Delta-ADC (apparent diffusion coefficient) analysis in patients with idiopathic normal pressure hydrocephalus

We have developed the delta-apparent diffusion coefficient (ADC), a new parameter of the water dynamics of brain tissue using MRI. Delta-ADC is the changes in regional ADC values of the brain during the cardiac cycle. The study included 6 idiopathic normal pressure hydrocephalus (iNPH) patients (iNPH group) and 12 healthy volunteers (control group). ECG-triggered single-shot diffusion echo planar imaging (b = 0 and 1,000 s/mm(2)) was used on a 1.5-T MRI. The delta-ADC image was calculated from the maximum minus the minimum ADC value of all cardiac phase images (20 phases) on a pixel-by-pixel basis. Delta-ADC values in the white matter of the frontal, temporal, and occipital lobe were obtained. Delta-ADC values in the iNPH group were significantly higher than those in the control group in all regions. ADC values in the iNPH were also significantly higher than those in the control group, but the differences in the ADC between the groups in each region were much lower than those for the delta-ADC. Although the changes in the delta-ADC and ADC values were similar, there was no significant correlation between the delta-ADC and the ADC. These results suggest that the ADC and the delta-ADC may reflect different kinds of water dynamics. The ADC depends on the water content in brain tissue. On the other hand, delta-ADC depends on not only the water content, but also on the degree of the fluctuation of the water molecules. Delta-ADC analysis makes it possible to obtain non-invasively new and more detailed information on the regional brain condition in iNPH.

Conduction Velocity of Swallowing Pressures in the Pharynx

Objective: During normal swallowing, longitudinal conduction of pharyngeal pressure occurs from the velopharynx to the esophagus for the transportation of a food bolus. In this study, we analyzed the conduction velocity (CV) of swallowing pressures in the pharynx using a novel high-resolution manometry (HRM) system.

Method: Pharyngeal pressure topographies (PPTs) were obtained from 95 asymptomatic subjects. PPT is a derivative of HRM data that dynamically displays intrapharyngeal swallowing pressure. We measured CV at the velopharynx (V1), meso-hypopharynx (V2), upper esophageal sphincter (UES, V3), and cervical esophagus (V4). We also measured their swallowing pressure durations by analyzing PPT.

Results: V1 to V4 were 24.7, 14.5, 15.0, and 4.7 cm/sec, respectively. The differences between V1 versus V2 and V3 versus V4 were statistically significant. Swallowing pressure durations at the same regions were 0.57, 0.23, 1.94, and 1.27 seconds, respectively.

Conclusion: These findings indicate the conduction pattern of pressures. The CV from the mesopharynx to the UES is almost constant because of the anatomical similarity of middle and inferior pharyngeal constrictors. The duration at the UES is longer than the others; this accounts for the prevention of backflow from the esophagus.

Effect of Chin Position on Swallowing Assessed by Manometry

Objective: Evaluate the effects of chin position during swallowing in the neutral, chin-up, and chin-tucked positions using a novel high-resolution manometry (HRM) system.

Method: Twenty asymptomatic volunteers were studied by HRM. We measured the maximum swallowing pressures at the velopharynx, mesohypopharynx, and upper esophageal sphincter (UES), the mean values of resting UES pressure, its length, the minimum swallowing pressure at UES, and the relaxation interval (RI) of UES, in each position.

Results: In the chin-up position, in comparison with the neutral position, the maximum UES pressure (311.1 mmHg vs 214.7 mmHg; P < .01), the mean value of the resting UES pressure (67.0 mmHg vs 29.5 mmHg; P < .01), the length of the UES (44.2 cm vs 32.7 cm; P < .01), and the minimum UES pressure during the RI (−0.5 mmHg vs −6.9 mmHg; P < .01) increased and the RI (0.29 sec vs 0.63 sec; P < .01) decreased significantly. In the chin-tucked position, significant change was seen only in the minimum UES pressure during the RI (−4.5 mmHg vs −6.9 mmHg; P < .05).

Conclusion: The chin-tucked position showed no change except for the increase in UES pressure during RI, and seemed to have no appreciable benefit in the facilitation of swallowing. In contrast, the chin-up position brought a marked disadvantageous effect against smooth swallowing by increasing the pressure in the region of the UES.

Enhanced CEA production associated with aspirin in a culture of CW-2 cells on some polymeric films

Human colorectal adenocarcinoma tumor (CW2) cells were cultivated in RPMI 1640 media containing 0-7.5 mM aspirin and 10% fetal bovine serum for the production of carcinoembryonic antigen (CEA). By adding aspirin to the media, the production of CEA per cell increased by up to one hundred fold compared to cultivation in normal media containing no aspirin, even though the total cell concentration decreased with the increase in aspirin in the media. The production of CEA was also investigated for CW2 cells cultured on silk fibroin, poly(gamma-benzyl-L-glutamate) and poly(gamma-benzyl-L-glutamate)/poly(ethylene oxide) diblock copolymer films prepared by the Langmuir-Blodgett and casting methods. The highest production of CEA per cell was observed for the CW2 cells on poly(gamma-benzyl-L-glutamate) and its diblock copolymer films prepared by the Langmuir-Blodgett method in the medium containing 5 mM aspirin after 168 hr of inoculation. This originates from the fact that the cell density on the films in the medium containing 5 mM aspirin was the lowest under these conditions. It is suggested that CW2 cells produce CEA more effectively when the cell growth is suppressed by addition of toxic chemicals such as aspirin or by culture on unfavorable films for cell growth.

Production of interferon-beta in a culture of fibroblast cells on some polymeric films

Normal human skin (NB1-RGB) cells were cultured in the presenceof polyinosinic and polycytidylic acids, diethylaminoethyldextran, cycloheximide and actinomycin D, which induced humaninterferon-beta. The simplest induction method, that requiredonly polyinosinic and polycytidylic acids and diethylaminoethyldextran was found to give the highest production ofinterferon-beta by the cells. The cell growth and productionof interferon-beta were investigated for NB1-RGB cellscultured on silk fibroin, poly(gamma-methyl-L-glutamate),poly(gamma-benzyl-L-glutamate) and collagen films prepared bythe Langmuir-Blodgett (LB) and casting methods. The cell densityof NB1-RGB cells cultured on the LB films was found to be higherthan that on the cast films made of the same polymer. Thisindicates that not only the chemical structure of the polymersused for the preparation of the films but the preparationmethods of the films, i.e., casting and LB methods, are also astrong factor affecting the cell growth. The production ofinterferon-beta per unit number of cells was found to behigher on the cast films than that on the LB films made of thesame polymer. This is explained by the fact that the optimalsuppressed growth of NB1-RGB cells on the cast films leads tothe enhanced production of interferon-beta on the cast filmscompared to those on the LB films prepared by the same polymer.

Influence of effortful swallow on pharyngeal pressure: evaluation using a high-resolution manometry

OBJECTIVE

To evaluate the effect of effortful swallow on pharyngeal pressure while swallowing saliva and water using a novel high-resolution manometry (HRM) system.

STUDY DESIGN

Case series with planned data collection.

SETTING

Nagasaki University Hospital.

SUBJECTS AND METHODS

Eighteen asymptomatic Japanese adult volunteers were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned from the velopharynx to the upper esophagus to record pressures while swallowing. The maximum values of the pressure while swallowing saliva (dry swallowing) and 5 mL of water were measured at the velopharynx, meso-hypopharynx, and upper esophageal sphincter (UES) with and without effortful swallows.

RESULTS

The maximum values of dry swallowing pressures (mm Hg) at the velopharynx, meso-hypopharynx, and UES were significantly higher with effortful swallow (155.7 ± 59.7, 256.7 ± 78.7, and 276.5 ± 87.5, mean ± standard deviation) than without it (115.3 ± 60.8, 172.9 ± 57.0, and 195.8 ± 61.3). Those of water swallowing pressures were also statistically higher with effortful swallow (169.3 ± 69.1, 236.6 ± 77.2, and 267.3 ± 79.1) than without it (119.2 ± 59.7, 189.5 ± 70.7, and 221.3 ± 72.7).

CONCLUSION

The present results provide quantitative evidence of effortful swallow as well as physiological information. It also is hoped to be an aid to future clinical and investigative studies.

Control of molecular rotors by selection of anchoring sites

We demonstrate a new method to switch on and off the rotational motion of a long-chain molecule by controlling the bonding geometry between the molecule and a substrate. An azobenzene derivative molecule adsorbed on a Au(111) surface is immobile only when its three rotation centers, comprised of two phenyl rings and a nitrogen-nitrogen bond, are located at hollow sites of the Au(111) surface, as observed by scanning tunneling microscopy. Rotational motion can be activated by exciting the vibrational modes and inducing hopping motion away from the immobile site with a voltage pulse.

Impaired gastric response to modified sham feeding in patients with postprandial distress syndrome

BACKGROUND

Impaired vagal function has been reported to be important in some patients with functional dyspepsia (FD). However, the pathophysiologic mechanisms influencing the cephalic phase of vagal activity in FD are incompletely understood. The aim of this study was to investigate the gastric response to modified sham feeding (MSF) on ultrasound and cardiovascular autonomic function in FD patients.

METHODS

Nineteen patients with postprandial distress syndrome (PDS, 11 men and eight women; mean age: 48.2 years) and 26 healthy subjects (HS, 13 men and 13 women; mean age: 45.0 years) were studied prospectively. Firstly, cardiovascular autonomic function was assessed by spectral analysis of RR interval variability. Antral contraction was then evaluated by ultrasonography after MSF was performed to stimulate the cephalic phase of vagal activity.

KEY RESULTS

Spectral analysis of RR interval variability showed that the high-frequency component was significantly smaller in the patients than in the HS (P<0.01). The frequency of antral contraction in response to MSF over 15 min was also significantly lower in the PDS patients than in the HS. The 15-min integrated antral contractile response (area under the contraction vs time curve) was significantly smaller in the PDS patients than in the HS (P<0.01). Univariate analysis revealed a modest correlation between the high-frequency component of RR interval variability and the area under the contraction vs time curve (n=46, r=0.49, P<0.01).

CONCLUSIONS & INFERENCES

Autonomic abnormalities affecting the cephalic phase of vagal activity may be important in the pathogenesis of FD.

[Pulmonary venous obstruction after the Williams procedure for partial anomalous pulmonary venous connection]

A 54-year-old man was admitted to our hospital because of chest discomfort. Cardiac catheterization revealed partial anomalous pulmonary venous connection with an intact atrial septum. The right upper pulmonary vein (RUPV) drained into the upper segment of the superior vena cava (SVC). Using the Williams procedure, an atrial septal defect (ASD) was created and a fresh autologous pericardial patch was used to fashion a new pulmonary vein return route from SVC to the ASD. Although the patient was stable after the procedure, he was admitted again 6 months later because of obstruction of RUPV. At reoperation, it was found that the previous pulmonary vein route was obstructed and that the pericardial baffle had adhered to the atrial septum above the ASD. The shrunken and thickened pericardial baffle was removed and the orifice of the ASD was extensively enlarged, after which an expanded polytetrafluoroethylene (ePTFE) patch was used as a new baffle. After the reoperation, the patient's condition improved.

Carboplatin plus weekly paclitaxel treatment in non-small cell lung cancer patients with interstitial lung disease

BACKGROUND

Since advanced non-small cell lung cancer (NSCLC) patients with the interstitial lung disease (ILD) have been excluded from clinical trials, it is uncertain whether chemotherapy really provides a benefit to these patients.

PATIENTS AND METHODS

Fifteen advanced NSCLC patients with ILD that was detected on the chest X-rays were enrolled in this study. Carboplatin plus paclitaxel was administered by two methods (method A or method B). Method A: Carboplatin (AUC 6, day 1) and paclitaxel (70 mg/m(2), days 1, 8, 15) were administered every four weeks. Method B: Carboplatin (AUC 2, day 1, 8, 15) and paclitaxel (60 mg/m(2), days 1, 8, 15) were administered every four weeks.

RESULTS

The response rate and the disease control rate were 33% and 53%. The median progression-free survival and the median overall survival time were 2.5 months and 7.0 months, respectively. The hematological toxicities were tolerable, but a grade 3 or higher pneumonitis was observed in 4 patients (27%).

CONCLUSION

Carboplatin plus weekly paclitaxel must be administered carefully to advanced NSCLC patients with ILD that is detected on chest X-rays after a sufficient evaluation of the risks and the benefits.