system: a single-centre retrospective study.

AIM: To evaluate the accuracy of the ADNEX MR SCORING system for characterising adnexal masses. MATERIALS AND METHODS: An institutional review board approved this retrospective study. The study population comprised 663 women who underwent magnetic resonance imaging (MRI) from January 2007 to December 2014 to characterise 778 adnexal masses that were indeterminate under ultrasonography (590 benign and 188 malignant). Two radiologists independently reviewed the MRI images. The masses were scored from 1 to 5 according to the ADNEX MR SCORING system. The diagnostic performance of the system was evaluated by receiver operating characteristic (ROC) analysis. Masses scored 4 or greater were considered malignant (including tumours of borderline malignancy or low malignant potential). RESULTS: The malignancy rates of masses with scores of 2, 3, 4 and 5 were 1.9% (8/419), 12.8% (19/149), 62.6% (57/91) and 87.4% (104/119) for reader 1 and 2.1% (9/424), 13.6% (20/147), 67.6% (71/105) and 86.3% (88/102) for reader 2, respectively. The areas under the ROC curves for the differentiation of benign and malignant masses were 0.929 and 0.923, respectively; the sensitivity, specificity and accuracy of diagnosis were 85.6% (161/188), 91.7% (541/590), and 90.2% (702/778) for reader 1 and 84.6% (159/188), 91.9% (542/590), and 90.1% (701/778) for reader 2, respectively. Tumours of borderline malignancy or low malignant potential had a higher rate of misclassification (46.1%) than other malignant tumours (6-7.4%). CONCLUSION: The ADNEX MR SCORING system was highly accurate in differentiating benign and malignant adnexal masses, although it may be less accurate for tumours of borderline malignancy or low malignant potential.

Sepsis patients' renal manifestation on contrast-enhanced CT.

AIM: To evaluate renal volume and attenuation changes in patients with sepsis on contrast-enhanced computed tomography (CT) with respect to the severity of sepsis. MATERIALS AND METHODS: Forty-four patients with sepsis who underwent CT before and after the onset of sepsis were retrospectively analysed. Renal volume and CT attenuation value of the renal cortex on contrast-enhanced CT were measured for each patient and changes in renal volume and CT attenuation value from before to after the onset of sepsis were calculated. The changes were correlated with the severity of sepsis (Sepsis-related Organ Failure Assessment [SOFA] score). The time course of the renal volume and CT attenuation changes were also evaluated. RESULTS: Renal volume increased by 17.6% and CT attenuation value decreased by 19% after the onset of sepsis with statistically significant differences (p<0.001 for both renal volume and CT attenuation changes). The renal volume and CT attenuation changes had significant correlations with the SOFA score (r=0.36, p=0.018 and -0.43, p=0.005, respectively). The time course of the renal volume and CT attenuation changes seemed to be gradual compared to that of the SOFA score and to lag behind the peak of the SOFA score. CONCLUSION: In patients with sepsis, the renal volume increases and the CT attenuation value decreases in proportion to the severity of sepsis. The changes may lag behind the peak of severity of sepsis and can be observed for a relatively long time after a patient's recovery from sepsis.

Polymerization of room-temperature ionic liquid monomers by electron beam irradiation with the aim of fabricating three-dimensional micropolymer/nanopolymer structures.

A novel method for fabricating microsized and nanosized polymer structures from a room-temperature ionic liquid (RTIL) on a Si substrate was developed by the patterned irradiation of an electron beam (EB). An extremely low vapor pressure of the RTIL, 1-allyl-3-ethylimidazolium bis((trifluoromethane)sulfonyl)amide, allows it to be introduced into the high-vacuum chamber of an electron beam apparatus to conduct a radiation-induced polymerization in the nanoregion. We prepared various three-dimensional (3D) micro/nanopolymer structures having high aspect ratios of up to 5 with a resolution of sub-100 nm. In addition, the effects of the irradiation dose and beam current on the physicochemical properties of the deposited polymers were investigated by recording the FT-IR spectra and Young's modulus. Interestingly, the overall shapes of the obtained structures were different from those prepared in our recent study using a focused ion beam (FIB) even if the samples were irradiated in a similar manner. This may be due to the different transmission between the two types of beams as discussed on the basis of the theoretical calculations of the quantum beam trajectories. Perceptions obtained in this study provide facile preparation procedures for the micro/nanostructures.

CD8 beta chain influences CD8 alpha chain-associated Lck kinase activity.

The CD8 molecule plays an important role in the differentiation of CD8+ T cells in the thymus and in their normal function in the periphery. CD8 exists on the cell surface in two forms, the alpha alpha homodimer and the alpha beta heterodimer. Recent studies indicate an important role for the CD8 beta chain in thymic development of CD8+ T cells and suggest that signaling via CD8 alpha beta may be distinct from CD8 alpha alpha. To better understand these differences, we introduced the CD8 beta gene into a T cell hybridoma which only expressed the CD8 alpha alpha homodimer. In the parent hybridoma, cross-linking of the CD8 alpha chain led to minimal enhancement of CD8-associated Lck tyrosine kinase activity. In the CD8 beta+ transfectants, several observations suggested that CD8 beta modifies CD8 alpha-associated Lck tyrosine kinase activity: (a) in in vitro kinase assays, antibody-mediated crosslinking of CD8 alone, or CD8 cross-linking with the TCR, resulted in 10-fold greater activation of Lck kinase activity, compared to cells expressing CD8 alpha alpha alone; (b) in vivo, markedly enhanced tyrosine phosphorylation of several intracellular proteins was observed upon CD8 cross-linking with the TCR in CD8 alpha beta-expressing cells, compared to cells expressing CD8 alpha alpha alone; and (c) Lck association with CD8 alpha was stabilized by the coexpression of CD8 beta. Thus, the differential Lck kinase activation and tyrosine phosphorylation seen with CD8 alpha alpha vs. CD8 alpha beta may reflect the unique signaling capabilities of the CD8 beta molecule. These differences in signaling may, in part, account for the diminished ability to generate CD8 single positive thymocytes in mice bearing a homozygous disruption of the CD8 beta gene.

Hepatic falciform ligament artery in patients with chronic liver diseases: detection on computed tomography hepatic arteriography.

BACKGROUND: The detection rate of hepatic falciform ligament artery (FLA) has been reported as ranging from 2-25%. The rate of FLA on laparotomy, however, is reported to be higher, at 68%. PURPOSE: To compare the detection rate of FLA on computed tomography hepatic arteriography (CTHA) with that on angiography and dynamic CT, and to clarify the clinical significance of FLA in patients with chronic liver disease. MATERIAL AND METHODS: 126 consecutive patients underwent CTHA angiography and dynamic CT to evaluate suspected liver tumors. Liver function was classified as follows: normal, n=5; Child-Pugh class A, n=94; B, n=21; and C, n=6. All CT images were obtained using multidetector (MDCT) scanners (Aquilion; Toshiba, Tokyo, Japan). For CTHA, CT images were obtained during contrast material injection through the left hepatic, proper, or common hepatic artery. On CT, FLAs were retrospectively identified within the hepatic falciform ligament and the hepatic round ligament by the paging method on a workstation (TWS-5000; Toshiba, Tokyo, Japan). The detection rates were compared among the three modalities (hepatic arterial phase of dynamic CT, CTHA, and angiography). The calibers of FLA were also correlated with the hepatic function of the patients. RESULTS: The detection rates of FLA by angiography, dynamic CT, and CTHA were 37% (47/126), 10% (13/126), and 77% (97/126), respectively. The calibers of FLA increased as the hepatic function deteriorated (P=0.001). CONCLUSION: The detection rates of FLA with CTHA are far higher than those with angiography and dynamic CT. Careful interpretation with recognition of FLA on CTHA images is important, as inadvertent embolization or chemotherapeutic infusion of the FLA may result in supraumbilical skin rash.

Microcoil embolization through a downsized coaxial catheter system: an experimental study.

BACKGROUND: Most of the recently developed microcatheters for abdominal angiography still have large diameters at their trailing ends, and thus cannot be used for microcoil embolization in combination with a 3-French (F) system. PURPOSE: To evaluate the in vitro passage of microcoils through a newly developed 2-F microcatheter (Meister Cath Superselective Plus, MC6) that is compatible with a downsized coaxial catheter system (3-F system) in an experimental study. MATERIAL AND METHODS: We evaluated the passage of microcoils through MC6 within a blood vessel model using the saline flush technique. Six types of microcoils and 17 size variations (maximal curled diameter 2-10 mm, total length 20-140 mm) were used. We evaluated the passage and post-deployment shape of the microcoils as well as the volume of saline required to flush them. RESULTS: In the experimental study, all microcoils passed through the MC6 and deployed in a satisfactory manner without catheter occlusion. The mean volumes of saline required to flush the TORNADO (n=1), Reverse TORNADO (n=6), HILAL (n=1), Micronester (n=3), VortX (n=4), and C-Stopper Coil (n=2) were 0.7 ml, 0.58+/-0.20 ml, 0.5 ml, 0.57+/-0.058 ml, 3.5+/-1.5 ml, and 0.70+/-0.14 ml, respectively. There was a statistically significant difference in the mean volume of saline required between the VortX and Reverse TORNADO (P=0.029), and between the VortX and C-Stopper Coil (P=0.031). The VortX required the greatest volume of saline. CONCLUSION: Microcoil embolization through a 3-F system appears to be feasible for the coils examined in this study.

Quantum Hall effect in epitaxial graphene with permanent magnets.

We have observed the well-kown quantum Hall effect (QHE) in epitaxial graphene grown on silicon carbide (SiC) by using, for the first time, only commercial NdFeB permanent magnets at low temperature. The relatively large and homogeneous magnetic field generated by the magnets, together with the high quality of the epitaxial graphene films, enables the formation of well-developed quantum Hall states at Landau level filling factors v = ±2, commonly observed with superconducting electro-magnets. Furthermore, the chirality of the QHE edge channels can be changed by a top gate. These results demonstrate that basic QHE physics are experimentally accessible in graphene for a fraction of the price of conventional setups using superconducting magnets, which greatly increases the potential of the QHE in graphene for research and applications.

Physiological significance of apoptosis in animal virus infection.

In contrast to insect viruses, animal viruses can produce considerable amounts of progeny virus in cells undergoing apoptosis. Nevertheless, viruses in general have acquired the ability to escape apoptosis of infected cells. These facts indicate that the role of apoptosis in virus infection is different in insect virus and animal virus, although both viruses need to avoid apoptosis of the infected cells for a viral life cycle in nature. In animal virus infection, the primary role of apoptosis is considered not to be a premature lysis of the infected cells (and the following abortion of virus multiplication) but to allow the dying cells to be phagocytosed by macrophages. This phagocytosis is able to prevent dysregulated inflammatory reactions at the site of virus infection and to initiate a specific immune response against the infected virus.

Antitumor agents. 78. Inhibition of human DNA topoisomerase II by podophyllotoxin and alpha-peltatin analogues.

It has been reported that the action of etoposide (VP-16) (14) as an antitumor agent is mediated through its interaction with DNA topoisomerase II which results in DNA breakage inside the cell. In order to understand the mechanism of action as well as structure-activity relationships of 14, several novel, synthetic and some naturally occurring analogues related to podophyllotoxin were examined for inhibition of the DNA topoisomerase II activity. Compound 2 exhibited enhanced activity and compound 5 slightly diminished activity relative to 14. A 4 beta-substituted ether at the C ring and O-demethylation at the E ring appear to enhance activity.

T cell subsets and Ia-positive cells in the sciatic nerve during the course of experimental allergic neuritis.

The changes of T cell subsets and Ia-positive cells in the sciatic nerve during the course of experimental allergic neuritis (EAN) in Lewis rats were studied using immunohistochemical techniques. OX-6+ Ia-positive cells and W3/13+ total T cells were found at the clinical onset of EAN. OX-6+ cells were more numerous than W3/13+ cells during all phases of the disease. In the acute phase, more W3/25+ helper T cells were found than OX-8+ suppressor/cytotoxic T cells in the sciatic nerve. In the recovery phase, W3/25+ cells were slightly fewer than OX-8+ cells. It is suggested that these changes in T cell subsets and Ia-positive cells are related to the self-limiting monophasic course of EAN.

Conglutinin microtiter plate ELISA system for detecting circulating immune complexes.

A new technique for a conglutinin ELISA using a microtiter plate has been developed for measuring circulating immune complexes. The sensitivity of our system ranges between 0.2 and 3.2 micrograms equivalents of aggregated human IgG. We have applied this system to 21 normal healthy controls and 80 neurological patients and have found high percentages of positivity in multiple sclerosis and amyotrophic lateral sclerosis.

Suppression of actively induced and passively transferred experimental allergic neuritis by cyclosporin A.

The effect of cyclosporin A (CyA) on experimental allergic neuritis (EAN) was examined. CyA suppressed the development of actively induced EAN. The earlier treatment with CyA was begun, the more effective was its effect. CyA was effective even after the development of clinical signs. In actively induced EAN, cessation of CyA treatment lead to the development of EAN. However, in passively induced EAN, it did not. We could not find any differences in the distribution of infiltrating T cell subsets between the control group and the CyA-treated group.

Dot microfiltration sandwich EIA for the measurement of IGM concentrations in cerebrospinal fluid.

A sensitive and simple sandwich enzyme immunoassay (EIA) using a dot microfiltration apparatus has been developed for the measurement of immunoglobulin M (IgM) concentrations in cerebrospinal fluid (CSF). The lower detection limit was 0.5 micrograms/dl. We applied this method to the testing of 200 CSF samples with normal concentrations of albumin, IgG and total protein, and normal cell counting. The non-parametric 2.5 and 97.5 percentile limits of IgM and the IgM index were 6.1-64.3 micrograms/dl and 0.012-0.063, respectively. We also applied this method to the testing of samples from 11 cases of multiple sclerosis (MS) and 15 cases of Guillain-Barré syndrome (GBS). High values for IgM and the IgM index were observed in 18.2% and 9.1% of MS, respectively and in 66.6% and 20.0% of GBS, respectively.

Are there histopathologic characteristics particular to fulminant hepatic failure caused by human herpesvirus-6 infection? A case report and discussion.

An 8-month-old boy was admitted to a neighboring hospital for severe liver dysfunction and drowsiness 4 days after a diagnosis of exanthem subitum. A diagnosis of fulminant hepatic failure was made, and liver biopsy was performed during the acute stage. The presence of human herpesvirus-6 variant B (HHV-6B) DNA was shown in liver tissue by polymerase chain reaction (PCR) and in the endothelium of the portal vein by in situ hybridization (ISH). Histologic examination showed microvesicular steatosis resembling that of Reye's syndrome, even though aspirin had not been prescribed. We considered HHV-6 to be the causative agent in this case and report what is perhaps the first precise histologic description of fulminant hepatic failure caused by HHV-6.

Magnetic resonance evaluation of patency of stented polytetrafluoroethylene graft connecting right atrium to pulmonary artery.

Magnetic resonance imaging (MRI) was used to evaluate late postoperative patency of a stented polytetrafluoroethylene (PTFE) graft, which had been used to connect the right atrium to the pulmonary artery in a patient with tricuspid atresia. The MRI depicted patency, luminal size, course, and geometric morphology of the conduit.

Development of a new experimental model for total exclusion of the right heart without the aid of cardiopulmonary bypass.

A new experimental model for the total exclusion of the right heart was successfully developed in mongrel dogs without the use of cardiopulmonary bypass. A Y-shaped conduit was constructed with tube grafts spirally stented on the exterior (10 mm in diameter), and each upper limb of the conduit was provided with a 30F cannula. The foot of the conduit was anastomosed with the main pulmonary artery in an end-to-side way with a side clamp. After a closed atrioseptostomy was performed with a special knife of our design, the upper limbs of the graft were connected to the superior and inferior venae cavae by a cannulation method. The operative procedure was completed by tightening the occluding snares around the venae cavae and ligating the root of the pulmonary artery and azygos vein. Thus, without any use of the right atrium, venous blood from the venae cavae was totally diverted to the pulmonary circulation via the conduit, and only the coronary venous return was shunted to the left atrium. Five consecutive dogs tolerated the operative procedure. No pressure gradients were observed between the pulmonary arteries and venae cavae. The circulation with this model was able to be sufficiently sustained with mean pulmonary arterial pressures of about 25 mm Hg, and no significant changes were shown in the left ventricular pump function from the preoperative state. However, the decrease in the mean pulmonary artery pressure to 20 mm Hg resulted in severe circulatory failure, and two of the five dogs succumbed to this condition. Our new model will be useful for studying the hemodynamic characteristics of the circulation after operations that result in total exclusion of the right heart.

Serial evaluation of cardiac function with aortic regurgitation caused by serious aortic lesions. A preliminary comparative study with isolated chronic aortic incompetence.

Clinical and hemodynamic appearances of aortic regurgitation caused by serious aortic lesions (AR-Ao-group) seemed more deteriorated than those with isolated chronic aortic regurgitation (AR-group). Often postoperative course and operative outcome are smooth and satisfactory in the AR-Ao-group. To support this observation, serial changes of left ventricular (LV) function and LV sphericity were evaluated before and after operation in ten cases in the AR-Ao-group and compared with those in the AR-group. Before operation, there were no significant differences in LV function between the two groups. Postoperative improvement of LV sphericity and LV function were statistically better in the AR-Ao-group. The LV function reserve was considered sufficiently retained in the AR-Ao-group. Results with this study supported that clinical observation. Therefore, the total correction, at the same time of aortic incompetence and aortic lesions is recommended.