Correlation between severity of carotid stenosis and vascular reserve measured by acetazolamide brain perfusion single photon emission computed tomography

Few studies have investigated the relationship between the degree of stenosis of the internal carotid artery (ICA) and cerebrovascular reserve (CVR). This study examined that relationship. A total of 56 ICAs in 43 patients were included. Computed tomography scan or magnetic resonance imaging showed no evidence of infarction in any of these patients. Both iodine-123-N-isopropyl-p-iodoamphetamine ((123)IMP)-single photon emission computed tomography (SPECT) in the resting state and (123)IMP-SPECT with acetazolamide (ACZ) enhancement were performed. Quantitated cerebral blood flow (CBF) images were acquired with the (123)IMP autoradiography technique. The mean CBF without ACZ administration (resting CBF) and CVR in the middle cerebral artery territory were calculated using stereotactic extraction estimation (SEE) analysis software. The degree of stenosis in the origin of the ICA was calculated from intra-arterial digital subtraction angiography. Resting CBF was not correlated with the degree of ICA stenosis; however, nonlinear regression analysis (second-order equation) showed a moderate correlation between CVR and the degree of ICA stenosis. In 72% of the cases with a CVR <30%, ICA stenosis was >74%. Using the SEE method, CVR was moderately correlated with the degree of ICA stenosis. Our findings indicate that evaluating CVR by ACZ-enhanced (123)IMP-SPECT in patients with ICA stenosis is of clinical value.

Novel ultrasonic bone densitometry based on two longitudinal waves: significant correlation with pQCT measurement values and age-related changes in trabecular bone density, cortical thickness, and elastic modulus of trabecular bone in a normal Japanese population

A reference database for trabecular bone density, cortical thickness, and elastic modulus of trabecular bone for a novel ultrasonic bone densitometry system (LD-100) based on two longitudinal waves (fast and slow) was determined over a wide age range in a normal Japanese population.

INTRODUCTION

A novel ultrasonic bone densitometry system (LD-100 system) was applied to create a reference database for trabecular bone density (TBD), cortical thickness (CoTh), and elastic modulus of trabecular bone (EMTb) for this device over a wide age range in a normal Japanese population.

METHODS

In a comparative study between LD-100 and peripheral quantitative computed tomography (pQCT) systems, 52 individuals were examined by both systems at the same radius simultaneously. To create a reference database, a total of 2,380 healthy subjects (1,179 men, 1,201 women), ages 18-99 years, were examined using the LD-100 system.

RESULTS

Highly significant correlations between the LD-100 and pQCT systems were found in TBD (r = 0.877, p < 0.001) and CoTh (r = 0.723, p < 0.001). For the reference database, peak values of TBD, CoTh, and EMTb were observed at 30-34 years (255.09 mg/cm(3)), 20-24 years (5.23 mm), and 20-24 years (4.09 GPa) in men, and at 25-29 years (209.24 mg/cm(3)), 25-29 years (3.98 mm), and 20-24 years (3.33 GPa) in women, respectively. The TBD fell significantly (p < 0.05) beginning at 55-59 years in both sexes, with a relatively rapid decrease in women. The CoTh showed a significant decrease beginning at 40-44 years in men and 50-54 years in women. The EMTb showed a significant decrease beginning at 40-44 years in men and 55-59 years in women.

CONCLUSIONS

The LD-100 system is a useful bone densitometry device and the database of age-related changes in TBD, CoTh, and EMTb established in this study will provide fundamental data for future studies related to bone status.

Trabecular and cortical bone separately assessed at radius with a new ultrasound device, in a young adult population with various physical activities

The aim was to evaluate a new ultrasound device in a young adult population and to assess its reproducibility via comparison to DXA measurements and geometrical measurements from high-resolution radiographs. Ninety-three subjects aged between 20 and 51 years were recruited and divided into four groups according to their gender and physical activity status: 22 male athletes, 19 male controls, 21 female athletes, and 31 female controls. Ultrasonic measurements were assessed by the prototype LD-100 (Oyo Electric Co., Kyoto, Japan) on the dominant distal radius. Attenuation in the radius (dB), cortical bone thickness (mm), radius thickness (mm), mass density of cancellous bone (mg/cm(3)), and elasticity (GPa) of cancellous bone were obtained. BMD was measured by DXA at the dominant distal radius. Radius images were obtained with a direct high-resolution digital X-ray device (BMA, D(3)A Medical Systems), and radius and cortical thicknesses were estimated using a specific software (ImageJ, Bethesda, USA), in an area site-matched with LD-100. There was a significant positive correlation between site-matched BMD measurement and LD-100 parameters (p<0.004), X-ray radius thickness, and LD-100 parameters except elasticity (p<0.05, r>0.32), X-ray cortical thickness and LD-100 attenuation and cortical thickness (p<0.01). A significantly higher attenuation, cortical and radius thicknesses were found in athletes compared to controls (p<0.05). The radius thickness measured on radiographs was significantly higher in athletes versus controls in both sexes, and cortical thickness was significantly higher in male athletes versus controls. These data suggest a positive influence of physical activity on bone cortical measurements. This study also confirmed the particular interest of bone assessment by ultrasound.

Measurement of human trabecular bone by novel ultrasonic bone densitometry based on fast and slow waves

SUMMARY

Two longitudinal transmitted waves, fast and slow waves, were observed by employing a new quantitative ultrasound (QUS) method. The trabecular bone measurements generated by this method reflect three-dimensional structural information, and the new QUS parameters were able to identify vertebral fractures.

INTRODUCTION

The aims were to identify new quantitative ultrasound (QUS) parameters that based on new QUS method reflecting not only bone volume but also the microstructures of trabecular bone ex vivo and to observe how much they predict fracture risk in vivo.

METHODS

Ex vivo measurement: Three human femoral heads were used for the experiment. Attenuation of the slow wave, attenuation of the fast wave, speed of the slow wave, speed of the fast wave (SOFW), bone mass density of trabecular bone, and elastic modulus of the trabecular bone (EMTb) of each specimen were obtained using a new QUS method and compared with three-dimensional structural parameters measured by micro-computed tomography. In vivo measurement: Eighty-nine volunteers were enrolled, and the bone status in the distal radius was measured using a new QUS method. These parameters were compared with data evaluated by peripheral quantitative computed tomography and dual X-ray absorptiometry.

RESULTS

Ex vivo measurement: SOFW and EMTb showed correlations with the parameter of trabecular anisotropy. In vivo measurement: The new QUS parameters were able to identify vertebral fractures.

CONCLUSION

The newly developed QUS technique reflects the three-dimensional structure and is a promising method to evaluate fracture risk.

Vasopressin-dependent upregulation of aquaporin-2 gene expression in aged rats with glucocorticoid deficiency

AIM

The study was undertaken to determine whether ageing affects kidney expression of the aquaporin-2 (AQP2) water channel in glucocorticoid-deficient rats.

METHODS

After adrenalectomy, 6- and 52-week-old Sprague-Dawley rats received aldosterone via osmotic minipumps (glucocorticoid-deficient rats). Aldosterone and dexamethasone were administered to control rats of the same age.

RESULTS

An acute water load test verified impairment of water excretion in both young and aged rats with glucocorticoid deficiency, with a more serious impairment in the older rats. Despite the presence of hypoosmolality, non-suppressible release of arginine vasopressin (AVP) was particularly evident in the aged rats with glucocorticoid deficiency in comparison with the young rats. The expression levels of AQP2 mRNA and protein were lower in the aged rats, with a particularly large reduction in AQP2 protein expression. AQP2 expression levels were significantly augmented in the glucocorticoid-deficient rats compared with the controls under both basal and water-loaded conditions. Acute water loading did not suppress expression of AQP2 mRNA and protein, and the percentage increases in AQP2 mRNA and protein expression vs. the respective controls were more pronounced in the 52-week-old glucocorticoid-deficient rats compared with the 6-week-old rats.

CONCLUSION

The findings indicate that upregulation of AQP2 expression is maintained dependent upon non-suppressible release of AVP in rats with glucocorticoid deficiency, and that AQP2 plays a crucial role in persistent impairment of water excretion in aged rats with glucocorticoid deficiency.

Phase I study of peptide vaccine with chemotherapy in patients with unresectable colorectal cancer

3067

Background: RNF43 is a cancer testis antigen expressed in colorectal cancer (CRC) but not in normal organs. RNF43–721 induces HLA A24 restricted cytotoxic T lymphocytes (CTL) against RNF43 expressed target. S-1/CPT-11 chemotherapy (CT) is reported to be obtained the similar result to FOLFOX or FOLFIRI as first-line for advanced CRC. We plan phase I study to evaluate the safety of different doses of RNF43–721 emulsified with Montanide ISA51 in combination with S-1/CPT-11 CT expecting synergistic effect. Methods: Inclusion criteria as follows: HLA A24 positive, pathological CRC, life expectancy > 3 months, WBC>3000/mm3, Hb>10mg/dl, Plt>75000/mm3, creatinine<1.2mg/dl, T. bil.<1.5mg/dl, AST, ALT<3x normal limits, written informed consent. Other malignancy, infection, treatment with steroids and immunosuppressive agents, and HBV, HCV, HIV infection are excluded. The study design is dose escalation of peptide (0.5, 1.0, 3.0 mg) with three patients’ cohort. The study regimen is that oral administration of S-1 at 40 mg b.i.d. for 21 consecutive days followed by a 7-day rest period and intravenous infusion of CPT-11 at a dose of 80 mg on days 1 and 15 are performed with weekly subcutaneous injection of peptide vaccine. Two courses are study periods and there is no restriction of therapy after study. Primary endpoint is safety and secondary are CTL, objective response rate and TTP. Results: Twelve patients (pts) were enrolled and 3 pts canceled treatment due to patient's proposal. In 9 evaluable pts, median age of pts with 7 males and 2 females was 61. Standard chemotherapy for CRC were failed in 8 pts. Systemic toxicities were observed in one pt with grade 2 and others were grade 1. Skin reactions were occurred in 7 pts. No pts were obtained CR and PR, 6 pts were SD and 3 were PD. CTL response was observed in 5 pts. TTP was calculated as 204 days. Conclusions: Treatment with peptide vaccine and S-1/CPT-11 CT was well tolerated. These results encourage further clinical trials of peptide vaccine with standard CT for advanced CRC.

No significant financial relationships to disclose.

[Surgical removal of native aortic valve thrombosis associated with acute myocardial infarction and protein C deficiency; report of a case]

Native aortic valve thrombosis is an uncommon event. We describe the case of a 76-year-old man who suffered acute myocardial infarction associated with native aortic valve thrombosis diagnosed by cardiac catheterization. Since the thrombus was localized on the right coronary cusp and occluded right coronary artery, rescue revascularization was performed using perfusion catheter, which was continuously engaged to the right coronary artery. Operation was immediately performed under cardiopulmonary bypass. After incision of ascending aorta, thrombus was removed easily and aortic valve was preserved without degenerative change. Histological study showed a typical thrombus without any specific findings. He had a good clinical course and discharged 9 days after the operation. He had no history of heart valve disease, left heart catheterization or bacterial endocarditis. Since laboratory data showed 41% in protein C antigen and 32% of protein C activity, he was diagnosed of protein C deficiency. Our report emphasize that this thrombus formation may be caused by protein C deficiency.

Effects of structural anisotropy of cancellous bone on speed of ultrasonic fast waves in the bovine femur

Ultrasonic waves in cancellous bone change dramatically depending on its structural complexity. One good example is the separation of an ultrasonic longitudinal wave into fast and slow waves during propagation. In this study, we examined fast wave propagation in cancellous bone obtained from the head of the bovine femur, taking the bone structure into consideration. We investigated the wave propagation perpendicular to the bone axis and found the two-wave phenomenon. By rotating the cylindrical cancellous bone specimen, changes in the fast wave speed due to the rotation angle then were observed. In addition to the ultrasonic evaluation, the structural anisotropy of each specimen was measured by X-ray micro-computed tomography (CT). From the CT images, we obtained the mean intercept length (MIL), degree of anisotropy (DA), and angle of insonification relative to the trabecular orientation. The ultrasonic and CT results showed that the fast wave speed was dependent on the structural anisotropy, especially on the trabecular orientation and length. The fast wave speeds always were higher for propagation parallel to the trabecular orientation. In addition, there was a strong correlation between the DA and the ratio between maximum and minimum speeds (V(max)/V(min)) (R(2) = 0.63).

Contrast-enhanced multi-shot echo-planar FLAIR in the depiction of metastatic tumors of the brain: comparison with contrast-enhanced spin-echo T1-weighted imaging

BACKGROUND

The usefulness of fast fluid-attenuated inversion-recovery (FLAIR) sequences after administration of contrast medium (f-FLAIR (+)) has been shown in depicting brain tumors including metastases and meningeal carcinomatosis. Contrast-enhanced multi-shot echo-planar FLAIR (Ms-EPI-FLAIR (+)), comprising combined sequences of f-FLAIR (+) and Ms-EPI, may provide the advantages of f-FLAIR (+) along with rapid acquisition.

PURPOSE

To compare Ms-EPI-FLAIR (+) with post-contrast spin-echo T1-weighted imaging (SE-T1WI (+)) in the depiction of brain metastases.

MATERIAL AND METHODS

In 14 patients with metastatic tumors of the brain, spin-echo precontrast T1-weighted imaging (SE-T1WI (-)), fast spin-echo T2-weighted imaging (FSE-T2WI), fast-FLAIR, SE-T1WI (+), and Ms-EPI-FLAIR (+) were acquired. For qualitative evaluation of SE-T1WI (+) and Ms-EPI-FLAIR (+), receiver operating characteristic (ROC) analysis was performed in two different readers. For quantitative analysis, the intensity ratios (intensity of tumor divided by intensity of peritumoral region) in SE-T1WI (+) and Ms-EPI-FLAIR (+) were compared.

RESULTS

Although pre-contrast f-FLAIR detected 84 of 106 tumors, Ms-EPI-FLAIR (+) detected 98 of 106 tumors. In the ROC analysis for observers A and B, Az values in SE-T1WI (+) did not differ from values in Ms-EPI-FLAIR (+). Quantitatively, the intensity ratio in Ms-EPI-FLAIR (+) also did not differ from that in SE-T1WI (+).

CONCLUSION

Detectability of brain metastases with Ms-EPI-FLAIR (+) is almost similar to that with SE-T1WI (+). Ms-EPI-FLAIR (+) could be an alternative to SE-T1WI (+) in the depiction of brain metastases.

The lateral wedged insole with subtalar strapping significantly reduces dynamic knee load in the medial compartment gait analysis on patients with medial knee osteoarthritis

OBJECTIVE

Two lateral wedged insoles were compared: one with, and the other without, subtalar strapping.

METHODS

Twenty-one patients (age 58-83, mean 72) with medial knee osteoarthritis (OA) were enrolled. Thirty-seven knees in the patients were divided into three groups based on the Kellgren and Lawrence OA grading system; grades 2 (cases=20), 3 (cases=11), and 4 (cases=6). The subjects were tested during walking barefoot and during walking with a silicon rubber lateral wedged insole with elevation of 10 mm attached to a barefoot. Gait analysis was performed on a 10 m walkway for each subject under three different walking conditions; barefoot, wearing a conventional insole, and a subtalar strapping insole. Peak knee varus moment during gait was measured under each condition, and compared between the three conditions and between the OA grades.

RESULTS

On the whole (cases=37), the peak varus moment was significantly reduced by wearing either of the insoles, compared to walking barefoot. The reduction was more obvious with the strapping insole (-13%, P<0.01), compared with the conventional insole (-8%, P<0.05). In moderate OA patients (grades 2 and 3), the moments were significantly lower with the strapping insole, compared with the conventional insole (P=0.0048 and 0.005, respectively). However, no significant difference was detected in severe OA patients (grade 4) between the two types of insoles (P=0.4).

CONCLUSIONS

Both lateral wedged insoles significantly reduced the peak medial compartment load during gait. The subtalar strapping insole had a greater effect than the conventional insole, particularly in patients with moderate medial knee OA.

Plasma vitamin D and risk of colorectal cancer: the Japan Public Health Center-Based Prospective Study

We investigated the association between plasma 25(OH)D and the subsequent colorectal cancer incidence risk by a nested case–control study in The Japan Public Health Center-based Prospective Study, covering 375 newly diagnosed cases of colorectal cancer from 38 373 study subjects during a 11.5-year follow-up after blood collection. Two controls were matched per case on sex, age, study area, date of blood draw, and fasting time. In a conditional logistic regression model with matched pairs adjusted for smoking, alcohol consumption, body mass index, physical exercise, vitamin supplement use, and family history of colorectal cancer, plasma 25(OH)D was not significantly associated with colorectal cancer in men or in women. However, the lowest category of plasma 25(OH)D was associated with an elevated risk of rectal cancer in both men (odds ratio (OR), 4.6; 95% confidence interval (CI), 1.0–20) and women (OR, 2.7, 95% CI, 0.94–7.6), compared with the combined category of the other quartiles. Our results suggest that a low level of plasma 25(OH)D may increase the risk of rectal cancer.

Venous Anatomy of the Sphenoparietal Sinus: Evaluation by MR Imaging

SUMMARY

The termination of the superficial middle cerebral vein (SMCV) has been described as entering or being partially equivalent to the venous sinus coursing under the lesser sphenoid wing, which has classically been called the sphenoparietal sinus. However, the recent literature reports that the SMCV is not connected to the sphenoparietal sinus. In this study, the venous anatomy was evaluated to clarify the anatomy of the sphenoparietal sinus and the termination of the SMCV. Magnetic resonance imaging (MRI) was performed on 1.5-T superconductive units using a three-dimensional fast spoiled gradientrecalled acquisition in the steady state (3-D fast SPGR) sequence with fat suppression in a total of 48 sides of 24 patients. Coronal source images and reconstructed axial images were displayed on the Advantage Window Console, and connections to the cavernous sinus were then evaluated for the venous sinus coursing under the lesser sphenoid wing (hereafter called the sinus of the lesser sphenoid wing), the middle meningeal vein, and the SMCV. The following findings were observed bilaterally in all patients. The sinus of the lesser sphenoid wing was connected medially with the cavernous sinus and laterally with the anterior branch of the middle meningeal vein near the pterion. The anterior branch of the middle meningeal vein entered the bony canal laterally above the junction with the sinus of the lesser sphenoid wing and coursed along the inner table of the skull or emerged into the diploic vein, indicating its parietal portion. Although the termination of the SMCV had several patterns, the SMCV was not connected with the sinus of the lesser sphenoid wing in any of the patients. The sphenoparietal sinus is considered to consist of the sinus of the lesser sphenoid wing and the parietal portion of the anterior branch of the middle meningeal vein; these were identified as venous structures distinct to the SMCV.

Visualization of anterior disc displacement in temporomandibular disorders on contrast-enhanced magnetic resonance imaging: comparison with T2-weighted, proton density–weighted, and precontrast T1-weighted imaging

OBJECTIVE

To compare postcontrast T1-weighted imaging (T1WI+) with precontrast T1-weighted (T1WI-), T2-weighted (T2WI), and proton density-weighted imaging (ProWI) in depiction of the anterior disc displacement (ADD) in temporomandibular disorders (TMDs).

STUDY DESIGN

A total of 120 joints with TMD were included in this study. Qualitatively, Receiver operating characteristic analysis was performed. Quantitatively, the ratio of the intensity in the retrodiscal tissue to intensity in the disc (intensity ratio) was measured.

RESULTS

One reader achieved superior performance in visualization of ADD with T1WI+ than with the other sequences. The other reader showed superiority with T1WI+ rather than T2WI or T1WI-. The intensity ratio on T1WI+ was significantly higher than the intensity ratio on other sequences. On T1WI,+ the intensity ratio in the joints with ADD was significantly higher than that in the joints without ADD.

CONCLUSION

Postcontrast T1-weighted imaging can improve the visualization of ADD in TMDs.

13 MANAGEMENT SYSTEM FOR FROZEN BULL SEMEN USING A RADIO FREQUENCY IDENTIFICATION TAG

An appropriate traceability system is essential for safety during production and distribution of food products. In Japan, the ear-tag system has been applied for this purpose. In this system, newborn calves are tagged individually with a bar code, and are registered to the database, so that everyone can know the information regarding individual cattle and meat. However, the management of frozen semen and the validation of frozen straws are out of the scope of the system. A traceability system for beef production totally covering the progression from semen to meat is necessary for food safety and validation. We applied radio frequency identification (RFID) for the identification of individual frozen semen straws. RFID is the management technology that uses a small tag with a radio transmitter (RFID tag) that has recently been used in the field of distribution management. We consider this technology as a tool to trace artificial insemination (AI) data before the birth of a calf and to establish a management system for production of the Japanese Black cattle breed. The microchip (�-chip) we used as an RFID tag was manufactured by Hitachi, Ltd., Tokyo, Japan. The �-chip is the smallest RFID chip in the world (0.4 mm square) and has a unique identification number (capable of corresponding to 128 bits, 1038 in decimal notation) readable by the RFID tag reader. The �-chip was attached to the frozen semen straw by ultrasonic sealing. We demonstrated that the �-chip retained its function after being stored in liquid nitrogen for at least several months. The information for bull semen, which was dispensed into frozen semen straws with the attached �-chips, was stored in the system database, and the straws were stored in liquid nitrogen. These straws with the �-chips were distributed to local farmers and inseminated into recipient cattle; the AI conditions, results of pregnancy diagnosis, and birth conditions were recorded in the system database. This system using the �-chips may be useful for confirmation and acquisition of trust for a commercially valuable bull and for the study of the improvement of AI for reproduction.