Odor discrimination of "IP3-" and "cAMP-increasing" odorants in the turtle olfactory bulb

The ability of the turtle olfactory system to discriminate between various odorants that increase levels of adenosine 3',5'-cyclic monophosphate (cAMP) and inositol trisphosphate (IP3) in the olfactory bulb was examined by the cross-adaptation technique and analyzed by multidimensional scaling. The mean values of the degree of discrimination among the IP3-increasing odorants were higher than those among the cAMP-increasing odorants, and were similar to those between cAMP- and IP3-increasing odorants, suggesting that the features of the receptors of cAMP-increasing odorants are different from those which respond to IP3-increasing odorants. Analysis by multidimensional scaling suggested that differences in second messenger pathways are not related to detecting odor quality in the turtle olfactory system.

Effects of voluntary leg muscle contractions on cardiac output while standing

To clarify the contribution of voluntary muscle contractions on the cardiovascular variables of humans, we measured stroke volume (SV), heart rate (HR), and cardiac output (CO) by impedance plethysmography in young males maintaining an upright standing position with 1) no voluntary muscle contractions owing to as little movement as possible (control condition), 2) voluntary muscle contractions in the calves along with a forward sway of the body, and 3) muscle contractions throughout the legs along with a backward sway. Muscle contraction in the calves did not provoke any significant increase in either SV or CO. Voluntary contractions throughout the legs, on the other hand, caused a reduction in SV and CO. From these observations we may conclude that contractions along with forward or backward swaying dose not enhance venous return unless the abdominal muscle is also contracting and unless the contractions are synchronous to one-minute wave in body fluid volume change.

Arterial baroreflex gain for muscle sympathetic nerve activity during head-up tilting in humans

To clarify the neural mechanisms involved in blood pressure regulation during head-up tilting (HUT), arterial baroreflex controls for heart rate and muscle sympathetic nerve activity (MSNA) were evaluated by applying frequency transfer function and coherence analyses to the equidistant time series data of RR-interval, MSNA and mean blood pressure during graded HUT in six healthy subjects. Coherence analysis indicated that the RR-interval and MSNA were linked linearly with mean blood pressure in the low (0.07-0.12 Hz) and high (0.23-0.27 Hz) frequency domains. Arterial baroreflex gain for the heart rate decreased significantly during HUT, while the baroreflex gain for MSNA showed no significant change. These results indicate that the preserved arterial baroreflex gain for MSNA plays an important role in maintaining blood pressure during orthostasis.

Storage and presentation of images

The concept of a Picture Archiving and Communication System (PACS) and its state of realization in the world involving USA, Europe and Japan is presented. As examples, MDIS in USA, EurIPACS in Europe and Osaka University in Japan will be reported. The question of to what extent the technical problems in realization of PACS have been overcome and are expected to be overcome in the near future is raised and discussed. As an example of technological difficulties, the problem of rapid exchange of image files between institutions will be mentioned. The position of medical images in the efficacy of diagnosis in hospitals will be also discussed. The integration of PACS with the Radiological Information System (RIS) and HIS is discussed. The technology assessment of PACS is going to be an important theme of study and investigation. An example of quantitative measurement of pre-post PACS/RIS/HIS is included.

Developing a new picture archiving and communication system for the new Osaka University Hospital

Osaka University Hospital moved into a new hospital building on the suburban Suita campus in October 1993. A newly developed hospital information system, a new radiologic information system and phase I of a completely new Picture Archiving and Communication System (PACS) also began operating. Work began in 1986 on this PACS. The PACS effort has been guided by one working group and two committees during the last 7 years. A survey of the previous diagnostic and image delivery system was performed as part of the preamble to designing an optimal PACS. Extensive analysis and measurement of pre-existing operational conditions was undertaken. These studies and technical research projects are described in a companion paper in this issue. The phase I hardware installation and initial testing were completed in March 1994. Subsequent phases will build incrementally until the completely new, hospital-wide PACS is realized.

Initial data-element selection for the evaluation of picture archiving and communication system performance

The completely new, hospital-wide picture archiving and communication system (PACS) now being implemented at Osaka University Hospital is described elsewhere in this issue. This paper lists the many studies of the department and hospital that were performed before the PACS for the purpose of identifying data elements for use in evaluating a PACS system. A second purpose of the initial data-element collection was to assist in the overall Osaka University PACS design. Selected studies from this work are presented here.

A comparison of conventional screen-film radiography and hard copy of computed radiography in full and two-thirds sizes in detection of interstitial lung disease

This study examined whether hard-copy radiographs produced from computed radiography (CR) images show the subtle interstitial pulmonary disease equally well to conventional screen-film radiographs, because a digital radiography should be chosen for introduction of the digital picture archiving and communication system (PACS) for the new Osaka University Hospital. Eleven radiologists examined 20 abnormal and 20 control chest radiographs presented in each of three groups: conventional screen-film radiographs and two sizes of hard-copy radiographs made from CR images. This study of digital image quality of chest examinations found that some findings on conventional screen-film radiography images are not reproduced by current CR (2,000 x 2,000 x 10 bits in matrix), especially when the experienced radiologists were observed. This finding suggested improvements are needed in CR before CR of chest should fully replace conventional screen-film radiography.

A new capacitive heating applicator for the simultaneous radiohyperthermotherapy of superficial and shallow-seated tumors

External capacitive heating is the usual method of electromagnetic wave heating, in which the tumor is caught and heated between two opposite applicators. Using a phantom, the authors developed and evaluated the performance of a new capacitive heating applicator designed for simultaneous radiohyperthermotherapy (SRH) in which the electron beam irradiation is provided from above an external capacitive heating applicator for the treatment of superficial and shallow-seated tumors. The trial applicator was constructed to fulfill the following conditions: 1. use of an electrode plate which does not affect the electron beam depth dose, 2. a uniform thickness to maintain flatness of the electron beam, and 3. a cooling function to prevent damage to normal skin tissue and enhance the therapeutic gain factor. This applicator was comprised of a 0.1-mm-thick copper electrode and a 5-mm-thick cooling chamber. The depth of the 80% dose of the new applicator was 21 mm with a 9-MeV electron beam and 36mm with a 15-MeV electron beam, which was comparable to the effect of a conventional irradiation bolus. The temperature distribution produced by the trial applicator was symmetrical on both sides from the center of the applicator. The 50% specific absorption rate region was 6.4 cm wide at a depth of 1 cm from the phantom surface and 2.8 cm wide at a depth of 3 cm. There have been no previous reports on the development of an external capacitive heating applicator designed for the SRH of superficial and shallow-seated tumors; this is the first such report.(ABSTRACT TRUNCATED AT 250 WORDS)

Diffusion of digital radiology modalities in the Nordic countries and Japan

The Nordic countries have 23 million inhabitants. About 14 million radiology examinations are performed annually at hospitals and in primary health care. This represents about 600 examinations per 1000 inhabitants per year. Japan, on the other hand, has 125 million inhabitants and annually performs about 200 million radiology examinations at hospitals and in primary health care. This represents about 1600 examinations per 1000 inhabitants per year. The above figures do not include dental X-ray examinations. Between 15% and 20% of all radiology examinations in the Nordic countries and about 5% in Japan are performed with digital modalities such as computerized tomography, digital subtraction angiography, computed radiography, and magnetic resonance imaging. Computerized tomography is the most diffused digital X-ray modality in the Nordic countries with 95,000 inhabitants per scanner while Japan only has 17,000 inhabitants per scanner. For magnetic resonance imaging the difference is almost of the same order. Japan has the same diffusion of magnetic resonance imaging units per 100,000 inhabitants as the Nordic countries have of computerized tomography scanners. The large difference between Japan and the Nordic countries regarding diffusion of digital radiology modalities is explained mainly by differences in the nature and organization of radiology services.

Round table discussions: standardisation and its role in PACS and medical imaging

The round table discussions dealt with standardisation and its role in PACS and medical imaging, and with the assessment of medical imaging and targeting R & D based on that. Two approaches to enable image files to be transferred were discussed in the standardisation sessions. Firstly, the standardisation efforts in Europe, USA and Japan which all focus on a single standard on image transfer and file format were discussed. A plea was made to merge these three approaches. It was also noted that the Japanese IS&C standard is essentially a standard for off-line PACS. Secondly, an argument was raised that as several i age file formats are already in existence (because of the different computer platforms in use), what is needed are converters between these de-facto formats instead of striving towards one common standard. The round table on assessment focused on the changes in the radiological practices which are already emerging following the introduction of new digital imaging modalities. It was argued that PACS will cause further organisational changes because a hospital-wide PACS enables images to be viewed everywhere. The radiology meetings have been the mechanism for discussing difficult cases. In the PACS world their role may change. However, PACS will only diffuse when it offers clear advantages over the present procedures. This means that PACS, digital imaging and radiology practices evolve in parallel and incrementally.

PACS in Osaka University Hospital

To develop the hospital information system, the radiological information system, and the picture archiving and communication system for our new hospital, we analysed the data volume at each step of the flow in our present film-based system. After that, we used a small PACS, and it indicated the problems in it. From the analysis of the data volume of the film-based system, it was found out that digital data should be compressed, and prefetching techniques should be employed for digital PACS. Several types of display terminals had been proved to be necessary for different purposes. An RIS connection was thought to be obligatory to avoid incorrect input of ID on the image. Image input terminals should have edit functions for easy recognition of the image information. Taking account of these requirements for digital PACS, we are developing an actual total PACS.

Technology assessment of PACS in Osaka University Hospital

This paper describes a methodology of PACS technology assessment and gives examples of the results of measurement of 24 items of PACS-related situations of image diagnosis systems in Osaka University Hospital before a PACS is installed. These data are to be compared with the data which will be measured after PACS is installed in the new Osaka University Hospital, in order to complete our technology assessment. We propose common variables, units, and conditions of measurement, in order to establish a standard method of data comparison between before and after PACS installation in hospitals at large. We designed our PACS taking technology assessment into account. We do not stop the technology assessment at the efficacy evaluation, because PACS must be more than a tool for radiological practice. We extend the technology assessment into the effectiveness evaluation, so that PACS is a part of radiological practice itself, and diagnostic accuracy, economy and efficiency are the results of PACS operation.

Development and evaluation of oral reporting system for PACS

Experimental workstations for oral reporting and synchronized image filing have been developed and evaluated by radiologists and referring physicians. The file media is a 5.25-inch rewritable magneto-optical disk of 600-Mb capacity whose file format is in accordance with the IS&C specification. The results of evaluation tell that this system is superior to other existing methods of the same kind such as transcribing, dictating, handwriting, typewriting and key selections. The most significant advantage of the system is that images and their interpretation are never separated. The first practical application to the teaching file and the teaching conference is contemplated in the Osaka University Hospital. This system is a complete digital system in terms of images, voices and demographic data, so that on-line transmission, off-line communication or filing to any database will be easily realized in a PACS environment. We are developing an integrated system of a speech recognizer connected to this digitized oral system.

Dibasic (amidinoaryl)propanoic acid derivatives as novel blood coagulation factor Xa inhibitors

Since activated factor X (FXa) is a coagulant enzyme that generates thrombin and participates in both intrinsic and extrinsic coagulation pathways, inhibition of FXa may be more effective than inactivation of thrombin for interrupting blood coagulation. To assess the possible effectiveness of FXa inhibition as an anticoagulant, we designed and synthesized 3-(amidinoaryl)-2-[4-[(3S)-3-pyrrolidinyloxy]phenyl]propanoi c acid derivatives as low molecular weight, nonpeptidic, orally active FXa inhibitors. These derivatives exhibited potent and highly selective anti-FXa activity in vitro and anticoagulant activity on oral administration. The most promising compound, (2S)-2-[4-[[(3S)-1-acetimidoyl-3-pyrrolidinyl]oxy]phenyl]- 3-(7-amidino-2-naphthyl)propanoic acid hydrochloride pentahydrate (4,DX-9065a), inhibited 50% of FXa activity (IC50) at 0.07 microM, doubled plasma recalcification time (PRCT) at 0.5 microM, and significantly prolonged activated partial thromboplastin time (APTT) at a dose of 100 mg/kg on oral administration. In contrast with FXa inhibition, 4 showed no activity against thrombin (IC50 > 2000 microM).

Cystic lymphangioma and plunging ranula treated by OK-432 therapy: a report of two cases

Among head and neck angiotumors, cystic lymphangioma occurs in infancy in most cases and it is rare in adulthood. Plunging ranula is one of the diseases which need to be distinguished from lymphangioma, though operation is the first choice therapy for both of these. In the present study, we report on 2 cases in whom we conducted intralesional injection of OK-432 for cervical lymphangioma and ranula found in 20 and 35 year-old female patients. We obtained excellent improvement. First of all, we punctured the tumors and sucked out the liquid content as much as possible, and then used OK-432 in the same volumes to those drawn out. No swelling was observed in either patient after 1 month, and cysts disappeared in CT 4 and 12 months after injection, respectively; at present, the prognosis is satisfactory, without recurrence. The intralesional injection of OK-432 is considered an effective method, as the speed of complete disappearance by this therapy is high. Cosmetically it is superb, leaving no lesions in the skin of the injection site.

Eosinophil and eosinophil cationic protein in allergic rhinitis

To evaluate the roles of eosinophils in allergic rhinitis, eosinophil cationic protein (ECP) levels in sera and nasal secretions were measured in 28 patients with allergic rhinitis. In patients, blood eosinophil counts and serum ECP levels were significantly higher than in controls (p < 0.05). However, there was no statistically significant correlation between blood eosinophil count and serum ECP level (r = 0.025). The number of eosinophils and the ECP level in nasal secretion were also measured. In patients, the ECP level increased with the number of eosinophils, and the ECP level in nasal secretion was significantly higher than in controls (p < 0.05). These results suggest that eosinophils and ECP play important roles in allergic rhinitis.

Detection of anti-neutrophil cytoplasmic antibodies (ANCA) using the immunoperoxidase method

Anti-neutrophil cytoplasmic antibodies (ANCA), which are present in Wegener's granulomatosis (WG) and other systemic vasculitis, were detected using the immunoperoxidase method rather than the indirect immunofluorescence method. It was possible to distinguish ANCA patterns (c-ANCA, p-ANCA) by the immunoperoxidase method. When neutrophil smears were treated with 0.4% hydrogen peroxide solution, the endogenous peroxidase activity was sufficiently inhibited. ANCA was also detected, using HL-60 cells (human promyelocytic leukemia) and THP-1 cells (human myelocytic leukemia) as substrates.

[Development of oral reporting system in PACS environment]

An experimental radiologic reporting system using oral presentations has been developed and tested. The rewritable and compact magneto-optical disk (MOD) is employed to store oral diagnostic reports together with read radiologic images. The MOD is 5.25 inches in diameter, has a 600 MB memory capacity, and is erasable, light and compact. Advantages of the system are simultaneous retrieval of oral reports by a radiologist and the images he or she interpreted, and the capability of media circulation in addition to the function of filing. Thus MOD has a multimedia function of both off-line communication and filing. When medical images are interpreted and oral presentations are registered, automatically digitized oral reports and digitized images are filed in the MOD. Referring physicians can get oral diagnostic reports and can see the images at the same time on a personal computer. Furthermore, integration with voice recognition capability is being tried in our experiment.

Report of a study using phantom materials, and clinical experience with simultaneous radio-hyperthermotherapy

Simultaneous radiohyperthermotherapy (SRH) is a combined hyperthermia-radiation therapy in which irradiation is given during heating. Mutual interference between the high energy radiotherapy system (Toshiba LMR-15A) and the 13.56 MHz capacitive heating system (Omron HEH-500C) was tested with phantom materials prior to a clinical trial with SRH. The energy and flatness of irradiation were not affected by the heating system within the range of clinical use. The high energy radiotherapy system did not affect the increase or distribution of temperature during simultaneous treatment. The results of this phantom study indicated that these apparatuses would not produce clinically significant mutual interference during SRH. A clinical trial was performed on a 57-year-old woman with postoperative recurrence of rectal cancer. This is the first reported clinical case treated with true SRH in which external irradiation was administered during mid capacitive heating. Twelve SRH treatments were performed on the recurrent lesion at a frequency of twice a week for six weeks using the apparatuses described above. There was a significant reduction in pain after treatment. The tumor marker carcinoembryonic antigen (CEA) level decreased after treatment. On CT images taken after treatment, the tumor site became a low density area which indicated necrosis. There were no side effects. These results suggest that further clinical study of SRH should be performed to clarify its advantages.

[Clinical and CT-findings in hemiballismus]

We studied the correlation between clinical and CT-findings in 33 cases with hemiballismus. Of these 33 cases, 4 cases were examined by the authors and 29 cases were obtained from the literature. Cerebrovascular disease was present in 27 cases and the localization of the lesion was examined with CT. Of these 10 cases had lesions in the subthalamus, while 17 cases had lesions outside the subthalamus. In 6 cases, the location of the lesion was not recognized on CT. In cases with lesions outside the subthalamus, 11 cases had lesions in the putamen, 10 cases had lesions in the caudate. Therefore the lesion were largely located in the striatum. Typical hemiballismus was seen in 16 cases. In this group, 6 cases had lesions in the subthalamus, 5 cases had lesions in the putamen, and 3 cases had lesions in the caudate. Hemiballismus accompanied by hemichorea was seen in 17 cases. In this group, while 9 cases had hemichorea with ballismus, and 5 out of 9 cases had lesions in the caudate, 4 cases had lesions in the putamen. Thus, all lesions were located in the striatum. Eight out of 17 cases had hemiballismus with chorea. In these 8 cases, 4 cases had lesions in the subthalamus, these were 2 cases in the putamen, and 2 cases had lesions in the caudate. When all cases were examined in terms of clinical manifestations, 10 cases were considered to have lesions in the caudate and 7 out of 10 cases involved chorea. Ten cases had lesions in the subthalamus, while 6 out of 10 cases showed typical hemiballismus.(ABSTRACT TRUNCATED AT 250 WORDS)

[Magneto-optical disk filing system for oral diagnostic reports and their synchronized images]

The rewritable and compact media of magneto-optical disk (MOD) is firstly applied to store medical images with spoken reporting. The MOD has multi-media function of communication and filing. Our system is optimized in terms of recording length of speech based upon our clinical research. The results will have influences over the future PACS. One of their examples is possibility of multimedia PACS with images, speeches and demographic data. Another example is prevention of dispersion of images which have no interpretations by radiologists. Our next step is to recognize filed speech in background processing for printing reports.