Evaluation of the methods for pupil size estimation: on the perspective of autonomic activity

The purpose of This work is to find the optimal calculation method about pupil size to estimate an activity of autonomic nerve system. To evaluate its state, we have to calculate an accurate pupil size from the image of free-rotated and yawed eye for 5 minutes. But calculation of the pupil size from image takes a long time. So we suppose three methods which considered cost (time), accuracy and evaluate for each. 'Method' 1 is to calculate the vertical pupil diameter from images, 'method 2' is to calculate the pupil size from whole image (method 2-1; by binarization and method 2-2; by binarization with shape evaluation) and 'method 3', the most accurate method, is from three-dimensional transformation of pupil image. As a result, for seven subjects, each method is takes about 6, 44, 124, 311 minutes to evaluate five-minute images (300,000 pixels/frame, 30 frames/sec). Also, the result of correlation between the parameter Lf/Hf ratio of heart rate variability, commonly used method for estimate the state of autonomic nerve system, and it of pupil size variability is, for each case, 0.34, 0.2, 0.69, 0.69.

Development of an implantable intrathecal drug infusion pump

An intrathecal drug infusion system has been designed, manufactured and tested. The system is composed of a drug reservoir and a pump/controller assembly. The drug reservoir made of SUS316L is a negative pressure gas chamber enclosing a bellows type drug chamber. The pump/controller assembly includes a bacterial filter, a controller circuit board, a battery and a micropump, and is connected to a catheter for intrathecal infusion. The micropump implements a peristaltic pumping of the drug by a sequential motion of three pairs of cam and cam-follower. In vitro performance tests were conducted with prototypes.

Hibernoma: MRI features in eight consecutive cases

AIM

To describe the preoperative magnetic resonance imaging findings of eight histologically-proven cases of hibernoma.

MATERIALS AND METHODS

The site, size, and signal characteristics of eight consecutive hibernomas were retrospectively assessed on T1-weighted spin-echo and short T1 inversion recovery (STIR)/fat-saturated T2-weighted fast spin echo magnetic resonance images. Four patients also had gadolinium-enhanced fat-saturated T1-weighted spin echo imaging. Patient age and sex, and duration of symptoms were recorded.

RESULTS

Three female and five male patients with an average age 36 years (range 16-53 years) were included. Seven lesions occurred in the thigh, four in the anterior compartment and three in the posterior compartment. One lesion occurred superficial to the scapula. All cases demonstrated common magnetic resonance imaging findings of a well-defined, heterogeneous mass, slightly or clearly hypo-intense to subcutaneous fat on T1-weighted spin-echo images, with prominent thin low signal bands throughout the tumour. The lesions failed to fully suppress on STIR or fat-saturated T2-weighted images. Only one of the four contrast-enhanced studies demonstrated increased vascularity in the tumour.

CONCLUSION

The MRI findings of a lesion that is diffusely slightly hypointense to surrounding subcutaneous fat, should prompt the operator to consider hibernoma in the differential diagnosis.

Managing venous stenosis in vascular access for haemodialysis

The prevalence of end-stage renal disease in Singapore is high and rising with some 2,700 patients requiring haemodialysis in the year 2004. In tandem with the increasing prevalence of diabetes mellitus, the number of dialysis patients is projected to rise to nearly 6,000 in the year 2010, adding to the national healthcare costs. Diabetic nephropathy accounts for about 40 percent of patients starting dialysis in Singapore. There have been few studies regarding vascular access for haemodialysis, despite its great demand in the local population. These vascular access channels are far from perfect, and provide great challenges for the vascular surgeons, nephrologists and interventional radiologists on a constant basis. The concomitant vasculopathies in diabetic patients also increase the risk of morbidity related to vascular access interventions. This paper will review the current state of interventions and research associated with managing venous stenosis in renal vascular access for haemodialysis.

Self-assembled Al(x)Ga(1-x)N nanorods grown on Si(001) substrates by using plasma-assisted molecular beam epitaxy

Hexagonal Al(x)Ga(1-x)N nanorods were grown by plasma-assisted molecular beam epitaxy (PAMBE) on Si(001) substrates. The Al mole fraction was determined from x-ray diffraction (XRD) measurement and its value was varied from 0 to 15. It is found that, under group III-rich conditions, the growth rate of the Al(x)Ga(1-x)N nanorods decreases and the diameter increases due to the possibility of incorporation of aluminium and gallium. In order to study structural and optical properties, x-ray diffraction and cathodoluminescence (CL) measurements were carried out. The Al content (x) is calculated from these measurements and their values are compared.

Imaging the infrapatellar tendon in the elite athlete

Extensor mechanism injuries constitute a major cause of anterior knee pain in the elite athlete. Sonography and magnetic resonance imaging (MRI) are the imaging methods of choice when assessing the infrapatellar tendon. A comprehensive imaging review of infrapatellar tendon normal anatomy, tendinopathy, and partial/full-thickness tendon tears is provided. The value of imaging the infrapatellar tendon in clinical practice, including whether sonography can predict symptoms in asymptomatic athletes, is discussed. Acute avulsion fractures, including periosteal sleeve avulsion, and chronic avulsion injuries, including Sinding-Larsen-Johansson and Osgood-Schlatter syndromes, are shown. Mimics of infrapatellar tendon pathology, including infrapatellar plica injury, patellar tendon-lateral femoral condyle friction syndrome, and Hoffa's syndrome, are illustrated.

Rabies, an emerging disease in Korea

Since the first rabies case was reported in a dog in 1907, the disease was enzootic up to 1975 in Korea. After a steady decrease in the number of rabies cases from 1976 to 1984, no case was reported for 8 years from 1985 to 1992. Then, a resurgence of the disease was noted in 1993, and a continuous increase of rabies cases was observed during the following years. This report provides information on rabies in South Korea during the reemerging period 1993-2003. A total of 364 rabies cases in five different animal species and five deaths in human beings as a result of rabies were reported. Cattle and dogs accounted for 46.4% and 40.4% of total animal cases, respectively, and raccoon dogs commanded an overwhelming majority (44/48) of rabies cases in wildlife animal species. All animal and human rabies cases occurred only in two provinces, Gyeonggi and Gangwon; majority of them in two counties of Gyeonggi and one county of Gangwon province that border the demilitarized zone. From the three counties, the disease continued to expand to the other areas of the two provinces. The average monthly frequency of animal rabies cases during the 11-year period peaked in January, and the incidence was highest during winter. There were three major rabies outbreaks in animals and the number of animal rabies cases increased with time. Data indicate that the temporal patterns were attributable to the ethology of raccoon dogs in the areas of outbreak.

Immunohistochemical Localization of Glutamate in the Gerbil Main Olfactory Bulb Using an Antiserum Directed against Glutamate

Information on the localization and the roles of glutamate in the nervous system is becoming valuable because the axon terminals of the olfactory sensory neurons and the synapses of the mitral and tufted output cells appear to be glutamatergic. In this study, we have analysed the distribution of glutamate immunoreactivity in the main olfactory bulb (MOB) of the Mongolian gerbil using an antiserum directed against glutamate. Glutamate immunoreactivity in the MOB was present in the olfactory nerve layer (Onl), glomerular layer (GL), external plexiform layer (EPL) and mitral cell layer (ML), but not in the granule cell layer (GCL). Glutamate immunoreactivity detected in the Onl was thought to be terminal ramifications of glomeruli. Some neurons in the periglomerular region showed glutamate immunoreactivity. In the EPL, glutamate immunoreactivity was found in some neuronal somata (tufted cells) and processes. In addition, mitral cells in the ML were labelled by the glutamate antibody. The pattern of glutamate immunoreactivity in the mitral cells was similar to that in the tufted cells. In brief, glutamate in the gerbil MOB is the neurotransmitter used by primary afferents and output neurons.

Epithelioid haemangioendothelioma in the parapharyngeal space

Epithelioid haemangioendothelioma (EHE) is an uncommon vascular neoplasm which occurs rarely in the head and neck and has an unpredictable clinical behaviour. It is characterized by round or spindle-shaped endothelial cells with cytoplasmic vacuolation. Most often, EHE arises from the soft tissues of the upper and lower extremities, and it has borderline malignant potential. We describe the first reported case of EHE in the parapharyngeal space, which was treated successfully via a transcervical–transparotid approach (following angiography with embolization), without massive intra-operative bleeding or facial nerve damage.

Design of a Subcutaneous Vascular Access Device Using Ni-Ti SMA Clamps for Hemodialysis

A subcutaneous vascular access device which utilizes an Ni-Ti shape memory alloy (Ni-Ti SMA) spring, has been developed as a new method for subcutaneous vascular access in the treatment of hemodialysis patients. Until now, the connection between the SVAD and needle cannot be externally monitored, and the clamp must be opened and closed with a percutaneous needle by a nephrologist.

The SMA-SVAD accomplishes the opening and closing of its clamp using two Ni-Ti SMA springs, and a transcutaneous energy transmission system (TET) transmits energy to the Ni-Ti SMA springs without the need for percutaneous wires. Two SMA springs open and close the clamp of the SMA-SVAD, without affecting any of the other parts of the system. Wasted thermal energy is reduced to minimal values via electrical regional heating methods. The state of the SMA-SVAD can be monitored according to the amount of power consumed by the external energy transmitter.

In in-vitro experiments, when the clamp was opened and the pressure difference in the hemodialysis machine was set to 50 mmHg, water flow through SMA-SVAD reached 500 ml/min. The maximal surface temperatures of the SVAD and catheter were successfully maintained at proper levels (38~39°C), 2~3 degrees higher than the temperature of the surrounding tissues. The time elapsed from the initiation of energy transmission until the opening of the SMA clamp was 5 seconds.

Postmastectomy Radiotherapy Reduces Locoregional Recurrence in Elderly Women with High-risk Breast Cancer

AIMS

Clinical trials of adjuvant radiotherapy after mastectomy have largely excluded women aged 70 years or over, even though they comprise 30% of the breast cancer population. This study examined outcomes in elderly women with high-risk breast cancer treated with or without postmastectomy radiotherapy (PMRT).

MATERIALS AND METHODS

Data were analysed for 233 women aged 70 years or over with high-risk breast cancer (tumours > 5 cm or > or = 4 positive axillary nodes) treated with mastectomy and referred to the British Columbia Cancer Agency from 1989 to 1997. Tumour and treatment characteristics were compared between two cohorts: women treated with PMRT (n = 147) vs women treated without PMRT (n = 86). Univariate and multivariate analyses of 10-year Kaplan-Meier locoregional recurrence (LRR), distant recurrence, breast cancer-specific survival and overall survival were carried out.

RESULTS

Median follow-up time was 5.5 years. The distribution of tumour sizes was similar in the two groups. Compared with women treated without PMRT, higher proportions of women who underwent PMRT had four or more positive nodes (83% vs 67%, P = 0.01) and positive surgical margins (14% vs 4%, P = 0.02). Systemic therapy, used in 94% of women, was comparable in the two cohorts (P = 0.63). Elderly women treated with PMRT had significantly lower LRR compared with women treated without PMRT (16% vs 28%, P = 0.03). No differences in distant recurrence, breast cancer-specific survival or overall survival were observed in the two treatment groups (all P > 0.05). On multivariate analysis, the omission of PMRT and the presence of high-grade histology were significant predictors of LRR, whereas an increasing number of positive nodes was significantly associated with distant recurrence and overall survival.

CONCLUSIONS

In women aged 70 years or over with tumours greater than 5 cm or four or more positive nodes, significantly lower LRR was observed in women treated with radiotherapy compared with women treated without radiotherapy. PMRT should be considered in the management of elderly women with these high-risk characteristics.

Fusing DEDD with ubiquitin changes its intracellular localization and apoptotic potential

DEDD, a highly conserved and ubiquitous death effector domain containing protein, exists in non, mono, and diubiquitinated forms. We previously reported that endogenous unmodified DEDD is only found in nucleoli and that mono- and diubiquitinated DEDD associate with caspase-3 in the cytosol suggesting that ubiquitination may be important to the apoptosis regulating functions of DEDD in the cytosol. We now demonstrate that many of its 16 lysine residues can serve as alternative acceptors for ubiquitination to maintain the monoubiquitination status of DEDD. A central region in DEDD (amino acids 109-305) outside the death effector domain was found to be essential for ubiquitination and/or the docking of the ubiquitination machinery. Fusion of ubiquitin to the C-terminus of DEDD to mimic monoubiquitinated DEDD relocated DEDD from nucleoli to the cytosol. This fusion protein also demonstrated a greater apoptosis potential than unmodified DEDD. Finally, we show that both mono- and polyubiquitination of DEDD can be achieved by the cellular inhibitor of apoptosis proteins 1 and 2 (cIAP-1/2). In addition, the cotransfection of DEDD with cIAP-1 or cIAP-2 results in the relocalization of the IAPs to the nucleoli. Our data suggest that monoubiquitination of DEDD regulates both its cytoplasmic localization and its proapoptotic potential and that IAP proteins can regulate DEDD's ubiquitination status.

Carcinoma erysipelatoides from squamous cell carcinoma of unknown origin

Carcinoma erysipelatoides, also known as inflammatory metastatic carcinoma, is a rare form of cutaneous metastasis from a malignancy. The characteristic histopathological finding is metastatic tumour cells inside the dermal lymphatic ducts. It is frequently observed in patients with breast carcinoma as well as adenocarcinoma of pancreas, rectum, lung, ovary and parotid gland. We present a 66-year-old man diagnosed to have metastatic squamous cell carcinoma by aspiration cytology from an enlarged neck lymph node and a core biopsy of a left axillary mass. He subsequently received radiotherapy; however, due to intolerance to erythema and swelling on local irradiated skin, radiotherapy was deferred. Skin lesions on upper chest and neck area, consisting of erythematous induration with telangiectasia and tenderness, progressed slowly and were treated as cellulitis. The erythema remained stationary with antibiotic treatment. Skin biopsy shows poorly differentiated squamous carcinoma cells within dermis and dilated dermal vessels.

Complex presentation of intussusception in childhood

The simultaneous occurrence of intussusception and volvulus in the paediatric age group is rare. We report the case of a volvulus of an ileoileal intussusception in an 8-year-old boy. This is the first time that computerised tomography (CT) images of a volvulus of an ileoileal intussusception have been published, and they clearly demonstrate both pathologies. This case highlights the use of CT in determining the nature of an abdominal mass and demonstrates how helpful it can be in diagnosing the cause of small bowel obstruction in children.

Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation

OBJECTIVE

To evaluate the sonographic findings of the rotator interval in patients with clinical evidence of adhesive capsulitis immediately prior to arthroscopy.

DESIGN AND PATIENTS

We prospectively compared 30 patients with clinically diagnosed adhesive capsulitis (20 females, 10 males, mean age 50 years) with a control population of 10 normal volunteers and 100 patients with a clinical suspicion of rotator cuff tears. Grey-scale and colour Doppler sonography of the rotator interval were used.

RESULTS

Twenty-six patients (87%) demonstrated hypoechoic echotexture and increased vascularity within the rotator interval, all of whom had had symptoms for less than 1 year. Three patients had hypoechoic echotexture but no increase in vascularity, and one patient had a normal sonographic appearance. All patients were shown to have fibrovascular inflammatory soft-tissue changes in the rotator interval at arthroscopy commensurate with adhesive capsulitis. None of the volunteers or the patients with a clinical diagnosis of rotator cuff tear showed such changes.

CONCLUSIONS

Sonography can provide an early accurate diagnosis of adhesive capsulitis by assessing the rotator interval for hypoechoic vascular soft tissue.

Livedoid vasculopathy: long-term follow-up results following hyperbaric oxygen therapy

BACKGROUND

Livedoid vasculopathy, also known as atrophie blanche, is a recurrent painful vasculopathy appearing mostly on the lower limbs. Treatment is challenging and relapses are frequent.

OBJECTIVES

To analyse the long-term effect and safety of hyperbaric oxygen (HBO) therapy in treating livedoid vasculopathy.

METHODS

Twelve patients with active livedoid vasculopathy were included in this study. All patients underwent HBO therapy five times a week. Each week photographs were taken and the total dose of analgesics was recorded. Side-effects were documented and assessed. Recurrence was defined as the presence of skin ulceration.

RESULTS

Of the eight patients who completed the treatment, resumption of ambulation and reduction of analgesics were achieved at an average of 4.9 HBO therapy sessions. Leg ulcers in all eight patients healed completely at a mean of 3.4 weeks (range 2-5 weeks). Six patients suffered relapses of ulceration and responded to additional HBO therapy. No significant side-effects were found.

CONCLUSIONS

HBO is a relatively safe, fast and effective method to treat patients with livedoid vasculopathy.

Histochemical and Electron Microscopic Study on Motor Neurone Degeneration Following Transient Spinal Cord Ischaemia at Normothermic Conditions in Rabbits

This study was carried out to investigate the motor neurone degeneration in the ventral horn following transient spinal cord ischaemia at normothermic conditions in rabbits. Transient spinal cord ischaemia was induced by occlusion of the abdominal aorta underneath the left renal artery for 15 min at normothermia (38.7 degrees C). Sections at the level of L7 were examined using histochemical and electron microscopic methods. Cresyl violet-positive motor neurones began to reduce in number at 3 h after ischaemia reperfusion, and were not detectable at 48 h after ischaemia reperfusion. Acid fuchsin-positive motor neurones were detected at 1 h after ischaemia reperfusion, significantly increased up to 6 h after the ischaemia reperfusion, and eventually disappeared by 48 h after ischaemia reperfusion. In electron microscopic findings, the disintegration of cytoplasmic membranes, and the disruption of mitochondria and endoplasmic reticulum were observed in motor neurones at 30 min after ischaemia reperfusion. Motor neurones showed necrotic findings with pyknotic degeneration at 1 h after ischaemia reperfusion. The necrotic degeneration became severer time dependently after ischaemia reperfusion. At 48 h after ischaemia reperfusion, cellular components were not detectable in motor neurones. In conclusion, we suggest that the degeneration pattern of motor neurones of the ischaemic spinal cord was necrotic after ischaemia reperfusion under normothermic conditions.

Longitudinal single-cell cytokine responses reveal recurrent autoimmune myelin reactivity in relapsing--remitting multiple sclerosis patients

The relationship between multiple sclerosis (MS) disease activity and myelin protein-induced cytokine responses over time is not elucidated. We addressed this relationship by examining longitudinal cytokine responses to myelin proteins every three months for one year, in the context of gadolinium (gad)-enhancing brain lesions and of clinical relapses. The ELISPOT assay was used to determine the ex vivo cytokine production in response to nine amino acid long peptides spanning the entire proteolipid protein (PLP) and myelin basic protein (MBP) molecules in relapsing-remitting (RR) MS patients and matched healthy controls. We identified three longitudinal levels of myelin-induced cytokine secretion by adding up the positive responses for all PLP or MBP peptides obtained for five timepoints, at three-month intervals: low reactivity (< 200 cumulative cytokine-secreting cells), isolated peptide reactivity (201-450 cumulative cytokine-secreting cells) and recurrent protein-wide bursts of cytokine reactivity (> 451 cumulative cytokine-secreting cells). The majority of MS patients showed recurrent bursts to PLP and MBP. In contrast, controls showed a more even distribution between all levels of cytokine reactivity. The majority of patients with gad-enhancing lesions showed PLP/IFN gamma and MBP/IFN gamma recurrent burst responses. This is the first longitudinal study on MS patients in which nine amino acid long myelin peptides are used to reveal the broad range of PLP- and MBP-peptide cytokine reactivity across the whole molecule of these two major myelin proteins. This study also reveals the extremely dynamic nature of the immune reactivity to numerous regions of myelin, which can fluctuate dramatically over time. Such fluctuation could hamper the efficacy of antigen-based therapies for MS.

Plant-originated glycoprotein, G-120, inhibits the growth of MCF-7 cells and induces their apoptosis

We characterized the biological function of G-120, glycoprotein isolated from the ethanol extract of the herb, Ulmus davidiana Nakai (UDN). G-120 has anti-tumor activity and significantly inhibited proliferation of MCF-7 cells, as measured by the thymidine uptake assay. In addition, MTT and trypan blue exclusion experiments showed that the G-120-mediated inhibition of DNA synthesis may be due to a cytostatic, rather than a cytotoxic effect. Further studies of DNA analysis and propidium iodide staining revealed that G-120 induces apoptosis in MCF-7 cells. Interestingly, G-120 (100 microg/ml) completely suppressed the binding of NF-kappaB to DNA and increased the cytosolic level of IkappaBalpha which prevented nuclear translocation of NF-kappaB. In addition, G-120 increased the expression of c-Jun, Fra-1, and Fra-2, but did not affect the expression of c-Fos. Collectively, it is believed that G-120 exerts an important role in the induction of apoptosis, suppression of NF-kappaB activation, and induction of c-Jun/Fra-1 or c-Jun/Fra-2 dimerization in MCF-7 cells. Consequently, G-120 could be considered as an anti-cancer agent, although further detailed experiments should be performed.

Detection of oncogenic mutations in the EGFR gene in lung adenocarcinoma with differential sensitivity to EGFR tyrosine kinase inhibitors

The complete sequencing of the human genome and the development of molecularly targeted cancer therapy have promoted efforts to identify systematically the genetic alterations in human cancer. By high-throughput sequencing of tyrosine kinase genes in human non-small-cell lung cancer, we identified somatic mutations in the kinase domain of the epidermal growth factor receptor tyrosine kinase gene (EGFR) that are correlated with clinical response to EGFR tyrosine kinase inhibitors (TKIs). We have shown that these mutant forms of EGFR induce oncogenic transformation in different cellular systems. Cells whose growth depends on EGFR with mutations in exons 19 and 21 are sensitive to EGFR-TKIs, whereas cells expressing insertion mutations in exon 20 or the T790M point mutant, found in tumor biopsies from patients that relapsed after an initial response to EGFR-TKIs, are resistant. Furthermore, by applying a novel, massively parallel sequencing technology, we have shown that clinically relevant oncogene mutations can be detected in clinical specimens with very low tumor content, thereby enabling optimal patient selection for mutation-directed therapy. In summary, by applying high-throughput genomic resequencing, we have identified a novel therapeutic target, mutant EGFR, in lung cancer and evaluated its role in predicting response to targeted therapy.

Exogenous Bcl-xl fusion protein spares neurons after spinal cord injury

Spinal cord injury (SCI) induces neuronal death, including apoptosis, which is completed within 24 hr at and around the impact site. We identified early proapoptotic transcriptional changes, including upregulation of proapoptotic Bax and downregulation of antiapoptotic Bcl-xL, Bcl-2, and Bcl-w, using Affymetrix DNA microarrays. Because Bcl-xL is the most robustly expressed antiapoptotic Bcl-2 molecule in adult central nervous system, we decided to characterize better the effect of SCI on Bcl-xL expression. We found Bcl-xL expressed robustly throughout uninjured spinal cord in both neurons and glia cells. We also found Bcl-xL localized in different cellular compartments: cytoplasmic, mitochondrial, and nuclear. Bcl-xL protein levels decreased in the cytoplasm and mitochondria 2 hr after SCI and persisted for 24 hr. To test the contribution of proapoptotic decreases in Bcl-xL to neuronal death, we augmented endogenous Bcl-xL levels by administering Bcl-xL fusion protein (Bcl-xL FP) into injured spinal cords. Bcl-xL FP significantly increased neuronal survival, suggesting that SCI-induced changes in Bcl-xL contribute considerably to neuronal death. Because Bcl-xL FP increases survival of dorsal horn neurons and ventral horn motoneurons, it could become clinically relevant in preserving sensory and motor functions after SCI.