Reference values for urinary protein, albumin, beta 2-microglobulin, and the alpha 1-microglobulin-to-creatinine ratio in Japanese children.

BACKGROUND: The importance of the ratio of creatinine to urinary protein, albumin, and low-molecular weight protein as a urinary marker in chronic kidney disease patients is widely recognized. However, no reference values have hitherto been established for these markers in Japanese children. The present study aimed to establish the reference values for these urinary markers in Japanese children. METHODS: The first morning urine was randomly collected from 1712 pupils aged ≥ 3 to < 18 years during school and kindergarten mass urinary screenings. The upper limit of the reference values was set at the 97.5th percentile of the creatinine ratio per marker. RESULTS: The urinary protein-to-creatinine ratio (PCR), urinary albumin-to-creatinine ratio (ACR), urinary beta 2-microglobulin-to-creatinine ratio (BMCR), and urinary alpha 1-microglobulin-to-creatinine ratio (AMCR) showed an age-related decrease at the 50th percentile reflecting an age-related increase in urinary creatinine. The appropriate reference value for the PCR and ACR was 0.12 g/gCr and 35 mg/gCr, respectively, in the entire cohort. The appropriate reference value for the BMCR was 0.5 µg /mgCr for age ≥ 3 to < 6 years and 0.35 µg/mgCr for age 6 years or older. The appropriate reference value for the AMCR was 5.0 µg/mgCr for age ≥ 3 to < 6 years and 3.5 µg /mgCr for age 6 years or older. CONCLUSION: The present study was the first to determine appropriate reference values for the PCR, ACR, BMCR, and AMCR based on an analysis of the first morning urine samples of a large number of children.

Electrocardiographic Diagnosis of Hypertrophic Cardiomyopathy in the Pre- and Post-Diagnostic Phases in Children and Adolescents.

BACKGROUND: The usefulness of electrocardiographic (ECG) voltage criteria for diagnosing hypertrophic cardiomyopathy (HCM) in pediatric patients is poorly defined.Methods and Results:ECGs at the 1st grade (mean [±SD] age 6.6±0.3 years) were available for 11 patients diagnosed with HCM at around the 7th grade (13.2±0.3 years). ECGs were available for another 64 patients diagnosed with HCM in the 1st (n=15), 7th (n=32), and 10th (n=17) grades. Fifty-one voltage criteria were developed by grade and sex using 62,841 ECGs from the general population. Voltage criteria were set at the 99.95th percentile (1/2,000) point based on the estimated prevalence of childhood HCM (2.9 per 100,000 [1/34,483]) to decrease false negatives. Conventional criteria were from guidelines for school-aged children in Japan. Of 11 patients before diagnosis, 2 satisfied conventional criteria in 1st grade; 5 (56%) of the remaining 9 patients fulfilled 2 voltage criteria (R wave in limb-lead I [RI]+S wave in lead V3 [SV3] and R wave in lead V3 [RV3]+SV3). Robustness analysis for sensitivity showed RV3+SV3 was superior to RI+SV3. For all patients after diagnosis, RI+SV4 was the main candidate. However, conventional criteria were more useful than voltage criteria. CONCLUSIONS: Early HCM prediction was possible using RV3+SV3 in >50% of patients in 1st grade. Voltage criteria may help diagnose prediagnostic or early HCM, and prevent tragic accidents, although further prospective studies are required.

Standard Values and Characteristics of Electrocardiographic Findings in Children and Adolescents.

BACKGROUND: Reference values and the characteristics of the electrocardiographic (ECG) findings using a large number of subjects are lacking for children and adolescents.Methods and Results:A total of 56,753 digitally stored ECGs of participants in a school-based ECG screening system were obtained between 2006 and 2009 in Kagoshima, Japan. Each ECG was manually reviewed by 2 pediatric cardiologists and only ECGs with sinus rhythm were included. A final total of 48,401 ECGs from 16,773 1st (6 years old, 50% girls), 18,126 7th (12 years old, 51% girls), and 13,502 10th graders (15 years old, 52% girls) were selected. ECG variables showed differences in age and sex. However, the effects of age and sex on ECG variables such as the PQ interval, QRS voltage, and STJ segment were also different. The 98th percentile values of well-known surrogate parameters for ventricular hypertrophy in the present study were much higher than the conventional criteria. CONCLUSIONS: The present study of a large number of pediatric subjects showed that the effects of age and sex on ECG parameters are different, and that criteria for ventricular hypertrophy should be newly determined by age and sex. We have developed reference data for STJ segment elevation for children and adolescents. These findings are useful for creating guidelines and recommendations for interpretation of pediatric ECG.

Solitary pulmonary metastasis from prostate cancer with neuroendocrine differentiation: a case report and review of relevant cases from the literature.

BACKGROUND: Solitary lung metastasis from prostate cancer is rare. There are few reports of such cases with neuroendocrine differentiation. CASE PRESENTATION: A 50-year-old man presented to our hospital with a chief complaint of dysuria. Histological examination revealed prostate cancer, which was classified as cT4 N0 M0, stage IV adenocarcinoma. Since the patient was at high risk, endocrine and radiation therapies were started. One year after starting radiation therapy, the patient developed bloody sputum. Chest radiography revealed a nodular shadow in his left lung (S5). Although 18-fluoro-2-deoxyglucose positron emission tomography revealed abnormal accumulation in the lesion, the cytological diagnosis was class IIIa, which did not yield a definitive diagnosis. Given that prostate specific antigen (PSA) was not elevated, a primary lung tumor was suspected, and thoracoscopic segmental resection of the lung was performed with lymph node dissection. The final pathological diagnosis was solitary lung metastasis from prostate cancer with neuroendocrine differentiation and mediastinal lymph node metastasis. The specimen showed a mixed pattern of conventional prostatic and neuroendocrine carcinomas. CONCLUSION: We herein report a case with neuroendocrine differentiation (NED), along with a review of the relevant literature, including histopathological findings. According to previous case reports, some patients with solitary lung metastasis from prostate cancer achieved relatively good long-term survival. We consider establishing the correct diagnosis and implementing an appropriate treatment plan to be essential in prostate cancer patients with oligometastases that have the potential to be neuroendocrine (NE) tumors.

High-Performance P-Channel Tin Halide Perovskite Thin Film Transistor Utilizing a 2D-3D Core-Shell Structure.

Metal halide perovskites (MHPs) are plausible candidates for practical p-type semiconductors. However, in thin film transistor (TFT) applications, both 2D PEA2 SnI4 and 3D FASnI3 MHPs have different drawbacks. In 2D MHP, the TFT mobility is seriously reduced by grain-boundary issues, whereas 3D MHP has an uncontrollably high hole density, which results in quite a large threshold voltage (Vth ). To overcome these problems, a new concept based on a 2D-3D core-shell structure is herein proposed. In the proposed structure, a 3D MHP core is fully isolated by a 2D MHP, providing two desirable effects as follows. (i) Vth can be independently controlled by the 2D component, and (ii) the grain-boundary resistance is significantly improved by the 2D/3D interface. Moreover, SnF2 additives are used, and they facilitate the formation of the 2D/3D core-shell structure. Consequently, a high-performance p-type Sn-based MHP TFT with a field-effect mobility of ≈25 cm2 V-1 s-1 is obtained. The voltage gain of a complementary metal oxide semiconductor (CMOS) inverter comprising an n-channel InGaZnOx TFT and a p-channel Sn-MHP TFT is ≈200 V/V at VDD = 20 V. Overall, the proposed 2D/3D core-shell structure is expected to provide a new route for obtaining high-performance MHP TFTs.

Isolated tuberculous liver abscess invading the abdominal wall: report of a case.

Isolated tuberculous liver parenchymal and subcapsular abscesses are unusual,^but an abdominal wall abscess secondary to a tubercular liver abscess is extremely rare. To our knowledge, there is only one reported case of an abdominal wall abscess occurring secondary to a subcapsular liver abscess. We report the first documented case of direct invasion of the abdominal wall from an isolated tuberculous liver parenchymal abscess, diagnosed by imaging, surgical, and pathological findings. Although ultrasonography and computed tomography showed nonspecific hypoechoic and hypodense findings with peripheral contrast enhancement, T2-weighted magnetic resonance imaging (MRI) revealed a heterogeneous mass with characteristic hypointensity, suggesting the presence of free radicals produced by macrophages during active phagocytosis in tuberculosis. Although our case is extremely unusual, when hypointensity on T2-weighted MRI is seen, the possibility of tuberculosis should be considered and the results of polymerase chain reaction, culture, and histopathological diagnosis must be taken into account to avoid needless invasive surgery.

Data management solution for large-volume computed tomography in an existing picture archiving and communication system (PACS).

Multidetector row computed tomography (MDCT) creates massive amounts of data, which can overload a picture archiving and communication system (PACS). To solve this problem, we designed a new data storage and image interpretation system in an existing PACS. Two MDCT image datasets, a thick- and a thin-section dataset, and a single-detector CT thick-section dataset were reconstructed. The thin-section dataset was archived in existing PACS disk space reserved for temporary storage, and the system overwrote the source data to preserve available disk space. The thick-section datasets were archived permanently. Multiplanar reformation (MPR) images were reconstructed from the stored thin-section datasets on the PACS workstation. In regular interpretations by eight radiologists during the same week, the volume of images and the times taken for interpretation of thick-section images with (246 CT examinations) or without (170 CT examinations) thin-section images were recorded, and the diagnostic usefulness of the thin-section images was evaluated. Thin-section datasets and MPR images were used in 79% and 18% of cases, respectively. The radiologists' assessments of this system were useful, though the volume of images and times taken to archive, retrieve, and interpret thick-section images together with thin-section images were significantly greater than the times taken without thin-section images. The limitations were compensated for by the usefulness of thin-section images. This data storage and image interpretation system improves the storage and availability of the thin-section datasets of MDCT and can prevent overloading problems in an existing PACS for the moment.

Parasitic Current Induced by Gate Overlap in Thin-Film Transistors.

As novel applications of oxide semiconductors are realized, various structural devices and integrated circuits are being proposed, and the gate-overlay defect phenomenon is becoming more diverse in its effects. Herein, the electrical properties of the transistor that depend on the geometry between the gate and the semiconductor layer are analyzed, and the specific phenomena associated with the degree of overlap are reproduced. In the semiconductor layer, where the gate electrode is not overlapped, it is experimentally shown that a dual current is generated, and the results of 3D simulations confirm that the magnitude of the current increases as the parasitic current moves away from the gate electrode. The generation and path of the parasitic current are then represented visually through laser-enhanced 2D transport measurements; consequently, the flow of the dual current in the transistor is verified to be induced by the electrical potential imbalance in the semiconductor active layer, where the gate electrodes do not overlap.

Bar code-based pre-transfusion check in pre-operative autologous blood donation.

BACKGROUND: The objective of this study was to demonstrate the feasibility of a bar code-based identification system for the pre-transfusion check at the bedside in the setting of pre-operative autologous blood donation (PABD). MATERIALS AND METHODS: Between July 2003 and December 2008 we determined the compliance rate and causes of failure of electronic bedside checking for PABD transfusion. RESULTS: A total of 5627 (9% of all transfusions) PABD units were administered without a single mistransfusion. The overall rate of compliance with electronic checking was 99%. CONCLUSIONS: The bar code-based identification system was applicable to the pre-transfusion check for PABD transfusion.

Primary leiomyosarcoma of the inferior vena cava: case report.

The patient was a 63-year-old woman with a chief complaint of blood-stained sputum. A tumor of the inferior vena cava was found on chest computed tomography (CT) and identified as a primary tumor based on multidetector CT and contrast-enhanced MR angiography. An intrapelvic tumor was also discovered. On autopsy, the two tumors were diagnosed as leiomyosarcoma and ovarian fibroma, respectively.

Characteristics of ectopic pancreas in dynamic gadolinium-enhanced MRI.

The characteristics of jejunal ectopic pancreas in dynamic gadolinium-enhanced magnetic resonance imaging are described in a 40-year-old man with bowel obstruction. The pre-contrast signal intensity and post-contrast enhancement pattern of ectopic pancreas are the same as those of the pancreas.

Issuing of blood components dispensed in syringes and bar code-based pretransfusion check at the bedside for pediatric patients.

BACKGROUND: The pretransfusion check at the bedside is the most critical step for the prevention of mistransfusion in pediatric patients, as well as in adults. The objective of this study was to assess whether a bar code-based patient-blood unit identification system could be applied to the pretransfusion check at the bedside for the issuing of blood dispensed in syringes. STUDY DESIGN AND METHODS: The issuing of blood components dispensed in syringes and the bar code-based pretransfusion check at the bedside were initiated for pediatric patients in May 2003. The number of blood components transfused to pediatric patients and rate of compliance with electronic bedside verification for blood dispensed in syringes were determined. Several variables in blood samples that were freshly collected, irradiated, split into 20-mL aliquots, and stored in syringes at 4 degrees C were measured. RESULTS: Between May 2003 and April 2007, a total of 3957 blood components (10% of all transfusions) were administered to pediatric patients without a single mistransfusion, of which 871 (22%) were issued by dispensing in syringes. The compliance rate with electronic bedside verification for blood dispensed in syringes was 99%. The supernatant potassium concentrations and extracellular free hemoglobin in blood samples stored in syringes at 4 degrees C for 24 hours were 14 +/- 1.3 mmol/L and less than 0.3 g/L, respectively, and these were considered to be acceptable for transfusion to pediatric patients. CONCLUSION: The bar code-based identification system that we used was fully applicable to the pretransfusion check at the bedside for blood dispensed in syringes.

A filmless radiology teaching conference system for pertinent displaying and image searching.

To solve the problems of image displays in filmless radiology conferences for the purpose of teaching, we made an experimental design of a conference system with dual 50-in. plasma monitors for displaying larger images and a shared folder containing shortcuts to images for quick display during conferences on the desktop of each client computer in a picture archival and communication system. The image quality of the monitors was evaluated using the TG18-QC test pattern. The display time of images was measured in 20 cases when the shared folder was used and when it was not. Monitor screen size and image quality, operability, display time of images, and overall impression given by the system were evaluated subjectively by five radiologists. Although the image quality of the monitor was not as high as that of the high-resolution monitors used for diagnostic radiology, its performance was good enough for teaching. The average display time using the shared folder (2.6 +/- 0.39 s) was significantly shorter than without it (16.9 +/- 5.04 s; p = 2.85 x 10(-6)). Despite the need for certain improvements in monitor size and in the operability of the system, the radiologists considered the system suitable for radiology teaching conferences. We believe that this system is useful for institutions that intend to introduce a filmless system for filmless radiology teaching conferences.

A computer-assisted system for diagnostic workstations: automated bone labeling for CT images.

Although accurate information on thoracolumbar bone structure is essential when computed tomography (CT) images are examined, there is no automated method of labeling all the vertebrae and ribs on a CT scan. We are developing a computer-aided diagnosis system that labels ribs and thoracolumbar vertebrae automatically and have evaluated its accuracy. A candidate bone was extracted from the CT image volume data by pixel thresholding and connectivity analysis. All non-bony anatomical structures were removed using a linear discriminate of distribution of CT values and anatomical characteristics. The vertebrae were separated from the ribs on the basis of their distances from the centers of the vertebral bodies. Finally, the thoracic cage and lumbar vertebrae were extracted, and each vertebra was labeled with its own anatomical number by histogram analysis along the craniocaudal midline. The ribs were labeled in a similar manner, based on location data. Twenty-three cases were used for accuracy comparison between our method and the radiologist's. The automated labeling of the thoracolumbar vertebrae was concordant with the judgments of the radiologist in all cases, and all but the first and second ribs were labeled correctly. These two ribs were frequently misidentified, presumably because of pericostal anatomical clutter or high densities of contrast material in the injected veins. We are confident that this system can contribute usefully as part of a picture archiving and communication system workstation, though further technical improvement is required for identification of the upper ribs.

Analysis of the hump phenomenon and needle defect states formed by driving stress in the oxide semiconductor.

The reduction in current ability accompanied by the hump phenomenon in oxide semiconductor thin-film transistors to which high DC voltages and AC drive voltages are applied has not been studied extensively, although it is a significant bottleneck in the manufacture of integrated circuits. Here, we report on the origin of the hump and current drop in reliability tests caused by the degradation in the oxide semiconductor during a circuit driving test. The hump phenomenon and current drop according to two different driving stresses were verified. Through a numerical computational simulation, we confirmed that this issue can be caused by an additional "needle", a shallow (~0.2 eV) and narrow (<0.1 eV), defect state near the conduction band minimum (CBM). This is also discussed in terms of the dual current path caused by leakage current in the channel edge.

Dietary Habits Had No Relationship with Adolescent Idiopathic Scoliosis: Analysis Utilizing Quantitative Data about Dietary Intakes.

Although several genetic and environmental factors have been identified as risk factors of adolescent idiopathic scoliosis (AIS), the influence of dietary intake has not been elucidated. We evaluated the association between AIS and dietary habits among female students. Junior high school girls aged 12 to 15 years in the Tokyo metropolitan area who underwent a second school screening for scoliosis were recruited. AIS was diagnosed by orthopedic surgeons specializing in scoliosis, using standing whole spine radiography. Students with a Cobb angle of ≥15° were classified into the AIS group, and others were considered healthy controls. Dietary assessment was performed using a validated diet history questionnaire. Dietary intakes were categorized into quintiles based on distribution, and crude and multivariable odds ratios and 95% confidence intervals for AIS for each quintile category of dietary variable were calculated, with the lowest quintile category used as a reference. In total, 2431 subjects were included in the analysis, and 47.8% of them were diagnosed with AIS. None of the selected nutrients or food groups was significantly associated with AIS. In conclusion, dietary habits may not be associated with AIS.

Electron-blocking by the potential barrier originated from the asymmetrical local density of state in the oxide semiconductor.

Defect generation in oxide semiconductor thin-film transistors under high-voltage driving has not been studied in depth despite being a crucial bottleneck in the making of the integrated circuit utilized in an oxide semiconductor. Here we report on the origin of the asymmetrical transport characteristics caused by the degradation in the oxide semiconductor during integrated circuit driving. The variation of the current profiles based on test conditions is related to the generation of local defect states in the oxide material; this generation could be caused by the structural change of the material. The numerical calculations show that the flow of the electron is blocked by the "electrical pocket" formed by the electric-field distortion due to the local defect states near the edge of the electrode.

Impact of transient currents caused by alternating drain stress in oxide semiconductors.

Reliability issues associated with driving metal-oxide semiconductor thin film transistors (TFTs), which may arise from various sequential drain/gate pulse voltage stresses and/or certain environmental parameters, have not received much attention due to the competing desire to characterise the shift in the transistor characteristics caused by gate charging. In this paper, we report on the reliability of these devices under AC bias stress conditions because this is one of the major sources of failure. In our analysis, we investigate the effects of the driving frequency, pulse shape, strength of the applied electric field, and channel current, and the results are compared with those from a general reliability test in which the devices were subjected to negative/positive bias, temperature, and illumination stresses, which are known to cause the most stress to oxide semiconductor TFTs. We also report on the key factors that affect the sub-gap defect states, and suggest a possible origin of the current degradation observed with an AC drive. Circuit designers should apply a similar discovery and analysis method to ensure the reliable design of integrated circuits with oxide semiconductor devices, such as the gate driver circuits used in display devices.